ATHABASCA UNIVERSITY
A LITERATURE REVIEW OF SOLUTION-FOCUSED ART THERAPY:
A MANUAL FOR THERAPISTS
BY
IRENE M HAIRE
A Final Project submitted to the
Graduate Centre for Applied Psychology, Athabasca University
in partial fulfillment of the requirements for the degree of
MASTER OF COUNSELLING WITH SPECIALIZATION IN ART THERAPY
Alberta
December 2009
COMMITTEE MEMBERS
The members of this final project committee are:
Name of Supervisor
Name of Second Reader
Dr. JoAnn Hammond-Meiers
Dr. Paul Jerry
ABSTRACT
Solution Focused Art Therapy (SFAT) strategies are examined, and then, developed
into an integrated Solution Focused Brief Therapy (SFBT) and phenomenological art therapy
(AT) model. An applied manual is tailored to children, adolescents and adults was developed
and included. The manual incorporates and credits the SFBT interventions of exceptions,
miracle questions, and scaling. A need to develop effective and developmentally appropriate
brief therapy models for clients with limited resources is particularly relevant to the current
contexts of practice and insurance companies. Specific combined or mixed models have
demonstrated some encouraging support for therapeutic efficacy. Highlights embrace
acceptance of the model by clients, quality of care, and a focus upon efficiency and
effectiveness. Further research can be conducted with this manual.
ACKNOWLEDGEMENTS
My grateful thanks go to everyone who helped me complete this final project, including my
supervisor, Dr. JoAnn Hammond-Meiers, who inspired me with her helpful suggestions,
knowledge, professionalism, guidance, and encouragement; my second reader, Dr. Paul
Jerry; and all the professors and support staff at Campus Alberta for their guidance in my
efforts to obtain knowledge to complete this master’s program. Special thanks to my
supervisors at the practicum sites at CASA, The Support Network, Prince Charles School,
and Inglewood School who assisted me in putting together theoretical knowledge
with practical ways to apply it Additionally, thanks go to my family and friends who
supported me and loved me even when I declined doing things with them during the years of
working on this master’s program.
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TABLE OF CONTENTS
CHAPTER I: Introduction …………………………………………………………………...2
Similar Therapeutic Principles of AT and SFBT...…………………............................3
Project Rationale………………………………………………….…….......................5
Current Developments…………………………………………………....……………6
Overview of the Manual…………………………………………………...………….8
CHAPTER II: Theoretical Foundations………………………………… …………..………9
Social Constructivism………………………………………………………………. 9
Solution-Focused Brief Therapy……………………………………………………..10
Strategies of Solution-Focused Brief Therapy…………………………..…..10
Phenomenology…………………………………………………………………..….12
Gestalt Art Therapy……………………………………………………..…...............13
Phenomenology Art Therapy……………………………………………………..…14
Symbolic Expression of Line…………………………………………...……15
Symbolic Expression of Shape……………………………………………… 15
Symbolic Expression of Colour………………………………………..……..16
Phenomenology Art Therapy Method………………………………...…….. 18
Solution-Focused Art Therapy……………………………………………………....20
Beliefs About Clients………………………………………………………...20
Compatibilities in the Principles of SFBT and AT……………….………….24
Benefits That Have Implications for Counselling…........................................26
CHAPTER III: Critical Evaluation of Research …………………………………………....29
Critical Review of Present Applications of SFAT ……………………………....…29
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Therapist and Client Relationship……………………………….…………..30
Client Motivation……………………………………………………………31
Art Therapy Environment…………………………………………………...31
Art Therapy Materials…………………………………………………...….32
Construction of Solutions…………………………………………..….…....33
Deconstruction Leading to Solutions……………………………….……….35
Reconstruction of Solutions……………………….………………...…....…37
Reflection on Clinical Practice and Research………………………………….…....40
Psychotherapeutic Approach & Methodology, Therapeutic Alliance, & Self
Healing…………………………………………………………………...40
Research Using AT, SFBT, and SFAT………………………………………….…..42
AT Studies……………………………………………………………………43
SFBT Studies…………………………………………………………………47
SFAT Studies…………………………………………………………………48
Exploring Complementary and Diverse Theoretical Aspects Between
AT and SFBT…………………………………………...………………………...50
Complementary Theoretical Aspects…………………………….…………...50
Diversity in Theoretical Aspects …………………………………………….51
Incompatibilities……………………………………………………...............52
CHAPTER IV: A SFAT Manual for Adults, Adolescents, and Children …………………..54
Table of Contents………………………………………………….…........................55
Introduction…………………………………………………………………………..56
A Solution-Focused Art Therapy Manual for Adults………………………….…….58
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A Solution-Focused Art Therapy Manual for Adolescents ……………………...….74
A Solution-Focused Art Therapy Manual for Children ……………………….........92
Additional Tools ………………………………...…………………………………109
Scaling Emotion Symbols ………………………… ……………………....109
Definitions of Interventions ………………………………………………………...112
References………………………………………………………………………..…118
CHAPTER V: Synthesis and Implications………………………………………………...120
References………………………………………………………………………..…125
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CHAPTER I
Introduction
Art Therapy (AT) and Solution Focused Brief Therapy have similar therapeutic
principles that can support the likelihood of the success of a trend that combines these therapies
to promote an effective and efficient therapeutic approach for many clients. AT using a
phenomenological orientation is a form of AT in which descriptions by clients about their
perceptions of their own art or artmaking experience, is the therapeutic focus (Betensky, 1995).
Betensky (1995) delved into various ways of authentically describing the art as it was unfolding
and clarifying effective means by which the therapists could approach, perceive, and describe the
art process with clients for the purpose of furthering the therapist’s and client’s understanding.
Initially, it may seem as though SFBT and AT theoretically clash or contradict each other
fundamentally, especially for some therapists who have training in SFBT or AT, but not both.
Contrary to first impressions, however, the marriage of the two can be quite complementary and
compatible, especially in the contents where Betensky’s (1995) ideas and the three interventions
of SFBT are skillfully and appropriately employed. AT integrates artmaking and verbal
psychotherapy; SFBT traditionally incorporates verbal exchanges within the therapy. Art
therapists who encourage the development and building of phenomenological descriptions in AT
and have an orientation and training in SFBT, may focus on how clients begin to find their own
solutions through artmaking and dialogue which evolves around their artmaking process and
their own examination of the art. The manual illustrates how the combined approach can be
adapted to a wide client age range.
Brief therapy models are required by clients of all ages in private practice,
institutions, agencies, and schools (Fleming & Rickord, 1997; Leeuwenburgh, 2000;
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Malchiodi, 2003, 2007, 2008; Matto, Corcoran, & Fassler, 2003; Riley, 1999; Selekman,
1997). Short term therapy is required by some insurance payers who set limits of 10 sessions
for clients (Fleming & Rickord; Riley). The seven-session solution-focused art therapy
(SFAT) manual developed in conjunction with this paper is a guide for therapists based on a
relatively new model as explored by Malchiodi (2003), Matto, et al. (2003), Mooney (2000),
Nims (2007), Riley (1999), Riley and Malchiodi (2003), and Selekman (1997).
The SFAT manual focuses on combining phenomenological (AT) with interventions
derived from solution-focused brief therapy (SFBT). Other AT frameworks are possible for
adaptation to SFBT (Malchiodi, 2003; Matto et al., 2003; Nims, 2007; Reisler, 1987; Riley,
1999; Selekman, 1997), but a fully developed repertoire of possibilities is beyond the scope
of this manual. Adaptations for the combined model for adults are demonstrated with SFBT
and phenomenology AT with adults and addictions as explored by Matto et al.
Play therapy techniques for children often employ AT and SFBT ( Nims, 2007).
Family systems AT and brief therapy are also combined (Reisler, 1987). Arts-basedtherapy and SFBT with teens were developed by Riley (1999). SFBT with AT interventions
with families appears promising and helpful (Selekman, 1997). Three, of several, SFBT
interventions, exceptions, the miracle question, and scaling are adapted into this model
(Iveson, 2002; Matto et al., 2003). These particular interventions originated from the SFBT
model developed by de Shazer and Berg (1997) and were further explored by Walter and
Peller (1992).
Similar Therapeutic Principles of AT and SFBT
With the proper mix of ingredients, it is sometimes surprising and interesting to see
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what is created and evolves when blending what initially appears as polar opposites. SFBT
emphasizes solutions and appears to be converging like a prescription, whereas AT is usually
more diverging or spreading into various directions through creativity. Curiously, one might ask,
What happens when we mix defined problems with a solution-oriented artmaker’s creative
unfolding? Are there unexpected benefits from the well-planned therapeutic execution of SFBT
strategies with the freedom of art expression?
There are some therapeutic principles that might be more complementary than
contrasting. Combining AT and SFBT is supported by a compatible underlying foundation; that
is, the therapies have some similar therapeutic principles, for example they value developing a
collaborative relationship between client and therapist (Betensky, 1995; Malchiodi, 2003; Riley,
1999; Selekman, 1997; Walter & Peller, 1992). Both therapies focus upon creating
empowerment for the clients (Betensky; Malchiodi; Riley; Selekman; Walter & Peller). These
two principles arise within the literature and are reconsidered and maintained throughout the
creation of this manual.
In both, AT and SFBT, a collaborative relationship between the client and therapist is
important (Betensky, 1995; Walter & Peller, 1992). A collaborative relationship, sometimes
referred to as a therapeutic alliance (Hiebert & Jerry, 2002), can be described as the development
of trust, respect, empathy, and supportive interactions between client and therapist, for a positive
outcome and expectations of change (Betensky; Malchiodi, 2003; Matto, et al., 2003; Selekman,
1997; Waller & Peller). Matto, et al.stated that a collaborative approach is essential to creating a
supportive environment, that facilitates a successful therapeutic outcome.
Betensky (1995) explained the therapist’s role as that of a helper to the client through
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offering and modeling compassion and understanding, while employing “ the help of visual selfexpression with methodological tenets of the phenomenological approach” (p. 23). The therapists
leave the expert role and include the clients’ perspective about treatment and participation within
the client’s own supervision (Shilts, Rambo, & Hernandez, 1997) The counsellor, who
incorporates art in therapy, respects the capacity and resilience of clients to find their own
solutions; this process leads to empowerment for clients (Matto et al., 2003).
The elements of empowerment as explored by Matto et al. (2003) include clients’ capacity
to find their own answers to their problems through exploration of resources and past successes.
Clients feel confident to try more changes through goals and tasks that are collaboratively and
creatively established for each client with the help of the therapist (Matto et al.).
Project Rationale
Fleming and Rickord (1997), Leeuwenburgh (2000) and Malchiodi (2003, 2007,
2008) suggested that there is a need for new models to create more comfort for clients who:
1) deal with family death and illness, 2) need to express emotions, 3) have diverse cultural
needs, 4) experience language barriers, and 5) for some who need efficacious, cost effective
brief therapy models because of limited funds. Fleming and Rickord (1997), Iveson (2002),
and Malchiodi (2003) claimed that the number of counselling sessions in a brief therapy
model is usually 10 or fewer. Fleming and colleagues defined brief therapy as having
an average of seven sessions. SFAT is a viable option as a brief therapy model because it
accesses innate creative desire, gets at the problem and solution more efficiently, organizes
thought processes, assesses the ongoing concrete process with art, is a gentle method of
exploring problems and solutions, is a more palatable form of therapy that can be a resource if
judged clinically appropriate by the therapist, and offers therapy within seven sessions
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(Iveson; Malchiodi, 2003; Selekman, 1997).
An SFAT manual demonstrating a method of using SFBT interventions with AT
can be a resource for art therapists in private practice who are working with clients who have
identified specific problems and need to reach their goals within fewer sessions. Reasons for
decreasing the number of therapy sessions include very challenging behaviours that need to be
resolved quickly, time restrictions on therapy, and cost efficiency. The manual offers a
therapeutically sound and thereby, hopefully credible approach with workable suggestions within
the solution-oriented framework, a model approach which mental health providers are currently
seeking (Fleming & Rickord, 1997; Williams, 2000). Future research needs to: 1) evaluate this
manual, 2) assess the viability of the combined approach, and 3) may be facilitated by employing
this manual consistently within several studies in order to compare its application with other
control groups. Further ideas about research will be discussed in the conclusion of the final
project.
Current Developments
A review of the current and relevant literature guided the development of an efficient and
effective therapeutic approach for children, teens, and adults (Malchiodi, 2003; Matto et al.,
2003, Nims, 2007; Riley, 1999). Studies on SFAT interventions and developmental concerns for
various ages were examined in the literature (Nims; Riley). In addition, AT benefits were
explored for diverse populations when combined with SFBT, taking into account, clients diverse
needs within various contexts, appropriate for combined SFBT and AT, and highlighting the
importance of diagnostic concerns and the resources available at varied settings (Kim, 2008;
Matto et al.; Malchiodi, 2008). Based on the current literature, and as far as possible, but to a
limited extent, the manual incorporates appropriate options for the interventions which may be
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applied to some diverse populations.
A few AT and SFBT combinations already exist with elements that are
therapeutic and have shown benefits (Matto et al., 2003; Nims, 2007; Reisler, 1987;
Riley, 1999; Selekman, 1997). For example, Reisler explored and reviewed a combination of
family therapy, AT and brief psychotherapy that planned, focused, and executed positive
change through client report with six sessions of therapy. The families involved, found that
they were able to communicate and interact with each other more easily through creativity.
Selekman (1997) combined SFBT with AT interventions with families and found that
the combination had therapeutic benefits. Selekman demonstrated these combined
interventions with various case studies showing that clients relaxed, had fun, and found
therapy less threatening than SFBT alone. Children and adolescents were able to become
involved and contribute to solutions through the art process by focusing on the here and now
(Riley, 1999; Selekman). Some children in this age group, between five and eighteen years of
age, may have more difficulty communicating their thoughts and feelings through words than
through art, because developmentally they may lack cognitive and emotional comprehension
(Malchiodi, 2003; Riley; Siegel & Hartzell, 2003). Riley explained that adolescents are not
able to discuss intimate life experiences and feelings with a therapist if they do not
understand these themselves. Siegel and Hartzell described the adolescent brain as in the
process of reorganization and explained that this partially assists our understanding
adolescent behaviours and emotional experiences. The authors noted that excessive stress
at the time of adolescence that releases high amounts of cortisol hormones may be a negative
factor in brain development.
Nims (2007) integrated SFBT with art techniques with children ages 5 years to 12
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years old. The SFBT model was used successfully to help children and teens experience
positive behavioural changes and solutions. These experiences become the fertile ground for
new thinking.
Similarly for adults with addictions, Matto et al. (2003) integrated AT and SFBT
and found a less threatening and more acceptable therapeutic model. Matto and colleagues
found that AT and SFBT offered a strengths-based treatment framework for adults with
addictions. This approach enabled them to move into functional behaviour without getting
stuck in shame around their past dysfunctions.
Overview of the Manual
This manual is divided into five chapters beginning with the introduction in Chapter I.
This portion continues with a brief scrutiny of current developments, explores the rational of the
project, and overviews the manual. Chapter II reviews the theoretical foundations of SFAT and
explores compatibilities, benefits and implications for counselling. Chapter III is a reflection on
clinical work and research with a critical review of present applications of SFAT and an
exploration of complementary and diverse theoretical aspects. Incompatibilities between AT and
SFBT are discussed. Research on efficacy of AT and SFBT is rationalized and theoretically
explored within the SFAT model. Potential implications of using SFAT are summarized. This
chapter examines the compatibilities of combining AT and SFBT within the SFAT manual.
Chapter IV describes a seven SFAT weekly sessions in three separate manuals including
interventions, activities, and rationales to be used with children, adolescents, and adults. Included
are scaling emotion-faces, followed with descriptions of interventions utilized, and references.
Chapter V explores the synthesis and implications of SFAT, a concluding summary, and future
research possibilities. References are included for further reading.
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CHAPTER II
Theoretical Foundations
The SFAT model is a relatively new model based on therapeutic work performed by
several therapists (Malchiodi, 2003; Matto et al., 2003; Mooney, 2000; Nims, 2007; Riley,
1999; Riley & Malchiodi, 2003; Selekman, 1997) who sought to improve efficiency and
effective therapeutic techniques for adults, teens and children. The SFAT model can combine
some SFBT strategies with phenomenological AT, but SFAT is not limited to only drawing
from a phenomenological art therapy approach. To enhance the understanding of this model,
theoretical foundations will be explored.
Social Constructivism
Social constructivism is a theoretical perspective, incorporating and compatible with
postmodern viewpoints of psychotherapy. It is counselling that observes a client’s reality
without questioning whether it is rational or accurate and from this platform the client and
counsellor seeks to elucidate the situation, and this may facilitate change (Corey, 2005).
Corey and Goldenberg and Goldenberg (2005) reported that a client’s reality is based on
language use and is a function of the situation that is socially constructed. Truth and reality
are understood as points of view based on history and context and not on objective
immutable facts (Corey). Corey explained that clients are viewed as experts on their own
lives and the therapist’s role is “to be an expert at exploring the clients’ frame of reference
and identifying those perceptions that clients can use to create more satisfying lives (p. 385).
SFBT is one type of post modern social constructivist therapy (Corey; Goldenberg &
Goldenberg).
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Solution-Focused Brief Therapy
SFBT evolved from brief family therapy and is a paradigm shift from the more
traditional psychotherapeutic focus on problem formation and problem resolution ( Corey,
2005; Iveson, 2002; Malchiodi, 2003; Walter & Peller, 1992; Wheeler, 2001). SFBT focuses
on client strengths and resiliencies and is based on solution-building, current resources, and
future hopes, rather than present problems and past causes (Corey; Iveson; Walter & Peller).
The therapist is directed by client’s goals and co-constructs solutions with the client with the
intention of reaching the objectives (Malchiodi). Walter and Peller wrote that “we shift our
presuppositions away from the traditional linear notions of causality, we move toward a
relativistic and constructivist view, as well as toward a future orientation” (p. 6). The shift is
away from pathology and objectification of people and towards a more positive viewpoint of
people within their communities and what they want to create for themselves (Walter &
Peller). The focus on solutions sets the stage for an expectation of change, the participation
of the client, ( Corey; Walter & Peller) and has the potential to reduce the number of sessions
in therapy (Fleming & Rickord, 1997; Iveson; Malchiodi).
Strategies of Solution-Focused Brief Therapy
Walter and Peller (1992) described the start of therapy sessions as “focusing on the
positive, the solution, and the future to facilitate change in the desired direction” (p.37). The
SFBT interventions can be defined with examples (Malchiodi, 2003; Matto et al., 2003; Riley,
1999; Selekman, 1997; Walter & Peller) and in general these interventions are complementary
with an AT approach.
Exceptions. SFBT therapists utilize exceptions as an intervention to map out solutions
to a problem by using the client’s own unique resources and ways of solving problems (Matto et
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al., 2003). Matto et al. found that exceptions reduce the intensity of the client’s problem for the
purpose of reducing the likelihood that the client will be as overwhelmed. The authors noted that,
clients’ use of their own resources helps empower them. Similarly to SFBT, an AT therapist may
direct the client to create a spontaneous creative expression which in itself may lead to new ideas
and influence the creation of solutions (Malchiodi, 2003). The therapist then guides the client to
discover exceptions to that problem in additional artwork and by words. They can explore
additional ideas for solutions within the artwork, and in this way engage and facilitate the change
process (Malchiodi; Matto et al.; Riley, 1999; Selekman, 1997; Walter & Peller, 1992). The
authors found that the therapist-guided art process empowers and motivates the client to continue
working on exceptions and solutions. The art process itself reduces the intensity of the problem
for clients because they can choose to explore parts of the problem at their own pace guided by
the therapist. The therapist assists with the framing of exceptions through questions, being
witness to the unfolding process, and helping clients notice their images within the art.
Scaling. A numerical assessment technique called scaling is a 1 to 10 value that can be
incorporated at the beginning, middle or end of therapy to clarify directional improvements or
success levels and to assist progress through feedback ratings about desired states, behaviours,
and goals that are feasible and expected (Matto et al., 2003; Walter & Peller, 1992). Children,
some teens, and even some adults have difficulty understanding the concept of scaling when
numbers are employed. Therefore a pictorial facial expression chart (see page 110) can be an
alternative. A smiling face represents 10 indicating a positive, happy client, and at the opposite
end of the continuum, a distressed face is a 0 which indicates the client is not happy at all. These
feeling symbols are used to help clients and therapists determine how clients feel at the start as
compared to how they feel later when change occurs (Selekman, 1997; Walter & Peller).
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The miracle question. Another intervention created for SFBT, the miracle question,
orients clients towards change. Malchiodi, 2003; Matto et al., 2003; Riley, 1999; Selekman,
1997; Walter & Peller, 1992). Hypothetical AT examples include asking an adult to draw a
miracle of change picture or suggesting that a child or teen imagine a safe space moment, which
can then be drawn. The art can then be discussed, exploring ideas from observations made, and
positive solutions where indicated.
Phenomenology
Phenomenology is a philosophy that refers to any methodology that focuses on the
cognitive experience as it occurs without reducing the experience to it’s components
(Hergenhahn, 1997). Edmund Husserl (1900), one of the founders of phenomenology, viewed
the ideal as freedom from preconceptions with primary importance on a belief in reporting what
appears in consciousness rather than primarily valuing a theoretical base. Husserl concentrated
on the workings of the mind that were independent of the physical world and attempted to reduce
phenomena to its essence. This philosophy led to the development of transcendental
phenomenology which was a science of intuitive investigation (Hergenhahn). A student of
Husserl, Martin Heidegger (1927/1962) developed hermeneutic phenomenology which related to
the meaning of phenomena pertaining to human existence (Betensky, 1995). Other
phenomenologists such as Geiger (1928/1995), Pfander (1900-1901/1976) and Scheler (18741928/1954) explored structures, interconnections and intraconnections within phenomena, and
the phenomena of aesthetics (Betensky). All these developments led to courses in philosophy and
phenomenology psychology that influenced psychotherapies of humanistic origins and to some
extent led to postmodern orientations. Phenomenology AT incorporates some concepts deriving
from phenomenology philosophy, psychotherapy, and Gestalt psychology (Arnheim, 1972;
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Betensky; Geiger; Heidegger; Husserl; Pfander; Scheler; Velman, 2007).
Phenomenological psychotherapy was a reaction to positivism, a philosophy focusing on
the sense experience and behaviour of human nature as the only important factors (Corey, 2005).
Phenomenology psychology, expanded into existential psychology, which studied the description
of human nature and what it meant to be a particular individual (Hergenhahn, 1997). The
optimistic assumptions became that people are healthy and competent and have the ability to
solve their own problems and the therapist’s role was to help the clients recognize the
competencies they have (Corey). The unconscious experience was diminished in phenomenology
psychology until modern writers on phenomenology, such as Todres (2007) explored and argued
for the acceptance of the unconscious within qualitative research.
Todres (2007) made a scholarly argument to research, not only conscious experiences, as
is traditionally found within phenomenological theory, but to include the unconscious images
like these that come through art. The conscious, unconscious (Todres) and even implicit
memories from the body (Siegel, 2007a) may be shown in the art and experienced in new ways
for clients. Siegel stated that implicit memory encoding does not require focal, conscious
attention but differs from unconscious memory because there are sensed memories, but no visual
imagery of the past events. The body sensations are often key sources of the implicit memories
(Siegel). McNiff (1992) and Betensky (1995) referred to the unconscious as that which is absent
from awareness or consciousness. Phenomenological art therapists explore the whole experience
with the client, the conscious experiences, implicit memories, and the unconscious memories that
appear in the art for verbal exploration (Malchiodi, 2003).
The Gestalt of Art Therapy
Betensky (1995) became acquainted with Gestalt psychology and the Arnheim
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Betensky (1995) became acquainted with Gestalt psychology and the Arnheim psychology of
arts in her student years, which influenced her development of phenomenology art therapy.
