The Psychocybernetic Model of Art Therapy, Second Edition

THE PSCHOCYBERNETIC MODEL
OF ART THERAPY
ABOUT THE AUTHOR
Dr. Aina O. Nucho (pronounced "Ina" "Nooko") is a professor

emerita at the University of Maryland School of Social Work where
she taught graduate level courses in clinical methods with individu-
als, families, and groups. She also taught human behavior, social
research, stress management and art therapy.
Dr. Nucho obtained her primary and secondary education in Riga,
Latvia, and later she studied at the University of Tuebingen in Ger-
many. Dr. Nucho holds a graduate degree in social work and a Ph.D.
degree, both from Bryn Mawr College. She is a Distinguished Fellow
and a recipient of the 2000 Ernst Kris Prize of the American Society
of Psychopathology of Expression, a Board Certified Diplomate in
Clinical Social Work (BCD), a member of the Academy of Certified
Social Workers (ASCW), a licensed clinical social worker in the State
of Maryland (LCSW-C), and a registered art therapist (ATR).
Dr. Nucho is the author of Stress Management: The Q,uest for Zest
(1988) and Spontaneous Creative Imagery: Problem-Solving and Life-
Enhancing Skills (1995), both published by Charles C Thomas,
Springfield, IL, and five books in Latvian. She has published articles
in professional journals and has presented papers at national and
international conferences.
Second Edition
THE
PSYCHOCYBERNETIC
MODEL OF
ART THERAPY
By
AINA o. NUCHO, PH.D.

A.T.R., A.C.S.W., L.C.S.W.-C., B.C.D.
University ofMaryland
With Forewords by
Irene Jakab, M.D., PH.D.

and
Akhter Ahsen, PH.D.
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ISBN 0-398-07377-5 (hard)

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Library of Congress Cataloging-in-Publication Data
Nucho, Aina O.
The psychocybernetic model of art therapy / by Aina o. Nucho ; with forewords by
IreneJakab and Akhter Ahsen.--2nd ed.
p.cm.
Includes bibliographical references and index.
ISBN 0-398-07377-5 (hard) -- ISBN 0-398-07378-3 (pbk.)
RC489.A7 N83 2003

616.89'1656--dc21
2002035973
FOREWORD
T his book is an instrument of complex knowledge transfer on the

subject of art therapy and specifically on the method designed and
defined by the author as the psychocybernetic model of intervention.
More than half of the book is dedicated to a detailed account of the
origins and the rationale of art therapy. These first six chapters attest to
the serious background research and include a rich array of historical
and biographical data. All this is presented with logical clarity. The pre-
cise quotations from the literature are clearly distinguishable in the text
from anecdotal data and from the backbone of the author's interpreta-
tion and judicious criticism of various theoretical models.
The description of the psychocybernetic model and the justification
for its use is built on its comparative merit over the other models. It is
an interactive model based on well defined phases of the therapeutic
process.
The second half of the book (Chapters 7 to 11) address in detail the
therapeutic process. In this segment the theoretical basis for each phase
is again clearly defined and interwoven with illustrative case vignettes
and several helpful case discussions.
For the therapist who intends to use the psychocybernetic model it is
of great value to find detailed case descriptions including the interpre-
tation of the dynamics of various phases in addition to such practical
details as the list of materials to be used with different patient popula-
tions, the space requirements and the time frame of individual and
group sessions.
The four phases of the therapeutic process: The Unfreezing phase,
the Doing phase, the Dialogue phase, and the Ending and Integrating
phase are demonstrated through case material which include the
patients' graphic productions under discussion.
The author provides several clearly presented graphs in support of
her concept of the therapeutic process.
v
vi ThePsychocybernetic Model ofArt Therapy
The whole second half of the book (Chapters 7 to 11) could stand on
its own as a practical guide to the implementation of the psychocyber-
netic model. Nonetheless, even this segment contains explicit theoreti-
cal data in support of the author's views and suggestions.
In order to support the clinical effectiveness of her method the
author quotes a comparative research study by Lindenmuth on 298
depressed patients in a nursing home exposed to various treatment
modalities. The art therapy was conducted by a therapist (MSW) who
received instruction in the psychocybernetic model from the author.
The results of this study attest to statistically significant (.001 level)
improvement of depression scores in the groups exposed to expressive
therapies (art, music, and exercise therapy).
The book is an important reference volume on the theoretical foun-
dations of art therapy-each chapter in the first half could be used as a
separate self-contained paper on its respective subject. The clear defi-
nitions of this historical overview introduce the reader to such broad
topics as cybernetics, general system theory, information processing,
imagery, and the rapport of systems and cognition.
While this first half may be considered as being addressed primarily
to academicians it is also useful to the practitioner of the psychocyber-
netic model of art therapy. At the same time, this book in its second half
contains excellent practical details which warrant its use by practition-
ers who are interested to include this new method into their day-to-day
work with patients.
A comprehensive bibliography and index add weight to this schol-
arly text.
I can wholeheartedly recommend this volume as a reference text-
book for libraries and for teachers of expressive therapies as well as for
the use by practitioners of various forms of psychotherapy.
IRENEJAKAB, M.D., PH. D.

Professor ofPsychiatry
University ofPittsburgh and
President, American Society ofPsychopathology of
Expression
FOREWORD
in a Nucho's clinical practice and teaching over the last 20 years

A has paralleled many of the major developments in the field of art
therapy. She is perhaps one of the last persons to interview Margaret
Naumburg, the eminent pioneer in art therapy whose stellar contribu-
tions to art therapy are well known. Having participated in and wit-
nessed the merging of art and therapy in the United States, it is
appropriate that Nucho be the chronicler of this new modality of inter-
personal helping. That she has done-and very ably-taking the reader
back to the Ancient Greece, down through the ages into the late nine-
teenth and early twentieth centuries, coming to Switzerland and to Carl
Jung and his method of active imagination, and then going further on
into the contemporary scene. By depicting the evolution of art therapy,
Nucho demonstrates the difference between the art wing and the ther-
apy wing of art therapy and she underscores the need for a new model
in this form of psychotherapy.
Nucho terms that new model the psychocybernetic model of art ther-
apy. Utilizing the general system approach she develops a model of
helping that incorporates what is currently known about human cogni-
tion and the functioning of the brain. She introduces the concept of
codification to elucidate the perennially perplexing phenomenon of
cognition. The reader will welcome the clear, jargon-free discussion of
how the mind works and how to facilitate the process of growth and
change.
Central to the psychocybernetic model is the understanding of the
phenomenon of imagery. Nucho reminds us that images are symbols
and thus an essential part of cognition; images are both mental and
physical, and they derive from both memory and imagination. Images,
too, like everything else, form a kind of a system. Images arise sponta-
neously in the mind, and they can also be created deliberately. Nucho
describes how the psychocybernetic model provides ways of therapeu-
vii
viii ThePsychocybernetic Model ofArt Therapy
tic handling of both kinds of images so that profound personal experi-

ences may be sorted out and dealt with.
Images, as Nucho views them, are part of the cybernetic control sys-
tem of the human mind. Each experience is considered to be encoded
as an image and linguistically in language, and to some the fit may be
more or less perfect between these two symbol systems, but she points
out, there may be a gap. The gap is filled by somatic response. She is
gracious to involve my Triple Code Model of imagery at this phase of
the formulation of her theory and it further enriches her psychocyber-
netic model. Images and words are not like two parallel, unconnected
clocks which do not interact but tell the same time; language which
describes images is only approximate. It is capable of error. Images, in
contrast, just are. They register the experience of the organism direct-
ly. If the discrepancy between somatic responses, imagery, and mean-
ing encoded in language persists over time, disease ensues. Images and
language are functionally connected. Images are not reducible to lan-
guage, nor is language reducible to images. Both are needed. And so is
the body. The psychocybernetic model shows how to behold and
examine images so that balance and wholeness may be attained.
Readers will find Dr. Nucho's discussion of the psychocybernetic
process immensely helpful, particularly if they wish to combine the tra-
ditional, largely verbal means of interpersonal helping with techniques
of art therapy. Nucho marches the reader through the various phases of
the therapeutic process, guiding the practitioner's efforts and warning
against pitfalls and false expectations. Her analyses of case studies and
her collection of artworks done by a number of clients all illustrate the
appropriate use of the new model of helping.
Nucho's achievement will work to the great benefit of mental health
practitioners. Far too long have psychotherapists resembled Cyclops,
the giant in Greek mythology who had only one eye and hence a dis-
torted and limited perception. The psychocybernetic model of art ther-
apy as stated by Nucho offers the means of using both eyes, both
symbol systems, the visual, holistic-imagistic as well as the verbal-ana-
lytic. Practitioners who include the psychocybernetic model into their
arsenal of skills will increase their effectiveness immensely.
AHKTER AHSEN, PH.D.

Editor,fournal ofMentalImagery and
Founding Chairperson, International Imagery Association
PREFACE
n creasingly, art therapy attracts the interest of forward-looking pro-

I fessionals in the mental health field. Especially those professionals
who are working with children and adolescents find art therapy tech-
niques indispensable in their work. Less frequently, art therapy is used
when working with adults. The second edition of this book should
prove useful not only when working with children and adolescents, but
also with various kinds of adults, ranging from minimally dysfunction-
al to severely dysfunctional, and also with those who are in the final
phases of life. Several new art therapy techniques are introduced in this
edition of the book to facilitate the work with these populations.
It is a pleasure to acknowledge my indebtedness to the people who
in various ways contributed to the development of my ideas that are
presented in this book. I want to pay a special tribute to my friend, the
late Hanna Y. Kwiatkowska, from whom I learned much about art ther-
apy and about life. I am grateful to Drs. IreneJakab and Ahkter Ahsen
for their interest in my work and for writing the Forewords. Dr. Vija
Lesebrink, a kindred spirit, has my profound thanks for her wise coun-
sel and her sustaining encouragement as the work progressed. The clin-
ical acumen of the late Dr. Mala Betensky has enriched my thinking as
we collaborated on various projects over the years. My colleagues at
the University of Maryland, Drs. Harris Chaiklin, Oliver Harris, Cur-
tis Janzen, Arthur Schwartz, and the late John Goldmeier, have my
appreciation for reading individual chapters of the first edition of this
work. My gratitude and admiration go to my friend and colleague Dr.
Sandra Snow for her enthusiastic use of the psychocybernetic model of
art therapy in her practice and teaching.
I thank the founding members of the Maryland Art Therapy Asso-
ciation for stimulating discussions, especially Michelle Flesher, Gwen
Gibson, Roberta Shoemaker, and Dr. Lucille Venture. I have also ben-
efited from exchange of ideas with a host of other art therapists, too
ix
x ThePsychocybernetic Model ofArt Therapy
numerous to mention by name. My special thanks go to Virginia

Austin, Robert Ault, Gladys Agell, GeorgiannaJungels, Dr. Myra Lev-
ick, Dr. Judith Rubin, Dr. Harriet Wadeson, and the late Marge
Howard, Connie Naitove, and Marie Reval. The late Dr. Elinor Ulman
was gracious enough to read and comment on several chapters of this
work.
I am particularly grateful to Louise White who helped me clarify my
thinking while straightening out my syntax for this book as well as for
my other books. Virginia Peggs was immensely helpful as she cheer-
fully typed and retyped the many drafts of the manuscript of the first
edition. Janice Hicks did the same for the second edition of the book.
I am deeply thankful to my clients who allowed me to get to know
them in a special way and for giving me permission to reproduce some
of their artwork. I extend my gratitude and appreciation to my stu-
dents, who over the years shared with me their thoughts, struggles, and
triumphs in the use of art therapy. And to my husband, the late Dr.
Fuad Nucho, I am grateful for his unwavering interest and encourage-
ment over many years.
Finally, I thank the American Art Therapy Association for permis-
sion to reproduce material previously published in the Conference Pro-
ceedings 1979, 1981, and 1982. I also thank Rawley Silver for
permission to reproduce the Draw-a-Story Form A. Charles C Thomas
has my thanks for granting me permission to reproduce the Wartegg
blank from E. Hammer (Ed.), The ClinicalApplication ofProjective Draw-
ings (1958).
AINA O. NUCHO
CONTENTS
Foreword-IreneJakab v
Foreword-Akhter Ahsen vii
Preface ix
PART ONE: THEORETICAL FOUNDATIONS

Chapter 1. AN INVITATION TO CHANGE 5
Paradigmatic Changes 5
Overview 7
Advantages of Visual Forms of Cognition 10
2. ART THERAPY, PSYCHOCYBERNETICS AND
SySTEMS 12
What Is Art Therapy? .12
Cybernetics 15
Images and Psychocybernetics 18
General System Theory 21
Information Processing and Imagery 23
Conclusion 24
3. IMAGES AND COGNITION 25
What Are Images? 26
Types of Imagery 28
Preferred Sensory Modality of Imagery 29
Images and Metaphors 30
Images and Symbolization 31
Ahsen's Triple Code Model of Imagery 33
The Concept of Systems 34
Two Types of Cognition 35
Hemispheric Differences 37
The Process of Codification 40
Systems and Cognition 45
Conclusion 47
xi
xii ThePsychocybernetic Model ofArt Therapy
4. THE MERGING OF ART AND THERAPY 49

"Go, Paint, It Is Good for Your Soul!" 50
The Ancient Greeks 51
Jung and the Method of Active Imagination 53
Adrian Hill, the Visiting Therapist 56
Margaret Naumburg and the Free Art Expression 59
Florence Cane and the Artist in Each of Us 64
Forging a New Discipline 65
Trailblazing in Art Therapy 69
Conclusion 71
5. VARIETIES OF ART THERAPY 72
The Art Wing 73
The Therapy Wing 74
Arts and Crafts 75
Theoretical Orientations 77
The Psychoanalytic Model 78
TheJungian Approach 84
The Gestaltists 88
The Phenomenological Trend 90
Conclusion 92
6. CONTOURS OF THE PSYCHOCYBERNETIC
MODEL 93
Duality of Knowledge 93
The Function of the Therapist 94
Ipsomatic vs. Nomomatic Seeing 95
Primary vs. Secondary Creativity 96
The Four Phases of the Therapeutic Process 97
When and How to Use the Psychocybernetic Model 99
Personal Qualifications .. 101
Professional Preparation 102
Art Materials 104
Space Requirements 107
Time Considerations 107
Conclusion 107
PART TWO: THE THERAPEUTIC PROCESS
7. THE UNFREEZING PHASE 111

Common Misapprehensions 112
Contents xiii
Preparing the Client for the Experience 114

Limbering Up 117
Structuring 117
The Process of Engagement 118
8. THE DOING PHASE 121
To Structure or Not to Structure? 121
The Free-flow Technique 122
The Wartegg Technique 126
Diagnostic Procedures 128
Themes Derived from Client Concerns 132
Interactional Drawing Technique 134
Principles of Timing, Gradualness, and Spotlighting 134
Self-System: A Technique Generating Matrix 136
Peripheral vs. Central Concerns 140
Rapport Building, Self-Sharing, and Closure 148
Free Expression, Assemblages, and Perceptual
Stimulation 149
What to Do While Clients Work? 151
The Length of the Doing Phase 153
9. THE DIALOGUING PHASE 157
The Nomomatic vs. the Ipsomatic Approach 157
Distancing 159
Decoding 160
Closure and Consolidation 163
Format and Length of the Dialoguing Phase 166
The Process of Amplification 171
Dispositional vs. Facilitative Understanding 171
Search for the Inner Design 173
The Dialoguing Process in Groups 174
Salience and Timing 175
10. ENDING AND INTEGRATING 177
Ratification 178
Resistance 179
Review 182
Resolution 185
Integration 192
A Practical Hint 193
Conclusion 194
xiv ThePsychocybernetic Model ofArt Therapy
PART THREE: WORK WITH SPECIFIC CLIENT

POPULATIONS
11. WORK WITH CHILDREN 199

Indirect Treatment 200
Direct Treatment 202
Therapeutic Styles 202
Tasks of the Therapist 205
Specific Techniques 206
Responsive Communication 215
12. ART THERAPY WITH ADOLESCENTS 221
Tuning In 222
Helping Strategies 223
Specific Techniques 226
Suicidal Adolescents 231
Eating Disorders 232
Sexual Abuse 233
Chemical Dependency 235
13. ART THERAPY WITH ADULTS 238
Being Grown-Up 238
Minimally Dysfunctional Adults 240
Moderately Dysfunctional Adults 241
Severely Dysfunctional Adults 245
Late Adulthood 252
PART FOUR: EFFECTIVENESS OF ART THERAPY

AND A LOOK AHEAD
14. CASE VIGNETTES 261

Yearning for the Family of Origin 262
Keeping Up with the Grown-Ups 262
Striving for Reconciliation 263
Pregnant Teenager's Dilemma 264
Stresses of Upward Mobility 267
The Last Leaf 269
15. AN EMPIRICAL OUTCOME STUDY 272
Research Design 272
Findings 274
Contents xv
16. LOOKING AHEAD 278

Desirability and Feasibility of Research 278
Life-Long Learning 279
Bibliography 283
AuthorIndex 293
Subject Index 297
THE PSYCHOCYBERNETIC MODEL
OF ART THERAPY
Part One
THEORETICAL FOUNDATIONS
Chapter 1
AN INVITATION TO CHANGE
eraclitus, the ancient Greek sage (c. 536-470 B.C.) declared that
H everything is in flux. Everything changes, and no one can step
twice in the same waters of a river. What seemed true to Heraclitus is
even more true in our times. Old certainties give way to uncertainty.
Old traditions no longer sustain human behavior. This is true in the
personal as well as in the professional realms. Professional monodoxy
has given way to a plethora of theories and interventive strategies
(Corsini, 1981). Change is all around us, but where is the way to suc-
cess?
This book is written for mental health specialists who are dissatisfied
with the extent of success of their current predominately verbal meth-
ods of helping. All mental health specialists are surrounded by a super-
abundance of distress. The discrepancy between the supply and the
demand for services is immense. Every program of human services suf-
fers from serious personnel shortages. It is essential to find ways of
speeding up our methods of helping.
Paradigmatic Changes
The method of intervention described in this book has been stimu-

lated by the paradigmatic change that is affecting various areas of
human endeavors. As pointed out by Thomas S. Kuhn, paradigmatic
shifts tend to occur periodically and simultaneously in all fields of sci-
ence (Kuhn, 1962). We are now in the midst of such a change. The
older paradigms of the vitalistic and the mechanistic kind now are giv-
ing way to the holistic paradigm. The holistic paradigm regards the
universe as one interconnected system. Matter and energy, space and
5
6 ThePsychocybernetic Model ofArt Therapy
time, living and nonliving phenomena are viewed as transformations

within the same hierarchically-ordered unity (Battista, 1977).
The emerging holistic paradigm is best understood with the help of
the system theory. General system theory is a set of concepts about the
nature and dynamics of systems. The field of cybernetics evolved out
of the general system theory in an effort to develop self-guiding and
self-correcting machines. Cybernetics is the study of the flow of infor-
mation in a system. Fundamental to cybernetics is the notion of feed-
back loops of information. The flow of information explains how a
system maintains itself and how it changes. Information organizes goal-
directed activities within a system and between various systems. In the
human system, information is encoded on several different levels, rang-
ing from the cellular to the interpersonal level. When engaged in inter-
personal forms of helping, the level of information of particular
concern is that which occurs through imagery and in the various other
forms of verbal and nonverbal cognition.
Information encoded in human physiology and metabolism is
increasingly better understood. The information contained in words is
studied extensively. But information embodied in imagery is the one
level of information processing that has been largely neglected in West-
ern culture until quite recently (Horowitz, 1970; Singer, 1972). The psy-
chocybernetic model described in this book provides convenient
techniques to tap this level of cognition.
Each human being is equipped with two sets of symbolic processes.
Since the days of Freud it has been customary to differentiate between
the prelogical or the primary process thought which appears mostly in
fantasy, imagery and dreams, and the logical, rational, or the so-called
secondary process thought. Only quite recently have we discovered
that the primary process thought is not necessarily a primitive and an
immature form of cognition which we should strive to outgrow and
leave behind. Rather, it has to be integrated with the secondary process
thought if we wish to attain high levels of creativity and originality (Ari-
eti, 1976). How to benefit from this undervalued and neglected form of
cognition is the topic of this book. The psychocybernetic model of
interpersonal helping offers the means of increasing the effectiveness of
both the help seeker and the help provider by showing how to harness
their imagery, this long neglected human resource.
The model of psychotherapy presented in this volume will foster
your ability to utilize both the verbal and the visual means of cognition.
An Invitation to Change 7
It presents ways of capturing the power of fleeting images. A method of

amplifying the faint messages contained in imagery is described and
illustrated with case excerpts. You will develop the skill to engage your
clients in expressing thoughts and feelings through visual means. You
will sharpen your perception and ability to discern ideas portrayed
visually, and you will know how to respond appropriately to the
imagery of your clients.
Overview
The book is organized in three parts. Part One contains six chapters
which present the theoretical foundations of the psychocybernetic
model of interpersonal helping which I have developed and practiced
for over 20 years. I have taught this model of intervention for the past
15 years. The theoretical framework of the model is the general system
theory and the so-called cognitive theory which is only now taking
shape in the behavioral sciences (Gardner, 1985). General system the-
ory, its main concepts and the field of cybernetics are discussed in
Chapter 2. This is a complicated set of ideas but once mastered, these
ideas help us understand better how the human mind works and how
positive changes can be brought about. Chapter 3 considers the cyber-
netic function of imagery and presents a model of cognition based on
the general system theory.
What constitutes art therapy is still a matter surrounded by contro-
versy (Ulman, 1975). The discipline of art therapy is of recent origin,
and it utilizes several different ways of promoting visual forms of cog-
nition. It is interesting to trace the course of the slow and arduous
process whereby art and therapy gradually merged to form this new
discipline now known as art therapy. By whom and how art and thera-
py were forged gradually into one entity is covered in Chapter 4. Chap-
ter 5 surveys the contemporary scene and delineates several kinds of
art therapy practiced in the United States and summarizes some of the
other major theoretical frameworks used by art therapists. It also out-
lines the personal and the professional qualifications necessary for the
practice of the psychocybernetic model of intervention and suggests
ways of acquiring these qualifications. Then it discusses ways of com-
bining the psychocybernetic model with the customary purely verbal
methods of psychotherapy and it describes practical matters such as
considerations of time and space requirements as well as the art mate-

rials useful for the practice of this model of helping.
Once you have absorbed the general systems ideas and have accept-
ed the fact that imagery is an indispensable form of cognition, the rest
is easy. You will be tempted to say about the psychocybernetic model
of intervention what Johann Sebastian Bach said about playing the
organ. He said that playing the organ is easy: all you have to do is hit
the right notes at the right time. Similarly with the psychocybernetic
model. It is simple. All you have to do is say the right things at the right
time. What these right things are and how to attain the proper timing
are matters that are considered in Part Two. Part Two contains five
chapters which discuss the implementation of the psychocybernetic
model. These chapters take you through the intricacies of the thera-
peutic process step by step and show you how to proceed in accor-
dance with the psychocybernetic principles. Chapter 7 deals with the
warm-up phase of the therapeutic process. This chapter describes ways
of introducing clients to visual forms of cognition, especially clients
who are not artistically inclined and who may not have used any art
materials since their early childhood days. The following chapter dis-
cusses the working phase when the clients are engaged in producing
the drawing, painting, or the sculpture which is to capture their
imagery in a visual format. A number of specific techniques are sug-
gested to promote visual cognition of various kinds of clients. Chapter
9 outlines the process of decoding the visual imagery portrayed by
clients. At this juncture of the therapeutic process the visual imagery is
translated into the verbal, secondary process thought. Chapter 10 deals
with ways of terminating the therapeutic interaction and considers the
matter of integrating the gains made in therapy. The final chapter dis-
cusses the scope and the effectiveness of the psychocybernetic model of
intervention.
The psychocybernetic model uses simple art materials to promote
the expression of imagery in visual format. Thus the psychocybernetic
model may be thought of as a form of art therapy. The art materials,
however, are used in a very specific manner. While some art therapists
will find the psychocybernetic model quite congenial to their own man-
ner of working, others will think of this model only as a distant cousin
to art therapy. Chapter 11 summarizes the results of a controlled empir-
ical study in which the outcomes of the psychocybernetic model of art
therapy and two other forms of expressive therapies were compared to
the outcomes attained by a number of other frequently used modalities

of helping. The expressive therapies provided were the psychocyber-
netic model of art therapy, music therapy, and exercise therapy. The
results obtained by the expressive therapies were compared with
results observed in verbal groups psychotherapy, chemotherapy, and a
no-treatment control group. The sample consisted of 298 depressed
elderly clients. The findings show that the expressive therapies, includ-
ing the psychocybernetic model of art therapy are most effective.
Chapter 11 also presents case vignettes to illustrate the scope of the
psychocybernetic model with several different kinds of clients who are
usually slow to respond to verbal forms of therapy, especially when
the gender and/or the racial background of the therapist differ from
that of the client.
If you want to enlarge the repertoire of your helping strategies and if
you are searching for ways to become a more effective therapist, you
are invited to try this new modality of helping. The psychocybernetic
model of helping has proven effective with clients spanning the entire
gamut of clinical concerns and ranging in age from 3 to 98. The levels
of ego development of these clients have varied from minimal to supe-
rior. What accounts for the effectiveness of this model of helping? It
appears to lie in the very make-up of our cognitive equipment.
Every person, however untutored in art, possesses a basic visual
vocabulary. Everyone, for instance, has some feeling about colors.
Some colors are thought to be pleasing while others are perceived as
being unattractive. The same is true for shapes. Some shapes may seem
enticing while others may appear to be jerky or bold. This visual
vocabulary, once discovered, can be expanded, and it becomes a
source of constant enrichment and excitement. Drug dependent clients,
for instance, who are accustomed to think of themselves as chronic fail-
ures, become quite intrigued by this discovery. It is rewarding to dis-
cover one's own visual vocabulary and to see how it converges or
differs from those of other members of the group while at the same
time having just as much validity (Nucho, 1977).
Visual means of expression are more appropriate for the subtle and
deeply personal experiences for which language provides no appro-
priate words. By and large, language, with all its complexity, contains
designations for those experiences which are of some social signifi-
cance but the more private and idiosyncratic experiences are less ade-
quately represented. Furthermore, many important experiences occur
during the first year of life, well before the person has adequate words
to attach to one's experiences. Therefore, some very significant and
fundamental experiences become encoded not in words but in pictures
in our minds. Also, we dream mostly in pictures, and dreams have long
been recognized as providing access to the deeper layers of our being.
To severely dysfunctional clients, verbal means of communication
are often dangerous and unreliable. Words may have been used to
evade, humiliate or deceive another person. In contrast, visual means
of expression, used less frequently in our culture, have fewer distortions
and negative associations attached to them. Not infrequently, a fresher
and more direct expression can be achieved through the visual than
through the verbal means of communication.
Advantages of Visual Forms of Cognition
Painting, drawing, and sculpting are action-oriented ways of con-

veying one's thoughts. The eyes, hands, arms and much of the rest of
the body are involved. The client is a doer, not a reactor, as is all too
often the case in other areas of the client's life. While making the pic-
ture, the client's neuromuscular as well as his cognitive faculties are
engaged. The client has to decide whether the picture will be small or
large, bright or dark. Once the decision is made, it remains as the client
made it, unless the client himself wishes to change it. The picture does
not argue with him. If the client is not pleased, he can change his deci-
sion without the penalties which customarily follow when one changes
one's mind in real life. Clients relish this sense of freedom and self-
determination once they have experienced it.
The visual format of communication utilized in the psychocybernet-
ic model is particularly effective when working with clients who are
"therapy wise" and who have learned to tell their therapists what they
think the therapists want to hear. The customary verbal means of
expression permit a client to be more evasive and noncommittal than
when engaged in visual forms of expression. In our culture visual
expression is not a routine activity and thus a greater degree of thought
is required. Visual percepts reflect more of a person's cognition than do
words. Visual expression by its very nature is more complete than ver-
bal expression. For example, a statement, "A person runs" does not say
anything about the sex, age, size, or speed of the runner. If you draw a
person running, you are bound to include more details than in the ver-
bal statement, and thus convey more information (Piotrowski, 1953). In

a drawing it is hardly possible to say the bare minimum. The visual
forms of expression tend to contain details which reveal one's attitude
towards the subject portrayed.
Another advantage of visual forms of expression is that it can over-
come the drawbacks of age and education. For instance, drawings done
by the entire family in therapy, simultaneously by the parents and their
children, provide the means for the children to make their thoughts
known just as effectively as do their elders (Kwiatkowska, 1978).
By visually depicting those experiences too difficult to put into
words, clients develop a sense of mastery that has a way of generaliz-
ing to other areas of their lives. Having portrayed feelings graphically
on paper or in clay, clients often find these feelings more amenable to
effective handling in actuality. In one art therapy group, when the psy-
chocybernetic model was used, a young woman with a long history of
illicit drug usage was able to confront her feelings about her mother
and attain a mutually acceptable solution to their difficulties after only
a few therapy sessions. Another client, a 22-year-old black male who
had felt on the verge of resuming his heroin habit, was able to shake off
his preoccupation with drugs and his restlessness after the fourth ses-
sion of therapy. A year and a half later, follow-up reports indicated that
he had remained drug free.
The psychocybernetic model presents ways of helping clients pin
down their depressions and express their angers symbolically. The
chaos of their lives is sorted out so that better ways of coping may be
discerned. The psychocybernetic model provides a means of combin-
ing the visual with the verbal forms of communication. The outcomes
achieved with the help of this model often prove superior to those pos-
sible when using the older models of intervention.
Chapter 2
ART THERAPY, PSYCHOCYBERNETICS

AND SYSTEMS
rt therapy, a relatively new modality of helping, is used increas-

A ingly by many mental health practitioners. Although its roots can
be traced back to antiquity, much of it is still puzzling not only to its
observers and participants but to its practitioners as well. Many art
therapists are inclined to think that art therapy transcends the confines
of logical discourse. What art therapy entails, they maintain, can be
understood only through experience, not through verbal description.
According to them, it may be easier to square a circle than to explain
what art therapy is and how to do it.
The concept of cybernetics is useful in understanding what art ther-
apy is and to learn how to do it. The term cybernetics is derived from
the Greek word for "helmsman" or "navigator." It was introduced by
Norbert Wiener in 1947 and it has come to designate the discipline
which studies the flow of information that organizes goal-directed activ-
ities of various systems. From the concept of cybernetics I have devel-
oped what may be termed the psychocybernetic model of art therapy.
This model provides clear guidelines to mental health practitioners for
the specific tasks that need attention during the various phases of the
process of intervention. It also helps us to differentiate between art
therapy and the other activities that may be beneficial but nevertheless
are peripheral to art therapy.
What Is Art Therapy?
From the perspective of psychocybernetics, art therapy may be

defined as the process of becoming aware of, externalizing, portraying,
12
Art Therapy, Psychocybernetics and Systems 13
and then decoding one's imagery in order to integrate experiences and

to discern new avenues for action.
Imagery is the central ingredient of the psychocybernetic model of
art therapy. Art therapy is the process of cultivating, clarifying, and
visually expressing the imagery that arises spontaneously in response to
various experiences in life. Images are symbolizations or crystalliza-
tions of life experiences. The experiences in life are condensed into
images both spontaneously and deliberately. Language itself may be
viewed as a frozen system of images. But what is the purpose of this
level of symbolization? Why are we equipped with this ability to pro-
duce images, both spontaneously in dreams and purposefully in art,
and inescapably in speech in the form of metaphors?
Although much vigorous theorizing has taken place since the con-
cept of imagery returned from the exile to which it was banished by the
early behaviorists (Holt, 1964), the function of imagery is still perplex-
ing to the human mind. From the perspective of psychocybernetics, it
may be postulated that the function of images is to regulate the flow of
information in the system. Images are information condensers. Images
store information so that it may be sorted out, compared with other
information already in the system, and transported from one place to
another, or from one time to another. More will be said about images
in Chapter 3.
As any other form of therapy, the psychocybernetic model of art
therapy may be thought of as a process of communication. Ideas and
feelings are exchanged between the helper and the help seeker.
Through the usual forms of psychotherapy, the exchange of informa-
tion is primarily verbal. Through the psychocybernetic model of art
therapy, however, the process of communication is instigated, facilitat-
ed and sustained with the help of a visual product. Furthermore, the
visual product that channels the communication is produced by the
help seeker spontaneously, without the benefit of technical skill or
instruction. Additionally, the visual product, be it a drawing, painting,
sculpture or other form of expression, is examined by both the maker
and the therapist not for its aesthetic merits but for the personal feel-
ings, thoughts and experiences it may convey.
How is this possible? How can anyone communicate anything with-
out the technical know-how? Here many art therapists themselves
become doubtful. Two distinct schools of thought have arisen among
professional art therapists precisely around this issue. The one school of
thought, known as the "ART as Therapy" wing of art therapy, holds

that nothing worthwhile can be communicated unless the client has
reached the point where some rudimentary technical skills have been
mastered. The other wing of art therapy, known as the "Art PSy-
CHOTHERAPY" school of thought maintains that the sense of form is
innate and the visual sense so prominent in human beings that much
information can be conveyed by persons entirely untutored in the visu-
al arts.
The psychocybernetic model of art therapy is the use of simple art
materials in order to stimulate the imagery of the help seeker so that
experiences may be sorted out, inspected, looked at, faced, integrated,
and understood better than before. Once externalized, the fearful and
perplexing experiences are not nearly so frightening as when harbored
secretly within the mind.
We know that verbal sharing of difficult experiences also eases the
mind. What then is the advantage of visual expression as compared to
verbal communication?
Words, as suggested earlier, are frozen images. Moreover, words are
like hand-me-downs instead of original products. They are not custom
tailored to fit the person's experience exactly. Words are like railroad
tracks. Feelings have to stick to these "tracks." Where there are no
tracks, the feelings cannot "go" and they cannot be communicated.
Words have arisen for experiences that have some social significance.
Experiences that are private often do not have adequate words to des-
ignate them. We all know that certain cultures are rich in words that
have survival significance for that particular culture while other expe-
riences are meagerly represented by verbal language. Eskimo language
provides a case in point. Eskimos have 20 different words for snow. In
contrast, western languages have only a few words to designate this
frozen form of precipitation.
Visual forms of expression have the advantage of originality while
words are rather "shop-worn." One has to be a poet and work at one's
language to get rid of hackneyed forms of speech. In contrast, visual
expression is closer to the immediacy of experience. We see and deeply
experience the world for many months before we possess verbal labels
for our experiences that already have shaped us. Later in life some of
these primary experiences can be contacted through the visual means
of expression. No wonder then that we have the saying that one picture
is worth a thousand words.
There is another profound reason why the visual forms of expression

are so potent. This power has to do with the way in which our very
brain is constructed. The two cerebral hemispheres appear to be dif-
ferentially engaged in the processing of information. The one part of
the cerebral hemisphere is more active when we engage in the verbal,
analytical, and rational forms of reasoning. The other, or the so-called
nondominant hemisphere, is engaged more actively when we use intu-
ition, holistic forms of thinking, or perform visual and spacial tasks
(Sheikh, 1983). Every human being, however untutored in the visual
arts, has both cerebral hemispheres and hence is equipped to benefit
from visual forms of communication as used in the psychocybernetic
model of art therapy.
Our immediate task in this chapter is to present the concept of cyber-
netics, discuss the general system theory which gave rise to the concept
of cybernetics, and to discuss in some detail what significance this con-
cept has for the understanding of the functioning of the human mind
and ways of helping of which the psychocybernetic model of art ther-
apy is but one.
Cybernetics
Cybernetics is the discipline concerned with the study of the flow of

information that organizes goal-directed activities in systems. The term
was coined by Wiener to designate the common interests of a rather
disparate group of mathematicians, engineers, and physiologists who
had joined forces to study various problems of communication and
control systems (Wiener, 1947). Despite the extensive public notice the
term received following the publication of Wiener's book, its reference
has remained rather vague. Sayre uses it to designate the study of com-
munication and control functions of living organisms, particularly
human beings, in view of their possible simulation in mechanical sys-
tems (Sayre, 1976).
The notion of cybernetics was known in physical and social sciences
long before Wiener gave it new vitality. Plato used the term cybernet-
ics to describe the prudent aspects of the art of government. A French
philosopher, A.M. Ampere, used the term "cybernetique" for the sci-
ence of civil government (Dechert, 1966). By the turn of the century
physiologists like Claude Bernard were fully aware of the processes of
homeostasis whereby an organism acts to restore its internal equilibri-
um. The self-regulatory aspects of neurophysiological phenomena are

further discussed by Cannon (1932). By the early 1940s physicists, elec-
trical engineers and mathematicians were at work on servo-mecha-
nisms of self-regulating systems that could be used for industrial and
military purposes. Wiener deserves credit for formalizing much of the
scientific thinking up to that point in time. These ideas have led now to
the so-called second industrial revolution. While the first industrial rev-
olution replaced human energy by mechanical energy, the second
industrial revolution now is relegating the control of machines from
humans to computers which are designed and monitored by the
human mind.
Cybernetics, then, is the study of processes that make purposeful
goal achievement of various systems possible. The principles of cyber-
netics permit the construction of goal-directed machines, robots, and
computers. The goal-direction is achieved through the so-called feed-
back processes. Feedback is a process whereby a portion of the energy
or informational output of the system is channeled back into the system
as information in order to stabilize or direct its actions. The same basic
principles of self-regulation are found in organic systems, human
behavior, social systems, and in various complex man-made machines.
Generally, two forms of feedback can be distinguished. One form of
feedback is called positive, the other is termed negative feedback. Pos-
itive feedback increases the activity of the system; negative feedback
decreases or eliminates the activity. A nagging spouse is an example of
a positive feedback that increases the activity of a system, in this
instance, that of the marriage. The more one nags the more the other
withdraws, and the more nagged spouse withdraws the more the nag-
ging continues. Thus, the nagging and the withdrawal both feed on
each other. Or, to cite another example of positive feedback, an inse-
cure child may incite teasing from his peers which in turn further
increases his sense of insecurity.
Negative feedback "negates" or prevents excessive deviation of the
system from a given baseline condition. Many physiological processes
are instances of negative feedback. The pupil of the eye, for instance,
contracts in bright light and expand when the light is dim. Many other
body processes, such as the regulation of temperature through sweat-
ing, are examples of negative feedback.
The concept of cybernetics can be applied to all levels of organic and
inorganic life. The very process of life is now understood as complex
feedback loops. The process of natural selection, for instance, is an

example of a large scale negative feedback which homeostatically pre-
serves life in a changing environment (Sayre, 1976).
In physics and chemistry each state of the system is conceived as an
effect of a previous state. In contrast, in the realm of organic systems,
many life processes are functionally related to subsequent states. Tro-
pism and other goal-seeking activities belong in this category. Here the
activities stemming from the present state of the system are actually
functions of an anticipated future goal configuration (Sayre, 1976).
Cybernetics provide an all inclusive way of understanding complex
processes in living nature, human society, and industry. Three branch-
es of cybernetics have been developed. One, known as theoretical
cybernetics, deals with mathematics and philosophical problems. The
second branch of cybernetics deals with control systems, including
problems of collecting and processing information. The third branch is
concerned with the application of cybernetics to fields of human activ-
ity (Dechert, 1966).
The existence of intricate feedback loops at all levels of reality draws
our attention to the fact that the universe itself may be regarded as a
great thought rather than a great machine. SirJamesJeans, for instance,
a prominent English scientist of the Cambridge school, states, "Mind
no longer appears as an accidental intruder into the realm of matter; we
are beginning to suspect that we ought rather to hail it as the creator
and governor of the realm of matter" (quoted in Foster, 1975, p. 164).
The principles of cybernetics have given rise to a whole new method
of health care in the form of biofeedback. Biofeedback has been greet-
ed as a scientific breakthrough which is expected to bring about the
next phase in the evolution of human beings (Kalins & Andrews, 1972).
Although the principles on which biofeedback is based are sound, the
accuracy, reliability, and the cost of the instruments still leave much to
be desired, and these realities have dampened the enthusiasm of its
supporters. With the help of equipment that can amplify bodily
processes and convert them into readily observable signals, such as a
flashing light, movement of a needle, or a steady tone, a person indeed
can learn to regulate his brain waves, muscle tension, heart rate, skin
temperature, and even the acidity of the stomach. Any neurological or
other biological function which can be monitored and amplified by
electronic instrumentation and fed back to the person through anyone
of his five senses, can in principle be regulated by that individual (Pel-
letier, 1977). The methods of biofeedback utilize the fact that every
change in the physiological state of a person is accompanied by a cor-
responding change in the mental and emotional state. Conversely,
every change in the mental and emotional state, be it conscious or
unconscious, is accompanied by a corresponding change in the physi-
ological state (Green, Green & Walters, 1970). Voluntary control of psy-
chophysiology can be achieved if subtle internal states are observed by
the individual. Many visceral and glandular processes previously
thought to be outside a person's voluntary control can now be regulat-
ed deliberately. Many people have learned to control their migraine
headaches, lower their blood pressure, and regulate their heart beats
(Girdano & Everly, 1979).
Whatever happens to or within the human system is registered either
as a state of well-being or as a state of distress. These states, however
fleeting, leave neurophysiological traces within the system. These
traces can be monitored with the help of various feedback devices that
implement the principles of cybernetics.
Images and Psychocybernetics
One type of feedback device which does not require any elaborate
electronic instrumentation, but nevertheless is still generally underval-
ued in our Western culture, is imagery.
Images may be thought of as natural feedback devices in that they
are information condensers. Prompted by various experiences in life,
images arise spontaneously in the mind. Images can also be activated
deliberately in order to monitor the state of the human system. This is
what is done by the psychocybernetic model of art therapy as well as
by the various applications of imagery techniques which are gradually
seeping into the mental health professions (Korn &Johnson, 1983). It
can be expected that imagery, this much neglected source of powerful
information will be increasingly utilized by mental health professionals.
One method of harnessing this potent but often overlooked source of
energy is art therapy.
Information arrives constantly through the various channels of per-
ception and is symbolized in one of the five sensory modalities. The
newly arriving information, both from inside of the system itself and
from the external world, has to be sorted out, codified, and integrated
with the information already in the system. Unless integrated with the
previously stored information, the newly received information will act

only as noise, not as messages. Additionally, it is important to empha-
size that the functioning of the system is hampered both by an infor-
mation overload as well as by a scarcity of information. When the
system is flooded with information from a variety of experiences, the
surplus information is automatically made more manageable by con-
densing it into images. In this manner, the influx of overwhelming
information can be sorted out gradually and eventually correlated with
the information already available within the system.
The assimilation of the incoming information leads inescapably to a
reappraisal and recodification of the previously acquired information
(Nucho, 1966). This in turn leads to a revision of the goals of the sys-
tem. This is a never ending process, and it is this process that the psy-
chocybernetic model of art therapy is concerned with and can offer
much needed assistance.
The psychocybernetic model of art therapy postulates that people
are purposeful information seeking and information processing behav-
ioral systems. The task of the therapist is to assist the client in consoli-
dating the information derived from various life experiences in order to
construct internal frames of reference for appropriate pursuit of goal
directed behavior. Art therapy, in the light of psychocybernetics may
be thought of as an information processing enterprise. From the psy-
chocybernetic perspective, art therapy may be defined as the process of
cultivating and explicating the internally produced signal system in the
form of images that arise in response to the various experiences in life.
The task of the therapist is to help the client facilitate the flow of the
information contained in the images so that this information may be
examined in order to discern the various options available to the per-
son.
In the course of the psychocybernetic model of intervention images
are examined and gradually transformed into more conventional sym-
bol systems such as verbal language. Unless concretized, images
remain ephemeral and fleeting. For this reason, images need to be por-
trayed in visual or some other tangible form. If unheeded in one form,
the same information may reappear in another but perhaps less desir-
able form. Information that is disregarded when it appears in the form
of visual imagery, either in dreams or in art products, may reappear in
the form of some somatic symptom or behavioral manifestation. If
energy is to be invested prudently it has to be examined and its force
and direction understood. This is the psychocybernetics of human

functioning which undergirds goal-directed and purposeful action.
Images extend the information processing and acquiring capacity of
human beings without increasing the bulk of their nervous systems.
The primary function of imagery is communication, ranging from per-
sonal exchange of information between the various levels of the system
itself to dissemination of information to external systems. With the help
of images, therefore, a broader range of experiences can be inspected
and benefited from than would be possible in the light of discrete and
unrelated experiences alone.
Imagery is a highly efficient form of information processing. Action
can be instituted and goals formulated prior to the occurrence of the
expected event itself. Images give human beings the capacity to reflect
upon circumstances beyond those actually present, and they foster the
ability to draw inferences from the particular to the general. Imagery,
then, is at the root of the fact that humans excel in the acquisition and
utilization of information. Many other species surpass man in various
areas. Pigs, for instance, surpass humans in their ability to utilize nutri-
tion. Elephants surpass people in the quantity of energy intake. No ani-
mal, however, surpasses human capacity for the acquisition and
processing of information. Imagery is one important channel of infor-
mation processing which has been overlooked far too long. And
imagery is one major asset which the psychocybernetic model of art
therapy is capable of nurturing. Subsequent chapters detail how this is
done.
One more comment is necessary about the concept of psychocyber-
netics. A plastic surgeon made an early effort to apply the ideas of
cybernetics to behavior change. Maxwell Maltz had observed that
many people who consult plastic surgeons need more than surgery and
many others do not need surgery at all. He speculated that by chang-
ing a person's self-image, benefits are obtained that amount to a spiri-
tual facelift and a healing of emotional scars. Maltz hypothesized that
if a person can accept one's self and feel successful, he will be able to
accept his appearance. Maltz correctly identified the power of inten-
tions embodied in one's self-image and how it shapes human behavior.
He also called attention to the value of relaxation and several other
practices now promoted by various stress management programs (Stro-
bel, 1983). On the whole, however, his work was a rather chatty mix-
ture of inspirational positive thinking and anecdotes about successful
business people. Although aware of the work of Wiener (1947) and

Penfield (1954), the idea of psychocybernetics remained rather meager
and generally confined to the building of a positive self-image (Maltz,
1960; 22nd printingJanuary 1973).
The popularity that Maltz's work has enjoyed may be partially
accounted for by the hunger people have felt to view themselves as
more than machines. Since the arrival of the so-called Third Force in
psychology, topics of self-determination and self-responsibility which
Maltz promoted, have become generally better understood and accept-
ed in the helping professions. Human beings are no longer viewed as
complicated machines or enlightened animals but as self-actualizers
(Maslow, 1968).
Psychocybernetics, as the term is used in this book, is the application
of cybernetic concepts to the functioning of the mind. And cybernetics,
as was indicated earlier, is an offshoot of general system theory which
has by now permeated most branches of the social sciences.
General System Theory
General system theory provides a unifying framework for the

understanding of the interrelatedness of various levels of reality. Gen-
eral system theory is an outgrowth of biological theories that empha-
sized the interrelationship between species and their environments.
General system theory opposes the simple reaction theories that ana-
lyze reality fragment by fragment rather than the interconnectedness
of phenomena.
Bertalanffy (1968) is generally acknowledged as the founder of gen-
eral system theory. He defines a system as "a dynamic order of parts
and processes in mutual interaction" (p. 208). Another definition of a
system is as "an organized complexity" (p. 19). Still another definition
Bertalanffy provides is that a system is "a set of elements in interaction"
(p. 38). These "elements" in interaction can be cells, organs, organisms,
people, institutions, nations, cultures, solar systems, and so on. Every
system consists of smaller systems and is a part of some larger system.
An individual as a system is determined in part by the system to which
he belongs, and in turn, he exerts influence on that system as well as on
the subsystems that constitute him.
A system is a concept that permits the elucidation of the mutuality of
influences between various entities. Instead of straight line cause and
effect relationships, general system theory explains the reciprocity of

effects, the interrelatedness, and the interconnectedness between enti-
ties in the realm of nature and society. A system is essentially a reci-
procity of effects. The reactions go both ways, not just in one direction.
It is more like a water bed-if you press on it in one spot, then the pres-
sure goes all through the waterbed. Or you can think of a system as a
net-you pull at it in one place, and the entire net responds. Similarly,
the repercussions of social problems can be understood with the help
of the system theory more readily than with some of the older models
of theorizing. For instance, problems in the larger community have
effects on the family, and those in turn, affect each member of the fam-
ily. When the breadwinner is out of work, the marital relationship dete-
riorates; there is no money to fix the roof of the house or to buy other
necessities; the children get into fights, their school performance dete-
riorates, and this in turn affects the relationships in the entire family,
and so on. Like a stone thrown into a lake, the ripples go on and on.
Systems may be classified as closed or open. A closed system is one
that does not admit the incorporation of matter from outside. It is there-
fore subject to entropy according to the second law of thermodynam-
ics. While some outside energy, such as changes in temperature and
wind, may affect a closed system, it has no restorative properties and
no input from its environment, and consequently it decays.
All living organisms are relatively open systems in that in each there
is both intake and output of energy and extensive transactions with the
environment. In addition, there is a relatively steady state so that the
intrusion of energy from outside will not disrupt the internal order and
form. Finally, over time, the complexity and differentiation of parts
increase and thus there is an increase of order in the system (Allport,
1960).
Before systems ideas became known to the social sciences, the ana-
lytical approach to problem solving predominated. Even though the
helping professions were influenced by the Gestalt notion that a whole
is larger than the sum of its parts, phenomena were dissected and ana-
lyzed piece by piece. People and events were separated and examined
one by one, like the layers of a cake. Now we view people and events
not strictly separated but as constantly interacting. The relationship
between various influences is more like that of a marble cake than a
layer cake. Events are not like a six-pack of beer where each bottle has
its own contents. They are more like a punch bowl where all the ingre-
dients intermingle and affect one another. Reality, as we now under-

stand it in view of general systems, is a system of interrelated entities.
Change in one part eventually affects all the parts of the system.
General system theory is not a theory in the traditional sense but is,
rather, a conceptual model built around a set of core concepts. Some of
these concepts are boundaries which can be rigid or fluid and thus give
rise to open or closed systems. Another core concept is the steady state
or homeostasis, also called the state of dynamic equilibrium. Still
another core concept is the self-correcting propensity through the feed-
back loops which we discussed in some detail in the previous section of
this chapter.
Information Processing and Imagery
One more of the central concepts deserves to be mentioned in this

context, namely that of information. Information is a message or a con-
figuration of signal elements that has meaning for the recipient. Infor-
mation is data that reduce uncertainty between two or more levels of
the system. Information increases predictability and hence the ability
to control the system (Sayre, 1976, p. 23). Cognition is a set of infor-
mation processing capacities about which a great deal more will be said
in the next chapter. Consciousness, this mysterious phenomenon that
for centuries has been puzzling to philosophers and psychologists alike,
is also a form of information processing. In view of the systems ideas,
consciousness may be regarded as the cardinal information processing
device. Man, as Bertalanffy points out, is a symbol-making rather than
merely tool-making creature (Bertalanffy, 1968).
One of the symbol-making devices is imagery. Images are the inter-
nal sensors that register changes in the internal and external environ-
ments and activate processes within the organism that can restore
acceptable relationship between the various subsystems of the system
and its environment. Images channel body energies according to the
cybernetic principle. Images program, direct, and govern the energies
of the organism. Images dig the riverbed as it were, and energy like
water follows the course of the river bed.
This proclivity of images to act as channels for the energies of the
organism can be utilized in health care (Simonton et aI., 1978) and in
psychotherapy. Body energies do not know the difference between real
and imagined events. Muscles contract and glands secrete in response
to actual as well as imagined experiences. If you do not believe this, try

to imagine a cool, fresh, fragrant, yellow lemon which you hold in your
hand and then cut and eat, the juices flowing down your chin, and see
what happens to your mouth. Similarly, through visual images you can
program deeper layers of your mind which we normally consider inac-
cessible to voluntary control. Through deliberately formed images we
devise new concepts and attract new experiences. The power of
imagery to channel the energy of the organism is utilized now, among
others, by athletes. They pretrain their bodies through deliberate
imagery of upcoming events (Winter, 1981).
Conclusion
General system theory which originated in biology began to trickle

into social sciences in the 1950s. It started to permeate social sciences
in the 1960s. By the 1980s, general system approach has become an
indispensable tool for understanding the multivariate complexity of
human affairs. General system theory regards human beings and soci-
eties as complex self-regulating systems interacting among themselves
and within a complex environment. Cybernetics is a conceptual tool
for the analysis of complex systems and their self-regulating capacities.
We now proceed to elucidate further the properties of human self-reg-
ulation with the help of symbol systems and imagery. We shall then dis-
cuss specifically how the symbol systems can be constructed and
decoded in art therapy.
Chapter 3
IMAGES AND COGNITION
T h e psychocybernetic model is a method of cultivating, portraying,

and decoding the meaning of images in order to improve one's
functioning. Images are the central ingredients in this helping modali-
ty. This chapter explores this still mysterious phenomenon-its major
forms, its relationship to cognition, and its place in the creative process.
The power of images has been widely acclaimed throughout human
history. Images have been used in religion to strengthen convictions; in
education, to convey information; and in healing, to evoke positive
emotions that affect bodily processes (Korn &Johnson, 1983). Images
are used in propaganda to arouse certain passions, and in advertising to
stimulate certain desires and cravings. And still, images retain an
inscrutable aura. To paraphrase Churchill's comment about Russia,
images remain an enigma, wrapped in a riddle, inside a puzzle.
The very concept of image is capable of arousing strong passions in
otherwise levelheaded scientists. There are two different positions con-
cerning images. While some extol the power of images as the source of
highest forms of creativity, others dismiss the very notion. To some,
images signal something transpersonal and even sacred. Among the
strongest proponents of this position are Hindu theologians who hold
that images are the messengers from a supernatural realm. There are
several kinds of "avatras" or ways in which God reveals himself. One
way is through incarnation, as in Krishna; another is through the pres-
ence in the human heart, as in the small voice of conscience; and the
third way is through a symbol or an image ("area"). The ancient Hindu
philosophers thought that by igniting determination to do God's will,
however this will be conceived, images are capable of performing a
service to deity (Eliot, 1921).
25
During the last half century a diametrically different position regard-

ing images has prevailed in Western psychology. John B. Watson
defined psychology as a science of behavior in which there was no
place for images (Watson, 1930). Images no longer were worthy of sci-
entific study. Psychologists became increasingly skeptical about the
concept of images. However, some interest in the study of images
remained among psychoanalytically-oriented clinicians. They contin-
ued to investigate images as they appeared in clients' dreams and slips
of tongue.
Computers, cybernetics, and studies in sensory deprivation brought
about a reversal of the trend to disregard images. These and other influ-
ences have converged now to form cognitive theory in which images
occupy a distinct place as one form of cognition (Merluzzi et aI., 1981).
In addition to cognitive theory, another impetus for such study arose
within behavior modification because some of its forms necessitate
reliance on the imagery generated by clients (Wolpe, 1958). According
to Singer, this forced behaviorists to "look their own private experience
full in the face and once again welcome man's inner experience back
into the realm of science" (Singer, 1974, p. 4).
What Are Images?
Images are "thought representations that have sensory quality"

(Horowitz, 1970, p. 3). An image is a quasi-sensory and quasi-percep-
tual experience in the absence of external stimulus, irrespective of the
sensory modality in which it occurs. Thus an image may be a percep-
tion of sound, smell, color, form, movement, or taste-all in the absence
of an external stimulus. The stimulus giving rise to these sensations and
perceptions may have been present in the past, but it does not exist at
the time when the sensation or perception occurs (Gordon in Sheehan,
1972, p. 63).
The three main modalities of images are the visual, auditory, and
kinesthetic. The other modalities-the olfactory; gustatory, and tactile-
often serve to elaborate and strengthen the images in the three main
sensory modalities, especially when strong affect is involved.
The ability to form images develops as the organism matures.
According to Piaget, the image forming ability emerges in children at
about the age of 18-24 months. The child is first able to form a recog-
nition image of the primary care-taking person, usually the mother.
Images and Cognition 27
The next step of development is the formation of an internalized men-

tal image (Piaget & Inhalder, 1971).
To be alive is to make sense of one's surroundings. Even a simple
organism has to distinguish between a friend and a foe. The multitude
of factors surrounding the organism can make the difference between
life and death. A frog, for instance, has to be able to discern whether
the shadow that falls on its retina signals the presence of a predator or
the possibility of a feast. The higher an organism is on the scale of evo-
lution the greater the number of factors that require correct perception
and interpretation.
Images are our tools for making sense of our experiences. We under-
stand things by comparing the new and the unknown to something
previously encountered and explored.
The distinction between perception and cognition is difficult to
make. Traditionally, perception has been regarded as an essentially
sensory matter. Cognition, on the other hand, is thought of as a mental
process. But perception too entails discrimination and understanding.
Otherwise we are dealing only with nerve receptors.
Perception and cognition are closely interrelated yet different
processes. One distinction is that perception involves recognition of
relationships between stimuli currently present. Cognition, in contrast,
involves recognition of relationships between past and present stimuli.
Thus cognition presupposes memory. Another distinction between per-
ception and cognition is that the outcome of perception is denotative
while the outcome of cognitive processes is connotative. The denota-
tive meanings designates a certain object. For instance, a denotative
meaning of "mother" is "a female parent." A connotative meaning of
the same object might be "care, tenderness, love," etc.
Both perception and cognition are processes whereby we acquire
knowledge of the world. Both can be expressed in a propositional
form, that is, as a statement in which the predicate affirms or denies
something about the subject.
It is important to keep in mind that while perception refers to a per-
son's knowledge of things, cognition casts a wider net and refers to a
person's knowledge of the meanings of things. Perception as well as
cognition provide us with knowledge. While perceptions result in signs,
cognition creates symbols.
Although the distinction among terms like cognition, perception,
learning, memory, and attention are difficult to make, these are sepa-
rate phenomena and should be treated as such (Robinson, 1979, pp.

