CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY

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1 Instructor s Manual for CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY with Judith Rubin, PhD and Eleanor Irwin, PhD Manual by Ali Miller, MFT

2 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY The Instructor s Manual accompanies the DVD Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD and Eleanor Irwin, PhD (Institutional/Instructor s Version). Video available at Copyright 2011, Psychotherapy.net, LLC. All rights reserved. Published by Psychotherapy.net 150 Shoreline Highway, Building A, Suite 1 Mill Valley, CA Phone: (800) (US & Canada)/(415) Teaching and Training: Instructors, training directors and facilitators using the Instructor s Manual for the DVD Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD and Eleanor Irwin, PhD may reproduce parts of this manual in paper form for teaching and training purposes only. Otherwise, the text of this publication may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher, Psychotherapy.net. The DVD Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD and Eleanor Irwin, PhD (Institutional/ Instructor s Version) is licensed for group training and teaching purposes. Broadcasting or transmission of this video via satellite, Internet, video conferencing, streaming, distance learning courses or other means is prohibited without the prior written permission of the publisher. Miller, Ali, MFT Instructor s Manual for Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD and Eleanor Irwin, PhD Cover design by Julie Giles Order Information and Continuing Education Credits: For information on ordering and obtaining continuing education credits for this and other psychotherapy training videos, please visit us at www. psychotherapy.net or call

3 Psychotherapy.net Instructor s Manual for CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY WITH JUDITH RUBIN, PHD AND ELEANOR IRWIN, PHD Table of Contents Tips for Making the Best Use of the DVD 4 Introduction to Using Art & Drama in Therapy 6 Reaction Paper Guide for Classrooms and Training 10 Related Websites, Videos, and Further Readings 11 Discussion Questions 13 Role-Plays 16 Video Transcript 19 Video Credits 50 Earn Continuing Education Credits for Watching Videos 53 About the Contributors 54 More Psychotherapy.net Videos 55 3

4 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY Tips for Making the Best Use of the DVD 1. USE THE TRANSCRIPTS Make notes in the video Transcript for future reference; the next time you show the video you will have them available. Highlight or notate key moments in the video to better facilitate discussion during and after the video. 2. FACILITATE DISCUSSION Pause the video at different points to elicit viewers observations and reactions to the concepts presented. The Discussion Questions section provides ideas about key points that can stimulate rich discussions and learning. 3. ENCOURAGE SHARING OF OPINIONS Encourage viewers to voice their opinions; no therapy is perfect! What are viewers impressions of what works and does not work in the sessions? We learn as much from our mistakes as our successes; it is crucial for students and therapists to develop the ability to effectively critique this work as well as their own. 4. CONDUCT A ROLE-PLAY The Role-Plays section guides you through exercises you can assign to your students in the classroom or training session. 5. SUGGEST READINGS TO ENRICH VIDEO MATERIAL Assign readings from Related Websites, Videos, and Further Reading prior to or after viewing. 6. ASSIGN A REACTION PAPER See suggestions in the Reaction Paper section. 4

5 Psychotherapy.net PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE THERAPIST Psychotherapy portrayed in videos is less off-the-cuff than therapy in practice. Therapists may feel put on the spot to offer a good demonstration, and clients can be self-conscious in front of a camera. Therapists often move more quickly than they would in everyday practice to demonstrate a particular technique. Despite these factors, therapists and clients on video can engage in a realistic session that conveys a wealth of information not contained in books or therapy transcripts: body language, tone of voice, facial expression, rhythm of the interaction, quality of the alliance all aspects of the therapeutic relationship that are unique to an interpersonal encounter. Psychotherapy is an intensely private matter. Unlike the training in other professions, students and practitioners rarely have an opportunity to see their mentors at work. But watching therapy on video is the next best thing. One more note: The personal style of therapists is often as important as their techniques and theories. Therapists are usually drawn to approaches that mesh well with their own personality. Thus, while we can certainly pick up ideas from master therapists, students and trainees must make the best use of relevant theory, technique and research that fits their own personal style and the needs of their clients. PRIVACY AND CONFIDENTIALITY Because this video contains actual therapy sessions, please take care to protect the privacy and confidentiality of the clients who have courageously shared their personal lives with us. 5

