a master’s project mp 2016.pdfthe effectiveness of art therapy and mindfulness for at-risk youth...

Running head: ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH 1

The Effectiveness of Art Therapy and Mindfulness for At-Risk Youth

A Master’s Project

Presented to

The Faculty of the Adler Graduate School

________________

In Partial Fulfillment of the Requirements for

the Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

________________

By:

Matthew James Darnold

________________

Chair: Nicole Randick

Member: Erin Rafferty Bugher

________________

May 2016

ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH 2

Abstract

At-risk youth face a number of challenges, including violence, poverty, substance use, mental

illness, and lack of support and resources in the community. A void and lack of services allow

art therapy and mindfulness to address the needs of the at-risk youth population. This literature

review will explore the needs of at-risk youth, define and explore art therapy techniques and

directives, as well as define mindfulness and review interventions as they pertain to at-risk youth.

Mindfulness assists at-risk youth to cope with intrusive thoughts and stressors and promotes

awareness, calmness, and emotional wellbeing. Art therapy can provide a safe environment for

at-risk youth to find a voice, empowerment, and a sense of community to begin their journey

towards recovery. A presentation will then be informed by the research to be used with this

population in a mental health treatment setting.


Table of Contents

Introduction ..................................................................................................................................... 5

Alfred Adler and Individual Psychology ........................................................................................ 5

Courage to be Imperfect.............................................................................................................. 6

Safety .......................................................................................................................................... 6

Significance................................................................................................................................. 6

Sense of Belonging ..................................................................................................................... 7

At-Risk Youth ................................................................................................................................. 7

Services and Interventions .............................................................................................................. 8

Art Therapy ................................................................................................................................... 10

Art Therapy and At-Risk Youth ................................................................................................... 10

Art Therapy Techniques and Directives ....................................................................................... 12

The Open Studio Process .......................................................................................................... 12

Mandalas ................................................................................................................................... 13

Magazine Photo Collage ........................................................................................................... 13

Kinetic Family Drawings .......................................................................................................... 13

Art Therapy and Mental Health .................................................................................................... 14

Art Therapy and Posttraumatic Stress Disorder........................................................................ 14

Art Therapy and Attention Deficit Hyperactivity Disorder ...................................................... 15

Benefits of Art Therapy ................................................................................................................ 15

Self-Esteem ............................................................................................................................... 16

Resiliency .................................................................................................................................. 16

Mindfulness................................................................................................................................... 17

Mindfulness Techniques and Directives ....................................................................................... 19

Check-ins .................................................................................................................................. 19

Walking Meditation .................................................................................................................. 19

Mindfulness and Mental Health .................................................................................................... 20

Mindfulness and Anxiety .......................................................................................................... 20

Mindfulness and Mental Health ................................................................................................ 21

Benefits of Mindfulness ................................................................................................................ 22

Prosocial Behavior and Self-Regulatory Skills......................................................................... 23


Teaching Mindfulness to Homeless Youth ............................................................................... 23

Mindfulness and Suicide Prevention ........................................................................................ 24

Mindfulness-Based Art Therapy ................................................................................................... 25

Cultural Considerations ................................................................................................................ 25

Conclusion .................................................................................................................................... 26

References ..................................................................................................................................... 27

Appendix ....................................................................................................................................... 31


The Effectiveness of Art Therapy and Mindfulness for At-Risk Youth

Introduction

This project will define and explore the use of art therapy and mindfulness with the

population of at-risk youth. A number of services and interventions will be explored that are

being utilized by mental health providers with this particular population. Art therapy and

mindfulness fills a gap in the current treatment interventions used in this population, utilizing

strategies to engage at-risk youth and promotes skills to manage their mental health needs. Little

information was found on specific treatment and service options for the at-risk youth population

and more research may prove beneficial in support of effective treatment options. Art therapy

and mindfulness were conceptualized through Individual Psychology within 3 pillars: safety,

significance, and belonging. The culmination of the information explored within this project

informed an art therapy and mindfulness curriculum for working with youth who are considered

at risk.

Alfred Adler and Individual Psychology

Alfred Adler, a medical doctor and psychologist, developed the concept of Individual

Psychology. Adler collaborated alongside Sigmund Freud during his early years. Adler differed

from Freud in many aspects, such as viewing people as socially embedded, goal directed,

decision-making, and indivisible (cannot be broken up into parts) beings. Each person is an

individual in their social environment and has their own capacity to make decisions and choices

within that context, reinforcing that all behavior has social meaning and cannot be studied in

isolation (Green, 2013). Several of his concepts that are important to this project include the

Courage to be Imperfect, Safety, Significance, and Sense of Belonging.


Courage to be Imperfect

Life can often bring about challenges and demands, especially for the at-risk youth

population. Adler argued that courage consists of two elements, activity and social interest,

promoting movement towards goals and connectedness with others (Mosak & Maniacci, 1999).

Some risk-taking can be expected and an encouraged person may be more willing to engage in

courageous behaviors. Art therapy interventions encourages at-risk youth to engage in the art

making process, which can be intimidating and leave an individual self-conscious at times. The

act of making art supports youth to take safe risks within a nonjudgmental environment.

Mindfulness interventions also reinforce the idea of courage by promoting awareness.

