We are sitting in the art therapy room with a blue haze of smoke all but obliterating our vision. Smoking is the prevalent gratification for many patients in psychiatric facilities; patients escape into their private worlds as they puff away. Reality, as they have experienced it, is ungratifying and filled with terror. Jack is almost catatonic and difficult to reach. He sings loudly and clutches his teddy bear when paper and materials are put before him. Asked to draw his bear, he lifts a crayon, scribbles something, then asks when he can leave. Ed is mumbling word salad,? and also scribbling regressively, piling on the colors until his paper is a muddy mess. David, ambivalent about staying or going, draws a few angry strokes and departs. Mary and Judith have their particular styles as well-both speak in baby talk, grab art materials impulsively and often destroy them in the process. Mary draws her usual stereotyped figure, a learned response from her numerous hospitalizations. Judith, too, has had a series of hospitalizations. Her art work in each institution has been the same-muddy masses of chaotic scribbling, proof after proof of her psychotic states. Does one need to see more of this for diagnostic conformation? What about Judith? What does she need to see from her own hand? It would almost seem that Judith has been given constant “unconditional acceptance” for her art work, no matter how distorted it appears. “That’s nice, Judith, now do another one.” And she does, retreating back into her chaotic world. Something is seriously wrong; this is not art therapy. When the patients leave this art room there is a sense that no changes have occurred. Instead, there is a reentrenchment of the miserable illness that plagues them. They are commonly labeled chronic schizophrenics, and many professionals consider them hopeless. Each person in the art room represents one or even several of the classic characteristics: isolation. a low level of trust. yet marked dependency, low motivation, short attention span, confused and often paranoid thought processes, profoundly impaired self-esteem. In the art room, there is no sense of relatedness. Each person mistrusts the other, mistrusts the therapist. The patients want to remain isolated-safe. Yet, the inner world to which they retreat contains a mass of painful and agonizing thoughts. Confusion is rampant. There seems to be tzo safe place for them. What can the art therapist do with such an expanse of problems? How can he/she intervene in such confusion and fear? How can he/she achieve some sort of relatedness, some useful creative work that enables the patients to express themselves and communicate to others? Before treatment goals are set for such severe-
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