SPIRITUAL ART THERAPY

ABOUT THE AUTHOR

Ellen G. Horovitz, Ph.D., ATR-BC, is Associate Professor and

Director of Graduate Art Therapy at Nazareth College in Rochester,
New York. She has had over twenty-five years of experience with
myriad patient populations (inpatient, outpatient, day treatment,
geriatric, visually handicapped, developmentally disabled, etc.) and
specializes in family art therapy with the deaf. Dr. Horovitz current-
ly is in private practice and works at the Speech Therapy and Apha-
sia Clinic at Nazareth College. She is the author of numerous articles
and book chapters as well as A Leap of Faith: The Call to Art. Dr.
Horovitz has served on the Education Program Approval Board
(EPAB) of the American Art Therapy Association (AATA), Mem-
bership and Education Committees and Education Chair for AATA.
She currently is on the Board of Directors for the American Art
Therapy Association (AATA). Dr. Horovitz is also mother to Kaitlyn
and Bryan Darby and is an avid painter and sculptor. She is fea-
tured above with her commissioned sculpture, “Horse Sense.”
 Second Edition

SPIRITUAL ART THERAPY

An Alternate Path
By

ELLEN G. HOROVITZ, PH.D., ATR-BC

With a Foreword by

Werner I. Halpern, M.D.

Medical Director
Hillside Children’s Center
Rochester, New York
 Published and Distributed Throughout the World by

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©2002 by CHARLES C THOMAS • PUBLISHER, LTD.

ISBN 0-398-07313-9 (hard)

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Library of Congress Cataloging-in-Publication Data

Horovitz, Ellen G.
Spiritual art therapy : an alternate path / by Ellen G. Horovitz ; with a foreword by Wern-
er L. Halpern.
p. cm.
Includes bibliographical references and index.
ISBN 0-398-07313-9 (hard) -- ISBN 0-398-07314-7 (pbk.)
1. Art therapy. 2. Psychotherapy--Religious aspects. 3. Mentally ill--Religious life. I. Title.
RC489.A7 H67 2002
616.89′1656--dc21
2002016172
This is dedicated to the memory of my father, David M.
Horovitz, and grandmother, Leah I. Billingkoff. Although they
no longer take part of this life on earth, they always walk
beside me in spirit. For that and the energy, which enabled me
to create this work, I am eternally grateful.
 FOREWORD

ith the approach of the millennial year 2,000, apocalyptic beliefs about
W life on earth are likely to afflict many among both the devout and the
unbelievers. To read meaning into existential events and landmarks, whether
spawned by religious doctrine, piety, folklore, or superstition, remains at the
very heart of the human struggle to fathom the seemingly impenetrable
essence of man’s relationship to creation and the Creator. The thinking per-
son, healthy or not, questions the meaning and purpose of existence. In cop-
ing with this uncertainty, some take refuge in philosophy and some in
ideologies, while others seek succor through religious or theologic belief sys-
tems. It must be apparent that none of these strivings bring genuine fulfill-
ment unless people are also morally informed, since ritual piety and pious
preachments often mask moral corruption.
Most clinicians sidestep their patients’ or clients’ existential concerns, usu-
ally out of conviction that these are not contributing significantly to adjust-
ment problems and to mental disturbance, except in delusional individuals
with mystical identifications. The spiritual realm, if acknowledged as part of
a person’s worldview, is often quickly assigned to officiants of whatever faith
community is adhered to by the troubled individual. Indeed, pastoral coun-
seling has become a discipline in its own right as it combines a blend of spir-
itual guidance and psychological insights.
In her treatise, Spiritual Art Therapy: An Alternate Path, Horovitz proposes
that, on one level or another, each person is a seeker of spiritual transcen-
dence, although most hide this need even from themselves. She perceives
this search to be a critical element in attempts to cope with life’s traumata,
specifically loss and grief, when people face the emotional work of accepting
the inevitable. Such groping for spirituality arises from idiosyncratic struggles
with putting to rest the feeling of remoteness from any divine authority. On
the other hand, those reared and steeped in the joyful tradition of worship
from youth may consider their spirituality as an organic aspect of religious
identity shared with family and co-religionists, which has a healing potential.
Thus, in the words of Martin Buber, “God dwells in all things as a germ and

