|
Alessandra Colfi, Ph.D.(c)
~ Expressive Arts Therapy with Developmentally Disabled and psychiatric Adult Clients |
~ Peter London |
Title | Content | Introduction | Why a web-based Dissertation | Review of Literature on Empathy | Story Telling | Cancer Patients | Developmentally Disabled | Bibliography |
University Community |
July 23, 2009
A Moment of Wonder I was invited to see the art exhibition by TERI’s developmentally disabled adults (affectionately called 'guys') in the Art Enables Program a few months ago; it reminded me of a challenging time working with them in 2007 - and of how instinctive it is to work with them. I could notice when I was present with them 100% and when I was instead distracted with other thoughts, at times tuning out or discouraged by how difficult it was to motivate and engage them, even when proposing something playful and easy. One day something I could call 'intuitive miracle' occurred while I was working with one of the ‘guys’ whom I name here Clayton, to protect his privacy; it was a special moment of stopping and letting observation and intuition be my guide. Clayton is an adult with severe developmental disabilities, blind and deaf, and very spastic in his hand movements. What am I supposed to do here? How can I engage him? - I asked myself …then I noticed that Clayton was bringing each object he had in his hands to his nose and smelled it, and then he was somehow trying to somehow use it …so, I thought of trying something new: I got some aromatic scents (candle and soap scent at the craft store) and the next time I had a session with him, I filled a palette with a different color paint in each well and dropped a tiny amount of scent in each well, trying to associate each scent with a color ( brown=cinnamon; red=berry; yellow=vanilla; etc.), mostly to help me be consistent with the color/scent combination, when it came the time to refill the wells with paint. Without hesitation, Clayton brought the tray to his nose, smelled each color and dipped his paint brush in each color, smelling and choosing the color he wanted…he kept on smelling and painting for a whole hour, without interruption; it wouldn't had stopped if it wasn't for keeping up with other scheduled sessions. ~ Mary: a developmentally disabled, psychiatric Client,
severely abused
1st Session
Mary came to meet
me with Julie, Director of the Day Program;
Mary was very polite and we shook hands, introducing each other;
good eye contact; she asked me if I knew her foster sister. While Julie
was talking, she kept her head tilted forward, looking down.
She showed
interest and eagerness to make art; she helped setting up table and
chairs in the room and watched as I was setting up our art station and
helped a little. Mary said she would show me later where the bathroom
is, if we needed more water for our painting – very well oriented to
person and place.
As a first
session, I offered a variety of materials to give Mary the opportunity
to express likes and dislikes and to see what medium/a she connects
with. Classical flute music in the background worked well.
As soon as I
pulled out a bag with feathers, Mary got excited and started pulling
some out and decided for 2 red ones and said ‘it’s a bird’. Soaring from
mountain to ocean, with bright smiley sunshine. She said it felt good.
Our dialog went on freedom and she seemed to connect with that idea. And
she was very pleased with her first artwork.
Mary responded
well to all the activities, handling the materials in an organized way
and acknowledging the messy glue. She was very prolific in her output,
at times, maybe because she seemed to just wanting to get through and
get onto something else.
She made stronger
connections with some of the images during the Magazine Photo Collage
exercises: she chose some images very carefully and many more
carelessly: horses, dog, a girl that ‘looks scared’, ‘but she will be
OK’; a group of people clinging to a raft in the middle of the ocean
made her find a solution for their predicament; she made a simple story
about her rescuing them with a boat. Another strong image was a girl
with boxer’s gloves on, her choice for ‘bad’; Mary expressed and
demonstrated that when she feels angry and she would like to hit
someone, she knows it’s best for her to go outside and go see the
horses. She might have
referred to a recent incident. The ‘good’ image as a contrast was a girl
swimming.
A woman on a
scale prompted her to mention about her weight. A young kid face covered
with foam from his bubble bath made her giggle, which might be a good
transition into enjoying her showers. She added sparkling confetti to
most artworks to improve the look and to fill in the blank spots – good
sense of composition and esthetic balance.
We stopped using
images and I put out paint and brushes. I prompted her to think of a
color that makes her feel happy, peaceful and she immediately asked for
some pink. So she learned to make it by blending red & white. She
painted a heart and a black spider hanging from its net. She said she
sends the spider her love. This resulted to be her favorite painting.
