Staff Perspective: Crayons Aren’t Just for Kids - Art Therapy in Addiction Treatment
As I sat down to write this this blog, numerous thoughts came to mind as to what I wanted to write for National Substance Use Prevention Month. We all too frequently hear the statistics across various sources regarding the opioid crisis, the rising numbers of overdose, and the impacts substance use has on the individual, families, relationships, and communities. With my thinking cap on, I contemplated the direction for the blog. Most of my career has been working within the addiction and comorbid behavioral health fields, so while statistics and assessment have their own importance, my mind kept going to the process of transformation that can occur and the creative process that individuals can take to reach the end goal of sustained recovery.
Before sharing my experience, let’s review a little background information on what is art therapy. The American Art Therapy Association (AATA, 2022) defines art therapy as a “mental health profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship”. In more general terms, art therapy provides a form of communication that allows clients to express themselves when their words and language fail them. Art therapists are credentialed and trained mental health professionals that use psychological theory, art media, and creative processes to help their clients cope with mental health challenges across diverse settings. In substance use disorder (SUD) treatment, the documented use of art therapy dates back to the 1950s (Moore, 1983) with benefits including decreased denial (Cox and Price, 1990), reduced opposition to alcoholism treatment (Allen, 1985), communicative outlets (Harms, 1973; Moore, 1983), and lessened shame (Johnson, 1990). Group discussion is centered around viewing, discussing, and interpreting the art. This process encourages change by moving away from reflection and motivates clients toward a state of action (Aletraris, et al., 2014).
As an art therapist working within the addictions field, anecdotally, I know the power of the creative process and therapeutic benefits of creating art within a clinical setting; however, the scholar side of me wanted research support. So, I began my writing with a quick literature review. Of course, as I refined my search, my curiosity led me down a rabbit hole, albeit a short one, but a rabbit hole to say the least searching for research related to the creative arts and SUD treatment. Unsurprisingly, the more I searched within the literature, both broad and narrow, the limitations of research within the field were notable. The case studies and anecdotal evidence exists, yet generalizability is limited, leaving much of my blog writing based on my own clinical observations and experiences.
Now to focus on my anecdotal experience using art therapy. While working as an outpatient counselor, I was fortunate to be able utilize my training as an art therapist across a variety of settings. I was also able to start an art therapy group at one of my former employers. The group was designed to have sequential directives focused on various elements of the recovery process that allowed individuals to contemplate and actualize change. The group members were from the inpatient unit and met with me once a week for three hours. Due to the rolling admission process of the unit, the group allowed for participants to start at any point within the series of six directives (About me collage, Villian/Superhero, Same/change Clay container, Soul Painting, Mask Making, Watercolor Breathwork, and “I am” poem with self-portrait) that followed a nine-week cycle. The Villain/Superhero and Mask Making directives occurred over two sessions each. A typical group session consisted of a brief check-in with the patients, a discussion of the directive, it’s relevance to the recovery process and an introduction to the materials. Group members were then provided the directive and engaged in art making for the remainder of group. The last 30 minutes of the group were used to observe/reflect on the finished pieces in a silent walk around, followed by a discussion on the process and piece created. Group members reflected and asked questions. Through this process, I observed how insightful patients could be about each other’s work, often times the creator revealed more about themselves than they realized within their piece. This led to deeper introspection, reflection, and processing both individually and within the group.
Each of the directives contributed to the process of change in its own way. One of my favorite directives, which evoked the “ah-ha” moment amongst group members consistently, was the Superhero/Villain. This directive asked the individual to create an image representative of their addiction (Villain), as well as create a biography consisting of a name, it’s traits and impacts. This was followed by the creation of the “superhero”. The “superhero” was a reflection of the traits and strengths possessed that were going to help them defeat their villain. Similar to the villain, they gave this image a name, traits and impacts, but also included strengths possessed. Once these two characters were created, the group members were asked to write out a short story using the characters to represent their addiction and recovery. They were given the option to create this in a narrative or comic strip format. The “ah-ha” moments were seen throughout the process, from reflecting on their addiction and its impacts, to asking them to think about their strengths. For many, identifying the impacts of their addiction came easily, while identifying strengths and supports for their recovery proved challenging. For those who the addiction, recovery, relapse cycle had become a revolving door, it provided opportunity to think about what worked, didn’t work, and needed to be different this time. During the processing time you could see the mutual understanding amongst group members of the themes that arose while discussing the impacts of their addictions, as well as the sense of support that buffered against feelings of loneliness in recovery. Their reflections, willingness to share their struggles and losses, while also allowing themselves to trust not only the process, but themselves, was only one of many components of transformation art and the creative process contributed to their recovery journey.