vii
viii Spiritual Art Therapy

a possibility of being; He is actualized by the fervor with which He is experi-

enced.”
In this book, therapists are urged to take into account the existence of spir-
itual aspects of personality, both in terms of making proper assessments and
more focused treatment plans for the people under their care. Although
addressing itself chiefly to art therapists, the thrust of this opus is an attempt
to sensitize all clinical practitioners to the spiritual dimensions of therapy. By
drawing on sources in the literature of religion, psychodynamics, systems the-
ory, sociology, art, and ethics, Horovitz lays a foundation for her mission,
namely to find a way of discovering, and if possible, measuring clients’ spiri-
tual sensibilities and search for personal meaning of their relationship to God.
Out of her own struggles with this relationship, she has fashioned an instru-
ment, which tries to integrate theologic and psychologic principles. Although
the Belief Art Therapy Assessment (BATA) is meant to be only one of the
diagnostic tools used by art therapists, its value to other clinicians may have
applications in its present form or with future modifications. Several chapters
in this book illustrate the usefulness of the BATA with quite different case
presentations.
Through the use of the BATA, Horovitz seeks to understand the particulars
of a person’s spirituality rather than describe abstractions as holiness and
grace. The prophet Micah summed up the values and deeds, which define the
practice of the spiritually faithful, namely to do justly, to love mercy, and to
walk humbly with God. May we all aspire to this lofty goal!

Werner I. Halpern, M.D.

Medical Director in 1994
Hillside Children’s Center
Rochester, New York

Author’s Note: Dr. Halpern passed away long before this new edition was birthed. I am
grateful for the time we spent together as colleagues and fellow artists. He was much
revered and will be long remembered in my community as well as the psychiatric com-
munity.
 PREFACE TO THE SECOND EDITION

deas gel in strange ways: twelve years ago, the premise behind this book
I originated from a dream. And over the years, I have learned to pay atten-
tion to those subconscious entities. They inform me, inspire me, and propel
me to fulfillment.
Years ago, after converting from Judaism to Catholicism, the priest at my
local parish, roped me into teaching the Sunday preschoolers. Having been
raised in Judaic customs, it amused me that a Jew, now practicing Catholi-
cism, would be imprinting young Christian minds. Unsure of the task ahead,
I had been preparing my lessons for weeks. Being the A-type personality that
I am, on the eve of my first day, I combed over my lesson plans and double-
checked everything. Then, I went to bed. But the next morning, just before
rising, I had this dream. In the dream, God called out to me and asked me to
throw away my lesson plans. Instead, the message received in my dream was
that I was to ask the children to “draw, paint or sculpt what God meant” to
them. Mind you, the instructions were very clear. As I swung my legs out of
bed that next morning, and bolted upright, I mused to myself, “What the
Hell was that about?”
As I dressed and prepared for my first Sunday preschool class, I was mys-
tified by the dream but decided to throw caution to the wind: I heeded the
instructions communicated to me. I was unsure of the outcome, but I knew
somehow that I was on a different path. And that trajectory has continued for
sometime. Indeed, ten years after the first publication of this book, I still walk
a road paved by inquiry. Always in the learning state, I am fittingly employed
as a professor, and continually find myself ambling this course; I am no more
certain of where this will lead me than when I first traversed this way.
Although, one thing is for sure: my luxury in discussing such spiritual matters
with patients, students, and colleagues has contributed to a secondary gain. I
have become a more enlightened person because of this pathway.
Indisputably, years later, the intent of this book still is to animate the spir-
itual dimension that exists within all of us and embrace its resource for growth
and change. It is my firm belief that tapping into a person’s belief system and