143-147).
Types of Imagery
There are several types of imagery. Dreams are the most widely
known form. Dreams are images that arise during sleep as the concep-
tual material is made perceptual. Dreaming has been defined as "pic-
torialized thinking" (Hall, 1953). Daydreams constitute still another
form of imagery.
Images tend to grow from single, fleeting, static images which pres-
ent only one concept, to increasingly more complex units. Fantasies are
the larger, more complex images that symbolize some event and con-
tain visual as well as other sensory modalities. A fantasy usually con-
sists of a series of mental images that have some vague continuity and
is usually rather pleasant.
Images that arise spontaneously just before falling asleep are termed
hypnogogic. Imagery that occurs just before awakening is called
hypnopomic.
Hallucinations are images that are based on internal information that
has gained some personal importance and a high degree of intensity
(Horowitz in Sheehan, 1972, p. 286). There is some evidence to suggest
that people who pay attention to their imagery and have the ability to
form images deliberately are less likely to develop hallucinations when
under extreme stress than persons who do not generally attend to their
imagery (Horowitz, 1970; Richardson, 1969; Thale et aI., 1950).
Eidetic images are another interesting kind of imagery. These are
images that are almost photographic in clarity and fidelity. They differ
from hallucinations in that the person having them usually recognizes
them as being subjective in nature. Children are more likely than
adults to have eidetic images. Few adults retain the ability to form eidet-
ic images in maturity. Most images of adults remain vague and frag-
mentary most of the time.
Imagination is the power to create mental images. This is an internal,
private level of mental activity that is not accessible to an outside
observer unless the person having this level of mental activity chooses
to make it available to the outside observer either verbally or in some
other form of expression, such as a gesture, a sound, or a visual repre-
sentation.
WilliamJames thought that images are born out of sensations. Sen-

sations, once experienced, modify the organism so that copies of the
original sensations arise again in the mind after the original outward
stimulus has disappeared. James termed imagination the "faculty to
reproduce copies of originals once felt" 0ames, 1890, II, p. 44). If these
copies are literal, the imagination may be termed "reproductive" or
memory imagery. When elements from different original experiences
are recombined into a new whole, James termed it "productive."
Another term for it is "imagination imagery." And mental pictures
formed from data freely combined, not recreating exactly any past
combination of data, are "acts of imagination properly so called"
Oames, 1890, II, p. 45). On the basis of his extensive studies in this area
Gazzaniga maintains that memory or the so-called reproductive
imagery is not simply a property of the actual visual system. It is "com-
putation." It is already a cognitive act (Gazzaniga, 1985, p. 132).
Memory images result from selective perception and selective recall.
Only the salient features of the remembered event are encoded. Con-
sequently, both memory images and imagination images are creative
products of the mind.
Preferred Sensory Modality of Imagery
An individual may have a preferred sensory modality for experi-

encing and expressing internal images. Some people depend on sight,
others on hearing in order to remember some piece of information. A
visually-minded person is inclined to transform kinesthetic and tactile
experiences into visual symbols. In contrast to the visualizers, the so-
called haptics (from the Greek word for "touch") depend primarily on
bodily sensations of touch for orientation when encountering an expe-
rience. For the haptic the main intermediary between sensation and
cognition is the body itself. While the visually inclined person casts
information in visual terms, the haptics proceed the other way around.
They tend to recast visual perceptions into touch and movement.
Lowenfeld (1952) found in his studies that some 47 percent of his sub-
jects were visually minded while some 23 percent were haptic. The
remaining 30 percent were mixed type. Studies confirm Lowenfeld's
observations, and, it is interesting to note, the visualizers and the hap-
tics differ in their preferences for art media. The visualizers tend to be
more drawn to two dimensional forms of expression such as drawing
and painting while the haptics are more inclined to use three-dimen-
sional forms like sculpting when portraying their images.
Regardless of individual preferences, by and large, the visual sense is
the primary channel of information for most people in contemporary
society. Furthermore, everyday language reflects the intimate connec-
tion between seeing and knowing. The word "idea" comes originally
from the Greek word "idein" which means "to see." Many words in
common usage link thought with vision. For instance, we talk about
insight, foresight, hindsight, and oversight to indicate several kinds of
knowledge. Many common expressions connect thinking and vision,
as the following: "SEE what I mean?", "LOOK at this from another
VIEWPOINT," "FOCUS on the details," "examine the big PIC-
TURE," "take a larger PERSPECTIVE." Often the terms "to know"
and "to see" function as synonyms and can be used interchangeably.
In summary, images are capable of denoting as well as connoting
things from which our senses originally derived the image. Images are
the spontaneous embodiments of general ideas (Langer, 1942/1951, p.
128). Recognition images appear to be the first step in the mysterious
process of transformation of sensations into perceptions. Once we can
form an image we can start making sense out of the stream of events
surrounding us.
Recognition images, once noted and labeled, serve as tools in under-
standing new events and experiences. Knowledge grows and develops
through this symbolizing ability of the mind.
What are the roots of symbol formation? The process of symboliza-
tion is essentially a matter of finding an appropriate metaphor to des-
ignate the salient similarities and differences between objects we know
and objects we wish to understand better. Metaphors are the building
blocks of abstractions, and abstractions create systems of several forms
of symbols.
Images and Metaphors
Jaynes has called attention to the fact that thought is basically a

process of finding and applying appropriate metaphors to the events or
objects we are trying to understand. A metaphor uses a term for one
thing to describe another thing because of a similarity between the two.
Metaphors increase the power of perception and understanding. To
understand something is to arrive at a metaphor for that thing by sub-
stituting something already familiar for an aspect of the unfamiliar. The
resulting feeling of familiarity is the feeling of understanding Gaynes,

1976, 49ff).
A metaphrand is the thing to be understood. The elucidator is the
metaphier. The human body is a rich source of metaphors and pro-
vides numerous metaphiers. For instance, we refer to the head of a
table, a head of a bed, a head of a household, a head of a nail; the face
of a clock, card, cliff, or the teeth of a comb, the lip of a crater, and the
lip of a pitcher. We have arms of chairs and legs of tables. Language
grows through metaphors. Metaphors create new objects. Language
itself is a "rampant restless sea of metaphor." "Abstract words are
ancient coins whose concrete images have worn away with use in the
busy give-and-take of talk." Jaynes suggests that in prehistoric times,
language and its referents "climbed up from the concrete to the abstract
on the steps of metaphors" Gaynes, 1976, p. 51).
To understand, then, is to grope for, to find, or to create an appro-
priate metaphor that represents the main features of the thing we are
trying to understand. In finding an appropriate metaphor one discerns
the salient similarities and differences between the metaphier and the
metaphrand. Metaphors, once created, eventually become firm con-
cepts, that is, specific designations for a particular class of objects.
The mind seems to be a metaphor creating agency. As we create
metaphors we try to embody them into something tangible. We are
constantly attempting to explain our vague notions by finding some
concrete designation for them. James observed that this process of
groping for knowledge entails a process of concretization. Inward
images "tend to attach themselves to something concrete" so as to gain
a certain degree of "corporeity" Games, 1890, II, p. 305). This "cor-
poreity" or concretization may be achieved through words, gestures,
chalk marks, straws, etc. "As soon as anyone of these things stands for
the idea, the idea seems to be more real." EvenJames when lecturing
used a blackboard to symbolize his ideas through lines, circles, and
squares Games, 1980, II, 305ff). Here we have the leap of an idea from
an image to a symbol. Once discerned and somehow designated, the
idea can be retrieved from the flux of experiences much more readily.
Images and Symbolization
The beginning of the process of symbolization occurs when an idea

attaches itself to something concrete. A symbol is the skirt worn by an
image so it can participate in social discourse. When the situation
demands it, we can remember and apply an image which has been
labeled or designated, either lexically or visually.
Symbol may be defined as anything that stands for or represents any-
thing else, by denoting, depicting, or exemplifying it (Goodman, 1978).
Goodman calls attention to the fact that we have a wide range of sym-
bols. Some symbols exemplify and express, while others denote. Words
are the distinctly denotative symbols. Diagrams, graphs, staff notations
in music, and some dance notations also denote. According to Good-
man's theory, symbols differ on five variables. First, to the extent to
which their meaning is "dense," that is highly condensed, and then, in
that some symbols may have several of their aspects changed and still
retain their meaning. For instance, in a Hokusai single-line drawing
every feature of shape, line, and thickness is essential. But the same
line may serve as a chart of daily stock market averages where only the
height of the line above the baseline matters. The five variables on
which symbols differ, and thus different symbol systems may be dis-
tinguished, are: syntactic density, semantic density, relative repleteness,
exemplification, and multiple and complex references (Goodman,
1978).
Only some categories of symbols are discrete, factorable, and con-
form to rules for combining their features. Other classes of symbols
consist of inseparable or unfactorable constituents. Much of the con-
temporary argument over the symbolic nature of mind is contaminat-
ed by the assumption that only the discrete or language-like objects are
properly a symbol. Contemporary congitivists have not appreciated
the fact that pictures are also symbols (Kolers, 1983, p. 146).
Nondescriptive, nonrepresentational paintings function as symbols
for features they possess either literally or metaphorically. What does
not denote may still refer to an object by exemplification or expression.
Serving as samples of some sharable form, such symbols focus atten-
tion upon features otherwise unnoticed and neglected. Certain feelings
may be highlighted by some symbols. They may induce a reorientation
of our customary world in accordance with these newly emphasized
features, "thus dividing and combining erstwhile relevant kinds, adding
and subtracting, effecting new discriminations and integrations, and
reordering priorities" (Goodman, 1978, p. 105).
There are several levels of symbols. A word is a symbol. Certain
words when used precisely, become concepts. Concepts are symbols.
So are signals and signs. Symbols are aggregates of meaning. Meaning
may be packaged in various ways, ranging from sounds to designations

for sounds, from visually perceived objects to pictures, and so on.
Every sensory modality produces a distinct class of symbols.
Goodman's suggestive variables may be utilized to sort symbols into
several categories. Brunner's distinction between the three models of
the world is another approach to differentiating between the different
kinds of symbols. Brunner describes the enactive, iconic, and symbol-
ic representations of information (Brunner, 1964). Horowitz recasts
Brunner's model by shifting the designations of the three systems
slightly to enactive, image, and lexical modes of representation
(Horowitz, 1970). Paivo (1971) goes a step further and suggests that we
can represent the world in two different but redundant coding systems:
the pictorial mental representations, also called the analogue, spacial,
or visual system, and the propositional representations, also called the
linguistic, or the language like, or the symbolic system. It is important
to note, however, that written language is both visual and verbal. As
Goodman points out, "symbolic" is not a concept that applies only to
one of these two systems of representation. It applies to both. For this
reason the terminology proposed by Susan Langer in her influential
work, Philosophy in a New Key (1942), is more appropriate for these two
coding systems. Langer differentiates between what she terms the dis-
cursive, sequential, language-like form of representation and the
nondiscursive, presentational manner of encoding meaning.
This debate has extended over many decades and is by no means
over. But it is important to keep in mind that images are also symbols
and thus are an essential part of cognition.
Ahsen's Triple Code Model of Imagery
Ahsen's Triple Code Model clarifies further the function of images.

Images do not simply copy reality, they transform it. Every image is a
compressed metaphor. A metaphor brings together two otherwise dis-
tant realities. A metaphor is not a mere analogy. It does not just com-
pare or provide a different name for the same thing. Rather, it is an
edited version of reality. Image abstracts features from the thing which
gives rise to it. An image is a "first order fiction." It is a kind of a mutant
which links sensation with cognition. An image, like a metaphor, points
beyond itself. Thus, an image provides not only sight but insight
(Ahsen, 1986).
In every image we have a somatic component, a cognitive meaning,

and a representation in one of the sensory modalities. According to
Ashen, the basic unit of psychological experience which entails
imagery is an ISM sequence. Images are neither purely mental nor
purely physical. They are both. An image contains experiential, somat-
ic, and semantic features. Ahsen's model proposes that there are always
three inseparable components in an image. One is the quasi-perceptu-
al experience in consciousness (I). The second is a psychophysiological
component, or a somatic response (S) and the third is interpretation, or
a meaning in the verbal-semantic system (M). This triple "ISM" code
is normally present for all imagery all the time. Images, in whichever
sensory modality, are never free of associated emotions and thoughts.
They are both stimulus and response. And every image is a product of
both memory and imagination.
The Concept of Systems
Ahsen's view of imagery would seem to underscore the point that,

like everything else in this world, images themselves form a kind of a
system. A system, as discussed in Chapter 2, is an organized collection
of interrelated elements characterized by a boundary and a functional
unity. The boundary may fluctuate between various degrees of perme-
ability. An image is a system and as such it functions as an entity. It con-
sists of parts which are interrelated. It is destroyed if we slice it up and
try to isolate any of its three main subsystems. The subsystems I, S, and
M may have different degrees of predominance in different types of
imagery, but they are all there all the time. The three subsystems of
imagery may appear in different order at times, e.g., there may be MIS,
MSI, etc. But whatever the order of the subsystems, an image is always
accompanied by a somatic response which may be either skeletal, pro-
prioceptive, motor-neural, sensory, and so on. And there is some
meaning or significance attached to it.
Not only are images themselves best thought of as systems, but
images invariably become part of a larger system. Images consist of
subsystems ("ISM"), and images are subsystems in larger systems. This
larger system is cognition, or as I prefer to term it, the system of codi-
fication.
In comprehending the phenomenon of imagery, the systems
approach proves to be the most appropriate model of reality. Reality
does not come neatly sorted out in layers. It is not a "layered look" but
rather an interconnected, intertwined arrangement that can be sliced
neither vertically nor horizontally. There is an "all at onceness" in real-
ity and its many components. Ahsen's Triple Code Model, although it
does not specifically refer to the systems concepts nevertheless presents
clearly the basic character of images that is compatible with the systems
idea.
The three aspects of images may be thought of as having boundaries
that have various degree of permeability. There is an exchange of infor-
mation between the three subsystems. As in any other system, we can
postulate feedback loops for each subsystem which regulate each of
them in relation to the entire system, in this case, the imagery. Imagery,
in turn, functions as a subsystem in a larger system which I term the
system of codification. The system of codification is a hypothetical con-
struct I have introduced to comprehend cognition, this still enigmatic
phenomenon that has perennially perplexed epistemologists and psy-
chologists alike.
It is first necessary to consider the two styles of thought each of
which appears to have a specific psychoneurological base and is
accompanied by specific physiological consequences.
Two Types of Cognition
The notion that we have two distinctly different styles of symboliza-

tion was well accepted among artists long before neurological sciences
provided empirical evidence concerning the differential functioning of
the two hemispheres of the brain. For instance, at the turn of the cen-
tury, Benedetto Croce, the noted Italian philosopher of aesthetics, sug-
gested that there are two forms of knowledge. One form of knowledge
is intuitive and is obtained through imagination. The other is logical,
attained through the intellect. Croce believed that imagination pre-
cedes rational thought and is indispensable to it. Thus, the artistic
image-forming activity of the mind predates its logical, concept-form-
ing activity (Croce, 1929).
Similarly, Susan Langer, a prominent disciple of Ernst Cassirer,
describes two distinct forms of mental activity or two ways of present-
ing information. One is discursive, the other is presentational. The dis-
cursive modality is employed by language. It strings out ideas
side-by-side, as clothes on a clothesline, or beads on a string. We can-
not talk in simultaneous bunches of words. But ideas, like clothing, are
actually worn one over the other. We find ideas, like clothing, crowded
one on top of the other.
Presentational symbolism operates far below the level of speech. The
mind reads this kind of symbolization in a flash. Presentational sym-
bolism consists of visual forms-lines, colors, proportion, and so on.
And this form of encoding is just as capable of conveying meaning as
are words. But according to Langer, the laws that govern this sort of
articulation are altogether different from the laws of syntax that govern
language. The most radical difference is that visual forms are not dis-
cursive. They do not present their constituents successively, but simul-
taneously. The relations determining a visual structure are grasped in
one act of vision. Consequently, unlike discourse their complexity is
not limited by what the mind can retain from the beginning of an
apperceptive act to the end of it (p. 86). The nondiscursive mode
speaks directly to the senses.
Langer thinks that language is a very poor medium for expression of
emotions. It cannot convey the ever-moving patterns, the ambiva-
lences and intricacies of inner experience, the interplay of feeling with
thoughts and impressions, memories and echoes of memories, and
transient fantasy (p. 92). For this kind of information the presentation-
al style of thought which uses visual forms or auditory sounds, is more
effective.
Image-making is a form of thinking in the nondiscursive modality.
According to Langer, "Images are our readiest instruments for abstract-
ing concepts from the tumbling stream of actual impressions. They are
our spontaneous embodiments of general ideas" (Langer, p. 128).
Mozart's description of his manner of composing exemplifies
Langer's nondiscursive modality. Mozart said that first bits and crumbs
of the piece he was working on appeared and gradually joined togeth-
er in his mind. "Then, the soul getting warmed to the work, the thing
grows more and more, and I spread it out broader and clearer, and at
last it gets almost finished in my head, even when it is a long piece, so
that I can see the whole of it at a single glance in my mind, as if it were
a beautiful painting or a handsome human being ..." (quoted by
James, 1890, I, 255). Note that even Mozart, whose auditory sense was
undoubtedly of paramount importance, still resorts to visual metaphors
when trying to explain his thought processes. Here again we have the
intimate connection between thought and the visual sensory modality.
Mozart goes on to describe yet another feature of the nondiscursive

process of symbolization-its simultaneity: "... I do not hear it in my
imagination at all as a succession the way it must come later but all at
once, as it were. It is a rare feast! All the inventing and making goes on
in me as in a beautiful strong dream. But the best of all is the hearing
of it all at once" (inJames, 1890, I, 255).
Creative people generally are those who are able to utilize both sys-
tems of symbolization, discursive and nondiscursive. In his famous let-
ter to Jaques Hadaman, Albert Einstein highlighted the importance of
the presentational or the nondiscursive style of symbolization in his
thought. He stated that neither written nor spoken language played a
role in his thought processes. For him the entities which seemed to
serve as elements of thought were certain signs and more or less clear
images which he could deliberately reproduce and combine. He
described these elements of his thought as being visual and at times
muscular. He would seek for words only in a later stage of thought and
finding the appropriate words was a laborious process, coming only
after "the associative play" was sufficiently established and could be
reproduced at will (Einstein in Hadaman, 1954).
Each style of thought has its advantages and drawbacks. When we
give the image a name or another type of designation, we have a sym-
bol. Now instead of dealing with things directly we can deal with their
stand-ins, their symbols, and thus save time and energy. But the sym-
bol may not contain the entire meaning of the original entity. This is a
drawback associated with the discursive style of thought. In most
instances it is clear and precise, but it is removed from the source of the
original idea. On the other hand, one of the complications with pre-
sentational symbols is that they may condense the meaning to an
extreme extent. It has been estimated, for instance, that in two seconds
we can dream the equivalent of 2,000 words (Osborn, 1953).
Hemispheric Differences
The two styles of cognition just described have a neurophysiological

basis. Since the epoch making work of Roger Sperry which earned him
the Nobel Prize in 1981 it has been generally acknowledged that the
two hemispheres of the brain are differentially engaged in the process
of handling information. The left cerebral hemisphere which in right-
handed individuals controls the right side of the body is more active
when the person is engaged in intellectual, analytical, verbal, and

sequential styles of thinking. The right hemisphere which in right-hand-
ed persons governs the muscles of the left side of the body, is more
active when the person is engaged in intuition and holistic, Gestalt-type
activities, in spacial thought, fantasy, imagery, and daydreaming.
When we speak, write, calculate, reason, classify, and name, the left
hemisphere of the brain is more active than the right one. When we
sing, draw, enjoy colors, listen to music, daydream, or engage in sports
that require awareness of space and movement, we activate predomi-
nately the right side of the brain.
In one study, six-month-old babies were held in their mothers' laps
and had electrodes attached directly over the area of the left hemi-
sphere of the brain which is thought to control speech. Electrodes were
also attached over the corresponding area of the right cerebral hemi-
sphere. When a tape recording of speech was played, the left hemi-
sphere showed greatest activity. When a tape of music was played or
when someone sang, the activity of the brain was greatest over the right
hemisphere. It is possible that lullabies stimulate child's later develop-
a
ment of functions lodged in the right cerebral hemisphere ayne, 1976,
p. 367). Individuals with well developed right cerebral hemispheres
may be more inclined to function with the presentational symbols than
people whose right hemispheres have received less stimulation. Also it
may be noted that there are differences between males and females in
this respect. The distinction between the two cerebral hemispheres are
somewhat less pronounced in women than in men. Psychological func-
tions in females are not as sharply localized into one or the other hemi-
sphere of the brain as they are for males but appear to be spread over
both hemispheres. In females the language functions are also per-
formed to some extent by the right hemisphere. Consequently, the
same extent of brain damage in the left hemisphere due to stroke, for
instance, leaves women less incapacitated than men.
The two cerebral hemispheres are richly interconnected through the
corpus collosum. Many of the sensory systems send signals to both
hemispheres. All thought is both analytical and synthetic. When enjoy-
ing the musical rhythms we engage the experiential, synthetic, analog-
ical processes. But as soon as a rhythm is noticed as a repetition of
another previously heard passage, or as a subtle transformation of a
rhythm heard earlier, we activate a different set of brain cells which
process information analytically and sequentially. We can fluctuate
HEMISPHERIC DIFFERENCES
RIGHT HEMISPHERE LEFT HEMISPHERE

(The "romantic" side) (The "logical" side)
Dominates the left side Dominates the right side

of the body and of the body and
more active in: more active in:
holistic thinking; intellectual,

intuition, analytical tasks;
imagination sequential, focal,
metaphoric thinking, verbal, rational,
synthesiz ing logical thinking;
recognition of faces, speech, grammar,
perception of gestalts, naming;
shapes, sizes, colors, math;
textures, forms; music (trained).
dreaming
ESP, The logician,
mediation, accountant,
music (untrained), linguist.
drawing,
depth perception, Digital codification
complex visual patterns. of information:
one aspect at a time
The artists,
inventor,
innovator.
Analogic codification:
a multitude of ideas
condensed in an image;
all at once; patterns;
wholes.
Figure 3-1. Hemispheric Differences.
with reasonable ease between the two styles of information processing.

This flexibility permits us to understand and be creative (Norman,
1977).
It is well to keep in mind that the hemispheric asymmetry is a mat-
ter of predominance rather than a matter of exclusion. Everyone is
capable of both styles of thought (Ahsen, 1981) although our Western
civilization has given preference to the styles of reasoning associated
with the left hemispheric activity. This one-sidedness is minimized
when the psychocybernetic model of psychotherapy is utilized. The
advantage of this modality of intervention is that it demonstrates ways
of engaging both styles of thought and thus promotes greater creativi-
ty and better problem solving ability than when only a portion of one's
cerebral equipment is activated.
Images are not inert. Images both consume and produce energy. No
longer can we dismiss imagery as an epiphenomenon that merely
accompanies but does not influence behavior. Images are not like shad-
ows that simply tag along but do not influence what happens to the
pedestrian. Empirical evidence is accumulating to support the con-
tention that specific physiological changes occur in the organism when
we engage in different kinds of imagery. Happy images produce dif-
ferent physiological changes than sad images. A wide range of meas-
ures have been used to study these physiological concomitants of
imagery and a substantial body of evidence has been reported to indi-
cate that different patterns of physiological responses accompany dif-
ferent types of affective images (Qualls, 1982-83, p. 92). Images of fear
and anger, for instance, are associated with increased heart rate and
systolic blood pressure. As indicated in Chapter 2, the fact that imagery
is accompanied by various physiological changes is now put to work in
health care through a number of biofeedback devices.
Defusing the potentially noxious imagery a person may be harboring
is also one of the functions of the psychocybernetic model of interven-
tion. The psychocybernetic model is a method to attain a cerebral
ambidexterity whereby a person can utilize both methods of informa-
tion processing, the discursive as well as the presentational styles.
The Process of Codification
Nothing has been more thought about than thought itself, and still
nothing is understood more poorly than this mysterious human attrib-
ute. For many decades psychologists tried to circumvent its awesome
complexity by following in Watson's footsteps and leaving the process
of thought largely out of their calculations. What transpired in the
human mind was simply the "black box" which was taken for granted
but not subjected to further scrutiny.
Psychologists made a Ll-tum when the cognitive theory started tak-
ing shape, spurred by the work of Piaget and others. Problems previ-
ously left up to epistemologists and other philosophers are now
beginning to receive attention.
Instead of talking about "thought" and "thinking" contemporary psy-
chologists prefer to use the term "cognition." The definition of this very
term, however, is still controversial. To some it designates "all the
processes by which sensory input is transformed, reduced, elaborated,
stored, recovered, and used" (Neisser, 1967). Other cognitive theorists
consider this definition to be much too broad and loose. This group of
theoreticians prefer to confine the concept of cognition to the study of
the organization of perceptual data according to fixed principles. They

search for the underlying logic and rules of perception and learning.
Robinson, for instance, defines cognition as the study of the possession
and application of valid rules of deduction and inference in a manner
appropriate to a given problem (Robinson, 1979).
Cognition may be better understood if we think of it as being essen-
tially a process of classification. Once we have found a metaphor or a
designation of some kind for a thing, we have categorized it. To cate-
gorize is to render discriminably different things equivalent. To cate-
gorize is to group objects and events into classes to which we can
respond more readily and more easily than when we have to discern
and find an appropriate response to each item on the basis of its indi-
vidual characteristics. Once the object is placed in a category, we can
respond to it in terms of its class membership.
The term "categorization" and "classification" have an aura of intel-
lectualization about them and both have a tinge of the so-called "left
brain" processes. Actually, when we attempt to classify or categorize an
object, both the left and the right hemispheric styles of symbol forma-
tion are activated. Therefore, to avoid misunderstanding, it appears to
be more expedient to introduce a new term to designate this process. I
have chosen to term this the process of codification to acknowledge the
contributions of both cerebral hemispheres and their attendant thought
processes to cognition, instead of using the concepts of classification or
categorization.
The process of codification designates those aspects of psychological
functioning whereby objects, both physical and social, are appraised
and responded to. This process is hypothesized to consist of sub-
processes of perception, evaluation, and classification as an individual
assesses one's present and past experiences. Codification combines
both the intellectual and the affective aspects of psychological func-
tioning, and it is accompanied by action tendencies. To codify is to
note, classify, evaluate, both intellectually and affectively, similarities
and differences between objects. The more readily a situation or a con-
stellation of factors is recognized as having aspects similar to a constel-
lation of factors known and dealt with previously, the more readily and
effectively it can be responded to (Nucho, 1966).
Distinguishing similarities between objects is functional in that it
facilitates the ordering of objects so that appropriate behavior patterns
may be instituted with minimal expenditure of time and energy.
A concept akin to codification is Kelly's definition of a construct

(Kelly, 1955/1963). To construe means to place an interpretation upon
what is construed. When a person forms a construct, "a structure is
erected within which the substance takes shape or assumes meaning."
The substance does not produce the structure; the person does (p. 50).
Kelly's term "construct" combines the features of a concept with that of
a percept. A construct is a personal act that involves forming an
abstraction (Kelly, 1955/1963, p. 69f).Just as countless previous gener-
ations of thinkers, Kelly wrestled with the mystery of how and by what
process a perception becomes a cognition, or if a perception already
implies a concept. The term "construct" tried to chart a middle course
between these two notions.
To construe or, as I prefer to call it, to codify an object is to assign it
to a category in order to know what meaning it has for us, what value,
what it portends for us. It is not just an intellectual process but a matter
that entails our entire being.
Once formed, the system of codification requires validation, that is,
synchronization with the systems of codification devised by other peo-
ple in our network of relationships.
It also requires constant updating and revising as additional infor-
mation becomes available to us. When we encounter new objects or
the same objects under different circumstances, we acquire new data
which dictates that our system of codification be either modified or
enlarged. As we encounter new objects and discover new aspects of
objects already codified, we have to recodify them and reclassify them,
using all our sensory modalities.
The process of updating one's system of codification may be thought
of in terms of assimilation and accommodation, the two terms pro-
posed by Piaget (1962). Assimilation fits an object into the categories or
"schemes" already devised in one's system of codification. Accommo-
dation, on the other hand, reshapes, revises, expands, or contracts
one's categories.
The process of codification is much like eating an ice cream cone.
There are two possibilities for the fit between the cone and the scoop
of ice cream resting in it. It is either perfect, in which case there is no
problem, or it is faulty-too small for the given amount of ice cream,
whereupon the ice cream flows over the sides. A larger cone would
solve this difficulty. This situation requires what Piaget termed "accom-
modation." Accommodation is the process of revising the "container"
in one's system of codification. The slots or categories of one's system

of codification are expanded. Another set of circumstances might
prompt the creation of a series of new "containers."
The process of assimilation is the process of absorbing the incoming
information into the already created "containers," "schemas," or cate-
gories. In other words, the amount of ice cream is appropriate for the
size of the cone.
In the real world, however, a perfect fit between the incoming infor-
mation and the system of codification, is rare. As we grow and change
we encounter new conditions, new objects, new relationships. The fit
between the influx of data and the system of codification we have
devised does not remain perfect for long. The expansion and retrac-
tion, the revision and the updating of one's system of codification is a
never-ending task.
It is interesting to note thatJames viewed the mind much like this
process of codification. He said that the mind is like a sort of a sieve.
We devise conceptual schemes in which we try to gather up the world's
contents. Most facts and relations fall through its meshes, being either
too subtle or too insignificant. "But whenever a physical reality is
caught and identified as the same with something already conceived, it
remains on the sieve, and all the predicates and relations of the con-
ception with which it is identified becomes its predicates and relations
too" Games, 1890,1,482).
Information arrives constantly from two sources, from the outside
world, and from within the organism itself. Information arriving from
the external world is received by the so-called exteroceptors, or the
sensory organs. The information that comes from the states and condi-
tions of our own organism is received by the so-called interoceptors.
For instance, you may register the fact that you feel hungry, and signals
are sent to the leg muscles to take you to the refrigerator. Most signals
of this kind, fortunately, are taken care of without conscious delibera-
tions.
The subconscious is the subsystem in the process of codification that
refers to all those psychological functions that are not directly available
to conscious inspection during one's customary waking states. This sub-
system nevertheless does influence one's behavior and experiences.
Freud called this the Unconscious.
We do not respond to all information surrounding us. We are aware
of some information while other types of information are seemingly
overlooked. There appears to be an automatic process of selection, as

if there were some kind of filter at work. Freud's term for this filtering
process was the "censor."
Some of the incoming data receive top priority while other informa-
tion remains ignored. The information that has some relevance to our
survival or to the sense of self tends to receive immediate attention. Fre-
quently, as we have all experienced, other words remain unintelligible
while the very mention of one's name is heard over the din of conver-
sation in a crowded room.
Memory is another component that shapes the process of codifica-
tion. The incoming information is either diluted or enriched by the
information already in the system. We appear to have a short-term
memory and a long-term memory. Information stored in the short-term
memory disappears into the subconscious quickly unless attention is
deliberately directed to this data and thus it is transferred to the long-
term memory. Information in the long-term memory remains available
after long periods of time.
Our general sense of space/time affects how we codify an experi-
ence. This component of the system of codification refers to our sense
of the flow of time and the structuring of space. It is a combination of
our cultural heritage, learning, and internal biological rhythms.
The amount of incoming information is immense. Information that
is not immediately relevant to our concerns and preoccupations is rel-
egated to the storage termed "subconscious." Information that is
repetitive may also end up in the subconscious portions of the system
as we habituate to this information and no longer pay conscious atten-
tion to it.
The categories in which the information is stored are our symbols.
The very term describes well this aspect of the process of codification.
The word "symbol" comes from the Greek word "syn" meaning
"together" and "bolein" which means "to throw." To symbolize is to
throw together, as it were, or to group together, information that is per-
ceived as having some common features and therefore as belonging
together in one category.
To encode information is to symbolize it. Two kinds of symbols are
possible for this process of encoding, as we indicated earlier in this
chapter. The one form of encoding or symbolization is what Langer
termed the discursive symbols. These are the linear, logical, rational,
verbal symbols which appear to engage predominately the left cerebral
hemisphere. The other type of symbols are the presentational or the

nondiscursive kind. Here the information is presented visually, audito-
rilly, kinesthetically, or in any other sensory modality rather than lexi-
cally. While the discursive symbols handle the information analytically,
the presentational symbols present the information synthetically and
holistically. When processing the information discursively the mind
functions as a spotlight. When using the presentational symbols, the
mind functions as a floodlight.
The process of encoding which engages predominately the left cere-
bral hemisphere results in words. The process of encoding based large-
lyon the right hemispheric functioning produces images. These images
are portrayed visually when the psychocybernetic model of psy-
chotherapy is used. This model combines and utilizes both forms of
encoding, the discursive lexical as well as the presentational or pictori-
al forms of encoding of information.
Western civilization has largely ignored or devalued the presenta-
tional forms of symbolization. Sufficient amount of empirical evidence
has accumulated in recent years to underscore the importance of
imagery. There are at least three profound reasons to pay attention to
one's imagery. For one, as we have found, images are the building
blocks, the ingredients of thought. They form an indispensable part of
our cognitive equipment. Two, images have psychophysiological con-
sequences. As discussed earlier, images trigger biochemical changes in
the organism, for better or for worse. And three, images prompt action.
What we imagine affects how we act.
The psychocybernetic model of helping is the method by which one
pays attention-effectively and constructively-to one's imagery.
A diagram in Figure 3-2 shows the components of the system of cod-
ification. This diagram includes several ideas suggested by Tart (1977).
It is important to note that each component of the system of codifi-
cation affects and is affected by every other component of the system.
The multiple feedback loops are indicated in the diagram by the arrows
interconnecting the various components of the system.
Systems and Cognition
The process of codification functions as a system. As in any system,

the various components that constitute this system may be thought of
as having boundaries which may be more or less permeable, depend-
< <
Feedback via external world
MOTOR
EFFECTOR
SYSTEM
=t>
.
Feedback via the body

( (
Figure 3-2. The Process of Codification.
ing on the particular information that is being dealt with and the con-
ditions under which it is handled. The sense of self, for instance, is
always there but it may be less involved when processing some objec-
tive data than when dealing with some aspect of a personal relation-
ship.
Until quite recently, psychologists have tried to understand the func-
tioning of the mind by examining discrete parts of the system. The
advantage of the concept of codification is that it emphasizes the sys-
tems characteristics of cognition. The interrelatedness and the multidi-
rectionality of the process has to be kept in sight if we want to do justice
to this miraculous ability to think and acquire knowledge. It is a mis-
take to isolate and study separately the components that constitute cog-
nition. Before the systems approach became known in behavioral
sciences, the experimental paradigm prompted the examination of
each component of the process separately. But this was like trying to
learn about the nature of an elephant by making a detailed examina-
tion of one of its toes, to use the apt metaphor coined by Marks (1986).
Although the systems approach is relatively recent in behavioral sci-
ences, the notion of a systems approach was already foreshadowed,
sensed, and obliquely formulated by great minds before the turn of the
century. James, for instance, criticized the tendency of his contempo-
raries to isolate discrete phenomena instead of studying their inevitable
interconnectedness. He said that psychologists tend to study phenom-
ena as if to say that a river consists of nothing but "pailsfull, spoonful,

quart-pots full, barrelful, and other molded forms of water. Even were
the pails and the pots all actually standing in the stream, still between
them the free water would continue to flow." He went on to say that
"every definite image in the mind is steeped and dyed in the free water
that flows around it. With it goes the sense of its relations, near and
remote, the dying echo of whence it came to us, and the dawning sense
of whither it is to lead."James then highlighted the function and impor-
tance of images in cognition by pointing out that the significance and
the value of the image is "all in this halo or penumbra that surrounds
and escorts it,-or rather that is fused into one with it and has become
bone of its bone and flesh of its flesh" Games, 1890, I, 255).
This is what can be accomplished best with the methods that consti-
tute the psychocybernetic model of psychotherapy. By examining the
images of things already experienced we create new images of "that
thing newly taken and freshly understood," to useJames's phraseology.
James appreciated the power of images long before images became
fashionable in contemporary cognitive theory.
Conclusion
The problem of cognition has daunted humanity since before the

dawn of history. Life itself may be thought of as a process of acquiring,
sorting, storing, retrieving, and applying appropriate information. How
we think and what facilitates thought are questions that take us to the
very heart of epistemology. As Titchener put it, asking how thought
arises is to "discover a hornet's nest: the first touch brings out a whole
swarm of insistent problems." It is necessary to raise these questions
because images are a form of cognition, and a central component of the
psychocybernetic model. Codification clarifies this mysterious process
of how information is acquired and how sensory impressions are trans-
formed into thought and symbols. Many great minds have grappled
with this mystery. Some philosophers held that the phenomena of men-
tal life, such as feelings, desires, cognitions, reasoning, and decision-
making powers, are manifestations of the "soul." These faculties were
the "absolute properties of the soul" which were not capable of being
further elucidated. The associationists like Hume, Mill, Herbart, and
others "described the dance of ideas," and the "weaving of an endless
carpet of ideas," but "whence do ideas get their fantastic laws of cling-
ing" still remained a mystery 0ames, 1890, I, 11).
This much is certain: images are an essential ingredient of cognition.
Cognition is a matter of encoding information in the presentational
and/or the discursive modality of symbolization. Images arise sponta-
neously in the mind, especially when strong emotions are experienced,
and images can be created deliberately. What to do with the sponta-
neously arising images and how to stimulate the creation of images so
that profound personal experiences may be sorted out and dealt with,
is detailed by the psychocybernetic model described in subsequent
chapters.
Images are not just byproducts or epiphenomena that can be safely
ignored. They are powerful cognitive tools. This long neglected form of
symbolization has relevance for one's life and for its redirection. When
we are at an impasse in life and have to reorient ourselves, we reach out
to friends or we seek psychotherapy. In psychotherapy we reexamine
our basic assumptions, that is, our system of codification. We search for
ways of updating the categories we normally apply. Images help us to
remodel our systems of codification. Images permit us to deal with
ideas while they are still pliable. With the help of images we can
reshape our thoughts before they become set and ossified. When we
pay attention to our images we can do a more thorough job of remod-
eling our manner of viewing and encoding events than when we deal
only with the verbal level of symbolization.
To paraphrase Pascal, words and images when arranged differently
have a different meaning. And meanings differently arranged have dif-
ferent effects on us. Once we understand events differently, we can
react to them differently, and they will have different consequences in
our lives. This is what the psychocybernetic model of psychotherapy is
all about. It is a process of rethinking and recodifying our assumptions
and conclusions with the help of both symbol systems. It helps us to
function as cognitive amphibians, so that we can use both symbol sys-
tems, the discursive as well as the nondiscursive, and in this manner we
activate more than the customary amount of brain cells. We become
more creative and more capable of solving the dilemmas life confronts
us with. How to use both the discursive-verbal and the pictorial-pre-
sentational systems of codification are the topics of chapters that follow.
Chapter 4
THE MERGING OF ART AND

THERAPY
his chapter traces the origins of some of the precursors of the psy-
T chocybernetic model. The psychocybernetic model of psychother-
apy is a combination of the verbal-rational-analytic thought processes
with the holistic-intuitive-presentational modalities of cognition. These
two styles of cognition remained far apart in the major forms of inter-
personal helping until rather recently when finally the "ostracized"
concept of images returned from the exile to which the early behav-
iorists had banished it, as Holt described it in his much celebrated arti-
cle (Holt, 1964). In the last decade imagery is increasingly being used
in stress management (Lazarus, 1984), in health care (Achterberg &
Lawlis, 1980; Ahsen, 1977; Korn &Johnson, 1983; Simontons, 1978),
and several forms of expressive therapies are flourishing (Chaiklin,
1975; Lerner, 1978; Tyson, 1981).
The expressive therapies cultivate and apply the nondiscursive-pre-
sentational forms of cognition. Of all the types of expressive therapies
the one of special relevance for the psychocybernetic model is art ther-
apy. The incorporation of the visual arts in interpersonal forms of help-
ing has been slow and tenuous. This chapter explores the gradual
process of harnessing the power of visual expression for interpersonal
helping. It details some of the major currents of ideas that eventually
coalesced to form the discipline of art therapy. It notes the contribu-
tions of the main architects of this modality of helping, and marks sev-
eral milestones in the history of art therapy chiefly as it evolved in the
United States.
49
"Go, Paint, It Is Good for Your Soul!"
The beginnings of most things are shrouded in mystery, and in this

respect art therapy is no exception. Art is, of course, as old as mankind.
Through the centuries the power of art to soothe the human spirit has
not gone unnoticed. In fact, quite a few of the leading professional
artists became artists for their own "therapeutic" reasons. For instance,
Utrillo, just nineteen and recovering from alcoholism, was urged by
his mother to take up painting. Similarly, Matisse, recuperating from an
illness, was advised to take up painting. Three years later, he gave up
studying the law and, encouraged by a friends, enrolled in an art acad-
emy in Paris. Eventually, he became one of the foremost painters of his
time.
Goethe, the German poet and dramatist (1749-1832), author of Faust,
took painting and drawing lessons when he was seventeen and recu-
perating from a hemorrhage. Although Goethe did not become a pro-
fessional painter, he wrote important works on aesthetics and on the
study of color (Goethe, 1810).
There developed also a long line of so-called "Sunday painters" who
enjoyed the benefits of visual expression. These amateurs were fre-
quently scorned by the professional artists who regarded them as dilet-
tantes and dabblers in the mysteries of the arts. Nevertheless, some of
these Sunday painters were persistent enough to derive considerable
enjoyment as well as health benefits from their avocation. Some of
them managed to experience not only therapeutic effects from their
painting but developed technical skill to an almost professional degree.
Winston Churchill was a Sunday painter. After he lost his position at
the Admiralty in 1915, and had to change from intensive executive
activities to largely perfunctory duties of a counselor, his self-esteem,
understandably, was quite bruised. "Like a sea-beast fished up from
the depths, or a diver too suddenly hoisted, my veins threatened to
burst from the fall in pressure," he wrote in his book, Amid These Storms
(1932). Churchill went on to describe how he suddenly had long hours
of utterly unwanted leisure in which to contemplate the frightful
unfolding of the First World War. "At a moment when every fibre of my
being was inflamed to action, I was forced to remain a spectator of the
tragedy, placed cruelly in a front seat." He said that it was then "that the
Muse of Painting" came to his rescue. Two years later, Churchill
entered some of his works in an amateur art exhibit, and one won the
TheMerging ofArt and Therapy 51
first prize. The works were of such high quality that the judges, includ-
ing Lord Kenneth Clark, suspected that they were actually done by a
professional painter, not a hobbyist. Later, during the Second World
War, when world events again reached a fever pitch, Prime Minister
Churchill was able to use painting to relax and as a means to restore his
energies.
It is well known that President Eisenhower also enjoyed the soothing
and healing powers of art. He also attained an almost professional level
of proficiency in painting. Both he and Churchill are examples of what
may be termed "art as therapy" branch of art therapy.
Thus the notion of art as a healing power was well established in
Western culture long before anyone had actually heard of art therapy
as a discipline. The admonition, "Go, paint, it is good for your soul!"
surfaced long before there was any inkling that art and therapy would
eventually merge into a distinct modality of helping.
The Ancient Greeks
The idea that art is good for you goes back at least to the ancient
Greeks. Plato articulated this conviction clearly in his Republic and
other works. In Plato's ideal state, the first ten years of life would be
devoted to sports in order to develop a strong and healthy body. The
Greeks believed that if the body is sound, the soul will be also. Athlet-
ics and gymnastics should produce strength and courage, but these two
qualities had to be supplemented by still a third quality, gentleness, in
order to make the soul graceful and just. This, Plato reasoned, would be
accomplished through exposure to music, because music teaches har-
mony and rhythm. He thought that rhythm and harmony would find
their way into the innermost parts of the soul and make the person fair
and just in dealings with others. In Plato's ideal state, therefore, the
child between the ages of 10 and 16 would study music. But just as
exposure to athletics alone was undesirable, too much exposure to
music was thought to be dangerous. According to Plato, to be merely
an athlete was to be nearly a savage. To be merely a musician was to be
melted and softened beyond what is good (Republic, 410).
Rhythm and harmony are not confined to music alone but are the
properties of all the arts. What Plato said about music therefore can be
applied to the other forms of art as well. In fact, at Pergamon, the bril-
liant center of Hellenistic culture (c. 200 B.C.), the great gymnasium
contained not only tracks, fields, and baths but also a small theatre for
practicing oratory, and a studio for painting and sculpting (Muller,
1958).
The power of art to persuade and soothe by conveying certain kinds
of information explains the fact that the arts have been closely con-
nected with religion throughout the history of mankind (Gombrich,
1972). The ability of art to transmit information may also account for
the fact that many religions have found it necessary to warn their fol-
lowers against false gods and the making of idols. Occasionally, when
the messages conveyed by works of art were thought to be contrary to
the teachings of the main segments of a given society, we find periods
when iconoclasts and image-smashers were rampant.
The qualities of balance, harmony, and rhythm are central to the
power of art to heal and ennoble those who are exposed to it. To be an
artist is to embody these much desired qualities. Dante, the medieval
poet (1265-1321) declared, "Who paints a figure, if he can not be it, he
can not draw it" (cited in Schachtel, 1959). The artist must become still,
receptive, and a perfect echo of that which he endeavors to portray. By
doing so he is transformed. Therefore, many European psychiatrists
knowing these traditions, were interested in promoting and collecting
the efforts at painting by mental patients. Among these psychiatrists,
Prinzhorn (1922) was the best known. Prinzhorn collected some 5000
samples from psychiatric institutions in Europe, dating from 1890 to
1920. He also devised a system of classification of the works by the
mentally ill, and he compared these works to works of children and to
folk art.
The idea about the beneficial powers of art was further promoted in
the more recent periods of history by progressive education and its ide-
ological undercurrents most of which can be traced back to the French
philosopher Jean Jacques Rousseau (1712-1778). Rousseau held that
man is good by nature but corrupted by civilization. Inasmuch as man
is basically good, Rousseau thought that spontaneity and self-expres-
sion should be encouraged. Rousseau's ideas deeply influenced the
thinking of many of Europe's great minds, among them Kant, Goethe,
and Tolstoy. Whether specifically acknowledged or not, the ideas of
Rousseau permeated the intellectual climate of the Western world and
shaped the thinking of those people whose work eventually led to the
formation of the phenomenon now known as art therapy. Among these
thinkers the most prominent is CarlJung (1875-1961) who, although he
did not use the term "art therapy," can be regarded as the father of this
branch of healing.
Jung and the Method of Active Imagination
Even though the beneficial powers of art were well recognized, art
and therapy proceeded to develop on separate tracks over the centuries
until they merged, finally, in the work of Carl Jung. Jung, the Swiss
psychiatrist and psychologist, was an admirer and collaborator of Freud
for many years. When the International Psychoanalytic Association
was founded in 1910,Jung became its first president and held the posi-
tion for four years. Freud referred to Jung as his "successor and crown
prince." Gradually, however, a rift developed in their relationship.
Jung was deeply interested in mysticism, primitive religions, rituals,
and the oriental philosophies for which Freud had no taste or under-
standing whatsoever. To Jung, on the other hand, Freud was entirely
too materialistic and ignorant of huge chunks of human history. When
in 1909, he asked Freud's views -on precognition and parapsychology
in general, Freud's answer seemed to Jung "so shallow a positivism"
thatJung had difficulty in checking the sharp retort he had on the tip
of his tongue Oung, 1961, p. 155).
The two disagreed about Freud's theories of libido. Freud used the
term in the narrower biological sense while to Jung libido meant a life
force, not simply the sexual energies. For instance, in one of his works,
Contributions to Analytical Psychology (1928), Jung commented that we
ought to be able to recognize and to admit that "much in the psyche
really depends on sex, at times even everything." Then he went on to
say that at other times, however, little depends on sex, and nearly
everything comes "under the factor of self-preservation, or the power-
instinct, as Adler calls it." He concluded, "At times sex is dominant, at
other times self-assertion or some other instinct. When sex prevails,
everything becomes sexualized, everything then either expresses or
serves the sexual purpose" Oung, 1928).
By 1913 the rift between Freud and Jung finally became so pro-
nounced that their personal correspondence ended. The same year
Jung decided to resign as the lecturer at the University of Zurich, a
position he had held for eight years. He thought now that it would be
intellectually dishonest to go on teaching young students when his own
"intellectual situation was nothing but a mass of doubts" Oung, 1961, p.
193). He was 38 years old and immersed in the study of mysticism and
the unconscious but, as he put it, as yet he "could neither understand it
nor give it form." The year before, he had completed and published his
book, The Psychology of the Unconscious, but it was not well received in
academic circles.Jung said that he was "utterly incapable of reading a
scientific book at this time." This state lasted for the next three years
Oung, 1961, p. 193).
It would appear thatJung was undergoing what we would now term
a severe "midlife crisis." But out of this suffering and crisis Jung gradu-
ally forged what we now call art therapy.
From early childhood,Jung had been attracted to "beautiful things."
He described his fascination with an old painting that hung in the par-
lor of his childhood home. At the age of six, an aunt took him to a
museum. He found the Greek statues fascinating, and lingered well
past closing time, unable to tear himself away. He felt "utterly over-
whelmed," having never before seen anything so beautiful. He stood
there, wide-eyed, unable to stop looking at the statues. As his aunt
pulled him towards the exit, he trailed a step behind her, still trying to
catch a last glimpse of the wonderful statues. His aunt was indignant,
and shouted, "Disgusting boy, shut your eyes; disgusting boy, shut your
eyes!" Only then didJung realize that the figures were naked and wore
fig leaves. "I had not noticed it at all before. Such was my first
encounter with the fine arts. My aunt was simmering with indignation,
as though she had been dragged through a pornographic institute"
Oung, 1961, p. 16).
Jung's fascination with the fine arts persisted. Occasionally he did
some water colors. They must have been of high quality because one
of his friends urged him to become a professional artist. During this
period, near the end of the First World War, Jung began to emerge
from his "darkness," as he put it. He credited two events with bringing
about his recovery. First, he made a decision to discontinue a relation-
ship with the woman who was trying to convince him that his fantasies
had artistic value. He also began to understand the meaning of the
mandalas he was drawing Oung, 1961, p. 195).
In 1918-1919,Jung was the commandant of a prisoners of war camp
in the French-speaking part of Switzerland. Every morning he sketched
in a notebook a small circular drawing, a mandala, which seemed to
correspond to his "inner situation at the time" Oung, 1961, p. 195).
With the help of these drawings,Jung said, he could observe his psy-
chic transformation from day to day. "In them I saw the self-that is, my
whole being-actively at work." He went on to say that at first he only
dimly understood his drawings. Nevertheless he guarded them "like
precious pearls. I had the distinct feeling that they were something cen-
tral, and in time I acquired through them a living conception of the
self" (p. 196). He noted that "When I began drawing the mandalas I
saw that everything, all the paths I had been following, all the steps I
had taken, were leading back to a single point-namely to the mid-
point" (p. 196). Jung regarded mandalas as cryptograms which desig-
nated the state of one's mind. He understood the circular path towards
development of the personality, and he thought that he had received
confirmation of his theories which for so long had been puzzling even
to him.
It took ten years before Jung wrote about his experiences with the
mandala drawings. By then he was firmly convinced that mandalas
were symbols of wholeness which arose spontaneously in the mind as
representations of the struggle and reconciliation of opposites Oung,
1961, p. 335).
In 1928, while working with a patient from the United States,Jung
finally arrived at a point where art and therapy merged harmoniously
for him in what we now regard as art therapy. The patient, to whom
Jung refers as Miss X, had visited Denmark, her mother's native coun-
try. While there, unexpectedly she had the desire to paint some land-
scape motifs. She had not noticed such aesthetic inclinations in herself
before, and she had no ability to paint or draw. Nevertheless she tried
her hand at water colors, and her modest landscapes filled her with a
strange sense of contentment. Somehow the painting seemed to fill her
with new life. After arriving in Zurich, she continued her efforts at
painting. When she related these experiences and feelings to Jung, he
naturally encouraged her to continue to paint. Jung thought that Miss
X had discovered all by herself the "method of active imagination."
Active imagination is Jung's term for what we now call art therapy
Oung, 1972, p. 6).
Miss X persisted but found painting excruciatingly difficult. Jung
wrote, "As usually happens with beginners and people with no skill of
hand, the drawing of the picture cost her considerable difficulty. In
such cases it is very easy for the unconscious to slip its subliminal
images into the painting" (p. 8).Jung counseled Miss X to be "content
with what is possible and to use her fantasy for the purposes of cir-
cumventing technical difficulties." The object of this advice,Jung com-

ments, "was to introduce as much fantasy as possible into the picture,
for in that way the unconscious has the best chance of revealing its con-
tents" (p. 10). He also advised her to use vivid colors, thinking that col-
ors would attract those ideas which were as yet not fully conscious.
Miss X was the first in a long line of patients and students who used
the method of active imagination while in therapy withJung.Jung also
held seminars especially for English-speaking students, and eventually
established a training institute in Zurich to teach his theories and meth-
ods to therapists from allover the world.
Although Jung's technique of active imagination was only one
among his many seminal ideas, it was a central idea. Gradually, the
notion that art and therapy could be united for the purposes of healing;
took hold and was transplanted to the United States.
Adrian Hill, the Visiting Therapist
While these ideas were developing in Europe, across the channel

another early effort was being made, independent of the Jungian
thought, to merge art and therapy.
During the Second World War in London, an artist, Adrian Hill, was
recuperating from tuberculosis. While convalescing, he sought ways of
easing his boredom. He related these experiences which led to the
development of art therapy in his book, Art versus Illness: A Story ofArt
Therapy (1945). The subtitle marks the first time that the term "art ther-
apy" was used. It is of interest to trace Hill's thinking because his strug-
gles and efforts are still reflected in some forms of contemporary art
therapy.
Hill had to give up his work in 1938 when he was hospitalized. Sud-
denly "time stood still" for him. By drawing he found that he could, to
some extent, set the pendulum in motion again. From an "impetuous
impressionistic painter" he now became a "diligent and leisurely com-
poser of precise pencil productions" in which he sought to express his
reactions to the "unreality" of his existence. Sadly he commented, "My
affairs conducted me, not me my affairs" (p. 14). Three years went by
while Hill bravely endured his convalescence.
In 1941 the hospital established a department of occupational thera-
py to work with the casualties of the Second World War. Hill noted
that the extent of damage to minds, bodies, and hopes far exceeded the
damage to property and estate, even though those too were extensive.
The director of the department of occupational therapy asked Hill to
provide instruction in drawing for those patients "to whom the other
crafts made no appeal."
Hill embarked on his new project enthusiastically, and he gave a
rousing speech to the other patients about the benefits to be expected
from art lessons. He attempted to convince the patients first that to be
happily occupied would ease the distress of their convalescence.
"When books bore, wireless wanes, games begin to grate, visitors give
one vertigo, drawing and painting come as a boon and a blessing." Art,
he thought, "once firmly planted in the heart and mind" would be a
germ that can "help enormously in banishing the latter bug," namely
the TB. He maintained that this was not "quack medicine" but just
common sense because "we are all best employed when attempting to
create something. And Art Therapy is constructive. Yes, I know what
is in your minds. 'But I can't draw, you would only laugh if you saw my
efforts.'" To his fellow patients' apprehensions Hill's response was,
"You do not know what you can do until you have tried." He promised
that he would not laugh at their efforts.
Hill suggested to the patients that they take up drawing from scratch
rather than attempt to recall technical tips they may have received
while in school. He thought those half remembered instructions were
wrong anyway. Further, he advised the patients not to take art too seri-
ously because "to appreciate the profound satisfaction to be derived
from drawing and painting, you must enjoy yourself, enjoy yourself
hugely" (p. 30).
Despite his enthusiasm, Hill was in for a disappointment. Patients
were slow to sign up for art instruction, perhaps because they recalled
the dull and uninspiring art classes in school. Also, even those patients
who took up the art lessons were discharged from the hospital in a few
weeks, and that was the end of their investment and interest in art. Art
had been for them just a "brief excursion" and a "marking time, simi-
lar to the traveler's cursory interest in the platform bookstall while wait-
ing for the train" (p. 28).
Hill attempted to persuade the patients that art was good for them,
then to "entice" them to "fancy it," and finally to try some drawing and
painting for themselves (p. 30). He referred to himself at first as a "vis-
iting teacher." By summer of 1942, however, he used the term "art ther-
apy" freely and considered himself to be a "visiting therapist" (p. 47).
For Hill, art therapy was an offshoot of occupational therapy, but he

was rather uncomfortable with the term "therapy" saying that the word
"therapy" had a rather ominous medical flavor about it. He himself
interpreted therapy to mean that "a little of what you fancy does you
good" (p. 30).
Interestingly, Hill had already introduced his patients to a doodling
technique which is used quite often by contemporary art therapists
(Rhyne, 1973). Hill reassured his patients that setbacks should be con-
sidered "indispensable rungs up the ladder to ultimate success" (p. 34).
Much as Hill hoped to awaken the "dormant talent" and "resuscitate
hope," the results were rather disappointing to him. He intended to use
art to "combat the mental and physical atrophy of a long illness," but
the pictures produced by the patients remained unimaginative. Hill
reasoned that he should try first to awaken "picture consciousness" in
the patients and foster their "imaginative faculty." He collected post-
card size reproductions of famous paintings and left ten cards with a
patient, and asked him to arrange the pictures in the order of prefer-
ence. He thought that postcards would be more convenient than a
heavy book for the bedridden patients. He also placed art reproduc-
tions on the walls in patients' rooms. In this manner he sought to
encourage appreciation of good art which in turn would positively
influence the artwork produced by the patients.
Hill found that the patients frequently preferred pictures with lesser
aesthetic merit over pictures he considered to be masterpieces. He
attempted to reeducate the taste of the patient by subtly pointing out
principles of composition. Thus, Hill's art therapy had become art edu-
cation. He was back to being the "visiting teacher" he had started out
to be.
The results of Hill's project remained rather mixed. He was still on
the very edge of art therapy, and struggling not to revert to art instruc-
tion. Other early proponents of fine arts who worked under the aus-
pices of occupational therapy departments encountered similar
experiences (Gelber, 1962). The course between art instruction and arts
and crafts was difficult to steer. Frequently, the new modality of help-
ing, which the early art therapy practitioners were attempting to shape,
was scorned by the older disciplines of occupational therapy and art
education.
Another attempt to differentiate art therapy from art education was
made by Lowenfeld (1957). He used the term "art education therapy"
which he defined as "a therapy specific to the means of art education

which deals neither with the interpretation of symbols, nor a diagnosis
reached by speculative inferences based on certain symbols." Lowen-
feld stated that this triple hybrid of art, education, and therapy utilizes
a motivation that "only differs from any other art motivation in degree
and intensity and not in kind" (p. 435).
Lowenfeld's efforts to carve out art therapy from the fields of art,
therapy, and education did not meet with success, however. The seg-
ment in which he discussed and attempted to clarify this new phenom-
enon which he called "art education therapy" was omitted from
subsequent editions of his book.
Margaret Naumburg and the Free Art Expression
Art therapy finally emerged full grown in the work of Margaret

Naumburg. Her journey started in progressive education which is
steeped in the ideas of Rousseau. Later, Naumburg's thinking inter-
twined withJungian psychology, and it was also tinged with psychoan-
alytic thought. Who was Margaret Naumburg, and how did she
manage to accomplish what so many others had tried but had failed to
bring about?
Her father was a clothing merchant in New York. He had been born
in Bavaria, of German Jewish parents, and came to America with his
parents when he was three years old. Her mother was of the same eth-
nic origin but she had been born in North Carolina. Naumburg was
born in New York City on May 14, 1890. Naumburg was the third of
four children. She had two older sisters and a younger brother.
Naumburg attended a New York public school for one year, the
Horace Mann School for three years, and prepared for college at the
Sachs School (Rosenfeld, 1924). She entered Vassar College in 1908,
but a year later transferred to Barnard College where she majored in
philosophy and economics. One of her professors wasJohn Dewey and
one of her best college friends was Dewey's daughter. They remained
friends for many years.
Naumburg was very interested in social reform and was the presi-
dent of the Barnard socialist club. After she obtained her BA degree in
1912, she went to London to study with Sidney Webb at the London
School of Economics. While there she wrote a paper about labor con-
ditions in the then emerging film industry.
InJanuary 1913, much against her mother's wishes Naumburg left

London, and went to Switzerland. The stay in Switzerland proved to be
a disappointment, however. She was chagrined to find that her friends
did not know how to teach her to ski. And she recalled, she wound up
with a bad cold.
From Switzerland she went to Rome to study with Maria Montessori.
Naumburg had had a French governess as a child. She could speak
French, and having studied Latin in school, she managed to pick up
enough Italian to get by. But the stay in Rome was not satisfactory.
Naumburg found Madame Montessori uncongenial, and in the Fall of
1913 she returned to New York.
Again, against her mother's wishes, Naumburg moved close to the
Henry Street Settlement and for a year taught a kindergarten class
there. This project left much to be desired. The social workers in those
days, according to Margaret Naumburg, acted as if they had all the
answers (Nucho, 1975). The next year she rented two rooms and start-
ed a school of her own. Gradually the school expanded and was named
the Walden School.
About the same time (1914) Naumburg entered psychoanalysis with
aJungian psychoanalyst, Dr. Beatrice Hinkle. Hinkle (1874-1953) was
a psychiatrist and a psychologist who was a lifelong friend ofJung and
translated one of his books, ThePsychology ofthe Unconscious (1916). Psy-
choanalysis with Hinkle was somewhat disappointing, because, as
Naumburg recalled, Hinkle preferred her male patients to her. How-
ever, it is quite likely that if she was not already familiar with Jungian
psychology, it now received her full attention. Naumburg remained in
psychoanalysis with Hinkle for about three years.
Naumburg's next analyst was Abraham Brill, and, according to
Naumburg, this was a much more satisfactory experience. Brill
(1874-1948) is considered to be the first psychoanalyst in the United
States. He was born in Vienna, and between 1908 and 1910, he was the
only psychoanalyst in New York City. Freud granted Brill permission to
translate several of his most important works. Brill was instrumental in
founding the New York Psychoanalytic Society, and he remained in
the forefront of psychoanalysis as a lecturer and writer throughout his
life (Freedman et al., 1975). His outlook was cosmopolitan. A few years
before Naumburg started in analysis with him, he had published a
study of Arctic hysteria in Eskimos (Brill, 1913), a fact that could not
have escaped Naumburg's attention.
The two periods of psychoanalysis remained among Naumburg's

most cherished formative experiences. In her vita, which she titled
"Professional Record in Relation to Art Therapy, Psychotherapy,
Research and Teaching" and which she apparently had prepared in
1972, she listed first that she was analyzed by Drs. Hinkle and Brill. In
fact, soon she insisted that all the teachers at her Walden school under-
go analysis, and about half of them did so (Cremin, 1964). She even
tried to convince Dewey that he should enter psychoanalysis, to which
he turned a deaf ear.
After Naumburg's death, a typed copy of an unpublished article, "A
Direct Method of Education," was found among her papers. Across the
top of the typed copy Naumburg had written in longhand, "First appli-
cation of psychoanalysis to education in the US, 1917" (Detre, K.C. et
aI., 1983).
The two psychoanalyses appear to have helped Naumburg pave the
way for the blend of education she developed at Walden School. That,
in turn, served as the bridge, during the second half of her life, for the
cultivation of creativity and mental health that became art therapy.
The Walden School received considerable acclaim in progressive
education circles Oohnson, 1923; Rosenfeld, 1924; Beck, 1959; and
Cremin, 1964). Like many other progressive educators, Naumburg
found the traditional schools stifling. Public schools, as Betrand Russell
once said, had demonstrated the "possibility of giving instruction with-
out education" (cited in De Lima, 1926, p. 215). Naumburg set out to
change this. In her book, The Child and the World (1928), Naumburg
discussed how the curriculum she developed aimed to foster the child's
"apparently unlimited desire and interest ... to know and to do and to
be." She wrote, "For us all prohibitions that lead to nerve strain and
repression of normal energy are contrary to the most recent findings of
biology, psychology and education. We have got to discover ways of
redirecting and harnessing this vital force of childhood in constructive
and creative work." According to Naumburg, this could be accom-
plished by eliminating the "false dependence on the blind authority of
teacher or text book." Instead, she set out to nurture "the independence
of feeling, thought and action" in the child (p. 14).
By this time Naumburg had given up her earlier hope to find solu-
tions to social problems in the economic and social realms. "Any pos-
sibility of an immediate social or economic escape from the impasse of
our civilization has become quite remote, and rather absurd to me
now," she stated in her book. She went on to say, "I have lived to see
that whether people fought to save democracy or imperialism does not
make the profound difference I had once hoped." She reasoned that
one could not change the existing institutions but one could change
individuals who would later reform the groups and institutions they
came in contact with. The solution to social problems, as Naumburg
now perceived, was not in social reform but in individual transforma-
tion. This then became the aim of her efforts at Walden School (Naum-
burg, 1928, p. 40). The curriculum tended to emphasize humanities
and the arts. Naumburg thought that the arts and artistic expressions
would bring to conscious life the buried material of child's emotional
problems.
Naumburg could well appreciate the difficulties even normal chil-
dren had in growing up. Her son later observed that Naumburg had
often told him how constrained and miserable she had felt as a child.
Interestingly, her sister Florence had also experienced something sim-
ilar. At the age of eight she began a diary, titled, "Things my mother
does to me that I won't do to my children" (Detre et aI., 1983).
After returning from Europe her life apparently brimmed with intel-
lectual excitement. She was active in the literary-artistic circles which
included the photographer Alfred Stieglitz, the poet Hart Cane and
many American painters, particularly John Marin and Georgia
O'Keefe. She was exposed to the works of European artists Matisse,
Braque, and Picasso who exhibited at Stieglitz's gallery. Naumburg her-
self wrote articles about education as well as poems, some of which
were published (Detre et aI., 1983).
Among the artists and writers during this period in New York was
Waldo Frank. Naumburg married him in 1916. When her son was born
in 1923, Naumburg gave up her position as the director of the Walden
School. Her marriage ended in divorce two years later. For the next few
years Naumburg lived in the West where she studied art and wrote her
book (Naumburg, 1928).
During the next phase of her life, Naumburg turned increasingly
from education to therapy. She studied with Moreno, the developer of
psychodrama, and was engaged in research on drama therapy at Belle-
vue Hospital in New York. In 1940 Naumburg became associated with
the New York State Psychiatric Institute where she worked on two quite
innovative research projects, both of which resulted in publications,
first in psychiatric journals and subsequently in books (Naumburg,

