Tag Archives: Creativity

Creativity

Superheroes and play therapy: The perfect imaginary combination

By Jetaun Bailey and Tonya Davis July 9, 2018

Superheroes have a profound influence on American culture. Recently, Marvel Comics’ Black Panther came to life on the movie screen. It appears the movie had a twofold impact.

First, it brought heroic life to a seemingly little-known character. Second, unlike most other big-screen superhero movies, Black Panther placed value on social consciousness, awareness, community, family and pride. It broke boundaries that went beyond simply box-office sales, introducing a male of presumably African descent as the superhero. During the movie’s opening weekend, many news outlets showed young African American children wearing their dashikis as a symbol of pride in the African ancestry depicted in the movie.

As a culture, we hold our superheroes in high esteem, even if they are fictional characters. Thanks to Black Panther, many African American boys can identify with a superhero for the first time. This experience has likely heightened the imaginations of many African American boys as they imitate characters from Black Panther in their play.

Escaping to the imaginary worlds of our superheroes seemingly has therapeutic powers. Author and blogger Remez Sasson describes imagination as the mental ability to formulate an image that is not tangible through our five senses. For young children, an even deeper escape possibly occurs when watching these types of movies. The imagination is a powerful tool for children, as reported by Patti Teel in Pathways to Family Wellness magazine. When children imagine, they can visualize their heart’s desire, thus welcoming it into their reality.

 

Reaching beyond traditional play therapy

The therapeutic power of imagination is also evident in various therapy practices, specifically play therapy. According to “Helping a Child Through Play Therapy” by Jane Framingham, adults mistakenly think that child’s play is solely for fun and games or to occupy time. Unbeknownst to these adults, through creative and imaginative play, children are developing cognitively and emotionally while improving their self-worth, positive self-image, and communication and coping skills. For those reasons, play can be therapeutic in helping children overcome challenges that might inhibit developmental growth.

To tap into children’s imaginations and gain deeper understanding of their problems, play therapists are reaching beyond traditional play therapy tools such as sand trays, crayons, paints, animals, toys and dolls. Technology appears to have revolutionized the art of play therapy, thus making it easily accessible to counselors. This can be especially important for school counselors, who work in settings in which the counseling process is often limited because of the other administrative duties assigned to them.

Technology-based programs such as Marvel’s Superhero Avatar Creator and DC Super Friends Super Hero Creator represent the infusion of electronic media into play therapy. Based on “The iPad Playroom: A Therapeutic Technique” by Marilyn Snow and colleagues, the infusion of technology increases the imagination and creativity of the child by allowing the child to create media, pictures and other artwork while the therapist is present, either in conjunction with or separate from the therapist. For example, many applications are available to aid children in fueling their imaginations to create family dynamics or events through drawing and colors that possibly hold symbolism to their presenting problems. This invites the opportunity for metaphors to help solve real-world problems.

 

An ideal therapeutic method

This method of integrating superheroes through a technology approach in play therapy potentially could be an ideal therapeutic method of working with children, especially African American males, in the school setting. It appears to offer a nonintrusive approach for getting students involved in counseling because it integrates technology and play without asking probing questions.

As former school counselors, we have been disturbed by the alarming rates of African American boys being suspended because of perceived aggressive behaviors. Through our lenses, we have seen many of these students struggling with low-self-esteem or low self-worth. Ironically, sometimes these issues are not apparent through traditional presentations such as withdrawing or isolating.

The adjustment between school and family cultures has proved problematic for African American males regarding understanding their importance and worth. This likely causes tension in the school setting, resulting in aggression. These adjustment issues, or inability to navigate from one situation to another, is better known as code-switching.

Eric Deggans, in “Learning How to Code-Switch: Humbling, But Necessary,” describes code-switching as beyond the exchange of two languages in a conversation. But in today’s diverse society, the term’s deeper meaning is shifting between different cultures to move through life’s conversations. Deggans, an African American man, implies that code-switching is an essential tool for African Americans to adjust culturally. Therefore, African American males are expected to recognize one set of rules in one setting and understand another set of rules in another setting while maintaining their identity.

 

Uses with a student

We have sought to address these adjustment issues with our African American male clients through the use of play therapy methods. Using the power of imagination in play therapy allows them to foster development and problem-solve issues that have been hindering their overall academic and emotional growth. In one case, Marvel’s Superhero Avatar Creator  was used with an African American male student who was having adjustment issues at school that produced aggressive behaviors both at school and at home. Although the nature of the school setting did not permit long-term therapy, this short-term approach showed significant positive results.

This student created a superhero avatar over the course of four sessions. During the creating phase, the student used his imagination to create a creature that had similar features and skin color to his own, thus solidifying the importance of identity and connection to the creature. Allowing the student autonomy in creating his creature aided in establishing the therapeutic relationship.

The student was able to arrange the way therapy was directed as the therapeutic relationship was established. Through the various stages of play therapy, from gaining insight to reorientation or reeducation, the therapeutic process became a playground in which the student could live out his imagination through his superhero in a way that was vivid and emotionally alive. This experience paved the way for deeper understanding of how the student perceived his school family in relation to his peers, faculty and staff, and his actual family. Through incorporation of a client-centered approach to play therapy, this student showed significant growth in his overall development and was thus able to transfer those skills (i.e., code-switching) between school and family relationships.

Once significant progress was made with the student, his parents were incorporated in one play therapy session. The student’s father decided to create a superhero avatar to bring life to his perceived role as the family protector. In retrospect, through this play therapy family activity, the father could see how his family viewed his role and their individual roles within the family.

The play therapy sessions, infused with the technology of creating superheroes, helped the student use his imagination to bring to life his own unique story and identity. In superhero stories, superheroes conquer their adversaries while overcoming their adversities. The ending of this student’s story depicted similar results.

This form of play therapy is a nonintrusive method that renders promising results by not asking direct questions, but rather allowing students to self-express through play. As such, we do not believe that the traditional mode of counseling would have achieved the same impact on this child’s growth and development. This lends support to the importance of expressive therapy for children, particularly African American boys. Expressive therapies can help children find their voices, especially through play-based techniques using superhero avatars.

 

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Jetaun Bailey, a former school counselor, is a certified school counselor, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University. Contact Jetaun at Jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Tonya Davis, a former school counselor, is a nationally certified school psychologist, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University.

 

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Related reading: See the upcoming September issue of Counseling Today magazine for an in-depth cover article on play therapy.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling people in the performing arts

By Bill Harrison April 10, 2018

Actors, dancers, musicians and other performers are vulnerable to a variety of challenges and clinical issues that are unique to those who choose to make their living using their creative talents and skills. Although artists are people just like the rest of our clients, I believe it is important for counselors to have a framework for conceptualizing the idiosyncratic personal, cultural and professional contexts in which many performers live. As Linda H. Hamilton says in her excellent book The Person Behind the Mask: A Guide to Performing Arts Psychology, “Catering to the special needs of performers is important because of the unique psychological, biological and social stressors related to this vocation.”

My knowledge about the performing arts community comes from many years of personal experience. I became a counselor after working as a professional musician and an occasional actor since the late 1970s. I have played, toured and recorded as a jazz and pop musician. I have also performed in theatrical pit orchestras for many national tours and local productions here in Chicago. I am trained in the acting methods of Sanford Meisner and have worked onstage and appeared in independent films and commercials.

As a counselor, I have been fortunate to work with a diverse cross section of artists, combining my counseling training with my intimate knowledge of the music and theater business. Even so, my clients have been my best teachers. In my view, performers are an underserved clinical population worthy of serious consideration by more counselors. There are, after all, many more actors, dancers and musicians who need counseling than there are clinicians who used to be performers.

Life onstage is analogous in many ways to life as an athlete. The performing arts and sports are inherently stressful professions because of the high expectations of both the audience and the people who have the power to hire and fire. Success in both fields depends on a lifetime of training and constant vigilance, both in maintaining awareness of one’s self in relation to the work and in maintaining one’s skills. Although a great deal of research and attention have been focused on sports physiology and psychology, relatively little clinical attention has been paid to performing artists. The few books available on the subject are largely outdated, and the scholarly literature is scant. Hopefully, this situation will improve in the near future.

