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On Our Mind: Thoughts from Mark & Michelle Dean

Group Art Therapy

by Michelle Dean 19-05-2014 | 9:28PST | Comments (2)

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Group therapy works!  In studies comparing group psychotherapy to individual therapy, group therapy has been shown to be as effective and sometimes even more effective.  In cases of medical illness, there is substantial evidence that this form of therapy helps people cope better with their illness, enhances the quality of their lives and, in some cases, such as breast cancer, has even been shown to help people live longer (AGPA).

Group psychotherapy is a special form of therapy in which a small number of people meet under the guidance of a professionally trained therapist to help themselves and one another. Group therapy has been widely used and has been a standard treatment option for over 50 years (AGPA). There are many benefits of group therapy, which cannot be obtained, in individual therapy alone.  Using art, a creative process, in the group therapy context, facilitated by a nationally certified professional enhances the group therapy experience (Bloomgarden & Kaplan, 1993; Drapeau & Kronish, 2007). 

Group Masks

LIFE IS A CREATIVE PROCESS! 

By utilizing materials, that promote a flow of creative energies allows for expression of ideas, emotions, and provides a reflective process ripe for insight and transformation.  Previous artistic ability or experience is not needed, only a willingness and an open mind.  In group art therapy, facilitated by Michelle L. Dean, MA, ATR-BC, LPC, CGP most groups are either 60 or 90 minutes depending on the group and begin with a brief check-in to ascertain important themes and concerns of the group. From group generated themes, a focus for creative therapeutic work is derived.  Group members spend 30 – 50 minutes engaged in creative work (i.e., drawing, painting, mask making, collage, writing) sometimes working quietly or in lively conversation.  All materials are provided by Ms. Dean, but on occasion and with advance notice, personal materials are brought to sessions for a particular focus such as work on childhood issues, loss, or identity and body-image concerns.  These items may include found objects, copies of personal photographs or magazine pictures for collage.  The last third of the group time is left for sharing stories, narratives, and associations to the work as well as group feedback.  

There is no right or wrong in group art therapy.  Unlike art classes, artistic skill is not our ultimate goal as not everything in life that needs to be expressed is beautiful, but is no less important.  One goal is to help group members create grace and beauty from life’s messes. 

EVIDENCE ON THE EFFECTIVENESS OF GROUP THERAPY

According to American Group Psychotherapy Association, during the last 30 years, studies have shown the growing benefits of group psychotherapy in a number of areas of life challenges.  Through groups, individuals find a forum of peer support, gaining strength as they share their feelings and experiences with others who are facing the same obstacles as themselves.  Some gain strength in seeing the resourcefulness of those in the same situation, while others renew their feelings of self-worth through assisting others.

IMG_7609During the group process, people develop a support network through each other — no longer feeling isolated by their condition and gaining a greater sense of normalcy.  With certain medical conditions, group psychotherapy can contribute to general improvement in one’s psychosocial functioning.  Research also has shown that survival rates have, in some cases, actually increased, with proper therapy.  Research has demonstrated that various forms of group psychotherapy, including group art psychotherapy (Bruch, 1973), are equally beneficial with positive results found across the board for a variety of disorders.  Group therapy is considered cost-effective when compared to individual treatment.  When a therapist’s time is spent with an entire group instead of one person, the expense for individuals is significantly reduced while the benefits remain and, in some instances, even greater. Although there may be individuals for whom group therapy may not be a viable option and as such individual therapy remains the treatment of choice, there are numerous therapeutic factors for participating in a group.  

THE THERAPEUTIC FACTORS OF GROUP THERAPY AND APPLICATION TO GROUP ART
THERAPY

paint and brushesYalom described these therapeutic factors (originally coined “curative factors” but renamed therapeutic factors in the 5th edition of his seminal text,The Theory and Practice of Group Psychotherapy). The following list names Yalom’s therapeutic factors followed by a brief explanation of how art therapy may complement and be seen in these therapeutic factors.

  • Universality – To know that others have similar experiences decrease group member’s sense of isolation, validate their experiences, and raise self-esteem. In group art therapy, feeling awkward about creating art in therapy is almost universal, until you realize everyone shares that feeling and the need to make beautiful pictures fades, and acceptance of who you are and what you create is authentic.

 

  • Altruism – When members help each other, they begin to feel a sense of value and purpose.  This leads to more adaptive coping styles and improved interpersonal skills. In group art therapy, altruism may be seen in assisting others in their creative process and thus promoting value and a sense of belonging or purpose. 

