Art Therapy

by Dympna Bonfield

Freud recognized early on that many of his patients’ most important communications were descriptions of visual images. He even couched his instructions in visual terms, asking the patient to ‘act as though you were a traveler sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside’. He discovered the importance of dream images. In 1916 he wrote the passage frequently quoted by Margaret Naumberg, ‘We experience it [a dream] predominantly in visual images…. Part of the difficulty of giving an account of dreams is due to our having to translate these images into words. ‘I could draw it’, a dreamer says to us, ‘but I don’t know how to say it’ ’. Freud reported a drawing by his famous patient, Little Hans, the fist case of child analysis. It is well accepted that drawing is part of child analysis.

The integration of Freudian insights about unconscious communication through imagery and the use of art in therapy was brought about largely through the efforts of Margaret Naumberg. She founded a school at Walden in 1914 that was based on psychoanalytic principles, and emphasized the arts. Making the unconscious conscious was seen then as a primary therapeutic goal; the release of unconscious imagery was therefore central in her approach. She herself had undergone analysis, working with both Jungian and Freudian analysts.

Naumberg saw releasing the repressed (unconscious) through imagery as curative in a cathartic as well as in a communicative sense. “Naumberg took the psychoanalytic patient off the couch and stood him in front of the easel” (Ulman 1986). The consequences of her doing so were far reaching. In Naumberg’s own words, art therapy, as she practiced it, based its methods on releasing [the unconscious by means of] spontaneous art expression. It has its roots in the transference relation between patient and therapist, and on the encouragement of free association. It is therefore closely allied to psychoanalytic therapy, (Naumberg 1958: 516). … Treatment depends on a continuous effort to obtain the patients’ own interpretation of his or her symbolic designs. The images produced are a form of communication between patient and therapist; [they] constitute symbolic speech”. (Naumberg 1958).

Even though Naumberg heavily subscribed to Freud’s ideas on transference, she did not place the same emphasis on it as he did. For Freud, the therapy was the analysis of the transference the took place during the session. Naumberg noted that the transference relationship in Art Therapy is considerably modified. (Naumberg 1966: 8). For her the attachment the patient developed to the artwork itself, was of great therapeutic benefit. This she refers to as the Narcissistic Cathexis (p.3).

The patient is gradually assisted to recognize that his own artistic productions can be treated as a mirror in which he can begin to find his own motives revealed. The autonomy of the patient is encouraged by his growing ability to contribute to the verbal interpretations of his art productions, whereas he originally depends on the therapist, he gradually substitutes a narcissistic cathexis to his own art to his previous dependence on the therapist.

The therapist encourages the client’s autonomy by withholding interpretations so that the patient begins to discover what the symbolic pictures mean to him. The making of art empowers the patient and there is less dependency on the therapist.

Naumberg cited the advantages of introducing painting and clay modeling in psychoanalytically orientated psychotherapy. It permits the direct experiences that occur as pictures rather than words. Picture projection of unconscious material escape censorship more easily than do verbal expression, so that therapeutic process is speeded up. The productions are durable and unchanging, their content cannot be erased by forgetting and their authorship is hard to deny. The resolution of transference is made easier. The autonomy of the patient is encouraged by his growing ability to contribute to the interpretation of his own creations.

Although Naumberg was not unique in her use of art for either diagnostic or therapeutic purposes, she was one of the few who stressed  its role as a primary agent, rather than an auxiliary tool. She called her approach dynamically orientated art therapy which meant one based primarily on Freudian understandings of psychological dynamics. She tried to stimulate free association and saw the patient’s art as a form of symbolic speech. She remained within the communicative framework of a more verbal model.

Margaret Naumberg’s work could be called an insight-oriented approach using art as a medium. Judith Rubens made the following statement in her book, Approaches to Art Therapy (p.21),

The psychoanalytical approach to Art Therapy in the hands of trained clinician  offer an extremely rich vehicle for change with many patients. My own conviction, by the way, shared by most practitioners trained in Freudian tradition, is that classical psychoanalysis is neither appropriate nor necessary for most, but that the theory which informs it is useful in understanding and guiding all therapeutic work.

