New Year's Resolutions

During Art Therapy Supervision today, I asked everyone to create a piece of art work based on their New Year's resolutions as an Art Therapist. These could include goals or where they saw themselves in the upcoming year. Answers were varied and included presenting at the next AATA conference, starting up a new group for the sex offenders that we treat, and growth as a clinician. I also like to use this directive with patients, as I think it can help people be more aware of what they would like to accomplish, and they can start thinking how they can meet their goals.

Supervision: "Scariest Patient"

Since it was Halloween recently, during Art Therapy supervision, I asked everyone to portray their scariest patient. Since we work with sex offenders, often, we experience "scary" or "creepy" patients. This directive helped the therapists be more aware of feelings that are aroused by the patients we serve, and to discuss countertransference. Some therapists focused on the physical aspects of the patients, and others were influenced by actions and behaviors of a patient. For example, one therapist talked about a patient who engaged in bizarre and sometimes disgusting behaviors, and we discussed how he may do that as a protective measure since he was just admitted from prison where sex offenders are disliked and often harrassed by other inmates.

Supervision: How Sex Offenders Use Sex

During a recent Supervision group, I asked everyone to create an image of how one of the patients had used sex to manipulate staff, either in an Art Therapy group or just in everyday interactions. When working with this population, it is important to be aware of how the sex offender will try to manipulate or take advantage of staff, often using sex, either in a subtle or obvious way. The more aware we are of the attempts and intent, the better we can prepare ourselves to defend against it and deal with the patient. Several examples were given such as the patient who tries to touch staff's hand when she is handing him his art supplies. Also, there are those patients who speak very softly, so staff have to lean in closer to hear him. Some offer compliments or a sympathetic ear. All these practices serve as a test of boundaries, so we were able to discuss feelings around these circumstances and how best to address the issue with the patient.

Supervision Directive: Animal Metaphor

This week during our Art Therapy supervision group, I asked the Art Therapists to think of one of their patients and draw him as an animal. (If this patient was an animal, what kind of animal would he be?) This was a fun directive and it provided the opportunity to work within a metaphor. Since we work with sex offenders, some of the animal images were monster-like. Others included a ferret for a patient who was particularly sneaky and tried to take art supplies from the Art Center. Another was a fish in a bowl because he had difficulty expressing his needs, though needed the occasional acknowledgement. For one patient, represented as a fly buzzing around, there was a suggestion of the need for sticky fly paper for him. This could be translated into some activity that would keep him occupied for a period of time. Using this directive and working in the metaphor can help the therapist look at the situation differently, and possibly come up with interventions not thought of before.

Supervision: Positive Experience

During a recent Art Therapy supervision group, I gave the directive to create an image about a positive experience that each therapist had in one of their groups or with a patient. Often, we focus on all the problems we have with the patients since sex offenders are a hard population to work with. I think we forget to discuss what goes well and some of the positive results that we see. This can help us feel more rewarded and fulfilled in our work, and it can help our peers to share what has worked for us, helpful approaches and techniques. Talking about challenges and difficulties can drag us down at times, so sharing positive experiences can be morale boosting and more uplifting for a change.

Book Review: Without a Conscience

When I started working with sex offenders, I learned that quite a few are psychopaths. I was referred to the book, "Without a Conscience" by Robert Hare, who created a psychopathy checklist. The book was an easy read and gave me a better understanding of working with psychopaths. He shared examples of real life psychopaths such as Ted Bundy and Jeffrey Dahmer, as well as fictional psychopaths such as Hannibal. Hare elaborated on the symptoms of psychopathy such as being superficial, lacking remorse, being manipulative, being impulsive, etc. He discussed treatment of psychopaths which is difficult and entails self protection and damage control. Since 20% of inmates are psychopaths, this is a book worth reading if you work with the offender population.