 

  • Instillation of hope – Group members can learn from others who have gone through life’s challenges and know that there is hope in recovery and support. In art therapy, hope may given when one group member says, “Don’t worry, when I started I felt I could only draw a stick figure too.”  Hope may also be seen in the graphic images created over time.  Progress and hope may be demonstrated by viewing artwork created at the beginning of treatment and again later on. Changes that occur in therapy can be slow, like any growth process, psychological growth may not always be visible without a means to mark progress, much like tick marks drawn on a wall marking the inches of a child grown over a lifetime. Over time, development in artwork may be detected in more intense or brighter color usage, just as affect may have brightened.  Energy may have increased thus resulting in a more active line quality and larger space usage on the page as well the inclusion objects or supports.  These changes and much more may be visible in the art productions as the psychological transformation occurs.

 

  • Imparting information – Understanding the stages and struggles of recovery from can reduce anxiety.  For example, understanding the discomfort associated with the re-feeding process common in some eating disorders is temporary, helps with the commitment to stick to a meal plan.  As well as knowing that body image distortion is one of the last things to change in recovery from an eating disorder helps to understand the patience and self-compassion needed for this healing process. Imparting information in an art therapy group can be as simple as explaining how oil pastels blend.  Or using artwork to outline the stages of grieving or to examine a decision by graphically drawing the pros and cons of an issue can yield visual cues such as weight and importance not always conveyed in words alone. 

 

  • Corrective recapitulation of the primary family experience – Understanding how our past relationships influence our current ones can be liberating.  In group therapy, members can learn how to identify these patterns and avoid repeating unhelpful, or even toxic, past interactive patterns in present-day relationships. It is sometimes much easier to observe family patterns and relationships in imagery than through words alone.  Proximity, weight, tension and line quality all can convey past and present unhelpful patterns while exploration of fantasy through art can reveal pined for relationships.  

 

  • Development of socializing techniques – The group provides a safe and supportive environment for members to take risks by expanding their repertoire of interpersonal behavior and improving their social skills. Often, in group art therapy, group members are called upon to create one work of art in which problem-solving and strength building skills are required thus building new patterns and skills.

 

  • Imitative behavior – One way in which group members can develop social skills is through modeling in which, group members observe and imitate the therapist and other group members. This happens more often than most would admit.  For example, sharing personal feelings, showing concern, and supporting others can all be modeled. Adolescents are notorious for trying on different fads and personae’s as they seek to express parts of themselves that feel like a good fit.  In an art psychotherapy group, working with various media can also help expand and amplify one’s ability to effectively understand and express oneself. Imitative behavior is a common aspect of creativity and play.

 

  • Cohesiveness – Group cohesiveness is an instinctive need to belong, and personal development can only take place in an interpersonal context. A principle goal of all of the groups offered at The Center for Psyche & the Arts, LLC is to offer cohesive groups in which all members feel a sense of belonging, acceptance, and validation. Connecting to others through similar forms and patterns drawn on a piece of paper can be easier and less stressful than sharing personal aspects of oneself.  Through the images, a bridge is created allowing for connection. An example of such is to temporarily subgroup based on line quality such as fuzzy lines, muted colors, or by pictorial elements.  When in small groups to discuss the images (before returning to the larger group), personal patterns can be observed and discussed by using the graphic qualities of the images created as they often yield information about personality types, likes and dislikes, and ways of relating to others. Group members are often amazed about how much is revealed in such a safe and enjoyable way.

 

  • Existential factors – Typically apply to learning that one has to take responsibility for one’s life and the consequences of one’s decisions.  In group art therapy each person makes a difference in our group and this world by sharing a part of themselves.  Focus on how our actions and relationships, can positively influence and help others, now and into the future is created in art therapy groups. One never knows how a piece of art may move another group member, creating resonance and meaning that permeates positively beyond the immediate group experience.

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  • Catharsis – Catharsis the experience of relief from emotional distress through the free and uninhibited expression of emotion. Have you every scribbled on a piece of paper hard?  It can be both exhausting and enlivening at the same time – this is a cathartic experience.  In addition to increasing creating physical energy from making art, when members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.

 

  • Interpersonal learning – Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member’s behavior and impact on others. The goal of interpersonal learning is to take these skills and experiences in group therapy back into their lives to enrich their relationships with others in many different contexts such as work, school, and family.

 

  • Self-understanding – This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one’s problems and the unconscious motivations that underlie one’s behavior. The images created in art therapy mirror internal conflicts and experiences, much in the same way a signature is unique to each person, one’s artwork is unique as well.  Each image holds facets of a personal story, ready to be mined through a relative, therapeutic experience.  Images created over time, create the complete portrait and evolve as the individual and group evolve. 

