The Use of a Special Painting Therapy Method in Patient Groups

The Use of a Special Painting Therapy Method in Patient Groups

A new special method for painting art therapy for patients in a group setting is presented and described in detail, which met with a favorable response with patients. It has helped the patient by introducing him into an active community, confronting him with a novel situation to cope with and help him to relax.
A definite decrease of aggression was noted during the sessions with often difficult patients, which is the result of catharsis, alleviation of
boredom, reduction of feelings of helplessness in face the authority by establishing a trusting fellow-artist relationship with the therapist.
Withdrawal symptoms are counteracted by providing a favorable setting for development of a trusting relationship, encouragement of self-expression in nonverbal form, safe from recrimination frequently encountered by verbal expression of anger, for example. Visual participation tends to set into action the patient’s expression by by-passing the conscious mind and thus the learned inhibitions. Symbols expressed in color and form appear less open to erroneous conclusions by the therapist than verbalized symbolism and can contribute to more awareness and insight leading to healing. The frequent tactile stimulation and interaction inherent in the process of painting may help the patient to overcome eventually a perceptive dysfunction through sufficient kinesthetic

At the request of a group of patients who expressed interest in his artistic endeavors, the author started demonstrating to his patients how to paint and, in this process, developed a new technique which lends itself to very spontaneous self-expression with simple yet very effective nonverbal means without any prior training. Patient response was so favorable that from this initial demonstration regular painting sessions developed as a form of therapy which he then continued. This Painting therapy was done with a special method – where the therapist takes the role of a fellow-painter – and in which primary emphasis is placed on productivity, and interpersonal interaction in a suitable nonthreatening environment.

Sessions are offered two times per week, each lasting for a period of about 2 hours. Patients are invited but not required to attend; at their discretion they may participate actively or merely observe. No coercive effort is made. Since, however, productivity and interaction are the major therapeutic goals, there is a considerable vocal reinforcement for both painting and attendance.
Of the options to paint or merely observe, a remarkably high number of patients choose to actually paint. Tempera on wet paper is the primary medium offered and it is demonstrated how to first outline a picture  by drawing with a Japanese ink stick. It remains at the discretion of the patient in which medium he wants to work; however, the great majority follow the example of the therapist and use the following simple technique: a large sheet of paper, approximately 22 by 18 inches in size, is spread on a table top and thoroughly wetted with water; lines and outlines for an initial sketch of the subject are drawn with the Japanese inkstick; subsequently, common, nontoxic, tempera paints are applied with a brush or other suitable means, such as hands, pencils, etc.
The therapist executes mainly portraits of patients. It is during the painting of these portraits that a large amount of the nonverbal communication between patient and therapist occurs establishing a trusting relationship.
The therapist seats the patient and then proceeds to wet the paper on which the portrait is drawn. Next, he begins to draw. It is at this point that one can begin to discern nonverbal communication of import. The patient is seated at the end of a long table. The therapist stands diagonally across the corner of the table with the paper flat on the table. The therapist then places his left arm on the edge of the paper outstretched toward the patient. Thus, a communicative effort leading to solidarity between the patient and the therapist occurs the subject of the portrait and the therapist.
The painting of the portrait is accomplished by a large number of glances, scowls, smiles and other facial expressions. Through observation, a pattern of glances directed toward the patient or subject of the portrait has been discerned. The average duration of time needed for the execution of the portrait is approximately 11 – 15 minutes. During this time, glances follow an inverted bell-shaped path.
At the beginning of the portrait, during the first 4 minutes, is the highest incidence of glances directed toward the subject with a mean number of 26; at approximately 6 – 7 minutes, during the middle period of the painting, this drops to an average number of 8 per minute;
  towards the end of the portrait the number of glances rises again to 18 per minute. The number of glances correlates with certain aspects of executing a portrait. To ascertain proper relationships numerous glances are needed when in the beginning the shape of the face with mouth, nose and – most important – the eyes are outlined. Applying the paint and developing the color scheme during the middle period of the portrait, the portrait being expressionistic in type, does not require a high level of glances and attention directed toward the patient subject. The increase in frequency of glances toward the end is correlated with finishing touches, particularly about the eyes.
Scowls also occur. Thes scowls, however, are scowls of concentration, not anger of frustration and the patient perceives them as such. Also, smiles occor, particularly when the portrait is going well and the patient, in turn, smiles back. All of this serves to accomplish a trusting relationship between the two.
Patients observe with fascination how a picture emerges from a wet neutral background and takes shape and becomes alive, participating actively or passively in the creative process.
As the session last 2 hours, the patients frequently choose to execute more than one painting. During the entire session the therapist is continuously engaged in painting the portraits of patients.
At the end of each session, the paintings – still wet – are placed on the floor and all people present congregate around them. Going from one picture to the next, the therapist discusses each painting with the patient who created it – offering his appreciation and encourages the patient to talk about his work and to explain it. The patient may confirm or reject the therapist’s comments; he may offer further elucidation of his original statement. Throughout this exchange, the therapist offers positive reinforcement for the work and encourages further self-expression. All paintings are considered worthy of praise – as a form of very personal expression – regardless of their artistic merit.

