Art Therapy with Adolescent Clients

Art therapy is a versatile modality that can be utilized with a wide range of human populations in a variety of settings (Malchiodi, 3). As a therapy, it is particularly suited to adolescents because it requires the active participation of the client to physically create art objects and discuss them (5). Art therapy is useful with clients who have “ordinary” problems, as well as the mentally ill, the sick or disabled, and those affected by trauma (46). It can take the form of individual therapy, family therapy (Riley, 66), or group therapy with peers (193).

Art therapy is a relatively new field. Although many factors paved the way, from Jung’s ideas about archetypes to an interest in the artwork of the insane (Malchiodi, 24-26), the specific concept of art therapy emerged in the mid-20th century. In the 1940s, psychoanalyst Margaret Naumburg began having her patients draw their dreams as well as talk about them. She believed these images were symbolic forms of communication, and as such, her approach was oriented toward the meaning of the final art product (35).

In the decade following Naumburg’s initial ideas, Edith Kramer became known for her ideas on the power of artmaking to initiate psychological healing. She emphasized the creative process in the act of expressing one’s inner experience (36).
The field of art therapy is still growing today and is practiced by therapists with a wide range of therapeutic orientations. Art therapy, which focuses on the visual arts, is now considered a subset of the genre called creative arts therapies (or expressive arts therapies), which also includes music therapy, drama therapy, poetry therapy, and movement therapy (Malchiodi, 38).

Although art therapy can be useful to a variety of client populations, it is especially well suited for adolescents. Teenagers are in a very creative but ambivalent period of their lives; art therapy can harness this creative energy and show them that “when creativity is introduced into problem solving, the art can provide fresh viewpoints and excitement” (Riley, 38). Art therapy usually succeeds with adolescent clients where other therapies may fail because, although teenagers have a strong desire to express their feelings and opinions, they are wary of talking to adults. However, they are willing to indirectly express themselves through art images because “the art form is safe and under their control” (21). Furthermore, art therapy doesn’t seem like “real” therapy to adolescents; it is creative play with the help of an adult who is not controlling (65).

Adolescents are in a time of volatile transition, both physically and emotionally. They are slowly moving into abstract and logical thinking, learning social skills, developing sexual feelings and individual identity, and trying to figure out social roles and their place in the world (31). Two processes of growth occur during the teen years: puberty (physical changes) and adolescence (psychological changes) (29). Riley states that the distinction is important: “No two teenagers are on precisely the same path of maturation. I no longer evaluate the teen chronologically, I consider him or her developmentally” (19). Because adolescents are in such a time of flux, art therapists working with teenagers must have a strong sense of humor, be comfortable with sexual issues (usually presented crudely, such as teenaged boys building clay penis sculptures), and not have lost touch with the pain and confusion of their own adolescence (79, 225).

Riley emphasizes that there is no one correct or unfailingly effective way to treat adolescent clients (27) and suggests that the therapist approach each new individual as if he or she were a member of a new and unfamiliar culture (35). Social context is an important complicating factor in treating teenagers because they are subject to so many different social influences: “regional, urban and suburban, poverty and wealth, culture and ethnicity” (28). Riley proposes that art therapists treating adolescents take a social constructionist view; that is, “the adolescent is viewed in the context of his/her environment and included in the co-construction of the treatment goals” (18). Rather than applying particular therapeutic techniques, the therapist working with adolescents should remain open to learning from each client and genuinely engage him or her (40-41).

At the beginning of a therapy session, the client will enter to find that the therapist has already laid out art materials on an appropriate surface. Riley recommends these materials: broad tipped felt pens, oil pastels, collage pictures (already cut out) as well as glue stick and scissors, and a roll of white butcher paper from which varying sizes of paper can be cut. Adolescent clients also respond well to plasticine (oiled clay that doesn’t dry out) (58). It is particularly important for materials to be presented casually and not appear “precious” (57-8). Also, the therapist must provide culturally “flexible” media. For example, if the client is offered collage materials, they must include magazine pictures that can be representative of his/her experience, rather than all being cut from fashion magazines; also, materials such as plasticine and markers are available in a variety of skin tones (35). Riley suggests that the therapist offer the same limited range of media at each session because adolescents prefer the stability of sameness (57). She notes that her clients tend to prefer drawing with black or red markers or working with collage materials (53).

Generally, the art session will begin with the therapist offering a directive-guidelines for a specific kind of image. However, the client is free to reinterpret the directive and do whatever conveys his or her desired meaning (39). Riley states that it is best, when working with a new client in a not-yet-established therapeutic relationship, directives should be “once removed”-that is, phrased so that the therapist is inquiring about teenagers in general rather than this client in particular. For example, the therapist might say, “Draw a picture that shows what most people your age worry about the most.” This approach allows the client to express an expert opinion and to safely reveal information about himself or herself (44).

