BODY-CENTERED ART ACTIVITY:

DEVELOPMENT OF LEXITHYMIC BODY AWARENESS IN OCCUPATIONAL THERAPY AND PROFESSIONAL TRAINING [1] ⁾

 

Georg Keller

 © COPYRIGHT by Georg Keller and by the German publishing house Verlag Modernes Lernen, Dortmund.  

Keller, Georg. Winter 2001. 'Body Centered Art Activity - Development of Lexithymic Body Awareness in Occupational Therapy and Professional Training,' The Canadian Art Therapy Association Journal, ISSN 0832-2473 (CATAJ), Volume 14 Number 2 pp.29-43.

 

Abstract: At first this article is pointing out a close connection between body awareness and emotional experience, especially illustrated by body-imageries. Then the term ‘Alexithymy’ and the relationships between medical treatment, body, body scheme, body image, self image and psychotherapy are explained. Afterwards there is a representation of different artistic activities, which can help both students in education and alexithymic patients in therapy to perceive the own body and own emotions clearer and to encounter their fellow men more openly and empathically. Occupational therapy can become a bridge between usual medical treatment and psychotherapy.

 Keywords: occupational therapy, art therapy, education, alexithymy, body image, sensory awareness

   

Introduction

The author is a German occupational therapy teacher. German occupational therapists often apply artistic means in their work in psychiatry and psychosomatic medicine. Some of them receive additional training in art therapy. This article describes body centered art activity as an incentive measure for starting a process of growing self-awareness in short-term therapy with hospitalised patients or in education. Georg Keller, Daniela Keller and Veronika Hofmann M.A./Vermont Coll. did the translation of this article.

 

1. The outside physiognomy versus the subjective body perception

Even though a person’s outside appearance is usually rather stable, the internal body perception can be completely different and does vary depending on momentary conditions. 

Frequently overweight patients draw themselves extremely small, opposite to their visible constitution. Inquired about their drawings in a trusting atmosphere, some of them will tell you they experience themselves small and lost in relation to the large, distant world. Their artwork is expressing their subjective anatomy’ [2] . Thure von Uexküll introduced this term in the context of his work on Psychotherapy of Psychosomatic diseases.

Children’s art as well as expressive artwork from the 20^th century often deal with this subjective anatomy. Two examples are the art of Alberto Giacometti and of Henry Moore (Fig.1). Reproductions of their work can inspire patients to creatively express their internal body perceptions.

 

Figure 1:

View on two open books: Books like these, with various reproductions of works of art by artists in particular those of the 20th century, 

can help to find out possibilities to express creatively, what you internally perceive

 

By making loose, expanding movements one can become aware of one’s own bones and joints. Thereby one can perceive oneself internally as thin and tall as Giacometti’s sculptures. The artist himself stated, as follows, that these typical characteristics of his art are originally rooted in specific childhood experiences: While my fingers knead the clay, I am on my way home from school on the mountain trails of Stampa. My shoes are covered with mud. Surrounded by the mountains and their undulating ravines, these make me want to climb up high on steep rocks and to overcome abysses, to walk up stairs made out of slate, flint or clouds.” [3]

On the other hand, during relaxation following slow, intense muscular activity, like after weightlifting, or during Edmond Jacobson’s relaxation exercises, the internal body perception is one of a warm, voluminous and heavy mass. Henri Moore’s sculptures [4] evoke comparable associations. It tells of how as a child Henri Moore often gave a massage to the rheumatic dorsal muscles of his mother, that impressed him very much.

 

2. Internal body sensations and the perception of emotions

The perception of our own emotions is rooted in the perception of our inner body, particularly in the enteroception and the proprioception. The inner awareness of our own body language and vegetative functions plays an important part in the understanding of our emotions.

In most parts of the body one can feel either tense or relaxed, depending on various emotions. You can fearfully pull up your shoulders. Or you let your head hang forward down, when you are resigned. Your heart will beat faster and stronger, when you are happy or in love. But when you are sad, your chest may feel narrow, your heartbeat becomes slow and your breathing becomes flat. Stress may strike your stomach or increase the blood pressure. When you feel well, you may feel a warm flow of energy from your heart going through your body. Problems can cause a headache. This list could be continued almost endlessly.

