Great Idea for Art Therapy New Year Activity!

Thanks to Pam Kirst for posting about the new year. This quote was in the conversation she posted. You can read her whole post at this link:

The idea involves letting go of the old and making room for the new. Here is the direct description that you can modify lifted from her blog post:

Well, it takes just a little bit of preparation. I go through the Christmas boxes and find one about shoe box size, and I paint it black, so it looks kind of like a coffin. It’s the box where all the bad stuff goes to die! Then, during the party, at about 11:15, I pass around paper and pens. I tell everyone to find a quiet spot where no one can peer over their shoulders, and to write down anything and everything from the past year they’d like to forget or get rid of or just flat out wish had never happened. They fold those up tight, and we put them in the black box. I always save some kind of pretty, flammable ribbon–some years, I’ll tie it up with a bright red ribbon and bow–or maybe silver, if I’ve gotten lots of glitzy wrapping. Then, no matter what the weather, I drag everyone outside to the driveway, and I make a little speech about letting go of all the things we regret or are sad or angry about from the last year. Then we ceremoniously douse the black box with lighter fluid and throw a match on it,and we stand around and watch the bad parts from the old year burn to ashes.

So this is a great idea for a New Year’s Party to both let go of the old year and ring in the new year with positive affirmations. To modify it for a group or individual art therapy directive, I might have the patient(S) make both boxes. I would invite the person or people to write down anything from 2014 that they have been carrying around and feels heavy and that they want to let go of and clean out their house for new things, to borrow from Rumi’s poem The Guesthouse. I might even read the poem to them. Then to write down their affirmations or dreams for the new year and make some kind of container for it.

Well there is nothing like Carpe Diem. I interrupt this post to say that I just tried out a version of this idea and it was transformative. Both I and my patient wrote down things to let go of and read them and put them in a box I already have. She picked a box for her Affirmations/Goals/Dreams. We both wrote down things for the new year and shared and inspired each other. Then she started painting her box. After the first part, she felt a relief and letting go and after the second part, she felt “good”. I did too.

I will collect people’s old stuff in my black box and burn it all somewhere, not the box! And people who want to can make a box for their dreams for the new year, or do a Vision Board instead and actually make a collage with their dreams for new year in the collage.

There are all sorts of ways to be creative and ring out the old and ring in the new; I really love this one so thank you to Pam and Loolie!!! I will post photos of my black box soon…






Medication and Therapy

In my last post, I touched on the topic of medications and mental illness. This post will attempt to address some of the issues connected with this vast topic…

Psychotropic medications have always been a controversial topic in many different societies. I have had much experience working with people on all kinds of medications, as well as working with people in the midst of going off their medications, starting to take medications for the first time, and many who tried out medications and then stopped them without finding a medication that was helpful. In addition, I have encountered people suffering from various emotional and mental difficulties and disorders who were vehemently opposed to taking any form of medications but were willing to try alternative forms of healing instead of medications.

I try as a therapist and person to be open to all points of view about this topic. What one chooses to put in one’s body is a very often private and vulnerable personal topic. While psychiatrists that I have talked to about this admit that we know very little about what makes a medication work and why and how, we also know a lot more now than ever before, and there are a lot more choices of meds than ever before…

As I mentioned in my last post, I have found that people struggling with and suffering from such issues/disorders as schizophrenia, schizoaffective disorder and bipolar disorder (both 1 and 2 as they appear in the DSM), really benefit from regular medication for an extended length of time. Often the reason for a re hospitalization or “relapse” with one of these serious disorders is caused directly by the person stopping taking their medications, usually because the person feels a lot better and thus thinks, “Oh, now I can stop taking these medications,” which makes some sense, as very often when our suffering is relieved by medication, it makes sense to stop taking it. But these disorders are more like diabetes. You don’t stop taking your insulin because you feel better. When I worked at a Continuing Day Treatment Center for adults and also at a residence for emotionally disturbed children, I saw how the medications really helped people with these serious types of disorders. Almost all the adults at the CDT were taking some kind of psychotropic medication, and a lot of but not all of the children I worked with at the residence were also on medication. The topic of medication and diagnosis and children is a complicated topic better addressed in a separate post. Suffice it to say that I saw children also helped by medications, especially those with ADHD and other behavioral disorders.

