Contemporary Art Therapy with Adolescents. Shirley Riley

be ignoring basic facts of adolescence.

      Three self-portraits by girl with esteem problems and identity confusion

      Figure 1.6a ‘Me’#1

      Figure 1.6b ‘Me’#2

      Figure 1.6c ‘Me’#3

      It seems strange to an adult who is not part of the adolescent world, that parents often sacrifice essentials to buy their son a pair of expensive athletic shoes. To the outsider the shoes do not appear to be any different than a less expensive pair, but the label is the child. I had a thirteen-year-old boy in therapy at the clinic, who carried his expensive athletic shoes with him in his back-pack. If he wore them he might be beaten and robbed by the local gang, but just to own them gave him status in his eyes.

      Metaphorical communication

      Finding a metaphorical idiom is at the heart of intimate clinical understanding and personalized dialogue.¹ Sims and Whynot (1997) explore the use of metaphor as a technique for recognizing and learning to employ a neglected linguistic resource. The metaphor is an aid to elaborating and making sense of the narrative. They suggest that ‘we postpone “making sense” and take time to explore the imagery being used and expand the range of association from which meaning will arise. In the narrative mode, meaning is not a destination. It is a process. The goal of our inquiry is not to arrive at knowledge but to cultivate understanding’ (p.343).

      Adolescents are constantly using their own individualized metaphors. They would much prefer to find their way in this mode, than to be confounded by adult grammatical rules. Metaphor is another aspect of their creativity applied to communication. This preference serves the art therapist in providing individualized treatment. Art therapy has always sought and utilized metaphorical communication inherent in the art product. Art makes it easier to enter into the range of associations that are embedded in the image. This is done by validating the image, staying with the imagery, rather than assuming knowledge of the meaning. Adolescent clients are comfortable talking through the metaphor. Their creativity embraces this artistic variation on mundane communication and they enjoy elaborating a narrative through an allegory.

      Resistance to revealing the content of the drawing should be expected from the adolescent, and, generally speaking, is appropriate. Resistance should be reinterpreted as appropriate withholding of private revelations. That is the rationale behind the use of metaphor, a way to circumvent disclosure and still have a meaningful dialogue. Most adolescent clients have had so many unfortunate and disappointing interactions with adults they have every right to be cautious about trust. The youth that reveals his/her secrets immediately is less appropriate than the reluctant sharer (Rinsley, 1980, p.7).

      Distancing, trust, and timing

      The early alliance between therapist and adolescent should be built on inquiries that are ‘once removed’. An adolescent will cooperate when you ask, ‘If you were reporting on your age group, what is the major issue most kids would be worried about? Illustrate this concern for me, to help me understand’. The therapist is asking about a broad issue where the client can act as an ‘expert’, and inform the therapist. S/he can deny that the subject under discussion has any personal significance. Exploring a topic by relating it to the art, not the client, reinforces the comfort of distance. An art therapist has the option of keeping his/her eyes on the drawing, and thus gracefully avoiding direct eye contact, which is often discomforting to the teen. If the therapist asks questions about personal matters early in the relationship the adolescent will be ill at ease and probably not respond. If general questions are proposed, the youth can reveal him/herself ‘behind’ the guise of the ‘other’.

      This way of working is in contrast to the more structured art therapy approach which has a pre-determined protocol set for establishing a therapeutic relationship. Having a progression of ‘directives’ provides comfort for the therapist, it does not necessarily fit the adolescent client in treatment. I believe that assessment procedures should be separated from the art therapy relationship. The teenager flees from confrontation, and is suspicious of any form of adult-driven directive.

      For example, a girl in middle school made a ‘scale of importance’ drawing. She felt that for most adolescents clothes and musical choices were a number one concern. She drew this most prominently on the page. Being ‘smart’ and going with ‘smart kids’ was her second choice; friends that you can trust followed. Only at my suggestion did family get on the list at all. I inquired if family meant a lot to her and her friends, she replied, ‘not really’. This child was from an intact and supportive family, and I believe that her relative disregard of the family was not only age appropriate, but demonstrated her assurance that they would be there when called upon. It would have been a mistake to judge her values and introduce some notion of pathology based on some theoretical evaluation.

      In many cases, the less sturdy the family relationship, the more frequently distorted family images are shown. For example, the family may be scattered all over the page with no interaction demonstrated; important members may be left out; or actual physical confrontations may be pictured. This often reflects the anxiety the child feels about permanence and security, or other family dysfunctions. An exception to this observation is the child that is totally abandoned. S/he may never cooperate with creating a family drawing because it is too painful to face the complete loss. All these variables invalidate a set interpretation of adolescent drawings.

      Figure 1.7 12-year-old projects a ‘divorce’ day at court

      Through the form of creating ‘once removed’ illustrations, and talking about ‘other kids’, it often becomes clear that the ‘other’ and the client are one. Even this interpretation should not be made with a feeling of certainty. This age group is very wise and s/he may be talking about concepts and abstractions rather than being self-revealing. Time will confirm the individual reality of the client. When there is a greater understanding of the youth in treatment the time will come for problem solving. Through illustrating concerns and stories with many alternative outcomes, a preferred conclusion can be created. If the adolescents can picture an alternative, then it stands to reason that they have a concept of success that can be activated and reinforced. Without a vision of change a positive therapeutic outcome is a very difficult challenge.

      Being ‘right or wrong’ should not be an over-riding concern in the therapy of adolescents. Following a narrative form of therapy, the most important concern is the discourse. What the story contains is what the client is willing to let another person know about his or her self. By continuing this form of ‘story telling’ dialogue the child will begin to feel safe as s/he teaches the therapist about issues of adolescence.

      Handling proscribed therapy

      I want to emphasize that there is a tremendous difference between adolescent youths who have had some stability in their lives and those who have not. Cobb (1996) examines the tremendous impact that loss or thwarted attachment from primary caretakers has on adolescent development. The losses experienced in childhood remain operative in adolescence. When the youth becomes overly anxious and has no attachment figure to turn to, the distress is heightened since they are reluctant to signal for help (p.62). There are also great differences between compliant adolescents who have been educated to accept the concept of therapy as a help, and those forced into therapy more as a punishment by courts or societal institutions. The youth who has to be in therapy will most probably see it as a point of honor not to be forthcoming. The youth who has been in therapy since s/he was a youngster, because either the parents or the system has attempted to have a series of therapists substitute for family, are also extraordinarily guarded and resistant.

      It is perfectly reasonable that during the period when a child is forming an identity, when they are searching for role models and