In order to keep in touch with oneself in daily life, it is essential to be psychophysically aware.  This includes distinguishing between real emotions and misleading cognitive ideas about oneself. This ability is of great importance in situations when the real feelings are more unpleasant than an easy illusion. Healthy self-assertion and self-confidence arise out of realistic psychophysical awareness. Moreover that awareness is a necessary basis for gaining mutual satisfaction in empathic and understanding relationships.

Paintings and drawings can make internal body experience visible. Many children produce these images spontaneously and straightforwardly. Adult patients though who are not familiar with art expression often need help in order to be able to consciously perceive or to express their inner experience.

Figure 2:

‘I have a headache’, M, 9;8,gouache [5]

 

An interesting example of child’s direct body expression shows Fig. 2. Prof. Max Kläger writes about this headache picture of the 9-year-old boy: “How to represent the feeling of suffering from a hot aching head? -  The child used colour and form to solve this problem. The pain embodies itself in the fire flames, which concentrate on the head. The general indisposition becomes clear by the dirty colour of the face, the white lips and the dark and gloomy body and background." [6]

Figure 3:

Childhood experience of a 29 year-old female patient: ‘I was beaten by my mother’

 

Figure 3 is an example of how a drawing can indicate deficiencies in body awareness. It shows a childhood reminiscence of a 29 year-old female patient. When she was young, her mother, who was an alcoholic, had often beaten her. The drawing has many things in common with children’s drawings (e.g. the objects are not overlapping, front view of the figures, the characterisation of the figures by attributes). The patient depicted holding a red bag and the mother with carpet beater. The lower edge of the painting as base line and the emotional perspective. This childless married female patient painted spontaneously. But there are also some noticeable differences between her picture and children’s art.

First, she draws the figure of herself and of her mother as stick figures with three legs! Children almost always draw a shape for the trunk. Adults tend to use figures abstracted to long thin lines especially in quick sketches. In more elaborated pictures however stick figures may indicate a disturbance of body sensing, because the artist seems to rather have an abstract idea of himself than being psychophysically aware. Abuse in childhood can cause this lack of body awareness. The patient’s stick figures in Fig.3 don’t express the same vital intensity, self-assertion and self-confidence as the portrait of the 9-year-old boy (in figure 2).

 

3. Progressive relaxation and body-sensing-imageries

Edmond Jacobson’s progressive muscle relaxation technique enhances an intense psychophysical awareness of diverse body sensations like warmth, coolness, gravity, lightness, restriction, width, tension, relaxation, pulsation and flow of energy...

The following drawings were made after relaxation sessions. The instruction was as follows: “Please first outline (with a pencil on a sheet of paper) the contour of your body. After that indicate by colours and symbolic forms (with pastel crayons or other) your body sensations. You can mark parts of your body-sensing-imagery for example with warm or cool colours or express tension, relaxation or pain with different smooth or hectic lines or symbols. There are no limits for your creativity. Later you can show me your drawing, and if you want, we can talk about the sensations expressed in it.”

The products of this exercise (Fig. 4, 5 & 6) show the patients’ abilities to perceive their inner body sensations and to express these creatively. The drawings also helped to assess the patients’ actual personal condition as a basis for planning further therapy.

 

Figure 4:

Body-sensing-imagery of a 22 year-old workaholic male patient

 

A very intelligent 22 years old male student, who was hospitalised because of suicidal ideas as a consequence of a workaholic personal attitude, painted Fig. 4. In his first progressive muscle relaxation session he had such a lump in his throat, that he could hardly exhale. At the end of the session his legs were circulated warmly with blood indeed, but trembling and exhausted. The trembling sensation in his legs is represented in his drawing by the black snaky lines. Furthermore the drawing shows: the brooding thoughts in his head (blue circular lines), his lips pressed together, a lack of awareness of the head except for these unpleasant sensations, the lump in his throat, an intense warmth in his abdominal wall, and an “aggressive tingle“ in the anus (without any medical findings, like eczema or haemorrhoids). He commented that the tingle increased when he was studying hard for exams.)

