Art Therapy and Dreams

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All that we see or seem is but a dream within a dream.
–Edgar Allen Poe
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The other night I had a dream that I was dreaming about dreaming…Confusing? A little. It was a dream within a dream within a dream! When I woke up I half-wondered, was I still dreaming? My take on “reality” had temporarily shifted, and I was inspired to write a little about my work with dreams and art therapy.
The combination of dream-work and art therapy can be a powerful and illuminating experience when approached in a way that honors the dreamer and his or her relationship to the dream.

Bruce Moon is an art therapist who often explores dreams within an existential framework. (For an excellent read, I recommend his book: Existential Art Therapy: The Canvas Mirror). He describes existential art therapy as “a journey of self-discovery that is shared by the client and the art therapist.” He believes that the overall purpose of engaging in dream-work and art therapy is to help the client discover and create meaning in his or her life.

In my work with clients and their dreams I deliberately refrain from offering my own interpretations of dreams. To analyze another’s dream is to assign meaning to something that belongs solely to the dreamer.  In this way, I approach a client’s dream in the same way that I approach his or her art work. I do not interpret the creations based on my point of view. Instead I serve as a witness and guide to the client’s unique journey.
During a session, clients may be open to creating an image of the dream. Since dreams are layered (and laden with many images) it can be helpful to ask the client to pick just one scene from the dream to depict. Some clients may work abstractly and capture the feeling of the dream in colors and shapes, while others may work in a more representational style. I have had clients draw, sculpt, or collage artwork about their dreams, based on their material preferences. When the client is finished with the piece, we usually place the art in between us. The client speaks freely about the piece and what he or she sees in it. Sometimes I will offer to take notes for the client, so that he or she has a record of initial responses.  Again, in this way of working, it is important to remember that there are no “cookie cutter” dream meanings. For example, one person might associate dreams of falling with feeling unencumbered by gravity and experience it as a symbol of freedom (for those of us who enjoy skydiving:) Another person may experience a dream of free falling as terrifying. The meaning is entirely derived from the client.
Sometimes I have asked clients to imagine themselves as different elements of the dream, and not just as “themselves.” For example, if a client has a dream about their mother, father, and sibling I might ask the client to re-inhabit the dream from each family member’s perspective. This way of exploring a dream will often provide additional insight to the dreamer. It also encourages the client to practice flexibility in interpersonal relationships and strengthens the ability to “try on someone else’s shoes.”
Since I was a child I have almost always remembered my dreams upon waking. Many clients have told me that they have difficulty remembering their dreams though. Keeping a dream journal by your bed can be a helpful method in strengthening dream recall. If a dream is particularly intense or even disturbing it can also help to write it down immediately upon waking up from the dream, even if it is in the middle of the night. Once the dream is jotted down, the intensity often diminishes and the dreamer is able to get back to sleep more peacefully. Writing dreams down upon getting up in the morning is also very useful. The writing does not have to be long, but can just include some key elements or words that are associated with the dream. Sketching an image from a dream is another way to record the dream.
Dreams provide clients with insight into the self, and they can also serve as rich sources of inspiration for creative work: art, writing, music, and movement. Dream-work can be further enriched by the addition of these creative modalities – for example, finding a song that seems to evoke the essence of the dream. There is no right or wrong way to explore a dream, as long as the dreamer is the one creating meaning.
Interested in diving deeper into the world of dreams? Here are a few movies I’d highly recommend – all exploring dream states and questions of what is really real?
Inception (2010)
Eternal Sunshine of the Spotless Mind (2004)
Spirited Away (2001)
Vanilla Sky (2001)
Waking Life (2001)
Avatar (2009)
The Matrix (1999)
What Dreams May Come (1998)

Top 10 Art Therapy Myths

“Imagination is not a talent of some men, but is the health of every man.”

– Ralph Waldo Emerson

 I’ve decided to write a short “top ten” list of common myths about art therapy – all of which I’ve come across in the past few years. I hope this information helps to dispel some current misconceptions about the field.

1) You have to be an “artist” to benefit from art therapy.