Edith Kramer’s basic ideas have much in common with Naumberg but throughout her writings she finds in art itself the explanations of the Art Therapist’s special contribution to psychotherapy. She did not work with Transference. She suggested that the Art Therapist should focus on promoting the ‘therapeutic alliance’. She defines this as the conscious aspect of the relationship between Therapist and Client. It is her view that the prototype of the therapeutic alliance is the area of relaxed tension between the mother and child essential for healthy development. Winnicott described it as a neutral space protected by the mother’s quiet availability, where the small child can experience impulses and fantasies without being overwhelmed by them, (Kramer 1979: 191). The Art Therapist evokes the prototype good mother of the young child who provides the rich environment. She is present to ensure safety, allow as much risk-taking as possible. The Art Therapist is present to provide the necessary tools, methods and expertise to the client while helping to promote the clients own autonomy. By gently directing the client to the art as container, the Art Therapist declines the power that through transference a client might invest in the therapist. Then through the creative process, the therapist would ease the client on to  verbal discussion leading to insight. The client would relate (a) to the Therapist (b) to the artwork, or more correctly, the client would relate to self via the artwork. The art process would be the primary concern while creating triangular relationship. Emphasis would be on the process throughout and not on the content of the artwork. While the client would be involved in the picture/ image making, a temporary loss of self would incur, and fusion with the picture would take place. This would be similar to the earlier fusion with the mother experience, bringing about a temporary release from the ego. The process itself would provide a unique version containment where symbols and images would be expressed.

When transferential material is expressed in drawing, it is rarely simple and straightforward. In one image a client may condense a lifetime of experiences, all  of which represent variations on a central experience related to some aspect of an early relationship. Here the client and therapist can be trading in an intuitive unconscious realm. Mask-making, sculpture, the inside outside aspect of a box can be useful in the expression and working through of transferential feelings. The therapist at this stage should encourage the client to stay with the image rather than talk, as this unconscious material unfolds. To do otherwise might short-circuit the integrative aspects of the art experience, ie, the working through of transferential material, and while insight is helpful, it is not the sum total of therapy. All the time the client is engaged at a conscious level with the therapist, at an unconscious level in the art process.

It would appear that each of us have within us the capacity for what Jung calls ‘individuation’ of psychic growth. He saw this growth being made possible through the study of our dream images. Naumberg emphasized ‘Narcissistic Cathexis’ and saw the Art Process in the context of a holding relationship, being of primary importance in helping unconscious material to unfold. Freud’s idea was that we know how to interpret our own dream but that we don’t know that we know. All this suggests that when feelings and experiences are symbolized through images they become a much more powerful means of communication than verbalization alone. In her article ‘The Scapegoat and the Talisman: Transference in Art Therapy’ in ‘Images of Art Therapy’ (Dalley et al 1987) Joy Schaverein writes on the power of the Image. Here Naumberg’s and Kramer’s attitudes to transference are put together. She suggests that there are two distinct types of pictures made by people in Art Therapy. One type she describes as the diagramatic kind. In this the patient tells the therapist something which can only act as a useful guide. In itself it does not effect very much in terms of the inner world of the client. The image follows the spoken word in this type of picture. It can be equated with a sign, but the actual pictorial image is not sufficient in itself.