Arnheim explored art through perception, abstraction, and visual thinking; perceptual dynamics
and expression; and perceptual beauty structurally (Verstegan, 2007). He felt that art should be
experienced visually, emotionally and intuitively in its totality. Betensky attempted to apply
these principles in phenomenology art therapy with her approach to the art of looking and seeing,
meaning and relatedness, and unity of emotions and expression. She helped her clients explore
their art expressions by stepping back and seeing the artwork from a different viewpoint, one
with minimal or no judgment, through shape, colour, placement, and size. She then assisted her
clients in relating and integrating the art expression with meaning and emotions.
Rhyne (2001) was the pioneer of gestalt art therapy and defined gestalt as form, pattern,
figure, structure, and configuration. A further explanation by Rhyne related gestalt to a way of
being that she explained as being in the present, giving full attention to what is being done,
choosing the project and trusting the client’s own experiential data. Therefore Betensky (1995)
explored and contributed the gestalt of art in her discussions of symbolic expression of line,
shape and colour, explored in phenomenological art therapy.
Phenomenological Art Therapy
Mala Gitlin Betensky (1995) is recognized as the founder of phenomenological art
therapy. Betensky (1995, 2001) defined phenomenology as “a study of phenomena or things and
objects, and their structures as they present themselves in consciousness as immediate
experiences” and based her writings on Edmund Husserl (1913/1976), the 20th century founder
of modern phenomenology (1995, p. 3). The author included in her descriptions of phenomena
visible, touchable, and audible things in the environment and thoughts, feelings, dreams,
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memories (conscious and unconscious), fantasies, and all that exists in the mental experience.
From a psychological perspective, Betensky (1995) described the phenomenological art therapist
as someone with fresh eyes who continually observes clients’ art and the whole experience and
guides clients to perceive their art visually, cognitively and emotionally.
Betensky (1995) explored the basic concept of Husserlian (1913/1976) phenomenology
with intentionality. She stated that humans and their being in the world are very intimately
related; therefore, humans are deeply affected by their experiences and often overburdened. This
burden makes humans retreat into psychopathology (Betensky). The art experience becomes a
release of tension related to the human burden and the art therapist guides the client into
intentional perception and new possibilities wherever possible (Betensky).
Betensky (1995) looked at expression in art therapy as “the whole quality of art therapy”
(p. 29) with clients that permeates the art expression of clients. AT “carries and conveys
meaning” (Betensky, 1995, p. 29). She explained that the expression is a potential source of
therapy that is related and intrinsic to the whole of the art quality. The whole quality of art to
which Betensky (1995) referred, is symbolic expression of line, shape, and colour. She
considered that human art expression contains forms of human or animal body, nature elements,
objects that are real or invented, and abstractions. In art therapy, she added, “organization and
surface properties and not primarily or only aesthetic aspects” (p.29) are considered as “parts of
self and states of the inner being and an expression of the inner universe” (p. 29). Integration and
awareness of these inner parts and states may occur in therapy and for Betensky (1995) were
essential components of phenomenological art therapy.
Symbolic Expression of Line
Betensky (1995) explored and experimented with expressivity of line, affect in
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line and the affective line relationship to the rhythms of nature. Lines reflect meaning and
emotion (Betensky). Vertical lines may be described as ranges of warm to hot and horizontal
lines as cool to cold which reflects temperament (Betensky). According to Betensky, studies
showed that irregular, jagged, and sharp angled lines expressed agitated emotions, while gently
curved and steady lines represent more quiescent states of mind. The author explored affective
values of line such as movement and tension. Conclusions from the studies regarding a
therapeutic art perspective illustrate that art makers assume the role of observers and actors and
confront self discoveries with the help of the therapist (Betensky).
Symbolic Expression of Shape
Betensky (1995) explored some visualization of shape concepts in order to help clients
reveal their truths about themselves in their world: 1) authentic humans have a need for
expression of what they think and feel and are unable to do so verbally but art expression may
connect to a verbal channel, 2) abstract lines and shapes have a double quality of both revealing
and concealing and have special appeal to clients, 3) the structure of shapes reveals the structure
of the inner experience in simplified form, and 4) the art materials are an important ingredient
from the world with strong appeal from the client as they arouse passive states. All of these
components of shape, assist the therapist and client to discover and connect the outer and inner
experience.
Betensky (1995) observed that when lines form closure or suggest closure they form
shapes that are abstract and simple. This concept the author explained, is a well known positive
gestalt quality and most client drawings contain these two characteristics, of abstractness and
simplicity. Many drawings consist of easy geometric figures such as circles, squares, triangles,
rectangles (or variations of these) and abstractions that shape artistic expression (Betensky).
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Though the art is simple, extensive thinking and feeling, which the author described as “complex
mental activity on a high experiential level” goes into the therapeutic expression (p. 45).
Betensky added that mental forces such as thinking, memory, emotions, sensory experiences,
humour, selectivity, and imagination are part of this cognitive-emotive act.
Symbolic Expression of Color
Betensky (1995) described colour as a phenomenon that has its own structure, properties,
and expressive qualities related to the human experience of symbolic expression. The author
reminded us that everyday life shows us that colour soothes, disturbs, arouses, and fascinates us.
Betensky explored colour by structure and its relationship to emotions, form and function of
colour in the context of clients expressing their inner experiences.
Betensky (1995) referred to the structure of colour by its innate pigment colour and other
qualities. She used Kandinsky’s (1977,1979) theories of psycho-philosophical orientation about
colour as her reference. Kandinsky’s method organizes colours as warm and cool and dark and
light. He stated that the primary colours are red, blue, and yellow, and the mixed colours are
orange, green, and violet. He explained that colours can be mixed so as to obtain variations of
these colours and tones that can be adjusted with black and white. Various colours have many
personal meanings (Betensky). For example, blue can be spiritual, vague, hiding, white can
define purity, holiness, and idiosyncratic meanings and black may mean grief, and depression or
even a sense of power. Betensky explained that colour may be very effective in expressing
emotions, growth, culture, transition, recognition, change, and tension but that it likely means
different things to specific clients. Lack of colour may have varied but significant meanings
(Betensky). From her experience with untrained clients, Betensky observed that “art components
carry feeling values which combine into certain wholes” (p.30) with components of line, shape,
17
and colour and their structural relationships. The whole quality of AT evolves through the
experience of lines, shapes, and colours, encompassing the phenomenological approach to AT
(Betensky).
Phenomenological Art Therapy Method
The phenomenological AT methodology, developed by Betensky (1995), integrates art
and verbal therapy. Betensky explained there are four sequences that therapists and clients
process in therapy: pre-play with art materials, the art process, intuiting, and the what-do-you-see
procedure. The phenomenological AT approach can be a way for the art therapist to explore art
expression with the client in order to probe for more comprehensive meaning and depth
(Betensky).
Sequence 1: Pre-play. Betensky (1995) explained pre-play as a time to
experience art materials with thoughts, senses, and emotions. The time of pre-play
relaxed anxious clients while children enjoyed messing around with materials before the
serious art process began (Betensky).
Sequence 2: The process of art work. The art work process might be a playful experience,
a serious consciously planned activity, or a silent contemplative work with verbal or nonverbal
communication of art expression while the therapist observes and witnesses (Betensky, 1995).
The therapist is present, and if needed assists with any problem solving such as composition or
mixing of colours. As well, the art therapist observes the client in the artmaking process
(Betensky). Composition problems may include not knowing where to start or not understanding
how to use an art medium (Betensky). Clients who lack artistic experience are supported and
encouraged by the therapist to develop their abilities and skills and to discuss their issues with
the therapist (Betensky). The therapist may explain that the artistic ability is less important than
18
being sensitive to the process, as high sensitivity and low skill emphasis takes the pressure off
the product or performance anxiety (Malchiodi, 2003). Meaning, experience, and emotional
content are observed in shapes, lines, composition, and colour (Betensky; Malchiodi ). The
therapist’s observation of the process informs the therapist how the client reacts to many
elements of the process, including frustrations, support, and inadequacies (Betensky). These
impressions allow the therapist to shape ideas about what to say or do within the client’s process
or in the art interventions (Betensky).
Sequence 3: Phenomenological intuiting. Betensky (1995) writes that for intuiting of the
completed phenomenon of artwork with its own structure, values, and meanings to take place,
the client needs to step away from the art expression to facilitate a measure of detachment. She
explained detachment is needed for the eye to see and to view with ownership awareness. The
client is asked to place the art expression in a space of his or her own choice, and often, both
therapist and client silently observe the artwork from a distance (Betensky). The therapist
explains to the client that things may be seen differently in this way than at close proximity
(Betensky). Betensky called this viewing in silence, intuiting, as the client begins to make
connections to details that matter and discover meaning from them. As the client’s awareness
deepens, important new things surface about relationships within the artwork such as two colours
meeting in harmony or contrast, an odd location for an object, or a line with thickness,
jaggedness, or faintness (Betensky). The therapist and client then proceed to the next stage.
Sequence 4: The what-do-you-see procedure. The art therapist invites the client to
describe what he or she sees in the client’s picture by asking the client, “What do you see?”
(Betensky, 1995, p. 17). Betensky explained that the client’s initial descriptions contain three
fundamental principles of phenomenological art therapy that the therapist can address: 1) the
19
client recognizing his or her own internal reality, 2) the client establishing trust by being heard,
and 3) the client telling the therapist what is in the art piece from the client’s own interpretation
and seeing. Through gentle probing, the therapist helps the client see structural components, how
these components relate to each other, how the components relate to the overall structure, and
what role each component plays in the whole picture (Betensky). The client can make a
conscious effort to connect the structure to inner experiences, locate expressive qualities from the
picture, and identify feelings and attitudes from the art that relate to self (Betensky). The
therapist will recognize the occurrence of integration, when the client connects the art to inner
self (Betensky).
Solution-Focused Art Therapy
The SFAT is a potentially viable therapeutic option since AT and SFBT have similar
beliefs about clients and elements of compatibilities in their principles. (Malchiodi, 2003;
Matto, et al., 2003; Riley, 1999; Riley & Malchiodi, 2003). Both therapies offer benefits
when combined into a practical model.
Beliefs About Clients
All humans have creative potential. All humans have the innate quality of creativity
(Leeuwenburgh, 2000). To clients, AT is an acceptable and often preferred means of
working that is partially related to the idea that in every culture there is an innate desire for
creating, promoting, and exploring through creative expression an “inherent, universal, and
biological trait of human species” (Leeuwenburgh, p.41). AT is a form of psychotherapy that
places art and artistic practices at the heart of the therapeutic work, and in addition includes
verbal therapeutic techniques as part of the interventions (Malchiodi, 2003, 2008).
Selekman (1997) introduced creativity to his work with families, in addition to talk
20
therapy, as he found it limiting to primarily work with words. He described children with
problems as resourceful, creative and enacting rather than reacting to problems and crisis they
faced. Art expression helps individuals quickly communicate relevant issues and problems and in
many cases artmaking and the art, itself, communicate what words cannot (Malchiodi, 2003,
2007; Selekman). Where appropriate, art-in-therapy needs to be brought into SFAT as art images
and artmaking processes are integral to many people’s healing development and visual learning
(Malchiodi, 2003). At about age four, pictorial representation of self occurs and makes art
expression useful in therapy because it allows metaphors (Kozlowska & Hanney, 2002). The
client’s metaphor is described by Malchiodi (2003) as an analog through which the therapist and
client communicate visually or verbally. One example of a client’s metaphor, that was explored
both verbally and visually by Malchiodi (2003), is a volcano erupting. This picture represented a
metaphor of a family’s problem. Selekman (1997) encouraged metaphors from his families, both
visually with art therapy and verbally, depending on the circumstances and the family.
People are resourceful and experts on their own lives. People or clients are seen as agents
of change with resources that make them experts on their own lives, according to the beliefs of
AT and SFBT therapists (Betensky, 1995; Malchiodi, 2003; Riley, 1999; Selekman, 1997;
Walter & Peller, 1992). A phenomenological art therapist empowers the clients by encouraging
interpretation and integration of their created art expression (Betensky). Walter and Peller
described “people as resourceful and having all they need to solve their problems” (p.23). Riley’s
SFAT approach with teenagers, illustrates that taking a positive frame of mind, and a focus on
strengths, helps teens relax, and succeed with their goals.
A collaborative relationship. One of the goals of therapy is for the therapist and client to
establish and maintain a collaborative relationship (Betensky, 1995; Malchiodi, 2003; Riley,
21
1999; Selekman, 1997; Walter & Peller, 1992). Work towards their goal begins in the first
session (Malchiodi; Riley; Selekman). Walter and Peller discussed the client therapist
relationship in the context of group membership. Riley noted that postmodern psychological
theories aim to construct therapy in a collaborative manner and to reach goals with the client
efficiently, by forming a working alliance quickly. Betensky found that concentrating on art
expression created an environment of perceived objectivity and trust. Within that holding
environment, a safe, warm relationship establishes between clients and therapists. Malchiodi
summed up beliefs in the client concisely when she said “to implement these approaches,
meaning AT and SFBT, the therapist must put aside the traditional long-term, pathology-oriented
theories and accept the client in an equal position of collaboration with the therapist”(p. 82).
The problem is seen as separate from the client. Betensky (1995), Malchiodi (2003),
Riley (1999) and Walter & Peller (1992) all saw the problem as separate from the client. The
problem is externalized because the art product is external to the client and therefore the
artmaker is not seen as a container of pathology (Riley). The potential metaphor as resource in
both AT and SFBT offers an effective method of externalizing the problem and helps clients
integrate the art expression to their lived-world experience, when they are ready (Malchiodi;
Riley; Selekman, 1997). Though Betensky did not refer to metaphor, she discussed the issue of
integration in terms of how what is observed in the art [i.e. art-image-metaphors] needs to be
linked to the client’s internal state. Matto, et al. (2003) adopted metaphor to constructing,
reframing, expanding, deconstructing, and finally reconstructing with the client from problem to
solution. Selekman developed many strategies to expand his SFBT method and to separate the
problem from the clients and make therapy more comfortable for families. For example,
Selekman used the Squiggle Wiggle game to relax families and to promote having fun for those
22
with emotionally laden material. In this approach, he asks a young child, or someone nervous
about creating art, to simply draw some squiggly lines and make a picture out of it, and then talk
about it.
Client empowerment. Both the AT and SFBT therapists encourage client empowerment
through the process (Betensky, 1995; Malchiodi, 2003; Matto, et al., 2003; Riley, 1999;
Selekman, 1997; Walter & Peller, 1992). Malchiodi (1997) stated that empowerment for clients
involves developing confidence in their own capacities. The authors found clients developed
empowerment by receiving affirmation from others, by constructing a positive sense of self
(Malchiodi; Matto, et al.), by developing their own goals, and by finding solutions to their
problems (Selekman; Walter & Peller). Selekman and Riley stated that families were
empowered through the act of placing them in the expert position, exploring their resiliencies
through questions about past successes and strengths, and externalizing the problem through
exploration of different approaches.
Cooperation in therapy. The focus within SFBT and AT therapy is on cooperation rather
than resistance (Betensky, 1995; Malchiodi, 2003; Matto, et al, 2003; Riley, 1999; Selekman,
1997; Walter & Peller, 1992). Walter and Peller described clients as always cooperating. As long
as the therapist understands what the client is thinking and acts accordingly, change progresses
as it should. Betensky explored cooperation as the art therapist’s role of guidance towards an
intentional focus upon perception. New perceptions may open up new possibilities for clients.
Turnell and Edward (1993) suggested giving a great deal of positive reinforcements to the client
to motivate them towards desired change. Malchiodi and Selekman discussed resistance as a
useless concept in therapy for the client and therapist. They suggested that therapists need to be
positively focused and to believe that clients come in because they want change.
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Compatibilities in the Principles of SFBT and AT
Phenomenological art therapy, which emphasizes the client’s experience of artmaking
and perception of art and life, appears to have many components that are inherently compatible
with SFBT (Malchiodi, 2003, 2008).
The process is seen as moving and emerging. For the therapist to provide benefits to the
clients through both therapeutic orientations, the process must be seen or experienced as moving
(Malchiodi, 2003; Selekman, 1997). Clients may benefit and potentially receive more meaning
out of the AT by viewing all their art periodically which becomes an ongoing process and not an
event (Malchiodi). Meaning will come out during a session or from the art that clients create and
view over time (Betensky, 1995; Malchiodi). The process of art therapy is arts based and
experiential, as clients draw, paint, sculpt, write, do collage or work in some other creative
modality, and as they participate in their own treatment (Malchiodi). Similarly in SFBT, Walter
and Peller (1992) explained that the positive focus on the solution, and the future, facilitates
change in the desired direction and keeps the process moving.
The art therapist is seen as a member of the process team taking on many roles that
become therapeutic through the relational nature of art therapy (Betensky, 1995; Matto et al.,
2003). Comparably, the SFBT therapist works with the client as a team, collaborating on goals
and tasks to create solutions for the problem (Selekman, 1997; Walter & Peller, 1992).
The art therapist may encourage clients’observation in their art expression through
questioning, but interpretation of the clients’ art is part of the clients’ own process (Betensky,
1995; Malchiodi, 2003). Art exploration produces an interactive process that is, potentially
ongoing and unfolding (Betensky; Malchiodi, 2002, 2003; Selekman, 1997). In some contexts or
situations, the verbal exploration becomes an empowering experience for the client when the
24
client and therapist explore the problem and solution in the art that the client initially produced
(Betensky; Malchiodi; Sekeman).
Though art is not interpreted universally but individually, there is universality
about all art and certain symbols and similar meanings show up across cultures (Leeuwenburgh,
2000). In Leeuwenburgh’s experience, culture may be explored and celebrated through the arts,
with the result being a greater understanding and appreciation of every client’s culture. Creating
art comes from within and is an innate ability that reflects the soul or inner being of all humans
(Allen, 1995, 2005; Malchiodi, 2002).
Small changes lead to motivation. A common principle with AT and SFBT is the belief
that a small change in thinking or behaviour results in a greater change in systemic issues. Walter
and Peller (1992) explored the advantages of a positive focus. The authors reported that focusing
on the positive and on the solution leads to change in the desired direction. Exceptions to the
problem, which are facilitated by the therapist and created by the client, kindle the change
process (Matto et al., 2003). Using art to explore the problem may result in faster resolution of
details and depth of the problem but the therapist must remain curious and allow and support the
client to figure out the whole problem and the solution (Malchiodi, 2003). Selekman (1997)
expressed that in his evaluation the most important part of therapy is the exploration of the
problem, as he found that the solution follows quickly. Walter and Peller explained that SFBT
therapists may not be able to work with problems that have unconscious origins and would have
to refer those clients. Combining the two therapies would give the therapist the flexibility,
effectiveness, and efficiency to work with these clients rather than referring them to other
therapists (Malchiodi).
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Benefits That Have Implications for Counselling
Conscious, unconscious, and implicit information. A benefit with SFAT is the concrete
form created through artmaking that may evoke conscious, unconscious, and implicit
information (Malchiodi, 2003; Siegel, 2007a). The product or concrete form is a container for
emotions, events, and actions of the situation (Malchiodi). This container may materialize in the
form of a symbol or metaphor and is an aide for the client in working with the problem because
it is usually safe for people with difficulties, for children who may not have the words to describe
feelings or what happened, and for teens who sometimes reject adult ways of expression and
prefer metaphors (Malchiodi; Riley, 1999). Artmaking may be helpful with clients who have
problems expressing themselves verbally, whether due to lack of education, shyness, or language
barriers. The problem might be very difficult to articulate, or it may be a subject to a barrier such
as a developmental problem (Malchiodi; Riley). The combination of AT with SFBT would give
these clients another option.
Concrete examples. Identifying problems and solution possibilities within the artwork in
fairly concrete ways, is an advantage of SFAT (Riley, 1999). Riley suggested that recurrent
patterns of behaviour may become obvious within the artwork, along with exceptions to the
problem, including where and when they occurred. Transformation and change are demonstrated
from the artwork over time (Riley). The art itself serves as a container for these memories, and
the art object begins to birth a solution, which allows clients to tolerate affect and thoughts
(Malchiodi, 2003) in part by mediating from the amygdale, the emotional centre, to the
hippocampus area in which the client finds words and ideas (Siegel, 2001, 2007a, 2007b). The
art itself helps identify ideas and can organize complexity, which helps in integration of trauma
and other stresses (Malchiodi, 2008; Siegel).
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Organizing information. Combining the therapies may organize the problem and help
form solutions for those times when a solution is important within a limited time (Matto et al.,
2003). Creative solutions may be promoted through the art itself (Malchiodi, 2008). The use of
AT with SFBT would be beneficial to assist the student who is angry at school or on the bus, in
order to explore options they might already have and to set some goals and solutions in place that
would help them deal with that anger quickly.
The client’s artwork and the interactions give the art therapist ideas with which to work
and similarly, the words the client says during SFBT gives the therapist ideas, which can lead the
way for the therapist to facilitate the client’s discovery to their own explorations and eventual
solutions. Malchiodi (2003) explains that art expression is employed with contemporary
approaches such as SFBT to underscore the client as a collaborator with the therapist in creating
solutions to the presenting problems. She further adds that art expression is promoted as a way to
help clients make visible their worldviews and create artful expressions to make positive changes
to problems.
Combining the two therapeutic approaches and organizing the information results in
access to details that are related to problems, as well as solutions, for the client and therapist
(Malchiodi, 2003; Selekman, 1997; Walter & Peller, 1992). Intake assessment , which is done by
all therapists, is the first step in gathering knowledge about the client, what brought the client to
therapy, and what the client has already tried to do to solve the problem. Selekman believed that
a well-defined problem leads to quicker solutions because both therapist and client are working
on the same problem, and on the right problem. The therapist leads in the direction of the client’s
goals, to the construction of solutions with the client, to reach specified objectives (Malchiodi).
Short-term therapy. SFBT and AT have compatibilities such as a tendency to reduce the
27
length of therapy and are often promoted as resulting in shortened therapy time, 10 sessions or
less (Iveson, 2002; Riley, 1999; Riley & Malchiodi, 2003; Walter & Peller, 1992). Malchiodi
discovered that AT brought about more “rapid resolutions of the presenting difficulties than
verbal therapy alone” (p.82). Riley and Malchiodi wrote that, “AT is compatible with brief
approaches such as SFBT, because the process of creating images tends to accelerate the
emergence of thoughts and recall of memories and details” (p. 83).Walter and Peller found with
SFBT that focusing on the solution and not the problem reduced the numbers of sessions that
clients needed to accomplish their goals.
Future critical inquiry could examine the value of reaching these specific goals and
determining whether these goals were in fact goals that both the clients and the therapists valued
reaching. Theoretical benefits such as conscious, unconscious, and implicit information,
organization of information, concrete art expression and short term therapy could be explored for
their value within SFAT for clients’ and therapists’ goals and strategies.
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CHAPTER III
Critical Evaluation of Research
Critical Review of Present Applications of SFAT
SFAT is a relatively new therapy model that combines principles and strategies from
phenomenological AT and SFBT (Malchiodi, 2003; Matto et al., 2003; Mooney, 2000; Nims,
2007; Riley, 1999). Selekman (1997) employed SFBT, but also incorporated AT interventions
within the therapeutic process for benefits, ease, and comfort to his clients. Though Selekman
found that selected clients relaxed, had fun, and were able to process problems with less stress,
more research is required into whether and when all or most clients could benefit. New treatment
models such as SFAT may have treatment advantages and serve as a practical tool while
promoting options for art therapists in settings such as private practice, hospitals, schools, and
mental health agencies for children, teens, and adults (Fleming & Rickord, 1997; Malchiodi;
Matto et al.; Nims; Riley; Selekman). Therapists working at these varied sites, work with clients
who have problems which can be constructed, deconstructed, and reconstructed (Malchiodi;
Matto et al.; Riley). Therapists may want to seek models such as SFAT, with its structured
guidelines and therapeutic interventions, to help them reach their goals within fewer sessions
(Malchiodi; Riley). Research of this model is currently limited to anecdotal reports and case
studies.
