Brandon Bruce Dellario LMSW LASAC
“In contrast to the impact of dysfunctional and broken families, parental drug and alcohol abuse, or neglect, art education may seem inconsequential. Yet, evidence suggests this may not be so.
”(Venable, 2005)
There are many professional journal articles on expressive arts therapy in regards to addiction and substance abuse treatment. However, few studies have the in-depth, qualitative research and evidence-based information clinicians now need on this subject. Most published research on art therapy has been in its use with children, not adults. Also, art therapists generally categorize their practice as more of a humanist venture than a science. Some postulate that all research regarding therapy can only be understood in subjective experience and documented as such.(Kellman, 2008) Clinical diagnoses, along with other black and white scientific terminology which liken human conduct to that of a lab rat, appear to be on their way out, at least in this small gamut of the social science spectrum.
Current substance abuse treatment is widely known for its small percentages of successful outcomes and high drop-out rates. Research shows that specific individual needs need be addressed in the substance abuse treatment population. These needs can vary from client age, gender and ethnicity to medical, mental health and resource concerns. The need for alternative treatment modalities is obvious and many are looking to avant-garde therapeutic models for the answers. Authors whom I have found most prolific on this subject of expressive arts therapy for substance abuse treatment are Karen Sharf Phd from the New York University School of Social Work, and Julia Kellman, author for The Journal of Aesthetic Education. These two scholars have a firm grasp on this small but developing field. The previous introduction and following body is in-part based on, and greatly inspired by their unique voices.
Substance abuse prevention and treatment are essential areas of concern in the United States itself. Every dollar spent on substance abuse treatment and prevention saves taxpayers $7 to $9, which otherwise would have been spent in the criminal justice system toward drug-related crimes. While the US government spends 12 billion dollars annually on the “war against drugs,” it most greatly utilizes a punitive system for drug crimes which constitutes 60%-80% of the 1.8 million people currently incarcerated.(Sharf, 2004) Additionally, this figure (60%-80%) is the same percentage of Americans with mental health challenges who suffer with substance abuse disorders. That being said, it is evident that the disease of addiction and other substance use, induced and abuse disorders are of prime concern to the domain of human services and contemporary society at large.
Expressive arts therapy is a continually growing and vastly dynamic field of therapeutic treatment. Addiction recovery and therapy itself have both been known colloquially as “an inside job.” Some theories regarding the etiology of substance abuse view addiction as a “self-destructive behavior that is reflective of internal struggles.”(Sharf, 2004) Art therapy has been known to help those who suffer with post traumatic stress disorder (PTSD). 25%-50% of female substance abuse patients who find their way to treatment suffer with PTSD.(Sharf, 2004) The number of chronic substance abusers who have experienced some form of trauma is far too high to ignore. Some statistics say 80% or more. Art therapy, while known to support clients on a path of recovery, has also proven to “reduce professional ‘burnout’ often associated with the treatment of substance abuse.”(Sharf, 2004) Clinicians can use various art therapy techniques which focus on issues of countertransference.
A key factor in clinical use of expressive arts therapy directed toward addiction treatment include the formation of a therapeutic alliance, which can involve a clinician’s use of: Empathy; active listening; open-ended questioning; unconditional positive regard; creating an environment of safety, security and acceptance; informed consent regarding roles, contract and confidentiality; establishment of trust which is often equivalent to the client’s length of treatment; and the client’s expression of drives and associated wishes.(Sharf, 2004) Many of these necessary factors actually become easier to accomplish when art materials are present. In fact, once a client has drawn, painted or otherwise expressed a part of themselves tangibly, its’ reality cannot be ignored. The subject can more easily become present in discussion, and that previously expressed part of themselves is more difficult for the client to ignore or disregard.(Sharf, 2004)
Three of the biggest evidence-based modalities for substance abuse treatment are 12-step mutual-help programs, cognitive-behavioral therapy (CBT), and motivational interviewing (relative to the appropriate stage of change). In spite of the overwhelming popularity of these addiction treatment methods and the myriad of techniques within, related expressive art therapies are almost non-existent.(Sharf, 2004) There are visualization, meditation and similar therapeutic activities involved in CBT. There are also scattered projects regarding visual representations of the 12 steps and so on which have become somewhat popularized.
