“It takes a really long time to realize this, but if you’re lucky you eventually see that you’ve got this life on this planet and you’re responsible for really loving yourself. And I mean really, really, really loving yourself. Love is never a corruption. I’m talking about loving yourself with a true love, a love that’s incorruptible and everlasting.”
― C. JoyBell C.
“To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.” ~Thich Nhat Hanh
What is radical self-acceptance? Really it is pretty simply exactly what those words mean. For something that easy, it is pretty hard for many adults to practice Radical Self-Acceptance.
Try saying out loud: “I accept myself completely as I am right now.” It sounds simple, but remember, it means you accept everything about yourself in this exact moment: your physical body, your emotional body, your mental, creative and spiritual bodies, not the way you might have looked or felt or been several years ago or as you think you “should be” right now or how you want to be in some future time. This means you accept your whole body, for example, you can’t just accept your head and pick apart which parts of your body are acceptable and what isn’t. It’s all or nothing. As one of my patients once told me, “You cannot receive something in parts or somewhat, you have to receive it completely or not at all.”
So the challenge is, can you receive yourself and accept yourself in this present moment, no matter what you are feeling, how you are looking, what is going on with you and your life. I posted a while back about this kind of self-acceptance. I took a piece I read about yoga “not caring”, which had a lot in it about yoga not caring what you know, how flexible you are, how you eat, etc., and turned it into a challenge to not “care” what state of affairs your life, body, career or lack thereof, apt or lack of home, family or no family, etc. is and to just care that you have showed up to your life in this moment. The link to the post is: https://natashashapiroarttherapy.wordpress.com/2014/12/01/just-show-up-and-be-here-now-getting-through-difficult-times-like-the-holidays/
Here are a few of the sentences:
“I don’t care what color my skin is or what gender I choose to love or what gender or non gender I am. I don’t care about others’ appearance, sexual orientation, gender, etc. either. We all share similar struggles and pain.
I don’t care how much money I have, what house or space I live in, what car I drive, or if I have to live on the streets right now.
I don’t care what my apartment, house, living space etc. looks like right now. It doesn’t matter; what matters is that I am still here anyway.
I don’t care if I smoke cigarettes, drink, use substances that are illegal, eat too much, binge and purge, starve myself, or am addicted to sex or other things or whether I hoard things in my abode. I’m still here and I showed up to this new day and that is enough.
I don’t care if I am single, with someone, with several people, in a messy relationship, stuck in a difficult relationship or anything else.”
To take these ideas into radical self-acceptance, we would not use the words “I don’t care”, but instead, “I accept that…”. For example, I accept myself as I am right now, including what I am doing right now, even if I am drinking, smoking, binging. I accept myself as I am right now, that I live alone in a tiny apartment and am in terrible debt and unemployed. I still can accept myself as I am in this moment, even though I need to lose 20 pounds and my house is a mess…
Here is something from that article: “So what’s Radical Acceptance? What do I mean by the word ‘radical’? Radical means complete and total. It’s when you accept something from the depths of your soul. When you accept it in your mind, in your heart, and even with your body. It’s total and complete.
When you’ve radically accepted something, you’re not fighting it. It’s when you stop fighting reality. That’s what radical acceptance is.”
So there is the importance of sort of surrendering to the reality of yourself and your life as it is, not as you would like it to be. The word “Radical” may sound extreme but it is just the right word to really pin down this concept, the idea of complete and total acceptance.
There is this too: “Often when you’ve accepted you have this sense of letting go of the struggle. It’s just like you’ve been struggling and now you’re not. Sometimes, if you have accepted, you just have this sense of being centered, like you feel centered inside yourself somehow. ”
So as this article says, this is an interior process but I disagree that it is hard to describe, as it is really very simple. The sense of struggle versus letting go gets at it. It reminds me of the feeling you have when you tense up part or as much of your body as you can and then release. That moment of release is what this is about. Radical Self-Acceptance is a bodily sensation as well as a verbal affirmation. It is what goes on when you focus on your breathing in and out. When you let the breath out, you let go; that is what goes on with this process. Hold your breath for a few seconds, then release it. There is a kind of metaphorical holding of the breath that people engage in during times of stress. Studying for law school exams and saying, I will attend to my body and get a massage and relax after the exams. That is holding your breath till you’re done. Taking care of yourself while going through some kind of big stress like this is a kind of radical acceptance. Accepting that you have no control over what might happen tomorrow, much less a week from now in the exam room is part of this process, for example.
When you are not calm, not grounded, not relaxed, not liking yourself, not using “healthy coping skills”, that is a time to practice this kind of self-acceptance. I accept that I am a mess, that I messed up, that I was doing great at “fill in the blank”, not picking my skin, not binging and purging, not getting drunk, whatever, and now I’m back in the muck, out of control, disgusting, ashamed, whatever. BUT, I can just stop, breathe and accept myself even in this moment of complete “failure”.
I have sat with very smart, very put together, very successful adults and asked them to say the words, “I accept myself as I am in this moment, right now, completely.”, and had them respond that they cannot do it. I press them to just say it out loud even if they do not believe it. Just getting someone to say that out loud is a huge struggle; for some, it is way more challenging than doing stuff that seems impossible, they can run a marathon, write and publish a book, etc. etc., but to say those words can feel impossible. Say them anyway, say them as if your life depended on it, because in a way, it does.
What I love about the theory of the “Dialectic” in Dialectical Behavioral Therapy, is the idea of two opposing things being true at the same time inside a person. That includes radical self-acceptance alongside the desire to change behaviors. It turns out you can’t change much until you completely accept yourself as you are now, in the bad, unchanged messy state. You can feel sad and self hateful and want to die and still accept yourself right now, and it is the only route to ever living at all.
Radical Self-Acceptance happens right now, but it is also a work in progress. I can say that I radically accept myself as I am now, and most of me not believe it and say it isn’t true, but when I say it, it is true.