While Bipolar Disorder is a serious and sometimes even deadly illness, it is amazing how much medication taken regularly can really transform someone and their ability to function, such that people who continue to take their medications on a regular basis can function and thrive. Sometimes one or sometimes a combination of medications, and there are now many different mood stabilizers whereas a while ago it was mostly lithium, anyway these meds can really help balance the fluctuation of moods from manic to depressive. Most people have to learn the hard way that they need to accept their biology and that they suffer from Bipolar Disorder, by going off their medications, having a relapse or even two or three, and then accepting it and staying on the medications that work for them. Luckily there are now a variety of mood stabilizers, and these medications don’t all take away a person’s creativity and liveliness; they just help an individual to manage their mood disorder.

Schizophrenia and schizoaffective disorder are much more debilitating than bipolar disorder. However, I witnessed many of my patients healing with a combination of therapy, day treatment which provides structure and socialization, and medication. This combination of approaches really help people with severe symptoms, such that the voices they are plagued by can disappear, or at least subside to the extent that the individual can function on some level and receive some relief. It is very unusual for an individual suffering from these illnesses to be able to not take any medications. There are many good medications out there that work; unfortunately many of these  st cause weight gain, and I saw my patients suffer with the side effects of weight gain as well as worse side effects. Some people manage to be careful with their diet and are able to take these very potent medications without experiencing weight gain. However, I saw many of my patients at the program who were on Medicaid and had poor dietary habits; still for many to be able to socialize with others, even to be able to leave their house or residence and attend the program was a big step towards healing. The medications were only one part of this; therapy, groups, meeting others with similar issues, having a structure to their day — all of this was necessary for some or partial recovery.

Depression, including both major depressive disorders and other less serious depressions, is much trickier in terms of medication management. I have certainly seen people with bipolar disorder take medication for depression along with a mood stabilizer and be helped by the extra medication. I have also seen people get out of a terrible depressive period with the help of anti-depressants. Some of these people were helped by taking some  kind of anti-depressant for several months to a year and then were able to stop their medications and use other means for their daily self care to avoid slipping back into a depression. I have also seen people with depression who continue to take their medication even when they are not depressed, and these people find it helps them to combat the return of depression. Any person taking anti-depressants temporarily or permanently is greatly helped by having  some form of therapy, as well as a support group or yoga or regular exercise or any other number of  “non medications” that help with healing. In fact, sometimes the medication helps the person to be able to be motivated to do these other things that they were too depressed to do for themselves before taking medications.

On the other hand, I have seen some people struggle with taking anti-depressants, even to the point that they are willing to try a few different ones, looking for one that works, only to be defeated. These people sometimes can find no medication that works for them ,and they often make a valiant effort to find one. However, the good news is that there are other ways to shift depressive brain chemistry. Art therapy is especially effective in that the act of making art and being creative in the moment does have a positive effect on the brain. With the support of the art therapist or the group therapy, a person with depression can begin to shift his/her mood towards feeling better. Regular exercise has been proven to help with depression as does yoga. With good support from friends, family, a therapist, a support group or therapy group, some people are able to combat their depression without the help of any psychotropic medication.

Of the people who refuse to try any of this kind of medication for their depression, many do self medicate and even are aware they are doing so. Some use drugs or alcohol, which of course actually physiologically contribute to depression, but the slight lift or high at the beginning of injesting substances can outweigh the crash for many people caught in a cycle of addiction or dependence. Even limiting food intake to an extreme is known to produce a high, so restricting food intake can be another form of self medicating. The challenge for this group of people is to become aware that they are self medicating in an unhealthy way and after that to change these behaviors.

