On Our Mind: Thoughts from Mark & Michelle Dean

Cultural Considerations of Eating Disorders through Art Therapy

by Michelle Dean 29-06-2015 | 5:03PDT | Comments (0)


This is an excerpt from the chapter: Dean, M. L. (2013). Cultural Considerations of Eating Disorders Through Art Therapy. (pp. 277-288). In Howie, Prasad and Kristel (Eds), Using Art Therapies with Diverse Populations: Crossing Cultures and Abilities, London and Philadelphia: Jessica Kingsley Publishers.

       Screen Shot 2015-06-29 at 7.11.43 PMWhile biological, genetic, and psychological factors contribute to the etiology of eating disorders, the influence of cultural beliefs and attitudes has long been appreciated as a significant factor to the continuum of disordered eating behaviors. Cultural beliefs and attitudes are meant to assist in societal structure and relationships within an identifiable group of people, and are passed down to future generations through messages about ideals and values; they may be seen in food rituals, as well as traditions, gender roles, body size, and beauty, as well as personal, spiritual, and ascetic values. They often are carried via images such as views of family life, holidays, illustrations of religious scenes, imagery of myths and fables, and popular culture as seen in art, on television, in movie theaters, and, more insidiously, through advertising campaigns. With the expeditious development of a global society and rapid social change, exposure to different cultures and beliefs brings a wake of potential clashes. These cultural fissures may create a disavowal of social customs and beliefs that, in many regards, are considered the glue that holds communities and societies together. The resulting loss of stability in a cultural foundation, a loss of purpose, a loss of meaning, and a loss of personal value that leads in turn to a heightened need for control may contribute to the emergence of eating disorder behaviors (Gordon et al. 2012; Katsounari 2009; Soh et al. 2007). Cultural instabilities and clashes are often not perceptible just as words may be understood differently, even for people of the same cultural background.

 In practice, working with the nuances and complexities of language as well as cultural issues are often overlooked in treatment. Amplifying meaning and understanding through a visual and symbolic process such as art therapy may be beneficial for illuminating individual and cultural meaning with all of its subtlety. For example, creating a graphic image such as a representation of one’s family as food and placing this depiction of a meal in a setting (Earley 1999a & 1999b) can provide opportunities to explore family dynamics, food preferences, as well as dialog regarding cultural beliefs as they pertain to food, family, and society. As an art therapist, I have assisted clients in utilizing their artwork to explore attitudes about food, including the messages about food imparted by family, food rituals related to personal and societal practice, as well as messages portrayed in the media which may polarize “good/bad” foods; thus the artwork provides a metaphorical canvas for understanding cultural beliefs and individual meaning.

The emergence of eating disorder symptoms and their meanings are constantly in flux as they are influenced by a plethora of factors, many of which still are not fully understood due to their complexity, symbolic meaning, and evolution. Eating disorder behaviors may be conceptualized as a “system of signs and symbols with multiple meanings” (Brumberg 2000, p.7). “Rates of these disorders appear to vary among different racial/ethnic and national groups, and they also change across time as culture evolves” (Miller and Pumariega 2001, p.93). Like the disorder itself, it is a shape-shifting expression of symbolic conflict and issues that take shape as a physical voice through the overindulgence, purging and/or restriction of food.

Saturn eating his childrenHesse-Biber et al. (2006) suggested shifting focus from a medical/psychological view to a sociocultural/economic perspective that examines messages that perpetuate derogatory values in gender roles as well as the mind/body dichotomy. While cultural attitudes may be seen in images portrayed in media that idealize thinness and other attributes, they are not the only sources of cultural information, neither are they a singular cause of disordered eating. It is thought that “[t]he experience and exposure to the difference between two cultures, rather than a particular culture itself, is also hypothesized to contribute to the aetiology [sic] of eating and body image disturbances” (Soh et al. 2006, p. 58), and that it is a “culture-change syndrome of communities modernizing” (Miller and Pumariega 2001, p. 103). Although the above authors were referring to immigrants or cultures whose community ideals have been influenced by another society’s cultural values, it would be the cause of an assimilation clash as is so often the case with Western capitalism or consumer–corporate culture and the individual’s original culture. It may not be the industrialization itself that is problematic, but rather an attitude of parasitic proportions that accompanies it. In other words, a “parasitic” cultural attitude latches onto the host culture (invaded by the new ideals) and is consumed by it or at least radically changed, altered, or ravished by the invading culture. Often working from the inside out, this most affects those with poor esteem, unstable cultural identities, and a host of other factors including trauma, childhood ruptures, and attachment issues. The external conflict of the differing cultures and internalization of the cultural conflict provide the pregnant constellation of factors necessary for the emergence of eating disorder symptoms.

From an ecopsychology viewpoint, as cultures become fragmented and communities are severed in order to seek economic development and opportunity, meaning and relational aspects to our environment, place, and culture are lost. Rudderless and vulnerable in these modern roles, women in particular are more prone to enact the conflict symbolically through the dismembered remnants of a central core of prior value: food for sustenance and well-being.

 Shinning lightAccording to Woodman (1980), “This one-sided consciousness can be corrected by focusing attention on a creative approach to the body loving-understanding of its mechanism” (p. 45). Likewise, “People who are in touch with the spontaneous archetypal creative/imaginative impulse are always in a state of creative ferment” (Taylor 1992, p. 113). Art and image making carry the dichotomy of cultural bias and conflicts simultaneously. Art images create distance while also providing opportunities for relatedness. Thus, this mirroring in the image becomes the individual’s response to a cultural attitude or pattern and can be related to and engaged in a therapeutic dialog (Woodman 1980; Dallett 2008). In art therapy, the image becomes the carrier of new meaning and offer opportunities for the reintegration of splits or voids that once were filled by actions of the eating disorder.

Want to learn more, join me at

The American Art therapy Associations’ 46th Annual Conference in Minneapolis, MN Friday, July 10 12:30 to 1:20 p.m. or purchase Using Art Therapies with Diverse Populations: Crossing Cultures and Abilities.


Brumberg, J. J. (2000) Fasting Girls: The History of Anorexia Nervosa. New York: Vintage Books.

Dallett, J. O. (2008) Listening to the Rhino: Violence and Healing in a Scientific Age. New York, NY: Aequiteas Book from Pleasure Boat Studio: A Literary Press.

Earley, M. L. (1999a) ‘Art therapy: Body image, media & art.’ The American Art Therapy Association Conference, Orlando, FL.

Earley, M. L. (1999b) ‘Art therapy with eating disordered clients.’ The Renfrew Center Conference, Philadelphia, PA.

Katsounari, I. (2009) ‘Self-esteem, depression and eating disordered attitude: A cross cultural comparison between Cypriot and British young women.’ European Eating Disorders Review 17, 455–461.

Miller, M. N. and Pumariega, A. J. (2001) ‘Culture and eating disorders: A historical and cross-cultural review.’ Psychiatry. 64, 2, 93–110.

