ATCBE- Made

 Cognitive Behavioral Therapy (CBT)

Approach that focuses on the connection between thoughts and feelings. Aims to identify and change negative patterns of thinking and behavior.

“Personal construct system”- how one views the world  (all people to be good, all people to be bad), can be verbal and nonverbal, art can problem solve problems, connection between thoughts and feelings, increase in sense of control over their own life

1. Draw personal constructs or “mind states”

Trauma-informed Therapy

1. Trauma is a common experience and can have a lasting effect, avoid re-traumatization, empower by providing a sense of control, create a safe and supportive environment 

2. Art therapy can activate brain activity which can help reprocess traumatic memories

   1. Self-expression, emotion regulation, reduces trauma symptoms, reduces depressive symptoms, enhance self-confidence/ self-esteem, and enhance mental resilience

   2. Cathy Malchiodi (AT) integrated trauma-informed care with art therapy

Humanistic

1. 3 assumptions: 

   1. Emphasis on life problem solving 

   2. Encouragement of self-actualization through creative expression

   3. Emphasis on relating self-actualization to intimacy and trust in personal relations and the search for self-transcendent life goals

2. 3 goals 

   1. Goal is to find balance between polarities (love  and anger) in a nonjudgmental environment 

   2. Goal not to get rid of negative emotions, transform their feeling sinto honest expressions (authentic expression)

   3. Goal is healthy mind in a healthy body in a healthy spirit in a healthy world

      1. 4 I’s (integrity, identity, individuation, and idealism), 3 C’s ( care compassion, and concern) and 3 A’s (authenticity, autonomy, and actualization or self)

3. Garai (AT) pioneered humanistic approach to art therapy

Gestalt Therapy

Founded by Fritz Perls (humanistic)

1. Experiential approach, active participation and enactment, sensory motor activation leads to recognition and clarification of problems

2. Mala Betensky (AT) combined phenomenological approaches with Gestalt to work with children and families through art and play

3. Janie Rhyne (AT) developed “Gestalt art experience”, allows for a range of personal expression, visual, sound, body language, and verbal communication

Existential

1. Concepts of personal freedom, meaning, and the search for values (humistic approach)

2. Therapy is about pushing the client to find meaning and purpose in their life and living authentically

3. Bruce Moon (AT) art expression as a personal search for meaning and creativity is important part of health, focused on dream image in art, responsive art making, responding to the artwork with conversation, the process is more important than the product 

   1. Six aspects of existential art therapy: 1. The capacity for self-awareness, 2. Freedom and responsibility, 3. Creating one’s identity and establishing meaningful relationships with others, 4. The search for meaning, purpose, values, and goals, 5. Anxiety as a condition of living, and 6. Awareness of death and nonbeing

   2. Questions: who am I, who have I been, and where am I going

Transpersonal

1. Yearning for spiritual unfolding as part of human growth and development Maslow (humanistic approach)

2. With art therapy addressing the mind-body concepts and spiritual practices, contemplation and meditation

3. Maintain the person’s intrinsic ability to achieve growth and health

4. Art therapist address person’s need to improve other areas of life such as relationships or life satisfaction, recognizing spiritual emergencies (emotional crises, serious illness, or death)

5. Art help explore “beyond the self”

Adlerian Therapy

A short term, goal oriented, and positve psychodynamic approach developed by Alfred Adler. Feelings of inferiority (discouragment or sense of belonging with in community) can produce negative behaviors.

Foucus on development of individual personality while understanding and accepting the impact of connection to people (community, family, society)

Asspects include: Engagement, assessment, insight, and reorientation

Art therapy: can explore early memories, dream, strengths, and social interest

Psychoanalytic

1. Freud

   1. Three layers of and individuals mind: conscious, preconscious, and unconscious 

      1. Unconscious motivates behaviors and art can provide insight to the subconscious

   2. Transference- is the projection of irrational feelings by the client onto the therapist or artwork

   3. Countertransference- projection of irrational feelings by the therapist onto the client or artwork

   4. Sublimation- change an impulse to a socially acceptable bx (could be a goal with art material)

Family Systems

1. Life cycle- identifiable and predictable phases and crisis points, generational trauma 

   1. Genograms

2. Communication/ Behavior- is done in a circular way, families will respond to “deviant” behavior in circular or dysfunctional way to reach homeostasis 

