Drawing the Line Art Therapy with the Difficult Client Lisa B. Moschini John Wiley & Sons, Inc. This book is printed on acid-free paper. o Copyright © 2005 by John Wiley & Sons, Inc. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. 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Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our website at www.wiley.com. Library of Congress Cataloging-in-Publication Data Moschini, Lisa B. Drawing the line : art therapy with the difficult client / Lisa B. Moschini p. cm. ISBN 0-471-68773-1 (pbk./CD-ROM) 1. Art therapy. 2. Drawing—Therapeutic use. 3. Psychotherapist and patient. I. Title. RC489.A7M675 2005 615.9'5156—dc22 2004049161 Printed in the United States of America 10987654321 This book is dedicated to the treasures of my youth: to my father, the late Giuliano P. Moschini, for you held my hand; and to my mother, Josephine, for you taught me to be myself. Together you provided a precious balance of wisdom, love, and compassion. Contents Preface xix Acknowledgments xxi Introduction: A Difficult Client Defined 1 In the Beginning 3 Interaction Is the Key 5 Developing the Language of Metaphor 10 Things to Come 15 PART I Defense Mechanisms and the Norms of Behavior 17 1 In My Defense 19 Intellectualization 21 Conversion 25 Condensation 30 Regression 36 Summary 43 2 Adaptation and Integration 45 Jean Piaget 53 Freud 71 Erikson 77 There Was, There Was, and Yet There Was Not 87 Collecting 94 Summary 97 v Contents PART II Reading Between the Lines 101 3Interpreting the Art 103 A Picture Is Worth a Thousand Words 106 Draw-a-Person (DAP) Examples 111 Draw-a-Person (DAP) Art Assessments 116 Case Illustrations 119 House-Tree-Person (HTP) 125 House-Tree-Person (HTP) Examples 130 House-Tree-Person (HTP) Art Assessments 143 Case Illustrations 143 Eight-Card Redrawing Test (8CRT) 151 Eight-Card Redrawing Test (8CRT) Art Assessments 152 Case Illustrations 153 Summary 165 4 Directives 171 Directives as Interventions 177 Summary 197 PART III The Practice of Art Therapy 199 5 Individual Therapy: Three Cases Revealed 201 Case Study 5.1 203 Case Study 5.2 216 Case Study 5.3 229 6 Group Therapy Illustrated 242 The Here-and-Now Interaction 245 Empathy 257 Self-Disclosure 265 7Two’s Company, Three’s a Crowd? Family Therapy Directives 274 Paired Communication Drawing 278 Family Mural Drawing 283 Case Study 7.1 285 Case Study 7.2 288 Appendix A: Structural Aspects: Quantitative Analysis 296 Appendix B: Formal Aspects: Qualitative Analysis of the Person 301 vi Contents Appendix C: Formal Aspects: Qualitative Analysis of the House 309 Appendix D: Formal Aspects: Qualitative Analysis of the Tree 312 Appendix E: Eight-Card Redrawing Test Adapted Scoring Sheet 315 Appendix F: Sample Directives 317 Appendix G: Sample Group Processing Directives 323 References 327 Index 335 About the CD-ROM 345 vii Tables 2.1 Parallel Patterns of Growth 52 2.2 Behavioral Reversion 53 2.3 Normative Behavior 85 2.4 Stories That Aid in Development 92 2.5 Myths That Aid in Development 93 3.1 Normative Stages in Children’s Art 126 4.1 Directives and Psychosocial Crisis 172 ix Illustrations I.1 Self-Portrait 4 I.2 Outside Mask: Sessions 1 & 2 6 I.3 Inside Mask: Sessions 3 & 4 7 I.4 Short-Timer’s Box 9 I.5 Flames of Passion 11 I.6 Memories of Sexual Abuse 12 I.7 The Winds of the Sun 13 1.1 At Home 22 1.2 Safe and Secure 22 1.3 Group Mural 23 1.4 Feelings of Loneliness 24 1.5 Mortar and Pestle 26 1.6 Feelings in Clay 27 1.7 Converting Memories