Theories Flashcards
Cognitive Behavioral Therapy (CBT)
B.F. Skinner
symptoms are learned and reinforced by environment
not events perse but rather the person’s assumptions, expectations, and interpretations of events which are responsible for the production of negative emotions
effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness
emphasis on helping individuals learn to be their own therapists.
Through exercises in the session and “homework”, patients/clients are helped to develop coping skills
emphasize what is going on in the person’s current life, rather than what has led up to their difficulties.
CBT art therapy
art is a cognitive process that uses thinking, sensing, and identifying as well as understanding emotions
artist is uncovering mental images and messages, recalling memories, making decisions, and generating solutions
Art provides a concrete record of inner processes that can be discussed and altered
- identifying and recording negative thoughts
- distance from cognitions / recognize schema
- cognitive re-structuring - analysis of faulty logic, hypothesis testing, alternative interpretations, enlarging perspective, and decatastrophizing
- experimenting with physically altering a negative image through art expression.
CBT concepts
stimulus-response
behavioral conditioning
behavioral modification
simple stimulus-response behaviors: first level behaviors like automatic habits
Second-level behaviors included language, imagery, thinking, and affect.
CBT strategies to change behaviors
Facing one’s fears instead of avoiding them.
Using role playing to prepare for potentially problematic interactions with others.
Learning to calm one’s mind and relax one’s body.
six basic steps in CBT:
(1) establishing a good therapeutic rapport
(2) having a problem focus
(3) identifying irrational thoughts
(4) challenging irrational thoughts
(5) testing the validity of thoughts
(6) substituting irrational thoughts with rational ones
Core principles of CBT
unifying goal of CBTs is behavioral adaptation
Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
Psychological problems are based, in part, on learned patterns of unhelpful behavior.
People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
three guiding principles:
(1) context engagement—re-examining problematic situations in order to imagine novel responses
(2) attention change— helping clients sustain or shift attention in order to better adapt to various situations
(3) cognitive change —gaining perspective or altering meanings of emotionally significant situations
CBT strategies to change thinking patterns
Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
Gaining a better understanding of the behavior and motivation of others.
Using problem-solving skills to cope with difficult situations.
Learning to develop a greater sense of confidence in one’s own abilities.
Trauma-informed therapy
The adoption of the PTSD diagnosis by the DSM III in 1980
no overarching definition
shifts focus from “whats wrong with you” to “what happened to you”
acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation
Realize the widespread impact of trauma and understand paths for recovery
Recognize the signs and symptoms of trauma in patients, families, and staff
Integrate knowledge about trauma into policies, procedures, and practices
Actively avoid re-traumatization.
Narrative Art Therapy
“Finish the story”
put fragments of trauma into ITR / change story from present tense to past with a definitive end.
simple, clear drawing materials
8 drawings
“Before” and an “After” picture serve as bookends that set the story in time.
- drawings that depict each aspect of the ITR - w/ thoughts, feelings, Body sensations
Under no circumstances should the therapist let the client leave a session without making certain he or she is grounded and fully oriented
“And now, we see that this very important story in the life of (client’s name) is truly over—and we can finally say, ‘The end!’”
The Instinctual Trauma Response (ITR)
Tinnin and Gantt (2014)
startle
attempt to fight or flee
freeze
altered state of consciousness (ASC)
Automatic obedience
Efforts at self-repair
Body sensations accompany each aspect
Humanistic
umbrella term for client centered, existential, gestalt, logotherapy, and narrative therapy.
focuses on a person’s individual nature, rather than assuming that groups of people with similar characteristics have the same concerns
emphasis on positive traits and behaviors and developing ability to use instincts to find wisdom, growth, healing, and fulfillment
since humanistic therapists may not focus on diagnosing a client, those with symptoms of certain personality disorders may not achieve success with this approach
therapist’s ways of being and attitudes are more influential, in terms of helping clients change, than are techniques or interventions designed to get clients to change
Humanistic art therapy
Josef Garai
three primary tasks
(1) being present, accessible, and open to clients
(2) honoring clients’ thoughts and feelings in the immediate experience
(3) engaging in artistic self-expressive activity along with clients
Gestalt Therapy
Fritz Perls
art therapy - Janie Rhyne
experiential and present focused
integration of thoughts, feelings, and actions
hot seat
empty chair
role playing
psychodrama
here and now focus of time
Gestalt art therapy
Janie Rhyne, Joseph Zinker, Violet Oaklander, Mala Betensky
genuine contact with client
emphasis on here and now
Gestalt: whole form or configuration which is greater than the sum of its parts.
art allows people to know themselves as a whole person in a short time
encourage and insist on responsible, honest, direct, and authentic communication between the person and therapist
individuals can deal effectively with their life problems
stresses assumptions of personal responsibility for the course of one’s life
Dreams are assumed to represent existential messages that reflect current ways of being in the world
perceiving and becoming aware of what is obviously there
Without pushing for interpretations, we explore the dimensions of the drawing and elaborate its impact, through active, present experiencing
focus on the active movement in the art done by clients.
client-centered treatment
requires the therapist to be empathic, open, honest, congruent, and caring
every person has worth, dignity, the capacity for self-direction, and an inherent impulse toward growth
assist people in becoming more autonomous, spontaneous, and confident
therapists genuineness
complete acceptance
Person-Centered Expressive Arts Therapy
- Natelie Rogers
- believe in ability of individuals to find appropriate self-direction
- psychological climate is empathic, honest, and caring
- use the arts to let go, to express, and to release
- All people have an innate ability to be creative.
- Personal growth and higher states of consciousness are achieved through self-awareness, self-understanding, and insight
- Self-awareness, self-understanding, and insight are achieved by delving into our emotions.
- Our feelings and emotions are an energy source
- The expressive arts lead us into the unconscious.
- “the creative connection.” - one art form can lead into another easily
Humanistic techniques
Congruence: being authentic, open, and genuine as they interact with the individual who is in therapy.
Empathetic understanding: not only understanding what the client is feeling and saying, but also communicating that understanding to the client. The individual should feel heard, seen, and understood.