Soh, N., Surgenor, L. J., Touyz, S. and Walter, G. (2007) ‘Eating disorders across two cultures: Does the expression of psychological control vary?’ Australian and New Zealand Journal of Psychiatry, 41, 357–358.

Taylor, J. (1992) Where People Fly and Water Runs Uphill: Using Dreams to Tap the Wisdom of the Unconscious. New York: Warner Books.

Woodman, M. (1980) The Owl was a Baker’s Daughter: Obesity, Anorexia Nervosa and the Repressed Feminine. Toronto: Inner City Books.

Michelle L. Dean, MA, ATR-BC, LPC, CGP is the cofounder of the Center for Psyche and the Arts, LLC. She is a board-certified art psychotherapist, licensed professional counselor, and certified group psychotherapist. In her clinical practice, she provides a warm and compassionate approach in which to explore and heal. She is also a clinical supervisor and an esteemed, nationally recognized educator and consultant. Her work has been recognized through many distinguished awards and several interviews in print, radio, and television.

© 2015; All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, DVATA HLM

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts and newsletters directly to your inbox. 



From the Amulet to the Monument: A Shared Material Spirit

by Michelle Dean 07-04-2015 | 11:37PDT | Comments (3)

Merit, wife of Egyptian official Maya, wearing ceremonial attire of temple singer and an amulet.

Merit, wife of Egyptian official Maya, wearing the ceremonial attire of temple singer and an amulet.

Three-dimensional artwork spans from amulet to monument and despite its scale, it has a similar essence, qualities of architecture and sculpture that share a material spirit. The amulet is a small portable charm worn as protection against evil or insurance of fertility and the monument, a structure permeated with spirit. It is believed that some of the earliest monuments were phallic shaped, columns, pillars, or obelisks, jutting toward the sky, linking heaven and earth. Originally the towers were intended as sculpture only but over time it became customary to make openings and hollow chambers within and deposit images of the divine, like a shell enclosing a seed (Read, 1977), a container for those things precious. Aspects of the monument are like the sarcophagus, “a flesh-consuming” stone deriving its name from arx meaning “flesh”, and phagein meaning “to eat”. Tombs, natural caves, grave mounds, stupas, hemispherical structures containing Buddhist relics, and pyramids often recorded the events of the deceased through murals or relief carvings on their interiors. Doorways into such structures serve as passageways, a transition into the interior while pediments, supported by pillars, turn our gaze upward toward the sky upon entering inside for contemplation. “As the art develops, in history or in sensuous experience of the individual, we may begin to associate with each shape an idea; we inhabit the shape with our spirit; and finally, if we are artists, we try to realize ideas as specific shapes, to create symbols for our indeterminate feelings-to become conscious, in the forms of art, of the dimensions of reality” (Read, 1977, p. 4 – 5). Through time, the temple and the tomb were merged and the spatial relationships transformed  – enlarging spaces to enter into like cathedrals, or scaling the divine into carried devotionals or transportable sacred spaces like alters and devotionals.

As Read points out in The Art of Sculpture (1977) more than nine-tenth of the sculpture found in museums is devoted to the human form. There is a convention between the human form and sculpture, unlike landscape or still life, which are typical subjects of painting. To sculpt a form a three-dimensional memory is necessary, one which visual perception alone does not provide. To clearly see a form in its entirety, memory coupled with sensation and imagination are required. These abilities, gradually acquired through a phylogenetic history, are laden with psychological and cultural attributes. The image we possess of ourselves is not one that is inherent at birth but instead constructed through growing awareness of our external and internal worlds. Immediate sensations both seen and felt, contribute to this image as well as the observation of others, cultural ideals, and external feedback. By conceiving an image of our body, can we place an idea of ourselves in the external world. This image is considered our body image. But our “vision is colored, as we say. It is distorted by memories, associations, and above all desires, and to a considerable extent we see what we want to see” (Read, 1977, p. 31). We look at others and see ourselves, a projection of our desires.

Narcissus by Hiolle

Ernest Eugene Hiolle (1834-1886) Narcissus. 1868. Marble

Like the Greek myth of Echo, a verbose nymph who has been cursed by Hera to repeat only the last words of others, and Narcissus, a handsome youth for whom Echo has fallen in love with while he was ensnaring a deer in the forest, the two, manifest aspects of a colored reality in which desire has grave effects. Narcissus calls out to inquire who is in the woods with him and is met by Echo’s mimicking response. Narcissus cruelly rejects her for she lacks the ability to express the substance of her true herself. Thus she retreats to a cave where she pines and withers away, leaving only her echoing voice for others to hear. Counterpoint justice is served by Nemesis who upon witnessing Narcissus’ cruelty curses him to fall in love with his reflection. While attempting to embrace the noncorporeality of his reflection he succumbs to the spring waters and dies, leaving in its place his namesake, the pale flower, narcissus. Both are lost as Echo, lacking a voice, is hindered; her inability to speak about who she is results in a lack of embodied as self, while Narcissus is unable to be desirous of anything other than himself. Echo and Narcissus carry the potentiality that we all possess to destroy ourselves when unable to speak or see the reflected gaze of another while compulsively pursuing desire.

Screen Shot 2015-04-07 at 11.58.31 AMThe flipside of a negative outcome to desire is the creation story of the artist Pygmalion who falls in love with one of his sculptures. He asked the Goddess Aphrodite to give her life. His wish was granted and upon marrying her named her Galatea. In some legends, Galatea was Aphrodite, goddess of love and procreation. Pygmalion is an excellent example how artwork, like the amulet and monument, become imbued with the love, or spirit, of the artist. These stories have captured the imagination for centuries and as can be seen in more modern adaptions such as in My Fair Lady and Pinocchio giving physical form to a mental projection of one’s desire and self. Utilizing three-dimensional work in therapy possesses the same enlivening processes, which are discussed further in my forthcoming text and future blog posts. Please share your thoughts in the comment section below.


Read, H. (1977). The Art of Sculpture. Bollingen Series XXXV. 3: Princeton University Press.

© 2015; All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, DVATA HLM

Using Art Media in PsychotherapyFor more information, see Using Art Media in Psychotherapy, Bringing Creativity to Practice.

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts and newsletters directly to your inbox. 



IAEDP 5th Annual Imagine Me Art Competition: A judge’s perspective

by Michelle Dean 07-02-2015 | 7:07PST | Comments (3)

Rising from the Ashes Rogers Memorial Hospital

Rising from the Ashes Submitted by Rogers Memorial Hospital

I am delighted to be a part of and share my experience about this year’s competition International Association of Eating Disorders Professionals (IAEDP) 5th Annual Imagine Me Beyond What You See Body Image Mannequin Art Competition and Eating Disorders Awareness Campaign. This, I believe, is my fourth year participating in the event as one of three invited judges – although judging is hardly a fair description. I feel I am an honored witness to the many powerful images that reflect the journeys away from an eating disorder and toward greater health.

