Thr Art3 in Psychothrrupy. Vol. 15 pp. 95-100. o Pergamon Press plc, 1988. Printed in the U.S.A. 0197-4556188 $3.00 + .OO

PERSPECTIVE

A PSYCHOAESTHETIC PERSPECTIVE ON CREATIVE ARTS THERAPY AND

TRAINING

ARTHUR ROBBINS, EdD, ATR*

Traditionally, creative arts therapists, due to their training and discipline, pay particular at- tention to the processing of treatment issues through a specific modality or a combination of modalities. More often than not, the therapeutic relationship, albeit important, takes a back seat to the technique and emphasis on working through problems within a particular modality. This paper, by contrast, will present a point of view that emphasizes the importance of the psychoaesthetic dimensions of the therapeutic relationship as a pivotal focus in working through intrapsychic issues.

In Robbins (1987) I stated the following:

When I speak of aesthetics, I’m referring to mak- ing the inanimate animate, giving form to diffuse energy or ideas, breathing life into sterile com- munications. Communication is a key word here, for a completed work of any medium be- comes art only when it touches us as a living truth. This happens when it is an authentic ex- pression of the artist, and more often it involves an integration of polarities.

In another section, I further elaborate on this point:

When symbolic form includes multiple levels of communication and transcends its individual parts to communicate a larger meaning, it ap- proaches the level of aesthetic communication.

In the therapeutic communicative structure, the expression of the aesthetic takes place both within a particular modality and in the patient- therapist relationship. These two levels of com- munication either complement, mirror, or op- pose one another, but the mode of interaction must be understood in order to facilitate appro- priate treatment interventions. For example, on a manifest level, the patient-therapist relationship may be highly ordered, controlled, and bland, but the patient’s nonverbal form of expression, as revealed by a particular piece of artwork, may be florid, unbound, and chaotic. The technical issues regarding how and when to deal with these variations are discussed in depth in the text of Robbins (1987). However, for the purposes of this paper, it is important to re-emphasize the existence and assessment of these levels of communication in order to understand and work with treatment technique. Further, it is essential to note that traditional academic programs do not offer the unique and disciplined form of training that a therapist needs in order to respond to such complex aesthetic levels of communicative organization.

Dr. Gilbert Rose (1987) also sets forth a thesis as to the weight of aesthetic form in art and therapy. He presents examples of creative writ- ers such as Dostoevsky and John Fowles who, through their art, transformed personal trauma into creative expression. He contrasts pathology,

*Arthur Robbins, Professor of Art Therapy at Pratt Institute and Director of the Institute of Expressive Analysis, is also Book Review Editor of Tha Arts it1 Psychotherapy.

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which under his definition has its own artistic expression and its own coherence and aesthetics, albeit skewed and distorted, with creative work that is far more conscious and integrated. Yet, both forms of expression are attempts to master personal trauma. Thus, in treatment, the art form of the patient is expressed through transference and enters into the communicative process of the relationship and/or in the patient’s artwork. Each expression presents its own particular pattern of aesthetic organization with its potential for trans- formations that are reshaped in an ongoing treatment process. Of great significance is Rose’s acknowledgement of the importance of the inter- nalization process that transpires between pa- tient and therapist as a facilitator in treatment. This identification process, however, is not con- fined to patients who exhibit primitive mental states. By way of propounding this thesis pertain- ing to the process of internalization and its utili- zation in treatment, Rose cites the literature of Behrends and Blatt (1985, p. 213).

Internalization according to these authors oc- curs through (a) the establishment of a gratifying involvement followed by (b) the experience of incompatibility of this involvement. In other words, internalization is triggered when interac- tions with others that have formerly been gratify- ing are disrupted. In order to regain some trace of this gratifying experience, an identification with the previously gratifying object must take place. The internalization of the therapist then becomes an important anchor and organizer that facilitates the assimilation of insight. Without this anchor and organizer, insight is not utilized and inte- grated within the self, but becomes part of the intellectualized defenses that are so often a part of ineffective treatment. Consequently, the need to develop a transitional space between therapist and patient cannot be overemphasized in facili- tating this identification process. This gratifica- tion occurs within a climate of deep mutual one- ness between patient and therapist reminiscent of both the artist merging with his or her medium in one phase of creation and the primary creativity of mother and child. In therapy, this can be ob- served as an experience of oneness and a deep feeling of relatedness or resonance between the two participants: patient and therapist. This quality of nonverbal relatedness channeled through the intonation of voice, postural and fa-

cial expressions, and kinaesthetic resonance are manifestations of the primary process that fuels the whole movement of treatment.