Reflective listening: actively listening to the individual and then summarizing what the client has said in their own words. This strategy can help reinforce what the client is saying, allow them to reflect back on their own words, and clear up potential misunderstandings.
Unconditional positive regard: accepting the individual without judgment. It is characterized by a caring attitude that plays an important role in fostering self-worth, personal growth, and self-awareness.
Existential
Friedrich Nietzsche and Soren Kierkegaard
death, freedom, isolation, meaninglessness
focuses on concepts that are universally applicable to human existence including death, freedom, responsibility, and the meaning of life
therapy should be
aimed at challenging individuals to find meaning and purpose in life
focus on individual not symptoms
All people have the capacity for self-awareness.
Each person has a unique identity that can be known only through relationships with others.
People must continually re-create themselves because life’s meaning constantly changes.
Anxiety is part of the human condition.
emphasizes a person’s capacity to make rational choices and to develop to their maximum potential
Existential art therapy
- Bruce Moon
- primary thrust of therapy is engaging the client in a creative struggle with the ultimate concerns of human existence
- one of the underlying realities of human existence is that we are ultimately alone
using the art process as a metaphor for choice and free will
(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
(6) awareness of death and non- being
Who existential therapy is good for
treating psychological concerns that are thought to result from an inhibited ability to make authentic, meaningful, and self-directed choices
Interventions often aim to increase self-awareness and self-understanding.
Symptoms: excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair, depression, guilt, anger, rage, resentment, embitterment, purposelessness, psychosis, and violence
life-enhancing experiences: relationships, love, caring, commitment, courage, creativity, power, will, agency, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence, and awe.
Existential Approaches
responsibility and freedom focus
find meaning in the face of anxiety
confronting negative internal thoughts rather than focusing on external forces like societal pressures or luck.
Fostering creativity, love, authenticity, and free will
The goal: To make more willful decisions about how to live, drawing on creativity and love, instead of letting outside events determine one’s behavior.
Transpersonal Therapy
Abraham Maslow and associates in the 1960 - stemmed from Carl Jung
emphasis on role of healing spirit
spiritual traditions and rituals
positive influences and role models
focus on a broader conception of how a person achieves meaning, purpose, and happiness
increase sense of empowerees
“reaching beyond humanistic concerns.”
Maslow’s Hierarchy of Needs
self actualization
self esteem
love and belonging
safety and security
physiological needs
Transpersonal Approaches
honesty, open mindedness, self-awareness
address the person’s needs to improve other areas of life such as relationships or life satisfaction and spiritual emergencies
draw from a variety of different religions and spiritual practices for tools and methods
Meditation
Guided visualization
Hypnotherapy
Dream work
Art-marking
Music therapy
Journaling
Holotropic breathwork
Spiritual Therapy
Mimi Farrelly-Hansen
part of a holistic approach to treating mental health symptoms and diagnoses
integrates spiritual or religious beliefs and practices into the therapeutic process.
acknowledges that you have unique spiritual and existential beliefs, values, and experiences about what it means to be human, that influence your understanding of yourself, others, and the world around you
the spirit is the most powerful and most important factor in a complete healing
techniques:
mindfulness
sacred texts
prayor
rituals
Psychodynamic
- ego, id, superego
- defense mechanisms
- transference and countertransference
- free association
- resolution of internal conflicts
- libido
- aggression
- defense mechanisms: automatic, unconscious strategies for reducing anxiety
- helps the therapist to know where a person is “stuck” (developmentally), what is being defended against (feared impulses), and how (favored coping and defense mechanisms)
- Sigmund Freud (Ego Psychology)
- less focused on the patient-therapist relationship and more focused on the patient’s relationship with their external world
- Individuals who have the capacity to be self-reflective and are looking to obtain insight into themselves and their behavior are best suited to this type of therapy.
- longer term than CBT
- our behavior and feelings as adults are rooted in our childhood experiences
- scribble technique complements the psychoanalytic principles of projection and free association
Ernst Kris
regression in service of ego
wrote psychoanalytic exploration in art (1959)
Amplification (analytic approach)
originally form of dream interpretation (Jung)
subjective: active imagination to find associations to the symbol.
objective: themes from mythology, religion, and other sources to illuminate the symbol
Object Relations
humans have innate drive to form and maintain relationships and relationships with people around us shapes our personality
- the “object” in object relations theory refers to the who and what in which a person’s libidinal energy is invested.
- “libidinal energy”: constitutional reservoir of energy and life that is part sexual, part aggressive, but is more than either.
- human behavior is conceptualized within a tripartite system of id, ego, and superego, which, when unbalanced, creates the conflicts manifesting themselves in the range of defenses and symptoms characteristic of the neuroses.
- The therapist cannot actually be that which the patient lost, yet the therapist’s presence and actual living with the patient’s problems serve to repair the original damage and problem
Melanie Klein
early fantasy life of infant
- projection and introjection
- splitting defense (borderline personality disorder)
DW Winnicott
- good enough mother
- transitional space
- transitional object
- holding environment
- Winnicotts squiggle game
- object-relations
Margaret Mahler
mother/child dyads
- developmental stages of human attachment
normal autism: infant respponds primarily to body sensations and internal stimuli
normal symbiosis: caretaker and baby form attachment and merged as one
rapproachment: child drawn to and runs from caretaker
separation/individuation: “object constancy
transitional space
intermediate area of experience where there is no clear distinction between inner and outer reality
art and play
transitional object
object that is important to the child because it represents something beyond what it actually is
stuffed animal, blanket, artwork
Psychodynamics
Uncovering traumatic events that had been repressed (“making the unconscious conscious”) thought to be the key to recovery from neurotic illness
conscious
unconscious
defense mechanisms:
projection
displacement
sublimation
dream symbolism
transference (psychodynamic)
client’s unconscious projection of feelings onto the therapist
originate in repressed or unfinished situations
helps to identify distorted perceptions, which are assumed to be based on unresolved conflicts from the past
patients’ attachment to the art work gradually replaced their dependence on the therapist (Naumburg)
countertransference (psychodynamic)
symbolic ways in which the therapist perceives and responds to the patient
clue to what is being evoked in the therapist by the patient
Ego
The “compromise” effected by the “ego” consists of finding some way to satisfy or discharge the impulse, without offending either the environment (reality) or the individual’s moral code (“superego”)
Id (psychodynamic)
source of repressed (forbidden) wishes (impulses, ideas).