3. Structure- implicit rules that govern the emotional relationships within the family (emotional or physical boundaries)

4. Unconscious life of the family- unconscious subjective life of attachments, thoughts, emotions, and representations of self and others that are internal in each member

5. Hanna Yaxa Kwiarkowska began work of family art therapy, developed Family Art Evaluation(1958)

   1. Use of art to heal and grow while thinking systemically, by engaging some or all of the family members

   2. Draw the following: free drawing, family drawing, abstract family picture, picture initiated by a scribble, joint family scribble made together, and free scribble individual

Positive Psychology

1. Approach to understand and enhance well-being by identifying paths such as positive emotions, strengths, relationships, and gratitude

   1. Gratitude 

   2. Engagement - finding purpose and flow in activities and relationships

   3. Accomplishments- achieving goals and experiencing a sense of pride

   4. Positive emotions

   5. Strengths

2. Art therapy help access “flow”, increase positive emotions, highlight strengths, identify meaning, increase sense of wellbeing and happiness

Solution-Focused

1. Identify the problems and work together to come up with solutions

   1. Problems formed due to faulty attempts to problem solve

2. Selekman (AT) Art therapy less threatening way to look at problems and see solutions, enhance partnership 

   1. Helps with resistance, exception  questions, the miracle question, and facilitating change

Attachment Theory

1. Looks at how early experiences shape our connection to others

   1. Ambivalent attachment, avoidant attachment, disorganized attachment, and secure attachment

2. Art therapy is used to help people understand and improve their relationships

   1. HElps identify and address relational issues

   2. Explore attachment patterns through creative expression

   3. Help client heal attachment wounds and improve relationships

   4. Support secure attachment by acknowledging and responding to a child’s needs

   5. Encourage nes capacities for emotional bonding

   6. Art therapy can tap into relational states that existed before words are dominant

   7. Art therapy can help process highly charged experiences

Erkson Developmental Stages

1. Trust vs Mistrust: 0-2 basic needs will be met, nourishment and affection

2. Autonomy vs Sharing: 2-3 learning to control and let go, independence in may tasks

3. Initiative vs Guilt: 3-5 develops right and wrong, may develop guilt when unsuccessful or boundary overstepped

4. Industry vs Inferiority: 5-13 develop self-confidence in abilities when competent or sense of inferiority when not

5. Identity vs Confusion: 13- 21 experiment with and develop identity and roles

6. Intimacy vs Isolation: 21-39 establish intimacy and relationships with others

7. Generativity vs Stagnation: 40-65 contribute to society and be part of a family

8. Integrity vs Despair: 65 and older asses and make sense of life and meaning of contributions

Piaget Developmental Stages

1. 0-2 Sensorimotor exploration through body trail and error process object permanence

2. 2-7  Preoperational egocentric learns to use symbolic substitutes learns to classify

Lowenfeld Developmental Stages

1. The scribbling stage: 2-4  manipulative random scribble controlled manipulation named manipulation early shapes

2. The preschematic stage: 4-7 representation of a person cephalopod house/tree/animal no particular schema

3. The schematic stage: 7-9 the achievement of a form concept, emergence of a baseline, natural colors, and identifiable shapes

4. Drawing realism/The gang age: 9-12 the dawning of realism and perspective

5. The pseudo-naturalistic stage: 12-14 the age of reasoning, value of light

6. The decision/ Crisis of adolescent art: 14-17 the period of decision

Hartley, Frank, and Goldenson Developmental Stages

1. Exploration and experimentation, 0-2 Manipulation water play and block play

2. Product-process phase 2-4 process of manipulation without intention creation of accidental form product itself important, not the representation

3. Representation of image 4-7 with intention beginning of fantasy

Rubin Developmental Stage

1. Manipulation 0-2 mouthing materials, Forming more conscious control

2. Naming 2-4 associating to the form, Representing qualities of object, Containing creation of boundaries

3. Experimenting 4-7 exploring different ways of doing

Williams and Wood Developmental Stages

0-2 Stage- Responding to the environment with pleasure sensory arousing art media as a means of motivation learning to trust