From the initial defenses of “crayons are for kids”, “I can’t draw”, and “I haven’t done art since I was in kindergarten” to lowering their guard and being open to the process rather than focusing on the product, the process of change was noted even in the most resistant of group members. Over the course of nine weeks and the numerous patients that participated, I had the privilege of seeing their struggles, reflections, insight, and overall transformation from “darkness to light”. While it has been many years since I facilitated those art therapy groups, the impact the creative process had on those individuals still remains with me today. It continues to remind me how powerful art can be as a mode for communication and instilling the process of change.
For additional information regarding art therapy, addictions, mental health and the process of healing and empowerment, the Substance Abuse and Mental Health Services Administration (SAMHSA) held an open call this past year focusing on art in recovery. While these works are not from the groups I held or individuals I worked with, these works are an amazing testament to the power of art within the therapeutic and healing process: 2024 Theme: The Art of Recovery | SAMHSA
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Heather Thompkins, Ph.D, MS-ATR, LCMHC, is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she provides oversight and fosters collaboration for creative arts related research projects in partnership with the Defense Intrepid Network.
References:
Aletraris, L., Paino, M., Edmond, M., Roman, P., and Bride, B. (2014). The use of art and music therapy in
substance abuse treatment programs. Journal of Addictions Nursing, 25(4), 190-196.
Allen, P. (1985). Integrating art therapy into an alcoholism treatment program. American Journal of Art
Therapy, 24, 10-12.
American Art Therapy Association (AATA, 2022). What is art therapy? Fact Sheet.
https://arttherapy.org/what-is-art-therapy/
Cox, K. and Price, K. (1990). Breaking through: Incident drawings with adolescent substance abusers. The
Arts in Psychotherapy, 17(4), 333-337.
Harms, E. (1973). Art therapy for the drug addict. The Arts in Psychotherapy, 1, 55-59.
Johnson, L. (1990). Creative therapies in the treatment of addictions: The art of transforming shame. The
Arts in Psychotherapy, 17, 299-308.
Moore, R. (1983). Art therapy with substance abusers: A review of the literature. The Arts in
Psychotherapy, 10(4), 251-260.
Substance Abuse and Mental Health Services Administration (SAMHSA, 2024). The 2024 gallery of hope:
Artistic expressions of recovery across the nation. https://www.samhsa.gov/recovery-month/gallery-of-hope-2024
As I sat down to write this this blog, numerous thoughts came to mind as to what I wanted to write for National Substance Use Prevention Month. We all too frequently hear the statistics across various sources regarding the opioid crisis, the rising numbers of overdose, and the impacts substance use has on the individual, families, relationships, and communities. With my thinking cap on, I contemplated the direction for the blog. Most of my career has been working within the addiction and comorbid behavioral health fields, so while statistics and assessment have their own importance, my mind kept going to the process of transformation that can occur and the creative process that individuals can take to reach the end goal of sustained recovery.
Before sharing my experience, let’s review a little background information on what is art therapy. The American Art Therapy Association (AATA, 2022) defines art therapy as a “mental health profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship”. In more general terms, art therapy provides a form of communication that allows clients to express themselves when their words and language fail them. Art therapists are credentialed and trained mental health professionals that use psychological theory, art media, and creative processes to help their clients cope with mental health challenges across diverse settings. In substance use disorder (SUD) treatment, the documented use of art therapy dates back to the 1950s (Moore, 1983) with benefits including decreased denial (Cox and Price, 1990), reduced opposition to alcoholism treatment (Allen, 1985), communicative outlets (Harms, 1973; Moore, 1983), and lessened shame (Johnson, 1990). Group discussion is centered around viewing, discussing, and interpreting the art. This process encourages change by moving away from reflection and motivates clients toward a state of action (Aletraris, et al., 2014).
As an art therapist working within the addictions field, anecdotally, I know the power of the creative process and therapeutic benefits of creating art within a clinical setting; however, the scholar side of me wanted research support. So, I began my writing with a quick literature review. Of course, as I refined my search, my curiosity led me down a rabbit hole, albeit a short one, but a rabbit hole to say the least searching for research related to the creative arts and SUD treatment. Unsurprisingly, the more I searched within the literature, both broad and narrow, the limitations of research within the field were notable. The case studies and anecdotal evidence exists, yet generalizability is limited, leaving much of my blog writing based on my own clinical observations and experiences.