This is one of the most frequently expressed misconceptions about art therapy. Art therapy is less about the finished product, and more focused on the creative process. You will never be judged for your artistic capability, just as you would never be rated on your ability to discuss certain topics during a talk therapy session. Many clients can recall a time in their youth when they decided that they “could not draw.” Perhaps a friend or teacher made an insensitive remark about their drawing, or art making simply faded out of their daily life. During one of your first sessions it can be important to share your current relationship to art making and include any fears or strong feelings about your ability to make art. An art therapist will work with your apprehension and introduce art making at a pace that feels comfortable for you.
2. Art therapy is only for children, and not for adults.
Many people are familiar with the use of art therapy when working with children. Children are usually very receptive to art therapy because it appeals to their innate curiosity and desire to create. In addition, art therapy is useful for children who have not yet developed the ability to verbally express themselves in the same way that adults have. That being said, art therapy can be beneficial to adults of all ages. Art has the ability to express what (even adults) do not always have the words for. In addition, art may bypass the purely intellectual side of the brain, and shed light onto the unconscious.

3) The art therapist will be able to know secrets about you just by looking at your art work.

As part of our training, art therapists do have a foundation in interpreting art pieces on different levels. However this understanding helps the art therapist to ask questions of the client, rather than supply answers. The meaning of the artwork is always derived directly from the client, and his or her own personal associations and feelings about the artwork. Just as each art piece is one of a kind, the attached meanings are highly individual and may even shift over time.

4) Art therapy is like going to an art class. During art therapy you learn to draw, paint, or sculpt.

The goal of art therapy is not to “teach” art skills, but rather to use art in a therapeutic capacity. That being said, art therapists may instruct clients in how to use various art materials so that the client has the freedom to then create whatever they desire. Over the course of art therapy it is natural that many clients would become more familiar with and adept at using art materials and different methods, but that is not the primary goal.

5) Art therapists are not real therapists.

An art therapist is a trained psychotherapist who specializes in the use of art making and the creative process within the therapeutic relationship. In other words, art therapists undergo similar training to other types of “talk therapists” but have the additional training in using art within therapy.

6) Only people who are currently struggling with many big issues should seek art therapy.

Art therapy can be very beneficial when working with a client who is struggling with severe physical or mental illness, addictions, trauma, or life changes, but anyone can benefit from art therapy and creativity development. For example, some people may seek art therapy as a way to enrich their current life experience and broaden their horizons. Others may utilize art therapy as a way to gain greater self-insight. In addition art therapy is a wonderful method of reducing overall levels of stress in a person’s life. Art therapy groups can provide members with a creative outlet as well as a community atmosphere where they can strengthen interpersonal skills.

7) Any therapist can call themselves an “art therapist” as long as they do art during their sessions with clients.

Before selecting an art therapist it is very important to make sure that they are legally allowed to call themselves an “art therapist” or a “creative arts therapist” (which is the title in NY state). Unfortunately some therapists who are not trained in art therapy may falsely use the art therapist title, simple because they are a therapist who sometimes uses art during sessions. The therapeutic use of art making can be a powerful and life-changing experience. Many feelings and issues may surface as art is created, which is specifically what an art therapist is trained to understand and work with.

8) An art therapist cannot be your primary therapist, but must be an adjunct therapist.

An art therapist can be the primary therapist, whether they see the client in private practice or within an organizational setting. Like other mental health professionals, art therapists may also be part of a treatment team, made up of psychiatrists, psychologists, social workers, etc.

9) It will be awkward during art therapy sessions because the art therapist will just stare at me in silence while I draw.

The idea of the “silent therapist” has trickled down from the original Freudian psychoanalytic style where a patient would lie on a couch and speak while the therapist appeared unengaged and at a distance. In reality, most present day therapists (including art therapists) are much more directly engaged during sessions. Silence can be a powerful aspect within the therapeutic relationship, but it does not define the way most art therapists work. Every art therapist will have his or her own personal style within the therapeutic relationship. Some art therapists create art alongside their clients at times, while others do not. Clients may choose to make art for the entire session, or for only a portion of the time. Some clients only create art outside of sessions, and then bring the art in to share and discuss with the art therapist.