Figure 5:

Body-sensing-imagery of the same male student 16 days later

 

The same patient drew a second body-sensing-imagery (Fig. 5) 16 days later, after further treatment with progressive muscle relaxation and body-centered occupational therapy with artistic means. In the meantime he succeeded in doing the progressive muscle relaxation more softly and it was a meaningful experience for him, that less effort can be more effective. He still achieved pleasant warmth in his legs, but now without any disturbing trembling sensation. (No more black snaky lines in the painting.) Now the anus sensation was pleasant. The abdominal wall was warm and less tense. The lump in his throat was minor. Meanwhile he could also feel his head relaxed, however not yet free of the brooding thoughts.

Figure 6:

Body-sensing-imagery of a 30 year-old female patient with neurofibromatosis and interpersonal problems

 

Figure 6 shows the body-sensing-imagery of a 30 year-old female patient with neurofibromatosis and several interpersonal problems. She felt overstrained by her work as a cashier in a supermarket and excluded by her colleagues. After a failed relationship with a partner, she moved back in with her parents again. In her painting she embodied herself very small and in an infant body scheme (oversized head in relation to the other parts of body) in the middle of the sheet of paper. She is dressed with a skirt. Later she supplemented in a childlike but poor manner a landscape with radiating sun. Her figure seems to have no ground under the feet. According to her explanation, the black object under the skirt was to represent a “lump in the stomach”! She did not understand my question about the deep placement of her ‘stomach’. It was apparent for the therapist that the patient was not ready to bring to consciousness whatever that black lump in the ‘stomach’ could mean. Anyway, the fact that this drawing was even made proves that she was asking for help, even if words were not the appropriate of therapy this time. Basically stimulating body centered occupational therapy could help her to gradually become more aware of her body and herself. The second priority was the establishment of a trusting therapeutic relationship as a basis for her to eventually allow for any traumatic experiences to come closer to surface.

 

4. Alexithymia

Alexithymic patients are unable to experience and to understand differences in their psychophysical condition. They show little awareness of their own feelings, living in a dissatisfied manner and unable to empathically relate to their fellowmen. Instead they tend to adhere to social conventions and roles. They behave like they feel they are expected to, rather than searching for possibilities in living according to their own true feelings and needs in sympathetic consent with their fellowmen. (In a lecture at the psychiatric hospital ‘Burghölzli’ in Zurich, the Swiss psychopathologist Prof. Ch. Scharfetter described these persons ironically as “normopath”. He said  “normopaths” are opposite to psychopaths mostly socially inconspicuous but nevertheless in need of treatment.) Their dissatisfied way of life causes with time increasingly bad temper or resignation and often produces psychosomatic disorders.

Despite the fact that alexithymia is a psychosomatic term it is also applicable for psychiatric patients. - In her book ‘Steps Toward Wholeness’ the physical and movement therapist Sophie Krietsch remembers the typical schizophrenic symptomatology. In 1955 and still before the general introduction of major tranquilizers and psychological treatment, Krietsch observed the typical expressionless faces and slack bodies, sitting around unrelated to time, space and fellowmen; several with machinelike stereotype movements. She describes that the faces became more alive and the movements became more flowing when she initiated contact with those patients with simplest means, such as throwing a ball. “The relationship with the own body, which I discovered at last, became the main point. Because I detected that the schizophrenic patient first must to some extent accept his body as his own, before he himself actively can relate to the exterior.” [7]

Box 1

 

Many schizophrenics are greatly distressed in their self-identity, and subsequently lack the abilities for reality testing and for accepting and defending their personal limits and vital needs. [9] In their imagination they are convinced that their own thoughts are put in or taken out by others. They experience themselves as fragmented and as being directed and controlled, instead of oneself being the origin of the very own feeling, thinking and activeness. The less a patient is aware of his body, the more pathological ideas about himself and his relationships with his fellowmen may achieve deceitful certainty. On the other hand, intensive body awareness can have a self-asserting anti-psychotic effect.

 

5. About the relationships between body, body scheme, body image, self image and therapy

The personal body awareness is the starting point for body scheme, body image and at last self image to evolve.

· Body scheme describes the autonomously functioning control and coordination of tactile, proprioceptive, vestibular and visual nervous stimulation. The body scheme develops during childhood in particular by promotable motor and tactile experience and it is the basis for the complex motor planning and motor coordination.  

· Body image describes the personal awareness of and attitude towards one’s body.

· Self image describes the lot of conceptions about oneself, regarding personal abilities, resources, characteristics, interests, moral opinions and aims.

