A BRIEF ART THERAPY HISTORY LESSON
In Guggenbuel’s Abenberg and Karl Kahlbaum’s Pedagogicum institution, aesthetic impulses were strongly applied. This impulsive progression led to the inclusion of some form of occupational therapy into practically every physical and mental health institution. Occupational therapy is usually determined by the different materials available, what the patient prefers to do and whether the primary motivation is enjoyment or occupation. Among the variety of activities successfully introduced were aesthetically directed art and handicrafts (Harms, 241).The various activities were conducted to acquire insight into tendencies/desires that may not be easily gained from verbal expressions. In the early days, artists, teachers and clinicians believed that art expression provided an enduring, moving and human experience.
“Neurotics find art a welcome means of expressing or trying to express experiences they are unable to verbalize. After having gotten into the swing of art therapy, they may even draw experiences they cannot and do not want to talk about” (Harms, 242).
The history of art therapy is characterized by a “rather long gestation period followed by a period of spectacular growth” (Agell, 8). Most of the early course work was a review of professional experience and case material derived from work with hospitalized patients, private clients, behavioral problem children and special schools. In the 1930s in the United States, art therapy was recognized in literature due to the efforts of Margaret Naumburg. Margaret Naumburg was a 20th century psychologist and she helped coin the term “art therapy”. Her book, Dynamically Oriented Art Therapy was published in 1966 and it illustrates how art therapy uses a psychodynamic approach that emphasizes the role of the unconscious. Naumburg believed that art could bring out unconscious feelings and she used art to help clients resolve interpersonal conflicts.
“By the 1960’s five institutions offered a total of seven courses in art therapy, taught by four art therapists and in 1971, there were four programs offering master’s degrees in art therapy” (Agell, 8).
In 1969, the American Art Therapy Association was founded and art therapists gained a structure for promoting their field. Art therapy training must develop to meet the needs of a discipline that was complex from the start and is not growing simpler. Currently, the United States offers 22 graduate programs containing concentrations or degrees in art therapy, 41 undergraduate programs offering preparation for graduate level study, lastly, 28 colleges/universities that offer one or more courses in art therapy (Agell, 9). Art therapy is presently applied in a more broader range of settings than was the case years ago.
EATING DISORDER OVERVIEW
According to the textbook, Abnormal Psychology by William Ray, eating disorders are defined as “inappropriate and unhealthy behaviors related to the intake of food.” The three major eating disorders are Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder (BED). Higher rates of prevalence for eating disorders exist in industrialized societies where food is plentiful and popular culture places a high value on “the perfect body image.”
Anorexia Nervosa occurs when individuals restrict food so their weight is below normal, they have a fear of gaining weight, they lack recognition of the seriousness of current body weight and they have a distorted perception or one’s body. In relation to distorted body image, an article by Simona Giordano illustrates how individuals with anorexia nervosa perceive themselves in the mirror.
“Anorexics have seemingly contradictory beliefs, they believe they are too thin, but they also believe they are too fat. Body image perception is a complex process, it includes cognitive processes (how people think they look like), affective responses (how they feel they look like) and optative responses (how they want to look like)” (Giordano, 247).
The anorexic patient desires to become very small as to disappear. Which in a way is contradictory because extreme thinness is very noticeable. The anorexic patient not only pursues thinness, but also lightness. This pursuit is unrelenting to the point that lightness itself becomes heavy, burdensome and unbearable.
“The deep irony that loiters in Anorexic Nervosa, the more vulnerable and frail one becomes, the stronger and more powerful they may feel, because weakness is the sign that one is mastering and transcending the bodily, vulnerable and corruptible nature and is closer to floating in the universe” (Giordano, 249).
To go along with the article about body image, anorexia nervosa is associated with a specific endophenotype that’s connected to anxiety and perfectionism. The distortion in body image is from the anxiety to appear perfect and in result of this stress, anorexic’s view their body as being larger than it actually is. There are two subtypes of anorexia nervosa, the first is the restricting type in which the individual accomplishes weight loss through dieting, fasting or excessive exercise and the second is binge eating/purging type in which the individual engages in episodes of binge eating or purging through self-induced vomiting or the use of laxatives, diuretics or enemas.