The second type she describes as the embodied image. Here the picture can become alive. This can happen when the client feels safe enough with the therapist. When the client has sufficient trust in the holding environment, she will allow the image to lead. Then by opening to the power of the image-making process, the images start to become affective. The recognition of this by the client brings about the possibility that subsequent images will be likely to be invested with more affect, and consequently they will become a powerful way of contacting the unconscious forces, and engaging with them. It can appear as if the picture-making process takes over. By the combination of inattention and conscious attention, a tension emerges creating a new kind of energy. This energy which has been part of the process, can be embodied in the picture. Such a picture can be imbued with life. It can be the product of the total absorption of its maker. This embodied image is rarely comfortable, containing as it does, the tension between the opposing forces which are temporarily reconciled ‘out there’ on the paper. This image can have reverberations in the emotional response, the unconscious of both artist and viewer. Schaverein goes on to say that for the production of these embodied images, it is the task of the Art Therapist to forma a relationship with the client, in which deep trust can develop and feelings become engaged. She says that it is only then that the pictures change, and that life emerges in the images. Images which may have been fused and locked in, appear outside on the paper. This can be concrete evidence to the client that he or she has these feeling that he or she cannot deny, which then become inescapable but separate. These kind of embodied pictures are likely to exhibit opposing elements, conflicts and emotions, which are repressed. These feelings, which may have been up to this point too painful and too difficult to face, become accessible, contained as they are ‘out there’ in the image within a frame, removes it from subjectivity to oneself. It can now be more objectively viewed. The frame marks off a reality inside, which is different from that which is outside.

I would now like to look at what Schaverein says about the potential of the image in interpreting itself. This ides that an image can interpret itself indicates a distinction between art therapy and psychoanalytic therapy and the very great potential of the image, ie, the embodied image. I would suggest that this is the potential the image has, over and above that of the spoken word. For the client in therapy who may not be able to relate to other people, to his or her therapist, or who is also perhaps unable to relate to himself or herself, the image-making process may play a fundamental part in enabling him or her to do so. To make something that can be seen can authenticate his or her experience and even his or her very existence. Experience, in the beginning, can be undifferentiated. Words and images can be fused. The differentiation between these modes of expression arises through a gradual process of separation, ie, development of consciousness. When the client in art therapy had just made a picture, it can happen that the maker can be fused with it, ie, in a state of fusion with the object. Space in this case must be allowed. To ask the client to give words for the content of the imagery at too early a stage may be to demand premature separation. If the therapist has confidence in the process, separation will occur in its own time and the words will eventually come, but now based in the client’s own motivation and from the client’s own need. A form of interpretation is then taking place in relation to the image being viewed, the phenomenon being bared, and this is a very private process between the artist and the image produced. There is a time in art therapy where words can be invasive and can interfere with the process of recognition and reconciliation, which is taking place between the artist and the image. Words potentially fix meaning and conceptualize experience. When the phenomenon is bared, when an image is newly exposed it needs space. The artist needs to get to know it before he or she can talk about it. He or she needs to find the words that fit. At this stage, the therapist must not demand explanations, as doing so at too early a stage can rob the client of his or her own process. The therapist must have confidence in the process and wait.

Imagery can exist on different levels of conscious awareness. These images can become manifest in dreams, fears, fantasies and imaginings. At times it may be difficult to contain such images and they may need an outlet. This outlet could take the form of acting out in socially unacceptable ways. The fear of experiencing oneself as bad may be so great that one attempts to stifle the imagery connected with these feelings- to keep them in the dark. The fear may be that, if allowed into the light of day, these images and actions associated with them, would overwhelm and threaten. If such images are kept within, unexpressed, they remain fused with the person. Unacknowledged, they could cause unpleasant symptoms like depression or angry outbursts or they may be projected on to others. If a picture is made, which reveals such imagery, the feeling is owned on some level of consciousness. The picture may be denied or destroyed, but even when this happens something has changed because the image has been brought out into the light. This image has been projected on to the paper or clay. The image has been transferred outwards, but unlike the transference on to the therapist in psychoanalytic therapy, where the transference in on to a person, the image in art making is transferred on to an inanimate object, ie, the paint or clay. It cannot be erased or attributed to anyone else. It has undeniably been make by the client. The image is thus owned. Instead of saying, ‘you are bad’ to the therapist, it reflects, ‘I am bad’ to its owner. This is the first stage in admitting the projected image and its associated feelings. The burden is not off-loaded on to another person. The picture is empowered with the image, the first stage of separation has taken place and the owner must take responsibility for it and accept ownership. This can be followed by deeper levels of knowing or acknowledgement within a process of familiarization. To see one’s picture is to know it better, and beginning to understand it can follow. The mere execution of pictures is not enough. It is necessary to have an intellectual and emotional understanding of them as well. “They must be consciously integrated, made intelligible and morally assimilated. We must subject them to the process of Interpretation”. (Jung Collected Works Vol. 16 1966)