Safety

Safety and stabilization should be the foundation of any therapy session. Adler believed

that people’s behaviors are in part a result to insure their safety and ward against feelings of

failure (Mosak & Maniacci, 1999). He coined the term Safeguarding Behaviors. These

behaviors are created by people to help protect themselves against harm to the physical self,

social self, or loss of self-esteem (Mosak & Maniacci). For example, Millar (2013) used

grounding and anchoring strategies to get an individual in a place to address safety before

progressing into their trauma history. This can be particularly important for at-risk youth who

can experience violence, homelessness, abuse, and poverty. Art therapy and meditation can

address these needs and promote an environment where safety is paramount.

Significance

Family is the first group that an individual seeks to find significance, with the goal to

develop a unique identity. Adler concluded that an individual might strive for significance and

superiority in the sense of self-improvement and greater competency (Green, 2013). He viewed


people through the lens of moving from a perceived minus (negative) situation to a perceived

plus (positive) situation (Mosak & Maniacci, 1999). Art therapy and meditation encourages an

environment where at-risk youth can build relationships and connection with peers, family, and

community, moving from this minus to plus situation. Promoting significance and belonging

with at-risk youth, may also promote engagement and increased participation in mental health

services.

Sense of Belonging

Adler spoke about the goal of belonging and how it can be fundamental to human nature

(Mosak & Maniacci, 1999). Feelings of inferiority can also be associated with a sense

belonging, leaving at-risk youth feeling a low sense of worthiness and value. Adler argued that

one’s mental health correlated with one’s ability to engage and connect with others. Happiness,

success in life, and overall mental status can all be affected by the social connectedness we have

with others (Green, 2013). This is particularly important in at-risk youth due to an increase in

familial problems and homelessness.

At-Risk Youth

At-risk youth, described by Sutherland, Waldman, and Collins (2010) may include youth

“living in communities where there is poverty, unemployment, reliance on welfare, and

exploitation can result in powerlessness and a lack of self-worth and self-esteem” (p. 70). These

variables can lead to violence and aggression within families, communities, and schools. At-risk

youth face increased stressors, “including violent neighborhoods, substance abuse, poverty, lack

of support, and limited resources. They also have increased risk of entry into the juvenile justice

system” (Oparaji, Nwachuku, & Rosenstock, 2015, p. 104). There are several programs within

the literature that have tried to address the complex needs of this population. Through the


context of this art therapy and meditation; at-risk youth can develop a sense of significance and

belonging in a safe environment with their peers through creativity and mindfulness. The

courage to be imperfect, an Adlerian concept, will be defined and reinforced through art

directives that focus on empowerment and mindfulness interventions that promote awareness and

non-judgment.

Services and Interventions

Oparaji et al. (2015) developed The Healthy Minds program, a curriculum that focused

on stress management, coping with trauma, family planning and sex education, body image, and

professional development with the at-risk youth population. This program was also developed to

address the lack of resources and affordability to bring these services to school systems instead

of juvenile centers. Participants in the program reported that the favorite part of the curriculum

were the interactive activities, suggesting that interactive teaching was more effective than

traditional lecture style.

Youth who were considered at-risk also have a high prevalence for mental health

problems. Dolgin (2014) described how the daily stressors of adolescents (e.g., social, academic,

and familial problems) could develop into long-lasting mental health issues if this population is

unable to adapt and cope. He developed a wilderness-based group intervention program to

educate youth in stress-coping strategies. Ultimately, through working in the wilderness, youth

were able to develop strong connection, understanding, and social support. As these connections

were developed, “the opportunity for authentic expression and engagement is increased through

structured therapeutic interventions and activities” (Dolgin, 2014, p. 85).

Engagement and participation with the at-risk youth population can likely be an essential

aspect of any successful intervention. French, Reardon, and Smith (2003) reported that the lack


of engagement with at-risk youth population may be due to difficulty accessing mental health

services, homelessness, lack of family support, substance use, and social isolation. During the

engagement phase, youth are drawn to several components depending on the attractiveness and

accessibility of the service provided. Feeling understood, confidentiality, choosing level of

disclosure, physical environment, maintaining contact, based in community, and outreach

available were categories identified by at-risk youth to promote engagement.

Reddy et al., (2013) developed a cognitive-based compassion therapy intervention that

addressed themes of psychosocial functioning, hopefulness, and generalized anxiety for at-risk

adolescents. Part of the intervention consisted of meditation and mindfulness practices, as well

as promoting loving-kindness, empathy, and compassion. Discussion of the study suggested that

the 6-week program did not result in significant improvement on self-report measures of

psychosocial outcomes. The study suggested more time for participants to learn and practice and

participating in an 8 weeks or longer program would be more appropriate time length for

participants to engage and find benefits.

A study conducted by Greco, Baer, and Smith (2011) looked to fill a void regarding a

lack of research in evidence-based data that supported the use of mindfulness in children and

adolescents. The Child and Adolescent Mindfulness Measure (CAMM) created by Greco, Baer,

and Smith (2011) was developed, looking at the skills of observing, acting with awareness, and

accepting without judgment. The CAMM appears to be a developmentally appropriate measure

for the reliability and validity of mindfulness with children and adolescents.

Art therapy and mindfulness interventions can provide engagement and expression in an

urban environment when other intervention programs are not available. Art therapy is defined,

including the benefits of art therapy to childhood development, self-esteem, and mental health


problems. Next, mindfulness is defined, and it’s benefits to youth and their mental health are

discussed. Specific techniques are described for each of these interventions to demonstrate the

effectiveness of art therapy and mindfulness with at-risk youth.

