Contemporary Art Therapy with Adolescents. Shirley Riley

the challenge of adolescent treatment. The following chapters record my clinical experiences, my reflections on adolescent treatment; and how I integrate art theory and practice with post-modern approaches to therapy. I speak to therapists, who, like myself, are interested in a pragmatic and theoretical re-evaluation of the merits of art therapy as a successful therapeutic intervention.

      The reflections and practical experiences that are offered throughout the text will demonstrate how, where, and why certain clinical art therapy tasks were selected to accomplish therapeutic goals.

      My philosophy embraces the notion that uncertainty and flexibility are positive traits for the ‘adolescent’ therapist. These traits are seen as an extension of a social constructionist belief system. By that I mean that the adolescent client is viewed in the context of his/her environment and included in the co-construction of the treatment goals. The teenager is encouraged to illustrate his/her perceptions through art tasks, and their narrative is respected. The results are positive.

      Uncertainty should apply when attempting to predict the patterns of adolescence; some youths are moving with ease through these years, some are caught in a fatal trap that leads to despair. Who is the adolescent we talk about, and what are his/her concerns? Adolescence is not the same from month to month. This creative, inventive segment of our population is in flux, and they capitalize on their fluidity. They move in a manner of weeks from one ideology to the next, from one form of self-expression to a contrasting form. We scarcely can keep their vocabulary straight, and we often are incapable of understanding their belief systems.

      Because a high percentage of clinical cases deal with the problematic adolescent, there is a necessity for a book that will address the practical and challenging needs of art therapists in the ‘trenches’ with the teenagers. In my opinion, authors who address the adolescent’s problems solely from a theoretical base, do not appreciate that there is no single theory that suffices. Many of the workable approaches with this age group come from experience and the ability to take a larger view of theory and bring it into the here and now of treatment. The art product is often interesting and conveys a message of meaning, but the process of arriving successfully to the point of making art, has often been neglected. The manner in which the therapeutic process must be individualized, and the belief system of the therapist, is of primary importance with an adolescent population.

      When talking about adolescence we should make it clear in what context we are placing the youths and which segment of this population we are addressing. Are we discussing all of Western society’s teenagers (rich, poor, educated, deprived), or the small segment of adolescents that pass through the doors of a mental health facility? Are we seeing the teens in an outpatient, inpatient, or day treatment center? Does the therapist like working with this population, or is s/he forced by circumstances to take a job that requires providing adolescent treatment?

      I bring forth these concerns because I believe that a clinically directed text has a tendency to use the term ‘adolescence’ in a manner that might be construed to mean most young people of the ages between ten and twenty years. The fact is, a text about therapy is focused only on the limited percentage of teenagers that have not been able to weather the storms of adolescence. These youths have experienced complex stressors that have diverted them from the normal developmental progression. Our task, as therapists, is to do our best to confirm their inner strengths and search for outside support systems. The goal of therapy is to find ways that will assist them to compensate for their distress. Not an easy task considering the complexities of society in the twenty-first century.

      A lens on development

      When I started to see teenagers through a lens that separated puberty from adolescence it helped me to establish a therapeutic relationship. By that I mean I recognized that there is a difference between physical growth and psychological maturation. Physical growth starts when the biological key turns on, and continues until the hormones and genetic patterns call a stop. Sexual drives, body changes, cognitive potential, all proceed at the individual pace of each child. No two teenagers are on precisely the same path of maturation. I no longer evaluate the teen chronologically, I consider him or her developmentally.

      Ideally the psychological growth is supposed to maturate in a synchronous fashion with the physical growth. In many cases, this does not happen. These are the young people we see in our practices. The two aspects of adolescence are ‘out of kilter’. We see great, tall boys, needing a shave, who relate to the world like ten-year-olds. We see buxom girls, fully matured physically, with the conceptual skills of pre-adolescents. We also see the baby-faced teen, who as yet has no secondary sex changes, who is miserable because s/he has not started the maturation of puberty. Their sophisticated intellectual abilities and psychological insights are not appreciated. Add the complexities of the family life, the socio-economic deprivations, the pressures of the peer group, and the chaos of the school system, and you have the adolescent client.

      The purpose of this text

      Bearing in mind the complicated challenges that these youths present to the clinician, as well as their natural reluctance to communicate on an intimate basis with any adult, how can therapy help? My goal is to share some of the successes I have had and reveal some of the failures. I offer utilitarian approaches to working in the real world with families and their adolescent children; clients who are not in therapy to ‘grow more aware’, but to solve real, everyday problems and get on with their lives. The problems sometimes are too much for therapy, and we have to turn to the social system for support. However, if the therapist sees the client through the lens of a ‘development skewed by circumstances’, and not as a pathological symptom, even small interventions can help. Solution-focused therapy takes advantage of small alterations to instigate greater changes.

      Clinicians in the field who are struggling to help teens bridge the gap between adolescence and adulthood in these difficult times, can apply some of the suggestions in this text. Through their own creative experimentation, therapists will be able to modify and build upon the work I have done. Many of our most resistant youths are being counseled by the least experienced therapists. Neophytes are forced to work where the jobs are, they need practical ideas structured to address the problems that they see daily. The more experienced clinician, who chooses the adolescent field by choice as I have, will resonate with some of the case examples and recall his/her own success and difficulties with this fascinating period of human development.

      Art therapy

      Art therapy is not an exclusive modality; it offers many positive opportunities for a wide variety of clients and therapists. It is a great way to get past the initial wall that surrounds the troubled teenager, and a fine therapeutic tool to encourage the story the youth would like to tell. Adolescents want to let others know how ‘screwed up’ they find the world, but they do not trust enough to use words. They can more comfortably employ the silent form of communication through images. As long as they are not pressed to talk, paradoxically, they will. The art form is safe and under their control.

      This book was written to be useful for art therapists and clinicians from allied fields. I believe that professionals of all helping disciplines often find some of their clients create graphic expressions. Whether or not the therapist deliberately encourages artwork, the teen will often make drawings and scribbles in the session. Some marks cry out to be acknowledged, others are defenses to avoid talking. It seems obvious to me that to pretend that this tool of communication belongs to one discipline exclusively, makes little sense. When the therapeutic qualities, inherent in creative expression, surface and become a challenge to the therapist, the advice and support of a trained art therapist can be utilized. Just as I have benefited from the psychological theories of verbal therapists, I hope our friends in allied professions will benefit from learning about art therapy. Art therapy synthesizes verbal and non-verbal communication.

      Therapists often are shy about labeling themselves as creative. I challenge that notion. Doing therapy is creative and, at best, artistic. Creative therapists can use art therapy to make visible the clients problems. The client ‘sees’ his/her problem and has an opportunity to solve it creatively. Art therapy, in my opinion, is a co-constructed fusion of theory, process, therapeutic relationship, and the client’s self-interpreted illustrations of their difficulties.

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