ix
x Spiritual Art Therapy

spiritual dimension can provide clinicians with information that can impact
both assessment and treatment.
As a family art therapist, I feel it is essential to ascertain this information in
order to better serve the needs of the identified patient and the family system.
Mourning issues and losses (Horovitz-Darby, 1991; Harvey, 1984) are often
prioritized in a family systems approach to treatment. Indeed, investigating a
family’s belief system seems paramount in ascertaining nodal events and fam-
ily member reactions to change and trauma. Consequently, this caused me to
look at people’s intrinsic belief and/or disbelief in God and how that impact-
ed them within their family systems. Moreover, it caused me to look at
humankind’s faith system, as well as how people sought strength and mean-
ing in life.
As a result, I initiated a review of the literature surveyed from the perspec-
tive of spirituality, mental health, and art therapy (Chapter 2). This revealed
not only myriad theories and perspectives, but more importantly that this
quest had invaded the minds of others on the same journey toward spiritual
healing (Coles, 1990; Dombeck & Karl, 1987; McNiff, 1987; Moon, 1990;
Ellison, 1983; Gordon, 1990; Maton, 1989; Walls, 1991; and Gartner et al.,
1991, to mention a few). This was strangely comforting since this pilgrimage
often rendered my closest colleagues to question not only my raison d’être
(and sometimes, sanity) but also my methodology and obsession with the rel-
evance of this topic to assessment and treatment.
As I meandered along this footpath, both subjects and friends warned me
that my journey would be fraught with “doubting Thomases.” In fact, one
subject warned me that I would continually be tested as I traveled. He
reminded me that not only would people doubt what I was actually writing,
but also they might question me in such a way that perhaps I would begin to
doubt myself.
In Gerald May’s book, Simply Sane, The Spirituality of Mental Health, he also
warned of such misfirings. He declared:
That intrusive voice of sanity is most disquieting, so one tends to move rather
quickly, to shut it up. . . . One can say, “Oh, that’s my sense of insecurity talk-
ing.” One can label one’s sanity as insanity. . . . Never stopping to realize that
those self-doubts are the most honest, most sincere voice we can hear. (1987, p.
2–3)
And so after almost fifty some odd years of life, I am finally becoming
comfortable with that voice and in the words of May, I am at last “going
sane.” Yet the struggle to quiet that inner, doubting voice often intercepts. In
fact, years ago, when I first attempted to write up a synopsis of this work for
presentation, I meekly remarked to a trusted friend, “Do you think I should
mention God in this or allude to the concept?” His remark awakened me. He
 Preface to the Second Edition xi

simply stated, “Never be afraid to sing God’s praises.” Growing up as an ana-

lytically minded art therapist, I had cowered and done anything but openly
discuss the potential of mixing up God and/or the inclusion of spirituality
with the healing process of therapy. Until now.
In Chapter 1, I discuss the evolution of this book and how I embarked
upon the inclusion of the spiritual dimension in assessment and treatment.
Chapter 2 reviews the literature that encircles art therapy, mental health, and
spirituality, and explores its impact on both assessment and treatment. Chap-
ter 3 examines the use of the Belief Art Therapy Assessment (BATA) as an
instrument for assessing the spiritual dimension of a patient. Chapter 4 high-
lights the interviews and use of the BATA with the clergy. Chapter 5 explores
the use of the BATA with a “normal” adult artist population. Chapter 6 looks
at spiritual art therapy for the purposes of both assessment and treatment of
emotionally disturbed children and youth in residential treatment. Chapter 7
offers a case vignette which illustrates the use of spiritual art therapy with a
suicidal anorectic bulimic. Chapter 8 summarizes my position and theosophy.
Two new chapters, 9 and 10, have been added since the first printing in 1994.
Chapter 9 examines the use of phototherapy as a means to investigate mourn-
ing and loss issues. Examples are proffered from my work with students as
well as clients with varying diagnoses from Asperger’s syndrome to aphasia.
Chapter 10 explores humankind’s search for inner and outer meaning, the
devastating effects of the September 11, 2001 attack on America, as well as
my own exploration of mourning and loss as it affected my resolve through
my artwork. And finally, I asked one of my current patients (from my private
practice) to write the prologue for this edition. The reason for this is that she
came to my practice because she had read my books and as a result wanted to
work with me. Since she is a talented photographic artist in her own right, and
studying to enter the field of clinical psychology, I thought that she could
offer yet another perspective of this work that we do. For the art of being spir-
itual with oneself and one’s patients involves empathic listening and co-cre-
ation.
The book, although finalized in Chapter 10, is by no means completed
since inclusion of the spiritual dimension in assessment and treatment is a life-
long struggle. I am committed to this work and feel that this treatise is mere-
ly an axis point. Feel free to embark and continue the dialogue.

