Starting Your First Art Therapy Session with Adolescents

How Do You Start Your First Art Therapy Session?
A similar question was posed to me in 2001 by Carmela Wenger, LMFT, RPT-S, for Volume 1, Issue 2 of the California Association for Play Therapy Newsletter. I was surprised by the positive response and requests for the paper. Since it was deemed useful, I have revised the article to focus on art therapy with young children, school age children, and adolescents. This is the third of three articles.

by Linda Chapman, MA, ATR-BC

The often resistant and temperamental adolescent can be a challenge to even the experienced clinician. I have found beginning with the introduction of self takes the adolescent off guard, as direct questioning is expected.

I then introduce the topics of confidentiality, trust, and reporting laws. I let the adolescent know that I don’t expect them to trust me until I earn that trust. I mention I will not speak with parents without them knowing the content first.

During the first session with an adolescent who has experienced acute trauma, I depathologize the reactions and behaviors, followed by a direct intervention to facilitate the creation of a narrative about the event, the ensuing events, the present time and the future. Important adolescent concerns such as rescue and revenge fantasies and traumatic reminders are discussed and adaptive coping mechanism introduced. As with the school age child, if the adolescent were resistant, I would not insist they participate in the intervention. In my experience with hundreds of teens, refusing to draw their story is extremely rare.
With adolescents who have been repeatedly exposed to trauma and loss, it is imperative to slowly build rapport and allow for the development of safety and trust. A tour of the art room and various art media is followed by a discussion about how teens may feel uncomfortable talking to a therapist, so why not introduce ourselves to each other with a collage. The teen is not about to be humiliated, so the comfort of the therapist participating reduces anxiety and the feeling of “being watched.”

I have a menu of 2-3 two dimensional media such as colored pencils or markers, and a small amount of Wheat Free/Gluten Free Dough, which is not PlayDough. Care must be taken not to expect the adolescent to engage in art tasks and media suitable for young children. I might suggest they hold the clay, or just draw something they like to draw, or doodle, or nothing. The adolescent must be in control of the therapy process, including media.

During the first session, I convey to the teen they are in charge of the therapy, and “I cannot tell you what to do or how to live your life, I can only help you discover your plan and how to implement your plan using your creativity and imagination. In a juvenile hall when I made this statement, several of the completely resistant youth asked, “Can you be my counselor?” I find art making ideal for adolescent therapy as the teen can use their own symbols and language to express, contemplate, and discover the self, the major task of adolescence.

I am clear about validating and normalizing the difficulties the teen may be having as a result of the abuses and/or violence they have experienced. Mentioning one or two common symptoms is helpful in letting the teen know this is universal, reducing anxiety. I often say, “I would be surprised if you were not having these symptoms, given what you have been through.” Following this discourse, one teen reported feeling ‘normal’ for the first time in his life. A brief discussion about the effects of stress and violence and or abuse on the system can help the adolescent understand the universality of their experience and symptoms or behaviors.

When terminating the first session with a teen, I refrain from any recap or discussion, and offer only a positive comment related to their courage for coming, the success of the session, or something that lets them know they met any imagined expectations. I inquire as to any media they prefer or would like for experimentation, and if not, suggest I will have some ideas for them to consider at the next session.

Take Home Message: the child must feel physically and psychologically safe to engage in therapy, and I believe this to be the primary goal for the first session.

© Copyright 2009-2011 Linda Chapman.