The terms mentioned are so closely connected to each other that a strict distinction is not absolutely possible. [10] While the body is usually the object of medical treatment (pharmacotherapy, operations, artificial limbs…), the self-image is the main subject of psychotherapy (client-centered therapy, gestalt-therapy, art therapy, music therapy…). Body-centered occupational therapy can in many ways serve as a bridge between medicine and psychotherapy. (Scheme 1)

Scheme 1

 

Occupational therapists can enhance their patients’ psychophysical awareness by various therapeutic activities particularly

· basic stimulation

· sensory integration (J. Ayres)

· arts and crafts challenging physical abilities

· body-centered art expression

· recreational activities

· relaxation exercises

Body-centered occupational therapy can support the process of verbal psychotherapy. It can help patients to find out more about essential connections between their feelings and events in their lives, without being caught up in the poor cognitive illusions which can hinder effective and satisfying modification of behavior. (Even in the verbal client-centered therapy by C. Rogers the verbal mirroring of the body language of a client is very important.)

 

6. Examples for activities to stimulate body-image awareness through art 

Figure 7:

Silhouette drawing done by a student

 

Making a silhouette drawing is a simple initial project for patients who do not have the confidence to try a more complex body-centered artwork. (Fig. 11) The silhouette can be easily produced by a source of light shining on a sheet of paper, which is fixed on a wall.

 

· Second example: Traditional European carnival masks and costumes as a source of inspiration for drawing

Figure 8:

Mask-painting (‘underdog’) of a 22 year-old workaholic student

 

The task to draw carnival-masks can give good inspirations for patients to discover unconscious parts of their personality. Figure 8 shows the mask drawing of the intelligent, workaholic and suicidal young student, whose varied body-sensing-imageries already shown above. This time he draws a kind of maliciously idiotic grinning ‘brainless underdog’, possibly an ‘alter Ego’ or ‘shadow’ (‘Schatten’). [11] In the hospital he made friends with a mentally handicapped patient and whom he spontaneously taught the board game ‘nine men’s morris’. Playing together became a favourite pastime for the two. This unusual friendship at this stage of therapy may have been part of positive shadow integration by the student. [12]

Figure 9

Carnival-mask drawing of a 39-year-old female patient

 

To a 39 year old, infantile helpless female patient suffering from schizoaffektive psychosis, who was hospitalized because of an episode of depression, it was suggested to draw a carnival mask. She drew the upper half of a clown-figure (Fig. 9). In previous stages of her disease she had heard internal voices telling her: ‘You don’t belong to us. We don’t want you’ (In childhood she had grown up with her grandmother, who had often said that to her.) From the lack of arms and hands it was concluded in this case that it could be helpful to offer this patient creative therapeutic activities which would enable her to become psychophysically more aware especially of her arms and hands and to experience herself active without being overstrained.

 

· Third example: Basic stimulation of the hands

Figure 10:

My feeling hands (group work of few students)

 

The group work shown in figure 10 also offered a various range of basic stimulation for arms and hands. The instruction given was to create something that expressed: 'My hands touching, feeling, gripping, holding, and exploring their environment’. Having a little walk in nature, the students were given the chance to pick up varied tactile stimulating materials such as bark, mosses, branches, leaves, earth, sand and stones in order to assemble them afterwards together with clay.

 

· Fourth example: Association to a stone-age mother-idol sculpted in clay

Figure 11:

A stone-age mother-idol sculpted in clay

 

A very satisfying project is sculpting whole figures in clay. Creating a figure like the above stone age mother-goddess with bare fingers can become an intense emotional experience, because the profound power of the symbol combined with the tactile-kinesthetic stimulation of the material provokes emotional involvement and an intuitive identification with the object. (Fig. 11) (When deeply repressed body awareness comes back to life very quickly after such projects, this can cause strong fears and acting out especially for very ill patients. On the other hand, being able to look at a finished sculpture, can with time be an important contribution to self-confidence, self-assertion and the ability to gradually integrate a fuller body awareness.)