Each year thousands of men and women are fortunate to receive the specialized treatment that is needed to help them recover from their eating disorder. These specialized treatment facilities and agencies understand the importance of the arts in recovery and employ credentialed art therapists. Art therapy is a creative, psychotherapeutic process that helps patients express themselves when they have lost their words. It helps to provide the ability to accurately, and more fully, link feelings with expression. The art therapy process gives individuals who have become stuck, whittled down, or overwhelmed an outlet that fosters growth and change. It is a mirror for past events, current situations, and future dreams and aspirations. And just as the form and structure of the art medium can be stretched and boundaries redrawn, so too with the aide of a qualified art therapist can the psychic structure be supported and compassionately pulled into a flexible and more comfortable place.

These sculptural works are representative of hundreds of brave souls, courageously embarking on their journey of recovery with the aid and support of their treatment teams, families, and friends. They are warriors and journeyers; they, as do we all, do battle with personal and cultural demons along this path we all call life and these are some of the images that reflect their process. I thank them and IAEDP for allowing me to share their work with you.

Broken and Mended, Stronger Than Before submitted by Laura Riss, PsyD at Kaiser Permanente

Broken and Mended, Stronger Than Before submitted by Laura Riss, PsyD at Kaiser Permanente

The following treatment facilities and individuals submitted work for the 2015 Art Competition:

University of Florida Health Eating Disorder Recovery Center

Rogers Memorial Hospital

Castlewood at Monarch Cove

Eating Recovery Center IP/Res

Eating Recovery Center PHP

Eating Recovery Center IOP

Veritas Collaborative

Rebecca Tishman

Fraser North Eating Disorders Programs

Cambridge Eating Disorder Centers/Adolescent

Cambridge Eating Disorder Centers

Doctor’s Health and Wellness Center

A Caged Spirit submitted by Willow Place

A Caged Spirit submitted by Willow Place

Laura Riss, PsyD of Kaiser Permanente

Shoreline Treatment Center for Eating Disorders

Eating Disorders Treatment Center

Willow Place

Rebecca Brennan

The Renfrew Center of Northern New Jersey


Beauty from Ashes; emerging new hope and life Submitted by Eating Disorders Treatment Center - NM

Beauty from Ashes; emerging new hope and life Submitted by Eating Disorders Treatment Center – NM





Imagine Me Beyond What You See Awards Ceremony will be held Thursday, March 19 during iaedp’s Opening Night Dinner. The evening opens iaedp’s signature International Flag Procession spotlighting the International and United States Chapter Delegations followed by Imagine Me Awards Presentation including the Professionals Choice Award, voted on by iaedp membership, Symposium attendees, and the general public.

View the entire 2015 Roster by visiting online and while you’re there cast your vote.


2015 Judges includes Michelle Dean, MA, ATR-BC, LPC, CGP, Board Certified Art Therapist and Professional Member of American Art Therapy Association, Fritz Liedtke, Photographic Fine Artist and Author, along with Leigh Cohn, MAT, CEDS, Author, Artist and Owner Gurze Books.

© 2015, All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP. For more information about eating disorder treatment and to schedule an appointment for yourself or a loved one, family support, or be included in one of our groups in the Philadelphia area, please contact, Michelle at or call 610.259.2550 ext. 2.

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts and newsletters directly to your inbox. 


Art Psychotherapy: Arriving or Departing?

by Michelle Dean 19-01-2015 | 8:46PST | Comments (0)


IMG_1792Blog post by Mark Dean, MFA, MA, ATR-BC, LPC

I recently received an exit interview from a professional art therapy organization that I had stopped participating in. I had not intended to leave, but simply failed to renew my membership. They wanted to know if they had represented me well. I have hesitated to respond, as on reflection, my feelings are entirely mixed and a simple response is not easily come by.

I have utter faith in the value of art within the psychotherapeutic process, as I understand it to be the intrinsic mode of the expression of psychological reality. Though I respect my fellow practitioners that are art therapists, I perceive a perspective emerging in the field that I see as an erosion of the potential of the modality and I find that difficult to embrace. I am willing to hear that the field is “evolving”. I have been evolving as well, and the direction of that evolution has been decidedly towards greater understanding of the nature, role, and function, of both psychotherapy as a healing ritual, and art, image, and creative process as expressive functions of the human psyche and therefore, of psychological reality. Perhaps we are evolving apart.

Following the phenomena in front of me, meaning, carefully tending to what is occurring within the psychotherapy process itself, as expressed through the images that frame, organize, and mediate, that process. It is impossible for me to conclude that extrinsic means of verification have much, if anything, to add. The depth of “intelligence” unveiled through imagery, arising within the immediate context of the therapeutic setting, exceeds the sophistication of any accumulation of statistical studies and is, by far more “articulate” and precise. Psychotherapeutic process is not a function of an accumulation of information. Were that the case, an undeniable trend would be observed clearly demonstrating that the effectiveness of psychotherapy generally increases with each new addition to the pile of scholarly articles. Does evidence of such a demonstration exist?

It would be my hope to feel excitement for a field that seeks to promote a mode of psychological involvement that clearly deserves and warrants such promotion. Art, as a modality of psychotherapeutic involvement is indeed worthy of that, even a necessity, if we are actually psychological in our approach. But while I understand and respect that approaches within a discipline differ, and that other disciplines come into play within a given field, I cannot concur with what appears as a shift away from the essential nature and function of the modality itself in the process of psychotherapy. From my perspective, that is to unwittingly seek a reduction of its value and its potential. Such a trend leads me to question if either, the intrinsic nature of that mode is actually understood, or, if other issues are occluding our ability to focus on what we mean by “art psychotherapy”.

Over time, it has become quite difficult for me to not conclude that art, in all of its forms, corresponds to the nature of the psychological, far more succinctly and accurately than the physical sciences ever will. That position requires an involved explanation, but it is by no means an ambiguous one. It involves multiple disciplines, including science, but also history, and philosophy, as well as others. Searching into this theme leads only into deeper verification, corroboration through multiple disciplines, and verification through grounding in direct experience.

The physical sciences do indeed play a role in our work, but it is decidedly not a defining one. The history of the field of psychotherapy, and consequently psychology, is telling. The operant themes presiding over the development of the practice, and ostensibly its “improvement”, have resulted in a re-casting their subject into term that render it amenable to quantitative analysis. That is not because the phenomenal life of the psyche is quantitative in nature, but rather because such means conform to the needs of a societal impetus. As such, what we have been dealing with is far less science itself, than its social influence. What was actually achieved is a re-casting of the image of the human psyche, and hence psychology, as a factor within a “scientistic” myth, or a particular philosophy of mind. But such a myth within the psychotherapeutic process itself is actually only a potential ingredient, one cohering notion out of many possibilities, existing within it, rather than a defining it, except for those for whom science as myth defines the extent of their potentially operating world-view.

