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A Group Psychoeducational/Art ATHABASCA UNIVERSITY UNIVERSITY OF CALGARY UNIVERSITY OF LETHBRIDGE THE ART OF BEING SPIRITED: A GROUP PSYCHOEDUCATIONAL/ART THERAPY GUIDE FOR USE WITH ADOLESCENTS WITH EATING DISORDERS BY ELIZABETH MAY YOUNG MCKENNA A Final Project submitted to the Campus Alberta Applied Psychology: Counseling Initiative in partial fulfillment of the requirements for the degree of MASTER OF COUNSELING Alberta (November) (2005) All rights reserved. This work may not be reproduced in whole or part by photocopy or other means without permission of the author. ii iii ABSTRACT This project is a guide that combines spiritual, cognitive, creative, expressive and experiential elements into a group process to help health care professionals support adolescents with an eating disorder. The process embraces a holistic approach towards therapeutic interventions that incorporates Eastern and Western philosophies towards healing and art history with cross cultural links to develop the critical being through mindfulness practice, consciousness raising and communal experiential processes. Literature reviews on spirituality, eating disorders, art therapy, creativity, critical thinking, self and group process identify themes, topics and strategies which form the foundation for interventions. Theoretical underpinnings, ethic of care, suggested topics, format for sessions, psychoeducational material for facilitators and participants, and ways to evaluate the product, process and facilitator are included. iv DEDICATION To my husband for his love, fidelity, acerbic wit, sense of humour and unwavering support and encouragement. To my children Nairn, Noel and Kirsty who have taught me the most of what I know about adolescents, and forced me to embrace change. To my siblings for providing a good model for what it means to be a family. To my Canadian/Scottish clan – you know who you are! To all the parents who do the best they can to raise children in a world that is often ill equipped to support them. And lastly to my mother, one of the wisest women I know for her incredible fortitude, strength of character, integrity and insight on human nature. I honour your legacy! v ACKNOWLEDGMENTS I owe a deep debt of gratitude to Pat Roles for agreeing to be my supervisor at Childrens’ and Women’s Hospital in Vancouver, for sharing so generously her clinical knowledge and skills in working with eating disorders, giving up her art therapy space so that I could learn, and always finding the right thing to say to push me further in my professional growth. To Dr. Pierre Leichner, Dr. Ron Manley, Dr. Jorge Pinzon, Dr. Glen Freedman, Dr. Carolyn Nesbitt and all the nursing and support staff in the Children’s and Women’s Hospital Adolescent Eating Disorders program who shared their knowledge and expertise with me – I am the richer for it. Particularly, I am indebted to my husband Brian and my supervisor Ross Laird who gave me feedback on content, language and structure which added to the richness of this document. To my friend Wilma Bates a special thanks for editing several drafts. I also wish to thank my committee members and the staff within the program for their support, particularly Dawn McBride (Second Reader), Tony Mishra (a computer whiz and very patient man), and Paul Pival and Marvel Nash (Librarians). Finally, I need to acknowledge a deep indebtedness to all the individuals and their families who shared parts of their lives with me. I am changed forever by the experience, honoured to have shared space with you, and humbled by the faith that you placed in me. vi TABLE OF CONTENTS ABSTRACT …………………………………………………………………… ….. iv DEDICATION…………………………………………………………………. ….. v ACKNOWLEDGEMENT………………………………………………………….. vi TABLE OF CONTENTS…………………………………………………………… vii LIST OF FIGURES ………………………………………………………………… xvi CHAPTER I: INTRODUCTION Introduction………………………………………………………………………….. 17 Introduction to the Guide ……………………………………………………….. 24 Problem Statement…………………………………………………………….... 25 Rationale………………………………………………………………………… 26 The Purpose of Spiritually Focused Workshops………………………………… 28 The Structure of the Guide………………………………………………………. 29 A Shift in Focus and Intention…………………………………………………... 30 About the Author………………………………………………………………......... 32 Personal Philosophy – Becoming……………………………………………….. 34 An Optimist at Heart…………………………………………………………….. 34 CHAPTER II: THEORETICAL FOUNDATION Creative, Self-Determined Growth Across the Lifespan………………………… 36 Human Nature ………………………………………………………………….. 37 Seeds of Pathology……………………………………………………………... 37 Working Alliance………………………………………………………………. 39 General Goals of Therapy…………………………………………………….... 40 vii A Cultural Perspective for Therapeutic Counseling……………………………….. 43 Internalized Culture and Worldview…………………………………………..... 