There are people who do not self medicate with unhealthy behaviors who believe alternative medecine is the way to go. These people really work hard to combat their depression with positive self caring behaviors such as regular yoga, massage, reiki, some kind of creative endeavor or creative arts therapy, as well as writing and using some of the cognitive behavioral therapy techniches as well as creative visualization, acupuncture, and even being careful with their diet, as it is true that certain foods contribute to depression.  Often it can become a vicious cycle where depression leads to eating unhealthy foods or bingeing on unhealthy foods, then becoming more depressed and continuing to take bad care of oneself. So changing one’s diet can really help with depression.

“Today was the best day ever!” Happy New Year!

This will probably be a relatively short post, but it feels important as it is my “new year’s” post, the last post for the year 2011 and the post to usher in the new year of 2012. I dedicate this post to C., an old friend whom I had not seen in about 8 years, who died this week. A terrible tragedy. The world has lost a really wonderful and great person. And way too early in his life. So the rest of this post will be about life…

Yesterday towards the end of the day, my four year old said, “This is the best day of my life!” If only I could bottle her enthusiasm for a perfectly normal day and give it out to everyone on their worst day.

Here are a few important arguments for choosing life over death even at your most difficult moments. And here I confess, I decided, since I’ve already gotten a bit personal for a therapy blog, and shared my daughter’s statement, I might as well get some help from her again in writing this post as I consider her to be a great expert on the joys of living. My four year old daughter. So here goes.

Some of the most coolest reasons about being alive include the following: “Having to pick flowers.” “Bubbles!” “Dresses and fancy dresses”.  “When you have a really good day what do you think your favorite thing about it is?” I ask. “Having to be with Mommy.” (I swear it’s what she said, and if my day has already been great hanging out with her from this morning non stop until now, about 6:15 in the last day of this year, of course it’s just gotten even greater. Some more help from my daughter about what makes life great: “Playing in the pretend play center. It’s a kitchen. It’s lots of cool things it has phones and cups and dressing up stuff. You can cook food. Have my own restaurant. Next when I go to school I’m going to have everyone be the customer, and I want to be the waiter. One is the waiter and one is the chef and the other two people get to be the customers.” (Only four people in the pretend play center at a time…) In fact she has been counting the days to when she gets to go back to Pre-K and talked about missing her teacher. I have seen the pretend play center and it is awesome. Partly because there just isn’t that much stuff in it, but the kids just love it because they get to make up whatever they want with a few kitchen utensil items, some play food and a couple of things to dress up in, and not very fancy stuff at that. But how cool is it to have a restaurant of your own for fifteen minutes, or be the waiter or cook there. Or get married a few times a week and only have it be about the wedding. (There have been more than a few weddings in the pretend play center. And mostly two girls marrying each other.) I think those are a few great things about life, enough to keep us going for a while, I would hope.

Back to the new year’s eve holiday, finally, the end of the long holiday season, which unfortunately too many people are very relieved about, and some are sad about. But there is still tonight, New Year’s Eve, the one holiday you can choose to completely ignore, be with your family or not, dress up and party the night away, or not. Drink festive drinks, with or without alcohol. Stay up late and be there in that magical moment when it changes from this year to next year, or sleep through it and ignore it completely. Do whatever you want or don’t, tomorrow will be the first day of the new year no matter what you end up doing. My daughter will not be sleeping through it. She was awake for it a year ago at age 3, and today, she keeps asking if it’s new year’s eve yet. As she normally doesn’t get tired until late at night, I’m betting she’ll be awake pretty late this year, the one day of the year when there should be no bedtime, at least in my family. I will confess here that I’ve always loved New Year’s Eve. I love that I can get too dressed up and hang out being fancy with other people who might be wearing jeans. As a New Yorker, I’ve always loved being in this city for new year’s. As I’ve gotten older, the night has become less about party hopping and more about getting really as dressed up as I feel like it, and then miraculously not have to go outside, therefore being able to wear sleeveless dresses which are the most fun to wear anyway… because – we now simply have to go up two flights of stairs to the neighbor’s apartment for their awesomely fun, very casual and low key, kid friendly annual New Year’s Eve party of our wonderful penthouse neighbors! (That means friendly for my kid who is the only young child at the party but who loves to hang out with the neighbors’ now 20ish year old daughters and their friends who are very nice to her.)

