Broken Crayons Still Colour

My journey with visual art therapy began three years ago during a workshop when I first met Susan Bolluogh Khare, a strong advocate of person-centred art therapy. Her exhibition in Pune on The Therapeutic Value of Art showcases the role of creative art in the therapeutic process.

One’s expression through art is used to address both psychological and emotional needs of the person in visual art therapy. According to Khare, it is the artistic process that is more important than the final product. Visual art therapy uses art as a medium for expressing oneself through a creative process on the path toward self-awareness. According to Cathy A. Malchiodi in her book Expressive Therapies (2005), art therapy uses traditional psychotherapy and its techniques in union with the creative process to improve one’s psychological health and wellbeing.

During her workshops, Khare urges participants to explore the art medium slowly in the beginning, by letting them to express their feelings through lines and colours. Subsequently through active imagination or the introduction of themes, art therapists like Khare help clients explore emotions like fear, anger, and sadness to get in touch with their senses. Extending emotions to cognition, Lusebrink (2004) explored the relationship between art expression and functions of the brain. The sensory processes involved while making art activates different brain regions, and the expression of art stimulates the kinaesthetic and visual senses in the brain before processing the information through cognition. By letting clients evince themselves through art, they may come to terms with difficult thoughts or feelings that may be at the root of their problems and explore ways to cope with them.

As an art therapist, one is skilled to identify the nonverbal representations and analogies that are communicated through the art form, which might not be as easily expressed in words. Riley (2001) has also shown that many adolescents are more comfortable expressing themselves with visual art than talking about their feelings. Khare emphasizes on the interpretation of the art by the person, who gives it meaning, as opposed to the therapist explaining the piece as followed in traditional projective techniques.

Art as therapy can be employed as a clinical intervention and is effective in treating a variety of symptoms in diverse populations. Creating art as a process in the therapeutic environment offers opportunities for counsellors to build relationships with the client and explore areas that arise from the client’s artwork. The integration of art therapy and solution-focused treatment has proved effective for substance abuse as it blends cognitive and perceptual strategies (Matto, Corcoran & Fassler, 2003). Research by Northwestern Memorial Hospital (2006), found that art therapy allows cancer patients to focus on something positive and gives them something they can control. Thus the process involved in making art is not only therapeutic but helps improve their quality of life and boosts their abilities to cope with stress.

Chapman et al. (2001) found that children receiving art therapy treatment experienced a reduction in acute stress symptoms and Gussak (2009) showed that art therapy greatly improved the mood of inmates by helping them shift to an internal locus of control. Creating art together brings a different synergy to a group and provides the therapist with insight into group dynamics. As prolific as art therapy is in groups, it can also be effectively used in a one-on-one format for personal development, self-exploration, and an in-depth understanding of one’s persona.

Pablo Picasso once said that “Art washes away from the soul the dust of everyday life.” According to Khare, only when we are comfortable working with art as a medium and have explored our personal issues through art, will we be able to effectively work with others. Art therapy is truly an opportunity to explore oneself and develop skills of acceptance and empathy for the people with whom we interact in our daily lives.  

Nikita D'Souza

Self-Care: The Vanquisher of Distress

“The heart pumps blood to itself, before the rest of the body.”

In the previous blog, we discussed self-care and how it ought to be made essential for a practicing psychologist. Self-care is defined as the behaviours and actions taken to increase one’s mental and physical well-being and resilience. Self-care helps in increasing a therapist’s competence as it models healthy behaviour for the client, enhances self-esteem and confidence, expands the therapist’s reservoir of empathy, and reduces the occupational hazards of compassion fatigue, emotional burnout, and vicarious trauma. Self-care is not a voodoo science. Extensive research has shown that self-care improves attention, immune functioning, self-esteem, empathy, and counselling skills (Schure, Christopher, & Christopher, 2008; Shapiro, Brown, & Biegel, 2007).

Empathy and vulnerability form the basis of self-care. These terms are often used casually in conversations, yet one may have failed to understand them. Wiseman (1996) classified empathy into four crucial parts. Empathy is built upon the cornerstones of perspective taking, non-judgementality, emotional recognition or understanding another’s feelings, and communication of the understanding. A therapist ought to apply the same concepts to themselves; for instance, they must not judge their own thoughts and feelings. A competent therapist would have to recognize their own emotions and communicate this understanding to their conscious mind. Empathy can’t be limited to clients only but has to be extended to therapists themselves. Empathize with your body, empathize with your brain, and empathize with your own depleting empathy.