The phenomenology of the human psyche exceeds the confines of any single world-view and extends itself to many others as well. In fact, by definition of being truly psychological, it must engage the world-view, or organizing logic, as it is expressed by the individual, through the sum total of their expressive abilities as these are naturally brought to bear, and not simply through reason or quantity alone. The psychological explorer is not, therefore, a colonizer of the human psyche, but rather a disciplined observer within whose awareness the intrinsic logic of psychological reality takes shape. Epistemologically speaking, and it is an epistemological issue and not a scientific one, such a means are an affair of the emergence of an image, and an observing consciousness capable of meeting it, much more so than the application of a pre-existing, stable, but indifferent fact. Art, as a mode, unveils a logic that corresponds to it, one irreducible to any other mode. It is entirely different from that unveiled by division and measure which have no means for the authentication of its findings.

In continuing installments, I will be articulating the position that it is actually image, rather than quantification, that frames and conveys psychological reality. In a society whose philosophic basis is excessively invested in measure and fixity, the mode through which we could actually understand the logic of the human psyche, a phenomenon that is neither fixed, nor certain, but individual, and creative, becomes diminished. What can it mean to abdicate the latter by folding it into the former?


The Role of Art in Overcoming Communal Rejection

by Michelle Dean 01-12-2014 | 5:25PST | Comments (0)


Samantha Baggott

As a part of her honors requirement for the Art Therapy: Media and Application course at Arcadia University this semester, I invited Samantha Baggott to write a guest post on her research about overcoming communal rejection through art, which includes an interview with art therapist, Gussie Klorer and her recent project, Ribbons of HOPE in Ferguson, Missouri.

An aspiring Art Therapist, Samantha Baggott is currently in her final year at Arcadia University working towards a Bachelors degree in Pre-Art Therapy with Honors. Following graduation in the spring of 2015, Samantha plans to pursue a Masters degree in Art Therapy and Counseling, beginning the journey to becoming registered and board certified. Her hopes are set on owning a private practice upon receiving her credentials to offer herself as a resource to others. Having completed an internship with a local social service agency in Summer 2014, Samantha has developed a new interest in the field of respite care for children with special needs, as well as family based therapy interventions with youth at risk for out of home placement in a psychiatric care facility. Her interests in those suffering with post traumatic stress disorder have grown greatly throughout her education and she would like to further explore this population, perhaps directing her initiative to assist these individuals. A personal and professional goal of Samantha’s is to become an active leader in the field of art therapy by achieving the capability to make a difference in life through creative expression and the therapeutic process.

Within the last twenty years the United States has experienced several major tragedies varying from natural disasters to planned acts of terror. The communities affected, and the witnessing individuals throughout the country, have endured considerable stress following these events. Within the United States, tragedy and loss have become highly publicized and reported matters. These tragedies strike communities without warning and leave survivors to cope with ensuing stress and trauma. While nothing can reverse the impact of the traumatic event, the use of artwork with communities and individuals affected by tragedy can help to lessen the effects of trauma, provide an expressive outlet for survivors to share their emotions and reactions, and make available a supportive environment open to all people to find condolence.

Although Americans have been shown to come together in support of survivors directly affected, there is also an undocumented effect of tragedy that occurs known as communal rejection. Communal rejection is a phenomenon in which support may be denied to groups of people directly affected by natural disasters or public health emergencies due to the refusal of others to recognize the severity of the effects of the disaster on the affected population (Hodge, Orenstein, Weidenaar, Meza, Van Buren, Wearne & Penunuri, 2013). This communal rejection may include acts of discrimination and refusal to address the needs of those affected by the incident as well as physical bans placed on the ability of affected people to relocate. This rejection leaves survivors without the physical and social resources needed to work toward recovery, a byproduct of such a traumatic event includes Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD) (Hussain, 2010).

Survivors who develop Post Traumatic Stress Disorder, a long term experience of anxiety or dissociation following a stressor, are most at risk are those who have been physically immobilized while trying to escape, those with first hand experience of the sounds, smells, and images of the event, who had witnessed death or dismemberment of another, and those whose lives have been altered due to the injury or death of a loved one (Hussain, 2010; Van der Kolk, 2002). According to Van der Kolk (2002), “Staying focused on problem solving, on doing something, however small, about the situation – rather than concentrating on one’s distress – reduces the chances of developing post-traumatic stress disorder” (p. 35). Becoming involved in a community art movement may be the resource survivors of tragedy are in need of. Not only will survivors be made aware of the suffering of others alongside them, they will be welcomed into a positive social context that will reestablish the feeling of safety needed for a successful recovery. A goal of positivity and growth following a tragic situation can be established though community art making and the response received from a community art project will “shape the way the victim comes to perceive the safety of the world and the benevolence or malevolence of others,” thus supporting a move towards recovery and overcoming possible communal rejection (Van der Kolk, 2002, p. 36).

Ribbons of Hope A current community art project developed in response to recent tragedy and ongoing violence is Ribbons of HOPE in Ferguson, Missouri. Two local art therapists of Ferguson, Gussie Klorer and Dana Sebastian Duncan, partnered with the Missouri Art Therapy Association, the Northern Arts Council, the Adolescent Resource Center, and the Ferguson Youth Initiative to begin this project (Missouri Art Therapy Association, 2014). Although the original idea can be credited to Dana Sebastian-Duncan, this movement and what it stands for along with its effects on the community of Ferguson are matters close to Klorer’s heart and of great importance (personal communication, October 4, 2014). Ribbons of HOPE is a continually developing physical display of weather resistant ribbons on which participants are asked to write or draw their vision of hope for the future (MATA, 2014). Upon beginning this project, the goal was to get a positive message out, both through the local community and spreading further into the nation, expressing that Ferguson is not a place of constant violence and corruption, but rather a community that is trying to thrive in the face of adversity. “The media has been so negative about Ferguson, and a lot of things are being projected onto Ferguson that I don’t believe belong to Ferguson… We really wanted to do something to turn a more positive note to this,” Klorer explained when asked about the purpose and goals within this project (personal communication, October 4, 2014). She feels that the community is attempting to move past the negativity and violence that have appeared recently, but are not receiving the proper support. “I think it’s really interesting that the local news has totally ignored it,” she states, providing an example of communal rejection within the greater Saint Louis area. She feels that newspapers are choosing to ignore the good being done within this community in favor of focusing on the controversial and negative, spreading inflated and often played out stories they feel to be worthy of headlines. Klorer and the accompanying organizations are currently working to combat this negativity through Ribbons of HOPE, not only to provide support for those directly effected affected within the community, but also to spread positive news to nationwide followers. “We wanted something to be very visible and to focus on the future, and focus on hopes and wishes and positive things for Ferguson rather than dwelling on all of this negative stuff that is happening,” (personal communication, October 4, 2014). Klorer notes the great interest and involvement on the local level that has come from the formation of this project inspired movement. As volunteers using their professional experience and knowledge to help the community, being present in the community and offering a regular but informal headquarters for creation of ribbons during the weekly farmer’s market has allowed this group to reach the local population and experience their immediate reactions to the process. Klorer shares that many people approach her while hanging ribbons, express interest and enthusiasm, and choose to contribute to the movement. She observes that, “people are contributing on their own and are moved by the project,” however “it is likely ignored by some people too, I mean I think people drive by it and don’t know what it is.” This is a rather new project, originating in September 2014, and Klorer expresses a mixture of discouragement and enthusiasm; she feels as though this project is not having the impact she hoped for in aiding Ferguson in the move out of communal rejection, but does acknowledges its potential to be very influential, referring to growing national involvement and sharing the correspondence she has exchanged with other art therapists that plan to contribute to the movement. Within less than a month, the group has received over 1,500 ribbons containing various hopes for the future and suggestions for positivity from a variety of locations. Examples include “you are beautiful no matter what people say,” “it’s okay to be mad, just calm down and take a deep breath,” and “love who you are, you are equal” (personal communication, October 4, 2014). The freedom of expression displayed in the messages on each ribbon, as well as their integration into two major locations has greatly changed the visual appearance of Ferguson, drawing more attention to this movement. “I don’t know if other people really understand what is happening here, but they certainly are resonating with us needing support and needing help,” Klorer states, expressing her overall pleasure in the positive coming together of the community of Ferguson and the rest of the nation in response to the negative tragedy and ongoing struggles. This project demonstrates the impact collective art making has on developing unity within a community and overcoming stigmatization and rejection, while enforcing healthy outlets to stabilize psychological reactions to stressors.CLOSE.allwe needlove