10) You will have to make art during every art therapy session.

As I mentioned earlier, art therapists are trained psychotherapists just as other types of “talk therapists” are. Therefore, there may be sessions when the client decides to just talk or engage in a different type of therapy experience – for example, guided meditations, dream work, or more body-centered work such as breathing exercises. Some sessions may be devoted to “problem solving” skills such as creating daily schedules, chipping away at fears, or building other life skills.
This list has focused on some of the most common questions about art therapy but I’m sure there are many others. Do you have other questions about art therapy as a profession? If so, please feel free to post a comment under this piece and I will post a reply 🙂 And keep checking back, as I will continue to create new posts about art therapy.

For the Bookworms!

I’ve been devouring books lately…nothing quite like curling up in a blanket and diving into a good book when it’s freezing outside.

Over the past few years I’ve amassed a growing personal library of books that I couldn’t do without. I’ve received a few questions about which books I might recommend for someone who is interested in art therapy. Below is a starting list of books that I’ve found really informative, insightful, and inspirational. I’ve divided them into the categories of art therapy, mental illness, creativity & art, and spirituality.

Hope you enjoy!

Art Therapy

Approaches to Art Therapy: Theory & Technique, Judith Rubin

Handbook of Art Therapy, Cathy Malchiodi (a new edition is coming out soon!)

Creative Arts Therapies Approaches in Adoption and Foster Care: Contemporary Strategies for Working with Individuals and Families, Donna Betts

The Secret World of Drawings: A Jungian Approach to Healing Through Art,
Gregg Furth

Studio Art Therapy: Cultivating the Artist Identity in the Art Therapist, Catherine Hyland Moon

Art Heals: How Creativity Cures the Soul, Shaun McNiff

Existential Art Therapy: The Canvas Mirror, Bruce Moon

The Artist as Therapist, Arthur Robbins

Art is a Way of Knowing, Pat Allen

Art Therapy for Groups, Marian Liebmann

Books on the Creative Process/Art

Art & Fear: Observations On the Perils (and Rewards) of Artmaking, David Bayles & Ted Orland

Trust the Process: An Artist’s Guide to Letting Go, Shaun McNiff

The Artist’s Way, Julia Cameron

Books on Psychology and Psychotherapy

Freud and Beyond: A History of Modern Psychoanalytic Thought, Stephen Mitchell & Margaret Black

Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow, Judith Viorst

Attachment in Psychotherapy, David Wallin

Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Nancy McWilliams

The Magic Years: Understanding and Handling the Problems of Early Childhood, Selma Fraiberg

Books on Mental Illness

The Buddha & The Borderline, Kiera Van Gelder

An Unquiet Mind: A Memoir of Moods and Madness, Kay Redfield Jamison

Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, Kay Redfield Jamison

I Never Promised You a Rose Garden, Joanne Greenberg

Books on Spirituality & Mindfulnes

The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, Mark Williams, John Teasdale, Zindel Segal, & Jon Kabat-Zinn

The Translucent Revolution: How People Just Like You Are Waking Up and Changing the World, Arjuna Ardagh

A Path With Heart: A Guide Through the Perils and Promises of Spiritual Life, Jack Kornfield

Autobiography of a Yogi,
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Paramahansa Yogananda

The Celestine Prophecy, James Redfield

The Bhagavad Gita, Swami Prabhavananda & Christopher Isherwood
(there are many translation versions – I happen to like this one)

Siddhartha, Herman Hesse

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Spotlight: Depression

It is interesting to note that in this day and age, psychological terms have trickled down into our everyday conversations. For example, it’s not rare to hear someone complain, “oh god – she is SO obsessive compulsive!” Or, “I’m so depressed right now!” What are the actual definitions of these terms though?