Frustration arises in the form of separateness and the disruption of this resonance with inter- pretive interventions. Thus, though the early re- sonance with the material is broken, if the thera- pist is able to provide “a good enough mothering space,” the patient can internalize the connect- ing symbolic links associated with the therapist and utilize it as a stabilizing center for the assimi- lation and organization of insight. In an ongoing treatment process, new forms are constantly being developed that can basically be facilitated through the medium of the transitional space. Without the development of a transitional space within the therapeutic relationship no identifica- tion process can take place. The identification process is also impaired if no shape or form is given to the transitional space. Form, through the medium of therapeutic interventions, can in- clude verbal interpretations or the giving of aes- thetic structure to a patient’s art expression. Therefore, a central aesthetic of treatment re- volves around the interplay of nonverbal reso- nance and a variety of verbal and nonverbal forms introduced by both patient and therapist. The appropriate mixing of frustration and gratifi- cation and/or form and resonance will be contin- gent on such factors as the patient’s ego defenses and self-object organizations as well as the de- velopmental level that is being expressed in treatment. Therapeutic artistry, then, becomes contingent on the therapist’s receptivity to a variety of different energies expressed on a number of different psychic levels, which in turn must be responded to with different types of holding environments and interpretive forms. In short, the structure that is created both in non- verbal and verbal expression, such as how loose or tight, distant or close, will be crucial in creat- ing this identification process, which is so impor- tant in building insight and internal psychic struc- tures.

It follows, then, that creative arts therapists cannot divorce themselves from the relationship in the belief that the identification process will grow without nurturance or awareness. It is es- sential, therefore, that therapists remain con- stantly aware of how to further this identification process in both nonverbal and verbal expression

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so that they can lay the framework for the build- ing of insight and an internal reorganization of the patient/self.

For this to be accomplished, therapists must be willing to feel the psychic fabric of a therapeutic communication. Like the artists who feel the very texture and character of their mate- rial, so too must therapists feel and touch the very essence of the patient’s being. The quality of the patient’s presence, the very character, the nature of his or her armor must be experienced before therapists can develop an empathic tran- sitional relatedness with the patient. As treat- ment progresses, therapists can feel the density of the patient’s use of psychic space as induced images organize the experience of this psychic fabric (i.e., soft, crusty, pliable, crass or fragile, etc.). Part of the artistry of therapy involves touching and experiencing the various interfacing layers of a patient’s fabric and developing a hold- ing environment that mirrors the multifaceted in- terconnections of these different layers. By so doing, therapists offer the patient a reflection of himself or herself at different stages of treatment. Often, this level of mirroring can be superficial, reflecting only the top layer, but, there are times when this technique of mirroring can deeply penetrate the interior of the patient’s core self. By providing nonverbal and verbal structures that respond sensitively to the changing nuances in the relationship, therapists offer balance or counterbalance to the energy in the relation- ship-accomplishing this task by temporarily los- ing their boundaries and feeling the inner life space of the patient. This is no easy task, for at any given moment therapists may encounter primitive emotions and affects of the patient that could temporarily overwhelm even the best of therapists. Thus, treatment, if nothing else, is a dance in which there is a variety of images, in- terplaying between the two participants-ther- apist and patient-and taking place on both an unconscious and conscious level, creating, in turn, its own dynamic art form.

From session to session this dance weaves a theme in and out that flows into other sessions. Yet, just as any artist’s space can become stale and repetitive, therapists and patients can get lost on a plateau of treatment communication. Stagnation arises when the homeostatic forces interfere with the patient’s attempt to create new

forms and balances. Traditional interpretations in some cases bring therapist and patient back in sync with one another. However, in other in- stances they do not help. Powerful introjects can at times interfere with therapeutic efforts, and their uncanny presence intrude into the pa- tient/therapist empathic relatedness. At this point, as when faced with similar problems that involve the creative process, therapists learn to let go of their old perceptions and listen to the patient from a new perspective. During these transitional periods, therapists take a creative leap, giving up old interpretations and yielding to a better perceptual integrative frame that fits the patient’s communications. On rare occasions, this transcending shift requires an enormous leap to a higher level of integration. Therapists are faced with a new and different experience of the patient’s complex reality and are forced to put aside their previous assessment of the patient.

