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James Watkins

Shelley Douma, Ph.D.

English 102 M/W 1:00-3:30pm

March 11, 2013

Creative Orthotics: Extending the Reach of Expressive Arts Therapy

A paralyzed graffiti artist looks out of a hospital window and writes his name on the

walls of a nearby building just by moving his eyes. A man prevented by disease from writing or

speaking moves a crowd to tears performing his own music from a wheelchair onstage. Children

sit at a round table and draw collaboratively, finger-painting with digital light, what each child

paints on a large touchscreen swirling under the next child’s spot at the table. These individuals

are accessing new realms of communication, intimacy, and healing through specialized

technology that provides them new ways to express themselves.

Art possesses unique power to offer hope and meaning in times of crisis or despair. The

struggles of living with serious mental illness or mobility impairment can be devastating.

According to the National Institute of Mental Health, depression is a frequent companion to

anxiety disorders, substance use disorders, and serious physical illnesses including “heart

disease, stroke, cancer, HIV, diabetes, and Parkinson’s disease” (“Co-Occurrence”). In The Birth

of Tragedy Nietzsche reminds us: “Here, when the danger to [the] will is greatest, art approaches

as a saving sorceress, expert at healing. She alone knows how to turn these nauseous thoughts

about the horror or absurdity of existence into notions with which one can live” (Nietzsche 60).

Expressive arts therapy is one approach to healing during times of suffering. Offering a

variety of guided creative exercises incorporating visual art, music, drama, poetry, costume, and

dance, expressive therapy helps individuals process difficult emotional material and find new

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ways to respond to struggles in their lives. But not everyone is a candidate for traditional art or

music therapy. What happens when an individual’s impairment directly affects his or her ability

to express him or herself through conventional means?

Holding a paintbrush or playing a guitar requires physical dexterity that may not be

possible for elderly, chronically ill, or developmentally disabled clients. Individuals with serious

mental illness may use art materials inappropriately, inadvertently eating paint, or damaging

delicate instruments with exuberant enthusiasm. Approaching common creative tools such as a

piano or a pottery wheel can evoke feelings of creative anxiety for able-bodied but inexperienced

or unskilled individuals. Historically, art therapists have adapted the physical space and artistic

tools to accommodate special-needs clients through practices including replacing paint with

pudding and using Velcro to help clients hold paintbrushes (Anderson 55-70). Digital technology

may now provide better solutions to these problems and unlock the creative power of even the

most physically and emotionally challenged artists.

Digital technology is already enabling innovative interfaces and thrilling new instruments

for professional artists and musicians. Imogen Heap wears seemingly magical electronic gloves,

and simply waves her hands during a performance to affect the sound of her voice

(WiredVideoUK). Laurie Anderson places a pillow speaker into her mouth and strange, beautiful

sounds emanate from her humming (SVACommencement). Brian Eno and Bjork have each

released new interactive albums, designed for tablet computers, which will never play exactly the

same way twice (Ehrlich). Almost all artists rely on technology in their creative endeavors, and

in the modern era of tiny yet powerful computers, many artists are working closely with

technologists to develop flexible new tools.

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These digital tools might be adapted to serve as orthoses to creative expression,

permitting impaired individuals to create otherwise impossible art of beauty and emotional

depth, but modern therapeutic practice is still behind the curve on embracing digital technology

in clinical treatment. Traditional expressive therapies are currently providing significant benefits

to some impaired individuals, however artists, therapists, and programmers have the opportunity

to work together, developing creative orthotics that offer digitally assisted expressive arts

therapy to even the most severely disabled clients.

Several impediments are slowing growth in this promising field of research. Artists are

unfamiliar with the principles and practices of expressive arts therapy, art therapists are not well

versed in the rapidly growing array of computer tools at their disposal, and computer

programmers need guidance in adapting available tools in new ways that are appropriate for

clients with serious impairment. For artists and programmers to understand the power of

expressive arts therapy it is first essential to clarify its goals and the clinical principles on which

successful treatment depends.

Expressive arts therapy is a multimodal therapeutic practice emphasizing the empathic

connection created between client and therapist through the shared process of creative

expression. Overwhelming experiences are externalized into a painting, a poem, a dramatic role,

or a song, so they can be safely analyzed, integrated into the client’s self-concept, and new

responses to situations can be tested (Rubin 222). Expressive arts therapy is approached from a

variety of therapeutic orientations, but essential to the discipline is emphasizing the expressive

content of creative material over artistic achievement or technical mastery (Levine & Levine

115). Influential art therapist Judith Rubin describes this person-centered value system quite

clearly: “It may… be necessary to expand one’s notion of art, so that it can encompass the

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manipulation of collage materials with feet by an armless child, or the rhythmic repetitive

swabbing of paint by a psychotic child” (247).