Now to focus on my anecdotal experience using art therapy. While working as an outpatient counselor, I was fortunate to be able utilize my training as an art therapist across a variety of settings. I was also able to start an art therapy group at one of my former employers. The group was designed to have sequential directives focused on various elements of the recovery process that allowed individuals to contemplate and actualize change. The group members were from the inpatient unit and met with me once a week for three hours. Due to the rolling admission process of the unit, the group allowed for participants to start at any point within the series of six directives (About me collage, Villian/Superhero, Same/change Clay container, Soul Painting, Mask Making, Watercolor Breathwork, and “I am” poem with self-portrait) that followed a nine-week cycle. The Villain/Superhero and Mask Making directives occurred over two sessions each. A typical group session consisted of a brief check-in with the patients, a discussion of the directive, it’s relevance to the recovery process and an introduction to the materials. Group members were then provided the directive and engaged in art making for the remainder of group. The last 30 minutes of the group were used to observe/reflect on the finished pieces in a silent walk around, followed by a discussion on the process and piece created. Group members reflected and asked questions. Through this process, I observed how insightful patients could be about each other’s work, often times the creator revealed more about themselves than they realized within their piece. This led to deeper introspection, reflection, and processing both individually and within the group.
Each of the directives contributed to the process of change in its own way. One of my favorite directives, which evoked the “ah-ha” moment amongst group members consistently, was the Superhero/Villain. This directive asked the individual to create an image representative of their addiction (Villain), as well as create a biography consisting of a name, it’s traits and impacts. This was followed by the creation of the “superhero”. The “superhero” was a reflection of the traits and strengths possessed that were going to help them defeat their villain. Similar to the villain, they gave this image a name, traits and impacts, but also included strengths possessed. Once these two characters were created, the group members were asked to write out a short story using the characters to represent their addiction and recovery. They were given the option to create this in a narrative or comic strip format. The “ah-ha” moments were seen throughout the process, from reflecting on their addiction and its impacts, to asking them to think about their strengths. For many, identifying the impacts of their addiction came easily, while identifying strengths and supports for their recovery proved challenging. For those who the addiction, recovery, relapse cycle had become a revolving door, it provided opportunity to think about what worked, didn’t work, and needed to be different this time. During the processing time you could see the mutual understanding amongst group members of the themes that arose while discussing the impacts of their addictions, as well as the sense of support that buffered against feelings of loneliness in recovery. Their reflections, willingness to share their struggles and losses, while also allowing themselves to trust not only the process, but themselves, was only one of many components of transformation art and the creative process contributed to their recovery journey.
From the initial defenses of “crayons are for kids”, “I can’t draw”, and “I haven’t done art since I was in kindergarten” to lowering their guard and being open to the process rather than focusing on the product, the process of change was noted even in the most resistant of group members. Over the course of nine weeks and the numerous patients that participated, I had the privilege of seeing their struggles, reflections, insight, and overall transformation from “darkness to light”. While it has been many years since I facilitated those art therapy groups, the impact the creative process had on those individuals still remains with me today. It continues to remind me how powerful art can be as a mode for communication and instilling the process of change.
For additional information regarding art therapy, addictions, mental health and the process of healing and empowerment, the Substance Abuse and Mental Health Services Administration (SAMHSA) held an open call this past year focusing on art in recovery. While these works are not from the groups I held or individuals I worked with, these works are an amazing testament to the power of art within the therapeutic and healing process: 2024 Theme: The Art of Recovery | SAMHSA
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Heather Thompkins, Ph.D, MS-ATR, LCMHC, is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she provides oversight and fosters collaboration for creative arts related research projects in partnership with the Defense Intrepid Network.
References:
Aletraris, L., Paino, M., Edmond, M., Roman, P., and Bride, B. (2014). The use of art and music therapy in
substance abuse treatment programs. Journal of Addictions Nursing, 25(4), 190-196.
Allen, P. (1985). Integrating art therapy into an alcoholism treatment program. American Journal of Art
Therapy, 24, 10-12.
American Art Therapy Association (AATA, 2022). What is art therapy? Fact Sheet.
https://arttherapy.org/what-is-art-therapy/
Cox, K. and Price, K. (1990). Breaking through: Incident drawings with adolescent substance abusers. The
Arts in Psychotherapy, 17(4), 333-337.
Harms, E. (1973). Art therapy for the drug addict. The Arts in Psychotherapy, 1, 55-59.
Johnson, L. (1990). Creative therapies in the treatment of addictions: The art of transforming shame. The
Arts in Psychotherapy, 17, 299-308.
Moore, R. (1983). Art therapy with substance abusers: A review of the literature. The Arts in
Psychotherapy, 10(4), 251-260.
Substance Abuse and Mental Health Services Administration (SAMHSA, 2024). The 2024 gallery of hope:
Artistic expressions of recovery across the nation. https://www.samhsa.gov/recovery-month/gallery-of-hope-2024