LET’S TALK ABOUT SEX: AN ART THERAPY WORKSHOP TO INCREASE THERAPEUTIC ATTUNEMENT PRESENTED BY: MOLLY HURD APRIL 22, 2024 AREAS OF NOTE All of the images used in this workshop are either pulled from queer affirming art history sites, were showcased in museums for shows highlighting artists and subject matter relating to sex, sexuality, or queerness, or are my own. If any of these images interest you, I would encourage you to explore them further through the resource list. I primarily utilized existing institutions within the United States when referencing resources and education opportunities for this presentation. This is because it is the information that was most accessible and familiar. It’s important to note that this presentation is heavily westernized and norms regarding art therapy and sex therapy are based on United States standards. This presentation is not comprehensive and I encourage you to take note and further explore areas that peak your curioisity. PURPOSE STATEMENT Figure 1 The purpose of this research paper is to develop a workshop curriculum to introduce mental health clinicians to the relevance and importance of integrating art therapy and sex therapy while providing an introduction to accessing further training and resources. (N/A). German image of St. Wilgefortis (N/A)]. Queer Art History. https://www.queerarthistory.com/category/transgender-gender-nonconforming/ JUSTIFICATION ATCB 1.1.6 Art therapists must not engage in therapy practices or procedures that are beyond their scope of practice, experience, training, and education. 1.2.4 Art therapists shall develop and improve multicultural competence through ongoing education and training. Art therapists shall use practices in accordance with the client’s or group’s age, gender, gender identity, gender expression, sexual orientation, ethnicity, race, national origin, culture, marital/partnership status, language preference, socioeconomic status, immigration/citizenship status, ability, religion/spirituality, or any other identity factor. Both fields are unique in structure and have the ability to skirt around the often limiting structures of mental health care. Western mental health care has historically been weaponized against people who do not fit in a sexual norm constructed by a patriarchal society (Pierik, 2022) . Due to this, the use of art therapy with sex therapy can provide a radical space for non-oppressive and comprehensive mental health care. TERMINOLOGY Let’s get on the same page Art Therapy- “Uses active art-making, the creative process, and applied psychological theory—within a psychotherapeutic relationship—to enrich the lives of individuals, families, and communities” (AATA, para. 3). Directive- An art prompt used in art therapy and for art as therapy. Art Therapist- “Mental health clinicians with Master’s degrees or higher that serve clients in different settings—from medical institutions and schools, to wellness centers and independent practices” (AATA, 2023, para. 4). Sexuality- A person's identity in relation to the gender or genders to which they are (or are not) typically attracted to. Sex Therapy- “Any type of psychotherapy that addresses a person’s sexual problems” (Caffrey, 2022). Sex Therapist- Help clients understand their own sexual needs concerning their mind and body and how to develop healthy sexual practices and relationships. Although sex therapy has a significant focus on sex, a sex therapists cover a much broader range of the human experience than exclusively sex (AASECT, 2024). Sex- Physical contact between individuals involving sexual stimulation; sexual activity or behavior (OED, 2023). Bias- Prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair. (OED, 2024) LITERATURE REVIEW Relationship between Art Therapy and Sex Therapy Person Centered Theory Relationship and client driven Expressive Therapies Continuum (ETC) Framework for AT Attachment Theory Identifies themes that encourage or discourage attachment at a young age (Hutchinson, 2023). Emotionally Focused Therapy (EFT) EFT has three stages: de-escalation, changing interaction patterns, and consolidation and integration (Caffrey, 2023), and is structured based on Attachment Theory. LITERATURE REVIEW Multicultural and Social Justice Counseling Competency (1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling and advocacy interventions. Weaponized Sexual Norms Throughout Society and Mental Health Care Patriarchal Power (Pierik, 2022) History of homosexuality in the DSM (Hectors, 2023) Cultural Significance of Integrating Art Therapy and Sex Therapy Integrating a sex-positive approach in Art Therapy (Kirby, 2023) “Visual expressions rather than the role of the greater visual culture in shaping clients’ perspectives and creating internalized oppression” (Talwar, 2010) LITERATURE REVIEW Sexuality and Gender Explored Through Art Therapy Somatic art therapy to explore and affirm LGBTQIA+ identity Art therapy for coming out Couples and Art Therapy Metzl utilized EFT and expressive sex therapy as a framework while integrating art therapy with couples Art based directives in a Swedish counseling system for couples- couples art therapy through government funding (Fjellfeldt & Rokka, 2022) Use of poetry therapy in sex therapy (Floyd, 