Art Therapy

Art therapy is defined by Malchiodi (2007) as

a recognized form of treatment in health and medicine. Art therapy is based on the idea

that the creative process of art making is healing and life enhancing and that it is a potent

form of communication. It utilizes the creative process, which exists within every

individual, to promote growth, self-expression, emotional reparation, conflict resolution,

and transformation. (Introduction, para. 4)

Art therapy began to grow interest in the 1960’s when artists from several backgrounds,

including formal art, psychiatry, and art education began incorporating psychiatric training and

the assistance of other mental health providers, to include art in the psychology field. As more

art therapists were trained, the use of art therapy grew to other populations such as those in the

correction facility. Art therapy had its roots as a mental health discipline, but has continued to

grow as a field and discipline helping those with both cognitive and physical limitations (Junge,

2010).

Art Therapy and At-Risk Youth

The primary goal of art therapy with the at-risk youth population is to address the social,

cognitive, and emotional needs of each youth. Art directives can promote growth and recovery

through art mediums and creative expression while reinforcing the courage to be imperfect by

focusing on the process of art making instead of the product produced. Engaging in art making

can reduce anxiety, while “helping the child feel comfortable with the therapist, increasing

memory retrieval, organizing narratives, and promoting the child to tell more details than in a

solely verbal interview” (Malchiodi, 2013, p. 7). Art therapy techniques can assist children in


learning and practicing developmental tasks and coping skills. Art therapy directives can also

help youth express feelings and build interpersonal skills in a safe and creative environment,

supporting the ideas of Individual Psychology of safety, belonging, and significance. Art

therapists can assess the developmental level and age-appropriateness of youth’s physical,

cognitive, and social skills based off of art directives, as well as to observe the effect of youth

during a session. An art therapy session will ultimately encourage and promote the youth to

develop and work on these skills while promoting empowerment and self-efficacy (Malchiodi,

2013).

A program developed by Sutherland et al. (2010) brought together the ideas of Alfred

Adler and art therapy to develop “The Art Therapy Connection” (ATC) in the inner city of

Chicago, Illinois. Utilizing an Adlerian perspective, the ATC developed group identity, group

cohesion, and group cooperation; while also promoting feelings of belonging, trust,

encouragement, and social interest. These ideas were also reinforced by providing a safe

environment that met the needs of at-risk youth and their mental health needs.

In a group art therapy format, students build a sense of belonging and begin to understand

the needs of others, as well as their own. Developing positive and rewarding experiences to

these students also promote connection, a change in negative attitudes, and a want and desire to

stay in school. These attitudes are also reinforced back at home and their relationships with

family, friends, and throughout the community. The effectiveness of the ATC was noted in the

graduation rates for those students who participated in the program. A 56% graduation rate was

noted for the entire student body, whereas a 78% graduate rate was noted for the students who

participated in the ATC program. The presentation informed by this review will promote many


of the ideas discussed through the ATC, incorporating the techniques and directives discussed,

and integrating the philosophies of Individual Psychology of safety, belonging, and significance.

Art Therapy Techniques and Directives

The Open Studio Process

The open studio time concept is based on The Open Studio Project (OSP) explained by

Block, Harris, and Laing (2005). The OSP offers year-round afterschool and summer programs

to at-risk youth in the Chicago area. The OSP consists of the four main concepts of intention, art

making, witness-writing, and sharing. Through these concepts, a safe environment is developed

that promotes youth to express themselves and build trust in the art process. The intention

begins the session, with students writing in a journal or sketchbook their goal or target. The

intention is intended to encourage responsibility, ownership, and resolution to the art pieces the

youth create. Materials are provided and laid out for the youth to discover, such as drawing,

painting, sculpture, and collage. Humor, freedom, creativity, and respect are encouraged during

this time of art making. The next step consists of a “witness” time, where each youth begins by

writing about their work. This is a time to reinforce the ideas of mindfulness, where youth are

invited to sit with the art piece they have created and to be nonjudgmental and noncritical,

respectful, and attentive. The writing process is open and spontaneous with any healthy words

being encouraged. The final aspect of the OSP is the sharing of the artwork with the group.

Each youth is promoted to decide on what aspects of their writing they want to share with the

group. The group is encouraged to listen with empathy and appreciation to the piece and writing

without responding to the piece shared. Through this OSP model, the ideas of Alfred Adler are

demonstrated with each student feeling significant and with a sense of belonging to the group

(Block et al., 2005).


Mandalas

A study by Curry and Kasser (2005) reported that coloring a mandala, a pre-drawn

circular geometric design, was more effective than free-form coloring in terms of reducing

anxiety. The effects found in the pre-drawn mandalas were also the same as those who colored a

square plaid design, noting both the mandala and plaid design provided structure and direction.

These results suggested that completing a structured and complex design may have drawn the

participant into a meditative state, whereas the open drawing required the participant to structure

their own time, which may have been more anxiety inducing.

Magazine Photo Collage

The magazine photo collage directive allows the youth a chance to pick imagery from a

selection of pre-cut magazines. Client conflicts, defense mechanisms, and styles of functioning

are pieces of information that can be generated through this directive. The magazine photo

collage can allow for cultural significance to be addressed, by providing imagery that matches

with the youth, which can allow for a stronger relationship between therapist and client (Brooke,

2004). A theme can be developed or left with free choice to the collage, resulting in both

conscious and unconscious material to be discussed and processed. “Completed collages allowed

the therapist to confront the meaning of the images, make an intervention, offer an interpretation,

or simply note the content” (Brooke, 2004, p. 136).