What are the life factors that distinguish performers from other individuals who make their way to our counseling offices? It is useful to discuss this population using several contexts: developmental, career, performance-related and societal. Each context has both case conceptualization and treatment factors.

Developmental considerations

Many performers began their training as young children. Some can barely remember when they began to exhibit signs of talent. They may have been singled out as “special” among their siblings or classmates if they showed an aptitude for singing, playing an instrument or dancing.

Counselors should pay particular attention to these clients’ attachment issues with both parents and teachers. Were caregivers supportive or resistant to their child’s talent? Did the client feel encouraged, pushed or dismissed in relation to his or her natural abilities? Was the child considered a prodigy? Did the parental emphasis on performing distract from focusing on social and emotional development?

Many artistically gifted children display a poise that is easily mistaken for emotional maturity. As a result, the normal childhood needs often are either ignored or derided as “childish.” The prodigy label often comes with potentially unhealthy complications, given that 3- and 4-year-olds are incapable of making life-altering decisions for themselves.

Early teachers of these children may have been supportive and loving or harsh and critical. For many young performers, competition for coveted positions can be intense. Children are keenly aware of the talent/skill hierarchies. Were they chosen for the best parts or overlooked? Did they land spots as lead actors in plays, prima donnas in the opera, first-chair players in the orchestra or principal dancers in the ballet? If they are relegated to secondary roles, some children feel that they have somehow failed. This can have repercussions when similar situations occur in their adult lives.

All of these factors play major roles in the personality development of performers. Young children who demonstrate a natural affinity for a certain area of performance are vulnerable to overidentifying with their talent. Counselors need to be aware that a client’s degree of healthy narcissism may be directly linked to his or her perceived level of artistic ability. Besides being treated as special and having to compete, young performers can become socially isolated and lead a very unbalanced life that consists almost exclusively of developing their artistic gifts at the expense of emotional and interpersonal growth. This can become problematic later in life, if and when the client realizes that there is more to life than performing. And in relationships, there is a risk that performance can substitute for genuine intimacy.

Career considerations

A performing artist’s career trajectory is often short and always unpredictable. Unlike in many other professions, there is no clear-cut path to professional success or advancement when you act, play, sing or dance for a living. No amount of natural talent or advanced training can predict success with any reliability. Talent or skill may not matter nearly as much as happenstance, luck or physical appearance (principally for actors and dancers).

Although things seem to be changing incrementally, considerable racial and gender bias still exist in casting. With the dearth of acting and dancing parts for women over 35, it is difficult for women performers to sustain a career much past that age. Issues related to stereotyping and appearance aren’t that much easier for men.

In addition, the ability to earn a living is quite limited for most performers. For example, in 2008, The New York Times reported that only 5 percent of Screen Actors Guild-American Federation of Television and Radio Artists members earned at least $75,000 annually. Actors’ Equity Association, the union representing the world of live theatrical performance, reported that during the 2013-2014 theater season, only 9 percent of its members earned more than $50,000. On average, just over 13 percent of unionized actors were working in any given week that year; their median annual income was $7,463. According to HuffPost, in 2012, the Future of Music Coalition estimated that full-time musicians earn an average of about $34,000 per year.

Low income is just one stressor in the life of most performing artists. A 2015 Australian study, “Working in the Entertainment Industry,” reported strong correlative evidence that underemployment, employment uncertainty, unregulated working conditions and the societal devaluation of artistic work often precede the onset of emotional and cognitive impairment. The large majority of actors, dancers and musicians have to secure secondary employment to make ends meet. The number of performers who continue working past age 30 declines precipitously. The researchers interpreted this to mean that as people begin to focus on their non-arts-related life (marriage, family, home ownership, financial stability), they are more likely to give up on their artistic ambitions and “get a real job.”

The authors of the study concluded “that there is ample evidence to support the assertion that the work environment of the creative person is … fraught with difficult and challenging circumstances. These include performance anxiety, work overload … career anxiety, a lack of career mobility, irregular working hours, high rates of injury, low financial rewards, [having to maintain] high standards of performance, financial insecurity and sporadic work.”

It is crucial for counselors to recognize these professional limitations for people in the performing arts and to keep them in mind as we would for any kind of cultural context.

Performance-related considerations

People in show business expose themselves to some of the most physically and psychologically stressful conditions on an everyday basis. Auditioning, rehearsing and performing require intense concentration, focused energy, strong self-confidence and years of preparatory work. Work hours can be extremely demanding. Knowing that a hundred people are waiting in line behind you to take your job if you falter is nerve-wracking. For these reasons, performers are at risk for anxiety, loss of motivation, difficulty concentrating, burnout, physical injuries, low self-esteem, poor emotional regulation, sleep disruption and crises of confidence and identity.

Because most performers work as members of an ensemble, there can be difficulties with group dynamics or conflicts with co-workers with whom they may be living or traveling. In addition, the “instant intimacy” that can develop between members of a cast can sometimes pose challenges to the stability of relationships outside of the ensemble.

Anxiety and depression are common complaints among performers, just as they are for the general population. However, recent research suggests that the prevalence of both mood disorders is much higher among artists. The Australian study found evidence that performers are 10 times more likely to suffer from anxiety and five times more prone to depression. Likewise, they are three times more likely to experience sleep disorders. Performing artists have higher rates of suicidal ideation, planning and attempts; their abuse of alcohol and other substances is also significantly greater when compared with the rest of the population.

One of the most ominous findings of the Australian researchers was pointed out to me in a personal communication from the lead author of the study, Julie van den Eynde. She wrote that the researchers found “a solid link with suicidal behavior … to depression, anxiety and lack of social support. There was no link to alcohol and drug use. There were no differences in gender or age. These findings run counter to the normal population, as suicide behaviour is different for age and gender and is linked to alcohol and drug use. This means that creative artists and performers are a different and separate group.”

In other words, this population is at higher risk for suicidal behaviors regardless of other factors such as age, gender and substance abuse.

Societal considerations

Despite the performing arts contributing so much to the enjoyment and enrichment of people’s lives, performers are often treated as if their work has remarkably little value (with the exception of the tiny subgroup of the most popular and famous individuals). Due to the nature and intensity of the commitment that a life in the arts requires, performers tend to identify very strongly with their work. If an artist’s work is subject to the uncertainty and devaluation described in the study, then that person’s identity is at risk.

As noted earlier, earning a living wage from performing is difficult for the majority of artists. As is the case for any client whose income is below average, artists are more vulnerable to the societal biases against people who aren’t comfortably middle class, don’t have health insurance or lack a high credit score.

Art often serves society by expressing cutting-edge ideas, including criticism of the status quo. This artistic purpose is often undertaken by people who are most impacted by racism, sexism, genderism, ableism, etc., and who make up a substantial portion of the artistic community. Societal marginalization can contribute significantly to myriad therapeutic issues. Although performing can serve as an emotional outlet for minority populations, the extent to which their ability to express themselves publicly improves their mental health will vary from person to person.

Clinical considerations

It almost goes without saying that performance anxiety (aka stage fright) is often the issue that brings people in show business into the counseling office. Many performers experience stage fright before every show. Famous sufferers include Laurence Olivier, Scarlett Johansson, Ella Fitzgerald, Adele, Pablo Casals, Mikhail Baryshnikov, Vladimir Horowitz and Renee Fleming.

But for many artists, auditions provoke the most anxiety. Auditions present a perfect storm of conditions almost guaranteed to induce performance anxiety in even the most seasoned artists. There is a saying among actors: “Auditioning is your vocation; working is your vacation.” Anxiety before and during auditions arises from the belief that a negative judgment of one’s performance equates with humiliation, embarrassment or personal rejection. Actors face this kind of scrutiny each time they read for a role; rejection is a normal facet of life for them.