It is 11:11. I should have done my yoga practice and be getting ready to go to sleep. I should have written this article last week as it is not this week’s assignment. I haven’t done the first assignment, the interview yet. My mouth tastes lousy and I should brush my teeth. I think I missed going to the dentist and probably haven’t flossed enough. Now that I focus on it, my teeth are too yellow. My body feels uncomfortable from eating too much heavy food a few hours ago. I am behind on some bills and not budgeting. That could lead me to my issues with money. There’s the graphic novel I started in 2000, 14 years ago, and ten pages of it that I misplaced in my own house/apt. I won’t go to the apartment and what kind of state it is in right now, versus how it should look. There’s my studio too, in disarray. I could go on and on about all the ways I am disorganized, not good enough, my little private addictions, like shopping for stuffed bunnies and old Betsey Johnson jewelry on Ebay, during a month when I am buying holiday gifts and have no business buying crap for myself. I will say, I accept myself anyway, as messed up as I could portray myself. I am vain about my hair, but I accept that it doesn’t look like it did ten years ago, and I accept my gray hair and my age.
None of this stuff matters. What matters is that I am trying to accept myself anyway, just like the rest of humanity. I still mostly can believe in my own inner goodness, good intentions, caring, alongside my grandiosity and selfishness, petty jealousies, etc.
I accept myself completely as I am right now. Can you say this too? Of course you can! Just do it, just say it. Look in the mirror and say it every day.
I have so many ideas and so many different topics I am thinking about and wanting to blog about my head is spinning! This happens to me in other areas of life, like my art making: Suddenly presented with even 20 minutes (which is a ton of time to have to myself these days) in my studio I have to make a quick decision as to whether to start something new, work on my graphic novel, get back to my big huge project, do another weird mixed media thing that is newish, or pick up a piece and keep working on it, or just chill out and do a collage in my journal. In a case like this, luckily being alone and in my studio, I just go for it and usually just do what feels easiest. If I am at my home and have a very rare opportunity of being alone with a million choices and a few hours time, I am extra challenged. Either I try to do a little of everything, or force myself to just clean some area or do what I did yesterday: I had a book I wanted to read and just sat on the couch reading that book for several hours. That was relaxing for me. No noise whatsoever, no need to look around at the chaotic apartment or be distracted by other things, just focusing on a fascinating riveting book I was learning something every page.
So I could blog about that book or topics related to it. But I have so many topics buzzing in my brain. In no particular order:
1. choose the easy way out and find a cool cultural ritual to discuss and celebrate.
2. pick something to add to the series I’m doing on society’s view of mental illness and separating fact from fiction
3. Mindfulness and how it is used in therapy and everyday life, prescription for any human suffering from anything or avoiding suffering
4. Basic fundamental of the idea of DBT, the dialectic between acceptance and change…
5. Self worth, liking yourself, self esteem, self love, whatever you want to call it and why it is so difficult to deal with in oneself and others and as a therapist as all patients seem to share this issue…
6. Importance of validation for parents
7. Trauma, a million topics emerge from just that word!
8. A holistic view of what “Recovery” means and how it can be empowered and person centered…
9. Borderline Personality Disorder, the hush that still surrounds it, despelling myths
10. many things you might share wtih someone with Borderline Personality Disorder even though you don’t have it, so why does everyone get so angry at even the name of it and why did people argue about it not existing and not being correct to put it in the DSM5 or changing the wording…
11. 9/11 is creeping up on us downtown New Yorkers, what ghosts still lurk down here and in our psyche and collective psyche as humans?
12. All healing boils down to finding balance, following the “Middle Path”. Why is this so incredibly hard to do???
13. Body image again: how can someone say that their low self worth has nothing to do with their body. Liking yourself starts with liking the form that you are in as a person, your shape and size, the inside of your body, things your body does, things you don’t know it does, what you do to it, put in it, stimulate it with, relax it with, soothe it with etc. what is the definition of negative and positive body image? If our own culture is any sign of our relationship with our body, we Americans have a very distorted image about what a body is and a lot of preoccupation with what shape and size it is and what kind of outside appearance we have, and obsession with food, nutrition, good eating, bad eating, dieting, fasting, extremes and middle grounds, feeding our babies and kids, etc. When you think about that, you have to really look at yourself and see how much you unconsciously on a daily basis participate in these fixations…
14. making assumptions about people too quickly. Learning to go back to the child’s curiosity and scientific investigation of everything you encounter through every one of your senses…
15. I can’t end at 14 as I have a crazy preoccupation with odd numbers. For alarms to wake up I have to set the time at an odd number, 8:01, not 8 for example, so I can’t end this post with only 14 topics. I guess the 15th is also about indeciciveness and making choices.
16. Uh oh I just remembered another. Noticing in your relationships with others, do you have some conflicts that could just be reduced to having totally opposing types of coping skills? This is so common in couples as opposites do attract.
17. “Look before you leap” versus “He who hesitates is lost.” The dilemma of the extremes around decision making and reactivity, ie. the person who spends too much time with a pros and cons list versus the person who can’t tolerate being in the “I can’t decide, I don’t know” zone and goes in the direction of acting on impulses and quickly…
18. The use of dollmaking in art therapy.
19. Systems theory explained simply: we all have many parts inside ourselves and we can get to know them better to help them work together. Often extreme crisis, even psychosis happens when all your parts of your psyche are at war or shouting at you at once. Hearing voices could be related to hearing from your parts… (look at “The Beautiful Mind” as example.)
Ok. I am sure I have a hundred more topics but at least I got some of them out there as things I want to investigate. Usually I veer towards making decisions too quickly, but I guess blog writing is helping me slow down, notice my mind’s chaos and speed and curiosity, wanting to connect many ideas and actually having a hard time making a decision!
Many art, music, drama, poetry, dance and other creative arts therapists in New York State, now that we have Licensing (thanks to the tireless efforts of NYCCAT: the New York Coalition of Creative Arts Therapists) want to know more about how health insurance works in NY, especially those in private practice, so this post is some clarification about what I know in my experience since I got licensed in 2005, when we first got licensing.
Before getting my license, I was operating a private practice without a license and not able to take any insurance from patients, so I was naturally more than excited to be recognized finally as equal to social workers and other psychotherapists. The license was far more meaningful in terms of respect for our work and for the creative arts therapies than about insurance reimbursement, but money is a big part of respect.
Having the license gave art therapists working in hospital and other settings the chance to be paid equal to other clinical practitioners. Those in private practice were able to use the license to get reimbursed by SOME health insurance companies.
At present, Cigna, Aetna, and United Health/Oxford are the health insurance companies which I have had good experience with, in terms of getting any reimbursements and having the ability to take on patients who wanted to use their insurance for therapy. There is only a small percentage of such patients who would be willing to come to a therapist if their particular insurance would not reimburse, so this is pretty important for those who want to take insurance and want a large bulk of their practice to involve health insurance reimbursement. The reason a therapist chooses this is for building or keeping their caseload to a certain amount, not because it is easier!
