Gratitude Tree

For one art therapy supervision, we created a Gratitude Tree. Each person cut out several paper leaves. Then we wrote down things we were grateful for, skipping the obvious "friends and family" ones. One art therapist was thankful for small health advances made after major surgery. Others wrote their favorite foods and drinks. Spa days, TV shows, and travel experiences were other items written. Then everyone helped make the tree trunk and branches, and we taped it to the wall and added our leaves. The tree looks cool, and we made an envelope with blank leaves, so more could be added. It was a nice self care activity to remind ourselves of thing we enjoy and appreciate. It also served to help the group get to know each other better. 

Power Thought Cards

For supervision last week, I asked everyone to fold their paper in half. I asked everyone to create an image on one side of a problem, difficult patient, or challenging situation. After they did that, I passed around some Power Thought Cards (box of 64 by Louise Hay) with various sayings on the front and back. I asked everyone to choose one that resonated with them or related to the image they drew, and then create another image on the other half of the paper related to the card they chose. Some therapists drew about a challenging patient, other's drew about difficulties with other staff. The Power Thought Cards served as an inspirational idea or a positive affirmation. The cards are useful in groups with patients as well. I used them in my poetry group as inspirations for poems, and in my Visual Journaling group as inspiration for stress management and coping skills. 

Setting professional goals

In a recent art therapy supervision, I asked everyone to think about their professional goals as an art therapist, either short or long term. Sometimes setting specific goals and/or talking about them can help us motivate ourselves and enable us to help and support each other in our endeavors. One therapist talked about working on some personal issues that would help her interactions with others. Other therapists talked about working toward their ATR or other licensure. One shared about an interest in play therapy while another said he would like to become a psychoanalyst. Attending trainings, presenting at conferences, and doing research were also discussed. It was a good way to learn about each other, and I talked about the importance of helping our patients set and meet their goals as well. 

Boundaries workshop

At a recent conference in a forensic setting, another art therapist and I had the opportunity to offer an art therapy experiential on boundaries. We asked participants to think of a time that a patient crossed their boundaries and to create an image about that. Participants were invited to show their art work and talk about their experience. One person talked about a patient who grabbed her, another shared about a patient who was being manipulative with him, and another new staff told of a patient trying to intimidate her. Discussion included ways to develop rapport with patients without physical touching and setting clear verbal limits as well as other ways to deal with patients with poor boundaries. Participants were able to offer each other feedback and tips. The group discussion illustrated that we were not alone in our challenges in dealing with boundary issues with a difficult population, and were indeed able to support one another. 

Termination issues

We have an art therapist who is retiring soon, and he is concerned with how to terminate with patients at the hospital--on his unit, and in his groups. I asked everyone in the supervision group to create an image about a time they had to say goodbye to someone, and then asked them to think about the feelings they had at the time. These feelings are comparable to what the patients feel when they have to say bye to therapists who leave the facility, but because they are patients with various issues, their feelings may be amplified, difficult to identify, and harder to express. We discussed how it is the therapist's responsibility to give the patient enough time to process his feelings and still have the opportunity to talk to the therapist about those feelings. 

Self-disclosure directive

One of the art therapists suggested this topic, so in supervision, I had everyone make a collage of info or topics they felt comfortable sharing or talking about with patients, and those they were not comfortable with. One therapist said she talked about her dogs in the pet therapy group while another therapist said she never talks about her pets with the patients. We discussed times we revealed too much, we overheard other staff disclosing too much, and what to do if you felt your co-facilitator was sharing personal information during a group. We also talked about how to deal with patients who ask personal questions, as sex offenders commonly do. Everyone has his or her personal boundaries, and the therapists were asked to think about theirs, and when sharing personal information to think how or if it is therapeutic and beneficial for the patients to know. 

Bob Ross and mural making with patients

When I first started working at the hospital, I ran a mural group to help the patients with their interpersonal skills as well as make a group mural that could be displayed in the hospital. Each group that I ran had difficulty making decisions in order to actually complete a group mural. Recently, a patient became interested in learning to paint via Bob Ross DVDs. He became proficient in the techniques and got peers interested in painting. A small group of patients decided to paint a mural using a Bob Ross instructional DVD. They were able to work together and complete a 4'x6' mural in about 10 hours. They got a couple of other patients interested in mural painting, and they recently completed their 3rd mural. The first one is hanging in the Visiting Room as a backdrop for photos. The use of the DVDs ensured success and prevented the need for a group leader to make compositional or technical decisions. The patients worked companionably, helping and supporting each other. This was a helpful tool to use with populations that are narcissistic or otherwise have difficulty working with others. 

