Using Art Therapy in the Treatment of Eating Disorders Art Therapy, while still a fairly new method of treatment, is quickly becoming a more and more relied upon tool used in the treatment of a number of psychological and emotional issues. Art Therapy has largely grown out of the psychiatric movement with connections to theorists who placed high value on symbolization and the unconscious, such as Freud and Jung. The use of Art Therapy did not come into the forefront until the 1940’s, the result of pioneers in the field such as Margaret Naumberg.
The first therapist to really use Art Therapy in practice, she believed that art gave her patients an opportunity to express themselves and reach their unconscious and in turn give therapists a better idea of the root of their problems and how to treat them. Different therapists use different aspects of the therapy and the approaches used in its practice have grown and branched out to include a wide array of applications.
The attributes of art therapy are numerous and include: a decreased use of defenses since verbal communication is more easily manipulated, the creation of a permanent object that can take focus off of the client, and the release of creative energy. When looking at the use of the art therapy in the treatment of eating disorders, the attributes stated above have been proven to be successful and beneficial. Because body image, attitudes about food, and perceptions of physical beauty are forms of knowledge not easily expressed verbally, art therapy has become an ideal method in the treatment in eating disorders (Soh, Touyz, & Surgenor, 2006).
Individuals with eating problems are typically very sensitive about their food-related behaviors and do not like to discuss them or share them with others. It is proposed that providing individuals with an alternate means of communicating their issues, through art for example, may provide for a better understanding of their conditions. This is especially important when culture and ethnicity are taken into consideration. Because of the varied differences in the classifications of eating disorders amongst women of different ethnicities, a large number of minority women remain undiagnosed with eating disorders (Soh et al. 2006). Art therapy can be a powerful communication link when dealing with these issues cross-culturally. Images and symbols often transcends languages barriers making it easier to assess when one actually has an eating disorder. (Soh et al. , 2006) Art therapy also plays an essential role in the area of managing control. Eating disordered patients often use food to negotiate and mediate between their inner world and their external environment and the art that is created during sessions may help build a connection between the inner and outer world of the client and as well as between the client and the therapist.
In theory, that images or objects created can temporarily become a substitute for the use of food in gaining control and the feeling of managing power. Being able to focus their attention on something other than food can give eating disorder patients a healthy option of object transference. By giving them this option, they are able to have an outlet for their need to extreme need for perfection and power. Problems with body image can be assessed and treated in a number of ways through the use of art therapy.
Mary Crowl provides accounts of her work with twelve adolescent girls with eating disorders and issues with body image distortion who received art therapy twice a week in an inpatient setting. While identifying major areas of conflicts most apparent in their drawings, Crowl found the most obvious to be one of self-image. Repeated drawings of the self as a “little girl” where immature bodies with hair ribbons, bows, and ruffles where often drawn. These symbols are thought to illustrate the stunned psychological and emotional growth that is a central dynamic in eating disorders. Crowl,1980). While Crowl found in her treatment that no amount of conversation could change the distorted body image her patient had of them selves, the images created helped provide realistic views that could help them confront and address this issue. The use of art therapy in this case gave each girl an outlet to express how they actually saw themselves without having to verbally communicate it. It also gave Crowl a concrete image to help show each girl the discrepancy between how she sees herself and the way she actually looks. Crowl,1980) According to Holly Matto (1997), body tracing and mirror image or self portrait drawings are two techniques that can be used in working with clients to help establish the difference in how they see themselves and what they actually look like. Body tracings can be used to challenge the distorted belief that the patient’s body is much larger than it actually is, by asking her to draw a life-size image of what she believes her body shape/size to be and then doing an actual tracing on top of it for comparison (Matto, 1997).
