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Enhancing Your Therapy with Gestalt Approaches
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Section 22
Interpreting Clients' Choice of Materials in Gestalt Art Therapy

CEU Question 22 | CEU Answer Booklet | Table of Contents | Gestalt
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Betensky (1987), a phenomenological art therapist, regarded art materials as active partners that challenge the patients' senses, and stimulate both their emotional arousal and their awareness. She saw the art material painting Therapy with Gestalt Approaches social work continuing educationas becoming a part of the patients' phenomenological field. Materials can enable the patient to maintain, through them, a dynamic, interactive relationship with processes that are otherwise mostly elusive.

Rhyne (1984), a Gestalt art therapist, advocated a permissive approach in the prescription of materials in art therapy. She believed that if provided a wide enough choice of materials and ample time for experimentation, patients would spontaneously choose those materials that suited them best. She believed that art materials should be viewed as sensory stimulants that are most efficient in uncovering non-verbal sensory memories.

The developmental approach to art therapy regarded materials primarily as assessment tools. Kagin (1969) suggested that the sensory properties of the material can evoke age-specific reactions, and, therefore, could aid in evaluating the patient's developmental level.

Psychoanalytic schools of art therapy emphasized that the different media activate different levels of psychological functioning. Some support the ego-organizing capacities of the mind, some tap libidinal levels, and still others have an exploratory quality. Some media challenge a sense of mastery, whereas others provide an opportunity for fun and play. Robbins (1994) pointed out that art media could be used to explore and work through psychological polarities. For example, patients who are naturally attracted to working with hard and resistant materials that require aggressive movements could benefit from a gradual exposure to softer, more pliable media requiring milder manipulations. Robbins (1994) provided another example involving armature wire. This material can be used both to create soft-looking rounded shapes, or spiky, aggressive projections.

Therapists are encouraged to give careful consideration to the specific materials they offer their patients for art therapy. Clinicians should familiarize themselves with the various working techniques and possibilities relevant to the suggested art material so as to minimize unnecessary frustrations and enhance the therapeutic use of the material. Rubin (1978) suggested that materials should be synchronized, in terms of their properties, with the patients' needs and skills. She likened the process of familiarization with the material to being introduced to a new acquaintance. This can be done cautiously or impulsively, by applying familiar exploratory styles or by venturing with daring innovation. The material is regarded as a partner in a dialogue, a partner possessing clear traits and characteristics that require negotiation. It is incorporated into the artist's phenomenological field of the self, and becomes a link between the artist's mind and his or her sensorium.

There are several dimensions on which art material can be classified. Kagin (1969) saw materials as possessing varying degrees of pliability, ranging from fluidity (e.g., liquids) to resistance (e.g., stone). The harder it is to process and manipulate the art material, the more energy is required to produce the desired expressive end. Working with resistant materials can promote awareness concerning the limits of the material, as well as the limits of one's own capacities.

Rubin (1984) differentiated between structured and unstructured materials. She suggested that the less structured the art material is in terms of the expected outcome, the greater the likelihood for projection of intrapsychic processes. Conversely, the clearer the qualities and boundaries of the art material, the greater the likelihood of accomplishing the intended result. Materials that possess clear boundaries can, with proper structured guidance, lead to ego strengthening accomplishments. More fluid materials, such as chalk, clay, or watercolors, can facilitate work that is not dictated by physical boundaries, or confined by them. This category of materials promotes an experientially expanding experience, and can trigger a sense of loss of control. This is a potentially regressive experience that can be enhanced if the material is wet, and if it is manipulated manually, without intermediary tools (Kagin and Lusebrink, 1978).

Lusebrink (1990) classified creative art materials along the fluidity-hardness continuum. When considering two-dimensional work materials, she anchored finger paints at one end of the spectrum, followed by water colors, pastel colors, chalks, markers, and felt pen colors. She placed pencils at the opposite end. When three-dimensional artwork was considered, she classified the materials in ascending order of resistance: water-based clay; oil-based clay; wood; and stone.

Robbins (1994) classified art media as soft, brittle, breakable, hard, or sticky. He also tried to understand the rhythm and movement that the material dictates to the working artist. Not only was he interested in the degree of control that had to be exercised to effectively work with the material, but he also saw importance in synchronizing what he termed "the patient's inner and outer flow." Investment of forceful energies in the art process, such as in stonecutting and chiseling (outer flow), may trigger powerful pre-existing emotions, such as anger or crying (inner flow), that could, in turn, impede the patient's capacity to work with the material and it's structural dictates. If a resistant material, such as stone, triggered rage, it would more likely be attacked than artistically sculpted. Although engraving and carving in wood may require similar rhythm and movement as working with stone, wood's characteristics can better "guide" the patient to the correct method of working with it.

To facilitate the encounter between the patient and the material he or she is working with, the art therapist should be conscious of predictable changes in the state of the material's matter, and of the patient's possible reactions to such changes. Robbins (1994) drew attention to plaster, which emits heat as it hardens. This is a surprising physical change to many novice artists, and can even be startling to some. Plaster hardens quickly, often in the patient's presence. This can be a disheartening experience to unprepared patients, as they discover that the material does not respond any longer to shaping attempts. The consistency of clay can also change over time, and may not be as plastic and malleable as it was during previous sessions.