BULIMIA NERVOSA & BINGE EATING DISORDER
Bulimia Nervosa and Binge Eating Disorder (BED) have similar characteristics in that they’re defined as periods of overeating in which the person feels out of control. However, individuals with Bulimia Nervosa participate in purging while individuals with BED do not purge. As opposed to the extreme thin physique of an individual with anorexia nervosa, those with bulimia nervosa usually display a normal body weight and those with BED are commonly overweight. The causes of bulimia nervosa are uncertain at this time, however, one’s self-worth is seen in relation to one’s weight or body shape (Ray, 358). Some of the common characteristics of Binge Eating Disorder is eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not feeling physically hungry and feeling depressed or guilty after overeating.
Study on Binge Eating & Negative Self-Awareness
I read a journal article about how binge eating is related to negative self-awareness, depression and avoidance-coping in undergraduates.
Heatherton and Baumeister’s Theory states that, “binge eaters have high levels of negative self-awareness and dysphoric mood states that combine to create a negative view of the self, from which the individual tries to escape” (Schwarze, 645).
In the article, negative self-awareness is defined as the combination of low-levels of positive self-esteem and high-levels of self-focused attention. Additional means of coping via escape include the use of avoidance coping strategies, dissociation and substance use. Therefore, research supports the hypothesis that those who binge eat have a negative view of the self.
– 207 female undergrads from a private Roman Catholic University in the Midwest.
-43 individuals in the Binge Eating Disorder (BED) group.
-164 individuals in the Non-Eating Disorder (NED) group.
-The first objective was to test the association between binge eating and negative self-awareness extending beyond negative body image or body dissatisfaction.
-The second objective was to test multiple forms of escape.
-The third objective was to ascertain whether between-group differences on levels of avoidance coping, dissociation and substance use remain significant when depression is controlled.
-The first hypothesis was that groups would differ on levels of depression, self-consciousness and self-esteem with the BED group scoring higher on depression and self-consciousness and lower on self-esteem measures than the NED group.
-The second hypothesis was that between-group differences would be found on the levels of avoidance coping, substance use and dissociation, with the BED group using more avoidance coping strategies and exhibiting higher levels of substance use and dissociation than the NED group.
The female participants were given various questionnaires and tests such as the Self-Conscious Scale (SCS), Rosenberg Self-Esteem Scale (RSE), Beck Depression Inventory-Second Edition (BBI-II) were used to measure negative self-awareness. The measures of escape included three questionnaires assessing coping strategies, a measure of substance abuse and a measure of dissociation (Dissociation Experiences Scale). Along with the questionnaires, a demographic one was also administered. The purpose of the demographic questionnaire was to obtain general information about the study participants. Some of the variables included gender, year in school, age, ethnicity, religious affiliation and history of childhood sexual or physical abuse (Schwarze, 648).
The results concluded that the BED group scored higher on depression and self-consciousness and lower on positive self-esteem than the NED group. This result is consistent with the negative self-awareness component of Heatherton and Baumeister’s theory. The finding is also mostly consistent with the escape from the negative self-awareness component. No between-group differences were found on dissociation in this study. Substance use turned out to be a significant, persistent variable, suggests that continued emphasize on substance use awareness and intervention at the college level is important.
In relation to the two studies about anorexia nervosa body perception and binge eating negative self-awareness, eating disorders are complicated disorders that stem from internal processes in the mind. These negative mindsets make individuals with eating disorders, a lot of the time refuse treatment. The average eating disorder will last two to seven years once it has been diagnosed and the client enters treatment.
ART THERAPY BENEFITS
“Art therapy has the advantage of gaining the trust of the client by using a non-threatening approach that allows for control of the physical body, the art media and the degree to which the client will disclose personal material” (Liang, 3).
Art has the ability to move the eating disordered client towards trusting and expressing their own feelings and abilities. Rather than being “perfect” in their art, clients are encouraged to express genuine feelings. Art can act as an intermediary step connecting the intellect (words) with the body (movement). Art can be a record of the therapeutic process and serve as a life-long testament to the client-therapist-group member relationship. It’s always important to know who supports you and it’s crucial to remember that people have the potential to care and listen. If a client can effectively learn to express emotions through art therapy, they may become inspired to confront other difficulties in their life (including their eating disorder) with creativity, confidence and self-expression (Liang, 3).
Aristotle once quoted, “the soul never thinks without an image” (Wadeson, 241).