Dr. Ellen G. Horovitz, ATR-BC

Director of Graduate Art Therapy
c/o Nazareth College
4245 East Avenue
Rochester, New York 14618
 PROLOGUE FROM A CLIENT

ne summer evening, a few months ago, I became acutely aware of what

O was missing in my life—a teacher/master/mentor of sorts. They say
“when the student is ready, the teacher will appear,” and I felt ready. My
graduate advisor and my therapist were not quite it. I wanted somebody to
guide me through a journey of self-discovery and transformation. Looking at
the starry sky through the slanted skylight in my living room, I prayed for this
new person to come into my life. In the week that ensued, nothing happened,
and I thought my prayer went unanswered. It took me a while to realize that
in fact it was answered very shortly thereafter. It started with visiting the
Nazareth Art Therapy website at the suggestion of a friend later that same
week. I was just browsing when I read about Ellen’s class on phototherapy,
and found the topic very much to my liking since photography is one of my
greatest passions. I found the work that Ellen seemed to be doing quite excit-
ing. Shortly thereafter, I read her books, A Leap of Faith: The Call to Art and
Spiritual Art Therapy: An Alternate Path. I was intrigued to see a combination of
psychology, art, and spirituality as an approach to healing and became con-
vinced that this was what I personally needed. I contacted Ellen and worked
out to be seen in her practice. I felt very excited and fortunate. A couple of
months later, thinking back to my prayer, I realized that it had hence been
granted, and I now had the guide I needed in my life journey.
I have a fair amount of experience as a client. Prior to Ellen, I had seen four
therapists. My anxiety and existential concerns survived intact through psy-
chodynamic, cognitive behavioral and “eclectic” approaches. My main prob-
lem in expressing myself to my former therapists was that I could only
articulate in the language they understood—psychology. However, my psyche
communicated itself in a different medium, art. Since I was old enough to
write, I have used writing as a way to express myself. Periodically, I used
drawing, and in the past six years, I have explored photography as a medium
to reflect on my life. I create images that my psyche dictates to me. My pre-
vious therapists showed interest in my art, and looked at my self-portraits
with curiosity, and even admiration, However, the message behind the art

xiii
xiv Spiritual Art Therapy

remained impervious to them. They didn’t get what art was for me, and what
it did for my psyche, and above all, they didn’t get the messages that came
through it.
For my healing to occur, I need to be understood in my art, a part of me
that was always shunned out and not understood in my family either. It is,
therefore, difficult for me to make real progress fitting into the traditional
therapeutic mold. The other aspect that I yearned for understanding was spir-
ituality. What I needed again was more than cognitive validation, but true res-
onance. Spirituality is given full credit only by those who are spiritual. Yet, it
seemed to me that a union of art, psychology, and spirituality would be
unlikely, if not an impossible combination of skills and abilities to find in one
therapist. What I needed to develop my personal process and work through
my neurosis was somebody who could meet me and understand all three.
One of my mentors, a spiritual artist, understood me quite well, but she is not
a therapist. After four therapists, I had lost hope for a better understanding.
My last therapist was also losing hope in me urging that an SSRI would rid
me of my anxiety and my existential crisis. It was then that I came upon
Ellen’s work. When I read Ellen’s books, I was in awe that somebody had put
together the three ingredients that I yearned for in healing and development
of my psyche.
I was very excited to start art therapy. I was delighted at the opportunity to
create images that went with ideas. In my visual journals, creating an image
meant creating a mirror that can reflect back, and the process of self-under-
standing could be furthered. Yet, these experiences had not prepared me for
the intensity of art therapy. In my second session, Ellen asked me to create an
image that depicted the way I felt inside. The image that arose in me was one
of a woman bound to a tree. I painted the image loosely in watercolors (see
Figure P-1).
Looking at it was scary and uncomfortable. There was the main issue right
in front of me, and now in the eyes of another, as well. Though I can twist and
turn my words, skirt issues, and avoid talking about what seems too painful to
talk about, the starkness of that image revealed all. Ellen has reminded me of
that image often, and has brought together how the same theme appears for
me in other images or dreams that are at surface level quite different.
The psyche is drawn to what hurts, and what hurts is revealed in many
ways in art therapy. Considering the quality of art is not of importance in this
therapy, the images or clay products are pretty raw, primitive, and childlike.
It is in these creations that I see painful memories take shape. Holding the
clay product or looking at the images is not easy because they are tangible
representations of issue or painful parts of me. Talking about them is an even
bigger challenge. Yet, it is in the moments we talk about these things, that I
 Prologue from a Client xv

