Maria Riccardi, MA, M.Ed, PhD candidate in psychology, ATPQ, ATR-BC, RCAT
Montreal, QC

Maria Riccardi is a career counselor and a registered art psychotherapist. She is an adjunct professor of art therapy at Concordia University and at l’Université du Québec en Abitibi-Témiscamingue, as well as a faculty member at Winnipeg Holistic Expressive Arts Therapy Institute. She is a board member of the Association des art-thérapeutes du Québec. She collaborates with local non-profit organizations and mental health institutions, developing community-based art studio programs. She has expertise with veterans living with combat-related post-traumatic stress disorder within the context of trauma intervention as well as in the evaluation of art processes and products during treatment. She has founded a clinic in Montreal based on the Expressive Therapies Continuum, providing educational and emotional support to children and families. Her current research interests include media properties and their role in assessment.

Gabrielle Gingras, MA, PhD candidate in psychology, ATPQ
Montreal, QC

Gabrielle is an art therapist with a Master's degree at Concordia and she is a professional member of the Association des art-thérapeutes du Québec (AATQ), co-founder of Canevas: Center for Art Therapy, as well as a lecturer at the University du Québec en Abitibi-Témiscamingue (UQAT). Her professional experience in art therapy is primarily in mental health in community settings, as well as in private practice with neurodiverse populations. Having worked in Quebec and internationally, she believes that art therapy is a tool that transcends differences and brings us closer to our human values and our potential. She works with a humanistic and participatory approach that emphasizes and respects the richness of each person's lived experiences and strengths. Gabrielle is currently developing new approaches to supervision in art therapy that focus on countertransference and continuing education courses.

Being an art therapist is an art, combining many colors, skills, and interventions within a unique relationship. The act of creation in this context leads a client to explore many avenues that may be molded and altered. Ruptures that emerge can be difficult to experience, but may actually become a “super highway” in the therapeutic relationship, providing insight into the fundamental organization of the client (Safran and Muran, 1996). Therefore, therapeutic impasses can provide excellent windows of opportunity to access the client's relational patterns (Safran & Muran, 2000). This article will explore the nature of the art therapeutic relationship, the ruptures that can occur throughout the therapeutic process, and the art of repair.

Engaging in the Creative Endeavors

A healthy working alliance is best defined as an ongoing process and can be described as the strength and quality of the co-created and collaborative relationship between the therapist and client (Norcross, 2010). When there is a rupture in the alliance, the tension between the client and therapist can take center stage (Safran et al., 1990). This deterioration could result from a disagreement regarding therapeutic goals, the tasks required to achieve them, or from a problem related to the emotional bond between the client and therapist (Bordin, 1979; Baillargeon et al., 2012). A study led by Corem et al. (2015) showed that when a client avoided their art therapist, creating tension in the relationship, the client was more likely to report having a negative experience with the art materials. Argaman BenDavid et al. (2021) explored changes in the therapeutic alliance in art therapy over time and revealed that although the therapeutic alliance increased over the course of treatment, in contrast, the working alliance experienced rupture and repair at specific points throughout the process. The researchers attributed the rupture and repair to a decrease in the Art-Task component, thus decreasing the client’s belief that the art materials have therapeutic value and can positively impact treatment. Possibly, this response might be due to the complexity of the client conveying implicit content nonverbally, which might not have been brought to light by the therapist, as well as the transference process onto the image, thus leading the client to express negative aspects about themselves or the therapist and increasing distrust or negative feelings towards the art therapy task (Argaman BenDavid et al., 2021). This last study also suggests that trusting the art materials to be an effective way of achieving therapeutic goals might be an important cue for art therapists as a possible point of rupture with clients.

