Basic Guide to the 3 Stages of the Altered Book Process in Art Therapy

I divide the process it into, The Beginning, Getting Into it! (like the middle), and The End. There are 3 subphases to the First Phase:

Stages, Activities, Directives and Methods of Altering Books:

 First Stage of The Beginning: The “Invitation”!

  1. Inviting your patient to do the altered book, introducing the process and choices of media as well as books to alter…
  2. It is best to have a variety of choices of books that you supply so the person does not feel like they have to “ruin” a book of their own and feel that the therapist will hold the “bad” part by giving permission to destroy a public already created object…
  3. Having, displaying one or more of your own altered book projects, finished or not, is a good way to show/explain the project, and make it fun, acceptable and inspiring!
  4. The Big Choice: Witness the patient choose what kind of book to alter or actively help with suggestions if appropriate. See list of materials for further classifications and descriptions.


Second Stage of the Beginning: Destruction/Preparation of Book as “Ground” “Surface” for Altering: The Separation Process of Removing Former “Author”/Identity of the Book to Prepare for Creation of Your Original Artwork:

Destroy, Take apart, Eliminate, Discard, Remove, Rip, Tear, Cut, Alter surfaces, Change, Separate, Dissolve, Kill, Remove, Expell, Extract, Remove

1.Take out pages, rip off half of pages, glue together pages, rip surface off board book pages, gouge out board book pages, make holes and tears on paper pages. Cut pages, cut edges of pages, staple or attach other pages or paper materials to be inside the book or extend beyond the page, Cut deep into the book through layers of pages, poke holes, use Sandpaper to rough up surface for holding paint or to alter photos and images in the book, keep book jacket as is, cut out parts, or discard. A whole session spent altering the surface and ripping and throwing out pages can be a good way to jump right in, have fun, and avoid getting overwhelmed with ideas about content.


Third Stage of the Beginning: Start Creating, Doing, Making, Using Materials:

Look, Find, Discover, Create Space, Begin Anywhere, Open, Enter, Conceive, Start Rebirthing Process (Book as House, Body to Redecorate, Design, Embellish)

            1. Choose some art materials, supplies, mixed media. See list provided.

2. Choose to jump in and explore and let the process lead you somewhere without an intention or with an intention, theme. What will this be? A Book, An Object made with the book? Note: Calling it a Self-Portrait can give permission to let the book unfold session by session. What makes this project so open, playful, fun and non threatening is often the idea of surrendering, seeing what happens, knowing you can redo pages and even rip them out, so it tends to go well with a “go with the flow” attitude which is mirrored in the improvisational aspect of the therapy session, thus, unless my patient states an intention or purpose for the book, I encourage him/her to wander, let go, play…

* Closed Flat Book versus Open “Accordion Book”: To keep the book flat if using thick or 3D media, remove pages all over the book so it can close. Otherwise, dive in and expect the book to start expanding like an accordion. (See Case Examples Presented.)

  1. Locus: Decide whether to start with cover or back cover, keep book jacket to use, or start at beginning, or dive into the book and work on pages at different sections.

4. Start altering/creating, with therapist as witness, companion, container, mirror, security guard…


Second Stage after 3 Beginning Stages: Getting Into It! Down the Rabbit Hole…

Play, Connect, Attach, Add, Embellish, Dig Up, Hide, Conceal, Reveal, Layer, Build

Directives/suggestions for this stage, which is the longest part of the process:

Note: There are so many things to do with altered books, these are just a few ideas to get you started… If a patient is “stuck” with how to begin in a later session with their ongoing project, I usually suggest some new materials. Otherwise, you can ask if s/he wants a directive or choice of ideas to experiment with…