Writing about models in journal articles, projects, and books, as reported in this thesis,
often stimulates field therapists to explore models and research sometimes follows (de Shazer &
Berg, 1997). SFAT has been utilized and written about by several authors (Kahn, 1999;
Malchiodi, 2003; Matto et al., 2003; Mooney, 2000; Nims, 2007; Riley, 1999; Riley &
Malchiodi, 2003). These writers illustrated how therapists can creatively use AT and SFBT
29
interventions and what benefits for clients are observed in therapy. Matto et al, Mooney, Nims,
Riley, and Selekman (1997) discussed elements of their models: 1) the ways of relating between
clients and therapists, 2) client motivation, 3) creating an appropriate environment, 4) art
materials, and 5) construction, deconstruction, and reconstruction of client narratives through art
work to stimulate stories about problems and solutions. The processes between client and
therapist were not found to be linear but rather back and forth throughout the therapy from start
to finish (Malchiodi; Matto et al.; Mooney; Nims; Riley; Selekman). For example Matto et al.,
Malchiodi, and Riley discovered that the working alliance between the client and therapist must
be continually worked on to be maintained. Matto et al. found the construction, deconstruction,
and reconstruction did not occur in an orderly manner at all times but was repetitive and
ongoing. Malchiodi explored art materials and the different approaches to selection that are
necessary depending on the client’s needs, the developmental needs of the client, and the client’s
creative desires and abilities.
Therapist and Client Relationship
A therapeutic alliance is defined as a working relationship in psychotherapy between the
therapist and client that includes the development of a bond and an agreement on goals and tasks
that lead to client change (Hiebert & Jerry, 2002). Research concurs that the therapist and client
relationship is one of the most important aspects of therapy (Garfield, 1998; Keijsers, Schaap, &
Hoogduin, 2000). Malchiodi (2003), Matto et al (2003), Mooney (2000), Nims (2007), Riley
(1999), Riley and Malchiodi (2003), and Selekman (1997) stressed the importance of the
therapist and client relationship during their therapeutic work. When it is supportive, empathetic,
nonjudgmental, and friendly it succeeds in term of positive treatment outcomes and change
expectations. The authors agreed that the therapist needs to support and be aligned with the
30
client, in order to explore the problems experienced artistically, behaviourally, cognitively, and
emotionally for the purpose of building solutions toward change.
Client Motivation
A working alliance leads to or becomes part of the motivation of the client as the client
experiences empowerment from the change process, the empathetic therapist, and the creative
environment of art therapy (Malchiodi, 2003, 2005; Moon, 2002). Malchiodi (2005) stated that
active participation with the arts helps clients get involved, energizes, alleviates emotional stress,
redirects attention and focuses their concentration on issues, goals, and behaviours. Malchiodi
(1998) also stated that client’s empowerment involves developing confidence in their own
capacities. Clients develop empowerment by receiving affirmation from others, constructing a
positive sense of self (Malchiodi; Matto, et al, 2003), developing their own goals, and finding
solutions to their problems (Selekman, 1997; Walter & Peller, 1992). Selekman and Riley
(1999) stated that the act of placing the families who are experiencing SFAT in the expert
position, exploring their resiliencies through questions about past successes and strengths, and
externalizing the problem through exploration of different approaches empowered and motivated
clients. Riley discussed “projecting the attitude of confidence in their clients to activate coping
skills” (p. 242) and “to bring strengths to the clients attention” (p. 243) as an alternative to the
problem script.
Art Therapy Environment
Appropriate space and client comfort within that space contributed to establishing a
working alliance (Hiebert & Jerry, 2002). Malchiodi (2007) described an ideal space as quiet and
private, well lit, with windows, and no carpet. The space should be large enough to display art
work [when appropriate to the setting], leave out supplies, have walls for painting large murals,
31
and have adequate storage space for completed projects (Malchiodi). She explained that this is
not always possible as schools, hospitals, and agencies may not have an ideal space and an art
therapist may have to make the offered space work. Creating a safe and private space within any
environment for the client is vital and is the responsibility of the therapist (Allen, 1995;
Malchiodi; Moon, 2002).
Art Therapy Materials
A large assortment of art materials or media is beneficial as clients need choices in order
to stimulate their creativity and express emotions (Malchiodi, 2003, 2007; Moon, 2002).
Malchiodi and Landgarten (1981) discussed the classification of art materials as more controlled
to least controlled. For example, lead and coloured pencils and crayons are more controlled
because they are more resistive and lead to more detail and precision, where as wet materials
such as oil, acrylics, water colour paints, and wet clay are more tactile and on the other side of
the scale as least controlled ( Landgarten; Malchiodi). The least controlled medium will stimulate
emotional expression more easily (Landgarten; Malchiodi). Landgarten and Malchiodi confirmed
that clients should always have their own choice of materials because their experiences are
different with each type of medium. Both authors added, having a choice of medium empowers
the client; however, clients with anxiety or trauma may benefit from choices made by the art
therapist, who may want to offer these clients some control over their emotions. Malchiodi
(2008) referred to this as titration of emotions for clients with trauma or anxiety.
Creative art materials are the media for expression and creative experiences (Malchiodi,
2008). Basic art materials that art therapists should include in their therapeutic space are:
white and coloured sheets of paper of different dimensions, a roll of white paper, pencils,
erasers, coloured pencils, felt markers, charcoal, oil pastels, crayons, conte, charcoal, chalk
32
pastels, and chalk (Malchiodi, 2003; Riley, 1999) Additional items may include: scissors, white
glue, clear tape, masking tape, magazines and various collage materials, basic colors of poster
paints, palettes for paints, glass or plastic jars or cans for water, assorted brushes, assorted colors
of clay/plasticine, a sketchbook, and a writing pad (Malchiodi, 2003; Riley; Riley & Malchiodi,
2003). These materials need to be optional but available if possible depending on resource
availability and appropriateness for clients’ therapeutic needs (Malchiodi, 2008).
Construction of Solutions
The construction of solutions in therapy starts with the therapist and client both
approaching the problem or problems with a positive frame of mind towards change, by working
together to set the stage for expectations of change, and setting goals that reflected what the
client wants and is willing to do, to bring about change (Malchiodi, 2003; Matto et al., 2003;
Riley & Malchiodi, 2003). Matto and colleagues believed that clients are experts on their own
lives and that client’s ideas are valued for their perspectives and worldviews. The client’s
definition of the problem is accepted and the therapeutic orientation and work occurred within
these parameters (Matto et al.). Malchiodi referred to construction of solutions as changing the
doing situation that is seen as the problem. The problem or problems are initially scaled to have a
reference point for evidence of change (Malchiodi; Matto et al.; Selekman, 1997; Walter &
Peller, 1992). That is, the client and therapist must have a starting value of the extent of the
problem in the client’s viewpoint in the present moment. As this value changes, it can be
evidence of change for the client and therapist that indicate that the collaborative goals and tasks
established are working.
Externalizing problems. To separate problems from clients, the artwork is explored for
how it represents or informs the problem (Matto et al., 2003). By freeing clients from the belief
33
that the problem is a fixed or an inherent part of themselves, and thus externalizing the problem,
clients are helped to deal with emotions surrounding the problem (Matto et al.). As a result, the
art becomes a container for the problem, for the emotions surrounding the problem, and for
various details that the client may explore over time (Malchiodi, 2003). Externalizing the
problem validates it within the art for the client and becomes a bridge to solution talk (Matto et
al.). Another method of externalizing is to elicit a metaphor from the client and the client’s art to
help the client explore the problem through an object in their art expression that might lead to
solution talk (Matto et al.; Riley & Malchiodi, 2003). This technique has been seen as effective
with all clients, but especially with children who lack the language to express themselves and
with adolescents who do not choose to be in therapy (Malchiodi).
Exceptions. Using the exception strategy with art expression is a method of “eliciting and
amplifying client strengths” (Matto et al., 2003, p. 266) that leads to the construction of
solutions. Through examining the artwork, through a few probing questions, and through
complementing clients on discovering exceptions to the problem, therapists do not take on the
expert role, but creates an empowering role for clients as they construct their own solutions
(Malchiodi, 2003; Matto et al.; Mooney, 2000; Nims, 2007; Riley, 1999; Riley & Malchiodi,
2003; Selekman, 1997). Empowerment, strengthening, or enhancing is a method of constructing
motivation for the client (Matto et al.). As small changes occur, the client usually wants to create
more change (Walter & Peller, 1992). These processes promote self-efficacy and self-directed
change, which are two highly motivating factors.
Scaling. Gradual steps in the change process further motivates the client and scaling offers
concrete evidence of the change process for the client and the therapist (Matto et al., 2003). In
her work, Malchiodi (2003) discovered that feelings, thoughts, and actions can be explored
34
through artworks created in the present or in the past. In addition, she noted more concrete
evidence of change can be shown by scaling. As Matto et al. explained, asking clients what they
are feeling on a scale of 1-10 can be a starting point for further exploration, such as drawing
what was occurring, who was present, and what was being said. Information such as this may
lead to the deconstruction of behaviours, thoughts, and feelings which then leads to the
reconstruction of cognitions, actions, and emotions (Matto et al.) as explained in the following
section.
Deconstruction Leading to Solutions
Malchiodi (2003) referred to deconstruction of the problem as changing the viewing of the
situation that is problematic to the client. Deconstructing artwork further externalizes the
problem, facilitates the therapist and the client in gaining knowledge about how the client
perceives the problem, and helps determine what weaknesses and vulnerabilities the client has
that may result in relapses (Matto et al., 2003). The therapist observes how the client handles
frustrations around the artistic process, handles challenges and difficulties within the art process,
and what the client’s relationship is with the art process (Matto et al.; Riley & Malchiodi, 2003).
The therapist silently observes and learns many things about the client through the artmaking
process (Malchiodi). The treatment process with SFAT is a combination of artmaking followed
by verbal processing (Malchiodi; Selekman, 1997). Matto et al. and Selekman found that client’s
comfort increased through artmaking even with verbal exploration of emotional material related
to the problem.
Verbal processing. Verbal processing is an important step in deconstructing the problem
and constructing the change process ( Matto et al., 2003). Matto and colleagues explored verbal
processing by critical engagement, initial reactions, relational attributes, and constructing change
35
opportunities. Critical engagement involved simple steps to start the process by observing the
lines, shapes and colours in the drawing (Betensky, 1995, 2001; Matto et al.). The authors
explored where objects are placed in the artwork, colour, size, shape, and the type of objects, and
how much of each medium is employed.
Betensky (1995) explained that a therapist may become curious about what certain
objects in the creative expression are, why some appear to be closer when compared to others,
why some are larger, and why others are hiding. The therapist’s curiosity is an object inventory
as the therapist inquires about what objects are, why they are the size they are compared to
others, and why some are only partially visible (Betensky). This therapist’s questioning gives
clients an opportunity to tell their story (Betensky, 1995, 2001; Matto et al.). Betensky (1995,
2001) and Matto et al. stated that the therapist does not interpret what is seen but rather
empowers the client through encouraging self-discovery. As the client becomes comfortable
exploring the problem artistically, and develops more trust with the therapist’s support of his or
her story, the therapist may attempt to explore feelings after checking that the client is ready to
do this (Matto et al.). Walter and Peller (1992) discovered that praising clients for their hard
work and apparent success leads to client motivation to continue with the process.
Verbal processing includes initial reactions that can be sorted out to explore feelings
around the associations by the therapist and client (Matto et al., 2003). Matto et al. explained that
the therapist can invite the client to see and feel more by asking various questions about the
artwork. The authors stated that adolescents may have components in their drawings that appear
to be there to shock or disturb viewers. These types of drawings should be explored for the
artist’s intent and then respectfully explored for the intended feelings and thoughts around the
components in the drawings. Riley (1999) who specialized in counselling adolescents, always
36
saw the youths’ view as radically different from the adult view, yet suggested that youths and
adults give the therapists an opportunity to negotiate change.
Patterns, themes, and connections within the art expression may relate to relational and
interactional attributes of verbal processing (Matto et al., 2003). Matto et al. specify three
components of relational attributes: 1) object-to-object among shapes, colours, symbols, lines,
and forms, 2) to self, others, and life circumstances such as clients in relation to their home,
school, family, neighbourhood, or community, and 3) to temporal elements of past, present, and
future. Matto et al. suggested that therapists explore how the clients relate to art process itself, as
relational aspects may orient clients towards more personal understanding of relating to self and
others in their world. In Matto et al.’s experiencing the relational components helped the client
change their problem orientation behaviourally, cognitively, and emotionally. Matto and
colleagues found that this furthered solution building.
Solution-focused analysis of the client’s ideas and testing possibilities may be developed
and followed through a construction of change opportunities, and visualizations of desired
changes through the created artwork (Matto et al., 2003). The therapist establishes a verbal
processing approach to manifest workable client treatment goals (Matto et al.
Reconstruction of Solutions
Malchiodi (2003) and Matto et al. ( 2003) viewed reconstruction of solutions as evoking
resources, strengths, and solutions to a problematic situation. Matto et al. suggested that the
images can then be tapped into by the therapist through questioning and seeking the
reconstruction of solutions, visualizing the desired changes, and testing new possibilities.
Exceptions, scaling, and the miracle question are interventions incorporated for the
reconstruction of solutions (Matto et al.).
37
Exceptions. Finding exceptions to the problem is a common intervention for both SFBT
and SFAT (Matto et al., 2003). More specifically, exploring exceptions refers to finding times in
the client’s life when the problem is less prevalent or does not exist (Matto et al.). Matto et al.
applied exceptions to mapping out clients strengths, unique resources, and previously successful
ways that clients solved problems in the past. The authors explored exceptions to reducing the
intensity of the problem for the client and making the problem more manageable and less
overwhelming. For example they found that addicts may be so focused on the problem of their
addiction that they aren’t aware of times they already use strategies to keep them from using.
The authors found that when this was brought to the client’s attention, the client felt more
positive about being able to stop using drugs.
Exception art work gives clients concrete evidence that problems are triggered by specific
conditions and contexts rather than flaws in their personalities (Matto et al.,2003). Malchiodi
(2003) declared that change is inevitable and exists in every dilemma in life and Walter and
Peller (1992) found change occurs all the time; therefore, through diverse or creative possibilities
exceptions always exist. Finding exceptions to the problem stimulates more change and leads to
deconstruction of the problem (Malchiodi; Matto et al.). Exceptions can be encouraged as the
session progresses to reconstruct change in small steps, set goals, and change goals (Matto et al.).
Scaling. By engaging the client in scaling, change can become a concrete process (Matto
et al., 2003). Scaling a drawing allows the client and therapist to have a progressive evidence of
change (Matto et al.). The client is asked to quantify a behaviour, cognition, or emotion in their
drawing on a rating scale of 1 to 10 (Matto et al.). Walter and Peller (1992) explained that the
therapist benefits by maintaining a positive frame of reference within therapy; therefore, scaling
may be adapted to scaling for happy instead of sad, even though the client may be feeling
38
extremely sad. The therapist suggests that the client to adapt the drawing to increase the scale to
a desired state and to develop a goal (Matto et al.). Either the therapist or the client or both, can
adapt scaling on a repeated basis, thereby promoting and progressing desired states, behaviours,
and goals (Matto et al.).
Matto et al.(2003) provided an example of a client drawing a desolate and damaged
tornado-struck landscape to demonstrate the hopelessness the client felt. When the authors asked
what the client would like to feel, the response was a feeling of hopefulness and a possibility of a
different kind of life. The initial drawing was scaled by the client for hopefulness at 1, then
another drawing was done to demonstrate what the client would like to see happen, which the
client scaled at 8 (Matto et al.). The therapist encouraged the client to draw the next small steps
needed to reach that goal (Matto et al.).
Scaling provides a concrete form for the client and therapist to observe and explore, thus
allowing the therapist to enter the client’s view of possibilities. The scale complements the
process to indicate outcomes and more likely motivates the client to keep the progression in
motion (Matto et al, 2003). Scaling allows both the client and the therapist to monitor the
process, feelings, and thoughts about an issue in order to understand what is happening, and to
assist the directional focus. A therapist may utilize creative drawings of emotional faces to make
scaling constructive and user-friendly for clients having difficulties with number scale
systems (see page 110 for emotional scaling faces). Standardized drawings of emotional scaling
faces are useful and essential for research (Duncan, Miller, & Sparks, 2004).
The Miracle Question. Another SFBT technique that is adapted for SFAT to orient clients
towards change is the miracle question which can be implemented by the inclusion of drawing
directives (Matto et al., 2003). The miracle question may be approached as an exploration of an
39
ideal home life, a safe space, or three wishes for some developmentally challenged clients, and
some young children who may have difficulty understanding the miracle question concept. When
a verbal response is required the therapist can refer to the problem drawing and explore with the
client to either draw a solution to the problem in a separate drawing or change the problem
drawing in some big or small ways.
A typical directive is “Imagine you go to bed tonight and when you wake up a miracle
happens and the problem is solved” (Matto et al., p.271). Matto et al. suggested rephrasing the
miracle question to explore the feelings around the changes to the problem “Imagine you go to
bed tonight and a miracle happens and the problem is solved, how would your feel when you
woke up?” (p. 272). The SFAT approach would add “Would you paint or draw how this would
be for you?”
The miracle question constructs solutions and aids in goal initiation with the client in a
therapy session (Matto et al.). Some clients may have problems visualizing a miracle. A
therapist may have to be creative and praise efforts and search for small strengths, and past small
successes to encourage and motivate the client to visualize future changes.
Reflection on Clinical Practice and Research
Psychotherapeutic Approach and Methodology, Therapeutic Alliance, and Self-Healing
The debate continues over the effectiveness of therapy (Garfield, 1998). Therapeutic
approaches and methodologies, the therapeutic alliance, and self-healing by clients (Castonguay
& Beutler, 2006) have all been noted to play a significant role in psychological healing.
Psychotherapeutic approach and methodology. Castonguay and Beutler (2006)
researched the process of change to determine which factors effect change: the client motivation,
the self-healing capacity, the therapist’s relationship with the client, or the therapeutic treatment.
40
The authors concluded that differences in treatments accounted for approximately 10% of the
change variability. Joyce, Wolfaardt, Sribney, and Alywin (2006) compared various
psychotherapies through a literature meta-analysis and concluded that psychotherapy showed
improvement over no therapy and that different approaches to psychotherapy showed equivalent
results. According to the authors the differences shown in other studies favouring behavioural
and cognitive therapies were due to misinterpretation of findings, subjective bias by narrative
reviews of literature, and confounding variables such as investigator allegiance. Castonguay and
Beutler declared, that psychotherapy works and studies are available to confirm that most
therapies are effective (Castonguay & Beutler; Garfield, 1998; Joyce et al.).
Therapeutic alliance. Borden (1979) and Hiebert and Jerry (2002) define the working
alliance or therapeutic alliance as a working relationship in psychotherapy between the
therapist and client that included the development of a bond, agreements on goals, and the
assignment of tasks or a series of tasks for client change. Yalom (2002), a group
psychotherapist who is well-known for his leadership in group therapy, supported the
importance of the therapist and client “travelling together” (p. 2). Garfield (1998) and
Castonguay and Beutler (2006) found that two common variables, the therapeutic alliance and
the client's emotional involvement in therapy, positively correlated with outcome. Mulhauser
(2009) supported and commented on similar findings in his evaluation of the effectiveness of
psychotherapy treatment. Several authors experienced and wrote about the importance of
forming a therapeutic alliance with the client (Betensky, 1995; Malchiodi, 2003, 2005, 2007;
Riley, 1999; Riley & Malchiodi, 2003; Selekman, 1997).
Bedi, Davis, and Arvay (2005) explored the client’s perspective in establishing a therapist
and client working alliance. Clients were interviewed after having a counselling experience. The
41
participant clients rated highly the importance of the therapist’s counselling skills, positive and
supportive attitude, friendliness, and a comfortable, private office space. Garfield (1998)
reported finding that clients expect therapists to be understanding, encouraging, helpful with
problems, and able to guide the client through the process. These elements are all vital aspects of
a therapeutic alliance.
Client emotional involvement. Another important factor for positive outcomes in therapy
is emotional involvement of the client (Castonguay & Beutler, 2006; Garfield, 1998). Emotional
involvement requires client trust in the therapeutic relationship, which builds confidence and
leads to motivation and movement in the change process (Garfield; Scheel & Gonzalez, 2007;
Watts, Cashwell, & Schweiger, 2004). Scheel and Gonzalez demonstrated with research that
counselling helped students become more motivated in academic achievement. Hoagwood
(2005) compiled a research review and synthesis of various aspects of family-based counselling
with mental health agencies and found that empowerment played a significant role in motivating
the client with counselling. Empowerment leads to motivation and supports progressive change,
which is a basic goal of SFAT.
Research Using AT, SFBT, and SFAT
Statistically significant research with the use of SFAT does not currently exist however
authors have written single case studies, group studies, and books that demonstrate therapeutic
work with clients using SFAT, leading to empowerment, motivation, and then to client change
(Barrows, 2008; Kahn, 1999; Matto et al., 2003; Mooney, 2000; Moore. 1983; Nims, 2007;
Reisler, 1987; Riley, 1999; Riley & Malchiodi, 2003 ; Selekman, 1997). Typically research
process evolves as therapists theorize, develop, use models, and appropriate research
methodology is applied. The models, viewed as effective for the client in therapy, are written
42
about in case studies, manuals, journal articles, and books. For the most part, these writings
illustrate and explain the process through anecdotal reporting (de Shazer & Berg, 1997; Quick &
Gizzo, 2007). Academic research is the next step for SFAT.
AT Studies
Many case studies demonstrate methods that employ AT and examine change processes
experienced with clients when the therapy involves an art therapist who integrates creativity and
therapist’s skills, including art and verbal therapy (Baumann, 1995; Case, 2006; Clements, 1996;
Kearns, 2004; Langarten, 1981, 1987; LeCount, 2000; Leeuwenburgh, 2000; Proulx, 2002;
Savins, 2002; Waller, 2006; Wellington-O’Neill, 1999; Yule, 2002). Several research studies
demonstrate that a larger numbers of clients have experienced change with AT, (Al-Krenawski &
Slater, 2007; Driessnack, 2006; Graf, 1986; Ireland& Brekke, 1980; Kopytin, 2002; Kozlowska
& Hanney, 2001, 2002; LeCount; Maat, 1997; Moore, 1983; Virshup, 1975; Waller; Winship &
Haigh, 1998), and these studies were reflected upon in order to further understand how change
occurs with AT.
Kozlowska and Hanney (2002) worked with children who experienced trauma and
discussed the hyperarousal response that children go into when a memory is triggered. This
response is characterized by hyperactivity, inattentiveness, anxiety, and impulsivity. However,
emotional shutdown was also found, which is characterized by disengaging from the present,
pretending to be somewhere else or pretending to be someone else ( Kozlowska & Hanney).
These authors described the effect of trauma as altering all aspects of the brain, with evidence
showing in the child’s behaviour, perceptions, feelings and development.
Al-Krenawski and Slater (2007) valued art therapy in working with Bedouin-Arab
children who experienced trauma when their homes were destroyed in remote villages in Negev,
43
Israel. The authors explained that the government of the State of Israel forced isolated
settlements into permanent dwellings in designated areas and destroyed current homes to enforce
this policy. Nineteen boys and girls aged 11 to 14 years old participated in this study. Negative
psychological effects were explored in order to access funding for additional counseling for
children in similar situations. The children experienced grief and symptoms of trauma, the study
demonstrated that children were psychologically affected and that they did benefit from drawing
and talking about their experiences.