Kinetic Family Drawings

The Kinetic Family Drawing (KFD) is a directive, focused on addressing child

development, self-concept, and interpersonal relationships (Burns & Kaufman, 1970). The

directive asks the client to draw a picture of everyone in their family, including themselves,

doing something. The participant is encouraged to draw whole people and avoid stick people or


cartoons. Family dynamics are also a significant aspect that this directive can address. An

evaluation of the directive suggested that this directive can be sensitive to mood changes of the

participant with the completion of a retest and does not indicate any personality traits. This

directive does not allow a distinction between emotionally disturbed and well-adjusted children

(Brooke, 2004). It should also be noted that this directive should be considered with the at-risk

youth as family and may not be involved or can evoke negative and powerful emotions.

Art Therapy and Mental Health

Art therapy and mental health work with at-risk youth can offer a safe space for youth to

engage in a process of expression and communication that can often be difficult and

uncomfortable. Malchiodi (2012) described art therapy reaching six specific factors (i.e.,

perceptual, emotional, imaginal, social, physical, and spiritual) that should be focused on when

working with and addressing the mental health needs of the at-risk youth population. Art therapy

can also be modified to work in a variety of settings, with many mental health diagnoses, and in

different forms of treatment to meet the individual needs of each client.

Art Therapy and Posttraumatic Stress Disorder

Gerteisen (2008) explained that clients who have experienced trauma, may experience

their memories as images, as well as a cognitive experience. Art therapy allows clients to

express their trauma experience in a sensory experience, while providing a safe space to do so.

These traumatic memories are reported to be held in the right hemisphere of the brain, the same

side of the brain closely connected with creativity and nonverbal language. Art therapy provides

an outlet for clients to express their memories through images, instead of relying on verbal

methods of treatment. Art directives that were primarily focused on self-expression showed

greater effectiveness than the art directives that were chosen to focus on a certain issue. This


allowed the client a sense of autonomy and ability to find their own path.

Art Therapy and Attention Deficit Hyperactivity Disorder

A study designed by Smitheman-Brown and Church (1996) to connect the effectiveness

of mandala drawings and lowering the symptoms of Attention Deficit Disorder and Attention

Deficit-Hyperactivity Disorder, found that these drawings increased attentional abilities and

impulsive behaviors in children diagnosed for more than one year. The session began with a free

choice mandala drawing, which lasted for 5 minutes at a minimum, the client could then choose

to continue on with the drawing or choose another artwork and art medium. The study found

that mandala drawings assisted in increasing attentional abilities and decreasing impulsive

behaviors. The drawings may have also taught better decision-making, completion of task,

expression of growth in developmental level, and an interest in personal aesthetics.

Benefits of Art Therapy

Art therapy is used to address mental health disorders, but can also address aspects of at-

risk youth that promote mental health and a positive outlook towards life. Self-esteem and

resiliency was discussed and how art therapy promoted these skills in at-risk youth was also

explained, as well as promoting other areas like assertiveness, self-mastery, self-control, and

flexibility. Incorporating the concepts of social interest, social awareness, and self-regulation,

the concepts of Alfred Adler appear to reinforce the skills and values learned through art and

mindfulness. Guzick, Dorman, Groff, Altermatt, and Forsyth (2004) explained that

incorporating Adlerian psychology may assist with developing optimism and interpersonal

relationships with youth, while lowering alienation and maladjustment. The presentation,

informed by this review, addressed that youth may feel inferior and self-conscious about art

making and focus on building an environment that is safe and encouraging, while also promoting


a sense of community and group cohesion.

Self-Esteem

When working with at-risk youth, lack of self-esteem may be one of the most common

aspects that these students might be suffering with. Franklin (1992), referred to self-esteem as

one of the core senses when trusting in personal ability and creating an attitude of self-worth.

Abused children experienced considerably lower self-concept, reduced ambition, and fewer

friends than those of children who did not experience abuse. It should be the goal of the

therapist to assist in solidifying this sense of personal qualities and unique abilities to at-risk

youth. Providing an environment that allows at-risk youth to tell their story in a safe and

contained space is another goal of the art therapist. “When creating art one can not help but look

inward and participate in decision making that is targeted at the resolution of various emotional

and cognitive processes” (Franklin, 1992, p. 79).

Assertiveness, empowerment, and self-mastery are skills that may start to develop and

build while creating art. Art making provides a safe place where old thoughts and ideas can be

challenged and new ones can emerge. It is also important to remember that shame, a feeling

related to low self-esteem, may result in anger and violence.

Resiliency

Prescott, Sekendur, Bailey, and Hoshino (2008) looked at the connection between

resiliency and creativity. Creativity and art making can be used as a sort of safe haven when

dealing with stress, pain, or hardships. “Creative people tend to have strong coping skills and

other inner resources such as flexibility, high ego strength, responsibility, tolerance, self-control,

intellectual efficiency, and openness to new experiences” (Prescott et al., 2008, p. 158). The art

process can be used to validate and empower youth in the pieces that are created in the studio,


allowing them a chance to voice and cope with their experiences.

An art therapy directive specifically designed to address aspects of resiliency is the

bridge drawing (Hays & Lyons, 1982). Participants are asked to draw a bridge spanning two

places, promoting youth to address their transition from childhood to adulthood. The bridge

drawing directive can also encourage participants to provide insight into their own identity and

independence and open up a conversation with the art therapist (Prescott et al., 2008).

