1A Addiction & dual-diagnosis treatment, art therapy intervention.

Art Therapy Intervention for Dual Diagnosis Treatment:
Recovery Map
Brandon Bruce Dellario LMSW LASAC

“Art therapy can often assist a chemically dependent individual to work through defense mechanisms that distort his or her sense of self and life circumstances.
”(Hanes, 2007)
     Therapeutic theories and techniques are significant to the method one administers an art therapy activity.  I myself have schooling and 5 years of professional experience in the field of mental health and addiction treatment.  I am also an artist who works in 2 dimensional media.  For the purposes of imagery to display my subjective experience in the following project, I will not refer to myself as “this clinician, practitioner, worker” or otherwise.  I will steer clear of clinical language unless necessary, in which case I will explain its’ meaning.  This I do in the spirit of humanizing the catalog of my own social science practice.  It also serves the purpose of de-mystification of the process involved.  Names and other identifying information of participants will be kept confidential.
     Let’s begin with the project at hand.  There are some art therapy activities using 2D art materials we have learned about such as:  Bridge drawings; abstract drawings of emotional states, memories and self-portrait; experimental, multi-media watercolor painting; and sandbox drawings in representation of the found object’s placement on a surface.(Walker, 2011)  In speaking with a colleague about this project, I came to understand the boundaries and freedoms in creation of an expressive arts therapy project.  She gave me an idea that I used in the first portion of an art, drama and movement activity.  My population is adults in substance abuse recovery.  I chose 2 men in their late thirties and early fourties, both clean, living in an adult foster care home.  One man in his 4th year of recovery, one in his first year.  I will refer to them as 4 and 1 in the rest of this paper.  They both are dual diagnosed (mental health and substance abuse recovery).  I chose not to focus on their specific mental and emotional conditions, in fact, we did not speak of any clinical diagnoses. 
     Pulling markers and paper out onto the table instantly drew them in.  I simply asked them to draw the disease of addiction.  The purpose of this activity was to get them thinking about what it is they are recovering from.  It only took them 5 minutes or less to put it down on paper.  4 drew a red face looking straight at the viewer, speaking negative messages.  1 drew a spiral which he described as “going down.”  I explained to them that this was a warm-up exercise to get the creative juices flowing.  We started to converse about the art pretty naturally at this point which made it a great ice-breaker.
Materials/Method
     Next I gave them another sheet of paper, provided a number of different colored markers, pencils and pastels and asked them to draw a map of their disease and recovery.  I explained to them that this activity is a take on the expressive arts activity called “life map.”(Walker, 2011)  I let them know they could do this however they wanted, and could use varied lines, colors, numbers, symbols and words to describe parts of the map.  The purpose of this exercise was to allow the participants to look at their own path into and out of addiction.  The expected outcome was that the participant would find their inner thoughts and feelings regarding addiction and where they find themselves now in recovery.  The term ‘addiction’ can of course be interchanged with ‘substance use’ or ‘abuse’ where appropriate.  These two (1 & 4) took more time in drawing the maps and thinking about them as they worked.  4’s map looked like many of the maps my fellow students did in our art therapy class, a single line with a beginning and ending.  1’s map was just a large spiral, but this time in red as oppose to black, and with a line going from the center to the outside. 
In the final part of this activity, I asked them to physically walk out their map with us following behind them.  I again told them they could do this however they wanted, while giving them some examples of how others have expressed themselves in doing it in the past.  4 wanted to start.  We placed our hands on his shoulders as he walked us along in baby steps.  He was so very animated with jumps, crouches and other unique movements, as well as telling us the story in a dramatic fashion all the while. 

Evaluation
     “Art therapy can provide numerous benefits for clients with chemical dependency and for their families.  Art therapy offers a an approach for bypassing denial and other defenses commonly used by substance abusers – this helps to open avenues for the identification and communication of feelings (Albert-Puelo & Osha, 1976/1977).  Naumberg (1966) has emphasized that putting mental representations in graphic form presents a space for the expression of the client’s important qualities, strengths and struggles.  In substance abuse treatment, this material becomes available for processing and creates an opportunity for the art therapist to facilitate the eventual transformation of mental representations that lead to maladaptive behaviors.  Addressing relationship issues arising from insecure attachment is an important aspect of this process because of the ability to seek support from significant others is crucial to recovery.”(Francis, 2003)
     The jist of 4’s story revolved around one of his first best friends who treated him very poorly.  He went on to talk about this for over an hour afterward.  It must have unlocked the memory of things he hadn’t thought of in a great while.  He was not overly emotional or torn about the subject, but seemed glad to put this piece into the puzzle.
     1 didn’t seem to want us touching him, so he asked to simply explain his map to us, although he was very engaged in the activity.  He told us about the woman that he once loved long ago, and eluded that there was a painful ending to that relationship.  Then he spoke of his new life in recovery as if things are pretty good now in his life.
     I remembered to take time to listen to each of them and ask questions, as to give them time to process what was going on.  The content of our project outcome made perfect sense to me.  These are two men who are healing, focused on good decisions and have begun to put their lives back in order.  I could see it helped them to organize some thoughts, if not more.  They also thoroughly enjoyed themselves.  I gave them a pack of the markers and asked them to keep up the art.  I look forward to using similar art therapy techniques in the future with clients who are in earlier stages of change, such as the pre-contemplation and contemplation stages where one might not be actively making changes or at least not by personal choice.  I believe, as with many therapeutic techniques therapists and counselors use, these and other expressive arts therapy techniques proplerly utilized can lead a client to their own inner truth.