2021) Available Sex Therapy Education for Art Therapists 2 separate human sexuality for art therapists elective courses (Metzl, 2013) and (Kirby, 2023) Figure 2 WORKSHOP STRUCTURE First Half (85 minutes) Relationship between Art Therapy and Sex Therapy Terminology Social Justice in Therapy Historical Awareness Understanding Bias Ethics and Scope 10 minute break Second Half (85 minutes) Talking about sex and sexuality in sessions Art Therapy directive for topics of sex/sexuality Høeg, M. (1895-1903). [Photograph]. Queer Art History. https://www.queerarthistory.com/category/transgendergender-non-conforming/ This is an interactive workshop and will include several art therapy directives as well as digital engagement. Please be in a location where you feel safe enough to fully engage and create. WHO IS THIS WORKSHOP FOR? Everyone! No matter the demographic you work with, sex and sexuality are human experiences that shape the clients we work with and ourselves! It’s important to note that the directives discussed in this workshop were pulled from art therapists and should only be used by trained art therapists. Many of these directives can be utilized as a form of art as therapy for clients to process emotions, but non-art therapists should seek further training and certifications to practice within their scope. “Even art therapists who do not wish to operate as sex therapists or specialize in this topic can and should consider the ways that the art interventions they already use might support clients’ wellbeing while they more directly acknowledge their clients’ sexuality” When Art Therapy Meets Sex Therapy Einat Metzl, 2017 1 MINUTE DIRECTIVE DRAW A SMILE FACE Materials: Notecard of sheet of paper Any drawing material Prompt: Quickly draw a smile face on your sheet of paper. PROCESSING Hold up your smile face. Are any the exact same? Any different? How may of you associated the smile face with an emoji? A symbol from your childhood? Or a cultural norm? Here are a few! This list is not comprehensive. All responses are anonymous Scan the QR code Figure 4 WHY SOCIAL JUSTICE IS IMPORTANT FOR ART AND SEX THERAPY The World Health Organization (WHO) defines sexual health as “fundamental to the overall health and wellbeing of individuals, couples, and families, and the social and economic development of communities and countries” (World Health Organization [WHO], n.d., para.1). (N/A). Portrait of We’wha Holding a Clay Ceremonial Prayer-Meal Basket (hand-colored)]. Queer Art History. https://www.queerarthistory.com/category/transgender-gender-nonconforming/ SOCIAL JUSTICE: THE WHY AND HOW Pierik defines Patriarchal Power as “men’s appropriated power over the flesh, over biological processes but also the knowledge and appearances of these processes, which results in it presenting itself as the ‘natural’ default state, and women’s challenge to it as unnatural and against biology.” (Pierik, 2022). Working from a social justice lens encourages broader perspective taking and cultural competency. Creating space to safely voice societal inequities can empower clients to recognize external factors that impact them. Working from a multicultural lens provides varied viewpoints and understanding of self and society. Both awareness and understanding are intended to be an ongoing responsibility to challenge clinicians to recognize their own bias, educate themselves on the elements of human sexuality (both physically and emotionally), and identify the social rules that dictate sexual norms. Skills can be approached once a clinician’s self-awareness and knowledge have been expanded (Kirby, 2023). Figure 5 UNDERSTANDING PERSONAL BIAS Bias (Verb) 1. prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair. (OED, 2024) Acknowledge you have bias Practice mindfulness to prevent bias taking over Take a Sexuality Attitude Reassessment (SAR) Brooks, R. (1924).Una, Lady Troubridge (Oil on canvas)]. Queer Art History. https://www.queerarthistory.com/category/transgendergender-non-conforming/ INSIDE ME OUTSIDE ME DIRECTIVE Part 110 minutes Part 210 minutes Materials Materials Sheet of paper Drawing materials 1. Draw the outline of a figure from the shoulders up. 2. Fill in the inside with all the parts that make up who you are as an individual. 3. If you are comfortable, include your relationships, sexuality, gender identity, religion, race, interests, hobbies, frustrations, challenges, etc. Same sheet of paper Drawing materials 1. Around the outside of your figure, draw the ‘professional’ version of yourself. 