These impulses (the “instinctual drives”) constantly strive for discharge (satisfaction) and are expressed in a disguised form, because only in that way can they bypass the “censor” (the force serving to keep unwelcome ideas out of awareness)
Psychodynamic Approaches
therapist helps the patient to understand and gain control over previously unknown sources of distress through questions, clarifications, confrontations, and other forms of intervention—especially interpretations, in which possible connections may be tactfully proposed.
free association
dream analysis
focus on recognizing, acknowledging, understanding, expressing, and overcoming negative and contradictory feelings and repressed emotions
helping the patient understand how repressed emotions from the past affect current decision-making, behavior, and relationships.
help those who are aware of and understand the origins of their social difficulties but are not able to overcome problems on their own.
Patients learn to analyze and resolve their current difficulties and change their behavior in current relationships through deep exploration and analysis of earlier experiences and emotions.
dream analysis / dream work
(psychodynamics)
Only idiosyncratic associations to the manifest content can lead to the hidden significance of the dream
Thanatos (psychodynamic)
aggressive drive
Psychodynamic effective for
depression
those who have lost meaning in their lives and have difficulty forming or maintaining personal relationships
social anxiety disorder
eating disorders
problems with pain
relationship difficulties
borderline personality disorder
*less used in instances of psychosis, post-traumatic stress disorder, and obsessive-compulsive disorder.
**Family Systems **
Dr. Murray Bowen.
each members behavior and emotions are interdependent and influence functioning of family unit
personalities, emotions, and behaviors of grown individuals are a result of their birth order, their role within their family of origin and the coping mechanisms
helps individuals resolve their problems in the context of their family units
work individual and together
8 interlocking concepts
family systems people
Nathan Ackerman
Jay Haley
Salvador Minuchin
Murray Bowen
Hanna Kwiatkowska
societal emotional process (family systems)
Broader social and cultural forces can influence family relationships.
sibling position (family systems)
Birth order can affect the dynamics between children, siblings, and parents.
emotional cutoff (family systems)
Family conflict with no resolution may lead some people to sever a relationship entirely.
multigenerational transmission process (family systems)
Small differences in differentiation between children and parents can lead to large differences among extended family members over time.
family projection process (family systems)
Parents may displace their feelings or anxieties onto their children, who then may displace their own feelings or anxieties onto others.
nuclear family emotional process (family systems)
Relational patterns that occur in the family, including marital conflict, dysfunction in a spouse, impairment of one or more children, and emotional distance.
differentiation of self (family systems)
The sense of individuality a person develops, rather than relying on others in their family or social groups.
Triangles (family systems)
The relationship dynamic between three people, which may influence relationships with others in the family.
family systems effective for
family conflict
Substance use disorder
Alcohol use disorder
Depression
Anxiety
Bipolar disorder
Personality disorders
Eating disorders
Coping with physical disabilities and disorders
Positive Psychology
Martin Seligman
emphasizes traits, thought patterns, behaviors, and experiences that are forward-looking and can help improve the quality of a person’s day-to-day life
goal is to minimize negativity in one’s thinking and behavior and to develop a more optimistic and open attitude that will enhance rather than disrupt one’s social, professional, and spiritual life
optimism
spirituality
hopefulness
gratitude
happiness
creativity
perseverance
justice
meaning and purpose
free will
Positive Art Therapy
promote well-being by building upon what is good in our lives.
negativity bias— an evolutionary mechanism that naturally commands our attention and propels us to channel resources toward correcting what is not functioning in our environment
Recent research demonstrates that experiencing high levels of well-being leads to greater physical health and longer life, improved work performance, good citizenship, and stronger social networks and societies
PERMA
Positive Emotions
Engagement
Relationships
Meaning
Achievement
just the process of doing art evokes positive emotions.
-Depict three positive events that happened during the day and what about you or the situation made them happen
-represent a positive memory
-identify the things that you value and give your life meaning
-depict a door that closed and a door that opened
-visualize and make symbols for people and creatures who matter to you or someone who you admire
Seligman’s Perma model
P Is for Positive Emotions: The pursuit of positive emotions will not necessarily improve your well-being. However, the experience of positive emotions through savoring your day-to-day moments may well boost well-being.
E Is for Engagement: Being engaged with life is important for well-being. Otherwise, your mind and body will run on automatic and you may suffer tedium and little meaning.
R Is for Relationships (Positive Ones): We thrive when we are connected in meaningful relationships.
M Is for Meaning: A sense of meaning and purpose is essential to well-being.
A Is for Accomplishment and Achievement: We each need to succeed and accomplish the goals we set. This quest for self-improvement is essential.
Solution Focused
Insoo Kim Berg, Steve de Shazer, and their colleagues in the late 1970s
focus on clients present and future goals
accept client as expert in an equal position of collaboration with therapist
finding solutions in the present and exploring one’s hope for the future in order to find a quick and pragmatic resolution of one’s problems
Solution focused techniques
Goal setting
neutralizing resistance - remove outside issues and focus on problem
exception finding questions- can you think of a time when that problem didnt happen
miracle question
facilitating change
0-10 scale
empathic support
narrative therapy
Attachment Theory
John Bowlby 1960s
brief, process-oriented form of counseling
client-therapist relationship is based on developing or rebuilding trust and centers on expressing emotions
looks at the connection between an infant’s early attachment experiences with primary caregivers, usually with parents, and the infant’s ability to develop normally and ultimately form healthy emotional and physical relationships as an adult
secure attachment
strong early attachment led to safety, security, and support, which then led children to develop healthy connections with others
anxious attachment
insecure, threatened, suspicious, and fearful of being rejected
avoidant attachment
develops during early childhood, particularly in those who do not experience sensitive responses to their needs or distress
causes a low tolerance for emotional or physical intimacy and, sometimes, struggles with building long-lasting relationships
disorganized attachment
can often lead to inconsistent behavior in relationships
want to be close to another person but then pull away out of fear
often the result of maltreatment, abuse, or trauma by a parent or caregiver when you’re young
reactive attachment
trauma- and stressor-related condition of early childhood caused by social neglect and maltreatment
aware of what happens around them, but they don’t respond emotionally to what’s going on
may not show or seek affection from caregivers or others and prefer to be alone.