Meditation using art

I was reading about all the benefits of meditation, so I've been trying to practice it more. In a recent Art Therapy supervision, I handed out a bunch of images of art work cut out of a desk calendar that a colleague gave me. I asked everyone to choose an image that appealed to them, and put it in front of them. Then, we closed our eyes and focused on our breathing for a few minutes. Next, we opened our eyes and looked at our image, observing the colors, lines, composition, etc. After that, I asked everyone to to close their eyes again, and imagine stepping into the image, then explore it.  Then, we "exited" the image, and opened our eyes.  I then had everyone create an image about their meditation experience. One person said she had had a headache all day, and that it went away after our short meditation. This can be done as a supervision exercise for self care or as a directive with patients.

Supervision--Feeling frustrated

After a few frustrations with patients during the week, during supervision, I asked everyone to create an image about a recent frustration. I was thinking everyone would have a work related frustration, but most images were about frustrations about life in general, from medical issues to buying a house, to dealing with friends' issues. Then I realized that while everyone probably had experienced frustrations with patients or staff during the week, their other frustrations might be more troublesome or even impact their work, if not dealt with. It was a good opportunity to vent and to also gain support from others, which was the main point of the exercise in the first place.

Yourself represented by the natural environment

During a recent Art Therapy supervision, I asked for a suggestion for a directive. One therapist asked us to draw ourselves/energy as an element in nature. It was very interesting that each of us chose something different, from a volcano to a tornado to lightening to wind to a body of water. Each of us got to say how our drawing represented our personalities, and we were able to hear feedback from peers that offered us a different perspective. A good directive for supervision or an Art Therapy group/session.

Art Therapy Poster Presentation

I recently had the opportunity to present a poster at the Forensic Mental Health Association of California conference. The poster was on The Use of Art Therapy to Address Dynamic Risk Factors with Sexual Offenders. The poster gave a description of Art Therapy, listed some dynamic risk factors for sex offenders, outlined how we facilitate Art Therapy at the hospital, and displayed some patient art work. This was my first poster presentation, so it was good experience for me. I had to convert a PowerPoint presentation to fit onto a poster. I struggled with the layout, and sought out feedback from peers. Then I had to figure how to use spray adhesive! At the conference, I was able to meet and interact with many different people and answer questions about my poster and where I work. I try to present at conferences to help other disciplines learn about Art Therapy and how it can be helpful with their clients, as well as challenge myself professionally.

What makes a good facilitator/staff member?

Today in Art Therapy supervision, I asked the Art Therapists to make a list of characteristics they thought a good facilitator/therapist/staff member should have to work with the forensic populations that we treat at the hospital. After everyone made their list, I gave them a list of qualities that was complied from patients when I asked them the same question. We compared our list for overlaps and differences. There were many overlaps including empathy, being authentic, and challenging the patient. Many of the therapists listed good boundaries while none of the patients did. When I was having the patients do this exercise, I asked them why they didn't list boundaries, and they said that it was a given. Though, obviously, from staff's perspective, and in reality, it's not a given at the hospital. Then I asked the Art Therapists in supervision to create an image about one of the listed (patient or staff) qualities that they would like to work on or improve. Many of the therapists responded to one characteristic a patient listed about the ability to break down barriers. Other images included using diplomacy, facilitating group dynamics, and being a positive role model. The topic brought up interesting discussions and food for thought. 

Music and Art Therapy Directive

A Music Therapist colleague and I facilitated a Music and Art Therapy session to try to foster more interdisciplinary groups within our Rehab Department. She sang and played the song "Demons" by Imagine Dragons on her guitar. We then asked the patients to create an image relating to the song or what they got from it. Some images depicted darkness and difficulties while some exhibited support and hope. One patient drew his inner child behind a brick wall, and spoke about protecting his inner child. The patients had positive comments about the combination of the modalities, and later the staff discussed possible groups that could be done using Music and Art Therapy. We discussed empathy groups, lyric analysis, and healing as potential group themes. It seemed like a helpful way to encourage collaboration and a better understanding of each other's disciplines. 