2. Include the following: How do you present professionally? What information do you share about yourself (both intentionally and unintentionally)? What are the areas in which you focus or specialize? How may a client view you upon first encounter? Processing How much overlap is there between the two spaces? Are there areas where you would like more or less overlap? Are there areas where you may not acknowledge how much your inner or outer self bleed through? Could some of these parts lead to bias or assumptions towards clients? Inspired by Coming Out Through Art: A Review of Art Therapy with LGBT Clients Figure 6 LET’S TALK ABOUT SEX: DISCUSSING SEX IN SESSIONS What to say? When to bring it up? What information is important? Start with yourself Make it easier to bring up Stay curious Potential Tools to Utilize Sexual Intake Sexual Genogram Kumari and king in coitus. Philadelphia Museum of Art. (n.d.). https://philamuseum.org/collection/object/290427 Canva can be a great tool for virtual art therapy and co-creation or genograms or other art forms as well as couples work Art Directives for Themes Related to Sex Therapy The following visuals are my own creations inspired by directives mentioned in a variety of peer-reviewed articles and books. A comprehensive list of the resources, will be provided in the resources handout. JOINT VERBAL AND NON-VERBAL DRAWING Directive 1: With your partner, each choose one drawing material and put one sheet of paper between you both. Decide who will begin. Without speaking during the process, one person starts and puts a mark on the paper. The other person then creates a mark on the paper. Continue taking turns until the artwork feels finished. Debrief INSPIRED METZL’S ART THERAPY WITH COUPLES: INTEGRATING ART THERAPY PRACTICES WITH SEX THERAPY AND EMOTIONALLY FOCUSED THERAPY Directive 2: Rules are the same as directive 1, however, the two members are allowed to talk during drawing. Processing Questions: What was the like for you both? Did anything surprise you? Did anything frustrate you? Were there any communication patterns that could be reflected in your relationship? SENSE BLACKOUT POEM Inspired by Floyd’s The Use of Poetry Therapy in Sex Therapy Directive: Based on Floyd’s example of a sense poem in conjunction with a blackout poem. Choose a book or article related to sex or themes the client(s) are wanting to process. Utilizing the senses, choose words that are associated to the desired experience (sex was the experience in the example) Once the poem is complete, have the client add to the image intuitively if desired. (Black out poetry may not be necessary but can be a good stepping stone for clients uncomfortable with fully writing their own poetry) Processing: What came up as you tried to associate language with this experience? Was is easy? Difficult? Why do you think? Did adding artwork intuitively add to or change this experience? SEXUAL IDENTITY COLLAGE Inspired by Coming Out Through Art: A Review of Art Therapy with LGBT Clients Directive: Create a collage reflecting your relationship and journey with your own sexuality and sexual exploration. Processing: What was this expereince like? Were you surprised? Were there any images you decided to add or take away? Is it finished? What do you see when viewing it? FELTED GENITALIA INSPIRED BY FERRANTO’S VULVA EDUCATION THROUGH FIBER ARTS: THE +CUNT PROJECT Directive Create genitalia (or any body part desired) using felt or other fabric. Processing What was it like creating this artwork? What surprised you about your choices? What is it like seeing it exist or holding it in your hand? BODY MAPPING INSPIRED METZL’S ART THERAPY WITH COUPLES: INTEGRATING ART THERAPY PRACTICES WITH SEX THERAPY AND EMOTIONALLY FOCUSED THERAPY Directive: List words that come to mind regarding your body around sexual encounters (define this as you prefer: individual or partnered encounters, positive, negative, real or imagined, etc.). Associate colors/patterns/ etc to each word. Using a primate body outline or drawing your own, color the body with the words chosen. This may include but is not limited to placing words on physical locations they are associated. Work as intuintely and non-judgmentally as possible. This can be done in an indecent or couples session. Processing: What came to mind as you chose your colors and words? How did you utilize the colors on your artwork? What came up as you created each layer? What made you curious about the process and product? FINAL DIRECTIVE Materials: Paper Any media Prompt: Take the next 20 minutes to create a mixed media artwork in response to this workshop and your own emotions. Independent Processing: What has come up? What was surprising or new? What interests you? Do you have any unresolved questions? LIMITATIONS Limited research available. Limited CE/CEUs on the integration of the fields (Updated based on new offering before the 2024 AATA conference). Two known human sexuality for art therapists courses in existence. Stigma around discussing sex and sexuality/knowing how to bring it up. A sex-negative, heteronormative society with a taboo around sex. Author’s own lack of training and professional in sex therapy and integration of the two fields. Research and testing of the workshop. Figure7 AREAS FOR FUTURE EXPLORATION/RESEARCH Recommended that ACATE requires a human sexuality for art therapists course as part of the required art therapist training. In addition to educational requirements, there should be a push for the development of CEs/CEUs on the integration of art therapy and sex therapy. Collet, J. (1779). An Actress at her toilet or Miss brazen just breecht [Paper and colored inks (hand-colored)]. Queer Art History. https://www.queerarthistory.com/category/transgendergender-non-conforming/ FINAL THOUGHTS There is an ethical and cultural need for more research and training on the integration of art therapy and sex therapy. These therapies can be used to challenge systemic oppression