Arf Therapy: Journal of fhe American Associotion,

l6(l)

pp, 3l-36 AATA, lnc,

.l999

Pointing A Poth of Well-being: Art Theropy os o Link to Mentol Heolth Treotment

Potricio Jo Pendleton, MA, LPC, CAC lll, Denver, CO
Abstroct
Engaging people in treatment i,s a primar"t:/ concern at a comnutnity outpatient day treatment program sensing 280 adults uith seDere mental illness and chemical dependencies. Goals include stabilizing one't lifu in orcler to remain out of the hospital and gaining skills to liue more independently. The imrned,iate focus is directed tousards monitored mecli,cations and attendance at the u,eekdall program that prouides breakfast, lunch, ancl a uarietu of eclucational and therapeutic groups and acti,uities. The art therapll progratn consists of ttuo u:eekly groups, a gallery fo, exhlblting client arttoork, ancl a quarterly newsletter fo, sharing art aniL uriting pro&rced by the comrTurni,ty. Aft therapy has proDen to be a strongltnk to treatment for manu indlulduals and fosters stablllty that uill pa:)e the usau,l to a greater sense of well-being and success in achieaing greater independence. Case material from one consumer of this program is presented in the follou;ing discussion.
advocacy, and adaption to individual needs. One only need navigate the rnaze that will lead to the path of recovery' (p. 154)

Bachrach (1993) identified nine essentials for successful rehabilitation of people with severe mental illness: f. individualized treatments 2. environmental adaption 3. a focus on client strengths

4, an emphasis on restoring hope 5. optimism about the individual's vocational potential 6. a range of comprehensive services l. -l involvement in the treatment t. cnent-consumer
process

8. continuity of care

9. a therapeutic relationship between the client-con

sumer and caregiver.

The following discussion will address a community dual-diagnosis duy treatment center that aims to provide these services; an art therapy program that supports the goals of treatment; and a case study of a 36-year-old man with schizophrenia who is recovering after an unstable 15
years living with mental illness.

lntroduction
Art therapy in community mental health treatment offers people with severe mental illness a path of well-being that is linked to an array of necessary treatment services. People with severe mental illness, such as schizophrenia, bipolar disorder, and major depression, often struggle for years to accept the reality of their illness and seek appropriate treatment. They are in and out of hospitals and frequently use substances to self-medicate their symptoms. This unstable lifestyle leads to isolation and estrangement from their communities. Family members may attempt to help, but often become fnrstrated when their efforts are not successful. Individuals are referred to this dual diagnosis treatment program when severe mental illness and/or substance abuse has led to hospitahzation, homelessness, or legal problerns. Most individuals starting out at the day treatment program are in need of medications, substance abuse treatment, housing, and benefits. If an individual with severe mental illness can become engaged in consistent treatment, a new sense of stability is discovered. Acceptance of the mental illness is the first step toward the rehabilitation process. Keil (1992) notes that once people accept the diagnosis of mental illness they realtze that they are now citizens, not tourists, in the kingdom of mental illness.
The problem is, without a passpoft it is difficult to travel this new land with its new language, new customs, and very foreign culture. The passport comes in the form of information, education,

Doy Treotment
Psychiatric rehabilitation for people with mental illness and substance abuse is increasingly focused on assessments and interventions to provide clients with medications, s)mlptom management, counseling, and skills leading to more

independent living (Nikkel, f994). This duy treatment program is open daily to address the needs of this population by offering showers, laundry facilities, free clothing, breakfast, and lunch. "Outreach and drop-in center services provide the much needed first inrritation to return to indoor living" (Backlar, 1994, p. 137). During recent years, the program has expanded the drop-in atrnosphere to include a wide range of treatment services.

This treatment center seryes 280 individuals and employs three nurses, three psychiatrists, eight case managers, two mental health therapists, and one mental health worker. The core of psychosocial treatment is providing each mental health consumer with a case manager who assists with basic needs such as housing, income, food, clothing, and medical attention (Backlar, 1994). In addition to basic needs, an individual is encouraged to discontinue use of harmful and addictive substances in order to begin a trial of
antipsychotic or mood-stabilizing medications. Individuals are offered individual counseling and encouraged to attend educational or therapeutic groups addressing mental health, substance abuse, daily living skills, art the rapy, recreational

3r

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PAINTING

PATH OF WELL BEING

this and hospitalizations treatment program is to prevent empower indiviiuals to live as independently as possible' Wh?ther that means living in a group home or an apartment, the aim is for each p"rrJn to find a life that holds greater

activities, and vocational rehabilitation. The- goal

of

ter and father who

are

in touch with him regularly' IR

to have no real friends' appears Ir been in treatment with this mental health agency has ]R fo, u f"w years. The chart shows a history of hospttartzations and near apartment evictions due to extreme acting- out
around delulsions and hallucinations. Backlar (1994) explains that "the person with schizophrenia is bombarded !I inter-

meaning.

