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Breakthrough Moments in Arts-Based Psychotherapy

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In psychotherapy clients sometimes experience breakthrough moments - profound moments in which their world and how they view themselves is changed for ever. But what exactly occurs during such moments? In Breakthrough Moments in Arts-Based Psychotherapy the author shares her very personal journey to discover what might be happening at these pivotal moments and demonstrates their importance for clients' change processes. Filled with examples from her own practice, the book dips into the worlds of chaos and complexity theory, neuroscience, quantum physics, and theories of change, in order to show how the use of arts-media in psychotherapy - visual images and drawing, drama and music, sand-tray and enactment - can encourage the arrival of these dramatic breakthrough moments. The aim of this unique book is to shine a spotlight for the first time on a deeply profound aspect of arts-based psychotherapy in an accessible and engaging way.

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Prologue: The Story Begins…

ePub

Ben's Story

“I feel pathetic!”

This was the first thing Ben told me when he came for a therapy session at the higher education counselling service where I was working. He said he was desperate to stop being so “clingy” around his girlfriend. This self-assured young man sitting opposite me in the practice-room certainly did not strike me as being the clingy type.

He said that he was managing to “hold it together” so far in his new relationship but recognised the increasing fear of becoming “clingy” and was wary of it. This was a quality he felt had led to the demise of all his past relationships. He feared it would not be long before he was checking up on his new girlfriend's every move. He would become angry and tearful every time she left the house and would be thinking the relationship was over every time she became deeply absorbed in her work or a television programme. Ben told me that he only had this one counselling session with me to fix the problem. He wanted to try and work out what was going on because the following week he would be moving away from the area.

 

Chapter One: The First Breakthrough

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I was seven years old and sat at the kitchen table by myself eating breakfast. I was staring absentmindedly at the cartoon image on the back of a cereal box and perhaps daydreaming about the day ahead, when suddenly I was arrested by something about the image I hadn't noticed at first. The image was of Mickey Mouse holding a bucket and spade, which was not sufficient in itself to halt the wandering attention of a seven year old, but I now noticed something else about it: on the bucket that Mickey was holding there was a smaller version of the same image of Mickey Mouse holding a bucket, and on that bucket there, again, was the image of Mickey Mouse holding a bucket, and so on and so on, smaller and smaller, as far as my eye could see.

It was my first vivid encounter with the recursive phenomenon of mise en abyme—a formal technique from Western art history in which a given image contains a smaller copy of itself, in a sequence that appears to recur infinitely. My seven-year-old imagination was enchanted and bewildered by the mind-boggling effect. Mickey and his bucket were getting smaller and smaller until they were so small I could see nothing at all. And yet still I imagined him going on and on.

 

Chapter Two: Mapping the Landscape

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Christine's story

At precisely the moment my client Christine was wondering if there was anything that could help her solve the dark and seemingly impossible circumstances of her life, an answer came that felt like it was sent from heaven. In our session one day, she was busy creating the beautiful image of a stone hand holding a crystal ball when a sudden ray of light exquisitely emerged from between the hand and the orb (see Figure 2.1).

It took a few seconds for us to realise that this was because the sun had emerged from behind a cloud and a ray of sunlight was shining through the practice-room window and was suddenly reflected under the orb. But it felt as though some sort of magical, otherworldly light had suffused her image with a revelation. The arrival of this light invoked the presence of something far greater than just the two of us and the strange process we had been engaged in. Although we were both aware of the explanation for the dramatic appearance of this light, it nonetheless felt like a powerful metaphor.

 

Chapter Three: The Power of Using the Arts

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It was quite clear that using arts media within a therapy session could lead my clients to experience powerful breakthrough moments. Sometimes these moments would arise from the use of a single arts medium, such as Ben's selection of the orangutan postcard, or Christine's creation of the stone hand; other times it was a combination of various arts media that proved most effective. Varying the art objects and materials used in a session enables a client to see their life situation from a wide range of different vantage points and offers different metaphors, which can increase opportunities for insight and change. This was especially the case with my client Betty. Thanks to Betty's patient creativity and brave desire to explore her feelings, one strange afternoon we found ourselves sitting down to dinner with a cockerel.