Art Therapeutic Relationship

Art therapy involves the person, the process, and the product in a relationship of trust existing in a safe environment. Ault and Kempler (1987) observed that the purpose of choosing activities tailored to a person’s abilities and needs is essential to helping the client express a vision, increase a sense of self, and build skills, supporting the client in developing inner images. Bordin’s (1979) proposed a definition of a working alliance that included three main components: the first component focused on the client and therapist reaching an agreement on the treatment goals. The second component included both parties agreeing on the task (the road map to achieve the goals). The third component highlighted the importance of trust and confidence in the partnership (Corem et al., 2015; Horvath & Luborsky, 1993). Bordin’s (1979) concept of “embedded alliance” stressed that various treatments may require the consideration of a specific feature of the working alliance related to the treatment modality (Bat Or & Zilcha-Mano, 2018). To create a healthy working alliance, a feature of the “embedded alliance” is the art-making process and outcome, which is critical for a positive therapeutic result. Hence, art making will influence and become an intrinsic part of the therapeutic goal, task, and bond. Another conceptualization of the therapeutic alliance is through the importance of the art materials in the process. Hinz (2019) proposed the Expressive Therapies Continuum as a stream of choices, reflections, and actions, providing a framework for the art therapist and the client to share a common language, with the media serving as a foundation.

Bat Or and Zilcha-Mano (2018) developed the Art Therapy Working Alliance Measure (AT-WAI), a self-report questionnaire, based on Bordin’s (1979) healthy working alliance components: goal, task, and bond. First, the working alliance was measured by the Art-Task component (Bordin’s Task), exploring the client’s confidence in the healing potential of the art mediums. Second, the Art Experience (Bordin’s Bond) measured the degree that the client explored and expressed emotions through the art process. Third, the Art Therapist’s Acceptance evaluated the client’s openness in receiving the art therapist’s suggestions and interventions when working with the art materials, in relation to the notion of Kramer’s (1986) “third hand” (as cited in Bat Or and Zilcha-Mano, 2018). The study supported the hypothesis that a healthy and positive therapeutic alliance has a positive impact on the clients’ artistic experience with the art materials. Another study demonstrated that a positive working alliance had an affirmative effect on the client’s perception of the art process and outcome (Gazit et al., 2021). These studies support art therapists in exploring the alliance not only by taking information from the client’s attitude towards the therapists and outcome, but also through exploring the client’s relationship and interactions with the art materials (Bat Or & Zilcha-Mano, 2018).

Rupture as Mending

The art of repair demonstrates that the key to supporting clients and creating the condition for therapeutic change to occur is knowing how to restore when there is a rupture. In fact, repairing mistakes and mending ruptures is what can build or disrupt the therapeutic alliance (Safran et al., 2001). As art therapists, we make mistakes and enter the relationship with our own history, bias, and sensitivity. Consequently, it is important that we demystify and normalize potential ruptures and take ownership of our mistakes in order to repair them with our clients. According to Safran and Muran (2000), ruptures reveal themselves in two different ways depending on the client’s or therapist’s personalities and relationship types. The first type of rupture is withdrawal. This event occurs when the client retreats and ceases engaging in the therapeutic process. The second type is called confrontation, which is sometimes more challenging for the therapist, as the client’s anger, dissatisfaction, and blame is directed towards the therapist (Safran and Kraus, 2014).

In the art therapeutic encounter, the client might withdraw from creating, or may invest little energy in the process, thus showing a form of disengagement towards the art-making process and product. A client might also confront the therapist by expressing dissatisfaction with the utility of creating art to achieve the collaborative goals. This can be shown by expressing dissatisfaction in the amount of art materials available and their quality. Furthermore, clients may not be ready to acknowledge the latent content poured into the artwork (Schaverien, 1992; 2000). This may result in retreating, confronting, or showing dissatisfaction with the process as a means of self-defence, which might cause a rupture in the working alliance and cast doubt (Argaman BenDavid and al., 2021). The conscious or unconscious behaviors, emotions, words, use of materials, or images prompted by the client or therapist that can lead to ruptures are in fact precious allies when it comes to opportunities for growth when addressed in the art therapy session with the client.