She made 2 more simple paintings; one of them started as a black
moon seen from different angles and added some dark blue sky; when Mary
took some distance from it, she said it looked like a crib, so she
painted a baby in it. It may be because at her foster family there is an
infant.
Love to the Spider 2nd session
Although I
always plan for specific activities to engage in each
session, I welcome input from each client and tune in to
what seems most beneficial at the moment. Mary asked me if I
had brought clay and expressed a strong interest in starting
with it.
Mary started working with clay; she
accepted and followed suggestions to keep the clay moist and
smooth, to enhance the shape, etc; simple basic techniques. At first she was moving her fingers with the clay rather quickly and carelessly, but gladly followed prompts and instructions on slowing down, smoothing the edges with a bit of water, adjusting for thickness, shape, adding clay; she stayed with it for a good 30 minutes. Peaceful music was playing in the background. She willingly tried to keep working on her clay piece with her eyes closed for a few moments. Mary said she likes to have me as a teacher and she asked me to be at her birthday party the following week. I thanked her for the invite and said that I would like to celebrate her B-day and will let her know. After her heart-shaped bowl was completed, I suggested to use oil pastel next and showed her a couple of techniques, which Mary practiced for a while. Then again, she was interested in drawing a spider and a spider web. She said a spider bit her once. She said she’s afraid of spiders. That might be a reference to her sexual abuse. Usually it takes a series of the recurring and developing theme to either work itself out or cause for direct confrontation with the issue. I will pursue this to see where it leads.
Mary followed
instructions for a relaxation, breathing and listening to a
simple, brief guided visualization; she saw herself in a
nice house and used more colors and much less black. This
could be her aspiration, but also confirmed much was just
fantasy.
3rd Session
Mary was walking
alongside a horse when I first arrived at the Day Program;
she said she got scared when she got on a horse last time
and wanted to take some easy steps to feel comfortable with
horses, since she loves them very much. Since the beginning of our session, I
found myself speaking very softly to Mary, even though I’m
aware that she has hearing impairment and wears a hearing
aid. This is a strong contrast in my mind, since everyone
around her uses very strong voices and tones, partly to keep
all the consumer under control and possibly other consumers
have hearing difficulties.
Mary started working with clay; she
accepted and followed suggestions to keep the clay moist and
smooth, to enhance the shape, etc; simple basic techniques. At first she was moving her fingers with the clay rather quickly and carelessly, but gladly followed prompts and instructions on slowing down, smoothing the edges with a bit of water, adjusting for thickness, shape, adding clay; she stayed with it for a good 30 minutes. Peaceful music was playing in the background. She willingly tried to keep working on her clay piece with her eyes closed for a few moments. Mary said she likes to have me as a teacher and she asked me to be at her birthday party on 6/16. I thanked her for the invite and said that I would like to celebrate her B-day and will let her know. Mary was pleased with the way her work was turning out and she said she wanted to give the bowl to her sister; it turned out to be a heart-shaped bowl and she was very proud of it and showed it to every one at the end of the session.
After her heart-shaped bowl was completed, I suggested to
use oil pastel next and showed her a couple of techniques,
which Mary practiced for a while.
Then again, she was interested in drawing a spider
and a spider web. She said a spider bit her once. She said
she’s afraid of spiders. That might be a reference to her
sexual abuse. Usually it takes a series of the recurring and
developing theme to either work itself out or cause for
direct confrontation with the issue. I will pursue this to
see where it leads.
After some free drawing, I announced
that we were going to do a relaxation and guided
visualization; I asked to close her eyes and my tone became
even softer, my voice almost a whisper. She followed my
instructions and was very clear in her images and intent. 4th Session
Mary was
getting a bit impatient and frustrated while
manipulating the clay, since it was hard at
first, but gently I showed her how to overcome
that problem, worked along side her for a bit
and she willingly continued.
We continued
working with clay and when Mary was done, I
asked her to go wash her hands, while I was
going to clean up our station, so that we could
start another activity. She went without
hesitation.
Clock Drawing
Test - I offered oil pastels and I asked Mary to
draw a clock. The Clock Drawing Test and
exercises are designed to assess cognitive
abilities and teach sequential, logical skills
with a visual, right-brain approach – see
pictures.
The first drawing is the result of simple
verbal instructions; it shows poor
identification of sequential numbers, but good
spatial concept and understanding.
The second time
I asked Mary to copy my drawing of a clock the
best she could and she identified and placed
almost all the numbers correctly. She was
tentative. We drew more clocks to represent and
read actual time and different hour/minute
combinations.