Yule (2002) evaluated the psychotherapeutic work that needed to be done with children
to set up large intervention groups in order to help children with troubling symptoms
of intrusion, arousal, and avoidance during the trauma, separation and loss after the of intrusion,
arousal, and avoidance during the trauma, as well as separation and loss after the war. The
guidelines set up by Yule and the services developed are being employed worldwide during wars
and natural disasters. Art therapy is one method used by Yule to stimulate narratives about
trauma.
Dreissnack (2006) researched fear with 22 children, aged 7 and 8 years old, using a draw
and tell conversation. The author’s approach was a more child-centered, child-driven self report,
deliberately set up to empower the children by discussing negative emotions in their own words.
The author found that children talked about fear that they had experienced as though the
experience had happened to others and that the emotion was unresolved. Limitations to this study
were a small number of children, purposeful selection, and male gender bias. Future implications
of the study are to revise the draw-and-tell methodology to work with larger groups and other
negative emotions such as pain, grief, chronic or life-threatening illnesses, and poverty
(Dreissnack).
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Graf (1986) developed research using Kinetic Family Drawings (KFD) with Hispanic
mothers to help them with their perception of problems their children were having at school.
Additionally, the Graf study was to help the school personnel and mothers with English as a
second language communicate in a less threatening way. Another therapeutic goal was to obtain
permission from the mothers to get help for their children who had problems (Graf). The KFD
method assisted the mothers in modifying their perceptions of the problems, and in working
through the denial of problems with very positive results as the mothers became more open to
accepting help for their children (Graf). Graf stated that replication with larger numbers, other
cultures, and using fathers as subjects with KFD were needed to correlate with larger
populations.
Nainis (2006) researched cancer patients to determine if art therapy reduced symptoms
related to pain and anxiety. Nainis worked with 50 participants from the oncology unit in a
hospital and reported statistically significant improvements in pain, tiredness, lack of
appetite, depression, anxiety, drowsiness, well-being, and shortness of breath after the
patients spent an hour working on art projects of choice over a 4- month period. Controls were
needed to establish reliability and larger subject numbers were needed to establish generalization
to the oncology population.
Lev-Wiesel and Liraz (2007) discussed their research on art and narratives with children
whose fathers were drug addicts to determine the richness of the narrative after art work
compared to narratives alone. The study consisted of 27 boys and 33 girls aged 9 to 14 years.
The authors found that narratives and emotions expressed were present and richer with artwork.
The resistance to discussions about families, that is often present with narratives alone, was
absent. Krystal, et al.(2000) suggested that impaired verbal expression by children with trauma,
45
may be part of what appears to be resistance to narratives. More optimism was evident in the
study group, which may indicate the hope that children often experience with art therapy (LevWiesel & Liraz). Larger numbers of subjects are required for effective statistical analysis.
Betensky (1995) discussed research conducted on lines and their affective values with
450 adults and 46 boys and girls in grades 4-6. The research supported the idea that certain lines
and colours relate to emotions of love, fear and anger. Jagged, irregular, and sharp angled lines
expressed agitated emotions such as anger, violence, and unpredictability, where as gently
curved or relatively straight lines expressed more quiescent moods (Betensky). Betensky
explained that sadness could be coupled with slightly curved down sloping lines and serenity and
tranquility with horizontal lines. The study of colour and line was not statistically supported so
no conclusions could be derived.
A scribble technique study described by Betensky (1995) which included 100
drawings by a client in the Cane-Ulman (1965) model of the scribble. Ulman (1965)
presented a study on a diagnostic drawing series, that is based on Cane’s (1951) formalized
scribble. The numbers in this study were large enough to generalize to the population at large.
Out of 100 scribble drawings 78 responded in a general way that related to everyday life in the
world and self. Twenty-two participants presented scribbles that were distorted, aborted and
fragmented. Betensky suggested that this technique could be used as a diagnostic tool for
children who come from disrupted homes. The study lacked descriptions of validity and
reliability as no reference to statistics or controls was made. Further studies on children who
come from disrupted homes are needed before this technique can be used as a validated
assessment technique.
Burkitt, Barrett, and Davis (2007) presented a study about the size and colour in
46
children’s drawings after different emotional descriptors were given to them. 102 children aged
4-7 years were given the task of drawing a baseline picture of a man with no affective descriptors
and two other pictures one of a nice man and one of a nasty man. A narrative was used to
describe a nice and a nasty man and the children were then asked to draw them again. In general
the drawings after the nice man descriptors were given appeared larger and children used the
brighter colours, where as the sad, angry or negatively emotionally described men were drawn
smaller and depicted by black and brown.
SFBT Studies
Many SFBT case studies, articles, books and research studies are available discussing the
application and value of SFBT (Barrows, 1999; Berg & Dolan, 2005; Brown-Standridge,
Standridge & Poole, 1993; Cowie & Quinn, 1997; de Shazar & Berg; 1997; Dietrich, 2005;
Estrada & Beyebach, 2007; Fleming & Rickord, 1997; Franklin, Moore, & Hopson, 2008;
Iveson, 2002; Kim, 2008; Kral, 1989; Lloyd & Dallos, 2006; Murphy, 1994; Quick & Gizzo,
2007; Selekman, 1997; Stobie, Boyle, & Woolfson, 2005; Turnell & Edward, 1993; Wheeler,
2001). A meta-analysis explored many studies that contained relevant information indicating
effectiveness of SFBT using a statistical method of random effects modeling (Kim). Kim’s study
provided professionals an easier review of methods that show the effectiveness of SFBT in
exploring the miracle question, scaling, exceptions, looking at strengths and solutions, goals,
compliments, and giving homework assignments. The study provided statistically positive
outcomes in internalized states such as depression, self-esteem, anxiety, and self-worth (Kim).
Through meta-analysis, Kim substantiated the hypothesis that student clients were happier and
less stressed. Other studies are needed for outcome measurements of the effects on school
performance with positive changes compared with internalized states, as the two may not
47
correlate. Reviewing this study provides therapists with a quick reference that aids credibility
and confidence for practice with SFBT, particularly as applied to various groups of clients
(Kim).
A study of SFBT by Gruninger (2004) explored the applications and efficacy of
SFBT. Gruninger found efficacy studies for a diverse range of clients including children,
adolescents, families, couples, and adults. The clients had various problems: low self
esteem and coping, behavioral issues, depression, psychosis, mental health issues,
problems with high school goals, parenting skills problems, couples relationship problems,
orthopedic rehabilitation, family problems, and schizophrenia. This research encouraged
the development of SFBT with AT by showing efficacy.
SFAT Sudies.
Nims (2007) integrated play therapy techniques with SFBT and employed art therapy
as one of his play therapy techniques. The author explained how he adapted SFAT for children
to explore a problem, set goals by drawing the miracle question, and brought out exceptions to
explore times when little pieces of the miracle have already happened. He found the techniques
effective with children because they enjoy doing art and do not have the challenges of
understanding that often occurs with talk therapy.
Selekman (1997) utilized SFBT techniques with art therapy interventions to make the
solution-focused approach more adaptable for children. The author explained that children
express themselves more effectively by nonverbal means and that verbal therapy is less effective,
or not effective, alone. Furthermore, abstract cognitive expressions such a miracle question,
exceptions, and scaling are not easily understood according to Selekman. He found that the
questions in SFBT were relevant for further exploration, but were not very effective with
48
children. Adding art therapy interventions was an effective tool for Selekman in his therapy with
families.
Reisler (1987) explored brief therapy and art therapy with a family in the thesis she
completed for her art therapy degree at Concordia College in Montreal. The master student’s
sessions took place at a hospital solarium: six sessions plus a closure session completed the
therapy. According to Reisler, the purpose of the therapy was to open up family
communications. Reisler’s anecdotal report suggested that this objective was achieved.
According to Riley (1999), adolescents generally gained benefits from SFAT because
they resist discussing problems with any adults, including therapists. Art therapy may offer
adolescents the opportunity to be creative. When the adolescent engages in the therapy, art
expression becomes a concrete product for contemplation and exploration (Riley). SFAT
therapists centered attention on the strengths and positive traits of adolescents, theoretically
making this approach more acceptable for this group in Riley’s experience. Riley wrote about
her many years of experience working with adolescents and interviewed other therapists for
their feedback on art therapy. In her work, she found SFAT especially beneficial with the
adolescents because they wanted therapy to be over quickly.
Maat (1997) worked with immigrant adolescents in a group context and found them to be
doubly challenged by the developmental stresses that teens normally have, and the difficulties of
the assimilation process that these adolescents had to go through to fit into a new society. These
teens found 10 sessions of group art therapy a helpful process. Kahn (1999) anecdotally reported
success employing brief art therapy while working with adolescents in schools in single sessions
and small group sessions.
AT and brief therapy, as demonstrated by (Moore, 1983), and SFAT as explored by
49
(Matto et al., 2003), showed positive results working with adults with addictions in groups.
These authors discussed the importance of a therapeutic alliance between the client and therapist
and empowerment of the client as enhancing motivation for change. Moore described the addict
as someone who has low self-esteem, feels helpless, manifests in denial as a form of defense
mechanism, and is frightened by a lack of control. The setting for the group in a quiet, private
space is mentioned as an important aspect of the therapeutic alliance. Construction,
deconstruction and reconstruction in therapy were used by Matto et al. and Moore. The
construction of motivation and hope initially is important to keep the client in the program
(Matto et al.; Moore). Matto et al (2003) said that deconstruction involved changing the client’s
behaviour, emotions, and thinking about the addiction from one of rigid, stable and permanent to
changeable and nonpermanent. The reconstruction of the new way of living helped the addict
develop a new way of behaving, feeling, and thinking (Matto et al.). The SFAT therapist adopted
the exception intervention to empower clients by exploring their resources and strengths (Matto
et al.). Scaling is a positive assessment technique that shows client and therapist that change
occurs, and its feedback offers motivation and hope (Matto et al.). The miracle question offers
motivation to the clients by having them visualize a future of hope and setting goals to bring
about the visualization (Matto et al.).
Exploring Complementary and Diverse Theoretical Aspects Between AT and SFBT
Complementary Theoretical Aspects
One of the many complementary aspects between AT and SFBT is the belief that
forming an effective working alliance and maintaining that alliance between the client and
therapist leads to success in therapy (Betensky, 1995; Malchiodi, 2003; Selekman, 1997; Walter
& Peller, 1992). Garfield (1998) explored the importance of an effective working alliance and an
50
emotionally involved client as factors in determining success in counselling.
Emotional involvement requires a fairly significant or critical level of client trust in the
therapeutic relationship. It builds confidence, and leads to motivation and movement in the
change process (Garfield, 1998; Scheel & Gonzalez, 2007; Watts, et al., 2004). Hoagwood
(2005) explored empowerment and found that it increased specific aspects of motivation. Both
AT and SFBT motivate clients through various techniques of increasing client empowerment
(Malchiodi, 2003; Selekman, 1997).
In both AT and SFBT, the therapist views the client as separate from the problem and an
agent of change ( Malchiodi, 2003; Walter & Peller, 1992). Therapists who employ AT
and SFBT, explore and respect the client’s knowledge of the problem, help the client find
solutions, and set goals for solving the problem that the client has identified (Malchiodi;
Matto et al., 2003; Walter & Peller). These authors discussed the therapists’ support,
empathy, and encouragement in facilitating change. If an intervention does not work for the
client, the therapist works with the client to develop other interventions and adjusts goals for
success.
The client metaphor is employed by the therapist to externalize the problem in both AT
and SFBT and through storytelling brings together actions, feelings, sensations, and thoughts so
that the internal and external world are more organized (Matto et al., 2003). The metaphor is an
intervention utilized by SFAT.
Diversity in Theoretical Aspects
SFBT employs verbal therapy and AT uses creative expression and verbal therapy which
can offer a diverse learning therapy style. AT often has advantages for clients who have cultural
differences, language barriers, or hearing problems, or who have experienced family deaths and
51
illnesses, but need to express emotions (Malchiodi, 2003, 2007; Moon, 2002)
The art in AT serves as a psychological container for emotions, experiences, and
memories ( Malchiodi, 2003). The art object becomes a solution allowing clients to tolerate
affect and thoughts and may be reviewed over time for additional insights and integrations
(Malchiodi; Riley & Malchiodi, 2003).
The client’s metaphor may be taken further or elaborated with active imagination or
further art making with art therapy. Lusebrink (2004) and Siegel, (2001, 2007a, 2007b)
explained that verbal and nonverbal expression of emotions are activated and used by both left
and right hemispheres and cortical and subcortical processing. Lusebrink confirmed that this
processing is an important therapeutic element with research and imaging of brain function and
art expression. This is useful knowledge for trauma therapy. The emotional work expressed in art
therapy is supported by an understanding that emotions are stopped at the point of the amygdale;
in order to process these emotions the client needs to have these emotions reach the hippocampus
area (Siegel, 2001, 2007b). AT may be one approach that helps the processing of traumatic
emotions through the making of art images, facilitating the verbal understanding of images and
feelings and finding new solutions (Malchiodi, 2003).
Walter and Peller (1992) explained that SFBT therapists may not be able to work with
problems that have unconscious origins and that they may need to refer such clients. Combining
the two therapies would give therapists flexibility to work with these clients rather than referring
them to therapists who have a practice that deals with unconscious issues.
Incompatibilities
One incompatibility with combining AT and SFBT relates to a possible diminishing of
spontaneity within a directive client approach. In a directive client approach, the therapist guides
52
the client through instructions that lead the activity. With a nondirective technique, there is no
instruction from the therapist (Malchiodi, 2003). A nondirective approach is frequently seen as
advantageous in AT, as the subconscious process is accessed more sideways or indirectly or
projected into the art with a natural flow of expression (Malchiodi).
Feminists criticized SFBT as committing beta-prejudice which they have defined as the
neglect of differences (Dermer, Hemesath, & Russell, 1998). SFBT minimizes
equitable issues from the past in relationships and this results in ignoring power differences and
other social implications in the lives of clients (Dermer et al.).
Another limiting factor is the current development stage of SFAT strategies. As more
training and interest develops in this area, more strategies may be formed, and evaluated for
effectiveness. New strategies may evolve for very specific problems. These strategies may come
from art activities or the SFBT approach and will need to be effective and efficient solutions that
involve the artmaking process. Combining AT and SFBT could satisfy a need for clients because
an urgent problem could be quickly organized into ten sessions or less and be a pleasant creative
experience for them (Malchiodi, 2003).
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CHAPTER IV
A Solution-Focused Art Therapy
Manual For
Adults, Adolescents, and Children
Copyright © 2009, by Irene Haire
You are welcome to photocopy the full manual. If you do so, no further permission is required,
as reference is made to this author in the manual.
54
Table of Contents
CHAPTER IV: Solution-Focused Art Therapy Manual for Adults, Adolescents, and
Children…………………………………………………………………………………..54
Table of Contents……………………………………………………………………55
Introduction……………………………………………………………………….…56
Solution-Focused Art Therapy Manual for Adults………………………………….58
Solution-Focused Art Therapy Manual for Adolescents……………………………74
Solution-Focused Art Therapy Manual for Children………………………………..92
Additional Tools and Definition of Interventions………………………………..…109
Scaling Emotional Symbols………………………………………………..109
Interventions Utilized………………………………………………………112
References………………………………………………………………………….. 118
55
Introduction
SFAT Sessions for Adults, Adolescents, and Children
The manual begins with a summary and three SFAT sections for: 1) adults, 2)
adolescents, and 3) children. The title pages contain expressive art work done by the
author. Each section consists of seven weekly 1 1/2 hour sessions. The first two sessions
establish a therapeutic relationship between the therapist and client. Stories from the client
about the artwork are encouraged by the therapist using the phenomenological approach of
questioning to learn about the client, to help the client relax, to make the client feel heard, to
develop a therapeutic alliance, and to guide the client to problem and solution exploration.
The therapist explores what problems on which the client wants to work, then guides the
client in exploring for exceptions. Through questioning and interacting with the client and
from the artwork, the therapist discovers strengths, resiliencies, and current resources that the
client has, that can be employed to build solutions and some basic starting goals while
exploring exceptions. Small changes that the client has already made, and that are discovered
through client-therapist interactions within a working alliance, initiate and motivate the client
to become actively involved in the therapy through both ideas and emotions. The therapist
continually works on maintaining the working alliance through out the sessions in order to
continue the therapeutic connection.
Sessions 3, 4, 5 and 6 employ art and verbal processing techniques as explored by Matto
et al (2003) and Betensky (1995) to deeply involve the client in the process with critical
engagement, initial reactions, relational attributes and change opportunities. Critical engagement
is a component of verbal processing that is operationally defined as an objective exploration of
the formal properties of the artwork such as colour, size, shape, and placement of the objects,
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and what art media was used, and allows the clients to tell a story about their art work (Matto et
al., 2003). Matto et al. defined initial reactions as verbal processing that allow an expression of
feelings with no constraint or interpretation. Verbal processing of relational attributes as defined
by Matto et al. is an exploration of themes, patterns, and connections within the artwork such as;
object-to-object among colours, shapes, forms and symbols, to self, to others, to life
circumstances such as the client in relationship at home, with family, and neighbourhood
community; temporal elements such as past, present, and future; and their own relational
components to the art process. Change opportunities with verbal processing follows objective,
subjective, and relational processing of the art experience which allows the client opportunities
to seek alternative constructions to visually desired changes, and to test new possibilities (Matto
et al.). These sessions demonstrate construction, deconstruction, and reconstruction as a means of
using SFAT to initiate change, maintain change, and discover new ways to make the change
process permanent as discussed by Matto et al. (2003). Session 7 finalizes the process with the
client for continued work after therapy and establishes closure between the therapist and client.
Scaling emotional symbols and definitions of interventions that were utilized follow the three
manuals. References used within the manuals are included at the end of the manual.
57
Solution-Focused Art Therapy
Manual For
Adults
58
Seven Sessions for Adults
Session One
Therapist’s goals for the session. The therapist’s goals for the first session are to make
the client feel comfortable with creating art, to establish a working alliance, and to start the
change process by construction of the problem and exceptions. The problem and exceptions are
created by the client in a concrete form with artistic expression.
Pre-session. The client is asked to come to the appointment half an hour early and is
given an assessment form that the therapist utilizes to fill out prior to the session and asked to
bring the completed assessment form into the session.
Beginning the session. The session starts with greetings, introductions, and an
explanation of SFAT for the client. Confidentiality is reviewed for understanding, the
assessment form that was filled out by the client is clarified, and the client is asked if he or she
has questions.
Assessment questions for the therapist’s mental use and to select with discernment, and
ask the client. (Adapted from Riley, 1999) For the client: What is the problem for which you
want to find a solution? What brought you here today? When does the problem occur? For the
therapist: Track down the pattern of behaviours by looking for the timing of the occurrence. For
the client: Does it occur daily, weekly, or monthly? Where does the problem occur? Where does
it not occur: home, school, office, or other location? For the therapist: Difficulties are often
related to the environment in which they occur. For the client: What is the performance of the
problem? What are the clues to look for in gestures, words, sequences of actions, that would
inform the client that it is happening? With whom does the problem occur? Who is often around
when this occurs? What do other people involved say and do before, during, and after the
59
behaviours have occurred? What do you say and do before, during, and after the behaviours? For
the Therapist: These questions help identify parent-child conflict versus peer-identity insecurity.
For the client: What are the exceptions to the rule of the problem? Recall when the problem was
absent; how did everyone involved defeat the problem? How does the problem restrict or rule the
client? How does the problem interfere with what the client would prefer to be doing? If
everything changed and the problem disappeared, what would the client be doing differently?
For the therapist: What are the client’s explanations for the problem and are they demonstrated in
the session? Listen to the client’s language and words and speak through the metaphor. Use the
client’s words to be in harmony with his or her communication. For the client: How will we
know when the problem is licked? What will be different? How will we notice the difference?
What will change your life? What will take the place of the problem in your life?
Questions for exception finding for the therapist to select and ask the client.
(Adapted from Matto et al., 2003). What would you do instead? What will your life look like
with out the problem? What will you do to decrease or eliminate the problem today? What
will your relationships look like if you no longer have the problem? What is your social
support network? When are you using this support network to help you? Were you able to
connect with your social support network when your problem was there? Could you still
connect with them? Or with one of them? How were you able to not do the problem
behaviour one time? What is workable in your life right now? What is going well? How do
you keep from making the problem become worse?
Continuation of session. The session continues with a review of the problem or the
problem question from the assessment form. If the client is nervous about doing art, an
introduction of spontaneous techniques is made, such as the scribble technique. The problem
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that the client has may show up through the use of spontaneous techniques. If the problem does
not appear initially, a directive may be given to the client to draw what brought him or her here
today. The problem can be explored using the phenomenological method and through a
metaphor if a metaphor exists in the drawing. Drawing the problem and using a metaphor is the
start of externalizing the problem and forming solutions by creating a method of narrating in a
safer way.
Initial scaling. Have the client rate the problem drawing from 1 to10 considering where
they are behaviourally, cognitively, and emotionally towards reaching their goal with 10 being
an ideal situation and 1 being the opposite. The emotions on faces illustrations can be used to
help with scaling for adults as needed for better understanding. The scaling can be used by the
therapist to set goals by asking the client what would have to happen to raise the scale, for
example, from 2 to 3.
Exception intervention. Ask the client to adapt the problem by using the same art
expression or a new art expression to reflect on times the problem was less than scaled above
or not there at all. Do another scaling after the drawing is completed.
Goals in session. The therapist and client can now use the drawing to discuss what the
client hopes to achieve from this and subsequent visits. Small goals will start to be developed
from the exceptions, and discussions. The therapist helps the client set personal goals that are
reasonable and achievable. Achievable goals motivate the client with small successes.
Compliments and coping. The client should be praised for his or her hard work and the
client’s strengths, resources, and successes in the past can be reviewed. Compliment the
client’s discoveries made through the art expression and what the client has already done to
solve the problem. Ask the client the following questions. How will you cope? What will you
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do for yourself this week to take care of yourself? Explore the client’s own ideas for coping
and suggest other self-care and coping strategies.
Adult client supports. Ask the client, who do you have in your life to support you?
Explore possibilities such as family, friends, neighbours, co- workers, people at church and
people at other organizations to which the client might belongs.
Homework. Assign to the client to do the following. Do more of what worked as
explored with exceptions on a daily basis and report next week. Observe what others around
you are doing and saying after these changes occur and how you are behaving, feeling, and
thinking. Journal your observations and do some art in your journal. Make note of self-care
strategies and supports that are effective in your journal. Bring your journal to the next
counselling session.
Session Two
Therapist’s goals for the session. Continue developing the working alliance and
motivating the client for additional small steps of change by exploring client strengths,
resources, what worked last week, and what worked in the past. Continue externalizing the
problem.
Questions for understanding through externalizing the problem for therapist to
select and ask the client. (Adapted from Matto et al., 2003). If you drew the problem what
would it be? What would it look like if it was dimensional? Can you draw a fantasy picture
and compare and contrast what the expectation was and what really happened? Can you now
do the same with the reality? Can you think about the problem and draw an incident that
occurred and what happened? What can you draw that did not have the problem?
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Greeting, exploration of last week, and current session work. Greetings such as Hello.
How are you doing today? How did the week go? set the stage for the session and makes the
client feel the therapist cares about him or her. What was better? Who noticed? What strengths
and resources were used to bring about the change? Sharing the parts of the journal the clients
chooses to share, can lead into doing some art work. Do an art expression to demonstrate the
changes. Explore the art with the client, using the phenomenological method. Do another scaling
with the client to determine where the client is now with the problem. If the client has had
success during the week then the miracle question can be introduced. If there was no success,
other exceptions to the problem have to be explored and tried.
Miracle question intervention. Say the following to the client: You go to bed one night
and a miracle happens and when you awake, the problem is solved. What would be different?