Within this conceptual framework, the act of creating is seen as inherently valuable. Art

is a pleasurable and educational expression of agency, and all human beings have an innate

capacity and drive for creativity and self-expression. It is not necessary that a client first develop

technical skill for their art to be worthwhile, but the act of producing art may provide anyone

with opportunities for individual, interpersonal, community, and sociopolitical growth.

Expressive therapy encourages individual psychic development as clients’ emotional,

cognitive, aesthetic, and creative skills are engaged to build empathy, cultivate problem-solving

skills, encourage improvisation, and train memory. The physical practice of making visual art

may serve as a form of physiotherapy, exercising fine motor skills (Anderson 101). Specific art

exercises have also been associated with cognitive gains (Malchiodi, Handbook of Art Therapy

104). Dance and drama therapies may encourage profound changes in somatic awareness and in

language and memory skills (Grainger 50). But even as a client is developing their individual

abilities, their social aptitude may be growing as well.

Clients are offered the opportunity for interpersonal and social skills development as they

negotiate and communicate on collaborative work, share space and materials, and develop

meaningful relationships with their peers and counselors. Drama therapy may provide clients the

opportunity to freely try out new roles and attitudes to see how others respond. In Drama and

Healing, drama therapist Roger Grainger explains that drama assists individuals with serious

cognitive impairment by offering them “the kind of experience of human interaction which they

can use to give shape to their own lives” (71). In a blind study by Schennum, children who

participated in an expressive therapy program were rated better behaved and more emotionally

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engaged than their peers (qtd. in Anderson 102). These social gains may also extend beyond the

confines of the arts group when the artwork is performed in public or put on public display.

Art is an expressive practice and its fulfillment depends upon an audience. While an

artist’s audience may initially be limited to the therapist, or other clients in a group, as the

client’s self concept grows to encompass their identity as an artist, public performance becomes

an important clinical tool. When the larger community encounters clients’ art its members

develop a greater understanding of the experience of the artists and the challenges they face. In

turn the community provides valuable feedback by reinforcing the artists’ sense of their human

worth and capacity to create change (Green).

Expressive arts techniques may also effect broad social change directly, by raising

awareness about individuals experiencing a variety of institutional or systemic oppression

including poverty, homelessness, and imprisonment. Practitioners like Augusto Boal and Peter

Schuman have used radical theater and related forms of art activism to confront political

inequities and to provide a vehicle for oppressed and disenfranchised people to demand rights

and justice for themselves. The organization Artists Recovering through the Twelve Steps

(A.R.T.S.) is another such group, a political organization comprised of artists experiencing

mental illness, who use expressive arts as activism for social awareness around mental health

issues (Malchiodi, Handbook of Art Therapy 278). Expressive arts therapists have also directly

approached community healing and growth through large-group art sessions designed to deal

with collective trauma like the World Trade Center attacks (Keemar 44).

Augmenting these kinds of traditional expressive arts therapy programs with new digital

technology necessitates evaluating new practices carefully. It is vital that the current strengths of

therapy are maintained, and that good matches are found between clients and technology. For

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example, the broad spectrum of capabilities and clinical needs of autistic clients suggests that

some will be excellent candidates for the eclecticism of a clinical approach that incorporates

creative orthotics and expressive arts therapy.

Autism is a serious disorder that affects one child in 88, and produces a wide variety of

symptoms and developmental impairments (Carey). Autistic individuals frequently struggle with

language, and may be nonverbal or only repeat back the words they hear. They may rely on

unusual self-soothing behaviors and refuse to engage with the world around them. Thought

disorders are common, and attendant social barriers and behavioral deviations can lead to a sense

of profound isolation. This isolation can manifest itself in antisocial, self-destructive, or even

violent behaviors including tantrums, self-abuse, or physical altercations (Anderson 14).

It is in the nature of expressive arts therapy for the therapist to find ways to meet an

autistic client where they are by working with what the client desires and is capable of.

Nonverbal clients can be alternatively engaged through dance or music. The physical stimulus of

painting or sculpting may provide a pro-social outlet for self-soothing behavior. The

collaborative nature of drama therapy may help those with serious social impediments learn to

communicate with their peers.

The documentary Autism: The Musical details the process of “The Miracle Project,” a

traditional drama therapy group for autistic kids. The film shows how group drama therapy

allowed the participants to explore their individual and shared experiences, resulting in improved

self-concept and social skills. The group produced a play that was written collaboratively during

the rehearsal process, with clients providing ideas and suggestions about story, character and

theme, which the director developed with a screenwriter into a script that incorporated dialogue,

vocal, dance and musical performances.

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Although the group’s final performance was a success, leaving the kids elated with both

their own performances and with the audience’s appreciation, the use of computer technology

might have offered additional support to the performers. Significant challenges that autistic

clients often face include communication difficulties and attention, memory and comprehension

deficits. Just as lights, microphones, and scenery allow the theatrical production to be seen,

heard, and understood, creative orthotics might have helped the clients overcome some of their

limitations to more successfully engage in the dramatic process.

