Intersubjectivity in Art Therapy
By Audra Tolbert

The role of art objects in facilitating the therapeutic relationship and healing. I
will be asking the question of whether or not the process of making art activates
the relational field in such a way to enhance the Intersubjective sphere between
client and art therapist. Do two subjective minds come into greater alignment
when art is employed in the relational field? Attachment research suggests that
the quality of the Intersubjective relationship is a necessary agent in facilitating
a healing therapeutic alliance. Does art enhance or expedite the Intersubjective
experience? Do art objects activate a therapeutic intimacy? Please join me as I
share my research findings.

Carmen is a thirteen-year old Hispanic female. Her parents are first generation
immigrants from El Salvador and Columbia. Carmen’s parents recently divorced and she is
presently living with her mother. She has two older siblings who are away at college. Carmen’s
mother is a non-traditional college student working on her bachelor’s degree. Her mother
reported during the intake process that she had experienced twenty-five years of marriage with
an emotionally and physically abusive husband. Her mother reported that Carmen and her
siblings had witnessed most of the physical abuse and experienced emotional abuse. Both
mother and daughter denied any physical abuse of the children by their father.
Carmen was initially referred to me with a preliminary diagnosis of Oppositional Defiant
Disorder and ADHD. The previous therapist had found it difficult to continue any progress with
her through stand alone-talk therapy. She and her mother both noticed that I made art in my
office and asked the pervious therapist if they could switch to me for counseling. The previous
therapist was hesitant, but also feeling very frustrated with Carmen’s resistance in sessions,
acquiesced. I decided to start Carmen’s therapy with some initial informal assessments; I was
curious about the Oppositional Defiant Disorder Diagnosis and felt more confident that it could
be something else based on the mother’s intake session report. The informal assessments
pointed to a diagnosis more like Complex PTSD. I began to believe a better explanation for
Carmen’s anxiety and angry responses may have been from history of witnessing abuse in the
home as well as her developmental age at the time of counseling. I did agree with the prior
diagnosis of Attention Deficit Disorder (inattentive type) as Carmen met the full criteria, and I
experienced her distractedness and impulsivity in session. Since her grades were poor, it was
necessary that Carmen’s mother find a psychiatrist for a psychopharmacology evaluation.

Research Session One: Carmen arrived to the counseling session with her mother.
Carmen’s mother asked to speak to me prior to the session. Her mother informed me that the
father had moved out of the family home. Because Carmen’s mother had shared in the intake
session that she and the father had been divorced for over two years and that the father refused to
leave the home, I was shocked to hear that he spontaneously packed his belongings and left the
home. I expressed my surprise and I found it interesting that the mother wasn’t more expressive
in her delivery. For me, it was as though it could have been another day. I found it a little
confusing.
Carmen entered the consulting room looking somewhat sullen and anxious. I informed
Carmen that her mother had just informed me that her dad had moved out, and I was curious how
she was feeling about it. Carmen shrugged and said that she had no feeling. I remember feeling
that Carmen’s body language was incongruent with her words. I also felt a little nervous that this
could be the beginning of what my colleague had described as Carmen’s shutdown to therapeutic
intervention. I feared Carmen would become obstinate in session and our time together would
become increasingly frustrating. Spontaneously, I asked Carmen to paint her feeling of no
feeling regarding her father’s departure. Carmen looked at me hesitantly and slowly began to
paint. I busied myself with a doodling type painting and decided to act like what I was
requesting of her was normal. I knew that Carmen had artistic ability and that she would
produce something. She had never failed in previous sessions to pull something out of herself
that had therapeutic merit. The risk in this scenario would have been her frustration with my
request to ask something of her after she told me there was nothing there. This seemed to be a
moment where my ignorant persistence could pay off. Carmen worked intently on her piece and
then announced after a while that she was finished. What appeared in front of me looked like

three breasts. Carmen described her image as three mountains with herself in the middle and a
sibling on each side of her, as represented by the mountains. I erroneously assumed that
Carmen’s painting was an image of support that while her father had left the family home and
that she would find comfort in her siblings. Carmen quickly let me know that the image did not
resemble anything near my supportive reflection. I knew at that moment my own fear of her
distress over her father’s departure was eliciting my desire to rescue her from any difficult
feelings. Carmen had stated in previous sessions her concern that her father would not continue
a connection with her once he left the home, and because of this revelation, I was finding my
own desire to protect her. Carmen stated to me that the mountains represented the distance she
feels from her siblings and how they were not close. It seemed her father’s departure from the
home was bringing to consciousness her sheer aloneness in the family home and lack of
connection between family members. Carmen’s siblings are a minimum of ten years older than
her and that alone usually puts sibling relationships at a disadvantage due to different
developmental needs. Once clarified, I was able to identify and process with Carmen her
feelings of loss and estrangement and her need to make coherent the distance between herself
and her siblings.
Carmen was able to articulate that even though her father was not very engaged at home,
it was nice to have him there. By having a physical body in the home, she felt less alone.
Carmen emphasized in her research inquiry that the colors used in her art piece represented her
emotions. I didn’t recall a discussion about the colors, but I can deduce from the image that the
muted colors represent her muted feelings about her situation. She also answered her
questionnaire that the art therapy process helped her feel more confident about what she was
feeling and something that she could remember. She stated that she felt I had a better

understanding of her feelings. I agree with Carmen. This exercise helped me understand the
magnitude of her problem and how she was perhaps grieving many losses.
Research Session Two. Carmen’s mother brought her to the counseling session. Carmen
reported in this session that she was on a group chat with one hundred or so other thirteen year
olds. Fortunately, Carmen was open to doing a meditation before we began making art and was
willing to set the phone aside. I’ve noticed in previous sessions that Carmen always says yes to
receive a meditation and often reports new imagery that comes to her during the meditations. I
was hopeful that the meditation would break her interest in the ensuing event. Not so; upon
completion of the meditation, Carmen returned to checking her cell phone. Carmen told me, as
she was holding tightly to her smartphone, that some incident had occurred during the chat that
was elicited the attention of parents and police. While I was initially generous with her need to
check her phone, I eventually asked her to refrain from looking at it. I tried to engage Carmen’s
feelings of anxiety about what was happening on the chat and what was happening inside her
body when not engaging the conversation with her peers. We were able to identify and process
her feelings of fear. She stated that while she knew she didn’t do anything wrong, she was still
fearful of being wrongly accused. I had observed Carmen experiencing a vicarious rise of
emotion from the other teens involvement on the chat and her desire to get confirmation that it
didn’t involve her directly.

