The Efficacy of Self-Care: Self-Efficacy through Art

Creating through painting has always been a part of my life, and a very valuable coping strategy for as long as I can remember. Since studying art therapy, I have become more and more aware of its value from a clinical standpoint. I took a year off from graduate school in art therapy, to get hands-on experience in the field. I wanted to test what I had learned thus far, plus I wanted to try to make a dent in the financial debt I had accrued.

Being around patients who have continued challenges, for which I am trying to soften through facilitating art sessions, comes with residual personal challenges. Since creating is an integral part of my life, I cope by painting. The above painting is the most recent expression of my unconscious world. I felt better when I was done, and I intuitively knew when I was done. But the relief was fleeting, leaving me with more self-analysis, and very few answers. I had a visceral sense of what I was processing, but not really. I then saw a profile of a face, that I enhanced on the right.

If all art is a self-portrait, a mirror as Bruce Moon so aptly puts it, then there I am clear as day. I’m looking away it seems, or looking toward something. Because there is such a pointed jagged image seemly piercing the back of my neck I should maybe consider this a bit more seriously. I consider the ETC, and see that yes, I got some relief from the kinesthetic and sensory expression while creating. Symbolically, there’s a bulls eye. The page is almost split right in half. The right side seems to represent a window with the blinds closed, and the bulls eye a need to peer in, or a need to contain it in the past. I don’t know. My question is; is it necessary to know? Do I need to understand the full potential of this painting, to transcend the message my soul is trying to convey? Can I truly be discerning without the guidance of another?

            I looked for answers through research. I inquired  through Research Gate. YES! I may have some answers. The first was a shared article by Dr. Martyn Queen of the University of Gloucestershire. Art Lift, Gloucestershire (Project Extension) Evaluation Report by Colin Baker, Lindsey Kilgour and Frances Clark Stone. Art Lift is a program where health professionals refer patients for this 10-week art program, usually delivered in a primary care setting. I have taken the National Center for Creativity in Aging Artist training, and am familiar with programs created by artists in various parts of the US.  This particular report evaluates the efficacy of such a program. The type of programming offers artist facilitators conducting their sessions at the facility. The report states that after 10 weeks of Art Lift, a key benefit included well being (enjoyment, new interest, improved confidence, distraction, therapeutic value). Many of the people who completed the 10 weeks, asked for another 10 weeks or more. These participants were recruited to participate in the study. The findings of this qualitative and quantitative report shows 4 key themes: Breaking the Cycle (of being defined by their condition), Sense of Control, Making Strides (acquiring meaningful skills) and Reconnecting.

            I was reminded of Albert Bandura, when on my search for studies on the efficacy of self-care in artists/art therapists. Since I’m not in the social science field, my studies haven’t taken me much past the "Bobo doll” experiment, but was happy to discover resources on self-efficacy. What I discovered is that I was really questioning was my own self-efficacy.  Isn’t that what the study was showing? Art creation was enhancing the realization of the participant’s ability for self-efficacy. In a way it was awakening and reminding them of what they had all along. In chapter 14 of Self-Efficacy for Adolescents, Bandura gives many examples of creating your own self-efficacy scales. This is something I intend to create for myself, in terms of my own self-care, and worth further investigation.

Check out this video of "Arts Prescribed" through HammondCare in Australia HammondCare "Arts Prescribed" in Australia

References

Baker, C., Crone, D., Clark-Stone, F. & Kilgour, L. (2013). Art Lift (Extension), Gloucestershire: Evaluation Report. University of Gloucestershire, U.K. 

Bandura, A. (2006). Guide for Constructing Self-Efficacy Scales. In Self-efficacy beliefs of adolescents (pp. 307-337). Charlotte, NC: Information Age Publishing.

Hinz, L. (2009). Expressive therapies continuum: A framework for using art in therapy. New York, NY: Routledge.

Moon, B. L. (1995). Existential art therapy: The canvas mirror. Springfield, IL, U.S.A.: C.C. Thomas.

Story Stones to Memory Stones: Activating Imaginative thought for Reminiscence

Storytelling has been around since humans have been on this earth. From visual expression through cave paintings, to historical oral traditions, passed on from generation to generation, it is a part of our collective unconscious. Knowing this fact, did not preclude me from being surprised, which I will tell you about momentarily.

Story stones are stones with predrawn images, that have been used to help stimulate the imagination and storytelling of children. They may have different faces with emotional expressions, along with objects and themes such as a house, a rainbow, a person, a tree, a book, etc. Picking from the stones, the child then composes his or her story. They have been used in therapeutic milieus, to stimulate the sharing of a traumatic event, and other issues difficult to discuss. As an activity director at a long-term care facility, with a diverse population, I am challenged to find meaningful activities for many participants. I happened to have some smooth stones I had collected from Presque Isle on Lake Erie, near where I live. I have painted on stones myself just for my own therapeutic activity. So I thought I would try encouraging the residents to paint on stones expressing their visual memory.  I usually try to create an example for 
each new artistic activity.