2-4 Stage 2- Learning skills that bring success able to use basic art tools and supplies shapes beginning to emerge

Dialectical Behavioral Therapy (DBT)

1. approach that uses CBT techniques with a focus on mindfulness and behaviors

2. Four areas of focus: interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance

3. Behavior is learned and enforced by the environment 

Motivational Interviewing (MI)

1. Client-centered approach that helps explore the barriers to change and reaching goals, empower clients to identify strengths and take ownership of their health and well-being, creating lasting change.

   1. 5 Rs : relevance, risk, rewards, roadblocks, and repetition

   2. Fosters empathy, supporting self-efficacy, in a collaborative environment

Transtheoretical Model (TTM)

1. Guide clients through the process of changing their behavior (motivational interviewing approach)

   1. 6 stage of change: precontemplation, contemplation, preparation, action, maintenance, and termination

      1. Precontemplation: no intention to change in the near future

      2. Contemplation: awareness of problems and considering making a change

      3. Preparation: getting ready to change gathering info and planning steps

      4. Action: changing behavior and making observable lifestyle changes

      5. Maintenance: maintaining the behavior change and presenting relapse

   2. Factors that influence change; decisional balance, self-efficacy, and processes of change

Florence Crane

(influenced by psychoanalytic) developed Scribble Drawing, Art teacher

Margaret Naumburg

1. (influenced by psychoanalytic “Freud”) psychologist and psychotherapist, first to note that art therapy is a separate profession

   1. “The mother of art therapy”

   2. Dynamically Oriented Art Therapy

   3. Art as Psychotherapy or dynamically oriented art therapy

   4. Art can be used to express the unconscious fantasies, daydreams,and fears (free association)

Edith Kramer

1. creative process is healing

   1. Second mother of art therapy: “Art as therapy”

   2. Sublimation 

   3. Assessment of personality and developmental level

Don Jones

responsible for the growth of art therapy in ohio, developed expressive arts program

Elinor Ulman

started The American Journal of  Art Therapy (1961)

Viktor Lowenfeld

Art educator, children's art strategies. (1952)

Stages of artist development

1. The scribbling stage: 2-4  manipulative random scribble controlled manipulation named manipulation early shapes

2. The preschematic stage: 4-7 representation of a person cephalopod house/tree/animal no particular schema

3. The schematic stage: 7-9 the achievement of a form concept, emergence of a baseline, natural colors, and identifiable shapes

4. Drawing realism/The gang age: 9-12 the dawning of realism and perspective

5. The pseudo-naturalistic stage: 12-14 the age of reasoning, value of light

6. The decision/ Crisis of adolescent art: 14-17 the period of decision

Mala Bentensky

- Pioneered phenomenological theory of art expression. (humanistic)

-enhanceming self-awareness through the use of art material

-Feel out different media. Hang image up “phenomenological intuiting”. Then think about the question “what do you see”

Helen Landgarten

developed an assessment technique using photographic collage

Expressive Therapies Continuum (ETC)

1. Kinesthetic/ sensory (action) level: infant and toddlers, sensory experience, influence the understanding of emotion and development of memory

   1. Lower functions of the brain

   2. Interacting with art in an exploratory way

   3. Kinesthetic: movement and motor activity (free movement or scribble)

   4. Sensory: tactile or other senses to explore media (finger painting)

2. Perceptual/ affective (form)level: drawing include emotions, way to explain and contain their impulses and emotions, perspectives

   1. Can identify emotions, facilitate discrimination among emotional states, and appropriately express emotions

   2. Limbic system

   3. Perceptual: using lines and colors to create form through a painting

   4. Affective: creating a piece of music to convey an emotion

3. Cognitive/ symbolic (schemas)level: adolescence, processing info outside of their own experience, images can have humor, irony, or sarcasm, use of symbols representing thoughts, feelings, or events