Mindfulness

Mindfulness in a clinical setting is both inspired by the Buddhist tradition and teachings,

as well as the work of Jon Kabat-Zinn. “Mindfulness is awareness, cultivated by paying attention

in a sustained and particular way: on purpose, in the present moment, and non-judgmentally”

(Kabat-Zinn, 2012, p. 1). Mindfulness can be broken into the three core elements of intention,

attention, and attitude. Intention is understanding why one is practicing mindfulness and being

clear about one’s intention. Valuing the practice and understanding if the intention is wholesome

or unwholesome or for the benefit or harm to self and others. Attention involves paying

attention to one’s moment-to-moment experiences. By attending to the surrounding world and

interpreting experiences in the here and now, one can learn how to cultivate attention that is

persistent and concentrated, perceptive and nonreactive. The last core element of attitude

promotes one to bring an openhearted and compassionate quality to mindfulness practice. An

acronym of COAL can often be used to assist with this element, standing for similar qualities of

curiosity, openness, acceptance, and love (COAL; Shapira & Carlson, 2009).

Meditation showed promising efficacy in working with school-aged children living with

symptoms of anxiety. Meditation can promote children to learn how to concentrate and

intentionally shift their attention. For example, a recent study by Lee, Semple, Rosa, and Miller


(2008) examined the feasibility and acceptability of mindfulness with this population. Through a

6-week trial, children were able to demonstrate the ability to “understand the concept of

mindfulness, utilize the techniques taught in the program, and integrate mindfulness into their

every day lives” (Lee et al., p. 16). Furthermore, an assessment, The Mindfulness-Based

Cognitive Therapy for Children (MBCT-C) was developed by Semple, Reid, and Miller (2005)

to address the needs of children and adapt programming to the developmental differences of this

population. Shorter and more repetitive sessions reinforce ideas and techniques, while being

attentive to a child’s memory and attentional competencies. The MBCT-C consists of a 12-week

program with each session lasting approximately 90 minutes. Each session was designed with an

opening brief sitting meditation; the group then would review last week’s session, following up

with a group discussion about the home practice exercises. Techniques learned in the MBCT-C

are focused on bringing in multisensory, attending to the need of limited verbal fluency.

Techniques used in the MBCT-C program to enhance mindfulness were designed to be

participatory and interactive, offering a wide variety of multisensory experiences.

Experiential learning exercises focused on awareness in a specific sensory modality, such

as mindful seeing, hearing, touching, tasting, and smelling. (Lee et al., p. 20, 2008)

Guardian participation plays a primary part of the program, reinforcing the use of home

practices, but also promoting mindful intentions, speech, and behaviors at home. Participants

were encouraged to practice these new skills with guardians, siblings, and peers, and incorporate

them into their daily lives. Participates were instructed to record these practices and complete

about 15 minutes per day. Reviewing the study, a sense of community appeared to have

developed and providing the participants a safe environment to become more aware of their

thoughts, feelings, and body sensations.


Mindfulness Techniques and Directives

Mindful techniques can include check-ins, walking meditation, standing and sitting yoga,

and mindful eating. These techniques can assist youth to bring awareness of breath, movement,

posture, thoughts and emotions. Each participant will be promoted to engage in the activity as

best they can, listening to the body’s flexibility, and practicing the intervention with wisdom and

compassion (Stahl & Goldstein, 2010).

Check-ins

A 3-minute mindful check allows clients to re-center themselves and engage in the

present moment. The technique encourages each youth to find a space, either lying down or

sitting up, to focus on their breath and inner experience to connect their mind and body (Stahl &

Goldstein, 2010). An example of a check in script by Stahl and Goldstein (2010):

Take a few minutes to be still. Congratulate yourself for taking this time for meditation

practice. Begin this mindful check-in by feeling into your body and mind and simply

allowing any waves of thought, emotion, or physical sensation to just be. There is no

need to judge or figure things out. Just allow yourself to be in the here and now, amidst

everything that is present in the moment. Spend about three minutes simply checking in

with yourself in this way. (p. 21)

Walking Meditation

A walking meditation promotes the participant to get out of a stressed or anxious mind

and ground themselves with their feet on the earth. Bringing attention to a task that becomes

unconscious throughout the day, a walking meditation focuses on each step taken (Stahl &

Goldstein, 2010). An example directive of Stahl and Goldstein (2010):

Start off by walking slowly and paying attention to sensations on the soles of the feet as

each part of the sole, from heel to toes, touches the ground. Notice how the body moves

as you walk and how the arms may swing back and forth. If at any point you notice the

mind wandering from walking, just acknowledge this and gently bring the focus back. (p.

59)


Mindfulness and Mental Health

Martin (2013) explained how mindfulness may be helpful for youth experiencing mental

illness. While practicing the skill of non-judgment, youth may start to begin to cope with painful

and overwhelming thoughts. A core principle of mindfulness is ability to deal with intrusive

thoughts, accepting them as they happen, then letting them go. Avoiding letting these thoughts

have any power and value, including the positive ones, thoughts become part of ones journey and

history instead of being intrusive. The Mindfulness Based Stress Reduction (MBSR) program

reported improved mental health in 11 studies, specifically showing reduction in anxiety and an

increase in positive self-statements. MBCT proved more effective in reducing depression

relapses and symptoms, as compared to standard care. The follow up presentation to this review

promotes mindfulness directives to be used both collaboratively and independently with the art

therapy techniques addressed. Skills like awareness, non-judgment, empathy, sharing, and

emotional regulation can also be utilized within an art studio space.