So I’ll end on a high note and a few more gems of wisdom from my child. “Are you excited about New Year’s Eve,” I ask. “Yeah!” “Why?” Cause I’m going to the H’s house party! and I can play with L. and M. and their friends! There won’t be any kids there cause there weren’t last year.”. “You think you’ll have fun even if there arent’ any kids?” “Yes. I like playing with grownups. I mean W. and M.”

Ok.  I have to ask her one more time, ” Tell me some of your favorite things.” “Barbies.” “Dinosaurs and ‘How I Met Your Mother’ more than cartoons.” Yes she likes that show. Thinking of you, C.

Art Therapy as Food

The holiday season is here and that means trouble for people with any kind of eating or food issues. Holiday dinners and tons of holiday parties which seems so cheerful and fun for some, for others can be big triggers. If you’re in some recovery process of relearning healthy eating and trying to follow a good schedule of meal times and eat nutritionally well, this is a time of many challenges. It’s a good idea to try to be flexible with yourself and allow yourself to eat more and eat things you don’t normally consider healthy rather than fall into the trap of self-punishment or get caught up in obsessing about food and body. It’s also a great time to focus on the non-eating activities of the holidays. Make your own wrapping paper or make your own cards. Make a holiday card to send out to family and friends. Make a fun photo or art calendar for 2012. If you like singing focus on the songs and sing a longs at the parties you go to. Enjoy dressing up if you like doing that…If you go to O.A. meetings talk about this season and your struggles with it tripping you up and any worries you have about getting into old bad habits/and/or destructive behaviors… Just a few suggestions for this time of year that itself is a big trigger for many.

I mentioned some art activities in the above paragraph but this post is meant to try to focus on art therapy and the question, Why is art therapy so effective at helping people with eating disorders as well as body image issues, food and exercise addictions, obsessive thinking about food, weight, body, etc.? Unlike other types of “obsessions” and “addictions”, such as alcoholism and drug addiction, when a person has issues around food and eating, s/he cannot simply avoid food, grocery stores and restaurants for obvious reasons. Triggers are everywhere and food and meal planning are necessities for becoming healthy. One has to change one’s relationship to food altogether and then rigorously watch out for and identify triggers and then have a plan for how to deal with them. For re-learning how to eat, how much to eat, what it feels like to be full, etc., cognitive behavioral therapy techniques can work very effectively to help a person manage their day to day life and find the difficult balance between being observant and watchful of one’s behaviors and familiar feelings or lack of feelings that trigger self-destructive behaviors around food and exercise. Just being able to call your therapist or some other helpful person when you feel challenged and scared you’re going to “relapse” is of course very useful. I have had many patients who reported that calling me when something difficult came up was very helpful or even knowing that s/he could call was also helpful. Speaking up when you’re feeling vulnerable is always helpful and can really get you through some bad moments if you know whom to talk to and can get in touch with him/her.

So where does art therapy fit in? To battle an eating disorder like bulimia or binge eating or anorexia and other related issues, one needs to learn more than ways to avoid unhealthy behavior. Besides becoming armed with ways to identify triggers for unhealthy behaviors and learning to identify one’s feelings rather than using food to literally stuff one’s feelings or cut off from them, you have to learn ways to notice when you feel a self-destructive impulse coming in, what was going on in you and what can you substitute the unhealthy behavior with, ie. learning about self-soothing. Any disorder or issue involving dissociating, getting out of one’s body, etc. can be very much helped by activities that bring you back into your body. A major part of the art therapy process in working with trauma of any kind involves using art making to learn or relearn self soothing.