Betty's story

Betty was an attractive young woman with a strong personality. She had recently begun a drama course in the city, many miles from her hometown and had been coming to see me in the hope of gaining perspective on difficulties she was experiencing with her training. In this particular session, she told me she had just returned from a weekend's visit home to see her parents. Whilst there Betty had become aware that she felt hyper-vigilant when back in the company of her family. She had felt this sensation when she was around them ever since she was a little girl. Hearing this prompted me, for some reason, to tell Betty that a cockerel stays permanently vigilant, watching out for signs of danger in the roost, which means the hens can peck for grain or rest peacefully, without needing to be on the lookout for predators. This information resonated deeply with her and she decided she would like to make a mask of a Vigilant Cockerel (see Figure 3.1).

 

Chapter Four: The Present Moment

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Guy's story

My client Guy's breakthrough moment was particularly intriguing. Guy was thirty-three years old. He had come to see me to try and work out why he found it so difficult to relax and enjoy his life. On the rare occasion he did manage to have a good time, Guy said he would feel terribly guilty. Now he had a new girlfriend who was also beginning to complain that he never seemed to enjoy himself.

We had been going round in circles in our sessions for several weeks and Guy was growing increasingly despondent. He was always complaining that he never enjoyed himself and the less than productive therapeutic work had given him a new complaint—this time about me. I was not successfully helping him and thus failing in my role as his therapist.

I was beginning to feel impotent and stuck until about halfway through one session Guy pulled towards him a basket of postcards and began absentmindedly flicking through them. He rifled through the cards with almost exaggerated disinterest, as if he wanted me to know how bored and frustrated he was with the art materials and the therapy itself. After a while he pulled out one particular card and said, “Perhaps this one is significant in some way but I don't know how”.

 

Chapter Five: The Therapeutic Relationship

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Lucy's story

It had been several months since Lucy first came to visit my private practice. She presented herself as a highly intelligent, middle-aged woman with a great sense of humour. But lately she had been feeling anxious and confused. She was particularly tall and her body seemed as though it was struggling to fully contain her energetic presence.

Lucy had been trying to tell me something for a while, but so far she had only been able to say it was something she found impossibly difficult to talk about. She seemed caught between desperately wanting to reveal whatever it was and needing to strongly defend against revealing it. I also felt pulled in two opposite directions. I was inclined to encourage her to talk about what was distressing her, but simultaneously found myself wanting to protect her from having to speak about it. The result was that Lucy and I had become respectively stuck. How could I help her feel safe enough to communicate what was going on?

It occurred to me that we might simply focus on trying to reach a safe place, here and now, in the therapy room and see if this encouraged anything new. In a previous session Lucy had chosen a selection of objects and figures to act as her personal defenders and protectors. I suggested she now create a new image of a safe place. She took some black paper and put a few of the “protectors” (from her previous session) around the paper like a border (see Figure 5.1).

 

Chapter Six: The Role of the Therapist

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Melissa's story

“I've been to see lots of therapists in the past and none of them have helped me.”

This was the opening statement of my client Melissa, a successful accountant in her late forties who came to see me one afternoon. We decided we would talk about her reasons for seeking therapy in a one-off assessment to see if we wished to work together any further.

“What is it that you need help with?” I asked her.

“I can't speak about it,” she said, “I've never told anyone before and it's just too terrible to speak about”.

“That must be very hard,” I said, “to be holding on to something that feels so dreadful you can't speak about it, but which bothers you so much that you must seek help. Perhaps something in this room could help you find a way to show me what it is you need to tell me without having to use words?”

“That feels a bit scary,” said Melissa, and she glanced nervously at the crowded shelves of my practice-room (see Figure 6.1).

Figure 6.1. Practice-room.