The unity and reactions displayed both within communities and throughout the nation in response to tragedies in the United States, as well as successful coping and recovery of survivors can be greatly credited to the simple act of bringing people together through creative and artistic means. “Being part of a large group of people who were vulnerably linked by a national tragedy created a forum where many unprocessed feelings were confronted simply by witnessing the symbolic imagery of others,” (DiSunno et al., 2011, p. 50). Regardless of the type, scale, or severity of tragedy, groups creating responsive and therapeutic art will thrive in a similar manner. Common imagery, themes, responses, and group dynamics may arise, promoting acknowledgment and discussion of emotions and working towards the elimination of communal rejection and the development of a supportive community. Donations of ribbons for Ribbons of HOPE are now being accepted. Materials needed are weather resistant ribbons 14-18” long and permanent or paint markers. On a ribbon, write and/or draw your vision of hope towards the future in a positive, creative, productive, prayerful and/or wishful way (MATA, 2014).

 Contributions for Ribbons of HOPE may be mailed to:

Gussie Klorer

200 Bemiston, Suite 309

Clayton, MO 63105


YouTube video: Ribbons of Hope : A community arts project for Ferguson, MO


Allen, P. B. (2008). Commentary on community-based art studios: Underlying principles. ArtTherapy, 25(1), 11-12.

DiSunno, R., Linton, K., & Bowes, E. (2011). World Trade Center Tragedy: Concomitant healing in traumatic grief through art therapy with children. Traumatology: An International Journal, 17(3), 47-52.

Gonzalez-Dolginko, B. (2002). In the shadows of terror: A community neighboring the World Trade Center disaster uses art therapy to process trauma. Art Therapy, 19(3), 120-122.

Hodge, J.G., Orenstein, D.G., Weidenaar, K., Meza, N., Van Buren, L., Wearne, N., & Penunuri, K. (2013). Legal responses to communal rejection in emergencies. The Journal of Law, Medicine & Ethics, 41(2). 529-534.

Hussain, S. (2010). Art therapy for children who have survived disaster. Virtual Mentor, 12(9), 757.

Missouri Art Therapy Association (MATA) (2014, August 23). Ribbons of Hope: A collaborative          community art project for Ferguson, Missouri. [Blog Post]. Retrieved from:

Van der Kolk, B. A. (2002). In terror’s grip: Healing the ravages of trauma. Cerebrum, 4(1), 34-50.


© 2014, All rights reserved, The Center for Psyche & the Arts, LLC; written by Samantha Baggott.

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts and newsletters directly to your inbox. 



The Symbolic Expression of Eating Disorders

by Michelle Dean 13-10-2014 | 6:29PDT | Comments (0)


Have you ever noticed how expensive, haughty cuisine is often associated with sex, the divine, and transcendent experience; and conversely cheap, junk food is equated with addiction, excitement, or an out-of-control behavior? For example, in some conversations with friends, clients, and even in online food reviews the following may be heard:

“The apple tarty ice cream pastry caramely thing was just orgasmic”

“The creamy tropical fruit gelato was just heavenly”crack donuts

“Succulent pork belly paired with seductively seared foie gras”

“I felt I had been transcended to another world by the decadent dish that made me melt”.

And when dealing with inexpensive, junk food we may hear statements like:

“I could not stop eating them, because the cheesy puffs were just too incredibly addicting”

“I want to experience a party in my mouth tonight”

“The crack donuts keep calling me back”

“I need my chocolate fix for the day”

IMG_1409The language we use to describe food may be symbolic, illustrating our relationship with it by drawing on images and experience. This symbolic language can be idiosyncratic at times and represent an attempt to fulfill personal, relational needs. In order to be successfully understood, a relational context (with oneself and with others), is needed to fully comprehend this personal meaning. When symbolic content is removed from the defining relational context, such as an expression between people, cultures, time, or situation, the expression, whether spoken or in image form, loses or changes its meaning and may be misunderstood or even literally translated. The feeling of hunger may be equated with eating, although the hunger may be an emotional, physical or spiritual hunger. Examples of these types of misunderstandings and attempts to meet emotional needs of hunger, loneliness or fatigue through disconnected actions abound.  

In our language, wishing someone good luck, by using the idiom “Go break a leg”, when taken literally, is not a kind wish at all! One must have a language and cultural context to understand this phrase and many others. A few cultural marketing blunders that demonstrate this, include, when automobile manufacturer Mitsubishi launched its “Pajero 4WD” in Spain, they forgot to bear in mind the word Pajero means jerk in Spanish. And when Honda introduced their new car “Fitta” into Nordic countries in 2001, if they had taken the time to undertake some cross cultural marketing research they may have discovered that “fitta” was an old word used in vulgar language to refer to a woman’s genitals in Swedish, Norwegian, and Danish. In the end, they renamed it “Honda Jazz.” When dealing with emotional expression it is not always easy to rename, express, and meet the needs of underlying hungers and thus they may manifest as behavioral, emotional, and physical symptoms. 