Mindfulness and Anxiety

Semple, Reid, and Miller (2005) reported that there was little evidence supporting long-

term interventions that assist with treating anxiety disorders for anxious children. Mindfulness

may help with impaired attention seen in many children living with anxiety. Mindfulness

interventions promote “recognizing anxious feelings, clarify repetitive or maladaptive thoughts,

minimize avoidant behaviors, and self-monitor one’s coping strategies” (Semple et al., p. 380).

By returning to the breath, mindfulness will assist with youth learning how to relax and practice

healthy stress reduction. Semple et al.’s research was based on the MBSR and MBCT model for

adults, but modified and integrated to assist with children from the ages of 7 and 8. The program

promoted participation and practicing the interventions, rather than just teaching the children


about the intervention, then reinforced these interventions with weekly home practice exercises.

An opening breathing exercise started each session, consisting of a 3-minute seated

breathing meditation. Each participant then wrote down on a piece a paper one of their biggest

worries of that day, then threw it into a wastebasket, encouraging separation from any anxious

cognition. Each session followed a structure of each participant coming into the room, removing

their shoes, finding their folders, sitting in their space, reviewing the rules, and then participating

in the exercise. The therapists are thoughtful to their own behaviors, modeling a space that is

quiet and attentive. A chair in the back of the room is provided for any participant who chooses

not to complete the exercise. The summary of this program describes the participants’

enthusiasm about the program and wished it had continued. Improvement in academic

functioning and a reduction of internalizing and externalizing problems were observed in most of

the participants in the program. In conclusion, the study suggested that mindfulness training for

youth may be potentially helpful and that more research may be worthwhile (Semple et al.,

2005).

Mindfulness and Mental Health

In an exploration from Waller, Carlson, and Englar-Carlson (2006) treatment and relapse

prevention in depression using mindfulness was researched using Adlerian concepts. An MBCT

eight-session program was studied, emphasizing stress management and the fostering of

behaviors inconsistent with depression. The program addressed the unwanted thoughts, feelings,

and body sensations associated with depression. Skills including awareness, dealing with

barriers, staying present, and allowing or letting be were incorporated to assist with preventing

any further depression relapses.

Kimbrough and Magyari (2010) explored the benefits of mindfulness interventions with


child abuse survivors, exploring the benefits of mindfulness in several different mental health

diagnoses including depression, anxiety, substance abuse, and post-traumatic stress disorder

(PTSD). The study incorporated the teaching of Jon Kabat-Zinn and aspects of the field of

positive psychology. Mindfulness may be a less confrontational intervention when working with

a vulnerable population like at-risk youth, where clarity, attention, calmness, and emotional well-

being can be taught in a safe environment. Relating these skills to Individual Psychology,

encouragement and social interest were reinforced by the group when practicing these skills.

The program was found to be safe and favorably endorsed by the participants. There were

statistical changes in all outcomes by the end of the 24 week program, specifically in depressive

symptoms and PTSD symptom criteria of re-experiencing, avoidance or numbing, and

hyperarousal.

Benefits of Mindfulness

The core concept of awareness in mindfulness practices, offers clients an opportunity to

expand on a multitude of other skills when practicing both formal and informal interventions.

Bringing awareness to daily tasks and living in the present moment can assist with clients who

may seem like they are on autopilot. Learning skills to assist with observing behaviors,

describing emotions, and participating in structured activities promote well-being in the

participants of mindfulness practices (Greason & Welfare, 2013). Integrating concepts of social

interest and social empathy in an Adlerian context may also strengthen the ideas of

non-judgment and awareness taught throughout many mindfulness interventions. Both

mindfulness and Adlerian psychology promotes the concepts of providing a safe environment

where growth can occur in a group setting (Guzick et al., 2004).


Prosocial Behavior and Self-Regulatory Skills

Prosocial behavior, self-regulation, and executive functioning were the focus through a

12-week mindfulness Kindness Curriculum (KC) designed by Flook, Goldberg, Pinger, and

Davidson (2014). Making the argument that these skills are imperative in the long-term outlook

throughout the lifespan, these skills are not taught in school. Just over a third of the participants

in the study were considered socioeconomically disadvantaged. The core principles aimed

through the KC were cultivating attention and emotion regulation, while also reinforcing

kindness practices like empathy, gratitude, and sharing. A child’s ability to regulate attention

and emotion, the KC provides them with the skills to efficiently learn in the classroom and build

healthy and positive social relationships. By teaching children self-regulation, the KC predicts

that is may also correlate with health, financial stability, and educational attainment throughout

adulthood. The program suggests that the interventions used throughout the KC appear

beneficial in promoting these skills to youth, particularly youth with lower baseline functioning

(Flook et al.).

Teaching Mindfulness to Homeless Youth

Homeless youth may experience a number of stressors including family stress, mental

illness, maltreatment, neglect, violence, substance use, and malnutrition. Socio-emotional effects

like low-self-esteem, aggressive behaviors, non-compliance, shorter attention spans, and poor

educational outcomes are additional aspects that mindfulness interventions hope to address.

New reports show hope that mindfulness may assist with past trauma when working with

children in domestic violence shelters. Viafora, Mathiesen, and Unsworth (2015) described how

mindfulness may benefit this population in school classrooms. The main concepts that

mindfulness hopes to encourage are social and emotional growth, strengthening attention,


learning healthy coping strategies, and supporting mental health prevention. Promoting

kindness, curiosity, and compassionate with oneself, youth learn mindfulness techniques to help

in multiple areas of life. Participants in the study were youth who were currently or had recently

lived in a homeless shelter with their families. The study followed The Meditation Initiative

(TMI), which taught mindfulness and meditation skills to the San Diego area schools.