Perfectionism is another anxiety-related malady that may surface in counseling sessions with performers. It may present in conjunction with excessive procrastination, practice or rehearsal avoidance, guilt, anger, self-criticism or blaming others, eating disorders and suicidal ideation. As pointed out in Robert H. Woody’s 2015 Psychology Today blog post titled “Perfectionism: Benefit or detriment to performers?” some performers exhibit narcissistic traits that may be associated with perfectionism.

Depression is precipitated in this population for many of the same reasons that anyone else might experience depression. However, some performance-related triggers for depression include:

  • Being overlooked for an audition
  • Despairing over not getting a coveted part
  • Sustaining a career-threatening injury
  • Being confronted with an inability to start (or finish) a long-dreamed-of creative project
  • Being forced to choose between one’s performing career and the demands of one’s romantic or familial life
  • Contemplating leaving a profession that has defined one’s identity

Although certain myths persist about the prevalence and glorification of drug use among performers, substance abuse is a real problem for many actors, dancers and musicians. The combination of high stress, employment uncertainty, low income, inaccessible health care and easy availability of alcohol and other mood-altering substances results in a higher-than-average probability that these clients may be affected by substance abuse and addiction. During intake, counselors should assess for drug and alcohol use, particularly with clients who present with anxiety or depression.

Social isolation, chiefly among musicians, is another common issue. Young people with musical talent, especially those singled out as prodigies, must spend many hours a day practicing their craft. In some cases, this single-minded approach, though perhaps necessary for achieving virtuosity, can lead to social anxiety, poorly developed social skills and difficulty forming intimate relationships. Adult performers who present with social anxiety may have long-established patterns of self-isolation resulting from intensive practice regimens begun in childhood. For a deeper understanding of these issues, I highly recommend Andrew Solomon’s chapter on prodigies in Far From the Tree: Parents, Children and the Search for Identity.

Many performers, and artists more generally, are what Elaine Aron calls “highly sensitive people” or HSPs. They tend to be aware of subtleties in their environment and are likely to have rich and complex inner lives. Although such sensitivity can be a real advantage in their chosen profession, our culture, unfortunately, has little tolerance for highly attuned or easily overwhelmed individuals. They are often thought to be overly fearful, inhibited or neurotic. Although some HSPs may exhibit these traits on occasion, they are not inherent characteristics of this personality type.

The majority of the people in the lives of HSPs may find them difficult to understand because of their sensitivity, their inability to relate to other people and so on. High sensitivity may open another pathway to the mood disorders and social isolation often seen in this population. Aron’s research on HSPs is invaluable with regard to performing artists.

Finally, it would be remiss not to mention the controversial relationship between mental illness and artistic talent. There are those who contend that a direct correlation exists between creativity and the prevalence of bipolar and schizoaffective disorders among artists. Kay Redfield Jamison makes a strong case for this link in her book Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. Contemporary neuroscience has produced evidence both supporting and contradicting this point of view.

Performers are often perceived to be more narcissistic than are members of the general public, although no real evidence exists to suggest that narcissistic personality disorder is more common in this population. Counselors should be aware of their own biases in this regard while maintaining an open mind about the possible presence of mental illness and personality disorders in their artistic clients.

Challenges to counselors

Performers will challenge counselors in a variety of ways. Some may treat their therapy hour as a kind of performance. Actors are notably accustomed to impressing and entertaining strangers, so they may initially prefer to hide their vulnerabilities behind a veneer of cheerfulness (despite having perhaps complained of terrible anxiety when calling to make the appointment). Some members of this population may see you as an authority figure, akin to a “stage mom” or a demanding teacher or director. Monitoring these kinds of transference possibilities is essential to creating a strong therapeutic alliance and allowing your work to proceed productively. Likewise, it is crucial to pay attention to your own countertransference. How are the clients’ projections influencing you? Is their charm or likability getting in the way of accurately assessing their therapeutic needs?

Some performing artists have a difficult time expressing themselves verbally. This is where your creativity might come into play. If clients seem unable to put their feelings into words in session, you might suggest that they write something between sessions or perhaps bring in a monologue from a play that conveys what they lack the words for. I had a client who had trouble discussing her feelings directly but would write and perform her poetry as part of our work. Another client played his instrument in a session to express something that he couldn’t verbalize. Even if you are not trained as an art therapist, you can encourage artistic clients to find alternative ways to communicate emotionally.

Actors and dancers might ask you to attend one of their shows. Musicians may want you to come to a recital or a gig at a bar or club. They might bring in CDs or DVDs of their work and ask you for your assessment. These requests bring up thorny issues for counselors. Do you bend your boundaries to attend a performance? Do you accept a recording, and if so, do you agree to listen (or watch) and offer an opinion? I don’t think there are universal answers to these questions. As always, if you’re unclear on what’s best for your client (and your professional boundaries), seek consultation or supervision.

Counselors know that the “why now?” question is always important, but it could be useful to know that performers often seek help at certain predictable points in their lives. Psychiatrist Peter F. Ostwald, in his article “Psychotherapeutic strategies in the treatment of performing artists,” suggested a few such points: at turning points in their careers, when they seem to be faltering or failing professionally, after a career-threatening injury and when they feel overwhelmed by career-related loneliness.

One final set of challenges directly impacts your ability to work with this population. As previously mentioned, many artists don’t earn a lot of money and often lack health insurance. Scheduling also can be difficult because many performers work full- or part-time day jobs and have either rehearsals or performances during the evenings and on weekends. Counselors must be clear in their decision-making process regarding their desire and ability to be flexible with their fees, schedules or both. Adjusting your professional boundaries should be done carefully and deliberately to ensure that you are able to provide excellent care without resentment.

Concluding thoughts

Life in the performing arts has its rewards, but it is also a difficult and often frustrating way to make a living. The people who choose to pursue the arts professionally make many sacrifices to bring to life diverse forms of expression. There is exceptionally little glamour in show business, despite what you might see on an Academy Awards or Grammys broadcast. I am regularly amazed at the reactions I get when I tell people that I have played for Broadway shows, at a certain jazz festival or on a TV show. Invariably, folks will exclaim how much fun that must have been and how envious they are of these experiences. Yes, it can be thrilling to perform under certain rare circumstances, but most of the real work of artists is unseen, and most opportunities to perform occur under far-from-ideal conditions.

I have tried to provide a comprehensive overview of the psychological and cultural milieu of performers, and to suggest some new ways to think about the unique issues that counselors may encounter with this population. If you provide mental health services to people in the arts, know that you are serving a group of people who truly need you. Performers contribute so much of themselves to make our world a richer, more vibrant place. As counselors, we are called on to perform the related task of helping to create a healthier, more emotionally stable environment for all.

 

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Bill Harrison is a licensed professional counselor on staff at the Claret Center in Chicago, where he specializes in the treatment of performing artists. Contact him at counselorbill1@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Creating comics with clients

By Devlyn McCreight February 1, 2018

Academic and clinical interest regarding the intersection of comics and health care is high right now, which is no surprise to readers of Counseling Today. The July 2017 issue of Counseling Today featured a cover story titled “‘Cultured’ counseling” that provided perspectives on the clinical utility of integrating pop culture (such as video games, movies and comic books) into counseling practice. Similarly, both the American Psychological Association and the American Medical Association have devoted time and journal space to covering the topic, signaling that mental health counselors are not alone in wanting to explore the positive impact that comics can have on delivery of services.

Case in point: The 2017 Comics & Medicine Conference was held this past June in Seattle. An eclectic cross section of cartoonists, medical doctors, mental health professionals, teachers, students and librarians from across the globe attended. The conference theme, “Access Points,” explored how comics can open new gateways to health care “because of its ability to provide a platform for marginalized voices.” Because this worldwide chorus of marginalized voices often includes people with mental health diagnoses and comorbid disorders, comics can also help bridge the gap between client and counselor when utilized correctly.