Figure P–1. “Bound.”

feel my feelings and that internal shift starts to happen. The journey has
begun.
Though I have seen Ellen now for some 18 sessions, we haven’t talked
directly about spirituality. My healing process is not going to happen
overnight, because how I came to my struggles didn’t happen overnight
either. It is hard to change a way of being that I learned for the first 20 years
of my life and that selectively reinforced the next 10, and probably still do.
My process goes slowly, and I feel that we have just taken the first steps. How-
ever, considering my existential struggles and the question how can one be
fundamentally safe in a sometimes erratic, unfair, and unsafe world, the ques-
tion always comes back to God. How can God let such things happen? How
can I make sense of the world then? If prayer is so helpful and God so gen-
erous, how come my grandparents died at a very advanced age without see-
ing their prayers answered? Didn’t they matter? How can I trust that my
xvi Spiritual Art Therapy

hopes and prayers will be answered? Didn’t they matter? How can I trust
that my hopes and prayers will be answered? How can I trust that I am safe
and what I hold most dear will be always mine? Ultimately, beyond the loss,
the anger and the mourning, beyond it all, the ultimate question is a spiritual
one.
Engaging in therapy with Ellen has given me the assurance that I need to
trust the process, and to trust that she can be with me in spiritual territory
when the time comes. Jung believed that all his patients over the age of 30
needed spirituality to complete their healing. Beyond art and therapy, I’ll
need the spiritual component to make sense of the world that has been harsh
and sweet to me. It is in the order of the universe, God, and soul that I have
found the greatest solace in the past, however fleeting. It is there that I believe
the antidote for my anxiety exists, too. Accessing all of that in therapy is the
real gift. I wish that Spiritual Art Therapy gives other therapists the courage to
incorporate art and spirituality into their work.
 ACKNOWLEDGMENTS

here are many people that I would like to acknowledge regarding this
T labor and invariably, I will probably leave some of them out: First, and
foremost, I am indebted to the people who shared their innermost thoughts
about their relationship or nonrelationship with God and as well permitted
me passageway via their art projections; I am also grateful to my patients who
have taught me the necessity of behaving spiritually; I am also thankful to
numerous people who supported me in a multitude of ways—my sister, Nancy
A. Bachrach; my brother-in-law, Orin Wechsberg; my brother, Len H.
Horovitz, M.D.; my sister-in-law, Valerie Saalbach; my mother, Maida M.
Horovitz; Laurie and Bruce Konte and John and Dawn Neel, for spiritually
taking care of my children while I pursued this work; “Spin” Michael Darby;
Carol Darby; Werner Halpern, M.D., who read the first edition of this man-
uscript and sustained me while challenging my thinking; Darlene Esposito,
MS, ATR for her continual friendship; my video art teachers, Keith
McManus (and the Visual Studies Workshop) and John Neel, my mentor in
videography; Lucy Andrus, MS, ATR, who taught me the necessity of “tak-
ing time to coast”; Victoria Laneri, ATR, who held down the fort at work;
Irene Rosner David, Ph.D., ATR-BC and Michael Franklin, ATR-BC, who
offered me a mirror for reflection; Katie Collie, ATR, a source of great spirit
and inspiration; Sandra B. Mitzner, M.D., who continually spewed reflective
comments via psychotherapeutic containment; Tom Ferland, who even in his
last days on this earth, never stopped supporting my work; Emily Krenichyn,
my wonderful graduate assistant; Bill “Birdheart” Bray for “e” communiqué;
my wonderful colleagues: Ron Netsky, MFA; Dr. Kay Marshman, and Dr.
Dennis A. Silva; my children, Kaitlyn Leah Darby and Bryan James Darby,
for the time they gave up their “MaBa.” Finally, I would like to thank the late
Payne E. L. Thomas for having the aplomb to accept this book for publication
and Michael Thomas for his support in recreating this second edition.

xvii
 CONTENTS

Preface to the Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix

Prologue from a Client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii

Chapter
1. EVOLUTION OF A SPIRITUAL APPROACH TO
COUNSELING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Early Stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Initial Impressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