Developmental
art therapy focus mostly on normal artistic development, and general principles of cognitive development (Piaget)
focus on explaining how children change and grow over the course of childhood
center on various aspects of growth, including social, emotional, and cognitive development.
treatment goals:
sensory stimulation
skill Aquisition
adaptation
Freud’s Psychosexual Developmental Theory
Failing to resolve the conflicts of a particular stage can result in fixations that can then have an influence on adult behavior.
The Oral Stage
Age Range: Birth to 1 Year
Erogenous Zone: Mouth
The Anal Stage
Age Range: 1 to 3 years
Erogenous Zone: Bowel and Bladder Control
The Phallic Stage
Age Range: 3 to 6 Years
Erogenous Zone: Genitals
The Latent Period
Age Range: 6 to Puberty
Erogenous Zone: Sexual Feelings Are Inactive
The Genital Stage
Age Range: Puberty to Death
Erogenous Zone: Maturing Sexual Interests
Erikson’s Psychosocial Developmental Theory
Successfully managing the challenges of each stage leads to the emergence of a lifelong psychological virtue.
Stage 1: Trust vs. Mistrust (Infancy from birth to 18 months)
Stage 2: Autonomy vs. Shame and Doubt (Toddler years from 18 months to three years)
Stage 3: Initiative vs. Guilt (Preschool years from three to five)
Stage 4: Industry vs. Inferiority (Middle school years from six to 11)
Stage 5: Identity vs. Confusion (Teen years from 12 to 18)
Stage 6: Intimacy vs. Isolation (Young adult years from 18 to 40)
Stage 7: Generativity vs. Stagnation (Middle age from 40 to 65)
Stage 8: Integrity vs. Despair (Older adulthood from 65 to death)
Piaget’s Cognitive Developmental Theory
Sensorimotor Stage: (birth - age two) infant’s knowledge of the world is limited to his or her sensory perceptions and motor activities. Behaviors are limited to simple motor responses caused by sensory stimuli.
Pre-Operational Stage: (2 - 6) child learns to use language. children do not yet understand concrete logic, cannot mentally manipulate information, and are unable to take the point of view of other people.
Concrete Operational Stage: (7 - 11) children gain a better understanding of mental operations. begin thinking logically about concrete events but have difficulty understanding abstract or hypothetical concepts.
Formal Operational Stage: (12 to adulthood) people develop the ability to think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage.
- deductive reasoning: general to particular (cause to effect)
- inductive reasoning: detailed facts to general principles (ability to generalize)
- transductive reasoning: cause and effect may be confused or inaccurate
Bowlby’s Attachment Theory
both children and caregivers engage in behaviors designed to ensure proximity. Children strive to stay close and connected to their caregivers who in turn provide a safe haven and a secure base for exploration.
Bandura’s Social Learning Theory
Albert Bandura
By observing the actions of others, including parents and peers, children develop new skills and acquire new information.
Vygotsky’s Sociocultural Theory
parents, caregivers, peers, and the culture at large were responsible for developing higher-order functions
Through interacting with others, learning becomes integrated into an individual’s understanding of the world
zone of proximal development: gap between what a person can do with help and what they can do on their own
Dialectical Behavioral Therapy (DBT)
Marsha Linehan
effective with history of self harm and borderline personality
acquisition of skills takes precedence over uncovering maladaptive thinking.
strong educational component designed to provide skills for managing intense emotions and negotiating social relationships
treatment of choice for borderline personality disorder, emotion dysregulation, and a growing array of psychiatric conditions
group instruction and individual therapy sessions, both conducted weekly for six months to a year,
dialectic: real life is complex, and health is not a static thing but an ongoing process hammered out through a continuous Socratic dialogue with the self and others
goals:
(1) identify and solve problem(s)
(2) address behaviors that undermine the therapeutic process
(3) work on problems that interfere with quality of life
(4) gain skills related to self-care, self-soothing, and mindfulness
(5) learn to ask for help when needed
(6) keep the patient invested In the treatment process through weekly team meetings
DBT useful for
Personality disorders, including borderline personality disorder
Self-harm
Post-traumatic stress disorder
Bulimia
Binge-eating disorder
Depression
Anxiety
Substance use disorder
Bipolar disorder
DBT techniques
Individual sessions usually last an hour
group meetings, usually consisting of four to 10 people, are designed to run for an hour and a half to two hours
present-oriented and skills-based
patients are asked to practice their skills between sessions (homework)
Mindfulness
distress tolerance
Emotion regulation
interpersonal effectiveness, allowing a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships
Motivational Interviewing
William R. Miller in 1983 and further developed by Miller and psychologist Stephen Rollnick
The first goal is to increase the person’s motivation and the second is for the person to make the commitment to change.
helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior
practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes
often used to address addiction and the management of physical health conditions such as diabetes, heart disease, and asthma
4 key principles
express empathy (motivational interviewing)
The therapist listens carefully to the patient and conveys that they understand the patient’s feelings, beliefs, and experiences.
support self-efficacy (motivational interviewing)
clients possess the strength and ability to grow and change—even if past attempts at change have failed.
supports the patient’s belief in themselves that they can change.
calling attention to the patient’s skills, strengths, or past successes.
roll with resistance
therapist avoids becoming defensive or argumentative if they encounter resistance
help the patient identify the problem and solution themself.
The therapist doesn’t impose their viewpoint on the patient but helps the patient consider multiple viewpoints.