The economy of art can condense into an image, often more expressively and personally than the traditional narrative of a paper. Educators are beginning to realize that material with an emotional impact is often more thoroughly integrated and longer retained than learning that is apprehended at an intellectual level only. The personal attachment to creative work enables the individual to become involved in learning on a deeper level, and the autonomy/sense of achievement enhances the confidence and self-esteem important to the beginning therapist. Problem areas can be addressed through the art product to further the individuals understanding. Self-awareness is essential for any therapist. Spontaneous picture-making and processing provide a rich opportunity for self-awareness (Wadeson, 242). In this way, individuals explore their dreams, family relationships and self-image. The therapeutic encounter embodies the elements of a creative endeavor, rather than a more scientific approach.
According to an article by Inger Anne Sporild and Tore Bonsaksen, there are a couple main therapeutic factors in art therapy for individuals with eating disorders.
Support & Group Cohesion
Cohesion refers to the value of the group for its members and a sense of unity/solidarity between the group members. Group cohesion may promote activity, engagement and mutually preformed activities may promote cohesion. Using activities in groups provides a unique opportunity to facilitate safety, mastery and community feeling.
Self-revelation refers to the therapeutic aspect of allowing yourself to show others who you really are. Revealing the true self within the boundaries of a warm and accepting group can be an emotionally powerful experience. Openness towards feelings and expression through the picture and subsequent group discussion, seems to be an important aspect of the emotional work of individuals with eating disorders.
Interpersonal learning encompasses two different, yet related aspects. The input aspect refers to the individual learning from the feedback they receive from the group. The feedback concerns the individual’s interpersonal style or pattern of behavior towards others. Feedback can be given as education or guidance directly attuned to the individual. It can also be given indirectly, such as learning by paying attention to a group member’s behavior (modeling) or processing of events (vicarious learning). The interpersonal output concerns how the individual makes use of the groups feedback to practice new ways of managing interpersonal relationships.
FEMALE ANOREXIA NERVOSA CASE STUDIES
Within the case studies that I have selected, the inpatient facility houses patients with anorexia nervosa, the patients undergo a combined program of behavioral techniques and individual/family psychotherapies in which the use of art therapy techniques is strongly encouraged. The treatment has three phases. The first is the nutritional rehabilitation phase (with a goal of reversing the starvation state. The second is a weight gain phase (with a goal set individually for the tenth percentile for height). The third is a maintenance phase at that weight (with a goal of autonomous body weight) (Wolf, 186-187). The art therapist meets individually or in groups with patients once or twice weekly throughout the hospital stay, which averages 3 months. Within the individual art therapy, patients have free, unstructured use of various materials in which the therapist encourages expressiveness without particular structure.
“H.R.” Case Study
The first individual is “H.R.” she entered the hospital at age 21 after a 1 ½ year history of losing weight but lost weight more rapidly over the last six months. She developed concern about her weight and attractiveness when she was in Europe for the armed forces. She’s the oldest of four children with a chronically depressed father and an anxious mother. In the armed forces, she developed depression and suicidal ideation. During an art therapy session, H.R. drew a picture of an idyllic meal. She was angry that she had to eat so much, while other patients talked about their diets (Wolf, 190).
“V.G.” Case Study
The second individual is “V.G.” she began losing weight at age 15 ½ after being teased about her weight. She was hospitalized twice before she was transferred to the psychiatric unit at age 17. V.G. was a model student and the youngest of four children. She had an older brother who had a psychiatric disturbance. She lives with her father who is openly critical and sarcastic and her somewhat overbearing mother. She broke up with her boyfriend after beginning to lose weight. During an art therapy session, V.G. drew the head of a cyclops. She described the figure as deformed, with earmuffs on to “act out” against the mocking mouths surrounding the head. At the time, V.G. was concerned that the staff was ignoring her anxiety about her weight. She was also becoming increasingly aware of her father’s teasing and sarcastic criticism. The cyclops represents her feeling of herself as deformed and mocked (Wolf, 191).
“P.A.” Case Study
The third individual is called “P.A.” she is 20 years old and had been symptomatic for 1 ½ years. She had two prior medical hospitalizations before her admission to the inpatient facility. Her symptoms began when she left home to begin college. She was the youngest of five children. Her father was withdrawn and depressed and he had a chronically unhappy marriage with her mother. Her mother was domineering and emotionally controlling. Two of her siblings also had psychiatric problems. During an art therapy session, P.A. drew a picture of a moon, describing that the moon did not seem real because it wasn’t constant. She associated her fluctuating emotions with the fluctuating moon, because she had no control over her feelings. She explained that her feelings did not seem “real” and were therefore untrustworthy. At the time, she was moving towards being discharged from the facility and she was doing all the right things in terms of diet. However, she still felt anxious about the intensity of her feelings and desired for them to be constant and in control (Wolf,192).