Carmen reported that she didn’t know what happened, but that she

feared her mother would react in a manner of restricting her phone use.
I encouraged Carmen to paint her feelings regarding her bodily response to the messages.
It was clear to me from observing her body that she was experiencing many feelings. She stated
that she could feel her body trembling. I wanted to see if we could make explicit what was
occurring implicitly in her body. Carmen painted quickly with vigor and emotion, and even

though she was absorbed in what was happening with her friends, she was also able to
simultaneously create a painted landscape. She painted a lake with murky waters and a deck like
platform jutting out into the water. In the distance, one could see jagged, imposing mountains. I
was quite impressed with her painting. Carmen was able to describe the murky waters as her
uneasiness inside and the jagged mountains as fear looming beyond. For me, Carmen’s personal
expression and willingness to share her present time struggle with a real life event felt, that
trusted me and her willingness to paint her feelings, reflected her very real capacity to engage
with raw emotions. Because I was open to her real-time experience and appreciative of her
output, I believe Carmen and I were developing a closer appreciation and depth to what we could
share in session. During Carmen’s research inquiry, she reported that she felt most understood
when we talked about her art piece and that the water held for her an understanding of her stress.
She stated that she could see her emotion. When asked if the artwork revealed meaningful
information to her, she reported no but added that it took away the stress.
Research Session Three: Carmen’s father brought her to session. Her mother texted me
earlier in the day to say that the father would be bringing her. I was happy to hear that her father
would be involved and I was also curious to see if he would initiate any conversation about
Carmen’s progress. Based on the intake interview with the mother and Carmen’s own admission,
it seemed that the father’s involvement in previous therapy sessions with my colleague had been
unfruitful. Both indicated no desire to involve him. They arrived to my waiting room
uneventfully, and when I went to retrieve Carmen, her Dad smiled and was kind and quickly
returned to engaging his cell phone. I turned up the music in my office to enhance
soundproofing in hopes to assist Carmen in feeling secure in my office as a safe space in which
her Dad could not overhear our conversation. Carmen, on her own initiative, informed me that

Dad had returned to the family home and that she was very confused. I asked if he had returned
with all of his belongings and she said no. I also asked how she perceived her mother’s feeling
about his return. She reported she wasn’t sure and that everyone was carrying on as normal.
Carmen lives with her mom and an aunt, a cousin, her brother and sister. The older siblings are
in college and are away from the home most of the time. I gather from our sessions that
substance use is an issue with her brother and cousin. I have often been curious if her father too
suffers from substance abuse, but Carmen and her mother have both denied that neither alcohol
nor drugs were contributing factors to his emotional and physical abuse. I asked Carmen if she
could paint the feeling of confusion that she was experiencing with this recent change. Carmen
became absorbed in her painting and seemed very confident in her execution. She reported that
the image was of a large body of water, like a lake or an ocean. I couldn’t immediately pick up
on anything in the painting that seemed narrative in nature. The most striking element of the
image to me was the dark mood and swelling nature of the water, as well as a blazing sunset in
the distance. I decided to ask Carmen where she imagined herself in the image. Carmen quickly
responded that she was in the middle of the water. She pointed to indicate where she would be,
which seemed to be in the center of the water. I then asked her where her dad would be in the
image. At this time, I was at a loss of where to go with this image, but followed my intuition to
at least see what could be narratively constructed. I could tell Carmen was perplexed about
where she would place her father in the image, and she seemed to struggle with this question for
a minute or so. Then suddenly, she looked up at me as though she had an epiphany and
announced with surprise, “He is the water!” We both just sat there with profound feelings of
new awareness. I reflected back to Carmen that it seems her dad was larger than life and
affected the emotional temperature everything. Carmen agreed. In Carmen’s research inquiry,

she stated that her artwork was meaningful to her because it helped her realize how much bigger
and confusing her problem is. She stated that the artwork as a co-participant in her therapy
session helped her ascertain meaning and experience different perspectives. Carmen also noted
that she felt most understood by me as her therapist, when we were discussing her artwork and
where she and her dad would be in the image. As noted before, Carmen is generally receptive to
mediations and noted in this session that she felt the meditation also contributed to her
understanding of her problem in today’s session. I am curious if the meditation helps to slow
down Carmen’s thinking and lower her anxiety so that she can experience more deeply from
where her anxiety is emanating.
Research Session Four: Carmen arrived to her counseling session 30 minutes late. Upon
entering the consulting room it appeared to me that Carmen looked a little lighter in her affect.
She was pleasantly approachable. I asked Carmen what she would like to do in session today
since we didn’t have the normal allotted time and we wouldn’t be able to do everything we
normally did. Generally, we started sessions with a meditation or bilateral drawings. I asked
Carmen if there was anything in particular that she needed to talk about. She said no and this
was not unusual. I had noticed that Carmen rarely took the initiative in session unless something
was really bothering her. Today she appeared open; she notice that I had clay out on my art table.
I asked her if she would be willing to make a clay sculpture of herself in a relationship with a
family member. Since Carmen didn’t express any pressing need to process new material, I was
hoping we could continue with the work we did the previous week. I was thinking that Carmen
would probably choose to make a sculpture with her father because our previous sessions had
revolved around her confusion with his presence in the home. When I had asked in a previous
session why Carmen didn’t just ask her father why he was back in the home, she stated that he