Art Theropy
"Expression is a need of the human tpiltj.rather than a tool for^revealing patholog,z" (McNiff, 1997). Prinzhorn's (Lgzz) publicatioir,^Arti,strl' of th? Mentally lll, describes a model that notes our hrrman iendency to express in distinc-

nal

illustration, writing' tive ways, such as imitative cop)nng' -sacred

symbolic (p' 14) ornamentation, pluyfrlness, uttd providing an ur"i." where individuals in a treatment settittg their natural expressive needs offelt u p-ath of may "*pior" podvolt (1gg0) ,i"rt to "islands of clarity" with*"it-u"lng. in each m-entally ill person (p 5l Thus, art therapy is a place severe to honor and ,rlrtrrie this health within people with

mental illness. facilThe art therapist at this community duy treatment 22 of caseload a ity is also u *"rrtiul health thgl?pist with are groups therapy art hour inaividuals. Two one-and-a-half offered each week. A maximum of six people may participate in each group due to room sLZe, buf the format is drop-in ;p"; strr?io. it ,"r"ly occurs that anyone is turned away' A core group of about 10 individuals participul". the group' new iarticipants are always enco,triged a: visit

t"gularly and

is While tfr" format is open studio, the art therapist choosing in her engaged with each p"rror, fo assist him or

voices These internal stimuli may take the form of mochng s thoughts" individual the ur" others that or belief "orrtrolling havi"g ? mental 1n OZ). Throughout these years, fn a"ttied alcohol to selfused He iilness and ,.ur8ly took *"di"utions. medicate his symPtoms. In Fall tsioO^1n was hospitalized and legally cerLifted to his p:yattend treatment and take medications prescribed by he srn3.e therapy art 1o him chiatrist. His case manager referred to able was He group' other any was not interested in att6n&ttg interventions. abuse substance without alcohol of use stop the with great reluctance. He pace$ IR began art thet?P/ ^thut it is i"*posible for him to sit still the roo* urrJ explain"d down lorrg enough to do anything WrJh some coaxing IT,t"! some scribbled He pencils. coJored uttd papet uriselect6d qujckbut musical notes'u"a words that he said were songs, He then ly iold"d ttrese up 1nd slipped them into his pocket. he While paper. white on green u"d^ dr"* a planet d blue afar from earth ol view ,lit iriage, his for hud ro ""planation life' T: suggest, fnt distance from tlie affairs of everyduy but jR talent, no having t"fiEu,"dty *ude comments about efforts' his dii seem-pleased with to attend art th-erapy regularly since JR has continued 75 drawhis start 7 months ago and has created *ote than

*"rrig", that have no connection to the real world'

*o:t#d, and proleits. Drawing, painting, and collage j"pclay' Cane plies are u.ruilubl", as well as .tuft Pro:9c1s and the of g"perience' capacity integrative 1tt ifgSg) wrote of the
,fr-"gfi three functions:
The She explains how hrrfrur beings "pPt+end movement' feeling, and thought'

"during this^.time. He has been quite ings and paintings #h the Jffectiveriess of his psychiatric medications. ftEur"a the first several 'E"cept

for frequent drowsiness during

their world

*ortir,

of artmahng involves a person in these three as a key ""ti"ity areas of frnctioning. Catie promotes utt

The art experience is"now tied into IR't feeling the art being. He fr"q,r"ntly mentions his enjoyment of

recoY"ry ut-:.t?d possibili'y:, IR is abie to imagine of well-

"dncation a person to gain the most from an ingredient in -Ft "rr"orr-raging^ of greater accomutt Allowiirg uri "*perience ""perience. to perceive treatment in a plishment pavesthe *at for person ^himself positive that link possibly and *ay new a in o, L"rrelf
experience to the entire treatment experience.

of experience. Tire range of IR't *otk shows many oil An Prinzhorn's (Ig72) h,rrriut teniencies for ex-pression'
shows p"r,"r in the style prinzhorn referred to as illustrati,on

the

of a coling on a new terraii (Figure r). Another iliustration

"Moonl"iai"g" that seems to reflect-|Rs

sense of land-

The environment of the art therapy room also contributes to treatment goals. Audiotapes of instrumental would premusic ur" ptuyed duringirt therapy g1oup. fome

t"ld"g orful butterfly with *tt?t spread wide suggestt ]R: butthis time, same flight with crluti"ity (I'iE rrd 2). At the medications effective as teifly is a sign of transfoimation IT:
allow him

music fer rock urra r.o[, but most come to rely on the relaxed producing While to set the-r,ug"'for the creative process. comartwork and &uft projects gives lmmediate pleasure, and art confribute to motivated ur" munity members ulro to proand newsle,tter a qu-art"lly in writing to be published day program duce u'Uoay of *otk that mry be shown at the

art gallery.