My fake memory was about a neighbor and best friend that moved away when I was a child. I don’t know why I chose a fake sad memory, but I did. So I’m thinking that I unfairly biased the outcome, nonetheless, I am still pleased with the results from the residents. I find most of them have no artistic background or much experience using their imagination, much less expressing it. When I began to speak of symbolism as a means to telling the story, I thought I had lost them, particularly given some of the results. But when they told their stories, I knew that they understood the gist.

One resident drew three different fruits on three different stones and reminisced about a fruit stand she had visited. The next one shared a memory of a fishing for trout. Yet another resident spoke of her favorite pet dog. The next person, said the lines on the rocks represented a language from a Native American tribe. Several of the residents remembered their husbands through his military service and love of deer hunting. Another resident created four stones to represent her daughter and her grandchildren. Yet another, thinking in a future tense, imagined what her new home would be like when she moved to more independent living. The next two are the surprises. When I shared that the resident may outline the image first with a permanent marker and she started to outline the periphery of the stone itself, I thought I had lost her. But when she painted the images, though not recognizable to us, represented her mother’s perfume bottle and a chair. She remembered when she was a child, climbing on a chair to get to her mother’s perfume on the dresser. The next example of surprise understanding, came from a resident who painted one stone green and one stone yellow. This resident loves watching TV, especially oldies and cartoons. The yellow stone represents the gold rush in Bonanza and the green stone represents Yogi bear’s tie.

Attention span is short in many cases, so reminiscing longer than 15 minutes is rare. Using the stones gave them tangible witness to their story, stimulated further discussion and gave them a keepsake, to relive those memories if they wished.

A Case for Adult Coloring Pages and Pre-made Images in a Long Term Care Facility

Anne Cameron Cutri

            I work as an assistant activities director at a long term nursing and rehabilitation facility. There, we have patients who have blindness, have had a stroke, have various degrees of cognitive loss, intellectual disability, mental health issues, physical issues, brain injury, stroke and many others. With an BA in Art Therapy and a year’s worth of graduate Art Therapy courses, I try to approach what I do with at least wellness and coping skills in mind, including sensory driven activities for the memory challenged.

            I have acquired quite a collection of adult coloring books. Mind you, not all coloring books are created equal. With the recent craze and the misused claim that it is art therapy, there has been some controversy around the subject. I have to say that I had similar reactions when I read peer reviewed articles analyzing pre-drawn mandalas and color usage, through computer software, evaluating mental state. I have read Jung and know the value of creating one’s own mandalas, and the balancing gestalt from doing so, as well as fleeting emotions and color choices. Any well-trained art therapist knows you don’t assess a person by one drawing.

            But when approaching adults with various backgrounds, some little more than an 8^th grade education, or dealing with the use of one side of their body, or someone who is highly creative, but doesn’t have a strong hold on what is considered normal reality—it’s quite a challenge. To come up with dignified art activities that are therapeutic; in the sense of giving the patient joy or pride in what they do, as well as tenderly nudging coping skills, is difficult. These populations are not separated by diagnosis, they are all together, separated only by areas of the facility.

            At any given time, scheduled activities may be effected by the area that they are given.   Most areas are a thoroughfare of travel for nurses, visitors, OT, PT, housekeeping and their loud buffers, who are moving from one wing to another. Needless to say, it can become very distracting. Nurses may interrupt with medication, or the patient may have discomfort because of their condition. Almost all the patients need assistance in completing certain tasks. So I have come to rely on coloring pages or images I have drawn myself as a starting point to more challenging activities. I like the Dover publications quite a bit, because often there is information about the images, and lends itself to discussion and reminiscence. For instance, the “Language of Flowers” coloring book, is an example. The flower images and their meaning led an room-bound patient down memory lane to her own garden. It prompted her to have a lengthy discussion about it, wanting to color those pages. These images also can be used as reference images for others to create a painting from, or to stimulate ideas.

            An 11 x 17 pre-drawn outline of a tree, that can be photocopied and mounted on poster board, was a start for another project. Using pre-cut colored paper shapes, patients have created paper mosaics to fill in the tree, along with affirming words or symbols collected from magazines, to create a positive visual reminder for them.  I have used a graphic of a 12 pointed star, enlarged to fit a 12” round cardboard. This was my measuring instrument that would later be used for a woven mandala tapestry. Another time we filled in a simple outline of stained glass- type images with colored rice. I have copied hundreds of images from coloring books, or free online pages for the residents. Many not only very skillfully color the pages, they add to them. One patient, in her eighties, shows tremendous concentration and stamina coloring mandalas and designs for hours and hours in the activity room. Her color choices are wonderful, and it gives her a purpose and a focus. Another elder, adds to the images, making spiritual meaning of each one of them, adding words and quotes.

            The point is that, it is a question of intent. My intention is to bring meaning, purpose, joy and a sense of accomplishment to the patients. As well, I want them to understand the power of the creative impulse, and the creative act as a way to overcome obstacles. Coloring pages or my own pre-drawn outlines, give them a safe place to start to explore. These steps build on themselves, getting the patient closer to taking a risk to paint, draw or create a collage without a pattern. Then the true magic of the imagination can begin to unfold.