45 CHAPTER III: ETHICS A Model for the Highest Ethic of Care ….…………………………………………. 49 A Motivational Approach for Change …………………………………………. 57 Motivational Enhancement Therapy …………………………………………… 57 Stages of Change Model ……………………………………………………….. 58 Motivational Interviewing Model ………………………………………………. 61 A Narrative Approach …………………………………………………………… 65 CHAPTER IV: LITERATURE REVIEW – SELF The Notion of Self ……………………………………………………………… 69 The Adolescent Girls’ Sense of Self ……………………………………………. 73 CHAPTER V: LITERATURE REVIEW - SPIRITUALITY The Spiritual Journey……………………………………………………………….. 79 What is Spirituality?.................................................................................................... 80 Spiritual Assessment and Intervention……………………………………………… 81 The Link Between Spirituality and Health………………………………………….. 82 A Historical Connection to Spiritual Healing……………………………………….. 84 An Aboriginal Connection……………………………………………………….. 84 An Asian Connection…………………………………………………………….. 85 A Western Connection…………………………………………………………… 85 The Spiritual Connection to Eating Disorders………………………………………. 86 Down Through the Ages………………………………………………………… 86 viii The Spiritual Connection Today………………………………………………… 88 In Search of the Spiritual Life……………………………………………………….. 89 A New Definition of Spirituality…………………………………………………….. 90 The Role of Faith…………………………………………………………………….. 93 The Value of Truth…………………………………………………………………… 95 The Power of Forgiveness…………………………………………………………… 97 Limitations of a Spiritual Approach…………………………………………………. 98 Spiritual Themes in Eating Disorders……………………………………………….. 99 CHAPTER VI: LITERATURE REVIEW – EATING DISORDERS What Are Eating Disorders?........................................................................................ 102 Prognosis………………………………………………………………………… 102 Recovery………………………………………………………………………… 103 Mortality………………………………………………………………………… 103 Age of Onset……………………………………………………………………. 104 Food Avoidance Tactics………………………………………………………… 104 Increased Risk of Suicide……………………………………………………….. 105 Co-Morbid Psychiatric Illnesses………………………………………………… 105 Increased Social Isolation……………………………………………………….. 106 Other Substance Use…………………………………………………………….. 106 A Historical Overview………………………………………………………………. 107 Changes Over the Last Twenty-Five Years…………………………………………. 108 Diagnosis………………………………………………………………………… 108 Etiology………………………………………………………………………….. 108 ix Treatment………………………………………………………………………… 109 Medications………………………………………………………………………. 109 The Diagnostic and Statistical Manual of Mental Disorders Criteria………………… 111 DSM-IV Criteria – Anorexia Nervosa…………………………………………… 112 DSM-IV Criteria – Bulimia Nervosa……………………………………………. 112 DSM-IV Criteria – Eating Disorders Not Otherwise Specified…………………. 113 DSM-VI - Developmental Risks………………………………………………… 114 An Alternative Classification – Great Ormond Street Criterion……………………. 114 Anorexia Nervosa…………………………………………………………………… 116 Medical Implications……………………………………………………………. 117 Bulimia Nervosa…………………………………………………………………….. 119 Medical Implications……………………………………………………………. 120 Socio-Cultural Factors………………………………………………………………. 121 Advertising……………………………………………………………………… 122 Fashion…………………………………………………………………………... 124 A Cultural Link………………………………………………………………….. 124 Eating Disorders - The Pros and Cons………………………………………………. 126 Eating Disorders - Recurring Themes……………………………………………….. 131 Perfectionism…………………………………………………………………….. 131 Hopelessness and Helplessness………………………………………………….. 132 A Sense of Control……………………………………………………………….. 132 Ambivalence……………………………………………………………………… 133 Issues for Future Consideration……………………………………………………… 133 x CHAPTER VII: LITERATURE REVIEW – ART THERAPY Art Therapy………………………………………………………………………….. 135 Historical Overview……………………………………………………………… 138 Art Product Versus Art Process………………………………………………….. 139 Evolution…………………………………………………………………………. 142 Today…………………………………………………………………………….. 144 Why is Art Therapy Important?.................................................................................... 146 Goals of Art Therapy…………………………………………………………….. 149 Tools of the Trade………………………………………………………………... 149 The Use of Art Therapy with Eating Disorders……………………………………… 151 Limitations of the Experiential Process……………………………………………… 154 Observations…………………………………………………………………………. 155 CHAPTER VIII: LITERATURE REVIEW – CREATIVITY Origins of Creativity…………………………………………………………………. 159 Social Psychology………………………………………………………………... 163 Narrative Perspective…………………………………………………………….. 163 Constructivist Meaning Making…………………………………………………. 163 Flow Theory……………………………………………………………………… 164 Creativity as a Process of Self-Actualization……………………………………. 164 Art Therapy and Creativity – A Special Connection………………………………… 165 Creativity/Art Therapy – The Role of the Unconscious………………………… 165 Creativity/Art Therapy - The Transitional Object……………………………….
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