2. ART THERAPY, SPIRITUALITY, AND MENTAL

HEALTH: WHERE THE TWAINS MEET . . . . . . . . . . . . . . . . . . .9
Some Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Starting Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Language Systems, Mourning, and Loss . . . . . . . . . . . . . . . . . . . . . .13
The Search for Meaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Spiritual and Mental Health Connections . . . . . . . . . . . . . . . . . . . . .17
Religious Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
The Nature of Spirituality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Religiomagical Healing and Shamanism . . . . . . . . . . . . . . . . . . . . .23

3. THE BELIEF ART THERAPY ASSESSMENT:

INTERVIEW AND EVALUATION . . . . . . . . . . . . . . . . . . . . . . . .26
Initial Stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
The Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Suggested Art Materials to Have on Hand . . . . . . . . . . . . . . . . . . . .29
The Belief Art Therapy Assessment (History Taking) . . . . . . . . . . .30
First Directive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Post-Assessment Interrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

xix
xx Spiritual Art Therapy

Second Directive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Considerations and Guidelines for Evaluation . . . . . . . . . . . . . . . . .32

4. SPIRITUAL DEVELOPMENT, BELIEF SYSTEMS,

AND STAGES OF FAITH: IMPACT ON ASSESSMENT
AND TREATMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Toward a Belief System Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Testing the Clergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
The Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Father Joe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Father Paul . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Faith in the Product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Sister Miriam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Rabbi Mark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

5. THE BELIEF ART THERAPY ASSESSMENT

CONDUCTED ON ADULT ARTISTS . . . . . . . . . . . . . . . . . . . . .64
Interview with Robert, Atheist . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Interview with Caitlin, Agnostic . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
The Light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Interview with Karen, Buddhist . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Interview with Renfred, Latter Day Saint Mormon . . . . . . . . . . . . .80

6. SPIRITUAL ART THERAPY: A WORKING

ALTERNATIVE FOR EMOTIONALLY DISTURBED
CHILDREN AND YOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Environmental Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Residential Treatment: The Warp and the Woof . . . . . . . . . . . . . . .90
A New Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Melissa: A Case for V62.61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94
The Results of the CATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94
The BATA Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Gary: Spiritual Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
The BATA: Gary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Conclusions about the Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
Melissa’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
Melissa’s Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
Gary’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
Gary’s Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
 Contents xxi

7. THE SPIRITUAL TREATMENT OF A SUICIDAL,

BULIMIC ANORECTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Presenting Symptoms and Psychosocial History . . . . . . . . . . . . . . .112
Parameters of the Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
Significant Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
A Note on Supervision and Record Keeping . . . . . . . . . . . . . . . . .116
Direction in Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Three Years Later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
The Spiritual Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Linda’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Linda’s Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146

8. SPIRITUAL REFRAME: A PATHWAY FOR LIFE . . . . . . . . . .147

The Ultimate Taboo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148

9. PHOTOTHERAPY APPLICATIONS: EXPLORING

MOURNING AND LOSS ISSUES . . . . . . . . . . . . . . . . . . . . . . .151
Mourning and Loss Issues: Finding One’s Belief Through
Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Academic Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
The Mahogany Drawer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
Student Samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Intervention 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Intervention 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Intervention 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163

10. A SEARCH FOR MEANING: INNER AND

OUTER EXISTENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
The effects of 9-11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Mistakes that Ground Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168

Appendix
Table 1. Table of Comparative Norms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
Table 2. Belief Art Therapy Assessment Interview . . . . . . . . . . . . . . . . . . . . . . . .178
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
Name Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
 FIGURES