As the body of literature regarding the therapeutic value of comics grows, the question is raised: Can comics be used as an intervention apart from traditional bibliotherapy? The focus of this article is to explore the rationale for creating comics with clinical clients, gain guidance from practitioners who use comic creation as a direct intervention and provide resources for those who are interested in learning more.

Beyond bibliotherapy

In the fourth edition of the American Counseling Association’s Counseling Dictionary, the intervention bibliotherapy is defined as “generally understood to be the reading of selected literature to help individuals gain a better understanding of themselves and others as well as to produce at times a healing or helpful catharsis.”

The bulk of recent literature regarding comics and mental health has fallen squarely into the realm of bibliotherapy, focusing on using graphic novels and memoirs to help clients better understand their own challenges. Although strong clinical evidence exists to support using existing commercially available materials to help articulate client experiences, a growing number of health services practitioners are advocating that patients and clients begin writing and illustrating their own stories.

Ian Williams, a comics artist, writer and physician who co-founded the Graphic Medicine movement, has suggested that revisiting trauma using sequential art can provide a form of catharsis for the creator, citing examples of prominent figures in the graphic memoir field such as Art Spiegelman (Maus) and Katie Green (Lighter Than My Shadow). His assertion is that the combination of visual art and narrative structure allows clients to reauthor their experiences in ways that simply talking through them do not.

This same hypothesis was the driving force behind the Defense Advanced Research Projects Agency (DARPA) using graphic novel software to assist combat veterans in dealing with symptoms of posttraumatic stress disorder. This initiative led to DARPA commissioning California-based software developer Kinection to design the Warrior Stories Platform for use with veterans.

Similarly, several public schools across the country have begun using online comic-creation software to help address ongoing behavioral issues for children with special needs. In addition, educators and social science researchers alike are using comic creation to help children tackle difficult real-world issues (such as making positive choices in the face of peer pressure), develop a more robust understanding of historical events (such as the Holocaust) and cultivate sound safety habits when interacting with friends and strangers.

As professionals from a multitude of disciplines create comics with others to help bridge the gap between educational content and personal experience, clinical mental health counselors can do the same with their clients.

The therapeutic act of creating comics

Scott McCloud, renowned cartoonist and educator, once defined comics as “images deployed in a sequence to tell a story graphically or convey information.” Given that comics are a storytelling medium, it is perhaps not surprising that the therapeutic act of creating comics falls under the scope of narrative therapy.

Narrative therapy is primarily concerned with the stories that clients have within them — those internalized beliefs formed by clients’ interactions with the various familial, social and cultural forces throughout their lifetime. Narrative therapies also place primary emphasis on the act of externalization of client issues. As Michael White and David Epston, the primary developers of narrative therapy, once famously surmised, “The person is not the problem, the problem is the problem.”

Externalization is used to help clients who overidentify with their problematic symptoms (“I am depressed”) begin to understand these experiences as distinct from their core self (“I am dealing with a really difficult depressive episode right now”). When I interviewed Katharine Houpt, an artist, licensed clinical professional counselor, board certified art therapist and lecturer at the School of the Art Institute of Chicago, she shared that the main strength of creating comics with clients is that it fosters the externalization process: “The idea is that experiences can be overwhelming and can take up so much space that it’s helpful to externalize them, and [creating comics] literally puts a container around those experiences so you can put them away on a shelf, so to speak, and [the problems] are separated from the person.”

Having a physical representation of an internal experience can be valuable because the idea of containment is extremely important when dealing with sensitive parts of a client’s experience. Each panel in the comic sequence functions as a figurative container for potentially overwhelming psychic material, allowing clients to approach the issue with a feeling of control or mastery that might elude them otherwise. The comic format also allows clients to represent themselves, others and even their disorders pictorially through the creation of avatars.

Working with clients to graphically depict interactions between themselves and problematic symptoms can help them uncover new insights. As with any other type of therapeutic intervention, it is important to choose comic-making directives that reflect an understanding of individual clients, their struggles and what resources they bring to the situation. “An example of something I’ve done recently is ask a client to create characters to have a dialogue based on the person’s conflicting thoughts when trying to make a decision,” Houpt says. “But again, this was done with careful consideration of the person’s history, possible responses, coping tools, motivation, ability, etc.”

Suggestions and considerations

Possessing a clear sense of best practices when creating comics (or any other type of art) with clients can help clinicians avoid therapeutic pitfalls and unintended confidentiality issues and create a safe space for the creative process. What follows are suggestions and considerations for therapists who are interested in beginning to integrate comic creation into clinical practice.

Create a functional space. Rebecca Bloom, a board-certified art therapist and licensed mental health counselor who practices in Washington state, suggested that clinicians try making art themselves in client spaces before introducing any interventions into practice. “I tell everyone that comes to my workshop, ‘Sit where the client will sit and try and make art in that spot.’ People inevitably come back and say, ‘Oh, well, it’s impossible to make art there.’ So I respond, ‘Great, now figure out how it would be more possible. Do the art supplies need to be closer? Do you need a lap desk? Do you need a coffee table that’s easy to use?’”

If the space available is not amenable for making art, this might require an investment in additional furniture that could be cost prohibitive. If an existing space and furnishings can be rearranged to accommodate the activity, it is also important to think through whether the space can remain in that configuration for clients who are not making art. If it can’t, it might be necessary to reserve time to reset the office between client sessions.

Remember, art is messy. Another consideration in determining whether a space is appropriate for incorporating any art making is whether the space is shared with other practitioners. “Art takes a little thinking through,” Bloom explained. “In some settings, it’s really hard, like for people who are in institutional settings. … Art is really messy. So, if there’s no way to be messy where you are, that’s going be a little problematic for art making.”

This holds true for comic creation too. India ink can be spilled, markers can be dropped onto couches, and erasers can leave behind rubberized crumbs. The reality of potential messes requires that practitioners be thoughtful about what materials they are willing to use during a session.

“Also, there need to be limits around time and mess,” Bloom said. “I stop the art-making process 10 minutes before the session ends because I want to make sure the people are back in their conscious process. I want to make sure we have time to clean up. [There are] materials that I don’t use. I don’t use paint in my office because it’s so easy to get out of control. I do spend money on fancy Copic markers with brush tips so you can have that experience of painting but without the mess.”

Invest in quality materials. Investing in quality materials will allow clients to stay focused on the therapeutic process instead of struggling to work with dried-out markers, inkless pens, stubby crayons or dull pencils. Additionally, having a selection of higher-grade media to choose from can signal clients that you are taking the art-making process seriously and being thoughtful about the materials with which you are asking them to work. “Clients can take a bad art-making experience personally,” Bloom observed.

Try it yourself first. Another common mistake clinicians sometimes make when using art directives during session is believing that instruction alone will inspire a client to make therapeutically meaningful art. “The only thing I hate for clients is when a therapist says, ‘Draw your darkest fear,’ and the client looks at them like, ‘You try that first. You try drawing your darkest fear,’” Bloom said. “You don’t want to ask anybody to do something that didn’t work for you, because you’re not going to be able to sell it very well, and you’re not going to be able to take care of somebody if it doesn’t go right. And you’re not going to understand the resistance in not wanting to do it.”

This also holds true for comic creation. If the counselor has never drawn a comic, then it will be difficult to understand client process from an artistic and therapeutic standpoint. One practice that can be helpful for therapists new to comic making is to try working with their own “daily comics journal.”

Kurt Shaffert, a fellow in applied cartooning at the Center for Cartoon Studies, located in White River Junction, Vermont, endorsed this practice, acknowledging that he has used it himself. “The basic idea is to sit down every morning and draw a simple three- to four-panel cartoon that captures where you are in that moment,” he said. “It was very helpful for me when I was going through some difficult personal circumstances. And when I began sharing them with my friends and family, they began to have a better understanding of what was happening with me during
that time.”