The patient's ability to take risks and tolerate mistakes related to mishandling of the material's properties is also worth considering in the selection of materials for art therapy. Patients who face the stubbornness and unforgiving nature of their art material may benefit from processing flexibility in decision making and attribution of responsibility in less controllable situations.
- Somer, Liora; Somer, Eli; Perspectives on the Use of Glass in Therapy; American Journal of Art Therapy, Feb2000, Vol. 38 Issue 3
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #8
The preceding section contained information about interpreting clients' choice of materials in Gestalt art therapy.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 22
Why does Rhyne advocate a permissive approach in the prescription of materials in Gestalt art therapy? Record the letter of the correct answer the CEU Answer Booklet.

 
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Enhancing psychotherapy process with common factors feedback: A randomized, clinical trial.
In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergraduates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU + CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU + CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU + CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Can reflecting on personal values online increase positive beliefs about counseling?
This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation—a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Depression symptoms moderate the association between emotion and communal behavior.
Depression is associated with emotion regulation deficits which manifest as elevated negative affect and greater continuation of negative affect over time. The present study examined a possible emotion regulatory deficit, whether depression symptoms attenuate the association between communal (i.e., agreeable, quarrelsome) behavior and affect. A community sample reported on depression and anxiety symptoms before recording their affect and behavior following naturally occurring interpersonal interactions over 21 days. Participants’ behaviors were measured using items selected to represent the Interpersonal Circumplex Model of behavior. Results indicated an association between affect and communal behavior, which was stronger for negative than positive affect. Depression symptoms moderated this association; elevated depression symptoms were associated with decreased association of affect and interpersonal behavior. Comorbid anxiety symptoms did not moderate this association. Results suggest that elevated depression symptoms are associated with a diminished ability to adapt communal behavior to emotion cues. Given prior evidence of elevated overall quarrelsome behavior among individuals with elevated depression symptoms, this may demonstrate an interpersonal mechanism by which emotion regulation deficits impact the generation of interpersonal problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Thwarted belongingness, perceived burdensomeness, and depression among asian americans: A longitudinal study of interpersonal shame as a mediator and perfectionistic family discrepancy as a moderator.
This short-term longitudinal study applied Joiner’s (2005) Interpersonal-Psychological Theory of Suicide to Asian Americans’ experiences with depression. Interpersonal shame (i.e., the experience of inadequacy arising from interpersonal concerns) was hypothesized to mediate the effects of (a) thwarted belongingness and (b) perceived burdensomeness on future depression. Furthermore, the positive associations between (a) thwarted belongingness and (b) perceived burdensomeness on future depression were hypothesized to vary depending on students’ experiences with perfectionistic family discrepancy (PFD; their perceived gap between their actual performance and what their parents expect of them). A total of 605 Asian Americans attending predominantly White, Midwestern universities completed 3 online surveys. Conditional process modeling via Hayes’s (2013) PROCESS was used to analyze the data. Results demonstrated that (a) thwarted belongingness and (b) perceived burdensomeness contributed to higher interpersonal shame, which influenced students’ future depression. Furthermore, the effect of thwarted belongingness on future depression was significantly positive for those with PFD levels greater than the 12th percentile, after taking into account students’ initial level of depression. The effect of perceived burdensomeness on future depression was not significant for those with PFD levels greater than the 3.5th percentile. This study identified that students with perfectionistic family discrepancy may be at higher risk for depression while experiencing thwarted belongingness. Overall, findings supported using Joiner’s (2005) theory to understand Asian American students’ risk for future depression. Future studies may gather data across Asian American students’ years in college. Counselors can apply these findings to increase students’ awareness about possible risk factors for depression. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Distress disclosure and psychological functioning among Taiwanese nationals and European Americans: The moderating roles of mindfulness and nationality.
Research using Western samples shows that talking about unpleasant emotions—distress disclosure—is associated with fewer psychological symptoms and higher well-being. These benefits of distress disclosure may or may not be observed in East Asia where emotional control is valued. Instead, mindfulness may be more relevant to emotion regulation in East Asia (e.g., Taiwan). In the present study, cultural context (Taiwanese nationals vs. European Americans) and mindfulness were examined as moderators of the relation between distress disclosure and both depression symptoms and life satisfaction. A sample of 256 Taiwanese college students and a sample of 209 European American college students completed self-report measures in their native language. Moderated multiple regression analyses revealed significant interaction effects of mindfulness and distress disclosure on both depression symptoms and life satisfaction for Taiwanese participants but not for European Americans. Specifically, distress disclosure was negatively associated with depression symptoms and positively associated with life satisfaction for Taiwanese low in mindfulness but not for Taiwanese high in mindfulness. For European Americans, distress disclosure was not associated with depression symptoms but was associated with higher life satisfaction, regardless of one’s level of mindfulness. These findings suggest that the potential benefits of disclosing distress are a function of one’s cultural context as well as, for those from Taiwan, one’s mindfulness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

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