Someone felt uncomfortable directive

This week in my Empathy group, the Art Therapy directive was to create an image about a time you noticed that someone else felt uncomfortable. This exercise was done to help the sex offenders identify signs of another's discomfort. Most were able to do this, though not all did something to make the other person more comfortable in the example he provided. One patient thought it was right to try to ask his victim how he was making her uncomfortable, instead of just walking away. However, some were able to describe what they did to make the person less uncomfortable, so that was positively reinforced. It was a good discussion about recognizing someone else's discomfort and then doing the right thing.

Supervision: Drawing to Patient

This week in supervision, we all drew a picture to a challenging patient (not actually to be given to the patient) to express how they made us feel. Previously, we had written letters to a difficult patient which was helpful to the supervision group. Since we are Art Therapists, I thought drawing would be a good way to express ourselves as well. The therapists discussed how the patients made them feel overwhelmed, frustrated, angry, annoyed, and drained, which is common with the sex offender population. They were able to discuss ways to deal with these issues and could just vent. It helped them to be more aware of their countertransference towards this difficult population. They reported that this exercise as well as the letter writing exercise were both helpful. One therapist said she preferred the letter writing because she could write down exactly what she was thinking and feeling in a precise way.

What prevents empathy?

This week, the sex offenders in my Empathy group talked about what factors have prevented them from feeling empathy for someone. A lot of things interfered with them having empathy, including feeling anger toward that person, feeling entitled, not taking responsibility for their actions, justifying their behavior to themselves, numbing their feelings, and being selfish. The art work ranged from depicting the situation to symbolically representing the feelings involved. This Art Therapy directive helped the patients be more aware of what can prevent them from feeling empathy, so they can more consciously work toward not letting that happen.

Termination in Supervision

One of my supervisees decided to move on, so during her last supervision with the group, I asked everyone to create an image that we could incorporate into one big "quilt" that we could hang on the wall. I expressed that I hoped the departing therapist would take what she learned from us with her in her future experiences, and that the image "quilt" that we made would symbolize that a part of her would always be with us at the hospital. This afforded the Art Therapists the opportunity to say good-bye and share memories and thank each other. Termination is an important process for the therapist to prepare her patients for her departure, and it is also important to engage in that process with colleagues.

Family Activity Directive

This week, I had my Empathy Group draw a memory of a family activity. Most chose a happy memory to depict, and I had them empathize with other members of their family from that time. Empathizing with their family brought up other issues, and some were able to talk about the abuse they suffered as children. Then I had some of them empathize with those same family members, after they had committed their sex offenses. They were able to talk about the effect their crimes had on their family, and be more aware of the impact of their crimes. This Art Therapy directive helped the sex offenders further explore their family dynamic and feelings surrounding their family relationships.

Empathy to promote a positive behavior

Since last week I had my group address a time they felt empathy and it prevented a negative behavior; this week, I thought we would explore a time when they felt empathy and it caused them to do a positive or pro-social behavior or act. They were all able to identify a time when empathy helped them do the right thing. A couple of the sex offenders talked about helping the elderly. One was able to discuss how feeling empathy for his elders compared to not having empathy for his victims. This Art Therapy directive helped the patients realize that they are capable of acting appropriately when they feel empathy, and they were encouraged to practice feeling empathy and responding in a positive manner on a regular basis.

Empathy preventing a negative behavior

This week, my group created drawings to represent a time they felt empathy and it prevented them from doing something negative. One group member reported that empathy for one of his friends prevented him from giving her drugs, after she revealed she was pregnant. The topic also brought up discussion about not doing something negative as a result of feeling empathy versus knowing right from wrong. Some patients were able to relate this Art Therapy directive to their sex offenses, a few of them admitting they had no empathy for their victims prior to offending. This exercise can help the offender be more aware of how empathy can help them do the right thing.