Develop Discrepancy (motivational interviewing)
identify discrepancies between their present circumstances and their future goals.
What thoughts and behaviors do they need to change to achieve those goals?
guides the patient in spotting this discrepancy and solutions to reduce it.
motivational interviewing techniques
O.A.R.S.
Open-ended questions: encourage patients to think deeply or differently about a given problem.
Affirmations: recognize a client’s strengths, which can instill confidence, or self-efficacy, in their ability to change.
Reflections: listening to the patient and reflecting back a response, which can demonstrate empathy as well as point out discrepancies between their current behaviors and goals.
Summaries: recapping at the end of a session.
Group Therapy Theory
- Forming, Storming, Norming, Performing, Termination
- specific focus: educational, career, social, or personal.
- emphasizes interpersonal communication of conscious thoughts, feelings, and behavior within a here-and-now
- often problem oriented, and members largely determine content and aims.
- Group members typically do not require extensive personality reconstruction, and their concerns generally relate to the developmental tasks of the life span.
- growth oriented
- provides empathy and support to create trust that leads to sharing and exploring concerns.
- members assisted in developing existing skills in dealing with interpersonal problems
Art Therapy Theory
use of creative techniques such as drawing, painting, collage, coloring, or sculpting to help people express themselves artistically and examine the psychological and emotional undertones in their art
clients can interpret the nonverbal messages, symbols, and metaphors often found in these art forms, which should lead to a better understanding of their feelings and behavior so they can move on to resolve deeper problems
5 benefits of art therapy
Perception and self-perception: Art helped the participants focus on the present moment, identify their emotional responses, and connect their emotions and body awareness.
Personal integration: They strengthened their identity and self-image.
Emotion and impulse regulation: They improved the ability to regulate and control emotions.
Behavior change: They learned to change their behavioral responses to themselves and others, perhaps through the self-directed nature of art-making.
Insight and comprehension: They verbalized their emotions and experiences.
Jungian
Carl Gustav Jung
psycho-spiritual approach
emphasis on myth and symbols
bring together conscious and unconscious parts of the mind to help a person feel balanced and whole
collective unconscious & universal archetypes
mandals and its uses
synchronicity
event in outside world coincides meaningfully with state of mind
temenos
sacred, protected space
personal container and sense of privacy that surrounds analytical relationship
indicated by images of quaternary nature (mandalas)
individuation
differentiation
development of individual personality
depends on relationship btwn ego and unconscious
leads to realization of self as greater than ego
Self
wholeness
center of psyche
appears in dreams, myths, and fairytales or in form of totality symbol (circel, square, cross)
Ego
central complex
out of self that ego develops
Puer aeternus
eternal child
child-god forever young
older man whose emotional life at adolescent level
coupled with too great dependence on mother
Trickster
descriptive of unconscious shadow tendencies of ambivalent mercurial nature
Shadow
hidden or unconscious aspects of self
good and bad
repressed or never recognized
often experienced through projection
Hero
heros journey
quest or task leading toward forging identity
Complex (Jung)
group of memories and interpretations related to archetype
Archetype
primordial, structural elements of psyche
insticntual images
universal patterns or motifs
basic content of religions, mythologies, legends, and fairy tales
Active imagination
assimilating unconscious contents through self expression
give voice to sides of personality normally not heard
first stage like dreaming with open eyes
spontaneous or induced
Jungian Analysis
specializing in neurosis
bringing unconscious to consciousness
less emphasis on transference
individuation (Jung)
achieve unity between the conscious and unconscious mind
closest someone could come to God.
Jungian techniques
Dream analysis: dreams are communications from the unconscious mind.
Word association: specific words are said and therapist record how long it takes the patient to respond with the first thing that comes to mind.
Art or dance therapies: painting, drawing, and dancing are conduits through which the unconscious mind can express itself and that the exercises themselves may help repair the areas of a patient’s ailments that come through their art-making.
exploring the “shadow”
focuses more on the source of a problem than on its manifestations or symptoms
Jungian analysis influenced……
modern-day lie detector test
Jackson Pollock
Myers-Briggs personality test
introversion (Jung)
basic personality style characterized by a preference for the inner life of the mind over the outer world of other people
extroversion (Jung)
personality trait typically characterized by outgoingness, high energy, and/or talkativeness
**Behavioral Therapy **
Edward Thorndike
all behaviors are learned and that behaviors can be changed
umbrella term including
CBT
applied behavior analysis
exposure therapy
Cognitive behavioral play therapy
Acceptance and commitment therapy
DBT
behavioral therapy techniques
Systematic desensitization “classical conditioning”
Aversion therapy: teaching people to associate a stimulus that’s pleasant but unhealthy with an extremely unpleasant stimulus
reinforcement
punishment
shaping
modeling
Waldeson’s Couple Art Evaluation
four specific drawing tasks
explore and express various dimensions of the couple’s relationship
structured to evoke particular dynamics and interactions between the partners
first task - self-portrait. express their self-perception and personal identity independently of their partner.
second task - exchange their self-portraits and then alter the portrait created by their spouse. represents the influence and impact each individual has on the other, highlighting the reciprocal nature of their relationship.
third task - abstract portrait of the marital relationship. separately create a drawing that represents their view of the relationship as a whole. emphasizes the personal and subjective interpretations of the shared bond from the perspective of each partner.
fourth task - joint scribble. both partners work together on a single piece of paper, adding to a joint scribble without any specific instructions other than to interact through the drawing. designed to reflect the couple’s ability to cooperate and communicate non-verbally, showcasing the dynamics of their partnership in real-time.