Taking on patients with insurance brings many challenges. First of all there is the difference between in network and out of network reimbursement. Many people think it’s good to get on “panels” otherwise known as being an “in network provider”, which means that people who have that particular insurance can pay you a copay for each session, which is usually the part on the member’s insurance card that says “Specialist” and then an amount, which usually ranges from 0-$45, sometimes $50. People with the same insurance can have a range of copays, so if you are in network with Cigna, for example, you may have a patient who has no copay at all and no deductible in network, in which case, you usually have to fill out the 1500 claim form and submit it to Cigna and wait to get paid. You may have other patients with copays. With Cigna, if it isn’t 0, it ranges from 25$-45$. The advantage of a patient having a high copay is simply that you get paid quicker, as the fee you get per session is exactly the same no matter what the copay. A patient got the mistaken idea that when her copay went up, at least I was being paid more, but I explained to her that I get the same $67.93 per session no matter what amount she pays. This brings up a big disadvantage with being an “in network provider” with an insurance company. The fee is set and you have no say about how much it will be per session. For every individual session you get paid the same amount. Most insurance companies don’t seem to raise the fee properly every year to account for adjustment in cost of living. In the many years I have been in network with Cigna, and paid $67.93 per session, this year was the first year Cigna raised the individual therapy session fee to $71!
So one advantage of being in network is that most people do not have mental health or medical deductibles in network. However, this seems to be changing a lot, and is an important thing to check out when you get a new in network patient. The reason for this is the following: a patient comes and only has one or maybe 5 sessions. They pay you the copay as it says on the card. You submit the claim to the insurance company, only to find out that the person has a deductible of $600 if you’re lucky, or maybe $2000. This is most problematic with someone who comes one to 6 times and then stops, as you get stuck chasing an ex patient for money they now owe you. I have two of these situations going on. In one case the first session which insurance companies pay more for, Cigna pays $150 for the initial session, so I’m stuck texting and leaving messages with this patient that came once. It’s been at least 6 months now and she still owes me $150. In another case, the patient came about 5 times and owes me for those sessions. Through numerous emails and texts, I finally got this patient to start a vague payment plan which is already imploding. I don’t remember how much the patient owes, but it is probably about $300 or more, and I still don’t have it.
Another problem with being an in network provider is that insurance companies have all kinds of strange deals with agencies and schools, which may not be obvious until you have submitted a claim. I have a terrible situation going on because one of my patients had a very confusing plan with Cigna due to the school the patient is affiliated with. I am used to submitting claims to one Cigna fax number and then following up with a phone call to make sure the claim is processing. (Another part of the annoyance of dealing with insurance in network and out of network, paperwork, submitting claims and following up to make sure the claim is processed and paid, a very frustrating and time consuming activity that basically sucks and makes you want to scream at the poor customer service people who have the terrible job of dealing with irate providers all day. So in this weird case, it took a few months to even figure out that I had submitted the claim to the wrong place and faxed it to another place which was incorrect as well, or sent it in the mail. I finally through a few frustrating phone calls and looking again at the patient’s card, found an address to send the claims to. These claims now represent about 18 sessions from January to June 2013, and I have not been paid a cent by Cigna. Through more phone calls to different numbers and getting claim statements in the mail that my claim was being processed, I found out that the institution that handles the claims is waiting for a price quote from Cigna. I won’t go into further detail about this, as it is obviously incredibly frustrating to imagine not being paid for about six months of sessions! The only way to avoid this kind of disaster is to look very carefully at the patient’s insurance card the very first time s/he comes to a session to make sure you have all the info, not just the ID number and the usual stuff but look at the address and contact info and see what kind of Cigna or whatever insurance it is and what it is called, as the companies are huge and have all kinds of subsets of different arrangements.
Also, if you have longterm in network patients, watch out for the new year, which is when their plan could change drastically; the copay could go up or down, and there could suddenly be a large deductible, which, depending on the patient, could drastically change whether or not s/he even is able to continue therapy. Also in July, some employers change things around and have their fiscal year start over, so that is another time when you could suddenly find out your in network patient got their insurance switched to another insurance. It just happened to me with a patient, but luckily I take the other insurance out of network, the deductible was low enough and the patient is invested and ok with these changes…
OK: Out of network, advantages and disadvantages…: As an “out of network” providor, you set your own fee, which is really great, believe me! It means I can finally charge my full fee! The insurance company, if they pay your particular type of license, will pay you a percentage of that fee, and the patient pays a “coinsurance” fee which is the rest, and can range from 50%, not so great, to lower. Of course the more the insurance company pays, the better, and the more likely your patient is to be ok with having you as an out of network provider. Most therapists have these patients pay the fee in full and then they submit the claim to the insurance company, and the insurance reimburses the patient. Of course, being in NYC, and being a “nice” therapist when it comes to these things, as most of these out of network patients tend to be students, often either Aetna or United Healthcare, and as such, they cannot pay up front unless I am lucky enough to get a student whose parent pays me directly, anyway, I usually end up just submitting to the insurance and then either having the patient pay part of it or none of it until the insurance company sends the check to me directly for their portion of the fee. So this can be tricky, as there are many patients who don’t really want to have to pay up front, and given the choice, would just find an in network provider so they could simply pay a low copay. As an LCAT, I am paid out of network by as I mentioned above, Aetna and United Healthcare/Oxford. Blue Cross Blue Shield and GHI do not pay LCATs otu of network, so you cannot bill them. I have some patients who have Blue Cross, for example, who are committed to working with me and just pay me on my sliding scale. This is one of the good cases of not being able to take someone’s insurance. You get paid by your patient and don’t have to submit claims and waste time with insurance companies.
In addition, you don’t have to figure out a diagnosis for the patient, which in some cases is a big relief, as it can be tricky figuring out the right diagnosis for some patients. Not everyone has an obvious depression or anxiety disorder, which is most common for private practice, and some people present with symptoms that do not fit any particular diagnosis very well, so putting down the number for the diagnosis on the claim form is another big important potentially headache making part of taking insurance. Luckily in most cases with insurance the diagnosis is obvious; it is especially helpful when someone comes in who already takes prescribed psychotropic meds, though that is not always an obvious pointer to the diagnosis. There are no particular meds usually for such disorders as the skin picking or hair pulling disorder, which are now included in the chapter on Obsessive Compulsive Disorders; it could take a long time to even find out that your patient has such types of symptoms.