Houpt also uses the daily comics journal exercise to help temper the high emotions and excitement that can accompany working with comics. “I always emphasize the importance of pacing with clients,” Houpt said. “I think people can get really excited about comics and want to get really deep really fast. So something that I’ve done a lot with folks is ask them to keep a daily comics journal with just six panels per page. It puts a little bit of structure around it so that the experience doesn’t become overwhelming. And that practice has been really helpful for people to identify problems and solutions in their lives, to start recognizing themes, patterns and alternative stories about who they are through their personal artistic languages.”

There are also many opportunities for clinicians to gain firsthand experience with art therapy and comic-making interventions by utilizing local resources. Many art therapists, including those interviewed for this article, offer community-based workshops for clinicians and laypeople alike. Connecting with local therapists who regularly use art-based interventions can also provide valuable networking opportunities and potential ongoing clinical support as counselors begin to integrate art into their practice.

Read comics … and talk about them. If you are reading this article, chances are that you have some interest in the medium of comics, which exists apart from the therapeutic value of making comics. Exposing yourself to a wide range of commercially available comic books and graphic novels can help expand your understanding of what comics are — or ultimately can be.

Cultivating a broader understanding of what is considered a comic can help the therapeutic process in the long run. “I do find that I have to explain comics in many different ways to people,” Houpt said. “Sometimes I won’t call them comics. Sometimes I’ll say, ‘stories using words and pictures,’ or I will talk about something they might be familiar with, like the Sunday cartoons. … There’s all kinds of different interpretations. So, I just use that and make that part of the process of making comics with the client because, same as any other identifier about a person, it will mean a different thing to each individual.”

Talking with clients about their own beliefs regarding the medium can put them more at ease, which might allow them to experience greater gains from creating comics as part of the therapeutic process.

Be aware of the ethics regarding client art. There are additional ethical considerations that accompany counselors asking clients to make art for a therapeutic purpose. “I definitely think that all kinds of people can do some basic art therapy directives,” Bloom said. “I produce books that have those directives in them. Lots of people do. One of the major differences between people [who] are trained as art therapists and people who are not is what happens to the art after [it has] been made. It’s very common that people who are not trained as art therapists will put the art right up on the wall. Whereas art therapists believe that’s a private clinical conversation and that the client either takes that artwork home with them, or they keep it in the client’s file, or maybe the client destroys it. But it’s not up for public view.”

Another unintended consequence is that if a client walks into a room filled with client art, this might unknowingly set the expectation that all client art will be displayed, which can be problematic. As Bloom explains, “The idea within art therapy is that you might release something on the page that is unattractive that you don’t want anybody [else] to see. … If you go into an environment that has people’s art up on the walls, people will make less revealing art, most likely.”

Additionally, displaying client art might unintentionally create a false standard of how comic-making interventions “should look” for clients. Because some clients are more artistically inclined than others, certain clients might be reluctant — or even outright refuse — to create art because of insecurity around their abilities.

Self-portraits drawn by Kurt Shaffert (top) and Katharine Houpt.

“I also like to talk with clients about what MK Czerwiec discusses in her chapter in the Graphic Medicine Manifesto, which is the ‘fourth-grade slump,’” Houpt says. “That’s the idea that before fourth grade, everybody raises their hand when the teacher asks, ‘Who in here is an artist?’ And then starting in fourth grade, everybody points to the one kid who draws the best. So, why do we do that to ourselves? Why should we limit this outlet for joy and expression in our lives just because we think we’re not the best at it?”

Allowing clients to create comics without the pressure of comparison is essential for therapeutic work to occur, and that should be the goal of any intervention used with clients. Counselors should also know that any art created during a therapy session receives the same protections under HIPAA (the Health Insurance Portability and Accountability Act) that any other physical media (such as audio recordings and written materials) would.

Resources

It can be difficult for those who aren’t art therapists to begin working with a medium such as comics because the sheer amount of available materials can be overwhelming. The following list serves as a brief primer on texts that might be useful when beginning to integrate comic making into an existing practice. These recommendations were provided by the clinicians interviewed for this article and are grouped into separate categories for clarity.

General art therapy

  • Art Is a Way of Knowing: A Guide to Self-Knowledge and Spiritual Fulfillment Through Creativity by Pat B. Allen
  • Square the Circle: Art Therapy Workbook by Rebecca Bloom
  • The Art Therapy Sourcebook by Cathy Malchiodi
  • Materials & Media in Art Therapy: Critical Understandings of Diverse Artistic Vocabularies by Catharine Moon

Comics and Cartooning

  • Cartooning: Philosophy and Practice by Ivan Brunetti
  • Comics and Sequential Art by Will Eisner
  • Cartooning: The Ultimate Character Design Book by Christopher Hart
  • Understanding Comics and Making Comics by Scott McCloud

Conclusion

Although interest regarding the intersection of health services delivery and comics is at an all-time high, empirical research regarding the efficacy of comic creation as a direct intervention is largely absent. This might dissuade practitioners from introducing comic making into their therapeutic work, but it is important to remember that every testable intervention begins with a theoretical question, moves to the gathering of qualitative/anecdotal evidence and then transitions to quantitative outcome measurements.

This article has briefly addressed the narrative frame of comic creating while also sharing anecdotal insights from practitioners who use the intervention directly. The next step for helping make comic creation a more widely accepted and accessible intervention is to conduct rigorous research regarding outcomes. For social science researchers, these pursuits do not have to be conducted in isolation. That is reassuring for therapists such as Houpt: “I think that’s part of what was so exciting to me [about going] to the Comics & Medicine Conference this year. It was my first one. And to see people from so many different fields … different silos, who are doing similar work with different frameworks, different approaches, but arriving at similar outcomes. So, there has to be something there, and I wonder if part of the answer is more interdisciplinary collaboration.”

 

Author Devlyn McCreight, LMHC, draws a comic at his art desk. Photo by Sarah McCreight.

 

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Devlyn McCreight is a licensed mental health counselor and owner of McCreight Psychotherapy & Clinical Consulting LLC. Contact him at devlyn@mccreightpsychotherapy or through his website at drdevlyn.com.

Letters to the editor: ct@counseling.org

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Stories of empowerment

By Lindsey Phillips September 26, 2017

In 2009, writer Chimamanda Adichie gave a TED Talk on the danger of reducing people to a single narrative, using her own personal stories to illustrate the complexity of individuals. In one of those stories, she revealed how her college roommate in the United States had a single understanding of Africa — one of catastrophe. Adichie, a middle-class Nigerian woman, did not fit this single-story narrative. To her roommate’s surprise, Adichie spoke English, listened to Mariah Carey and knew how to use a stove.

Adichie points out that people are impressionable and vulnerable in the face of a story. Stories are powerful, she says, but that power is dependent on who is telling the story and how it is told. “Power is the ability not just to tell the story of another person, but to make it the definitive story of that person,” Adichie says.

Storytelling can also be used to empower people, which is one of the primary functions of narrative therapy. In many ways, the story of narrative therapy began in the late 1970s through shared stories and conversations between Michael White and David Epston. This counseling approach assumes that culture, language, relationships and society contribute to the way that individuals understand their identities and problems and make meaning in their lives.

The narrative approach also separates the person from the problem — a technique that allows clients to externalize their feelings. “The spirit of externalizing the problem is so that the client doesn’t see that as something that they can’t change,” says Kevin Stoltz, an American Counseling Association member who is an assistant professor of counselor education at the University of New Mexico. Moreover, this approach places clients as the experts in their own lives (see sidebar, below).

Don Redmond, an associate professor of counseling at Mercer University in Atlanta and director of the university’s Center for the Study of Narrative (CSN), points out that White and Epston’s original vision of narrative therapy was not prescriptive. “It really is in some ways theoretical, even though there are specific techniques that you can learn. It really is about celebrating and appreciating each person’s unique story and helping them frame it in a way that is more self-affirming and less self-defeating,” he explains.

(Re)writing memories

Narrative therapy can help clients release the burden of painful memories. Cheryl Sawyer, professor of counseling at the University of Houston–Clear Lake, started using narrative therapy in part because of an aha moment she experienced while watching a scene in the movie Harry Potter and the Goblet of Fire. In the scene, Hogwarts headmaster Albus Dumbledore shows Harry the Pensieve, an object that stores thoughts and memories.