would shift the conversation back onto her and make her feel guilty. Carmen had made this
common before regarding her father. Her relationship with her father was constrained and
lacked the curiosity or spontaneity of inquiry that some relationships are able to attain. Carmen
worked steadfast in the clay and used the entire remainder of the session to make her sculpture.
Carmen appeared to struggle with the clay and I asked if she needed water. It wasn’t clear to me
what she was trying to make but things looked primordial in nature and not fully formed. I
decided to appear focused on something else to relieve any pressure Carmen may have perceived
by me watching her process. Carmen announced soon after that she was finished. I asked
Carmen what she wanted to say about her sculpture. She shared that it was a sculpture of a heart.
She said my mom and I are sometimes very close. She always takes care of me and prepares my
food. I said to Carmen that I could see that she spent a great deal of care in making her sculpture
and that I noticed that the heart she made had a lot of character to it. I didn’t explain what I
meant by character. I was trying to use a word that she could grab onto and take the
conversation in a direction that served her needs. Carmen said to me that yes, the heart had
character because the relationship with her mother was not perfect. I helped Carmen identify and
process her feelings of relying upon and needing her mother and often feeling hurt by her. I
asked Carmen if there was one thing she could change about her relationship with her mother
what it would be. Carmen said that while her mother was strict and she wished that her mother
would be more flexible that what really bothered her more was her mother’s anger. I asked
Carmen for an example and Carmen said that her mother often yelled to her from another room
in the home, but when Carmen yelled back her answer in response to her mother, her mom
would fly into a rage and accuse her of being disrespectful and then ground her for a weekend. I
assisted Carmen in processing feelings of hurt and loss. I reflected to Carmen that she must

often feel misunderstood when these situations occur. Carmen said that yes it was very
confusing and what seemed like a normal moment in the house could turn suddenly into Carmen
being grounded without her not fully understanding why things had escalated. We laughed as I
gestured what it must look and feel like to think you are doing one thing to only be yanked in
another direction. It was nice that Carmen and I could connect through human and acknowledge
that one can love their mother and also be hurt by them. I asked Carmen if this was regular
behavior by her mother or if it only happened with Carmen. Carmen assured me that her mother
behaved this way in many contexts. I had not observed this irrational and arbitrary behavior in
my dealings with Carmen’s mother. There had been moments where miscommunications had
occurred but I often attributed them to second language acquisition issues. What I did observe
about Carmen’s mother that was striking from the intake session was her mother’s minimization
of the physical abuse she endured and when I asked her mother to answer an informal assessment
regarding trauma to Carmen, her mother’s responses minimized Carmen’s trauma. Carmen’s
answers did not match her mothers. I think I had expected her mother to emphasize the exposure
to abuse as being far harder on Carmen than Carmen would recall for herself, but the opposite
happened. At the end of session, Carmen completed her research inquiry. She answered that
she felt understood by me her session today and that talking about her art piece enhanced her
understanding of herself. She also commented that what she would take with her from the
session today was that she would always remember the strong foundation she has with her
mother. I am reminded that the good enough mother goes a long way in life and that while
Carmen’s mother had coping deficits that are not helpful to Carmen she has proven to Carmen
her devotion and care. This is a difficult case because I am not fluent in Spanish and Carmen’s
mother could benefit from individual and family counseling. The previous therapist was bi-

lingual but having her do family therapy was no longer a viable option. I can see that Carmen’s
mother could benefit from counseling that could help her enhance her mentalizing capacities.

Mary
Mary is a twenty-four year old Caucasian female, recent college graduate of an
elite East Coast university. During her senior year of college she became involved with
a man one year her junior. They dated for several months and long enough in Mary’s
mind for her to determine he was the one – the one she would one day marry. However,
during the same time that Mary was planning her future with Mr. Right, he revealed that
he had no interest in a monogamous commitment and felt most comfortable in
polyamorous relationships. He explained to Mary that he was no longer interested in
keeping this part of himself from his partners, and because of the upset it caused in his
last relationship, he wanted to reveal this about himself at the onset of the relationship.
Mary was deeply hurt by her boyfriend’s revelation and in her own words worked hard
to come to terms with it. To her knowledge her boyfriend is currently in a relationship
with two monogamous women, herself and another student at his university. I have
learned a lot about polyamory from Mary. Mary has informed me that a person who is
polyamorous doesn’t feel gratified in the way that normal monogamous people do. In
her words, monogamous people generally stop seeking new relationships when they fall
in love, but with polyamorous people that doesn’t happen; the urge to seek continues.
What perplexes Mary most is that she has read that polyamorous relationships work
best when all participating parties are self-identifying polyamorous individuals, and if
not this what generally causes the problems. Mary came to counseling to help her cope
with her decision to wean off of her psychotropic medication. Under her doctor’s
supervision, Mary wanted to try to cope with life without medication. She was
concerned that she would fall into depression when triggered with these situations

involving her boyfriend. The beginning of our work involved learning about Mary’s
history of depression, her family of origin history, and her difficult relationship with her
mother and somewhat estranged relationship with her brother. Mary says that she is the
feeling-oriented child in the family and that her brother is the “money driven” child.
Mary reports her mother to be very driven in her profession and not having too much
emotional availability for Mary as a child nor an adult. Mary reports her mother as
having a low tolerance for emotional expression. She reports her closest relationship is
with her father, and that he is the one who is able to be there for her emotionally. She
thinks herself to be similar to her father. She reports her father a disappointment to her
mother because of never earning enough money. Mary reports he was one to follow
passions before money. This often caused financial strain and hardship for the family.
In Mary’s first session with she shared sharing her feelings around polyamory
and her firm sexual identity of monogamy. I remember feeling that Mary had a very
clear sense of her values and what she needed and expected. However, with each
successive session it became clear to me that Mary was a young woman struggling with
co-dependency tendencies. I observed that Mary had difficulty sustaining and honoring
her needs, and she increasingly discussed her desire to accommodate the needs of her
partner. Mary made it clear early on that the polyamorous situation was distressing for
her and that while regular polyamorous relationships discussed things more openly
(ex.,spending time with the other partner), Mary could not; Mary was not able to openly
discuss the polyamorous details with her boyfriend. Mary acknowledged her desire to
take an out of sight, out of mind approach. While this avoidant approach was helpful in
regulating Mary’s emotions, it wasn’t necessarily something I could see as effective for