6 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY Introduction to Using Art & Drama in Therapy* Why Art & Drama? Need for New Techniques Over the last 50 years, it has become clear that traditional forms of psychotherapy have limited effectiveness for many people. Talk therapy does not work with those who are less articulate, or who, for emotional or neurological reasons, are not able to use language to access their feelings and ideas. For optimal mental health, everyone needs to be able to connect feelings and ideas (both right and left hemispheres of the brain), to link past and present, to make sense of the now, and to plan for the future. For those who have particular difficulty expressing themselves verbally, the arts offer a way to make contact, connect, and begin meaningful dialogues. In multiple settings community agencies, schools, jails, inpatient and outpatient centers art, drama, music, poetry, and dance therapy have expanded treatment options for the worried well as well as for at-risk or fragile populations, from the very young to the elderly. The Arts Offer Many Avenues for Communication The arts may use words, but they do not depend on words allowing ideas and feelings to be expressed in color, gesture, movement, sound, or drama. These forms of communication can bypass the usual defenses, clarifying what was unclear and confused, making visible what was hidden or invisible. The arts help individuals affirm what they know, discover what they do not know, and discern what is vaguely felt, yet out of awareness. Through pre-symbolic, symbolic, or representational imagery, people can be helped to recognize, tolerate, and manage the anxiety that entangles past painful experiences, memories that Freud said were both unrememberable and unforgettable. Painful memories are sometimes out of awareness, stored in the right hemisphere of the brain. Intrusive images as well as kinesthetic and sensory body memories can encapsulate frightening ideas and feelings. These emotions, while they cannot be expressed in words, often exert 6

7 Psychotherapy.net enormous (unconscious) impact on an individual s life, but can be expressed effectively through art, movement, sound or drama. Essential Conditions An atmosphere of playfulness can reduce anxiety and enrich the arts experience, helping people of all ages to be more open, less guarded. To stimulate the imagination and encourage play, Winnicott believed that the good enough therapist, like the good enough mother, provides a psychologically safe transitional space. In time, empathy enables the growing child (or changing patient) to become more authentically himself, more real. The arts provide an intermediary play space, encouraging patients to express themselves freely and to try out new behaviors and feelings, in the effort to become real. Thus, the arts can be the bridge from a diffuse to a more definable sense of self. Over time, a symbolic bridge is formed as well, linking patient and therapist in their mutual journey. Through the arts in therapy, individuals can gradually learn to be more introspective, becoming familiar with the hidden true self. Materials Creative materials that are durable and aesthetically pleasing and that stimulate the imagination are critical to success. However, materials need not be costly. For example, while many sand play therapists have shelves full of miniatures, it is also possible to offer fewer items, while at least including some of the following categories: people (adults, children, fantasy); animals (wild, tame); and aspects of nature (trees, rocks). While most use a tray, one can also use a plastic container, a table, or the floor, with materials stored in cabinets, baskets, or on shelves. There is no one right way to do sand play or any art or drama activity, for that matter. Basic art materials include something to draw, paint, model, and construct with. These need not be fancy or extensive, but they do need to be sturdy enough to be used without frustration. Likewise, good quality puppets are essential, and variety spurs the imagination. Try to include some of the following categories in your collection: people (realistic, royalty); animals (wild, domestic); occupation figures (doctor, 7