Anyway, I digress. All this is to say that people are wrong when they say to wait until your patient walks in the door to discuss fees. This is an old fashioned out dated point of view. It is actually much easier and usually you have no choice about it, to figure this out in a phone conversation or by email before your patient comes to you. I had someone come in only to find out that I did not take her credit card which she was using for all medical fees with Cigna. I was not sure she would find many therapists who would take her credit card, but maybe some therapists out there have started taking credit cards. Anyway it was a waste of her and my time. Sometimes it is clear that the person will not be using their insurance and in most of these cases I do wait to meet them to discuss fees. However, it is much easier to figure out what’s going on with insurance payment right away, especially with non Cigna patients.
In most cases, the patient does not know much about their mental health benefits and needs to be guided to contact Aetna or United or whatever and ask the following questions and then call you back if they find out they can work with you or figure out what they want to do about the fee:
Do I have out of network benefits for outpatient mental health providers? Is there a deductible? How much is it? What percentage of the providers fee does the insurance pay and how many sessions are covered? The last question is very important, as some companies only cover 20 sessions. The average used to be around 32, but now it can be as low as 20. Supposedly, insurance companies are not allowed to limit sessions if the patient has what is called a “biological disorder”. As far as I have found, that only refers to a few diagnoses, depression and bipolar disorder, schizophrenia and maybe a few others, but no anxiety disorders are included. I’m not sure about PTSD. However, even this “rule” seems to not be followed by all health insurance companies…
In addition, Medicaid and I think Medicare patients get no reimbursement for LCATs, so you either have to charge Medicaid patients a super low fee and consider them to be your “Pro Bono” patient, which I have done in rare cases. In my experience, it is worth it to do this when you have a very interesting kind of patient and the work is extremely rewarding and different from any other kind of work you have done. One of my most transformed patients is such a person, and it is one of the most rewarding experiences I have had recently in my private practice. As they say, great things come in small packages, ie. low fee!
This sums up most of the important info I have garnered from my experience as an LCAT in private practice dealing with insurance companies. There are also a few patients I’ve had who had only in network benefits but as their copay was $50, I was able to make a deal with them to pay around that much and not use their insurance…
Also, with art therapy groups in private practice, check with the insurance company what the rate is for that, because it is usually much lower than for individual therapy. Cigna pays only $40 per group session, for example.
Note to LCATs out there: as far as I know, Blue Cross, Medicaid and other insurance companies that limit their reimbursement to psychiatrists, psychologists and social workers do not care about the benefits of art therapy or other variants of creative arts therapies and there seems to be nobody to contact who would have any influence whatsoever on whoever decides what professionals to reimburse or not in NY state, so I would not waste time with individual companies trying to convince them to start paying us. Probably the more politically active among you may know which politicians or other organizations to work with to lobby or promote paying LCATs, so that is a great thing to do, but the insurance companies themselves do not care and are such huge beaurocracies, you might as well bang your head against the wall rather than waste any time trying to change their policies…
I hope this proves helpful. Please feel free to comment and post further questions which I will try to answer…
When I was in graduate school for art therapy, I had never heard of an altered book or seen one, and certainly it did not come up in my “Materials” class. We did not get assigned any kind of Altered Book in any class, whereas now I am hearing from grad students that in some class or other, one of their assignments involves an altered book, which is usually assigned to do outside of class.
I think my first experience of an altered book may have been at the Outsider Art Fair. I distinctly remember going to this Fair years ago when it was always in the lovely Puck Building, which is still there, located on Lafayette near Houston St. in Soho, downtown NYC. In fact years before that, I had some of my graduate art therapy classes in the Puck Building and we organized the student art show on one of the floors of this building. It is certainly a beautiful building. The last time I was there for an art event was the comic book graphic novel fair a few years ago when I met one of my favorite graphic novel authors/artists, Lynda Barry. It must have been back in 2008 when she had just published this beautiful book about her art making process, called “What It Is”. Anyway I think I saw an altered book years before that encounter in the same building. It was made by a female outsider artist and I remember the book being very thick and beautiful and having a lot of glue on all the pages. It was very inspiring and I wish I could remember the artist and find a photo of it.
I made my first “altered book” years before that without knowing it was an “altered book”. It was not quite what we tend to think of these days when thinking of Altered Books. I took all the pages out of this strange pretty bad dramatic novel I did not read and altered the cover completely to the point where it was not recognizable as having been a book. I put a lot of plaster of paris on it and then mod podged tissue paper collage. Then I somehow found part of a cardboard box and attached the book to it so the top opened up as the cover. I think I used the pages to rip up and glue inside the box. I will take a photo of it. Strangely it was a gift for a close friend, but she was a close enough friend that she told me she found the box to be too disturbing to use or look at, so I took it to my studio, where it has been more appreciated! It inspired one person to make something like it with me, and she ended up taking a dislike to the project and left it with me when she left town after we went through her art that she had done in art therapy with me. I still have that rejeccted box in my studio as well. (It inspires me to write a whole post about “ugly” and “rejected” art work and how it is therapeutic in art therapy!)
More recently, a few years ago I stumbled on an online class about altered books, and in fact I have now taken 3 online classes about it, each class covering different aspects of the art making process involved in altering books. I have been making them with patients for a while now, and by making, I really mean inviting patients to try it out and see if they like it. The first part of the process involves the explanation of what it involves, which is, basically, you choose a book and then you can start anywhere in the book or with the cover or back cover and start picking art materials to use on the book. The first steps also often involve ripping out pages from the book, either to use in the book or to throw out. It is usually good to do this at the beginning as a way to give yourself permission to “alter” the book. We all have pretty fixed notions about the sacredness of books, which I think still exists despite the internet, reading on tablets and other devices, or perhaps, the tablets have made books seem even more precious. Jumping in to starting an altered book project requires a certain amount of adventurousness, ability to tolerate anxiety about the unkonwn and anxiety about trespassing a boundary and destroying something in some way in order to create something completely new. It also involves changing ones mind in framing the idea of that book, from something to be read and kept intact, to an object just like any other “found object” to transform and make your own through your own creative expression.