her in the long-term. Mary often discussed that her desire was to move in with her
partner and one-day start a family. It would be during these times that Mary would be
forced to confront the reality of her relationship. I was mindful to support Mary but
also encourage cautious exploration of these forthcoming events. Many of our
discussions revolved around Mary’s guilt at not being able to meet someone’s needs. I
eventually confronted Mary about my own concerns of wanting to collude with her and
stay in her head with her and avoid feelings. Mary was suffering with a strong external
locus of control. It was apparent that Mary spent a lot of time thinking about others and
manipulating situations to get her needs met. Because her boyfriend would not formally
invite her to visit him at school, Mary would often concoct ways to be there so that they
could be together. Mary was currently living at home and working at a local company
while her boyfriend was finishing his senior year of college. The commute to his
campus was close to four hours away. Even though he would not invite her, Mary
managed to be at his college campus most weekends. In many sessions Mary described
her future plans with her boyfriend. They had finally agreed that she was the primary
person in his relationships and the only one he with whom he was allowed to have
children. This pleased Mary that her boyfriend would agree to keep her interests in
mind. My feeling was that Mary was extremely accommodating and willing to forgo
her monogamous needs and possibly her ambitions of graduate school. It was hard for
me to get a clear picture of how the co-dependent tendencies were transmitted from one
generation to the other in Mary’s family or origin, but Mary described in detail her
desire to please others and in one instance this was demonstrated in her going overboard
to do her mother’s work duties (reading important papers and making summaries). I

imagined that Mary learned very early, using her intuitive gifts, that she could extract
the love that was available in the home. By accommodating her primary caregiver’s
needs. (Mirrer, 1993) writes about the gifted child as being the child who is intuitively
able to get the love that is available in the home. The intuitive child will likely grow up
with co-dependency tendencies…. an external locus of control, whereas the other
children may become more narcissistically focused if not able to adjust themselves in
ways that yield rewards. Mary spoke of her brother as someone out for himself. I often
wondered if this is what happened in this family system. Mary was able to adapt to the
narcissist needs of her mother, but her brother was not and developed his own form of
getting his needs met. I will also add that Mary had some other peculiar behaviors. She
wrote in miniscule handwriting. I had to use a magnifying glass to read the findings
from her research inquiry. Also, if Mary arrived to a counseling session when I had the
outer door to my office locked (something I did when I had a cancellation, but would
inform her via texts), she would knock in the lightest, most undetectable knock. My
experience of Mary was that she was very intelligent and competent. I often imagined
that she was a real asset to her company. Mary reported that in meetings and when she
was attending college, she never once contributed to an in-classroom discussion. She
said that she was happy and excited to contribute, but would only do so in writing.
Mary didn’t report distress with this adaptive coping skill, but that her professors and
high school teachers did and had often failed in coaxing her to comply. It seems that
Mary’s feelings about not speaking publicly were stronger than meeting the needs of
her classmates, coworkers, or professors. The one area in Mary’s life where she
repeatedly stated she held firm was in public speaking. Mary would not budge. I enjoy

Mary and found her delightful. My hope is that the rigidity in this area will loosen as
Mary increases her confidence and value in her own expression. I imagine others miss
her contributions.
Art Session One. Mary reports that a co-worker asked her to help repair a
zipper on her daughter’s jeans. Mary agreed to do this task because she had previously
shared with her co-worker her love of sewing. Since assuming responsibility for the
task Mary had yet completed it and two months had passed. I asked Mary to paint what
it felt like to not be able to meet someone else’s needs. Mary painted a symbol, a sign
in sign language representing anxiety, which depicts a wringing of the hands. She said
this symbolized to her the anxiety, fear and uneasiness about saying no to the needs of
others. Next, I asked her to paint what it feels like to meet the needs of others. Mary
painted a symbol, which for me evoked a religious feeling. I spontaneously made the
gesture of wringing my hands (mirroring the physical sign language gesture Mary
demonstrated to me when she showed me the symbol) and then I raised my hands in the
air as if rejoicing (trying to evoke a gesture that met the religiousness of the image).
We both laughed and Mary said that these gestures captured what it was like for her to
experience these emotions. My experience in this session was that Mary and I were
communicating through a language that was more exacting of Mary’s inner feeling. I
was able to grasp the angst she experienced in her interpersonal relationships. Mary
had reported that prior to me she had been seeing a male therapist who was very
Dialectical Behavioral Theory oriented. She stated dreadfully they she even had a
workbook. When I asked why she didn’t return to him she stated that she often felt he
wasn’t “getting her” and that he would tell her to just stop in the middle of her talking.

Mary said that part of her needed that because she was aware of her distorted thinking
patterns, but the other part of her needed something more. My experience with Mary is
that the therapeutic experience itself needed something more. Mary has strong
tendencies to stay in her cognitive mind when discussing interpersonal relationships. I
too would have become more directive with Mary if not able to meet her on a different
plane. It seemed that after the first session of employing art therapy we were getting to
something more feeling oriented and less clear in verbal explanation, but more exacting
in our communication.
Art Session Two. Mary had been reporting over previous sessions a coworker
that was asking her to do minor things for her on a regular basis. Mary was often
perplexed because this person doing the requesting was in a higher position than her in
the company and was technically more qualified. Mary found herself increasingly
frustrated with minor requests that didn’t correlate with the job duties. On this
particular session, Mary reported that the woman was discussing openly in the office
space that she needed to have her teenage daughter’s jean’s zipper repaired. Mary had
shared previously with the woman that she sewed at home as a hobby. The woman did
not directly ask Mary to fix her daughter’s jean, but Mary volunteered. Mary brought
up this incident because she said she was feeling guilty about the fact that she agreed to
fix the zipper and for the past two months has found herself unable to follow-through
with the commitment. During our discussion, Mary reported this was a pattern of
behavior in her life. She often volunteered to take on more than she really wanted to
do. I asked Mary to paint or draw how she felt when she was overloaded and unable to
meet other’s needs. I asked her to connect with those feelings of depletion. Mary

painted a plant whose leaves were drooping. She described the plant as feeling and
unable to look and feel like a healthy plant. During this moment we discussed how
overextending her reach was causing her to feel resentful with others. I mentioned the
idiom, “No Good Deed Goes Unpunished”. Mary had never heard this saying and she
reported finding it intriguing and something pertinent to her pattern of feelings when
these occasions occurred. We then role-played possible responses to someone eliciting
a need. Mary was able to try on a more assertive personality where she might respond,
“I would love to help, but I can’t” or simply not offering to help at all. We did several
of these responses, trying to find the one that best fit Mary’s personality. I asked Mary
to also try on the idea that not everyone struggles with hearing the call to rescue or
caretaker others. I could tell Mary was finding our conversation enlightening and she
was nervously exploring new ways of relating. I then asked her to connect with those
strong, assertive feelings. Mary painted a plant that was standing erect. She also drew a
watering vessel next to the plant. I noticed the petals had changed colors from orange
to violet. For me this depicted, perhaps something like a spring feeling, where the
potential for something new was emerging. Mary reported that the image felt good to
her and the image itself was conveying strength and that she must nurture herself in
order to be healthy. I advocated for Mary to try on her assertive responses when she
returned to work the following day. In Mary’s research questionnaire, she reported that
the art making experience allowed her to view her problem differently and that it was a
pivotal point in the session where she felt better understood. When asked about how
she felt about the art product as co-participant in the therapy session, she reported that it
was strange but that it was something she could definitely get used to relying on.