Prologue 1-1. Bound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv

Figure 1-1. John’s treasure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Figure 4-1. Fr. Joe’s light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Figure 4-2. Fr. Joe’s barbed wire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Figure 4-3. Fr. Paul’s work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Figure 4-4. Sr. Miriam’s work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Figure 4-5. Rabbi Mark’s eye of the beholder . . . . . . . . . . . . . . . . . . . . . . .60
Figure 4-6. Rabbi Mark’s eye of the beholder (view 2) . . . . . . . . . . . . . . . .61
Figure 5-1. Robert’s world . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Figure 5-2. Robert’s patriarch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Figure 5-3. Caitlin’s light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Figure 5-4. Karen’s flower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Figure 5-5. Renfred’s response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Figure 6-1. Melissa’s mermaid (CATA painting) . . . . . . . . . . . . . . . . . . . . .96
Figure 6-2. Melissa’s smiling God on cross (CATA #2) . . . . . . . . . . . . . . . .97
Figure 6-3. Melissa’s BATA (1st directive) . . . . . . . . . . . . . . . . . . . . . . . . . .99
Figure 6-4. Melissa’s BATA devil (2nd directive) . . . . . . . . . . . . . . . . . . . .100
Figure 6-5. Gary praying to God . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Figure 6-6. Gary’s God’s son . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
Figure 7-1. Linda’s KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Figure 7-2. Good Linda/bad Linda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
Figure 7-3. Linda’s view of herself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Figure 7-4. Linda’s view of Ted’s take on life . . . . . . . . . . . . . . . . . . . . . . .123
Figure 7-5. Linda’s time running out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
Figure 7-6. Linda’s final frontier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
Figure 7-7. Linda’s demons, Mary and Cory . . . . . . . . . . . . . . . . . . . . . . . .129
Figure 7-8. Linda’s gray land—Axing mother to death . . . . . . . . . . . . . . . .131
Figure 7-9. Linda’s BATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Figure 7-10. Heaven scent (by author) . . . . . . . . . . . . . . . . . . . . . . . . . . . .133

xxiii
xxiv Figures

Figure 7-11. Linda trapped by her body . . . . . . . . . . . . . . . . . . . . . . . . . . .137

Figure 7-12. Linda’s mother with lobotomy/castration . . . . . . . . . . . . . . .137
Figure 7-13. Linda’s view of being positive . . . . . . . . . . . . . . . . . . . . . . . . .140
Figure 7-14. The groan and the agony . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Figure 7-15. Linda’s faith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Figure 9-1. Stevens’ quilt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Figure 9-2. Jessica’s purse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Figure 9-3. Joy’s bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Figure 9-4. Megan’s doll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Figure 9-5. Sisters (by author) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
Figure 9-6. Brett’s eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Figure 9-7. Aphasic client’s work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Figure 9-8. C’s tee shirt transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Figure 9-9. C’s pillow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
Figure 10-1. Family (by author) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Figure 10-2. Dad’s shadow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Figure 10-3. All that’s left you (by author) . . . . . . . . . . . . . . . . . . . . . . . . .172
SPIRITUAL ART THERAPY
 Chapter 1

EVOLUTION OF A SPIRITUAL APPROACH TO

COUNSELING

The more one forgets himself

— by giving himself to a cause to serve or another person to love
— the more human he is and the more he actualizes himself.
—Victor E. Frankl

n the beginning, I experienced an extraordinary surge of energy associat-

I ed with the purpose behind this book. Yet, often I felt unworthy of the task
as well as inept in my pursuit. In fact, several times before I began this book,
I played with ideas of coauthoring it with another—an associate, a psycholo-
gist, a priest, anyone who would have more knowledge than I have about
spirituality, mental health, and/or God. I suppose I was so overwhelmed by
this task, that I felt sharing it with someone would protect me from my pro-
jected criticism. I felt not only inferior for such a formidable task, but also
(quite honestly) unprepared in the Judeo-Christian sense to tackle such work.
After all, I was hardly cut from the teachings of divinity school. But having
been raised Jewish only to convert to Catholicism in my later years certainly
gave me an edge on guilt and the original sin. After all, I had enough guilt for
both worlds. Yet, somehow, in my heart, I knew I had to tackle this alone and
couldn’t rest on others’ coattails.
It is a difficult subject. Just the mere mention of God and psychotherapy is
often enough to alienate one from several camps. But after all these years, I
have decided that there really is only one camp from whose helm I derive
comfort. Still, allowing God’s work to infiltrate my existence as a therapist
and clinician was simply uncharted territory, and, I might add a continuous
struggle. This was due not only to my conflicts with associates but more
alarmingly to my own resistance. In the words of Father Paul, an Indian

3
4 Spiritual Art Therapy

priest, whom I tested: “The distinguishing of humanity that doesn’t permit the
mingling of God. . . . my own self interests . . . my own motives . . . those are
times I keep God away. . . . The closer you are to God, the more you’ll be test-
ed, the more that humanity comes to your mind and that is quite testing. So
the struggle is always there. That struggle is possible to keep God away from
you. You can’t really sustain that struggle and realize that God is in there wait-
ing.” And, how true that is. To continue the battle is exhausting and akin to
anxiety, which exerts an inordinate amount of counterproductive, negative
energy. Yet surrendering one’s existence and succumbing to such ministry is
enormously difficult in the face of the challenging opposition.

