Implementing the Expressive Therapies Continuum

A Guide for Clinical Practice

Sandra Graves-Alcorn, Christa Kagin

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317228578
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Implementing the Expressive Therapies Continuum aims to explore the use of the Expressive Therapies Continuum (ETC) in the form of specific expressive therapy initiatives intended to be used in both educational and professional settings. Drawing on materials co-developed by Dr. Sandra Graves-Alcorn, co-author and developer of the ETC, as well as tried and tested curriculum by Professor Christa Kagin, this interdisciplinary resource will be of great value to students, teachers, mental health clinicians, as well as other healthcare practitioners interested in utilizing the ETC developmental model. All of this is delivered in a clear and easy to follow presentation designed to engage readers.

Chapter 1

History and Formulation

Sandra (Kagin) Graves-Alcorn

In the year 1964, I began a sojourn that was to last the rest of my life and, with the writing of this book, hopefully beyond. I am also delighted that a second generation of Kagin art therapists has joined me in this endeavor. Christa Pickens was a graduate student of mine at the University of Louisville, where she met my son Stephen Kagin. She is now my daughter-in-law! I am proud that she also took the academic route and is associate professor and chair of the Art Department at Benedictine College in Atchison, Kansas. Christa and Stephen also gave me three wonderful grandchildren!

Brief History

We believe history is very important to critical thinking and creativity. It is essential to know what went before and what kind of thinking went into change.

This history is from my own experience as I remember it.

In 1964, while at the University of Tulsa completing my B.A. in Fine Arts, I was fortunate to be in a child psychology class taught by Dr. Robert Parrish. Early in the semester, Dr. Parrish mentioned the term “art therapy” and said there was an art therapist at the Children’s Memorial Center. I was so excited, as I had been wondering if art could be used in psychology and healing. After class, I told the professor that I wanted to study art therapy, and he set up an independent apprenticeship with Margaret Howard at the Children’s Memorial Center.

Marge was a feisty, enthusiastic, and funny woman in her 60s. She had been sent to New York to take classes in art therapy with Margaret Naumburg, the acknowledged American pioneer of our profession. In New York, she had met Elinor Ulman, Elsie Mueller, and Irene Jakab, all of whom later played a huge role in my professional life.

Marge worked at an in-patient hospital for children and adolescents who were diagnosed as severely emotionally disturbed or schizophrenic. Those were the days long before the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The youth were in long-term care that was psychodynamic in orientation. This was where I completed my apprenticeship with Marge and where I would begin the real first steps of my journey. I shall always be grateful to this lovely lady, who shared her information with me and led me to ask questions and develop my own answers, as well as reference many others in leading the trek across the professional and academic plains of art therapy.

Marge began by reading her notes from Naumburg’s class then allowed me to observe her working with a patient. She had a large art room, fully stocked with materials, and she saw both individuals and groups. After about a week, I was introduced to my first patient. The girl was just a bit younger than I and taught me a great lesson in manipulation and transference/countertransference. She was doing a painting when she informed me that she was running away and wanted me to promise not to tell. I could not have been more green and naïve! Fortunately, I disclosed this bit of information with Marge, who laughed and told me I had been “had”!

One of my favorite stories about Marge was that during World War II, she had earned a living painting nudes on cigarettes. I realized this was one creative woman who was way ahead of her time! Years later, as I reflect on that experience, I realize that the creativity of the therapist is so essential that it cannot be separated from the clinician; rather, it is part of the art therapist’s success.

At the end of the year, I graduated and set out to establish myself as an art therapist. In 1965, I was hired by the Hissom Memorial Center in Sand Springs, Oklahoma, as a social worker in the department of psychology, as there was no classification for an art therapist. I also started my master’s degree in special education and child psychology.

Hissom was a state facility for what was then called the mentally retarded, although many of the residents would have been diagnosed differently today. The “children” (some were adults, but we called them all children back then) were divided by IQ and level of adaptive functioning and lived in cottages together. There was also a large infirmary that housed individuals with severe hydrocephalus, phenylketonuria (PKU), brain damage, and other debilitating injuries and illnesses. At that time, they were called the “profoundly retarded.” This unit was very difficult for me to even walk into, and there was no art therapy in there. (It would be several years before the sensory operant stimulation [SOS] movement would arrive here and in other similar units.)

Children were brought to me in a room in the psychology department. They were called “the worst of the worst,” and I shall never forget them. My first published article was about a 9-year-old named Becky and entitled “Art Therapy with Atypical Retarded Children.” I presented this research at the founding meeting of the American Society of Psychopathology of Expression in Washington, DC. It was there that I met Irene Jakab and Elinor Ulman. Irene became a personal friend and mentor.