Relating back to the case studies, art serves as a very good indicator of both the issues and conflicts occupying the patient, as well as the defenses utilized to deal with conflict. A picture may be worth a thousand words, but perhaps more importantly, a picture may express what the patient lacks words to describe (Wolf, 198).
MALE ANOREXIA NERVOSA CASE STUDIES
These next set of case studies were very difficult to find. I am curious as to why there are not a ton of case studies done on the effect of art therapy on male eating disorder patients. These case studies were collected in a thesis done by Elizabeth Helen Beck for the Masters of Arts in Creative Arts Therapy at Drexel University.
Doug Case Study
The first case study involving art therapy with an eating disordered male was written by Connie Naitove. The individual is a 16-year-old named Doug who suffered from anorexic and bulimic symptoms. Doug’s home environment was difficult due to marital discord between his parents, in which he was frequently directly involved. His mother had successful battles with cancer when Doug was 9 and 14 years old. Ten months prior to his arrival in the United States, Doug’s parents separated and his father moved out of the house. Upon admission to therapy, Doug was 6’0 and 110 pounds (Beck, 81).
At the start of therapy Doug addressed a couple goals, which were to gain weight, handle his obsession with his parent’s separation and to free himself from his mothers dependency and fears related to cancer. Naitove used an eclectic approach combining art, drama, movement and poetry, as well as transactional analysis and creative analysis in a therapeutic setting.
“With regards to the creative art therapy sessions, Doug would often choose to stand during sessions while the therapist presumably sat, stating that it allowed him to feel more in control. The patient also began refusing to include positive self-images or self-statements in his artwork and journal entries” (Beck, 82).
Feelings of guilt, ambiguity and the need for control were present in Doug’s artwork and verbalizations. One of Doug’s artwork depicted a lifesize figure that was faceless, monochromatic and standing in an unbalanced position. Upon discharge, Doug had gained 10 pounds and was considered to have a brighter affect than upon admission.
Carlos Case Study
The second individual is Carlos, he entered inpatient treatment when he was 23 years old. Upon admission, Carlos was 5’9 and less than 84 pounds. He had been gradually restricting his dietary intake for four years and he was socially isolated. Carlos was the oldest of six children and when he was 2 years old, his mother married a man who wasn’t his biological father. Carlos was not aware that this wasn’t his biological father until it was revealed in a family therapy session (during inpatient treatment).
“When admitted to the hospital, Carlos signed a therapeutic contract in which he agreed to remain in a private room with a bed and washroom until he met his goal weight. This took approximately 10 months to achieve” (Beck, 88).
Most of Carlos’s artwork seems to have been produced without the presence of the art therapist. He also admits creating numerous sketches before creating his final product, this was seen to indicate a need for control in his life. During his sessions, a couple themes emerge from his artwork. Some of the themes include, “the struggle to separate from the internalized mother, or mother image, the womb, fetuses, eggs and bubbles (recurring metaphors), control, dependency, passive aggression and regression, crucifixes and the sun” (Beck, 90-91).
Eventually, Carlos began eating normally and stopped trying to manipulate his weight by hiding food or vomiting after meals. This period corresponds to a series of violent and aggressive images such as cloaked figures stabbing one another. This may indicate that long, repressed anger was beginning to come conscious for Carlos. After 10 months, Carlos reached his goal weight. He stopped making rough sketches before making his final product and he started using larger paper and paint. This suggests improvement in his ability to be flexible, spontaneous and less controlled in his thoughts and behaviors.
“His imagery seemed to suggest more confidence with his sexuality and his conceptualizations of masculinity, anger and power, as well as hopefulness for the future” (Beck, 93).
After treatment, Carlos went back to his family’s home where he was able to maintain a healthy body weight.
To conclude these two case studies, there is a quote within Beck’s thesis by Elise Warriner, an anorexic patient herself who describes the role of art therapy in the process of self-discovery.