 

Chapter Seven: The Role of the Client

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Gillian's story

The first thing that struck me about my client Gillian was her hair. It virtually covered her face. It was as though she was trying to hide behind a wavy black curtain. This made it difficult to see her eyes, and the resulting lack of eye contact made it difficult to engage with her directly. Gillian was in her early twenties but appeared much younger. When we spoke about her life—her family, boyfriend, and housemates—she remained flat and disinterested. I almost felt like I was intruding on her and this didn't seem to fit with the fact that she had referred herself to therapy. In our initial assessment session she told me that her parents and boyfriend didn't know she'd come to see me.

An image popped into my head as I tried to navigate Gillian's lack of enthusiasm. I felt as though I held a fishing rod with bait and was trying to entice her to come up to the surface of a lake. This mental image reminded me that I needed to stop “fishing” for answers. Instead we sat in silence for a fairly long time. Eventually I asked her if she could tell me why she had come for therapy. Suddenly her demeanour changed and she seemed to come alive.

 

Chapter Eight: Art-Images and the Art-Experience

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Barbara's story

Barbara was trapped in a controlling relationship. She had become completely obsessed with a song she had heard playing on the radio. She bought the song on CD and told me that she kept playing it on repeat. I suggested she bring this CD and a copy of the song's lyrics to our next session. We sat together and listened through the song twice, each of us following a copy of the words as Barbara entered what appeared to be a trance-like state.

The lyrics were about a person feeling caught in the web of an addictive love triangle. As we listened I felt unaccountably sick. There was no connection to the song from my own life that could account for this sudden onset of nausea. I imagined it had to have something to do with Barbara's own feelings and her obsession with the song. At the end of our second listen, and while she was still in her trance-like state, I invited Barbara to select or draw an image of what she was feeling and to do this without thinking about it too much. My desire was for her to act without breaking the spell that seemed to have woven itself around her and also to give myself some time to recover from feeling nauseous.

 

Chapter Nine: Inside the Brain

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Julie's story

My fifteen-year-old client Julie had a secure and loving attachment to her mother. The strength of this relationship had enabled her to develop a number of ways to regulate and calm her feelings when faced with difficult circumstances. But Julie's father had an alcohol problem and it seems that her otherwise-nurturing mother had never quite known how to explain or acknowledge this to Julie. Julie had not understood at first that her father's erratic behaviour was caused by alcohol and thus now whenever she found herself in a situation where someone was acting strangely or exhibiting detached emotions, she would become overwhelmed by anxiety. She would feel inexplicably fearful and could never understand why. Julie had come to see me in order to try and help her understand and manage these difficult feelings.

Julie's mother had privately made me aware of her husband's alcoholism and I observed almost immediately that Julie herself would show great anxiety (often appearing to become frozen) whenever she was trying to say anything connected to her father. She also seemed anxious about the idea of using arts materials, so I suggested that she and I might make art-images together. I sensed intuitively that this was easier for Julie than being asked to create something on her own. She readily agreed.

 

Chapter Ten: Chaos and Complexity

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Ben's story (continued)

I had often found myself wondering if Ben's breakthrough moment with the orangutan image had precipitated any changes in his life, and, if so, whether these had been lasting changes. After his single counselling session with me, Ben moved to London and I resigned myself to the fact that I would never know what had happened following his experience. To my surprise, however, several years later, he returned to see me. He revealed that after his session with the orangutan image, a cascade of new changes had taken place in his life. He had felt his behaviour, thoughts and feelings all change for the better—especially in the area of his relationships. He had moved to London as planned but soon after had broken up with his girlfriend. A few months later he began a new relationship, which felt more suitable.

One major change, which he attributed to our session, was that he now had more of a handle on his feelings of clinginess. He still frequently felt clingy with his new girlfriend but he now had a different approach for how to deal with it. Thanks to our counselling session, he told me that he now had a clear understanding that these feelings belonged to events in his past. As a result, he felt able to speak to his new girlfriend about the feelings and felt greater insight around them in general. This gave him increased confidence because it raised his self-esteem, which in turn helped him secure a new job (and later led to his being offered a post at the educational establishment where I first met him).

