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ACQ Volume 11, Number 3 2009 137
piece of paper on the floor (Luzzatto, Sereno, & Capps,
2003) began in the second session. If the group members
did not feel comfortable enough to have someone trace
around their body, they also had the option to use a
pre-traced life-sized outline of a body.
After the tracings were complete the psychologist
conducted a mindfulness exercise in which the focus was
on developing awareness of tensions within the body. Once
a participant identified a bodily tension, he or she was asked
to think of a colour to connect with that feeling. At this point,
the art therapist directed the group members to represent
these tensions, using the colours that represented them
by making marks with a paintbrush and acrylic paint on
the body tracing, specifically in the areas of tension in their
“bodies”. Discussion about this followed and further painting
about similar emotions, such as anxiety, fear, loneliness,
stress, etc. also depicted with colour and marks. Once
more, “emotion cards” were used to give a visual (words)
tied to these emotions.
In the third session, participants put their body tracings
up on the wall. Some group members had been working
on these tracings horizontally and the act of placing them
vertically provided a very different perspective for viewing
their work. Participants stood in front of their art and quietly
observed, mindfully absorbing what they had created. A
group discussion followed in which the art therapist asked
the group members to identify colours that evoked feelings
of being calm and relaxed recalling previous group reflections
from the progressive relaxation. The group members were
then asked to apply these colours, as much or as little as
they wanted, on the parts of the tracing. The final processing
of this intervention occurred with group discussion about the
entire process over the previous three sessions.
Art therapy in case management
In the day program, each member of the team has case
management (Rapp & Goscha, 2004) responsibilities for one
or more clients. During the intake process, each new client is
assigned to a case manager who develops a therapeutic
relationship with the client and provides the linkage between
the client and his or her family and the wider multidisciplinary
team. This section will examine two ways in which the art
therapist as case manager uses art work to assist in the
development and maintenance of a successful relationship
with the client.
The case as visual metaphor in the development
of a collaborative relationship
One of the challenges in the development of an effective
case management relationship is helping the young client to
understand what the relationship involves. Case
management is an abstract and organisationally oriented
concept that may have little meaning
to children and adolescents. The
young person knows he or she has a
“case manager” but what is this?
To assist with the process of
engagement and alliance building at
the beginning of a case management
relationship, the art therapist has
developed some visual tools to assist
the young person to engage in a
dialogue about case management.
These tools consisted of simple
line drawings (Figure 1) depicting a
suitcase.
between their minds and bodies. This included promoting
heightened self-awareness and reflection, practising
relaxation techniques, developing better communication
skills, sharing experiences and insights, relating to others,
and discovering coping strategies.
The psychologist utilised mindfulness meditation
techniques to help the adolescents find new techniques to
be calm and gain insight into their own behaviours. The art
created in the group enabled an external expression of these
young peoples’ internal experiences.
This group comprised 8 one-hour sessions conducted
over a period of eight weeks with six adolescent participants
with varying mental health diagnoses, such as somatoform
pain disorder, anxiety with school refusal, depressive
symptoms, and eating disorder. Each session included
mindful breathing and a “visual check-in” whereby each
member selected an image that caught their attention and
verbally shared with the group something about the image
they chose. Both the consistency and practice of these
weekly interventions were designed to give the group of
young people a sense of security, inner calmness, and
connection with one other. In addition, each group included
specific activities that may run over more than one session.
Two of these specific activities are described in more detail.
Water colours
In this activity, the meta-message was “explore your
potential”, using this flexible, yet sometimes unpredictable
medium. Initially the group worked on a collective artwork.
Although a brief demonstration of the medium was given by
the art therapist as well as a reminder to be respectful of
each others’ work, no specific form was required. The
exercise was simply about each participant learning about
what he or she could do with the paint while interacting with
others. Specifically, participants needed to actively
communicate with each other if they wanted to add to
someone else’s art and were not to obliterate anyone else’s
work by painting over it.
Following the collective activity, the psychologist
conducted a mindful breathing exercise (with eyes closed).
At the end of the exercise, participants opened their eyes
and were asked to identify an emotion or feeling they had
become aware of or were experiencing at the time. Using
colour, lines, and marks they were asked to depict that
particular feeling “emotion cards” were placed around the
room for the group members to refer to, if they required a
further visual and vocabulary prompt. The group members
easily engaged in the art making and were subsequently
invited to guess what feeling each group members’ image
was depicting, as well as to guess a possible reason for
their interpretation of their peers’ image. The original artist
then had an opportunity to clarify (if needed) what their
image represented and share their image’s meaning with the
rest of the group. This sharing encouraged a more natural,
conversational group process and engagement through the
artwork that contributed to group cohesion.
Body tracing
The initial session of the body tracing intervention included
the visual check-in and mindful breathing. The main focus
was on relaxation with both group discussion about
participant experience of relaxation and a progressive
muscular relaxation exercise. The body tracing, in which
each participant had another member trace the outline of
their body while they were either standing up against a large
piece of paper taped on the wall or laying down on a large Figure 1. The “cases”