EARLY STAGES

Formerly, I intended the Belief Art Therapy Assessment (described in

Chapter 3) to be a phenomenological investigation of people’s belief (or dis-
belief) in God and how that theosophy impacted them as they functioned
both within their families and society. Nevertheless, it became clear that there
were numerous factors that also needed to be configured. Yet, the ability to
test subjects was not as clear cut as one might think. Because of the religiosi-
ty, it was not possible to gather information and test subjects in the usual man-
ner.
For example, requests to administer this test were naturally rejected by the
public school sector. So as a result, acquiring the information from a small
batch of subjects from varied religious backgrounds was my only recourse.
My hope was that the test be “ecumenical, eclectic, and empirical” as
described by Bergin (1991). He proposed the following inclusion of spiritual
orientations in the strategies for assessment and eventual treatment: (1) a con-
ceptualization of the spiritual within the human experience; (2) a moral frame
of reference, concluding that therapy is not value-free, suggesting universal
limitations for human behavior; and (3) the use of spiritual techniques to
improve the practice of psychotherapy.
In an attempt to incorporate these elements, I developed an interview for-
mat (which will be presented in Chapter 3) that preceded the actual BATA.
Conducting these questions enabled me to ascertain background information,
which not only summarized a subject’s spirituality and religiosity but also
gauged nodal events that may have contributed to the person’s belief system
and/or change in belief system. Yet it became crystal clear that a subject’s
responses to these questions could be both saccharine and/or superficial. So,
it became necessary to conduct the BATA only when the patient questioned
his belief system and after other diagnostic tests had been administered. The
 Evolution of a Spiritual Approach to Counseling 5

reason was twofold: (a) this is predicated on the patient’s lead and (b) the pre-
vious tests offer the administrant enough sense of a patient’s operational func-
tioning to rule out false or misleading responses to the interview component
of the BATA.
Not only age, sex, population, religion, et cetera are considered but more
specifically, common icons that seemed to be appearing in the responses of
the subjects. Some of the symbols were of no surprise both from an historical
and psychological perspective. Yet what was truly amazing was how these
symbols seemed to cut across the different strata of the populations surveyed.
And so in addition to the literature review, there was the overwhelming task
of collating the symbols and attempting to decipher their meaning, even if
that meant “imagicide” (Moon, 1990). But it became all too clear that analyz-
ing this data, while possibly quite relevant information, took a back seat to
interviewing people and gathering information that could impact the inclu-
sion of the person’s spiritual component in treatment. It seemed that talking
to people about God’s impact in their lives was more relative to the quest then
collating the symbols and analyzing the results. The data merely punctuated
the study. But the discussions generated spirit. The essence of the art was to
transliterate this language.

INITIAL IMPRESSIONS

The first person that I tested was four years old; his name was John, and his
religion was Roman Catholic. When I asked him to draw, paint, or sculpt
what it was that God meant to him, he began to draw a symbol that had three
distinctly closed elevations. It was colored in a bright yellow that seemed to
exude light. When he finished, I politely asked him to explain his drawing.
He stated quite matter-of-factly (and as if I should know) that it was a “crown.”
And I went on to ask him “how a crown meant God to (him)?” And just as
certainly as he drew it, he replied, “A crown is a treasure and God is a treas-
ure to me” (Figure 1-1). The simplicity and eloquence that he imparted
through his meaning astounded me. I knew right then and there that this jour-
ney was going to be like no other. It was also abundantly clear that the spiri-
tual dimension was linked to an ethical basis of human existence. Because of
that truism, pursuing the spiritual dimension always needs to be tempered
within the ethical confines of one’s belief system.
The conversations with subjects of this study have left me abashed,
amazed, and inspired. It has also confirmed my suspicions that when a patient
has no one to turn to either through adversity or choice, often times the last