“Strange as it may seem, anorexia and illustration have at least one thing in common. They are both about expressing oneself without using words, yet one is destructive and the other creative. One of the greatest assets of art therapy for me was that I had a creative space in which to explore my emotions. Putting emotions down on paper also helped to make them real. No longer could I reject them as a figment of imagination, invisible and therefore unimportant. To a certain extent, if anorexia was used as a numbing agent, art therapy brought the pain into the open” (Beck, 60).
PERSONAL EATING DISORDER JOURNEY
I guess you could say my fascination with art therapy and the effect it has on individuals with eating disorders is because I have personal experience. When I was in sixth grade, I began to struggle with body image. Along with going through the changes of puberty, I also felt the pressure to be perfect. I desired to be that perfect teen girl who’s thin, pretty, has good grades and an attractive boyfriend. Unfortunately, all this stress to have this “perfect” life got to me and as a way to cope I began stress eating.
Stress eating to the point where I would hide in my room after school and eat a whole entire box of granola bars (my binge snack of choice).
As time went on, I began to spiral downwards into a deep depression, in where I pushed my family and friends away. Within this dark period of my life I didn’t count how many calories I would consume in a day but now that I look back, I must have consumed around 3,000 calories in one sitting. In a result of stress eating I began to gain weight in all the wrong places. I would try to work out but not on a continuous basis, I would work out every couple days, spending hours running on the treadmill. So, I was stuck in this repeated cycle of feeling the enormous pressure to be someone that I wasn’t, feeling very depressed, binge eating to find happiness and then excessive exercising to keep the weight off.
The moment I realized I needed help was when I went ate an entire two boxes of my brother’s favorite granola bars and he was very upset/disappointed in me that I ate them all. To this day, it hurts me to reflect on that memory because I can feel the shame and loss of control that I was enduring.
I was so embarrassed with my behavior; however, my parents were very supportive of me and they offered the option of going to art therapy. As a kid, I was always very creative and I loved to do arts and crafts. I began art therapy at the end of 7th grade, I met with the art therapist once every week for about a year. During my sessions, I did multiple activities that helped me build a better body image and gain positive self-esteem. One activity that stuck out to me was when I was asked to draw a life-size outline of my body. Once I drew the outline I laid down on the drawing while the art therapist traced my body. Looking back at the drawing, I realized I had perceived my body to be way larger than it really was.
Throughout art therapy I learned many essential things. One of the most important things I worked on is building up my self-confidence through accepting my body for the way it was. Once I changed my mindset, things began to change for the better, I stopped binge eating and I switched to healthier snacks, I finally began to maintain a healthy weight, my attitude improved and I attended more social events. The process of creating art helped me through a difficult time in my life. Art therapy proved to be a positive experience and guided me towards living a better life.
BULIMIA NERVOSA CASE STUDIES
Marcia Case Study
The first individual is Marcia and she is a married woman in her early 40s. She has been bulimic for more than 15 years. She reported a history of serious depression, several extramarital affairs, a suicide attempt and the abuse of prescription medication (Hornyak, 149). During an art therapy session, Marcia was asked to draw a self-portrait of herself. Within Marcia’s self-portrait, her face is made up and her hair is styled. Her body is nude and reveals a detailed depiction of her digestive organs and a cartoon-like drawing of her heart. When asked to describe her painting, Marcia is bitter and says that she had become her digestive system. She is displeased with her small breasts and pretty face.
“When asked how she might make the picture more pleasing, she said that she would take a little off the thighs” (Hornyak, 151).
In result of Marcia’s reaction, the art therapist didn’t focus on Marcia’s bitter remarks and body distortion. Instead the art therapist focused on the cartoon heart and how it’s different from the rest of the drawing. The heart may represents self-love.
Candy Case Study
The second individual is Candy and she began treatment when she was 29 years old. She had been binge eating and vomiting for 10 years. Also, at the same time of treatment, she was a recovering alcoholic. She had a recent history of prostitution and drug abuse. Throughout most of her treatment she was living with her fiancé. During an art therapy session, Candy was asked to create an early memory. Candy created a color painting that depicted a child’s room. The room is shared by Candy and her younger sister. They are in bunkbeds and off in the upper right corner of the painting is an image of a witch. Working from this piece and Candy’s various paintings, the therapists formulated a view of a disengaged family with a powerful but emotional absent mother.
“By using art therapy techniques, therapists can gain access to deeply held issues that are often outside conscious recall or verbal recounting. Additionally, art therapy allows therapists to identify, describe and monitor the specific structural defects that are unique to each individual client” (Hornyak, 164).