Mary applied herself diligently,
listening and responding and adding short and
long arrows (=hands).
The activity was apparently very intense
for Mary ; it made her very tense.
All of the
sudden she complained that her shoulder hurt,
but she finished her clock assignments. We left
the room at the end of the session and walked to
the lunch room; Mary started crying and whining
about her shoulder. Julie said she had a rough
morning, so I suggested to let me know the next
time it happens, and offered to work with Mary
on issues as they present themselves.
Mary was
shaking and whining and holding her shoulder
with both hands. I set her down and very softly
instructed her to breathe and I showed her how
to tap on her collar bones. She seemed to calm
down. Julie called her sister and Mary talked to
her, which also helped Mary regain control and
then decided she could eat her lunch then.
Mary showed to
be very happy to see me.
She asked me if I hade missed
her and when I pointed out that we
can work together as long as she
stays out of the hospital, she
offered to shake hands and said ‘I
promise, I won’t hit anybody’.
I met Mary's
new ‘mom’. Mary showed me the
backyard with the vegetable garden –
she named most of the vegetables and
the lemon tree; then she wanted to
show me her room.
showed us a good space
to work, in privacy.
Mary accepted
suggestion to use oil pastels and
draw while listening to soothing,
relaxing music.
She also drew a
picture of her new family, but at
first didn’t include her new mom ,
although Mary shows a lot of
affection for her and shows to
be very caring and thoughtful.
Mary then
requested to work with clay and
proceeded on her own for a while.
With both media she worked
rather fast and especially with
clay, she was making very rough
shapes and moving on to the next
quickly. I prompted her to stay a
bit longer with each shape, talking
about them, describing them.
She liked to get her picture
taken with all her work.
Mary
volunteered to go wash her hands
after she said she was done working
with clay.
She was getting tired faster
than usual, probably due to the
medications and to the event-filled
last few days.
I made her take a break and
helped her with some
breathing/gentle movement exercises
(similar to Qi Gong) to have her
take in more oxygen, to help her
feel more awake and energetic.
She was looking
at her hands while working and
showed me a small scar, saying it
was from a cigarette burn, inflicted
by her birth mother. She became sad
thinking that her mom didn’t want
her.
Mary was very
happy to receive a sketchbook and
markers; I suggested for her to draw
on it any time she wants, but
especially when she feels angry,
upset or sad.
I feel this new
home and new family is well matched
for Mary. Her Mom was going to get her
new shoes to help her walk better
and safer.
Mary was eager
to start the session.
She asked me what we
were going to do, so I
offered a variety of
options and Mary chose
painting.
I shared with
Mary my intention to
work together for 1 ½
hour this time and she
responded positively.
She didn’t show
to be getting tired at
all throughout the
sessions.
She painted
various subjects on
several sheets of paper:
clothing, a scene of
nature with a very solid
tree bearing fruits; she
was responsive to my
questions and prompts
for adding new element
to her paintings. She
painted herself and her
‘boyfriend’; she kept
showing me the necklace
she was wearing, a gift
from him. The theme of
wanting her own
house/apartment came up
again but she painted
her current house, with
attached her Grandma’s
house; in fact, she
wanted to introduce me
to her Grandma and talk
about her vegetable
garden.
I feel Mary is
benefiting greatly from
this family nurturing
environment.
The painting of
the house, although
simple and
monochromatic, shows
much better proportion,
lines and composition
and overall skills than
her other paintings,
usually more primitive.
Mary is showing very
good observation skills
and with painting
certain subjects, good
eye-hand coordination.
Mary showed me
some drawing she made in
her sketchbook and very
proudly the money she’s
making doing chores
apparently at the day
program and selling her
bracelets.
7th Session Mary told me she had made some money, but was not sure how much she had in her wallet, because she said she couldn’t count; I offered to teach her so we went over dollar bills and change; she’s quite confident counting bills, but couldn’t quite grasp the change. We settled on an estimate.
We are dealing
with a sense
of
frustration
and
expectations
for tasks to
be done
quickly and
move on to
the next
activity.
I’m
working on
making it
interesting
and
comfortable
for Mary to
work on
projects a
little
longer,
helping Mary
making some
considerations,
asking
questions,
modifications,
in other
words,
exploring
and playing
more fully
with the
materials.
Mary wanted to
paint; she
designed a
t-shirt for
her new
boyfriend.