There are many different aspects to altered books as part of the art therapy session that are quite fascinating, so this post will only touch on the first part, the beginning. Once invited the interested patient will next be introduced to the random assortment of books I have to choose from and pick something that speaks to them to alter. Usually Hardback books are more inviting as it is easier to treat the cover like a canvas, but lately I have seen a few people pick soft cover books, becasue I have a few that are an interesting size, kind of square and with a lot of photos, and a cover that is more sturdy than the usual paperback. So far, nobody has decided to go home and pick out one of their own books. Part of this I think is the therapeutic value of taking a book that’s in my studio already taking up space as a book waiting to be chosen, so the process of accepting this odd art project is made easier as you are not “ruining” one of your own books. And I really have a strange random assortment of everything from dictionaries/thesauruses to cookbooks to spiritual meditation type books. Included is a thick hard back Italian novel and some other random novels as well as several books with pictures about fashion or the styles of certain decades. I have a travel guide. I had a guide for artists about materials and how to use them.
This aspect of rejection of the project that began when I made my own rejected “too intense” book box and then an “ugly” book box with a patient is a part of the altered book project. I have had a few people pick out a book and start altering it and then by the next session ask to shelve the project until “I’m in the mood for it. It’s too daunting right now.” The Altered Book will either be seen as a great container that is continually inviting or sometimes it represents being overwhelmed and unable to make any decisions about what to do, resulting in the project getting “shelved”. One of my patients started a first session very excited about all the varied materials I had, wanting to jump right into art therapy and got going very creatively with some book that she even worked on for the first few sessions. At some point I think she started cutting pieces out of the book to create a kind of box within the book, maybe even using an exacto knife. Then in the next session she declared she no longer wanted to work on it, was not in that “headspace” anymore and went to other forms of art making. She made great use of art therapy but never went back to the book until we were terminating and she fondly remembered it as her introduction to me and our work and I think decided to take it with her. The book project just functioned as a jumping in point.
Why do some people get excited to do an altered book in the first one or two sessions of trying it out and then run away from it, shelve it, reject it? Maybe when this happens it is because I, the art therapist, am actually more excited about it than the patient and have high expectations for it being a great kind of project for long term therapy. Perhaps for some people, there is too much commitment too early and they are not really ready for it.
The other interesting thing about doing Altered Books is when people do get invested in them and go back to them every session. Lately that has been happening, probably because a few people in my supervision group randomly chose to work on altered books without my prompting them. Two people have left the group with unfinished books they have taken with them. One person brought her own book to the group to alter with materials from the studio. So that energy of the altered book I really believe was “percolating” for a while in the studio. I had another rejected altered book started about a year ago in one session and then put aside. For a while I was not really focusing on altered books in the studio, just taking these classes and thinking once in a while about it, and learning more ways to approach the Altered Book.
At this moment, my studio feels filled with Altered Books! Like anything that grows in a garden on its own, it feels like this altered book contagion has just sprung up naturally. Just this week I introduced the altered book as an option to 2 patients who got excited about it, chose their books and jumped right in using different media. Last week I had started my own altered book project in the supervision group I facilitate, thinking that now that I have so many patients working on them, I want to do one at the same time. So I chose a book that is a guide to artist’s materials for artists. It was very exciting to imagine taking this book that divides up all the materials and methods and painstakingly describes how to achieve certain effects, and how to “properly” use the different materials and media and rip up the pages and paint on it and collage ripped pieces on to the pages to start the process of making it into a book I hope will be hard to guess exactly what it was even called or to have a vague sense when looking through my book that there are a lot of pictures of how to make art and art materials terms but nothing much else kept from the original book. Synchronicity abounds in doing altered books. For me it came when I opened the book and realized it had belonged to the friend who rejected my first book box project and returned the gift to me. Of course I ripped her name out of the book first.
Anyway, at this moment there are at least 8 altered book projects that have been just begun or are in the mid stages of alteration. If I actually count how many patients have started altered books recently, excluding the person from last year who has not expressed interest in going back to the project, it would be 7, so my guess was not far from wrong, as I am the 8th and then there are one or two people in supervision doing them.
The next post would raise the question: What helps a person stay with an altered book project and continue working on it regularly? and What is it about Altered Books that some people become “blocked” or lose interest after jumping in excitedly.
The one thing true of everyone is that the beginning, that first session of being invited to make one, choosing the book and jumping into it or onto the cover and starting right away to alter it is universally exciting and stimulating. I have only seen people be intrigued and excited when they begin this process. Some express having a weird feeling about “destroying” a book but when encouraged get past that feeling. The fascinating part of the Altered Book is after the initial excitement and embarking on this without a doubt long-term project, there is a moment of remaining with it and committing to it further through getting inside the book and getting going with paint, collage, mixed media, ripping out pages and getting one’s hands dirty. It seems to require about 3-4 sessions at least to determine if one is going to get “turned off” of the project and too overwhelmed, or further jumping in and committing more and more to it. Those who find it to be a kind of safe container stay with it. Leaving it with me in the studio is a big part of that process. I will hold on to their book until they come back to it, so they don’t have to see it for a week. It is very different to work on a long term art project whether it is because the work is very large and will take a long time to finish no matter what or the project by its very nature requires time invested. It is hard to work on a lot of pages at once, especially if you are using any kind of paint or ink. Anyway, leaving the book with me allows the creator to take a break from it and not have to look at it in between sessions. This seems to help the project to become a safe container and holding environment. Even with my own altered book, I decided to try out at first just working on it during the supervision group and leaving it alone, so I also take a week off from it, in order to further get into the experience of my patients and supervisees doing this kind of project…
To be continued…
Here are some photos from my own altered book which I have worked on in different situations, first started it in the supervision group I facilitate, then worked on it alongside several patients who are doing altered books as well as in my studio the other day when I added a kind if nest into the book…
Interview About My Art Therapy Career! I am very excited to announce that the first of a two part interview that took place in my studio/office with art therapist Victoria Scarborough is now online at the above link! The interview is about how I started out in the field, my past experience, my present experience […]
I just wrote this post and it vanished, so I’ll start again. This is another short post just to bring up some topics and questions, especially for artists and art therapists and those who identify as both.
