An activity I use with clients who may have communication difficulties, is that of collage making. Communication difficulties can happen for a very broad range of reasons. For example, a person may have experienced a trauma and so may either be unable to, or may not want to, use words to communicate. Sometimes, disability may be the reason that a person has difficulty expressing themselves verbally.
A person may have a learning difficulty or a mental health condition that may make communicating with words problematic. A person may not have a broad emotional vocabulary and so may struggle to describe their feelings or they may have a limited language vocabulary for a variety of reasons. Children and young people may have yet to learn words that adequately represent their thoughts, feelings and emotions. (This work should only be undertaken with children and young people, by a suitably qualified therapist specialising in work with those under eighteen years of age).
Culturally, a person may be unaccustomed to speaking about his/herself; sometimes through traditions of modesty or other times through the cultural norm being that one does not disclose private matters or subjects that may be judged as shameful or breaching a standard of honour. These are but some of the many potential reasons that a person may experience difficulty in communicating through use of words, in a therapy situation.
I would add that this exercise is not just about finding a way to express something when using words is difficult. This exercise is often about finding meaning, whether the words are known or not. The process of collaging can help a person to explore, consider and to make sense of something in a way that simple discussion may not achieve.
It is important not to suddenly spring the activity onto your client and, equally, it is important that you consider how the client may feel about being faced with the prospect of committing something to paper through the use of art materials. From what I have seen, may people feel quite daunted at the prospect, initially. The reason for this, is that they almost always express an apologetic sense of not being good at art and a fear of having an artwork judged.
To introduce the collage making, I have always found it best to introduce the idea in a prior session with the client. This provides the opportunity to explain the purpose of the exercise and it allows the client the chance to explore, consider and question the idea. I take this explorative process further by then helping the client to understand that the outcome we would be working toward would not be to create an artwork that is to then be viewed and judged as an artwork. One of the outcomes that would be achieved would be, instead, a form of self-expression; a piece that describes something, that communicates something or that explains something.
A major point, however, is that the ‘finished piece’ is actually not the only outcome. In fact, the most significant outcome is achieved while the collage is in the process of being created. I explain to my client that this is where we would be talking. I would use my skills to help the client to explore why they would be choosing a particular image to be added to the collage. I would be looking at symbolism and the significance of everything from the images or materials being chosen to their positioning on the paper or board. I would be encouraging the client to ‘tell their story’ and we would work together to consider which materials would represent something of what the client is thinking, feeling, remembering, communicating, describing and disclosing. This is where, from a therapeutic perspective, the true outcomes are achieved and I make the client aware of this. In fact, once the client knows we are not creating an ‘artwork’, they often describe feeling far more comfortable to be creative.
Finally, I also set out some rules. These include that I would not be letting the client depict trauma. I will not take a client into a trauma, while using art materials, and I will not permit the client to depict a trauma in their imagery. The reason for this is that doing so may potentially cause the client to experience a flashback; reliving their trauma, or it may trigger them into an existing or new experience of Post Traumatic Stress Disorder. This would not be the desired purpose of the session. It is okay to explore around a trauma; for example to consider impact and consequence or to explore aspects of change in the person before and after a trauma; but this must be carefully assessed as being helpful to the client and something that works towards their goals, rather than being an indulgent process. Again, I would only suggest this be done by any therapist trained in working with and around trauma.
My recommendation for this exercise would be, instead, to use collaging for exploring aspects that are about the present and the future. This makes the process a safer one and it means that the client will, at the end of the task, be taking away something that may have more hopeful and optimistic significance rather than being a representation of something disturbing from the past. That said, I do allow a small representation of the past to be included, if the client feels the need to do so.
I have to consider the needs and special needs of my client. To assess the potential value of the session, to consider what I know about the client and whether the process will be helpful towards the goals they have set and what I need to have in place in the setting. This taps into also considering special needs; is the client in need of any special equipment? Can the client discern between colours? Do they have any allergies? Does the client have the manual dexterity to use scissors, glue and all of the other equipment that I provide? Do I need to provide a table of a particular height or a chair that meets any special physical needs? These are just a few of the practical considerations.