She
wasn’t happy
with the
result, so I
encouraged
to paint a
new one.
In
the
meantime,
she told me
about her
new
boyfriend,
and later
she added
the previous
one ‘dumped
her’ – I
heard from
that Mary
had a first
bad reaction
to the
breakup but
she got over
it quite
quickly.
Mary
is quite
focused on
their
interactions. I brought in several sheets of smooth canvas ready to paint on, with the idea of mounting several paintings as scroll-type wall hangings in her room, but also to be displayed in the office when we have several completed. Mary completed 2 paintings very quickly, featuring recurring themes and for the first time, a church, quite dominant in the composition.
I invited Mary
to explore
with images
(Magazine
Photo
Collage)
about what
is good and
what is bad;
very
decisively
she picked a
variety of
food images,
a one dollar
bill and a
playful,
relaxing
image of
monkeys as
good things;
the next
collage
shows images
of smoking a
cigarette,
smoke,
burning and
winter as
bad things;
the next
collage is
of ‘good’
images of
people and
the last one
is of ‘bad’
images
related to
people. This
last collage
shows a
woman
seemingly
relaxing on
the sand
although
Mary said
she is
waiting for
the water to
come up and
drawn her –
Mary said
she wouldn’t
do that.
Mary
described
that the
mountaineer
is taking
the risk of
slipping and
dying; the
children
remind Mary
of when she
was baby
sitting (her sister’s
children, I
assume); the
fact that
this image
is included
in the bad
images of
people it
might be
related to
her hitting
them. Good Things Bad Things Good - People Bad -People
Mary was
getting
restless and
expressed an
interest in
exercising –
Mary and
have been
addressing
nutrition
and talking
about a bit
of belly
fat.
I
took the
opportunity
to invite
Mary to
learn and
practice
Yoga; I was
very careful
in guiding
her, given
her limited
flexibility.
She started
shaking a
bit and she
said it has
been
happening
earlier in
the day.
Drinking
water or
juice seems
to help.
joined in,
as an
encouragement,
so we went
through
breathing as
awareness
and
relaxation
and a few
gentle
stretching
poses.
Her new
mom
complained
that Mary
drew and
colored with
markers in
her
sketchbook
while in
bed, so we
agreed on
some rules
and
guidelines
about when
and where to
use the
sketchbook;
Mary
accepted and
said she
promised to
use it
accordingly.
Mary's
interactions
with her new
family are
quite
positive;
the whole
family is
very
supportive.
Mary was admitted to the hospital early in the week and upon discharge, moved with a new host family Mary arrived at the office after her day program; she had scratches on the left shoulder and shoulder blade. She later told me that one of the other consumers pushed her; she showed me a scar behind her ear, that apparently was connected with that incident, but to me seemed quite old; it wasn’t clear if they were playing or if there was some confrontation, due to the fact that Mary earned ‘a lot of money’ (?). Those two accounts seemed blending together. She also told me about her concern with the medications causing her shaking. She changed subject and started painting. Mary seems to be mostly expressing pleasant events and likes in her paintings. She discovered and became quite fascinated with writing her name and other people’s names by gluing sand on cardstock. She wrote ‘blind’ names with a glue stick and then sprinkled sand on top of the page, revealing letters and complete names. Upon suggestion, she added short messages to these people, using the same technique. She spent quite some time doing that. She was careful and neat throughout these processes.
After a good hour, we took a bathroom break, and leisurely chatted. Mary said her new host is ‘a nice guy’ and bought her some chips and a flavored drink. We talked about nutritious food that’ doesn’t make you fat’ versus chips who are loaded with salt and fat. We stepped into the adjacent room to do some yoga. Mary remembered some of the poses we did 10 days earlier and even showed improvement in the inhale-exhale rhythm in coordination with the pulling & releasing into the pose. Her mobility requires careful and gentle movements, and she seems very interested in working on improving her back and belly. Mary and I worked on a couple of paintings; I noticed her left hand shaking, and that she wasn’t using it to hold the paper down; I encouraged to use her left hand to help.
The shaking seems to subside. Usually, it takes a few fast sparse paintings before she settles down; then she spends a little more time and paint more carefully, more focused, with more items on the same paper and more details. Mary likes painting on canvas and seems motivated to paint for her own art show. While painting she made remarks about her new job and the positive fact of getting paid. Mary seemed in distress because she didn’t know her schedule for the rest of the week.