It is critical to the program that each client completes an extensive packet of forms during their intake. You will need to assemble various forms to be completed during the initial interview, including:
medical history
payment schedules
goals and objectives
insurance forms
disclosure forms
Expressive arts therapy
inclusion of any of the arts therapies—art, music, dance/movement, drama, and poetry/writing
underlying belief - principle of unconscious expression
expression, imagination, active participation, and mind-body connection
*What section of the Code of Ethics-General Ethical Standards is art therapists shall ensure regular contact with clients and prompt rescheduling of missed sessions found
responsibility to clients
*Art therapists obtain written, informed consent from clients or legal guardians (if applicable) before using clinical materials and client artwork in any teaching, writing, and public presentations. Reasonable steps are taken to protect client identity and to disguise any part of the artwork or videotape that reveals client identity.”
client artwork ethical principle
Adlerian therapy model
Alfred Adler
understanding unique perceptions and experiences
strive for sense of belonging and significance
To challenge clients’ basic premises and life goals
Help clients achieve personal success and become contributing members of society
Cognitive theory
Jean Piaget and Howard Gardner
intellectual functioning: level of functioning, capacity for symbolic functioning, and concrete to abstract thinking
memory
perception
sequencing
problem-solving
development of a person’s thought processes
how thought processes influence how we understand and interact with the world.
Howard Gardner
multiple intelligence theory
- word
- logic
- picture
- music
- body
- person
- self
D.W. Winnicott’s theory of attachment
best known idea is explanation of child’s habit of becoming very attached to a favorite blanket or toy - Interaction with this material object tends to lessen anxiety and also help the child adapt to change.
“good enough” mother
continuum of separation
individuation
Social / Interactive
development of social and family roles
dev of social responsibility
potential for regression in dev
psychosexual concepts
libido:
aggression:
oedipal complex:
(how Freudian concepts may be manifested in art and behavior)
Rudolph Arnhem’s theories of perception
continuum of gross to fine motor skills
normal dev of eye-hand coordination
Motor Development
heredity and diet play important roles
girls accelerated in physical growth
boys develop more muscle tissue by adolescence
phylogenetic reflexes (birth)
voluntary movement
crawls, creeps, stands
precise pincer grasp
walks alone (12-15months)
runs, climbs (18 months)
delights in scribbling
builds tower of 9 cubes (3 years)
improved eye-hand coordination (4 years)
copies square, triangle (4-5)
uses scissors (5-6 yrs)
basic motor skills present by 6 years but need refinement - ride bicycle, skip rope, play sports
Victor Lowenfeld dev stages
scribble (2 years)
Preschematic (3-4 years)
Schematic (5-6)
Drawing Realism (Gang) (7-10)
Pseudo-naturalistic (crisis) (11-13)
Period of Decision (14+)
Period of Decision (Lowenfeld & Edwards)
14+ years
Art is something to be done or left alone
Natural development will cease unless a conscious decision is made to improve drawing skills
Students are critically aware of the immaturity of their drawing and are easily discouraged.
Lowenfeld’s solution is to enlarge their concept of adult art to include non-representational art and art occupations besides painting (architecture, interior design, handcrafts, etc.)
Support: Encourage artistic prompts that are inspired by emotions. Study work of master artists to experience a vast range of styles and techniques that can be mimicked and added to a child’s “toolbelt of skills.”
Pseudo-naturalistic “crisis period”
(Lowenfeld & Edwards)
11-13 years
end of art as spontaneous activity as children are increasingly critical of their drawings.
focus on the end product - strive to create “adult-like” naturalistic drawings.
Light and shadow, folds, and motion are observed with mixed success, translated to paper.
Space is depicted as three-dimensional by diminishing the size of
objects that are further away.
The beginning of adolescence marks the end of artistic development among
most children, due to frustration at “getting things right.”
Those who do manage to weather the crisis and learn the “secret” of drawing will become absorbed in it.
Edwards believes that proper teaching methods will help children learn to see and draw and prevent this crisis.
Support: Balance observational drawing with art based in meaning. Show artwork where the outward appearance is secondary to the emotional response or message sent to the viewer. Continue to practice perspective, shading, anatomy and composition as well as color theory.
Drawing Realism “Gang Stage” (Lowenfeld & Edwards)
7-10 years
schematic generalization no longer suffices to express reality.
more detail for individual parts but is far from naturalism in drawing.
Space is discovered and depicted with overlapping objects in drawings and a horizon line rather than a base line.
Children begin to compare their work and become more critical of it. While they are more independent of adults, they are more anxious to conform to their peers.
(9-10 years) children try for more detail, hoping to achieve greater realism, a prized goal.
Concern for where things are in their drawings is replaced by concern for how things look
The passion for realism is in full bloom. When drawings do not “come out right” (look real) they seek help to resolve conflict between how the subject looks and previously stored information that prevents their seeing the object as it really looks.
Children struggle with perspective, foreshortening, and similar spatial issues as they learn how to see.
Support: Introduce techniques to simplify complex forms for drawing, such as finding basic geometric shapes in objects. Explore one-point perspective to continue growth with spatial relationships. Encourage experimentation with abstract (non-objective) drawing to increase the scope of art awareness. Practice shading, anatomy, and simple composition.
Scribble Stage (Lowenfeld & Edwards)
2 years
enjoyable kinesthetic activity, not attempts at portraying the visual world.
After six months of scribbling, marks are more orderly
name scribbles
Random scribbles begin at age one-and-a-half, but quite quickly take on
definite shapes.
Circular movement is first because it is most natural
anatomically.
Support: Give toddlers ample opportunities to make marks with a variety of easily grasped tools. Use colorful materials and introduce papers with a range of textures.
Schematic (Lowenfeld & Edwards)
5-6 years
schema: a definite way of portraying an object, modified when he needs to portray something important.
The schema represents the child’s active knowledge of the subject.
definite order in space relationships: everything sits on the base line.
develop a set of symbols to create a landscape. (blue line and sun at the top of the page and a green line at the bottom become symbolic representations).
Landscapes are composed carefully, giving the impression that removing any single form would throw off the balance of the whole picture.
Support: Discuss basic atmospheric perspective and overlapping to enhance an understanding of spatial relationships. Simple figure drawing increases awareness of all the parts of the body to be drawn. Continue to invite children to tell stories and talk about their work.
