Contemporary Art Therapy with Adolescents. Shirley Riley

receiving art therapy and other services through a drop-in center in an urban setting. All of these adolescents live on the streets, some choosing to leave home and family and others neglected or abandoned by parents or caretakers. They invariably reflect the predominate issues of today’s youth – drug abuse, gangs, crime, sexuality, and social problems.

      Many of the earlier writings on adolescent development and treatment that I found useful during my first experiences with young people are no longer practical in addressing the problems I see before me each week. Luckily, Shirley Riley has synthesized her vast clinical experiences with adolescents into a wonderfully pragmatic, insightful, and realistic text which addresses contemporary adolescence and today’s priorities in adolescent treatment. While other authors have described the use of art therapy with adolescents, Riley goes beyond classic and often outdated developmental and psychological theories about adolescence and takes a refreshing look at adolescent therapy within a contemporary context. The significance of societal, cultural, and familial is emphasized along with the importance of narrative approaches, post-modern thought, and short-term, solution-focused treatment. Riley also infuses a variety of salient clinical issues such as distancing, reflecting, and timing in adolescent therapy, addressing and respecting metaphorical communication, and understanding the therapist’s countertransference or ‘entanglements’ that inevitably arise when working with adolescents. Additionally, the reader is treated to lively case descriptions and practical clinical applications of art therapy in adolescent group treatment, adolescents and family therapy, inpatient and outpatient populations, residential programming, school settings, and a wide range of individual treatment situations.

      Art expression is a rich window to the world of our clients, but with adolescents it sometimes may be the only window available to us. I find, like Riley, that working with adolescents involves identifying and understanding the cultural differences between adults and young people. In this sense, all therapeutic work with adolescents is multicultural. We sip our morning tea, answer our e-mail, think about contributing to a retirement fund, and attend professional development seminars to enhance our skills; they watch TV, worry about rock concert tickets, and think about body piercing. Other adolescents have more serious cultural concerns such as pressures to take drugs, whether or not to engage in sexual activity, or survival in neighborhoods fraught with violence or gang activity. Many of the adolescents I work with identify themselves with internalized cultural images such as ‘gutter punks’, ‘street rats’, or ‘coke heads’, or have created names for themselves such as ‘Bones’, ‘Terminator’, or ‘Cutter’, indicative of their self-concepts and world views.

      As a therapist and an adult outside of the teenage culture, I can only hope to begin to connect with these adolescents if, as Riley notes, I can see treatment through multiple lenses: regional, urban and/or suburban, socio-economic, race, ethnicity, and culture. Rather than clinging to the notion that adolescence is a series of predictable tasks, it is more helpful to take a post-modern stance which honors context and personal perspectives in addition to developmental issues. Art expression is one of the few ways that a therapist can begin to recognize these cultural differences and utilize the multiple lenses available for understanding. It is one of the few means through which many adolescents feel comfortable sharing the impact of culture and society, gender and family.

      The contents of this book and observations by its author are refreshingly realistic, reflecting both the successes and failures inherent to adolescent therapy. Adolescents are undeniably unpredictable, no matter what their life circumstances or background, and therapists, no matter how skilled, are consistently confronted by unexpected or unanticipated responses and behavior. In reading the cases described by the author, those who work with adolescents will be confronted by their own experiences with adolescent treatment and the difficulties of art therapy with this population. I was reminded of a recent encounter I had with a fourteen-year-old boy in my practice for the first time last month. During our initial session he asked me about my sexual activity with my husband, demonstrated his ability to burp and create other gastrointestinal noises, attempted to rummage through a file cabinet, and then asked me if I could drive him to a local ski resort at the weekend. While some teenagers may give the therapist the silent treatment, others, like my young client, may test interpersonal boundaries and ultimately the therapist’s patience.

      When confronted with unpredictable behaviors that can frustrate even the most skilled therapist, we often wonder if it is possible to build a relationship with the troubled adolescent before us. Certainly, as demonstrated throughout the pages of this book, art is an amazingly effective and potent way to begin the process of creating a meaningful bond between the therapist and adolescent client. However, what Riley emphasizes is that it takes more than simply offering art expression to establish a relationship and eventually initiate change and growth. Respecting adolescent clients as experts, recognizing cultural, societal, and economic backgrounds, and responding to their unique world views form the basis for Riley’s approach to intervention. These are necessary components to successful treatment and the development of rapport and by using art therapy as the vehicle, the therapist is able to establish a lasting relationship necessary to successful adolescent therapy.

      Lastly, Riley’s book is not about diagnosis and assessment per se,but is about developing a positive and productive therapeutic structure for exploration, change and growth with adolescent clients. Descriptions of strategies in this text do not correspond to specific diagnoses; rather the therapist takes a creative approach dependent on the pace of the relationship, interactions between therapist and client, and personal needs of the adolescent client rather than a diagnosed pathology. First and foremost, the adolescent’s view of self and the world and unique life experiences as expressed through art and image dictate what the therapist must do in order to be of service.

      Most importantly, however, this book finally brings adolescent art therapy into the post-modern world where brief, solution-focused treatment is a must. Riley skillfully and cogently demonstrates the importance of contemporary theories of therapeutic intervention and adolescent development, taking the reader through numerous case examples which integrate contemporary theory with actual clinical practice. The richness of this book is enhanced by the variety of settings and adolescent populations presented, offering both the beginning and advanced therapist methodology, strategies, and advice which will enhance their clinical skills and expertise in work with a variety of adolescent populations.

      It has been wisely observed that ‘therapy with adolescent often requires a departure from traditional talk therapy’ (Sommers-Flanagan and Sommers-Flanagan, 1997). Effective work with adolescents requires the creativity and flexibility of therapists and the usual approaches to intervention and treatment may not always fit. Hardy (1996) concurs, summarizing therapy with adolescents as follows: ‘Therapy has to be about creating, and then holding, a connection’ (p.55). As an art therapist I can’t think of a better way to describe the power of art therapy as a modality with adolescents and I can’t think of a more accurate way to describe what Riley conveys in this book. Adolescence is a period of the life cycle dedicated to creating and adolescents are busy with the tasks of shaping identity, experimenting with relationships, and formulating ideas, beliefs, and world views. It is also a time of enhanced creativity, making art expression a natural and effective way to establish a connection with adolescents. Engaging their interests and talent for creativity is one way of few ways to reach this population and overcome the resistance to traditional therapy common to adolescents in general. Art therapy, as Riley persuasively demonstrates, is unquestionably an effective means of engaging this difficult population and of establishing and maintaining a connection which is therapeutically meaningful and productive.

      Cathy A. Malchiodi, MA, ATR, LPAT, LPCC

       Director, Institute for the Arts and Health, Salt Lake City

      Introduction

      Figure 0.1 16-year-old adolescent male, self-portrait

      This book on adolescent art therapy treatment looks at the difficulties of adolescence through a contemporary lens. The text will bring the reader into the real world of clinical practice. It is directed to meet the needs of the practicing clinician and