Art Session Three. In this session, Mary reported that her boyfriend had ended
his relationship with the other monogamous woman. Mary reported that she felt
genuinely sad to hear this and that she was especially sad for her boyfriend who really
at one time wanted that relationship to continue. When I heard Mary’s deep
compassion and commitment to her boyfriend’s needs, I found myself feeling a little
under the spell as well. Mary almost appeared glossed over in her loyalty to another’s
desires. I joked with Mary that I was feeling a desire to play the Devil’s Advocate or at
least stir the pot a bit. Laughingly, with affection, I asked Mary if she could be a
participant in a cult. We both had a belly laughed and then Mary told me seriously that
her friends often said the same thing to her. She informed me that she was aware and
that her friends had noticed that she lacked a normal fear response. When Mary shared
this I couldn’t help but think of a story she had told me a week earlier of having
attended daycare since she was an infant and that her mom often told her the story of
how Mary had ingratiated herself to the front receptionist and would often spend her
time in the receptionist’s lap. When I heard Mary proclaim a lack of natural fear
response I couldn’t help but wonder why this was. I gently pointed out to Mary how
her focus on other’s needs, feelings, desires, fantasies seems to be in disproportion to
her attention to her own inner needs and desires. Mary agreed and added that she often
distrusted people who gave her compliments. She stated that she could handle someone
liking a dress she was wearing, but when her boyfriend complemented her nude body
she immediately went to distrust and a feeling of being manipulated. Mary was able to
identify her thoughts as being discounting and rallying behind her to not believe the
sincerity of another’s attention. I explained to Mary that when one suffers from

codependency tendencies it is not uncommon to have difficulty in receiving. I wanted
to normalize some of this for Mary for her to feel not alone in her process of recovery. I
asked Mary if she could paint or draw what it felt like to receive from others. Mary
painted an image of yellow being pushed on and crowed out by blue spiked external
forces. Mary stated that it felt immediately good when someone gave her special
attention, but then the outer core (blue area) would begin pushing inward. Mary did not
mention the orange area that rested between the yellow and blue but to me it appeared
that it might be representative of her anxiety. I imagine that the blue served a dual
purpose: to discount the good and to rid the anxiety. In Mary’s research questionnaire
after this session, Mary reported that the artwork as a co-participant in her therapy
session was definitely helpful and that she felt better understood. Mary answered that
her artwork was meaningful to her because it helped her visualize her feelings and that
her therapist was able to assist her in seeing what change she needed to make to better
tolerate the good feelings. I think Mary and I both found our session fruitful and the coparticipating artwork invaluable in understanding how Mary’s low comfortability with
good feelings is a contributor to her pattern of focusing outward on others. For me,
what was interesting is that after having the connection with the artwork, Mary
spontaneously shared a story about her mother shaming her for wanting to wear a tutu
to a recent St. Patrick’s Day event. It was through the sharing of this story that I came
to better understand Mary’s relationship with her mother. Mary was able to make
coherent in her narrative that her mother was a formal woman who held firm beliefs
about how one should behave, especially adults. It seems that Mary’s mother had a low
tolerance for spontaneity and play. Mary was able to elaborate on other examples.

Mary reported that she regretted not honoring her feelings to wear the tutu and that she
knew several hours later, after acquiescing to her mother’s lament, that she had missed
an opportunity to be herself. I felt mothering urges toward Mary and wanted so much
for her to experience an unconditional love and acceptance. I had to balance my own
feelings of anger towards to her mother so as not to encroach on Mary’s right to vent
her loss.

Maya is an eleven-year-old Caucasian female. She and her family live in an affluent

East Coast suburb. Even though Maya’s family chose to move to a more affluent suburb to

provide better educational access for Maya and her brother. Maya’s father is a police

officer and her mother is a nurse and they find themselves struggling financially. Maya

started counseling one year ago due to adjustment issues she was having with transferring
to a new school. What was most striking to me upon meeting Maya was her disheveled
appearance. Being that I am artist, I am not a judgmental person when it comes to

appearances. I have great latitude for how one presents themseles in the world, including

myself. In fact, I often feel disheveled in my appearance and even pondered if this was my
projection onto Maya. What struck me most about Maya was that she was struggling to

make new friends and her appearance at times was one that elicited attention, not only for
her lack of care in her appearance, but her directed efforts to gain attention by dying her

hair neon colors. On the one hand, I was impressed with Maya’s family in allowing her to

express her individuality, and on the other, I was curious about the gestalt of Maya’s image
and what it was that wasn’t registering as positive. I’m struggling to express this

experience because there were many positives about Maya and her appearance, as well as
her family’s support of it. She had the kind of freedom that most fifth graders would die
for. Her parents allowed her to present herself as she wished and this was to be envied.

But still there was something that didn’t strike me as coming from a place of self-esteem in
her self-presentation. There wasn’t an intention that seemed to meet with a sense of care.