8 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY police officer, fire fighter); symbolic characters (witch, devil, skeleton, fairy, wizard). Puppets are a good investment and have a long shelf life. Enhancing Creativity In both art and drama, having a variety of materials available and providing choices help to reduce anxiety and promote self-definition. It is also essential to explain the task clearly, and to convey the idea that there is no right or wrong way to participate and that all creative work is acceptable. Helping individuals to feel more comfortable and less self-conscious about a creative task is illustrated through a variety of warm-up activities and starters for both individuals and groups (e.g., a scribble drawing or a round robin story). These can vary according to what is comfortable for the therapist. What to Do The therapist has three elements available to achieve assessment or treatment goals: Materials, Themes, and Methods. First, it is essential to be clear about one s goals. It is then possible to choose art or drama materials that will facilitate achieving those goals. One can suggest a theme, or invite the individual(s) to do so. In addition, the method of working can be specified by the therapist, i.e., working alone or with another, with or without prior discussion, with or without a time limit, etc. It is important for activities to be stimulating, yet age-appropriate, for people to be able to fully engage. How to Do It Observe the Process The therapist s task during the creative process is to observe carefully and unobtrusively. Patients talk through their selection and use of materials, revealing valuable diagnostic information. While people are choosing materials, the therapist can pay close attention to facial expressions, body movements, and spontaneous verbalizations. It is important to note which media, puppets, props, or toys are selected 8

9 Psychotherapy.net from the array of choices offered, and which are considered and then rejected. Once creative work begins, the therapist should carefully observe both nonverbal and verbal behavior, especially the sequence leading to the final product. It is also helpful to keep or record the final product, noting any spontaneous verbal reflections on it as well as on the process of creating it. In understanding creative products, both content and form are useful indices. Facilitating Reflection As with all symbolic activities, it is assumed that in projecting material from their inner worlds, patients are telling about themselves. Thus, all parts of the story are probably parts of the author, owned or disowned. In fact, this is true of all creative products. After the story or artwork is finished, there is a time to look at it and reflect on it together along with an assurance that no mind reading will be going on! It is best to ask about the artwork or story in an open-ended way (e.g., Tell me about it ). Then both parties can work together to facilitate the process of self-discovery. It is critical to let the patient be in charge, while the therapist tries not to project his or her own ideas about either the process or the product of the creative experience. However, because the arts have the capacity to bypass defenses, one must be sensitive and tread carefully, particularly when inquiring about and discussing the event or the artwork. Since the arts elicit powerful material, it is also vital to facilitate closure, thereby helping people make the transition from the therapy session to outside life. *Adapted from Creative Healing in Mental Health: Art & Drama in Assessment & Therapy by Expressive Media, Inc. 9

10 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY Reaction Paper for Classes and Training Video: Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD and Eleanor Irwin, PhD Assignment: Complete this reaction paper and return it by the date noted by the facilitator. Suggestions for Viewers: Take notes on these questions while viewing the video and complete the reaction paper afterwards. Respond to each question below. Length and Style: 2 to 4 pages double-spaced. Be concise. Do NOT provide a full synopsis of the video. This is meant to be a brief response that you write soon after watching the video we want your ideas and reactions. What to Write: Respond to the following questions in your reaction paper: 1. Key points: What important points did you learn about using art and drama in assessment and therapy? What stands out to you about how the featured therapists work? 2. What I found most helpful: As a therapist, what was most beneficial to you about the models presented? What tools or perspectives did you find helpful and might you use in your own work? What challenged you to think about something in a new way? 3. What does not make sense: What principles, techniques, or interventions did not make sense to you? Did anything push your buttons or bring about a sense of resistance in you, or just not fit with your own style of working? 4. How I would do it differently: What might you have done differently from the featured therapists in the sessions highlighted in the video? Be specific about what different approaches, interventions, and techniques you might have applied. 5. Other questions/reactions: What questions or reactions did you have as you viewed the video? Other comments, thoughts, or feelings? 10

