child, but you can control how you move on from it. You can make a decision about how these horrible events will continue to shape your experience of the present moment. It is bad enough when terrible things happen to us, but to succumb to these events and their influence through self-inflicted perpetuity is to always feel pain.
“Easier said than done,” you might say, and you would be right. But it begins with making the choice, with realizing that holding onto a lovely fantasy that only causes you heartache is not a way of honoring the dead or the lost, but a form of self-punishment. Equally, beating yourself up over things you might have said or done, or failed to say and do, is to place the work of forgiveness in other people’s hands, and absolve yourself of responsibility. In this vein, the work of grief is the work of growth, defined by a revisiting and revising of our attachments, through the process of integration. It is a choice between contracting into a victimized identity, or “discovering grace” on the other side of helplessness and surrender (Tolle, 2004).
What is integration? In essence, integration is how we observe, understand, interact with, create, and communicate our life story. Integration has been defined through various stage theories, models of change and research methodologies, many of which you will find illuminated in this text. Less important is discerning which of these approaches to dealing with grief is the “right” one; more important is discovering which one resonates for the individual. Like a thumbprint, no two persons are the same, and so it is with how we make meaning of our stories. Integration is the work of discovering what is ours, and what was given to us. What we want to keep and what we want to change. It is not finding the missing pieces of a puzzle—we are already whole and always have been—it is a reshaping of the puzzle to include all the pieces that need fit.
Integration doesn’t happen overnight. Relying solely on time to heal a wound, however, inadequately bandages an untreated infection. Only through a concerted effort to confront the depths of our pain and the origins of its structure is it possible to feel the sun on our face. In C.S. Lewis’s (1961, pp.52–53) A Grief Observed he notes, there was no sudden transition from fear, anger, grief and pain to warmth and light. It was “like the warming of a room or the coming of daylight. When you first notice them, they have been already going on for some time.”
Art therapy and short-term treatment
If the work of integration is equivalent to reshaping our psychic puzzles to fit all the necessary pieces, then art therapy challenges us to create that puzzle in a tangible way. A theory may suggest a particular outcome based on an educated guess, but it is only through experimentation that an extraneous variable makes itself known, serving to validate, disprove and/or revise our original thinking. Through a willing suspension of disbelief, creative acts allow for this element of the unknown; we accept, for a moment, we don’t know everything, and are willing to try a new way of perceiving. This suspension allows us to watch a film, read a book, gaze at an abstract painting, or play a song and experience emotional resonance, which may be derived of fictional content, but nonetheless helps us solve real life quandaries.
In the context of art therapy, we might refer to these “extraneous variables” as sensations, metaphors, images and/or personal symbols that bubble up from the unconscious to deliver their own critiques of our conscious “self” theories. It is the responsibility of the art therapist to contain, assist, and mirror, in this fantastic “transitional space,” what reconciliation lies between the client’s inner and outer worlds (Winnicott, 1970). To meet this challenge, the art therapy student and working professional benefits from three things: knowledge of theory, an experiential understanding of its applications, and a mastery of implementation. Adhering to this philosophy, the content of this book was divided into three parts:
Part I: Examines grief and attachment, including definitions and key terms, existing change and recovery models, a developmental framework, a bio–psycho–social–spiritual perspective, and a discussion of directive and non-directive art therapy approaches.
Part II: Examines through the art-based self-studies of art therapists the intra-psychic journey of addressing the grieving process. Methods, procedures, and a discussion of themes are organized in an instructional manner for ease of replication.
Part III: Examines through the implementation of art therapy interventions with various populations the observable journey of integration in the grieving process. Methods, procedures, and a discussion of themes are organized in an instructional manner for ease of replication.
According to its website, the American Art Therapy Association (AATA) represents more than 5000 professional art therapists across the globe (and others who hold the belief that the creative process involved in art making is healing and life enhancing). A survey conducted of its members in 2013 revealed over two-fifths (41.9%) of respondents work with “Mood or Anxiety Disorders,” and “Posttraumatic Stress Disorder” was chosen by 30.7 percent of respondents. The American Psychological Association offers four “psychological effects” of mood disorders and PTSD: depression, generalized anxiety, survivor’s guilt, and grief and loss. Additionally, risk factors for complicated grief, which is a prolonged, dysfunctional experience of grief, include being a woman, a history of mood disorders, low social supports, insecure attachment style, positive care giving with the deceased, and pessimistic temperament and personality correlates—all of which “suggests common underlying vulnerability” (Shear et al., 2011). It is the argument of this author that the “underlying vulnerability” quite clearly relates to one’s fundamental attachment dynamics, and this has predictive and possibly protective implications for the experience of grief.
Much of the psychotherapeutic literature consists of studies and case examples that have been conducted over a long period of time, and in private practice. But many art therapists working in institutional settings engage their clients on a short-term basis, due to the terms of their employment (per diem work, volunteer positions, or internships are typically limited in their scope), the nature of the setting (such as in acute care, hospice, rehabilitation centers, foster care programs, or transitional programs and residencies), or because the clients are ambivalent about engagement and have no external incentive to participate (such as in community-based programs, outpatient programs, and harm reduction programs). A short-term treatment model was selected for this reason.
Studies of brief interventions and short-term treatment models have been conducted in a wide range of healthcare settings, from hospitals and primary healthcare locations (Babor et al., 1994; Chick, Lloyd, and Crombie, 1985; Fleming et al., 1997; Wallace, Cutler, and Haines 1988) to mental health clinics (Harris and Miller, 1990). Because they are timely, focused, and client centered, short-term treatment models can quickly enhance the overall working relationship with clients and can be useful for addressing specific behavior change issues in treatment settings. Interventions administered in short-term treatment are usually structured and focused. Its primary goals are to raise awareness of problems and then to recommend a specific change or activity that moves a client towards a new conception and/or experience of their problems (in the context of this text, the experience of grief and loss, and related attachment disturbances).
Additionally, while scholarly in nature, this book provides its readers with hands-on activities for working with grief. It is my fantasy that when the art therapist working in an institutional setting is asked to create a “billable” treatment plan, he or she will be able to pull out this book and feel up to the task, fearing the auditors and regulatory bodies who are ignorant to the benefits of art therapy no more.
How to read this book
If you have picked up this book and perused the introduction, grief has likely touched you or your clients in some fashion. My recommendations for considering its contents are as follows:
If you are a student in training, I ask you to consider your motives for exploring the topic of grief, and examine what unfinished business