Painting Therapy succeeds in achieving three objectives: By painting and discussing their work, the patients are placed in an interacting group. Communication, on both a verbal and nonverbal level is required not only for the discussion of the picture, but also if it is to be executed. For example, the patient may need blue paint and may have to approach another patient to obtain it.
The patient is confronted with the threatening feature of working in a new medium, in a new setting; thus perhaps, we may mobilize his emotional and somatic defense forces. Even if the patient chooses not to paint, he is still in a novel and threatening situation, i.e., to resist in the face of peer pressure and not to paint.
Painting Therapy helps to quiet and relax the patient. This effect is certainly most profound as in many sessions over a 10-year period not a single violent or disruptive act has been observed. This is especially striking as some of the patients who attended were reported to be unruly and difficult to manage. Even patients from the Forensic Division function and interact well in Painting Therapy sessions.
It is exceedingly rare that the subject of a portrait exhibits restlessness during the execution of the portrait. Patients typically sit und watch both the therapist-painter and the portrait growing from his hand with much interest. As to the reasons for the lack of aggressive overtones in the therapy sessions, no firm hypothesis has been established. Whatever the cause of active anger, it is nevertheless certainly present. Yet there has not been a single case of expression of anger during Painting Therapy in the author’s 10 years of experience. It thus appears that the expression of anger and irritability is accomplished through means other than verbal or physical outbreaks, i.e., CATHARTHIS IS ACCOMPLISHED THROUGH THE ACT OF PAINTING. Thus, Painting Therapy benefits the patient’s response.
Furthermore, Painting Therapy as training in a socially more acceptable form of catharsis may have long-term benefits. Boredom and feelings of helplessness and impotence in the face of authority are considered to be major factors in tipping the scales toward producing violent responses. Painting Therapy introduces a new and, therefore, beneficial event into the routine life of the patient.
One of the reasons violent activity and assaults by patients occur is due to a feeling of helplessness in the face of powerful authorities who can determine the patient’s fate and which can and will exacerbate latent resentments stemming from earlier arbitrary treatment at the hands of significant figures in his life. In our experience the therapist is perceived as a fellow-artist, not in an authoritarian position. Thus, resentment and feelings of helplessness do not occur, hostility is virtually absent and violent behavior has not erupted. It is felt that the irritability and anger expressed is a natural sequel to the misunderstanding of the environment which would create fear and therefore hostility.

Numerous studies cite the importance of the development of a trust relationship between the patient and therapist in this regard. By its very nature, Painting Therapy encourages a trusting relationship. This occurs because of the unorthodox position of the therapist, who, during the first part of the session in particular, appears only as an artist, engaging in the same behavior as the patients. Thus, no fear and hostility result and peer relationships, trusting in nature, is built. At the very worst, conditions favorable for this development ARE met. Even during the discussion part of the therapy, when therapist and patient engage in discourse concerning the appearance, intent and meaning of the pictures, it is done in a manner of artistic exchange rather than in the traditional therapeutic sense.
It has been established that motoric expression as employed in painting therapy is executed directly by by-passing consciousness of emotionally charged complexes. In painting the visual participation during the creation of a picture seemed to directly stimulate the patient’s own responses, setting in motion motoric expression, not only by by-passing the conscious mind but also by inhibiting other forms of learned behavior. Even the autistic child responds more directly to rhythmic stimuli rather than to a verbal relationship, because rhythmic stimuli appeal immediately to the subconscious mind.

Painting Therapy  attempts to restore healthy mental functioning and insight simultaneously. It does not appear that they occur naturally hand-in-hand; one can lack insight – yet maintain a relatively healthy mental functioning. Yet, both are necessary for the development of a non-pathological personality. If healthy mental functioning does not necessarily lead to insight nor if the opposite process occurs, it seems reasonable to attempt to benefit the patient in both areas, rather than relying on the occurrence of one as a natural outgrowth of the other.
Painting Therapy affords the patients an avenue of expression in nonverbal form. Furthermore, poor verbalization in patients is frequently due to fear of recrimination, not due to an actual disorder. A picture holds no fear for the patient – color and form are not considered damning, only words. In addition, Painting Therapy presents a remarkable opportunity for the study of symbolization. A clear understanding of the symbols the patient utilizes is necessary for the patient to benefit from the therapy. Attention must be paid to the separation between archetypal symbols and personal symbolizations. Due to the nonverbal nature of painting therapy, the possibility of the obfuscation of symbolization is markedly reduced.

There exists a far greater probability of occurrence of tactile interaction between the patient and the environment during Painting Therapy than during verbal modalities, due to utilization of the brush touching the paper, wetting the paper and other essential acts necessary to produce a picture. Perception is understood as a four-fold process: reception, registration, processing, and feedback. At each stage, even perception at a peripheral sense organ, organizing processes lawfully select and shift accents of stimulus attributes. What is essential to the whole matter though, is that each of the four acts of the perceptual process must be accomplished in order to obtain proper perceptual registration. Otherwise, perceptual dysfunction remains. Through the presentation of constant tactile stimulation in Painting Therapy, one may accomplish sufficient feedback in kinesthetic form, not only visual and auditory, that perceptual dysfunction is overcome. This, of course, is a long-term process.

A new special method of Painting Therapy described above provides a treatment modality for patients which helps to introduce the patient to an active community, confronts him with new responsibilities and risks in personal interactions and helps him to relax through a nonthreatening and nonverbal form of approach.
Possible mechanisms leading to the observed decrease of aggression are catharsis, alleviation of boredom, reduction of feelings of helplessness in the face of authority through establishing a trusting fellow-artist relationship with the therapist.
Withdrawal symptoms can be decreased and social interaction enhanced by providing favorable conditions for the development of a trusting relationship in a nonthreatening group.
Painting Therapy strengthens healthy mental functioning through participation in the creative process, actively or passively, which appreciates the patient as a potentially creative individual, and – if his portrait is painted – his human face is given value.

— Dr. Hans J. Vorbusch, psychiatrist-artist. 1977. (Modified by me.)