During the initial intake process, I learned that Maya’s brother suffered from severe ADHD
and that a family history of attention deficit type symptoms existed. My experience with
Maya’s brother was that he demanded a lot of attention from his mother and what Maya

reported in session, as feeling overlooked due to his needs, often seemed true from what I

observed in the waiting room. It wasn’t very long into my work with Maya that I learned of

the emotional volatility at home. I soon began working with Maya’s family to better

understand what the constant strife was about and how best to contain it to support Maya
in her efforts to heal and find stability. It seems that within the past few years Maya’s
mother had engaged in an affair. The father having a history of abandonment and

significant loss in his childhood was having difficultly finding stability and security and the
fate of the marriage was in constant jeopardy. I counseled with the family for four sessions
and we were able to find a place in which the family could stabilize itself. The father would
seek ALCOA, Al-Anon and individual counseling to help him cope with his childhood

trauma and the same was recommended for the mother (which she opposed). What I came
to learn was that both of Maya’s parents had grown up in alcoholic homes and the

dysfunction from those earlier systems had been transmitted generationally to Maya’s
current family system. Maya’s father was more receptive to counseling and self-help

groups as he had been pushed to his limits and was experiencing an emotional bottom of

his own. As a child his mother had died and his alcoholic father struggled to maintain the
family. Maya’s mother was a gregarious character with a strong personality. She too had

experienced alcoholism in her family system and was still caring for her substance abusing

adult parents. Maya’s mother’s redeeming quality was her commitment to Maya, and while

she refused to read any books or attend any meetings, she steadfastly kept Maya in therapy.
I admired her for this and knew that her forthrightness about her own recovery wasn’t

helpful, but that she was doing what she could to help Maya. My experience was that Maya
‘s mother felt ashamed to seek counseling, and that while it was okay for her daughter, it

was not something she validated for herself or other adults. She was often dismissive

about counseling or an adult having mental health problems at all. Even so, she exhibited a

commitment to getting help for her children and was consistent with their treatment plans.
Research Session One: Maya reports in session that she continues to struggle at

school and feels that her teachers are being too harsh with her about her learning

difficulties. Since I had started working with Maya it had become evident that Maya

struggled in some unusual ways. Her handwriting was extremely difficult to read and I

expressed concerns to her mother that she should be assessed for dysgraphia. The mother

pushed for this testing at school, but it still was never addressed in a way that helped Maya
improve get the accommodations needed in order not to be singled out by her teachers.
The other interesting issue with Maya’s schoolwork was that she would not put spaces
between her words. She explained to me that she couldn’t train herself to implement

spaces between her words. This became increasingly frustrating for her teachers, and

Maya was feeling their frustration in class in front of her peers. Numerous times I

advocated for Maya’s mother to have her assessed by the school psychologist and for

accommodations to be implemented. In my mind, I could imagine the very real frustration
her peer and teachers would experience trying to decipher her sentences when editing

papers. On this session, Maya reported an increasing inability to concentrate. I asked Maya
if she could paint on one side of the paper what it felt like for her to not being able to focus.
Maya, who was always a willing participant when it came to making art, quickly painting a

green circle with marks swirling about it She described the image as chaos and distraction.

We processed how she felt overwhelmed and increasingly behind in her school subjects,

and how small sounds in the room often distracted her from hearing the lecture. I then

asked Maya to paint what it felt like to feel focused. She quickly painted a bull’s eye. It was
evident from the image that the clarity of the image represented a more focused endeavor,
and the black circle indicating the bull’s eye was front and center. It was during this
session that I began to believe that Maya needed to be assessed for Attention Deficit

Disorder – Inattentive type. It seemed that her symptoms, along with her total profile,

were pointing to something more than anxiety. I also wondered what else would be

learned through a full neuro-psych evaluation. She had reported in previous sessions that

she felt different from her peers because she didn’t like music. She confided to me that she
often pretended to like music just to fit in because she never felt moved by music. I did

notice, however, that Maya enjoyed doing guided meditations and would often be open to
receiving one at the beginning of session. In my opinion, Maya has much artistic strength
and had a unique sensibility with her use of color. Her mother had scheduled an

appointment with a psychiatrist and agrees that Maya meets the criteria in the DSM for

ADHD Inattentive type and that we should seek further consultation for a pharmacological
evaluation. Given Maya’s family history, addressing the ADHD symptoms may allow Maya

to sustain her academic progress. I am concerned how Maya will overcome her dysgraphia
hurdles and sentence composure issues. She was at first excited to use a computer in class
for her assignments, but has since reported not wanting the unsolicited attention. In
research session one, we did not have time to complete the research inquiry.

Research Session Two. Maya reports that her ankle injury has forced her to sit out

cheerleading practice. She reports that she feels incredibly awkward and useless sitting in

a chair watching her teammates practice. She reports a strong desire to quit the squad and
even discussed with me at length the myriad of ways her mother could recoup the money

investment. I asked her to paint her awkward feelings. Maya painted on a small scale large

expressive gestures much like seen in the era of modernist abstract painters. She identified
and processes feelings of awkwardness, uselessness, and boredom. She was able to

process the difficulty of sitting for three hours observing others practice cheering while she

pretended to be interested. I can tell from Maya’s expression that she had a lot of bottled
up energy, and her ability to endure and pretend is inauthentic to her true being. We
began to discuss her desire to leave and what consequences that would have for her

emotionally. I asked Maya to paint what it would feel like to leave the cheering squad at

this point in the season. She was able to bring her gestures down to a more intimate scale.

She later identified and processed feelings of loss and concern with how she would identify

herself at school and within her peers groups. It was through the painting that we were

able to see that Maya relied on the cheer group as an anchor of her identity that signified

she belonged. We had in previous sessions processed the conflict within the cheer group

when Maya failed to comply with dress code, but that she also enjoyed dressing alike with
her teammates on given days at school. Maya identified and processed that even though
she felt awkward that the loss of her peer group would be greater than the short-term

awkwardness of sitting out a few practice sessions. In Maya’s research inquiry, she stated
that the paintings help her find a middle ground and that through the talking and relating

to the artwork she would be able to take away from the session an ability to fix her issue. I
think Maya was able to find expression to both sides of her feelings and within that find a
place that made more sense to her. I think she found a way to slow down her habitual

impulsive and reactive nature where she could see how the short-term uncomfortability
would have longer-term gains.

Research Session Three. Maya reported that she is having difficulty at school with a

peer whom she considered a friend. She reported that this friend is teetering on bullying
behavior, so much so, that she and another friend went to the counselor’s office to report

their distress. While we were talking Maya began to paint. She painted with an intention

and finishes one piece. I offer her another sheet of paper and she painted a second image.
When she announced that she had finished, I ask her what she believed her artwork is

communicating. Maya reported that the first image was about slowing getting better; she

titled it, Progression. She pointed to the image and indicated that moving from left to right

was a series of stones, with each one getting bigger and more readable. I asked Maya if she
was one of the stones and she pointed to a middle stone that seems to rest between two

other ones. It’s almost as if the stone is a shadow of another stone, but Maya indicated it

was a singular stone. She told me that the black stone would probably be an adult. She said

an adult to her would be someone who had figured out more in life. In the second painting,
Maya employed a very different color palette. Maya said this image is titled, The Basics.