Symptoms of many kinds of illnesses, both mental and physical are also considered symbolic and as such may manifest themselves as a bodily expression, as evident in somatoform disorders, conversion disorders, eating disorders, as well as some addictions, carrying symbolic longing, desires, and conflicts about self care; all turning unmet underlying relational needs into physical form and behaviors. For example, the meaning of a person’s eating disorder is unique to him or her, understanding the underlying symbolic expression of it is imperative in assisting the individual to relate to these needs and desires and transforming them into a impetus that does not pose damaging or life threatening ramifications.

iStock_000005583030MediumIt may be said, eating disorders are disturbances of relationships: Relationships to others and the environment, to oneself, to one’s emotions, and to one’s needs, desires, and imagination.  As Woodman (1980) indicated, being free from externally exposed famine means we are all the freer to project onto food that have nothing to do with assuaging our alimentary needs, seeking through eating to satisfy our longing for affection or sexual fulfillment, or to muffle our grief or rage.  Food can also become the repository of our secret fears and fantasies of perfect health and thus, becomes a symbolic function of complex, underlying psychological processes (Burch, 1973; Dean, 2013a, 2013b; Dallett, 2008; Woodman, 1980, 1982).  And as Carl Jung is quoted, “The underlying, primary psychic reality is so inconceivably complex that it can be grasped only by the farthest reach of intuition, and then but very dimly.  That is why it needs symbols” (1975a, p. 159).

Art psychotherapists are especially poised to work with art, image, and symbolic function, in the therapeutic process with clients who manifest eating disordered behaviors, thus providing an experience that creates the necessary bridge over deficits left by personal and cultural experiences, which have failed to provide adequate nurturance for development (Dean, 2013b; Isis, Bishop, Tulucci, Dean & Betchel, 2012; van der Kolk, Perry & Herman, 1991).  As art psychotherapists, patients, and as a culture this means, “[…] cultivating new skills and enlarging our scientific horizons so that there is room for the creativity that is a part of our everyday experience of living” (Goodman, 2007, p. 31) restoring symbolic function to a process rather than direct destruction, and potentially lethal actions, upon the body (Dean, 2008; Jackson, 1996; Ramos, 2004; Sidoli, 2000). 

Screen Shot 2014-10-03 at 8.57.28 PMJoin me for an online webinar hosted through The Center for Psyche & the Arts, LLC on October 26th or at The Expressive Arts Therapies Summit in NYC for my workshop: Emaciated Imagination: Disordered Eating and Symbolic Expression on Sunday Nov. 9, 2014 from 10 a.m.– 1 p.m. as I explore the symbolic nature of eating disorders from a personal, familial, cultural, and environmental perspective utilizing a Jungian and depth psychology framework.  The importance of context and symbolic function in attachment ruptures, trauma, and recovery is discussed as well as the meaningful treatment of such symptoms through a symbolic, image-based means, such as art psychotherapy. 

If you are unable to join me for these live events, the webinar will be available for download within 24 hours of the live event. Individuals who register before the October 26th will receive the lowest rates, so register early. A link to the recorded video will be provided to both live and distance-learning webinar participants for repeat viewing should you choose to review the material multiple times. Additionally, continuing education credits will be available for all programs. Please see our website for more information and to register.

References (not included as links):

Bruch, H. (1973). Eating disorders: Obesity, anorexia nervosa and the person within. New York: Harper Collins.

Dallett, J. O. (2008). Listening to the rhino: Violence and healing in a scientific age. New York, NY: Aequiteas Book from Pleasure Boat Studio: A Literary Press.

Dean, M. L. (2013a). Cultural considerations of eating disorders. In P. Howie, S. Prasad, and J. Kristel (Eds.), Using Art Therapies with diverse populations: Crossing cultures and abilities. (pp. 277-288). London: Jessica Kingsley Publishers.

Dean, M. L. (2013b). Conference Proceedings from Binge Eating Disorder Conference: Crack Donuts and the Emaciated Imagination: Disordered Eating and Symbolic Expression. Bethesda, MD: BEDA.

Dean, M. L. (2008) Preserving the self: Treating eating disordered individuals who self­injure with art therapy. In S. Brooke (Ed.) Creative arts therapies with patients who have eating disorders. (pp. 56-82). New York: Charles C. Thomas.

Goodwin, B. (2007). Nature’s due: Healing our fragmented culture. Edinburgh: Floris 

Isis, P., Bishop, E., Tulucci, Dean, M. L. & Betchel, A. (2012). Conference Proceedings from The American Art Therapy Association Conference Keynote Plenary Panel: Eating Disorders. Savannah, GA: AATA.

Jackson, E. (1996). Food and transformation: Imagery and symbolism of eating. Toronto: Inner City Books.

Jung, C. G. (1975a). The collected works of C.G. Jung. Bollingen Series XX. (Vol. 16 The practice of psychotherapy: Essays on the psychology of the transference and the subjects). (2nd ed.) New York: Princeton University Press.

Jung, C. G. (1975b). The collected works of C.G. Jung. Bollingen Series XX. (Vol. 8 The Structure and dynamics of psyche: Including “Synchronicity: An Acausal connecting principle”). (2nd ed.) New York: Princeton University Press.

Ramos, D. G. (2004). The psyche of the body: A Jungian approach to psychosomatics. New York: Brunner-Routledge.

Sidoli, M. (2000). When the body speaks: The archetypes in the body. London: Routledge.

van der Kolk, B. A., Perry, J. C. and Herman, J. L. (1991). Childhood origins of self­ destructive behavior. American Journal of Psychiatry, 148, 1665–1671.

Woodman, M. (1980) The owl was a baker’s daughter: Obesity, Anorexia Nervosa and the repressed feminine. Toronto: Inner City Books.

Woodman, M. (1982). Addicted to perfection: The still unravished bride. Toronto: Canada: Inner City Books.

© 2014, All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts and newsletters directly to your inbox. 

Paste Papers: The What For…  

by Michelle Dean 09-10-2014 | 5:48PDT | Comments (2)


Artist’s journals © Michelle L. Dean

Decorated paste papers, as described in Paste papers: The How To…, may used in a multitude of educational and therapeutic applications. Using the slick and flexible pigments can facilitate abstract and playful imagery as well as lessen anxiety and encourage creative flow (Chilton, 2013). The less structured, or sometimes referred to as regressive elements, inherent in working with paste pigments may lessen defensiveness and encourages spontaneous creation and play. Working with larger pieces of paper, a minimum 18” x 24”, is recommended as it encourages bi-lateral gestures, which are associated with restorative integration and improved cognitive processing. Once the pigments are dry, the paper may be pressed with a warm iron or just placed under books to be restored to a flat sheet for drawing. If the paper is to be used in bookbinding or collage, pressing may not be necessary, as the glue will assist in holding its new shape.

