BOOK REVIEWS: Drawing from Within
Reprinted from Eating Disorders Review
January/February 2007 Volume 18, Number 1
©2007 Gürze Books
Over the years I've been privileged to work with several eating disorders patients who were talented visual artists. Through painting and drawing, each of them had, from time to time, tried to express their anguish and struggles with their eating disorders. I encouraged some of them to show and publish their work because I felt that they'd managed to capture in images aspects of eating disorders that could never be put into words. My sense was that something powerful and meaningful occurred in them as they grappled with their representations. Furthermore, a psychiatrist who is a good friend and colleague, who for decades has specialized in treating patients with eating disorders and whose judgment I deeply respect, regularly refers eating disorders patients for adjunctive treatment with an art therapist who practices in his professional building.
I always sensed that this activity might be helpful, but I wasn't really familiar with exactly what went on in art therapy sessions or how this was supposed to work. After reading Lisa Hinz's fine book, I think I "get it," and have a much better understanding and appreciation of what art therapy might bring to the treatment of patients with eating disorders.
Dr. Hinz is a Ph.D. clinical psychologist who also holds a postdoctoral certificate in art therapy from a major university. Her highly informative, clearly written, nicely illustrated, well-researched and referenced, cautious and thoughtful book lays out the premises and rationale of art therapy in general and of its utility for patients with eating disorders in particular. Dr. Hinz educates us about specific and technical exercises that art therapists might use with patients with eating disorders. She is careful to point out that reading this book will not turn you into an art therapist, and that it's important not to practice outside your scope of competence. Her cautionary words are written with clinical and ethical thoughtfulness: It's not a good idea for novices to rush in with techniques that might, if improperly applied, cause more harm than good. But the book will probably inspire many clinicians who are not art therapists to find one locally, refer some suitable patients, and see what happens. Some readers may be sufficiently inspired to want to learn more about these techniques and perhaps ultimately try incorporating some of these exercises in assessment and treatment.
Theoretically, art therapy offers a way in which patients can nonverbally explore cut-off parts of themselves. They can also explore emotional and cognitive aspects of experience pertinent to their eating disorders, addressing the "right brain" rather than engaging the more cognitive "left-brain" perspectives of most conventional talking psychotherapies. Technically, the kinds of paper, ink, chalk, paint, and other art media are explained for what they offer therapeutically. Media differ in the types of expressions they facilitate, from loose to more carefully controlled and "tight," and their various uses offer ways in which patients can otherwise touch and express themes that may uncover new ways of understanding and dealing with eating-disorder-related issues.
In the technical exercises, each of which has a dominant theme and suggested media technique, patients are encouraged to draw, paint, create collages, and/or sculpt images. An array of media is intentionally made available to them, and patients are encouraged to make personal selections that best suit them for many of the exercises. Art exercises take place in the office, and patients are prepared to work by first being eased into a relaxed meditative state akin to that in guided affective imagery. They are instructed to set aside their "inner critic," with explicit instruction that there are no rights or wrongs, that this isn't about artistic talent, and that concerns about perfectionism and self-derogatory impulses about the "art" (explicitly differentiated from "Art") are best set aside.
After the patient does the exercise, therapist and patient join to engage in "intentional viewing," a nonjudgmental review of what has been produced. The patient is asked to produce a list of single-word associations evoked by the art, and, ultimately, the patient and therapist may consider deeper, symbolic, dynamic and personal meanings and what is revealed. A rich array of structured exercises focus on creating an image of the eating disorder, portraying its impact (both its promises and realities), creating more positive self-images, body image explorations and corrections, coping exercises, and drawing time-lines of past life and of envisioned and desired futures, among many others that may be conducted in sequence. For each exercise the author describes clinical examples, themes likely to emerge, and homework (mostly reflection and journaling, but not additional art production) to occur between office sessions. The entire enterprise is directed toward uncovering, helping integrate the personality, healing and wholeness, and ultimately enhancing spiritual well being.
Included in this book are important considerations of understanding and dealing with transference and ethical issues that emerge in art therapy, conducting art therapy with families and groups, and handling termination.
I'm unaware of controlled trials examining the adjunctive use of well-conducted art therapy in various subpopulations of eating disorders patients, but this intelligent presentation makes me think they'd be worthwhile. As with most interventions, I doubt that these techniques would necessarily improve outcomes and add measurable value over other methods for every patient. However, after reading this book I can certainly think of several of my own patients who might benefit greatly. As the author nicely reminds us, "It is often said in the fields of counseling and psychotherapy that therapists cannot take their patients where they cannot go themselves. This extends to media properties and information processing preferences." In opening up my awareness about what art therapy might potentially offer, Dr. Hinz has shown me new areas in which I've never been. While I don't yet know if I can go there myself, my curiosity has certainly been peaked. I'm inspired to learn more, and I'd be very interested to know exactly how we can systematically explore the added values that art therapy may well provide.