Exploring Entitlement through Art Therapy

Next quarter we are starting a new Art Therapy group to address the high risk factor for sex offenders of excessive entitlement.  We ran a pilot session with a group of patients and asked them to draw a time they felt excessively entitled and how they handled it. They were all able to think of an incident right away, and a few of them were able to relate feeling entitled to committing their crimes. Other examples included one patient who wanted to cash a check at a bank, but was told he had to wait until it cleared, so he got angry and yelled at the staff until he was asked to leave, and another patient who plays sports and feels entitled to take his anger out on other players. We asked the patients for feedback on how to make the group more appealing to patients since it is a challenging topic and many patients may be in denial of being entitled. It was helpful to have actual patient input, and to see how well the patients could do with the topic. 

Supervision Directive--Getting Feedback from Peers

An Art Therapist who went to the recent AATA conference shared a directive from a workshop he went to. He asked us to write down something at work that was bothering us. Then he asked us to create an image about our difficulty. He gave everyone a pad of post-it notes, and asked everyone to look at each other's art and writing, and to write a note to that person with words of advice or support or encouragement. After, everyone could read what the others wrote, and maybe gain a new perspective, or find something that resonated for him or her, or just feel supported.  It was a helpful exercise, and one that could also be used with patients.

Art Therapy sessions during supervision

I like to observe my supervisees facilitating an Art Therapy group which helps me when writing up their ATR paperwork, but due to my schedule, it's been hard to do that. So, on occasion, we have been able to run special Art Therapy sessions during our supervision time with volunteer patients. This has worked out well as we can all learn from each other. We have a diverse group of 19 Art Therapists with different backgrounds, and therapy styles.  It is also beneficial in that we can later discuss the patient art work and their process and all be familiar with them. This is also a good way to introduce Art Therapy to a patient who has never done it before.

Self Esteem through Art Therapy

We are starting up a Self Esteem through Art Therapy group for the sex offenders and the mentally ill inmates, so during supervision, we all brainstormed directives. I asked everyone to think about the Good Lives Model and also high risk factors for sex offenders, so we could reference those when we write up the lesson plan. Everyone had great ideas from a collage of what the patient is good at to drawing himself as a superhero to puppet making and role play. The great thing about making the lesson plan a collaborative effort is that we came up with a variety of creative and effective directives for a 12 week quarter.

Art Therapy with Forensic Population

Due to a recent loss of a tool during a studio group, we've had to overhaul our procedures for handling tools in the Art Center. When I first started at the hospital when it opened, I had no experience with forensics, and did the best I could in setting up policy and procedure. Through an on going learning process, I've discovered that a good part of forensic Art Therapy includes safety and security. Every item has its place. Everything is labeled. Items must be specifically checked out to patients. Every tool has to be accounted for. Every sharp and hazmat has to be disposed of properly. Back stock inventory must be accurate. We are constantly organizing and counting items. This is obviously time consuming and frustrating, and still subject to human error.  It takes adjustment and flexibility on the part of staff and patients. However, when the environment is safe, then that creates a space where therapy and healing can take place.

Empathy through Art Therapy with Mentally Ill Inmates

I recently started an Empathy through Art Therapy group with our small population of mentally ill inmates at the hospital. In our first group, I asked them to create a picture of what empathy means. Some didn't really know, so first we discussed what empathy is, and gave some examples. We also talked about the difference between empathy and sympathy. Some still had some difficulty with the concept, but they were all willing to give the directive a try. One man drew several faces of a person trying to have empathy for another person.  Other patients drew about their own experience of feeling empathy for someone else. I hope this group can help these patients understand better what empathy is, and help them practice feeling empathy for others, in an effort to help them to not re-offend.

Helping New Staff

In supervision recently, I asked everyone to create an image with her/his best advice for a new Art Therapist who just started working at the hospital. Since the rest of us had been working at the hospital from a few months to several years, we all had various tips and suggestions for working with the sex offenders. The images included themes about asking questions, walking purposefully, self care, not losing your keys, and telling patients "I don't know, but I'll get back to you."  It's overwhelming to start work in a large, bureaucratic institution, so it's good to have as much support as possible in the beginning. We all gave our drawings to the new Art Therapist to refer to down the road.