What would you notice? What would others notice? If the client is uncomfortable with the
miracle question offer an alternative such as, draw three things you may want that would be
different in your life. Have the client draw, paint, or collage the miracle. A collage can be very
effective because it is easily adapted from week to week as small steps are taken to work
towards the miracle. An option with collage is to cut away parts of the problem as the client
works on changes. It is important to explore many details about the miracle so that small goals
can derive from it.
The miracle question, questions for therapist to select and to ask the client. (Adapted
from Matto et al., 2003). How will you know the problem is solved? What will you be doing
differently? What will others notice you are doing differently? How will that be helpful?
What will your heart feel? How will you be feeling? How will your thinking be
affected? What will your thoughts be? What will you be saying to people around you?
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How will they be respond? This problem drawing can be adapted for small changes as the
client continues therapy. Another art expression can be assigned to explore the client’s next
steps could be to the miracle. Check for goal changes with the client. Scale the progress
and ask the client what he or she thinks is needed to get to the next scale.
Compliments and coping. Compliment the client on new discoveries that were made
and the work that was accomplished last week. Explore the coping strategies from last week
and remind the client to use what worked. Discuss new strategies.
Adult client supports. Clients can benefit from the therapist drawing their attention to
supports in their life. Was there a supportive person or persons last week that the client could
talk to? How did that work for the client? Could the client access supports in the future? What
could the client specifically draw to help remember this person or resource and where could
the client put the drawing as a reminder?
Home work. Assigning homework can be helpful for some clients (Iveson, 2002;
Turnell & Edward, 1993) as it helps extend the therapy hours and is cost-effective. Ask the
client to do the following. Observe what others are doing after these changes occur and how
you are behaving, feeling, and thinking. Journal and engage in artmaking for some of these
observations. Bring the journal to your next session.
Session Three
Therapist’s goals for the session. Some verbal processing has already occurred now a
more in-depth processing can begin. Based on the work of Matto et al. (2003), you may
proceed with a construction of change by using critical engagement for the next session.
Questions for critical engagement for therapist to ask the client. (Adapted from
Matto et al., 2003). For the client: What is most noticeable when you look at your work?
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What catches your eye first? Tell me about your picture. Is there content repetition? What
does this represent? For the therapist: Is there excessive shading? Excessive shading may
indicate that the client has anxiety. For the client: Notice the amount of shading in your
drawing? Does that have any significance for you? What do you think this means? What
would a three-dimensional drawing look like? Would you like to make the drawing into a
three-dimensional structure? What would you title this picture?
Greeting, exploration of the previous week, and current session work. Greetings may set
the stage for the session if the therapist gives the client full attention and concern at the start and
pays attention to how the client is feeling when she or he comes in. Pay attention to body
language and facial expressions. Hello. How are you doing today? You seem a little low. How
did your week go? If the client is not doing well, this could be acknowledged. Ask the client the
following questions: How did you cope? Who helped you? What changes in yourself and in
others were observed? Are you satisfied with the changes? What challenges did you have and
how did you handle them? You can emphasize through your journal if you like, or portions of it
if you prefer.
Ask the client if she or he is ready to go to a deeper level. The problem-focused art
expression may be drawn for this process. A portion of the initial drawing could be enlarged or
one can suggest a new drawing, or the client can create the problem as she or he currently sees it.
Have the client choose the medium if this is assessed as appropriate and is not contraindicated. A
metaphor can be encouraged where appropriate and taken from the drawing. Choose the critical
engagement question approach with the client’s drawing. Another drawing may be advised or
even required if the client has an awareness regarding a repetition of a theme or appears to have
high anxiety as observed by the therapist concerning excessive shading. A three-dimensional
65
representation can be explored using clay. Some types of collage could produce more exceptions
from the art expressions or steps from the miracle question drawing can be explored.
Goals may need to be adjusted again. Scale the progress with the client and ask the client
what he or she thinks needs to be revised for a more positive rating scale.
Compliments and coping. Praise the client for hard work and discoveries.
Explore how the coping strategies are working. Discuss alternatives if needed.
Adult client supports. Explore the supportive people that are in place and how
productive they are. Review for additional supports with the client.
Homework. Encourage self-care and continued work on the changes. Ask the client to do
the following: Make observations about others around you as you did last week and implement
your ideas from the more positive rating scale. Work with your support people as needed. Ask
your support people if they notice any changes in you. Journal and do art of your observations.
Bring your journal to the next session.
Session Four
Therapist’s goals for the session. The fourth session provides an opportunity for the
client to emotionally process by using initial reactions. Mentally check on the working alliance
and go slow if needed. The therapist may use the following questions to guide the process with
the client.
Questions for initial reaction of verbal processing for therapist to select to ask client.
(Adapted from Matto et al., 2003). What comes to mind when you look at your drawing?
What are the feelings around these objects or people? How do these people wish they could
feel? Where are the emotional and spiritual centres in this image? What is the affirming
centre of this picture? Where do you find strengths or hope in the picture? Where is the
66
strength and hope coming from? Where is the energy level felt in your picture? What part of
the image surprised you most, invited you, challenged you, and engaged you most? When
you look at the whole picture, where does it reside best in the human body (head, heart, or
stomach). What was the most significant physical or physiological sensation you had when
you were creating your art work? When you look at it?
Greeting, exploration of previous week, and current session work. Warmly greet the
client and ask how she or he is doing. Check in with the client about the client’s week and
what he or she noticed, what changes may have occurred, what if anything surprised the
client, and what others did or said? Ask the client if the he or she is ready to do some
emotional work. Assure the client, he or she can go at the client’s own pace and when he or
she is ready. Have the client scale rate how hopeful and how strong the client feels about the
problem. Explore a drawing from last week that has changed to account for the changes the
client made or have the client do a new drawing on how the client sees the problem now.
An exploration of the drawing or other art form can be done using initial reaction
questions previously defined with the client. This section explores emotions and may take
more than one session, but one session is suggested in this manual. Have the client draw the
emotion on a separate drawing. If the client is working through a metaphor, explore feelings
through the object and later ask if the client has ever had feelings similar to what the object
has in the drawing. Feelings can usually be projected upon objects if the client identifies with
the qualities of the object or the nature of the object’s use or context. Scale the progress
the client feels at this time. You might say “ You have experienced some emotion here to day
and some very effective work has been done. How are you feeling right now? Take a few
minutes to think about this and rate on a scale of 1 to 10 how hopeful you feel with 10
67
being very hopeful and 1 being the opposite. How strong do you feel about the problem
now with 10 being as strong as you can be and 1 being the opposite?
Compliments and coping. Praise the client for her or his emotional work. Normalize the
emotions by stating that emotions are a normal part of all humans and expressing them makes
you stronger. Allowing yourself to express all of your emotions makes you feel all of your
emotions more. Discuss new strengths that the client showed today. Ask the client to do
something very special for herself or himself this week and to do extra self-care strategies
tonight, such as buying yourself some flowers as a reward for the hard work, having a relaxing
bubble bath, and listening to quiet, soothing music. If more feelings come up, it is okay to feel
them.
Adult client supports. Approach the support people that you feel will be
emotionally supportive and share your emotions with them if you feel ready to do so. Call
the therapist if you need to. Many emotions were brought out in this session; the client
may have difficulties containing these emotions and may need to talk to the therapist for
some guidance or have an extra session mid-week.
Homework. Pay attention to and feel the emotions that may come up this week. Journal
and do art about the emotions and bring this into the next session to share any parts you wish to
share with the therapist. Some suggestions for coping strategies to deal with overwhelming
emotions are walking, running, or calling a person who would be supportive with emotional
reactions. The Support Network Edmonton has a 24-hour crisis line that can be used if needed
780-482-4357.
Session Five
Therapist’s goals for the session. Have the client explore relational components to
68
understand what the client and others mean to their art materials, art process, and artwork and
connect this to relational aspects of the client’s life. For example, relating to others is
contextual, meaning that different parts or aspects of ourselves may be relating to one or
another positive or negative event or behaviour.
Greeting, exploration of previous week, and current session work. Greet the client and
ask how feelings were this week. Explore the highlights and certain feelings within the client’s
journal. How was the week, how did you feel, did your supports work for you, what did you do
for yourself, and how did these actions make you feel? What worked well this week? What
didn’t work well? Question how the client sees the problem now through a new drawing. Explore
the art expression for relational attributes. The therapist explores relational attributes with the
client for patterns, themes, and connections within the piece through object to object, shapes,
colours, forms, and symbols, and to self, to others, and to life circumstances such as home, work,
family, community, and neighbourhood. More art work may be suggested if some aspect would
benefit the client with further exploration of art to evolve ideas or challenges. The therapist can
also explore temporal elements such as past, present, and future in terms of the client’s
connection to the art object and the art process through time.
Questions for relational aspect to ask clients. (Adapted from Matto et al., 2003).
How does the picture relate to you? Where in time is this image located? What is the loudest
part of the image? Who is saying it? Who is listening? Who would you like to be listening?
Who is the softest voice? Who would you invite to witness this image and who would you
not invite? Which parts need more exploration?
Questions for process for the therapist. (Adapted from Matto et al., 2003). How did
the client engage with the materials? What range of materials was used? What was the
69
relationship of the client to the art process and the reaction of the client? How did the client
respond to difficulty, challenges, and frustrations? Ask the clients if he or she wants to revise
their goals. Scale the progress that the client sees and ask what the client thinks would bring
him or her to the next beneficial scale level. Follow the client’s comments in order to
facilitate with dialogue.
Compliments and coping. Praise the client for all of the wonderful work done and the
changes taking place. This helps reinforce or shape the client’s behaviours. Review strengths
observed in past sessions and acknowledge new strengths in the session today. Review coping
strategies.
Adult client supports. Explore which supports work for the client and in what way they
are helpful.
Homework. Work on the next step of the miracle question and exceptions that may have
come up within the session today and review suggestions made by the client when scaling. Ask
the clients to pay attention to relational aspects as explored in the session, to do artmaking, and
to write reflections in the client’s journal.
Session Six
Therapist’s goals for the session. Explore new possibilities with the client
for solution possibilities and alternatives for constructing change. Prepare the client for the last
session next week. For example, have the client make a list of possibilities and alternatives that
the client is interested in trying now and in the future. Make another list of coping strategies
that have worked for the client and for people who support the client, defining the various
ways they support the client, such as cognitive stimulation, emotional support, fun, and
activities.
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Questions regarding new possibilities for therapist to select and ask the client.
(Adapted from Matto et al., 2003). How would the picture be different if you had used
markers instead of paints? Would you like to try markers? Chalk instead of pencil? Clay?
What would you like to be different about your drawing? What part of the picture do you
need to let go of? Do you need a closure piece? What would a drawing in response to this
piece look like? What would it be titled? What would a new ending to your story be? What
would you need to come about for that ending to take place? If you were not doing the
problem behaviour, what would you be doing?
Greeting, exploration of previous week, and current session work. Greet the client, ask
how the week went, explore the journaling, and artwork that the client wishes to explore. Remind
the client that next week is the last session. Review all of the artwork done from all of the
sessions and have the client summarize what solutions and progress were observed. Ask the
client to think of other change possibilities. Compliment and encourage the client to keep going
with the change process as excellent progress is being made. Use artwork to construct alternative
changes, list new possibilities through brain storming, and then check out some more viable
choices by testing them. Review the artwork for possibilities. Explore exception situations with
more artwork. Scale the progress that the client has made cognitively, emotionally, and
spiritually. What is one small thing the client can do to increase that scale?
Compliments and Coping. The therapist should praise the work the client has done to
promote new possibilities and reinforce creative options. Discuss new strengths seen, coping
strategies, and supports for the next week.
Adult client supports. Suggest that the client assess her or his supports this week and
pay attention to which support person helps in what way.
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Homework and tasks. Suggest that the client utilize as many of the new possibilities as
the client feels and thinks he or she can do and journal about their successes and setbacks that
can be discussed next week. Have the client establish some long term goals to discuss in the
final session for continued work after therapy is finished. Suggest that the client create a list of
effective strategies and a list of support people noting which support people are best for
emotional support, discussing problems, goal strategies, working on art together, and for doing
fun activities.
Session Seven
Therapist’s goals for the session. Explore the long-term goals, coping strategies, and
supports the client has developed for themselves, and review all of the artwork including
journal work searching for success the client has had and facilitating closure.
Greeting, exploration of previous week and current session work. Greet the client and
explore and discuss the clients’ successes and setbacks this week. Ask the client how he or she
feels about today being the final session. Have the client do another miracle question drawing
and establish where the client is today to encourage further work for the future. Scale the
client’s progress cognitively, emotionally, and spiritually. Examples of scaling:
1) If you were to scale your progress by determining where you want to be as 10 and 1
as the opposite, where would you be?
2) If you were to scale your hope today with 10 being very hopeful and 1 being the
opposite direction, where would you be?
3) If you were to scale your strength with the spiritual help you have as 10 being the
strongest you can be and 1 as the opposite direction, where would you be?
Have the client set goals for the next few weeks to get closer to their imagined miracle
72
outcome. Discuss how capable the client feels about setting goals, and following through step
by step, documenting progress through artmaking, art reflections, scaling, journaling, and a
charting progress. Review the client’s self-care strategy and support list. Discuss how the
people have supported the client in the past. Review all of the artwork and discuss the client’s
progress in order to facilitate closure with the client.
Compliments and coping. Compliment the client on observed successes, changes, and
efforts that were observed. Tell the client what a pleasure it was to work together. Ask the
client how the experience was for him or her.
Adult client supports. Ask the client to continue to connect with the support team that
the client has identified.
Home work. Ask the client to continue to work towards the miracle through a focus on
what was explored. Encourage the client to continue to set new goals to work on new problems
and solutions in the same way you did together. Urge the client to use the coping strategies that
worked for the client and to call on the supports that were effective. Encourage the client to
journal for the purpose of personal growth, recording, scaling, and change. Ask the client to
come back if needed.
73
Solution-Focused Art
Therapy Manual For
Adolescents
74
Seven Sessions for Adolescents
Session One
Therapist’s goals for the session. The therapist’s goal for the session is to make the
client feel comfortable with creating art, to establish a working alliance, and to start the change
process by construction of the problem and exceptions. The problem and exceptions are
created by the client in a concrete form with artistic expression. The therapist looks for
metaphors in the art form to use as a communication tool with the adolescent clients and to
utilize as directive themes for artwork.
Pre-session. Have the client’s guardian or parent come to see you on an earlier day to
fill out an assessment form that the therapist utilizes and limits of confidentiality prior to the
first session. A consent form is also signed on behalf of the underage client (known as a minor)
to be seen in therapy. The parent/guardian and therapist review the assessment form or forms
as required by one’s agency, institution and private practice. The review process serves for
facilitating clarity and the parent’s or guardian’s version of the problem is explored. The
therapist explains confidentiality and the therapeutic process to the parent/guardian and asks if
the parent/guardian has any questions. The adolescent client is then seen alone the following
day or later the same day.
Beginning the session. The session starts with greetings, introductions, and an
explanation of SFAT for the client. Confidentiality is reviewed for understanding, the
assessment form that was filled out for the client is clarified if the therapist has further need of
it, and the client is asked if she or he have questions. The therapist explains that the parent has
to give consent for the adolescent to be seen and that the parent has filled out forms on the
client’s behalf and explained the parent’s version of the problem. The therapist explains that
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the parent has the right to see the artwork and ask about the therapy, and that the therapist will
discuss this with the client before any information is given to the parent and the client can be
present when this occurs. The client is asked to explore the problem(s) from the client’s
perspective.
Assessment questions for the therapist to select and ask the client. (Adapted from Riley,
1999). The following questions can be asked, but for adolescents who are not open to questions,
artwork is introduced and the therapist explores these questions through the artwork. For the
client: What is the problem for which you want to find a solution? What brought you here today?
When does the problem occur? For the therapist: Track down the pattern of behaviours by
looking for the timing of the occurrence. For the client: Does it occur daily, weekly, or monthly?
Where does the problem occur? Where does it not occur? Home, school, or other places? For the
therapist: Difficulties are often related to the environment in which they occur. For the client:
What is the scene or performance of the problem? What are the clues to look for in gestures,
words, sequences of actions that would inform the client that it is happening? With whom does
the problem occur? Who is often around when this occurs? What do they say and do before,
during, and after the behaviours have occurred? For the therapist: This helps identify parentadolescent conflict versus peer-identity insecurity. For the client: What are the exceptions to the
rule of the problem? Recall when the problem was absent, how did everyone involved defeat the
problem? How does the problem restrict or rule the client? How does the problem interfere with
what the client would prefer to be doing? For the therapist: This is important with adolescents as
the problem may restrict maturation. For the client: If everything changed and the problem
disappeared, what would you be doing differently? For the therapist: What are the client’s
explanations for the problem and are they demonstrated in the session? Listen to the client’s
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language and words and speak through the metaphor. Use the client’s words to be in
harmony with the client’s communication. For the client: How will we know when the problem
is licked? What will be different? How will we notice the difference? What will change your
life? What will take place of the problem in your life?
Questions for exception finding for therapist to select and ask the client. (Adapted
from Matto et al., 2003).What would you do instead? What will your life look like without
the problem? What will you do to decrease or eliminate the problem today? What will your
relationships look like if you no longer have the problem? What is your social support
network? Draw the people in it. When are you using this support network to help you? Draw
a time. Were you able to connect with your social support network when your problem was
there? Could you still connect with them? Or with one of them? How were you able to not do
the problem behaviour one time? What is workable in your life right now? What is going
well? How do you keep from making the problem become worse?
Current session. The session continues with a review of the problem, or the problem
question from the assessment form, and the client is asked to do some spontaneous art. If the
client is nervous about doing art, an introduction of spontaneous techniques such as the
scribble technique is effective for adolescents (Riley, 1999). The problem that the client has,
may show up through the use of spontaneous techniques. If the problem does not appear
initially, a directive may be given to draw what brought the client here today. The problem can
be explored using the phenomenological method and through a metaphor in the drawing.
Drawing the problem and using a metaphor is the start of externalizing the problem and
forming solutions by creating a method of narrating in a safer way. Speaking through a
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metaphor is especially effective with adolescents. Selekman (1997) applied football tactics as a
metaphor to life with a male client who loved football and played the running back position.
Initial scaling. Have the client rate the problem drawing from 1 to 10 with a 10 rating
meaning the problem is solved (and the team is winning) and 1 is the opposite. Using
Selekman’s (1997) example, a therapist might say, If your problem was football, how would
you rate that play as a running back, if 10 was winning the game and 1 was the opposite?
Consideration may be given emotionally for the client’s hopefulness towards the situation,
cognitively for how the client thinks the problem is and behaviourally how the client’s actions
are in her or his life towards reaching the client’s goal. Using the football example, You would
ask the client how hopeful are you at this time that you will be a successful running back? How
do you think you may succeed as a running back? and How are your actions as a running back?
How will your actions help or hinder the team? The emotions on the face illustrations can be
employed to help with scaling for the adolescents’ better comprehension of feeling changes.
The scaling can be used by the therapist to set goals by asking the client what would have to
happen to raise the scale from, for example, 2 to 3.
Exception intervention. Ask the client to adapt the problem by using the same art
expression or as a new art expression to reflect on times the problem was less than scaled
above or not there at all. Do another scaling after the drawing is completed. The football
metaphor could be continued throughout the session.
Goals in session. The therapist and client can now use the drawing to discuss what the
client hopes to achieve from this and subsequent visits. What alternatives may be developed
from the exceptions and discussions to make the team more efficient? The therapist helps the
client set personal goals that are reasonable and achievable. Achievable goals motivate the
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client with small successes.
Compliments and coping. The client should be praised for his or her hard work and the
client’s strengths, resources, and successes in the past can be reviewed. Compliment the
client’s discoveries made through the art expression and what the client has already done to
bring the team closer to a win. Ask the client: What will you do for yourself this week to take
care of yourself? Explore the client’s own ideas for coping and suggest other self-care and
coping strategies.
Adolescent client supports. Who do you have in your life to support you? If none, how
would you picture support looking like in your life, if you were to experience it? Explore
possibilities such as family, friends, neighbours, school friends or staff, people at church,
people at other organizations the client might belong to such as the football team or a coach.
Homework. Assign the client to do the following: Do more of what worked as explored
with exceptions on a daily basis and report next week. Observe what others around you are
doing and saying after these changes occur and how you are feeling, behaving, and thinking.
Journal your observations and do some art in your journal. Bring your journal to the next
counselling session.
Session Two
Therapist’s goals for the session. Continue developing the working alliance and
motivating the client for additional small steps of change by exploring client strengths,
resources, what worked last week, and what worked in the past.
Questions for understanding through externalizing the problem for therapist to
select and ask the client. (Adapted from Matto et al., 2003). If you drew the problem what
would it be? What would it look like if it was dimensional? Can you draw a fantasy picture
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and compare and contrast what the expectation was and what really happened? Can you now
do the same with the reality? Can you think about the problem and draw an incident that
occurred and what happened? What can you draw that did not have the problem?
Greeting, exploration of last week, and current session work. Greetings such as Hello.
How are you doing today? How did your week go? How is your team doing? sets the stage for
the session and makes the client feel that the therapist cares about the him or her. What was
better? Who noticed? What strengths and resources were used to bring about the change?
Sharing parts of the journal that the clients chooses to share can lead into doing some artwork.
Do an art expression to demonstrate the changes. Explore the art with the client, using the
phenomenological method. Do another scaling with the client to determine where the client is
now with the problem. If the client has had success during the week, then the miracle question
can be introduced. If the client had no success, other exceptions to the problem have to be
explored and tried.
Miracle question intervention. Say the following to the client: You go to bed one night
and a miracle happens and when you awake, the problem is solved. What would be different?
What would you notice? What would others notice? If the client is uncomfortable with the
miracle question, offer an alternative such as, Draw three things that you want different in your
life. Or, using the football example, What three football tactics would it take to have a winning
team? Have the client draw, paint, sculpt or collage the miracle. Riley (1999) described using
an alternative approach as a method to progress to an ideal or miracle. Riley suggested
exploring with the adolescent to draw how it is and how they would like it to be. Threedimensional objects may be sculpted or collaged with some clients. A collage can be very
effective because it is easily adapted from week to week as small steps are taken to work
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towards the miracle. It is important to explore details about the miracle in order that small
goals can derive from it.
The miracle question, questions for therapist to select and ask the client. (Adapted
from Matto et al., 2003). How will you know the problem is solved? What will you be doing
differently? What will others notice you are doing differently? How will that be helpful?
What will your heart feel? How will you be feeling? How will your thinking be
affected? What will your thoughts be? What will you be saying to people around you?
How will they respond? If a an adolescent says that a miracle would be to get mom and dad
back together when they are divorced, rephrase and ask, How will things be different when
you are not so sad about your parents? Explore the sadness through art expression and
using the phenomenological method. This problem drawing can be adapted for small
changes as the client continues therapy. Another art expression can be assigned to explore
what the client’s next steps could be to the miracle. Check for goal changes with the client.
Scale the progress and ask the client what he or she thinks is needed to get better and to the
next scale.
Compliments and coping. Compliment the client on the new discoveries that were made
and the work that was accomplished last week. Explore the coping strategies from last week
and remind the client to use what worked. Discuss new strategies.
Adolescent client supports. Clients can benefit from the therapist drawing their
attention to supports in their life. Was there a supportive person or persons last week that the
client could talk to? How did that work for the client? Could the client access supports
in the future? What could the client specifically draw to help the client remember this person
or resource and where could the client put this drawing as a reminder?
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Homework. Assigning homework or tasks can be helpful for some clients (Iveson,
2002; Turnell & Edward, 1993) as it extends therapy hours and is cost-effective. Ask the client
to do the following. Observe what others are doing after these changes occur and how you are
feeling, behaving, and thinking. Journal and engage in artmaking for some of these
observations. Bring the journal to your next session.