Elinor Ulman studied with Margaret Naumburg at New York University and became an artist-therapist at a hospital in Washington, DC. She was the first publisher and editor of Bulletin of Art in Psychotherapy, Education and Rehabilitation. Her “art as therapy” approach emphasized the intrinsic therapeutic potential in the art-making process and the central role the defense mechanism of sublimation plays in this experience. Ulman’s most outstanding contributions to the field have been as an editor and writer. She was also on the ad hoc committee that wrote the bylaws to develop the American Art Therapy Association. She founded Bulletin of Art Therapy in 1961 (American Journal of Art Therapy after 1970) when no other publication of its kind existed. Elinor was a woman way ahead of her time. In her youth, she interned with Frank Lloyd Wright. She fought hard to get this position then was relegated to the kitchen! In 1983, she nominated me as president of the American Art Therapy Association, telling me, “I believe you have the seasoned intelligence to do the job.” My last memory of Elinor was lovely. She and I, along with Robin Goodman (also a past president), had visited Elinor at her home in Vermont. It was just a few years prior to her death in 1991 and we were literally sitting on the dock of her “golden pond,” laughing with the sun on our backs.

These two powerful, pioneering women became not only my mentors but also my role models, and I remain grateful to this day for their encouragement.

The founding meeting of the American Society of Psychopathology of Expression in 1965 in Washington, DC, brought together some of the best-known psychiatrists and psychologists of the day. This organization preceded the American Art Therapy Association and was a stellar gathering of scholars and practitioners. It was held at the National Gallery of Art and hosted by Dr. Raymond Stites, noted author and expert on the sublimations of Leonardo da Vinci. I was to present my first professional paper at the American Association of the Psycho-pathology of Expression… and I was terrified! My presentation was terrible, but I was forgiven for my youth. Although I had written the thing out, I tried to talk extemporaneously. I will never forget Elinor Ulman coming up to me and saying, “No matter what you said I see tremendous potential in you!” (This paper was published in Psychiatry and Art, 1968 and entitled “Psychiatric Art Therapy with Atypical Retarded Children.”)

Having been taught the principles of psychodynamically oriented art therapy, which relies on the projection of unconscious material to gain insight, I quickly became lost in treating these children at Hissom, as insight was not a realistic goal due to their level of cognitive functioning. I began studying cognitive and developmental psychology and learned which art materials were appropriate for treatment of this population and which were not.

In 1967, I obtained the position of director of art and occupational therapy at Parsons State Hospital in Parsons, Kansas. This research facility was well-funded with grants studying adaptive behavior of the mentally retarded. I met and worked with Dr. Henry Leland. In fact, Henry introduced me to my first husband.

It began to occur to me that the appropriate “therapy” to use with the “mentally retarded” (and so too with any population) was directly related to the media, the project, and the structure of the sessions. Most sessions were done in large groups, covering all ranges of what was then called mental retardation from severe to borderline.

I had an incredible staff and budget. The team had our own building, with large studio space as well as private therapy rooms. My budget for just art supplies was more than $5,000! It is hard to imagine what this translates to in today’s market.

My colleagues were artists and very creative. We studied what seemed to “work” with the various groups and individuals. I was also completing my master’s degree at that time, so I applied what I had developed programmatically into fairly sophisticated variable definitions and statistics. The concept of Media Dimension Variables (MDV) was born.

Transition to Kentucky and Development of the American Art Therapy Association

Through my friend Bob Ault (later to be original president-elect of the American Art Therapy Association [AATA] and then president), I sought a contact in Kentucky, because at this time I was married, and my husband wanted to attend law school near his family, and this required a move. He told me that a Dr. Roger White had started an art therapy master’s degree at the University of Louisville. I did contact Dr. White, who told me that the program was defunct but still on the books and asked if I would like to start one (very different world in hiring back then)!

Simultaneously, several people had formed an ad hoc committee to develop a professional organization, and serendipity took over, as that founding meeting was scheduled at the University of Louisville in June of 1969, the same day I was interviewed to become a faculty member. The ad hoc committee consisted of Myra Levick, Bob Ault, Elinor Ulman, Don Jones, and Felice Cohen.