Do you exhibit your work? If so, is it very sporadic or often? Where do you exhibit it? If you don’t, why not? Do you have gallery representation? Do you want to have your art out in the public eye? Do you sell your art work? Do you enjoy selling it? Are you attached to any of your art work, such that if you exhibited it, you would mark it as Not For Sale? Are you easily discouraged by the competition? Do you find yourself making lots of work as a way to procrastinate trying to show it? Do you every get blocks where it is hard to get yourself to make art? These questions are not easy to wrestle with for any artist, and often more frought with inner turmoil for us artists/art therapists…
For me, I’ve been an artist for way longer than an art therapist, even though I didn’t go to “art school” or major in Art. However, although my artist resume has a long list of exhibitions at various types of venues that I have shown my work, I find that in the last two years, I have not really exhibited it, beyond having it out for public view during the Tribeca studio tour: (http://www.toastartwalk.com/toastartwalk/Natasha_Shapiro.html)
I don’t have issues with getting attached to any of my art work, so that is not a road block for me. I admit that I get easily discouraged by rejection, and find it hard to hussle and market myself as an artist. I am currently working on these very issues, by writing about it here, and by actively trying to look for galleries and opportunities to show my work, that I normally don’t get out of my comfort zone to do… I have always been lucky in that I have no problem with blocks around making art. While I may have a block on a specific piece or idea, I always have two or three other things I’m working on, so I don’t notice getting blocked. However, I confess that I too find it very easy to procrastinate the marketing and selling end of things. For example, I got invited to be an artist on a great website called “Artiscle”, and it took me about a month to make a profile and get some work on it. I still need to post a lot more work on the site, as it is a great opportunity to not only sell work but rent it out.
I find myself making myself promises I do not keep. So it’s time to get on it, and work through all the things that get in the way of trying to succeed more as an artist! Share your struggles and triumphs in comments please!
I am starting a new art therapy group for women suffering with and dealing with issues around anxiety and depression. Any woman age 19 and up who would benefit from this group is invited to join.
The group will meet at my downtown NYC studio for an hour and a half on Thursdays, either from 11-12:30 or 12-1:30 pm, depending on the preferences of group members.
Thus, the group is great for students, freelancers, women who work part-time, or women who can leave their job to come during their lunch hour…
As it is an art therapy group, art making and sharing and processing of art work will be emphasized along wuth verbal processing.
You do not need a formal diagnosis to join this group. The fee will be low for those whose insurance does not cover it or those with no insurance. Those with Artna or Cigna or possibly other insurance will pay a low copay.
Please call or email me directly with referrals or if you are interested in jining the group.
It will start some time in September once I have at least 4 definite participants.
I am reading “Fragments” by Marilyn Monroe, which constitutes notes, poems, musings, diary entries, etc. I have long been fascinated by her for many reasons, psychological reasons being the obvious focus for this blog.
In publishing these fragments of writings in 2010, the editors and publishers wanted to show a very different side of this very complicated person, and they succeed. One of the interesting things about the photos in this book is that they show a lot of photos of Marilyn reading all kinds of books, and she was actually a voracious reader who tackled Dostoevsky and James Joyce’s Ulysses. It is even stated in the book that she liked having pictures taken of herself reading. This was no Sarah Palin pretending to read a newspaper. Those who were close to her knew she had a sharp curious mind and loved reading. Seeing these photos did make me reflect on present day actors as well as past ones. I couldn’t think of any who especially liked to be pictured reading. There is something interesting about a photo of a woman reading a book, especially this woman who was so in touch with the camera. In most photos of her she is looking at the camera, but in these she is dressed fashionably but casually and seen sitting or standing in a casual position in a homey looking environment, and her eyes are on the book, so there are two subjects to the picture. There is the mystery also of what page she might be on and what words age might be reading when the photo was taken!
Anyway, it is quite interesting to read her fragments, many of which are poetic and quite beautiful, while others are filled with insecurity, loneliness and the desire to improve herself. Some are even directly related to her being in psychoanalysis. I’ve been looking through the book for something to quote somewhere and finally found something for this blog rated to a recent post I wrote about relationships. It is very thought provoking and both sad, realistic and somehow hopeful, which is a curious combination, but not so strange when touching on the subject of childhood and attachment. So here it is; please react and comment if you are moved to do so…
“(page 131) re relationships
Everyone’s childhood plays itself out
No wonder no one knows the other or can completely understand. By this I don’t know if I’m just giving up with this conclusion or resigning myself-or maybe for the first time connecting with reality-
how do we know the pain of another’s earlier years let alone all that he drags with him since along the way at best a lot of lee-way is needed for the other-yet how much is unhealthy for one to bear.
I think to love bravely is the best and accept-as much as one can bear”
(words underlined in this passage: plays, much, unhealthy)
Quick reactions. I found this to be very truthful and really focused on relationships that are very mature and/or deep, those moments when people become unsure and unsettled by what they observe in themselves and their partner. It raises some interesting questions for couples who are examining their relationship or in couple’s therapy: “what are the parts of your partner that you do not know or want to know better but seem buried under a lot of pain?” ” Do you think you can share your own childhood painful parts with your partner, and if so, can you use this to better understand your child selves within the relationship?” “Do you give “lee way” to each other for all that emotional baggage you still carry?” “How much can you each bear of this part of yourself and of her/him?” “Are you afraid of it and avoiding it, or are you bearing too much of it to the point that either of you can recognize it is unhealthy?” “Or, are you asking too much of your partner and wanting ir demanding him/her to bear an unhealthy amount of this early pain in the relationship as it is right now?” “Do you feel that you love bravely and strive to accept what you can reasonably bear in each other?” “What does it mean for you to love bravely?” “Have you ever done it or do you shy away from it?”
As a side nite the word “lee-way” is quite interesting, with origins in the concrete meaning of a sideways drift if a boat or plane. The best definition I came across that seems to fit her use of the word was “leeway – a permissible difference; allowing some freedom to move within limits.” Just thinking about this word and this definition, well, what a perfect word to encapsulate a bug part if intimate relationships: the balance between acceptance and tolerance of difficult aspects of the other while at the same time having reasonable limits, thus capturing the combination of surrendering as well as separating/having boundaries… Real food for thought in just a few short sentences…
Ok. I started a very long post a few days ago and it got erased! Then I spent a lot of time finishing the post and part of that got erased! Major frustration!!! I’m feeling blog post guilt for not posting in so long!
I thought of calling this post “Death or Necklaces”, but, as is the way of blog writing, I know there will turn out to be some connection between the two topics. Already they are connected, as the main topics related to art therapy and psychology that came up while I was on vacation in the woods upstate.