  1. In individual art therapy, with the altered book project, each session begins with an invitation and choice to bring out the book and work on it or not. Some patients work on it every session, and some put it aside and get reignited at a later time. Putting the book “on the shelf” can be therapeutic in terms of the idea of letting something be unfinished, unknown, waiting for a new moment, accepting that you don’t feel like working on it. Or take out some other art work from previous sessions and consider recycling it, cutting it up, incorporating it into the book somehow.
  2. Tape up or paint on page or page spread and just reveal a few words that you choose.
  3. Paint/mark up one side and stick it to the other and then separate for mirror image effect/print.
  4. Openings and pockets: make different kinds of windows, doors openings: holes of different sizes and shapes, windows that open and close, fold page in some way to create a pocket.
  5. Experiment with unfamiliar materials from the list provided or take a familiar material and do something new (stick feathers or other objects into model magic and glue to the page…)
  6.  Pick a paper doll cutout and glue it on a page to create a full body self-portrait.
  7. Glue an envelope to a page and hide or store things in it. Pick words from magazines, other pages of the book or a word box.
  8. Yarn and fabric, sewing supplies, experiment with sewing paper and fabrics on the paper of the book or create a new page to put into the book somehow.
  9. Go through the book and start creating layers by working on several pages at a time. If you wet the page you can put objects between pages to keep them from sticking together or use binder clips. Big binder clips can allow you to use wet media in different areas of the book in one session.
  10. Consider the layout, you open the book and there are two sides. Are the two sides delineated and separate or do you take both sides and turn them into one continuous surface? Can each side represent opposing aspects of the Self?
  11. Consciously consider the book to represent different aspects of who you are, your identity, parts of yourself that you hide or reveal, parts you want to transform.
  12. Write a letter to yourself or to your future self or someone else and put it in the book.
  13. If you want to consider a topic or theme, think about what part of your story to tell: Is this book about childhood, you now, the therapy process and what you are doing in therapy, or dedicated to someone else, living or dead. Is it about a loss of some kind? Or your future child/baby? Does the theme reflect an interest or passion of yours or something new to discover?
  14. You can surrender to the book and let it lead you where to go and enjoy the process without having any idea what it is about or how it will turn out. Or, ask the therapist to lead the way with his/her book and copy the what s/he is doing.
  15. Take a page or page spread and deliberately make it ugly, use colors you don’t like, put words you don’t like on it, make an image that you find unpleasant. Put it aside and look at it during another session to see if your attitude towards it has changed and what you learn from this Ugly Self. Keep it or rip it out and cut it up and put it throughout the book.
  16. Try weaving with paper, ribbon, yarn, rubber bands…
  17. Use double sided decorative paper or fabrics or foldouts to add new pages into the book.
  18. Glue two books together and start from there.
  19. Find words in the book to create a title…
  20. Create fold out pages and add things in the hidden page.
  21. Deliberately use materials that extend beyond the page, horizontally or vertically, like suspending cut fabric or thread or wire with bead on it, a painted tea bag, or a glued on book mark.
  22. Use an unconventional type material: glue a teabag somewhere, make a chain of safety pins, play with aluminum foil, napkins, paper clips, coffee beans, sand, etc.
  23. Add in personal objects, old photos, tickets, menus, receipts…
  24. If your patient wants to, you could create two books at once, either by both working on similar or different books at the same time or even passing books back and forth.
  25. Use a page spread or page in the book to process a dream.
  26. Make a small doll, figure or animal to attach somewhere to the book, either to be able to move it to different parts of the book or to stay in one place with the book as environment.


Third and Last Stage: Finishing the Book!

The End, Time for Reflection on the whole process… Book as Therapeutic Object

  1. How do you know it’s finished? Does the book supply the stopping point? Do you intentionally “end” it? Do you choose to finish it by stopping but considering it unfinished and that it will remain unfinished? (Accepting the unresolved parts of the Self, seeing the Book as a Book of life that you put aside or decide to end with extra pages left in unaltered.)
  2. What feelings come up around finishing your book and your therapist witnessing the ending of this big Project?
  3. Does the book mirror something in the therapy process? Are you feeling like you have reached a turning point in therapy and ending the book satisfies that feeling? Does the book signal that you want a break in therapy or to end therapy?
  4. What else comes up around ending/finishing/completing or leaving incomplete?
  5. What do you want to do with your Altered Book? Does it now have a Title? How does it feel to hold it in your hand and look through it? How does it feel to watch your therapist hold and look through it? Are there moments you remember that were important for you on certain pages? Do you have a narrative that tells a story and how did the story arise? What does it feel like to have a chaotic book with no title that was made in no particular order with many different media versus making a book where you started at the beginning and knew you were finished when you reached the last page?
  6. If you and your therapist made “mirror” books together, what do you want to do with the finished books? How do they reflect your therapeutic relationship?
  7. For those who started the book at the beginning of therapy with their art therapist or a few sessions after beginning and worked on the book continuously in every session, what does it reflect to you about the therapeutic relationship, the therapeutic process, trust, intimacy, vulnerability? What does it feel like to have a concrete physical record contained in a book as reflected or symbolic of the therapy?
  8. Does ending this book inspire you to start another one or take a breather? Are you working on more than one book? If so what is it like to end one while continuing with one or more others?
  9. Post-partem feelings: process any emptiness, sadness, feelings of loss about finishing, ending the book…



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