11 Psychotherapy.net Related Websites, Videos and Further Reading web resources Expressive Media, Inc.: Arts Therapies Films and Resources, founded by Judith Rubin and Eleanor Irwin The National Coalition of Creative Arts Therapies Associations American Art Therapy Association National Association for Drama Therapy Related Videos Available at Art Therapy Has Many Faces, with Judith Rubin Person-Centered Expressive Arts Therapy, with Natalie Rogers Gestalt Therapy with Children, with Violet Oaklander Person-Centered Child Therapy, with Anin Utigaard Exploring Narradrama, with Pamela Dunne The Zerka T. Moreno Psychodrama Series, with Zerka Moreno Healing Childhood Abuse and Trauma Through Psychodrama, with Tian Dayton Recommended Readings Irwin, E. C. (2000). Psychoanalytic approach to drama therapy. In P. Lewis & D. R. Johnson (Eds.), Current approaches in drama therapy (pp ). Springfield, IL: Charles C. Thomas Publisher Ltd. Irwin, E. C. (2005). Facilitating play with non-players: A developmental perspective. In A. M. Weber & C. Haen (Eds.), Clinical applications of drama therapy in child and adolescent treatment (pp. 3-24). New 11

12 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY York: Brunner-Routledge. Irwin, E. C. (2006). Peter: A study of cumulative trauma: From robot to regular guy. In L. Carey (Ed.), Expressive and creative arts methods for trauma survivors (pp ). London & Philadelphia: Jessica Kingsley Publishers. Rubin, J. A. (1984). The art of art therapy. Levittown, PA: Taylor & Francis. Rubin, J. A. (1999). Art therapy: an introduction. Philadelphia: Brunner/ Mazel. Rubin, J. A. (Ed.) (2001). Approaches to art therapy: Theory & technique, second edition. New York: Brunner-Routledge. Rubin, J. A. (2005a). Artful therapy. Hoboken, NJ: John Wiley & Sons. Rubin, J. A. (2005b). Child art therapy (25th anniversary edition). Hoboken, NJ: John Wiley & Sons. 12

13 Psychotherapy.net Discussion Questions Professors, training directors and facilitators may use some or all of these discussion questions, depending on what aspects of the video are most relevant to the audience. 1. Personal experience: Have you ever been a client in art or drama therapy? If so, how was the experience for you? After watching this video, would you like to be a client with a therapist who uses some of these creative healing modalities? Why or why not? 2. Professional experience: Have you ever used art or drama in assessment and therapy with any of your clients? If so, what did you like and dislike about it? If not, can you see yourself incorporating any of these creative healing techniques into your work with any of your clients? 3. Techniques: What did you think of the various art and drama techniques demonstrated in this video? Were there any that you found particularly intriguing, fun, or useful? Any that you didn t understand or thought were not so useful? Which techniques can you see yourself using in your work? 4. Matching clients and interventions: Do you think certain types of clients might be more likely to benefit from some of the approaches demonstrated in this video? If so, with what types of clients would you see using these approaches? Do you ever experience limitations with pure talk therapy where active or creative approaches may be helpful? Can you discuss a client with whom you are working and how you might incorporate art or drama therapy into your work? 5. Therapist stance: In the sessions highlighted in this video, what stood out to you about the way the therapists related to their patients? Can you see yourself interacting with any of your patients in this way, or is your style of relating to your patients significantly different? For example, does your stance tend to be more or less reserved than the therapists in the video? Do you tend to be as active? Do you tend to be more or less directive? Were there any particular therapists whose styles you particularly admired or 13