1947 & Naumburg, 1950).
The future path that Naumburg's work would take was influenced
largely by two colleagues. One was Nolan D.C. Lewis, the other was
her sister, Florence Cane.
Nolan D.C. Lewis was the director of the New York State Psychiatric
Institute between 1936 and 1953. Lewis had studied with Freud in
Vienna, and during the Second World War he served as the psychiatric
expert at the Nuremberg War Tribunals. He had published an article in
1928 in which he pointed out that graphic art can be used as one of the
avenues for exploring the unconscious. Like dreams, mesmerism, and
unconscious mistakes, drawings can be used objectively to assess and
clarify the experiences of patients. In fact, he said that through draw-
ings the unconscious regions of the mind can be explored "with greater
facility than through dream analysis" (p. 345). He proposed that, simi-
lar to dreams, graphic art could be interpreted on three levels-the
manifest content, the latent content, and the deductive meaning. He
thought that drawings were more or less disguised but permanent
forms of projection of the person's conflicts, wishes, identifications, dis-
placements, conversions, symbolizations and rationalizations (Lewis,
1928).
The Freudian version of psychoanalysis had emerged as the domi-
nant one in the United States-for many decades it was tantamount to
a professional suicide to veer away from the orthodox Freudian posi-
tions toward rival theories. But Lewis also discussed in detail and
endorsed the concept of the collective unconscious advanced byJung.
Lewis stated that "Much of the material obtained through careful study
of the drawings of psychoneurotic and psychotic patients may be used
in support of the concept of the collective or archaic unconscious,
which, notwithstanding its denunciation by many authorities who have
not yet supplied as satisfactory an explanation of certain phenomena,
expresses itself universally in the dream" (p. 346). It is obvious that he
was well versed in Jungian thought although his cited references are
decidedly Freudian.
But by the time Lewis wrote the Foreword to Naumburg's book,
Studies of the "Free" Art Expression ofBehavior Problem Children and Ado-
lescents means of Diagnosis and Therapy (1947), the tone of his remarks
were well in line with the accepted Freudian orientation. There was no
mention of universal symbols or the collective unconscious. Here, in
keeping with Freudian theory, Lewis suggested that the material

expressed through drawings was usually "of the erotic and aggressive
drives of the person in the midst of an involved life problem."
It is revealing to note that in the Foreword Lewis referred to draw-
ings as tools for the study of emotional problems of both children and
adults. The emphasis was on the means of investigation, not on healing.
He stated, "The utilization of drawings for studying the emotional
problems of both children and adults is well on its way to becoming an
established useful procedure." And he concluded the Foreword by say-
ing that "These studies of Miss Naumburg represent progressive steps
in a type of research that promises much for the future."
Florence Cane and the Artist in Each of Us
Naumburg's sister, Florence Cane, provided another source of ideas

for her conception of art therapy. Florence Naumburg Cane was eight
years older than Margaret Naumburg. Her daughters described her as
a fun-loving and an out-going person. After high school, she studied
art. However, before she found stimulating teachers who furthered her
creativity, she encountered several bad ones. "It was primarily those
bad teachers who stimulated her to research her own ideas on good art
instruction" (Detre et aI., 1983, p. 117).
Florence Cane had many interests. Besides being a teacher, artist,
wife and mother, she joined the suffragettes and fought for the cause of
women. Both Florence and her husband, the writer Melville Cane,
were analyzed by Hinkle, Naumburg's first analyst. In addition, Flo-
rence Cane was much interested in the philosophy of the mystic Gur-
djieff, in yoga, in the work of F.M. Alexander ("I brought him to the
United States," Naumburg said later), and in WH. Bates' "Perfect Sight
without Glasses" (Nucho, 1975).
Florence Cane's daughters attended the Walden school. When Flo-
rence noticed that the art teacher was stifling the creative spark of the
children, she entreated Margaret to let her try her hand at teaching art
there. This she did and she continued to teach there long after Mar-
garet resigned her position as the director of the school. Florence Cane
also had her own art school, and for fourteen years she was director of
art for the Counseling Centre for Gifted Children at New York Uni-
versity (Detre et aI., 1983).
After many years of teaching, Cane gathered her ideas into a book,
The Artist in Each ofUs, published by Pantheon in 1951 (revised edition
by Art Therapy Publications, Craftsbury, Vermont, 1983). The follow-
ing spring, Cane died (Detre et aI., 1983).
Undoubtedly Cane's ideas influenced Naumburg's efforts to merge
art and therapy into a new helping discipline. Naumburg, however,
evolved a form of art therapy which may be termed the "therapy wing"
of art therapy while Cane remained in the forefront of the "art wing" of
art therapy.
In Dynamically Oriented Art Therapy: Its Principles and Practices (1966)
Naumburg described the use of the so-called "scribble technique"
which is generally assumed to have been originated by Cane, although
something similar was already known to Leonardo Da Vinci
(Kwiatkowska, 1972). However, it may be noted that Cane's name does
not appear in the index of Naumburg's book.
Furthermore, in the book, Naumburg took a firm stand as to who can
practice her brand of "dynamically-oriented art therapy." She stated,
"It is often assumed mistakenly that only those with previous art train-
ing can work with art therapy. Previous art training can be an asset,"
she went on to say, "but unless such special training includes back-
ground in abnormal psychology and, when possible, some personal
psychotherapy, students can not be adequately trained to become art
therapists" (p. 14).
Naumburg pointed out that, in her experience, a well trained
psychotherapist "who has a sympathetic interest in any of the creative
arts" was capable of doing dynamically-oriented art therapy. Accord-
ingly, "What is essential, then, to a psychotherapist who wishes to learn
how to use the art therapy approach is not that he be able to create pic-
tures himself, but that he have a sympathy for and understanding of the
creative efforts of his patients and that he believe in their creative
potentiality" (p. 14).
Forging a New Discipline
It is difficult for the current generation of art therapists to appreciate

the courage and determination of Naumburg and other early art ther-
apists to practice their modality of helping. Art therapy was a double
struggle for these early pioneers. The battle was on two fronts. Not only
was it a conceptual struggle of reconciling and merging the two chief
components of art therapy, namely art and therapy, but in addition

there was the struggle against the opposition to the very idea that a
new modality of helping could be practiced by people without medical
degrees. While Freud himself and many psychiatrists and psychoana-
lysts in Europe were quite willing to permit well qualified nonmedical
therapists to practice psychotherapy and psychoanalysis, in the United
States the situation was quite different. Here no "lay analysts" were tol-
erated. During the 1940s and the early 1950s even psychologists had to
fight for the right to do psychotherapy. Psychiatric social workers, fre-
quently better trained in relevant psychodynamic theories than many
psychiatrists, had to be careful to term their helping efforts "casework"
while the same kind of helping efforts on the part of a medically trained
professional could be freely called psychotherapy even when these
consisted of nothing more elaborate than old-fashioned admonitions
and advice.
The change was brought about, in part, by the work of Kenneth
Appel, then the president of the American Psychiatric Association. In
1953, he called on the profession of psychiatry to examine itself and, in
order to gain objectivity, to invite many other disciplines to participate
in this study. Appel pointed out that the challenge posed by mental ill-
ness was too great to be met by a single profession. Appel's plea led to
the establishment of the joint Commission on Mental Illness which
issued its report in 1961. One of its recommendations was for the cre-
ation of a new pool of mental health professionals. The way was paved
for the community mental health movement, and a crack in the door of
mental health was opened for the entry of several new mental health
professions, among them art therapy.
Appel had been instrumental in bringing Naumburg several times to
lecture to the psychiatric residents at the Institute of the Pennsylvania
Hospital, and he had developed a warm working relationship with her.
In 1957 at the International Congress of psychiatry in Zurich, both of
them presented a paper entitled, "Treatment of a Schizophrenic Patient
by Means of Art Therapy."
Art therapy was still a long time aborning. It did not spring ready-
made like Athena from the head of Zeus. The struggle to carve out art
therapy from allied but different endeavors can be charted with the
help of Naumburg's writings and presentations at professional confer-
ences during the 1940s and 1950s.
From 1941 to 1949, when she was a "special researcher worker" at

the New York State Psychiatric Institute, the titles of her publications
usually contained the term "studies." For instance, there was "A Study
of the Art Expression of a Behavior Problem Boy as an Aid in Diagno-
sis and Therapy" (The Nervous Child, 1944, 3, later included in the book,
Studies of the "Free" Art Expression ofBehavior Problem Children and Ado-
lescents as a Means ofDiagnosis and Therapy, 1947). It is well to note in this
connection that the original edition of this work did not sport the title
which now greets the reader of the revised edition of the book (1973).
"Introduction to Art Therapy" is the 1973 addition. In 1947, art and
therapy were still rather far apart.
Beginning in 1946, Naumburg prepared almost yearly exhibits of
patients' art to be shown at various psychiatric conferences. Although
the catalogues she prepared in conjunction with these exhibitions auda-
ciously proclaimed that there is such a thing as art therapy, her papers
during this period still continued to hedge on the exact topic of her
efforts. Naumburg prepared the first exhibition in 1946 for the Annual
Meeting of the American Psychiatric Association held in Chicago. The
title of the catalogue for that exhibit was still a general "Art Expression
of a Behavior Problem Boy and an Adolescent Schizophrenic Girl."
But the following year the catalogue for the exhibition shown at the
Fifth Pediatric Congress in New York was boldly entitled "Art Therapy
in Diagnosis and Treatment of Behavior Problem Children."
Whereas Naumburg had designated her work as that of a researcher,
beginning in 1949, she stated in her vita that she was doing "Art Ther-
apy with selected case" in New York at Mt. Sinai Hospital's Depart-
ment of Child Psychiatry. Between 1949 and 1951, she lectured "on art
therapy" to residents at the Institute of the Pennsylvania Hospital in
Philadelphia. The ten lectures she gave at the New York Postgraduate
Center for Psychotherapy in 1950, however, carried a more general
title of "The Use of Art Productions in Diagnosis and Therapy of Emo-
tional Problems."
In 1954, Naumburg organized and chaired a symposium on "The
Use of Spontaneous Art in Psychotherapy" and presented a paper on
"Stereotype and Symbol in the Art Production of an Obsessive Com-
pulsive Boy." Here it would seem that the emphasis was again more on
the "study" part than on the "therapy" aspects of her work. But by
1955, however, the idea of art therapy as a distinct modality of treat-
ment had taken shape clearly in her mind, and Naumburg entitled the
seminar she offered at the Postgraduate Center for Psychotherapy in

New York, "The Theory and Practice of Art Therapy." Art therapy as
a modality of helping had finally arrived on the scene of professional
endeavors. What exactly Naumburg's version of art therapy consisted
of will be discussed in the next chapter.
The seeds of art therapy were already in Naumburg's work at the
Walden School which she established and directed beginning in 1914.
It started to take shape in her work at the New York State Psychiatric
Institute with the help of her mentor, Nolan D.C. Lewis. It was nur-
tured by her two periods of personal psychoanalysis with psychoana-
lysts who themselves were interested in the therapeutic aspects of art
expression. By the mid 1950s, Naumburg was boldly proclaiming, clar-
ifying, and teaching the new sodality of treatment she had evolved.
At the first annual conference of the American Art Therapy Associ-
ation in 1970, the first Honorary Life Membership was awarded to
Margaret Naumburg in recognition of her distinguished contributions
to the field of art therapy. After accepting the award, Naumburg gave
a brief presentation on the "Importance of Training Art Therapists in
the Adequate Use of the Psychiatric Interview." A lively discussion fol-
lowed the presentation during which a young art therapist, Harriet
Wadeson, then associated with the National Institute of Mental Health,
expressed her dismay that Naumburg appeared to be equating the the-
ory of art therapy with the theory of psychoanalysis. Rightfully Wade-
son pointed out that there were several other possible theoretical
frameworks for art therapy besides the psychoanalytic theory.
Naumburg's attendance at that conference proved also to be her last.
Naumburg was then 80 years old. Although she lived for another 13
years, she did not participate in any of the Association's subsequent
conferences. Characteristically, she had managed to stir up a contro-
versy on this occasion as she had frequently done throughout her life.
It was ironic that the criticism hurled at Naumburg on this -occasion
identified her with the psychiatric profession, the same establishment
against whose vehement opposition she had fought so persistently
while forging the discipline of art therapy out of the ingredients of art,
education, and therapy.
When Naumburg was awarded the American Art Therapy Associa-
tion's first honorary life membership, she was generally thought to be
a proponent of the psychoanalytic school of thought. Actually the ver-
sion of psychoanalytic thought Naumburg subscribed to was that of the
Sullivan, Homey, and Fromm variety, also known as Neofreudianism.

Furthermore, Naumburg's version of Neofreudian thought was rather
thoroughly saturated with Jungian psychology as well as with ideas
derived from progressive education.
The richness of ideas Naumburg managed to weave together is truly
astounding. Perhaps she was able to accomplish what others had failed
to bring about precisely because of the immense scope of her intellec-
tual heritage. She managed to blend together the therapeutic ingredi-
ents in art with the art of therapy in a manner that had eluded many
others before her, and, we might add, is still eluding many of her fol-
lowers. For Naumburg, art and therapy truly fused into one entity,
never to come apart again. This forging of art and therapy into one dis-
cipline, however, did not come about without stiff opposition from
both the art and the therapy establishments of her day. Naumburg per-
sisted and prevailed. Her fortitude and vision have assured her a place
of honor in the history of art therapy.
Trailblazing in Art Therapy
Naumburg's vision of art therapy might have faded from the arena
of mental health had this vision not been nurtured and reinforced by
a number of additional professionals from various disciplines. The dis-
parate notions about art therapy held by these professionals were
brought together into a distinct stream of ideas largely with the help of
Elinor Ulman and the Bulletin ofArt Therapy which she founded, pub-
lished and edited beginning in 1961. Renamed AmericanJournal ofArt
Therapy in 1969, this publication provided a forum for the exchange of
ideas of professionally diverse and geographically scattered practi-
tioners.
The Bulletin ofArt Therapy contained theoretical articles, research
reports, descriptions of practice, critical reviews, and world-wide news
of developments in the field of art therapy. Ulman nurtured, encour-
aged, pruned, and published the various efforts to carve out a unique
method of helping which combined art and verbal psychotherapy. By
1969 the ranks of the professionals who considered themselves to be art
therapists had swelled to the extent that it was possible to form a
national association of art therapy. This took place in Louisville when
about 50 persons comprising the Organizing Ad Hoc Committee chart-
ed the American Art Therapy Association.
The first annual conference of the American Art Therapy Associa-

tion was held in September 1970 at the Airlie House in Warrenton, Vir-
ginia, 45 miles south of Washington, D.C. About 100 people attended
the conference, and the membership in the organization was 142.
The setting for the first annual conference of the AATA was pastoral
and tranquil. Outside the conference center, on the banks of a lake,
swans were preening themselves. Inside the building, however, the
atmosphere was tense and laced with controversy. The business meet-
ing, scheduled to last for one hour in the afternoon, continued well past
midnight, into the early hours of the morning. The shape of the consti-
tution of the organization was heatedly debated. The difficulties sur-
rounding the process of certification of art therapists and the question
of the grandfather clause appeared insurmountable.
The program of the two-day conference consisted of 18 items and fit-
ted comfortably on three typewritten pages. By 1973, when the Fourth
Annual Conference was held in Columbus, Ohio, the program of the
conference consisted of 64 presentations. By that time, the membership
in the organization had grown to 544, and by 1980-the end of the first
decade-the membership was well over 2,000, and still growing.
In 1984, when the 15th annual conference of the AATA was held in
Washington, D.C., the program consisted of well over 100 items, and
was amplified by a number of pre and postconference courses.
Several surveys have been conducted to ascertain the status and
future of art therapy in the United States. The first was done in 1972
when 468 facilities in the Midwest and 199 facilities in Southern Cali-
fornia were contacted by mail. Of these, 237, or 51 percent, of the Mid-
west sample responded. Of the Southern California sample, 80
facilities, or 40 percent, returned the questionnaire (Anderson &
Landgarten, 1974).
In the Midwest, 50 percent of the facilities had an adjunctive or activ-
ities department, while California sample reported such departments in
36 percent of the facilities. The existence of separate art therapy depart-
ments were reported by 12 percent of the Midwest institutions and by
10 percent of the California institutions. However, the comments dis-
closed that these departments overlapped with other departments,
most frequently with occupational therapy.
In the 1972 survey, hospitals, mental health centers, correctional
facilities, and residential treatment centers indicated the greatest inter-
est in adding art therapists to their staffs in the future. Many of the
respondents in this survey asked for information and literature about

art therapy, and they expressed readiness to serve as training sites for
art therapists (Anderson & Landgarten, 1974).
Ten years later, a follow-up survey on the status of art therapy in the
Greater Los Angeles area contacted 245 institutions. In this survey, 137
institutions, or 56 percent, returned the questionnaires. Responses were
compiled from community mental health/family counseling facilities,
out- and in-patient units, schools, centers for developmentally disabled,
residential and rehabilitation facilities, day-care treatment units, sub-
stance abuse treatment centers, and nursing homes. The results of the
survey showed that art therapy was well accepted as a viable mental
health modality equal to social work and school psychology. In fact,
several institutions noted that art therapists were filling positions for-
merly held by social workers or psychologists with master's degrees or
by other degreed counselors. It appeared that art therapy had made
impressive gains in the past 10 years, and in spite of funding cutbacks
for many institutions, future hiring plans for art therapists were prom-
ising. The survey indicated that art therapy had forged its way to an
acceptable position among other mental health professions
(Landgarten, 1984). From these surveys and the various reports pre-
sented at the annual conferences of the AATA, it is clear that art thera-
py is not only here to stay but is becoming a vital link in the chain of
mental health disciplines.
Conclusion
And so, from the ancient Greeks, and from the Renaissance, down
through the nineteenth century, the threads of a new way of helping
were being spun. But it took the 20th century, with its explosion of
thinking and practice in the field of human behavior, to refine a phi-
losophy and mold a clinical approach into what is now termed art ther-
apy. Today, in the twenty-first century, with its promise of a radical
development of new knowledge in the neurosciences and in behavior,
art therapy has come of age, and promises to playa strategic part in the
healing arts for future generations.
Chapter 5
VARIETIES OF ART THERAPY
his chapter traces several of the major models of art therapy and
T discusses the theoretical frameworks used in art therapy. It does
not intend to provide an exhaustive review of the art therapy literature
but rather to place the various models of art therapy in their theoreti-
cal and historical context. These various models of art therapy predate
the psychocybernetic model of intervention, and selected aspects of
these older models have influenced the development of the psychocy-
bernetic model.
What is art therapy and how is it done? These are complicated ques-
tions and the answers vary depending on the relationship between the
definer and the matter to be defined. In this regard, art therapy is some-
thing like a pyramid. Depending on your vantage point, a pyramid will
appear to you as something entirely different. Looking at it directly
from above, you could claim that a pyramid is essentially a square. If
you look at it from a side, you could say that it is a triangle. Similarly
with art therapy. What it is depends on how you look at it.
There are essentially three different kinds of art therapy. These three
forms are largely associated with the professional home base of the
practitioner. People who are engaged in the practice of art therapy and
who are contributing to its development arrive at art therapy by way of
two routes. One is via fine arts, and the other is the helping profes-
sions. The helping professions in this context may be thought of as
including psychiatry, occupational therapy, psychology, and clinical
social work as well as various kinds of counseling. Let us take a look at
these two professional home bases and the concepts of art therapy gen-
erally associated with each.
72
Varieties ofArt Therapy 73
The Art Wing
A considerable proportion of art therapists have been schooled in

the fine arts. At some point in their professional development they
decided that they wanted to work directly with people. To satisfy this
desire, they turned to the practice of art therapy. What kind of art ther-
apy do they practice?
Those who have come to art therapy by way of the fine arts tend to
emphasize the "art" component of art therapy. Being artists themselves,
they tend to feel that beneficial results stem from the exposure of the
person to the power of art, whatever that is. They consider themselves
primarily artists, and they endeavor to awaken and cultivate the spark
of creativity in their clients. Their art therapy sessions frequently
resemble rudimentary art lessons. The client is instructed in the basic
principles of composition, use of materials, and the understanding of
perspective. The visual product, even when it is produced quite spon-
taneously, is examined for its aesthetic merits. The visual product is
approached with objective criteria in mind as to what constitutes "good
art." The product is valued more than the process of producing it. The
application of technical skills is expected, and the results of art therapy
sessions are frequently exhibited for the enjoyment and appraisal of
other patients and staff of the institution where the art therapy sessions
are held (Kramer, 1958). Art therapists who practice this form of art
therapy expect that the private experience depicted in the painting or
sculpture will reach the level of clarity where the message is available
not only to the art maker but to the onlooker as well.
The art wing type of art therapy is appropriate for clients who are
artistically inclined. These clients can develop their dormant artistic
talents with the help of art therapy sessions of this kind. They can also
enjoy the opportunity to mingle with like-minded people. Their circle
of friends is enlarged, and they can develop new ways of meeting and
interacting with people. New interests are developed and cultivated,
and the results often are beneficial and enriching.
Enjoyable and enriching as this type of activity might be, however,
it falls short of utilizing the full potential of art therapy. The art wing
variety of art therapy is essentially what could be termed a hobby ther-
apy in the best sense of the word. Hobbies frequently are beneficial and
even essential for the attainment and maintenance of health, both in its
physical and emotional aspects. Hobbies can be all absorbing and life-
enriching. However, there is more to art therapy proper when seen in

the light of psychocybernetics than is utilized by the art wing of art
therapy. The differences between the art wing type of art therapy and
the psychocybernetic model of intervention will become apparent in
Chapter 6 which present a more detailed discussion of the latter model.
At this point in the discussion it is important to note the several reasons
why the art wing type of art therapy is insufficient. For one, only a
small proportion of clients are interested in art. Secondly, the majority
of clients can not devote to art therapy the amount of time necessary to
reach the level of technical proficiency where the art activity itself
becomes enjoyable and rewarding. Thirdly, the level of emotional and
physical energy of a large proportion of clients is so low that it pre-
cludes their participation in the type of art therapy propagated by the
art branch of art therapists.
It is interesting to note in this context that the difficulties that have
been identified with the "art branch" of art therapy were already
encountered by Adrian Hill whose experiences as part of the develop-
ment of art therapy were discussed in Chapter 4. A different kind of art
therapy is often practiced by those therapists whose professional iden-
tities lie within one of the helping professions. That is the therapy wing
of art therapy.
The Therapy Wing
In contrast to the art wing, there is a second form of art therapy. It is

practiced mostly by professionals with a home base in one of the help-
ing professions-psychiatry, psychology, clinical social work, some
form of counseling, or occupational therapy. Practitioners of this per-
suasion are more attuned to the "therapy" part than to the "art" part of
art therapy. They are inclined to designate their form of art therapy as
"art psychotherapy," in contrast to the "art" branch which incidentally,
is frequently termed the "art as therapy" form of art therapy. Indeed,
the titles of two books by Edith Kramer, one of the most prominent
practitioners of the art wing, exemplify this controversy. Her second
book is entitled Art As Therapy (Kramer, 1971), whereas the title of her
first book is Art Therapy in a Children's Community (Kramer, 1958).
Practitioners of this second type of art therapy are more interested in
the process than the product of the session. The client's experience
while engaged in making the visual product is more important than
the product itself. The purpose of the session is not to produce some-
thing of aesthetic quality but rather something that has some personal
meaning for the art maker. Although frequently when the client suc-
ceeds in contacting some genuine emotion and the outcome is of aes-
thetic quality, the aim is not to produce something that can be
exhibited for others to admire. The purpose of the visual product is to
clarify some aspect of the client's life experience. In this regard there is
an affinity between this branch of art therapy and the psychocybernet-
ic model of intervention.
Those who subscribe to a format of art therapy which emphasizes
the therapy aspects of the process discount the benefits of acquiring
technical skills in art. As a matter of fact, the client's desire to acquire
technical skills is frequently thought to be detrimental to the therapeu-
tic process in art therapy. Naumburg, who may be regarded as the
mother of art therapy in the United States, went so far as to make a
client choose between continuation in art therapy with her and enroll-
ment in an art class (Naumburg, 1966). Striving after technical profi-
ciency, Naumburg thought, would detract from the therapeutic benefits
a client could derive from the art expression.
Arts and Crafts
One more form of art therapy can be recognized. It may be called

the arts and crafts version and it is the oldest of the three forms of art
therapy. It originated and was practiced mainly under the auspices of
occupational therapy departments.
In the arts and crafts format the emphasis is on acquiring good work-
ing habits while making some item, usually of a useful or decorative
nature, such as an ashtray, a leather belt, or a book mark. Also, the
client may be encouraged to paint pictures by numbers. Little if any
spontaneity is expected. The client's greatest accomplishment lies in
following directions and staying with the task until it has been com-
pleted.
This form of art therapy often is quite beneficial to the participating
clients. It promotes sociability and a sense of accomplishment. The
recognition for the work done received from the therapist and the other
clients, no doubt contributes to a sense of well-being and this, in turn,
may hasten the client's recovery and may facilitate improved social
functioning in general.
Although this form of art therapy may be useful and enriching for
many clients, it is not considered central to art therapy from the psy-
chocybernetic perspective. However, occasionally even a psychocy-
bernetically-oriented art therapist may utilize this arts and crafts
version when working with a type of client population for whom it is
appropriate. For instance, certain physically handicapped and learning
disabled clients can benefit from some form of arts and crafts (Ander-
son, 1978; Barlow, 1976).
The arts and crafts is frequently favored by those professionals in
the helping disciplines who have some acquaintance with group work.
In social group work, this form of art therapy is subsumed under the
"program media" together with activities such as sports, games, and
dramatics. From the psychocybernetic perspective, this form has less to
do with art therapy than with what might be called activities therapy. It
may be therapeutic just as gardening or splitting wood may be thera-
peutic in that it may help a person feel more effective and worthwhile.
But it has very little to do with the information sorting and processing
endeavors which are the core of the psychocybernetic model of help-
ing (see Chapters 2,3, and 6).
The three clusters of art therapy which we have discussed thus far are
portrayed in Figure 5-1.
It may be noted that in the American Art Therapy Association, the
art wing of art therapy is the most prominent one. The lines of demar-
cation, however, are becoming blurred as increasingly more art thera-
pists acquire credentials in the various helping professions in the form
of advanced degrees and professional licenses. Some professional
artists have developed into skillful therapists capable of using the visu-
al as well as the verbal forms of therapy (Kwiatkowska, 1978). Con-
versely, some practitioners trained in the traditional forms of the
predominately verbal modalities of helping have acquired proficiency
in the uses of visual techniques of communication (Betensky, 1973).
The distinction between the three types of art therapy are still very
real, however, and occasionally these differences lead to heated
debates within the American Art Therapy Association (Kramer et al.,
1982).
The psychocybernetic model of intervention has a greater affinity
with the therapy wing of art therapy than with the art wing. The psy-
chocybernetic model promotes the client's search for personal, nondis-
cursive symbols and it stimulates the client's own interpretation of the
VARIETIES OF ART THERAPY
HOME BASE: HOME BASE:
THE HELPING PROFESSIONS

FINE ARTS
(Painting; (Psychiatry, psychology,
sculpting, etc.) clinical social work,
counseling, etc.)
B. ART WING: C. THERAPY WING:

PRODUCT ORIENTATION PROCESS ORIENTATION
Art lessons; skills; Visual thinking promoted;
technical proficiency;
new interests developed;
B search for personal non-
discursive symbols (Langer);
secondary creativity clarification of experiences;
expected (Maslow). primary creativity (Maslow).
Allo-gnosis; Auto-gnosis;
Nomomatic seeing Ipsomatic seeing (Nucho}.
(Nucho ) •
A. ARTS & CRAFTS
Sociability; good work habits; HOME BASE:

sense of accomplishment.
A version of Activities Therapy. OCCUPATIONAL THERAPY
Figure 5-1. Varieties of Art Therapy.
visual product through the ipsomatic seeing. It emphasizes the primary

rather than the secondary type creativity (see Chapters 2,3, and 6).
Theoretical Orientations
The other set of factors that shapes the kind of art therapy the prac-
titioner will adopt, in addition to the practitioner's professional home
base, is the practitioner's theoretical orientation. Art therapists, like any
other kind of mental health specialists, have had to utilize the theories
of human development and functioning that were available to them at
a given time in history. When art therapy first evolved, the predomi-
nant stream of ideas was through psychoanalytic theory. Psychoanalyt-
ic thought itself has undergone several stages of development. These
stages of development range from the orthodox psychoanalytic
thought to the newer existential-phenomenological versions (Hall &
Lindzey, 1957; Weisman, 1965).
The other stream of ideas that has molded the thinking of many art
therapists isJungian thought Oung, 1916;Jacobi, 1959). Two addition-
al theories have shaped art therapy. These are the Gestalt therapy
(Perls, 1969) and the existential-phenomenological approach (May et
aI., 1958). These four theoretical orientations that still influence the
work of art therapists all predate the psychocybernetic model of inter-
vention which is discussed in greater detail in subsequent chapters.
The Psychoanalytic Model
The two most prominent proponents of the psychoanalytic model of

art therapy are Naumburg (1947; 1966) and Kramer (1958; 1971).
While Naumburg represents what was termed the therapy wing of art
therapy, Kramer is firmly identified with what we described as the art
wing of art therapy. Both Naumburg and Kramer, as well as other art
therapists who have followed in their footsteps (Lachman, 1985;
Landgarten, 1981; Levick, 1983; Robbins, 1976; Rubin, 1984; Wades-
on, 1980), use the psychoanalytic theory to understand the process and
the products of art therapy sessions. Several basic concepts shape the
practice of art therapy of those practitioners who subscribe to this the-
oretical orientation.
One of the key concepts of the psychoanalytic theory is the concept
of unconscious mental processes. Psychic processes are not chance but
have a specific purpose even when this purpose is not obvious to the
conscious portions of the person's mind. Repression, denial, projec-
tion, displacement, and reaction formation are some of the ways in
which mental process take place without conscious awareness. Mental
processes are ruled by psychic determinism, and energy is associated
with these processes. Art therapists who are psychoanalytically orient-
ed note and try to understand the manifestations of unconscious men-
tal processes.
According to psychoanalytic thinking, human behavior is shaped by
two powerful drives-sexual and the aggressive. In his New Introductory
Lectures (1933), Freud stated, "We suppose that there are two funda-
mentally different finds of instincts: the sexual instincts in the widest
sense of the word (Eros, if you prefer that name), and the aggressive
instinct whose aim is destruction." It is of some interest to note that
Freud himself emphasized "the widest possible sense" when speaking
about the sexual instinct and that he suggested the name of Eros as
another term for this "widest possible sense" of the manifestation of

the sexual instincts. Many of his followers, however, overlooked
Freud's comments in this context and proceeded to use the concept of
the sexual instincts in their narrower biological sense.
In art therapy, the psychoanalytically-oriented art therapists are alert
to the manifestations and expressions of sexual and aggressive drives in
the art productions of their clients. Shapes and objects that are elon-
gated are thought to be "phallic" symbols while box-like shapes are
thought to represent feminine sexuality. In Figure 5-2, for instance, a
psychoanalytically oriented art therapist would note the sharp claws of
the cat, its pointed ears, and the phallic shapes of the tail and the limbs
of the animal.
In addition to the concept of the unconscious mental process and the
instinctual drives, the third set of concepts that influences the thinking
of the psychoanalytically oriented art therapist is the distinction
between the primary and the secondary process of thought. Primary
process thought operates according to the pleasure principle which
aims to attain immediate satisfaction of desires. It disregards the laws of
logic, reason, and experience. In contrast, secondary process thought is
held to be reality-oriented, and it is shaped by the laws of logic (Rapa-
port, 1951). Primary process thought, according to Freud, takes place in
dreams and through visual representations of experience. In his book,
The Ego and the Id (1927), Freud stated that thinking in pictures approx-
imates more closely to unconscious processes than does thinking in
words. He went on to say that this form of thinking is "unquestionably
older both ontogenetically and philogenetically," that is to say, both for
mankind as a whole and for every individual person. According to
Freud, thinking in pictures predates the thinking which proceeds
through the use of words. Freud pointed out, and many art therapists
have found this to be true, that it is possible for thought processes to
become conscious through a reversion to its visual residues. Naum-
burg, for instance, stated that art therapy is "based on the recognition
that man's fundamental thoughts and feelings are derived from the
unconscious and often reach expression in images rather than words"
(Naumburg, 1966, p. 1).
The psychocybernetic perspective supports Freud's theory that visu-
al thinking or thinking with the help of images is the older form of
thought. Early in life, while exposed for a considerable period of time
to many deep and formative experiences, we think long before we
Figure 5-2. The Cat.
have appropriate verbal labels which we can attach to our experiences.

But there is sufficient evidence to disagree with the psychoanalytic
assumption that this form of thought is inferior to the secondary
process thought which is based on logic and which proceeds rationally
and incrementally. On the basis of the research on the differential func-
tioning of the two cerebral hemispheres, it can no longer be assumed
that these two forms of thinking are qualitatively different. As discussed
in Chapter 3, both are essential for adequate codification and process-
ing of information. Instead of using the psychoanalytic concepts of pri-
mary and secondary thought with the implication that one form of
thought is more rudimentary and primitive than the other, it is prefer-
able to use the concepts of discursive and nondiscursive thought sug-
gested by Langer (1942). Both forms of thought are essential for a full
understanding of reality and for the full utilization of the means of
information processing available to the human mind. To use only one
of the available channels of information processing is to expect a train
to run on only one of its two rails.
Art therapists who have been influenced by the older versions of the
psychoanalytic thought which differentiates between the primary and
the secondary thought processes tend to favor the logical, sequential,
and rational processes associated with the dominant cerebral hemi-
sphere over the intuitive, holistic, global, visual, and spacial processes
of thought. These art therapists tend to overinterpret and overanalyze
the visual creations of their clients. Perhaps for these reasons Naum-
burg was frequently satisfied to let her clients produce their drawings at
home, and then used the time during her therapy sessions with the
client in discussion of the visual product.
Before leaving the psychoanalytic model of art therapy, the final set
of concepts that should be highlighted are the pleasure principle and
the reality principle. The pleasure principle, as has already been indi-
cated, aims at an immediate gratification of desires. The reality princi-
ple, in contrast, advocates the postponement of gratification until such
time when the desires may be satisfied at a lesser cost and to a fuller
extent.
According to psychoanalytic thought, art is the bridge that connects
the pleasure principle with the reality principle so that both may oper-
ate simultaneously. Art is seen as the means of balancing the conflict-
ing demands of these two principles-the pleasure and reality. Art
permits the gratification of both principles in that art expresses the
desires in a half-disguised, half-concealed manner. In this way, the so-
called "censor" is not aroused, and the prohibited and socially unac-
ceptable desires may be partially expressed and satisfied. Art, like
dreams, presents desires in a manner that can slip by the "censor" of
the conscious mind. It could be said that from the psychoanalytic per-
spective art is a kind of a bootlegging operation.
Through art, socially unacceptable needs and desires can be trans-
formed and expressed in more acceptable manner. This process is
known as sublimation. According to Kramer, who may be regarded as
one of the most prominent representatives of the older psychoanalytic
position, one of the main benefits of art therapy is that it provides
opportunities for sublimation of the aggressive and the sexual needs. In
drawings and other forms of art the wish is depicted, symbolized and
transformed into a socially acceptable expression. Little boys, for
instance, may first make replicas of big sexual organs out of clay in
their attempts to gain a sense of masculinity. Later they may build
structures like the Empire State Building and other forms that convey
the notion of power and masculinity to them (Kramer, 1971).
What does the client gain from art therapy? The psychoanalytically-
oriented art therapists hold that the therapeutic benefits in art therapy
stem to a large extent from the opportunity to sublimate the aggressive
and the sexual drives. Through the process of sublimation clients learn
to attain partial and symbolic forms of satisfactions for their socially
unacceptable needs and desires. Another benefit that accrues from art
therapy is catharsis or the discharge of feelings associated with painful
life experiences. Naumburg cites a case example of a 42-year-old,
twice-married woman who suffered from ulcers. In her art therapy ses-
sions, she projected her illness in drawings which contained blood-red
masses symbolic of her ulcer. Gradually, the patient was encouraged to
interpret her own drawings instead of accepting Naumburg's interpre-
tations. By the seventh month of art therapy, this patient was able to
express her anxiety through making pictures about her conflicts instead
of panicking or developing ulcer symptoms (Naumburg, 1966, p. 66).
The third form of benefit in art therapy frequently emphasized by
psychoanalytically-oriented practitioners is the attainment of increased
awareness of some recurring pattern of behavior that may be self-
defeating. As one of Naumburg's patients put it, "The patient draws
pictures of fears, loves, hates-many of which elude the definitions nec-
essary to capture them in words, whether the pictures are good art or
bad art. No mastery of formal technique is required to give a glimpse
inside oneself that is more accurate and more deeply suggestive than
words usually are...." The patient went on to describe how the process
of drawing clarifies matters about which one may not have been con-
scious before but nevertheless may have been exposed to the crippling
effects of these experiences. The patient concluded, "... eagerly one
draws, until the trouble's hidden nature is sufficiently revealed to be
dealt with adequately" (Naumburg, 1966, p. 113). Another of Naum-
burg's clients remarked that the more she permitted herself to express
her true feelings, the more she grew emotionally. She said, "I found
that once you've let hate out when you are making pictures, then the
hate gets all used up by the time I've finished drawing" (Naumburg,
1966,p.110).
The psychoanalytically-oriented art therapists are prone to conduct
art therapy sessions that extend over a relatively long period of time.
Naumburg, for instance, worked with many clients for several years. In
fact, one of her clients was in art therapy with her for four years. Usu-
ally the same client was also in psychoanalysis concurrently. Gradual-
ly, the time spent with the psychoanalyst decreased, while the time
spent in art therapy increased. One client, for example, saw her psy-
choanalyst once a month for 20 minutes while she spent an hour and a
half in weekly art therapy sessions with Naumburg. The frequency of
art therapy sessions conducted by Naumburg ranged from once a week
to three times a week. Under special circumstances, particularly if the
client had to travel long distances, Naumburg could be quite flexible
and would conduct either marathon sessions or space the sessions at
longer intervals.
Throughout her life, Naumburg kept up with the developments in
psychoanalytic theory. She was well versed in the contributions of the
various Neo-Freudians, such as Homey, Sullivan, Fromm, and others.
She was also well aware of the contributions of ego psychology. Fur-
thermore, although officially Naumburg was identified with psychoan-
alytic thought, it is interesting to note how deeply she was influenced
by Jungian psychology. Her concept of the unconscious, for example,
is closer to the Jungian than to the traditional psychoanalytic view.
While aware of the irrational elements in a person's unconscious por-
tions of the mind, Naumburg was convinced that the unconscious also
contained transformative powers. She stated, "While the unconscious
contains destructive and fearful forces which some religionists and psy-
choanalysts warn against, the unconscious is also the source of that gen-
erative power which makes it possible for art to become a means of
integration and renewal of the human psyche" (Naumburg, 1966, p.
42).
The function of fantasy and imagination is another area where
Naumburg veers away from the purely psychoanalytic position.
Although at times fantasy may be a means of escape from reality,
Naumburg nonetheless maintained that fantasy may also serve a uni-
fying function that "deals with a collective past or an individual's
future, in theJungian sense" (Naumburg, 1947, p. 51).
Like Jung, Naumburg was fascinated by symbolism in various cul-
tures. She decried the narrow psychoanalytic view that regards sym-
bolic expressions as the result of intrapsychic conflict between the
repressing tendencies and the repressed (Naumburg, 1966, p. 29). She
regarded symbolic expression as a fundamental and creative aspect of
human functioning. A considerable portion of her course at the New
York University therefore was devoted to cultural anthropology and

the study of symbols of various religions and ancient cultures (Naum-
burg, 1966, p. 33).
The Jungian Approach
While the psychoanalytic theory postulates that personality rarely

changes after childhood, Jung held that we have life-long possibilities
for growth and development. According to Jung, life is a process of
individuation, that is, a process of becoming uniquely oneself as one
actualizes one's every potential. As people grow older, they choose
some possibilities and neglect others. They tend to become one-sided.
This is what makes us neurotic, Jung pointed out. In order to be
healthy, one has to use one's entire potential.
One way of developing one's entire potential is through the method
of "active imagination." This is Jung's term for what we now call art
therapy. Jung's method of active imagination is a way by which a
dream or a fantasy image is activated and amplified. In contrast to pas-
sive fantasy, it is a technique of introspection in which the stream of
inner images are observed and made to come alive by active partici-
pation in their unfolding. In a letter to Count Hermann Keyserling,
Jung explained the process of active imagination by suggesting that one
should "switch off" one's noisy consciousness and "listen quietly
inwards and look at the images that appear before one's inner eye."
Jung added that "images should be drawn or painted assiduously"
regardless whether one is able to do so or not Oung's Letters, Vol. 1,
1973, p. 83). With the help of the method of active imagination one can
contact the neglected portions of one's psyche. Or as Lyddiatt put it,
this method permits a client to "join up with the unknown side of your-
self so that you cease to feel out of joint" and life becomes more har-
monious for you (Lyddiatt, 1972, p. 137).
Jung held that enrichment and self-development is attained through
contacting deeper layers of the psyche, or what Jung termed the col-
lective unconscious. Jung thought that in addition to the personal
unconscious, each person has access to the collective unconscious that
contains the psychic residues of the evolutionary development of all
humanity. The personal unconscious contains the forgotten or
repressed impressions and those impressions which may have been too
weak to leave conscious impressions. The collective unconscious, on
the other hand, harbors human predispositions to perceive and react to

the world in certain ways. All humans, for instance, have had a moth-
er. Thus, a human infant is born with the predisposition to perceive and
react to a mother in certain ways. Jung's term for the structural com-
ponents of the collective unconscious is "archetype." An archetype is a
universal thought form or an idea which is invested with strong emo-
tions. Jacobi points out that archetypes can not be defined but they
may be thought of as being invisible energy centers Oacobi, 1959, p.
75ff). These energy fields can be activated through certain experiences.
In this way archetypes become conscious and they can enrich the per-
sonal unconscious. Archetypal material may appear in myths, dreams,
visions, rituals, works of art, as well as in neurotic and psychotic symp-
toms.
Some archetypes have evolved to the extent thatJung regards them
as separate systems of personality. For instance, Jung describes per-
sona, or that part of personality that is developed in response to social
conventions and one's own archetypal needs. Another system of per-
sonality is anima or the feminine archetype, and animus, the masculine
archetype. Still another is the shadow which is similar to the Freudian
concept of the unconscious, namely the reservoir of the vital and pas-
sionate animal instincts in humans.Jung also distinguished ego or the
conscious portions of the mind, and the self by whichJung meant the
sense of identity and the center of personality.
From the Jungian perspective, the task of the art therapist is to pro-
vide the materials to the client, to lend a reassuring presence, and to
value the activity of self-expression. As Lyddiatt observed, "The
essence of treatment lies in helping everyone to express his own indi-
vidual link with the activity of the mind below the surface of con-
sciousness" (Lyddiatt, 1972, p. 136). Art therapy according to this
model is a way of expressing and experiencing one's own imagination.
It is a method of linking the conscious with the unconscious portions of
the mind to enrich the personality and to augment one's capabilities.
This linking of the conscious with the unconscious portion of the mind
is accomplished by "deliberate efforts to let a mood speak without seek-
ing to control it and without being overwhelmed by it" (Lyddiatt, 1972,
p. 1). The task of the client is simply to watch what one's imagination
is doing. The client is encouraged to observe objectively how a frag-
ment of one's fantasy grows and develops. "The important thing is not
to interpret and understand but to experience" the fantasy (Lyddiatt,
1972, pp. 4-10). A client is simply asked to put paint on paper. Lyddi-
att noted that the paintings seemed to make themselves. "It is a per-
petual surprise to see how quickly scribbles grow and change when
valued by the painter as well as by the therapist." Ideas flow around
what one is portraying, and fragments of the imagery join and make
sense. Harking back to the concept of the collective unconscious, Lyd-
diatt suggested that, "It is a spark of something greater than ourselves
that can lead us on so long as we do not seek to cage it in" (p. 13). Lyd-
diatt added that those who have tried this seemingly simple method of
active imagination know that it is much more difficult to objectify a
mood than to allow oneself to be possessed by it (p. 26).
Although aJungian art therapist would search for the manifestations
of universal symbols and would be inclined to compare the expres-
sions of a client with the symbols known from myths and ancient forms
of art, these thoughts are best kept to one's self. No interpretation is
offered to the client. As Lyddiatt pointed out, "it is terrifyingly easy to
project one's own problems on to the patient and to add to their bur-
dens and bewilderment" (p. 26). In the opinion ofJungians, the client
benefits simply from the process of making the images. In art therapy
a client searches for another dimension of himself. "One carries on a
conversation with an unknown part of oneself in which one gradually
comes to believe" (p. 105).
When looking at the picture of the cat (Figure 5-2), a Jungian art
therapist might speculate about the meaning of the archetype conveyed
by the drawing. The therapist may note that cats in Egyptian mytholo-
gy were thought to be associated with the moon, and that it was sacred
to the goddesses Isis and Blast, the latter being the guardian of mar-
riage. Black cats are frequently associated with powers of darkness and
death. These musing, however, would remain unspoken in the art ther-
apy session. They can nevertheless alert the therapist to be somewhat
more perceptive and attentive to some of the client's comments and
thoughts when the drawing is contemplated during the dialoguing
phase of the art therapy process.
Some Jungian art therapists have endeavored to promote deliberate
portrayal of objects that are thought to symbolize certain archetypes. In
order to activate the corresponding energy fields, clients are asked to
draw, for instance, the sun, moon, fire, water, bird, tree, fish, flower,
eye, nose, mouth, ears, and so on Oacobi, 1969). Actually, archetypes
can never be fully expressed in either pictures or in words. All forms of
expression are only approximations. Although the personal uncon-

scious repeatedly produces images, only the spontaneously occurring
images have any value for healing. The process of healing stems from
being in contact with the deeper regions of the collective unconscious.
The Jungian form of art therapy, easy as it sounds, takes time and
patience. Lyddiatt reported several case examples where astonishing
results occurred after long periods of seemingly unproductive art ther-
apy sessions. For example, a 45-year-old woman who had an IQof 40
and a mental age of 5.5, would sit in a crouched position, pick at her
clothes, look at the ground and not say a word. She would sit for half
an hour in the art therapy room without touching any materials. Final-
ly, she produced her first picture which consisted of 10 horizontal
ragged lines, a blue border and 3 leaf-like shapes. Her second picture
was 6 horizontal lines, a green border, and again three shapes, this time
rectangular. A month later she still did not talk but she did nod when
asked if she wanted more paper. Three months later she drew what
looked like yellow animals in a field, and she placed a sun in the sky.
From then on, her pictures became increasingly richer in content. After
five months, her pictures contained houses with people, furniture, and
a garden. Eight months into therapy, she wrote on one of her pictures,
"Boys and girls come out to play!" and she listed all 12 names of the
nursing and medical staff. She was retested and now her I Q was found
to be 73, and her mental age had reached 8-3/4 years. She had
matured, her attention span had increased, and she was more content
than she had been previously (Lydiatt, 1972, p. 83ff).
In recent years, an original development within the Jungian frame
work has taken place in art therapy. It is the work with the sand tray,
and it is used both with children and adults. This method of working
was originally devised by Dora Kalff (1966) who was one ofJung's stu-
dents. Originally a pianist, she later studied religion and was in analy-
sis withJung. OccasionallyJung's grandchildren stayed with her.Jung
was curious to know what she did with the children because they were
exceptionally well behaved after visiting with her. She related that she
had used the sand tray method which she had learned from Margaret
Lowenfeld in London. While Lowenfeld used the sand tray method
mainly for diagnostic purposes at that time (Lowenfeld, 1979), Kalff
combined this method with the Jungian ideas and gradually evolved a
technique which she called the sandplay therapy (personal communi-
cation to Nucho, 1974).
Kalff's sandplay method consists of a specially proportioned tray

filled with sand. The sand can be either dry or damp, and it is used to
form figures, landscapes, or designs. In addition, the client uses numer-
ous small figures, for instance, humans, predatory animals, birds, etc.,
to be placed in the sand to give tangible form to one's fantasy. The
client also has clay and wood to make new figures, as desired.
Sandplay keeps fantasy within physical limits and thus a polarity of
freedom and constraints is created. Gradually, the opposites within the
personality are portrayed and united. "We find that when totality
begins to manifest itself, the patient is deeply moved. One of the most
beautiful expressions of this experience is the representation of a man-
dala in sandpictures" (Kalff, unpublished paper, undated).
Several art therapists have incorporated Kalff's sandplay method in
their work, notably Rhinehart and Englehorn (1982), and Weinribb
(1983).
Jungian psychology was scarcely known in this country until about a
decade ago. It has been much more widely accepted and used in
Europe than in the United States. In recent years, however, there has
been an upsurge of interest in Jungian thought (Perry, 1962) in the
United States, and it is to be expected that this model of art therapy will
exert an influence on the thinking of increasing more art therapists.
The Gestaltists
Ideas from Gestalt therapy are used by Janie Rhyne to devise a

model of art therapy that may be thought of as representing the "art
wing" of art therapy.
The Gestalt psychotherapy goes back to Fritz Perls who obtained his
MD and PhD degrees from Berlin University and then was trained in
psychoanalysis. He was analyzed by Karen Horney and Wilhelm
Reich. He came to the United States after the Second World War and
was associated with the Esalen Institute in California for many years.
Perls himself considered Gestalt Therapy to be one of the existential
therapies (1969). He thought that except for his brand of existential
therapy, all other forms of the existential therapy borrowed ideas from
some other body of thought. He maintained that Buber borrowed ideas
fromJudaism, Tillich from Protestantism, Heidegger from linguistics,
Sartre from socialism, and Binswanger from psychoanalysis. Although
Perls himself did not think so, it would appear that the ideas of Bergson
permeated his thinking. The central premise in Perls' Gestalt therapy is

that neurosis comes from being stuck in what Perls calls "unfinished
business." Old hurts, scars, regrets, resentments, and guilts are bottled
up, and these mind states contaminate current life experiences. Perls
thinks that the unfinished feelings are stored in the various organ sys-
tems and are manifested in nonverbal forms of communication such as
tone of voice, gestures, and posture. In this, Perls is in agreement with
Wilhelm Reich who spoke of the "character armor" as a means of
guarding against additional pain (Reich, 1933). Perls suggest that the
aim of his Gestalt therapy is to establish a continuum of awareness so
that the organism can work on the healthy gestalt principle and finish
the unfinished situations which we carry with us and are preoccupied
with (Perls, 1969, p. 51). Perls is of the opinion that awareness by and
of itself can be curative (p. 16). He points out that emotions are the
most important sources of behavior. To Perls, emotions are the basic
life force and supplier of energy. The more aware one is of all that one
feels, the more alive one is. Feelings that are not admitted to full aware-
ness stagnate and are experienced as anxiety. According to Perls, to be
healthy is to be mature. To be mature is to accept and integrate all that
one is experiencing. Perls reminds us that maturation is never com-
pleted. There is always something new to be integrated. There is
always the possibility of taking more responsibility for ourselves. Thus,
self-development and creativity are identical to being rich in experi-
ence. And responsibility is simply the willingness to accept oneself and
say, "I am what I am" (Perls, 1969, p. 64). The opposite is being neu-
rotic, pretending, playing a role, or as Jung might have said, of having
only the "persona" and not the "self."
Gestalt therapy of both kinds-verbal and art-consists in helping a
person grow and mature by taking personal responsibility and by being
what the existentialists term "authentic," that is by letting one's outside
appearance match what one is truly feeling within. Growth comes
about by experiencing all one's emotions and by becoming aware of
what it is that one is avoiding and repressing. The means to accomplish
this is not through free association as in psychoanalysis nor is this
brought about by reviewing past events and experiences but by fully
concentrating on the current experiences here and now. Perls points
out that verbal communication is not reliable. "Verbal communication
is usually a lie. The real communication is beyond words. So do not lis-
ten to the words; listen to what the voice tells you, the movements,
posture, image." Or, "Let the content of the sentence play the second
violin only" (Perls, 1969, p. 53). This, of course, is very much along the
same line as the "listening with the third ear" described by Theodor
Reik (1952).
Gestalt therapy has developed a whole series of ingenious techniques
for facilitating the translation of the various nonverbal behaviors into
verbal messages. Some of these techniques are the principle of the
"Now," moving from "It to I," and the "Hot seat" (Fagan & Shepherd,
1970).
Janie Rhyne is the art therapist who has utilized the Gestalt tech-
niques in her work with clients. While living and working in Haight-
Ashbury area of San Francisco in the mid-sixties, Rhyne applied the
Gestalt ideas in her work with clients from the drug culture. She was
convinced about the insufficiency of words, intellect, and the rational
approaches. Instead she embarked on the use of fantasy as a way of
exploring and expanding personality. She saw art expression as a
means of self-expression and a way of extending the scope of experi-
ence.
Rhyne suggests a series of guidelines for Gestalt art experience, such
a trusting one's own perceptions, respecting one's own creativity, giv-
ing one's self permission to play with the art materials, and being fool-
ish. She also encourages the participants in Gestalt art experiences to
pay attention to their feelings and thinking, and to accept the fact that
one has "response-ability," that is, one cannot be passive, and thus one
has to choose what sort of response is best for oneself (Rhyne, 1973).
Gestalt therapy and Gestalt art therapy are most appropriate for the
overly socialized, restrained, constricted individuals who develop var-
ious neurotic manifestations of phobias, perfectionism, and depression.
Gestalt therapy has proven to be less effective with more severely dis-
turbed, psychotic and acting-out kinds of clients. These clients may
need therapeutic techniques that strengthen their contact with reality,
strengthen their social skills, and, in general, provide a slower and
longer process than what Gestalt therapy entails (Fagan & Shepherd,
1970, 234ff).
The Phenomenological Trend
Phenomenology is a descriptive analysis of subjective processes,

according to Edmund Husserl (1859-1938), one of its chief exponents.
A phenomenon is any fact, circumstance or experience that is apparent

to the senses. Phenomenology merely seeks to describe without identi-
fying causal explanations. Applied to psychology, phenomenology is a
theory that holds that behavior is determined by the manner in which
a person perceives reality at any given moment. The phenomenal field,
that is, whatever we perceive, shapes our behavior. The most important
portion of the phenomenal field is that portion of the field which is
ourselves. Our self-perceptions or our self-concept has a great deal to
do with how we respond to events in life. The so-called "self-theorists"
in psychology-Carl Rogers is one of the most prominent ones-postu-
late that a person's behavior will change if his perceptions of his phe-
nomenological field, that is, his concept of himself, can be changed
(Rogers, 1951). Whatever happens to us in life is filtered through our
self-concept. Our self-concept shapes our expectations. Or as Will
Rogers, the homespun Western humorist put it, if you thought you
deserved to be hanged, you would be mighty happy to be merely
whipped.
Mala Betensky was the first to point out the relevance of phenome-
nology to art therapy (Betensky, 1977). A client's art expression may be
regarded as a phenomenon. As such, it has an existence of its own, and
its qualities are observable. This observation should take place without
any preconceived notions in so far as possible, by both the therapist
and the client. The client is guided to see his art expression objective-
ly even though he is, of course, subjectively involved with it. The con-
tent as well as the structural elements of line, form, color, shading,
space, location, tension-and-relief patterns, and abstractions are exam-
ined. Through the detailed examination of their art expressions, clients
discover new facets of their personalities. The clients learn to perceive
more clearly and more accurately the phenomena that abound within
them and in their external world. As clients assume responsibility for
their art work they also start actively to participate in resolving the dif-
ficulties that have arisen in other parts of their phenomenal fields
(Betensky & Nucho, 1979).
The phenomenological approach calls attention to the importance of
an unbiased, objective examination of the clients' art expression. In
this regard the phenomenological approach is similar to the psychocy-
bernetic model which also cautions against the dangers of reading
extraneous meanings into the art productions of clients. The term for
this unbiased examination of clients' art productions in the psychocy-

bernetic model is "ipsomatic seeing" (see Chapters 6 and 9).
Conclusion
The art wing of art therapy, the art psychotherapy, and the arts and
crafts version of art therapy are three distinct models and are practiced
by mental health specialists with several different professional affilia-
tions. Their points of view have been developed through exposure to
psychoanalytic theory, or more recently, through their understanding
and use of Jungian, Gestalt, and the phenomenological approaches.
Against this background, lively theorizing and clashes of opinion have
emerged. The psychocybernetic model is a younger half-sibling of
these several varieties of art therapy and it holds promise for greater
accessibility of art therapy to clients and practitioners alike.
Chapter 6
CONTOURS OF THE PSYCHOCYBERNETIC

