The Role of Art in Child and Adolescent Group Therapy
Kathryn Fisher, MS, ATR, CGP

In art therapy groups, members create art that reflects the culture of the group. How and why artwork is made can teach us so much about a specific group and its members. This is as true now as it was in ancient cultures. It can give us information that we may otherwise overlook or undervalue. Consider some of the following examples.

In a young adolescent group for children who struggle with peer relationships and understanding of social cues, one of the six members continually tried to throw crayons and markers. Because of his agitated state and his need to throw something, one of the co-therapists suggested that he make a ball. He and a therapist wadded a piece of paper, wound a full roll of masking tape around it, and then played catch. Other members watched and were relieved because he was now busy and there was some predictability about flying objects in the room. One member voiced frustration because of the wasted materials; a discussion unfolded about what is wasteful and what is valuable. Spontaneously, a ritual arose: every week thereafter, a roll of tape was wound around the ball. Eventually everyone participated; even the more sophisticated members asked to hold and feel the ball. One member prided herself in her “densifying” technique, a careful rolling and patting of the ball. The boy who started the ball had a rise in status and was proud of his shared creation. Its form changed from lumpy and crude to spherical and smooth; its weight and power grew; and it began to have increasing importance. Between layers, names were signed and messages were written. One week, when it had grown to the size of a bowling ball, it was given a smiley face, a chair, and dealt into the day’s UNO game. In an impulsive angry moment, it was thrown at a boy; hard and heavy, it caused pain. The group spent the next session discussing all aspects of this moment. The following week the ball was used in a game where the person who held the ball said something about himself or herself. The job of wrapping required two group members every week. Much discussion followed the choosing of partners and the job of wrapping. Tape stretched from one side of the room to the other; hair got caught in the tape. All of these situations required thought and patience on the part of the therapists. The ball came to represent the group; it was something whole and complicated that we had created together.

A young girls’ group (8–10years) with four members, altered large cardboard boxes to symbolically express various things, especially about home and self. The girls, who had been surrendered by their biological parents and then again by foster and/or adoptive parents, lived their young lives awash with feelings of grief and loss, yearning for homes. Frequently they acted these feelings out in anger towards adults and peers. They transformed their boxes almost immediately into houses. They were neighbors. Their natural expression of play flowed from there. They began to call 911 on their neighbors for beating their children; they went off to work and left babies behind because they were “bad.” One girl, who had no contact with her family and struggled to even remember her siblings’ names, cut pictures out of magazines, calling them her family portraits, and taped them to the cardboard wall. They made mailboxes, and the members and therapists wrote messages to each other, saying things that were difficult to say out loud. As the intimate play progressed, feelings of abandonment were re-stimulated, and this led to two members attaching their boxes. The others immediately felt excluded and reacted with anger and hurt. Homosexual anxiety may have intensified the feelings. A fight erupted. Members yelled and screamed all at once. A therapist made a crude cardboard cell phone and called up a member. Other phones were made and members began to talk to one another. They cried and told their stories of abandonment and grief. One member pretended to be another member’s mother, using the cardboard phone, calling her to make plans for a weekend visit. The conversation ended with “hugs and kisses.” At the close of these sessions, the therapists were left with cardboard that had been transformed into art and props for powerful play therapy. 

In a teenage boys’ grief group, one boy asked, “How large is the kiln? how big a pot can I make?” He told me that he would like to make a garbage can. “One big enough for all of the shit in my room.” I wondered what this meant for the group. Was he sensing the enormity of the pain in the room, desperate to contain it? This 15-year-old, whose father killed himself and who had often felt suicidal himself, began to build a base for a very large pot. The four other members also used clay, but the large pot became the focus of the group. I became attached to the pot, and the boy sensed my feelings. I wrapped it week to week so that he could build the layers. A few weeks into the group he came in and threatened to destroy the pot. I felt reactive and tried to stop him, but other members egged him on, and urged him to smash it. This went on for a few sessions, until I stepped back. Members, sensing my attachment to the boy as well as the pot may have desired the pot’s destruction out of anger and jealousy. Also hostility and rebellion against me as the transferential mother may have his reflected adolescent struggle with a parent. I wanted to protect the pot and try to save what I had no power or right to save. After I talked about it in supervision, I told him and the group that I didn’t want him to destroy the pot but if he was intent on doing so, I couldn’t stop him. At the same moment I realized that I couldn’t stop him from killing himself either. The group continued to encourage him to smash the pot. He immediately shifted and became protective of his pot. He asked me for one more clay and worked to complete it over the next few weeks. He carefully made a top for this vessel. Members stepped back and respected his need to complete the work.