Riley finds certain directives particularly useful with this age group. She employs “polarity drawings,” in which the client is asked to divide a sheet of paper in half and then respond to a question such as, “How do your parents punish you? How do you punish your parents?” (48). Often she suggests projects involving the embellishing of a box, such as decorating the outside of the box to represent the client’s outer self and the inside to represent the hidden inner self. In this way, the box becomes a safe container for overwhelming feelings about identity (160, 167). The therapist might instruct the client to draw or collage a message to someone with whom they are in conflict (52). Clients that demonstrate significant talent or interest in making art can be encouraged to keep a visual journal outside of therapy time (61). In family therapy, artmaking can be metaphorical and encourage communication among family members. For example, family members might be instructed to construct clay figures of themselves, which can then interact with each other (a metaphorical interaction). Or the family could be instructed to cooperate in making a mural on one large piece of paper, with the therapist pointing out how family dynamics affected the process of making the picture (202).

Riley believes that having a series of directives pre-planned for a particular client is comfortable and easy for the therapist but doesn’t serve the client-the client must feel in control of what happens in therapy and not feel subjected to an adult agenda (45). In general, she avoid one-session directives and instead offers long-term projects that give a sense of continuity and relationship-building. One example is an illustrated Life Story Line (164). Adolescents like the challenge of complex long-term projects, and an ambitious approach keeps the art process from being boring or seeming like busywork (167).

Riley states her interest in both the product produced by the client and the process of creating it (18). She prefers to avoid the concept of “assessment” through viewing artwork, except as “an ongoing comparison of the artwork that the client offers from session to session” (21). She notes that if an image reveals dysfunction in the issue at hand, the image can be “corrected” by the client in several ways-by using a different color to add to the original drawing, or by altering the image (ex, cutting it up and reassembling it) (48). In this way, the product can again become part of the process.

A particular challenge of working with this age group is an absolute need to maintain confidentiality, even more so than normal. The therapist should never show client artwork to anyone-including the client’s peers or family members, or even the therapist’s colleagues-without explicit permission from the client. Riley states bluntly, “Adolescents are unforgiving if betrayed” (51). One such incident means the end of the therapeutic relationship. It is also important to respect the client’s rights in other aspects of the therapy. For example, if it became necessary to report a member of the client’s family to social services because of reported abuse, it should not be done without the client’s knowledge; the client needs to be in the room when the reporting happens and be able to present his or her side of the story to the caseworker (230). The therapist must be cautious and aware of client’s suspicions of adults. According to Riley, “a false move of interpretation or an imposition of the therapist’s agenda on the relationship” will jeopardize the therapeutic relationship (40). Riley emphasizes that the art therapist should never make judgments or assumptions about the content or meaning of the client’s artwork; the therapist must always request input from the client and take social contexts into account (34).

It is not surprising that active therapy with adolescents will frequently involve power struggles initiated by the client. Riley suggests that if the client resists revealing the meaning behind their creations, the therapist should respect this resistance. In fact, she states, “Resistance should be reinterpreted as appropriate withholding of private revelations” (44). In other words, the therapeutic relationship is defined by the client’s willingness to be vulnerable; if the client is not ready, it is his or her right to abstain from sharing too much . In the case of clients who do not come to therapy willingly, it can be expected that they will refuse to cooperate with the goals of therapy. One approach to this dilemma is to temporarily abandon the idea of therapy altogether and suggest that the client just make art for the pleasure of it. Usually even the most reluctant client is willing to draw graffiti-type images or play with colors abstractly, especially if he or she believes that the therapist will not be able to decipher the meaning of the images (47). Occasionally there will be times when a client simply refuses to make art at all. Riley believes that a therapist needs to be comfortable with the concept that some clients sometimes will not want to produce artwork: “If the therapist needs to control the production of art it is anti-therapeutic” (223).

An art therapist working with adolescents will frequently have to treat depressed clients. Riley suggests that the therapist should begin by acknowledging that no one can truly know or understand another’s pain, and then indicate a willingness to accompany the client on their journey despite not having the answers (139). If a therapist can engage a depressed client in artmaking, the process of creation itself can be very healing. It shows the client that they can choose not to be passive and that “they have power that can be activated” (145). Artmaking also has been associated with the psychosomatic release of stress, which in itself begins the healing process (184). Riley states that sometimes an art-related gift from the therapist to the client (for example, a small set of felt pens to use at home) can work as a transitional object to keep them engaged in the process (118).

References Malchiodi, C. (1998). The art therapy sourcebook. Los Angeles: Lowell House. Riley, S. (1999). Contemporary art therapy with adolescents. London: Jessica Kingsley Publishers.

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