MODEL
h is chapter is an overview of the psychocybernetic model. It

T sketches the specific tasks of the therapist and outlines the various
phases of this model.
The psychocybernetic model is a method of utilizing the two coor-
dinates of human cognition, the visual and the verbal. As discussed in
Chapter 3, the visual means of information processing is generally
thought to be associated with the activities of the right cerebral hemi-
sphere while the verbal means of managing information are governed
by processes lodged predominately in the left cerebral hemisphere.
The psychocybernetic model of intervention presents the means of
gaining access to this dual system of encoding. By paying attention to
both channels of information processing in their clients and in them-
selves, therapists can work far more effectively than when only the ver-
bal means of information exchange are heeded. Why hop on one leg
when you can walk on both legs.
Duality of Knowledge
The possibility that human beings normally function with only a

fraction of their brain power was noted by WilliamJames who specu-
lated that we customarily use only 10 percent of our brain capacity
Games, 1890). Human cognition is like a ten-speed bike, but seldom
we use all ten speeds.
The pictorial, nondiscursive modalities of thought have been largely
neglected and belittled in Western culture, except by artists. For
instance, Croce, the Italian philosopher of aesthetics, was convinced
93
that imagination precedes and is indispensable to thought. The artistic

image forming activity of the mind comes before its logical, concept-
forming activity (Croce, 1929).
Croce held that the essence of artistic activity lies in the effort of the
artist to conceive a perfect image. According to Croce, the miracle of
art lies not in the externalization, but in the conception of the idea.
Croce maintained that the difference between us and Shakespeare or
Rubens lies not in the power of externalization of the image, but in the
power of inwardly forming an image that expresses the essence of an
object. Similarly, Michelangelo is reported to have remarked that one
does not paint with the hands but with the brain (Croce, 1929). The
externalization of the idea is secondary to its conception, and it is a
matter of manual skill and a technical know-how. Maslow (1971) makes
a similar distinction with his concepts of primary and secondary cre-
ativity. These two concepts will be highlighted shortly.
The Function of the Therapist
When practicing the psychocybernetic model of interpersonal help-

ing, the task of the therapist is that of a facilitator, mentor, and com-
panion in the client's search for information from internal and external
sources. Thus thoughts and feelings may be clarified and integrated,
new avenues for action may be discerned, and new courage can be
acquired.
In this context it is useful to recall that the original meaning of the
term "therapy" is precisely that of being a companion. The term "ther-
apy" comes from the Greek word "therapon" which means a compan-
ion in arms or a comrade. In Homer's Illiad, Achilles had a "therapon"
by the name of Patroclus. He was a friend and an equal, even though
inferior in rank. The ancient Greeks called kings the servants of God
("Dios Therapontes"), and poets were the servants of the Muses. The
original meaning of the term "therapy" is "to foster and to nurture."
Eventually this activity of fostering and nurturing became associated
with tending the sick and the functions performed by the medical pro-
fession (Liddel and Scott, 1949, p. 315). Now therapy is often thought
to designate exclusively activities associated with the so-called medical
model where the client is a passive recipient of the ministrations of the
helper. The psychocybernetic model reflects the original meaning of
the term. In this model, therapy is regarded not as a process of provid-
Contours of thePsychocybernetic Model 95
ing answers and solutions to be accepted passively by the client, but

rather as a joint venture where the client performs most of the work
while the therapist assists and facilitates this work. Therapy, it seems, is
an activity that is akin to midwifery. The therapist assists in the process
of delivery but the delivery is limited to that which the client has con-
ceived and eventually will have to cherish and care for. The outcome
is in the hands of the client.
In the psychocybernetic model the task of the therapist is to help
clients pay attention to their imagery. This is accomplished through the
various techniques of structuring and by responding to clients' visual
creations in a specific manner. These techniques and principles are pre-
sented in subsequent chapters in some detail. The job of the therapist
is not to impart some specific philosophy of life. Rather it is to help the
clients discern their own inner designs from their previous experiences
in life and to understand their various obligations and aspirations. This
thinking is compatible with the existential stream of ideas which views
the development of the person as being molded by the commitments
and future intentions rather than exclusively by past experiences
(Bugenthal, 1965).
Ipsomatic vs. Nomomatic Seeing
According to the psychocybernetic model, when working with the

externalized imagery of clients, the task of the therapist is not to inter-
pret the symbols contained in the imagery. Rather it is to facilitate the
client's own seeing and understanding of those symbols. Two different
ways of looking at the imagery contained in the client's art works will
clarify this distinction. The one is what I term the nomomatic manner
of looking at the visual product. Here the visual expression is analyzed
according to the assumptions and findings of some theoretical
approach. The term is derived from the Greek word "nomos" meaning
"law" plus "mntos" meaning "thinking." When using the nomomatic
approach, explanations are provided to the client by the therapist
based on laws derived from some theoretical position or some empiri-
cal research. For instance, a nomomatic manner of looking at the
client's drawing shown in Figure 5-2 would be to notice shapes that
might conceivably be interpreted as being phallic, if the therapist's ori-
entation happens to be Freudian. Or, a therapist familiar with the
research spearheaded by Machover might pay attention, among other
things, to the presence of buttons in client's self-portraits. These have

been found associated with dependency strivings in clients.
The other manner of looking is what may be termed the ipsomatic
seeing. This term is coined from the Latin word "ipse" meaning "self,"
plus "mntos" meaning "thinking." Here the clients themselves provide
the concepts and the assumptions that make sense out of their visual
imagery. These two methods of analyzing the client's art productions
are discussed further in Chapter 9. The ipsomatic seeing is one of the
core concepts of the psychocybernetic model of helping. The ipsomat-
ic approach enables clients to use their own premises and criteria to
decode the meaning contained in their imagery and thus enrich their
fund of useful information. Therapists who want to implement the psy-
chocybernetic model of intervention have to incorporate the concept
of ipsomatic seeing into their thinking so that they may implement it
consistently when guiding their clients towards greater clarity of their
various experiences. Subsequent chapters detail how this is accom-
plished.
Primary vs. Secondary Creativity
Another important function of the therapist is to help clients rekin-

dle the joy in the primary forms of creativity. Primary creativity is the
idea generating phase of creativity which in many clients may have
been squashed by well meaning but misguided parents and teachers
who made premature demands for performance.
The distinction between the primary or idea generating phase of cre-
ativity and the secondary or the execution phase was suggested by
Maslow (1971). The first or the idea generating phase, according to
Maslow, is the manifestation of true creativity. The next phase, when
that idea is given form through persistence and workmanship, is actu-
ally more a matter of diligence and plain work than a matter of cre-
ativity.
When applying the psychocybernetic model of intervention, we
attempt to stimulate the primary creativity rather than the secondary
type creativity. We ask clients to work spontaneously and fairly rapid-
ly, without worrying about polishing and perfecting their creations.
What matters is the process of stimulating imagination and what the
client experiences during this phase of activity rather than what the fin-
ished product looks like. Primary creativity is the realm of information
processing. It provides the means for discerning the propitious direc-

tions one's life can take after it has bogged down, burdened by various
perplexities which have accumulated from the conflicting messages
absorbed from contradictory sources of counsel.
The distinction between the primary and secondary forms of cre-
ativity is not clearly drawn in many other forms of interpersonal help-
ing where art therapy techniques are used. In fact, many art therapists
expect their clients to acquire artistic skills of an increasingly greater
complexity so that the work created may be meaningful not only to the
creator but to the spectators as well. Here the primary creativity is
downgraded in favor of the secondary forms of creativity. This is the
crux of the controversy between what may be termed the art wing and
the therapy wing of art therapy. (See Chapter 5 for a discussion of the
differences between these two versions of art therapy.)
By harnessing the clients' primary creativity and by externalizing the
imagery with the help of simple art materials, the information encoded
in the several levels of the human system can be made available for
more effective problem solving. Human cognition proceeds with the
help of two coordinates, sensory/visual and the verbal/rational. The
psychocybernetic model provides the means for combining these two
forms of information. The customary reliance on the verbal/rational
means of information processing is like trying to function by using only
one eye. It is much more advantageous to use both coordinates of
human information processing, just as it is so much more effective to
use both eyes instead of just one.
The Four Phases of the Therapeutic Process
The therapeutic process in the psychocybernetic model consists of

four phases which are summarized here. Subsequent chapters detail
each of these phases.
The first phase is the Unfreezing Phase. At this point the client needs
an explanation about the purpose of Visual expression. The therapist
has to be aware and respond appropriately to the various fears that
clients invariably experience when they agree to engage in art expres-
sion. Many clients may not have used any art materials since their very
early school days. The therapist also has to clarify with the client how
much time can be spent working and what will happen after the picture
or the sculpture has been completed.
During the next phase, termed the Doing Phase, the task of the ther-
apist is to make the art materials available to the client and to structure
the experience by either suggesting a specific theme for the visual prod-
uct or by agreeing that the client will proceed according to his or her
own inclinations. From then on the therapist remains an unobtrusive
observer and, if necessary, a troubleshooter by fielding interruptions
that may arise from some external source, such as the telephone. The
length of this phase varies depending on the kind of client one is work-
ing with. The clients should be encouraged to work spontaneously and
fairly quickly without worrying about the aesthetic merits and the
aspects of workmanship. This conforms to the concept of cultivation of
the primary forms of creativity as opposed to the secondary forms of
creativity referred to previously (Maslow, 1971). The Doing or Execu-
tion Phase is usually quite absorbing for the clients, and care should be
taken not to distract their concentration during this phase.
When the client indicates that he or she has finished the work, the
Dialoguing Phase begins. Now the therapist initiates the discussion of
the visual creation. The right brain messages are now transposed into
the logical, sequential, verbal, and logical terms of the left brain.
The final phase of the therapeutic interaction is the Ending Phase
when the session or a series of sessions come to a close. A sense of clo-
sure has to be attained and the ideas acquired during the therapeutic
interaction have to be consolidated with the information previously
available to the client. The closure and integration of the ideas derived
from the visual expression may proceed bit by bit as ideas tend to
resurface long after the therapeutic process has officially come to a
close.
The four phases of the psychocybernetic model and the extent of
client's investment in each are presented diagrammatically in Figure
6-1.
The length of each phase varies depending on the kind of client one
is working with. With children the warm-up, or the Unfreezing Phase,
is quite short. Also, the Dialoguing Phase may be quite short, consist-
ing only of a few comments. With adults the warm-up or the Unfreez-
ing Phase will be more extensive at the beginning but will be quite
brief during the latter sessions. Figure 6-2 portrays these distinctions.
The specific handling of these four phases of the model with different
kinds of clients is discussed in greater detail in subsequent chapters.
PHASES OF THE PSYCHOCYBERNETIC

MODEL AND THE EXTENT OF CLIENT'S
INVESTMENT
High
Doing
Producing
Dialoguing
Examining
Sharing
Closure
Unfreezing
Warm-up
Low
Time
Figure 6-1. Phases of the Psychocybernetic Model and the Extent of Client's Investment.
When and How to Use the Psychocybernetic Model
The psychocybernetic model, utilizing the image-making capacity of

human cognition, can take several forms. It may be the exclusive
modality of therapeutic communication and some visual product may
be created by the client during each session. Or the creation of some
visual expression may take place intermittently. For some adult clients
the visual creation at times is so rich in ideas that several sessions may
be required to deal with these ideas and their implications.
Depending on the age of the client and other factors which are dis-
cussed in Chapter 8, clients may produce one single form of visual
expression during a therapeutic session or they may generate a series
of creations. When a client is exceedingly prolific, care should be taken
to discover if this wealth of visual creation may not be a way of cur-
tailing the Dialoguing Phase of the process.
With whom can the psychocybernetic model be used effectively? In
my experience, good results can be obtained with clients of all levels of
education and from all socioeconomic classes, ranging in age from
RELATIVE LENGTH OF EACH PHASE OF

THE PSYCHOCYBERNETIC MODEL WITH
DIFFERENT CLIENT POPULATIONS
A B C D
Children
A B C D
Adolescents
A B C D
Adults
CODE: A = Unfreezing
B = Doing
C = Dialoguing
D = Closure
Figure 6-2. Relative Length of Each Phase of the Psychocybernetic Model with Different
Client Populations.
three to 93 and beyond. In fact, art therapy was used effectively with a
gentleman who was 96, blind, and wheel-chair bound (Doll & Nucho,
1982). He produced a series of clay figures while engaged in what is
known as life review (Buttler, 1963). The making of the various figures
facilitated reminiscing and sorting out his diverse life experiences.
Is it necessary for clients to be interested in art in order to benefit
from the psychocybernetic model of intervention? Decidedly not.
Many clients have confessed that they disliked art. In fact, some have
said that art had been their "worst" subject while in school. In the psy-
chocybernetic model the secondary forms of creativity are not
required, and soon the clients discover that this type of "art" is differ-
ent than what they remember from school. The primary or the idea
generating forms of creativity can be resuscitated by a caring and sen-
sitive therapist so that new forms of knowledge can be generated for
the improvement of clients' functioning.
The psychocybernetic model can be used with clients individually as

well as in groups. Working with clients in groups does place additional
requirements on the therapist but for the clients it also provides added
stimulation and opportunity for sharing.
Do clients need to have a certain level of verbal or intellectual
sophistication to benefit from the therapeutic process conducted
according to the psychocybernetic principles? Again, the answer is a
decided "no." The psychocybernetic model has been used effectively
with learning disabled clients who otherwise have difficulties in
expressing themselves and conveying their thoughts. The very fact that
there is a concrete self-produced product enables these clients to stick
to what they are grappling with and want to convey.
Let us assume that by now you are convinced that it is worth to
expand your repertoire of therapeutic skills and you have decided to
incorporate the psychocybernetic model into your practice. You want
to utilize the verbal/discursive as well as the pictorial/presentational
modalities of symbolization with your clients. What do you need to get
started? Certain personal and the professional qualifications are neces-
sary for the use of the psychocybernetic model of intervention. Practi-
cal matters such as the space, time, and the necessary art materials also
have to be considered.
Personal Qualifications
By and large, the personal qualifications of a therapist who wants to

apply the psychocybernetic model are the same as those required for
the practice of most other forms of interpersonal helping. To be a ther-
apist you need a certain level of sensitivity and perceptivity. The fol-
lowers of Carl Rogers tend to subsume these qualities under the
acronym WEGs: warmth, empathy, and genuineness. Most standard
texts on psychotherapy describe these qualities well (Hepworth &
Larsen, 1982). In general, it is best if the therapist assumes the role of a
guide and a companion, as the original meaning of the term "therapist"
suggests. This was discussed in Chapter 4.
Besides the general therapeutic stance, are there specific artistic qual-
ifications? Does the therapist have to have artistic training to be able to
use the psychocybernetic model of intervention? In art therapy, two
distinct schools of thought exist on the question of art background. As
far as the practice of the psychocybernetic model is concerned, no spe-
cific art training is necessary for the therapist. Actually, the therapist
who is not a trained artist finds it easier to adopt the ipsomatic approach
to viewing the clients' productions than does a therapist with an exten-
sive art background. The ipsomatic approach discussed earlier in this
chapter is an essential part of the psychocybernetic model. Also, a ther-
apist who harbors no ambitions to be an exhibiting artist generally finds
it easier to promote the primary creativity (Maslow, 1971) and its idea-
generating features than does a therapist who strives to satisfy some
general audience. Therapists who have attained or who aspire to artis-
tic excellence themselves usually want their clients to reach the level of
secondary mastery when technical skills and persistence of execution
are called for. But as Termo Pasto, one of the early art therapists used to
say, in art therapy, skill is not the horse that pulls the cart.
To engage clients in the practice of art expression of the kind that
leads to good therapeutic results according to the principles of the psy-
chocybernetic model, the therapist needs respect for the creative
process and an appreciation of visual forms of expression. This position
is similar to the one promoted by Naumburg (1966). She thought that
it was a mistake to suppose that only persons with previous art training
can use art therapy techniques. Instead, Naumburg thought that pro-
fessional psychotherapeutic training was the paramount requirement
for the practice of art therapy. In her experience, "a sympathetic inter-
est in any of the creative arts" would be sufficient to help the therapist
encourage the creative efforts of one's clients. Naumburg said, "What
is essential, then, to a psychotherapist who wishes to learn how to use
the art therapy approach is not that he be able to create pictures him-
self, but that he have a sympathy for and an understanding of the cre-
ative efforts of his patients and that he believe in their creative
potentiality" (Naumburg, 1966, p. 14).
Professional Preparation
The psychocybernetic model is a form of psychotherapy and as such,

it is subject to the same professional regulations as those of any other
form of psychotherapy. Thirty years ago it was generally assumed that
only psychiatrists were qualified to do psychotherapy, while psycholo-
gists, social workers, and other mental health specialists functioned in
an ancillary capacity. In recent decades the immensity of emotional
problems in our society has considerably expanded the cadres of pro-
fessionals who can qualify for the practice of psychotherapy. In recent

years, the self-help movement has burgeoned and good results have
been attained by helpers who have little or no professional training.
Many of these well-meaning helpers, however, soon burn out and go
stale. What ever the legal licensing requirements in each state for each
level of practice, formalized professional training is necessary for the
protection of the therapist's own mental health. A solid foundation in
any of the mental health professions, be it psychology, social work,
occupational therapy, or as a nurse practitioner, will permit the thera-
pists to function well and add the psychocybernetic model to their
repertoire of skills. Perhaps the quickest and the surest way to becom-
ing an effective therapist is by acquiring the MSW degree. This is a
two-year, full-time course of study leading to a masters in social work
degree. Part of it consists of classroom work and part of it is an intern-
ship working with clients in various human service agencies. At some
universities, the course of study may be pursued on a part-time basis
over a period of four years. This permits the student to hold on to a job
and be relatively self-supporting financially while working toward a
degree.
Once a solid foundation has been attained in one of the primary
mental health professions, the skills required for the practice of the psy-
chocybernetic model can be acquired easily by taking courses offered
at a number of institutions. Information about these courses can be
obtained from the American Art Therapy Association. The American
Art Therapy Association holds annual conferences and various work-
shops are offered at locations allover the United States and in several
countries in Europe as well.
How to update and expand one's therapeutic effectiveness is a mat-
ter each professional learns during the basic course of professional
preparation. Supervision is one avenue towards increasing and polish-
ing one's therapeutic skills. If a seasoned practitioner is not available to
provide supervision and/or consultation, peer supervision can be
worked out whereby professionals of equal level of experience meet
periodically to discuss their work in order to learn from each other and
safeguard against personal blind spots or biases.
A credentialing process has been developed under the auspices of
the American Art Therapy Association, and information about it can
be obtained from that organization. But long before the requirements
for this kind of certification can be satisfied, a person with a solid pro-
fessional education should be able to derive considerable benefit and

enjoyment by trying out the techniques suggested by the psychocyber-
netic approach.
Some of the tangible ingredients needed for the practice of the psy-
chocybernetic model are art materials and adequate space. Time is
another factor that is essential to a successful practice of the model.
Art Materials
The psychocybernetic model of therapy requires simple art materi-

als of the two-dimensional and the three-dimensional kind. Two factors
will generally influence the kind of art materials the therapist will want
to use. The one factor is the size of the budget available for this pur-
pose. The other factor is professional affiliation of the therapist.
Therapists who have come to art therapy by way of the fine arts gen-
erally tend to assume that the art materials needed are rather elaborate
and extensive. One art therapist, for instance, who is a noted artist her-
self, considers the following materials to be indispensable, although she
herself has been able to do effective art therapy with far fewer materi-
als: charcoal, tempera paints, pastels, ceramic clay, easels, a kiln, run-
ning water, a large sink, and ample storage space (Kramer, 1971, p. 44).
Therapists whose professional identification is with one of the help-
ing professions tend to use quite simple and few art materials. For
instance, one psychiatrist carries a few colored felt tip pens in his shirt
pocket and he uses ordinary writing paper for many of his therapy ses-
sions (Horowitz, 1970).
For work with most clients, you will need 12" by 18" white drawing
paper, two or three sheets per client per session; a box of semi-hard
pastels, either for each client or to be shared by several clients; and a
handful of black and colored Magic Markers". A roll of brown or white
wrapping paper may also prove useful, especially for group murals, or
for continuous work extending over a number of sessions. It is best to
avoid using materials which the clients may have used in school, such
as crayons, pencils, and ballpoint pens, because these may bring back
some unfortunate associations with previous efforts at art expression.
The pastels generally turn out to be the most popular material. The col-
ors blend easily and thus the altering of the drawing done in pastels is
simpler than when done with crayons or felt-tip pens.
Additional materials may be offered to the clients from time to time

in order to stimulate their imaginations. Poster paints, clay, wire, and
pipe cleaners may be used. However, more often than not, these mate-
rials are ignored by the clients in favor of the semi-hard pastels and
white drawing paper.
Pastels come generally in two kinds: semi-hard and oil pastels. The
oil pastels have brighter colors, but they are more difficult to use and
they do not blend as easily as the semi-hard variety. The semi-hard
pastels are somewhat crumbly and messy but generally clients adjust
easily to their use, provided that they have access to a place to wash
their hands, or they can use paper towels to clean their hands when fin-
ished.
The pastels come in boxes of 12 or 24 sticks per box. The boxes con-
taining 12 sticks are quite sufficient for most instances of the psycho-
cybernetic model. If you work with clients who are depressed, you will
find that the black color will be used up twice as rapidly as any other
color.
If you want to use poster paints, buy the dry pigment and mix your
own. Any brand is fine. You will need to collect some glass jars (from
baby food, instant coffee, and the like) for mixing the paints. The best
way to mix the paints is to put the pigments in a jar and then add water
slowly, stirring with a stick until the mixture is a thick glob. Then add
water to attain the desired consistency. It is wise not to use paints until
you are certain that your clients, especially the younger ones, can use
them without regressing to an acting-out stage. The properties of vari-
ous materials useful in art therapy are discussed in some detail by
Kagin and Lusebrink (1978). This article contains additional sugges-
tions concerning the properties of the various art media.
When paint is used, brushes of several sizes will also be needed. The
natural bristle house painter's brushes, one and one-half by two inch-
es, are the most appropriate and the least expensive ones available.
If storage space is available, you may want to use ceramic clay to
encourage the three dimensional forms of expression. The red earth
clay is most inviting. It comes premixed in plugs of 25 and 50 pounds.
Between sessions it may be stored in some plastic container or bag and
covered with some wet cloth to keep it from drying out. Again, con-
sider the age and the developmental stage of your clients. Young clients
are sometimes inclined to use clay as ammunition to settle their dis-
putes!
A base for clay work will also have to be provided. It may be a

board, approximately 18 by 18 inches. Masonite or plastic or any
smooth surfaced material will do.
Some plastic tape, such as freezer tape, 3/4 inches wide, will be need-
ed to attach the pictures on the wall so that the pictures can be dis-
played when the clients are ready to engage in what is termed the
dialoguing phase of the process.
It is advisable to have the visual products available for examination
at various points of the therapeutic interaction. For this reason, it is use-
ful to store all the drawings in some folder and keep them in the ther-
apist's office until the conclusion of the treatment. A sturdy, folded over
sheet of paper can serve as a folder for each client's pictures. If your
client is prolific, you may want to select only a representative picture
for the folder from each session's crop of productions. The clients may
have access to their folders whenever they wish, but the folder should
be stored in some safe place by the therapist so that the visual creations
may be reviewed by the therapist and the client during the termination
phase of the therapy.
For pictures made with pastels, some kind of fixative will be needed
so that the pastels do not rub off. Fixative can be bought at any art sup-
ply store, or you may want to use a hair spray for this purpose. Usual-
ly the cheapest hair spray serves the purpose quite nicely.
Have a roll of paper towels and a damp sponge handy so that clients
may wipe the pastels off their hands at the end of the session. It may
also be wise to alert the clients not to wear their very best outfits on the
days when art expression is planned for the therapy session.
And finally, the size and quality of the paper are important. The
quality of the paper used may have to depend on the size of the budg-
et available to you for this purpose. Paper of too low a quality may
seem somewhat depreciating to some clients. On the other hand,
expensive materials may be experienced as inhibiting and demanding
a high level performance by other clients. The least expensive is
newsprint paper which comes in large sheets and may be cut to desired
size. White paper generally works best, but for the sake of variety you
may want to add some construction paper of various colors and some
manila drawing paper.
The size of the paper will depend on the type of clients you are work-
ing with. Aggressive clients may need some sturdier and larger size
paper than depressed clients. Aged adults will want smaller size paper
than do energetic adolescents. For clients who are in wheelchairs or
paralyzed on one side, you may want to tape the paper down so that it
does not slide around.
Finally, it is best to keep the art materials fairly simple. Do not over-
whelm your clients with too many choices. Start with the pastels and
add other materials later, if your budget permits.
Space Requirements
Another consideration is the space requirements. In most instances

you can engage clients in art expressions based on the psychocyber-
netic principles by using simply a corner of a regular office desk. Art
therapists who belong to what is termed the art wing of art therapy like
to use easels when working with clients. It is quite possible, however, to
do without any easels. It is best to be quite informal in this regard.
When working with children, adolescents or young adults in groups,
clients frequently simply flop down on the floor to find adequate work-
ing space. With elderly clients one needs some space at a table. Bedrid-
den clients will need some board to support the paper or the clay they
are working with.
Time Considerations
A final comment is the time required for art expression. If you nor-
mally spend 45 minutes with your client individually when engaged in
verbal forms of therapy, allot some 75 minutes when using the psycho-
cybernetic model of helping where some visual expression will take
place. The clients tend to find a wealth of information even in seem-
ingly primitive and meager visual productions. Consequently, the
process of discussion tends to consume more time than originally
planned. Also, time is needed for cleaning up and putting away the art
materials before your next appointment. Be prepared to return with
your client to the discussion of the visual product during subsequent
sessions as additional ideas will have been stimulated by this new
modality of expression.
Conclusion
The psychocybernetic model is a creative-experiential form of inter-

personal helping. It utilizes both the right and the left hemispheric
forms of symbolization. Both the verbal and the visual channels of
expression are engaged. Thus, this model provides a new method of

therapeutic intervention and it offers ways of enlarging one's repertoire
of therapeutic skills.
Part Two
THE THERAPEUTIC PROCESS

Chapter 7
THE UNFREEZING PHASE
T h e first phase of the psychocybernetic model of art therapy may be

thought of as the unfreezing phase. It is more than simply a warm-
up phase; the therapist deliberately has to perform several tasks so that
the warm-up may take place. These tasks are, first, to deal with the
client's apprehensions about the process of visual expression, then, to
provide a structure for the process, and finally, to provide the psycho-
logical and the concrete means of getting started.
As discussed in earlier chapters, the psychocybernetic model differs
from the traditional forms of verbal therapy in that it utilizes a process
of communication that is not primarily through words but, instead of
and in addition to words, it is communication through lines, shapes,
and colors. But how do you get a client to use the art materials when
they frequently claim to have no interest in art and when they think
that they have no artistic ability whatsoever? Additionally, males in our
culture often view art to be "sissy stuff," a feminine-type activity which
they consider beneath their male dignity. Not infrequently a well-mean-
ing therapist has to cope with clients who instead of eagerly embracing
the opportunity to engage in art expression, maintain adamantly, "I
cannot draw. Art was my worst subject in school. It bores me to death."
Granted that some people are visualizers while others are more
inclined to use their auditory faculties, and still others are what Lowen-
feld termed "haptics," that is, instead of depending on the sight, even
when endowed with good vision, they depend more on the sense of
touch (Lowenfeld, 1964), still the visual sense is basic in most human
beings. It is a rare person indeed who is entirely bereft of the visual
modality of relating to the world, leaving aside for the time being the
problems of people who are born blind. Behind the reluctance to
111
engage in the visual forms of expression are usually apprehensions and

misgivings that clients have acquired through various painfully belit-
tling experiences early in life which have robbed them of their natural
ability to utilize what Langer terms the nondiscursive means of com-
munication (Langer, 1942). The first task of the art therapist, therefore,
is to be aware of the normal and expected apprehensions of clients
when first asked to portray their thoughts and feelings in some visual
format. These apprehensions may be voiced openly or they may be
lurking behind a brave exterior.
Common Misapprehensions
The most common concern of adult clients is the lack of their tech-
nical proficiency. "I have not touched paints since I was in grade
school." Without engaging in a long scholarly discourse on the advan-
tages of the visual means of expression, all the therapist needs to do is
to assure the client that this is a "different kind of art." Or, "you do not
have to be an artist to do this kind of art. In fact, you will get more out
of it if you do not have the technical skills of a professional artist." Addi-
tionally, something may have to be said to explain to the client the
purpose of the art therapy session. The therapist should make it clear
to the client that the purpose of using the art materials is not to engage
the client in an art lesson but to provide a different method of getting
hold of some feeling or experience which may be difficult to put in
words. "Words are clumsy. Sometimes it is hard to make oneself under-
stood. It is so easy to be misunderstood. See what you can do with this
type of expression. See what you can convey with just lines and colors."
Or, the therapist may choose to say something like, "This is a different
kind of art than what you used to do in school. The purpose is not to
find out how well you can draw but to see what you can figure out
about yourself."
Another frequent apprehension of clients is the possibility of reveal-
ing too much about themselves. Basically this is the fear of not being
liked and accepted should others find out what one is "really" like.
Here the therapist through her own demeanor and through explicit
statements has to convey to the client an interest and respect for the
client's feelings. Furthermore, verbally and nonverbally the therapist
has to make clear to the client that the client and no one else is the final
authority on what the client's creation means. The psychocybernetic
The Unfreezing Phase 113
model promotes what was termed the ipsomatic as opposed to the

nomomatic seeing (see Chapter 6). The therapist and the other mem-
bers of the group, if the session takes place in a group setting, can only
say how the picture affects them and not what it signifies. As the clients
realize gradually that they themselves are the experts and the final
authorities on the meanings of their art expressions, their defensiveness
and apprehension about revealing too much of themselves invariably
wither away. In fact, soon clients themselves openly solicit reactions to
their creations from the therapist and their fellow clients in order to
deepen their perceptions of what they have conveyed through their
work.
Still other clients phrase their apprehensions about the process of
visual expression by claiming that the activity is "childish." If the ther-
apist is convinced about the benefits to be derived from the use of the
so-called nondominant cerebral hemisphere all the therapist needs to
say is that it is alright to dally and be child-like at times. "You deserve
to have a good time once in a while. To play around is one way to
unwind and to recharge our batteries." Or to pseudosophisticates a
therapist might comment that there is such a thing as "serendipity,"
that is, making fruitful discoveries accidentally.
Concerning the idea of some male clients that art is a feminine activ-
ity ("sissy stuff"), one can remind the client that actually throughout his-
tory, as we know it, males have been the prominent artists. Some forms
of art require a great deal of physical strength. No particular physical
exertion will be required in art therapy. However, there will be mental
exertion at times, and that takes courage and determination.
Many adults who claim that they have no artistic inclinations or abil-
ity actually have engaged in activities which although not usually con-
sidered artistic, nevertheless have required discernment of patterns and
a combination of ingredients. Many homemaking activities, for
instance, entail the use of the right cerebral hemisphere. Cooking, fur-
niture arranging, letter writing, carpentry, gardening, quilting, and so
on, engage many of the same mental processes that are used in artistic
expression.
One additional group of clients deserves a special mention in this
context. Although it is a rather small proportion of the general popula-
tion, not infrequently in art therapy one encounters clients who are
either children of, or siblings of, artists who have attained the level of
professional expertise in some branch of the visual arts. Many of these
clients are not only convinced of their lack of talent but, in addition,
they have some rather humiliating memories associated with their
early artistic endeavors and their inability to compete with their artisti-
cally accomplished parents or siblings. For these clients the discomfort
with art expression can be eased considerably by making the distinc-
tion between what Maslow terms the primary and the secondary cre-
ativity. By primary creativity Maslow means the idea generating and
inspirational phase, while he terms the phase of execution and appli-
cation of technical skills the secondary creativity (Maslow, 1971). In art
therapy we are interested only in the primary creativity, not the sec-
ondary creativity. It should be kept in mind that these clients may have
expressed their innate creativity in different ways than what was
rewarded in their particular family. When the psychocybernetic model
is used, this creativity can be further cultivated and enhanced.
Client apprehension which the therapist ignores or overlooks will
snowball into resistances which will impede the process of therapy.
One young therapist visualized the resistance of her client as a bunch
of balloons pulling him away from the therapist (Figure 7-1). If the
therapist does not pay attention to the client's resistances the client
indeed will be pulled away and he will become a therapy dropout.
The client's verbal and nonverbal messages about his apprehensions
have to be dealt with both at the outset and as they arise in the course
of the session. The therapist's own comfort with this modality of com-
munication goes a long way towards easing the client's fears of the
process. No long lectures about the benefits of visual expression are
necessary but rather sensitivity to the common expectable worries
about the strangeness of the unaccustomed activities. All beginnings
are somewhat frightening. Beginning to use art materials is no excep-
tion.
After the initial fear has been overcome, clients benefit from the
opportunity to compare and see that their fears were not unique. One
client, for instance, expressed his apprehension about being different
than the other members of the group by portraying his experience of a
beginning as being the "odd man out" (Figure 7-2).
Preparing the Client for the Experience
Inasmuch as all beginnings are difficult, it is best to engage the client

in the art experience as soon as possible so as to give the client a taste
Figure 7-1. Resistance. Reprinted with Permission from the American Art Therapy Asso-
ciation, DiMaria, A.E. (Ed.), Art Therapy: A Bridge Between WOrlds, 1981. All rights reserved.
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Figure 7-2. The Odd Man Out.

of what it is actually like. When already engaged in verbal forms of

therapy, depending on the kind of client one is working with, the ther-
apist may choose to alert the client that next time something different
would be tried. This gives the client the opportunity to "brace" and
gather his wits. With other clients it is best to do the explaining and the
doing immediately, one after another, in the same session. With still
others, the therapist may choose to be noncommittal and say some-
thing like, "Some people have found this way of communicating bene-
ficial. See if it does anything for you." In some instances, the therapist
might use a rather authoritative approach. For example, in a setting
where the clients are used to being told by authority figures what to do,
one young art therapist, desperate that his group therapy sessions were
producing only monosyllabic responses from the clients despite his
best efforts, told the group, "We are not getting any place. Next time we
will try something else which, I think, will help you." Next time he
brought along some paper and crayons, and the group, after some ini-
tial hesitation, engaged in an unusually rewarding sharing of their
hopes and worries through their admittedly primitive pictures.
No one method of handling the initial apprehensions will work for
all clients and all therapists. The therapist's own style and personality
will determine what is appropriate. The main thing is to know that all
clients are apprehensive, for various reasons, and do need some reas-
surance from the therapist. Moreover, once provided,-the reassurance
may have to be repeated again at some later point. In fact, it is wise to
provide some simple statement about the purpose of the art expression
at the outset of each session, even when the client has engaged in art
therapy for a considerable period of time and with apparent degree of
enjoyment. For instance, one gO-year-old gentleman who was wheel-
chair-bound had been in therapy for six months. At the beginning of
one of his art therapy sessions, he said, "I am going to make a mess
today..." Here the therapist had to explore what he meant by "mess"
and why "today." As it turned out, he had tried, up to that point, to pro-
duce drawings he thought were pleasing to his art therapist. He was in
a bad mood that day because the nursing aid had not helped him to get
ready for the session in time. Instead of his usual sunny memories he
was more inclined to draw a picture of the unpleasant current reality.
This, too, he was assured, was quite acceptable, and he felt better once
the unpleasant feelings were down on paper, instead of simmering
within.
Limbering Up
During the beginning phase, which we have decided to term the

unfreezing phase, the therapist's second task is to help the clients over-
come their inhibitions and warm up for the art expression process. To
some extent, the mental loosening up may have taken place through
the explanations and comments offered in response to the various
apprehensions of the client. Now the therapist has to get the client to
actually make contact with the art materials and use them. Some art
therapists simply encourage the client to explore the materials and to
experiment and see what can be done with each (Rhyne, 1973). One art
therapist used to take a pastel and shows how it could be used like a
pencil or on the broad side, and how the colors would blend
(Kwiatkowska, 1978). Still another art therapist suggested that physical
limbering up exercises help to stimulate the mind and let the images
arise. Cane, for instance, suggested to her young artists that they stand
with their feet about twelve inches apart, bend down from the hips,
and touch the ground. Then she asked them to imagine that they were
reaching up toward the sky, or that they had a tree trunk between their
hands, feeling its texture as they reach toward the tips of the branches
(Cane, 1951, pp. 48-53). Exercises of this kind loosen the clients' mus-
cles and give them a sense of the expansion of their bodies, which in
turn facilitate their sense of power and rhythm, and these qualities may
then be invested into their drawings.
When working with adults who have no previous exposure to the
fine arts the bending and stretching, simple circling of arms and the
drawing of lines in the air, some wiggly, some straight, some circular,
tend to dissipitate the tension which has been generated by the sugges-
tion that they engage in art activity. It also provides a touch of light-
heartedness and a sense of enjoyment. The spontaneity generated by
the physical limbering up seems to spillover into spontaneity of visual
expression. Additionally, the physical activity prompts blood circula-
tion and this has a positive effect on the mood and the mental state of
the clients.
Structuring
During the beginning or the unfreezing phase, the final task of the
therapist is to structure the experience. The therapist should indicate
how much time the client has to make the picture, to sculpt the figure,
or to do whatever else is to be accomplished. Normally, in the interest
of promoting spontaneity and easing the fears about the lack of techni-
cal skills, it is best to suggest that the client proceed without much delib-
eration. "Work fairly rapidly. No need to bother with details." The
therapist should not impose any specific time limit, but he should have
some idea about how much time can be allotted to the working phase
and how much will be devoted to the discussion phase, or what I term
the dialoguing phase. Usually the therapist finds that it requires twice as
much time as anticipated. Usually so many ideas surface in response to
even seemingly meager pictures that the sessions tend to exceed the
time limits originally set.
When structuring, the therapist should either suggest that there is a
particular theme for the work or that the clients are free to produce a
picture about whatever they wish. More about ways of suggesting spe-
cific themes in our next chapter when we turn to a discussion of the
doing or the working phase.
The Process of Engagement
Here is how an art therapist engaged a group of institutionalized eld-

erly clients in the process of art therapy. Emphasizing two ideas, the
therapist first encouraged the clients to produce something that was
meaningful to themselves rather than something that might appeal to
other people. Then they were encouraged to be imaginative, to exper-
iment, and to find out what appealed to them. These ideas were
emphasized as the therapist proceeded to demonstrate what could be
done with the semi-hard pastels that were used in the session.
First, the therapist suggested that actually everybody is an artist. "To
be an artist means that you have a certain freedom to experiment. You
do not have to please others. You can be unique. Picasso, for instance,
made pictures that look rather weird, and yet no one laughs at him any
more because he was an artist." While the therapist spoke, she took a
pastel and began to move it across the paper, punctuating her conver-
sation with lines and curves until she had completed several images.
'Just draw some lines. Like this. What do these lines look like? To me
they look like a mountain. I can turn them into something. I am an
artist now. I can do what I like. Just experiment. To be an artist is to
experiment. Just put down all kinds of colors ... then I will see if I can
turn them into something ... To me it looks like ... a lot of things ...
I keep adding to it ... until I am finished ... I keep working at it for a
.
I ong time.... "
Secondly, she conveyed to the clients the notion that uncertainty
could be tolerated. In fact, uncertainty is part of the process of creating.
"I do not know yet what it will be ... I can turn it into anything I want.
It is just a scribble. It does not take brains just wanting to express
yourself ... scrubbing it ... and scribbling it just push the crayon
around the paper. Then see if you can turn it into something ... per-
haps some flowers here ..."
Then it was suggested that the same process could be used with dif-
ferent materials. Clay, for instance. "If you do not want to draw, you
can use clay. Just press down with your fingers. You can make some-
thing out of it ... it does not take long ... you shape it ... you work
with it ... and then you finish it anyway you like it."
Finally, after the elderly clients had witnessed the apparent ease and
enjoyment of the art therapist, they were encouraged to try for them-
selves. They were ready to respond positively to her question: "Are
you ready to do something?"
In conclusion, then, we should keep in mind that during the first ses-
sion, the clients must be helped to overcome their inhibitions, misgiv-
ings and apprehensions about art which they may have harbored all
their lives. These apprehensions will not be laid to rest once and for all
but will resurface periodically in the later sessions. The therapist has to
be alert and ready to reassure the client from time to time. Some reas-
surance can be provided verbally. Sometimes the therapist may choose
to provide some simple demonstration about how to use the materials.
If the therapist happens to be a skilled artist, however, it is best to avoid
the demonstrating. This might inhibit the client whose work, in com-
parison, might appear quite immature and sterile.
One brain-damaged nursing home client could not be engaged in art
expression. For three weeks, she came and paced up and down in the
room. The therapist tried to demonstrate the process of art therapy by
putting some lines on her sheet of paper. Several sessions later when
the sheet contained what looked like four boxes, she smiled and said,
"It is mine!" Mine what? She proceeded to work on her picture for 45
minutes. At the end of the session the therapist asked her to explain her
picture. She said that it was her family. "This is my mother, this is my
sister, and this is myself." "And what is this here?" the therapist
inquired, pointing to the fourth smaller and darker box. "That is my

no-good father who left us when we were quite small ..."
Lyddiatt (1971) reported a similar example of a slow but eventually
successful process whereby a brain-damaged adult client successfully
engaged herself in the process of art therapy. A 53-year-old woman
with an IQ of 33 and mental age of 4.8 used to go to the art therapy
room where she poked around, fiddled with the materials, and drove
others to distraction with her restlessness and chatter. One day she sud-
denly let out a loud "Moo," and the therapist saw that she had pro-
duced what looked like a cow. Apparently three vertical lines
connected on top with a horizontal line accidentally suggested a cow to
her. From then on the woman was never a nuisance again. Each week
she made a new and a rather amusing picture. The next picture was
again a cow, in violet, with a turquoise blob in a corner suggesting a
person milking the cow. Henceforth, there was no shortage of subjects
for her pictures. She had succeeded in contacting some meaningful lore
of experiences which she was relishing and reliving. Her behavior and
experience of her current reality changed accordingly.
These two examples illustrate that with certain clients the process at
times may not take off immediately. And yet, even brain-damaged
clients can benefit from the visual expression. Visual expression may
provide a bridge to communication. The drawing, be it as primitive as
just a couple of lines, draws out memories and ideas like a magnet. The
psychocybernetic model does not look for aesthetically pleasing cre-
ations but for ways of stirring memories and sharing experiences, and
sorting out what is painful and what is still treasured amidst the painful
experiences so that new avenues for action may be determined.
Chapter 8
THE DOING PHASE
n ce the client has agreed to engage in art therapy and is willing to

O attempt to give a visual form to imagery, the therapist is con-
fronted with several major decisions. First, the therapist has to decide
whether the client will make a picture or a sculpture of the client's own
choosing, or be asked by the therapist to address a specific theme. The
first topic in this chapter is what to suggest and when.
The second decision facing the therapist is related to the first. Will
the client select the materials to be used, or will the therapist ask the
client to use a specific medium for the visual creation?
The third decision the therapist has to make at this juncture in the
therapy process is what to do while the client is engaged in the creation
of visual product. Should the therapist sit by and watch the client work?
Draw or sculpt alongside the client? Use the time to tidy up the office
or proceed to read a magazine?
Finally, how much time can be allotted to the doing phase so that a
sufficient amount of time remains for the discussion of both the visual
product and the process of creating it? This chapter discusses appropri-
ate choices the therapist can make when working with various clients.
To Structure or Not to Structure?
The first of the several decisions the therapist has to make in the exe-
cution or doing phase pertains to the topic or the subject matter of the
client's visual creation. Several factors shape this decision. One is the
level of functioning of the client. Another is the purpose of the art ther-
apy session. A third factor is the stage (early or late) that has been
reached in the therapy process.
121
Clients who are functioning on a relatively high level of ego devel-

opment usually welcome the opportunity to make a visual product of
their own choosing. Especially clients who have some technical skills or
some taste for visual expression like to try their hand at a drawing or a
sculpture to see what ensues from their efforts. Emotionally impover-
ished clients, however, frequently have difficulty deciding what to por-
tray. This may be due to their meager imagery, to their fear of
self-disclosure, or to their unwillingness or inability to commit them-
selves to a specific course of action. In general, the lower the level of
ego development, or the lower the level of ego functioning of the client,
the more structuring has to be provided by the therapist. For instance,
one group of elderly nursing home residents had engaged in half a
dozen successful art therapy sessions in which the therapist had sug-
gested specific themes for the clients' creations. However, when the
therapist left the selection of the theme for their drawings up to them,
they became totally immobilized and just sat, unable to make any
choices.
Children usually need no prodding or suggestions as to what to por-
tray. After a brief period of thought, most of them are quite ready to
produce their drawings or sculptures.
When the client appears to have some hesitancy about what to work
on, the therapist may inquire as to whether there was something spe-
cific in mind that the client would like to portray. If not, how about help
in getting started? If the answer is yes, the therapist can demonstrate
what has become known in art therapy as the "scribble" technique. I
prefer to call it the free-flow technique because "scribble" tends to have
some demeaning connotations for most adults.
The Free-Flow Technique
The free-flow technique is used extensively in art therapy sessions.

Its origins go back to Leonardo Da Vinci. In his Notebooks, Leonardo
referred to Botticelli's remark that throwing a sponge soaked in various
colors at a wall left the stains that can easily appear like a landscape.
Leonardo went on to say that one may see all sorts or things in such
spots, according to one's fancy: the heads of men, animals, battles,
rocky scenes, seas, clouds, woods, and so on, "just as in the sounds of
bells we may hear whatever we choose to imagine" (Kelen, 1974, p.
121). In another place in his Notebooks, Leonardo added that similar
TheDoingPhase 123
effects could be attained when looking at cracks in walls and blends of

different stones. Leonardo suggested that in this manner the mind can
be stimulated and aroused "to various inventions" (cited by Cane,
1983, p. 57).
Cane described the scribbles as a "kind of play with a freely flowing
continuous line." It is made spontaneously, "without plan or design."
The line occurs when the chalk or pen is permitted to trail on the paper
in any direction as the person moves the arm in some rhythmic pattern.
The easy rhythmic movement of the arm is the first step in this tech-
nique. The movement may be done first in the air and then transferred
to the paper. The free-flow design may be made with eyes open or
closed. Cane suggested that the value of having the eyes closed is that
in this way the mind is prevented from directing the hand to deliber-
ately represent some familiar object (Cane, 1983, p. 56).
The next step is to look for a while at the lines produced in this man-
ner. Soon one will discern some form among the lines, "much as one
may find some form in the clouds" (Cane, p. 56).
The third step in this free-flow technique is to emphasize or color in
the forms one has discerned among the lines. If desired, new lines and
shapes may be added and certain other lines may be ignored in order
to represent the objects suggested by one's imagination.
According to Cane, the objects a young child finds in the jumble of
the lines will be simple and part of his life. The child may see animals,
or other children, or flowers, or toys in the scribbled lines, whereas
objects seen by adults very often reveal their aspirations, conflicts and
concerns. Sometimes no object is seen. Instead a design is found. "That
also may be useful," according to Cane. "When the design is devel-
oped, it serves the purpose of freeing the individual from the inhibi-
tions against getting started. The mere play with form and color frees
energy and imagination" (Cane, 1983, p. 57).
Occasionally, a client does not seem to be able to detect anything at
all in the freely flowing lines. Experience shows that when this hap-
pens, it is usually because some object is seen such as a sexual organ the
client is either afraid or ashamed to portray. Eventually, as the thera-
peutic rapport grows, the client will feel free to share these concerns
with the therapist. In the early stages of therapy, however, it is best not
to persist but to help the client save face. If necessary, the therapist can
suggest that the client try another set of free-flow lines to see if some-
thing does not emerge from the second attempt.
The free-flow technique works well with most adults and adoles-
cents, regardless of their level of artistic sophistication. Artistically
unsophisticated people find this technique an easy way of getting start-
ed with the work. They can use the accidental lines as an excuse that
the work is not more finished and accomplished. Artistically sophisti-
cated people enjoy the stimulation of their imagination that this tech-
nique affords. In fact, some professional artists use it frequently to find
subjects for their drawings. In art therapy, some clients use the free-
flow technique in the early sessions until they feel comfortable enough
to work directly on a subject. Others like to return to the free-flow tech-
nique at various points in treatment when they feel stuck and seem to
have run out of ideas of what to portray. Still other clients like to use
this technique exclusively to start their pictures. Naomi, a IS-year-old
anorexic, was such a client. At the beginning of each art therapy session
she made a spontaneous line on the paper and then proceeded to dis-
cern a configuration of people in it, and she completed the drawing by
elaborating on the envisioned scene (Figure 8-1).
There are several variations of the free-flow technique. One of these
variations has already been mentioned, namely, the free-flow may be
produced with eyes either open or closed. Usually clients who are
severely emotionally impaired do best with eyes open while producing
the line for the free flow design. In many instances they experience the
world as being too dangerous to close their eyes while other people are
around. The therapist can suggest that they try to look up at the ceiling
instead, or attempt to look away from the drawing rather than at it
while producing the spontaneous line.
Another variation is the use of the nondominant hand. For instance,
a right-handed person may be asked to use the left hand to draw the
initial line and then proceed to use the right hand to complete the
drawing.
Still another variation of the same technique is to have two or more
people produce the drawing. For example, the client may make the
initial line, and then the therapist may attempt to turn that into a sim-
ple drawing. Turns may be taken whereby the next time the therapist
provides the initial line and the client attempts to turn it into a drawing
of some object or a scene. This variation was first suggested by Winni-
cott, the British psychoanalyst, who called this form of the free-flow
technique the "squiggle game" (Winnicott, 1971).
TheDoingPhase 125
Figure 8-1. Naomi's Free-flow. Reprinted with permission from the American Art Thera-
py Association. Gantt, L. & Evans, A. (Eds.), Focus on theFuture: TheNext Ten Jears, 1979.
Similarly, Kwiatkowska used the free-flow technique in her series of

family assessment procedures. She asked each member of the family to
make the initial line and then asked the entire family to select and fin-
ish one of the lines as a joint project (Kwiatkowska, 1978, p. 41).
Betensky comments that this technique is a simple way to foster a
richer expression which is "exciting to persons who could be sponta-
neous, always helpful to persons who were not very spontaneous, and
resourceful for persons slow in imaginative thinking" (Betensky, 1972,
p. 315).
Generally the free-flow technique is not appropriate with very young
children who lack the ability of abstract thinking. However, young chil-
dren often produce what looks like a scribble and then they proceed to
explain their drawings as portraying some quite elaborate, imaginary
scene.
Even when the results of the free-flow technique are rather meager
from the aesthetic point of view, the experience of producing it and the
product itself is usually deeply meaningful to the clients who succeed in
getting in touch with some current or some long forgotten, perhaps
painful, perhaps a joyful, but in any event, a very personal and signifi-
cant experience with the help of this technique.
When the client feels tense, the lines do not flow freely but are stiff
and jerky. Figure 8-2 shows a picture developed with the help of the
free-flow technique by an 18-year-old white female whose premature-
ly born infant son was in the intensive care nursery. She called her pic-
ture "A Cat" but then thought it resembled a sphinx and she proceeded
to talk about the mystery of life. The body of the animal suggested a
coffin to her and she talked about her grief and her fear of losing her
baby.
Another young mother whose infant son was also in the intensive
care nursery saw a turtle in the jumble of her free flow lines which she
had drawn with a green pastel (Figure 8-3). She outlined the turtle in
black and said it looked more like a snail than a turtle. She spoke of the
slow process of her son's recovery but thought there was still some
hope. She derived some comfort from the fact that she had used green
color which to her was a color of life.
The Wartegg Technique
In some respects, the Wartegg technique is similar to the free-flow

technique. It was developed by a German psychologist, Ehrig Wartegg
in the late 1920s, and it was further refined by Marian Kinget, a psy-
chologist at Michigan State University in the 1950s. This technique
consists of eight spaces or boxes which are produced by first dividing
a sheet of paper in half, then dividing it again and again until eight
compartments or boxes are produced in this manner. In each space
the therapist places one specific shape, such as a dot, a straight line, or
a curved line, in a prearranged sequence (Figure 8-4). The client is
then asked to utilize each shape or line to make a drawing in each of
the eight spaces (Hammer, 1958, pp. 344-364).
Originally intended for personality assessment, the Wartegg tech-
nique was adopted by some of the early art therapists as a device to
help stimulate and prime the client's imagination. This technique also
has another advantage. By collecting responses to an identical proce-
TheDoingPhase 127
Figure 8-2. The Sphinx.
Figure 8-3. The Turtle.

dure from a large number of different clients, the therapist's own per-
ceptivity and awareness of individual differences is heightened. Even
without a formal and systematic scoring procedure, the therapist
acquires a considerable amount of experience in detecting idiosyncrat-
ic and unusual responses.
The Wartegg technique is a particularly apt device for helping elder-
ly inhibited males with no art background venture into free expression.
By having something tangible to work with, they tend to use the stim-
uli forms provided as starting points for drawings of tools and other
concrete objects. Some other clients of both sexes approach this task in
the spirit of a crossword puzzle and feel challenged to see what draw-
ings can they develop from the strange starting ingredients. However,
impulsive, impetuous adolescents, especially females, are one group of
clients who tend to dislike the Wartegg technique and seem to feel
hemmed in by it.
Examples of Warteggs completed by two different people are shown
in Figure 8-5 and Figure 8-6. Both provide a sample of the maker's
imagery and preoccupations.
When the Wartegg technique is used with elderly, brain damaged, or
very young clients as a warm-up device, it is sufficient to use only a few
of the shapes rather than all eight. As with any other procedure, the
length of the client's attention span and level of energy will be the
determining factors in deciding how to proceed.
Diagnostic Procedures
Art therapists do not depend on a single drawing for diagnostic

assessment of their clients. Occasionally they may utilize some of the
drawing tests familiar to psychologists conjointly with other forms of
visual expression. The House-Tree-Person Drawing test is one well-
known drawing test which is occasionally used by art therapists togeth-
er with other sources of data. Although there is an immense amount of
literature on the H-T-P drawing test and on the related Draw-a-person
test, the validity and reliability of both procedures are still problematic
and should be used for diagnostic purposes only along with other
sources of information. Information on these two diagnostic procedures
can be found in Hammer, 1952; Machover, 1949; and Nucho, 1979.
A more recent further elaboration on the H-T-P and the Draw-a-per-
son-test is the Kinetic Family Drawing procedure developed by Burns
TheDoingPhase 129
-,
/
Figure 8-4. A Wartegg Blank. Reprinted from Hammer, E.F. (Ed.), The Clinical Application
ofProjective Drawings, 1958, courtesy of Charles C Thomas Publisher, Springfield, Illinois.
Figure 8-5. A Wartegg completed by a well-functioning adolescent.

Figure 8-6. A Wartegg completed by a talented adult woman.
and Kaufman (1970 & 1972). As with the H-T-P and the Draw-a-person-
test, the interpretation of KFD is still based largely on clinical impres-
sions although some attempts at devising a systematic scoring system
have been made (Elin & Nucho, 1979).
Inasmuch as a single drawing may not adequately tap the richness of
a person's imagination, art therapists favor the use of a series of tasks
for diagnostic purposes. Kwiatkowska, for instance, developed a series
of six drawing procedures which she used with excellent results in
assessing family dynamics (Kwiatkowska, 1978). The first and the last
drawing is a "free" or "anything picture." That is to say, the choice of
the subject to be portrayed is left up to each member of the family.
Each person, the parents, as well as the children, make pictures of
whatever they wish. In many instances, the free or anything picture is
a self-representation or a symbolic presentation of one's concerns. The
free picture at the end of the procedure helps the art therapist to gauge
the impact of the art therapy session. If the last free picture is better
organized and richer than the first one, then it is likely that the session
had been helpful to the client. If the final free picture is more disor-
TheDoingPhase 131
ganized and weaker than the first one, then the art therapist has to rec-
ognize the possibility that the client may have more severe psy-
chopathology than originally revealed.
After the initial "free" or "anything picture," Kwiatkowska asks the
family to make two types of portraits. The first is a picture of the entire
family. Kwiatkowska asks simply for a picture of the family, not neces-
sarily a picture of the family engaged in some activity as was the case
with the Kinetic Family Drawings. The amount of information con-
tained even in static family pictures is so immense that Kwiatkowska
did not consider it desirable to introduce the additional variable of
action.
After the family portrait has been drawn and briefly discussed, the
family is asked to make an abstract family portrait. Here the people
may be represented by some of their abstract qualities or interests.
After these three pictures, that is, the free picture, and the two types of
family portraits have been made and briefly discussed, Kwiatkowska
suggests to her clients some simple limbering-up movements to loosen
the arm muscles in order to proceed with the free-flow or scribble
drawings. First, the family members make individual free-flow draw-
ings. Then they select one of a new set of lines for the joint free-flow. It
is of some diagnostic interest to see how the family goes about per-
forming this joint task and whose free-flow line is chosen for the joint
enterprise. The assessment procedure concludes with the second of the
two free pictures (Kwiatkowska, 1978).
For the purposes of family evaluation, all six of these procedures can
be used in one two-hour session. However, therapists who want to
practice the psychocybernetic version of art therapy will tend to find
that two hours are not sufficient to discuss the wealth of material
brought forth by these six diagnostic procedures. It may be more real-
istic to allot an entire session, an hour and a half in length, for each sin-
gle procedure contained in the Kwiatkowska assessment protocol.
The Kwiatkowska assessment procedures are used extensively by
many art therapists, and several variations have been devised. One is
that by Wadeson who uses part of the Kwiatkowska procedure with
married couples. One interesting innovation proposed by Wadeson is
to ask the spouses to exchange their self-portraits. Then each partner
elaborates and improves upon the self-portrait of the partner, anyway
he or she sees fit. This often reveals some of the dissatisfactions arid/or
support each partner brings to the relationship (Wadeson, 1980).
Landgarten is another prominent art therapist who has developed

further the Kwiatkowska procedures of family assessment. Knowing
the specific concerns of single parent families she has devised a series
of tasks, both two- and three-dimensional, that not only bring forth the
dynamics of each family member but also provide a way of resolving
some of the impasses among the family members (Landgarten, 1981).
Themes Derived from Client Concerns
Frequently the topic for the visual creation emerges from the gener-
al discussion between the therapist and the client or clients at the begin-
ning of the therapy session. As the client reviews the events of the
preceding few days or weeks, or as the members of the group engage
in small talk and an exchange of ideas, some common concern or inter-
est gradually surfaces. This common interest or concern can serve as a
suggestion for a picture. In a group of heroin-addicted clients in a
methadone maintenance clinic, for instance, a series of pictures was
produced, one each week, on the following topics: "a picnic," "work,"
"my best friend," "things that make me angry," "the Clinic," "enjoying
myself," and the like. The clients had the option of working on the
common theme that had been suggested either by the therapist, or, in
later sessions, by another client, or they could engage in producing a
work around a theme they had chosen themselves.
At times, some clients prefer to work on a picture without any spe-
cific theme in mind. When finished, they may decide what the picture
is all about. For instance, one young black polydrug user spent several
weeks working on pictures that appeared to be experiments with vari-
ous lines and colors. He was piling one color on top of another while
making rather graceful swirls on the paper. At the end of each session,
although the final product did not look like anything objectively dis-
cernable, the client continued to admire his production wistfully and
seemed to have a hard time separating from it. In order to facilitate the
decoding of the meaning contained in the picture, the client was asked,
"If you had to give a title to this picture, what would you call it?" After
some thought, the young man responded, "The Beginnings of a Rain-
bow" (Figure 8-7). The therapist expressed her interest and suggested
that he write the title on the picture. He proceeded to do so with con-
siderable amount of help from the other members of the group on
spelling of the words. Some discussion ensued, and it turned out that
TheDoingPhase 133
Figure 8-7. Beginning of a Rainbow.
the client was at a juncture in his life where some new feelings were stir-
ring in him, and he was hoping to get away from his dependence on
chemical highs. His subsequent work and marital performance attested

that this picture had indeed marked a realistic and substantial "begin-
ning of a rainbow" of hope for him. The picture helped this young
man, it seemed, to lift his wishes from the realm of desire into the realm
of determination and implementation.
Interactional Drawing Technique
There are times when it may be appropriate for the therapist to

engage in some art expression along with the client in order to encour-
age the client's efforts at art expression. One such instance was already
mentioned in connection with the discussion of one of the variants of
the free-flow technique, namely the Winnicott's "squiggle game." With
this technique Winnicott attempts to engage children in the process of
sharing their concerns.
Another procedure where the client and the therapist may work
together producing a joint picture is the Interactional Drawing Tech-
nique. This procedure is appropriate especially with mentally ill adults
who are fearful both of their own feelings and of the presence of anoth-
er person. First, both the therapist and the client engage in drawing sep-
arately and finally jointly on the same sheet of paper. This technique
was devised by Mardi Horowitz (1970). The aim in this procedure is to
provide a sense of security to the client by introducing solid objects in
the picture, such as houses, trees, etc., next to objects which may be
self-representations of the client. The therapist can also lend support by
drawing objects or animals that may be reassuring to the client. The
therapist can make connections and promote "object relations" by
drawing bridges, paths, or putting up road signs. In one instance while
using the interactional drawing technique, the art therapist introduced
several protective themes, for example, by drawing an icebag on the
cracked head sketched by the client (Horowitz, 1970).
Principles of Timing, Gradualness, and Spotlighting
One of the greatest fears of inexperienced art therapists is that they

will run out of ideas about what to do with their clients. Similarly,
young therapists doing verbal forms of therapy are apprehensive that
they will not know what to say to their clients. One beginning therapist
TheDoingPhase 135
put it this way, "What if the client just sits there and does nothing?"
Very soon therapists discover that this is the least of their worries. It is
most unlikely that they will have nothing to say or ask, or that the client
would not talk. Soon the task becomes to cut through the stream of ver-
balizations and get to the core of the matter. But no sooner has the
novice discovered that scarcity of both verbal and paralingual com-
munication is not the greatest problem when another trouble arises.
Being in too great a hurry to help the client solve his many difficulties
results in there being no time for listening and paying attention to what
the client is actually conveying through the various channels of com-
munication. The same frequently happens in art therapy. Beginning art
therapists must not race from one technique to another without paying
attention to what the client is experiencing. Rather, they should pay
attention to what is transpiring in the session beyond the creation of the
visual product.
If the therapist has mastered one of the several versions of the free-
flow technique, if the relationship between the therapist and the client
is one of trust, and if the client is willing to attempt to portray visually
some of his experiences and feelings, then neither the therapist nor the
client will ever run out of subject matter for the client's next creation.
The danger lies in another direction, namely in suggesting premature-
ly subjects for pictures in areas the client is not yet prepared to deal
with. Just as it is in any other kind of therapy, it is best if the therapist
proceeds gradually from the more general to the more personal con-
cerns. For instance, an energetic 89-year-old lady, whom we shall call
Bertha, had enjoyed the weekly art therapy sessions for two and a half
years. She appeared to derive satisfaction from the group interaction
and from her own artwork. Bertha related well to the art therapist, and
she liked to prod the other members of the group to experiment with
new materials and new techniques. One day the art therapist suggest-
ed that the members of this art therapy group make Kinetic Family
Drawings, that is, to draw a picture of their families, including them-
selves, doing something. There was a definite resistance from several
members of the group to the suggestion that they include themselves in
the picture. Several people commented that they were just too old to be
bothered, and that they did not want to look at themselves. Bertha
drew a picture that included several people. Then she stated that this
was not what she had come to the art therapy group for, got up and
walked out. She did not rejoin the group for the next six months. What
went wrong?
Apparently the level of communication between Bertha and the art
therapist, even after two and a half years, had remained on a level
much different than what would permit the sharing of painful feelings
in the current circumstances as well as in one's past. This art therapist
may have conveyed to the clients her interest and warmth, but it would
appear that there was not sufficient empathy or understanding of what
the clients were experiencing, and there apparently was not sufficient
genuineness so that all feelings, joyful as well as sorrowful, could be
shared comfortably in the group.
When a sufficient degree of trust has been achieved in the relation-
ship, a useful technique is to suggest to the client that a second picture
be made to highlight some specific aspect of the experience portrayed
in a previous picture. This usually leads to a deeper grappling with the
experience already portrayed. For example, one art therapist asked a
couple who had portrayed their relationship in rather bland and gen-
eral terms, to make their next pictures about the specific concerns that
each had hinted at in the first picture. The wife in this instance had por-
trayed herself as saying something to her husband. Now she was asked
to make a picture specifically about what she was saying to her hus-
band. If the client is not able to comply with the therapist's suggestion,
reasons for this reluctance are of interest and can also be discussed to
the advantage of the therapeutic process.
Self-System: A Technique Generating Matrix
As one's experience with the psychocybernetic model grows, the

therapist spontaneously generates appropriate suggestions for the
client's productions. Also the therapist is able to encourage the client to
make relevant choices for each session depending on what is going on
in client's life. Less seasoned therapists have difficulty in shaking off the
fear that they will not know how to proceed with their clients. To them
it may be helpful to use the concept of the self-system to guide their
effort to structure the therapy sessions constructively. What is a self-sys-
tem, and how can it be used to generate appropriate techniques for
visual expression?
In psychology, the concept of self is one of those elusive ideas that
periodically surface and then disappear. It is prominent in the Jungian
TheDoingPhase 137
psychology Oacobi, 1959) but it is avoided by the behaviorists (Ford &

Urban, 1963). It is interpreted differently in the Eastern cultures than it
is in the West (Chang, 1982). WilliamJames was one of the first psy-
chologists to call attention to the importance of the concept of self in
the West. He attempted to clarify the concept of the self by differenti-
ating between the "I" and the "Mine." He was forced to conclude, how-
ever, that the line of demarcation between the two is rather fluid. He
said, "The same object is sometimes treated as a part of me, at other
times as simply mine, and then again as if I had nothing to do with it at
all. In the widest possible sense, however, a man's self is the sum total
of all that he can call his" Oames, 1890, p. 291).
In a similar vein, the existential philosopher Martin Heidegger
(1953) holds that a person's world is as wide as the reach of his care and
concern. As a person grows, his sense of self grows, and it includes
more than just the immediate organism and its surroundings. Piaget
(1976), on the basis of his research, concludes that at first one's world is
as far as the arms can reach. Then, it is as far as the eye can reach.
Finally it is as far as the imagination can reach.
The self-system, from the psychocybernetic perspective, is a cardinal
self-regulating component. If one can change the way in which a per-
son perceives himself, then his views of his situation will change. As the
person's view of his situation changes, his behavior will change accord-
ingly. The strengthening and the modification of a client's self-system,
therefore, is central to the efforts of a psychocybernetically-oriented art
therapist.
What are the components of the self-system? When you think of who
you are and what gives you a sense of pride and accomplishment, you
are likely to describe experiences which fall under five headings. These
five components of the self-system are interrelated and may be thought
of as having semipermeable boundaries. The five interrelated compo-
nents of the self-system are portrayed in Figure 8-8 and are summa-
rized as follows:
First, there is what might be termed the Body Self. This is the physi-
cal body and the concern here is with one's physical appearance and
performance.
Second, there is the mind, consisting of one's mental and emotional
endowment and abilities.
TRANS-
PERSONAL
,_ ......
....... ,
",
FACTOR
""
".
\ / /
I
\ \ I I
\ \ I I
INTER- \ \ I I ACHIEVE-
PERSONAL" 'I / / MENT
RELATIONSHIPS "", _ J l-"-'"
...... --.....-. ) (
.... ----- REALM
","
/
I
/
A
, \
~
" .....
........ _ - - " I \ ....... _ - - - '
I \
I I
BODY \ I MIND
\ I
\
,
,/
/
I
Figure 8-8. The Self-System. Reprinted from Nucha, A.G., Stress Management, 1988, cour-
tesy of Charles C Thomas.
Third, there is the Interpersonal Self which consists of one's various

relationships. These may range from intimate to peripheral, and from
positive to hostile.
The fourth component of the self-system is what might be termed the
Achievement Self. It may be thought of as consisting of work perform-
ance and other accomplishments, including the roles one carries and
the supports one is capable of providing to other people.
The fifth segment of the self-system is what can be called the
Transpersonal Self. This portion of the self-system contains a person's
values, ideals, heroes, reference groups, and other matters pertaining to
one's ethical and ethnic influences.
The five factors constituting the self-system may be used to generate
and select art therapy activities appropriate to the particular client one
is working with. The therapist can deliberately highlight the various
experiences that have contributed and are still contributing to the for-
mation of each of the four parts of the self-system.
TheDoingPhase 139
The client may be asked specifically to make a drawing or a sculp-

ture to portray some aspect of the five components of the self-system.
Or the self-system paradigm may be used to examine the visual prod-
ucts already created by the client to see which portion of the self-system
receives attention and which remain underdeveloped. A spontaneous-
ly created free picture, for instance, may portray anyone of the five
aspects of the self-system. One 28-year-old white female drug addict,
for example, drew a picture of a closed door with a dog sitting outside
it, begging to be let in (Figure 8-9).
She explained that she felt like the dog in her picture when she could
not find her car keys to drive to the hospital for her appointment with
her therapist. Another patient, a 23-year-old white male produced a
picture of a duckling from a scribble (Figure 8-10). After a number of
sessions it became clear that the duckling was an abstract self-portrait
that captured well how he felt in his world.
An example of the interpersonal portion of the self-system is shown
in Figure 8-11. In this drawing a 26-year-old white mother of a 5-year-
old boy portrayed herself with her son. She commented that her son
appeared to be pulling her forward, and she said that this was quite true
to life. "I can never keep up with him," she said. And she added, "Nei-
ther physically or mentally."
A 27-year-old black female polydrug user drew a head of a lamb
from her free flow lines (Figure 8-12). She then talked about one of her
early foster homes where she apparently felt some affection for the
farm animals and had received some warmth from some of the people
there. Since then she had found no closeness in any of her subsequent
relationships.
The next three pictures show examples of the achieving self. Figure
8-13 portrays a young professional woman at work. She is surrounded
by piles of books, some on the floor, some perched precariously on her
desk.
The drawing in Figure 8-14 was made by another young woman
whose professional career as a dancer had been interrupted by her
pregnancy, much to her distress. She noticed, however, that she had
portrayed herself on the stage as if she was about to fallon her face. She
then talked about the many obstacles she had encountered and admit-
ted that her dance career had not been going well even before she
became pregnant and had to give up her professional ambitions.
Figure 8-15 contains a drawing made by a 28-year-old black woman

after an unsuccessful job interview. The most prominent feature of this
bleak picture is the sign which proclaims that no jobs are available.
The client has portrayed herself sitting in a chair, her feet not reaching
the ground. The sense of helplessness and discouragement are obvious
and these feelings need to be dealt with if the client is to have the
courage to face another job interview.
Aspects of the transpersonal self are contained in the next two pic-
tures. The racing car in the so-called liberation colors of black, green
and red was drawn by a 28-year-old black male (Figure 8-16). The tiny
figure in the middle of the car he said represented himself. His sense of
ethnic identity appears to be a source of strength to him. The size of the
human figure in relation to the car, however, would seem to bode ill for
his ability to implement his ambitions.
The drawing shown in Figure 8-17 was made by a 37-year-old black
male whose hero was Muhammed Ali. This man said he too wanted to
be a champion but he was not certain in what realm of endeavor he
could attain the status of a champion. In the meantime he was drifting
from one low paying job to another.
When one examines the various techniques of art therapy, one is
likely to find that these activities can be arranged under the five head-
ings which designate the self-system. Examples of some of the various
activities frequently used in art therapy which can be utilized to
strengthen each portion of the self-system, are listed in Figures 8-18
through 8-22.
Peripheral vs. Central Concerns
The therapist must pay attention to the rate at which the client is
able to disclose painful and embarrassing feelings and experiences. It
is best to start with rather neutral subjects, such as, "My favorite holi-
day," or various reminiscences, such as, "When I was in High School."
Or, "my best friend," or "My wedding." Gradually one will be free to
address directly the losses and disappointments one has encountered
and may still be reeling under, such as "My saddest experience," "A
problematic relationship to someone or something:" Or, "One of my
greatest disappointments:" In short, the therapist should start with
more peripheral themes and then, after the sense of trust has been
established, proceed to the more personal and traumatic experiences,
TheDoingPhase 141
Figure 8-9. A Begging Dog.