 

· Fifth example: Papier-mâché sculptures

Figure 12:

A school class with their papier-mâché figures

 

Papier-mâché is a very good material for large sculptures. Figure 12 shows a school class with papier-mâché figures, which were formed in partner-interaction in the first term of their professional training. The students are usually very motivated to do these paste-paper-figures. The partner-interaction enables the students to become more intimate with each other in a playful manner at the beginning of the professional training. Fascinating is the diversity of varied figures. Subsequent to the manufacturing of the paste-paper-figures all students of the class created together a humorous, fictitious description of each figure. Considering also the physiognomy of the figures creative ideas to topics like name, age, anamnesis, interests, abilities and disabilities were collected and discussed.

 

· Sixth example: Spontaneous figurative drawing

Figure 13:

‚Black man’ (epileptic aura painted by a young man)

 

Figure 13 shows a “black man” painted by a 27 year old male, who suffered from epileptic grand mal seizures caused by an accident several years ago causing brain injury. That “black man” had repeatedly appeared in his epileptic aura before the seizures. He had also seen this “black man” standing on the top right next to him before his recent seizure. The figure had always been dressed in black leather with a coat of chain mail. Remarkable are the missing feet and hands in the drawing, giving the impression of a child wearing oversize clothes. The still very muscular patient explained that he had been much more muscular some years ago. In the vocational school he had been the best of his class, because he had learned intensively and practised intense bodybuilding. However, he also was a heavy drinker and had a reputation among his peers for being aggressive. He also told me further, how his father had always been a very hardworking man. Each time after an epileptic attack the patient felt helpless and inferior and was even ashamed to ask someone to drive him to hospital, since due to his epilepsy he was forbidden to drive himself.

In this case, the drawing served as a basis for the patient to talk about his feelings of inadequacy. This helped him in his psychotherapy to integrate his fear and to start developing new competencies and a new personal identity in accordance with his handicap.

 

· Seventh example: Art reproductions as a source of inspiration

Figure 14:

Examples for art reproductions that may be inspiring

 

As most O.T. patients are inexperienced in doing art and do not dare yet to paint freely, a collection of art reproductions can be inspiring. It is important that patients can select from a large variety so that they have a chance to find something that is appealing to them in their momentary personal condition. The offered inspirational copies should not be too difficult concerning painting technique and should not be done in a photo-realistic way of painting but rather inspire free expression of internal experience. The  patient should be aware that exact copying is not the task, but rather free creative dealing with the selected picture (e.g. doing a completion tasks or developing own imagery that is only inspired by the copy).

Figure 15:

Supplemented picture (made by a student)

 

· Eighth example: Footprint-island

Figure 16:

Footprint- Island (made by a student)

 

Figure 16 shows another possibility for body-centered drawing. The own footprint was the starting point for the subject: ‘What things would I take with me on a lonesome island?’  Drawing around the own’s foot with a pencil is activating and vestibular stimulating. The own footprint in the drawing facilitates the identification with the subject and prevents - by a kind of ‘grounding’ - a too cognitive approach to the task.

 

· Ninth example: Abstract stained glass drawing

Figure 17:

Non-representational ‘stained-glass’-painting about the subject: ‘tones, timbres, vibrations and the chords of colours’ (made by a student)

 

Even non-representational drawing can be arranged in a body-centered way, by humming and singing tones and vowels first, and thereby feeling the various vibrations in the own body. Then one can assign light and dark colours to the various high and low vowels, just the way one feels it. Finally one can paint a synaesthetic non-representational ‘stained-glass’-painting about the subject: ‘tones, timbres, vibrations and the chords of colours’. (Fig. 17) This therapeutic measure stimulates respiration and body awareness and helps to improve as well the sense of colour as the development of a non-representational but emotional artistic expression.

 

· Tenth example: Modelling plaster masks

Figure 18:

Students modelling plaster masks

 

Figure 18 shows students modelling plaster masks. Tactile stimulation is achieved by putting vaseline and plaster on the face. While hardening, the plaster produces perceivable warmth. The hardened plaster inhibits the movement of face muscles and removing it effectuates liberation for mimic expression again. The modelling of plaster masks requires a certain amount of self- confidence from participants and a trusting and reliable atmosphere. If the model does not feel safe, the brief ‘blindness’ and the inhibition of facial expression during the modelling of the plaster may evoke too much anxiety.