Lacking empathy directive

Since last week we had talked about a time each group member felt empathy for someone, I decided that this week, we should talk about a time each patient had lacked empathy for another person. Most talked about how it is difficult to have empathy for other patients who are hard to get along with. A couple talked about not having empathy for staff, though one did go back and try to fix the situation with the staff he felt he offended. So, that showed pro-social behavior as a result of feeling empathy for someone else. At the end of the group, I emphasized that it's important to be aware of when you feel empathy for another as well as when you don't, so then you can figure out what you can do about.

Recent Empathy Directive

Last week, I asked my Empathy group members think about a time they felt empathy for someone in the last 3 months and to create an image about that. It was interesting to see who each person felt empathy for. One patient, who was new to sex offender treatment, chose a character from a movie. He later admitted that it was safer for him to empathize with someone in a movie rather than in real life. Another patient empathized with the parents of a child who had been killed which he saw on the news. He was able to relate how those parents felt to how the parents of his victims felt. I'll use this Art Therapy directive on occasion to help the patients think about times they have felt empathy and to explore it a little more.

What is empathy?

This was the first week of a new quarter, so for the first session of the Empathy group, I asked the group members to create an image to represent what empathy meant to them. I had several new members, so this helped me get an idea of their thoughts and feelings about the topic. I had done this directive in the past, and one patient actually drew himself squished inside a boot, to represent putting himself in someone else's shoes. It was telling that he looked uncomfortable and had anxiety lines drawn around him. This quarter, most of the patients drew symbolic images to represent trying to feel or understand what another is feeling and going through.

Overwhelmed directive

Last quarter, I had the Empathy group members create an image about a time they noticed that someone else felt overwhelmed. This helped them to be in tune with different cues another person might be giving, such as body language or behavior. One patient drew about a peer who attempted suicide and how that peer tried to give away some of his belongings beforehand. It also led to discussion of how we can help others who seem overwhelmed. They were also able to relate the feeling of being overwhelmed with how their victims may have felt or still feel.

Supervision Exercise

This week in supervision, I asked the group to write a letter and/or draw a picture to one of the patients they were having a hard time with. I got this idea of the "unsent letter" from the book, Creative Supervision by Mooli Lahad. Some of the ideas from her book seemed a little out there or involved for my supervision group, but this free writing exercise was a big hit. It helped the therapists have an outlet for their countertransference. It helped them be more aware of it, so they are able to deal with their responses to these difficult patients better. One therapist wrote what she learned from the patient, another wrote phrases that she could actually use with the patient. You could even do this on your own to vent or gain insight. Just be sure not to put the patient's real name on it or leave it in an unsecured area! We'll definitely do this exercise again...

Feeling Embarrassed Directive

This week, I asked my Empathy group members to create an image about a time they felt embarrassed or humiliated. At first, some patients couldn't think of anything embarrassing that happened to them. We talked about how we sometimes repress those memories because the associated feelings can be painful to think about. I told them they should choose a memory that they felt comfortable talking about, as one patient said he didn't want to share some really embarrassing moments from his past. The patients were able to talk about their situations and feelings and relate their feelings to how their victims may have felt or still feel.

Group Drawing

This week in my Empathy group, I had the members create a group drawing. Each person had 2 minutes to add to the drawing and then it went around again and each person had a minute more to add to it. This was a good exercise about boundaries, and I also noticed that each person generally drew their own thing, not taking into consideration what the others had drawn. Each patient seemed pretty self-absorbed in his own thoughts, ideas, or issues. I pointed out that when this happens, he may have less empathy for others because he is so focused on himself. I then had them do another group drawing with the instruction to try to be a little more aware of what the other group members drew and what was going on for them. The second drawing was more cohesive and supportive than the first disjointed, disconnected one.

Empathy through music

For this directive, I listened to various classical music pieces and chose 4 different songs. I tried to find pieces that were upbeat, sad, angry, anxious sounding, etc. I played the first piece for the group and then asked everyone to draw the feeling they got from the song. They did the same thing for all 4 pieces and then got to talk about their art work and the feeling that inspired it. They were able to compare their art work, so it was interesting to see who got similar feelings from the same musical piece. This was a different approach, yet another way to help the patients tune into feelings.