OTHER ART BASED THERAPIES
Even though the majority of my research was conducted on the behalf of art therapy, I am also interested in traditional as well as arts-based therapies for individuals with eating disorders.
“In the past several decades, emergence of multidisciplinary approaches such as the incorporation of experiential therapies in combination with one or more traditional forms of therapy in the comprehensive treatment of eating disorders” (Frisch, 131-132).
Arts-based therapies include, music therapy, dance/movement therapy and creative arts therapy. Programs offer a wide variety of reasons for incorporating arts-based therapies, such as, self-discovery, self-exploration and self-expression. Other programs report that arts-based therapies allow clients to face and challenge issues such as self-esteem, body image, depression and the tendency to isolate by providing an alternative, healthy outlet for expression of emotions and development of positive coping skills.
Music is often used in the treatment of eating disorders as a tool for self-discovery or as a method for relaxation. A wide variety of songs may be used in this therapy and song selection is typically based on the individual characteristics of an individual or group. Music may be played during meal time to alleviate anxiety, psychological and physical discomfort that is often experienced after meals when patients can become preoccupied with thoughts of purging or feelings of guilt (Bibb,1). Case studies derived from patient’s experiences have described feelings of renewed self-confidence and empowerment through participation in music therapy.
Music Therapy Study
This study was conducted in an inpatient eating disorder program situated in an acute psychiatric unit. The program is for adults with severe anorexia nervosa, who were unable to recover through outpatient treatment. The average age of the patients is 22 years old and they are predominately young women. The study aimed to determine if participation in music therapy decreased subjective distress during post-meal support and to understand how participants described their experiences of music therapy during this time.
Eighteen participants attended music therapy intervention twice per week for the duration of their admission. During the music therapy sessions, participants were encouraged to partake in singing and listening to songs, talking about and sharing music with others and writing songs together. The music therapist maintained a perspective of unconditional regard instead of a more directive approach, common to cognitive behavioral therapy groups in inpatient eating disorder programs. The Subjective Units of Distress Scale was used to measure the participant’s anxiety on a 0-10 scale. 0 being “totally relaxed” and 10 being “highest distress/fear/anxiety/discomfort that you have felt” (Bibb, 2). After the meal, there was a one hour group session to evaluate feelings and offer encouragement on achieving goals.
In result of this study, participants reported decreased anxiety post-session compared with straight after lunch (pre-session). These results suggest that group music therapy is a more effective intervention for reducing meal-related anxiety than standard post-meal support therapy in an inpatient setting (Bibb, 4). Participation in music therapy may have acted as a cognitive divergence for patients, allowing time for the body to digest food while the mind was attending to something else that was engaging for them. The current study is the first to use music therapy post-meal time.
Dance/Movement Therapy is usually based on the idea that the body/mind are unconsciously/consciously connected and they strive to impact the mind through some type of direct work with the body. Positive effects on the body may often result in positive changes within the mind. Most approaches incorporate some form of psychotherapy with Dance/Movement Therapy. Others have incorporated Dance/Movement Therapy into body image therapy.
“By examining and experiencing different aspects of actual versus perceived body images, it is reported that the client is able to reach a more realistic perception” (Frisch, 136).
The body itself is tool and movement is the process used to effect integration and growth of the individual. Body image has conscious and unconscious components, which include positive investment in awareness of and control of the body.
A healthy body image is made up of three components.
1) A healthy body image is flexible,
2) A healthy body image is connected with the reality of the world.
3) The body image is three dimensional.
Dance/Movement Therapy Case Study
Ellie is a 23 year old woman and she has been anorexic for five years. She is also an incest survivor. The Dance/Movement therapist worked with her for nine months, once a week. One treatment goal was to increase her body awareness.
During therapy, they focused on awareness of sensations in specific body parts. Ellie’s pelvis was particularly stiff so they did various exercises for movement in that region. They also practiced touching exercises on the hand, foot and cheek.
“Through these exercises, Ellie was learning to use her other senses, in addition to sight, to become more aware of her world” (Hornyak, 273).