Sawyer specializes in trauma counseling and often works with children who are refugees or who have been abused. She wanted to help her child clients release their traumatic memories, so she created a narrative project in which children create memory books. As Sawyer explains, the memory books operate like the Pensieve, allowing the children to unpack their trauma and give it a safe place to live.

Children do not narrate the episodes of their lives chronologically, Sawyer notes. Instead, their level of trust determines where their stories begin. If they trust the counselor, she says, they will reveal more intimate details (e.g., “I was beaten up at my birthday party”) rather than offering only the generic version (e.g., “I received presents”).

Because children’s narratives typically are structured but not sequential, it can be hard to discern cause and effect, says Sawyer, a member of ACA. To overcome this, counselors can have child clients place events from their stories on a timeline. This technique allows clients to see the cause and effect, understand their own behavior and possibly project what might come next based on the patterns they notice.

In Stoltz’s experience, Adlerian theory and early recollections (an Adlerian process in which counselors instruct clients to remember actual events from their early life) work well with narrative therapy. This is because they help people understand their self-concept and self-identity and make meaning out of the experiences embedded in their lives.

In a classical Adlerian sense, early recollections are defined as memories before age 10, Stoltz says. “The time frame … is somewhat artificial in some aspects, but in other aspects, it’s good to understand the very core of when those first experiences started to come out for people — what they remember, what they really think is poignant that … shapes their beliefs and their worldview,” he says. Childhood memories are often distorted by one-dimensional thinking because people’s perception in childhood is different than in adulthood, he adds. Re-storying involves recalling these early memories and reinterpreting them with an adult mindset that is capable of higher cognitive exploration.

Stoltz is currently applying guided imagery to career narrative stories. As he explains, clients often have a fictional or real-life person they admired when they were young because the person’s traits or behaviors matched the way they thought the world should operate. Often, they used this hero narrative to move through life, Stoltz says.

For example, with one client who presented a heroic memory of Spider-Man, Stoltz noticed a pattern: The client kept using the word conflict in his narrative. In discussing this pattern, they discovered that the client no longer wanted to let his responsibilities be an excuse for shying away from conflict. So, they worked together to determine how the client handled conflict currently, how the client wanted to handle it in the future and how the client’s role models handled conflict.

“Guided imagery is a way of projecting that hero data onto a future career decision or a career transition. And it makes it more lifelike in the session for the person. It begins to allow them to purposefully imagine and really begin to apply that self-concept to the next step in their career,” Stoltz says.

Stoltz uses narrative data from the career construction interview to develop individualized scripts, including ones focused on supporting client identity, meaningfulness of work and aspects of adaptability and skills. “The narrative approach is always about writing the next chapter, and this is a way of applying the next chapter to an imagined world, a daydream,” he explains.

Pictures worth a thousand words

Words can sometimes fail clients. If clients cannot or will not articulate their stories with words, counselors must be creative and find another way for clients to express themselves, Redmond says. “The more versatile a counselor can be, the better,” he adds.

Sawyer works with some clients who possess limited vocabularies because they have lived on the streets from an early age and haven’t been exposed to higher levels of language. For example, a child might say, “I’m really mad,” but that statement is insignificant compared with what he or she is actually feeling.

When children don’t have all the words they need to express their thoughts, Sawyer relies on pictures. She asks clients to draw pictures, find pictures on the Internet or even go out and take pictures that support the deeper level of emotion in their personal stories. Often, she will take a series of pictures into the counseling session and ask clients if any of the pictures express how they feel that day and why that image best exemplifies what they are feeling.

Technology is providing yet another avenue for clients to communicate their stories. Sawyer finds that children and adolescents are often more comfortable texting than talking, so she has started using technology as a tool in storytelling. She creates digital narratives by typing the clients’ stories into PowerPoint slides. Then, she gives clients the option of adding music, images or art to depict how they feel. For example, one client added a picture of his father’s death certificate, and another client added a picture of a pair of shoes she was going to send her sister before her sister was murdered.

Redmond also combines technology and narrative therapy. At Mercer University’s CSN, counseling students interview people in the community and then convert these interviews into digital narratives (approximately five-minute videos) by selecting pictures, art and music to complement each person’s narration of his or her own story. One woman whom Redmond interviewed painted and sang to express her story, and both aspects were incorporated into her digital narrative. Pairing descriptions of her artwork with actual images of it captured her essence more fully than if she had been only interviewed, he adds.

These digital narratives allow individuals not only to rewatch their stories but also to share their stories with others. In fact, one of Redmond’s goals for CSN is to create a digital library that will help individuals going through a difficult time to realize that they aren’t alone.

Taking a back seat

Narrative therapy falls under postmodern theory. “One of the hallmarks of the postmodern approach is embracing the fact that there is subjectivity with an individual’s perception and what they’ve been through and not having the counselor come in and be the expert,” Redmond says. With narrative therapy, he explains, clients are the ones verbalizing the new or modified narrative of their lives, and counselors only paraphrase or mirror what clients are saying.

Because narrative therapy is client driven, it is more important for clients to understand how they are feeling than for the counselor to understand it, Sawyer says. “[Counselors are] the tool that [clients are] using, the base that they’re using, to tell their stories for themselves,” she explains. Clients must be provided with a safe space where they can share their stories and learn to express their feelings about what happened.

As a volunteer with Bikers Against Child Abuse, Sawyer often attends court cases involving children who have been abused, and she has observed children’s frustration when lawyers interrupt or guide their stories in answer to a specific question. For Sawyer, this observation further underscores the importance of allowing clients, not counselors, to direct and narrate their stories. As she points out, counselors are facilitators for the client’s story, so their job is to listen and help the client structure the order of the story, not the content.

Stoltz has found that the process of deconstructing and reconstructing the elements of a client’s story is often challenging, particularly for counseling students. To demystify this process, in 2015, Stoltz, along with Susan Barclay, published a guidebook, The Life Design ThemeMapping Guide, that provides counselors with a process for deconstructing narrative data, developing specific themes for the career construction interview and helping clients reauthor their stories. For the past five years, Stoltz has used this technique to train students to deconstruct and theme elements together.

Taking a back seat and allowing clients to guide the session can be particularly difficult for new counselors because they want to feel that they are accomplishing something, Stoltz says. They want to sense that the client has made a decision and is moving in a direction. Drawing on James Prochaska and Carlo DiClemente’s Stages of Change model, Stoltz reminds counselors that they’re “raising awareness now. You’re in the beginning of the change model. You’re in the contemplation stage or precontemplation stage. You’re not looking for movement. You’re looking for insight or awareness, the aha moment.”

A voice for marginalized, multicultural populations

With narrative therapy, clients inform counselors about their world, values and beliefs. In fact, early recollections provide counselors with an inside view of the client’s culture, Stoltz says.

Within this dynamic, a counselor’s culture and values may differ from the client’s, but counselors should not place cultural judgment on what clients have done, Sawyer says. For example, clients might disclose that they have offered sex in exchange for food, or they may use profanity in telling their story, but counselors must refrain from passing judgment, even if they think this act or language is hideous or immoral based on their own cultural perspective. Clients must feel safe to use their own language and words to freely tell their stories, Sawyer adds.

Redmond agrees that narrative therapy is compatible with cross-cultural environments because narrative counselors do not presume to know and tell clients about their problems. He also realizes that too often, the stories of marginalized individuals remain unheard. One of Redmond’s inspirations for creating CSN was StoryCorps, an oral history project that allows people to record their stories in a studio by having a family member or friend interview them. The recordings are then archived at the Library of Congress. Through CSN, Redmond expanded the project to include marginalized populations (e.g., people who are homeless, refugees) who do not readily have someone available to interview them and record their stories.

