Trisha Deb
'Art Imitates Reality’ is usually used in the context of paintings, films or books inspired by real life events with a hint of fiction and creativity. However, an interesting manner in which it can be interpreted is art being a decoding lens for the creator's mind and personality. While mental illnesses have extensively been linked to creativity, research suggests that personality disorders have an intriguing relationship with art therapy.
One such example is Borderline Personality Disorder- BPD. This is characterized by “fear of abandonment; identity disturbance and unstable self-image; impulsivity in areas that are potentially damaging; recurrent suicidal behaviors/gestures or self-harm; affect instability and chronic feelings of emptiness; inappropriate, intense anger; transient, stress related paranoid ideation or severe dissociative symptoms” (Eastwood, 2012). DBT- Dialectical Behavior is often used to treat BPD since it is effective in managing feelings of suicide and emotional volatility (Drass, 2015). Art therapy, on the other hand, provides a space for the individual to articulate their feelings in a visual rather than verbal medium. This “encourages the ability to self-express, promote self-awareness, improve insight, and enhance general psychological well-being” (Lamont et al., 2009).
However, what exactly connects art therapy to BPD? A case study was conducted in New Zealand, on a 46-year old woman who had a long history of BPD and frequent suicidal tendencies. She was exposed to 11 individual sessions of art therapy (Lamont et al., 2009). Through her artwork, she was able to express the internal turmoil in the form of symbolic shapes and colours. She painted a purple curtain being opened to depict her opening up about her early trauma to the therapist. She painted a fist to express her urge to self-harm and give herself a black eye due to her hatred towards herself. In the later sessions, she painted a distorted figure that she described as her body after her death. The night after she punched her eyes, she painted the colour yellow, wishing she had that warm light inside her to guide her. The most intense painting she created was one after she was put in solitary confinement. She fueled her feelings of frustration, guilt and unhappiness by drawing a figure of herself shrouded in blue behind bars, with multiple arms stretching out for help. But with these angry arms, she painted specks of yellow to reflect hope and green for growth around her. Her last session consisted of her feeling at peace, and returning to the therapist with artwork that she made at home to anchor her and calm her down- a musical note.
Therefore, art therapy helped her externalize her relationship with herself and her trauma and look at it from a non-accusatory lens. This process is similar to that of decantering, where individuals are asked to explore and observe emotions rather than be controlled by them. While this provides qualitative information about how art therapy helped in putting her BPD in remission through the consumers active engagement with the art, it also helps the therapists access repressed memories and experiences that the client is unable to verbalize. This can be done through other forms of art therapy that have been found to emulate the key aspects of DBT- building a sense of self.
A framework created by Jessica Drass describes 8 art therapy interventions that explore this relation (2015). The first one was- ‘Wise mind books’ where individuals are asked to create accordion-like books by gluing elements that represent themselves inside the book. This emulates the intuitive aspect of DBT and helps people gain a sense of control and identity. This idea of control is also present in the- ‘Save it for Later- Boxes’ intervention where the individuals are asked to put elements representing a symptom or traumatic memory they are working on. The ability to open and close the box without feeling emotionally overwhelmed helped the clients gain control over their dissociative tendencies. The other interventions of Layered Collages, Distress Tolerance Baskets, Strength Medallions, Printmaking Workshops and Water colour Painting, covered themes of integration, self-soothing, empowerment, trust and patience respectively. The most effective intervention, however, was that of ‘Dialectical Dilemmas' that asked individuals to create images that reflect oxymoronic ideas such as gaining emotional control and letting go of the past or specifically, holding onto their self-concepts and identities while letting go of self-harming tendencies. The latter resonated with BPD patients the most since they were struggling to overcome early trauma.
While this was effective, further replication of these specific interventions is required to establish reliability. In spite of this, experiments evaluating the efficacy of art therapy on BPD have found statistically significant findings that depict that it has resulted in some patients showing almost no symptoms of BPD after the treatment, and the rest showing reduced suicidal tendencies, greater emotional regulation and self-awareness (Springham et al., 2012). While this provides compelling evidence for the effectiveness of art therapy in decoding BPD, there is a prominent gender bias in the diagnosis and treatment of BPD through art therapy. It has been found that 75% of those given a BPD diagnosis through the DSM-IV (Diagnostic and Statistical Manual) or NICE (National Institute for Health and Clinical Excellence) guidelines are women (Eastwood, 2012). Likewise, BPD patients entering art therapy are also predominantly female. It is therefore essential to explore how art therapy affects males with BPD, in the socio-cultural context of art or creativity being labelled as patriarchal ‘feminine’ activities.
In conclusion, art therapy has been found to be an effective and engaging way of treating, understanding and humanizing individuals with BPD. Even though people in the group art therapy sessions were afraid of the violent behavior of patients with BPD (Eastwood, 2012), hearing them talk about their art and gaining an insight into their personality beyond the label of BPD helped alleviate this fear. This de-stigmatization of mental illness through art teaches us to empathize as well as learn to channel and regulate our own feelings through a healthy, creative coping mechanism.
One such example is Borderline Personality Disorder- BPD. This is characterized by “fear of abandonment; identity disturbance and unstable self-image; impulsivity in areas that are potentially damaging; recurrent suicidal behaviors/gestures or self-harm; affect instability and chronic feelings of emptiness; inappropriate, intense anger; transient, stress related paranoid ideation or severe dissociative symptoms” (Eastwood, 2012). DBT- Dialectical Behavior is often used to treat BPD since it is effective in managing feelings of suicide and emotional volatility (Drass, 2015). Art therapy, on the other hand, provides a space for the individual to articulate their feelings in a visual rather than verbal medium. This “encourages the ability to self-express, promote self-awareness, improve insight, and enhance general psychological well-being” (Lamont et al., 2009).