   1. Cortical functions

   2. Use of art for problem solving, structuring, and seeking meaning

4. Creative level: Structured to unstructured art material, functioning with all levels or within a level

Jungian

1. Unconscious images connect back to the person and archetypal and become conscious by curiosity and dialogue with the image

   1. Images connect to the past, present, and future

   2. Key is to identify an individuals archetypal factors, to live within their myth rather than be lived by it

      1. Archetypes: The innocent, The orphan, The hero, The caregiver, The explorer, The rebel, The lover, The creator, The jester, The sage, The magician, and The ruler 

      2. Shadow- denied or feared parts of ones personality

      3. Animus or anima- male and female

      4. The persona- a mask we present to the outside world, the roles we play and the expectations we fulfill in society

   3. Goal is to trust the archetypal figures as a source of insight and creative development

2. Art therapy use the artwork allows a buffer, filter, screen or container, it mediates between patient and therapist

   1. Naumburg and Cane were inspired for their child-centered approach 

   2. Relationship client has with the art material is important to the process

Behavioral

1. Identify specific problem behavior, history is taken to learn cause and effect relationship of problem behavior, trusting relationship with agreed upon goals, techniques are used to change behavior. 

   1. Operant conditioning, shaping, prompting, positive reinforcement, systematic desensitization, and modeling

   2. Reality shaping- education during processing art by identifying a concept poorly conveyed, then make this concept by increasing complex two and three dimensional models. Concepts that may be vague and made concrete

2. Acceptance and commitment therapy (ACT)

   1. Approach stops avoidance, denying, and struggles with emotions by accepting that feelings are appropriate in certain situation, which leads to an acceptance of hardship and commitment to change

Eco-Art therapy

1. Heal the separation between the persona and the natural environment

2. Materials can be anything found in the environment, which can help connect to the seasonal cycle, regional plants, and animals

3. Richard Louv coined the phrase “nature deficit disorder”

Internal Family System (IFS)

1. Everyone has a multiple minds or parts, recognizing the parts can lead to healing

   1. Managers- protective parts, control surroundings, manage emotions, and daily living task

   2. Exiles- locked away, hold fear, hurt, or shame, carry difficult emotions or memories

   3. Firefighter- help manage overwhelming, painful feelings any way possible (binge eating/ substances)

   4. Self- 8 Cs and 5 Ps of self, help the parts, don’t have to run the system, distrust in self didn’t help when trauma happen and allowed parts to get exiles, (place of mindfulness of enlightenment, higher self), need to access self

   5. Mapping

2. Art therapy helps make the inner world visible

Somatic Approaches

1. Techniques that focus on the body and its relationship to the mind and emotions, release damaging emotions in the body with mind-body techniques, caused by trauma

   1. Techniques: acupressure, hypnosis to breath work, dance, body awareness, pendulation, titration, and resourcing 

2. Art therapy can help with mind body integration, through exposure to a variety of art material, neuroplasticity, and emotion regulation

Feminist Theory

1. Wellness is connected to social, cultural identities, and the political environment that one lives in

2. Equality between therapist and client (authentic connection), provides an understanding of how social factors affect mental-health, discovering of identity, and development of strengths

3. Art therapy: intersectionality, empowerment/ agency, collaboration/ egalitarianism, and social justice/ activism

Systems Theory

Goal is homeostasis within a system or group. When creating a new system it must work for all members, expectations, needs, desires, and behavior. Issues aren’t a result of one person, it is due to a breakdown in the system

Kinesthetic/ sensory (action) level (ETC)

1. infant and toddlers, sensory experience, influence the understanding of emotion and development of memory

   1. Lower functions of the brain

   2. Interacting with art in an exploratory way

   3. Kinesthetic: movement and motor activity (free movement or scribble)

   4. Sensory: tactile or other senses to explore media (finger painting)

Perceptual/ affective (form)level (ETC)

1. drawing include emotions, way to explain and contain their impulses and emotions, perspectives

   1. Can identify emotions, facilitate discrimination among emotional states, and appropriately express emotions

   2. Limbic system

   3. Perceptual: using lines and colors to create form through a painting

   4. Affective: creating a piece of music to convey an emotion

Cognitive/ symbolic (schemas)level (ETC)