Figure 19:

Students with their painted plaster masks next to ceramic totem poles

 

Masks and faces can also be modelled in clay. Figure 19 shows students with their painted plaster masks next to ceramic totem poles. Sculpting masks and faces can improve the awareness of nonverbal facial body language. Occasionally patients become aware of their habitual facial expression and its emotional quality while hiding behind a plaster-mask. This is a chance to integrate usually unacknowledged feelings. A woman suffering from chronic migraine headaches, who worked as a waiter in a restaurant, reported: “Without regard to my real feelings, as a waitress I always have to show a friendly smile to everybody. With an unhappy face I lack 50 Dollars tip a day”.

Finally, there are various mime and acting techniques that can be used to facilitate the deepening of therapeutic work with masks, disguises, made puppets and figures. As a discussion of these would lead us beyond the limits of this article, these techniques are described further in the author’s book. Many of these are especially valuable for continuing education and self-awareness training of therapists.

 

Epilogue by Veronika Hofmann M.A./Vermont Coll.

I graduated in 82 at Vermont College as a Master of Arts in Art Therapy and studied afterwards corporal mime and African dance in Montréal, Boston, Munich, and Senegal.

In 87 I finally settled down in Munich with my private practise. Children as well as adults suffering from psychiatric and psychosomatic diseases are prescribed occupational therapy combined with art therapy with me by their G.P. or  psychiatrist.

Being absorbed in my practical work with patients I’ve always been very glad to read Georg Keller’s articles who has the talent to describe the practical basics of our work in a very clear way. I find this often helpful for reflection in the process of the own therapeutic work. I am glad he had the initiative to offer this article to the journal and I was happy to help him with the translation.

I hope this will be a starting point for professional exchange with our American and Canadian colleagues. We would welcome any feedback or information about comparable therapeutic work combining body-awareness-training and art therapy.

 

References:

- Ayres, A.J.: Bausteine der kindlichen Entwicklung - Die Bedeutung der Integration der Sinne für die Entwicklung des Kindes; Springer Verlag, Berlin, Germany 1998

- Brooks, Charles: Erleben durch die Sinne (Sensory Awareness); Junfermann, Paderborn, Germany, 1997

- Jacobson, E.: Entspannung als Therapie. Progressive Relaxation in Therapie und Praxis; Pfeiffer, München, Germany, 1990

- Kayser, A., Kayser, E.: Körperschema, Körperbild, Objektbeziehungen – Die Bedeutung der Konzepte für die Ergotherapie; in: Zeitschrift Praxis Ergotherapie; Verlag Modernes Lernen, Dortmund, Germany; Heft 3/1997,  page 144 – 161

- Keller, Georg: Körperzentriertes Gestalten und Ergotherapie - Unterricht und therapeutische Praxis; Dortmund, Germany: 2001

- Keller, Georg: Die Nutzung bildnerischer Mittel in der Ergotherapie, in: Zeitschrift Beschäftigungstherapie & Rehabilitation, Verlag Schulz-Kirchner, Idstein, Germany; Heft 3/97, page252ff

- Kläger, Max: Verständnis für Kinderkunst - Ordnungsprinzipien bildnerischen Handelns; Baltmannsweiler: Schneider-Verlag, Hohengehren, Germany, 1997

- Krietsch, S., Heuer, B.: Schritte zur Ganzheit – Bewegungstherapie mit schizophrenen Kranken; Gustav Fischer, Stuttgart, Germany, 1997

- Kubny, Beate: Körperorientierte Therapie – Ein gestalterischer Ansatz bei Depersonalisationsphänomenen; in: Zeitschrift Ergotherapie und Rehabilitation, Schulz-Kirchner-Verlag, Idstein, Germany; Heft 6/1993, page 414 - 418

- Petzold, H.: Psychotherapie & Körperdynamik – Verfahren psycho-physischer Bewegungs- und Körpertherapie; Junfermann-Verlag, Paderborn, Germany, 1977

- Scharfetter, Christian: Allgemeine Psychopathologie – Eine Einführung; Georg Thieme Verlag, Stuttgart, Germany, 1976

- Uexküll et. al. (Hrsg.): Subjektive Anatomie - Theorie und Praxis körperbezogener Psychotherapie; Schattauer, Stuttgart, Germany, 1994

 

Address of the Author:

Georg Keller

Im Weierfeld 14

D-54470 Bernkastel-Kues

Germany

www.ergokreativ.onlinehome.de/