However, what exactly connects art therapy to BPD? A case study was conducted in New Zealand, on a 46-year old woman who had a long history of BPD and frequent suicidal tendencies. She was exposed to 11 individual sessions of art therapy (Lamont et al., 2009). Through her artwork, she was able to express the internal turmoil in the form of symbolic shapes and colours. She painted a purple curtain being opened to depict her opening up about her early trauma to the therapist. She painted a fist to express her urge to self-harm and give herself a black eye due to her hatred towards herself. In the later sessions, she painted a distorted figure that she described as her body after her death. The night after she punched her eyes, she painted the colour yellow, wishing she had that warm light inside her to guide her. The most intense painting she created was one after she was put in solitary confinement. She fueled her feelings of frustration, guilt and unhappiness by drawing a figure of herself shrouded in blue behind bars, with multiple arms stretching out for help. But with these angry arms, she painted specks of yellow to reflect hope and green for growth around her. Her last session consisted of her feeling at peace, and returning to the therapist with artwork that she made at home to anchor her and calm her down- a musical note.
Therefore, art therapy helped her externalize her relationship with herself and her trauma and look at it from a non-accusatory lens. This process is similar to that of decantering, where individuals are asked to explore and observe emotions rather than be controlled by them. While this provides qualitative information about how art therapy helped in putting her BPD in remission through the consumers active engagement with the art, it also helps the therapists access repressed memories and experiences that the client is unable to verbalize. This can be done through other forms of art therapy that have been found to emulate the key aspects of DBT- building a sense of self.
A framework created by Jessica Drass describes 8 art therapy interventions that explore this relation (2015). The first one was- ‘Wise mind books’ where individuals are asked to create accordion-like books by gluing elements that represent themselves inside the book. This emulates the intuitive aspect of DBT and helps people gain a sense of control and identity. This idea of control is also present in the- ‘Save it for Later- Boxes’ intervention where the individuals are asked to put elements representing a symptom or traumatic memory they are working on. The ability to open and close the box without feeling emotionally overwhelmed helped the clients gain control over their dissociative tendencies. The other interventions of Layered Collages, Distress Tolerance Baskets, Strength Medallions, Printmaking Workshops and Water colour Painting, covered themes of integration, self-soothing, empowerment, trust and patience respectively. The most effective intervention, however, was that of ‘Dialectical Dilemmas' that asked individuals to create images that reflect oxymoronic ideas such as gaining emotional control and letting go of the past or specifically, holding onto their self-concepts and identities while letting go of self-harming tendencies. The latter resonated with BPD patients the most since they were struggling to overcome early trauma.
While this was effective, further replication of these specific interventions is required to establish reliability. In spite of this, experiments evaluating the efficacy of art therapy on BPD have found statistically significant findings that depict that it has resulted in some patients showing almost no symptoms of BPD after the treatment, and the rest showing reduced suicidal tendencies, greater emotional regulation and self-awareness (Springham et al., 2012). While this provides compelling evidence for the effectiveness of art therapy in decoding BPD, there is a prominent gender bias in the diagnosis and treatment of BPD through art therapy. It has been found that 75% of those given a BPD diagnosis through the DSM-IV (Diagnostic and Statistical Manual) or NICE (National Institute for Health and Clinical Excellence) guidelines are women (Eastwood, 2012). Likewise, BPD patients entering art therapy are also predominantly female. It is therefore essential to explore how art therapy affects males with BPD, in the socio-cultural context of art or creativity being labelled as patriarchal ‘feminine’ activities.
In conclusion, art therapy has been found to be an effective and engaging way of treating, understanding and humanizing individuals with BPD. Even though people in the group art therapy sessions were afraid of the violent behavior of patients with BPD (Eastwood, 2012), hearing them talk about their art and gaining an insight into their personality beyond the label of BPD helped alleviate this fear. This de-stigmatization of mental illness through art teaches us to empathize as well as learn to channel and regulate our own feelings through a healthy, creative coping mechanism.
References
Drass, J. M. (2015). Art therapy for individuals with borderline personality: Using a dialectical behavior therapy framework. Art Therapy, 32(4), 168–176. https://doi.org/10.1080/07421656.2015.1092716
Eastwood, C. (2012). Art therapy with women with borderline personality disorder: A feminist perspective. International Journal of Art Therapy, 17(3), 98–114. https://doi.org/10.1080/17454832.2012.734837
Haeyen, S., van Hooren, S., van der Veld, W., & Hutschemaekers, G. (2018). Efficacy of art therapy in individuals with personality disorders cluster B/C: A randomized controlled trial. Journal of Personality Disorders, 32(4), 527–542. https://doi.org/10.1521/pedi_2017_31_312
Lamont, S., Brunero, S., & Sutton, D. (2009). Art psychotherapy in a consumer diagnosed with borderline personality disorder: A case study. International Journal of Mental Health Nursing, 18(3), 164–172. https://doi.org/10.1111/j.1447-0349.2009.00594.x
Springham, N., Findlay, D., Woods, A., & Harris, J. (2012). How can art therapy contribute to mentalization in borderline personality disorder? International Journal of Art Therapy, 17(3), 115–129. https://doi.org/10.1080/17454832.2012.734835
Comments
Post a Comment