I have absolutely wonderful memories of these people, and if the purpose of this book were to delve deeply into the history of the American Art Therapy Association, founded that hot June day of 1969, it would be a volume of material. I will mention, however, that on that day, we passed and adopted the bylaws of the American Art Therapy Association. Myra Levick (Hahnemann College) was elected president and Bob Ault president-elect (Menninger Foundation). Don Jones (Harding Hospital) was secretary and Marge Howard (Children’s Medical Center) was treasurer. I was elected chair of education (highly qualified, since an hour earlier I had just been hired by the University of Louisville!), Ben Ploger (Louisiana) was standards chair, Elsie Mueller (Kansas) was parliamentarian, and Helen Land-garten (California) was public relations chair. All these individuals contributed greatly to the field of art therapy and are considered the professional pioneers and should be familiar to anyone who has studied in this field. At the date of this writing, only two of us are still alive, me and Myra Levick, the last of the original pioneers. That was also the day I discovered I was pregnant with my first child, who 28 years later met and married my coauthor!

Through the years, the concepts of Media Dimension Variables were further studied and refined. I joined the faculty of the University of Louisville in 1969 to revamp and resurrect a master’s degree in art therapy, which had begun in 1956, graduated two students, then lay dormant since 1957. I was able to develop a course of study that included my theoretical background and experiences and promoted the efficacy of both art as therapy and art psychotherapy. In fact, I saw this well-worn argument by other professionals as a continuum of interventions, allowing flexibility and including a wide range of populations who could benefit from art therapists’ services.

One of my hopes for this book is the realization that together as expressive arts therapists, we are stronger and have more influence to make a difference in health care.

In the early 1970s, I founded the Institute of Expressive Therapies with the intent to include music, dance, drama, and poetry in the curriculum of the master’s degree in expressive therapies. This was the beginning of art therapists observing the commonalities rather than the differences among the disciplines. It has long been my contention that the creative arts therapies together have a professional foundation that differentiates us from all other mental health professionals. The Expressive Therapies Summit, held each November in New York City, was founded by Barry Cohen during his role as executive director of Expressive Media, Inc. (Judy Rubin and Ellie Irwin formed this organization in the mid-1980s, and I was asked to join the executive board in 2011.) The success of this endeavor and its cutting-edge mission of integration of the healing arts may be what ultimately defines and saves our profession. At the writing of this book, there are few stand-alone masters’ programs in art therapy. Most have been subsumed into counseling curricula.

When my colleague Vija Lusebrink joined the faculty, we researched the interrelationship among the various expressive therapies, later to culminate in our published article “The Expressive Therapies Continuum” in 1978. We found a commonality first in developmental theory. The well-known work of Viktor Lowenfeld (1957) in the field of art education had been one of the foundations of MDV. Since the field of art therapy was fixing “deviating” behaviors, then what was the expected “normal” or expected and acceptable behavior in the arts arena? To recognize deviations, one must know the developmental norms. Although other researchers wrote about the development of children’s graphic expression, I was especially taken with Lowenfeld, as he fit with my other favorite developmentalist, Jean Piaget. When the stages were placed side by side, they beautifully explained each other.

References

Graves, S. (1968). Psychiatric art therapy with atypical retarded children. In Jakab, I. (Ed.), Psychiatry and Art: Proceedings of the IVth International Colloquium of Psychopathology of Expression, pp. 68–74. Basel, NY: Karger Press.

Lowenfeld, V. (1957). Creative and Mental Growth (3rd ed.). New York, NY: MacMillan.

Chapter 2

Media Dimension Variables

Sandra Graves-Alcorn

The concept of exploring variables in use of media was the subject of my master’s thesis. The following has been quoted in numerous articles, the latest being my chapter in the book Expressive Arts and Play Therapy with Children and Adolescents (Green and Drews, 2014).

Exploitation of media dimension variables, those qualities or properties inherent in a given medium and process which may be utilized in a therapeutic or educational situation to evaluate and/or elicit a desired response from an individual.

(Kagin, 1969)

The premises upon which the concept of media dimension variables (MDV) was developed are:

1. The reinforcement value of making “art” can be a therapeutic process;
2. All individuals can be creative to some degree;
3. Dimensions of art media are discernible and can be classified; and
4. Media dimensions can be therapeutically applied.

(Kagin, 1969)

The numerous definitions of creativity back then were focused on behavior change and later on information system retrieval to develop unique thoughts. In the early years of its professional development, art therapy focused on the projections of unconscious material, directed toward the goal of insight into inner conflicts. Little attention was given to the media by which these projections were promoted. I therefore began lookin...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Illustrations
• Acknowledgments
• Introduction
• CHAPTER 1 History and Formulation
• CHAPTER 2 Media Dimension Variables
• CHAPTER 3 Theoretical Structure
• CHAPTER 4 Kinesthetic-/Sensory-Focused Initiatives
• CHAPTER 5 Perceptual-/Affective-Focused Initiatives
• CHAPTER 6 Cognitive-/Symbolic-Focused Initiatives
• CHAPTER 7 Creativity and Its Role
• Appendix 1: Additional References
• Appendix 2: Resources
• Index