Art therapy's three-layered-cake approach

Liu Xiaolin
When Miki Goerdt first came cross the phrase "art therapy," she was in high school back home in Japan.
Liu Xiaolin

Podcast EP12

When Miki Goerdt first came cross the phrase "art therapy," she was in high school back home in Japan. One day, she read about a man in the newspaper working at a nursing home doing art for the residents there.

This article propelled her, then 18, to think about what art therapy is. One year later, she went to college in Iowa in the United States and studied art and psychology. Later, she majored in social work for her master's degree and the graduate level certification in art therapy.

Her first art therapy internship was with the Alzheimer's Association in Denver, Colorado. She still remembers one of the first sessions she had with clients. "They couldn't remember what they ate for breakfast. But once they started painting, they were trying to talk about the favorite pets they had, the places they used to love, their family," Goerdt told Shanghai Daily in a Zoom interview. "It was amazing. And I told myself, this is the thing I'd like to do for the rest of my life."

About four years ago, Goerdt was credentialed by the Art Therapy Credential Board in the US, and is now running her own private practice, Emerald Leaf Counseling in Falls Church, Virginia, a suburb of Washington, DC.

"What's interesting about art therapy is you see what they create... Some of the places that I've worked, I have done different projects with clients, of course with clients' consent, to share their artworks with others in the form of a calendar or mural or public display like an art show. So the people who are looking at the clients' artworks get to learn about their healing process, how they are discovering themselves and how they are actually managing their struggle," Goerdt said.

Art therapy's three-layered-cake approach
Courtesy of Miki Goerdt

Art therapist Miki Goerdt

Q: What exactly is art therapy, and how can it actually help?

A: Art therapy is different from talk therapy because of three different things: the art media, meaning what kind of art supplies are used; the art process by creation of art itself; and the product, meaning the artwork itself that comes from the art making. So art therapists use all three things during the session to manage or improve clients' mental health conditions.

Probably the best theory to describe how art therapy works is the expressive therapies continuum. In that theory, we talk about what an art therapist does in a "three-layered cake." It's like a compass for art therapists to figure out what to suggest a client should do, what media to use during the session.

It's like a map. Each layer has two components that are complementary. The bottom layer has kinesthetic and sensory; the middle layer has perceptual and affective; and the top layer has symbolic and cognitive. All of these are ways for clients and therapists to process information. At any level, there's an additional level called the creative level. If an art therapist is working with a client and trying to utilize these components in these three layers and it works, then the client gets to experience the creative level, and that's the level where they can actually experience joy and healing.

I'll give some examples of how these layers work. Let's say a client comes to my office, and I can see the client is becoming emotional and overwhelmed by the emotions she's experiencing. She is in the (layer of) affective information processing. So then what I do is to pick out the complementary component that's perceptual, meaning I prompt her to use more observation skills so she can actually contain her emotions.

Then in the session I might say, "let's take a pause here, and look at your painting together." I might put the painting on the wall, and then step back a little bit so we can be more objective about the artwork. I will ask questions to prompt her observational or perceptual skill, sticking with what she sees in that image.

"What color are you noticing? What shape do you see? What do you think about the quality of the lines you use?" Just to engage her observational skills. When clients do that, the emotions that are so overwhelming become more contained and calm down.

Art therapy's three-layered-cake approach
Courtesy of Miki Goerdt

Mindless artmaking is one of the daily practice Miki Goerdt would suggest her clients do at home.

Q: What's the normal standard procedure?

A: I have two types of clients. The artist type, the ones who like making art and say "I want to do art therapy with you, Miki." Those clients might actually start the beginning like an art task, like "let's start the session drawing how you're feeling." That becomes a warm up, and then I will suggest something else that's related to that for the main part of the therapy session. If the client draws something that represents anxiousness as they check in, then the main part of art making in the rest of the session could be about making the kind of container they want to create for their anxiety. That becomes more extensive art making.

But the other type of clients are those not used to making art. If I ask them to draw at the beginning of the session, they will say something like, "Wow, I don't know what to do with that." So with this type of clients, I start with talk therapy, and maybe after 15 to 20 minutes, I'll suggest doing something hands-on. I would not use the word "art." It has a stigmatizing effect.

Q: What's the main media you use in therapy?

A: A lot of my clients like collages, magazine cut-out images and words they can put together, water colors and clay. I also do print making, which is an interesting thing to do, because it's not as intimidating as painting or drawing. The types of printmaking I most often use with my clients include styrofoam printing and mono print.

Art therapy's three-layered-cake approach
Courtesy of Miki Goerdt

An example of styrofoam printmaking

Q: Will you prescribe daily practice for your clients?

A: Yes, I give them homework. Actually, a lot of my clients like that.

Q: What are some of the things you suggest your clients do at home?

A: It could be something like mandala drawing, like creating a circular shape. For homework, I don't ask them to draw anything big, because that could become discouraging. Something that's the size of mug cups, that would be perfect. And I ask them to do page after page. Last week, I had a client with nighttime anxiety problems. So her assignment was to get a sketch book, and do a palm-size mandala drawings each night before she goes to bed. Do it for 10 minutes and then close it up, and the next day do it again. Do it for two weeks, and then come back and let's look at what you made. It actually has a kind of calming effect for her. She slept better as a result.

Q: How do you manage to understand how clients' emotions fluctuate through their drawings?

A: For two weeks' mandala drawing, there would be 14 images. And there is usually a change in images from the first to the last drawing. As an art therapist, you're looking at the artwork and making a comparison between how the client starts an artwork and how she ends it; the images are very clear sometimes to show the internal changes. I make lots of observations of the clients and the artworks and try to correlate the two.

For me, whenever I had any kinds of thoughts or observation, I always double check with client. Client owns the artwork. Whatever I think, it must be validate by the client's perception, out of respect and out of accuracy.

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