Training, then, in understanding and coping with the aesthetics of a therapeutic relationship is a very complex challenge. Learning to oscillate from an ego state of form to formlessness can substantially contribute to the capacity of thera- pists to organize, contain, and process introjec- tive identifications of patients. This is equally important in furthering good therapeutic identifi- cations. We find, therefore, that a tightly con- trolled therapeutic stance, as manifested by ther- apists who exhibit a detached demeanor, will in- variably interfere with the aesthetic ability to feel the very essence of a transitional space. On the other hand, we also observe that therapists’ loose boundaries can substantially contribute to a muddiness and lack of conceptual clarity. Ideally, a state of free-floating attention should be maintained. Needless to say, the better ac- quainted therapists are with their demons, the easier it is for them to process introjective issues as well as maintain an aesthetic perspective. However, despite the state of preparedness of therapists, the constant battling with a patient’s induced introjects and the ongoing painful iden- tifications that they must find within themselves can take an enormous toll, periodically knocking the best of therapists off their therapeutic center. Therefore, if therapists are to remain effective and not prematurely burn-out, support groups wherein it is possible to vent rage and upsets, and regain equilibrium become an absolute necessity.

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In graduate creative arts therapy education, small supervisory support groups serve an im- portant function in the processing of this mate- rial. Classwork also can offer much in refining a psychoaesthetic perspective. However, a strictly cognitive approach cannot do the job in develop- ing such a point of view. Studio work, too, has its place, but it may be very limited in its transfera- bility to interpersonal issues. Robbins (1987) of- fers a variety of structured exercises that explore student’s particular empathic resonance with a wide variety of primitive mental states. Through these exercises, students learn that their life experiences are all too similar to those of their patients. For instance, they may discover that everyone has a sad, lonely part of the self that is similar to the schizoid patient and, indeed, if they search hard enough, they may find islands of their own craziness-borderline components as well as whole series of constellations-that bring them closer to a patient’s inner life. Through drawing and expression of a variety of ego states, students are able to see that psychopathology is a continuum, rather than an absolute defined entity.

An illustration of psychoaesthetic education may shed more light on this thesis. Recently, 1 conducted an exercise in exploring the dimen- sions of blackness that has been presented in var- ious parts of the United States. In this workshop I asked the participants to take a black crayon and allow themselves to scribble lines without attempting to control the form on a white sheet of paper, to simply allow the rhythm of the lines or form to emerge. Then I asked them to find the hidden order of the blackness and to amplify the blackness in the creative expression of them- selves. In other words, to give form to the work of art. The results highlighted a whole range of different reactions to the experience of black- ness. A few of the students ripped up the paper until one couldn’t discern the blackness at all. Others put so much color around it that black was disguised about the white part of the draw- ing. It was not the black part that scared them, but the whiteness or emptiness. All too often therapists view “blackness” as a unidimensional category. From my experience both with patients and students it seems that it is not enough to talk about depression in either/or terms, as either in- dicating aggression directed toward the self or a state of hopelessness, helplessness, or low self-

esteem. These are flat categorical descriptions that do not really do justice to the complex, mul- tifaceted state of emotional blackness that exists to some extent in all of us. For instance, in its most positive dimensions, black becomes an ethereal poeticness, a directed power, a spiritual connectedness, or a sensual black variety of ele- gance. Its more pathological form, the “black spot,” can either be covered over by a “false self’ structure, restricting an organic integration of affects, or can invade every orifice of the being like a heavy, dark cloud laying fallow and creat- ing the paradox of still energy being experienced as diffused, unbound, and inarticulated.

Helping students to experience blackness be- comes an excellent avenue to understanding both schizoid and depressive phenomena. Too often, we as therapists either miss the multiple dimen- sions of these states or else try to impose an order rather than encourage our patients to feel the very heart of blackness, to discover their own particular essence of blackness. Clearly, black is not simply black. Making use of our aesthetic sensibility and language offers a rich framework with which to approach black states.

What of the creative arts therapists who have already completed their formal academic train- ing? For mental health professionals, it would be beneficial to develop training groups outside of the formal educational system that can facilitate the nurturing of the aesthetic professional thera- pist/self. Developing empathic and aesthetic re- latedness is a complex affective cognitive skill that requires, like any artistic engagement, both discipline and emotional engagement. The in- depth exploration of one’s personal life in a tra- ditional institutional setting may be politically unwise as well as unmanageable, but there is no doubt a need for what I call “countertransfer- ence education” that furthers the development of an aesthetic professional self. The goal of this form of education is to ‘promote the development of each therapist’s unique aesthetic style in the processing of and responding to the subcurrents of treatment communications.