Equally, I need to consider ethics. So, in my materials I will need to ensure that if I provide magazines or pictures of people, that a broad and diverse range of people types are depicted; from skin colour and race to images of disabled people, differing body shapes and sizes, different gender types, different age groups, faith based imagery, couples of different and same sex, different social class imagery and so on. The person must have access to materials that are relevant to them. This is why I ask the client to also bring in materials that they may like to use. Who better than the client to know which materials would best depict their culture, their social status, their relationship and family structure and their age, faith (or none) and gender identity?
You will note that I have used the word ‘materials’. Well, if you think about the broad range of thoughts feelings, emotions and experiences we have then we must accept that the means to express, communicate or describe these without the use of words may require quite a range of materials. From glitter and sand, through to feathers, leaves, dried food, animal fur, gravel, fluffy materials….the list is endless. I always bring something that represents the five senses; sight sound, taste, touch and smell. From a couple of perfumes, to magazines and images, through to dried food, fluffy and coarse materials and things that are tactile, like wood with grain, bird seed etc.
Other considerations are to ensure that scissors are small and round ended, not sharp point ended. To ensure that you have done your best not to provide items or objects that could be used for self-harm or that could be used to assault you. Such incidents are almost unheard of but must be considered. I also consider whether the client has been , or is, an addict. If I am providing glue or products that can be sprayed, then this could place an addict at risk. In the imagery I have provided in magazines and other sources, I need to ensure that there is nothing associated with a direct link to historic trauma in the client and I also need to consider the flammability of any items I bring into the venue.
This may all sound onerous but it is simple and I actually now have a pre-made set of basic materials that I keep in a couple of boxes, that form a standard basic content, which I then can add to based upon each specific client, closer to the session.
It can also be good practice to have the client sign a simple agreement form with you. For example, that you will provide an apron and even goggles but that if the client’s clothes are stained or damaged, the client accepts responsibility. That the client confirms the session purpose and rules have been explained to them, that their needs and special needs have been assessed and that they are happy to undertake the exercise.
I recommend that you have a go at making a collage, yourself, before you ever do so with a client. This will help you to empathise with them about the experience. It can help you become aware of which materials are best to use and it can also help you be better aware of time management and the comfort of the venue.
I made a simple collage to represent a perfect day. Here is mine:
This was an useful exercise, for the reasons stated, but I also rather enjoyed just taking the time to think about what makes a perfect day. I decided on the subject, simply because it was a nice and optimistic subject. It was interesting to practice and I was surprised by the depth of the thought processes about things I enjoy. It was actually challenging to then look for the imagery to represent that.
As you can see, by me showing a client this, they will immediately recognise that the end product is in no way about art! That offers them reassurance.
Finally, in the session that follows the collage making, this is when I ask the client to return with the collage and we talk through, reflectively, the experience the client had in making it, we discuss how they found the session and then what they gained from the process. The collage remains theirs to keep. We consider whether there are any subjects that we may need to take from the experience into our work together, going forward.
If you are a therapist who rents therapy room space, don’t forget to book yourself around twenty minutes setting up and clearing away time and the extra room hire cost may need to be added to your fee for the session, so that you are not disadvantaged. Some therapists will ask for a small fee to help cover the cost of materials, but I do not.
This is not a session that you can advertise as Art Therapy. Only a qualified Art Therapist can do that and would do so as part of a broader art therapy programme with the client. It is okay to use art materials in your work with your client but unless you are a qualified art therapist, these should be occasional supporting methods rather than a regular feature. Always consult with your Clinical Supervisor before and after you undertake such sessions with your client. Your Clinical Supervisor should also be able to offer you Clinical Supervision using art materials, to again further your insight and empathy into the experience and to help you better develop some of your skills.
If you are a client in therapy, do ask your therapist about collaging. It really can be a very helpful exercise. Any of my regular readers from the Parkinson’s community; you may like to try this yourself to express something of how you feel about living with Parkinson’s. Remember, don’t just focus on the difficulty. Try to make the piece something uplifting and optimistic. Perhaps depict both a difficult and a good day in the one piece?
(C) Dean G. Parsons. 2019.