Art making in the presence of a therapist or in a group with an art therapist can be healing in many different ways. There are many different forms of art making that are soothing to most people. Being given a blank piece of paper or a canvas has been shown to actually increase anxiety and trigger self-criticism in many people. So one must pick particular art making activities that are able to decrease anxiety levels and can even help a person get back in his/her body. Making a mandala with oil pastels or watercolors, which involves tracing a circle or filling in a circle that the therapist has already pre-made for the session is a very popular and tremendously healing activity. Not only are mandalas soothing, as a symbol for the self, the mandala can give one information about one’s feelings about oneself. How you treat the boundary of the circle is of course important. I have found that having people do the mandala with their non-dominant hand can release a lot of worry about how it will look and decrease perfectionistic tendencies. For some, the lack of control of the non-dominant hand becomes too frustrating to be therapeutic, but this seems to be in a minority of cases. Making the mandala on black or colored paper is also a useful way to reduce anxiety and increase excitement about the task, just by being stimulated by the color of the paper or soothed by its darkness. Mandalas are very useful for identifying one’s body energy in the here and now. For example, I have done workshops involving doing a quick mandala at the beginning of the session, followed by some form of meditation exercise, and then a much longer time to make and complete a second mandala. People are always pleasantly surprised to see that their energy at the beginning (often more chaotic or too controlled or else a minimal effort to complete the picture without much satisfaction), has completely changed from the meditation and the art making at the end of the session. The two mandalas can be compared and give a person an actual blueprint or “emotional x ray” of what was going on in their bodies at the beginning of the session, and how changed their energy feels by the end of the session, usually descriptions include “more grounded”, or that the picture feels “more whole”. At some points in treatment or recovery or self-care, it can be useful to do daily or weekly mandalas and then write a few words about one’s feelings and thoughts. put it away and look at your mandalas later as a group to see what changes may have occurred.

Other soothing art making activities involve collage, beading, and decorating boxes as well as making dolls or decorating and covering/painting pre-made dolls. For some people painting is incredibly soothing. The metaphors of art therapy in direct relationship to food are interesting in themselves. The materials and the media are a different form of food which can literally be used for symbolic filling up. If the art therapy session is highly structured with some form of directive and structured around time to make art and time to process, this structure can help a person feel more regulated and grounded. Most impulsive unhealthy behaviors are performed when one is not grounded in one’s body and in some kind of anxious or compulsive state or fughe state. Meals in themselves are what structures the day for many people, and when there is no structure to when one eats, one can get easily caught up in feeling out of control. There are many art directives that are helpful for all sorts of aspects of recovery and regaining a healthy lifestyle as well as a healthy relationship with one’s body. Identifying and making pictures of different forms of hunger: emotional hunger, mental hunger, physical hunger and even spiritual hunger. Just describing and identifying these states is helpful. However as in most cases with art therapy, having an image to play with, observe and help organize oneself is highly useful. It is a great tool for measuring progress in therapy; to have something tangible like a body of work over time — what better way to actually see self transformation/

Of course there are all kinds of directives and activities (the art therapy “menu”) specifically geared around confronting and dealing with eating issues. I have named only a few above. Positive self image collages are another great art activity that is fun, non-threatening and promotes thinking good thoughts about oneself. Making affirmation boxes, a great transitional object for you to bring home and add to on your own. For some people that I have worked with, doing a body tracing by lying on the paper and having the therapist trace around your body and then filling it in in any way with whatever materials there are at hand is very useful in working on these difficult body image issues. Again, this is even better if you are in long term therapy and do one every couple of months or so to be able to compare the different images and notice what has changed for you. This is one of those activities that is best done when you have come to trust your art therapist and are ready to grapple with difficult feelings, even trauma memories, that can surface while filling in the body tracing. This is a prime example of why our training in working with trauma is so important. It is also a great activity to do with pregnant women in a group or individual session.