On my vacation, I brought only several books with me all of which were related to therapy; luckily I was reading “Alice in Wonderland and Through the Looking Glass” out loud to my daughter every night to offset the fact that I didn’t bring any “vacation” books, such as novels. (Note: good rule for next vacation and for other therapists, only bring books unrelated to our profession when going on vacation or staycation.) The main book that had a huge effect on me was Yalom’s “Staring at The Sun: Overcoming the Terror of Death”. I started reading it the first night and couldn’t stop myself from reading it every night, until about page 248, when I had to stop, as it had become too overwhelming. I think this happened somewhere in the middle of vacation. I found myself thinking too much about death, dying, death anxiety, and loss. I know the book brought me to the point of tears, but oddly I can’t remember what it was that I was reading in it that did that. I’m also not sure what I was reading about when I put the book down. I had already read his chapter about his own experiences with death and death anxiety…
Oddly enough, a long vacation already has an element of loss and awareness of how the present slips into the past and how the future is limited, as the “longer than a week” vacation has a beginning, middle and end. Having about 18 days away afforded me the kind of reflection about the vacation itself that was due to its length and my being hyper aware of the vacation’s having an end date, the “death” or “expiration date” of the vacation… For, in contrast, with a short week’s vacation, one barely has time to get used to it before it is over. So this book topic oddly resonated with my having my first long vacation as a therapist, and as an adult actually, as I never before took such a long vacation,at least in the past 15 or 20 years…
I spent most of that time in the woods with my family, on a small pond populated mostly by frogs and a few crayfish. The frogs were a highlight of our stay at our friends’ “Froggy Pond Cabin”. A daily activity involved going out in the paddle boat and spotting frogs. As they are well camouflaged both day and night, it was very exciting to find a frog at the edge of the pond, and then just sitting and watching a frog, as, surprisingly, many of them sit quietly in the same place not moving at all, even hearing us talk to them and about them or at night shining a flashlight on them. Each evening as the sun set, the place was filled with a chorus of frogs croaking, calling to each other. At times I could also hear frogs in some other nearby pond. Their voices were wondrous and strangely had no connection whatsoever to the “ribbit” frog talk in the English language. (At least “moo” is a close enough approximation to a cow’s real sound!)
I mention the frogs to start the topic of being far away from the city in nature and strangely, very close to death all around us. The first night we were there I was not that surprised to find the corpses of 2 dead mice in the house, which had decayed to such a point that their skeletons were viewable. Last year, staying at the same place, I had found a mouse newly dead and seen some live mice, so I was very aware that I would likely encounter a dead mouse. I have seen many dead mice in my lifetime but nothing like these two. They looked like they could soon become fossils. Somehow the extra time of their being dead, the idea that they had died long before we got there, to discover them like that was very strange and the eerie feeling it brought up stayed with me as the vacation continued. They were under a bed, and I developed an irrational fear of seeing them again, as well as guilt at the edge of my mind that I wanted to clean up this mess, but couldn’t bring myself to do it as they seemed enmeshed with the carpet. There was something very spooky about accidentally spotting them with my flashlight at bedtime with my daughter, who may have even asked to look at them. It was also strange as Alice in Wonderland encounters a live talking mouse soon after arriving at the bottom of the rabbit hole. The aliveness of the creatures in that book was even more interesting as we encountered some out in real life, both alive and dead. We saw live moving caterpillars and dead ones, all sorts of spiders, mostly alive, and many other insects including some creepy variety I was unable to recognize, as well as one dead frog found at the end of vacation, which was saddest of all, as we had become so friendly with the frogs.
I go on about dead animals as well as live ones and fictional talking ones because dead creatures of other species are all around us, and usually we remain unaware of them. Of course every time you enter a supermarket, no matter what you eat, there are dead animals there… The first night when I began the book with his introduction to the concept of death anxiety, I had a premonition that I would have a dream about death, and I did.
I dreamed about having a dog that was only 2 and dying of cancer. I was talking to the vet who was telling me it was over and I had a hard time believing her because the dog was so young. The dog was the same kind of unusual dog my close friend had and recently lost in a very traumatic sudden manner a few weeks prior. Also, in the dream, my own dog, who died in 2009, was there in the background, a kind of ghostly presence. It was a very sad and emotional dream and very vivid. The dream resonated on many levels. The obvious one was that it was about a recent loss my friend experienced that touched me, and about my own loss of my dog. What did not occur to me until now while writing about it is the idea of the dream being about my own death anxiety, if I look a little deeper or apply the idea that everyone in the dream is me. Perhaps I was telling myself to live as though I had very little time to live. A few days later, when I told my daughter about the dream because she was curious, I was struck by her saying, “Oh you had that dream because you are do sad about Claude (my friend’s dog who died suddenly and traumatically), and you think about it a lot.” She was right in terms of the vivid urgency of the dream and seemed more aware than I about the effect of Claude’s death upon me. Her short life experience of death is of my own dog’s death, so she senses a lot about my own sensitivity to dogs. She remembers him and learned a lot about death because of it. My own experiences of death that I remember, besides having turtles and a hamster, happened when I was much older and lost my first beloved grandmother at about age 13, though I am sure I thought a lot about how strange death is and what happens when you die, and other typical childhood wonders about being put in a box in the ground, etc. Being a native New Yorker, I have more vivid memories about my concern with garbage and where it is dumped. (Recycling did not exist.) I remember spending a lot of time being freaked out by the idea that there is a limit to the space on earth, and how do we manage to keep generating garbage, where does it go, and why does it not overpower us because of the constant continuance of it. What will we do when we have no more room to put the garbage? I think this coincided with my wondering about dead bodies accumulating and a limited amount of space for them. It still bewilders me that at some point there will be no more space for cemeteries…
What struck me about this book was the author’s philosophical approach to death and death anxiety. He is a therapist, but quoted a lot of philosophies to his patients and discussed philosophers and philosophy a lot in the book, as they deal a lot with the subject of death and human existence. Questions arose about what makes a life meaningful, how do we deal with the fact that many years from now even our most famous authors and philosophers may not survive? Our art will likely be eventually destroyed, millions of years from now, so even the idea of living on through what we make is ultimately an illusion and delusion. The only thing that can save us from the anxiety of nothingness and not being or even being remembered is his idea of the concept of “rippling” like water in a pond, our effects upon others in our relationships, whether as friend or mentor, that is, to, in life, have a meaningful effect upon others. I agree with Yalom that when we die we cease to exist. That’s it. Concepts of reincarnation or after life are just false comforts for death anxiety. To really deal with our death anxiety we have to face our mortality and accept that we will disappear completely. Although unlike Yalom, I believe in synchronicity and unconscious connections and sometimes maybe in some idea of fate or that things happen for a reason, ultimately I have to agree that death just happens and that’s that. There is no explanation for babies and children dying. Or our pets dying too young or dying at all. It doesn’t happen for a reason. The only way to deal with the fact of death and our own mortality is to live as much as possible in the present moment. It’s why we are drawn to dogs, cats and children. They bring us into the present moment so we can indeed be here now. Sex functions the same way. I have seen countless movies where people seem to be inexplicably drawn to having sex after a funeral, for the obvious reason that it is a way to move away from thinking about dying and that our lives will end like blowing out a candle.