When I ask her to tell me more about The Basics, she indicated that each color represented

a feeling state: orange as anxious/stressful, turquoise as a positive energy and red as
power. My feeling was that Maya was owning more of her personal power in her

relationships and she was learning that she could stand up for herself and endure the

consequences of taking action to protect herself. Maya wrote in her research inquiry that

she fel5 most understood by me when we talk about her art. She also said that she became
aware that small things matter a lot, and was meaningful information revealed to her by
her artwork. Maya answered that she experienced feelings that were new to her. What

Maya felt she would take away from the session is that little things matter. I imagined that

Maya was feeling better equipped to fight her own battles and that by going to the school

counselor’s office with a her friends support, she was able to take a stand for her wellbeing.
While she didn’t label the incident with the friend at school as a full on bullying incident,

she indicated that enough was enough. She wanted the girl’s negativity toward her to stop.
I think many of us in life haven’t utilized our resources enough to stop nonsense at times

when it could have been stopped. Not every environment we encounter has mechanisms
built into it to assist in stopping negative behaviors. Maya took a stand for herself and

other to utilize the school’s resources to make it a healthier learning environment for all.
Research Session Four. Maya reports that the girl that she reported to the school

counselor is no longer speaking to her. She tells me in session that several girls have come
to her informing her that the girl is very mad at her. I ask if she believed the girl is mad at

her because of her reporting the incident. Maya says that she is not sure, but that it doesn’t
matter because she is just happy that the negative behavior stopped, and that she is okay
with the girl being mad at her. I found myself impressed with Maya’s unflappability. In
past sessions when Maya had distress with her friends we would spend more time

processing hurt feelings. This time Maya exuded an air of clarity. She held firm in her
belief that getting the behavior to stop was her primary goal and if that meant not

temporarily having a relationship with this other girl then she could handle that just fine. I
thought to myself if this is not progress what is? I asked Maya what she would like to do

that day, and she stated that she wanted to draw a dress. This seemed very specific to me
and so we started making art. Maya quickly discarded her first version and I offered her
another sheet of paper. She spent a considerable amount of time mixing colors and

painting an intimate sketch of a red dress. When she finished she told me that she had

been thinking a lot about dresses. I reflected to her that maybe she was interested in

expressing more of her feminine side. She agreed. She told me that girls normally don’t

wear dresses to school because they are not practical in hallways with their flowingess. I
noticed that the first image Maya drew attempted to have a girl wearing it. In the second
image, Maya just concentrated on painting the dress and the space around it. I was
imagining that Maya was going through some developmental changes and perhaps

awareness about the opposite sex. I was not really sure what to make of the fixation on
dresses, but I saw it as a balancing of her assertive self with her feminine self. She has

never spoken negatively about her body image, but I was surprised at how narrow the
dress is portrayed in the drawing. In the research questionnaire, Maya wrote that the

meaningful information that her dress revealed to her was that she was good, strong, and
beautiful. Maya had expressed in recent session more awareness of her classmate’s

knowledge about her struggles with handwriting and some other functions in writing.

Maya reported that she is a very good reader, and her parents report she makes strong B’s
on her report cards. My concern is that Maya’s shortcomings are gaining strength as her
classes become more difficult. I can imagine that Maya’s handwriting and poor ability to
differentiate between words consistently in sentences is noticeable.

The Sessions

My research was conducted over the course of three months. The research
participants were five female clients who were existing clients at my private –practice
counseling agency. I decided that working with existing clients posed a lower risk of
harm as opposed to working with new clients with which I had no pre-existing rapport.
Even though my plan was to remain open throughout the process and follow the lead of
the client, regarding whether or not they were comfortable on a given day to participate in
the research, I still felt that the risk was too great with clients whom I had no prior
relationship. My original goal was to complete between 4-6 sessions with each client. In
the actual research, I was not able to complete six sessions with any of my research
participants. The maximum number of times that I meet with a client was four sessions.
The client population was female: two adults and two adolescents, and one teen.
The Case of Parastoo
Parastoo is a twenty-four year old Muslim female college student. Parastoo began
therapy with me shortly after her parents divorced. Parastoo’s mother and father are from
Syria. While both parents are Muslim they practice their religion and culture differently.
Her mother is Kurdish and Parastoo informed me that the Kurdish Muslims are more
respectful of women and women are allowed more rights. She reminded me of the
Kurdish women soldiers who are sent to war. I was familiar with the images of Kurdish
women soldiers because I was researching them for a painting on which I was working. I
remember feeling admiration for the strength these women exhibited in their fight for
their beliefs.

Parastoo’s father is Arab Muslim, and according to Parastoo, he is much more
traditional in his belief system and exhibits more control and ownership with her
whereabouts. The clashing of beliefs is one reason Parastoo’s parents ultimately
divorced. Unfortunately, Parastoo’s mother moved across the country immediately after
the divorce from Paratoo’s father and left Parastoo responsible for her younger sibling.
Parastoo’s younger brother, aged twelve at the time, became her full
responsibility. Her father also put all domestic chores and cooking responsibilities on
her. Parastoo was in grief over the loss of her mother’s support in the domestic sphere,
plus she struggled with a very intense secret relationship. She had started dating a man
her age who is not Muslim and while Parastoo stated she did not care what her parents
thought about the relationship she did not share with them that she was even in a
relationship. Many times I broached this subject with Parastoo because I was concerned
with her physical stability and how this would impact her ability to survive and continue
with her college studies if her father were to find out about the relationship. Parastoo
wants a committed relationship with this man, but he steadfastly refuses.
The relationship had many ups and downs, and shortly after she started therapy
they broke up. Parastoo wailed in my office with the intensity that signified to me that
she was grieving not only this loss, but others as well. I soon learned that Parastoo’s
mother was very critical of her throughout childhood, and that her mother had survived
stage four cancer when Parastoo was only eight years of age. Parastoo reported that in
high school the counselor at school requested that her mother give her more freedom as
she felt that Parastoo she was more capable than her mother was portraying her.
Parastoo’s emotions intensified so much during the beginning course of treatment