Session Three
Therapist’s goals for the session. More in-depth verbal processing will be attempted
based on the work of Matto et al. (2003). A construction of change by using critical
engagement will occur at the next session.
Greeting, exploration of the previous week, and current session work. Greetings may set
the stage for the session if the therapist gives the client full attention and concern at the start and
pays attention to how the client is feeling when he or she comes in. Pay attention to body
language and facial expressions. Greet the client with Hello, how are you doing today? How did
your week go? If the client is not doing well, this could be acknowledged. Ask the client the
following questions: How did you cope? Who helped you? What changes in yourself and in
others were observed? Are you satisfied with the changes? What challenges did you have and
how did you handle them? You can emphasize through your journal if you like, or portions of it
if you prefer.
Some discussion of feelings and normalization of feelings occurs with the therapist and
client. Have the client choose the art medium if this is assessed appropriate by the therapist and
is not contraindicated. Direct the client in creating art work that expresses feelings that the client
has experienced. The problem as the client currently sees it may be drawn or collaged. In Riley’s
(1999) experience with adolescents, collage offers many metaphoric possibilities and is the least
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threatening medium. Alternatively a portion of the initial drawing could be enlarged with a new
drawing, or collage. Encourage the client to draw each individual of the team and how the client
is feeling today, but this time relating it to the client’s team at home. Encourage the client by
letting him or her know that the art expression holds the client’s emotions and only he or she can
disclose as much or as little as the client wants to. Explore how each member drawn is feeling
and how the client relates to those feelings. Choose the critical engagement question approach
with the client’s drawing. Another drawing may be advised or even required if the client has an
awareness regarding a repetition of a theme or appears to have high anxiety, as observed by the
therapist concerning excessive shading. Use of more controlled media for anxiety may be
required as assessed by the therapist. A three-dimensional representation can be explored using
clay if the client is not anxious. Some types of collage could produce more exceptions from the
art expressions or steps related to the miracle question drawing.
Goals may need to be adjusted again. Scale the progress with the client and ask the client
what he or she thinks needs to be revised for a more positive rating scale.
Questions for critical engagement for therapist to select to ask the client. (Adapted
from Matto et al., 2003). For the client: What is most noticeable when you look at your
work? What catches your eye first? Tell me about your picture. Is there content repetition?
What does this represent? For the therapist: Is there excessive shading? (For therapist’s
thoughts for assessment of anxiety). For the client: Notice the amount of shading in your
drawing. Does that have any significance for you? What do you think this means? What
would a three-dimensional drawing look like? Would you like to make the drawing into a
three-dimensional structure? What would you title this picture?
Compliments and coping. Praise the client for hard work and discoveries.
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Explore how coping strategies are working. Discuss alternatives if needed.
Adolescent client supports. Explore the supportive people that are in place and how
the supports are working. Review additional supports with the client.
Homework. Encourage self-care and continued work on the changes. Ask the client to do
the following: Make observations about others around you as you did last week and attempt your
ideas from the more positive rating scale. Observe family members, their feelings, and your
feelings. Journal and do art about of your observations. Bring the journal to your next session.
Session Four
Therapist’s goals for the session. The fourth session provides an opportunity for the
client to emotionally process by using initial reactions. Mentally check on the working alliance
and go slow if needed. The therapist may use the following questions to guide the process with
the client.
Questions for initial reaction of verbal processing for therapist to select and to ask
client. (Adapted from Matto et al., 2003). What comes to mind when you look at your
drawing? What are the feelings around these objects or people? How do these people wish
they could feel? Where are the emotional and spiritual centres in this image? What is the
affirming centre of this picture? Where do you find strengths or hope in the picture?,
Where is the strength and hope coming from? Where is the energy level felt in your picture?
What part of the image surprised you most, invited you, challenged you, and engaged you
most? When you look at the whole picture, where does it reside best in the human body
(head, heart, or stomach).What was the most significant physical or physiological sensation
you had when you were creating your artwork? When you look at it?
Greeting, exploration of previous week, and current session work. Warmly greet the
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client and ask how he or she is doing. Check in with the client about the client’s week and
what was noticed by him or her about their team, what changes may have occurred, what
if anything surprised the client, what others did or said, and what feelings were observed and
came up? Ask the client if she or he is ready to do some emotional work. Assure the client he
or she can go at the client’s own pace and when he or she is ready. Have the client scale rate
how hopeful and strong the client feels about the problem with 10 meaning the problem is
solved and 1 being the worst case scenario. Explore a drawing from last week that has
changed to account for the changes the client made or have the client do a new drawing on
how the client sees the problem now.
An exploration of the drawing or other art form can be done utilizing initial reaction
questions with the client. Have the client do art expressing the team’s emotions and the
client’s own emotions that occurred and were observed during the week. How does each
member of the family contribute to the emotional status of the whole team? This section
explores emotions and may take more than one session, but one session is suggested in this
manual. Scale the progress the client feels at this time. You might say: You have experienced
some of your emotions and other’s emotions here today and some very effective work has
been done. How are you feeling right now? Take a few minutes to think about this and rate
on a scale of 1 to 10 how hopeful you feel? How strong do you feel about the problem now?
Ten is very hopeful and very strong and one is the opposite.
Compliments and coping. Praise the client for his or her work with emotions. Normalize
emotions by stating that they are a normal part of all humans and expressing them makes you
stronger. Allowing yourself to express all of your emotions makes you feel all of your emotions
more. Discuss new strengths that the client showed today. Ask the client to do something very
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special for himself or herself this week and to do extra self-care strategies tonight, such as a
manicure, a relaxing bubble bath and listening to quiet soothing music. A male client may want
to bounce a basketball around or go for a walk alone. If more feelings come up it is okay to feel
them.
Adolescent client supports. Approach your support people that you feel will be
emotionally supportive and share your emotions with them if you feel ready to do so. Call
the therapist if you need to. Many emotions were brought out in this session; the client
may have difficulties containing these emotions and may need to talk to the therapist for
some guidance or have an extra session mid-week.
Homework. Pay attention to and feel the emotions that come up this week. Journal and
do art about the emotions and bring this into the next session to share parts you wish to share
with the therapist. Some suggestions for coping strategies to deal with overwhelming emotions
are walking, running, playing sports, or calling a person that would be supportive with
emotional reactions. The Support Network Edmonton has a 24 hour crisis line that can be used
if needed 780- 482-4357.
Session Five
Therapist’s goals for the session. Have the client explore relational components to
understand what the client and others mean to the art materials, art process, and artwork and
connect this to relational aspects in their life. For example, relating to others is contextual,
meaning that different parts or aspects of ourselves may be relating to one or another positive
or negative event or behaviour.
Greeting, exploration of previous week, and current session work. Greet the client and ask
how feelings were this week. Explore the highlights and certain feelings within the client’s
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journal. How was the week, how did you feel, did your supports work for you, what did you do
for yourself, and how did these actions make you feel? What worked well this week? What
didn’t work well? Explore how the client sees the team problem now through a new drawing.
Explore the art expression for relational attributes. The therapist explores relational attributes
with the client for patterns, themes, and connections within the piece through object to object,
shapes, colours, forms and symbols, and to self, to others, and to life circumstances such as
home, work, family, community, and neighbourhood. More artwork may be suggested if some
aspect would benefit the client with further exploration of art to evolve ideas or challenges. The
therapist can also explore temporal elements such as past, present, and future in terms of the
client’s connection to the art object and the art process through time.
Questions for relational aspect for the therapist to select and to ask clients. (Adapted
from Matto et al., 2003). How does the picture relate to you? Where in time is this image
located? What is the loudest part of the image? Who is saying it? Who is listening? Who
would you like to be listening? Who is the softest voice? Who would you invite to witness
this image and who would you not invite? What parts need more exploration?
Questions for process for the therapist. (Adapted from Matto et al., 2003). How did
the client engage with the materials? What range of materials was used? What was the
relationship of the client to the art process and the reaction of the client? How did the client
respond to difficulty, challenges, and frustrations? Ask the clients if he or she wants to revise
the goals. Scale the progress that the client sees and ask what the client thinks would bring
him or her to the next beneficial scale level. Follow the client’s comments in order to
facilitate with dialogue.
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Compliments and coping. Praise the client for all of the wonderful work done and the
changes taking place. This helps reinforce or shape the client’s behaviours. Review strengths
observed in past sessions and acknowledge new strengths in the session today. Review coping
strategies.
Adolescent client supports. Explore which supports work for the client and in what way
they are helpful.
Homework. Work on the next step of the miracle question and exceptions that may have
come up within the session today and review the suggestion made by the client when scaling.
Ask the clients to pay attention to relational aspects as explored in the session, to do artmaking,
and to write reflections in the client’s journal.
Session Six
Therapist’s goals for the session. Explore new possibilities with the client
for solution possibilities and alternatives for constructing change within the team. Prepare the
client for the last session next week. For example, have the client make a list of possibilities
and alternatives that the client is interested in trying now and in the future. Make another list of
coping strategies that have worked for the client and for the people who support the client,
defining the various ways they support the client such as emotional support, cognitive
stimulation, fun, and activities.
Questions for new possibilities for therapist to select and ask the client. (Adapted
from Matto et al., 2003). How would the picture be different if you had used markers instead
of paints? Would you like to try markers? Chalk instead of pencil? Clay? What would you
like to be different about your drawing? What part of the picture do you need to let go of? Do
you need a closure piece? What would a drawing in response to this piece look like? What
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would it be titled? What would a new ending to your story be? What would you need to come
about for that ending to take place? If you were not doing the problem behaviour what would
you be doing?
Greeting, exploration of previous week, and current session work. Greet the client and
explore the week with the client and the journaling and art work that the client wants to explore.
Remind the client that next week is the last session. Review all of the art work done from all of
the sessions and have the client summarize what solutions and progress were observed. Ask the
client to think of other change possibilities. Compliment and encourage the client to keep going
with the change process, an excellent progress is being made. Use artwork to construct
alternative changes and list new possibilities through brain storming, and then check out some
more viable choices by testing them out. Review the artwork for possibilities. Explore exception
situations with more artwork. Scale the progress that the client has made cognitively,
emotionally, and spiritually. What is one small thing that the client can do to increase that scale?
Compliments and coping. The therapist should praise the work the client has done to
promote new possibilities and reinforce creative options. Discuss new strengths seen and
coping strategies and supports for the next week with the client.
Adolescent client supports. Suggest that the client assess his or her supports this week
and pay attention which support person helps in what way.
Homework. Suggest that the client utilize as many of the new possibilities as the client
feels and thinks she or he can do and journal about their successes and setbacks that can be
discussed next week. Have the client establish some long-term goals to discuss in the final
session for continued work after therapy is finished. Suggest that the client create a list of
effective strategies and a list of support people, noting which support people are best for
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emotional support, discussing problems, goal strategies, working on art together, and for doing
fun activities.
Session Seven
Therapist’s goals for the session. Explore the long-term goals, coping strategies, and
supports the client has developed and review all of the artwork including journal work for
closure.
Greeting, exploration of previous week, and current session work. Greet the client and
explore and discuss the client’s successes and setbacks this week. Ask the client how he or she
feels about today being their final session. Have the client do another miracle question drawing
and establish where the client is today to encourage further work for the future. Scale the
client’s progress cognitively, emotionally, and spiritually. Examples of scaling:
1) If you were to scale your progress by where you want to be as 10 and 1 as the
opposite, where would you be?
2) If you were to scale your hope today as 10 being very hopeful and 1 being the
opposite, where would you be?
3) If you were to scale your strength with the spiritual help you have as 10 being the
strongest you can be and 1 as the opposite, where would you be?
Have the client set some goals for the next few weeks to get closer to the imagined miracle
outcome. Discuss how capable the client now feels about setting goals for themselves, and
following through step by step, documenting their progress through artmaking, art reflections,
scaling, journaling, and charting progress. Review the client’s self-care strategy and support
list. Discuss how people have supported the client in the past. Review all of the artwork and
discuss the client’s progress that can be done in order to facilitate closure with the client. If the
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client is an adolescent, a small art supply gift or a new journal may be appropriate.
Compliments and coping. Compliment the clients on successes, changes, and efforts
that were observed. Tell the client what a pleasure it was to work together. Ask the client how
the experience was for him or her.
Adolescent client supports. Continue to connect with the support team that you have
identified.
Homework. Ask the client to continue to work towards their chosen miracle through a
focus on what was explored. Encourage the client to continue to set new goals to work on new
problems and solutions in the same way we did together. Use the coping strategies that worked
for you and call on the supports that were effective. Journal for the purpose of personal growth,
recording, scaling, and change. Ask the client to come back if needed.
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Solution-Focused Art Therapy
Manual for Children
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Seven Sessions for Children
Session One
Therapist’s goals for the session. The therapist’s goals for the session are to establish
client comfort with; art materials, creating art, the therapist, and the verbal process by
constructing the problem and exceptions. The problem and exceptions are created by the client
in a concrete form with artistic expression. The therapist looks for metaphors in the art form to
use as a communication tool with the child and to use directive themes for artwork.
Pre-session. Have the client’s guardian or parent come to see you on the day of therapy
about half an hour before the scheduled time to fill out an assessment form, any agency forms
prior to the first session, a limit of confidentiality form, and sign a consent form on behalf of
the underage client to be seen in therapy. The parent/legal guardian and therapist review the
assessment form and any other agency forms given to the parent/legal guardian for clarity and
the parent’s or guardian’s version of the problem is explored. The therapist explains
confidentiality to parents/ legal guardians (both should sign if there are two), summarizes the
SFAT process, and asks if the parents/guardians have any questions. After all of the questions
are answered and the parent or guardian or both consent to having their child in therapy, the
child client is then seen alone at a scheduled time and the parent stays in the waiting room. If
the child is seen at the school, the parents have a short meeting with the therapist before the
session to fill out the necessary documents, the process is explained, and any questions the
parent or guardian has are answered. The child is then seen at the school at a scheduled time.
Beginning the session. The session starts with greetings, introductions, and an
explanation of SFAT for the client. The therapist must simplify the explanation of SFAT so
that the child can understand it. An example might be that therapy helps people with problems
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and we do that by doing art and talking. Do you know what a problem is? Do you know what
problem you have? Your mom and I met yesterday and talked and she told me you are very
afraid to be away from her and don’t want to go to school. Do you think that is a problem?
Yes, well, that’s good that you see that as a problem too. Do you think you and I can work
together to help you with this problem? Do you like to do art? What kind of art is your
favorite? Do you think you might like to try some art? I want to tell you about confidentiality
and then we will start. Confidentiality means that I will not tell anyone what we talk about and
what you draw except your parents, unless you want me to. Your parents have the right to
know what we talk about but we can tell them together if you like or you can tell them
yourself. The other time I have to tell someone what we talk about or what you do in art is if
you tell me someone is hurting you or abusing you. Then it is required by the law that I report
to someone so we can get help and that person can not hurt you anymore. Do you know what
the law means? Do you have any questions or thoughts about this? If not, then we can start
right away, but if you have any, please let me know now. If not, then let us look at all the art
materials and try out your favorite ones.
Current session. Ask the client to do some spontaneous art. If the client is nervous about
doing art, an introduction to spontaneous techniques such as the scribble technique, scribble
chase, or the squiggle game are effective for children (Riley, 1999). The problem that the client
has, may show up through the use of spontaneous techniques. If the problem does not appear,
or the client does not want to talk about what appears in the art, explore the problem through a
metaphor by using the phenomenological method. Children are not developmentally capable of
explaining how they feel at a particular time; therefore, a narrative using a metaphor is usually
utilized (Malchiodi, 2007). Drawing the problem or utilizing a metaphor from the art is the
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start of externalizing the problem and the start of a narrative for the client. The therapist might
explore the problem and initiate narrative from the child by asking questions such as: What is
the bunny in your drawing doing? Is he hiding behind his mommy? What is he afraid of? Is he
afraid to leave his mommy? Tell me a story about the bunny.
Initial scaling. Have the client rate the problem the bunny is having in the drawing by
using the emotion faces with a 10 rating meaning the bunny is not afraid of leaving his
mommy and a 1 rating meaning the opposite.
Exception intervention. Explore for exceptions by having the client do a drawing of
times when the bunny was away from her or his mom. What was the bunny doing? How did
the bunny feel when he was a big bunny and away from his mommy? Was it scary? Why was
the bunny afraid? What would make the bunny less afraid? Do you think there was a time
when the bunny was away from his mommy and was not afraid? Do another scaling after the
drawing is completed to determine how afraid the bunny is now.
Goals in session. The therapist and client can have a discussion about what having a
goal means and what the client would like in subsequent visits. The therapist can explain that a
goal is like a wish you might have of what you would like when you come again. Small goals
will start to be developed from the exceptions and discussions. The therapist helps the client
set personal goals that are reasonable and achievable. A child’s goal might be to have fun, be
distracted from stressful situations, do art when he or she comes or want some new ways to
create. Another goal might be to be less afraid to be away from mommy at art therapy or at
school and other places. Maybe we could look at feelings as a goal, how would that be?
Achievable goals motivate the client to want to come back, to have fun with art, to be creative,
and to achieve goals.
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Compliments and coping. The client should be complemented on his or her art work, for
exploring some new ways of working with art, for being away from his or her mom, and for
being brave. Do you think you can tell your mommy when you are afraid this week and talk
about why you are afraid? Then maybe you could tell me about those times and why you were
or weren’t afraid.
Child client supports. Who do you have in your life to help you when you are sad,
lonely, or want to have fun? Let’s do some art about support people. Explore possibilities such
as mommy, daddy, siblings, or other family, friends, neighbours, people at school, people at
church, and people at other organizations.
Homework. How would you like to write or draw in your journal about the times you
and mommy talk when you are afraid? Or when you talk to someone else like your dad, a sister
or brother, or a friend? Could you bring your journal into the next counselling session? Would
you like me to tell your mommy about our journal plan so she helps you remember, or should
we tell her together? Explain more about the client’s homework to her or his mom after the
client has had a chance to tell her or his mom.
Session Two
Therapist’s goals for the session. Continue developing the working alliance and
motivating the client for additional small steps of change by exploring client strengths,
resources, what occurred last week, and what worked in the past.
Questions for understanding through externalizing the problem for therapist to
select and ask the client. (Adapted from Matto et al., 2003). These may be effective with
some children. If you drew the problem what would it be? What would it look like if it was
dimensional? (Use an object to explain “dimensional”, such as a box or a ball). Can you draw
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a pretend picture and then one showing what really happened? Can you think about the
problem of being afraid to be away from mommy and draw what happened? Can you draw a
time when you weren’t afraid to be away from mommy?
Greeting, exploration of last week, and current session work. Greetings such as, Hello.
How are you doing to day? How did your week go? set the stage for the session and make the
client feel that the therapist cares about the him or her. Do you have your journal here and did
you get a chance to do some art or write in your journal? Sharing parts of the journal that the
clients chooses to share can lead into doing some artwork. Do an art expression to demonstrate
how the client wants things to be and a second art expression about how things really are.
Explore the art with the client, using the phenomenological method. Do another scaling with the
client to determine where the client is now with the problem. If the client has had success during
the week, then the miracle question can be introduced. If no success, other exceptions to the
problem have to be explored and tried. Check with the mom for success.
Miracle question intervention. Say the following to the client: You go to bed one night
and a miracle happens and when you awake, the problem is solved. What would be different?
What would you notice? What would others notice? If the client is uncomfortable with or
doesn’t understand the miracle question, offer an alternative such as, Draw your safe place, or
name three wishes, that makes things the way you want them to be. Ask the client to explain
the miracle question if the client says she or he understand. Have the client draw, paint, sculpt,
or collage the miracle. Three-dimensional objects may be sculpted or collaged with some
clients. A collage can be very effective because it is easily adapted from week to week as small
steps are taken to work towards the miracle. It is important to explore many details about the
miracle so that small goals can derive from it. Explain to the client that she will make a book
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of all her art with your help and then she can take the book home when art therapy is finished.
The miracle question, questions for therapist to select and ask the client. (Adapted
from Matto et al., 2003). How will you know the problem is solved? What will you be doing
differently? What will others notice you are doing differently? What will your heart feel?
How will you be feeling? How will you be thinking? What will your thoughts be? What
will you be saying to people around you? How will they be responding? If a child says that a
miracle is to get mom and dad back together when they are divorced, rephrase and ask,
How will things be different when you are not so sad about your parents? Explore the
sadness through art expression using the phenomenological method. This problem drawing
can be adapted as the client continues therapy for small changes. Another art expression
can be assigned to explore what the client’s next steps could be to the miracle. Check for
goal changes with the client. Scale the progress and ask the client what he or she thinks is
needed to make things even better?
Compliments and coping. Compliment the client on the new discoveries that were made
and the work that was accomplished last week. Explore the coping strategies from last week
and remind the client to use what worked. New strategies can be drawn. The client is
encouraged to try the strategies that appeal to him or her.
Child client supports. Clients can benefit from the therapist drawing their attention
to supports in their life. Was there a supportive person or persons last week that the client
could talk to? How did that work for the client? Could the client access supports in the future?
What could the client specifically add to his or her drawing from last week to help remember
this person or resource and where could the client put the drawing to remind him or her?
Homework. Assigning homework or tasks can be helpful for some clients (Iveson,
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2002; Turnell & Edward, 1993) as it extends the therapy hours and is cost- effective. Ask the
client to do the following: Journal and engage in art making for more times similar to last week
when you were not afraid or less afraid to be away from mommy. Journal or draw times when
you were not afraid and think about why those times were different. Do some art just for fun.
Bring the journal and your fun art to your next session.
Session Three
Therapist’s goals for the session. Some verbal processing has already occurred now a
more in-depth processing can begin. Based on the work of Matto et al. (2003) one may proceed
with a construction of change by using critical engagement for the next session.
Greeting, exploration of the previous week, and current session work. Greetings may set
the stage for the session if the therapist gives the client full attention and concern at the start and
pays attention to how the client is feeling when he or she comes in. Pay attention to body
language and facial expressions. Hello, how are you doing today? You seem a little sad and
quiet. How did your week go? If client is doing well or not doing well this could be
acknowledged. Wow, you are so happy today, tell me how your week went. Ask the client the
following questions: Who helped you this week? What challenges did you have? How did
you handle them? You can emphasize through your journal, if you like, or portions of it if
you prefer.
Ask the child client if he or she would like to work on a feeling book or box or just do
some art on feelings? Malchiodi (2007) suggested using different colours chosen by the
child to represent different feelings and to do a drawing that is not a stick drawing or face
that represents each feeling. When the drawing is complete, ask: Are the feelings connected?
How do the feelings relate? Do they have common shapes, lines, or sizes? Which one did you
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spend the most time on? Normalize feelings to the child and let the child know that everyone
has feelings and it is okay to feel them because it makes you stronger. Explore the problemfocused art expression for feelings. A portion of the initial drawing could be enlarged to
portray feelings about the problem. Encourage the client by letting him or her know that the
art expression holds their emotions and only the client can disclose as much or as little as the
client wants. Have the client choose the medium, if this is assessed as appropriate, and is
not contraindicated. A metaphor can be encouraged where appropriate and can come from
the drawing. For example, how is the bunny feeling in your drawing? A three-dimensional
representation can be explored using clay. Betensky (1995) found in her experience with
clients that a three-dimensional object can help some clients more easily integrate the object
to themselves, their feelings, their experiences, and also, that some types of collage can
produce a similar experience. Scale the progress with the client and ask the client what he or
she thinks needs to be revised for a more positive rating scale.