 

by Michelle L. Dean, MA, ATR-BC, LPC, CGP HLM (DVATA)

Co-Founder, The Center for Psyche & the Arts, LLCBoard Certified Art Therapist, Licensed Professional Counselor & Certified Group Psychotherapist Honorary Life Member – Delaware Valley Art Therapy Association

© 2014, All rights reserved. Images and text The Center for Psyche & the Arts, LLC

 

References

American Group Psychotherapy Association. What is Group Psychotherapy?http://www.agpa.org/home/developing-healthy-communities/what-is-group-psychotherapy-

American Group Psychotherapy Association Evidence on the Effectiveness of Group Therapy http://www.agpa.org/home/practice-resources/evidence-based-group-practice

Bloomgarden, J. &  Kaplan, F., F. (1993) Using Visualization and Art to Promote Ego Development: An Evolving Technique for Groups, Art Therapy: Journal of the American Art Therapy Association, 10:4, 201-207.

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

Burlingame, G.M., Fuhriman, A., & Mosier, J. The Differential Effectiveness of Group Psychotherapy: A Meta-Analytic Perspective.  Salt Lake City, Utah: Brigham Young University, p. 13.

Callahan, K (2004) A review of interpersonal-psychodynamic group psychotherapy outcomes for adult survivors of childhood sexual abuse. International Journal of Group Psychotherapy, 54 (4): 491–519

Davis, R., Olmsted, M.P., & Rockert, W. (1990)  Brief Group Psychoeducation for Bulimia Nervosa: Assessing the Clinical Significance of Change., Peterson, C. et. al. (1998) Group Cognitive-Behavioral Treatment of Binge Eating Disorder: A Comparison of Therapist-Led Versus Self-Help Formats., and Wilfley, D.E. et. al. (1993)  Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Nonpurging Bulimic Individual: A Controlled Comparison.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change,  p. 22. 

Drapeau, M.C. & Kronish, N. (2007) Creative Art Therapy Groups: A Treatment Modality for Psychiatric Outpatients, Art Therapy: Journal of the American Art Therapy Association, 24:2, 76-81,

Fuhriman, A. & Burlingame, G.M. (1994).  Group Psychotherapy: Research and Practice. Piper, E. & Ogrodiczuk, J.S., Brief Group Therapy, p. 2.

Kanas, N (2005) Group Therapy for Patients with Chronic Trauma-Related Stress Disorders. International Journal of Group Psychotherapy, 55 (1), 161–6

Leszcz. M. & Goodwin, P.J. (1998) The Rationale and Foundations of Group Psychotherapy for Women with Metastatic Breast Cancer.  In Sherman, Mosier, Burlingame et. al. Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York: American Group Psychotherapy Association, p. 3.

Luzzato, P. & Gabriel, B. (2011) The Creative Journey: A Model for Short-term Group Art Therapy with Posttreatment Cancer Patients. Art Therapy: Journal of the American Art Therapy Association, 17:4 pp. 265-269.

McRoberts, C. et. al. (1998) Comparative Efficacy of Individual and Group Psychotherapy. In Piper, E. & Ogrodiczuk, J.S., Brief Group Therapy, p. 3.

Mitchell, J.E., et. al. (1993) Cognitive-Behavioral Group Psychotherapy of Bulimia Nervosa:  Importance of Logistical Variables.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 23. 

Mitchell, J.E. et. al. (1990) A Comparison Study of Antidepressants and Structured Intensive Group Psychotherapy in the Treatment of Bulimia Nervosa.  In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p.  23. 

Simonton, S. & Sherman, A. (2000) An Integrated Model of Group Treatment for Cancer Patients.  In Piper, E. & Ogrodiczuk, J.S.  Brief Group Therapy, p. 10.

Spiegal, D. et. al. (1989) Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer.  In Sherman, Mosier, Burlingame et. al. Group Interventions for Patients with Cancer and HIV Disease: Part I.  Efficacy at Different Phases of Illness.  New York: American Group Psychotherapy Association, p. 70.

Tschuschke, V., et. al. (1999) Gruppentherapie Versus Einzeltherapie [Group Versus Individual Psychotherapy – Equally Effective?] In Burlingame, G.M., MacKenzie, K.R. and Strauss, B. Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change, p. 38.

Yalom, I (1985). The Theory and Practice of Group Psychotherapy (3rd ed.). New York: Basic Books, Inc., Publishers. 

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