I thought it would be interesting to do a series on this blog that I am calling the “Spotlight” series. In it I will explore some of the better known (but often misunderstood) mental illnesses, such as Depression, Bipolar Disorder, Obsessive Compulsive Disorder, and Borderline Personality Disorder. In each post I will include the official DSM IV description (Diagnostic & Statistical Manual of Mental Disorders, 4th Ed.). I will also highlight current treatment approaches – both medical and therapeutic. I am starting off with a spotlight on Depression. I hope these posts are informative, and give you a jumping-off point from which to explore further. Please keep in mind that thousands of books have been written on each diagnosis, and that these blog posts are only intended to give the reader a brief introduction to each disorder.
Before talking about the different types of Depression, it is helpful to define what a depressive episode consists of. According to the DSM IV, a person must meet 5 (or more) of the following symptoms during the same 2 week period, and one of the symptoms is either 1)depressed mood or 2) loss of interest or pleasure to meet the criteria for having a Major Depressive Episode:

1) depressed mood most of the day, nearly every day
(in children and adolescents this may present as an irritable mood)

2) noticeably diminished interest in activities that are usually pleasurable

3) significant weight loss or weight gain (not due to dieting)

4) insomnia or hypersomnia nearly every day (not sleeping or oversleeping)

5) noticeable psychomotor agitation or retardation nearly every day (rapid or slowed speech)

6) fatigue and loss of energy nearly every day

7) feelings of worthlessness or excessive and inappropriate guilt

8) trouble thinking and concentrating, indecisiveness

9) recurrent thoughts of death, suicidal ideation with or without a specific plan

From this list it is helpful to remember that any 2 people diagnosed with a major depressive episode may present very differently. For example, one may lose weight, have insomnia, and speak more rapidly, while another person may gain weight, sleep too much, and speak much more slowly. In addition, it is now known that children and adolescents may present very differently with depression than adults do. Often times, children and adolescents who are clinically depressed may act out and be irritable (and be mistakenly diagnosed with ADHD) when they are actually exhibiting signs of depression.

Types of Depression
A look at a few different forms of depression…

Major Depressive Disorder
(Also called: Unipolar Depression, Clinical Depression, & Major Depression)
This is the most well known type of depression and falls under the diagnostic category of Mood Disorders (as do all forms of Depression). Mood disorders are identified as a person presenting with a disturbance in mood as the predominant feature.

There are two types of Major Depressive Disorder: Major Depressive Disorder (Single Episode) and Major Depressive Disorder (Recurrent). A single episode indicates that the person meets the criteria for a Major Depressive Episode (see above) and that this is their first or only episode. In the recurrent form of Major Depressive Disorder, the person has had 2 or more separate episodes, with an interval of at least 2 consecutive months between episodes.

Dysthymic Disorder
The DSM IV definition for Dysthymic Disorder is a “chronically depressed mood that occurs for most of the day more days than not for at least 2 years.” Although Dysthymia is seen as a milder form of Major Depression, the course of this illness is much longer. People suffering from this form of depression may have lived with it for so long that they have difficulty remember a time when they ever felt “good.” In addition, people with Dysthymia are less likely to seek treatment, because they may believe that feeling this way is just part of who they are, instead of seeing it as a mental illness that may be treated.

Bipolar Depression
I will be writing a future post on Bipolar Disorder, which will cover Bipolar Depression in more detail. For now, it is important to know that Bipolar Depression meets the same criteria as seen in a Major Depressive Episode, but that the treatment (especially medication-wise) is usually very different. In addition, a bipolar depressive episode will later be followed by a manic or hypomanic episode.

Depression Due to a General Medical Condition
There are a number of medical conditions that may cause mood symptoms such as those found in clinical Depression. Examples of conditions include degenerative neurological conditions (e.g. Parkinson’s disease, Huntington’s disease), stroke, metabolic conditions, endocrine conditions (e.g. hyper and hypothyroidism), autoimmune conditions, viral or other infections (e.g. hepatitis, HIV) and certain cancers. It is obviously important to discern whether the Depression is due to a medical condition, as the medical treatment approach will vary greatly.