Entitlement leading to decreased empathy

This week in my Empathy group, I asked the group members to portray a time that feeling entitled caused them to have decreased empathy for someone. Half of them were able to relate this directly to their crimes. A couple said that they felt entitled to sex which led up to their offenses. Many sex offenders have entitlement issues and related distorted thinking that they need to address. This directive helped them be more aware of how their feelings of entitlement caused harm to others.

A Valentine directive

In one of my Empathy groups, I asked the participants to create an image about a time they felt loved. This helped to remind them that they could be loved, which is a concept that many offenders struggle with. Some feel they do not deserved to be loved or will never be loved again. This directive helped them get in touch with this feeling better and could encourage them to talk about how to be able to attain that feeling again. One patient drew some flowers to represent the love he had felt from his older sister. Later, he reported that this exercise helped him to talk to his younger sister, who he felt was more accepting of him, about how his crimes impacted his family and his desire to make amends with his older sister.

Out-of-Control directive

I tried this directive with my group this week...I asked the group members to think of a time where they felt out of control. I asked them to depict that in an image, but using their non-dominant hand. After, each member was able to discuss the feeling and also the experience of using their non-dominant hand. Some said that using their non-dominant hand helped them get in touch with the out-of-control feelings better. They were able to relate feeling out of control to times they committed their crimes, and they were also able to relate their feelings to how their victims may have felt out of control as well.

Book Review--Challenging Experiences

I like the book "Challenging Experiences" by John Bergman and Saul Hewish. I once ran a Drama Therapy group to promote empathy with the sex offenders at the hospital. I used many exercises in this book which provides drama therapy ideas to help treat offenders. One exercise that was popular was to have the group break into pairs. The first person would start a conversation with the word "Fortunately" and the second person would counter with a statement that started with the word "Unfortunately." ("Fortunately, I have the day off." "Unfortunately, you have to clean your house.") This exchange could go on for a few minutes and the pair could switch roles. After, each person could talk about what the experience was like to be positive, negative, come up with a comment spontaneously, etc. The book is broken down into warm up, low intensity, and high intensity exercises, and how to process the experience. There were many different exercises provided that included visual, verbal, and kinaesthetic techniques. The patients in the group enjoyed the exercises and were able to learn about themselves, their coping skills, and their behaviors through this group.

Mail Art

One of the Art Therapists in my supervision group started a Mail Art group at the hospital. The patients can design and create their own greeting cards, post cards, and envelopes. It can be a great way for them to keep in touch with family and friends, as well as be creative and express themselves. There are many blogs about mail art and you can even submit your mail art to one of the many mail art exhibits out there! The above photo is a postcard made by a friend of mine who is an illustrator.

Act of Kindness Directive

In a Self-Esteem through Art Therapy group, I asked all the group members to do a random act of kindness for another patient sometime during the week. They would then come to the next group session and create an image about that experience. Some of the things that the patients did ranged from saying "Good Morning" to a peer he didn't like, to giving an old set of headphones to a peer who had an old damaged pair, to giving a peer some extra greeting cards because he knew that peer liked to send cards to his family. Doing something nice for someone else helped the patient feel good about himself and also helped him practice pro-social behavior.

Altered Books

Two Art Therapists in my supervision group have started an Altered Books group. They bought a various hard cover books at the local thrift shop (picture books, travel books, novels, etc.). The patients get to choose a book that appeals to them and then can alter the book to convey their story. The group facilitators offer directives to encourage the patients to think about themselves and express their feelings. A multitude of collage materials are offered as well as paint and drawing materials. Many issues have come up through this process which have been very revealing. This is an innovative and fresh way of providing Art Therapy for a variety of populations.