14 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY 14 disliked? What was it about their style that you liked or disliked? 6. Not analyzing: Several therapists in the video assured their patients that they wouldn t be analyzing or interpreting their creations. Why do you think they emphasized this? When you work with patients using creative modalities, do you also make it a point to emphasize this? What do you think the advantages and disadvantages could be of analyzing or interpreting a patient s creative expression? 7. Sand play: What did you think of the sand play technique? Have you had the opportunity to be a client using sand play? If so, discuss your experience. Have you utilized the sand play with any of your clients? If so, what do you like and dislike about incorporating sand play into your work? 8. Follow patient s lead: The narrator emphasized the importance of following the patient s lead, particularly when the patient is telling a story using sand play. Why do you think this is so important? For some therapists who like to be directive, following a patient s lead can be challenging. Is this true for you? If so, how do you deal with this challenge? 9. Choice: The narrator emphasized the importance of giving patients choices when utilizing creative modalities, saying, Being able to choose is vital. Why do you think there is such an emphasis on choice in art and drama therapy? What do you think the connection between choice and self-expression is? What role does choice play in your work with clients? 10. No right or wrong: In her instructions to her client, Natalie Rogers said, There is no right or wrong to this and I don t interpret art, and her client responded, That s a good thing. What do you think her client meant when she responded this way? Why do you think Rogers and other art and drama therapists put an emphasis on no right or wrong? Is this judgment-free zone something you try to cultivate with your clients? If so, how do you do it? 11. Closure: The narrator spoke about the importance of closure in sessions that involve creative expression and that reviewing

15 Psychotherapy.net the experience helps patients transition from the session to the real world. Is providing closure something you try to do in your sessions? What are some of your favorite ways of ending sessions? Have there been cases when it was challenging to provide closure because the emotional intensity was so high? How did you handle this? 15

16 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY Role-Plays After watching the video and reviewing Introduction to Using Art & Drama in Therapy in this manual, assign groups to role-play a therapy session utilizing art and/or drama therapy techniques as described in the video. Organize participants into groups of two, consisting of one psychotherapist and one client. If time permits, rotate so each person has a chance to play the role of therapist. The point here is not to try to resolve the client s issues, but to experiment with some of the creative healing techniques presented in the video. Instructions for Role-Players: One person will start out as the therapist and the other person will be the client, and then switch. Therapists can choose any drama/art modality they saw demonstrated in the video, or may choose from the three options listed below, depending on what materials are available. Therapists should keep in mind that the purpose of the session is to help clients express themselves in a relaxed setting. Begin by explaining the task clearly, and convey the idea that there is no right or wrong way to participate and that all creative work is acceptable. The therapist s role during the creative process is to observe both nonverbal and verbal behavior carefully and unobtrusively. When the client has completed his or her project, use open-ended questions to facilitate reflection, such as, Can you tell me about what you made? and, How does it make you feel to look at what you made? Then both parties can work together to facilitate the process of self-discovery. It is critical to let the client be in charge, while the therapist tries not to project his or her own ideas about either the process or the product of the creative experience. As it is important to provide closure at the end of the session, therapists can invite clients to review the experience to help with the transition, by asking something like, How was this experience for you? Therapists should focus primarily on practicing the following skills: creating a relaxed, nonjudgmental environment; observing and listening unobtrusively during the creative process; giving clients 16

17 Psychotherapy.net choices so that they are in charge; following their clients lead; and asking open-ended questions that facilitate reflection and selfdiscovery. Choose from the following techniques or select another one from the video: Scribble drawing: (materials needed: 8 x 11 white paper, colored markers) The therapist should invite the client to draw a scribble, without thinking too much about it. After the scribble is finished, invite the client to find an image within the scribble. Then ask the client to add lines to help the therapist see the image he sees. Ask the client to talk about what he has made and the meaning it has in his life. Conclude by asking the client how he felt during this experience. Self-portrait: (materials needed: clay or Play-Doh) Invite the client to make something with the clay or Play-Doh that represents who she is or something she wants to express about herself. Then invite her to tell you about it, inviting as much detail as she wants to share. Conclude by asking the client how she felt about this experience. Empty chair: (materials needed: two chairs) The empty chair technique provides a safe way for the client to engage with another person. Invite the client to sit facing an empty chair and to imagine that someone from his current or earlier life is sitting in that chair. It can be someone he wants to confront, someone with whom he would like to have a difficult conversation, or even someone who is no longer around to actually talk to. This is an opportunity for the client to fully express any emotions that he has in relation to this other person. Encourage the client to say whatever he longs to say (whether or not he would actually say it to the real-life person) and follow up with a conversation about his experience doing the exercise. After the role-plays, have the groups come together to discuss their experiences. Invite the clients to talk about what it was like 17