A clear routine is definitely beneficial to Mary and contributes to her feeling of being cared for. Mary asked to use clay; I introduced some tools that she could use with it. She made a very complex figure, very carefully, taking the time to make sure all the pieces were in place: she called it her angel and that would go on her nightstand. The other piece she took home is a collage of animals that she carefully cut out from larger photos. All the other paintings will stay in the office for the art show. I asked Mary about her sketchbook and she said that she did paint in it when feeling happy and when feeling angry and that she filled all the pages. I gave her a new one to continue working on her own and she appreciated that.
Mary wanted to show me her book of vegetarian recipes and wanted to know which ones are not fattening. We reviewed some of them, pointed out those with cheese that need to be scaled down. Mary wanted to copy one of a Greek salad that she remembered liking. But she got off quickly and said she was tired; she had a late night at Sea World.
Again, the art show came up as a motivating factor. She wanted to know when and where it is going to take place, and who’s going to be invited. While painting she mentioned that she has the prospects of moving in to her own apartment with a roommate; however, she didn’t paint any house this time. She was happy to receive a new set of markers and she asked for a new sketch book, saying that she already filled up the one I gave her last week.
We moved to the adjacent room to do yoga; we went over the same routine and also some breathing exercises – in general, Mary tends to hold her breath while doing the exercises and tries really hard to get into each pose.
While she finished this first drawing she looked at me with a very
tensed expression, and said she was seeing ‘things’, people…dead people.
I acknowledged what she was saying and invited her to draw what she saw,
just as she was seeing it. Mary proceeded to draw a face with simple,
features, stick- like body, tense grin and then I suggested to use
colors when Mary mentioned blood. Mary took a red oil pastel and drew a
face with blood coming out of her mouth.
Mary said it was
her grandmother, who passed away.
One hypothesis is that Mary could also have been referring to
grandma Rose at the house where she was staying previously, since she
was ill. Then Mary
proceeded with other paintings, playing with materials and things she
likes: apple, tree, fireworks. She asked again about her art show and I
encouraged her to keep painting to build her body of work. Mary asked to
work with clay and made 3 objects, asked for help, accepted input and
then proceeded by herself. She
worked quickly and didn’t want to spend much time on these.
Mary asked me to
tell Joey about the fact that she ‘sees dead people’ and she thinks it’s
due to the medications that she takes. I reassured that I would. Mary was eager
to do some yoga; she’s improving and willingly following instructions.
She does hold her breath when the stretch is a bit challenging, and I
need to keep reminding her to breathe in and out to ease the pose. She
likes the names of the poses which help her remembering some of them. When Mary's host
mentor came back for Mary, we were reviewing her paintings and taking
pictures – Mary enjoys having her pictures taken with her work; it’s a
source of pride and satisfaction.
I did share about Mary's visions as per her request, and I followed up
asking her
I did share
about Mary's visions and I asked her if she felt better after drawing
what she saw. She said yes, nodding.
I gave her a new sketchbook and encouraged her to draw what she
sees, to help her feel less upset about it. She showed much
appreciation.
12th Session
Conclusions Individuals with special needs like Mary spend most of their lives trapped in a skewed relationship between their bodies, hearts and minds, limited in functionality and constantly having to cope with the struggle of their psychic upheavals, emotional conflicts, longings and physical limitations. Building self-motivation presents challenges and needs to be linked to attainable goals that are related to the individual personal interests and their level of development/maturity; careful attention needs to be made not to create illusions or false expectations, but to encourage individuals like Mary to stretch their usual boundaries a little more each time, to create unusual colors, to use new techniques under gentle guidance, to combine different modalities. This helps them finding their unique style, their hidden voices and assist them in coping in difficult moments and in building confidence. As such individual feels the empathic relationship with their mentors, they are always ready to act with empathy and little by little they feel more at peace within themselevs and they welcome more and more self-exploration with confidence and ease. Often new connections are made, a better understanding and improved behavior result from this process. the very experience of relaxing, calming and prolonged focus during art making is an encouragement to devote more time and efforts in pursuing such activities.
The Empathy Quotient: An
Investigation of Adults with Asperger Syndrome or High Functioning
Autism, and Normal Sex Differences.Preview
By: Baron-Cohen, Simon; Wheelwright, Sally.
Journal of Autism & Developmental Disorders, Apr2004, Vol. 34 Issue
2, p163-175, 13p; (AN 12729112)
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