Figure 8-10. The Duckling.
Figure 8-11. A Mother and a Son.

TheDoingPhase 143
Figure 8-12. The Lamb.
Figure 8-13. Achieving.

Figure 8-14. The Dancer.
Figure 8-15. AJob Interview.

TheDoingPhase 145
Figure 8-16. The Race Car.
Figure 8-17. The Champion and the Loser.

BODY DOMAIN
What can I do?
How do I look?
1. Self-portrait, full length, realistic
2. Self-portrait, abstract
3. Self-portrait, a year ago
4. Self-portrait, ten years from now
5. Favorite activity
6. Favorite vacation
7. How would your best friend portray you?
Figure 8-18. Body Domain. Reprinted, with modifications, with permission from the Art
Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights
reserved.
MIND DOMAIN
Mental and emotional endowments, moods, feelings,
temperament, and abilities
1. A happy day
2. A real sad day
3. A disappointment
4. Best vacation
5. Three wishes
6. What I let people see about me
7. What I do not let anybody see
8. Three wishes
9. Telegram or e-mail I want to receive
Figure 8-19. Mind Domain. Reprinted, with modifications, with permission from the Art
Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All rights
reserved.
TheDoingPhase 147
INTERPERSONAL DOMAIN
Relationships: intimate, distant
1. Realistic family portrait
2. Abstract family portrait
3. Kinetic family drawing
4. My family ten years from now
5. My best friend
6. Sculptures or pictures of important people in my life
7. You in grade school
8. You in high school
9. House you lived in that you liked best
10. What are some of the pleasant/unpleasant aspects of
being single/divorced/widowed?
Figure 8-20. Interpersonal Domain. Reprinted, with modifications, with permission from
the Art Therapy Association, DiMaria, A.E. (Ed.), Art Therapy: Still Growing, 1982. All
rights reserved.
ACHIEVEMENT DOMAIN
Work Performance, Accomplishments
1. An ideal place of work
2. Your place of work
3. If you could be anybody, who would you be?
4. Doing something your father would approve
5. Doing something your mother would approve
6. The proudest moment of your life
7. One of the most difficult situations you have lived through and
what made it bearable
8. What do you like most/least about school, work, being retired?
Figure 8-21. Achievement Domain. Reprinted, with modifications, with permission from
rights reserved.
TRANSPERSONAL DOMAIN
1. Favorite team
2. Favorite actor/actress
3. An ideal friend
4. Favorite movie/show
5. A favorite fairy tale
6. Sad vs. happy holiday
7. A person you envy most
8. Your necessities vs. your luxuries
9. A person you admire most
10. Collage about an ideal person
Figure 8-22. Transpersonal Domain. Reprinted, with modifications, with permission from
rights reserved.
especially when working with adults who pride themselves in their self-
sufficiency and fortitude.
Rapport Building, Self-Sharing, and Closure
It is wise to group all the various activities and themes one can sug-
gest to one's clients according to the level of self-disclosure each pre-
supposes. Some of the activities and themes are appropriate for
building trust and for establishing a rapport. The "Free" or "Anything
picture" referred to at the beginning of this chapter is one such tech-
nique. Another might be the making of a picture by incorporating in it
the client's initials. Or, a making of a "name plate." Such a name plate
would contain the client's name and whatever he may wish to add to
indicate some personal interests and activities. In groups, the making of
a joint free-flow with another member of the group usually accom-
plishes the purpose of setting people at ease with one another.
TheDoingPhase 149
Many of the themes concerning specific experiences already dis-

cussed in this chapter may serve to promote self-disclosure. For
instance, self-portraits, family portraits, picture of a problematic rela-
tionship, doing something your mother or father would approve/dis-
approve, etc. It is important to keep in mind that all these themes touch
on experiences one is not likely to want to share if the therapeutic cli-
mate is still of questionable quality.
Finally, there are activities and themes that are appropriate for
attaining a sense of closure at the end of the session. Often if the art
therapy session has been rather intense, it is wise to suggest that the
client simply make a picture of what the session was like. This pro-
duces a sense of being in charge rather than at the mercy of the intense
feelings of anger, loss or whatever else may have been touched upon in
the session. Another method of helping the client to attain a sense of
closure is to do a mandala, that circular drawing favored by art thera-
pists ofJungian orientation, discussed in Chapter 4.
Free Expression, Assemblages, and Perceptual Stimulation
Simple two-dimensional art materials such as pastels and paper are

used most often in art therapy. But for some clients, something other
than drawing materials may be appropriate. The various properties of
different materials have received some attention in art therapy litera-
ture and those interested should refer to it (Kagin & Lusebrink, 1978).
In this context, the art therapist should keep in mind not only the var-
ious properties of the materials themselves and the specific interests of
one's clients but, more importantly, the extent of the clients' physical
and mental capabilities.
When working with very young, very old or mentally impaired
clients, the therapist essentially has three types of procedures to choose
from. First, there is the free expression. Second, the client may engage
in producing what may be termed the assemblages. Finally, there is
simple perceptual stimulation.
Free expression is by far the most common type of activity in the
various forms of art therapy. Here the client works on either a two
dimensional or a three-dimensional product to portray a self-selected
theme or a theme suggested by the therapist. Free expression types of
creations are appropriate with most clients across the entire span of the
life cycle. But when working with the very young, the very old, or the
mentally impaired, two other types of activities may be indicated.
One type is assemblages. There are two kinds of assemblages. The
first are designs made from shapes, cut-outs or some objects, such as
stones, cones, shells, or beans. The second are collages made of pic-
tures found in magazines and books.
When assemblages are appropriate for the clients, the therapist must
provide the necessary materials and help the client select a theme for
the creation. Then the client is asked to select the shapes, objects, or
pictures and arrange them in some order so that they convey some
information or tell a story.
Making an assemblage stimulates the client's thinking, promotes ver-
bal communications between the client and the therapist, lessens the
sense of emotional isolation, and focuses the client's attention on some
aspect of the external world (Doll & Nucho, 1982). There may be addi-
tional gains from this activity, such as the improved fine motor coordi-
nation.
The use of collages with patients in a psychiatric setting is discussed
sufficiently elsewhere in the literature, particularly Moriarty (1973).
It may be noted in passing that the assemblages work well not only
with the kind of clients already mentioned but also with adults of nor-
mal intelligence who are rather inhibited and uncertain of their creative
capabilities.
When the assemblage is finished, the therapist must help the client
tell what the creation means to him, just as it would be done if it were
a free expression. Ways of facilitating the decoding of the meanings
contained in the visual creation are part of the Dialoguing Phase of the
therapy process (see Chapter 9).
Perceptual stimulation used simply to stimulate imagination may be
appropriate with any kind of client. With the very young, the very old,
and some types of brain-damaged clients perceptual stimulation may
be the only form of activity that produces some emotional sharing and
communication. The first part of the process is to provide an object for
the perceptual stimulation. The object may be from nature, such as
leaves, flowers, a pine cone, or wood chips. Some everyday object,
such as a comb, bar of soap, or a mitten may serve the intended pur-
pose as well. Or a symbol of some specific holiday or some object with
religious significance, such as pumpkins, Easter eggs, Bible, etc., may
be used. The client is asked to explore the object with as many senses
TheDoingPhase 151
as is appropriate. The object may be touched, squeezed, smelled, and

so on. The purpose is simply to engage the brain cells and the senses,
and to stimulate verbal sharing, finding and attaching verbal labels to
the various sensations, and, if done with elderly clients, to promote the
process of reminiscing. The therapist's task is to encourage the explo-
ration of the object and to call to the attention of the person the specif-
ic features of the object in order to encourage the powers of
discrimination ("Do you see the dark spot here?" Or, "Do you like this
better than that?"). Some objects can be pasted on paper. Others may
be traced, and appropriate background may be drawn in. Or the ther-
apist may draw a rough outline of the object, and the client may color
it in.
When assemblages are produced, art therapy starts resembling what
might be termed "activities therapy." However, many art therapists
work with clients for whom the so-called "free" expression is not appro-
priate. The "free" art expression is not the only form of art therapy.
Moreover, the imagination of many adults of normal intelligence is
rusty and may need some prodding too. Assemblages can serve this
purpose. In some instances, the assemblages may even reach a high
level of aesthetic merit.
What to Do While Clients Work?
The final decision of the therapist in the Doing Phase concerns what
the therapist should do while the client is engaged n the creation of the
visual product. A beginning therapist frequently feels superfluous and
useless while the client is busily producing his or her visual expression.
Being at a loss as to what to do, some art therapists work alongside the
client. Others, not wanting to overshadow the client with their own
wealth of imagery and technical skills, proceed to tidy up their office or
do other chores until the client indicates that he or she has finished.
Some inexperienced therapists think that their presence might make
the client self-conscious and uncomfortable, so they read a magazine or
leave the room.
From the psychocybernetic perspective, these various solutions are
undesirable. The task of the therapist during the Doing Phase is to be
an unobtrusive observer and if necessary, a troubleshooter. The infor-
mation processing does not proceed only on the paper, or in clay.
Much information about the client is conveyed through his verbal and
nonverbal behavior, such as casual comments, grunts, hesitations, and

sighs. It is important to note in what order the client proceeds with the
making of the visual creation. Where does he get stuck? Where does he
invest most of his time and energy? How does the mood of the client
change as he goes about his work? Unless the therapist pays attention,
much data is lost.
Experience shows that a relaxed and alert stance on the part of the
therapist is best. Young children in particular appreciate the undivided
attention of the therapist while they work, provided the therapist is not
intrusive. They like to share their thoughts by brief remarks or ques-
tions as they proceed with their work. Often, with young children, a
formal discussion phase after the picture or sculpture has been finished,
is not feasible. Therefore, it is especially important that therapist pay
attention to their young clients as they work.
It is true that at times clients indeed do feel self-conscious in the pres-
ence of the therapist. Usually an appropriate comment from the thera-
pist which contains some expression of the therapists interest and some
encouragement is sufficient to reassure the client. A seven-year-old
boy, however, told his art therapist that she should leave the room
while he worked. In this instance, it appeared that this was part of the
child's way of "calling the shots," and his way of asserting his domi-
nance over adults in his world. The art therapist stood her ground and
told the child that her job was to sit and watch while he worked so that
they could talk about what he produced. This was acceptable to the
child. Had it been otherwise, the therapist could have inquired what in
particular was objectionable to the client and attempted to reach some
kind of a compromise.
Apart from the specific techniques discussed earlier, such as the
interactional drawing, experience shows that it is best for the therapist
to refrain from drawing during the therapy session. Otherwise it is too
easy for the therapist to get absorbed into one's own imagery and lose
track of what the client is doing. The therapy session is primarily for the
benefit of the client, not for the enjoyment of the therapist. The art
therapist should do everything possible to make herself comfortable in
the session. Her energy and creativity, however, should be channeled
into the understanding of the client and the client's experience. This
may entail paying close attention to the imagery that arises in the ther-
apist's mind. Nevertheless, that imagery at this point should remain
TheDoingPhase 153
private and should be shared with the client selectively and with great
care.
The Length of the Doing Phase
Among the decisions the therapist has to make when embarking

with the client on the Doing Phase is how long it will take to create the
visual product. In arriving at this decision, one has to estimate how
much time will be needed afterward for the discussion of both the visu-
al item and the client's experience of producing it.
Several factors determine the length of the Doing Phase. The first
factor is the type of client one is working with. Another is the theoreti-
cal framework of the therapist. A third factor is the specific activity
selected for the session.
When working with physically ill clients or with the frail elderly, the
length of the session, by necessity will have to be shorter than when
working with able-bodied adults. When working individually with
most able-bodied adults, the entire art therapy session, including the
Unfreezing, the Doing, and the Dialoguing Phases, may take about an
hour and a half. In contrast, when working with a physically ill person,
all three phases may last 15 minutes. The Doing Phase in this instance
would last perhaps only 5 minutes. Similarly with children. When
working with a child individually, the entire art therapy session may
last half an hour, although frequently the therapist will discover that
children who normally have a very short attention span are perfectly
happy to engage in art therapy sessions that last for two hours and even
longer. With children, the Doing Phase will exceed the length of the
Dialoguing Phase, and usually the child will want to produce more than
just one picture or sculpture. Work in groups, both with adults and with
children, will require more time than when working with clients indi-
vidually. For most groups of adult clients, allow two hours; allow about
45 minutes for group sessions with children.
Clients who have some training in art at times wish to spend a con-
siderable amount of time on their art work in order to complete it to
meet their own standards of achievement. This kind of client can be
reminded of the distinction between what Maslow terms primary cre-
ativity or the idea-generating phase, and the secondary creativity or
the execution phase (Maslow, 1971). In art therapy we are only inter-
ested in a rough sketch of the idea to be portrayed. If the client feels the
need to polish the work, it can be done outside the art therapy session
itself.
Clients who do not possess any artistic skills usually welcome the
encouragement to work quickly and spontaneously and not to worry
about attaining perfection of their idea. However, some compulsive-
obsessive clients find it difficult to be spontaneous and to leave some-
thing half finished. They often want to stay with the one project until it
has been shaped and molded to their requirements. At times it helps to
empathize with the client's predicament that things just do not seem to
work out the way one wants to. The discussion can be broadened from
this one example of disappointment to other similar instances in life
where the client aimed for "perfection" but for various reasons could
not achieve it. At other times the therapist may suggest a specific time
limit and ask the client to do only as much as is possible in the speci-
fied time period. ("We are running out of time. Do you think you could
try to bring your work to some point of completion within the next 5
minutes? I know there is much more that you still would want to do.")
With groups, especially children, some clients will need more time
than others. If the discrepancy between the amounts of time required
by the several clients is great, sometimes the therapist can suggest that
the clients who prefer to work fast make two pictures for each one pic-
ture produced by the slow creators. When the dialoguing phase arrives,
the fast workers can decide which of their several creations they wish
to share and focus on for discussion purposes.
At times, especially when working alone with one client, consider-
able amount of flexibility can be used by the therapist in deciding how
to proceed. One teenage boy who had a minimal learning disability
had several periods of "Doing" interspersed with periods of "Dialogu-
ing" while working on a single picture. He would think he had finished
his picture to his satisfaction and would start explaining what he had
produced only to discover additional features that he wanted to add to
his drawing. He would then proceed to work some more on his picture,
and then resume the discussion of it.
Does a picture have to be finished in one session? Occasionally a
client may want to spend several sessions working on the same picture.
If this is not simply an attempt on the part of the client to avoid talking
about what the picture means to the client, there is no reason to dis-
suade the client from devoting several therapy sessions to working on
a single item. However, in light of the psychocybernetic model, it is not
TheDoingPhase 155
the final product that is of a paramount importance but the client's

experience while producing it. Therefore, sufficient amount of time
needs to be allotted for the discussion of the product and the process of
producing it. Take, for example, the case of a 32-year-old black male.
He came to his usual art therapy group session after his estranged wife
was brutally murdered in front of his two young children. He proceed-
ed to work on a picture which he called "The Black Madonna" (Figure
8-22). The Madonna holds a child in her arms. There is a cross behind
her, and a peace sign in the lower right hand corner. At the end of the
session the grieving man said that he had not finished the picture and
that he would continue working on it the next time. A week later, he
resumed his work on his "Black Madonna." He did some additional
coloring but the picture was essentially left as it had been at the end of
the previous art therapy session. His mood had changed during the
intervening week, and he was ready to proceed to some other theme.
A profound experience requires a profound investment of time and
energy for its resolution. Sometimes a client will produce several series
of pictures about the various aspects of an experience. In order to help
the client grapple with a painful experience the therapist may deliber-
ately suggest that the client portray the experience in step-wise fashion.
A foster child, for instance, drew a series of pictures in cartoon style
which showed his encounter with his new foster family. Similarly, dur-
ing a number of art therapy sessions a 63-year-old gentleman produced
a series of clay figures representing various experiences from his adult
years when he worked as a bartender. This was his own unique man-
ner of engaging in what gerontologists term the "life review" process
(Butler, 1963).
The type of activity or technique chosen for the visual expression
influences the format and the amount of time devoted to the Doing
phase. Some activities may require a short period of time while others
may need a considerable length of time. For instance, self-portraits may
take a long time for most clients. However, in order to lessen the
clients' concern with the technical aspects of the drawing, the therapist
may arbitrarily set a very short time limit, for instance five minutes, for
its completion. When engaged in working on a drawing concerning
some difficult experience, for example, "A problematic relationship to
something or someone," the therapist may purposefully allocate a con-
siderable length of time for the completion of this picture in order to
facilitate the clients' coming to terms with the various aspects of these
concerns.
An additional factor which determines the length of the Doing
Phase, besides the physical, emotional, chronological, and other char-
acteristics of the client population one is working with, is the type of art
therapy the practitioner has adopted. The several versions of art thera-
py were described in Chapter 5. By and large, therapists who practice
what may be termed the "art wing" type of art therapy will devote
more time to the Doing phase of the process than to the Dialoguing
Phase. Art therapists of the "therapy" wing are inclined to pay more
attention to the Dialoguing Phase than do those of the "art" branch.
When engaged in the psychocybernetic model of therapy, the length of
the Dialoguing Phase tends to exceed that of the Doing Phase, in most
instances.
There is one more factor that shapes the amount of attention paid to
the various phases of the art therapy process. Regardless whether the
practitioner belongs to the "art wing" or to the "therapy wing" of art
therapy, the theoretical framework adopted by the practitioner will fur-
ther determine the amount of attention paid to each phase of the ther-
apy process. Those of the Jungian persuasion (Lyddiatt, 1971) devote
time primarily to the Doing Phase. Relatively little time is spent on dis-
cussing and analyzing the visual creation. In contrast to the Jungians,
the psychodynamically oriented art therapists spend more time on the
discussion of the product than on its creation (Naumburg, 1966; Beten-
sky, 1972). The differences between the several theoretical approaches
to art therapy and how these differ from the psychocybernetic model of
therapy are discussed further in subsequent chapters. For now let us
keep in mind that there are several choices open to the practitioner in
regard to the length of the Doing Phase and the manner of utilizing the
time allotted to it.
In summary, there are a number of techniques and procedures avail-
able to the therapist. Several principles guide the selection of tech-
niques and procedures appropriate for various kinds of clients. There
are decisions the therapist has to make at this point in the art therapy
process and invariably, the best guide is the therapist's own experience
with the process. These choices and decisions soon take care of them-
selves, once the therapist has acquired some experience with the psy-
chocybernetic model and has noted the value and enjoyment clients
derive from the therapy sessions in which visual expression is used.
Chapter 9
THE DIALOGUING PHASE
n old Chinese proverb says that one picture is worth a thousand

A words. The eloquence of the pictures produced in art therapy,
however, is frequently rather muted. These pictures tend to be enig-
matic and puzzling, often to the maker of the picture as well as to the
therapist. This chapter offers specific suggestions about the process of
unlocking and decoding the messages contained in clients' visual cre-
ations.
The pictures and sculptures made by clients in art therapy present
their messages in the language of the non-dominant cerebral hemi-
sphere. (See Chapter 3 for a discussion of the differences between the
two symbol systems associated with the two cerebral hemispheres.)
During the dialoguing phase the visual language of the non-dominant
hemisphere has to be translated into the more conventional language
of the dominant cerebral hemisphere so that it may be shared more
easily with the therapist and, if necessary, with other significant people
in the client's life. The visual language has to be translated into verbal
language in order to clarify the information contained in it. While
embodied in the visual creation, the message often remains a cryp-
togram, a term used byJung for a message written in code Oung, 1961).
Often the information contained in the visual creation appears myste-
rious and perplexing even to the maker. How can this information be
decoded for the benefit of both the maker and the therapist?
The Nomomatic vs. the Ipsomatic Approach
Some therapists may object to the notion that the visual product is an
enigma or a cryptogram even to a well trained and experienced pro-
157
fessional. It is true that the theoretical framework adopted by the ther-

apist casts some light on the visual expressions of the client. For
instance, therapists of the orthodox Freudian persuasion tend to regard
elongated objects as being phallic shapes, and they would then pursue
the sexual implications of these forms. If the visual product contains
sharp, jagged, pointed shapes, these therapists would be inclined to
regard these forms as expressions of aggressive drives. Similarly,]un-
gian therapists may have strong convictions concerning the meaning of
certain other symbols. These schools of thought are discussed at some
length in Chapter 5. Whatever the theoretical persuasion of the thera-
pist-and even a psychocybernetically-oriented therapist will have
incorporated some aspect of the other theoretical orientations-it
behooves the therapist to approach the client's creation with an open
mind. In this respect the psychocybernetic model resembles the phe-
nomenological approach, which also advocates that the therapist dis-
card all preconceived notions when looking at client's artwork
(Betensky and Nucho, 1982).
The therapist can view the visual creation of the client in two ways.
One is the nomomatic, the other is the ipsomatic approach. (See Chap-
ter 6 for a discussion of the two ways of examining the visual product.)
The approach is nomomatic when the therapist attempts to apply to the
client's visual creation ideas derived from some theoretical perspective
or empirical research. The therapist is proceeding ipsomatically when
the art work is observed phenomenologically, from the maker's own
point of view and, insofar as possible, without any preconceived
notions.
The psychocybernetic model suggests that the approach in the dia-
loguing phase be ipsomatic, using the tools, notions and ideas that stem
from the maker's own experience rather than from theories, research,
or experiences imported from someone else's life. In light of psy-
chocybernetics the ipsomatic approach is more effective than the
nomomatic for the decoding and processing of the information con-
tained in the visual expression of the client.
There are four aspects of the dialoguing process. First, there is the
dialoguing between the maker and the visual expression just created.
Next, the dialoguing is deepened by the discussion between the client
and the therapist, while the therapist observes the ipsomatic principles
and then proceeds according to a specific procedure detailed below.
Then there is the dialogue within the mind of the therapist. That might
TheDialoguing Phase 159
be an admixture of the nomomatic approach-those notions the thera-

pist has derived from a theoretical perspective and empirical research
coupled with her own professional experiences with other clients
whose concerns were similar to those of the present client. And last,
there are the subjective messages and feelings derived from personal
life experiences that arise in the therapist on viewing the client's pro-
duction. As suggested earlier, the last two aspects of the dialoguing
process should remain submerged and silent while the therapist
attempts to facilitate and clarify the first two levels of the dialoguing
enterprise.
The dialoguing phase consists of three distinct parts. Distancing is
the first part. The decoding of the visual messages and the process of
translating the visual messages into conventional verbal symbol sys-
tem is the second part. The third part is the consolidation of the newly
derived information and the attainment of a sense of closure.
Distancing
In the dialoguing phase the therapist must first encourage the dia-
logue between the client and his visual expression. This is facilitated by
stepping back after the picture or the sculpture has been completed.
The stepping back may take the form of actually stepping back physi-
cally after having taped the picture to the wall, or setting the sculpture
somewhere where the maker can look at it from various angles. The
therapist should remember to give the client some time to contemplate
the object before intruding into the client's internal dialogue. After the
client has had the opportunity to inspect the visual creation, the thera-
pist moves to the next step of the dialoguing phase by simply inviting
the client to tell the therapist what has been produced. That starts the
process of putting the right brain messages into the conventional left
brain symbols. It may not be easy. Some clients may even find the talk-
ing superfluous. As one client commented, "If I could say it, I would
not have to portray it in pictures."
The Jungian therapists are of the opinion that the mere externaliza-
tion of the ideas has a beneficial impact. They think that the archtypes
are activated through the visual expression and this in itself and by
itself promotes wholeness and integration of the psyche. Therefore,
verbal explanation of the meanings contained in the picture is of sec-
ondary importance. But from the psychocybernetic position it can be
postulated that the clarity of the message will be enhanced and the
steering of the system will be more secure and appropriate if the mes-
sage can be expressed in the language of both and not just in one of the
symbol systems. The use of both cerebral hemispheres strengthens and
clarifies the information contained in the visual expression so that it
may be either heeded or discarded deliberately, as the case may be,
rather than left slumbering in the information processing channels of
the system.
Decoding
Decoding the messages contained in the visual forms of expression

is the second part of the dialoguing phase. How is this accomplished?
The decoding of the visual messages consists of three progressively
more intensive lines of inquiry. These three lines of inquiry are (a) the
inventory, (b) the search for affective qualities, and (c) the distillation of
meanings.
The first line of inquiry during the decoding process concerns the
content of the creation. This begins by simply asking the client to
describe what is portrayed on the piece of paper or in the clay. "Tell
me, what do we have here?" Or, simply, "Tell me about it."
At this point the client may go on at some length explaining the pro-
duction. Or the client may have only a few fragmentary comments to
share with the therapist. The process of decoding the meanings con-
tained in the visual product can be facilitated by simply asking the
client to point out and name the various shapes and/or objects that are
there. Dewdney (1967) called this the "object inventory." Dewdney
noted, and I share his observation, that the shape or object mentioned
last, or the one that is entirely overlooked by the maker, frequently has
some particular significance to the client. When the client has finished
describing the shapes and objects in the picture, the therapist may ask,
"Anything else?" The client may then point out some additional feature
of the production. Not infrequently, however, the client has nothing
further to add. But later, the client may suddenly notice some essential
feature of the creation. This may occur weeks or even months later.
Portions of the picture that had remained entirely blank to the client on
first viewing may now take on some special significance. At this point,
the client's codification system may have been expanded so that it
reaches a level where the additional information can be accommodat-
ed and integrated with the previously acquired information. (See Chap-

ter 3 for a discussion of cognition as a system of codification.)
Another way of facilitating the decoding of the messages contained
in the visual creation is to ask the client what in particular stands out for
him, what catches his eye, or what appears to be central in the picture.
This line of inquiry helps the client organize cognitively the meanings
contained in the creation. The more pertinent parts of the message are
sorted out from the peripheral ideas.
Still anther way of facilitating the comprehension of the visual mes-
sage is to direct the client's attention to the portions of the graphic
expression that have not yet been addressed. The therapist might ask
something like, "Can you say something about this area here?" Or,
"What sort of feeling do you get from this line here?"
These questions lead to the next step in the decoding process. The
dialoguing process has now deepened from a survey of the various
items, objects, shapes, and portions of the creation, or a simple inven-
tory, to the examination of the affective qualities associated with the
various parts and shapes of the creation. First the therapist might pose
a general question about the overall feelings contained in the creation.
For instance, the therapist might ask, "What kind of feeling do you get
now as you look at it? What kind of feeling does it convey to you?"
This mayor may not be the feeling the client intended to convey while
producing the visual expression. Often there emerges something
entirely different from what the client originally intended to portray.
The therapist can discover this by asking the client something like this:
"Did you plan it to be this way? Or were there some surprises as you
worked on it?" Not infrequently the clients report that the picture
seemed to have almost a mind of its own, and the visual product took
a shape different than what the maker intended it to have. These "inad-
vertencies" are of interest because they may contain feelings more gen-
uine than those the client deliberately intended to portray. If the client
feels secure enough with the therapist, he will readily explore the
meaning of the "surprises" that arose in the course of the work. The
acceptance and the support from the therapist may provide a sense of
adequacy and the necessary courage to consider the feelings and expe-
riences that have been too overwhelming or too humiliating to be
addressed before. These concerns and apprehensions may have
appeared beforehand only in nightmares. Solutions to these concerns
are more likely to surface now than when they are harbored in some
remote region of one's information processing channels.
The distillation of meanings from the visual expression is the final
step in the decoding portion of the dialoguing phase. To achieve this,
the discussion turns to a more intellectual, "left brain" level than it had
been up to this point. The therapist might ask the client to tell about the
messages the client gets from the picture or the sculpture. In most
instances, this will be a further elaboration and clarification of the ideas
expressed in the portion of the inquiry that dealt with the affective mes-
sages. The meanings contained in the visual creation may be consoli-
dated and clarified further with the help of some Gestalt-type questions.
These questions personify the visual creation. For instance, the thera-
pist might ask the client what the sculpture would say if it could talk. A
48-year-old woman, for example, thought that her sculpture conveyed
to her the idea, "Be bold, do not buckle under." Next, the therapist
might ask what the client could say in response to the message received
from the visual creation. "How would you respond to it, or what would
you like to say to your sculpture?" The woman in question told her
sculpture, "It is not going to be easy but this time I will do it!"
Sometimes asking the client to give a title to the picture or sculpture
helps to distill the meaning contained within. A 28-year-old black man
drew a head in the lower left hand corner of the sheet. The head
appeared to be bandaged and had blood dripping from it. A sun occu-
pied the upper right hand corner of the page. After he had explained
the picture to the therapist and had talked about the way the person
with the head injury was feeling, he decided that the title of the picture
could be "Endurance." He summed up the meaning of his picture as
containing the notion that although there was much pain and suffering
in his life, he was still able to endure life. By "enduring life" he meant
that he would be able to continue to abstain from taking heroin for still
some time longer, and that he would stay away from his former friends
(Figure 9-1).
When the level of trust between the therapist and the client is ade-
quate, the client is able to share with the therapist feelings and experi-
ences that up to now have been painful and embarrassing. Now
experiences and concerns are permitted to surface into awareness so
that they can be dealt with and disposed of. Thus the system can be sta-
bilized and steered into some more beneficial and constructive direc-
tion.
Figure 9-1. Endurance.
Closure and Consolidation
The final part in the dialoguing phase is the attainment of closure

and consolidation of the meaning. At this point the client should have
the opportunity to reflect on the entire experience of creating and dis-
cussing the product. The client will welcome the opportunity to explain
what came easily, and what had to be labored over. He will want to
reflect to what extent the production turned out to his satisfaction, and
what would he want to change, if that were possible. For instance, the
therapist might say, "Now suppose you had a professional artist who
could help you with your picture. What would you want him to touch
up? Any parts you would want him to go over and improve upon?
How?" Curiously enough, even when the pictures are obviously in
poor perspective or otherwise distorted, clients seldom notice the dis-
tortions because the pictures reflect the clients' own sense of the world
and their place in it. One 22-year-old black man, for instance, drew a
self-portrait where the large head sat precariously on a rather weak
body, with one huge foot going in one direction while the other foot
went in another direction. When he finished the self-portrait, he was
quite pleased with it. He thought he had accurately portrayed his life at
that time. Indeed, he was going in all directions at once, and he rather
relished this opportunity to capture this sense of noncommittal and
freedom (Figure 9-2).
Not all pictures will turn out to the client's satisfaction. At times the
client should have the opportunity to reject a work. If the visual prod-
uct contains ideas and feelings the client is not yet prepared to deal
with, and if the client is dissatisfied with how it turned out, the therapist
may ask what in particular he dislikes about the picture, and what
would make it more acceptable to him. At times the spotlighting tech-
nique described in Chapter 8 can be used at this juncture in the thera-
py process. Also, the client may be asked to make a picture about the
feeling that his picture conveys to him, or what it felt like to work on
that unsatisfactory picture. Thus, the experience becomes externalized
and can be inspected and placed among other life experiences. The
information processing in art therapy is for the benefit of the client,
and not the therapist. However, at this point the therapist might indi-
cate some feature that seemed aesthetically attractive while acknowl-
edging that the client's externalized feelings were rather scary or
otherwise unpleasant to him.
The making of a picture about the experience of the picture making
itself is one way to help the client attain a sense of closure. Inviting the
client to make a free choice picture or a picture about anything is anoth-
er method. The concerns touched upon in the previous picture will be
portrayed in the free picture, and frequently some resolution will
emerge. With a few strokes, for instance, a 33-year-old black woman
produced the sad looking puppy shown in Figure 9-3. During the dia-
loguing phase it turned out that the client's own sadness stemmed from
her desire to go back rather than to go forward in her life. The affection
the miserable puppy evoked in her gradually mobilized her own deter-
mination to take care of herself and proceed with her life.
Finally, many clients find the process of mandala making to be a
way of achieving a sense of consolidation and a closure. A mandala is
a circular drawing produced usually by starting at the center and then
proceeding outward toward the boundary of the circle. The mandala
shown in Figure 9-4 was done by a professional woman in her twen-
ties. Prior to her encounter with art therapy she thought that she did not
have any artistic ability. But within a few weeks her innate creativity
was flourishing. Not only did the mandala making help her sort out her
Figure 9-2. Carefree.
thoughts and feelings but it also gave her the pleasure of creating aes-
thetically attractive intrinsic designs.
Figure 9-3. A Sad Puppy.
The work to be done in the Dialoguing Phase may be summarized as

shown in Figure 9-5.
Format and Length of the Dialoguing Phase
The format and the length of the dialoguing phase of the art therapy
process are shaped by two sets of variables. The first are the character-
istics of the clients one is working with. The second set of variables
which determines the format and the extent of the Dialoguing Phase is
the theoretical orientation adopted by the therapist. These two sets of
factors are important considerations for the art therapist.
When working with children, the doing phase will be far more time
consuming than the Dialoguing Phase. Children enjoy picture making,
and unless the therapist persists, they may offer only a few snatches of
verbal comments. In contrast, when working with adults, the Dialogu-
ing Phase in most instances will be longer than the Doing Phase.
Here is an example of a Dialoguing Phase with a developmentally
normal and physically healthy six-year-old girl whom we shall callJen-
Figure 9-4. Mandala.
nifer. Jennifer had been an only child for all six years of her life, and
much affection and attention had been lavished on her by her parents.
Within the last four months, however, two factors had assaulted the
stability of her world. Her mother had become pregnant and was suf-
fering from severe nausea and fatigue. Suddenly her mother was less of
an active factor inJennifer's life and she was, in general, less accessible.
Jennifer's father tried to fill the gap but he could not fully compensate
for the loss of her mother's attention. AlthoughJennifer expressed joy
at the prospect of having a little brother or sister, she also verbalized
her considerable anger and sadness, wishing that her mother would get
back to her normal level of activities quickly.
Her recent promotion from kindergarten to the first grade was the
second factor affecting Jennifer's life. While kindergarten had been a
thoroughly enjoyable experience, the first grade with its rules and reg-
ulations, plus a new and somewhat intimidating teacher, appeared to
THE DIALOGUING PHASE

The Nomomatic Approach The Ipsomatic Approach
Application of ideas derived from theory Use of ideas derived from client's own
or empirical research life experiences:
Distancing
Decoding
Object Inventory
Affective Qualities
Cognitive Meanings
Consolidation/ Closure
Reflecti ve on Process
Acceptance of the Product
Portrayal of the Process
Figure 9-5. The Dialoguing Phase.
lower Jennifer's threshold of frustration tolerance. Her sense of confi-

dence and competence seemed to crumble. She tended to have temper
tantrums or dissolve in tears.
In her art therapy sessionJennifer produced a huge tree with a size-
able knothole, a small house next to the tree, and two flowers on the
other side of the house. A smiling sun adorned the upper left-hand cor-
ner of the picture (Figure 9-6). The picture was entitled, "The Outside
Picture," and it filled the entire page.
Jennifer's description of the items depicted tended to center around
her technique and choice of colors: "The tree is fat and big. The cur-
tains are made of light orange. The picture is made of crayons. The sun
with a happy face is made of lemon yellow and black. The flowers are
pretty. I worked as hard as I could." In an attempt to move Jennifer
away from the concrete to the affective aspects of the picture, the ther-
apist askedJennifer who lived in the house. Her response was, "My
UncleJohn, my Aunt Elsie, and my cousinsJulie and Dannie. That's all
I can tell you." The therapist praisedJennifer for the lovely picture she
had produced and pointing to the knothole, asked further about the
"black space in the tree." Jennifer identified it as a knothole. When
asked if anyone lived there, she responded, "A squirrel lives there with
her whole family-mommy, daddy, grandma, and grandpa, and there
are many nuts to at in there. It's a very fat tree." The therapist then
inquired if there was enough room in that tree for all those squirrels to
live there without fighting and getting in each other's way. Jennifer
Figure 9-6. The Outside Picture.
thought that there was enough room for everyone, adding, "And
besides, they all love each other very much, and they are very happy
together." At this point she drew the heart on the knothole. She was
asked to tell the therapist something about the flowers. Jennifer said,
"They are roses and they are closer to you than the house. The house
is further away, and that is why it seems smaller. Actually, it is almost
as big as the tree. That's all there is to say about it." The therapist still
persisted and askedJennifer which was her favorite part of the picture.
Jennifer said that the sun was her favorite part of the picture and added,
"I worked very hard on the sun." She was asked if there was any part
of the picture she did not particularly like. Jennifer replied that she
wished she could have drawn the flowers better. "They are not as pret-
ty as I wanted them to be."
In general,Jennifer seemed pleased with the drawing which she had
produced with great care and attention to detail. She appeared to expe-
rience some anxiety over doing what she perceived to be a "good job."
This example shows how a skillful therapist can facilitate the verbal
discussion of the picture even with a young child who thought on sev-
eral occasions that she had nothing further to say about her production.
The therapist introduced themes verbally that were depicted by impli-
cation in the child's picture, including her concerns about space need-
ed for the next addition to the family.
The second set of factors that shapes the format and the length of the
Dialoguing Phase is the theoretical framework adopted by the thera-
pist. And here, in the Dialoguing Phase of the art therapy process, the
differences between the various theoretical frameworks become most
apparent.
Art therapists who have adopted the psychoanalytic orientation tend
to emphasize the Dialoguing Phase over the Doing Phase. Often the
Dialoguing Phase is considerably longer than the Producing Phase.
This theoretical perspective differentiates between the so-called pri-
mary process thinking and the secondary process thought. According
to Freud, thinking in pictures approximates more closely the uncon-
scious processes than does thinking in words. It is assumed to be older
both for mankind as a whole and for each individual person, that is
both ontogenetically and philogenetically. The visual thinking or the
primary process type of thinking is held to be inferior to the secondary
process thinking. The visual expression therefore is explicated in great
detail into the verbal or the secondary process thought. Experience
shows that when Freudian therapists do art therapy, they are prone to
the dangers of overanalyzing, overcommenting, and oververbalizing.
Art therapists of the Jungian orientation, on the other hand, tend to
err in the other direction. Many Jungians dismiss as unimportant the
verbal dialoguing with the visual creation. They hold that the process
of expression is healing in itself. In their opinion, as previously indi-
cated, the archetypal forms portrayed do not have adequate verbal
equivalents, and even when attempted, the process of dialoguing will

fall short of the meanings captured in the visual expression itself. Con-
sequently, the dialoguing process in this form of art therapy is very
short or even omitted altogether.
It may very well be true that the visual expression indeed transcends
the confines of verbal language. However, in light of the psychocyber-
netic concepts, the process of dialoguing should not be shortchanged.
It is one form of feedback to the system. Even though the dialoguing
process will not capture all the nuances contained in the visual cre-
ation, it still has value because it facilitates the process of codifying and
integrating the new information with the information already stored in
the system.
The Process of Amplification
In this context it is well to note the process of amplification which

Jung himself used to clarify the messages contained in dreams. The
same process of amplification is needed also to understand the mes-
sages contained in the visual forms of expression produced in art ther-
apy. The message contained in the visual creation is less likely to
evaporate or remain effervescent if it is poured into a lexical symbol
system. What doesJung's process of amplification consist of?
Jung thought that the various aspects of dreams could be understood
by relating them to images and symbols which they suggest. By using
analogies, a common theme might emerge, and in light of this common
theme, each separate part of the dream might be examined to further
elucidate its meaning. In this painstaking manner, the probable sense
of the dream might be deciphered. However, Jung thought that this
"objective amplification" would not be sufficient. He pointed out that
also a "subjective amplification" would be necessary. When only a few
archetypal motives are contained in the dream the dreamer must sup-
ply personal association from his own life experiences in order to make
sense of the dream Oacobi, 1959, p. 130ff).
Dispositional vs. Facilitative Understanding
Jung's method of amplification of dream content indicates thatJung

himself was not averse to the efforts to find appropriate verbal equiva-
lents to the dream imagery. The same holds true for forms of purpose-
ful visual expression in the course of art therapy. Here too a process of
"amplification" is needed. What Jung terms the "objective amplifica-
tion" parallels what been designated as the nomomatic seeing while
his "subjective amplification" corresponds to the ipsomatic seeing.
According to Jung, the subjective amplification may provide the
means of understanding dream content that cannot be explained by the
means of the objective forms of amplification. In the context of art ther-
apy, when is it appropriate to engage in the nomomatic seeing, and
when is it more appropriate to use the ipsomatic seeing?
Experience shows that the nomomatic approach to visual forms of
expression leads to an objective understanding of the client and his
experience. When is it important to achieve an objective understand-
ing of what the client is going through? It appears that an objective
method of understanding is indicated in those circumstances where the
therapist is expected to provide solutions for the client's difficulties.
This may be termed the "dispositional" diagnostic understanding of
the client. This form of understanding is necessary if the therapist has
to provide a disposition to the client's problem-in recommending that
the client be treated in a certain manner or in certifying that the client
is entitled to certain provisions. In many instances, however, it is not
the therapist who will take the necessary steps to resolve the client's dif-
ficulty. It is the client himself. These instances call for a "facilitative"
diagnostic understanding or a form of understanding that facilitates the
client's own grappling with the problem. Here the client has to make a
specific decision, or take certain steps to insure that his behavior will
change and be more in his own best interests. If this is the case, the
ipsomatic seeing is necessary because it enables the client to know how
to proceed. Whether the therapist sees the solution or not is of a lesser
importance than the client's own knowledge of what he should do next.
The decoding of the meanings contained in the visual product, done
nomomatically at the exclusion of the ipsomatic features, results in
what usually is thought to be an objective understanding of the visual
creation. Actually this type of understanding may be very slanted and
contaminated by the therapist's own proclivities and life experiences.
This occurs because therapists feel drawn to, and tend to adopt certain
theoretical positions that are congruent with their own philosophies of
life which in turn have been shaped by their own life experiences.
The nomomatic or the so-called objective approach, when utilized

exclusively, results in psychological testing. This is in contrast to the
psychocybernetic model of where the understanding of the client him-
self has to be cultivated so that his life experiences may be properly
understood and responded to.
Search for the Inner Design
With most clients, even with very young children, the main impetus
for a beneficial and lasting behavioral change comes from their own
efforts rather than from the efforts and desires of the therapist. The
sense of clarity and determination that needs to be attained is that of
the client and not necessarily that of the therapist.
In the psychocybernetic model of art therapy, the dialoguing process
unlocks the information contained in visual expression so that one's life
may be steered dependably and securely with an adequate supply of
information. In the model, the information processing utilizes two
coordinates-the visual and the verbal. Both the primary and the sec-
ondary processes are essential for adequate information processing.
Both cerebral hemispheres have to be heeded. Information is embed-
ded in a dual coding system in humans, and the psychocybernetic
model pays attention to both.
The steering and the functioning of the human system may be
impeded by scarcity of information as well as by an overload of infor-
mation. Experiences that may have been too overwhelming and fright-
ening are frequently compartmentalized. They are not admitted to full
awareness where this information can be sorted out and inspected in
the light of contemporary reality. Such information may remain stored
at the kinesthetic/sensory level and may be represented by various
bodily symptoms. By interconnecting and integrating the information
stored at the various levels of the system, energy is made available for
goal-directed functioning.
The psychocybernetic model postulates that imagery is one of the
most important channels of information processing. Experiences in life
are encoded into imagery of the various sensory modalities. Of these,
visual modality is one of the most paramount and strongest.
The visual forms of expression are like the conveyor belts that bring
forth information. They deliver the meanings like fossils which can be
transformed into their original state. They can be resuscitated, as it
were, and the energy contained in the original experience can be reac-
tivated. Or, like frozen vegetables which when properly treated, can be
restored almost to their original state.
The relationship between the information stored at various levels of
the human system and the functioning of the entire system may be
thought of as something akin to a shoe store. There are all kinds of
styles, sizes, and colors of shoes. However, they are all useless until the
proper size and style is found for the particular occasion in mind. The
same with information. The information stored in the system has to be
codified and tried on "for size" for the particular tasks one is about to
engage in. This is accomplished with the help of the dialoguing process.
Anxiety is experienced if the input-output sequence of information
processing is interrupted. Gradually this anxiety coalesces into psy-
chopathology and undesirable behavior. This sequence of events takes
place not only in the human system but in animals as well (Sebeok,
1962). In rats, for instance, information overload created by over-
crowding produced various abnormal internal cognitive and affective
processes, particularly frenetic activity and pathological withdrawal.
According to some scientists, repeated interruptions of the completion
of the normal input-output sequences by new inputs lead to what has
been termed "future shock" (Toffler, 1970). In affluent industrialized
societies the individual is flooded with an excess of attractive informa-
tion inputs. He is pressured by social influences to choose from among
attractive inputs which creates a conflict over which alternatives should
be chosen. He attempts to cope with the information overload by fil-
tering, escape, repeated approaches to many different goals or sources
of information, aggressive behavior, or passive surrender. Young peo-
ple are particularly vulnerable to the effects of excessive information
overload because they have not developed ways to choose from among
alternatives and to strive in a sustained manner towards selected goals
(Spitz, 1964).
The Dialoguing Process in Groups
When art therapy is done in a group setting, it is well to keep in

mind the cardinal principle that only the artist knows what the creation
means. The other group members can only say how the item affects
them, not what it means. Often the reactions of the other members of
the group to the visual expression are quite diverse. Each reaction,
however idiosyncratic, is accepted and respected as a rightful experi-

ence of the commentator. Each person has the right to personal likes
and dislikes, but only the artist knows which of the comments is correct
or actually fits. Sometimes the perceptions of some members of the
group differ markedly from those of the rest of the group. That being
the case, they may eventually want to explore the possible reasons for
their particular perceptions.
The art maker should have the opportunity to present and explain
his production to the group before others offer their comments and
reactions. After the artist has explained what he tried to do and after he
has mentioned the feelings evoked while looking at the art production,
the other members of the group may comment and react. This experi-
ence of sharing the different reactions to the same picture or sculpture
is usually quite satisfying to the maker, particularly if the therapist has
succeeded in developing a no critical atmosphere in the group. Clients
thrive on this attention even when they themselves have little to say
about their productions.
The client may insist that the therapist give her own interpretation of
the visual production. If this is a genuine desire on the part of the client
to understand his creation more deeply and not simply an attempt to
avoid revealing his own thoughts, the therapist may say something like
this: "If it were my picture ... if I had made it ... I would think per-
haps that ... etc."
Salience and Timing
In the Dialoguing Phase, the therapist has to keep in mind two spe-
cific considerations. The first consideration pertains to the depth of the
inquiry. Should the inquiry exhaust all the possible information con-
tained in the visual creation, or should some information remain dor-
mant? The second consideration is timing.
In most instances the therapist can get beyond the cliches and the
global statements of the client. As we saw withJennifer earlier in this
chapter, the child indicated several times that she had nothing further
to add to the discussion. Still, the therapist was able to elicit additional
information. It takes clinical seasoning to know when to continue with
the inquiry and when to stop. The dialoguing process is for the benefit
of the client and not for the sake of satisfying the therapist's sense of
completeness of the process. Yet, timidity is no virtue during the Dia-
loguing Phase. While working with a depressed woman client, an art

therapist in psychiatric hospital noticed in the client's picture what
appeared to be a loop of a rope. The therapist did not proceed to
explore the meaning of these mysterious shapes in the drawing. The
woman was permitted to go home on a weekend pass. While at home,
she hung herself.
This is one instance where the therapist needed to attain what we
have termed the dispositional diagnostic understanding. Steps should
have been taken to institute suicidal precautions for this client. If the
meaning of the suicidal implements had been verbalized during the dia-
loguing phase, it is possible that the client might have attained for her-
self what we term the facilitative understanding. She could have been
helped to realize that suicide was not the only alternative open to her.
In addition to the considerations of what information is salient and at
what point in the therapy process, the therapist has to keep in mind the
distinction between eliciting the client's own thinking and imposing
her thinking on the client. It is difficult if not impossible for most clients
to contradict the therapist. Comments need to be phrased gingerly and
tentatively if the client's own ipsomatic seeing is to be facilitated by the
therapist. For instance, instead of telling the client that something "is"
or "means" a certain thing, the therapist might say something like,
"What do you make of this part here? Am I way off to think that . . .
Does this look like that to you, too, or is this just my fantasy?" The con-
clusions the therapist is tempted to draw either on the basis of profes-
sional experiences with similar clients or on the basis of the theoretical
orientation she has adopted, should be regarded as "soft" data. That
data has to be substantiated with information obtained from the par-
ticular client one is now confronting, rather than treated as "hard" data
that can be regarded as firm evidence.
In summary, the psychocybernetic model advocates a phenomeno-
logical or what we have termed an ipsomatic approach whereby the art
maker's own ideas are used to explain the meanings contained in the
visual creation. The three steps of the ipsomatic approach are distanc-
ing, decoding, and consolidation. Ideas derived from some theory or
empirical research, or what was termed the nomomatic approach, may
help the therapist form hypotheses about the significance of the various
aspects of the visual product but these ideas should remain hypotheses
until they can be supported with information obtained from the art
maker or some other appropriate source.
Chapter 10
ENDING AND INTEGRATING
h e handling of the ending phase in therapy is frequently more com-

T plicated than that of any other phase of the therapeutic process. It
presents special difficulties in art therapy as well as in other forms of
therapy. Several factors conspire to make the final phase of the thera-
peutic interaction complicated for therapists and clients alike.
For one, treatment frequently ends unexpectedly and prematurely.
Many clients decide unilaterally simply to drop out of treatment. Many
endings come about not because the goals of treatment have been
achieved but because clients-and in many instances their therapists as
well-have run out of hope time, and energy. Often the desired out-
comes are as distant at the end of the interaction as they were at the
outset.
Other endings come about due to external factors, such as the reor-
ganization of services at the institution or agency where treatment is
offered. Still others are necessitated by the therapist's departure from
the institution because of advancement and change of employment.
Many treatment interactions are cut short when the client is discharged
and insurance payments run out. For these and other reasons the topic
of termination is distressing for many therapists.
The handling of the ending phase is further complicated by the fact
that professional literature is quite meager on the topic of termination.
This is true for art therapy as well as for other forms of treatment. The
process of termination appears to be shrouded in a conspiracy of
silence. Some of the major works on art therapy avoid the mention of
termination entirely while others devote only a few sentences to it. So
far only one art therapy theoretician has incorporated consideration of
177
termination in her discussion of the therapeutic process (Landgarten,