Cose Moteriol
t"girr;ril"g" and f.3p:9 to study
,"hiiophrenia
man who experienced the onset of JR is a 36-year-old drrring the late teen years.. He attempted to music but due to the ill-

,r"3, droppZd out ur^d began,diifting from p119" ,to place has a sisuntil l"rrdirrg in Denver a ti,tmber of years ago' He

feel fewer symptoms of his mental illness. he While ]n ptoduced his "^'ly pictures ?i his owrl' loohng began and seemed to be at aloss for ideut uit"i that for ideas. After selecting a picture o{ a through that ^ugJines bi.y.lZ to use as ? guide, jR rendered his own version of shll using level suqprising a express able"to was he showed his love of music' i,mitati,tse copying (Figut" S). Returning to several drawwith busy him he found guitar image, tt 4 t ept in his confident more 6""ame ings (Figure 4). IR_gradually depict to paints watercolor using u"diegan *"trtay tJ creat" plgtos (Figures 5, 6,7)' his intelpretation of ,."ii. ^ugirr"" ts ptayfulnesswith paint J*"tg"dlltyis willing to colof Iaborate with the art therapist (Figrir. S)r This exploration using an of paintingy series a create to led possibilities |R ornamt";;i ufpiou"tt in abstract paintings of black and enough vibrant color that are lovely to ,"" 6t't do not offer

t[

PENDLETON

33

Figure I JR, "Moon Londing"

7a O"

r
(a

-J l^r -1 (.
-Dl

t;
ra .t
Figure 2 JR, "Butterfly"

I
r)

I
O,

-b:

Figure 4 JR, "Three Guitors"

Figure 3 JR, "Rough Drowing of

o 10 Speed"

contrast for black and white reproduction.

IR switched back to colored pencil as he expressed a desire to draw detailed pictures of animals. Shown here is a selection of large cats (Figure 9) and a selection of birds (Figure t0). when IR was asked which animal he would choose to be, his reply was the seahorse. "That way I'll be left alor," he explained. During these months of art therapy, JR showed

Figure 5 JR, "Field of Flowers"

34

PAINTING

PATH OF WELL BEING

Figure 6 JR, "Flowers"

Figure 8 JR, "Colloborotion"

Figure 7 JR, "Jungle"

increased confidence in his interactions with others. He even broke into a Beatles' song, "Blackbird singing in the dead of

Figure 9 JR,

*Young "Tiger"

"Leopord Kicking in Dust"

Tiger"

night...," after completing his drawing called "Raven."

Winnicott (1971) explains how art objects become "other, yet not other self, yet not self' and offer healing as "transi(p. 50). IR't wildlife pictures served as tional phenomena"

transitional objects and provided healing as he gained

strength from knowing his creations. jR includes his full name, date, and descriptive title on

many of his pictures. He moves beyond the concrete titles of earlier works with his picture of sun and moon over mountains (Figure lf ) with a poetic use of words: "The slq'2, you see forever. The sun, you have soul." This grounded expression illustrating Prinzhorn's writing tendency shows that ]R is living more fully in his environment. McNiff (1997) confirms this with a discussion about how people express them-

PENDLETON

35

Figure l0 JR, "Porrot" "Bird" "Roven"

these delusions. JR is no longer legally certified to receive treatrnent and he is able to reco gnize that voluntary participation is beneficial. He is able to live a rnore meaningful life Ly taking good care of hirnself. ]R has achieved stability that uilo*, ffi to maintain a nice apartment, prepare food, engage

in enjoyed activities, and interact more effectively

with others. This recovery to

a better quality of life is possible through an ongoing participation in treattnent.

Conclusion
People with severe mental illness benefit from a community lreatment prograln that offers a wide range of services. Sy*ptom management combined with case management and therapeutic interventions encourages a person with severe men[al illness to a rnore stable lifestyle. A treat-

rnent program that provides creative opportunities allows

consumers of rnental health care to paint their own paths of well-beitrg. Art the rapy supports a mental health care environment that ernphasiies rehabilitation and recovery by offering an irnmediate experience of competence and skill developtnent. This increas"d t"ttse of well-being may encourage the consumer to becorne more strongly linked to the array of services and treatments that lead to recovery. Art therapy offers a positive experience of creative self-expression that reinfoices a positive experience of treattnent compliance.

Figure I I JR, "The Sky, You See Forever. The Sun You Hove Soul,"
selves atrthentically when they come to life and interact with

their environment. The artworks they produce are reinforced when exhibited, contributing yet another cycle of
therapeutic affirmations. Art therapy participants at this program experience this second level of self-esteem rvhen they see their work hanging on the artroom walls or printed in the duy program newsletter or exhibited on the walls of the duy program gallery. IR't symptoms of schizophrenia are managed well now. He has indicated that certain delusions remained fixed, but he rarely mentions these and is not outwardly focused on

References
Backlar, P. (f994). The farnily face of schizophrenia: Practical coun.sel Jrom Arnerica's leoding exyterts. New York: J.P. Putnatn'.s Sons. Bachrach, L. (1993). Continuitl, of care and approarches to case mtlnagernent for long-term rnentally ill patients. Hospitals {, Comrrrunity
Psy

chiatry, 44, 465-468.

Bindeman, S. (1996). Schizophrenia and postrnodern philosophy. The Humanistic P sq cholo gist, 24(2), 263-282.