Besides the structure and the helpfulness of particular directives, non-directive forms of art therapy also work well. I have had patients with eating disorders who enjoyed having choices of what to do and figuring out on their own what they liked, being able to explore my art studio and feed themselves. What can replace walking into a deli or grocery store hell bent on buying certain foods to fill an empty hole inside that one is barely aware of?  Walking into the art studio/office and taking in the visual stimulation. The atmosphere may be overwhelming at first, but the excitement of just picking out a material and playing with it is hard to describe in words and hard to pinpoint in terms of feelings. I get the same feeling in art supply stores, but there is a big difference between an art supply store and an inviting healing creative space. (I knew I was on the right track with my studio when  a father who had no interest in art making suddenly picked up a piece of cardboard and started painting! freely with all sorts of colors; his kids who had been focused on their own projects of course rushed over and asked for cardboard so they could imitate him!) As an art therapist, I can say that there is nothing like the satisfaction of having a patient who has been talking to you for months suddenly out of the blue pick out some art materials with no encouragement, suggestions, or pushing from me. It is delightful to witness!

Certainly the art materials and art making can just function as a good distraction from obsessive thinking about food and body. Havi ng an hour of respite from one’s own intrusive thinking is not only worth while but provides hope that this experience can be repeated, both in the studio and at home. So there is a lot to be said for allowing for discovery and choice of media, especially with people who are very aware of how “in control” they feel from moment to moment. In some cases, consuming the therapist’s materials can replace bingeing. There is a delicate balance between feeding oneself emotionally and spiritually in a session and working on mindfulness, versus mindless consuming and using of art materials that can be perseverative and imitate unhealthy behaviors outside of the studio. I try to stay mindful that any substance or activity has healing properties when used in a mindful prescribed manner versus when the material, activity or person is abused or addictively consumed to fill an empty hole. As therapists, we can sense sometimes during, sometimes after a session, whether the session has been a healing one or a “filler”; it is not so bad to have some sessions be fillers once in a while anyway.

This is only a mere blog post, not meant to be an exhaustive discussion of the merits of art therapy for  people with eating disorders and related challenges. Please feel free to share your experiences as a therapist or patient…

As a side comment, I was thinking tonight about the challenges of being a therapist and eating healthy meals. A lot of us work through the dinner hour and come home exhausted and starved with no energy to cook a proper meal. It can become a major family issue; how to have meals with partner and/or child/children all together and at regular meal times. I try to have extremely moderate goals, such as, let’s try to have a family meal at least once a week, not too great I admit, but I get home late several evenings a week and then there are other schedules besides my own to accommodate. This is going into a new related topic, probably good for next week’s post…

Old Post from Last Week: Being Thankful

So I’ve venture into the dark shadow side of the holidays, and thought I’d interrupt that topic with a more positive uplifting topic:

Make a list of what you are thankful for! Write it down, or make a drawing/collage/painting to go with it. Share or make the list with your significant other, child or children or a good friend, or even with your therapist…

When I worked at a Day Treatment Center for people with chronic mental illness, my favorite day was the Wednesday before Thanksgiving when we gathered as a big group for food and then the best part, when clients voluntarily stood up and announced to everyone gathered, clients and therapists, what they were thankful for. It was amazing to see people who normally had trouble saying anything in individual meetings or small groups stand and say what they were thankful for. Most memorable of the little speeches was the following:

(and I might add, I am remembering these statements from when I was an intern there in 1997 and when I worked there many years ago…)

“I am thankful to finally have a home after being homeless…”

“I am thankful for this program that helps me a lot…”

“I am thankful for my family…”

So I will add my own list:

I am thankful for everyone in my family.

I am thankful for having really really wonderful thoughtful and compassionate friends, old and new.

I am thankful for having a roof over my head, heat and electricity!

I am thankful for all the small things that make life worth living.

I am thankful for the opportunity to use my creativity in so many ways.

I am thankful I found art making as a way to express myself.

I am thankful to have started this blog, and I hope to find people who are interested in reading it and contributing to it.

Those are just a few…