Redmond believes the community plays a significant role in narrative therapy. Therefore, CSN’s purpose is both to allow counselors to practice their listening skills and to provide a service to the community by letting people who are marginalized know that they are valued. Even though the CSN interviews are not considered official therapy, most people would agree that the simple act of telling one’s story can be therapeutic, Redmond says.

Redmond’s personal story also played a role in the creation of CSN. Besides the fact that he has always enjoyed stories, Redmond had two professional experiences that strengthened his belief in the power of narrative therapy. First, in his role as a supervisor at Hillside in Atlanta, a facility that serves children with severe emotional behavior disorders, he discovered that the children with the most severe behaviors and who had been at the facility the longest also possessed the most strengths. This observation made an impression on him, especially considering all the negative messages directed at these children, many of whom had been abused and were in and out of foster care.

The second experience occurred when Redmond was an access clinician at a community services board. Many individuals were at this facility under court order or because they were dealing with mental health issues. While conducting intake interviews, Redmond amused himself by writing down the clients’ strengths (e.g., intelligent, strong work history, sense of humor, family support). At the end of the interview, he would tell the clients the strengths he had jotted down and then would ask if they wanted to add anything. He often witnessed powerful reactions from the clients, including those who cried and said no one had ever told them that they had strengths.

These two experiences reinforced Redmond’s belief that “people start creating negative self-stories, and they start to only believe the negative images, and then they forget about the strengths that they have.” Therefore, Redmond advises counselors never to forget to account for the strengths of their clients, no matter the difficulty of the case.

The cultural awareness gleaned from narrative therapy also applies to clients, allowing them to question their own cultures. Often, Stoltz says, the difficult part is relating the memories and stories back to the client’s present life. Some clients grasp this concept more easily than others, and some struggle to understand how childhood events are still affecting them as adults. The latter scenario is challenging. “Early memories really are a good tool to have to be able to talk to people from different cultures because [there are] stories in every culture. … Memories are a story, and [they are] a way of relating that whole story back to the person,” he says.

Validating narrative therapy

Critics of narrative therapy often question how counselors objectively measure narrative techniques, which are subjective. “I think we’re in the infancy of starting to measure these kinds of things. I think we’re just beginning to rediscover some of the things that have been helpful in mental health counseling, and we’re applying those as new techniques to the career narrative area,” says Stoltz, who served as chair of the research committee for the National Career Development Association, a division of ACA. At conferences, counselors are discussing how the narrative approach works, and they are doing outcome research that says it works, but they are not yet validating the process, he adds.

“You cannot quantify emotion,” Sawyer acknowledges. She and her colleagues attempted to measure narrative approaches by administering a pretest and posttest to children who had suffered trauma. They found a valid instrument and administered it in the children’s native language, but the formality of the instrument and the fact that the counselors had not yet established a relationship with the clients caused some clients to leave prematurely. Based on this experience, Sawyer decided not to administer the posttest and concluded that sometimes narrative therapy is not about research; it is about clients and their needs.

The best method Sawyer has found for measuring the success of narrative therapy involves having clients point to shapes (e.g., small, medium and large circles) to indicate how big their problems are both before and after counseling sessions. Using this method, she has found that narrative therapy has a positive effect because for most children, the representative shape decreases in size at the end of the counseling sessions. However, because counselors cannot account for all variables — if court is over, if the client is living in a home with 14 other children, if the client has learned to speak English and so on — it is impossible to know whether clients have improved strictly because of narrative therapy, she points out.

Redmond is a proponent of mixed-methods research because quantitative research (e.g., a Likert-type scale) provides more breadth than depth, whereas qualitative research provides the depth. In addition, they complement each other: Quantitative research can provide counselors with great ideas for qualitative research and vice versa. Redmond recommends first using quantitative research, such as a survey, because clients find it less threatening and less personal, but it will still get clients thinking about their experiences. Then, counselors can ask clients the magic question: “Is there anything you haven’t discussed that you would like to talk about?”

Stoltz has discovered that finding thematic codes for categorizing narrative data is one way to measure narrative techniques. For example, people who engage in storytelling about traumatic events in their lives tend to integrate these life events into meaningful stories and report higher life and career satisfaction.

“Preliminary evidence is beginning to show that when trained people read these stories, they come to the same conclusions,” Stoltz says. “That’s an important first step in validating …
this process.”

In addition, digital narratives may provide opportunities to quantify narrative interventions in the future, Redmond says.

Integrating narrative practices

Narrative therapy is not for the lightweight, and it is not as easy as it sounds, Sawyer says. In fact, self-doubt can prevent counselors from using narrative techniques, she points out. To avoid this, counselors need practical experience. Just taking one course or workshop or reading a book on the topic won’t mean that counselors will know how to use the approach correctly. Instead, Sawyer argues that counselor training should involve a holistic approach in which counselors expose themselves to the topic not only through courses, books and articles but also by practicing under supervision and processing all along the way.

Also, some counselors are hesitant to incorporate mental health-based approaches if their training is in another specialty such as career counseling. Stoltz, however, stresses the importance of taking an integrated perspective because people have multidimensional experiences that are not mutually exclusive. “Career counseling is often seen as limited to the career dimension, but it is really counseling with a career goal in mind,” he says.

For Stoltz, it makes sense to apply narrative therapy to career counseling because there is always a story behind one’s career. Furthermore, many people spend eight to 10 hours working every day, and work stress is a significant contributor to a person’s well-being or absence of well-being, he says. Despite this, counselors are generally not incorporating work aspects into mental health, he points out.

Thus, Stoltz argues that counselors “need to rethink [their] specialization construct.” Unfortunately, it is easy for counselor educators to design courses that address a certain standard (e.g., a career counseling course, a trauma course, a multicultural course). However, when counselor educators create stand-alone courses, students often move from one course to another without integrating those courses, Stoltz says. To avoid this, he incorporates basic counseling skills alongside career counseling because students must learn to respond to content and meaning before they can help a client deconstruct a story.

Sawyer’s counseling program at Houston–Clear Lake integrates narrative therapy into the curriculum by introducing narrative therapy as a counseling tool and working narrative techniques into multiple courses. “It is not the only way to counsel but … like how everybody knows how to do Rogers, everybody knows how to do Gestalt … all of my students know how to do CBT [cognitive behavior therapy] and trauma-focused CBT, and they all know how to do narrative counseling,” she says.

Stoltz agrees with expanding counseling areas, but he also worries that as counseling training becomes broader, counseling programs are finding it difficult to retain depth. Counseling students need to understand both the academic jargon and the practical training associated with those terms, he stresses. “Re-storying needs to be accompanied with a practical, pragmatic application of what that looks like and what that process is,” he says.

Stoltz is helping to bridge this gap by incorporating experience work in his classroom, which is a technique modeled after Mark Savickas’ pedagogical practice. For example, a counseling student might do a case study and follow someone through a career intervention, or a career story, and present this constructed story to the class.

Redmond finds that counseling students infrequently have many opportunities to train specifically in narrative therapy or narrative studies. Currently, students in his program are introduced to narrative therapy under the umbrella of postmodern approaches in a counseling theories course, but his goal is to have students do more specialized work in narrative therapy in the future. As a step toward achieving this goal, he will be working this fall on a proposal for a narrative certificate program.

Authoring the next chapter

Stoltz acknowledges that misinterpretation or a unitary interpretation of a client’s story is one of the pitfalls of narrative therapy. “[Counselors] feel like [we’ve] got the inside track on this because [we] have this psychological knowledge, this counseling knowledge, and [we] have to be careful with that,” he warns.

Often, counselors will make up their mind about what the story means to the client. But the counselor’s job is to test, not to interpret, Stoltz says. Counselors should make the client aware of what they see and test that theme or theory with the client while still respecting that it is the client’s story, he explains. The client is the one who has to live the life and rewrite the story; the counselor’s job is to help the client accomplish this.