After 3-4 months, Ellie’s movements were stronger and clearer. She appeared less resistant and timid. Nearing the end of her sessions, Ellie complained that the dance/movement therapy room was too small, a symbol that she was getting healthier and needed more space for self-expression (Hornyak, 274). During the last session, Ellie created a movement that pushed her away from her therapist. She described the movement as a symbol for her freedom, such as like a bird experiences. Ellie says that she can repeat this particular movement in the future to remind herself of her own special spirit.
STANDARD THERAPIES & MEDICATIONS
According to the textbook, Abnormal Psychology by William Ray, as more standard therapies go, it’s often the family that pushes for treatment. Concerning underweight individuals, a hospital stay is usually required to help the individual gain weight. Following this, psychological or family therapy is the next step.
The Maudsley Approach is a popular method of therapy for adolescents with anorexia nervosa. This type of therapy is designed to take place in the family home rather than the hospital. The first goal is to help the adolescent gain weight without accusing them of having an eating disorder. The second goal involves the adolescent to take more control over their eating problem. The third goal is for the adolescent to develop/maintain healthy habits and personal autonomy (Ray, 355).
Cognitive Behavioral Therapy (CBT) is also a popular treatment method for individuals with eating disorders. CBT with patients with anorexia nervosa focuses on irrational thoughts, mood intolerance, clinical perfectionism, low self-esteem and interpersonal difficulties. CBT in those with bulimia nervosa usually begins with a psychoeducational and monitoring phase, which includes discussions of regular eating. This is followed by a cognitive phase that emphasizes techniques to eliminate binge eating and challenge obstacles to normal eating behavior. The final sessions discuss ways to cope with relapse.
“About 40-50% of individuals with Bulimia Nervosa treated with CBT recover” (Ray, 358).
Exercise combined with CBT are shown to be effective in individuals with binge eating disorder. As far as medications go, neuroleptics are used for treating psychosis in individuals with anorexia nervosa and fluoxetine (Prozac) has been show to treat the depressive aspects of bulimia nervosa.
Throughout the process of researching and coming across countless case studies, I have come to one conclusion, the process of arts-based therapies is healing in one way of another. From personal experience to reviewing case studies, creativity benefits the soul. I was scrolling through social media a couple weeks ago and I came across this amazing video about a Pakistani woman who found her purpose in life through painting. The woman, Muniba Mazari comes from a very conservative family and she was arranged into a marriage when she was very young. After two years of marriage, Muniba and her husband got into a very tragic car accident. Her husband jumped out to save himself and left Muniba with serious injuries. She had multiple fractures, along with a fractured spine that left her confined to wheelchair for the rest of her life. During the two and a half months she was in the hospital, she became depressed and desperate. Her spinal injury was so bad that she will never be able to walk again as well as give birth to a child.
Her quote, “I started to question my existence, why am I even alive,” was very heartbreaking to me.
Well, one day in the hospital she asked her brother to bring her some canvas and paints. Within the video, Muniba explained how painting was therapeutic and helped her convey what she couldn’t express vocally. Once she began painting, she decided that she was going to live life for herself and conquer her fears. Some of her fears included divorce and not being able to give birth. Well, she let go of her ex-husband and made herself emotionally strong. She also adopted a child from a very small city in Pakistan. Muniba decided to share her story publicly and she has begun to accept herself for who she has become because “giving up is not an option.” I find Muniba Marzari’s story very inspiring and in some terms, relatable. We all have struggles that we go through in life, some big, others small. Through expressing ourselves, whether it’s in the form of art, music, dance, etc, we find that the creative process is beneficial for us all.
Agell, G. (1980). History of Art Therapy. Art Education, 33, 8-9. Retrieved from, http://www.jstor.org/stable/3192414
Beck, E. (2007). Art Therapy with an Eating Disordered Male Population: A Case Study, 58-95. Retrieved from, http://idea.library.drexel.edu/islandora/objects/idea%3A2956
Bibb, J. Castle, D. & Newton, R. (2015) The Role of Music Therapy in Reducing Post Meal Related Anxiety for Patients with Anorexia Nervosa. Journal of Eating Disorders, 1-5. DOI: 10.1186/s40337-015-008-5
Frisch, M. (2006) Arts-Based Therapies in the Treatment of Eating Disorders, 14, 131-142. DOI: 10.1080/10640260500403857
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Pakistan's Iron Lady Muniba Mazari will tell you why failure is an option, but giving up is notTo watch the full video in HD or to embed it on your website, go here: http://bit.ly/2yuxnEE
Posted by Goalcast on Wednesday, October 18, 2017