Building the Neurodiversity Bridge: A Grounded Theory Examination of Popular Culture Perseverations in Art Therapy with Individuals with Autism Spectrum Disorders by Jessica Woolhiser Stallings A Culminating Project and Dissertation Submitted to the Faculty of the Graduate School, Mount Mary University In Partial Fulfillment of the Requirements for the Degree Doctor of Art Therapy Milwaukee, Wisconsin May 2019 ii © Copyright by Jessica Woolhiser Stallings ALL RIGHTS RESERVED 2019 iii iv Abstract Art therapists may be unique in their ability to build a therapeutic relationship with people with Autism Spectrum Disorders (ASD). One strategy in working with individuals with ASD is to bridge the goals of therapy with clients’ perseverative or repetitive interests. Art therapy literature has focused on the advantages of working visually with these clients. However, little attention has been paid to how art therapy can also integrate these clients’ special interests from popular culture and adapt them into personally meaningful symbols and metaphors that help individuals connect with their world. The author sought to develop a facilitative therapeutic framework for the integration of perseverative interests derived from popular culture into art therapy using a grounded theory study that examined the role of perseverative interests in therapeutic relationships with individuals on the spectrum. Grounded theory analysis was conducted on data from art therapy clinical notes from 8 clients with an ASD diagnosis, documentary footage, and a videotaped walk-through interview with a child with ASD. The study identified 6 ways in which popular culture can function in the art therapy relationship with clientele who have autism: (a) as behavioral reward, (b) as social initiator, (c) as social facilitator, (d) as personal metaphor, (e) as anxiety mediator, and (d) as communication clarifier. Study results were organized into a creative portfolio and website that articulates how to integrate these interests within art therapy with clients with ASD while respecting the systems within which this therapy occurs. Visit the resulting website at www.arttherapyandneurodiversity.com. v Keywords: art therapy, autism spectrum disorder (ASD), neurodiversity, neurodivergent, popular culture, perseverative interests, restricted repetitive behaviors, grounded theory vi Acknowledgements Thank you to my committee chair, Dr. Lynn Kapitan, for being supportive yet challenging and for helping me to embrace my role as a leader in our field. Thank you especially for holding my hand through unexpected bumps in the process and your seemingly endless energy and enthusiasm for art therapy! Thank you to my committee members Dr. Chris Belkofer, Dr. Penelope Orr, and Dr. Máire Johnson for your time and expertise. Thank you Dr. Bruce Moon for challenging me to embrace my artist and researcher identity from day one in the DAT program. Thank you to Alex Kapitan for copy editing! Thank you to my Emporia State family Libby, Gaelynn, and Trina. Without your friendship and support, I would have never gotten here. Thank you to my doctoral cohort Huma, Kai, Melanie, and Tzafi—thanks for being “so extra” with me! Thanks for your support, humor, insights, and inspiration throughout this process! I am richer for knowing you all and can’t wait for our reunion! Thank you to my parents Jim and Debbie and my brother Josh for your encouragement, inspiration, and love throughout my educational journey. Thanks to my in-laws Fran and Gordon for your curiosity and support. Finally, thank you to my husband Ben for your seemingly endless love and support. Thank you for being my cheerleader and for grounding me. Dedication I dedicate this project to my clients—past, present, and future. Thank you all for helping me build a bridge to your worlds. vii Table of Contents Acknowledgments and Dedication ..................................................................................... vi List of Figures ..................................................................................................................... xi Chapter 1: Introduction ........................................................................................................ 1 Significance to the Field of Art Therapy ................................................................. 2 Current Practice and Research ..................................................................... 3 Bridging Neurotypical and Neurodivergent Realities ................................. 5 The Need for Practice-Based Research Knowledge .............................................. 12 Organization of the Contextual Essay ................................................................... 13 Chapter 2: Literature Review and Contextual Framework ................................................ 16 Understanding Autism Spectrum Disorder ........................................................... 16 Autism Spectrum Disorder as Described in the DSM-5 ............................ 16 Restricted Repetitive Behavior ...................................................... 18 Perseverative Interests ....................................................... 19 Sensory Symptoms ............................................................ 20 Social Communication and Understanding ................................... 21 Co-Occurring Anxiety Disorders .................................................. 22 Neurological Theories for ASD Symptoms .............................................. 22 Empathizing–Systemizing Theory ................................................ 22 Weak Central Coherence ............................................................... 23 Multi-System Brain Disconnectivity-Dissynchrony and Temporo-Spatial Processing Disorders ......................................... 24 Executive Dysfunction .................................................................. 25 Inner Speech .................................................................................. 26 Neurodiversity ........................................................................................... 27 Psychological Theories of Development and Addressing ASD Symptoms in Therapy .................................................................................................................. 29 Psychoanalytic and Psychodynamic Theories ........................................... 30 Attachment and Intersubjectivity Theories ............................................... 39 viii Child-Centered Play Therapy ........................................................ 43 Joint Attention ............................................................................... 45 Art Therapy and Intersubjectivity ................................................. 47 Cognitive and Behavioral Theories ........................................................... 52 Behavioral and Learning Theories ................................................ 52 Cognitive Theories ........................................................................ 55 Cognitive Behavioral Therapy .......................................... 57 Applied Behavior Analysis ................................................ 61 Developmental Art Therapy .............................................. 64 Socially Related Psychological Theories .................................................. 66 Bioecological Systems Theory and ASD Treatment ................................. 69 Principles of Ecological Systems Theory ...................................... 69 Proximal Processes ............................................................ 71 Systems .............................................................................. 74 Process-Person-Context-Time Model ........................................... 75 BST and Therapeutic Applications ............................................... 78 BST and Art Therapy ........................................................ 78 Systems-Based Therapies .................................................. 80 Art Therapy’s Role in Addressing ASD Symptoms .............................................. 83 Systemic Factors in Art Therapy With Individuals With ASD ................. 84 Mesosystem of Client and Therapist ............................................. 85 Systemic Properties of Art Therapy Expression ........................... 86 Popular Media and Culture in Art Therapy ............................................... 88 Popular Media and Culture in Art Therapy With Individuals With ASD .................................................................................................. 95 Sociopolitical Influences on Art Therapy Outcomes With Individuals With ASD .................................................................................................. 98 Conclusion ............................................................................................................. 99 Chapter 3: Project Details and Ethical Considerations .................................................... 102 Methodology ........................................................................................................ 102 ix Data Collection ........................................................................................ 103 Data Analysis ........................................................................................... 108 Ethical and Validity Considerations .................................................................... 114 Ethics of Online Dissemination of the Results .......................................