1981).
This chapter presents several principles that can make the manage-
ment of the final phase of the therapeutic process effective and con-
structive for both clients and therapists. It identifies and discusses
specific tasks of the therapist in the ending phase of treatment.
The ending phase of art therapy process can be managed effectively
if this portion of the therapeutic interaction is regarded as consisting of
four components: ratification, resistance, review, and resolution. They
are not strictly consecutive and linear but rather they intertwine and
overlap. Applying the concepts from the General System Theory
which were discussed in Chapter 2, these four components of termina-
tion may be thought of as subsystems of the therapeutic process. They
are identifiable but their boundaries are semipermeable, and thus each
subsystem is affected by the other subsystems.
Ratification
Ratification is the first step in the process of termination. This is the

attainment of an agreement with the client on how long the contact
between the client and the therapist will last. The approximate number
of sessions is agreed upon and the rationale for the use of these sessions
is discussed. This discussion generally takes place during the contract-
ing phase of treatment. During these early discussions a tentative date
of termination is set. Determining the anticipated length of treatment
helps to shape the interaction so that it proceeds realistically and eco-
nomically. Energy is focused on the tasks that can reasonably be
expected to be accomplished in the time allotted for the interaction.
For instance, a therapist at a methadone maintenance clinic worked
with a group of heroin addicted adults who were notorious for their
lack of investment in any of the modalities of treatment that had been
offered to them previously. The therapist agreed with them to conduct
six art therapy sessions with the stipulation that during the fifth session
a decision would be made whether to extend the contract for another
six sessions or whether the sessions would be terminated altogether.
This contract was renegotiated and clarified during the second session.
Although several members of the group voiced skepticism about the
possibility of art therapy making any difference in their lives, none
dropped out. During the fifth session the progress attained up to that
Ending and Integrating 179
point was discussed, and the contract was renewed for an additional
period of six weeks: At that point two of the 12 members of the group
decided to discontinue and two new members were added to the
group. In this manner the group process was not detrimentally affect-
ed by the departure of the two members. Although unanticipated
dropouts often negatively affect the remaining group members, that
was not the case in this instance (Nucho, 1977).
Some therapists, while contracting, attempt to preclude the possibil-
ity of members dropping out precipitously. Clients are free to discon-
tinue treatment at any point prior to the date set for termination. But
they are asked to agree to come back for one additional session in order
to discuss their reasons for their decision to terminate treatment (Shul-
man, 1984).
Ratification then is a matter of attaining clarity about the expected
duration of the therapeutic interaction. Both the client and the therapist
should be clear on this so as to focus their energies effectively instead
of stumbling along indefinitely. There is increasing evidence in the pro-
fessional literature that relatively short-term treatment, if planned
ahead of time, is just as effective as indefinite, open-ended treatment
(Puryear, 1979). In settings where long-term, open-ended treatment is
the norm, the practice of establishing specific segments of short-term
treatment helps the clients mark the passage of time and gain a sense of
accomplishment. An aura of "graduation" can be achieved by having
completed, for instance, two or three 6-week periods of treatment.
Resistance
Resistance is the second component of the ending phase that

requires careful attention. Resistance to the necessity of facing the fact
that the therapeutic process is coming to a close is an inevitable, if fre-
quently subtle, manifestation on the part of clients as well as the thera-
pists. This resistance is fed by two sources. One is the realization that
many of the hoped for radical improvements have not materialized.
The client has to face and mourn the death of the fantasy of living "hap-
pily ever after" as in some fairy tale. Therefore, to eliminate this form
of resistance to termination it is essential that realistic goals for the ther-
apeutic interaction be set and agreed upon at the very beginning of the
contact.
The other source of discomfort connected with termination which

produces various forms of resistance is the inevitable reawakening of
the pain associated with previous endings in one's life. Ending therapy
invariably reactivates in clients as well as in therapists the old scars
caused by previous endings in life. Rarely does a person manage to go
through life without having had to endure the pain of having been left
behind by some emotionally significant person. Most of us have expe-
rienced the distress of various forms of separation, be it through a
death, a divorce, or some other kind of dissolution of an important
relationship. These painful feelings about having been previously aban-
doned by-or having had to abandon-someone or something, tend to
resurface when the client and the therapist face the ending of a treat-
ment relationship.
Resistance to termination takes many forms. To guard against the
possibility of reexperiencing the old hurts occasioned by earlier end-
ings and losses of supports, people automatically engage in various
avoidance behaviors. In clients this avoidance often appears in the
form of forgetting the fact that a specific date for the termination of the
treatment had been ratified at the outset of the treatment interaction.
Other clients suddenly lose interest and start missing appointments as
the date of termination approaches. They seem to want to reject the
therapist before the therapist has the chance of "rejecting" them by ter-
minating treatment. Still other clients suddenly reveal an overabun-
dance of problems as if to prove to the therapist that treatment should
not possibly come to a close.
In therapists the same need to guard against the possibility of reex-
periencing old hurts associated with previous losses of important rela-
tionships often surfaces in the form of reluctance to broach the topic of
termination with their clients. Many therapists avoid bringing up the
topic of termination as long as possible. They frequently permit their
clients to stagger through the ending phase without help, or they let
clients terminate treatment prematurely.
There are ways the therapist can cope with resistance to termination
and two things need to happen in order to lessen the therapist's dis-
comfort. First, the therapist has to take time to grieve and come to
terms with personal losses of meaningful relationships. Having the per-
sonal psychological house in order, the second task can be addressed.
That is to attain clarity about levels of improvement that can be realis-
tically expected for various clients. Instead of hoping to cure each and
every client, the therapist has to set realistic treatment goals that can be
achieved in the time allotted. Naturally, this ability to estimate and
establish realistic treatment goals comes with experience. Unrealistic
goal setting is one of the predicaments of unseasoned therapists. They
tend to be devastated if they do not succeed in turning their clients into
the fully functioning and self-actualizing persons which they them-
selves aspire to be.
What are realistic treatment goals when working with severely dys-
functional clients? The psychocybernetic perspective which was dis-
cussed in Chapters 2 and 3 provides some rough guidelines for
deciding what are appropriate treatment goals when working with
clients who have been chronically deprived both emotionally and
socially. Some of the specific client concerns will be resolved. But the
majority of their concerns will still be there after termination. In most
instances what can be accomplished with chronically dysfunctional
clients is to set in motion the process which will help them go on living
with somewhat less wear and tear on themselves and on others than
before. It is useful to think in terms of inputs, both material and emo-
tional, that steady the system. Clients should be able to leave treatment
with some greater clarity as to what realistically can be changed in their
lives, and to have the resolve to pursue the means to do so. They
should be clear about what supports, both emotional and material, they
need and where and how to get them. They should be more certain
about their own goals in life, and more aware of their own personal
assets. The tenacity and the courage many of our clients display while
often enduring subhuman living conditions is an impressive source of
strength for which they can be justifiably proud. They should be helped
to feel part of some superordinate system, some "whole," or what
Andras Angyal termed "homonomy" (Angyal, 1958). From isolation
and a mentality of a victim they should be helped to move toward
being more in charge of their own lives. They should feel the possibil-
ity of change, with all its risks and rewards. Their boundaries should be
reasonably firm in the sense that they know who they are, aware of
their identity while having the courage to seek energy emanating from
other systems, such as other people, institutions, and belief systems.
This process can be set into motion but not brought to a completion, no
matter how extensive therapy may be.
If the therapists are realistic about the extent of change that can be
anticipated in clients' external and internal worlds, their reluctance to
deal with the matters related to termination will be lessened. They will
be ready to help their clients cope with the approaching termination.
What specifically can a therapist do to ease a client's discomfort with
termination before it has blossomed into full-fledged manifestations of
resistance? The first and most important thing that can be done to help
clients enter the ending phase constructively is to keep reminding them
of the passage of time and of the number of sessions remaining. Even
if it is a short-term treatment, clients should be involved in planning
how to utilize whatever length of time still remains. Another essential
activity for the therapist is to notice, anticipate and acknowledge
empathically the feelings that the fact of termination awakens in the
clients. If the therapist is aware of the nature of the previous endings in
the client's life, this empathic acknowledgment will come naturally
(Puryear, 1979).
The emphasis at this juncture in treatment should be on the "Now."
The question that should be raised in various forms with clients is,
"What does it mean to you that we have only X number of sessions
remaining?" As the termination approaches, one art therapist likes to
suggest that the client "Make something that shows how you feel about
the fact that this is our next to the last session" (Landgarten, 1981). In
this manner, the client is helped to sort out the conflicting feelings asso-
ciated with termination instead of being permitted to run away from
these feelings. Now the ground has been prepared for dealing with
review, the next component of the ending phase.
Review
Review is the third component of the ending phase. At this point in

treatment the entire experience is surveyed, even if this experience
may have lasted only a few hours or a few days. Now is the time to
identify the changes that may have occurred in the clients and in their
external circumstances since the beginning of their contact with the
therapist.
Ideally, the process of review takes place also in the verbal forms of
treatment. In verbal therapy, however, the process of review is fre-
quently hampered by the lack of tangible markers of the changes that
may have taken place. By the time the review process takes place, both
the client and the therapist may have reached new mind states. Traces
of their previous mind states may have faded by then. Growth and
change usually proceed so gradually and imperceptibly that the indices

of change are difficult to establish.
Art therapy has a decided advantage over the verbal forms of thera-
py in this respect. The visual creations produced while in therapy serve
as permanent sources of information that indicate the progress made,
or the lack of it. The thoughts and feelings experienced at earlier junc-
tures in therapy as one wrestled with one's concerns are clearly docu-
mented. The visual creations are there despite the tendency to
remember and forget selectively.
During the process of review at the end of therapy clients frequently
are able to discern their own growth quite vividly. A 32-year-old pro-
fessional woman, for instance, noticed during the process of review that
in an early picture she had portrayed herself as a small, shadowy figure
who was reaching in a manner of a supplicant towards several large
and overbearing figures. Upon reflection she realized that she no
longer assumed a little girl's demeanor as she had done previously
when dealing with her superiors at work. Now she was able to hold her
own and present her ideas in a grown-up manner.
Behavioral changes of this kind are usually more obvious to outside
observers than to the clients themselves. It is essential, however, that
clients be helped to become aware of such changes in order to prevent
the possibility of their backsliding into old habits after the termination
of treatment. The examination of their visual creations during the
process of review tends to highlight so clearly the changes the clients
have experienced while in therapy that subsequent experiences in life
can no longer obliterate the progress they have achieved.
Several methods of review may be followed. The therapist may
choose to ask clients to inspect their creations serially, from the first to
the last session, noting the changes in themes and in the means of
expression. For instance, clients may notice some recurring symbols, or
subtle changes in their use of color, line, and form. Clients are often
able to connect these changes in their means of expression with
changes in their moods and attitudes. Their system of codification, that
is, their manner of sorting out and appraising their experiences, has
changed.
Another way of facilitating the process of review is to ask clients to
select their most and least meaningful creations from among those pro-
duced while in therapy, and to say what makes one creation meaning-
ful and the other not meaningful to them.
For most clients the most meaningful creation usually turns out to be
the picture or sculpture in which they had invested genuine emotion,
positive or negative. Their works may portray a dreaded and traumat-
ic experience but if the client has grappled with this experience, how-
ever damaging, the results are frequently quite satisfying personally
and attractive aesthetically. In several groups, for instance, the majori-
ty of clients selected as their most meaningful picture the one which
portrayed the theme of "A problematic relationship with someone or
something." A 47-year-old black male, for example, depicted his rela-
tionship with his 13-year-old stepdaughter. His picture portrayed the
turmoil his stepdaughter was creating in his life, and included many
symbols of her defiance of him. Upon examining the picture he noticed
some of the gentler colors on one side of the cyclone-like shape which
was supposed to represent the girl. He realized that the child had some
positive qualities which he could cultivate while respecting her need to
grieve the loss of her biological father.
The least meaningful production usually turns out to be the one the
client has produced hurriedly but not spontaneously. It is important
for clients to identify what makes a picture meaningless to them. A
meaningless picture or sculpture usually is the one in which the client
has not invested much of himself. Frequently the lack of investment sig-
nals the client's unwillingness to grapple with a certain experience or
concern. If this is so, the client eventually may want to ponder the rea-
sons for this. This may be the place where some additional work may
have to be done at some future point in time.
Still another way of facilitating the process of review during the end-
ing phase of treatment is to suggest to the clients that they try to portray
what the entire experience in treatment had been like for them. This
may be done in the form of a drawing, painting, sculpture, collage, and
so on. For instance, one group of clients who, having been heavy users
of heroin were currently on methadone. A 22-year-old white male
drew a picture in pastels which covered the entire sheet of paper, 9 by
12 inches in size. It portrayed a yellow hazy looking sun, surrounded
by red (Figure 10-1). He explained that for him the experience had
been like being in a warm, sunny place. This young man had the habit
of muttering threats under his breath, directed at people who he
thought had slighted him in some way. In the art therapy group, how-
ever, he had felt safe, having been permitted to participate at his own
Figure 10-1. A Warm Place.
pace. Having a place where he was not attacked and criticized appar-
ently was a rare experience in his life.
While reviewing their productions, clients at times wish to redo a
picture or a sculpture that had not turned out to their satisfaction. One
32-year-old woman, for example, was dissatisfied with her self-portrait
which she had drawn during an early session. In the meantime, having
faced and resolved some of her conflicts with her mother, her sense of
herself as a person had changed considerably. She drew another self-
portrait, and the results clearly reflected the growth she had attained
while in therapy.
The process of review serves like a bridge which helps clients move
from the resistance and avoidance to the resolution. Knowing clearly
where one has been and where one is going provides the courage and
the determination to face one's future with all its threats and promises.
Resolution
Resolution is the fourth and final component of the ending phase.

The ending phase begins by asking the client to address the question,
"How is it with you Now?" The emphasis is on the immediate reaction

to the fact of termination and how this fact affects clients' mind states.
This is followed by the review process, when the client considers the
entire experience in treatment. During this review process the question
to the client in various forms is, "How has it been for you?" Now in
order to facilitate the process of resolution, the client is asked to proj-
ect into the future, and to what awaits after treatment has ended. Now
the question the client grapples with is, "What comes next for me?" It
may be something the client is anticipating with pleasure. Or it may be
something the client is reluctant to face. In any event, the future, what-
ever it holds, is inexorably on its way. What matters now is that the
client feels the courage to face the future, whatever it contains.
Two factors comprise the component of resolution which follows.
First is the resolution of the conflict over one's reluctance to cope with
the fact that the therapeutic relationship is coming to an end. The sec-
ond is the formation of a resolve or a decision about one's future course
of action. This course of action may be short-range, comprising the
next few hours or days. Or it may be long-range, dealing with several
years or even decades.
One way of facilitating resolution of the conflicts and feelings sur-
rounding the ending of therapy is to ask clients to look ahead by mak-
ing a picture or sculpture about what they hope they will be doing, .or
what their lives will be like next week, next month, next year, three
years from now, or whatever seems to be an appropriate interval of time.
Another method of aiding clients to work through to a state of
resolve and resolution during the ending phase is to ask them to make
a picture about what they are leaving behind as they end therapy, and
what are they taking with them. Some experiences may be left behind
gladly, others may be left behind reluctantly. Even the leaving of a bur-
den may create ambivalence. This may be inferred from a picture
drawn by a well-functioning and a successful professional woman (Fig-
ure 10-2). The huge, heavy, black anchor represents the burden she is
leaving behind. A link in the chain is broken, and yet the tiny human
figure, instead of being liberated, appears to be falling into the abyss
towards the anchor. Having portrayed one's current state of mind this
clearly one can take precautions to avoid the dangers inherent in this
situation.
One foster child who was returning to the home of her own parents,
made a picture about leaving behind assignments, chores, and the
Figure 10-2. The Black Anchor.
enforced curfews. These were matters she thought she could well do
without. The one thing she wished she could take with her was her fos-
ter mother's cat. Apparently the cat was a symbol of the ambivalent
affection she was feeling towards her foster mother. One art therapist
draws the outlines of two hands and then asks her clients to make pic-
tures in these hands showing what they will hold on to, and what will
they let go (Landgarten, 1981).
The process of resolution can also be facilitated by the therapist's
singling out for a special mention a work of the client which marks
some important turning point. With some imagination, the therapist
may be able to offer a token of appreciation to each member of the
group, if art therapy has been done in a group setting. For instance,
there may be a prize for the best free-flow creation, for the best self-por-
trait, for the best use of black color, for the most effective use of lines,
and so on.
The resolution that one should strive for is not in the sense of insur-
ing that the client can live "happily ever after" but rather in the sense
that the client is capable of facing the trouble that may be lurking dur-
ing the next phase of life. In response to the question of what was she
leaving behind and what was she heading towards after therapy, a 36-
year-old white professional woman drew a picture consisting of two
parts. She professed a desire to devote more time to her family by giv-
ing up some of her professional commitments. Between the two parts
of the picture she had drawn a bridge. On the bridge was a car.
Although it was supposed to be going in the direction of that portion of
her drawing which represented her family life, the car was obstinately
turning in the opposite direction, towards the items depicting her pro-
fessionallife. She was able to recognize that she had not resolved her
ambivalence concerning the demands placed on her by her family, and
that she still had to continue to struggle with the balancing of her sev-
eral roles in life.
In long-term treatment, the ending phase of art therapy may extend
over a number of weeks. In short-term treatment these four compo-
nents of termination-ratification, resistance, review, and resolution-
may be touched upon very briefly in one or two sessions. Nevertheless,
they should be there. Even when the contact with the client lasts only
for a single session, attention must be paid to them.
To end is to reconnect with where you were at the beginning of the
process. The distance traveled, emotionally, cognitively and in any
other way has to be appraised and noted. The distance traversed can be
estimated by comparing what it felt like at the beginning, and what it
feels like now. What were the apprehensions then, and what are they
now? What were the hopes then, and what are they now?
The extent of change can be estimated by comparing the first with
the last picture produced in therapy. This method of assessing change
is particularly convenient when working with young children whose
verbal ability is limited. A five-year-old black male whose therapist was
of the same racial background, provides an example. His first picture
was a rather disjointed affair consisting of several lines (Figure 10-3).
He explained these lines as portraying a boat, water, and a shark. He
also mentioned a truck. None of these objects are actually discernable
in the picture.
His next picture was better organized and more age appropriate (Fig-
ure 10-4). It contained a house with his parents on the left. On the
other side of the house he portrayed himself climbing a tree while his
sister watches him. The figure representing him was less well devel-
oped than the figures of his parents and his sister. A small partial moon,
two stars and a dark sky complete the picture.
Figure 10-3. A Boat, Water, Shark, and a Log Truck.
Nomomatically, on the basis of empirical research and clinical expe-

rience, the execution and the placement of the objects in Figure 10-4
suggest a rather immature and a depressed child. The last picture pro-
duced in the same therapy session, however, bespeaks a much more
mature and secure child (Figure 10-5). It shows a well drawn human
figure in a multicolored outfit, wearing a jaunty hat and juggling 12
well placed balls in the air. He called the figure "Boy Lee" although that
was not his own name nor was it a name of any of his friends. The con-
trast between this last picture and the first picture produced by the
child in the same therapy session is astounding. This therapist obvi-
ously succeeded in fostering a sense of mastery in this child which is
bound to strengthen his growth. Without the pictorial evidence the
impact of the session on the child would be much more difficult to
judge.
Termination has an element of mourning and an element of triumph.
If all has gone well, there may be an aspect ofjoy and a sense of accom-
Figure 10-4. Climbing a Tree.
plishment. Frequently there will be a tinge of sadness, because reality

hardly ever lives up to one's expectations. A mark of maturity is to rec-
ognize and come to terms with the inevitable shattering of dreams.
Figure 10-5. Boy Lee.
Like the Roman deity Janusis, represented with two faces the ending
phase looks both backward and forward. One face looks backward to
the past, the other forward to the future. This double look of surveying
both that which lies behind and that which lies ahead, serves the cyber-
netic function of steadying the system. Informational inputs are pro-
vided by surveying these two directions so that the proper course of the
system may be determined.
Integration
The human system is steered by the information that arrives from

various sources, both internal and external. This information has to be
codified, that is, sorted out and integrated with the information already
in the system so that the next phase of activity may be charted propi-
tiously and appropriately. How information is codified and organized
will determine how the energy of the system will be utilized. It may be
squandered aimlessly, or it may be invested prudently in goal directed
activities.
The information contained in the imagery that was portrayed in the
visual creations during the therapy sessions and which was generated
through the dialoguing process is not decoded entirely when treatment
comes to an end. Some of the meaning of the experiences portrayed
will remain enigmatic. Other portions of the meaning of the experi-
ences will be unlocked and incorporated into one's cognitive and
behavioral systems gradually as the client encounters subsequent expe-
riences of either similar or contrasting kind. Some of the information
condensed in the imagery will remain dormant, like a sleeping beauty,
or a slumbering monster. The nature of the therapeutic relationship
may make the difference in this regard. If it has been constructive, it
will continue to radiate energy and provide constructive information
even if there are still some slumbering monsters that have not been
dealt with adequately during the treatment. On the other hand, if the
therapeutic relationship has been toxic, it will continue to exude detri-
mental messages about one's worth and abilities long after treatment
has come to a close. Like a melting ice cube, it will dilute future expe-
riences.
It is worth keeping in mind that the work does not go on only dur-
ing the face-to-face interactions with the therapist. It continues between
sessions and long after the sessions have ended altogether.
During the therapy session, questions were posed that required
thought and effort. These questions focus one's mental energies. Both
cerebral hemispheres were engaged in grappling with these questions.
One's mind, like a net, had to cast for answers, sorting out past and cur-
rent life experiences. The various exercises of art therapy and the dis-
cussion of the visual creations could not provide all the answers and
solutions but they set the process in motion. The search for appropri-
ate solutions reverberates throughout the various subsystems of the
mind. Having engaged both cerebral hemispheres, the solutions that
finally present themselves are bound to be more appropriate than
when only a portion of one's mind is utilized. Like modules of energy,
the questions posed in therapy generate energy and attract new energy
in the form of thoughts, feelings, intentions, and decisions. By observ-
ing the psychocybernetics of human functioning, the process began
with the help of the therapist. The mind continues this process, nib-
bling at those questions that can make a difference in one's life. In a
cybernetic manner, the information obtained in this way is used to
steer the course of one's life. More importantly, in therapy the client
learns to pay attention to the images that arise spontaneously in the
mind. They are bearers of information that have to be sorted out and
processed unceasingly even after therapy has come to a close.
A Practical Hint
The process of termination can proceed effectively as discussed

above only if the visual creations produced by the client in the course
of therapy are readily available for examination when the ending phase
has arrived. For this reason it is wise to establish the practice of keep-
ing the drawings and the other items produced by clients in the thera-
pist's office. Make a folder of some sturdy material. After each session,
ask the client to date and sign their creations and then place the two-
dimensional products in the folder; the three-dimensional objects can
be stored in whatever place can be made available to the clients for this
purpose. The clients should have access to their creations whenever
they wish to see them. But it is best to agree that these works will not
be taken out of the therapist's office. They are the documents of one's
therapeutic progress, or the lack of it. They are not made to entertain
one's friends or family.
There is one more reason why the art therapy products should not
circulate outside the therapist's office. Most people who are not famil-
iar with art therapy will approach the work produced in art therapy as
they would approach any other works of art. In a museum or at an art
gallery, the works of art are examined for their aesthetic qualities and
merits of workmanship. In contrast, the works produced in art therapy
are not produced with aesthetic criteria in mind. What matters in art
therapy is not the aesthetics but the thought processes that are prompt-
ed in the maker while producing the visual creation.
Especially when working with children, the therapist has to guard
the client against unfair criticism that may be hurled at the child by the
parents who use artistic yardsticks to evaluate their child's work. Most
children will want to share their works with their parents and teachers.
If so, these adults should be apprised of the purpose of the artwork
made in art therapy so that they do not dampen the child's enthusiasm
for this form of information processing.
Clients are free to take all their creations with them after treatment
has been concluded. Some of the pictures and sculptures are very
meaningful to the clients, and they cherish them as reminders of the
therapeutic interaction and the resolutions made while in treatment.
Other works are discarded, or left with the therapist for safekeeping.
Many clients like to leave with the therapist those works that signify
parts of themselves that they have now outgrown.
Conclusion
The Ending Phase consists of four parts. Ratification is the agree-

ment reached with the client about the approximate length of therapy.
Next, as the date of termination approaches, resistance surfaces. The
therapist must watch out for the various indications of resistance as the
client attempts to avoid the necessity of dealing with the discomfort of
the separation. This is followed by the process of review, instituted
when the client surveys what has happened while in treatment. The
review of the process leads to the final component of the Ending Phase,
namely the resolution when clients are helped to chart their future
directions.
Life is a never ending process of sorting out the messages that arrive
ceaselessly to us through our various sensory modalities as we cope
with our manifold tasks and expectations that we have for ourselves
and for those with whom we interact in our various roles. Ideally, dur-
ing the therapy, clients learn to pay attention to the messages that
arrive from outside themselves and those that arise from within. The
visual products created in art therapy are the means of halting the flow
of this information temporarily so that the various messages may be

examined and integrated with the information already stored within
the system. The therapist is an assistant in this process of sorting out the
various forms and levels of information in which the human system is
submerged. After therapy, this process of sorting out the influx of infor-
mation has to go on without the immediate assistance of the therapist.
If the relationship with the therapist has been a constructive one, the
therapist will nevertheless remain symbolically a very real presence in
the life of the client from then on.
Part Three
WORK WITH SPECIFIC CLIENT

POPULATIONS
Chapter 11
WORK WITH CHILDREN
h e theoretical foundations of the psychocybernetic model were dis-

T cussed in Part One. The several phases of the therapeutic process
were considered in Part Two. Brief case examples illustrated the vari-
ous phases of the therapeutic process. Part Three will deal with specif-
ic matters that need to be kept in mind when working with particular
client populations. Using the notion of life stages as the organizing prin-
ciple, factors are highlighted that are specific to work with children,
adolescents, and the various kinds of adults.
How do we work with a child who is symptomatic? Suppose the
child has a problem. It may be a problem at home or in school. Maybe
the child is being picked on; or he is a bully and picks on other chil-
dren; or is restless and cannot sit still in class, even for a few minutes.
Now, not only does the child have a problem, but he is a problem to his
teachers and his parents. What is the therapist to do?
The art therapist's first impulse is to have the child draw some pic-
tures to find out what is going on. After all, according to Rhoda Kellogg
(Kellogg, 1969), to a child, drawing is as natural as eating a cookie. But
what if he refuses? A child diagnosed with Attention Deficit Disorder
with Hyperactivity would not simmer down long enough to draw a
picture and would be even less inclined to talk about the drawing. The
unfreezing phase of the psychocybernetic model, discussed in Chapter
7, would have to be considerably expanded. Some vigorous physical
activity would be indicated (Hensely, 1998). One art therapist has
found that doing a mandala drawing helped calm hyperactive children
(Smitheman-Brown & Church, 1996).
When the child is a problem or has a problem, the art therapist
should consider whether working directly with the child is the best
199
approach before proceeding any further. Although art therapists are

trained mostly to work directly with children, that is only half of all the
possible considerations. In addition to the direct treatment mode there
is the indirect treatment modality where the child is helped through
work with the parents. Often, working with the parents is the most
expeditious way to help the child in trouble.
Indirect Treatment
A child is a part of his family system. Inescapably, the child absorbs

the parental distress, be it financial, social, health, or some other diffi-
culty. He is the more sensitive, delicate part of the system. The parents
may still be able to "grin and bear" their troubles, and sometimes they
put up with their difficulties "for the sake of the children." But the child
feels the pain and the tension. He may start acting out the tensions, or
start to daydream or becomes depressed and develop health problems.
He is like a barometer in the family, showing the stresses the family is
enduring. In these situations, working directly with the child would be
like being in a leaky boat. You may try to scoop out the water in the
boat, but that does little good unless you can fix the hole. This is true
especially with young children. However, there are situations where
the parent is not available or willing to seek help. The father may be
incarcerated. Or the mother may be deep in narcotics. What then?
Think of a case where the father is sentenced to life in prison for hav-
ing shot the mother in front of the child. The mother is dead. The
father is in prison. What else can you do but try to "scoop out the
water?" But even while in prison, the father is still a father. He is the
only father the child has. It would help if the father could be convinced
at least to write to his child. The father could then assure him that he is
sorry for what happened, that the child is in no way responsible for
what happened, that the father loves him and is eager to know how he
is doing in school, etc.
When working with an older child or in a situation where the parents
are unavailable, the therapist can provide some form of life enrich-
ment. Establish a relationship with an adult who can be counted on-a
Big Brother or Sister, for example, who plans trips to the zoo, or sports,
or some other kind of activity. Although the art therapist may not know
enough about available forms of life enrichment, she can make refer-
rals and consult colleagues from another profession. Usually, social
Work with Children 201
workers are good at such things. Turn to direct treatment of the child in
trouble only after you have explored all possible avenues of indirect
forms of treatment through the parents, grandparents, and the social
environment. Indirect treatment may also be effective when used con-
currently while the child is in direct treatment with the art therapist.
The separation of indirect and direct treatment was well established
in the mental health field when the current generation of the Baby
Boomers came on the stage. It was called the Child Guidance Model.
The psychiatrist worked directly with the child, occasionally using
some form of art expression, while the parent, usually the mother,
spoke with the social worker. As the mother sorted out her troubles
with the help of the social worker, the child improved. And who got the
credit for the improvement in the child's condition? The psychiatrist!
The first thing to do when working with a young child who is a prob-
lem or has a problem is to see if the parents can start solving their own
problems. They may need hard services, like financial aid, or they may
need marital or employment counseling. In other cases, they may need
family therapy. Family therapy may be appropriate even for a frac-
tured family, and in such cases, the grandmother and/or the mother's
boyfriend may participate in the process. Consider, also, some form of
life enrichment. It has been said that "It takes a whole village" to raise
a child, and we have to see if some semblance of a "village" communi-
ty could be activated to help the family and through it, the child. Work-
ing directly with the child should be the last resort of help, when other
forms have been considered and explored.
Direct Treatment
Direct Treatment is appropriate for working with children when the

parents are not available. It is appropriate with children in institutions
and in foster care. Direct treatment is actually a "fire-fighting model" of
helping. The trauma has already taken place-maybe long ago. Now try
to foster so-called "secondary mastery" to help the child heal the pain
and develop a more positive self-image. Through new relationships, the
child comes to feel valuable, competent, and lovable. He also develops
new identifications, new skills, new reference groups, and heroes.
In art therapy, one may proceed from the visual expression to the
verbal, or from the verbal to the visual. The younger child does picture
making first, and then tries to attach words to what the picture portrays
(see Chapter 9). He learns to recognize and deal with his troublesome
feelings. Attaching words to feelings gives the child a certain degree of
sense of mastery. Now he is in control, instead of somatising or acting
out behaviorally.
The therapist can also proceed from the verbal to the visual form of
expression. The Mutual Story Telling Technique lends itself well to this
procedure (Gardner, 1971). First, the child tells a story about a dilem-
ma. Then the therapist tells a story that has a more positive outcome.
Finally, the child draws a picture. The picture helps to retain the expe-
rience of the solution to the predicament. It is now further explored
with the help of the "right brain" thinking (see Chapter 3). Figure 11-1
summarizes the procedure.
Therapeutic Styles
There are three therapeutic styles of working with children-the psy-

chodynamic, the participant observer, and the behavior modification
style. These styles may appear in art therapy as well as in various forms
of play therapy.
Psychodynamic Style
In the psychodynamic style, the therapist acts like a sounding board,

eliciting and responding to the child's actions and words. The therapist
may reflect back to the child what he says and does, and perhaps do
some "editing," selectively emphasizing his strengths and providing
words for the feelings the child has exhibited by his actions and ver-
balizations. All feelings-not only the good, positive feelings, but the
angry and the taboo feelings as well-receive attention and are noticed
and accepted. All feelings are legitimate. The only question is what to
do with them. Acting out angry feelings in real life is not permitted
because that would get the child in bigger trouble than before and
would make him feel guilty. First, the therapist might say, "You feel
like hitting your baby sister ... because you are angry ... because she
gets everything ... and you fear that nothing is left for you...." Some
time later, the therapist would try to educate the child. After his feelings
have been acknowledged and accepted, the therapist can say, "Yes, it
makes you angry ... it is sad... But she is just a little kid ... She knows no
better ... " Then the therapist could proceed by saying, "What can you
MUTUAL STORY-TELLING TECHNIQUE
PREPARATION
1. Invite the youngster to be your guest on a make-believe TV program.
2. If you have a tape-recorder, get the child used to taping by asking questions
he can easily answer, i.e., name, address, grade in school, name of the
teacher, etc. Then play back to let the child hear his own voice.
3. Explain the rules: the story must have a beginning, middle and end; it must
be made up on the spot, not something that he has read or heard about;
and it must have a moral or a lesson. Tell him that you will also tell a story.
4. The child may begin when ready. Give him some reassurance: "Try, you will
be surprised to find that you have millions of stories in your head."
PROCESS
5. If necessary, help the child get started. "Once upon a time ... a long, long
time ago ... in a distant land ... there lived a...." Then give the child a
sign to continue.
6. If the child has difficulties, you may help out with some connecting phrases,
e.g., "And then ...", and "And the next thing that happened was ..."
7. When the child has finished, ask for the moral, or the lesson or the title of
the story.
8. Ask clarifying questions if needed, e.g., was the dog angry? Was it a he or a
she?
9. Praise the child for having told a fine story.
THERAPIST'S STORY
1O. You may want to take notes while the child is talking to help you construct
your own story. Use the same characters but a different setting or different
props. Try to find a healthier resolution to the dilemma the child may have
hinted at.
11. Be sure you know which character in the story represents the child himself
and who are the other significant figures. At time the various figures may
stand for the different aspects of the child's own personality.
12. In your story try to provide the child with more constructive alternatives and
options than he had in his/her story.
Figure 11-1. Mutual Story Telling. Based on Gardner, Richard, Therapeutic Communication
with Children. New York: Science House, Inc., 1971 (also in Am. J of Psychotherapy, July
1970, 419-439).
do when you are very angry? ...go out and kick a ball? ... " If the feelings
are accepted and granted, and shared and understood, there will be no
need to act out on them.
An inexperienced art therapist was working with an eight-year-old

boy. He was referred by his teacher because he was restless in class and
was causing all kinds of turmoil. Not knowing how to proceed, the art
therapist recalled Virginia Axline's book on play therapy (1947) and
hoped to emulate her method. Walking down the hall from the boys'
classroom, and not sure about the location of the room allotted for the
children's play therapy sessions, the therapist noted that the boy knew
where the room was. He also knew where to get the key. She also
noticed how his little chest expanded as he showed the way. Soon they
reached the proper room and the therapist took out the toys and paper
and crayons she had brought along. She tried to entice the boy to sit
down at the little table to see what she had brought, hoping something
would spark his interest. But the boy just flitted around the room. After
a while, he went to the window and looked out. It was quite warm and
the window was open. The classroom was on the second floor of the
building. The boy asked, "Would you like to see me jump? I can do it!"
What was the therapist to do? Get up and grab the boy and close the
window? Fortunately, the therapist was able to hear the message the
boy was sending. He was trying to say that he was not afraid of thera-
pists, or of a situation that was new and strange to him. His tone of
voice clued the therapist in. He was trying to assert himself. She said,
"I know you are not afraid of anything. You are brave...." That was
all it took, and the boy then turned away from the window and
approached the table. Axline's basic philosophy had saved the situa-
tion. Once the feelings are expressed and accepted, they do not need
to be acted out. Expression can take place either verbally or visually, or
both. In play therapy, feelings are expressed mostly through play
action and some verbalization; in art therapy, feelings are expressed
visually either on paper or in some three-dimensional production, such
as clay or mobiles or collages and the like.
The psychodynamic style in art therapy and in play therapy is used
by Rogerians, the followers of Axline and other psychodynamically-
oriented therapists.
Participant Observer
Participant observer is another therapeutic style. There the therapist
may enter in the play scene, bending and affecting the plot. Betensky,
for example, describes a case situation where she dispatched a heli-
copter to a scene the child was creating (Betensky, 1973). Interactional

drawing technique, discussed in Chapter 13, is another example of the
participant observer style of helping. There the therapist draws objects
that may provide a hint of help or empathy to the patient. As partici-
pant observer, the therapist must be careful not to negate the pain the
client needs to communicate. In many instances, the best policy is to let
the child figure out by himself what could be done to alleviate the
predicament.
Behavior Modification
In the behavior modification style, the therapist rewards the child's

desired behavior by giving him a token, which can be exchanged later
for candy or a toy. If the child draws a picture, he may receive a
reward. If he makes up a story about the picture, he could earn anoth-
er reward. Richard Gardner is a prominent child psychiatrist who start-
ed out as a psychoanalyst. Currently, he is applying this form of
helping in work with resistive children from upper income families
(Gardner, 1975). Behavior modification has vociferous proponents and
opponents. These techniques are widely used with children as well as
with adults. Parents and educators, as well as therapists, do have to
shape the child's behavior. The child has to be socialized to know what
is acceptable and what is not. This is best done in the family as the child
grows up. The material forms of reward are replaced gradually by
social rewards and self rewards in the form of self-esteem and a good
conscience. From the psychocybernetic perspective, in most situations,
behavior modification is the least desirable modality. The child's own
thinking and search for appropriate rewards should be promoted. This
will become clearer when we review the therapist's overall tasks.
Tasks of the Therapist
The therapist structures the session by making it clear what will be

done, where and for how long. How to proceed is left up to the child.
Then the therapist notes and puts into words feelings the child
expressed verbally or through his behavior, and in his art productions.
The therapist's main job is to provide a safe atmosphere and a rela-
tionship in which feelings can be shared. When the child feels accept-
ed and valued, he will start to value himself, he will be considerate, and

his behavior towards other people will be appropriate.
The therapist accomplishes a number of things while promoting the
child's ego development through play and art activities. Working with
the therapist, the child acquires a sense of mastery as he imposes order
on the art or play materials. The child experiences himself as a doer,
not as a victim (see Chapter 8). He can rework or re-experience painful
situations, but now from a safe place. The painful experiences can be
portrayed symbolically. He can now understand and reformulate situ-
ations he could once only endure. This is what is termed the "second-
ary mastery," in which one can sublimate unacceptable feelings by
symbolic expressions. Making and killing monsters is a good example
of secondary mastery. Through the various art activities, the child
forms a new sense of identity. Various self-representations are pro-
duced and tried on "for size." He strengthens his self-esteem and sub-
sequently his behavior becomes increasingly more satisfying and
socially rewarded. As he engages in the various art activities, he stimu-
lates his "right brain" and he becomes more creative and a better prob-
lem-solver in the various areas of life. (See Chapter 3 for a discussion
of right and left brain hemispheres.)
Specific Techniques
The doing-phase of the therapeutic process, discussed in Chapter 8,

presented a number of specific techniques that are useful when work-
ing with children and other age groups. Let's take a closer look at some
of these techniques and add some additional ways to proceed.
If the child is anxious and reluctant to engage in the art therapy activ-
ities, the therapist must ease the child into picture making, building
rapport and setting the child at ease. With some children, one needs
only to ask if they ever draw pictures. The child then proceeds to make
a picture of his choosing. If, on the other hand, the child responds that
he is not good at art in school, then the therapist must reassure him that
this is a different kind of art. It does not have to be "just so." No one will
criticize his production and he is the only one who will decide if the
picture is good or bad. In fact, one way to get him started is to have him
"make something ugly, deliberately." Have him do an "icky" picture on
one part of the paper, and something good looking on another part
(Landgarten, 1981). This leads naturally into a discussion about good
and bad behavior at home and school, and how the parents or teach-
ers respond.
If the child is still reluctant, ask if he would like to see an easy way to
start a picture. Introduce him to the "Free Flow technique," also known
as the scribble. "First I go like this on the paper (and the therapist
makes a squiggly line), and then I look to see what I could make out of
the line. What does this look like? Maybe this could be a flower? Or
could this be something like a bird? What happens if we add dots here?
Could we then make this into a face?" etc.
"The Winnicott Squiggle Game" is similar to the Free Flow tech-
nique. (Winnicott, 1971). The therapist can ask the child ifhe ever plays
the "squiggle game." He will most likely shrug his shoulders. Would he
like the therapist to show him how to play it? The response again may
be something noncommittal. Proceed to show the beginnings of the
free flow. "1 go on the paper like this. And then you see what you could
turn it into. Then you go like this on the paper, and I will see if I can
turn it into a picture. Who will go first, etc." Pretty soon most children
decide that they can draw a better picture all by themselves, and the
process if off to a good start.
"A Name Design" is another useful procedure to break the ice. Ask
the child to write his name anyway he likes, but encourage him to write
it as big as possible and to use as many colors as he likes. This conveys
the message symbolically that the child's name is important and worth
"fussing about." Next have him embellish the letters and add any
objects he likes. This technique can help reveal some of the child's
interests. "Draw around your name things you like and what you enjoy
doing-show some of your hobbies." If the child is young and still does
not know how to write his name, the therapist can write it for him and
then have him embellish and color the various letters.
"Body tracing" is another technique that small children enjoy. It
serves to strengthen the sense of identity. Tape a large sheet of paper to
the wall and have the child stand in front of it. The therapist traces the
outline of the child's body. Then the tracing is further defined and
maybe some clothing is drawn in. Usually a child is quite impressed
that he or she looks "that big." When working with children in groups,
do body tracing in pairs. Have the children take turns tracing each
other. The tracer has to name the body part he is tracing, and if he can-
not name it, he has to stop. Also the tracer has to stop when the tracee
says so. This way the child who is being traced has control over the
process and does not feel at the mercy of someone else.
Once the child feels comfortable with the art therapy situation and is
willing to either draw pictures, form sculptures, build mobiles, or make
collages, the therapist must then decide how much to structure the ses-
sions and how much initiative to leave up to the child. Generally the
lower the client's ego development, the more structure is needed. At
the start of the session, simply ask the child what picture he would like
to make that day, and what materials he wants to work with. If time is
limited, conduct theme-oriented sessions to explore the dynamics of
the child's personality and social situation. The theme-oriented sessions
help ascertain the child's self-perceptions and perceptions of significant
people in his world. The "self-system" idea, discussed in Chapter 8 is a
simple way to keep track of the various dimensions of the client's life.
The Body Self
The body self can be understood and self-image can be improved by

making pictures and sculptures that represent the child, as body trac-
ing, discussed above. In another procedure, the therapist outlines a
body and then asks the child to "color in where he feels pain" or where
he "feels various feelings" (see Figure 11-2). The child selects the feel-
ings and the colors appropriate for each feeling, or the therapist gets
him started by suggesting some feelings and some of the colors that
could be used.
The Domain ofthe Mind
The domain of the mind can be explored with themes related to

one's endowments, abilities, prides, and wishes. Ask the child to por-
tray a "Happy Day" or a "Sad Day," for instance; or "what an e-mail to
the child should say"; or what would be his "Three Wishes" were he to
meet a "Fairy Godmother" who would promise to grant the child
everything he wants. Malchiodi has used the latter theme with children
in a battered women's shelter. She found that the picture usually turns
out to be of something the child has lost or is afraid of losing-for exam-
ple, the old neighborhood, a home, a friend, or a bicycle (Malchiodi,
1990).
'ol\Ae. sad
b\o.c,k. • ~eCl\.-
'o'rO\.v\;\ • ~ui l-t
'f- e d · a. VI ~~ ~
ye.J10'N • ho.l'f)'
Figure 11-2. Feelings in the Body.
The Interpersonal Domain ofthe Self-System
The interpersonal domain of the self-system can be explored and

strengthened through pictures and sculptures showing one's "Best
Friend," "School Mates," "Favorite Teacher," "Coach," and the like.
The "Kinnetic Family Drawing" (KFD) is the best technique for explor-
ing the family situation. However, use it carefully with children in fos-
ter placement and from fractured family situations. Introduce it only
after the therapeutic relationship is firmly established, and only if you,
as the therapist, have sufficient therapeutic skills to cope with the pain
such a picture might open up it. One child refused to draw a picture of
his family. The therapist encouraged him to make a picture of any kind
of family, not necessarily his own, or even a human family. It could be
a family of kittens, or birds. He could also draw a "Picture of an Ideal
Family."
With the standard KFD, when asking the child to draw a picture of
his family, it is important to tell him to include himself in the picture.
Say, "Make a picture of your family, including yourself, doing some-
thing." Leave the "doing" up to the child and let him choose. Some
children draw a picnic, or a family at the dinner table, or at the Thanks-
giving table. But in most KFD, we see each person in the family doing
something separately.
Achievement Domain
Achievement domain can be highlighted and strengthened by asking

for pictures about school. "Draw about when you were in first grade,"
"Draw about you doing something your mother approves," or "doing
something that would make your father proud." "If you could be any-
body, who would you be?" "What are you most proud of?" "What do
you like most or least about school?"
The Transpersonal Domain
The transpersonal domain of the self-system highlights one's values,

ideals, and philosophy of life. "Pictures of a specific holiday" might
reveal something about the family's stance with respect to religious
observances. Inquiries about the child's "favorite sports team" or "tel-
evision show" reveal what he admires and aspires to be. Asking him
"what he wants to be when he grows up" sheds some light on his cur-
rent value orientation and could serve as a springboard to further clar-
ification of his ideas. Similarly, inquiry about his favorite toy or
possession would reveal something about what he regards as impor-
tant.
The boundaries between the various parts of a system are semiper-
meable. This is true also for the domains of the self-system. What hap-
pens in one domain affects the other domains. For instance, if there is
a problem with the physical body, the mind would be affected also, as
well as the interpersonal relationships. The achievement realm would
Figure 11-3. The Dragon.
suffer, too. And a picture that highlights one domain might shed light
on one or more other areas of functioning as well. The "Dragon Tech-
nique" demonstrates this clearly. Tell the child, "Imagine you have
stumbled onto a treasure but a dragon is guarding it. Make a picture to
show how you get to the treasure." Give the child a sketch of a dragon's
head, with open teeth, or have him draw the dragon from a sample pic-
ture.
One seven-year-old girl drew a little figure in the dragon's mouth.
The little figure was yelling "Help!" The girl said that she would throw
her little brother in the dragon's mouth "and then run to the treasure,
and run home."
This gives us some idea of the girl's ability to solve problems and
how she might fare with her achievements. But we also learn about
how she feels about her little brother, that is, about a portion of her
Interpersonal Domain. We also discern something about her current
value stance (e.g., her treasure is more important than the life of her lit-
tle brother). Now the therapist can proceed in several ways. The ther-
apist can recognize the little girl's resourcefulness and quick thinking.
But the therapist must then find out in what way the little brother is a
nuisance to her and what she can do about it besides "throwing him
into the mouth of the dragon." In her family, she may very well be a
"parental child" who is burdened with the caretaking of younger sib-
lings and may need some help from the adults in the family.
The dragon picture is quite popular with many art therapists. Mal-
chiodi regards it as a metaphor for how one gets around problems in
life. The dragon may be the abuser, or some painful situation in the
child's life. Children create a variety of solutions: some kill the dragon
with a sword, some put it to sleep; others make friends with it (Mal-
chiodi, 1990). Some well-adjusted children find a grown-up to help
them to get the treasure.
"The heart" is another technique that is useful when working with a
young child. The therapist draws the outline of a heart and then asks
the child to draw, inside the heart, pictures of "people who are in your
heart." One child drew a picture of her mother and the head of her best
friend. Then she added wings to the heart to show that her mother had
died, and "Now she is an angel."
Another child left the heart empty because he said he did not love
anyone. The therapist can gain a considerable amount of information
with the help of the outline of the heart. Having drawn a heart, one
therapist asked, "What does a heart stand for?" One nine-year-old boy
responded that a heart symbolizes love. When asked to make a picture
of someone he loved, he answered that there was "no one" whom he
loved. The therapist then inquired if there had been someone he loved
"a long time ago?" Again the answer was "no." After a pause, he said,
"My family." Now the therapist said, "Draw a picture of your family."
The boy responded that he could not do that, but he wrote the word
"family" inside the heart. Then he told the therapist that they did have
some good times when he was younger. But now, "it is hard to love
Mom because she does not seem to care" about him. She never visits
him at the institution where he now lives. He cannot love his father
because "he hit everyone" and then abandoned them. And he cannot
love the stepfather because "he drinks everyday and is mean." The
therapist then asked, "Who do you wish could fill your heart?" The
child said that if he had to choose someone, it would be his family, but
even they could not fill his whole heart. He said he wished there were
enough people he really loved to fill every space of his heart. He said
he hated to see the heart so empty.
No wonder that the child is depressed. He also has the diagnosis of
Oppositional Disorder. That would indicate that he is still fighting and
Figure 11-4. A Heart.
trying to get his affectional need met. Later he was asked what would
be a symbol of sadness. The boy said, "a tear drop." He was then asked
to "draw a teardrop." Having done that, he put in a picture of a table
with a telephone on it, "because Mom never calls." The child was able
to share his deep grief with the therapist, and he felt understood. Now
he had at least one person in his world for whom he might have some
positive feeling.
Another child drew a picture of rain and lightening inside the
teardrop, symbolizing his sadness.
Some children portray events that cause sadness.
A similar procedure is for the therapist to "draw an arm with a fist"
and to ask the child to make a picture of someone he is angry at. A boy
drew a picture of what appeared to be a bully and two other figures-
one was smiling, the other seemed ready to fight back.
Using a similar technique, simply draw two parallel curved lines and
say that it is a hug. The therapist then asks whom the child would want
to hug. Between the two lines symbolizing "the hug," one child drew
both of her parents, her big brother, and her two little brothers and
three of her cousins. This child has an ample supply of positive inter-
personal relationships.
Figure 11-5. The Tear Drop with Rain and Lightning.
Using the concept of the Self-System, therapists can select specific

techniques to employ for a child who represents particular diagnostic
category. For sexually abused children, first develop the relationship
with the child by asking for a "free/anything picture," or a "picture
about school." Or try the "Winnicott squiggle." Then ask for a "picture
of yourself." Here, note the feelings of being ugly or fat, etc. Then ask
for a picture about the "child's room," and then a picture about "some-
thing good or bad that happened" to him in his room. Focusing more
specifically on the possibility of being abused, ask him to make a pic-
ture of a person, or a "picture of a child," and then "tell a story about
that child or person." A picture of a "bad dream" might disclose what
has happened to the child. As with any client, try to conclude the ses-
sion on a positive note. A picture of the "three wishes" or a "mandala"
might serve this purpose.
Figure 11-6. The Tear Drop and the Killings.
Responsive Communication
The production of a picture or some other visual item helps the child
sort out and clarify the multitude of feelings that burden him. After the
so-called "right brain" thinking, verbal communication, when words
are attached to what is portrayed in the picture, often serve to further
the child's problem-solving efforts.
In the psychocybernetic model, the dialoguing phase is the term for
verbal processing of the visual product. With children, even though
talking about the visual creation tends to be quite short, the dialoguing
serves two important purposes. First, the therapist gains additional
information about the situation and has the opportunity to check out
the diagnostic clues that might have surfaced while looking at the cre-
ated product. Second, the therapist may offer the child support and
strengthen the therapeutic relationship with him.
Figure 11-7. The Arm, Fist, and the Bully.
An example of the first purpose was given in Chapter 9 where the

work ofJennifer, a developmentally normal and physically healthy six
year old, was described. Having drawn her picture,Jennifer indicated
several times that she had nothing further to say about it. Skillfully the
therapist gained additional information by verbalizing themes that had
been depicted by implication in the child's picture. The therapist
touched on the child's concern about the space that was going to be
needed for the next addition to the family. A new baby was expected.
Parenthetically, the prominent knothole inJennifer's picture does sug-
gest the possibility of some physical injury. It does not seem to have left
any significant scars in the child's personality at this stage, but is a fac-
tor that may deserve some further attention. (For the significance of
knotholes in trees, see Bolander, 1977.)
Figure 11-8. A Hug.
The art therapy session with another child whom we shall call
Leonard illustrates how a therapist can provide considerable support
and build a warm therapeutic relationship while helping the child to
discuss his picture. Leonard, an eleven-year-old black boy, came from
a deprived, abusive, and chaotic background. The art therapy session
took place at a residential treatment facility for children who are
severely emotionally and mentally disturbed. The boy has had no con-
tact with his mother since he was six years old. His current diagnosis is
attention deficit disorder with hyperactivity. He resorted to physical
violence to solve conflicts with his peers. The goal of the session was to
lessen Leonard's violent acting-out behavior.
The room was set up with two different sizes of paper and various
markers, paints, and crayons. Leonard chose the thick, bold markers
and a large sheet of paper. He was told that he could draw a picture of
whatever he wanted. He worked for about 10 minutes and then
informed the therapist that he was finished. The description and
appraisal of the picture followed. During the Dialoguing Phase the ther-
apist used mainly responsive communication style. Here are excerpts
from the dialoguing phase:
Therapist: "Wow, this is some picture. You are a great artist. Look at all
the colors you used here. This looks like a person; could
you tell me who this is?"
Leonard: His name is Lemme. He is a boy!"

T: So this is a boy and his name is Lemme. How old is this
boy?
L: His name is Lemme Cooper, and he is eight years old."
T: I see you only drew his face. Can you tell me if Lemme is
tall or short?
L: He is short. He wears glasses. See, here are this glasses
(pointing to the thin circles around the eyes). He likes read-
ing. That is why he wears glasses.
T: So Lemme wears glasses, and these are his glasses that he
uses for reading, right? Are these his eyes? (pointing to the
orange and red circles inside the black lines)
L: Yes, those are his angry eyes.
T: These are his angry eyes. Why do you think he is angry?
L: He is angry 'cause kids agitate him.
T: Kids agitate him and he gets angry, right?
L: Yes.
By simply following the lead of the child, the therapist has succeed-
ed in letting the child touch on his own difficulty, namely that other
children "agitate" him. He is starting to share his own feelings with the
therapist, though indirectly. The discussions continues:
T: Where do you think Lemme is going?
L: He is going to school. It is not me, OK?
T: I know it is not you. It's Lemme, and he is going to school.
Does he like school?
L: Yup, except other kids agitate him.
Leonard had to emphasize that he is not talking about himself. The
discussion was starting to get too close to himself. So the therapist reas-
sures him of his personal boundaries.
T: What does he do when the other kids agitate him?
L: He beats them up.
T: Oh, so he beats up the kids who agitate him. That is kind of
what you do, right?
L: Yes, but this isn't me. It's Lemme Cooper.
T: OK. I was just noticing that Lemme deals with his anger
the same way you do. Where does Lemme live?
L: He lives in a house by himself. He lives alone. He has no

parents.
T: Oh, where are his parents?
L: They are dead. They got killed. They got shot.
Here Leonard has revealed how he feels all alone. He has nobody he
can count on. These feelings can now be explored further, behind the
guise of Lemme.
T: So does he like being all alone?
L: Yeah, but he can't tell anyone he's alone because then if
they find out, they will put him in Hospice Maris. (A resi-
dential treatment facility).
T: And he does not like Hospice Maris?
L: No, he does not like it there ... He is going to die soon.
T: He is going to die? How do you know he is going to die?
At this point, the therapist considers the possibility that the child
might harbor some suicidal plans. So she zeros in on the possibility of
dying.
L: He is going to die because he is all alone and he can't work.
So he can't get a job, and then he can't get money, and with
no money, no food. No food and he will die.
This sounds quite logical. There is no specific plan for committing a
suicide. It is just that the boy feels helpless and sees no solution to his
predicament.
T: So Lemme is all alone in his house and he is going to die
soon because he has no food and no parents ...mmm.
What do you think he can do to protect himself?
L: He can go to karate (at this point he adds the Teenage-
Mutant Ninja Turtle face).
T: Is this Ninja Turtle? (pointing to the green face below in the
drawing).
L: Yes, but he cannot go to karate because you need parents to
take you there to sign you up and to pay the money.
T: Did you ever do karate?
L: Yes, that is how I know all this stuff.
The therapist has managed to learn much about the boy's inner land-
scape. He has revealed his depression and hopelessness, but he also has
reached the point where he is aware of something he can be proud of,
namely, his knowing about karate. Eventually, more realistic problem
solving can take place, after his feelings are explored, accepted, and
understood. This session was a constructive experience for the boy,
and he will be able to work further with this therapist in subsequent ses-
sions. The responsive communication employed by the therapist put
the child in charge, and the session proceeded at his own pace. He was
the authority on his drawing and he was able to express his feelings and
apprehensions through the character he had drawn. His personal
boundaries were respected.
Children naturally think visually, in pictures. The so-called "right
brain thinking" is more effective for them than the logical, sequential,
analytical "left brain thought processes." By encouraging children to
make pictures, the therapist can enter more fully into their world. Pic-
tures, however meager and primitive, contain a wealth of feelings and
ideas. They are like a bridge that let the adult and the child meet each
other at least halfway, deepening their understanding and strengthen-
ing their relationship. Feeling understood and accepted, the child can
proceed to use his own abilities to ease some of his predicaments, to
some extent.
Chapter 12
ART THERAPY WITH ADOLESCENTS
dolescents come in all sizes and colors. Some are bright normal
A adolescents with "growing pains." Others are dull and mentally
delayed or physically handicapped. Some come from stable homes,
others from broken homes whose absent fathers or drug-abusing moth-
ers provide no adequate role models. Some are loners; others are delin-
quents who belong to gangs.
This is a period of transition, a period of change, socially and physi-
cally, for all adolescents. It contains all the ingredients for a crisis-even
under the best of circumstances-because the previous problem solving
devices are no longer adequate. Physically, there are spurts of growth
and bodily changes-voice change for boys, menses for girls-that pro-
duce clumsiness, dissatisfaction, and self-consciousness. Socially, an
adolescent is in no-man's land. In some situations, the adolescent has
no rights. In others, he is expected to function as an adult. One
moment he is made to feel like a child, but in another he is regarded as
an adult. Psychologically it is difficult to keep up with one's self and
others. Adolescents have difficulty sorting out the "reality principle"
from the "pleasure principle," the immediate pleasure vs. the long-
range gains. They seem unpredictable, inconsistent, impatient, in a
hurry, and want to have all the answers immediately.
How does one work with an adolescent? It helps to keep in mind the
developmental tasks of adolescence. It is a period when the sense of
identity is formed, vocationally and sexually (Erikson, 1950). In forming
his own identity, an adolescent attempts to emancipate himself from his
parents, who had been his most important source of affection. Often,
this emancipation takes the form of a rebellion. He has to break away
and find new role models. He needs to belong and wants to conform to
221
his peer group. His search for a new identity leads to conformity in
dress, jargon, behavior, and sometimes it leads to drinking and drugs.
Tuning In
Therapists find it useful to try to "tune in" to what it is like to be an

adolescent by recalling their own adolescence. Was it a happy period?
A sad one? And if sad, what made it difficult, and during what period-
early, roughly 11-14; middle-lS-17; or late-18-19? Try to portray
your feelings and recollections by drawing a picture. Then, on the
reverse, write a sentence or two about what it was like for you to be an
adolescent at that stage of your life. If you find yourself blocking, think
about an adjective to describe that period of adolescence and then
transform the adjective into a picture.
In a group of 15 therapists in a masters program, 13 said their ado-
lescence was chaotic and confused-a period of breaking away from
family. About her early adolescence, one said, "It is like a roller coast-
er. Your feelings are never stable and grounded, but are always up and
down, and most of the time you cannot understand why." Another
mentioned that in middle adolescence, she felt independent enough to
drive and work, yet still felt dependent on her parents and struggled to
define herself by acting differently in different groups she interacted
with. The theme that appears frequently is one of feeling "vague,"
imposed upon, sorting out levels of chaos and feelings of order, inside
each other.
The most troublesome period appears to be middle adolescence.
According to one member of this group, adolescents use external stim-
uli to define themselves, and those stimuli act as a cover up for the fact
that adolescents do not know who they are. In Figure 12-1 hair spray,
belly button piercing and jewelry serve this purpose. Note also that there
are no facial features, perhaps symbolizing a lack of a clear sense of iden-
tity. The hands are missing, too, suggesting a sense of helplessness.
Only two therapists in this exercise had some positive feelings about
late adolescence. One felt his strengths and described himself as
unique, independent, and full of energy. Another said that her late ado-
lescence was a relatively carefree time, full of friends and laughter, with
the only worry being what to wear and how to get ready for the prom.
In another group of 16 art therapists in training, 10 described their
adolescence as a stressful period, five used adjectives such as "con-
Art Therapy with Adolescents 223
Figure 12-1. The Adolescent.
fused" and "exciting," and only one considered his adolescence a pos-
itive period in his life.
Helping Strategies
In work with adolescents, the overarching principle is to help them

attain a sense of identity and mastery. If an adolescent feels more self-
sufficient, he will feel less hostile and rebellious. Therefore, therapists

should be alert to situations where the adolescent might benefit from
concrete help with reality problems, such as how to handle a situation
in school or in the family; how to get some grooming advice; and how
to implement one's hopes and aspirations. Think of yourself as an
"auxiliary ego" for the adolescent, namely that portion of the person-
ality that organizes and integrates experiences by testing reality and
appraising the expectations of others and weighs those against the
potential consequences of actions contemplated. In various situations-
running away, for instance, or getting into a fight, ask, "How will that
help you?" or, "Does it help you to get what you want?" The therapist
takes the side of the young person and looks for ways to increase the
"pay-offs."
"Calling attention to the choice points" is another technique that
increases the sense of mastery. Sprinkle your language liberally with
expressions such as "You could do that ... or do that; or, "The choice
. yours... "; or,
IS " 1t IS. up to you.... "
"Constructive arguing" is another technique that fosters the sense of
mastery. Here the therapist or parent offers another point of view while
encouraging the youngster to "stick to his guns." One should not be too
quick to puncture the youngster's arguments. And after the verbal
exploration when one has to draw the line, at least give him credit for
his vigor in defending his ideas. Constructive arguing is a verbal explo-
ration method which allows people to consider the matter from all
sides in order to find means of solving the problem.
While working with adolescents, it is essential for therapists to be
direct and open when talking about difficult topics. It is better to be
blunt and forthright than circumspect. Nothing derails a relationship
quicker than pretense and phoniness on the part of the therapist. The
therapist is a potential role model for the adolescent on what it is like
to be an adult. Do some self-sharing about how to deal with negative
emotions. How do you, the therapist, cope with frustration, boredom,
and anger? Adolescents can be infuriating and they relish the opportu-
nity to make a dent into an adult's feelings. Haim Ginott has some
sound suggestions for parents on coping with anger that can apply to
therapists, as well. Anger is a fact of life. Failure to get angry at certain
moments indicates indifference, not love. Do not pretend not to be
angry when you are angry. Be genuine, but do not insult the young per-
son. Simply describe the situation and say how you feel. For instance,
instead of attacking the noise maker by screaming, "What's the matter

with you? Don't you know better? Stop this minute," simply say,
"Noise makes me very uncomfortable." At home, the parent often has
to state clearly what needs to be done in order to change the situation
that generates the anger. For instance, "When I see good towels on a
wet bathroom floor, I get mad! I get furious! Towels do not belong on
the floor. They belong on the rack." Instead, the parent might be
inclined to say, "What are you, a slob? Your girl friend should see the
way you really are, messy and inconsiderate" (Ginott, 1969, p. 96ff).
Many teenagers have an inner radar that detects what irritates their
teachers and parents. If the parent values neatness, the teen, in his
search for his own identity, will be sloppy. He becomes disobedient
and rebellious, less to defy his parents than to experience his identity
and autonomy. It is bewildering to watch his shifting moods and to lis-
ten to his never-ending complaints. Family therapy could help parents
live through this turmoil. As a general principle, remember that this is
a time of uncertainty, self-doubt, and suffering for adolescents. Teens
do not want instant understanding. They feel unique, complex, myste-
rious, and inscrutable, and they would feel insulted if you said, "I know
exactly how you feel. At your age, I, too, felt the same."
It is wise for the parent and adults in the adolescent's world to dif-
ferentiate between acceptance and approval. If the parents accept the
outrageous hairdo, they destroy its value as a symbol of autonomy and
rebellion. The young rebel might have to substitute a more obnoxious
behavior. Do not collect "thorns," as Ginott puts it. Parents want their
children to be perfect and tend to call attention to small defects in their
character. Let them be. And do not step on "corns." If the youngster is
short, he will be called "shorty," if tall, he will be called "a bean pole."
The youngster should not be teased, even in jest. And by all means, do
not remind him of his babyhood (Ginott, 1969).
When working with adolescents in trouble with the law, it is impor-
tant to keep in mind that no one can become a responsible mature per-
son without having experienced a relationship with a mature and
caring person. If the parents do not provide such a relationship, a sub-
stitute has to be found, and the substitute could be the therapist, a
teacher, Big Brother, or another member of the community.
William Glasser's Reality Therapy approach is useful when working
with youngsters who do not have stable home situations (Glasser,
1965). The first thing Glasser does in therapy is to find out what goals
the youngsters may have. If they have none, then the first imperative is
to develop some goals to work toward-to earn money for something,
a new pair of shoes, for example.
Glasser manages to point out to the young person that reality is so
constructed that there are consequences to one's actions. It matters
what you do. You are not powerless. You do not have to go to school,
but if you don't, certain things will follow. You will not be able to get a
well-paying job, for instance; nor will you be able to enlist in the
Armed Forces.
Many adolescents feel unhappy most of the time. Glasser tends to
provide some "reality education" for them. Reality, he tells them, is so
constructed that the only way to be happy is to make someone else
happy. It may sound old fashioned and trite to the young person, but it
is true. There is no straight path to happiness. Rather, it is like a
boomerang. Only by making someone else happy do we attain happi-
ness. Glasser would ask, "You feel unhappy? No wonder! Whom have
you tried to make happy recently?" But to want to bring some happi-
ness to someone else presupposes that there is a close relationship, at
least potentially. To actualize a close, rewarding relationship with some-
one means taking the initiative and acquiring some social skills.
Specific Techniques
Adolescents who come to the therapist's attention usually have a