Adichie reminds us that “stories can break the dignity of a people, but stories can also repair that broken dignity.” Narrative therapy provides clients with a safe space to tell their stories. With a counselor’s guidance, clients can slowly reject the negative stories and stereotypes that create an incomplete or inaccurate representation of who they are as individuals and replace them with stories that empower them to take control of their lives and regain their humanity.

Stories are powerful, but the person holding the pen is the one who controls the story. Revision is key when writing a novel, and this holds true in narrative therapy as well. People first have to understand and narrate their stories in order to rewrite them and become the authors of their next chapter.

 

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Narrative approaches

As explained in the fifth edition of Counseling and Psychotherapy: Theories and Interventions, edited by David Capuzzi and Douglas R. Gross and published by the American Counseling Association, narrative therapy is based on the following beliefs:

1) Clients are not defined by problems they present in counseling.

2) Clients are experts on their lives, so in counseling, judiciously seek their expertise.

3) Clients have many skills, competencies and internal resources on which to draw when impacting change and growth.

4) Therapeutic change occurs when clients accept their role as authors of their lives and begin to create a life narrative that is congruent with their hopes, dreams and aspirations.

 

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Lindsey Phillips is a freelance writer and UX content strategist living in Northern Virginia.
She has 10 years of experience writing on topics such as health, social justice and technology. Contact her at lindseynphillips@gmail.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: The canvas of counseling

By Cheryl Fisher August 17, 2017

“My life has been a tapestry of rich and royal hue, an everlasting vision of the ever-changing view.” ~ Carole King

Summertime often brings opportunities to gather with family and friends. Over grilled goodies and cold beverages, we wallow away the hours, reminiscing of old and fabricating new visions and ventures. It was during one such event that the conversation turned toward the topics of careers, financial advisers and retirement.

My husband and I have differing views around the idea of retirement. He has wanted to live a life of leisure from the time I met him in his early 30s. I, however, have fallen madly and hopelessly in love with my vocation and can’t imagine a life without a clinical practice … or academic appointment … or literary presence … or speaking opportunities … or … Well, you get the idea. I am smitten.

When asked why I am so devoted to the cause, however, I fumble and stammer. “Well, we help people! And there’s never a dull moment. And …” — I finally concede — “I don’t actually know.”

After meditating on the question, I have arrived at six possible answers (beyond the obvious altruism of the craft):

 

1) Diversity. My counseling career extends over several decades and has taken me from work in geriatrics to hospice care and bereavement. As a young counselor, my elderly and terminal clients offered me wisdom around aging well and examining life fulfillment. I have made midnight runs, pumping with adrenaline, as I responded to survivors of rape and we attempted to untangle the multiple violations they had experienced, both from their perpetrators and the systems designed to help survivors. I have gone into school systems and witnessed an entire faculty and administration rally around young children whose home lives left an abysmal track of trauma and abuse. I have watched couples choose to remain together despite a breach of vows. I have witnessed the selfless act of a young mother relinquishing her parental rights in an attempt to offer her newborn baby a life that she could not provide while struggling with addiction. I have counseled in clinics, hospitals and hospices and, over the past decade, have settled into a more routine private practice. Each placement offered me rich and varied clientele, experiences and life lessons.

2) Flexibility. Counseling requires flexibility. Agendas are fluid and cocreated with the client. And let’s face it … you never know what your client will present in session. So we wait in anticipation, realizing that counseling is a dance perfected between therapist and client, but that each client brings her or his own footwork to the session. The counselor must be versed in a variety of dance steps and be willing to freestyle when it is appropriate.

In addition to the flexible nature of the counseling session, counseling hours are rarely 9-to-5. Instead, being a counselor often requires evening or weekend availability. It’s hardly a banker’s workday; we must be prepared to navigate inconsistent schedules that may include a crisis call or hospitalization. At the same time, not being locked down by a set schedule also allows for an occasional two-hour lunch with an old friend, a midday stroll, a hair appointment or even a nap.

3) Contemplative practice. I don’t know of any other career that promotes (requires) reflexivity. We are encouraged to “do our own work” and continue to examine the dynamics that occur in the counseling session. We process our feelings and thoughts not only in relation to our clients but also around our personal experiences that are occurring simultaneously. Is our countertransference therapeutically employed or hindering the therapeutic alliance? Have we devoted time to our own processes?

I remember coming home one night following a very long day and beginning a processing session (de-identifying my clients, of course) with my husband the engineer. We have been married long enough for him to know that he is not being asked to FIX anything when I process. However, at the end of my discourse, my husband just shook his head and asked, “Doesn’t all this thinking tire you out?” I laughed and responded, “No, it’s actually one of the things I love most about my work!” As Irvin Yalom wrote in his novel The Spinoza Problem, “[Counseling] is a strange field because, unlike any other field of medicine, you never really finish. Your greatest instrument is you, yourself, and the work of self-understanding is endless.”

4) Community. It is true: We counselors are a curious people. As such, we benefit from other similar-minded and like-hearted folks. We seek each other out through conferences, workshops and supervision. Through the years, our practices and the clients we serve also become extensions of our community. After all, we journey with our clients during their most vulnerable times, including in the aftermath of cancer diagnoses, struggles with substance abuse, marital affairs, deaths, divorces and other instances of devastation. We create community in the most unlikely of places through our work on disaster teams and travel to locations where unspeakable traumatic events have occurred. We are experts at building community.

5) Creativity. The field of counseling is broad enough to embrace the creative in practice. Counselors welcome the creative, as evidenced by the fact that I will be presenting workshops on “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling” at the Association for Creativity in Counseling’s national conference in September. (The Association for Creativity is a division of the American Counseling Association.)

In addition to a slew of creative practices, our clinical canvas includes other modalities of service to the field that may include mentoring and supervising neophyte counselors. It is a privilege to be part of the skill-building of hope-generating newbies whose desire to help others supersedes their own discomfort around presenting their clinical work in class.

Furthermore, opportunities exist to contribute to the field through research, writing and presentions at conferences. And if that isn’t enough, there is a plethora of administrative and advocacy roles to serve the many affiliations that support the counseling field. This profession offers endless creative avenues for practice and service.

6) Mystery. Psychologist, researcher, author and educator Kenneth Pargament, in his book Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred, wrote, “Spirituality is an extraordinary part of the ordinary lives of people. … It manifests in life’s turning points, revealing mystery and depth. … It is interwoven into the fabric of the everyday. We can find it in music, the smile of a passing stranger, the color of the sky at dusk or a daily prayer of gratitude upon awakening.”

Although counselors employ strong evidence-based standards of practice, pastoral counselors (in particular) are cognizant of the mystery in our work and in the therapeutic process. That mystery can be found in the experience of when, having exhausted all tools in the clinical toolbox and feeling incredibly ineffective, a random question pops into your head. Having nothing to lose, you pose the question to your client, which results in a flood of emotional release (or an epiphany of sorts) that propels the session toward healing.

The counseling experience is filled with the unknown and the sacred — mysteries of interaction between human and divine. It is that experience of mystery that I have trusted when positioned with a client in the cesspool of tragedy and despair, knowing that the light will shine … eventually … again.

 

Conclusion

Image via Flickr https://flic.kr/p/9U6ha2

Counseling has served me well over the past 25 years. I embrace counseling and counselor education as vocations filled with integrity, diversity, flexibility, community and creativity. Counseling is a field that promotes continued personal growth as well as professional competence and humility. Counseling recognizes the beautiful mystery that at times transcends logic.

A colleague described her experience as a counselor as “a quilt of many shades and hues that converge together in a beautiful tapestry.” It is a tapestry of many threads, woven over time and accommodating the varied fabrics of a lifetime — of my lifetime. Retirement? I think not, for I have only just begun!

 

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Why do you enjoy being a counselor? Let me know. And don’t forget to stop by the Association for Creativity in Counseling 2017 Conference, Sept. 8-9, in Clearwater Beach, Florida, and visit me at “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling.”

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty for Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. She will be presenting “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling” at the Association for Creativity in Counseling Conference in September. Contact her at cyfisherphd@gmail.com.

 

 

 

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.