“Staring at the Sun”, Yalom calls this book because we really can’t do it for too long, or we get blinded. We need to be aware of our own anxiety about our own death, but we can’t be too preoccupied with it, or we will cease to live. The only unanswered questions I felt he did not address were about suicide and suicide fantasies. Those people who fly straight into the sun and have their wings melted, what about them, the people who deal with death anxiety by trying to control death and take their own lives? He does not grapple with that subject, though he has plenty to say about his experiences of working with people who know their time is limited and that they will die soon, and how much he has learned from these very awake people. I was also just curious about other aspects of suicidal ideation, such as people who fantasize about being dead and at peace as well as the phenomenon of a person failing at a suicide and reporting that in the middle of it, s/he changed his/her mind about it. Did death anxiety save such a person, or the desire to have more life? Probably these two ideas are tied together.
We all fantasize about peeking in at our own funerals. What would people be saying about me? we think. Another useful fantasy is to imagine that you are told you have a month or a week left to live. What would you do differently? If your answers look very different from your life right now, you know you have urgent work to do in therapy and in your life. If your answers are close to your present life, you are living more fully, but there are always changes to make and ways to awaken yourself more now here while you are still breathing. In my family we have a goodbye ritual when any of us are leaving the house, that, though a quick one, serves as a way to ensure that even if tension was in the air about something, we know we acknowledged our bond before the possibility of ultimate separation. As I not only live in NYC but close to Ground Zero, I am hyper aware of the concept of leaving the house or someone else leaving and never seeing each other again…
Bringing me to the topic of necklaces… On my vacation I made a lot of art with and without my 4 year old, so my art was very influenced by the materials we used as is usual. The one different thing for me was a sudden desire to use beads and make necklaces. It probably started before vacation when I took my daughter to Beads of Paradise in New York City, and we picked out beads and made necklaces. I had thought of it as a fun activity to do wuth her, but when I got home, I hunted out my beads that I bought years ago on a trip to new Mexico and made another necklace. It was then that I had that “aha” moment when you do something without thinking about it, and suddenly you really like it. So on vacation I brought those beads with me and got obsessed with not only making necklaces but getting more beads and sorting the beads by color and starting a kind of collection of beads. It became my alone meditative time at the cabin because my daughter did not show interest in beading.
Sitting outside and putting beads on a string was a discovery similar to my discovery of knitting many years ago. I didn’t take jewelry making of any kind or beads too seriously when I started learning about art therapy. I had the usual bias that somehow it wasn’t as creative as drawing, painting, sculpture and collage. That bias disappeared over the years as I witnessed the therapeutic effect of working with beads and other media traditionally thought of as “crafts” rather than “art”.
In any case, I had a few stray thoughts about beading as a process and what makes it so enjoyable and therapeutic. For one thing, it is like origami in that it is shown in the moment. While origami can be a performance akin to a magic trick, the necklace is also “finished” and has a definite end point. Wearing your own art can be empowering, and I’m sure it’s a part of what inspires people to become jewelry designers. Making a necklace out of colored beads also has the feeling of taking part in folk art and traditionally thought of as “woman” folk art activities such as quilting. The necklace, like the vacation and the life span, has a beginning, middle and end. I was making long necklaces so the middle became the focal point where I had the most fun picking out the extender and the special beads to put on it, and then continuing up the other side, carefully trying to copy whatever pattern I had invented for the first half of the necklace. (Note: this is where my writing got erased, so I’m not sure I remember everything I said on this topic…
For some reason, making these necklaces (see below for some photos of some of the ones I made), reminded me of the three fates in Greek Mythology. Definitely one of them is spinning something that has an end to it and is meant to represent the individual’s fate, life span, etc. Interestingly, the three fates are older unattractive women:
The Moirai were described as ugly old women, sometimes lame. They were severe, inflexible and stern. Clotho carries a spindle or a roll (the book of fate), Lachesis a staff with which she points to the horoscope on a globe, and Atropos (Aisa) a scroll, a wax tablet, a sundial, a pair of scales, or a cutting instrument. At other times the three were shown with staffs or sceptres, the symbols of dominion, and sometimes even with crowns. At the birth of each man they appeared spinning, measuring, and cutting the thread of life. (Quote lifted from Wikipedia.)
Besides the meditative quality of the repetitious action of beading, there is the linear quality to it, with one following another. When I made mistakes I had to take out all the beads up to the mistake and start again. Of course now I think I had some profound thoughts connecting death awareness to necklace making, and I have no idea what they were… Another interesting point Yalom makes in his book is that we often live with a false presumption of immortality or of death always being far into the future. He uses the example of starting to write a book with the assumption that one will be alive to finish it. I would even venture to say that some procrastination connected to writing or finishing a written work may be related to an underlying death anxiety. Anyway, making these necklaces is not quite the same process as they do not take so long to make. Another interesting point is the accidental dropping of beads and sudden loss of a pattern.
Ultimately there are many connections between actual death, death anxiety, separation and loss, hyperconciousness, forgetting the fact of one’s own death, the living dead, etc. One thing that struck me as sad is the difference between a memory, which in some ways represents a lost moment in the past, that one can never have back, and the gaps in memory of one’s own life story; for some reason, I get sadder at the idea that so much of my life involves moments and episodes of living that I have no memory of. Having a dim memory or an awareness that the memory may not be factual is not quite as bad as the “blackout” of moments of life. However, memory and time could be a whole topic on their own…