considerable gap between their chronological and psychological ages.
Physically they may appear rather mature but emotionally they are
often still children. Not infrequently, their development may have been
halted by various traumas they have experienced, and perhaps are still
enduring. Therefore many of the specific techniques already discussed
in connection with children may be appropriate for them also.
The Name Design is a good technique to break the ice, especially
when working with adolescents in groups. Have them simply choose a
color and write their name. Then have them emphasize and decorate
their name however they like and draw items around it to depict what
they enjoy and what interests them.
Draw YOur Initials. This method, used frequently by the noted art
therapist Helen Landgarten, resembles the Name Design technique.
Landgarten would have adults or adolescents draw their initials, then
have them see what form they could discover in them and then elabo-
rate on the basic design (Landgarten, 1981). For some, the design may
suggest an object from which they can develop a picture. Here the ini-
tials serve as a starting point to develop something akin to a Free
Flow/Scribble technique.
The Wartegg technique, described in Chapter 8, is in some respects
similar to Landgarten's methods but is not as warm and personal. The
Wartegg technique, which works well with adult males and with elder-
ly clients, can also be used effectively with somewhat inhibited young
males who are interested in tools and technical things. Depending on
the level of energy and attention span, it is wise to use only two or
three of the eight stimulus compartments.
A Picture ofOne's Choosing. This is a useful warm-up procedure and
it is also appropriate at any later stage of the process. Ask the young
person to draw a picture, leaving him as much self-determination and
initiative as possible. When it is necessary to structure the session to
explore some specific area of functioning or some specific experience,
avoid the appearance of regimentation by giving him a choice between
two or more possible approaches to the task.
A Two-part Picture. This is a technique that works very well with
adolescents and young adults. Ask the client to make a two-part pic-
ture. One part portrays what he is like and lets the world see it. The
other part depicts how he feels inside-feelings he won't let anyone see.
This can be a two-dimensional drawing or a three-dimensional con-
struction, using a box or a paper bag where one can separate the inside
from the outside. It can also be a sculpture or a collage.
Other techniques, described in Chapter 8, work well with adoles-
cents. They include a picture, collage, or a sculpture about the "Three
Wishes," and the "Telegram."
The Interpersonal Domain. Themes of "The Best Friend" and "The
Kinnetic Family Drawings" explore and strengthen the Interpersonal
Domain of the Self-System.
The Achievement Domain. The achievement domain of the Self-Sys-
tem is highlighted with portrayals of one's "hobbies," "interests,"
"school," "work," and what the person is "most proud of."
The Transpersonal Domain. The transpersonal domain can be
observed in the pictures and sculptures about one's "Heroes," "Favorite
team," "Favorite actor," "Best-liked movie or TV program," "Sad vs.
happy holidays," " Person most people envy," and other categories.
Self-Portrait Drawings
Self-portrait drawings are most effective exercises for adolescents

because they are generally quite preoccupied with themselves. A single
session or a number of sessions can be spent on self-portraits. Self-por-
traits shed light not only on the Body Domain of the Self-System, but
on several of the other areas of functioning as well.
For the initial self-portrait, simply tell the youngster to draw of full-
length picture of himself, from head to toe. Give him a time limit in
order to avoid getting bogged down in details. "See what you can do in
five minutes. Do not bother with too many details. Just make a rough
sketch." When you discuss the self-portrait during the dialoguing
phase, ask which parts of the sketch he thinks are the best, which ones
were difficult to portray, and where did he devote most of the time.
During the same session, or in the next, have the youngster draw
another self-portrait. For the second image, say, "Make a picture of
yourself a year ago." Around it write or draw pictures of the things that
were important to you then. How did you use your time? Who were
your friends last year? What were your goals and hopes a year ago?"
These directions by themselves will stimulate ideas and prompt him to
search for goals. This is a good exercise for adolescents as well as adults
(see Chapter 13).
Focus the next version of the self-portrait on the "current self as com-
pared with the self a year ago." Say, "Change or make a new picture to
show what is going on in your life now. Cross out activities you are no
longer involved in. Add people and activities that are important to you
now." And ask the youngster how his goals and aspirations have
changed.
Still one more version of the self-portrait can be developed with
good results either in the same session or in ones that follow. Say,
"Draw a picture of yourself a year from now. Around the picture write
or draw the activities you will be involved in. How will you spend your
time? What will be your goals and aspirations?"
Instead of drawing pictures, youngsters can make collages. This
could be a homework assignment, because pondering one's goals and
hopes, as opposed to one's immediate needs, takes quite some time.
These series of self-portraits have also proven useful with adults as
well as with young children. Extend the time frame for adults. Have
the client draw a picture of himself, not just a year from now, but three
years from now; five years from now; and even ten years from now.
Elderly people frequently fear that their lifetime is running out and
think there might not be much of a future beyond the immediate pres-
ent. Stimulating their imagery about a possible future can mobilize
their energy and improve their outlook.
Drawing a picture of one's self "a year from now" has proven to be
a difficult but useful exercise for many inner city children. In recent
years, in Baltimore, for instance, there have been frequent random
shootings in the streets. Grade school children make pictures of their
own funerals because they do not expect to be alive the next day. Put
on paper, the therapist can deal with this frightening prospect, and can
sort it out to provide some emotional support to the children.
It is useful to obtain a self-portrait at the outset of therapy and then to
compare it with a self-portrait drawn at the conclusion of the therapy
contacts. Changes between the two pictures point to the growth that may
have taken place and the extent to which it may have been facilitated by
the therapeutic interaction between the adolescent and the therapist.
Draw-A-Story Procedure
Some children as well as adolescents become anxious when asked to
engage in relatively free choice artwork. They say, "I do not know what
to draw." "Draw-A-Story procedure" is useful in these situations. It was
developed by Peggy Dunn-Snow (1994), and is based on the work of
Rawley Silver (1993). This technique was originally intended to assess
depression, and also works well to stimulate the creativity and spirit of
adventure in children and adolescents.
Prepare an array of stimulus cards and let the youngster take two
cards or make copies of two of them. Having chosen two of the 14 stim-
ulus cards, the youngster imagines what might happen in the pictures
and draws his version of it. After he finishes the drawing, he gives it a
title and writes a three-sentence story about it.
Dunn-Snow has used the Draw-A-Story-Technique with individuals
as well as with groups of children and adolescents. Each group mem-
ber chooses one stimulus card. Then the group members collaborate
on how each of their images can be combined in a single drawing with
a common theme, title, and story line. According to Dunn-Snow, the
opportunity to choose provides some sense of control and structure so
that conflicts in the group are ultimately resolved with minimal or no
Figure 12-2. Draw-A-Story Stimulus Cards.
adult intervention. However, in the case of unsocialized adolescents, it

might be safer to divide the members of the group into dyads to work
on the task of developing a story between their chosen cards.
Collages
Collages are particularly effective for work with emotionally impov-

erished, guarded, resistive adolescents. The therapist collects a rich
array of various magazines and distributes them to the client. The ther-
apist or the clients choose the theme and the client looks through the
magazines and cuts out pictures to illustrate the theme. For instance,
have the client pick pictures or draw how he sees himself and how oth-
ers see him. Or have him choose pictures to depict his "current expe-
riences," or "draw the content of the letter in the mailbox." "Devise a
collage about the tear that is falling from the eye," or "make a collage
about various feelings-loneliness, depression, anger." Clients cut the
pictures from the magazines, paste them on paper, embellish them as
they wish, and then write a story about the picture on the other side of
the paper (Linesch, 1988).
Several diagnostic categories-the suicidal adolescent, the anorexics-
bulimics, the sexually abused, and the chemically dependent-are par-
ticularly difficult to deal with. We now turn to the consideration of how
to deal with these kinds of adolescents.
Suicidal Adolescents
As with any client, the first thing to do is to get to know him and to
establish a relationship that helps him feel valued and accepted. This
can be done by first focusing on what it is like to be an adolescent in
general. In one useful assignment, the client draws a picture or makes
a collage about an "Adolescent's Nightmare." What do adolescents, in
general, dread, worry about, struggle with? Next, a picture about the
"Three Wishes" gives a glimpse of what is going on in the young per-
son's world and what troubles him. It is important to help the suicidal
person to express his negative emotions. Ask him to draw an "Angry
Picture," "Real Sad Picture," or a picture or a collage about "Some Dis-
appointment" a person has experienced."
Gradually the therapist has to find ways to increase the person's self-
esteem. Whatever increases the person's sense of self-worth will make
ideas about committing suicide less attractive. One way to do this
might be to ask for pictures that portray the person's good qualities.
Have him make a picture about "what you admire in people," or a pic-
ture of a "person you would like to have as a friend." More personally,
have him draw a picture about "something you are proud of." Then
perhaps a picture about "a goal I have for my future." Also have him
draw a picture or make a collage about "a decision I have made lately
I am proud of," or "a decision I would like to make." It could be to give
up smoking, for instance, or lose some weight, or start exercising.
"What I would like people to notice about me," is another picture that
lets you explore the person's world. Let the young person choose the
people. They could be teachers, parents, classmates, friends, or others.
Once the suicidal young person feels that he matters to someone
who knows him well, suicidal thoughts will recede. Then, with the ther-
apeutic relationship firmly established, good results can be achieved by
asking for a two-part picture or a collage to show "how the person is
feeling now" and "how the person would like to feel" (Landgarten,
1981).
It is customary to consider suicide as a "cry for help" (Shneidman et
aI., 1970). Psychopathology and behavior disturbances are natural reac-
tions to emotional and social deprivation. Problems are distress signals.
They are alarm reactions, "auch" signals. One must look for the sources
of distress before the distress leads to contemplation of suicide. Many
of the young people therapists work with come from broken families
and have nobody to satisfy their emotional needs. Therapists have to
help adolescents find sources of love, acceptance, and security in their
world that would not lead them into greater deprivations. Therapists
cannot be a substitute mother or father or girlfriend, but they can help
adolescents find such sources of nourishment in their world. And, also
importantly, we can help them learn what they themselves are doing to
defeat the nourishment that might be scarce but available in their sur-
roundings.
Eating Disorders
Two types of eating disorders-anorexia nervosa and bulimia-are on

the rise in our society today. These disorders are 10 times more com-
mon in women than in men. It has been estimated that two-thirds of all
young women have some mild form of problematic eating behavior
(Motto, 1997). Physical symptoms of anorexia include a loss of more
than 15 percent of body weight, often combined with amenorrhea,
hyperactivity, and hypothermia. Psychological symptoms include a
preoccupation with thinness, fear of gaining weight, distorted body
image, denial of hunger, sense of ineffectiveness, and struggle for con-
trol (Crowl, 1980). Some researchers speculate that problems with food
have their roots in histories of sexual abuse and may represent an
attempt to alleviate post-traumatic stress symptoms (Root, 1989). At
any rate, eating disorders are self-destructive behaviors where the per-
son seems to want to get rid of the body, and thus, in effect is commit-
ting a partial suicide.
In art therapy, the self-drawings made by anorexics portray them-
selves as little girls and show very low self-esteem. Mechanical, robot-
ic forms are also frequently seen images. It appears that anorexics, who
may be survivors of sexual abuse, try to remain asexual to gain control
over their bodies, their destiny, and their lives (Crowl, 1980).
A "Self-portrait" done in front of a full-length mirror is a useful tech-
nique for work with an anorexic client. The client lists the body parts
she thinks are drawn incorrectly or she is unhappy about. Then, she is
asked to list three things she likes about her appearance. The discussion
can then focus on the tendency to magnify the dislikes and to minimize
what she likes about herself.
"Body tracing" is another useful approach. First the client outlines
her body as she imagines it would look if it were traced. Then, the ther-
apist traces the body. The discussion that follows highlights the dis-
crepancies between the two outlines.
"Mask making" is also a useful technique. Some art therapists have
clients make a mask and then give the mask a voice and engage it in a
dialogue (Motto, 1997).
Most of the exercises mentioned previously in work with adolescents
are effective with clients struggling with eating disorders. The notion of
self-system, discussed in Chapter 8, helps to explore and understand
the various domains of functioning. The "Name design," "Pictures of
one's interests," "Hobbies" and "Relationships," as well as "Pictures of
a range of emotions" lead to a fruitful examination of the various prob-
lems the young person is struggling with. In addition, adolescents with
eating disorders might also benefit from the Alcoholics Anonymous
model whereby clients recovering from the illness serve as mentors
and role models to clients still in treatment (Madigan, 1994).
Sexual Abuse
Sexual abuse is a serious problem with a wide range of possible psy-

chological consequences. It has been estimated that some 27 percent of
women and 16 percent of men have experienced sexual abuse as chil-
dren (Rodriguez et aI., 1997). Some studies indicate that childhood sex-
ual abuse is two to three times as common in females as males (Richter
et aI., 1997). Symptoms common to victims of sexual abuse are intense
fear, anger, role confusion, low self-esteem, anxiety, social isolation,

and self-destructive behavior patterns. Fifty percent of psychiatric inpa-
tients have experienced severe or long-term childhood sexual and/or
physical abuse and are at risk of developing dissociative disorders and
post-traumatic stress disorder (Van der Kolk & Van der Hart, 1989).
Treatment efforts with sexual abuse victims in group format provide
mutual support and reassurance that one is not alone. It is important to
use the term "survivor," instead of "victim" of sexual abuse. The
themes that emerge from the artwork and discussions touch on anger,
self-blame, and grief. Anger arises from the fact that the perpetrator
receives none or minimal punishment, even when charges are brought
through legal channels. Some studies show that less than 10 percent of
all reported rapists go to jail, and most go free without even probation
(Ledray, 1994). There is self-blame for the survivors who question if
they could have prevented the abuse had they behaved some other
way. And there is grief about missing out on "normal" childhood.
Backos and Pagon (1999) have devised a particularly effective treat-
ment format. They start their sessions with a "check-in" and ask the
group members first to create a "mandala" showing "Myself Tonight."
Then, next to the drawing, they write how they were feeling (e.g.,
"jumpy, confused, down"). Their current concerns-school avoidance,
depression, suicidal thoughts, homicidal thoughts, explosive outbursts,
drinking, running away, promiscuity, and bulimia-begin to emerge.
This results in themes for discussion, such as how to deal with anger,
how to improve self-esteem, how to deal with other students at school
and with family conflicts, and how to build trust. Additionally, Backos
and Pagon use a "question jar," whereby each group member can write
a question anonymously for the group to explore. This gives the girls
the opportunity to discuss topics they might be too shy to address open-
ly. For example, during one week the group clarified the difference
between rape and sex, and talked about sexual relationships and sexu-
ally transmitted diseases. Thus sexual ignorance was replaced with sex-
ual knowledge (Backos & Pagon, 1999). Although this particular group
met for only eight weeks, there were positive changes. The girls started
to focus outward and considered how they could empower themselves
to help other survivors.
Powell and Faherty (1990) describe another, longer treatment plan
for survivors of sexual abuse. This group used sand play, as well as
videotapes, psychodrama, snacks, and prizes in addition to two dimen-

sional drawing.
For those who have been severely traumatized over many years,
there is a tendency for the least traumatic memories to emerge first and
the most traumatic ones to emerge later in the healing process. As new
memories begin to emerge, the survivors may be plunged back into
some "victim" thinking, feeling, and behaving. Furthermore, an indi-
vidual may not be at the same stage in all areas of functioning. She may
be a thriver in regard to certain relationships, but a victim in others
(Matsakis, 1994). Recovery may be a process that lasts a lifetime. For
some the trauma may be analogous to an acute infectious disease that
can be taken care of relatively easily. For others, it may resemble more
a chronic condition, like a diabetes, which requires attention through-
out ones life.
Chemical Dependency
In our contemporary society, it is most difficult for an adolescent to

avoid being sucked into alcohol and/or drug dependency. Peer pres-
sure and one's own curiosity, risk-taking, wanting to appear "cool," and
similar factors easily lead into experimentation with illegal substances.
For many, experimentation results in addiction when the adolescent is
no longer able to function without the chemical "crutch." Adolescents
are particularly vulnerable to drug addiction. Some of them, for what-
ever reason, are unable to deal with the usual stresses of growing up.
Drugs to them may represent an escape from feelings of inferiority and
disappointments. To overcompensate for feelings of inferiority and
helplessness, they set unrealistic goals for themselves which only fur-
ther reinforce their sense of failure. The adolescent covers up the pain
and confusion with a facade of denial, indifference, and anger. Behind
the facade is a youngster deeply hurt who feels inadequate, insufficient,
incomplete, and guilty for not measuring up to his own expectations.
He thinks he has to be a superman or he is a nobody. She is a prima
donna, or she is no good. These adolescents regret lost opportunities,
lost relationships, lost possessions, and even lost health. They cover up
the painful awareness of the many losses by more drinking or drugging.
How does a therapist extricate a youngster from the drug culture?
Art therapy in group sessions can provide a new circle of companions
who gradually find other ways to fill their time. They are no longer
attracted to drug procuring, gambling, and other risk-taking and self-

destructive activities. They learn new ways of structuring time, and
they experience the satisfaction of expressing meaningful emotions
without being hurt and slighted.
As you ease the chemically dependent adolescent into art therapy,
remember that people unaccustomed to visual means of expression
exhibit the usual apprehensions. An adolescent is prone to claim that
art is his worst subject in school (see Chapter 7). At this point, all the
therapist needs to say is that this is a different art than they do at school.
"I know you are not an artist. You do not have to be an artist to do this
kind of art." Drug-using adolescents are also concerned about what the
therapist will find out about them. Verbally and nonverbally, the ther-
apist has to make it clear that only the client himself is the authority on
what the picture "means." The therapist and other group members can
say only how the picture affects them, not what it signifies. As the client
perceives that he is the expert and the final authority on the meanings
of his productions, his defensiveness and apprehension invariably with-
er away. Still, in one drug-abusing adolescent group, it was necessary to
reassure the group and explain again that art therapy is just a different
way of exchanging ideas and that the only person who knows what the
picture really means is the person making the picture. It is not a secret
way of keeping a client under surveillance for illicit drug use, and that
there is no way of telling from the pictures what drugs a client is taking
(Nucho, 1977).
Clients can be eased into picture making by the techniques previ-
ously described in this chapter and in Chapter 7. "Free Flow technique"
works well. So does the "Name Design," or making a "Picture from
one's initials."
At the beginning of one art therapy group, chemically dependent
adolescents and the therapist engaged in a general discussion about the
events of the week. A theme began to emerge from this general dis-
cussion. The clients liked to have the therapist suggest a theme for their
pictures, but they had the option of either using that theme or working
on one they, themselves, would choose. The themes that emerged
were, "My best friend," "Work," "Things that make me angry," "Pic-
nic," "Enjoying myself," and others." The techniques illustrating the
various domains of the self-system, mentioned earlier in Chapter 8, are
appropriate as well. The themes that appear in the clients' art work
touch on feelings of loneliness, guilt, fear, anxiety, depression, empti-
ness, anger, and disappointment. Gradually, it becomes clear that the

bland exterior facade masks a deeply troubled person. Through the
relationship of acceptance with the therapist and support from the
group members, the chemically dependent adolescent begins to accept
limitations in his life, recognizes his remaining strengths, and thus
improves his self-esteem (Nucho, 1977). One art therapist likes to assign
a two-part picture for the client to work on. On one part of the picture,
the client uses colors, images, and symbols to "portray his weaknesses."
On the other part, he "draws his strengths." Then, each member of the
group presents and explains his picture to the entire group. The mem-
bers then fold and pocket their strength pictures for safekeeping. The
other pictures are ripped up and thrown away (Potocek & Wilder,
1989).
In addition to the various types of self-portraits discussed earlier in
this chapter, two kinds of Kinnetic Family Drawings also provide rich
sources of information to the therapist as well as to the monosyllabic
client. While the customary KFD provides information about the
maker's current or past family relationship, in the "Prospective Kin-
netic Family Drawing" (Kismiss, 1992), the therapist asks the client to
draw a picture of what he thinks his life will be like ten years later. The
Prospective KFD promotes thinking about one's future and stimulates
goal-setting. The adolescent's choices of whom and what to include in
the picture, the size of the items portrayed, and their distortions pro-
vide information from which to form hypotheses about the dynamics of
the client to be explored further in verbal treatment. The fears and
wishes associated with one's future can be discussed, and the person
can be helped to modify unrealistic self-expectations and set realistic
goals that can provide need satisfaction without resorting to chemical
means.
Chapter 13
ART THERAPY WITH ADULTS
any people, unfortunately, reach adulthood chronologically but

M not emotionally. What does it mean to be an adult?
Adolescents impatiently wait to be regarded and treated as adults. To
them, adulthood means a state of certain rights and privileges. Only
gradually do they become aware of the obligations and stresses that
accompany those rights and privileges.
Being a Grown-up
When does a person start feeling like a grown-up? What particular

event stands out to mark the arrival of adulthood? For a group of grad-
uate students, the most frequently mentioned event that suggested to
them that they had reached adulthood was when they received their
driver's licenses. Some thought that they started to feel grown-up when
they began paying back their college tuition debts. One young woman
recalled that she felt having reached the status of an adult when she was
permitted to go to the dentist all by herself. It seems that the ability to
assume responsibility for some aspect of one's behavior signals the
arrival of adulthood.
During late adolescence, young people start making their own deci-
sions. They attain a certain level of financial independence. They no
longer spend the entire summer with the family. They start living apart
from their families.
According to Erikson, during this period, an adolescent decides what
he wants to do and with whom he wants to associate. Now, as an adult,
he has to decide whom he wants to take care of. To be an adult means
to have the ability and the desire to care for someone and something.
238
Art Therapy with Adults 239
This, Erikson suggests, can lead to the crisis of intimacy vs. isolation
(Erikson, 1950).
Freud emphasized that to be a healthy adult one has to be able to
work and to love. An adult must decide what line of work to pursue.
Another big decision concerns one's lifestyle-to remain single or to
combine life with a life partner. In the Western world, these decisions
are particularly difficult for women. Having children means postponing
one's career aspirations. Studies show that among women in executive
level positions, a relatively small number have children by the time
they are 40. Lack of parental leave and scarcity of adequate childcare
facilities makes it very difficult for a woman to invest herself in a pro-
fession and motherhood at the same time. Women have lost the secu-
rity of traditional marriages, half of which end in divorce. This,
combined with the low earning potential in the job market, makes
many women choose whether to be mothers or successful profession-
als. The Smith College Office of Career Development reports that in
the 1960s, some 61 percent of their graduates said that they wanted to
be homemakers. In the 1970s, only 15 percent wanted to be full-time
homemakers. By the 1980s, less than 1 percent said they wanted to be
homemakers. Combining motherhood and a career is a daunting prob-
lem for women. To the career, add the needs of one's children and
spouse, plus the care for one's aging parents, and stresses for adults
reach unbearable levels. No wonder the Diagnostic and Statistical
Manual (DSM IV) presents a bewildering array of forms of psy-
chopathology that can assail an adult. Often the hassles and stresses of
life trigger a full-blown episode of mental illness, even for those condi-
tions that are thought to have some genetic predisposition,
The long list of forms of psychopathology can be made more man-
ageable for art therapists by focusing on the extent of the client's func-
tional impairment. There are the minimally, the moderately and the
severely dysfunctional adults. Minimally dysfunctional adults function
adequately in most of their roles. They do not present problems to their
role partners or society at large, but are dissatisfied with their own level
of performance. They may be struggling with a major life decision-
whether or not to pursue a course of action, for example, or to break off
a relationship.
Moderately dysfunctional adults are capable of functioning in all but
one specific area of life. For instance, many alcoholics pride themselves
on being able to hold down a job, but their marital relationship causes
much pain and confusion. They are inadequate as parents, and their
children suffer. Some sex offenders are also moderately dysfunctional,
and some of them may have even reached socially prominent posi-
tions. Secretly, they are child abusers.
Severely dysfunctional adults are unable to fulfill most or all of the
adult roles in life. They may have had numerous hospitalizations for
mental illness. Art therapists encounter severely dysfunctional adults in
halfway houses, shelters for the homeless, prisons, and other institu-
tions.
The specific art therapy procedures that follow have proven useful
with the minimally, moderately, and the severely dysfunctional adults.
Minimally Dysfunctional Adults
Minimally dysfunctional adults seek therapy on their own accord

rather than being urged to be in therapy by some external authority.
They appear to function well in all their major life roles, vocationally
and socially. They present no problems to other people, but they may
be problems to themselves. They may be dissatisfied with their own
performance; they feel that they are not reaching their full potential; or
they may be experiencing some troublesome relationship. Profession-
als term them, facetiously, the YAVIS-type clients. They are "Young,
Attractive, Verbal, Intelligent, and Successful." They may be young, if
not in years, then in their outlook, and they are young at heart. They
mayor may not be physically attractive, but they are able to attract
other people and form lasting friendships. They tend to be verbally
expressive, but they know how to use their vocabulary defensively,
without saying anything meaningful. Art therapy is a less well-known
means of communication in our society, and as such, it is particularly
useful when working with these clients. Most of them have a normal or
above normal level of intelligence. Despite the fact that they have a low
opinion of their level of financial and social success, they are success-
ful in the sense that they are capable of supporting themselves. Their
ambitions and level of expectations may be higher than what they have
achieved so far. Often they come to therapy in order to further personal
growth and self-actualization. They may have concerns about some
relationships in life, but these tend to be their problems, not problems
for their role partners, for other people or for society at large.
YAVIS-type clients do well in art therapy and their difficulties usu-

ally clear up in a relatively short period of time. All the art therapy
techniques described in previous chapters are appropriate for them. It
is useful to start with various warm-up-type activities, like the "Free
Flow" technique, "Anything" or "Free Picture," and various forms of
"self-portraits." All of these exercises soon lead into self-exploration
and deeper sharing with the therapist and, if the sessions are conduct-
ed in a group format, with the other members of the group. Think in
terms of the various domains of the self-system (see Chapter 8) in order
to explore specific areas of functioning. Mandalas serve well as closure
activities, and many clients enjoy doing them at home on their own at
the end of a busy and stressful day. The various art therapy exercises
help YAVIS-type clients gain a deeper grasp of their own potential and
how to proceed to actualize it. Art therapy strengthens self-confidence
and promotes confidence in their own problem-solving abilities.
Moderately Dysfunctional Adults
Moderately dysfunctional adults function well in one area of life but

have problems in another area. This category includes people who can
hold down jobs but have difficulties in some relationships; they could
also be alcoholics or sex offenders.
Some moderately dysfunctional adults eventually get in trouble with
the law and are "sentenced" to therapy. Naturally they are resentful
and are uncooperative. At first, they just go through the motions. They
may be present, but they are not invested in getting anything out of
therapy. It helps to work with these clients in groups. Gradually they
begin to disclose their hurts and feel supported by the other group
members who have similar difficulties.
"A name design" picture is a useful initial exercise for art therapy
with groups. Each person writes his name and then draws around it
something to signify his activities, interests, or hobbies. Early in thera-
py, ask each client to make a picture or a collage about "a problematic
relationship." It can be with a person or an institution-the court, the
hospital, the job, or something else. This exercise tends to lead to
meaningful sharing and mutual support in a group.
Themes that touch on "the difficulty of being a male" in our society
provide useful explorations for groups of male sex offenders. Many
have not had adequate male role models. It helps to focus on their atti-
tudes and experiences in relation to their fathers. What were "some of

the good times they had with their fathers?" Or what were "some of the
good times they would have liked to have had with their fathers?"
What was "their father like?" In their opinion, what "would an ideal
father be like?" Direct similar explorations to their mothers. What did
they "like and dislike about their mothers?" What did they "like and
dislike about their wives or girlfriends?"
"The Kinetic Family Drawings" help to understand what it was like
to grow up in the family. Here the client makes a picture of the family,
including himself doing something. It can be a picture of the family
when he was young, or his current family. Many dysfunctional adults
have not had adequate family upbringing. Perhaps they had been in
foster care, or had been taken care of by various relatives, or their par-
ents were cold and disinterested in them. Often there is a stepfather
and/or stepmother, and conflict with siblings and half siblings. Family
pictures therefore are apt to awaken much resentment and suppressed
sorrow. Sharing this with an understanding therapist and group mem-
bers who endured similar difficulties while growing up can gradually
ease the pain.
Pictures of the "best dream" or of a "dream I would like to have" can
lead to meaningful discussion. Also a picture of the "worst nightmare"
is worth exploring. It need not be a nightmare of the client himself, if
he is reluctant to disclose his feelings. It can be a particular situation or
a nightmare about men, in general.
Frequently, treatment has to be quite brief because of inadequate
insurance coverage. When clients do not remain in therapy for more
than a few sessions, all you can do is to sow a seed, as it were, and let
the client continue to think about the question you posed. In one brief
program, the therapist asks his clients to draw a block in the lower left
corner of the sheet of paper, and another one in the lower right corner.
The block on the left represents their problem, and the block on the
right is the solution to the problem. Then they are asked to "draw a
bridge" between the two blocks to show how will they get from the
problem to the solution.
In a similar exercise, the client draws a "wall" that is keeping him
from achieving his goals. Or the client draws a "treasure map," placing
an X anywhere on the paper and another X where the treasure is
buried. He then draws a path leading to the treasure and describes
what is obstructing his path. One depressed substance abuser said that
his treasure was "real happiness." Then he spoke about the problems
that kept him from getting to his "treasure": medical problems, lack of
money, his addiction, his family problems, and his lack of friends. Hav-
ing revealed those obstacles, it was possible to do some problem solv-
ing by partializing his many problems and prioritizing what he could
begin to do.
Another useful exercise is to "Draw a Mask you wear to cover your
problems." One client drew something that appeared to be an angel,
with something blue underneath. He said those were his "blues," mean-
ing his depression he tried to hide. Another drew a mask with red eyes
and nose and tears that resulted from snorting cocaine. It became clear
that this client's drug addiction covered up some deeper emotional
problem he was struggling with.
If done in a group, clients can comment on each other's pictures and
share the feelings the process has evoked for them.
The customary verbal treatment methods used with drug dependent
and other moderately dysfunctional clients are fraught with many dif-
ficulties. Many are ingenious in avoiding their counselors even when
some form of counseling is mandatory to obtain the medication. A 30-
year-old woman with a long history of heroin and barbiturate depend-
ency, for instance, would sit on the edge of her chair in her counselor's
office and bolt out the door the moment the discussion became uncom-
fortable to her. When confronted with this behavior, she claimed that
she had double parked, or she invented some other kind of emergency
she supposedly had to attend to immediately. Later she was able to
admit, "I have nothing to say to my counselor. Maybe if I led a differ-
ent life, I'd have something to say to her. She keeps sending me these
little notes with the help-wanted ads cut out from newspapers...."
To a considerable extent, counselors using art therapy techniques
can avoid many of the difficulties frequently encountered in the verbal
treatment forms. Art therapy is particularly appropriate with clients
who are inarticulate and action-oriented. In art therapy, the client is
actively involved in producing some visual item. This activity engages
his mind but also his eyes, hands, and much of the rest of his body.
Here is something concrete and tangible that sustains his interest and
provides a rallying point for his attention. For the counselor, the visual
creation provides a rich source of information about clients who other-
wise might be quite monosyllabic. The counselor can derive a great
deal of information from the content and the form of the visual prod-
uct. The counselor can gain additional insights from the process of pro-
ducing the item, from the client's comments and reactions to the item,
and from the comments and the reactions of the other group members
if he produced it in a group setting. In addition, the therapist's own
reactions to the visual material are significant.
Every person, however untutored in art, possesses a basic visual
vocabulary. For instance, everybody has feelings about colors. Some
colors are thought to be pleasing while others are perceived as being
unattractive. The same is true for shapes. Some shapes may seem
intriguing, while others are disquietening. Some lines may seem
smooth and soothing, while others may appear to be jerky or bold.
This visual vocabulary, once discovered, can be expanded, and it
becomes a source of constant enrichment and excitement. Clients who
are accustomed to thinking of themselves as chronic failures become
quite intrigued by this revelation. It is rewarding to discover how one's
own visual vocabulary converges with or differs from those of other
members of the group while at the same time it has just as much valid-
ity as that of others.
Many dysfunctional adults are deeply hurt people who have often
experienced words as being dangerous and unreliable. Words may
have been used to evade, to humiliate, or to trap another person. On
the other hand, visual means of expression have been used less fre-
quently in our society, and have fewer distortions and stereotypes
attached to them. Not infrequently, a fresher and more direct expres-
sion can be achieved through the visual rather than the verbal means
of communication.
The visual means of expression tend to be more suitable for the sub-
tle and deeply personal experiences for which there are no appropriate
words. By and large, language, with all its complexity, contains desig-
nations for those experiences which are of some social significance and
neglects the more private and idiosyncratic experiences. In addition,
many important experiences are accumulated during the first year of
life, well before the person has adequate words to attach to his experi-
ences. It may be, therefore, that some very significant and fundamen-
tal experiences became encoded in mental pictures rather than in
words. After all, we dream mostly in pictures, and dreams have long
been recognized as providing access to the deeper layers of our being.
As he makes his pictures, the art therapy client is the doer, not a
reactor, as is the case all too often in his life. He has to decide whether
the picture will be small or large, bright or dark. But once the decision
is made, it remains as he made it, unless the client himself wishes to
change it. The paper does not argue back with him. If he is not pleased,
he can change his decision without a penalty, which is a rare privilege
in his real life. Clients truly relish this sense of freedom once they have
experienced it. So long as it is art therapy and not art instruction he
does not have to justify his decisions nor does he have to try to please
anyone else.
Many drug counselors have noted the so-called plateau period in the
lives of drug dependent clients. After the clients have stabilized their
lives to the point where they are able to hold a job and provide for their
housing, clothing, and the medical needs, they soon start feeling rest-
less and bored. The drudgery and the tediousness of life makes them
feel as though they were stuck and only spinning their wheels, as it
were, without getting anywhere. Art therapy introduced at this point
can help the clients appreciate the growth that is taking place in them.
New shapes, new color combinations and new styles appear in their art
work, as they start thinking new thoughts and having new experiences.
As one's life style changes, so does one's art. With the help of their art
work, clients can appreciate better the strides they are making toward
a more satisfying life.
Severely Dysfunctional Adults
Severely dysfunctional adults are unable to function adequately in

any major role in life. They cannot hold down a job and they cannot
fulfill either their marital or their parental roles. They are a problem to
their families and to themselves, unless their concerns are covered up
by some delusions of grandiosity. They suffer from schizophrenia,
manic-depressive disorder, or some other major form of mental illness.
They shuffle in and out of mental hospitals. In recent years, they tend
to be heavily medicated and the manifestations of their illness are hid-
den by a bland exterior. Art therapists encounter them while they are
hospitalized for relatively brief periods of time, or are in halfway hous-
es, group homes, or shelters for the homeless. They have frail egos,
low self-esteem, and a flat affect. Their associations are loose. They are
disappointed, suspicious, and disillusioned. It is difficult to form a ther-
apeutic relationship with them because they are not eager to risk emo-
tional investment in yet another potentially disappointing relationship.
They are beset by chronic stresses, and their problem-solving skills are
meager.
People with major mental illness generally suffer from what could be
termed an overdose of pain. They have overdosed on some traumatic
experience. Although there may be a genetic predisposition to mental
illness, still it often is triggered by some deep emotional trauma. It is
important to keep in mind that, contrary to popular belief, by no means
is mental illness limited to the lower socioeconomic levels. For exam-
ple, one young woman, a member of a prominent professional family,
became involved in LSD and developed schizophrenia after her sister
was admitted to the Harvard School of Medicine. Another woman
from an upper socioeconomic level gradually sank into a major form of
mental illness when she gathered that she had disappointed her father
who expected her to win the Nobel Prize in chemistry.
How does one work with mentally ill adults? Contrary to work with
most other kinds of clients, the therapist has to be careful not to be
overly warm with those who are mentally ill. For many of them, close
personal relationships have caused pain and disappointment. They are
distrustful and they need emotional space. Also, it is essential for the
therapist to communicate clearly and establish structure so that the
client knows what to expect.
The Interactional Drawing Technique
The Interactional Drawing Technique, already mentioned in Chap-

ter 8, is appropriate with clients still in the acute psychotic phase. Most
very disturbed patients may have to go through several preliminary
steps before they are willing to engage in interactional drawing. Some
patients do not draw unless the therapist is several feet away. Gradual-
ly, the patient may be willing to draw while sitting at the same table as
the therapist. Finally, the patient may be willing to engage in drawing
on the same sheet of paper as the therapist but would stop if the thera-
pist intrudes into their "territory."
The therapist and the client may draw simultaneously or take turns.
Materials are simple and only a few colors are used to reduce the com-
plexity of stimuli. Pencils or felt-tip pens are best. The originator of this
technique, Mardi Horowitz, simply has a few colored pencils in his
shirt pocket and gives one to the patient and keeps one himself. In this
way, he knows what the patient contributed to the drawing and what
he himself added (Horowitz, 1970).
Interactional Drawing is kind of a symbolic dialogue where the ther-
apist can provide ego support to the patient by visually introducing
protective themes. In one instance, the therapist sketched an ambu-
lance when the patient had drawn a scene of an earthquake with peo-
ple falling from damaged buildings. The therapist can lend support by
introducing certain objects, like pets and people. Connections can be
strengthened by drawing bridges, paths, or putting up road signs. In
general, solid objects in a drawing, such as houses and trees, convey a
sense of security, especially when placed next to symbolic self-repre-
sentations, like animals, a car, a ship, or a person (Horowitz, 1970).
With Interactional Drawing Technique, the therapist must be careful
not to overshadow the patient with her technical skills or abundance of
ideas and associations. Depending on the condition of the patient, a
session would be short, lasting from 10 to 20 minutes.
Like art therapy in general, the Interactional Drawing Technique uti-
lizes the visual means of expression that provides a new and undistort-
ed language. The technique may be less threatening to the mentally ill
person than conventional language, especially to patients such as cata-
tonics, who have renounced words altogether. The experiences por-
trayed symbolically may be easier to put into cognitive terms later on.
Symbolic discharge, control, and integration of affect occur while draw-
ing. The therapist and the patient both focus their attention on the
drawing and thus anxiety concerning the interaction itself becomes
more tolerable. If the therapist is perceptive and attuned to the patient,
the patient can set the rules and the speed of the discourse (Horowitz,
1970).
Collages
Collages are another appropriate technique with chronically ill men-
tal patients. Collage making is more structured and less threatening to
patients who are concerned about their ability to draw or paint. All
they have to do is cut out and arrange pictures. Collage making pres-
ents less opportunity to wander off into autistic thinking because the
patient focuses his attention on the external world through pictures of
persons, objects, and events of everyday life (Moriarty, 1973).
The format is as follows: the group sits around a table, and in front
of each is a glue stick, blunt scissors, construction paper, and several
popular magazines, like Good Housekeeping, Ebony, People, or Sports
Illustrated. The patients are told to look through the magazines and
cut out pictures and words. Then they have to arrange the pictures and
words to make a collage about themselves. They can choose their own
theme for their collages or the therapist can offer a new theme in each
subsequent session. For instance, make a collage about "the worst thing
that ever happened to you" or "the best thing that ever happened to
you" or a collage about "the hospital" or "how to become what you
would like to be." Some groups of patients may decide on a joint topic
for the entire group to work on. This promotes the development of
social skills. It also reveals who leads, who follows, who works better
alone, who works better in a group project, how close each one's con-
tribution is to the central theme, and how unified or confusing is the
end product. The discussion of the process of producing the collage as
well as its content can be very fruitful (Moriarty, 1973).
A collage-making session requires an hour-and-a-half. It usually
takes half-an-hour to make the collage. The remaining time can be
spent in verbal interaction. Each patient tells what his collage means to
him. Others offer their reactions and comments. The therapist focuses
attention on the reality-oriented aspects of the collage and emphasizes
the here-and-now, problem solving, and learning alternative behaviors.
The therapist reinforces constructive behavior by verbal approval and
devotes the last five minutes of the session to tying together the various
themes and what can be learned from them. Patients are free to keep
their collages in their portfolios or display them on the wall (Moriaty,
1973).
The collage-making experience enhances the participants' self-
esteem and provides a tangible week-to-week progress record, as well.
The group process gives enough structure to be supportive and enough
freedom to develop autonomy. Patients can speak, listen, and interact
socially. They are free to select their own pictures, arrange them in
their own way, and tell others what they mean by them. The process
also offers the therapist a rich source of observations. Why do the
patients choose these and not other pictures? Why do they arrange
them this way? Why do they make these associations? Why are the
themes different or alike from week to week (Moriaty, 1973)?
Art therapists frequently use various other kinds of collages, espe-

cially by Landgarten and art therapists trained by her. In one group, for
instance, Landgarten asks the patients to choose three pictures that
appeal to them and paste them on a sheet of newsprint. Then the
patients write a few words under each picture (Landgarten, 1981).
The Art Dialogue Technique
The art dialogue technique is somewhat similar to collage in that in

both the clients work with images created by someone else, not by the
clients themselves. But in addition to the benefits of the collages, the art
dialogues offer aesthetic enjoyment to the participants.
In Art Dialogues, the art therapist gives the patient an array of post-
card size reproductions found in art museums. These are works by
prominent artists. However, the patient does not appraise the aesthet-
ic qualities of the works of art or figure out what the artist "really"
meant to say. Instead the patient engages in a more receptive and med-
itative way of looking. The viewer immerses himself in the work of art,
enjoys it, and if possible, attempts to derive some personally meaning-
ful message from it. The purpose is not to have the patient evaluate the
work of art but to see what light it might shed on the dilemmas and per-
plexities the viewer is struggling with (Nucho, 1983).
In order to accomplish this, the therapist asks the viewer to approach
the work of art with three questions in mind. The first question is sim-
ply, "What is there? What catches the eye? What stands out there for
me?" The second question is, "What kind of feeling or mood is there?
What kind of feeling does it evoke in me?" The third and final question
is, "What does it say to me? What messages does it have for me?"
The qualities of the work of art, such as unity amid variety and the
eloquence of expression, affect the viewer both consciously and sub-
liminally. Still, the various feelings of enjoyment or displeasure the
viewer experiences depend mostly on his own disposition and readi-
ness to be moved to pleasure or pain. Art may be a universal language,
but to each beholder it tends to say something unique. This is the well-
known phenomenon of selective perception at work-a phenomenon
regarded gingerly and with suspicion in most instances-but in the art
dialogue technique, it is actively encouraged and appreciated. What
matters is the meaning, which the viewers actively construct in the light
of their own unique life experiences.
When the art dialogue technique is used individually or in relatively

small groups it may be possible for the clients to share their reactions
to the works of art spontaneously, verbally, out loud. If the group is
larger, or if the clients wish to avoid premature modification of their
thoughts and feelings by the comments of the other members of the
group, they may record their reactions to the three questions suggest-
ed earlier, first in a brief, telegram style and then share and discuss
them later.
When working with clients individually or in small groups, the works
selected for the art dialogue technique may be shown in the form of
originals or reproductions. Slides are the most convenient way for
large-group viewing.
It takes approximately two to three minutes for the client to examine
each artwork. This varies, depending on the kind of clients one is work-
ing with. Clients who are anxious and not accustomed to looking at
works of art may want to see each work two or three times before being
satisfied that they have seen all there was to be seen. With most clients,
by the time the work is shown for the third time, the apprehension of
having missed something is gone. They are now quite ready to share
their own reactions and to hear what other members of the group have
to say about each work under examination.
The number of works considered in each session should be kept
quite small. Even seemingly bland and non-problematic pieces of work
can arouse intense feelings and memories in some viewers. The three
questions that the viewers address to themselves can awaken a deep
sense of loss, remorse, guilt, or some other complicated emotion. Usu-
ally three works per session are quite sufficient to provide rich materi-
al for meaningful sharing of personal experiences. When four or more
works are used, the viewers tend to slip into a more detached, museum-
like form of inspection of the works, and remain rather untouched per-
sonally. The intensity of involvement with one piece of art may
preclude the client's ability to engage with yet another piece of work.
What types of art works are appropriate for the art dialogue tech-
nique? Keep in mind the principle of gradualness when selecting suit-
able pieces of art. For the early sessions, when the clients have not yet
developed a secure and trusting relationship with the therapist and with
each other, it may be best to use rather neutral, non-problematic sub-
jects. Sunny pleasant landscapes, flowers, still lifes, and pets may be
appropriate. Gradually, as the level of comfort with each other and the
readiness to share personal experiences grows, introduce works of art

depicting people and some more problematic human relationships.
The final item in each session, however, should be non-problematic
and sunny in order to provide a sense of security and closure prior to
the end of the session.
Each art therapist can select artworks to be used according to their
availability and one's own preferences, depending on the type of
clients one is working with. Works by Matisse, van Gogh, and others
produce good results. For instance "The Artist in the Olive Grove" by
Matisse presents a seemingly sunny, restful scene, which in most view-
ers evokes a repose and relaxation. Some viewers respond to the heavy
black tree trunks and note the scorching sun. Occasionally, a viewer
misperceives the easel for a second person in the painting and devises
various fantasies about the relationship between the artist and this fic-
titious figure.
Pablo Picasso's "Man on the Beach" is a possible second selection.
This figure is often perceived as a sinister, menacing, suspicious person
who is trying to get away with something. A minority of viewers
respond to the sense of loneliness and man's determination to get
someplace in order to accomplish his goals despite the odds.
"The Shoes" by van Gogh is appropriate as the third work in the
series. The majority of viewers respond to this painting with memories
of hikes and outdoor activities. For some viewers this work generates
recollections of grandfathers or someone else who might have worked
hard and worn shoes like these. Much exchange of memories usually
takes place, and the sense of mutual sharing and understanding grows
among the participants in this experience.
Mary Cassatt's "In the Garden" is an example of a work of art which
should be reserved for use in later sessions when the clients have
attained a good relationship with the therapist and with each other. It
portrays a mother-child relationship and as many similar works of this
topic, it tends to awaken ambivalent feelings which for most people
are not easy to disclose to others.
The art dialogue technique can be used effectively not only with
severely dysfunctional clients but with a wide variety of other kinds of
clients as well. It requires very little by way of materials and equip-
ment. It can be used successfully with clients who are emotionally and
socially impoverished as well as with people who are leading active
lives despite their many burdens. It works well with people who are art
lovers as well as with those who profess no interest in art at all (Nucho,
1983).
Late Adulthood
The fastest growing age group in the United States today are people
over age 100. But still in Western society there is horror of growing old.
The terminology itself for this phase of life reflects our discomfort. We
say the aging, the elderly, senior citizens, the golden age, and so on. We
do not have a comfortable designation for the final phase of life
because we as a society still have not come to terms with it. We are pre-
occupied with dieting, plastic surgery, face-lifts and physical exercise.
Underneath all these efforts at self-improvement lurks the fear of grow-
ing old. We are afraid to grow old because we have not solved the mys-
tery of death and what, if anything, comes after death.
We joke about growing old. Bob Hope said, "You know you are old
when the candles on your birthday cake cost more than the cake." To
art historian Bernard Baruch, old age was 15 years older than he was at
any given time. He did not feel old at age 70 because then to him old
age was 85. And conversely, a 20-year-old girl refers to an 23-year-old
person as being "so much older" than she is.
The actor Cary Grant reportedly observed, "Had I known I would
live so long I would have taken better care of myself."
If we are fortunate to live long enough, eventually we all will be the
"aged." What is it like to be old? We know that there are physiological
changes that come with age. After age 70 there are problems with
vision. There is sensitivity to glare and cataracts may develop. There is
diminished acuity of hearing. The loss in pitch discrimination can lead
to social isolation. Two-thirds of taste buds are lost by the age of 70. Of
those over age 65, 80 to 85 percent have at least one chronic health
problem. Among the noninstitutionalized persons over 85, 41 percent
need assistance with going outside, walking, bathing, dressing, etc. In
addition to physical health, there are economic losses as well as psy-
chologicallosses. One's close friends and contemporaries die. Depres-
sion tends to be high in this population.
Chronological age itself is not a good measure of aging. Instead of
lumping them all together, it is important to individualize each person,
keeping in mind two coordinates-the extent of physical impairment
and the extent of mental impairment. A person may be low on physi-
High
--------A I
I
I
..., I
I
c: I
eu I
E
'- --------,.-----8 I
,,
I
to
0-
e I
, I
I
to
I I
U
--------~----~-------------------c
Low High
Mental tmpalrment
Figure 13-1. The Extent of Physical and Mental Impairment.
cal impairment and high on mental impairment. A person high on

physical impairment may be low on mental impairment. Different art
therapy techniques are required for each of these types of clients.
Depending on the level of the client's impairment, three clusters of
art therapy techniques can be used. These are the Free or Anything
productions, the Assemblages, and Perceptual Stimulation.
Free Expression
Free expression or "Anything pictures" work well with those clients
who are low on mental impairment, although they may have various
degrees of physical impairment. They may be recovering from an ill-
ness or may be suffering from a chronic health problem-a heart con-
dition, diabetes, kidney failure, arthritis, poor eyesight, or diminished
High
PERCEPTUAL
STIMULATION
ASSEMBLAGES
to
0-
S
FREE
ro
u EXPRESSION
Low High
Mental Impairment
Figure 13-2. Three Clusters of Techniques for Late State Adulthood.
hearing. They are mentally alert, however, and are interested in people
and events around them. They are in touch with reality, able to con-
verse and sustain interest in an activity.
The same exercises work as well with this group of adults in the late
stages of adulthood as they do with younger adults who are minimally
dysfunctional. Make clear that this type of art is different than what
they may have done in school. It is not to find out how well they can
draw but to stimulate their imagination. It is simply a different way of
thinking and exchanging ideas (see Chapter 7 on Unfreezing). The
emphasis should be on reminiscing. Art therapy activities serve the
process of so-called life review (Butler, 1963). The therapist or the client
can suggest the theme for the art product. Pictures about the different
domains of the self-system work well (see Chapter 8). Clients usually
enjoy drawing pictures about their favorite activities or things-"my
favorite season of the year," or favorite place, favorite animal, or
favorite food. The therapist can simulate reminiscing by asking for a
picture or sculpture of a host of subjects, including "my family tree,"
"my wedding" "my confirmation or bar mitzvah," or "the happiest

experience in my life." When the relationship with the therapist is well
established, suggest "my saddest memory," "the house/apartment I
used to live in," "the place that felt most like home," or "the thing I miss
most that I had to leave behind when I moved to the nursing home."
Clients seem to enjoy drawing "something that makes me happy."
Interestingly, this group of clients tend to portray not their children, but
their grandchildren.
The purpose of art activities at this stage of life is to review the good
experiences and take pride in having endured. The art exercises can
promote mourning that which is gone, to attempt reconciliation and
forgiveness to one's self and others, and to say good-bye.
Sessions may be conducted individually; or clients may work inde-
pendently on their own project in a group setting; or they can work on
a group project, perhaps something that portrays a specific concern
common to many seniors.
Depending on the level of the clients' physical impairment, it is best
to keep the sessions relatively short, doing just one project in each ses-
sion. Also, remember that with this age group, the warm-up period
may extend over several sessions before the clients discover some proj-
ect they can invest themselves in wholeheartedly. One elderly gentle-
men, for instance, first dabbled with paints. Then, he attempted to
build something out of wood chips until finally he produced a simple
but eloquent picture of his family tree, with himself as the last leaf on
the tree, "ready to falloff" (Nucho, 1987).
Assemblages
Assemblages work well with clients in the late stages of life who have
medium level of mental and physical impairment. Assemblages are
designs made from shapes, cut-outs, or various objects, such as pieces
of wood, stones, pine cones, leaves, flowers, sea shells, or beans. The
therapist provides appropriate materials, helps the client select a theme
for the work and the client then arranges the shapes or cutout pictures
to tell a story. When complete, the client tells what he has produced.
Inquire what special meaning it has for him and what memories it may
bring back. If the work is done in a group, try to get reactions and com-
ments from group members and then tie the various themes together.
This lessens the emotional isolation, stimulates verbal communication

and centers attention on the external world.
Perceptual Stimulation
Clients with a high degree of mental impairment are confused, have

a short attention span, and may have idiosyncratic perceptions of real-
ity. This group includes clients with chronic brain syndrome and
Alzheimer's disease. Use perceptual stimulation activities to engage
brain cells and stimulate some verbalization. However minimal, ver-
balization provides some emotional sharing and reminiscing.
The therapist must find and provide appropriate objects that can be
explored in different sensory modalities. They can be touched,
smelled, and seen, and may be from nature, like leaves, flowers,
seashells, cones, stones, tree barks, wood chips, and various fruits. They
can be an everyday object, like mittens in winter, a comb, a bar of
soap, brushes, eyeglasses, or a coffee cup. Use various holiday sym-
bols-pumpkins, Easter eggs, matzos, or various religious objects may
be useful, such as bibles, candles, hamentashon, or yamalkas.
Clients can paste objects on paper; other objects can be traced, and
appropriate background may be drawn in. If possible, the client can
sketch the object or color in a rough outline the therapist has made.
Stimulate perception by asking the client to explore the object by
touch, smell, sight, calling the attention to specific features of the
objects. "Do you see this dark spot here?" or "Do you like this better
than that...."
When working with late stage of life clients, it is particularly impor-
tant to individualize each one and assess the level of physical and men-
tal impairment. Appropriate materials may have to be provided for
those with poor eyesight, such as markers that have a specific smell for
different colors. Also tactile media may be useful. A 94-year-old client
who had been blind for the previous eight years used clay, which gave
him the opportunity to review various life experiences (Nucho, 1982).
Therapists must take into account the physical and sensory limita-
tions of geriatric populations. Speak slowly and distinctly, and louder
than you would in usual social situations. Be active, structured, and
give information in small amounts at a time. State clearly what is to be
done and repeat the information because the client may be disoriented
and have short-term memory difficulties, and use simple, concrete

words.
Be generous with reassurance and recognize the client's efforts. Sup-
port and encourage, but take care not to infantalize him.
An important principle is that the more impaired the client, the more
structuring has to be provided. Tell the client what to do and how and
keep choices to the minimum. Give him just one kind of paper and few
colors and keep the session short.
When starting to work with a new client who is approaching the final
phase of life, guard against your personal discouragement by assessing
the baseline. The therapist may rate several variables informally on a
four-point scale-from low to high. For instance, the level of energy;
extent of attention span; initiative; use of space; acceptance of own
work (Likes it? Proud of it?); participation in discussions; interest in
work of others. Keep reiterating that the purpose of the art therapy ses-
sion is not to "perform," but to express and share some personally
meaningful idea, recollection, or experience. And do not be discour-
aged, even if the ratings on the informal baseline show no progress. At
this stage of life, just maintaining the current level of functioning can be
regarded as an achievement. It is a downhill process at this age, and the
best that can be hoped for is to slow it down, mentally and physically.
Most art therapists work with the ailing aged in nursing homes or
hospitals. In order not to get overwhelmed by the extent of pain and
suffering, seek ways to work with some different types of client popu-
lations who could affirm the power of life and creativity. Working with
children may serve this purpose. Also, it serves well to the therapist's
own mental health to remember that besides the ailing elderly, there
are the well aged who exhibit an impressive level of courage and cre-
ativity. Think of Grandma Moses who, having raised her many chil-
dren and working on the farm, took up painting and became
world-renowned (Biracree, 1989). Or remember Grandma Layton who
suffered from depression for many years but was able to overcome her
illness when she discovered drawing (Mobley, 1980).
The resiliency of the human mind and the power of visual expres-
sion are miracles to be admired and gratefully celebrated.
Part Four
EFFECTIVENESS OF ART THERAPY

AND A LOOK AHEAD
Chapter 14
CASE VIGNETTES
ow effective is art therapy? How do we know that what we do

H with clients in art therapy does any good?
Two types of evidence underscore art therapy's effectiveness. The
first are case studies, and the second are empirical research studies.
This chapter considers case studies. The next chapter will present an
example of an empirical research study.
Every art therapist has an array of case vignettes to show that a client
is better off after some art therapy sessions than before. At times, only
a few seemingly simple art therapy sessions bring about an astonishing
improvement in severely dysfunctional clients. Some of those exam-
ples have been cited in previous chapters. For instance, a young black
man deep in a drug-using habit was able to shed his addiction and
remained abstinent for over a year. A drug-using young white woman
was able to reestablish contact with her mother with whom she had had
a very painful relationship. It took only a few sessions of the psychocy-
bernetic model of art therapy.
What is even more astounding are the rich diagnostic clues that the
psychocybernetic model of art therapy provides to guide the therapeu-
tic efforts. Even very elementary drawings reveal diagnostic clues hard-
ly available in the usual verbal forms of therapy.
The following series of case vignettes highlight specifically the scope
and the therapeutic potential of the psychocybernetic model. Although
the majority of clients in all forms of psychotherapy are women, the
clients in the case examples chosen for this chapter are mostly males.
The relative overrepresentation of men in the case examples was cho-
sen to illustrate the usefulness of the psychocybernetic model with this
kind of client who is often difficult to engage in therapy that presup-
261
poses the sharing of one's feelings. In some instances, the therapist and
client were of the same race; in other instances, the therapist and the
client came from different racial backgrounds. These factors are noted
in the case examples.
Yearning for the Family of Origin
A sexually abused eight-year-old, black male foster child was asked

by his white male therapist to draw a picture of his family. The child
was not willing to do this but eventually consented to make a picture of
a "happy family" (Figure 14-1). This turned out to be a picture of the
social worker and his wife, with the client himself in the corner of the
picture. It may be noted that the child has outstretched arms as if reach-
ing to something on the left but outside the picture. One could specu-
late that the child might be reaching for his own parents who are not
available and, literally, not in the picture for the child.
In addition to inviting many speculations about the dynamics of the
case, all of which would need to be substantiated or rejected as infor-
mation is assembled, this picture provides a glimpse of the quality of
the therapeutic relationship and the ability of the therapist to help this
child. It is an eloquent testimonial to the effectiveness of the therapist.
The child is starting to identify and draw strength from him, even
though the child is well aware of his own racial identity as can be seen
from the coloring he has added to his own face. This simple picture
provides a wealth of information to the therapist to guide the helping
process.
Keeping Up with the Grown-ups
Difficulties in growing up are not confined to broken and low-

income families. Growing up in affluent families with two loving and
caring parents can be difficult, too. Figure 14-2 depicts a picture drawn
by a seven-year-old girl who was the youngest member in a family
where both parents were professionals. Nevertheless, they managed to
do many things together with their children. Despite all their best inten-
tions, this youngster found that growing up in this family was difficult.
Note how the child has portrayed herself as the last one in the line, try-
Case Vignettes 263
Figure 14-1. A Happy Family.
ing to keep up with her energetic father, mother, and older siblings.
She is about to falloff the cliff.
Perceiving the world through the eyes of the child, as this picture
permits, can alert the parents to the stresses the child is experiencing,
even though the stresses may still be hidden under the excitement and
joy of many rich experiences they are providing for her. The therapist
in this instance was a white female, and so was the child.
Striving for a Reconciliation
The picture shown in Figure 14-3 was drawn by the mother of a 15-
year-old, white male who was suspended from school for stealing and
fighting. The boy's stepfather had left the family, but the mother
ardently hoped for a reconciliation. The stepfather disliked the boy,
and did not wish to have anything to do with him. The boy's acting-out
impeded the mother's desire for reconciliation. Note that in the picture
the mother has not only placed the boy behind the tree and on the
Figure 14-2. Hiking.
other side of a car, but she also has her back turned towards him. All
her attention appears to be directed to her husband. The intertwined
fingers in the picture (Figure 14-3) eloquently express the mother's
desire for a reconciliation with the boy's stepfather. No wonder the boy
feels superfluous and unwanted.
The picture alerted the therapist to the nature of the family dynam-
ics long before the situation could be sized up through verbal discus-
sion. The therapist in this instance was a white male.
Pregnant Teenager's Dilemma
A 16-year-old, racially mixed, female adolescent whose mother was

white and whose father was black, had been raised in a foster home
since birth. Her mother feared raising her in a white neighborhood,
and her father would have nothing to do with her. Her foster family
was black and was in the process of adopting her just before the girl dis-
covered that she was pregnant. When the picture shown in Figure 14-4
Case Vignettes 265
Figure 14-3. A Picnic.
was drawn, the girl had not revealed her pregnancy to her foster fami-
ly, nor had she mentioned it to her social worker, a black female who
was making arrangements for the adoption. Noting the turmoil the girl
was in, the social worker invited her to make a Free-Flow picture (see
Chapter 8 for a description of this technique). The girl was told that she
did not need to be an artist to do this kind of drawing. "When you fin-
ish, we will look at it and see what thoughts and feelings it conveys to
you. You will have to explain it to me because it is your creation and
only you know what it means." After making some free-flowing move-
ments in the air while holding a pastel in her hand, the girl drew some
lines on the paper. Next she was encouraged to use these lines to make
a picture. When she had finished her picture, the therapist asked her to
give a title to it. She called it "Fetus." She then said that the picture
showed her growing baby. The dark area (drawn in blue) symbolized
her stomach, she said, and the scribbly lines were her intestines. The
eyes in the middle symbolized her baby who is looking at her and ask-
ing, "What are you going to do with me? Why do you hate me so
much? Why do I make you so unhappy?"
Figure 14-4. The Fetus.
The therapist encouraged the client to respond to her baby in the

picture. She said that she felt guilty. She was also afraid that when her
foster parents discovered that she was pregnant that they would aban-
don their plans to adopt her. Now the ice was broken and the client was
able to discuss what to do about her situation. Later the same client
made a self-portrait shown in Figure 14-5. She said that she left out the
lower part of her body because she wished it were not there. She talked
about her fat stomach and her sexual organs, and said that if she did not
have them, she would not be in her present predicament. She said she
omitted her arms and her hands because she could not make any deci-
sions about her life and felt hopeless. Through the two pictures, the
withdrawn teenager provided eloquent statements about the dilemma
she was facing. The therapist could now proceed to deal with the
themes of helplessness and self-rejection and assist the girl in working
out ways to approach her foster parents. They also focused on the feel-
ings that were surfacing as the client started to identify with her baby
and with her own mother who had left her in the care of strangers.
Case Vignettes 267
Figure 14-5. Despairing.
Stresses of Upward Mobility
The next client was a 32-year-old black male who had a responsible
and well-paying job but suffered from ulcers and was dissatisfied with
his own work performance. He told his black female therapist that
since his promotion at work he thought his coworkers were taking
advantage of him and not working as hard as they had when someone
else had been the foreman. He was now the boss himself, and no
longer one of the boys. Two sessions were devoted to picture making,
and the third session was entirely verbal. Work with this client con-
cluded in the fourth session. He summed up his therapeutic experience
in a collage which showed what he had achieved in treatment.
In the first session, the therapist asked him to draw his name and add
whatever else he wished in order to show some of his interests. Neatly
executed, his name was surrounded by a wrench, a baseball, a football,
and a bolt. As he explained his picture, he said, "I always have to fix
something. I left the lower part blank because I do not like clutter."
From the picture, one gets the feeling of the man and the orderliness of
his life with its still undeveloped portions.
The next picture was a free-flow, which he entitled, "Self-percep-
tion." It was a rainbow-like arrangement of various colors. He
explained that the left side of the design represented his negative side,
by which he meant his "picky, tense, angry, and moody feelings." He
talked about the situations at work when he got angry but tried not to
show his anger. He used purple color for the tension he felt when under
pressure, which was most of the time. The color blue signified his mood
at the end of a bad day at work. On the right side, he drew colors to
suggest his warmth, cheerfulness, and "charm ... mostly with family
and friends, not at work." Although not a masterpiece to be admired by
others, the picture was most meaningful and precious to the client him-
self as he tried to sort out his various feelings and conflicts.
The next session was devoted entirely to a verbal discussion of his
struggles at work. The theme that emerged with the help of the draw-
ings was his desire for perfection. He expected perfection of himself,
and also of his subordinates. When they did not measure up to his
expectations, he thought they were deliberately defying him.
The collage that he produced during the fourth and the last session
showed a person sitting in a relaxed position, with his shoes kicked off.
The collage was supposed to show what the sessions had meant to him.
He said that he had attained a different perception of his conflicts with
his subordinates at work. He was able to accept his role as the boss, and
was less upset by the imperfections of his coworkers. The anxiety he
Case Vignettes 269
Figure 14-6. A House.
had experienced was subsiding, and his ulcers seemed to be less both-
ersome.
The Last Leaf
The last client in this series of vignettes was a 78-year-old white male
who had lost a leg to diabetes. His experience with art therapy were
already alluded to in the previous chapter in connection with the dis-
cussion of Late Adulthood. Figure 14-6 shows his first picture, which
he described as a house.
His next picture, made shortly before Easter, looked like a some-
what truncated Easter egg, but on some deeper level, perhaps it sym-
bolized the stump of his amputated leg.
After a number of seemingly unfinished pictures and some work
with wood chips, he finally produced what he named "The Tree" (Fig-
ure 14-8). He explained this picture as showing his family tree. Each
leaf designated one important member of his family, either on his
Figure 14-7. An Easter Egg.
Figure 14-8. The Tree.