1. adolescence, processing info outside of their own experience, images can have humor, irony, or sarcasm, use of symbols representing thoughts, feelings, or events

   1. Cortical functions

   2. Use of art for problem solving, structuring, and seeking meaning

Creative leve (ETC)

Structured to unstructured art material, functioning with all levels or within a level

 Bridge Drawing

1. All ages

2. Understand functioning, perception of their environment as a stable place, and perception of movement

3. Draw a bridge going from some place to some place

 Kinetic-Family-Drawing (KFD)

1. Burns and Kaufman (1972) 

2. Age 5-20

3. Understand children self-concept and interpersonal relationship, family dynamic

4. Draw a picture of everyone in the family including yourself DOING something

5. White paper (8.5 x 11), #2 lead pencil

Kinetic School Drawing

1. School age children

2. Understand child’s relationships within the family and school setting

3. “Draw a school picture, put yourself, your teacher, and a friend or two in the picture. Make everyone doing something. Try to draw whole people and make the best drawing you can. Remember draw yourself. Your teacher, and a friend or two, and make everyone doing something”

House-Tree-Person (HTP)

1. All ages, Buck (1987)

2. Understand their personality, behavior pattern, and interpersonal interactions 

3. H-T-P drawn on three pieces of paper

4. Six sheets of white paper (7x8.5), #2 lead pencils, and wax crayons

Kinetic House-Tree-Person (K-H-T-P)

1. All ages

2. Helps with understanding the client in multiple situations, visual metaphor of self with storytelling

3. Done on one piece of paper (8.5x 11)

Person Picking an Apple from a Tree (PPAT)

1. All ages

2. Assess the process and how the image is drawn rather than the content (objective rather than subjective content), how people draw instead of what people people draw

3. 12× 18 white paper, pack of 12 Mr. Sketch marker (black, brown, orange, red, yellow, green, dark green, hot pink, magenta, purple, turquoise, dark blue

Bird’s Nest Drawing (BND)

1. All ages, children with attachment disorders or substance abusers likelihood of relapse

2. Understand attachment style and insight into past attachments

Draw-A-Person-In-The-Rain (DAP-R, PIR)

1. All ages

2. Understanding vulnerabilities, environmental stressors, supports, and coping strategies

3. 8.5 × 11 white paper, two #2 graphite pencils

 Draw-A-Story (DAS)

1. Ages 5+

2. Assessing for depression, also can be used with children who were abused, brain injured, or emotionally disturbed

3. Choose two subjects from stimulus drawings then imagine something happening between the images they select

Diagnostic Drawing Series (DDS)

1. Adult/ adolescent assessment of cognitive capacity, behavioral , and affective states. Provides info on strengths, defenses, and issues, and response to structured and unstructured drawing tasks

2. Done within 3-5 days of admission

3. Three parts: free drawing, tree drawing, and drawing of feelings using lines/ shapes/ colors

4. Bbox 12 Alphacolor square pastels, three sheets of white drawing paper (18x24), and Krylon Crystal clear spray fixative

Road Drawing

Visual timeline of past, present, and future experiences, may explore current decisions about the future and obstacles in their life

The Levick Emotional and Cognitive Art Therapy Assessment (LECATA)

1. Age 3-11

2. Measure normal emotional and cognitive development of children, identify defense mechanisms 

3. Free art task and story about the complete image, drawing of the self, scribble with one color and picture created from the scribble. A place you would like to be (3-5 yrs of age), a place that is important to you (6-11+ yrs of age) and a family

4. White drawing paper and sixteen oil pastels

Belief Art Therapy Assessment (BATA)

1. No age limit

2. Designed to understand the spiritual dimensions of client, interpretation based on the client’s developmental level, subject matter, formal qualities of artwork, and client attitude

3. “.. if you believe in God, draw, paint, or sculpt what God mean to you”

4. Variety of paint, 3-d media, and drawing material

Face Stimulus Assessment (FSA

1. Children and older

2. For clients who are nonverbal or have communication disorders, especially for use with multicultural populations

3. 8 pack of Crayola markers, 8 pack of Crayola multicultural markers, stimulus picture #1, 2, and 3, 1 white xerox paper (8.5x 11) of the complete face stimulus, 1 white xerox paper (8.5x 11) of the outline of the face and neck, and 1 blank white xerox paper (8.5x 11)