These countertransference sessions employ supervisory group contacts, with the leader, presenter, and supporting members interacting throughout. At the outset, the members and leaders present the case material in an open- ended fashion where free associations, fantasies,

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and feelings are spontaneously encouraged for members and the presenter. There is no fixed selection as to who presents, as a group process takes on a life of its own. The group creates an atmosphere reminiscent of a therapy group within a climate of nonjudgment and open-endedness. At the same time, firm boundaries are maintained between material that facilitates the ongoing process of case management. Transference is- sues invariably arise btween the members and the leader, but are not processed unless they interfere with the total learning experience. Of considerable importance is a group contract re- garding the distinction between personal material relevant to therapy versus material that facili- tates the processing of a particular case. It is as- sumed that the members have enough personal treatment behind them so that they will be able to emotionally move back and forth between deeply emotional forms of communication and cognitive learning. Out of this mix a structure arises that is emotionally engaging and supportive. These pre- sentations, then, take place in a free-wheeling atmosphere where there is an underlying climate of trust and rapport among the members and, also, an internal discipline that is directed toward developing an aesthetic understanding of the in- terplay of form, space, and energy in the treat- ment relationship.

In the interplay of these dynamics, we observe a splitting process in which patient, group, and therapist become part of the projected mix of the patient’s identifications, which further become part of the case presentation. In other words, the presenter (therapist) experiences parts of the “real” patient’s internal world within the group structure. A variety of defenses are also mobilized through the case presentation as the leader or members become excessively interpre- tive or supportive, interfering with the emerging treatment dynamics. Resistance to learning can be handled in a variety of ways besides confron- tation and interpretation. There is a good deal of mirroring, role-playing, and encouragement of fantasy trips and dramatic dialogues, as well as the employment of a variety of expressive mo- dalities that contribute to a very alive and charged atmosphere.

With the help of expressive modalities, we explore those characteristics of the “real” pa- tient that can facilitate the presentation; walking

like a patient, experiencing his or her voice, or giving nonverbal intonations through role-play- ing helps presenter, members, and leader interact and assess the situation more effectively. Mem- bers of the group draw their perceptions of the group climate while the case is being presented. Often this material mirrors the subtle aesthetic form of the “real” patient-therapist relationship that becomes part of the group processing. Deeper clinical material is often tapped through expressive modalities. At times, the therapist, the presenter, and the group draw pictures of the patient’s and therapist’s parent. A processing of this material often leads to an uncovering of var- ious introjective identifications that have subtly crept into the treatment process. These identifi- cations must be tapped and productively used in treatment. Robbins (1988) offers extensive clini- cal examples of this training process.

Countertransference supervision provides a vehicle within which to play with different therapeutic styles and observe colleagues strug- gling with similar material. Furthermore, this format offers opportunities for the presenter to observe the leader at work as the material is introduced and processed with the group in- teraction. The countertransference group then provides an educational, emotional, and aes- thetic format for the modeling and channeling of empathic conduits of therapeutic communica- tion For instance, within such a group, we can observe how we use soft mothering tones, the use of more pointed confronting edges, as well as a whole range of styles that are associated with particular forms of internalizations.

This author recognizes that this format of learning will not resonate for all therapists. For those professionals, however, who are open to such a learning experience, the countertransfer- ence training group can offer a unique opportu- nity for learning, and can provide a means by which to bring about synthesis of affective, aes- thetic, and cognitive forms of organization for dynamic case material. Therefore, if this integra- tion is considered an intrinsic part of the treat- ment process, then this educational model should in some respects be a reflection of this experi- ence.

As the reader can surmise, this author’s posi- tion on this subject is patently clear: emotional, cognitive, and aesthetic learning ultimately takes

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place within the same space. All too often there is a split between cognitive, emotional, and aes- thetic learning. This violates the very essence of the meaning of aesthetic and artistic learning; they should not be viewed as separate learning experiences, but as connective parts of the same structure.

Psychoaesthetics speaks of the language of the artist as applied to the treatment process. As creative artists, we have all too often utilized the language of psychiatry and psychology to further our own particular understanding of therapy. We, too, have something very special to offer in furthering our understanding of the treatment process. The language of the artist and our psychoaesthetic perspective are our unique con- tribution to the treatment process. It requires

nurturance, development, and discipline if it is to realize its full potential. Countertransference training groups may well serve as an important tool in filling this educational void.

References

Behrends, R. S. & Blatt, S. N. (1985). Internalization and psychological development throughout the life cycle. In A. J. Solnit, R. S. Eissler, & P. B. Newbauer (Eds.), The psychounalyric study ofthe c,hild, 40: 1 l-39. New Haven, CT: Yale University Press.

Robbins, A. (1987). Thr artist as thcmpisr. New York: Human Sciences Press.

Robbins, A. (1988). Betn,ecn therapists: The processing oj trcins~,rcnc.c,-c.ouiz~~,rfran~f~,r~,n~,~, material. New York: Human Sciences Press.

Rose, G. (1987). Trauma and mastery in /(jk und ari. New Haven, CT: Yale University Press.