Client's don't often come into treatment with any knowledge of (or interest in) art history, so I try to find as many opportunities as I can to introduce them to visual art. Today's art therapy group drew inspiration from the Impressionist Berthe Morisot and the Expressionist Erich Heckel. I showed them Morisot's Psyché and Heckel's Männerbildnis because I wanted them to use Impressionist and/or Expressionist visual language to produce self-portraits. There was, however, a catch. The two self portraits had to be conceived from the perspective of two people: a stranger and someone who knows you well. This constraint, in addition to the artistic mode of expression, produced the therapeutic effect of the group; namely, creating self-portraits through others' eyes helps to make visible how we see ourselves, how we hide parts of our emotions from view, and how we yearn for others to see the parts of ourselves that we hide. 

Research supports the use of art therapy as a means of fostering emotional regulation, enhancing insight, and promoting psychological flexibility (Kimport & Robbins, 2012; Gussak, 2007; Slayton et al., 2010). The dual self-portrait exercise specifically encourages clients to explore the discrepancy between internal and external perceptions of self, which can be particularly valuable for individuals in recovery who may struggle with shame, self-stigma, and identity confusion (Mezo & Short, 2012; Kim et al., 2017).

Since most clients are highly judgmental, especially when it comes to their own perceived lack of artistic skill, I provided a few extra words of guidance:
  • Use of Color: Participants should represent affective states and emotional intensity through color choice (Moon, 2010).
  • Use of Line: Use lines to show your measure of self-cohesion and mindfulness regarding present-moment awareness.
  • Background Setting: Let the background image or texture act as a metaphorical tool for exploring underlying values, personality traits, and environmental influences on identity.
Here are some of the results:
Therapists looking to highlight clinical themes in exercises like this might notice the following. First, there is a discrepancy between self-image and public persona in the portraits. One client, whose works aren't pictured here, offered an image of her face surrounded by hearts. The second image, however, was a split canvas with one whole-body representation of herself residing in a box. In that version of herself, her heart was broken in her chest and a frowning, disembodied facial expression floated outside of her facial area. I commented, "it looks like it takes a lot of energy to come across as so loving all the time." She replied, "It's exhausting. And I have to keep my sadness locked away." Clearly, the client suffers distress any time she wants to fulfill her own emotional needs.

Second, the role of shame and vulnerability in recovery comes across loudly in the images. Consider the male figure crouched in a fetal position contrasted against the dark background. That image clashes with its partner, a back-view of the man seated in a folded-leg meditative position. The former, likely the image imagined through the eyes of someone who knows the client well, has access to a world of pain that strangers don't see at all.  

Third, on a more optimistic note, it is possible to see emerging self-compassion as clients explore their authentic identities. A lot of the relational therapy work we do in group settings asks clients to evaluate the percentage of themselves they present to the world on a daily basis. What will encourage us to show all of ourselves? What fears prevent us from showing the important parts? How do we overcome our fears of judgment and insecurity, and how are clients supposed to set aside their chemical coping skills as they find ways to tap into their innate courage?

Fourth, and finally, it is possible to see growing insight into the ways social roles and substance use history influence clients' perceived identity. What are these portraits if not glimpses into the roles that each client imagines they are supposed to play on a daily basis? The two portraits presents a choice: play the parts assigned to me or play the part I yearn to play. The intensity of emotion crammed into that choice could fuel at least 10 groups. Fortunately, artistic expression helps "say" things with out needing to utilize words, and that type of silent self-disclosure can sometimes give clients permission to show parts of themselves that they would otherwise keep locked away.

Interested in reading evidence-based studies on the effectiveness of art therapy? Check out the following:
Kimport, E. R., & Robbins, S. J. (2012). Efficacy of creative art therapy for reducing anxiety, depression, and stress: A meta-analysis. Art Therapy: Journal of the American Art Therapy Association, 29(1), 46-53.
Gussak, D. (2007). The effectiveness of art therapy in reducing depression in prison populations. International Journal of Offender Therapy and Comparative Criminology, 51(4), 444-460.
Slayton, S. C., D'Archer, J., & Kaplan, F. (2010). Outcome studies on the efficacy of art therapy: A review of findings. Art Therapy, 27(3), 108-118.
Mezo, P. G., & Short, M. M. (2012). The art therapy trauma and resiliency model: A theoretical framework for art therapy practice. Art Therapy: Journal of the American Art Therapy Association, 29(1), 8-13.
Kim, S., Kim, G., & Ki, J. (2017). Effects of art therapy on individuals with addiction: A meta-analysis. Journal of Social Science & Medicine, 190, 31-39.
Moon, B. L. (2010). Art-based group therapy: Theory and practice. Charles C Thomas Publisher.