Still, why this historical lack of creative energies concerning substance abuse treatment modalities? Is it because of the stereotyped population of non-compliant, low-motivated and often involuntary substance abusing clientele (insert other cliché terms for “we’re doing something wrong with this person”)? This population is known as being difficult to work with among clinicians, and clients do require knowledgeable professional care, but does that mean we can’t utilize creative freedoms within treatment? The challenges professionals often face with treatment of substance abuse populations may have less to do with a, “problematic population,” and more to do with the traditionally rigid approaches most commonly used. Albeit the disease of addiction is cunning, baffling and powerful… progressive, incurable and fatal… we do know from documented treatment outcomes, therapy can help. How can we incorporate creative freedoms into an individual program of recovery?
Creative freedoms have certainly been left out of many public schools in contemporary America. Were the arts disposed of, thrown to the wayside in our narrowed aim at a media propagated, corporate identity and political profit margin? Were they disregarded as something un-needed, or simply left alone for too long and forgotten? Many people feel they are personally energized by using their imaginations in day-to-day activities. Some folks have great fun being creative which sparks interest, shortens long days, and makes life worth a struggle. Struggles can be common in recovery from the disease of addiction. What can we do to make our own or the struggles of others bearable?
Natalie Rogers expresses radical artistic notions in her book, The Creative Connection: Expressive Arts as Healing. She calls the arts, ancient forms whose practice bring balance and harmony into our world. It sounds like they must be invited and utilized to be effective. Rogers incorporates the person-centered or client-centered approach in art therapy. This approach was created by her father, Carl Rogers, whose teachings are widely hailed and frequently used in the mental health field today. In fact, Rogerian therapy and principles of practice are the essential methods in the recovery of our mental health system. This is a system transformation which materialized in the late twentieth-century and continues today across the country. It, like Rogerian theory, is focused on client respect, worth, dignity, potential and the facilitation of growth.(Rogers, 1993) Although there are many bridges to cross in implementation, its growth has been quick and expansive. This “recovery transformation of the mental health system” involves programs for peer support services, person-centered planning, self-determination, supported education/employment and various other services aimed at supporting self-direction. What better way to allow a client self-direction than offering them alternatives to how they may express themselves in treatment?
Check out these amazing Expressive Arts Therapy Videos (listed below), studies show that many of these alternative therapeutic techniques we seldom hear about are indeed evidence-based:
- Bill T Jones with Bill Moyers: Still Here (choreography and dance with terminal patients)
- Gabrielle Roth: The Wave (The 5 rhythms of movement)
- Gabrielle Roth: I Dance the Body Electric (conversation about her work)
- John Fox/John Graham Pole: Healing Words, Art and Medicine (creative expression at Shands Hospital, Florida)
- Of Sound Mind and Body (survey of music and vibrational healing)
- Sharry Edwards: Sonic Apothecary (Bioacoustic Sound)
- Kurt Toftin: Shakespeare Behind Bars
- Natalie Rogers: Creative Connection
- Shands Hospital Arts in Medicine Program, Florida: Color My World
Francis, D., Kaiser, D., Deaver, S. (2011). Representations of attachment security in the bird’s nest drawings of clients with substance abuse disorders. Art Therapy: Journal of the American Art Therapy Association, Vol. 20, #3, 125-137.
Hanes, M. J. (2007). Face to face with addiction: the spontaneous production of self-portraits in art therapy. Art Therapy: Journal of the American Art Therapy Association, Vol. 24, #1, 33-36.
Kellman, J. (2008). A place for healing: a hospital art class, writing, and a researcher’s task. The Journal of Aesthetic Education, Vol. 42, #3, 1-14.
Kellman, J. (2008). HIV, art, and a journey toward healing: one man’s story. The Journal of Aesthetic Education, Vol. 39, #3, 33-43.
Rogers, N. (1993). The creative connection: expressive arts as healing. Science & Behavior Books, Inc., Palo Alto, CA.
Sharf, K. (2004). Art therapists’ perceptions of their work with patients in treatment for substance abuse: a qualitative investigation. New York University School of Social Work.
Venable, B. (2005). At-risk and in-need: reaching juvenile offenders through art. National Art Education Association, Vol. 58, #4, 48-53.
Walker, G. (2011). HOL 5500: Introduction to expressive arts. School of Holistic Health, College of Health and Human Services, Western Michigan University, Summer I, 2pm-4:30pm.
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