Preschematic (Lowenfeld & Edwards)
3-4 years
conscious creation of form (3ish) - provides a tangible record of the child’s thinking process.
first representational attempt is a person - usually with circle for head and two vertical lines for legs.
other forms develop, clearly recognizable and often quite complex.
Children continually search for new concepts, so symbols constantly change.
tell stories or work out problems with her drawings, changing basic forms as needed to express meaning. (4 or 5ish) Often once the problem is expressed, the child feels better able to cope with it.
Support: Ask children to explain their drawings and tell the stories that spring from their work. Avoid guessing what symbols may be; ask and listen.
Rhoda Kellogg dev stages
restricted her focus to line formations
formal design emerges before pictorialism
left to their own devices and provided with appropriate materials, children will self-educate themselves artistically and develop a uniquely individual sense of aesthetics.
Pattern (24-31 months / 2-3)
Shape (24-36 months / 2-3)
Design (36 - 48 months / 3-4)
Pictoral (48 months / 4years)
Design Stage (Kellogg)
3-4 years
- Combines: units of two diagrams
- Aggregates: Units of two or three diagrams.
- Mandalas: Sanskirt word for circle. Child proceeds from mandalas, to
suns, to humans. Mandaloid formations are perceived by children long before the first diagrams are made. - Suns: The sequence from mandala to sun is a prevailing sequence that
appears only after the child has drawn complex aggregates. The sun and mandala provide stimulus for the child’s first drawings of humans. - Radials: A formation with lines that radiate from a point or small area usually from the center. Early radials appear to be formed from a rhythmic motion, and do not require eye control. these forms can appear by 18
months in the form of placement patterns.
Pictoral (Kellogg)
4 + years
- Humans: The first humans are made when the child joins the face
aggregate with body parts that form a modified mandala. - Animals: Early animals resemble humans that are horizontal. Usually by
this time children are influenced by pictures of animals books. - Buildings: Are drawn by combining diagrams in various ways, not by observing houses.
- Vegetation: Early trees resemble armless humans.
- Transportation: Children draw common formulas for boats and wheeled vehicles whether or not they have seen them. Pictorial labels for these formulas may not be used by the child until an adult uses them.
- (5 years) Children copy schemas favored by society: often a time of crisis in child art. Kindergarten teachers seldom appreciate spontaneous art, and give
children formulas to copy. Once formulas for objects which are “acceptable” to adults are learned , the child will make combinations of them into scenes. - (6 years) Most children stop all spontaneous art activity by the age of eight or so, those that go on usually study and practice the techniques to master various media.
Shape Stage (Kellogg)
2-3 years
- Emergent Diagrams: Emergent Diagrams are formed when the total configuration implies a shape.
- Diagrams: Definite shapes drawn in outline form.
Pattern Stage (Kellogg)
2-3 years
- basic scribbles: Classified into 20 different types these marks appear to be
spontaneous with or without eye control. - Placement patterns: Require both seeing and the eye’s guidance of the hand.
Hanna Kwiatkowska
research and family art therapy
coauthored a short book that helped introduce the field of art therapy to the general public
Edith Kramer
- art as therapy
- influenced by Freud
- goal of therapy: establishing possibility of sublimation (primitive urges transformed by ego into socially productive outlets - art)
- work with children
- synthesis of content and form was achieved by transforming emotional material into fully formed images
- emphasizes the intrinsic therapeutic potential in the art-making process
Judith Ruben
psychoanalytic understanding of patient is enhanced through art expression as therapy
relationship between verbal therapy and art therapy
transference to art object
permanence of art object
externalization of inner material through artwork
how art therapy provides means for illustration of world view of clients and families
acceptance and commitment therapy
Steven C. Hayes
action-oriented approach
stems from behavior therapy and cognitive behavioral therapy
learn to stop avoiding, denying, and struggling with inner emotions
accept that deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives
core principles:
- acceptance
- cognitive diffusion
- being present
- self as context
- values
- committed action
environmental / ecotherapy approaches
belief that human wellbeing is connected to natural world
utilize healing power of nature
goals:
alleviate stress
enhance well being
ecological interconnectedness
Feminist Theory
acknowledges and addresses impact of gender-based inequalities and power dynamics on mental health
social, cultural, and political factors influence experiences
goal:
empower clients
promote self-determination
challenge oppressive norms
foster sense of agency
Social Justice Approaches
Protests are full of strong emotions which are often released in art
Art therapists are social activists
Artistic activism is a practice aimed at generating aeffect
Strategic arts-based peacebuilding
Art therapists viewed as most useful in leadership
At roles in social movements
Visualizing injustices:
Create art to spark change, not just shock
“What do you want policy makers to know about your experience as a ___”
Representing voices:
Can use your art to create image of your experience
Ensure stories are not exploited or misunderstood
Using these images to create an exhibit
Bringing people together:
Portable studio/ urban art therapy studio
Art used as a way to begin discussion
Imagining solutions:
Imagination is core to social justice
Socially-engaged Practice
community based efforts and social activism
incorporates advocacy, education, and direct involvement in community initiatives
recognizes societal context where people live
empower clients within therapy and communities
collaborative efforts to address systemic issues and promote positive change for individuals and larger social environments
Psychoanalytic art therapy
Margaret Naumburg: “release” of unconscious imagery through “spontaneous” art expression was therefore central to her approach to education, as well as to her later development of what she called “dynamically oriented art therapy.
attempted to stimulate free association
Margaret Naumburg
- “mother of art therapy”
- influenced by Jung and Freud
- art psychotherapy (art in therapy)
- spontaneous drawings within the framework of psychoanalysis
- free associations
- art productions were viewed as symbolic communication of unconscious material in a direct, uncensored, and concrete form
Elinor Ulman
founded The Bulletin of Art Therapy in 1961 - The American Journal of
Art Therapy after 1970
published the first book of collected essays on art therapy
Internal Family Systems (IFS)
Richard Schwartz
within each individual, there are multiple sub-personalities “parts”
understand, communicate with, and harmonize various parts
self-leadership and compassion
Somatic Approaches
focus on physical sensations, movements, and experiences
connection between mind and body
emotional issues can manifest physically and vice versa
mindfulness
breathwork
body awareness
somatic experiencing
most effective for: trauma, stress, anxiety
systems Theory
views individuals as part of larger systems
problems and behaviors not fully understood isolation
reciprocal influence btwn individuals and environments
Creative Axis Model
Goren-Bar
Stage 1: Contact. initial period, contact with the art form
Stage 2: Organization. organizes the various elements
Stage 3: Improvisation. uses trial and error to explore materials and characteristics of the medium
Stage 4: Central theme. theme becomes clear and person invests more attention and effort in that particular aspect of the artwork
Stage 5: Elaboration (Variation). person is preoccupied with the modification, development, or improvement of the artwork.