Case Vignettes 271
mother's side of the family on the left, or on his father's side of the fam-
ily on the right. When asked about the most prominent leaf, he replied,
"That is me, the last member of the family, ready to falloff." What is
noteworthy here is that the warm-up period extended over a number
of weeks and only after several seemingly futile attempts did the client
manage to produce a picture that was not only deeply meaningful to
himself but was capable of communicating his feelings to an onlooker.
If the therapist can tolerate seemingly unproductive sessions, the client
eventually succeeds in conveying his ideas more clearly, not only to
himself, but to his therapist as well.
In the next chapter we turn to a consideration of a controlled empir-
ical research study done with highly depressed elderly nursing home
residents, using the psychocybernetic model of art therapy.
Chapter 15
AN EMPIRICAL OUTCOME STUDY
Research Design
T h e effectiveness of the psychocybernetic model of intervention was

examined in a study conducted at a nursing home with highly
depressed residents (Lindenmuth, 1981). The random sample consist-
ed of 298 subjects ranging in age from 65 to 98. The residents were
assigned to one of six different modalities of intervention: verbal group
psychotherapy, music therapy, exercise therapy, chemotherapy, art
therapy, and a control group. The art therapy groups were conducted
according to the psychocybernetic principles outlined in this book. The
residents assigned to the control group received the same pre and post-
treatment testing but no other intervention besides the usual activities
available to nursing home residents, such as eating in a common din-
ing room, participating in church services, and visiting with family and
friends.
Each modality of intervention lasted for eight weeks and consisted of
five weekly sessions, each 45 minutes long.
All of the residents of the nursing home were given the Zung Depres-
sion Test (Zung, 1965) four weeks after admission to the facility. The
administration of the test was purposefully delayed because previous
pilot studies showed that most residents suffer a reactive-type depres-
sion immediately after admission and that the adjustment period last-
ed two to three weeks on the average.
Those residents who scored high on depression (a score of 50 or
above on the Zung scale) were selected for the study. The purpose and
the procedures of the study were explained to the residents and their
families, and signed release forms were obtained prior to the study.
272
An Empirical Outcome Study 273
Ten subjects were randomly assigned to each treatment group for an

eight-week period of therapy. None of the participants received any
antidepressants or phenothiazines for the duration of the study, except,
of course, those residents assigned to the chemotherapy group who
received antidepression medication as prescribed by their own physi-
cians. They received no other form of therapy for the eight weeks
except for the activities of daily living, church services, visits with fam-
ily and friends, and eating in the dining room.
The verbal group psychotherapy consisted of general discussion of
common concerns. It provided the opportunity to share personal
observations and reactions to current and past experiences. It was con-
ducted according to the psychodynamic principles, and it was thought
to offer the opportunity to universalize the features of the depressive
syndrome and thus free ego energies (Deutch & Kramer, 1977).
The music therapy offered the opportunity to listen to songs played
on a stereo type equipment, especially songs of the 1920s and the
1930s. On some occasions, the selections were chosen by the therapist
and on others, by the members of the group. The music stimulated the
sharing of painful as well as joyful memories (Palmer, 1977). The par-
ticipants in this group were encouraged to sing along, tap their feet,
clap their hands, or to do whatever else seemed appropriate to express
their reactions to the music.
The exercise therapy group provided simple physical exercises and
some freewheeling discussion during and after the group sessions
(DeVries, 1976). The exercises consisted of simple stretching and bend-
ing, passing medicine balls, throwing the balls, and some light weight
lifting. The exercises were selected with the help of a physical therapist,
and the level of their difficulty was appropriate for persons with various
physical limitations.
The art therapy group was conducted according to psychocybernet-
ic principles. The sessions were rather unstructured in that each partic-
ipant decided what art materials to use and what topic to portray. If a
person had difficulty deciding what to do, some mild encouragement
was offered.
The therapist in all the groups was the same person, a white male
who had a MSW degree and had received instruction in the psy-
chocybernetic model of art therapy. The instruction lasted for one
semester (15 weeks) and it was provided on an individual tutorial basis
by the author.
The dropout rate in this study was a relatively low 4 percent: seven
residents died, and five dropped out due to early discharge. The mean
age for the entire sample was 82. Of the 298 persons in the sample, 236
were women, 62 were men. The large proportion of women in the sam-
ple is due to the higher longevity rates for women and the dispropor-
tionate number of women in nursing homes. In our society, by and
large, wives tend to take care of their husbands at home, and after the
husbands die usually there is no one to care for the widows at home,
and so eventually they end up in nursing homes. The annual report of
the nursing home used for this study showed that 74 percent of the
occupants that year were women.
Of the 236 women in this sample, eleven were black, two were Span-
ish-American. Of the 62 men, six were black, three Spanish-American.
The low percentage of minorities does not reflect any discrimination
but is the result of the low percentage of minorities living in the partic-
ular county where the study was done.
Each modality of treatment was offered five times to obtain the nec-
essary sample size. Each participant was rotated through each treat-
ment modality and their depression levels were tested before and after
participation in each group.
Findings
The mean depression scores of the elderly nursing home residents

before and after the art, music, and exercise therapies for each treat-
ment cycle are summarized in Table 15-1.
In examining the data, it can be noted that the means of the three groups
of participants prior to treatment are roughly the same. The mean scores are
also about the same after receiving the eight weeks of art therapy, music
therapy, or exercise therapy. Of particular interest is the fact that in all three
groups the depression scores are considerably lower after treatment than
they were prior to treatment. The differences between the depression scores
before and after treatment in each of these three treatment groups are sub-
stantial and statistically significant (p < .001) when examined by one way
analysis of variance test (Lindenmuth, 1981).
Table 15-2 contains the mean depression scores of the nursing home
residents before and after treatment with verbal group psychotherapy,
chemotherapy, and the scores of the control group which received no
specific therapy.
Table 15-1
MEAN DEPRESSION SCORES OF NURSING HOME RESIDENTS BEFORE AND
AFTER TREATMENT WITH EXPRESSIVE THERAPIES, BY TREATMENT CYCLE
ART MUSIC EXERCISE
Cycle Before After Before After Before After
1. 68.9 55.3 70.6 52.1 73.8 51.2
2 71.5 50.7 71.5 53.3 69.5 48.8
3. 71.9 48.7 72.0 51.4 68.3 48.5
4. 73.2 54.7 71.0 51.6 68.3 49.7
5. 72.7 52.9 69.1 51.9 67.9 50.6
X= 71.6 52.56* 70.8 52.1* 69.6 49.8*
*Significant at the p < .001, Analysis of Variance Test.
Table 15-2
MEAN DEPRESSION SCORES OF NURSING HOME RESIDENTS BEFORE AND
AFTER TREATMENT WITH VERBAL PSYCHOTHERAPY, CHEMOTHERAPY
AND NO TREATMENT, BY TREATMENT CYCLE
VERBAL PSYCHOTHERAPY CHEMOTHERAPY CONTROL
Cycle Before After Before After Before After
1. 68.5 62.8 68.4 59.9 67.7 64.5
2. 68.2 61.2 67.4 61.9 65.7 66.8
3. 69.0 61.8 68.0 58.6 68.6 65.4
4. 68.3 59.2 69.0 59.4 68.6 65.5
5. 68.2 62.2 68.7 59.6 68.3 65.6
X= 68.4 61.44 68.3 59.9* 68.2 65.5
* Significant at the p < .05 level, the Sheffe's Test.
The data presented in Table 15-2 show that the depression scores
remained virtually unchanged in groups which received verbal group
psychotherapy. The depression scores of the residents assigned to the
control group also remained unchanged. The residents receiving
chemotherapy did achieve a lessening of their depression scores, but
the decrease in depression is smaller than the decrease of depression in
the groups which received art, music, and exercise therapy. The differ-
ence between the before and after treatment scores of depression in the
chemotherapy group is statistically significant at the .05 level. The dif-
ference between the before and after depression scores attained by the
three groups which received art, music, and exercise therapy, on the
other hand, was statistically significant at the .001 level.
Table 15-3
MEAN DEPRESSION SCORE DIFFERENCES OF NURSING HOME RESIDENTS
BEFORE AND AFTER TREATMENT IN ALL GROUPS
CYCLE ART MUSIC EXERCISE VERBAL CHEMO CONTROL
1. 13.6 18.6 22.6 5.70 8.50 3.27
2. 20.72 18.27 20.73 7.83 5.50 -.90
3. 23.20 20.60 19.80 7.20 9.40 3.40
4. 18.50 19.42 18.64 9.10 9.57 3.18
5. 19.80 17.20 17.30 6.0 8.42 2.69
x= 19.16** 18.80** 19.81** 7.16 8.42* 3.33
*Significant p. < .05
**Significant p. < .001
Table 15-3 presents the mean depression score differences before

and after treatment in all six groups.
Table 15-4 presents the results of the one way analysis of variance
and contrasts within the groups.
The results of this empirical study show that the psychocybernetic
model of art therapy, music therapy, and exercise therapy reduce
depression in elderly nursing home residents more effectively than
does chemotherapy which is the usual modality of treatment in most
nursing homes. Not only do the three expressive art therapies reduce
depression more effectively than chemotherapy but the expressive
therapies do not produce the negative side effects that are often associ-
ated with chemotherapy.
It also should be noted that verbal group psychotherapy in this study
did not prove any more effective than did the control group condition.
In both the verbal psychotherapy groups and the control groups the
depressions scores changed very little in eight weeks, and these mini-
mal changes in the depression scores were not statistically significant,
as shown in Table 15-3.
The results of this carefully designed and controlled empirical study
offer a strong endorsement for all the expressive therapies used in this
study. The excellent results obtained not only with the psychocyber-
netic model of art therapy and with music therapy but also with the
simple exercise therapy were somewhat unexpected but considering
the fact that the nursing home residents are primarily concerned with
the various aspects of the physical functioning of their bodies, are not
surprising. The simple physical exercises may have improved the
Table 15-4
ANALYSIS OF VARIANCE OF MEAN DIFFERENCES BEFORE AND
AFTER TREATMENT
SOURCE OF VARIATION SS DF v: EST. F
Between Groups 1430.17 5 286.03 64.89
Within Groups 105.78 24 4.41
1535.95 29
F(5.24) = 2.62 = .05
3.90 = .01
Fobt = 64.89
P < .001
blood circulation and increased the oxygen consumption, and thus this
easily provided form of therapy may have increased the sense of well
being of these elderly nursing home residents. More research is need-
ed to determine whether or not similar results can be obtained with
exercise therapy in other age groups of participants.
This empirical research study attests to the effectiveness of the psy-
chocybernetic model of art therapy. More well-designed and controlled
studies are needed, but it is clear that art therapy based on the psy-
chocybernetic principles is a therapy that works. This form of inter-
vention can be mastered relatively easily by clinicians, and it produces
excellent results in a relatively short period of time.
This model has the advantage over several other forms of art thera-
py in that it does not just fill the empty hours, but it stimulates thinking
and sharing of one's concerns and experiences. Thus, it is not per-
ceived as being childish and demeaning by adults who have no partic-
ular interest in the arts and who have no previous exposure to or
training in the use of art materials.
Chapter 16
LOOKING AHEAD
n some respects, the psychocybernetic model of art therapy is like a

I bicycle. You can get so much further and faster on a bicycle than on
foot. But the bicycle is not self-propelling. It does not roll forward on its
own. You have to supply the energy. You have to pedal to get it mov-
ing. The same is true with the psychocybernetic model of intervention.
The energy that propels this modality of interpersonal helping comes
from two sources. One source is the professional training and experi-
ence that equip the therapist with relationship-building skills, percep-
tivity, and understanding of human behavior in all its ramifications, its
needs, yearnings, and aspirations, and with knowledge of what hap-
pens when these are thwarted. The other source that provides the driv-
ing power for the psychocybernetic model is the combination and
utilization of the two systems of symbolization discussed in previous
chapters. This model not only engages words and the sequential,
rational thought processes, but also uses the presentational symbolism
and the holistic, intuitive, preverbal cognitive styles.
Desirability and Feasibility of Research
Within the American Art Therapy Association there is a lively

debate concerning the desirability of conducting empirical research
studies about the effectiveness of art therapy (Allen, 1995; Gantt, 1998;
Junge & Linesch, 1993; Kaplan, 1998; Malchiodi, 1998; McNiff, 1998;
Rosal, 1998). There are those who are convinced about the power of
the right brain form of thought and they dismiss empirical research as
being too pedestrian, one-sided, and inadequate to capture the power
of visual expression. In contrast, others point out that unless art thera-
278
Looking Ahead 279
pists can offer empirical research evidence concerning the effectives of

art therapy, the very existence of the discipline is dismal because it will
not be able to gain funding for its activities.
Once the necessity to communicate with other disciplines and the
funding source has been granted, then the question arises about the
feasibility of research. Doing research is a costly undertaking, both in
time and money. Moreover, it requires skills most art therapists do not
have. There is hardly time in the two-year art therapy graduate pro-
gram to equip art therapists with the basic clinical skills, not to mention
research skills. So what is an art therapist to do?
Life-Long Learning
Art therapists need to consider themselves as being professionals. To

be a professional is to be a life-long learner. To be a professional is to
be in training for the remainder of one's life, even after one has finished
the two-year graduate program. This involves continuing education
courses, whether or not those are part of licensing requirements. Art
therapists need to continue to sharpen their clinical skills, and they
must acquire some rudimentary skills in research. There they might
team up with colleagues from other disciplines, like psychologists and
social workers, some of whom may have received more adequate
research instruction in the course of their professional training.
Undoubtedly, some professionals are more clinically oriented, while
others may lean toward empirical research. But to be a professional,
nevertheless, is like wearing bifocals. You must be able to do both. You
must be a therapist, and you must be able to examine critically the
results of your practice.
Every beginning is anxiety provoking. One young therapist por-
trayed her view of a new beginning as a jump off a cliff. You do not
know what is below and you wonder if you will land on your feet. No
amount of case vignettes and empirical studies will suffice until one
takes the plunge and finds out for one's self if the psychocybernetic
model as described in this book is worth the effort. It is a new venture,
and it takes courage to begin to use a new treatment modality. But once
you experience what happens to you and how much faster you can get
your clients to go where you think they should be going, you will never
again want to be without this new form of helping.
Figure 16-1. A Beginning.
The story is told of a Texan who visited New York and sawall the
sights of the Big Apple. When he was about to return to Texas, he real-
ized that he had not been to Carnegie Hall. He was not particularly
interested in music, but he figured that he might as well see everything
there was to see before returning home. He got on the subway to go to
Carnegie Hall. Stations came and went; still there was no Carnegie
Hall. He got off the subway and went up to the street and on a corner
he saw an old lady. He asked politely, "Madam, can you tell me how
do I get to Carnegie Hall?" The woman looked at the Texan and with
a twinkle in her eye replied, "Son, that is simple enough. You just keep
on practicing, and eventually you might get to Carnegie Hall." The
same is true with this new modality of helping you have read about in
this book. The secret of success is practice. Start doing it and see how
this vehicle of therapy works for you and your clients.
If you are working with children, chances are that you already are
using picture making in some form to help your young clients feel
more at ease with you. Picture making is a vital if neglected form of
cognition adults can use too, based on the differential functioning of the
Looking Ahead 281
two cerebral hemispheres. The paradigmatic change that is affecting all

sciences forecasts that this previously neglected form of cognition will
not remain neglected for much longer. It is quite likely that increasing-
ly therapists will strive to be experts not only in the verbal and gestur-
al forms of communication, but also in the visually expressive
modalities. Growth never ends. Take the next step.
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AUTHOR INDEX
A Chaiklin, S., 49
Chang, 137
Achterberg,]., 49 Church, R.P., 199
Adler, G., 53 Churchill, Winston, 50
Agell, G.L., 76 Corsini, R., 5
Ahsen, A., 33-34, 39, 49 Cremin, L.A., 61
Allen, D., 278 Croce, Benedetto, 35, 93-94
Allport, G.W., 22 Crowl, M., 232, 233
Ampere, A.M., 15
Anderson, F., 76 D
Anderson, F.E., 70-71
Andrews, L.M., 17 Dante, 52
Angyal, A., 181 De Lima, A., 61
Arieti, S., 6 Dechert, C., 15, 17
Axline, Virginia, 204 Detre, K.C., 61, 62, 64, 65
Deutch, C., 273
B DeVries, H., 273
Dewdney, 160
Backos, A.K., 234 DiMaria, A.E., 146-148
Barlow, G., 76 Doll, A., 100, 150
Battista,].R., 6 Dunn-Snow, Peggy, 229
Beck, R.H., 61
Bernard, Claude, 15 E
Bertalanffy, L. von, 21, 23
Betensky, M., 76, 91, 125, 156 Einstein, Albert, 37
Betensky, Mala, 158, 205 Elin, N., 130
Biracree, T., 257 Eliot, C.E., 25
Bolander, K., 216 Englehorn, P., 88
Brill, A.A., 60 Erikson, E., 221, 239
Brunner,].S., 33 Everly, G., 18
Bugenthal, 95
Burns, R.C., 128-130 F
Buttler, R.N., 100, 155, 254
Fagan,]., 90
c Faherty, S.L., 234
Ford, 137
Cane, F., 117, 123 Foster, D., 17
Cannon, W.B., 16 Foy, D.W., 233
293
Freedman, A.M., 60 johnson, K., 18, 25, 49

Freud, S., 43-44, 53, 78, 79 jung, Carl, 53-56, 78, 84, 85, 157
junge, M.B., 278
G
K
Gantt, L., 278
Gardner, H., 7, 202, 205 Kagin, S., 105, 149
Gazzaniga, 29 Kalff, Dora, 87, 88
Gelber, B.L., 58 Kalins, M., 17
Genest, M., 26 Kaplan, F.F., 278
Ginott, H., 225 Kaufman, S., 128-130
Girdano, D., 18 Kelen, E., 122
Glass, C.R., 26 Kellogg, R., 199
Glasser, W., 225-226 Kelly, G.A., 42
Goethe, W., 50 Kismiss, 237
Gombrich, E.H., 52 Kolers, P.A., 32
Goodman, N., 32-33 Korn, E.R., 18, 25, 49
Gordon, R., 26 Kramer, E., 73, 74, 76, 78, 81
Gorey, K.M., 233 Kramer, N., 273
Green, A.M., 18 Kramer, S., 74, 78, 82, 104
Green, E.E., 18 Kuhn, Thomas S., 5
Kwiatkowska, H.Y., 11,65, 76, 117, 125, 130,
H 131
Hall, C.S., 77 L
Hall, D.C., 28
Hammer, E.F., 126, 128 Lachman-Chapin, M., 78
Heidegger, Martin, 137 Landgarten, H., 70-71
Hensely, 199 Landgarten, H.B., 78, 132, 178, 182, 187,
Hepworth, D.H., 101 206,227,232,249
Hill, Adrian, 56-59 Langer, Susan, 30,33,35-36,44-45,80,
Holt, R., 13, 49 112
Horowitz, MJ., 6, 26, 28, 33, 104, 134, 247 Larsen,j.A., 101
Husserl, Edmund, 90 Lawlis, G.F., 49
Lazarus, A., 49
I Ledray, 234
Lerner, A., 49
Inhelder, B., 27 Levick, M.F., 78
Lewis, N.B.C., 63-64
J Liddel,94
Lindenmuth, F.A., 272, 274
jacobi,j., 78,85,86, 137, 171 Lindzey, G., 77
james, William, 29, 31, 36-37, 43, 46-47, 48, Linesch, D., 278
93, 137 Linesch, D.G., 231
jasper, H., 21 Lowenfeld, M., 87
jaynes,j., 30-31, 38 Lowenfeld, V., 29, 58-59, 111
jeans, james, 17 Lusebrink, V., 105, 149
johnson, A., 61 Lyddiatt, E.M., 84, 85-86, 87, 120, 156
AuthorIndex 295
M Q
Machover, K., 128 Qualls, PJ., 40
Madigan, S., 233
Malchiodi, C.A., 208, 212, 278 R
Maltz, Maxwell, 20-21
Marks, D.F., 46 Reich, Wilhelm, 89
Maslow, A., 21, 94, 96, 98, 102, 114, 153 Reik, Theodor, 90
Matsakis, A., 235 Rhinehart, L., 88
May, R., 78 Rhyne,j., 58, 90, 117
McNiff, S., 76, 278 Richardson, A., 28
Merluzzi, T.V., 26 Ritcher, N.L., 233
Mobley,j., 257 Robbins, 78
Moriarty,j., 150, 247, 248 Robinson, D.N., 28, 41
Motto, H.C., 232, 233 Rodriguez, N., 233
Muller, 52 Rogers, C., 91
Rogers, Will, 91
N Root, M.P.P., 232
Rosal, M.L., 278
Naumburg, M., 62, 63, 64, 65, 75, 78, 79, 82, Rosenfeld, P., 59, 61
83-84, 102, 156 Roussear,jeanjacques, 52
Neisser, D., 40 Rubin,j.A.,78
Norman, D.S., 39 Russell, Betrand, 61
Nucho, A.a., 9, 19, 41, 60, 64, 87, 91, 100, Ryan, S.W., 233
128,130,150,158,179,236,237,249,
251-252,255,256 s
o Salomon, K., 28
Sayre, K.M., 15, 17,23
Osborn, F, 37 Schachtel, E.G., 52
Scott, 94
p Sebeok, T., 174
Sheikh, A.A., 15
Pagon, B.E., 234 Shepherd, I.L., 90
Paivo, A., 33 Shneidman, 232
Palmer, M., 273 Shulman, L., 179
Pascal, 48 Silver, Rawley, 229
Pasto, Termo, 102 Simonton, O.C., 23, 49
Pelletier, K.R., 17-18 Singer,j.L., 6, 26
Penfield, W., 21 Smitheman-Brown. V., 199
Perls, F., 78, 89-90 Snider, E., 233
Perry,j.W., 88 Sperry, Roger, 37
Piaget,j., 26-27,40,42-43, 137 Spitz, R.A., 174
Piotrowski, Z.A., 11 Strobel, C.F., 20
Plato, 15, 51
Potocek, 237 T
Powell, L., 234
Prinzhorn, H., 52 Tart, C.T., 45
Puryear, D.A., 179, 182 Thale, T., 28
Titchener, E.B., 47 Watson,John B., 26

Toffler, A., 174 Weiner, Norbert, 15-16
Tyson, F., 49 Weinribb, E.L., 88
Weisman, A.D., 77
u Westcott, G., 28
Wiener, Norbert, 12,21
Ulman, E., 7 Wilder, 237
Urban, 137 Winnicott, D.W., 124,207
Winter, B., 24
v Wolpe,J.,26
Van der Hart, 0., 234 z

Van der Kolk, B.A., 234
Vaude Kemp, H., 233 Zung, W.W., 2721
w
Wadeson, H., 76, 78, 131
Walters, E.D., 18
SUBJECT INDEX
A American Art Therapy Association, 68,

69-70,76,103,278
abstract family portrait, 131 AmericanJournal ofArt Therapy, 69
abstract self-portrait, 139 Amid These Storms, 50
acceptance, 225 amplification, 171
accommodation, 42-43 amplification of dream content, 171-172
achievement domain, 138, 139, 210, 227, 147 ancient Greeks, 51-53
fig· anger, 224-225, 233
"Achieving" picture, 139, 143 fig. anima, 85
activeima~nation,55-56,84,86 animal instincts, 85
activities therapy, 76, 151 animus, 85
addiction, 235 anorexia nervosa, 232-233
"The Adolescent" picture, 222, 223 fig. anxiety, 89, 174
adolescents "anything" picture. see "free" picture
characteristics of, 221-222 Appel, Kenneth, 66
chemically-dependent, 235-237 apprehensions, 111-114
eating disorders in, 232-233 about growing old, 252
helping strategies, 223-226 approval, 225
sexually-abused, 233-235 archetypal forms, 170-171
specific techniques, 226-230 archetypal material, 85
suicidal, 231-232 archetype, 85,86-87,159
adults Arctic hysteria, 60
chemically-dependent, 242 "The Arm, Fist, and the Bully" picture, 216
late adulthood, 252-257 fig·
minimally dysfunctional, 239, 240-241 arm with a fist technique, 213
moderately dysfunctional, 239, 241-245 art
severely dysfunctional, 240, 245-252 beneficial powers of, 52
stresses for, 239 and emotional problems, 62
YAVIS-type clients, 240-241 graphic. see graphic art
affective messages, 162 healing power of, 52
aggressive clients, 106 and religion, 52
aggressive drives, 78-79, 81-82 art as therapy, 14, 51
Ahsen's Triple Code Model of Imagery, Art As Therapy, 74
33-34,35 art background, 101-102
Ahsen's view of imagery, 34-35 art dialogue technique, 249-252
alcohol dependency. see chemically-depend- art education, 58-59
ent "art education therapy," 58-59
ambidexterity, 40 art expression. see visual expression
297
art materials, 104-107, 149, 246, 248, 256 "Climbing a Tree," 190 fig.
art psychotherapy, 14, 74 "The Dancer," 144 fig.
art therapists "Despairing," 267 fig.
certification of, 70 "The Duckling," 142 fig.
during doing phase, 151-153 "An Easter Egg," 270 fig.
function of, 94-95 "Endurance," 163 fig.
Jungian, 86-87 "The Fetus," 266 fig.
psychoanalytically-oriented, 79,82-83 "A Happy Family," 263 fig.
psycho cybernetically-oriented, 158 "A Heart," 213 fig.
psychodynamically-oriented, 156,204 "Hiking," 264 fig.
qualifications of, 101-102 "A House," 269 fig.
reassurance from, 78, 116, 119 "A Hug," 217 fig.
reassurance from, 134 "AJob Interview," 144 fig.
training of, 65, 68, 278 "The Lamb," 143 fig.
art therapy Mandala, 167 fig.
for adolescents. see adolescents "A Mother and a Son," 142 fig.
for adults. see adults Naomi's Free-flow, 125 fig.
vs.arteducation,58-59 "The Odd Man Out," 115 fig.
art wing type. see art wing of art therapy "The Outside Picture," 169 fig.
arts and crafts type. see arts and crafts of "A Picnic," 265 fig.
art therapy "The Race Car," 145 fig.
benefits of, 81-82 "The Raindrop and the Killings," 215 fig.
for children. see children "Resistance," 115 fig.
definition of, 12-15, 19 "A Sad Puppy," 166 fig.
dynamically-oriented, 65 "The Sphinx," 127 fig.
and imagery, 18 "Teardrop with Rain and Lightning," 214
method of active imagination, 55-56 fig·
origin of, 7 "The Tree," 270 fig.
research study, 273, 274-277 "The Turtle," 127 fig.
and schizophrenic patients, 66 "A Warm Place," 185 fig.
surveys concerning, 70-71 a Wartegg, 129 fig; 130 fig.
varieties of, 77 fig. Art Therapy: Still Growing, 146-148
vs. verbal therapy, 183 art training. see training
wing art type. see art wing of art therapy Art versus Illness: A Story ofArt Therapy, 56
Art Therapy in a Children's Community, 74 art wing of art therapy, 73-74, 76, 78,88,97,
art therapy pictures 107, 156
"Achieving," 143 fig. art works, use of, 249-252
"The Adolescent," 223 fig. "The Artist in the Olive Grove," 251
"The Arm, Fist, and the Bully," 216 fig. artistic expressions, 62
"A Begging Dog," 141 fig. artists, 50, 52, 56-59, 118
"A Beginning," 280 fig. TheArtistsin Each of Us, 65
"Beginning of a Rainbow," 133 fig. arts and crafts of art therapy, 75-77
"The Black Anchor," 187 fig. assemblages, 149-151, 254 fig, 255-256
"A Boat, Water, Shark, and a Log Truck," assessment
189 fig. of change, 188
"Boy Lee," 191 fig. of depression, 229
"Carefree," 165 fig. diagnostic, 128-132
"The Cat," 80 fig. Draw-a-person test, 128
"The Champion and the Loser," 145 fig. family, 125
Subject Index 299
of family dynamics, 130-131 Cane, Melville, 64

House-Tree- Person Drawing test, 128 "Carefree" picture, 163-164, 165 fig.
Kinetic Family Drawing procedure. see case studies
Kinetic Family Drawings 15-year-old male, 263-264
Kwiatkowska procedures, 131-132 16-year-old female, 264-266
personality, 126 32-year-old male, 267-269
assimilation, 18-19, 42-43 7-year-old female, 262-263
athletics, 51 78-year-old male, 269-271
Attention Deficit Disorder with H yperactivi- 8-year-old foster child, 262
ty. see hyperactive children keeping up with the grown-ups, 262-263
auxiliary ego, 224 the last leaf, 269-271
avatras, 25 pregnant teenager's dilemma, 264-266
avoidance behaviors, 180, 194 stresses of upward mobility, 267-269
striving for a reconciliation, 263-264
B yearning for the family of origin, 262
case vignettes. see case studies
balance, 52 Cassatt, Mary, 251
"A Begging Dog" picture, 139, 141 fig., 142 "The Cat" picture, 86, 95, 80 fig.
fig· categorization, 41
"Beginning of a Rainbow" picture, 132, 133 catharsis, 82
fig· censor, 44
"A Beginning" picture, 280 fig. central concerns, 140, 148
behavior, 82, 91 cerebral hemispheres. see also left cerebral
behavior modification, 26, 205 hemisphere; right cerebral hemisphere
behavioral change. see changes and codification, 41
behaviorists, 137 differences in, 37-40, 39 fig.
best dream, 242 and information processing, 15
Betensky, Mala, 91 nondominant, 157
biofeedback, 17-18 preferences of therapists, 81
biological theories, 21 and types of cognition, 35
"The Black Anchor" picture, 186, 187 fig. use of both, 159-160, 193
"A Boat, Water, Shark, and a Log Truck" pic- cerebral ambidexterity, 40
ture, 188, 189 fig. "The Champion and the Loser" picture, 140,
body domain, 137, 228, 146 fig. 145 fig.
body self, 208 changes
body tracing, 207-208, 233 assessment, 188
"Boy Lee" picture, 189, 191 fig. behavioral, 173, 183, 205-206
brain capacity, 93 extent of, 181-182, 188
brain, hemispheres of. see cerebral hemi- identity of, 182
spheres in moods and attitudes, 183
Brill, Abraham, 60-61 chemically-dependent adolescents, 235-237
brushes, 105 chemically-dependent adults, 242, 245
bulimia, 232-233 chemotherapy, 274-276
Bulletin ofArt Therapy, 69 The Childand the World, 61
Child Guidance Model, 201
c children
direct treatment, 201-202
calling attention to choice points, 224 hyperactive, 199
Cane, Florence, 63, 64-65 indirect treatment, 200-201
inner city, 229 consequences, 226

responsive communication, 215-220 consolidation, 163-166
role of art therapists, 205-206 construct, 42
sexually-abused, 214 constructive arguing, 224
specific techniques, see therapy techniques consultation, 103
for children continuing education, 279-281
therapeutic styles. see therapeutic styles contracting phase, 178-179
thought processes, 220 Contributions toAnalytical Psychology, 53
choice points, 224 control group, 274-275
Churchill, Winston, 50-51 corporeity, 31
circular drawings. see mandala drawings creativity
clarity, 173 cultivation of, 61
classification, process of, 41 and hemispheric asymmetry, 39
clay, 105-106 primary and secondary, 94, 96-97, 98,
client apprehension. see apprehensions 102, 114, 153-154, 100 fig.
client preparation, 114-116 process of, 119
client's initials. see initials drawing stimulation of, 229
"Climbing a Tree" picture, 188-189, 190 fig. credentialing process, 103-104
closed system, 22-23 crisis of intimacy vs. isolation, 239
closure, 148-149, 163-166,251 cryptograms, 55, 157-158
codification curriculum, 61-62
in the dialoguing phase, 160-161, 171 cybernetics, 6, 12, 15-18,24,26
explanation of, 47
process of, 40-47, 46 fig. D
and processing information, 80, 192-193
system of, 35, 45, 48 Da Vinci, Leonardo, 122-123
cognition "The Dancer" picture, 139, 144 fig.
definition of, 40-41 daydreams, 28
and images, 25-26,47,48 decoding the messages, 157, 160-162
and information processing, 23 deductive meaning, 63
and perception, 27-28 defensiveness, 112-113
styles of, 37-40,49 demonstration, 118-119
and systems, 34-35,45-47 denial, 78
types of, 35-37 denotative meanings, 27
cognitive theory, 7,26,40 denotative symbols, 32
collages, 150,230-231,247-249 depressed clients, 106
collective unconscious. see unconscious depression, 90, 229, 272
colors, 244 designs, 150
Commission on Mental Illness, 66 desires, 81-82
communication "Despairing" picture, 266, 267 fig.
verbal. see verbal expression determination, 173
visual. see visual expression diagnostic assessment, 128-132
complex references, 32 "The Dialoguing Phase," 168 fig.
computers, 26 dialoguing phase
concept, 42 with adolescents, 228
concept forming activity, 94 with children, 215-220
concretization, 31 closure and consolidation, 163-166
connotative meanings, 27 decoding the messages, 160-162
consciousness, 23, 85 dispositional understanding, 171-173
Subject Index 301
distancing, 159-160 dream imagery, 172

explanation of, 98 dreams, 28, 63, 79, 84, 171-172,244
facilitative understanding, 171-173 dropout. see therapy dropout
format and length, 166-171 drug dependency. see chemically-dependent
in groups, 174-175 duality of knowledge, 93-94
meanings of products, 150 "The Duckling" picture, 139, 142 fig.
nomomatic vs. ipsomatic approach, Dynamically Oriented Art Therapy: Its Principles
157-159 and Practices, 65
process of amplification, 171 dysfunctional adults. see adults
salience and timing, 175-176
search for inner design, 173-174 E
DiMaria, A.E., 146-148
direct treatment, 201-202 "An Easter Egg" picture, 269, 270 fig.
discursive lexical, 45 eating disorders, 232-233
discursive modality, 35-36 education
discursive symbols, 44, 45 art, 58-59
discursive thought, 80 continuing, 279-281
displacement, 78 progressive. see progressive education
dispositional understanding, 171-173, 176 and psychoanalysis, 61
distancing, 159-160 reality, 226
distillation of meanings, 162 ego, 85, 122,206,208,224
distress, 232 The Ego and theId, 79
doing phase, 121 ego psychology, 83
explanation of, 98 ego support, 247
free expression, assemblages, and percep- eidetic images, 28
tual stimulation, 149-151 Eisenhower, Dwight D., 51
free-flow technique, 122-126 elderly people, 229, 256-257
interactional drawing technique, 134 emotional problems, 62, 64, 122
length of, 153-156 emotions, 36, 89,202-204
peripheral vs. central concerns, 140, 148 encoding, 44, 45, 48
principles of timing, gradualness, and ending phase
spotlighting, 136-140 explanation of, 98
rapport building, self-sharing, and closure, integration, 192-193, 195
148-149 length of, 188
self-system, 136-140 ratification, 178-179, 194
structuring, 121-122 resistance to termination, 179-182, 194
themes from client concerns, 132-134 resolution, 185-192, 194
therapist's role during, 151-153 review, 182-185, 194
domain of the mind, 208 "Endurance" picture, 162, 163 fig.
doodling techniques, 58 energy, 23-24
"The Dragon," 211 fig. engagement process, 118-120
dragon technique, 211-212 enrichment, 84
drama therapy, 62 Eros. see sexual drives
draw a bridge, 242 Eskimos, 60
draw a mask. see mask making executing phase. see doing phase
Draw-a-person test, 128 exemplification, 32
Draw-a-Story Stimulus Cards, 230 fig. exercise therapy, 273, 274-277
draw-a-story technique, 229-230 existential-phenomenological approach,
draw a wall, 242 78
existential stream of ideas, 95 future, projection of, 186-188, 237

existential therapies, 88 future shock, 174
expression in images, 79
expression of emotions, 36 G
expressions, symbolic, 83-84
expressive therapies, 49 general system theory, 6,7,21-23,24
externalized feelings, 164 geriatric populations, 252-257
externalized imagery, 95, 97 Gestalt notion, 22
exteroceptors, 43 Gestalt therapy, 78, 88-90
Ginott, Haim, 224-225
F Glasser, William, 225-226
goals. see treatment goals
facilitative understanding, 176 Goethe, 50
failure, sense of, 235 Goodman's theory, 32
family assessment, 125 gradualness, 134-136
family dynamics, 130-131 Grandma Layton, 257
family portrait, 131 Grandma Moses, 257
family relationships, 241-242 graphic art, 63
family situations, 209-210 gratification, 81
family system, 200 Greeks, 51-53
family therapy, 201, 225 group dialoguing, 174-175
fantasy growth, 89
function of, 83
and the Jungian approach, 84, 85 H
and personality, 90
and sandplay, 88 hallucinations, 28
type of imagery, 28 happiness, 226
Faust, 50 "A Happy Family" picture, 262, 263 fig.
fears. see apprehensions haptics, 29-30, 111
feedback, 16-18 hard data, 176
feedback devices, 18 harmony, 51, 52
feedback loops, 17,23,35,45 healing power of art, 52
feelings. see emotions "A Heart" picture, 213 fig.
Feelings in the Body, 208, 209 fig. heart technique, 212
feminine archetype, 85 Hellenistic culture, 51-52
"The Fetus" picture, 264-265, 266 fig. helplessness, 222, 235
final phase. see ending phase hemispheres of the brain. see cerebral hemi-
flow of information, 6, 12 spheres
format of dialoguing phase, 166-171 hemispheric differences. see cerebral hemi-
forms, 29-30 spheres
Frank, Waldo, 62 "Hiking" picture, 262, 264 fig.
free expression, 149-151 Hill, Adrian, 56-59, 74
free-flow technique, 122-126, 131, 134, 139, Hindu theologians, 25
207 Hinkle, Beatrice, 60-61, 64
"free" picture, 130-131, 139, 148, 164, hobbies, 73-74
253-255, 254 fig holistic paradigm, 5-6
freedom, sense of, 244-245 homeostasis, 15-16, 23
Freud, 53, 66, 79 homonomy, 181
Freudian theory, 63-64, 79-80, 158, 170 Horowitz, Mardi, 246-247
Subject Index 303
"A House" picture, 269, 269 fig. transformation of, 19

House-Tree-Person Drawing test, 128 types of, 39-40
"A Hug" picture, 217 fig. imagination
hug technique, 213 definition of, 28
human functioning, 20 function of, 83
human systems, 18, 19 and theJungian approach, 85
hyperactive children, 199 and knowledge, 35
hypnogogic, 28 memory and, 34
hypnopomic, 28 and thought, 94
hysteria, 60 imagination imagery, 29
imaginative faculty, 58
I "In the Garden," 251
indirect treatment, 200-201
ice breakers, 207, 226 industrial revolution, 16-18
"icky" picture, 206 inferiority, 235
ideal state, 51 information
identity, sense of, 207, 221-222, 223, 225 assimilation of. see assimilation
illegal substances. see chemically-dependent definition of, 23
image forming ability, 26-27 disregarded, 19
image forming activity, 94 encoding of, 44, 45
image-making, 36 exteroceptors and interoceptors, 43
imagery flow of. see flow of information
Ahsen's Triple Code Model, 33-34 management of, 93
externalized, 95, 97 processing of. see processing of information
function of, 13, 20 storage of, 44
importance of, 45 usefulness of, 174
and information processing, 6-7, 23-24, information overload, 174
173 inhibitions, 117
physiological concomitants of, 39-40 initials drawing, 148,226-227
preferred sensory modality of, 29-30 inner city children, 229
productive or imagination, 29 inner design, 173-174
reproductive or memory, 29 inquiry, depth of, 175
the systems approach, 34-35 inquiry, lines of, 160-162
and therapists, 95 instinctual drives, 78-79, 85
types of, 28-29 integration, 171
images integration, 192-193, 195
and cognition, 25-26, 47, 48 intellect, 35
definition of, 26 interactional drawing technique, 134, 205,
eidetic, 28 246-247
and encoding process, 45 interoceptors, 43
expression in, 79 interpersonal domain, 138, 139, 209-210,
as a form of thinking, 36 211, 227, 147 fig.
function of, 33-34 intimacy, 239
as information condensers, 18-19 intuitive knowledge, 35
inward, 31 inward images, 31
and metaphors, 30-31 ipsomatic approach, 91-92, 95-96, 102, 113,
modalities of, 26 158, 172, 176, 168 fig.
recognition images, 30 ISM sequence, 34
and symbolization, 31-33 isolation, 239
J M
James, William, 137 "Man on the Beach," 251

"AJob Interview" picture, 140, 144 fig. mandala drawings, 55, 149, 164-165, 199
joint free-flow, 148 "Mandala" picture, 164-165, 167 fig.
Jung, Carl, 52-56, 89, 171-172 manifest content, 63
Jungian approach, 84-88 masculine archetype, 85
Jungian art therapists. see art therapists mask making, 233, 242
Jungian psychology, 83, 136-137, 156, 158, mastery, sense of, 223, 224
159, 170-171 materials. see art materials
J ung's technique of active imagination. see Matisse, 50, 251
active imagination maturity, 89, 190
mean depression scores, 274, 275 table, 276
K table, 277 table
meaningful productions, 184
Kinetic Family Drawings, 128-130, 131, 135, meaningless productions, 184
209-210,237,242 memory, 34, 44
Kinget, Marian, 126 memory imagery, 29
knowledge, 35, 93-94 mental health, 61
Kwiatkowska assessment procedures, mental health movement, 66
131-132 mental illness, 52, 66, 239, 247
mental impairment, 252-253, 254 fig, 255,
L 256,253 fig.
mental patients, 52
"The Lamb" picture, 139, 143 fig. mental processes, 78
Landgarten, Helen, 132, 226-227 metaphors, 30-31, 33, 36
language and metaphors, 31 Michelangelo, 94
language functions, 38 mind domain, 137, 146 fig.
late adulthood, 252-257 minimally dysfunctional adults, 239-240,
latent content, 63 240-241
left cerebral hemisphere, 37-40, 44-45, 93, misapprehensions, 112-114
220. see also cerebral hemispheres moderately dysfunctional adults, 239-240,
length of dialoguing phase, 166-171 241-245
length of doing phase, 153-156 Montessori, Maria, 60
length of ending phase, 188 Moreno, 62
length of treatment, 178, 182, 194 Mozart, 36-37
Lewis, Nolan D.C., 63 MSW degree, 103
life enrichment, 200-201 multiple and complex references, 32
life-long learning, 279-281 music, 51
life review, 254 music therapy, 273, 274-276
limbering up, 117 Mutual Story Telling Technique, 202, 203 fig.
lines of inquiry, 160-162
logical knowledge, 35 N
logical thought. see secondary process
thought name design, 207, 226, 241
long-term memory, 44 name plate, 148
long-term treatment, 188 Naomi's Free-flow picture, 124, 125 fig.
Lowenfeld, Margaret, 87 National Institute of Mental Health, 68
Subject Index 305
Naumburg, Margaret, 59-64, 66-69, 75, 79, personal unconscious. see unconscious
81,82-83 personality, 90
negative feedback, 16-17 personality assessment, 126
Neofreudianism, 69, 83 personification of product, 162
neurophysiological phenomena, 16, 18 phases of psychocybernetic model, 98, 99
neurosis, 89, 90 fig; 100 fig·
New Introductory Lectures, 78 phases of therapeutic process, 97-99
New York Psychoanalytic Society, 60 phenomenology, 90-92
New York State Psychiatric Institute, 62-63 Philosophy in a New Key, 33
nomenological approach, 158 phobias, 90
nomomatic approach, 95-96, 113, 158, physical impairment, 252-253, 255, 256,
172-173, 168 fig. 253 fig·, 254 fig·
nondiscursive modality, 36-37 physical limbering up, 117
nondiscursive thought, 80 Picasso, Pablo, 118, 251
nonverbal behaviors, 90 "A Picnic" picture, 263, 265 fig.
Notebooks, 122-123 pictorial forms. see presentational symbolism
Nuremberg War Tribunals, 63 picture consciousness, 58
picture of one's choosing, 227
o Plato's ideal state, 51
play therapy, 204
object inventory, 160 pleasure principle, 81, 221
objective amplification, 171-172 positive feedback, 16
obsessive compulsive disorder, 67 potential, 84
occupational therapy, 75 power of art, 52
"Odd Man Out" picture, 115 fig. power, sense of, 117
open system, 22-23 prelogical thought. see primary process
oppositional disorder, 212-213 thought
"The Outside Picture," 168-170, 169 fig. presentational symbolism, 35-37, 38,45
primary creativity. see creativity
p primary process thought, 6, 79, 80-81, 170
problem solving ability, 39, 97
painting, 50 problematic relationship, 241
paints, 105 process and product, 73, 74, 78, 95, 96, 106.
paper, 106 see also products
parents, 200-201, 225-226, 241-242 process of amplification, 171
participant observer, 204-205 process of creating, 119
passive fantasy, 84 process of engagement, 118-120
pastels, 105 processing of information
peer supervision, 103 and imagery, 6, 20, 23-24
percept, 42 and primary creativity, 96-97
perception and cognition, 27-28 in the psychocybernetics model, 173
perceptual stimulation, 149-151,254 fig, sensory/visual and verbal/rational, 97
256-257 visual means of, 93
perfectionism, 90, 154 productive imagery, 29
Pergamon, 51-52 products. see also process and product
peripheral concerns, 140, 148 meaningful and meaningless, 184
Perls, Fritz, 88 personification of, 162
Perls' Gestalt therapy, 89 storage of, 193
personal qualifications. see qualifications professional preparation. see training
progressive education, 59, 61, 69 relative repleteness, 32

projection, 78 religion and the arts, 52
Prospective Kinetic Family Drawing, 237 reminiscing, 254-255
protective themes, 134, 247 repression, 78
psychiatric interview, 68 reproductive imagery, 29
psychoanalysis, 61, 63-64, 66 Republie, 51
psychoanalytic model, 78-84 research study
psychoanalytic orientation, 170 design, 272-274
psychoanalytic theory, 77 desirability and feasibility of, 278-279
psychoanalytic thought, 59, 68-69 findings, 274-277
psychocybernetically-oriented therapists. see "Resistance" picture, 115 fig.
art therapists resistance to termination, 179-182, 194
psychodrama, 62 resistive children, 205
psychodynamic style, 202-204 resolution, 185-192, 194
psychodynamically oriented therapists. see responsibility, 89
art therapists responsive communication, 215-220,
psychological functions, 38, 43 215-220
psychology, definition of, 26 review, 182-185, 194
psychotherapists, 65 rewards, 205
psychotherapy, 66, 69, 103 Rhyne,janie, 88, 90
The Psychology of the Unconscious, 54 rhythm, 51, 52, 117
right cerebral hemisphere, 38-40, 45, 93,
Q 220
Rogerians, 204
qualifications, 101-102 Rogers, Carl, 101
question jar, 233 Rousseau, 59
R s
"The Race Car" picture, 140, 145 fig. "A Sad Puppy" picture, 164, 166 fig.
"The Raindrop and the Killings" picture, 215 salience, 175-176
fig· sandplay therapy, 87-88
rapport building, 148-149 schizophrenic patients, 66
ratification, 178-179, 194 scribble technique. see also free-flow tech-
rational thought. see secondary process nique
thought second mastery, 206
reaction formation, 78 secondary creativity. see creativity
reactive-type depression, 272 secondary process thought, 7, 79,80-81, 170
reality, 21, 23, 91, 226 security, sense of, 247, 251
reality education, 226 self-blame, 233
reality principle, 81, 221 self-concept, 91, 137
reality problems, 224 self-correcting propensity, 23
reassurance, 116, 119, 134 self-destructive behaviors, 232-233
reclassify, 42 self-determination, 21
recodify, 42 self-development, 84
recognition images, 30 self-disclosure, 148-149
reconnect, 188 self-expression, 90
references, 32 self-help movement, 103
relationships, 200-201, 225, 226, 241 self-image, 20-21, 208
Subject Index 307
self-portrait, 131, 185, 228-229, 233, 223 fig. subjective amplification, 171-172
self-regulating systems, 16-18 sublimation, 81-82
self-responsibility, 21 subsystem in codification process, 43
self-sharing, 148-149 subsystems of imagery, 34
self-system, 136-140, 208-211, 227, 228, 138 suicidal adolescents, 231-232
fig· supervision, 103
self-therapists, 91 surveys, 70-71
semantic density, 32 symbol formation, 41
sensations, 29 symbol-making devices, 23
sense of identity, 207 symbolic expressions, 83-84
sense of space, 44 symbolic processes, 6
sense of time, 44 symbolism, 83
sensory deprivation, 26 symbolization, 31-33, 44
sensory modality, 29-30, 256 symbols
sensory organs, 43 classes of, 32-33
sensory/visual, 97 definition of, 32, 44
severely dysfunctional adults, 240, 245-252 presentational. see presentational symbol-
sex, 53 ism
sex offenders, 240, 241-242 universal, 63
sexual drives, 78-79, 81-82 syntactic density, 32
sexually-abused adolescents, 233-235 system, definition of, 21-22, 34
sexually-abused children, 214 system of codification. see codification
shadow, 85 system theory. see general system theory
shapes, 244 systems and cognition, 45-47
"The Shoes," 251 systems approach, 34-35,46-47
short-term memory, 44
short-term treatment, 188 T
simple reaction theories, 21
social group work, 76 teardrop technique, 213
social problems, 61-62 "Teardrop with Rain and Lightning" picture,
social work degree, 103 214fig.
social workers, 200-201 termination phase. see ending phase
soft data, 176 tests. see assessment
solutions, 193 theme-oriented sessions, 208
space requirements, 107 theme selection, 122, 132-134
space, sense of, 44 theoretical cybernetics, 17
Sperry, Roger, 37 theoretical orientations, 77-78
"The Sphinx" picture, 126, 127 fig. therapeutic interaction, 106
spotlighting, 134-136, 164 therapeutic process, 97-99
squiggle game, 124, 134, 207 therapeutic styles
state of dynamic equilibrium. see homeostasis behavior modification, 205
state of human systems. see human systems participant observer, 204-205
stress, 239 psychodynamic style, 202-204
stress management programs, 20 therapy, definition of, 94-95
structuring, 117-118, 136, 208, 257 therapy dropout, 114
Studies of the "Free" Art Expressions ofBehavior therapy techniques for children
Problem Children andAdolescents means of achievement domain, 210
Diagnosis and Therapy, 63 "The Arm, Fist, and the Bully" picture,
subconscious, 43, 44 216fig.
arm with a fist technique, 213 unconscious

body tracing, 207-208 collective, 63, 84-85, 86, 87
dragon technique, 211-212 and the conscious, 85
free-flow technique, 207 Freud's term, 43
"A Heart" picture, 213 fig. Naumburg's view on the, 83
heart technique, 212 personal, 84-85, 87
"A Hug" picture, 217 fig. unconscious mental processes, 78, 79
hug technique, 213 unfreezing phase
ice breakers, 207 with children, 199
"icky" picture, 206 client preparation, 114-116
interpersonal domain, 209-210 common misapprehensions, 112-114
Kinetic Family Drawing procedure, explanation of, 97-98, 111-112
209-210 limbering up, 117
name design, 207 process of engagement, 118-120
"The Raindrop and the Killings" picture, structuring, 117-118
215 fig. universal symbols, 63
responsive communication, 215-220 unlocking the messages. see decoding the
squiggle game, 207 messages
teardrop technique, 213 Utrillo, 50
"Teardrop with Rain and Lightning" pic-
ture, 214 fig. v
transpersonal domain, 210-214
therapy wing of art therapy, 74-75, 76-77, validation, 42
78,97,156 van Gogh, 251
Third Force, 21 verbal exploration method, 224
thought processes, 79-80, 193 verbal expression, 10-11, 14, 89, 90, Ill, 244
three dimensional forms, 29-30, 105 verbal means, 93
time considerations, 107 verbal/rational, 97
time limits, 154, 155 verbal therapy, 76, 182-183, 273, 274-276
time, sense of, 44 verbal treatment methods, 242
timing principles, 134-136, 175-176 vignettes. see case studies
titles, 162 visual expression, advantages of, 9-11,
topic selection. see theme selection 14-15,244
training, 102-104 visual forms of therapy, 76
transformation of images. see images visual imagery. see imagery
transpersonal domain, 138, 140, 210, 227, visual means, 93
148 fig. visual modality, 111
treasure map, 242 visual products. see product
treatment goals, 181-182 visual sense, 30
"The Tree" picture, 269, 270 fig. visual sensory modality, 36, 111
trust, 136, 140, 148, 162 visual thinking, 79-80
"The Turtle" picture, 126, 127 fig. visual vocabulary, 9-10, 244
two dimensional forms, 29-30 visualizers, 29-30
two-part picture, 227, 237
w
u
Wadeson, Harriet, 68, 131
Ulman, Elinor, 69 Walden School, 60-62
uncertainty, 119 "A Warm Place" picture, 184-185, 185 fig.
Subject Index 309
warm up, 117 works of art, use of, 249-252

Wartegg Blank, 126, 129 fig. worst nightmare, 242
Wartegg, completed, 128, 129 fig; 130 fig.
Wartegg, Ehrig, 126 y
Wartegg technique, 126-128, 227
WEGs (warmth, empathy, and genuineness), YAVIS-type clients, 240-241
101
William Glasser's Reality Therapy approach, z
225-226
Winnicott's "squiggle game." see squiggle Zung Depression Test, 272
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THE PSCHOCYBERNETIC MODEL

Dr. Aina O. Nucho (pronounced "Ina" "Nooko") is a professor

AINA o. NUCHO, PH.D.

Irene Jakab, M.D., PH.D.

CHARLES C THOMAS • PUBLISHER, LTD.

CHARLES C THOMAS • PUBLISHER, LTD.

This book is protected by copyright. No part of

©2003 by CHARLES C THOMAS • PUBLISHER, LTD.

ISBN 0-398-07377-5 (hard)

Library of Congress Catalog Card Number: 2002035973

With TH 0 MAS BOOKS careful attention isgiven to all details of manufacturing

Printedin the United States ofAmerica

Library of Congress Cataloging-in-Publication Data

RC489.A7 N83 2003

T his book is an instrument of complex knowledge transfer on the

IRENEJAKAB, M.D., PH. D.

in a Nucho's clinical practice and teaching over the last 20 years

tic handling of both kinds of images so that profound personal experi-

AHKTER AHSEN, PH.D.

n creasingly, art therapy attracts the interest of forward-looking pro-

numerous to mention by name. My special thanks go to Virginia

PART ONE: THEORETICAL FOUNDATIONS

4. THE MERGING OF ART AND THERAPY 49

PART TWO: THE THERAPEUTIC PROCESS

7. THE UNFREEZING PHASE 111

Preparing the Client for the Experience 114

PART THREE: WORK WITH SPECIFIC CLIENT

11. WORK WITH CHILDREN 199

PART FOUR: EFFECTIVENESS OF ART THERAPY

14. CASE VIGNETTES 261

16. LOOKING AHEAD 278

The method of intervention described in this book has been stimu-

time, living and nonliving phenomena are viewed as transformations

It presents ways of capturing the power of fleeting images. A method of

considerations of time and space requirements as well as the art mate-

the outcomes attained by a number of other frequently used modalities

Advantages of Visual Forms of Cognition

Painting, drawing, and sculpting are action-oriented ways of con-

bal statement, and thus convey more information (Piotrowski, 1953). In

ART THERAPY, PSYCHOCYBERNETICS

rt therapy, a relatively new modality of helping, is used increas-

What Is Art Therapy?

From the perspective of psychocybernetics, art therapy may be

and then decoding one's imagery in order to integrate experiences and

thought, known as the "ART as Therapy" wing of art therapy, holds

There is another profound reason why the visual forms of expression

Cybernetics is the discipline concerned with the study of the flow of

um. The self-regulatory aspects of neurophysiological phenomena are

feedback loops. The process of natural selection, for instance, is an

Images and Psychocybernetics

previously stored information, the newly received information will act

and direction understood. This is the psychocybernetics of human

business people. Although aware of the work of Wiener (1947) and

General System Theory

General system theory provides a unifying framework for the

effect relationships, general system theory explains the reciprocity of

dients intermingle and affect one another. Reality, as we now under-

Information Processing and Imagery

One more of the central concepts deserves to be mentioned in this

to actual as well as imagined experiences. If you do not believe this, try

General system theory which originated in biology began to trickle

IMAGES AND COGNITION

T h e psychocybernetic model is a method of cultivating, portraying,