of Sexual Abuse 28 1.8 Man without a Body 29 1.9 Hot and Spicy 29 1.10 The Blue Man and the Anger Microphone 32 1.11 The Blue Man and the Butterfly 32 1.12 He Tells Him to Do the Right Thing 33 1.13 Compartmentalizing His Emotions 33 1.14 Abandonment Feelings Well 34 1.15 The Symbol Remains the Same 35 1.16 Open Arms 36 1.17 The Snail Only Knows the Box 38 1.18 Erasing the Regression 38 xi Illustrations 1.19 When I Am Angry 39 1.20 Love Oasis Ignorance 40 1.21 Sexualized Symbols 41 1.22 Board and Care 42 1.23 The Good Things in Life 42 1.24 Life at the Board and Care 43 2.1 My Family 48 2.2 Examples of Oversized Heads 48 2.3 Dwarf Foot 49 2.4 Organic Tadpole Drawing 50 2.5 Acrylic Paintings 51 2.6 Fine-Line Markers 51 2.7 Anna at Age 12 Months 55 2.8 Anna at Age 17 Months 55 2.9 23-Month-Old Male 56 2.10 Dizzy, Mommy, Spinning Very Fast 57 2.11 Mommy and Avocado 58 2.12 Molly at Age Two and a Half 58 2.13 Anna’s Tadpole Figures 59 2.14 Anna at Age 4 Years 11 Months 60 2.15 LeAnn’s Three Houses 61 2.16 One-Dimensional Drawings 61 2.17 Anna at Age Six and a Half 62 2.18 LeAnn at Age 6 Years 9 Months 62 2.19 Anna’s Party 63 2.20 Anna Begins Classifying 64 2.21 Anna at Age 8 65 2.22 JoAnn at Age Nine and a Half 66 2.23 Carpinteria, California 67 2.24 JoAnn at Age 10 68 2.25 JoAnn at Age 10 Years 11 Months 68 2.26 A 14-Year-Old’s Questions 69 2.27 Equilibrium 70 2.28 The Electra Complex 74 2.29 Belying the Stage of Calm 76 2.30 Release and Adapt 78 2.31 Retain 79 2.32 Who Are You? 81 2.33 A Young Adult Answers “Who Are You?” 82 2.34 Where I Came From 83 2.35 The Snake 95 xii Illustrations 2.36 Superheroes 96 3.1 Structural Analysis 109 3.2 Draw-a-Person Sample #1 112 3.3 Bipolar Disorder with Psychotic Features 120 3.4 Bipolar Disorder without Psychotic Features 123 3.5A Schizoaffective Disorder, Depressed Type 129 3.5B Schizoaffective Disorder, Depressed Type 129 3.6 Major Depressive Disorder with Psychotic Features 137 3.7 Dysthymia 144 3.8 Adjustment Disorder with Mixed Anxiety and Depressed Mood 145 3.9 Organic Brain Syndrome Secondary to Substance Abuse 149 3.10 Conduct Disorder, Adolescent Onset, Severe 154 3.11 Draw-a-Person in the Rain 158 3.12 Schizophrenia, Paranoid Type 159 4.1 Letting Loose 173 4.2 Power and Control: Adolescents 175 4.3 Power and Control: Adults 176 4.4 Grief Work 177 4.5 Hands of Love 178 4.6 Female Hand Mural 179 4.7 Collage of Me 180 4.8 Help 181 4.9 The Flames of Anger 182 4.10 Rocky Mountain 184 4.11 Clouds of Loneliness 185 4.12 Evil Child and Happiness 186 4.13 It’s G.O.D. 187 4.14 Beethoven and His Home 188 4.15 Jungle of Illusion 188 4.16 2 Me, 4 Me 190 4.17 The Feeling behind My Anger 191 4.18 I Don’t Let People See 192 4.19 Pictorial Family Genogram 194 4.20 Accomplishment 195 4.21 The Group Bids Farewell 196 5.1 Log Cabin in the Ozarks 205 5.2 Children of Love 207 5.3 John’s Family 208 5.4 John’s Playthings 209 5.5 The House That John Built 210 xiii Illustrations 5.6 Completed Clay Project 211 5.7 Omish Land of Love 212 5.8 Quietness of Flowers—Mind Resting 213 5.9 Trees of Love 214 5.10 Closure Mural 215 5.11 Running from the Crime 217 5.12 Dion’s 8CRT 219 5.13 Something a Child Could Understand 222 5.14 Dion as an Infant 223 5.15 Dion at 8 and 14 224 5.16 Dion at 23 and 30 224 5.17 Man under Construction 225 5.18 Dion’s Crushing Powerlessness 226 5.19 Practice Makes Perfect 227 5.20 Ug, Thug, and the Rest of Paradise Island 232 5.21 Paradise Island 233 5.22 Ug’s New Home 236 5.23 The Island of Guidance