Abstract Drawings:

suminagashi paper

Suminagashi paper made by the author

Instead of beginning a work of art with a stark white page, use a paste paper, or an inked suminagashi paper (to be described later), as it may take some of the anxiety out of starting a drawing or collage. For example, when working with the paper for a drawing, a design or pattern may inform the image as it may “speak” to the artist and imagistic associations may be drawn or created onto the page.  This method is akin to the projective scribble drawing (Hones, 1995) except the “scribble” is provided by the pigment or ink. Additionally, these papers may be used to elicit a symbolic or metaphorical response to: “What do you do when life hands you something you did not ask for?” like a line created by another group member in a pass a picture intervention or by utilizing the pattern created by the pigments as the “thing” to be reckoned with (McCafferty, Kwak, Dean, & Kane, 2007). The patterned paper may stand in for an undesirable event and subsequent sequela, such as a traumatic event and a graphic response, either painted, drawn or collaged, provides an opportunity to explore and work out various responses to a to an image and in turn to life’s event(s) or situation.

photo 1

Artist’s journals © Michelle L. Dean


By combining images and found objects of interest, patients may overcome anxiety associated with pressure to create a realistic image of their own as well as general resistance to art therapy itself (Landgarten, 1994). Collage may offer relief to those who lack confidence in the quality of their work and allow for many different combinations to be tested before a final commitment is made. By increasing the patient’s choices of imagery to be incorporated into a therapeutic artwork, it may also evoke an increase in dialog between patient and therapist about association to the abstract and unconscious material.

Book Binding:

Hand-made journals

Hand-made journals made by Arcadia University students utilizing their paste papers for their semester-long project.

In covering the outer pages of a book, one may select only the parts of the paste paper that are most desirable. This allows the patient to choose the area that they connect with most and place it in a way that it may be seen clearly. Along with choosing the cover of the book, patients can create a blank journals for which to carry on their creative process. This process, referred to as visual journaling, art journaling, or creative journaling, creates individual time for personal reflection and may allow for experience of underlying themes and increased familiarity with oneself.

These are only a few examples of how paste papers may be utilized in educational and therapeutic contexts. If you would like to learn more about bookbinding for therapeutic means, be sure to join us for Therapeutic Art Journals, a workshop in the near future or invite me to facilitate one near you.

Special thanks to Arcadia University art therapy student, Samantha Baggott.  She has been invited this semester to provide assistance in research for this blog and may be featured as a future guest contributor as a part of fulfilling her honors requirement for the AT310: Art Therapy: Media & Applications course this semester.








 References (not provided as links):

 Chilton, G. (2013). Art Therapy and Flow: A Review of the Literature and Applications. Art Therapy Vol. 30, 2, 64 – 70.

Hones, M. J. (1995). Clinical Application of the “Scribble Technique” with Adults in an Acute Inpatient Psychiatric Hospital, Art Therapy: Journal of the American Art Therapy Association, 12:2, 111-117

Landgarten, H. (1994). Magazine Photo Collage as a Multicultural Treatment and Assessment Technique. Art Therapy 11, 3, 218 – 219.

McCafferty, J., Kwak, K., Dean, M. L. & Kane, J. (2007). Eating disorders: A collaborative approach to treatment. In The American Art Therapy Association Conference Proceedings: vol. 38, (pp. 80), Albuquerque, NM: The American Art Therapy Association.

© 2014, All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts directly to your inbox. 

Paste Papers: The How To…

by Michelle Dean 04-09-2014 | 2:35PDT | Comments (2)


photo 5 - Version 2For centuries, artisans have been decorating papers by drawing designs in colored paste (Maurer). Paste papers are lovely way to create easy decorative papers, which may be admired on their own, incorporated into drawings or utilized in a variety of contexts such as collage, book binding, and scrapbooking.  They lend themselves to a multitude of educational and therapeutic applications, which I will discuss in Part II of this blog post  Paste Papers: The what for…  

The patterning of the paper is made through the use of pigment and a paste agent, such as flour paste, cornstarch paste or methyl cellulose (recipes below).  Methyl cellulose, my personal favorite, is a clear viscous solution or gel product that is pH neutral and may be used in archival glue for book binding as well as an adhesive for paper repair and mounting.  Use it as a paint extender and slicking agent with tempera for finger painting.  Methyl cellulose may also mixed with glue to create an economic decoupage and extend the life of many white, PVA (Polyvinyl acetates)glues such as Elmer’s™ and Sobo™.

photo 1Poster paints, tube gouache, watercolor, and acrylic all may be mixed with the paste of your choosing to create the colors for paste papers.  My personal preference is acrylic mixed with methyl cellulose due to its ease and availability in our studio.  Patterning tools such as combs, hair picks, multiple line calligraphy pens, plastic forks, potter’s tools, and wood-graining tools are recommended because they all make interesting and varied marks.  To create homemade graining tools, use pinking sheers to cut an edge from a plastic jug or use a knife to create “teeth” of various widths from the side of cardboard milk container.  Additionally, stamping may be done on the paste papers with plastic or foam stamps, buttons, bottle caps, corks, lace, bubble wrap and many other found materials.

The ideal paper is 70 – 80lb. offset printing paper, or charcoal weight paper.  The paper must be strong enough to endure raking tools over its wet surface without falling apart.  Highly absorbent papers should be avoided, as they tend to shed or rip as you work with them.  Wetting the papers first by soaking, sponging or spraying with water allows the paper to relax and creates slower drying times, which may be helpful when creating intricate designs.  Papers that are uneven in their moisture content will buckle and could create distortions in the patterns.

Brush the tinted paste of your choice over the moistened paper and experiment with various pattern making tools and mark directions.  Many people at first experiment with symmetrical patterns, which according to Maurer-Mathison (1993), reflect more historical designs.  Be sure to experiment with asymmetrical designs and contemporary influences.  Once completely dry, double and triple “printing” may be done by applying another layer of colored paste on top of the first pattern.

Recipes:photo 3
Flour Paste 

4 Tablespoons rice flour

3 Tablespoons wheat flour

3 Cups water

½ teaspoon glycerin

1 teaspoon dish detergent

Cook the flours with a little water over medium heat; continue to add water until it resembles thin custard. Remove from heat and add the glycerin and detergent to keep the paste smooth and pliable.

photo 2Cornstarch Paste

Mix ¼ cup cornstarch with ¼ cup water until well blended.  Heat over medium heat while adding an additional cup of water until it resembles custard. Add ½ cup of water to thin.

Methyl cellulose

Mix 1 Tsp into 1 pint of cold water (hot water does not work as it prevents it from “melting”).  Let stand overnight or longer.  Does not go bad, so make up extra and store in a sealed container (i.e., Mason jars) for whenever needed. 

Reference not included as link:

Maurer-Mathison, D. V. (1993). Decorative Paper. New York: Illustrated Books.


© 2014, All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)

Visit our website for more information about our servicesworkshops, and training opportunities. Sign up to receive blog posts directly to your inbox. 

Using Art in Psychotherapy

by Michelle Dean 22-07-2014 | 7:53PDT | Comments (6)


mad girl cookingArt in a psychotherapy practice is so much more than a series of directives and ingredients rattled off like a recipe in a cookbook.  Although recipes may get the cook in the kitchen, what separates the novice from a chef is a discerning appreciation of the individual ingredients and their synergetic effects.  Likewise, the ability to transform the application of art and imagery into attentive and skillful interventions in a psychotherapy practice requires competent mental health providers who are able to capitalize on the transformative synergistic effects of imagery and the art process.