which, if left unchecked, can harm clients and their therapeutic process. Providing further education, training, and research for therapists to integrate art therapy and sex therapy can grow both fields and encourage comprehensive ethical practice for clinicians. The goal of this workshop is to help clinicians feel empowered and encouraged to pursue further training in these fields and request more opportunities for education and training. AATA CONFERENCE 2024 Sunday, October 6, 2024, 9:00 AM - Sunday, October 6, 2024, 5:00 PM (USEST) DEI117 - Establishing a Sex-Positive Therapeutic Approach to Encourage Healthy Sexuality and Sexual Wellness Led by: Daniel Blausey, Tamara Galinsky, Michaela Kirby This course addresses the theory and practice of incorporating sexual wellness in therapy through didactic and experiential methods. The course normalizes sexuality discussions across participants’ lifespan, gender, and sexual orientation in the context of culture, intersectionality, and mental health. Additionally, participants examine historical sexual messaging, professional comfort, and art-based interventions. QUESTIONS? THANK YOU! RESOURCES FOR FURTHER EDUCATION AASECT AATA STAR ATCB Education opportunities specific to the combination of art therapy and sex therapy are limited. Reach out and request more CE and educational opportunities to AATA, AASECT, STAR, ACATE, or your local chapters. Art Therapy Literature that Includes Directives for Sexuality/Sex Related Topics When Art Therapy Meets Sex Therapy by Einat Metzl Journal of the American Art Association, Volume 40, Issue 4 (2023) This was a special issue centered on topics related to sexuality and houses many of the resources and directives referenced in this workshop. Coming Out Through Art: A Review of Art Therapy with LGBT Clients by Laura Pelton-Sweet and Alissa Sherry Art Therapy with Couples: Integrating Art Therapy Practices with Sex Therapy and Emotionally Focused Therapy by Einat Metzl The Use of Poetry Therapy in Sex Therapy by Ashley Floyd Images Used in this Presentation https://www.queerarthistory.com https://philamuseum.org/collection/curated/queer-art-collection Linked Resources Implicit BiasSAR CDC Sexual Intake Recommendation Recommended Literature When Art Therapy Meets Sex Therapy by Einat Metzl Ace by Angela Chen Polywise & Polysecure by Jessica Fern The Leather Couch & Kink-Affirming PracticeAce by Stefani Goerlich Mating in Captivity by Esther Perel Art Therapy: Journal of the American Art Therapy Association Newest journal centers on relevent topics related to this presentation References About art therapy. American Art Therapy Association. (2023, January 18). https://arttherapy.org/about-art-therapy/ American Association of Sexuality Educators, counselors and therapists |. AASECT. (n.d.). https://www.aasect.org/ American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-ofethics.pdf?sfvrsn=55ab73d0_1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association American Psychological Association. (n.d.). APA Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/sexuality Art Therapy Credentials Board. (2021). Code of ethics, conduct, and disciplinary procedures.https://atcb.org/wp-content/uploads/2020/07/ATCB-Code-of-Ethics-ConductDisciplinaryProcedures.pdf Barsky, A. E. (2022). Sexuality- and Gender-Inclusive Genograms: Avoiding Heteronormativity and Cisnormativity. Journal of Social Work Education, 58(2), 379–389. https://doi.org/10.1080/10437797.2020.1852637 Caffrey, C. (2022). Sex therapy. Salem Press Encyclopedia of Health. Ferranto, J. (2023). Vulva Education Through Fiber Arts: The +cunt Project. Art Therapy: Journal of the American Art Therapy Association, 40(4), 220–224. https://doi.org/10.1080/07421656.2023.2206778 Floyd, A. A. (2021). The use of poetry therapy in sex therapy. Sexual & Relationship Therapy, 36(1), 106–115. https://doi.org/10.1080/14681994.2019.1658865 Hays, D. G. (2020). Multicultural and Social Justice Counseling Competency Research: Opportunities for Innovation. Journal of Counseling & Development, 98(3), 331–344. https://doi.org/10.1002/jcad.12327 Hectors, A. (2023). Homosexuality in the DSM: A Critique of Depathologisation and Heteronormativity. New Zealand Sociology, 38(1), 18–28. Kirby, M. (2023). 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Art Therapy: Journal of the American Art Therapy Association, 25(4), 170– 176. Pierik, B. (2022). Patriarchal power as a conceptual tool for gender history. Rethinking History, 26(1), 71–92. https://doi.org/10.1080/13642529.2022.2037864 Queer art history. Queer Art History. (n.d.). https://www.queerarthistory.com/ Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. M., Sadler, J. Z., & Kendler, K. S. (2010). What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychological Medicine, 40(11), 1759–1765. doi:10.1017/S0033291709992261 World Health Organization (WHO). (n.d). Sexual health. WHO. https://www.who.int/health-topics/sexual-health#tab=tab_1 Zeiger, K. D., & Ball, M. A. (2022). How the Compulsory Gender Binary Language in the DSM-5’s Category of Sexual Interest Disorders Interacts Negatively with Patients’ Nonbinary and Genderqueer Identities. Sexuality & Culture, 26(4), 1531–1539. https://doi.org/10.1007/s12119-022-09950-0