that she went to the emergency room on several occasions for severe abdominal pain.
Each time, the doctors concluded that Parastoo was suffering from severe anxiety. She
was prescribed Xanax as needed. While I had her diagnosis listed as Generalized
Anxiety Disorder, I firmly believe she in fact suffers more accurately from Complex Post
Traumatic Stress Disorder. I believe Complex PTSD is a better explanation for her
anxiety, panic attacks, intense attachment distress and chronic feelings of low selfesteem.
Thus far in counseling, Parastoo had exhibited a resiliency and commitment to
coming to counseling sessions. She was a good candidate for guided meditations and art
therapy. Prior to starting the research, I had already completed several art therapy
interventions with Parastoo and found that her ability to connect non-verbally was more
depthful than her verbal expression would allow. I’m noting that we had previous art
therapy sessions because once the guise of art therapy research was made explicit to
Parastoo, her ability to be less conscious seemed at first to regress.
Session One. Parastoo reports that her needs are not being met in her relationship
with her boyfriend. I assisted Parastoo in identifying and processing feelings of hurt and
confusion. By this point in the therapeutic process we were well aware of the
relationship patterns and Parastoo’s continuing pursuit of a man who continually told her
in a very upfront manner that he had no intentions of being in a committed relationship.
This concerned me because Parastoo was having a sexual relationship with this man,
experiencing feelings of bonding and yet he was staying firm in his intention to not be in
a committed relationship with her.

I asked Parastoo to paint on one side of a piece of paper her feelings about her
situation. She was asked to contrast her two most inner feelings. Parastoo, who
previously would paint pictures and often surprise me with their depth, reported that she
felt stumped and only wanted to paint words. She painted on the left side of the paper the
word RELIEF and on the right side of the paper the words DRAMATIC, WHAT IS TOO
MUCH? CRAZY?
It appeared to me that Parstoo was exploring her feelings of being overly tolerant
and unable to draw a boundary for herself. We discussed what the color choices meant to
her. Parastoo stated that her use of green for the word relief was her desire to grow
beyond this stagnant place. She felt that the black used for the word dramatic was her
depression and anxiety with the ups and downs of the relationship and the orange for the
statement, “What is too much?” indicated her confusion with the relationship and
herself. She said the red used for the word crazy was her anger and rage for tolerating the
lack of reciprocity in the relationship. While it seemed at first to me a resistance to
exploring deeper emotions, Parastoo was actually able to clarify her feelings by using the
paint to paint her feelings with words. The colors helped her connect with disassociated
emotions and I came to see Parastoo as more nuanced and self-aware than she presented.
It was important for me to see that Parastoo was struggling with her dilemma and that she
was making progress even if it meant remaining in her situation for the time being.
During the post session questionnaire, Parastoo wrote that the art therapy session
helped her feel more understood and validated. She emphasized a few times that she felt
validated and that it was okay to have her feelings. I think Parastoo and I both were
seeing that she was in a struggle between her heart and mind. She wanted this

relationship desperately in order to avoid any further loss and feelings of abandonment
and yet, the relationship keeps bringing forth doses of loss on a chronic basis.
Session 2. During this session Parastoo reported that she didn’t have a lot of
time. Time was an issue during my sessions with Parastoo because she commuted to a
state college about 45 min. from my office. We decided she could bring back the
questionnaire the following week. During this session Parastoo was focused on the idea
of what is love and exploring openly how she finds that she loves the man she is dating,
but that his love doesn’t feel the same as her love. I ask Parastoo if she could paint what
love feels like without safety/security and what love would feel like with safety/security.
Parastoo was able to identify for herself that love without safety and security is a feeling
of darkness, confusion, and the unknown. For Parastoo, love with safety and security is a
feeling of warmth, home, happiness and passion. I was able to assist Parastoo in
identifying and processing her deep desire for safety and security and how that the
longing she is experiencing is historical and something not occurring only in this present
relationship but something that she had been missing for a long time. Parastoo was very
emotional in this session and able to connect deeply with feelings of loss and grief.
Parastoo did not return the questionnaire the following week. While I was not able to
gather her written response to the session, I do feel that the session was productive and
brought Parastoo and I in closer alignment with the core issues which keep her in her
current pain provoking romantic relationship.
For me this session allowed me to connect deeply with Parastoo’s deep
attachment wounds and her need to feel cared for on an emotional level. While
Parastoo’s boyfriend was surprisingly firm in his ability to remain committed to a non-

committed relationship, he was often surprisingly emotionally available to her. The one
economy he offered generously to her was support for her pain and loss with her family
and her weekly crisis’s with school, work, or car problems. The hook this man had with
Parastoo was an ability to gratify her emotionally, something her parents were not able to
do. Both Parastoo’s parents offered little to no emotional support and often were blunt in
their belief that she would amount to nothing.
In my opinion, it seemed that her parents ruled with fear. Their idea of
motivating Parastoo was from a place of fear. They did not see the burdens that she had
carried since a young child. She remembered her mother sick with cancer and how hard
it was to be responsible for her younger sibling. Parastoo reported one memory in a
previous session where her mother threatened abandonment and left the home with
Parastoo distraught inside. Her mother would often use threats of abandonment as a way
to control the children. These threats were very real given that Parastoo had also faced
the very real threat of her mother dying when she was receiving treatment for Stage Four
breast cancer. Parastoo reported that her father’s mother left him as a young child and
that he was often an angry and abusive man to her mother.
Parastoo felt that her parents were never meant to be together. She felt that while
they were both Muslim, they differed on many things. Parastoo’s mother, now living
across the country, calls her daily to berate her and criticize. I have advocated strongly
for Parastoo to no longer tolerate this, as the absurdity of the situation doesn’t validate
her mother’s criticism. Parastoo’s mother abandoned her children to go and live with
another man (a way for her to financially survive) and now she was calling Parastoo
guilting her daily as if she is the mother of the younger sibling. Parastoo has gradually

instituted better boundaries with her mother and this seems to help her anxiety. I will add
that Parastoo is deeply committed to her brother’s well being even though she reports the
burdens are heavy and that she hopes to one day leave home (when she gets a job after
college graduation). She worries about the long-term well being of her brother and how
her father will manage the home if she is not there to cook and care for them both.