These drawings can be used to help the patient identify different parts of the body that are liked or disliked, and to eventually work the client through exaggerating and confronting one or more of the disliked parts and praise the liked parts. Matto goes on to discuss how magazine and multi-media collaging can be an excellent way to begin discussion about cultural messages that lead to the development of personal beliefs, dysfunctional thoughts, and negative self-esteem and can also be used to start conversation among other group members. Matto, 1997) Nadine Kaslow and Virginia Eicher (1988) emphasize the importance of combining creative arts therapy and verbal therapy in body image work with anorexics. They report that a wide variety of art media can be used in body image therapy to allow individual expression and exploration of different issues (Kaslow et al. , 1988). Gesture drawings involve asking patients to cover as much of the paper as possible, making random markings in a very short period of time.
The drawings are then titled and discussed. They also encourage the use of the “The Squiggle Game,” where the therapist initiates an impulsive line drawing and the patient turns it into an image or picture and a discussion is follows. These activities are designed to allow the patient to engage in safe artistic self-expression with no emphasis on the final result. Kaslow & Eicher go on to describe projective drawings, which they define as the translation of one’s inner experiences into visual images.
Examples of these creations include drawing what hunger looks like or what their ideal self looks like. This specific form of treatment can be helpful when a particular issue needs to be addressed. (Kaslow et al. , 1988). Lisa Hinz and Vicki Ragsdell (1990) conducted a study utilizing mask making and videotaping with bulimic patients. Because masks typically represent a part of the self that is not usually overtly expressed, the authors used the videotape to record the patient’s masked self, asking her unmasked self a series of questions.
Hinz and Ragsdell describe those suffering from bulimia as, “perfectionistic people-pleasers who rarely represent their real selves in relationships with others”, and instead present themselves as, “ideal and conforming, fearing that if others knew the real persons within that they would be rejected”. The authors found that with the introduction of this exercise into their previously existing stable group of nine members there was a drastic drop in attendance to two members per session, which they attribute to resistance.
According to the authors, the three members who did eventually fully complete the task seemed to be at a stage in their therapy where they were struggling with issues of independence and personal responsibility. It is assumed that videotaped presentations may have been introduced to this group prematurely, and that a project of this nature could work better in the future if it is presented at the beginning of a group and every member is firmly committed (Hinz et al. , 1990).
In summary, art therapy can be an excellent tool for use with eating disordered patients for a number of reasons including the idea many aspects of what one is going through when they have an eating disorder are not easily translated through verbal communication. Art therapy allows therapists to get to the root of where the eating disorder stemmed from by opening up communication in the early developmental stages of the disease. It can also get around defenses and resistances that verbal therapies cannot that persons with eating disorders often have.
Additionally, it can become a temporary substitute for food, allowing them to act out their behaviors in a safe and productive way. There have been numerous themes in eating disordered artwork, some of which include: dependence, control, opposing forces, immaturity, victimization, and traps. Some specific art therapy approaches for eating disorders may include body tracings for distortions concerning body image, the exaggeration and confrontation of disliked body parts, and the open creation of objects and images without a expectation of a specific final result .
Lastly, art therapy groups can be very helpful for eating disordered patients in that they provide them the opportunity to practice relating to others, another area where they tend to have difficulties. To conclude, Art Therapy gives eating disorder patients a much needed outlet. They are often struggling with issues of control, power, low self-esteem among others giving them an option in which they can express these issues in a healthy environment has been seen to have major benefits. References Crowl, M. (1980). Art therapy with patients suffering from anorexia nervosa. The Arts in Psychotherapy, 7, 141-151.
Hinz, L. , & Ragsdell, V. (1990). Using Masks and video in-group psychotherapy with bulimics. The Arts in Psychotherapy, 17, 259-261. Kaslow, N. , & Eicher, V. (1988). Body image therapy: A combined creative arts therapy and verbal psychotherapy approach. The Arts in Psychotherapy, 15, 177-188. Matto, H. (1997). An integrative approach to the treatment of women with eating disorders. The Arts in Psychotherapy, 24, 4, 347-354. Soh, N. , Touyz, S. , & Surgenor, L. (2006). Eating and body image disturbances across cultures: a review. European Eating Disorders Review, 14, 54-65.