by Megan Mc Swain Mann, ATR, LCP, Atlanta, GA
Annie, a willowy blond girl, is every bit the image of teen perfection: smart, pretty, and popular. However, as she sits silently at the large art table, holding a large paintbrush loaded with blues and purples, a different story emerges. Slowly and wordlessly an image appears on the page. Bold and sweeping strokes begin to tell a different story. The story of a girl who feels lost, alone, and fearful. A girl who is grasping for control, afraid to disappoint, and unable to speak her truth. The truth is she is afraid to betray the inner critic in her head that whispers the promises of perfection, where the only cost is to not eat, purge or “run” off the food that enters her body. Annie has an eating disorder, but like most girls she feels afraid to say the words, knowing that to tell is against the inner critic’s rules.
Research informs us that, “In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS) (Wade, Keski-Rahkonen, & Hudson, 2011).” NEDA. We know early intervention is imperative, and that trusting and the right connection are extremely important. We also know that some of the biggest challenges are to help those struggling take those first steps towards acknowledging a problem exists, identify ways the eating disorder has helped them cope, and end the damaging relationship with it, choosing instead healthy life skills and relationships to take its place. While there are many effective and useful interventions and approaches to treat eating disorders, some of my best tools are in the form of paint and paper. As an art therapist, I use the art making process to help my clients learn to see and express their relationship with this dangerous and potentially deadly illness. It is my belief that the more ways we can empower and help our clients see a future that includes a life not ruled by their eating disorder the better. Art making can be one way to hold up a mirror that does not lie. It can be a mirror that reflects back the reality of this serious issue, and the hope of a life not ruled by ED.
So what is art therapy?
Art can be said to be — and can be used as — the externalized map of our interior self. Peter London, No More Secondhand Art
Art therapy is a branch of the mental health field that uses the art making process, be it visual art or performing arts, to treat a wide array of psychological or physical challenges. Art therapy can be used with a wide range of clinical populations from children and teens to families and adults helpful site. Art therapy taps into our inherit creativity and helps us see and express our thoughts and feelings in unique ways. Art therapy is not about being a “good artist”, but about finding the inner artist within us all. As Van Gough stated, “Every child is an artist, the trouble is to remain one once he grows up”. Long before the written word humans have used images to convey stories and make meaning out of life.
Also distinct to art therapy, is that “the art” is about both process and product. In art therapy there may be times where the focus is on using the creative process for change, and the art product is a reflection of this complex process. However, there are other times where the final art product becomes an important witness to therapeutic efforts, and deserves to hang on the wall as a reminder of courage and hard work! Overall, the field of art therapy is a distinct therapeutic discipline with its’ own set of ethics, licensing, and certification process. For more check out: AATA http://www.arttherapy.org
Art Therapy and Treatment of Eating Disorders: A Brief Overview of the Cycles of Change
As mentioned in the example of Annie, there are times where art offers a window into our deepest truths, and becomes a powerful tool that gives permission to say what we cannot always put into words. Art therapy can be a key component in the diagnosis, expression, and treatment of eating disorders. The art making process taps into our deepest emotional ways of knowing and shifts us away from the familiar verbal defenses. Art allows us to delve deeper into the unconscious and unnamed, and help our clients learn safe ways to begin to speak their truth and tell their stories.
To organize a way to explore various applications of art therapy that can be utilized for the treatment of eating disorders, I have adopted the Stages of Change Model. The Stages of Change Model was originally developed by James Prochaska and Carlo DiClemente in order to study about how individuals who successfully stopped smoking were able to give up their addiction. The Model has since been used for various addictive behaviors. The Stages include the following: Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. At each of these stages clients have different therapeutic needs, and as such different forms of art therapy intervention may be most appropriate.
Most clients that enter into treatment are often waffling between contemplation and pre-contemplation. For me this stage is about helping clients learn to see. By seeing I mean seeing their eating disorder and seeing the relation they really have with the eating disorder. Using the art at this stage may also assist mental health professionals see through their client’s eyes. In learning to see from our clients perspectives we can develop more awareness and empathy for where they are in their relationship to change. While we may be eager to move to action, the client’s images at this stage may tell a different story, one that may say, “Wait, I am not ready! or I am afraid!” Lastly, when it comes to assessment at this stage, while the art may help us see our clients relationship and effects of the eating disorder, it is critical to note that art should be part of a wider assessment and that the assessment of the image is best done by client- not clinician.
The next stage is preparation and is all about looking. By looking I mean looking forward, planning and identifying roadblocks. At this stage clients can begin to ask the question, “What might my life look like with out this problem?” Also during this stage art making can be use to create a literal road map, including physical visions of the future. This may be a great time to ask clients to make a vision board or create a shield of strengths to help their along their journey toward recovery.
Next comes the stage of action, or the working stage of therapy. In terms of art I think of this stage as the time of making and building. This is a time of great movement and change; often clients are doing deep work and taking many steps forward and backwards. At this stage clients may make and unmake images. It is a great time to help clients become experts of their emotions by having them draw- out an image of feelings. It is also a time where depending on the therapeutic setting clients can go deep, but it is important to create containment. Much like the words our client shares, we must also honor and listen to what their images say. When images seem particular powerful it may be important to ask about the content or assist clients in creating containment for the image, this is particularly important in trauma work! Lastly comes the stage of maintenance, this is a time of witnessing, and potentially becoming transitional objects. At this stage clients may be ready to move into a stage of less intensive need for therapy. During this stage as a clinician you are focusing on closure, planning, and prevention. During this stage you may also be looking back over past art works and reflecting on progress. This stage is a good time for making images of the future and of symbols that may trigger or prevent relapse. At this stage art is a great way to say, “ Look and see all of the hard work than you have done!!”
In conclusion this is only a very brief example of all the ways that art therapy and the art making process can be used to treat eating disorder at the various stage of recovery. When it comes to the treatment of eating disorders if we can draw-out hope and paint new possibilities for life, we can move one step closer to recovery and healing for our clients and those who love them.
Individual (s) has been de-identified in this article to keep confidential their privacy.
To learn much more about Art therapy as an intervention tool to access voice and healing for individuals struggling with eating disorders, join us on August 15th, with Art Therapy Expert, Megan McSwain for Drawing Out Hope: Utilizing Art Therapy for the Treatment of Eating Disorders. Register Now.