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…