Seasonal Affective Disorder (SAD)
SAD is a form of Depression that affects the person during certain parts of the year. A person with SAD exhibits the indicators of Depression with a pattern that is related to the time of year (usually seen during the winter and/or fall months). In addition, the depressive episodes are not linked to external stressors (such as unemployment or strained family relations).

Postpartum Depression
Postpartum Depression describes the time of onset of a depressive episode. With Postpartum Depression, the new mother experiences a depressive episode within 4 weeks of giving birth to a child. It should not be confused with the “baby blues” that some new mothers may experience 3-7 days after delivery (but which disappears quickly). A mother experiencing Postpartum Depression may experience increased anxiety (even panic attacks), difficulty sleeping, trouble concentrating, spontaneous crying, and a lack of interest in her newborn.

Treatment Options
These forms of Depression can be treated in multiple ways, either with medication, therapy, or a combination of both.

Medication Treatment Options
The most widely used (and known) brand name antidepressant medications are in a family called Selective Serotonin Reuptake Inhibitors (SSRI’s). Common SSRI’s include: Prozac, Luvox, Celexa, Paxil, Lexapro, and Zoloft. These medications work primarily by regulating a chemical in the brain called Serotonin. Although SSRI’s seem to help many people with depression, the exact way that they work within the brain is still unknown.

Atypical Antidepressants affect neurotransmitters such as serotonin, norepinephrine, and dopamine. Brand name drugs in this category include: Wellbutrin, Effexor, Cymbalta, Remeron, Desyrel, and Serzone. Often times, prescribers will try a medication from this category when an SSRI has not helped alleviate depression. As with the SSRI’s, the exact mechanism of action is still not fully understood with these medications.

In addition, some presribers may turn to older classes of antidepressants, such as the Tricyclics, and MAOI’s (Monoamine Oxidase Inhibitors). However, these drugs are more commonly used as a last resort, since they have a lengthier list of side effects and less selective mechanisms of action.

Currently it is not uncommon to add a second drug to the primary antidepressant (called augmenter drugs). Two of the most popular brand name augmenter drugs are Buspar (also used to treat anxiety) and Wellbutrin.

Lastly, a (rather controversial) development in treating depression has been the addition of lower dose antipsychotics to the antidepressant. I’m sure many of you have seen the most recent commercials for adding Seroquel or Abilify to your antidepressant treatment (both are antipsychotics). This practice remains controversial in part because of the additional side effects that treating with an antipsychotic creates.

Therapy Approaches
Here I’ve highlighted just 2 different therapy approaches for Depression (although there are many more to be explored in future posts).

Art Therapy (Yes…I am biased!)
There are too many approaches, techniques, and theories on art therapy and depression to fully delve into within this post. A future post is planned to explore art therapy and its applications to mental illness. For many, the process of creating art is intrinsically healing in itself. Often, the experience of depression can be paralyzing. The act of creating art can serve as a way of reconnecting with the world around us, using our hands constructively, and re-engaging with dormant energy. When a person is depressed, it can seem overwhelming to put their feelings into words. However, it is at these times that art can serve as a more direct expression of what the person is feeling. Frequently the therapist and the client are amazed at what surfaces within the art, providing insight into deeper issues and themes.

Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that is based on the idea that what we think directly influences how we feel (emotions) and what we do (behavior). Therefore the focus is on retraining our brains to think differently, which in turn will directly change/impact our feelings and behaviors. CBT utilizes many approaches during therapy, with a strong focus on “homework assignments.” These assignments are all part of retraining the brain and becoming more cognizant of our thoughts – so that we become aware of some of our more harmful automatic thoughts. Unlike psychoanalysis, little attention is paid to the person’s past, and emphasis is placed on the person’s present day experience of life. CBT has been increasingly used and combined with other treatment modalities and is generally shorter term than other approaches to therapy.

These are just 2 therapy approaches for Depression. In future “spotlight” posts, I will be exploring many other types of therapy and their applications to different populations.

I’ll end this post with a quote by R.W. Shepherd:

“If depression is creeping up and must be faced, learn something about the nature of the beast: You may escape without a mauling.”