One way of relating to images is through dialoguing with them. The idea of personifying our feelings and thought brings the imagination to bear on conflicts and problems. Personified images can visually be present through art works, and a sense of dialogue with the unconscious can begin. The ‘otherness’ which the image brings up, must be claimed as one’s own. It can be astonishing to discover hidden aspects of one’s own personality confronting one’s conscious ego. The dialogue that follows with those hidden aspects made visible or ‘other’ is important. No valid judgements should be made. If these images are seen as nothing more than a problem being portrayed, then the possibility of deeper, more complex meaning is lost. Imagery can carry several meanings at one time. The image should be regarded by the client and the therapist in a variety of ways, from different perspectives and in different contexts. The subtle overtones and nuances of the image should be responded to with non-judgmental acceptance. The image should be allowed its own authority without overwhelming the client with its message or without being striped of its power.

When the image-making process comes to an end, the images can be placed in a different position and looked at from a distant perspective. The image then becomes a more separated object, allowing the maker to stand back, to move away. This can be a new perspective. Seeing the ‘otherness’ can be a surprise. The image can become part of the outer world. it can inhabit the room, and exert its influence on whoever happens to be there. It is now a statement about a personification of what was formerly an inner experience. The therapist could ask the client for transitory first impressions, before more developed perceptions begin to take over. It can be viewed from other perspectives, viewed upside down or just regarded silently and meditatively. Other associations can be make by the patient. As a personified object, the image may demand a particular way of being in the world. Often the image possesses an element of vulnerability, in which case the assimilation needs to take place in a protected situation, where it will not be exposed to public viewing. Equally some images can be too powerful or too frightening for assimilation. In such cases the therapist will take some responsibility for the image that threatens to overwhelm, by putting it in a ‘safe place’. Again, the transference in this case is less strongly projected on to the therapist, because they are experienced more objectively through the artwork. Seeing the image as an extension of the personality or an independent entity is in keeping with Jung’s idea as the image having both past and future aspects. It can be limited to the past by actual events expressed in the image from the person’s life, and to the present and to the future by the archetype structure inherent in the situation. When these archetypal factors are allowed a sense of participation and dialogue, the material in personified form is acknowledged.

References

Buoy, A. (1988) A Consideration of Transference in Art Therapy American Journal of Art Therapy, Vol. 26.

Dalley, T. (1984) Art as Therapy. London: Tavistock.

Dalley, T (1984) Images of Art Therapy- New developments in Art Therapy. London: Tavistock.

Freud, S. (1978) Introductory lectures in Psychoanalysis Vol.1.  London: Penguin Books.

Freud, S. (1967) Case Histories. London: Penguin Books.

Jung, C.G. (1986) Analytical Psychology in Theory and Practice. London: Random House.

Kramer, E. (1971) Art Therapy with Children. New York: Shocken Books.

Naumberg, M. (1958) Dynamically Oriented Art Therapy. Magnolia Street Publishers.

Naumberg, M. (1973) An Introduction to Art Therapy. Teachers’ College Press.

Rubens, J. (1987) Aproaches to Art Therapy. New York: Brunner Routledge.

Storr, A. (1987) The Art of Psychotherapy. London: Butterworth Heinemann

Walbridge, D. (1981) Boundary and Space. Keruac.

Winnicott, D.W. (1988) Playing and Reality. London: Routledge.