Participants engaged in an 8-week program, lasting for 45 minutes each session. Each session

was structured with an opening guided breathing exercise, then transitioned to learning new

mindfulness practices. An example of a mindfulness activity taught may have been mindful

listening, mindful pauses, guided mindful breathing exercises, mindful movements, pleasant

experiences, and test taking. “Significant improvements in stress, anxiety, self-esteem, quality of

sleep, interpersonal difficulties, personal goals, awareness, impulsivity, social problems,

happiness, and general improvements in ADHD symptoms” (Viaform et al., p. 1181) were

observed in youth participating in mindfulness programs.

Mindfulness and Suicide Prevention

Mindfulness techniques can aid in the treatment of suicide prevention. “Mindfulness is a

potentially effective prevention intervention strategy for suicide by providing individuals with

important tools to recognize and manage self-destructive thoughts and emotions along with

developing the capacity ‘to be’ with difficult thoughts and emotions” (Le & Gobert, 2015, p. 12).

Mindfulness practices promote an environment of nonjudgement where embarrassment and

stigma may prevent some participants in finding treatment. This specific study utilized the Mind

Body Awareness Project, which was a 10-module curriculum designed from aspects of the

MBSR program. This program specifically addressed the difficult-to-reach and resistant-to-


treatment at-risk youth population, with the youth participants reporting improved awareness,

relaxation, and calmness (Le & Gobert, 2015).

Mindfulness-Based Art Therapy

Combining art therapy interventions and processes with some of the principles of the

MBSR program, “Walkabout: Looking In, Looking Out” designed by Peterson (2015) looks at

the benefits of these two modalities working together. This mindfulness-based art therapy

intervention combined the use of mindful walking, digital photography, and collages. Through a

number of sessions, participants utilized digital cameras and were promoted to focus on

awareness and mindful attention while taking pictures and reacting to stimuli on a walk. Ten

photos were chosen, ones that expressed both pleasant and unpleasant feelings, and then

deconstructed the photos into a collage. These collages promoted self-expression and bringing a

narrative to personal experiences. Participants were encouraged to practice several mindfulness

practices like breathing, “non-judging, trust, patience, non-striving, beginner’s mind, acceptance,

and letting be” (Peterson, p. 79).

Cultural Considerations

Westrich (1994) explained the importance for art therapists to keep cultural

considerations in mind when working with clients and that sensitivity to the cultural differences

between the art therapist and client promoted the therapeutic alliance that was built. When

working with a client whose ideas, beliefs, and cultural traditions may vary from the therapist, it

was important to become aware of the field of cross-cultural therapy. This type of therapy

becomes important when therapists and clients are “culturally different because of socialization

acquired in distant cultural, subcultural, racio-ethnic, or socio-economic environments”

(Westrich, 1994, p. 189). Art therapists need to remember that any behavioral patterns that come


off as strange, unfamiliar, or different to them, need to keep in mind the client’s cultural or social

frame of reference when these behaviors are demonstrated. Art therapists should learn about the

traditional art and traditional art materials included in the cultures they may be working with.

Conclusion

Art therapy and mindfulness were explored as an effective and beneficial intervention for

the at-risk youth population. Through an Adlerian lens, the presentation that was influenced by

the research presented addressed concepts of social interest, safety, belonging, and significance.

The at-risk youth population was defined and services provided for this population was explored

to understand if art therapy and mindfulness were able to fill a void in the services specific to this

population. Art therapy was defined and explained in regards to the at-risk youth population.

The mental health needs addressed through art therapy were discussed, including mental health

diagnoses and other benefits art therapy has in the mental health field. Directives and

interventions were explored that were incorporated into a presentation for mental health

professionals. Mindfulness was also defined as a Western secular modality in treatment of at-

risk youth. Directives and interventions were explained and the benefits of mindfulness and

mental health were discussed. A combination of mindfulness-based art therapy was explored

that combined the two modalities and cultural considerations were explained to best address the

needs of each individual youth.


References

Block, D., Harris, T., & Laing, S. (2005). Open studio process as a model of social action: A

program for at-risk youth. Art Therapy: Journal of the American Art Therapy

Association, 22(1), 32-38.

Brooke, S.L. (2004). Tools of the trade: A therapist’s guide to art therapy assessments.

Springfield, IL: Charles C. Thomas, Publisher, LTD.

Burns, R., & Kaufman, S. (1970). Kinetic family drawings (K-F-D); An introduction to

understanding children through kinetic drawings. New York, NY: Brunner/Mazel.

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy: Journal

of the American Art Therapy Association, 22(2), 81-85.

Dolgin, R. (2014). Into the wild: A group wilderness intervention to build coping strategies in

high school youth through collaboration and shared experience. Journal of Creativity in

Mental Health, 9, 83-98.

Flook, L., Goldberg, S. B., Pinger, L., & Davidson, R. J. (2014). Promoting prosocial behavior

and self-regulatory skills in preschool children through a mindfulness-based kindness

curriculum. American Psychological Association, 51(1), 44-51.

Franklin, M. (1992). Art therapy and self-esteem. Art Therapy: Journal of the American Art

Therapy Association, 9(2), 78-84.

French, R., Reardon, M., & Smith, P. (2003). Engaging with a mental health service:

Perspectives of at-risk youth. Child and Adolescent Social Work Journal, 20(6), 529-548.

