Using the Expressive Arts in Mental Health Therapy part 1
Dr. Kristi Perryman, Assistant Professor in the Department of Counseling, Leadership and Special Education here at Missouri State University, spoke with KSMU's Randy Stewart to give an overview about the ways in which the creative (or "expressive") arts can be used in psychological therapy.
Dr. Perryman started out by distinguishing between "creative/expressive arts" therapy and "art therapy" as a discipline. Art Therapy, she says, requires specific classes, training, and a special license certifying one as a Licensed Art Therapist. "There is no specific training or license to be a 'creative arts therapist,' she says, though as she will point out later, counselors shouldn't attempt to use creative arts in therapy without SOME experience and training--which Dr. Perryman provides in some of her Counseling classes at MSU. The other major difference between the two is in terms of technique and expected outcome: "In Art Therapy, the therapist actually analyzes the product, whereas in 'creative arts therapy' the art--whatever medium they're using--is used as a means of expression. And so if you created something with me, whether it was a floral bouquet, or we did pottery, or whatever we did, then I would use it as a tool for you to be able to express yourself... rather than me looking at it and saying, 'Oh, I see you used black here--that means...' and interpreting it specifically. It's free to YOUR interpretation because it's your piece." The idea is to allow the creative impulses in the client to be drawn out, which then acts to draw out their feelings on whatever issues have brought them to the counselor in the first place.In addition to teaching counseling courses at Missouri State, Dr. Perryman is herself a licensed counselor and a registered children's play therapist-supervisor. She also maintains a private practice at Ozarks Psychological Associates in Springfield. She started out as a school counselor at Reed Middle School. She says MSU's Counseling program is "very experiential. So in some of my classes--one of which is an Expressive Arts class [and by the way, the terms "creative arts" and "expressive arts" can be used interchangeably here], the students actually participate in these activities, and have to create activities of their own. And they do this as part of a group, and I limit the class (size) to 6 people so that we are a small group. And they actually get to experience the activities themselves, which I believe is an ethically sound way to do it before they're doing it with someone else." Dr. Perryman believes the real "power" of expressive arts therapy is that it's a "projective" technique, "much like play therapy is for children. With play therapy, we say that 'play is their language and toys are their words.' And I think of expressive arts therapy as being the same way for children, adolescents and adults. Because, in doing this type of therapy, they're projecting, and therefore the unconscious comes out in ways that they're not even aware of until after it's happened. It's also a much less threatening way to talk about issues, because they're talking about it as part of their bowl that they've made or their bouquet, rather than talking about themselves."Asked to give a "status report" on how arts therapy is being used in this area, Dr.Perryman cites some of her former students who are out in the field and using it in various places, "from residential homes with adolescent girls to school counselors, agency counselors." She says she isn't aware of any full Licensed Art Therapists in the area, and she doesn't know of a lot of people incorporating arts therapy techniques on a regular basis. "But I suspect there are more than we know about," because interest in it seems to be growing. Dr. Perryman is hearing some of the local medical community talking about their growing awareness of it, especially where traditional medicine doesn't seem to be working. She notes St. John's has a program that incorporates this type of therapy. Art therapy doesn't simply involve children sitting around drawing pictures of people or things that have traumatized them. The field of creative art therapies includes--in addition to the visual arts--dance and movement therapy; poetry; music; drama and psychodrama; and floral therapy, which we'll get to a bit later. "It encompasses any medium you can think of," says Kristi Perryman, and it's highly effective even (or especially?) with clients who don't necessarily think of themselves as "artistic." Dr.Perryman mentions how often students come into her classes who state categorically that they're not "artistic," they're not "creative." "And I can identify with that--I'm not an artist!" she says, though she adds, "I've come to realize that I'm 'creative.' When my students worry about coming up with an activity, I start off with, 'What do you like to do? What do you find relaxing? What's interesting to you?' Because probably if it's relaxing and somehow theraputic for you, there's a way to make it that way for other people. Or, it may come up as part of conversation, or the therapist can also suggest activities and see what the client is open to."While her own specialty is working with children, Dr. Perryman says she's used expressive arts therapy with all age groups. "As I've said, much of my use of it now is with my college students who are training to be counselors. But I've used it in cancer-survivor support groups, in-patient hospitals, middle school, elementary school--various ages. It tends to bridge language barriers as well as cultural barriers in some ways, as well as age, because it's something everybody likes to do--everybody likes to play." A student in one of Dr. Perryman's classes was a drama major, but after taking her class he decided he was also interested in psychology, and now he's working on a degree in psychodrama.Dr. Perryman notes that people in this day and age have become more "counseling-savvy"--there's no longer quite as much stigma attached to psychological therapy (though, she insists, there is still some). "It's important for counselors to have more tools in their toolbox that they can utilize with those clients who have done the traditional 'talk therapy' over and over, and maybe it hasn't worked for them." One of the benefits of expressive arts therapy is that it often gives the client "something tangible that they can have to leave with. And many times, whatever it is that they've created is something they can also CHANGE if they're not happy with it. Many times in life there are things we don't have control over, that we can't change, and this seems to empower people with something they DO have power over, and that they can change and make it different." She says she's seen this a lot in the floral therapy sessions she's done, using fresh flowers and plants. "People would take their bouquets home... we did one (session) called 'Family of Origin,' where they had a flower to represent each member of their family." One client returned the following week and said when she got home she had to "move herself" (i.e. the flower in the bouquet that represented her)--she realized she had placed her flower right in the middle, between her parents--a position she was in all her life and "hated it." So she moved herself out of the middle. Dr. Perryman says, "that's another thing about having something tangible: the therapy doesn't end at the therapy session, it tends to keep having an impact later."In many ways, expressive arts and horticultural therapy have been around for centuries. "You think of, in different cultures, where drumming and dance and music have been used as part of their cultural traditions. And many of those things had theraputic value even though they weren't being used for 'therapy.' My students actually have done studies on it, as I have--my study was on floral therapy, using that in six-week groups in a retirement home. Because floral therapy was something new--floral therapy actually came from Nancy Cantrell, who was a student of this program during the time that I was also a student. She was working in a flower shop and she found that it was very theraputic for her--she had lost her son in an accident, and talked about how just being around the flowers and plants was theraputic for her. And so she got together with a therapist and developed six sessions using fresh flowers. And I actually participated in that group as a student. When I was working on my doctorate I wanted to use it to see what kind of differences it makes. And so I did a qualitative study--we didn't know what to measure because it was so new. Some of the findings were that people went through the same traditional group stages as they do in traditional groups, but also, it actually quickened the stages, the process. In other words, because it's a 'projective' technique, it tends to get to issues quicker than traditional therapy. It also had an added benefit because of working with fresh plants and flowers--aesthetically, because there are memories specific TO flowers that you wouldn't have with anything else, because of weddings, funerals, anniversaries, birthdays--all those things that we associate flowers with in our culture."Dr. Perryman points out that one vital element in using any kind of expressive arts technique in a therapy setting is that "you need to have some training in it yourself, prior to trying to use it with a client." She says you must also "take time... this gets to issues so much faster--faster than sometimes people are ready for. And so it's so important that you leave time at the end, whether it's a group or with an individual client, to process. Because if you don't, you could actually leave that client in more crisis than when they came to you."