 

Chapter Eleven: The Quantum World

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Christopher's story

“I think I'm having a nervous breakdown!” These were the first words uttered by Christopher—a smartly dressed student in his early twenties who came to see me for therapy one morning. He volunteered the nub of his difficulty without any prompting: “I'm stuck,” he said. “I can't write my college paper and it's so important that I do well.” Whenever he tried to start writing the essay, he said he would feel sick, panicky, and compelled to stop. He had not had any difficulty completing assignments before. He was so desperate for help that he had now referred himself for therapy.

I felt instinctively that Christopher was an intelligent, conscientious student who had become anxious rather than someone who was by nature an anxious individual. I noticed he kept fidgeting in his seat.

“What is the subject of this college essay you have to write?” I asked.

“Quantum physics,” he said, tapping the floor nervously with his foot. “What can and cannot be understood about the quantum world.”

 

Chapter Twelve: Stories and Dreams

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Elias’ story (continued)

Elias was a personable young man in his early twenties. He had been struggling with his sense of identity and seeking to find purpose in his life. He had been raised in a strict, religious household and when he first came to see me, he was slowly trying to discard its prescriptive doctrines. At the same time, he was trying to maintain a sense of his core values. The reader may remember Elias’ earlier session with the frog and baby. He had worked through many issues since then, although we had still not uncovered what lay behind his complex relationships with women. I first recognised Elias’ conflicting attitudes towards women through countertransference. I had found myself feeling seduced by the charm of this young man and yet simultaneously pushed away by him. This gave me a better understanding of his tendency to feel drawn to women but later resent what they wanted from him.

About a year into his therapy Elias began a piece of work that spanned several weeks. Using miniature objects and art materials he started to recount and enact a metaphorical story called The Knight and The Baby (see Figure 12.1).

 

Chapter Thirteen: Conclusion

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Ali's story (continued)

There are many different ways for a client to end therapy. Some endings are planned in advance, others are more spontaneous. But however an ending occurs, it is individual to a particular client and the work they have explored. In general, we try to work with the ending in mind for around five to six sessions. During these sessions, the client and I will recall pivotal moments that have occurred along the way and look back at any images that have been created. On completing their therapy, ideally the client will leave with a new way of viewing themselves (or their issues) that can be practically incorporated into their everyday lives. There will hopefully be the potential for further change to take place in the future.

As my client Ali was approaching the end of her therapy, we discussed what she wished to do with her drawing of Eating Disorder Ali (that had been kept safely in my practice-room) (see Chapter Six, Figure 6.1). After much deliberation, Ali decided to create a ritual in which she would burn the image. The ritual was scheduled to take place five weeks before her final session. When the day in question arrived, she carefully and ceremoniously tore her drawing of Eating Disorder Ali into tiny pieces. Then she placed these pieces in the sand tray, clearing an area of sand where the fire would take place (Figure 13.1). To ensure our safety, the pieces would be kept small and within the confines of a metal candle holder as they burned. Everything was ready for the ritual.

 

Epilogue: The Story Ends…

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Susan's story (continued)

During a session a few weeks before the end of her therapy, Susan and I were looking back at the many art-images she had made during the course of her work. Susan told me that “all the Susans” we had uncovered in the previous weeks were now hanging on an imaginary mobile (a kinetic sculpture that she imagined was suspended between us). She said the Susans were not exactly in harmony but that they were now coexisting on this hanging mobile without any one particular Susan being completely in charge. She told me that this meant none of the Susans had to be totally silenced or banished. She described the mobile as making a tinkling noise as the Susans moved around. This was because each of the Susans was symbolised, in her mind, by a tiny bottle. I could vividly picture this mobile and imagined hearing the tinkling of all the Susans. We sat together for a long time just visualising the hanging sculpture she had described.

“Can the Susans change position on this mobile or are they fixed?” I asked. This was based on my genuine curiosity as to whether each Susan remained in the same place or if the Susans could vie for different positions on the sculpture. I obviously had not read the situation well. I should have waited longer before posing any questions, because a few seconds after I said these words Susan gasped in horror and sat staring at the floor. She had gone very pale and all her excitement about the visualisation had disappeared. “It's collapsed!” she said. “It's all tangled up now on the ground!” Her imaginary mobile was now imaginarily broken. She was crestfallen.

 

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