Vulnerability is a vital part of self-care. Brene Brown, one of the pioneers in research on vulnerability, says that “Vulnerability is the birthplace of innovation, creativity, and change.” She found that embracing one’s vulnerability and breaking the power of shame helps people in forming connections and fostering self-growth. Therapists should not see themselves as all-mighty superheroes. Accept your vulnerability, acknowledge your limits, and don’t be ashamed of seeking help when needed.

Hence, a self-care regime should involve practices that help you empathize with yourself and cultivate acceptance of your vulnerability. There is no one correct method of self-care. It can be tailored to your own interests and needs. Practicing mindfulness, exercising, practicing yoga, walking, reading, listening to music, or even watching trashy reality TV can be a form of self-care. I have had a colleague tell me that she would take 30 minute nap every day in order to reenergize herself. A therapist should also seek supervision as it acts as a constant source of support. Often a supervisor would be able to spot the signs of compassion fatigue or emotional burnout in a therapist and would prevent him/her from falling down the rabbit hole.

You must have surely noticed how vital self-care is, as well as how easy it is to practice. However, one of the common barriers to self-care is lack of knowledge. It is not an aspect of formal training. There might be PowerPoint presentation on it but that’s where it stops. It should be promoted just like any other counselling or clinical skill. Hence, self-care should be a fundamental part of a therapist’s daily regime. It should treated as a vital skill for we often hear the age-old adage “Prevention is better than cure.”

Here are some resources to get you started, because the first step to practising self-case is learning about it.

Brene Brown: The Power of Vulnerability

Caring for Ourselves: A Therapist's Guide to Personal and Professional Well-Being by Ellen K. Baker, PhD

Prachi Bhuptani

Self-Care: Create your own calm

“Self-Care is not selfish. You cannot serve from an empty vessel.”

Over the course of their training, psychologists have often been told to maintain objectivity in their work. They are supposed to suspend their personal beliefs and feelings and look at clients with clear glasses. However, psychologists cannot discard empathy and compassion for they are the tools that help them connect with clients. Without these two, a psychologist is rendered as a mere robotic device that hears their clients, but does not listen.

However, the act of being compassionate and empathetic comes with a hidden cost, especially for clinical psychologists as they traditionally see clients with more complex issues. Compassion fatigue and emotional burnouts are prevalent in increasing rates amongst helping professionals. Compassion fatigue is a psychologist’s reduced capacity to feel empathy, positive regard, or authenticity for their clients and is usually “the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced or suffered by a person” (Figley, 1995, p. 7, as cited in Adams, Boscarino, & Figley, 2006). Psychologists use compassion to increase the effectiveness of their therapy. Unfortunately, feeling compassion for clients also puts psychologists at the risk of compassion fatigue. It becomes a serious issue as it decreases psychologists’ competence in helping their clients. The APA Ethical Principles of Psychologists states that “psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.” This means that a psychologist shouldn’t practice when they find themselves experiencing compassion fatigue as it affects their ability to foster the well-being of their clients.

Experiencing compassion fatigue for a longer duration can lead to an emotional burnout. It is characterized by emotional and physical exhaustion, depersonalization, and reduced personal accomplishment (Maslach, Schaufeli, & Leiter, 2001). When psychologists do not release their emotions regarding their work, the resulting emotional exhaustion provides the perfect breeding ground for emotional burnouts. All mental health practitioners experiencing burnout disengage from work, which consequently leads to decreased competence. Both compassionate fatigue and emotional burnouts can create feelings of depression, anxiety, and helplessness amongst therapists. Ironically then, the therapist herself/himself becomes the client.

All helping professionals like nurses, emergency room personnel, police, and mental health providers are equally at risk for becoming victims of both compassion fatigue and emotional burnouts. However, clinical psychologists who tend to survivors of trauma are at a unique risk of experiencing vicarious trauma. Vicarious trauma occurs when psychologists develop trauma reactions after being exposed to their client’s traumatic experience (Trippany, Kress, & Wilcoxon, 2004). Psychologists start exhibiting symptoms of Post Traumatic Stress Disorder such as experiencing intrusive thoughts and images of their client’s stories along with physiological arousal and somatic complaints. Researchers working in the field of trauma are also not safe from vicarious trauma (Bell, Kulkarni, & Dalton, 2013). All psychologists are vulnerable to compassion fatigue, emotional burnouts, and perhaps, vicarious trauma. The only thing that can buffer the effect of this debilitating kryptonite is self-care. This includes all behaviours and actions taken to increase mental and physical resilience and well-being. Self-care acts as a safeguard against psychological distress caused over the course of a psychologist’s career; it recharges the therapist and helps them cultivate optimism.

Thus, self-care helps a therapist navigate around these pitfalls of compassion fatigue and emotional burnout. The next blog in this series will include various kinds of self-care techniques as well as some common things that get in way of it.

Prachi Bhuptani