Questions for critical engagement for therapist to select to ask the client. (Adapted
from Matto et al., 2003). For the client: What is most noticeable when you look at your
work? What catches your eye first? Tell me about your picture. For the therapist: Is there
content repetition? What does this represent? Is there excessive shading? (For therapist’s
thoughts for assessment of anxiety). For the client: Notice the amount of shading in your
drawing. Does that have any significance for you? What do you think this means? What
would a three-dimensional drawing look like? Would you like to make the drawing into a
three-dimensional structure? What would you title this picture? For the therapist: With
children, titling an art expression can be meaningful to the client and the therapist and can
express the theme of what the child expressed in the artwork. Malchiodi (2003) suggested
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that themes both organize and add information to the experience.
Compliments and coping. Praise the client for the hard work and discoveries.
Explore how the coping strategies are working and add to last week’s drawing. Discuss
alternatives if needed.
Child client supports. Explore the supportive people that are in place and how the
supports are working. Ask the client, Shall I talk to your mom about the feeling work we
did and shall we talk to her together to help you this week? Review additional supports
with the client; these can be added to the last drawing on supports.
Homework. Ask the child to do the following: make observations about others around
you. What feelings do they have this week and what are your own feelings? Journal and do
artmaking about what you see and feel. Bring your journal with you next week.
Session Four
Therapist’s goals for the session. The fourth session provides an opportunity for the
client to emotionally process by using initial reactions. Mentally check on the working alliance
and go slow if needed. The therapist may use the following questions to guide the process with
the client.
Questions for initial reaction of verbal processing for therapist to select and to ask
client. (Adapted from Matto et al., 2003). Ask the child to explore all of her or his emotions
and the emotions of those around the client that he or she drew in her journal last week.
These can be used with art expressions today, too. Ask the client the following: What do you
see when you look at your drawing? What are the feelings around these objects or people?
How do these people wish they could feel? What part of the image surprised you most, made
you think about feelings most, and what part made you feel your feelings most? When you
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look at the whole picture, where are the feelings in your body (head, heart, or stomach).
Where in your body do you feel it most? When you were drawing your picture, where did
you feel it and where did you feel it most?
Greeting, exploration of previous week, and current session work. Warmly greet the
client and ask how he or she is doing. Check in with the client about her or his week and
what the client noticed, what changes occurred, what if anything surprised the client,
and what others did or said? Ask the client if he or she is ready to do some more feeling
work. Ask the client the following: Did you have some of the feelings this week that we drew
last week? Draw the experiences today. An exploration of the drawing or other art form can
be done utilizing initial reaction questions with the client. This section explores emotions and
may take more than one session, but one session is suggested in this manual. Have the client
draw the emotion on a separate drawing. If you are working with the client through a
metaphor, explore feelings through the object and later ask if the client has ever had feelings
like the object does in the drawing. Feelings can usually be projected upon objects if the
client identifies with the qualities of the object or the nature of the object’s use or context
(Malchiodi, 2003). Scale the progress the client feels at this time. How are you feeling right
now? Let’s look at the emotion faces again. Have the client draw a safe place today to help
the client cope. Explain a visualization of the client’s safe place and have the client do it if
she or he feels sad this week.
Compliments and coping. Praise the client for his or her efforts with emotions and the
work the client did in the journal. Discuss new strengths the client showed today, such as You
seem more confident and explain how you notice that. You went right to the art work and chose
what you wanted to do yourself and never even mentioned wanting mommy once. Have lots of
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fun with friends this week. If more feelings come up it is okay to feel them.
Child client supports. Talk to mommy or daddy about your feelings this week.
Homework. Journal and do art about the emotions and bring this into the next session to
share parts you want to share with the therapist. Notice other people and how they have
emotions and what they do. You can journal that part too you like.
Session Five
Therapist’s goals for the session. Have the client explore what the client and significant
others mean in terms of their art materials, art process, and artwork and connect this to
relational aspects in their life. For example, relating to others is contextual, meaning that
different parts of or aspects of ourselves may be relating to one or another positive or negative
event or behaviour.
Greeting, exploration of previous week, and current session work. Greet the client and ask
how feelings were this week. Explore the highlights and certain feelings within the client’s
journal. How was the week, how did you feel, did your mommy and daddy help you with your
feelings? Did you play with friends and have fun? Did you see other people feel emotions? What
did they do with their emotions? Did they feel them? Explore how the client feels right now
through a new drawing. The therapist explores the art expression for relational attributes with the
client for patterns, themes, and connections within the piece through object to object, shapes,
colours, forms and symbols, and to self, to others, and to life circumstances such as home, work,
family, community, and neighbourhood. More art work may be suggested if some aspect would
benefit the client with further exploration of art to evolve ideas or challenges. The therapist can
also explore temporal elements such as past, present, and future in terms of the client’s
connection to the art object and the art process through time.
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Questions for relational aspects to ask clients. (Adapted from Matto et al., 2003).
Are you in your art piece? Where are you? What time of day is it in your artwork? Is it
summer, spring, fall, or winter? Is it today or yesterday or last week? What is the loudest part
of the image? Who is saying it? Who is listening? Who would you like to be listening? Who
is the softest voice? Who would you ask to come and to see this image and who would you
not invite? What parts of your painting do you want to talk about more or do some more art
about?
Questions for process for the therapist. (Adapted from Matto et al., 2003)
How did the client engage with the materials? What range of materials was used?
What was the relationship of the client to the art process and the reaction of the client?
How did the client respond to difficulty, challenges, and frustrations? Ask the clients if he or
she want to revise the goals. Scale the progress that the client sees and ask what the client
thinks would bring him or her to the next beneficial scale level. Follow the client’s comments
in order to facilitate with dialogue.
Compliments and coping. Praise the client for all the wonderful work done with
feelings that the client explored. This praise helps reinforce or shape the client’s behaviours
(Malchiodi, 2003; Selekman (1997). Review strengths observed in the past sessions and
acknowledge new strengths in the session today. Review coping strategies.
Child client supports. Explore which supports work for the client and in what way they
are helpful.
Homework. Do some more art on feelings this week by watching others and from
feelings you have. Do some artmaking and write in your journal. Have fun with art this week,
too.
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Session Six
Therapist’s goals for the session. Explore new possibilities with the client
for solution possibilities and alternatives for constructing change. Prepare the client for the last
session next week. For example, have the client make a list of possibilities and alternatives that
the client is interested in trying now and in the future. Add to the list of coping strategies that
have worked for the client and add people who support the client, defining the various ways
that they support the client such as emotional support, cognitive stimulation, fun, and
activities.
Questions for new possibilities for therapist to select and ask the client. (Adapted
from Matto et al., 2003). How would the picture be different if you had used markers instead
of paints? Would you like to try markers? Chalk instead of pencil? Clay? What would like to
be different about your drawing? Do you need a goodbye art piece to your problem art piece?
What would it be titled? What would a new ending to your story be? If you were not doing
the problem behaviour what would you be doing?
Greeting, exploration of previous week, and current session work. Greet the client and
explore the week with the client and the journaling and artwork that the client wants to explore.
Remind the client that next week is the last session. Review all of the art work done from all of
the sessions and summarize solutions and progress observed with the client. Ask the client to
think of other change possibilities. Compliment and encourage the client to keep going with the
change process, as excellent progress is being made. You are now a change expert, keep up the
good work and keep your artwork alive through more artmaking. Use artwork to make changes,
and list new ideas you have and then check out some more choices by testing them out. Review
the artwork for possibilities. Explore exception situations with more artwork. Scale the progress
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that the client has made cognitively, emotionally, and spiritually. What is one small thing that the
client can do to increase that scale?
Compliments and Coping. The therapist should praise the work the client has done to
promote new possibilities and reinforce creative options. Discuss new strengths seen and
coping strategies and supports for the next week with the client.
Child client supports. Suggest that the client to assess his or her supports this week and
pay attention which support person helps in what way.
Homework. Suggest that the client utilize as many of the new ideas as the client feels
and thinks he or she can do. Journal and do art about separation times from mommy that were
fun and you did not worry about her coming. How did you do that?
Week Seven
Therapist’s goals for the session. Explore and have the client draw coping strategies and
supports the client has developed, and review all of the artwork including journal work by
having the client tell what she or he sees in the artwork for closure. Do a piece of
artwork together for the client and one for the therapist.
Greeting, exploration of previous week, and current session work. Greet the client and
explore and discuss the client’s successes and setbacks this week. Ask the client how he or she
feels about today being the final session. Have the client do another miracle question drawing
and establish where the client is today to encourage further work for the future. Scale the
client’s progress cognitively, emotionally, and spiritually using the picture faces scale.
Examples of scaling:
1) If you were to scale or rate how you feel about being away from mommy, with a
happy face ( see page 110 for emotion face rating scale) meaning you are not
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afraid at all and a grumpy face meaning you are very afraid, where would you
be?
2) If you were to scale or rate how you feel right now about all the work you did,
with a smiley face meaning very happy and a grumpy face meaning not very
happy, where would you be?
3) If you were to scale how strong you feel away from your mom, with a smiley
face being strongest you can be and a grumpy face meaning not very strong,
where would you be?
Remind the client that he or she is now a change expert and can solve problems or ask others
to help solve problems that come his or her way. Discuss how capable the client now feels
about setting goals, and following through step by step, documenting progress through art
making, art reflections, scaling, journaling, and charting progress. Have the client add to the
self-care strategy and support list drawing. Discuss how people have supported the client in the
past. Review all of the art work and have the client talk about the progress that occurred, in
order to facilitate closure with the client. Do two art fun pieces together, one for the client and
one for the therapist. For a child client a small art supply gift or a new journal may be
appropriate.
Compliments and coping. Compliment the clients on their successes, changes and
efforts that were observed. Tell the client what a pleasure it was to work together. Ask the
client how the experience was for him or her.
Child client supports. Continue to connect with the support team of which you are
making your drawing.
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Homework. Ask the client to continue to work towards their chosen miracle through a
focus on what was explored. Encourage the client to continue to set new goals to work on new
problems and solutions in the same way we did together. Use the coping strategies that worked
for you and call on the supports that were effective. Journal for the purpose of personal growth,
recording, scaling, change, feel your feelings, have fun, try new ways to do art and be creative.
Ask the client to come back if needed. The journal suggestions and ideas need to be modified
for the individual child taking into consideration the emotional, cognitive, and social supports
available to the child outside of the sessions. The child can be given the pages of the Scaling
Emotional Symbols if they are familiar with them from the sessions (See additional tools p. 110112).
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Additional Tools
Scaling Emotion Symbols
Sad Scale
1
6
2
3
7
8
4
5
9
109
10
Mad Scale
1
2
6
3
7
4
8
5
9
110
10
Anxiety Scale
1
2
6
3
7
4
8
9
111
5
10
Interventions Utilized
The following interventions and terms are central techniques within SFAT.
Therapeutic Alliance. Malchiodi (2003), Selekman (1997), and Walter and Peller (1992)
stressed the importance of forming a therapeutic alliance between the therapist and the client.
Motivating and empowering client with appropriate AT and SFAT interventions has been shown
to be a factor for success in therapy (Hoagwood, 2005; Malchiodi; Selekman). The following
interventions, which may be applied within SFAT, have the above factors in common.
The scribble technique. Malchiodi (2003) explored the scribble technique as instructing
the client to draw a series of scribbled lines on a paper followed by looking for shapes, figures,
images, or objects that can be further expanded by detail of colour and drawing. Through
exploration of the drawing by the therapist and client a free association of information takes
place (Malchiodi).
Malchiodi (2003) stated the scribble technique provides opportunities for free association
by providing images with which a client can see and associate, completing an additional
drawing, and verbally discussing thoughts, feelings, and experiences through images created.
Malchiodi explained that this technique may be directive or follow the client’s lead and used to
explore the problem, help the client relax and have fun, and form a client and therapist
relationship.
The squiggle game. Malchiodi (2003) described the squiggle game, a free association
technique, and a variation of the scribble technique developed by Winnicott in 1971, as a tool
that helped and encouraged children with creative expression. The therapist and client play
together by taking turns making squiggles and the child describes what is seen (Malchiodi).
Malchiodi found that this technique helps the child relax and have fun in therapy.
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The scribble chase. Lusebrink (1990) developed the scribble chase technique and applied
it with adults and children to engage free expression (Malchiodi, 2003). The client chooses a
crayon and the therapist selects a different coloured crayon and leads or follows the client’s
crayon all over the page (Malchiodi). The client is asked to look for shapes or images and to add
details to the scribbles as an inspiration for more art expression, a means to help the client relax
with the art process, and a way to form a therapeutic relationship as valued by AT and SFBT
(Malchiodi).
Exceptions. SFBT therapists utilize exceptions as an intervention to map out solutions to a
problem by using the client’s own unique resources and ways of solving problems (Matto et al.,
2003). Matto et al. found that exceptions reduce the intensity of the client’s problem for the
purpose of reducing the likelihood that the client will be as overwhelmed. The authors noted that,
clients’ use of their own resources helps empower them. Similarly to SFBT, an AT therapist may
direct the client to create a spontaneous creative expression which in itself may lead to new ideas
and influence the creation of solutions (Malchiodi, 2003). The therapist assists with the framing
of exceptions through questions, being witness to the unfolding process, helps clients notice their
images within the art, and engage and facilitate the change process (Malchiodi; Matto et al.;
Riley, 1999; Selekman, 1997; Walter & Peller, 1992).
Scaling. A numerical assessment technique called scaling is a 1 to 10 value that can be
incorporated at the beginning, middle or end of therapy to clarify directional
improvements or success levels and to assist progress through feedback ratings about desired
states, behaviours, and goals that are feasible and expected (Matto et al., 2003; Selekman, 1997;
Walter & Peller, 1992). Children, some teens, and even some adults have difficulty
understanding the concept of scaling when numbers are employed. Therefore a pictorial facial
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expression chart can be an alternative. A smiling face represents 10 indicating a positive, happy
client, and at the opposite end of the continuum, a distressed face is a 1 which indicates the client
is not happy at all.
The miracle question. Another intervention created for SFBT, the miracle question,
orients clients towards change. Malchiodi, 2003; Matto et al., 2003; Riley, 1999; Selekman,
1997; Walter & Peller, 1992). Hypothetical AT examples include asking an adult to draw a
miracle of change picture or suggesting that a child or teen imagine a safe space moment, which
can then be drawn. The art can then be discussed, exploring ideas from observations made, and
positive solutions where indicated.
The metaphor. Malchiodi (2003) described the metaphor intervention as an analog
through which a client and therapist can communicate in a powerful, direct, and non-threatening
way. Metaphors are used in both AT and SFBT to externalize the problem and helps clients
integrate new behaviours into their life when they are ready (Malchiodi; Riley, 1999;
Selekman, 1997). Riley suggested that a metaphor is “an aid to elaborating and making
sense of a narrative” (p. 43) and adds meanings of the metaphor itself. An assignment might be
to draw the problem. The image of the problem is explored for what it is, how it relates to the
client, how long it has been a problem, habitual aspects, or how the client perceives the
problem as part of life, different perspectives, and demystification of the problem.
Art Media. A large assortment of art materials referred to as art media, are beneficial
in helping clients have choices with which to stimulate creativity and express emotions
(Malchiodi, 2003, 2007; Moon, 2002). Art media are utilized by the art therapist as a form of
intervention (Malchiodi, 2007).
Helen Landgarten (1981, 1987) defined art media in a classification range
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of more controlled to least controlled as explored by Malchiodi (2007). Landgarten
explained that lead and coloured pencils, as well as crayons, are more controlled because
they are more resistive and promote more detail and precision, where as on the other side of the
scale (least controlled) includes wet materials such as oil, acrylics, watercolour paints, and wet
clay. Wet materials are more tactile and stimulate feelings more readily (Malchiodi).
Malchiodi (2007) confirmed that clients should always have their own choice of
materials because their experiences will be different with each type of medium and having a
choice of medium empowers them. The therapist can use art media to stimulate or control
emotional expression when appropriate (e.g. with clay and paint) (Malchiodi).
Art process. The process of art therapy is arts-based and experiential. As clients draw,
paint, sculpt, write, or collage, the clients participate in their own treatment (Malchiodi, 2007).
Artmaking is a treatment of choice when there is value in a process that is ongoing and that
gathers more meaning the day it is created and over time (Malchiodi). The client may interpret
the art when ready to do so, which empowers the client (Malchiodi; Riley, 1999). The art
produced becomes an interactive process, potentially ongoing and unfolding, but the client may
want to tell a narrative, write a poem, or even simply title the work (Malchiodi).
The universality in art touches clients emotionally and leads to cultural exploration
(Allen, 1995, 2005; Malchiodi, 2007). Artmaking was described by Allen as having the potential
to be interpreted spiritually. The author discussed the exploration of spirituality through the arts
as an additional option for clients. Solutions can evolve for mind, body, and spirit from the
clients’ views of their own art.
The product. The product that is created within the artmaking process of art therapy is a
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container for the emotions, events, and the actions of the situation (Malchiodi, 2003, 2007; Matto
et al., 2003; Riley, 1999). The authors described the container materializing in the form of a
symbol, or metaphor. The client works through the problem in the art, partially because art
affords a safe way for people with communication challenges. For example, children who may
not have the words to describe feelings or thoughts about what happened, and for teens who
sometimes reject adult ways of expressing.
Complimenting. Therapist motivate clients by encouraging them to continue
the change process with compliments. Small changes can be noted and the client praised for
accomplishing them. With therapists continually noticing and praising clients for the
work they are doing, clients are motivated to continue working and the working alliance
develops between the client and therapist.
Coping strategies. When clients are in the change process, emotions may be bothersome
as various issues come up and are gradually worked on. There may be times that clients want to
take the more familiar pathway and stop therapy that becomes painful. Establishing some coping
strategies during these times helps clients and keeps the change process going. Clients should be
asked for their own ideas of coping strategies they may already use and therapists should pay
attention to comments by the clients during therapy suggesting coping ideas. These are more
likely the ones the client wants to use, as they are their own ideas, and finding their own
solutions becomes empowering. Therapists may suggest other various coping methods for the
client to choose from, such as doing art work, journaling, listening to music, writing poetry,
undertaking other creative modalities, exercise, hobbies, talking by phone or in person to friends
or other supportive people, attending church, reading self-help books, having a warm luxurious
bath with bubbles and candles, treating the self to flowers, walking, attending support groups,
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and calling a crisis line such as The Support Network at 780-482-4357.
Client supports. A person who assists clients with empathetic listening and concern for
their well-being, is an effective support person. The support person can be a friend, family
member, co-worker, neighbour, person from church, pastor, a person at a club or social event, or
a person from a support group.
Homework or tasks. Homework or tasks that are assigned by therapists in agreement
with clients reduce the number of sessions in therapy that clients need because it speeds up the
change process (Turnell & Edward, 1993). Homework allows clients an opportunity to try out
new skills and gives them evidence of the change process. Clients report that the tasks being
used are effective for achieving the goals that were set, and this gives therapists evidence of
effectiveness. Conversely, the goals may need to be changed or adjusted.
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References
Allen, P. (1995). Art is a way of knowing: A guide to self-knowledge and spiritual
fulfillment through creativity. Boston: Shambhala.
Allen, P. (2005). Art is a spiritual path: Engaging the sacred through the practice of art and
writing. Boston: Shambhala.
Betensky, M.G. (1995). What do you see?: Phenomenology of therapeutic art expression.
London: Jessica Kingsley.
Haire, I. (2009). SFAT manual for adults, adolescents, and children. Athabasca, AB:
Campus Alberta Applied Psychology Counselling.
Hoagwood, K. E. (2005). Family-based services in children’s mental health: A research
review and synthesis. Journal of Child Psychology and Psychiatry, 46(7),
690-713.
Iveson, C. (2002). Solution-focused brief therapy. Advances in Psychiatric Treatments, 8(2), 149157.
Langarten, H. B. (1981). Clinical art therapy: A comprehensive guide. New York:
Routledge.
Langarten, H. B. (1987). Family art psychotherapy. New York: Brunner/Mazel.
Malchiodi, C. A. (2003). Handbook of art therapy. New York: Guilford.
Malchiodi, C.A. (2007). The art therapy sourcebook (2nd ed.). New York: McGrawHill.
Matto, H., Corcoran, J., & Fassler, A. (2003). Integrating solution-focused and art
therapies for substance abuse treatment: Guidelines for practice. The Arts in
Psychotherapy, 30(5), 265-272.
118
Moon, C. H. (2002). Studio art therapy: Cultivating the artist identity in the art therapist.
Philadelphia: Kingsley
Riley, S. (1999). Contemporary art therapy with adolescents. London: Kingsley.
Selekman, M.D. (1997). Solution-focused therapy with children: Harnessing family
strengths for systemic change. New York: The Guilford Press.
Turnell, A. & Edward, S. (1993). Introduction to solution focused brief therapy.
Epping, NSW: Centre Care Brief Therapy Service.
Walter, J. L., & Peller, J. E. (1992). Becoming solution-focused in brief therapy. New
York:Brunner.
119
CHAPTER V
Synthesis and Implications
New brief therapy models are needed (Fleming & Rickord, 1997; Leeuwenburgh, 2000;
Malchiodi, 2003, 2007, 2008). Manuals can help therapists know how to manage a new model
and to obtain the new ideas, rationale, and organization of applied material. The SFAT model
creates comfort for clients who deal with family death and illness. It provides a workable model
for those who need to express emotions, or have cultural differences, or have language barriers.
The model offers hope for an efficacious and cost-effective brief therapy approach where there
are limited funds (Fleming & Rickord). Another reason for considering this model is the ability
to decrease the number of therapy sessions, especially when very challenging behaviours need to
be resolved in a timely fashion (Malchiodi; Riley, 1999), trauma (Siegel, 2007a), when helping
adolescents who want counselling to be quick and effective (Riley), when there is a shortage of
counsellors, such as in rural areas and when short interventions may be all that is possible
(Barrows, 2008). It may also provide credibility with workable solutions which mental health
providers are currently seeking (Fleming & Rickord; Williams, 2000).
SFAT can be a useful model for clients with trauma because it allows conscious,
unconscious and implicit memory to be accessed (Lusebrink, 2004; Siegel, 2001,2007a;
Todres, 2007). Expression of emotions can take place in art expression and be verbalized
when the client is ready. As discussed earlier, Siegel (2007a) and Todres (2007), researched
about levels of consciousness and showed the benefits of three ways of knowing: conscious,
implicit memory, and unconscious images. Art therapy is one approach that can help clients
process traumatic emotions through the making of art images, and then, facilitate the verbal
understanding of these images and feelings and finding new solutions (Malchiodi, 2003).
120
When using SFAT, there are the advantages: 1) making concrete illustrations of problems
and possible solutions within the art work, and 2) conducting an organized therapeutic method
(Riley, 1999). This therapeutic structure becomes particularly advantageous when a review of all
of the client’s work is periodically made in order to gather even more longitudinal information
for the client, such as transformations, and patterns that are demonstrated from the artwork
(Riley). This additional information may help clients integrate understandings, and integrate
images, into verbal understandings, informed by the art to facilitate change (Matto et al., 2003).
SFAT could be researched by using KFD as explored by Graf (1986) to facilitate
understanding for cultural groups with English as a second language, people with developmental
concerns, or those who are feeling sensitive about discussing their problems. The KFD allows
conscious, implicit, and unconscious memories to appear in the art because instructions for
drawing are minimal (e.g. draw the family in some activity). The assignment serves as an
icebreaker for problem talk and helps the therapist gain some knowledge of the family dynamics
such as; emotional closeness, interdependence, dependence, and sibling rivalry. The KFD
intervention combined with SFAT is one research method that would utilize an assessment
intervention that has been studied (DeGraw, 2002). Larger groups would substantiate reliability
and validity.
SFAT is a therapy that focuses upon a positive human orientation and promotes
empowerment for the client. This philosophy parallels my humanistic ideas about people and
about how I want to practice counselling with clients in my therapeutic space. An
empowered client is more likely to be a motivated client for ongoing change and personal
development (Malchiodi, 2003; Moon, 2002).