Formal Elements Art Therapy Scale (FEATS)

1. Children and older

2. Designed to correlate with psychiatric symptoms scoring is based on graphic equivalents of psychiatric symptoms, 14 scales include: prominence of color, color fit, implied energy, space, integration, logic realism, problem solving, developmental level, details of objects and environment, line quality, person rotation and perseveration

3. “Draw a person picking an apple from a tree”

4. White paper (12x 18) and pack of 12 Mr. Sketch watercolor markers 

Family Art Evaluation

1. Use of art to heal and grow while thinking systemically, by engaging some or all of the family members

2. Draw the following: free drawing, family drawing, abstract family picture, picture initiated by a scribble, joint family scribble made together, and free scribble individual

Mandala Assessments Research Instrument (MARI)

1. Assist in treatment planning, assessing progress

2. Oil pastels (set of 48), white drawing paper (12x 18)

3. Outline a circle with a pencil around a plate (10.5 inches), then use oil pastels to fill the circle

   1. “Try to center and balance within the circle because it will help you feel center and balance. Think of things in nature that open from the center, like flowers and snowflakes. You are part of nature and you have a center which you want to keep open and flowing, start in the center, your center with a shape and a color and let your design flow from there”

Silver Drawing Test (SDT)

1. Ages 5 and older

2. Assess cognitive abilities in three areas: sequential concepts, spatial concepts, and association/ formation of concepts

Session Closure

Interview skill

Final session, providing a structured opptunity for the client and therapist to acknowledge the progress made, discuss future plans, and encure a smooth transition out of therapy, promoting closure and fostering continued growth

Reflective listening

Interview skill

Actively listen to speaker, relect back their message and emotions, to show an understanding and buld rapport

Summarizing

Interviewing skill

Reflecting back key points and themes to ensurse calarity, validate understanding, and promote client self-refection and motivstion for change

Comprehensive intake and ongoing evaluations include the following

-coduct biosocial evalutation (biological, social, and psychological factors)

-obtain demographic info/ relevant history

-assess the reason for referal/ presenting problems

-determine the current level of functioning

-mental status (appearance/ bx, speech, mood/ affect, thought process/content, cognition, and insight/ judgement)

Group Therapy Theory

1. Promote growth, self-understanding, and diagnostic opportunities by illuminating the here and now

2. “Group mind” do or say thing wouldn’t do alone

3. Assumptions- fight/ flight, dependency, and basic assumption pairing can be experienced by anyone in a group

4. Yalom 11 therapeutic factors: instillation of hope, universality, imparting of information, altruism, the interpersonal learning

5. Art therapy in groups

   1. Three types: studio based, theme or task focused, and process oriented group

Crisis intervention

Short-term, urgent approach designed to address a crisis situationa nd reduce the risk of harm

-goal stablize, address the immediate crisis, help retuen to pre-dridid level of functioning

1. Suicidal ideations- alleviate the immediate discomfort and desperation 

   1. Signs: final plan formation, direct verbal warnings, acutely depressed behavior, social behavior changes, history of suicidal behavior or ideation, drug and alcohol use, and concern of support system

Witnessing

Art therapy skill

Therapist creats a safe space for the cleint’s creative process by being present and attuned to their art, process, and emotions, without judgement or intervention, allowing the cleint to explore and express themselves freely

Intention Setting

Art therapy skill

using the creative process to translate abstract ideas and aspirations into tangible forms, engage emotionally, foster mindfulness, and bild a rituatl that grounds and inspires

-Examples; vision board, symbolic art, color exploroation, mindful creation

Supervision Models

-Traditional; supervisor is the expert, focus on skills

-Cognitive Behavioral- focus on thoughts, feelings, and behaviors

-Humanistic- Existential; foucus on personal growth and development

-Psychodynamic; focus on theraputic relationship, transferance and countertranserance

-Intergrative; use of mutiple theoretical orientations baised on the needs of supervisee