These are just a few examples of how art materials and the art-making process can deeply impact and inform a group and its leaders. Art can bring out the regressed and primitive, as well as the sophisticated and intellectual in all of us. It is a symbolic language. Every mark that is made can hold valuable information and should be considered as an important messenger.

The Importance of Belonging
I co-lead a number of child and adolescent art therapy groups in a variety of settings from residential, to outpatient clinic, to private practice. The common link in all of the groups is that the children frequently feel disenfranchised and isolated. They search for a place to belong. Group therapy can provide them with that place. Time and again I have witnessed children and teenagers finding a place for themselves in the process of coming together at a set time and place. It requires that the therapists encourage honest communication and feedback, manage scapegoating with some creativity, and allow the expression of verbal and visual feelings, however difficult or unattractive. Feeling lost and alone, group members find a place of belonging and a feeling of ownership. The hope is that they then take what they have gained in the group and use it in their lives. We have had parents report successes that they directly attributed to the group. One mother said that her daughter was invited to a birthday party for the first time since preschool.

Art therapy groups, like other modalities take diverse forms. In my work, I do not tend to give assignments (e.g.: “draw an angry feeling”) but rather present materials and invite members to create. This style requires that a therapist trust the group and believe that the resources and healing power are held within the group and its membership. It demands trust in human creativity, a trust in members to be playful and will want to do something to connect to one another. Many times, each member at the table is working on a different project using a different material. At ther times, one member brings an idea to the table that inspires the whole group and everyone chooses to do the same thing. Energy, ideas, and creativity ricochet around the room. This, of course, provides the group with information too, as art can be a catalyst for all kinds of feelings like competition, frustration, and joy. It can stir all kinds of memories that can then be talked about. 

Art Therapy is Not Art Class
Talent is not a requirement for art therapy group membership. Members may scribble, poke at and cut clay, use gimp, or wind tape to relieve anxiety and allow them to stay in the group and focus on the conversation. Sharing art materials provide groups with many negotiation opportunities. In a Simpsons’ television episode, the precocious Lisa and her more primitive brother Bart are fighting over a bottle of Elmer’s glue. Tugging back and forth with it, Lisa says, “Bart, you know that this is ??not?? about Elmer’s glue. This is about our boundaries.” So too, in group, art therapy dealing with materials is frequently a symbolic struggle. 

Different materials lend different expressive and interactive qualities to the group. Dry materials are always good to start. They give clients a sense of control. Paints are flowing and fluid and tend to elicit that response from the group, which can be dangerous if done too soon. Paint and the mixing of colors can stimulate regression. Clay offers physicality, something to resist, poke and cut. It’s a material that can be built in multiple shapes and forms. Aggression that might otherwise be used against another member can be acted out with clay. It is an ideal medium for someone to use to doodle when a client is not interested in formed expression. Clay can also stimulate regression. Sometimes when groups get out of control, I have had to pull back and offer less stimulating materials. A dry material that I have had magical results with is pipe cleaners. Even in the toughest teenage groups, a few sets of pipe cleaners in the center of the table can evolve from everyone in the room wearing pipe cleaner eyeglasses or crowns, to a lively game of pipe cleaner people playing basketball with a pipe cleaner ball and hoop. 

Sometimes the tools involved can be used to threaten or hurt. At this point they must be taken away and not returned without a whole group agreement to maintain safety. The pressure from the members usually prevails. I tell the members that tools have all kinds of functions but within the group they will only be used in safe ways and for creative purposes. I do everything in my power to support the creative side.

Issues of authority and leadership loom large in every group, but perhaps even more so in child and adolescent groups. We work with clients who relate dysfunctionally to authority. How do we, as the authority, in the room create and support a setting that invites and sustains honest expression? At the start of group we represent their primary authority figures. Our job, at least in part, is to help them to separate from infantile ties to parents and to move towards healthy peer relationships. The work of art therapy allows this to happen. The culture of the group and the work of the therapist support the transformation of mundane, raw materials, and ordinary child and adolescent moments into extraordinary opportunities. These seemingly simple moments have the power to open feelings where words have sometimes failed. The art that is created in these interactions serves as symbolic language and offers a path to change. 

Kate Fisher is a Registered Art Therapist who practices at Hillside Children's Center, Saint Mary's Out Patient Clinic, and is in private practice in Rochester New York.

References
Azima, Fern Cramer & Richmond, Lewis H. (1989), Adolescent Group Psychotherapy. Madison: International Universities Press, INC.

Gans, Jerome (1989), Hostility in Group. International Journal of Group Psychotherapy 39(4). 

Kramer, Edith (1971), Art as Therapy with Children. New York: Schocken Books.

Silverstein, Judith L. (1997). Acting Out in Group therapy: Avoiding Authority Struggles. International Journal of Group Psychotherapy 47, 31-44.

This article was published in the August/September 2002 issue of The Group Circle.