121
Some evidence exists for the therapeutic efficacy of SFBT (Gruninger, 2004; Kim, 2008)
and AT (Al-Krenawski & Slater, 2007; Dreissnack, 2006; Graf, 1986; Kozlowska & Hanney,
2002; Lev-Wiesel and Liraz, 2007; Nainis, 2006). Studies, with statistical analyses on large
groups of clients are lacking in most AT studies. AT efficacy can not be generalized to the client
population at large until larger numbers of clients are researched. Statistics need to be applied
with control groups for confidence of reliability and credibility. When this criterion is met, the
therapy model becomes evidence based and is more likely to be funded and accepted for use by
therapists, mental health agencies, counselling agencies, schools and insurance payers.
Currently, AT is used by some agencies, schools, and therapists because of the acceptance
of this therapy by children, adolescents, and adults and the evidence of change observed with
these groups of clients. Others may not adapt AT because more research has been done that is
evidence-based in areas such as cognitive behavioural therapy. Other therapists and agencies
utilize AT with some caution, while others are skeptical, and refuse to consider it. However,
some clients regardless of age are not able or willing to engage in verbal therapy and having
scientific evidence of efficacy for verbal approaches does them no good when they refuse to use
it and stop after one or two sessions. Having research to substantiate AT as an evidence-based
therapy would be useful and helpful for clients, who need a different approach from verbal
therapy.
AT is employed as a modality of choice in some situations with success when other
therapies are not successful, such as with deaf clients, clients with Alzheimer’s disorder, and
adolescents who refuse to speak. Generally more research is needed for AT specifically for
clarity about what is changed and the degree and quality of change.
122
A few studies of SFBT have met the criteria for evidence-based therapy, but other
research fails to meet all the criteria required for evidence-based therapies. Kim (2008) in a
meta-analysis showed evidence of efficacy with various age groups in counselling with
internalized behaviours such as depression, anxiety, self-concept and result in better self-esteem.
The positive effects on internalized states appear to make clients happier and have better selfesteem, however, the outcome of school performance is not necessarily positively affected
(Kim). Kim suggested more research is required to replicate these outcome effects.
In books, case studies, and journal articles, psychotherapists report successful outcomes
with the use of AT and SFBT for a variety of problems that exists in our society (Allen, 1995;
Berg & Dolan, 2005; Berger, 1980; Betensky, 1995, 2001; Camic, 2008; Case, 2006; Clements,
1996; de Shazer & Berg, 1997; Evans, 1999; Ferrara, 2004; Franklin et al., 2008; Gruninger,
2004; Henley, 1998; Iveson, 2002; Kim, 2008; Kozlowski & Hanney, 2001, 2002;
Leeuwenburgh, 2000; Malchiodi, 1998, 2003, 2005, 2007, 2008; Matto et al., 2003; Murphy,
1994; Nims, 2007; Proulx, 2002; Quick & Gizzo, 2007; Raskin, 1999; Reisler, 1987; Riley,
1999; Selekman, 1997; St Thomas & Johnson, 2007; Stein-Safran, 2002; Stobie et al., 2005;
Todres, 2007; Van Lith, 2008; Waller, 2006; Walter & Peller,1992; Wellington-O’Neill, 1989;
Wheeler, 2001; Williams, 2000; Yule, 2002). SFAT has been demonstrated with adults having
addiction problems, children in schools, and adolescents in schools and agencies. Generally,
evidence of efficacy is scarce partially because research is expensive and time-consuming.
Research-based doctoral programs are needed in AT. Meanwhile, therapists proceed to help
clients based on what is now known.
Therapists can derive various therapeutic concepts from an assortment of therapies to
create an individual therapy program. Such a methodological approach is a valid and specifically
123
suited for unique clients, especially when applied sensitively and appropriately to the context of
the client. Art therapy can be integrated within many psychotherapeutic approaches: 1) Gestalt,
2) Jungian, 3) psychoanalytic, 4) feminist, 5) solution-focused-brief therapy, 6) cognitive, 7)
behavioural, 8) humanist, 9) family, 10) phenomenology, 11) multicultural counselling, and 12)
other expressive arts (Corey, 2005; Malchiodi, 2003, 2005). Malchiodi stated: “a multimodal, art
therapy approach to treatment offers creative modalities through which individuals can express
thoughts and feelings, communicate nonverbally, achieve insight, and experience the curative
potential of the creative process” (p. 117). Many therapists currently utilize integrative or
multimodal therapies for specific benefits for clients (Lusebrink, 1990; Malchiodi, 2003, 2005;
Moon).
Future uses of the manual in research, as well as studies of the manual itself, are outside the
scope of this paper. By offering guidelines and structuring, the manual could facilitate the
replication of approaches and lead to evidence-based research studies of SFAT. An SFAT
manual with an SFBT structure and AT could facilitate the consistency that is required and might
aid research. Evidence-based research is vital in demonstrating that SFAT as indicated in the
manual can be employed with clients in various age ranges.
124
References
Al-Krenawski, A. & Slater, N. (2007). Bedouin-Arab children use visual arts as a
response to the destruction of their homes in unrecognized villages. Journal of
Humanistic Psychology, 47(3), 288-305.
Allen, P. (1995). Art is a way of knowing: A guide to self-knowledge and spiritual
fulfillment through creativity. Boston: Shambhala.
Allen, P. (2005). Art is a spiritual path: Engaging the sacred through the practice of art and
writing. Boston: Shambhala.
Arnheim, R. (1972). Toward a psychology of art. Los Angeles: California University Press.
Barrows, P. (2008). Brief work with under-fives: A psychoanalytic approach. Clinical
Child Psychology and Psychiatry, 4(2), 187-199.
Baumann, S. L. (1995). Two views of homeless children’s art: Psychoanalysis and Parse’s
human becoming theory. Nursing Science Quarterly, 8(2), 65-70.
Bedi, P. B., Davis, M.D., & Arvay,M.J. (2005). The client’s perspective on forming a
counselling alliance and implications for research on counsellor training. Canadian
Journal of Counselling/Revue Canadienne Counseling, 39(2), 71-85.
Berg, K. I., Dolan, Y. (2005). Working with multi-problem and challenging clients.
Toronto, ON: Brief Therapy Training Centres.
Berger, L. R. (1980). The Winnicott squiggle game: A vehicle for communicating with a
school- aged child. Pediatrics, 66(6), 921-924.
Betensky, M.G. (1995). What do you see?: Phenomenology of therapeutic art expression.
London: Jessica Kingsley.
125
Betensky, M. (2001). Phenomenological art therapy. In J. A. Rubin (Ed.), Approaches to
art therapy: Theories and techniques ( pp. 121-132), New York: BrunnerRoutledge.
Borden, E. S. (1979).The generalizability of the psychoanalytic concept of the working
alliance. Psychotherapy: Theory, research, and practice, 16(3), 252-260.
Brown-Standridge, M.D., Standridge, C. R., Poole, Y. M. (1993). The brief systems family
therapy process model: First results. Simulation, 61(5), 317-324.
Burkitt, E. Barrett, M. & Davis, A. (2007). Effects of different emotion terms on the size
and color of children’s drawings. International Journal of Art Therapy, 10(1), 1-11.
Camic, P. M. (2008). Playing in the mud health psychology, the arts, and creative
approaches to health care. Journal of Health Psychology, 13(2), 287-298
Cane, F. (1951). The artist in each of us. New York: Pantheon Books.
Case, C. (2006). Observations of children cutting up, cutting out, and pasting down.
International Journal of Art Therapy, 11(1), 42-52.
Castonguay, L. G. & Beutler, L. E. (2006). Principles of therapeutic change: A task
force on participants, relationships, and techniques factors. Journal of Clinical
Psychology, 62(6), 631–638.
Clements, K. (1996). Use of art therapy with abused children. Clinical Child Psychology
and Psychiatry,1(2), 181-198.
Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th Ed.). Belmont,
CA: Brooks/Cole.
Cowie, K. & Quinn, K. (1997). Brief family therapy in the schools: A new perspective on
the role of the rural school counseling professional. The Family Journal, 5(10), 57-68.
126
de Shazer, S., & Berg, I. K. (1997). What works? Remarks on research aspects of
solution- focused brief therapy. Journal of Family Therapy, 19(2), 121-124.
DeGraw, D. (2002). Using the kinetic drawing (K-F-D) to assess Bowenian dynamics in a
young adult population. (Doctoral dissertation, Seton Hall University, 2002).
Retrieved May 29, 2009 from http://domapp01.shu.edu/depts/uc/apps/
libraryrepository.nsf/resourceid/36B4E853A11FFB5585256E1A006CF
12D/$File/DeGraw- Dale Doctorate.pdf?Open
Dermer, S. B., Hemesath, C.W., & Russell C. S. (1998). A feminist critique of SF therapy.
American Journal of Family Therapy, 26(3) 239-249.
Dietrich, S. L. (2005). A look at friendships between preschool-aged children with and
without disabilities in two inclusive classrooms. Journal of Early Childhood
Research, 3(2), 193-215.
Driessnack, M. (2006).Draw and tell conversations with children about fear. Qualitative
Health Research, 16(10), 1414-1435.
Duncan, B. L., Miller, S. D. & Sparks, J. A. (2004). The heroic client: A revolutionary way
to improve effectiveness through client-directed, outcome-informed therapy. San
Francisco: Wiley & Sons.
Estrada, B. & Beyebach, M. (2007). Solution-focused therapy with depressed deaf
persons. Journal of Family Psychotherapy, 18(3), 45-63.
Evans, K. (1999). Art therapy with children on the autism spectrum: Beyond words.
London: Kingsley.
Ferrara, N. (2004). Healing through art. Montreal, QC: McGill-Queen’s University.
Fleming, J. S., & Rickord, B. (1997). Solution-focused brief therapy: One answer to
127
managed mental health care. The Family Journal, 5(4), 286-294.
Franklin, C., Moore, K., & Hapson, L. (2008). Effectiveness of solution-focused brief
therapy in a school setting. Children & Schools, 30(2), 15-26.
Garfield, S. L. (1998). Some comments on empirically supported treatments. Journal of
Consulting & Clinical Psychology, 66(1), 121-125.
Geiger, M. (1995). Phanomenologische Authetik. (Author trans. p. 136-158) Leipzig,
Germany: Original works1928.
Goldenberg, I. & Goldenberg, H. (2005). Family therapy. In R. J. Corsini & D. Wedding
(Eds.). Current psychotherapies (7th ed.) (pp. 372-404). Belmont, CA: Brooks/Cole.
Graf, M. H. (1986). The use of kinetic family drawing with Hispanic mothers in the
school setting. School Psychology International, 7(4), 217-223.
Gruninger, B. A. (2004). Solution-focused brief therapy: It’s uses, applications, and
efficacy. Athabasca, AB: Campus Alberta Applied Psychology Counselling.
Haire, I. (2009). SFAT manual for adults, adolescents, and children. Athabasca, AB:
Campus Alberta Applied Psychology Counselling.
Heidegger, M. (1962). Being and time. (English Trans) London: SCM Press. (Original
work published 1927).
Henley, D. (1998). Art therapy in a socialization program for children with attention deficit
hyperactivity disorder. American Journal of Art Therapy, 37(1), 1-6.
Hergenhahn, B. R. (1997). An introduction to the history of psychology (3rd Ed.) Pacific
Grove, CA: Brooks/Cole.
Hiebert, B. & Jerry, P. (2002). The working alliance concept. Retrieved May 3, 2006,
from http://www.abcounsellored.net/courseware/caap605/wadiagram/waimage
128
map.html
Hoagwood, K. E. (2005). Family-based services in children’s mental health: A research
review and synthesis. Journal of Child Psychology and Psychiatry, 46(7),
690-713.
Husserl, E. (1900). Logical investigations. Halle, Germany: Niemeyer.
Husserl, E. (1976). Ideas. New York: Humanities Press. (Original work published 1913).
Ireland, M.S. & Brekke, J. (1980). The mandala in group psychotherapy: Personal
identity and intimacy. The Arts in Psychotherapy, 7, 217-231.
Iveson, C. (2002). Solution-focused brief therapy. Advances in Psychiatric Treatments, 8(2),
149-157.
Joyce, A. S., Wolfaardt, U., Sribney, & Aylwin, A. S. (2006). Psychotherapy research at
the start of the 21st century: The persistence of the art versus science controversy.
Canadian Journal of Psychiatry, 51(13), 797-809.
Kandinsky, W. (1977). Concerning the spiritual in art. New York: Dover.
Kandinsky, W. (1979). Point and line to plane. New York: Dover.
Kahn, B. (1999). Art therapy with adolescents: Making it work for school counselors.
Professional School Counseling, 2(4), 291-299.
Kearns, D. (2004). Art therapy with a child experiencing sensory integration difficulty.
Art Therapy: Journal of the American Art Therapy Association, 21(2), 95-101.
Keijsers, G. P. J., Schaap, C. P. D. R., & Hoogduin, C. A. L. (2000). The impact of
interpersonal patient and therapist behavior on outcome in cognitive-behavior
therapy: A review of empirical studies, Behavior Modification, 24(2), 264-297.
Kim, J.K. (2008). Examining the effectiveness of solution-focused brief therapy: A meta129
analysis. Social Work Practice, 18(2), 107-116.
Kopytin, A. (2002). The silver drawing test of cognition and emotion: Standardization in
Russia. American Journal of Art Therapy, 40, 223-237.
Kozlowska, K. & Hanney, L. (2001). An art therapy group for children traumatized by
parental violence and separation. Clinical Child Psychiatry, 6(1), 49-78.
Kozlowska, K. & Hanney, L. (2002). Healing traumatized children: Creating illustrated
storybooks in family therapy. Family Process, 41(1), 37-65.
Kral, R. (1989). IDEAS: The Q.I.K. (QUICK INTERVIEW FOR KIDS):Psychodiagnostics
for teens and children- Brief therapy style. Brief Therapy Case Studies, 4(2), 61-65.
Krauss, R. (1930). Uber Graphischen Ansdruck (Concerning graphic expression).
Zeitschrift fur Angewandte Psycologie, 48, 1-141.
Krystal, J. Bremner, J.D., D’Souza, D.C., Anand, A. Southwick, S. M., & Charney, D.
(2000). The emerging neurobiology of dissociative states: Relevant to PSTD. In
A. Shalev, R. Yehuda, & A. C. McFarlane (Eds.), International handbook of
human response to trauma. (pp.307-320). New York: Kluwer Academic/Plenum
Pub.
Langarten, H. B. (1981). Clinical art therapy: A comprehensive guide. New York:
Routledge.
Langarten, H. B. (1987). Family art psychotherapy. New York: Brunner/Mazel.
LeCount, D. (2000). Working with difficult children from the inside out: Loss and
bereavement and how the creative arts can help. Pastoral Care, 18(2), 17-27.
Leeuwenburgh, E. E. (2000). Children, art, and home health care: The universal
language. Home Health Care Management Practice, 12(5), 40-45.
130
Lev-Wiesel, R., & Liraz, R. (2007). Drawings vs. narratives: Drawing as a tool to encourage
verbalization in children whose fathers are drug addicts. Clinical Child Psychology and
Psychiatry, 12(1), 65-76.
Lloyd, H. & Dallos, R. ( 2006). Solution-focused brief therapy with families who have a
child with intellectual disabilities: A description of the content of initial sessions
with the processes. Clinical Child Psychology and Psychiatry, 11(3), 367-386.
Lundholm, H. (1924). Affective tones of lines: Experimental researches. New York:
Columbia University.
Lusebrink, V.B. (1990). Imagery and visual expression in therapy. New York: Plenum.
Lusebrink, V. B. (2004). Art therapy and the brain: An attempt to understand the underlying
processes of art expression in therapy. Art Therapy: Journal of the American Art
Therapy Association, 21(3), 125-135
Maat, M. B. (1997). A group art therapy experience for immigrant adolescents. American
Journal of Art Therapy, 36(1), 11-21.
Malchiodi, C. A. (1998). Understanding children’s drawings. New York: Guilford.
Malchiodi, C.A. (2002). The soul’s palette. Boston: Shambhala.
Malchiodi, C. A. (2003). Handbook of art therapy. New York: Guilford.
Malchiodi, C. A. (2005). Art therapy. In C. A. Malchiodi (Ed.). Expressive therapies
(pp.16-45). New York: Guilford.
Malchiodi, C.A. (2007). The art therapy sourcebook (2nd ed.). New York: McGrawHill.
Malchiodi, C. A. (2008). Creative interventions with traumatized children. New York:
Guilford.
131
Matto, H., Corcoran, J., & Fassler, A. (2003). Integrating solution-focused and art
therapies for substance abuse treatment: Guidelines for practice. The Arts in
Psychotherapy, 30(5), 265-272.
McNiff, S. (1992). Art as medicine: Creating a therapy of the imagination. Boston:
Shambhala.
Microsoft Corporation.(n.d.). Microsoft Clip Art: Emotions. Retrieved June 29, 2009 from
http://office.microsoft.com/en-us/clipart/default.aspx
Moon, C. H. (2002). Studio art therapy: Cultivating the artist identity in the art therapist.
Philadelphia: Kingsley
Mooney, K. (2000). Focusing on solutions through art: A case study. The Australian and
New Zealand Family Therapy Journal, 21(1), 34-41.
Moore, R. W. (1983). Art therapy with substance abusers: A review of the literature. The
Arts in Psychotherapy, 10(4), 251-260.
Mulhauser, G. (2009). Evaluating therapeutic effectiveness in counselling and
Psychotherapy. Retrieved June 6, 2009 from http://counsellingresource.com/types/
effectiveness.html
Murphy, J. (1994). Brief therapy for school problems. School Psychology International, 15(2),
115-131.
Nainis, N. (2006). Art therapy can reduce pain and anxiety in cancer patients.
Journal of Pain and Symptom Management, 31(2), 162-169.
Naumburg, M. (1966). Dynamically oriented art therapy: Its principles and practice. New
York: Grune & Stratton.
Nims, D. R. (2007). Integrating play therapy techniques into solution-focused brief
132
therapy. International Journal of Play Therapy, 16(1), 54–68.
Pfander, A. (1976). Phenomenology of willing motivation. (H. Spiegelberg, Trans.),
New Haven, CT/London: Yale University Press. (Original works published 19001901).
Proulx, L. (2002). Strengthening emotional ties through parent-child dyads art therapy:
Interventions with infants and preschoolers. Philadelphia: Kingsley.
Quick, E. K., & Gizzo, D. P. (2007). The “doing what works” group: A quantitative and
qualitative analysis of solution-focused group therapy. Journal of Family
Psychotherapy, 18(3), 65-84.
Raskin, J.D. (1999). Metaphors and meaning: Constructing the creative psychotherapist.
Journal of Constructivist Psychology, 12(4), 331-347.
Reisler, W. (1987). Reviewing certain issues in brief therapy in the context of family art
therapy experience. Unpublished master’s thesis, Concordia University, Montreal,
Quebec, Canada.
Riley, S. (1999). Contemporary art therapy with adolescents. London: Kingsley.
Riley, S. & Malchiodi, C. A. (2003) Solution-focused and narrative approaches. In
C.A.Malchiodi (Ed.), Handbook of art therapy (pp. 82-92), New York: Guilford.
Robinder, P. B., Davis, M. D., & Arvay, M. J. (2005). The client’s perspective on
forming a counselling alliance and implications for research on counsellor
training. Canadian Journal of Counselling/Revue Canadienne Counseling, 39(2),
71-85.
Rhyne, J. (2001). The gestalt approach to experience, art and art therapy. American
Journal of Art Therapy, 40(1), 109-120.
133
Savins, C. (2002). Therapeutic work with children in pain. Paediatric Nursing, 14(5), 14-16.
Scheel, M. J. & Gonzalez, J. (2007). An investigation of a model of academic motivation
for school counselling. Professional School Counselling. Retrieved June 6, 2009
from http://findarticles.com/p/articles/mi_m0KOC/is_1_11/ai_n21093611/pg_8/?
tag=content;col1
Scheler, M.(1954). The nature of sympathy. (P. Heath, trans) New Haven, CT/London:Yale
University Press. (Original works published 1874-1928).
Selekman, M.D. (1997). Solution-focused therapy with children: Harnessing family
strengths for systemic change. New York: The Guilford Press.
Shilts, L., Rambo, A., & Hernandez, L. (1997). Clients helping therapists find solutions
to their problems. Contemporary Family Therapy, 19(1), 117-132.
Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind:
Attachment relationships, “mindsights”, and neural integration. Infant Mental
Health Journal, 22(1-2), 67-94.
Siegel, D. J. (2007a). Reflections on the mindful brain: A brief overview adapted from the
mindful brain: Reflections and attunement in the cultivation of well-being. Retrieved
February 12, 2009 from http://www.lifepanlearn.org/documents/Siegelarticle.pdf.
Siegel, D. J. (2007b). An interpersonal neurobiology approach to psychotherapy:
Awareness, mirror neurons, and neural plasticity in the development of wellbeing. Retrieved March 5, 2009 from http://www.jibc.ca/cfc/video/danSiegel.htm.
Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out. New York: Penguin.
St Thomas, B., & Johnson, P. (2007). Empowering children through art and expression:
Culturally sensitive ways of healing trauma and grief. London: Kingsley.
134
Stein Safran, D. (2002). Art therapy and AD/HD: Diagnostic and therapeutic
approaches. London: Kingsley.
Stobie, I., Boyle, J., & Woolfson, L. (2005). Solution-focused approaches in the practice of
UK educational psychologists: A study of the nature of their application and
evidence of their effectiveness. School Psychology International, 26(1), 5–28.
Todres, L. (2007). Embodied enquiry: Phenomenological touchstones for research,
psychotherapy and spirituality. Forum: Qualitative Social Research, 10(2), 1-4.
Turnell, A. & Edward, S. (1993). Introduction to solution focused brief therapy.
Epping, NSW: Centre Care Brief Therapy Service.
Ulman, E. (1965). A new use of art in psychiatric diagnosis. Bulletin of Art Therapy, 4(3),
91-116.
Van Lith, T. (2008). A phenomenological investigation of art therapy to assist transition to
a psychosocial residential setting. Art Therapy: Journal of the American Art
Therapy Association, 25 (1), 24-31.
Velmans, M. (2007). How experienced phenomena relate to things themselves: Kant,
Husserl, Hoche, and reflexive monism. Phenomenology Cognitive Science
6(3), 411- 423.
Virshup, E. (1975). Latency-group art therapy: Teaching socialization skills through art.
Child Welfare, 54(9), 624-644.
Waller, D. E. (1990). Group analysis and the art therapies1. Group Analysis, 23, 211-213.
Walter, J. L., & Peller, J. E. (1992). Becoming solution-focused in brief therapy. New
York:Brunner.
Waller, D. (2006). Art therapy for children: How it leads to change. Clinical Child
135
Psychology, 11(2), 271-282.
Watts, R. H., Cashwell, C. S., & Schweiger, W. K. (2004). Fostering intrinsic motivation in
children: A humanistic counseling process. Journal of Humanistic Counseling,
Education and Development, 3, 125-112.
Wellington-O’Neill, E. (1989). Art therapy with children with cancer. Journal of Pediatric
Oncology Nursing, 6(2), 36-38.
Wheeler, J. (2001). A helping hand: Solution-focused brief therapy and child and
adolescent mental health. Clinical Child Psychology and Psychiatry, 6(2), 293-306.
Williams, G. R. (2000). The application of solution-focused brief therapy in a public school
setting. Clinical Child Psychology and Psychiatry, 8(1), 76-78.
Winship, G. & Haigh, R. (1998). The formation of objects in the group matrix:
Reflections on creative therapy with clay. Group Analysis, 31(1), 71-81.
Yalom, I. (2002).The gift of therapy. Retrieved October 26, 2009,
http://www.yalom.com/gift/intro.
Yule, W. (2002). Alleviating the effects of war and displacement on children.
Traumatology, 8(3), 160-180.
136