Stage 6: Preservation. ending of the experience (distancing, preserving the work, putting it away, or presenting it)
Expressive Therapies Continuum
Sandra Graves-Alcorn & Vija Lousebrink
Understanding what is happening in the brain can help us to develop experientials
Less about dominance and more about communication between sides of the brain
cognitive symbolic
perceptual affective
kinesthetic sensory
stages of change / Transtheoretical Model (TTM)
process individuals go though when making behavior change
1: pre contemplation
2: contemplation
3: preparation
4: action
5: maintenance
change is dynamic and individuals may cycle through multiple times before lasting change
Kohlberg’s Moral Development Theory
stages of moral reasoning
level 1 - premoral
- obeys rules to avoid punishment
- conforms to receive favors or rewards
level 2 - morality of conventional role-conformity
- conforms to avoid disapproval or dislike by others
- conforms to avoid censure by legitimate authorities
level 3 - morality of self-accepted moral principles
- accepts social contract, democratic ideas
- develops individual principles of conscience
moral thinking evolves from focusing on self-interest to considering broader ethical principles
provides insight to how individuals grapple with ethical dilemmas
** Language Development**
- birth-5 months: coos, Vocalizes pleasure and displeasure sounds differently, Makes noise when talked to
- 6-11 months: Understands “no-no”, Babbles, “ma-ma” or “da-da” without meaning, Tries to communicate by actions or gestures, Tries to repeat your sounds, Says first word
- 12-17 months: Answers simple questions nonverbally, Says 2 to 3 words to label a person or object, Tries to imitate simple words, Vocabulary of four to 6 words
- 18-23 months: 50 words, pronunciation unclear, common foods by name, animal sounds, pronouns, 2-word phrases
- 2-3 years: spatial concepts, pronouns, descriptive words, 3-word sentences,
Speech more accurate, Answers simple questions, question inflection, plurals, regular past tense verbs - 3-4 years: Groups objects, Identifies colors, most speech sounds, Strangers able to understand, describe use of objects, poems and recognizes language absurdities, Expresses ideas and feelings, verbs that end in “ing,”, Answers simple questions, Repeats sentences
- 4-5 years: spatial concepts, complex questions, Speech is understandable, some irregular past tense verbs, Describes how to do things, Lists items, Answers “why” questions
- 5 years: time sequences, Carries out series of 3 directions, Understands rhyming, Engages in conversant, 8 or more words sentences, compound and complex sentences, Describes objects, Uses imagination to create stories
Expressive language
childs skill in speaking and communicating orally
receptive language
ability to comprehend spoken language
syntax
grammar or sentance structure
overregularization
tendency of child to make language regular
echolalia
child repeats same sounds over and over
- not normative beyond babbling period
hand-eye coordination development
- 0-6 months: Grabbing objects and passing things between hands.
- 6-12 months: Using thumb and forefinger for pincer grip and picking up smaller objects.
- 1-2 years: Stacking blocks, holding a pencil and using a spoon.
- 2-3 years: Drawing circles or simple shapes, turning pages of a paper book and beginning to control a ball.
- 3-5 years: Developing better use of cutlery, showing intention with the fine placement of small objects and beginning to write.
- 5-7 years: Coloring within the lines, being able to do and undo buttons and beginning to play sport.
**Rudolph Arnehim’s theory of perception*
perception is strongly identified with thinking, artistic expression is another way of reasoning
denial
refusing to accept reality or facts
blocking external events from awareness to avoid emotional distress
repression
unconsciously pushing distressing memories or thoughts out of awareness
projection
when people attribute their unacceptable thoughts or feelings to others
displacement
transferring feelings from original source of distress onto safer, more acceptable target
rationalization
explaining unacceptable behavior or feeling in rational or logical way
avoiding true reasons for behavior
regression
when individual reverts to earlier stage of development in response to stress or conflict
reaction formation
behaving in way that is opposite to ones true feelings b/c those feelings are socially or personally unacceptable
sublimation
channeling unacceptable impulses into more acceptable or socially valued activities
intellectualization
focusing on facts, logic, and abstract reasoning to avoid dealing with emotional content
dissociation
person disconnects from thoughts, feelings, memories, or sense of identity
undoing
attempt to reverse or undo thought or behavior that is deemed unacceptable by engaging in opposite behavior
splitting
tendency to view people or situations as all good or all bad
acting out
engaging in destructive or risky behaviors as way of expressing feelings that are otherwise difficult to verbalize
fantasy
retreating into imaginary world to escape painful realities
compartmentalization
process of separating conflicting thoughts, behaviors, or emotions into separate mental compartments to avoid distress that arises from coexistence
Florence Cane
- sister of Naumburg
- art educator
- developed kinesthetic warm up
Edward Adamson
- worked with patients in psychiatric hospital
- studio approach
Rita Simon
- art therapy in psychiatic after care
- 4 basic art styles
archaic linear
archaic massive
traditional linear
traditional massive - creative initiative as main vehicle for mental health
Daniel Goleman
emotional intelligence
- ability to interact with others
- read emotional cues
- communicate effectively
Shaun McNiff
humanist and Jungian approaches
dialoguing with artwork
Lesley college
art therapist as “Shaman”
movement, drumming, and vocalizing to expand on imagery in artwork
Pat Allen
studio approach
embracing mysterious nature of creative process
artists authentic experience