Deepening the Bond Through Repairs and Opportunities for Growth

With every challenge encountered, an opportunity for growth is also present. Safran and Muran (1996) further support that when the tension between the client and therapist is explored and resolved, the new relationship becomes an opportunity for change. The art media can be a gateway to explore the implications of change, giving the client the power to alter the work of art, and consequently life. Thus, the concept of authenticity allows practitioners to work above and beyond clients' pathologies, thus becoming a springboard towards a more truthful life. The art therapist guides the client's choices genuinely and empathetically, honors the client's potential to deal with the difficulties of life, confronts the client to encourage reflection, and relies on a relationship forged with genuine wisdom rather than on a defined set of procedures or interventions.

Through entering a world built on authenticity, the therapeutic process becomes a path the client and therapist choose, where healing and mending are an integral part of the process. According to Ricœur (1991), stories, and the way they are told, appeal to the temporality that link human experiences, and the affective dimension related to these lived experiences. Consequently, engaging with responsive art making can act as a mirror allowing the client and the therapist to take responsibility and to repair the obstacles that may arise in the story of the relationship. The art therapy studio as an authentic playground becomes the vehicle driving the client’s memories and thoughts towards the collaborative goals set collaboratively.

Rupture as Mending

The art of repair demonstrates that the key to supporting clients and creating the condition for therapeutic change to occur is knowing how to restore when there is a rupture. In fact, repairing mistakes and mending ruptures is what can build or disrupt the therapeutic alliance (Safran et al., 2001). As art therapists, we make mistakes and enter the relationship with our own history, bias, and sensitivity. Consequently, it is important that we demystify and normalize potential ruptures and take ownership of our mistakes in order to repair them with our clients. According to Safran and Muran (2000), ruptures reveal themselves in two different ways depending on the client’s or therapist’s personalities and relationship types. The first type of rupture is withdrawal. This event occurs when the client retreats and ceases engaging in the therapeutic process. The second type is called confrontation, which is sometimes more challenging for the therapist, as the client’s anger, dissatisfaction, and blame is directed towards the therapist (Safran and Kraus, 2014).

In the art therapeutic encounter, the client might withdraw from creating, or may invest little energy in the process, thus showing a form of disengagement towards the art-making process and product. A client might also confront the therapist by expressing dissatisfaction with the utility of creating art to achieve the collaborative goals. This can be shown by expressing dissatisfaction in the amount of art materials available and their quality. Furthermore, clients may not be ready to acknowledge the latent content poured into the artwork (Schaverien, 1992; 2000). This may result in retreating, confronting, or showing dissatisfaction with the process as a means of self-defence, which might cause a rupture in the working alliance and cast doubt (Argaman BenDavid and al., 2021). The conscious or unconscious behaviors, emotions, words, use of materials, or images prompted by the client or therapist that can lead to ruptures are in fact precious allies when it comes to opportunities for growth when addressed in the art therapy session with the client.

Deepening the Bond Through Repairs and Opportunities for Growth

With every challenge encountered, an opportunity for growth is also present. Safran and Muran (1996) further support that when the tension between the client and therapist is explored and resolved, the new relationship becomes an opportunity for change. The art media can be a gateway to explore the implications of change, giving the client the power to alter the work of art, and consequently life. The concept of authenticity allows practitioners to work above and beyond clients' pathologies, thus becoming a springboard towards a more truthful life. The art therapist guides the client's choices genuinely and empathetically, honors the client's potential to deal with the difficulties of life, confronts the client to encourage reflection, and relies on a relationship forged with genuine wisdom rather than on a defined set of procedures or interventions.

Through entering a world built on authenticity, the therapeutic process becomes a path the client and therapist choose, where healing and mending are an integral part of the process. According to Ricœur (1991), stories, and the way they are told, appeal to the temporality that link human experiences, and the affective dimension related to these lived experiences. Consequently, engaging with responsive art making can act as a mirror allowing the client and the therapist to take responsibility and to repair the obstacles that may arise in the story of the relationship. The art therapy studio as an authentic playground becomes the vehicle driving the client’s memories and thoughts towards the collaborative goals set collaboratively.

References

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