Gerteisen, J. (2008). Monsters, monkeys, & mandalas: Art therapy with children experiencing

the effects of trauma and fetal alcohol spectrum disorder (FASD). Art Therapy: Journal

of the American Art Therapy Association, 25(2), 90-93.


Greason, P. B., & Welfare, L. E. (2013). The impact of mindfulness and meditation practice on

client perceptions of common therapeutic factors. Journal of Humanistic Counseling, 52,

235-253.

Greco, L. A., Baer, R. A., & Smith, G. T. (2011). Assessing mindfulness in children and

adolescents: Development and validation of the child and adolescent mindfulness

measure (CAMM). Psychological Assessment, 23(3), 606-614.

Green, R. V. (2013). Theory and practice of Adlerian psychology. San Diego, CA: Cognella.

Guzick, D. T., Dorman, W. J., Groff, T. S., Altermatt, E. R., & Forsyth, G. A. (2004). Fostering

social interest in schools for long-term and short-term outcomes. Journal of Individual

Psychology, 60(4), 361-378.

Hays, R. E., & Lyons, S. J. (1982). The bridge drawing: A projective technique for assessment in

art therapy. The Arts in Psychotherapy, 8(3), 207-217.

Junge, M. B. (2010). The history of art therapy in the United States. Springfield, IL: Charles C.

Thomas Publisher, LTD.

Kabat-Zinn, J. (2012). Mindfulness for beginners: Reclaiming the present moment-and your life.

Boulder, CO: Sounds True.

Kimbrough, E., & Magyari, T. (2010). Mindfulness intervention for child abuse survivors.

Journal of Clinical Psychology, 66(1), 17-33.

Le, T. N., & Gobert, J. M. (2015). Translating and implementing a mindfulness-based youth

suicide prevention intervention in a Native American community. Journal of Child and

Family Studies, 24, 12-23.


Lee, J., Semple, R. J., Rosa, D., & Miller, L. (2008). Mindfulness-based cognitive therapy for

children: Results of a pilot study. Journal of Cognitive Psychotherapy: An International

Quarterly, 22(1), 15-28.

Malchiodi, C. A. (2007). The art therapy sourcebook. New York, NY: McGraw-Hill.

Malchiodi, C. A. (2012). Handbook of art therapy. New York, NY: The Guildford Press.

Malchiodi, C. A. (2013). Art therapy and health care. New York, NY: The Guildford Press.

Martin, G. (2013). On mindfulness and mental health. Advances in Mental Health, 11(3),

208-212.

Millar, A. (2013). Trauma therapy: An Adlerian perspective. The Journal of Individual

Psychology, 69(3), 246-261.

Mosak, H., & Maniacci, M. (2013). Primer of Adlerian psychology: The analytic-behavioural-

cognitive psychology of Alfred Adler. Ann Arbor, MI: Routledge.

Oparaji, J. N., Nwachuku, E. L., & Rosenstock, J. M. (2015). Healthy minds: Promoting mental

health for at-risk youths. Psychiatric Services, 66(1), 104-105.

Peterson, C. (2015). “Walkabout: Looking in, looking out”; A mindfulness-based art therapy

program. Art Therapy: Journal of the American Art Therapy Association, 32(2), 78-82.

Prescott, M. V., Sekendur, B., Bailey, B., & Hoshino, J. (2008). Art making as a component and

facilitator of resiliency with homeless youth. Art Therapy: Journal of the American Art


Reddy, S. D., Tenzin Negi, L., Dodson-Lavelle, B., Ozawa-de Silva, B., Pace, T. W. W., Cole, S

.P,… Craighead, L.W. (2013). Cognitive-based compassion training: A promising

prevention strategy for at-risk adolescents. Journal of Child and Family Studies, 22,

219-230.


Semple, R. J., Reid, E. F. G., & Miller, L. (2005). Treating anxiety with mindfulness: An open

trial for mindfulness training for anxious children. Journal of Cognitive Psychotherapy:

An International Quarterly, 19(4), 379- 392.

Shapiro, S. L., & Carlson, L. E. (2009). The art and science of mindfulness: Integrating

mindfulness into psychology and the helping professions. Washington, DC: American

Psychological Association.

Smitheman-Brown, V., & Church, R.P. (1996). Mandala drawing: Facilitating creative growth in

children with ADD or ADHD. Art Therapy: Journal of the American Art Therapy

Association, 13(4), 252-262.

Stahl, B., & Goldstein, E. (2010). A mindfulness-based stress reduction workbook. Oakland, CA:

New Harbinger Publications.

Sutherland, J., Waldman, G., & Collins, C. (2010). Art therapy connection: Encouraging

troubled youth to stay in school and succeed. Art Therapy: Journal of the American Art


Viafora, D. P., Mathiesen, S. G., & Unsworth, S. J. (2015). Teaching mindfulness to middle

school students and homeless youth in school classrooms. Journal of Child and Family

Studies, 24, 1179-1191.

Waller, B., Carlson, J., & Englar-Carlson, M. (2006). Treatment and relapse prevention of

depression using mindfulness-based cognitive therapy and Adlerian concepts. The

Journal of Individual Psychology, 62(4), 444-454.

Westlich, C. A. (1994). Art therapy with culturally different clients. Art Therapy: Journal of the

American Art Therapy Association, 11(3), 187-190.


Appendix

a master’s project mp 2016.pdfthe effectiveness of art therapy and mindfulness for at-risk youth...

Documents