Understanding the essential history and contextual importance of art throughout history and the underpinnings for its application in psychotherapy practice is imperative for clinicians who wish to use art in their practice.  Using art in therapy does not replace the need for specific education and training in psychotherapy processes and an understanding of art making, nor is it meant to be used as a replacement for professional help and mental health services.  Art psychotherapy however, gives a glimpse into the rich and transformative use of art, and the art making process, as a means of understanding human creativity and its role in healing and transformation.

My work, and upcoming book publication (Routledge), jettisons the idea of reductionist formulaic “cookbook” of activities but instead provides authentic relational and transmutative opportunities and an integrated and contextual understanding of the origins of commonly used art forms as well as an insight into its applications in mental health healing practices.  It is my hope, and opinion, that by understanding the inherent nature and function of the art media, therapists will find more meaningful and personal applications of art making in a psychotherapeutic process.  Clinicians and student clinicians should not have to reach haphazardly into a “bag of tricks,” grab for worksheets, or rattle off activities to keep clients busy.  Instead, art-based interventions need to come from psychologically minded and clinically astute choices informed with depth and integrity that honors the client and the wisdom of the therapeutic relationship and its synergy.



© 2014, All rights reserved, The Center for Psyche & the Arts, LLC; written by Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)

Visit our website for more information about our servicesworkshops, and training opportunities.

Asking for a Raise: Money, Worth, and Private Practice

by Michelle Dean 29-06-2014 | 12:33PDT | Comments (0)


Food prices go up, gas goes up, your utility bills go up, your insurance premiums go up, your office rent goes up, as well as taxes, and, well, pretty much everything else related to your cost of living goes up, but how easily do you ask for a raise when you are in private practice or self-employed?  

In the same vein, as Art Psychotherapists: What is your Worth?, this blog post addresses a professional practice question asked by many art therapists: “I have not increased my rate for service and supervision for years, however I am conflicted with how to handle a substantial increase.  I would like to be at double what I am asking her now because my fee is so low.  How do I raise my rates?”

iStock_000008562442MediumHere is the simple answer:  You decide what your new rate* is going to be and pick a date at least six weeks in advance to implement it.  Send a written letter to all of your clients or supervisees informing them what your new rate will be and when it will become effective.  If you do not see your clients weekly, send this letter by mail so enough time is given to prepare and adjust for this change.  I believe it is best to give current clients the letter at the beginning of a session, rather than the end in order to give ample time to discuss this change, if need be.  If you have a waiting room, you may wish to post such changes as announcement in a visible place including your stated new fees.  By posting this in the waiting room, it gives your clients a little time to digest this information before entering into the therapy space and before being notified directly by you.  Bottom line, you must inform your clients what your regular rate is and let it be known before the first session, preferably in writing (perhaps in your Consent to Treatment Form) and anytime thereafter. 

Here is where it gets a little more complicated: You cannot have different rates for the same service for different clients.  This would be akin to employers offering different rates to employees of similar background, training, or expertise based on an arbitrary determinate, which is considered discriminatory and creates a lot of animosity in the workplace if (and most likely, when) salaries are leaked.  This is why employers offer a salary range for certain positions based on education and expertise, even if they don’t always disclose it.  So if you offer a sliding scale to clients based on financial need you will have to determine how you will assess that need.  Will you take their word that they have the need because they said so?  If so, consider, how will you may feel when they buy a new car, get their nails done weekly, or take a lavish vacation?  In order to determine need will you ask for a monthly budget to assess their income and expenditures; request a copy of their tax return; or want to see proof of public assistance?  If accepting a fee lower than your normal rate, be sure to make a notation on the receipts indicating the amount paid is a sliding scale rate based on need and is discounted from your regular rate, which is also stated on your receipt.  This prevents the adjusted rate be your “new norm”.  When a sliding scale fee is established, it is helpful to discuss the expectation that should their financial circumstances change (i.e., a better job, a second job, a roommate or partner that helps to share the patient’s financial burden, or a lucky windfall) that a revisiting the current sliding scale fee will be necessary.

Here are the big issues that make discussing money so difficult for therapists and clients: The financial arrangements for therapy are often related to larger issues with money and need to be addressed within the therapy.  In my experience, the three largest issues when working with couples are: Children, sex, and money (not necessarily in that order).  Attitudes and relationships with money can be very complex and need time for processing.  For many, discussing money is a huge taboo; so struggles are kept secret.  How people prioritize their spending often reveals their values.  Money can be used as a means of restricting and compulsive buying, acting out, or getting even.  It can symbolize love, esteem, power, security, greed, and good will.  It can be used as a form of punishment and may become an instrument for some sadomasochistic behaviors.  These are not the proprietary issues of clients.  Therapists too must grapple with the multiple meanings and relationships they have with money, including how they ask for what they deserve and how to continue to evaluate and adjust course when needed.

When selecting a mental health provider or supervisor or setting rates as a professional, like perfume, cheap is not better.   In private practice, therapists want to be reknown for their expertise (or niche), not as the “cheapest” therapist.  As a clinician, undercutting yourself, your colleagues, and the mental health field only leads to an unsustainable, anxiety-filled existence and sets a poor example of self-care, advocacy of professional and self worth, and mentoring of future professionals.  Managed care companies have already derogated the value placed on professional mental health services.  Asking for a living wage and adjusting as needed is imperative for therapists.  The monetary portion of the work allows therapists to invest in their work and focus more fully on their clients.  You are the best tool, and arguably the only tool, you have in the therapeutic relationship so it makes sense to care for yourself. 

Seeing sixteen – twenty clients per week is considered full-time in private practice due to all of the other administrative and business demands as well as the emotional intensity and potential hazards of the work.  Seeing more clients, on a regular basis, runs the risk of eroding the quality of the therapy as well as placing the therapist at risk of developing illness (i.e., vicarious traumatization and compassion fatigue).  Being able to care for oneself and family and attend trainings and retreats allows mental health workers to be in the best position to care for others.  The caretaker must able to have their own needs taken care of emotionally, spiritually, and physically in order to provide the optimum service.  Payment for services are just one piece in this equation. 


* If you are having a difficult time naming a reasonable rate, check with your national and local professional organization for their latest salary survey.  According to the DVATA’s latest survey, the average fee for private practice is $110 with the highest rates in this area $169.99 per session and groups are reported at $60.50/session.  For the full report check the member’s only section of their website.


© 2014, All rights reserved, The Center for Psyche & the Arts, LLC and Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)

Visit our website for more information about our servicesworkshops, and training opportunities. Workshops and consulting regarding developing a private parctice or consulting business are available. Be sure to join us for Drawing on your Strengths: Creating a career that is right for you! – Webinar now available on demand – Get started on your independent practice today! Call to inquire or email for more information. 

If you have a question you would like Michelle to address in a future blog, send it to  Please note: Questions may be edited for length and clarity.