18 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY to participate in the particular creative modalities they used. How did this kind of session feel different from traditional talk therapy? Did they feel comfortable and relaxed? Did they feel able to express themselves fully and freely? Did they feel that the therapists were following their leads and giving them choices along the way? What did clients like and dislike about the way the therapists related with them? Then, invite the therapists talk about their experiences: How did it feel to conduct a therapy session using these creative modalities? What was it like to facilitate reflection on the process? How was it to follow the client s lead and yet also be somewhat directive? Did they find the techniques useful? Did they enjoy themselves? Finally, open up a general discussion of the strengths and the challenges in using art and drama in therapy. An alternative is to do this role-play in front of the whole group with one therapist and one client; the rest of the group can observe, acting as the advising team to the therapist. Before the end of the session, have the therapist take a break, get feedback from the observation team, and bring it back into the session with the client. Other observers might jump in if the therapist gets stuck. Follow up with a discussion on what participants learned about using art and drama in therapy 18

19 Psychotherapy.net Complete Transcript of Creative Healing in Mental Health: Art & Drama in Assessment & Therapy with Judith Rubin, PhD & Eleanor Irwin, PhD Narrator: This film is designed for trained mental health workers who want to be more creative in their work. It s about using art and drama in assessment and therapy with people of all ages, ideally or if possible under the guidance of an expressive arts therapist. What are the benefits of including simple art and drama activities in your own work? Well, the arts allow even those with little or no language to express themselves more freely and more fully. Ralph Rabinovitch: Something like that? Show me what. Show me. Carole Kunkle-Miller: So what do you think you would like to start with? Looks like it s the magnets, huh? Zac: Yes. Kunkle-Miller: They are pretty amazing, aren t they? So you can use them in any way you want. What are you thinking as you are putting this together? Zac: I don t know. How tough it is. Kunkle-Miller: It is tough, isn t it? It is tough. Margo: Hello? This is Margo. And we want to order two large pizza. Narrator: The arts help people to relax and to project aspects of themselves that are often hard t know about. Participant: I was dragged here entirely against my will. I was supposed to be lunching at the manse. I don t know what you people are up to, and I was here to lunch the governor and his wife. I have no idea where you fruitaloons have come from. Narrator: Even verbal patients have trouble when overwhelmed by 19

20 CREATIVE HEALING IN MENTAL HEALTH: ART & DRAMA IN ASSESSMENT & THERAPY strong feelings. Violet Oaklander: What I would like to do is I want you to imagine that this is Sara. Child Client: Mm-hmm. Oaklander: This rough figure. And I would like you to tell Sara what you would like to say to her, about her. You really are angry at her, huh? Child Client: Mm-hmm. Oaklander: Do you have any words that you could say to her with that? Child Client: I would like to mutilate you. Traumatic Memories Narrator: Because traumas are often remembered in images and the body, the arts are an ideal pathway for coping with the pain they leave. Client: And I still get nervous. I mean, I really get nervous. I like being able to do the drama therapy because you get to talk about things. And that s what helps me. I don t know why, but that stuff helps me feel better. Mary Lou Lauricella: What is the thing that you could say that could change a person s mind, even as a combat veteran? Client: So how these images in my head. It s like it s real. They are like real, you know? Therapist: Yeah. Client: You know that. I be alone and I start to paint. You went through that kind of thing where you just want to talk to somebody and don t get the chance to talk to anybody, just you by yourself, you know? Therapist: I thought these were portraits. This is Vietnam. Client: Yeah. Those are the images that don t go away. And there s no one I can talk to about it. You know, they just 20

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