During a recent experimental production by Annie Dorsen, the sole actor was equipped

with small in-ear-monitors that allowed dialogue and cues to be fed to the actor by a computer in

real-time (A Piece of Work). Technology of this sort might help accommodate performances by

individuals with serious memory issues, allowing them to deliver lines, recover from dropped

lines, or know when they are to enter and exit the stage. Alternatively, digital projections of

dialogue and stage directions could be shown to performers on teleprompters in case of a

catastrophe. While the cognitive gains clients experience as a result of memorizing lines are a

significant benefit of drama therapy, creating a technological safety net to reduce the stress of

live performance may help certain clients strive even harder to overcome their challenges.

The suggestion of using computers as a technological adaptation in expressive arts

therapy has been around for quite some time. A 1985 article by Diane Weinberg on the subject

suggested that art therapy using a computer “has the unique power and advantage to elicit

disabled patients curiosity and motivation to build upon their residual strengths” (Qtd. in

Malchiodi, Art Therapy and Computer Technology 23). Almost 30 years later, this is still true,

but the use of computers in therapy still hasn’t grown proportionally. Meanwhile, researchers

have been rapidly developing new technologies that could make even more diverse subjects

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suitable for expressive arts therapy approaches. Many of these tools were designed to allow

mobility-impaired individuals to accomplish a variety of everyday tasks, but have been adapted

to enable creative expression.

The Adaptive Use Musical Interface (AUMI) from the Deep Listening Institute provides

software that requires nothing more than a simple webcam and a laptop to allow disabled

musicians to play music with a variety of instruments and styles (Gombay). The artist behind the

program, Pauline Oliveros, has a long history of using sound as an object for mindfulness, and

seems to have a profound understanding of the power of making music as meditation, therapeutic

modality, and as undeniable evidence of agency. The composer or performer selects a style of

instrument, percussion or keyboard, a scale to play, and simply by rocking their body

expressively directly translates their movement into sound.

By limiting the notes the software plays to those within a certain scale, it becomes easy

for an artist to stay within a key while improvising with other musicians of different

developmental abilities. Eliminating the need for fine motor movements, AUMI is an excellent

option for research for expressive therapy for children with autism or profound developmental

disabilities. Incorporating elements of dance and music therapy, AUMI provides a direct

feedback loop between the artist’s movements and the sound they are creating, without

depending on the artist’s manual dexterity, technical skill, or knowledge of theory. By merely

listening and moving in response to what they hear, anyone is capable of composing and

performing unique and deeply expressive musical material.

AUMI depends on gross movements, but what about clients for whom any movement at

all is a struggle? EyeWriter is an open source and D.I.Y. eye tracking software that was

developed in response to the special needs of Tony Quan, a graffiti artist with amyotrophic

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lateral sclerosis, better known as ALS or Lou Gehrig’s disease (Webley). Consisting of a small

and inexpensive camera that mounts to a pair of eyeglasses, the software tracks the motion of the

artist’s eye and can convert these motions into digital drawings. When it is connected to a

powerful video projector, the drawings can be cast onto the sides of buildings, creating the

opportunity for beautiful and temporary graffiti work. The software is free, and its code is easy to

adapt to other purposes, creating an affordable alternative to expensive proprietary eye tracking

systems for speech synthesis and other applications. Quan said of his initial experience with the

EyeWriter, "It feels like taking a breath after being held underwater for five minutes" (Webley).

The EyeWriter was designed for creating two-dimensional art, but with some adaptation it could

be modified to work with three-dimensional printers, also permitting paralyzed individuals to

create sculptures.

Dan Ellsey used a similar eye-tracking system in writing and recording his 2008 album

Masterpiece with the software Hyperscore, developed by Tod Machover at MIT (Swed). Despite

the cerebral palsy that confines Ellsey to his wheelchair and prevents him from speaking, the

combination of eye-tracking software and Hyperscore allowed Ellsey to perform his original

composition “The Eagle Song” before a live TED audience. His eye movements were used

initially to compose the piece, and then during the performance to control the timing and

expression of the music. Hyperscore was designed originally to teach children to write music

without notation by drawing lines on a chart, but would make a great tool for anyone who wishes

to write music but is unable to learn traditional musical notation or theory due to cognitive or

physical impairment (Jennings 226). Machover has also created an instrument called the

“hypercello”, along with a variety of other “hyper-instruments” designed to extend the

expressive range of traditional instruments (Levenson). Hyperscore can also output compositions

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in traditional music notation (Jennings 227). By combining hyperscore with touchscreens,

EyeWriter, or motion tracking software like AUMI, researchers could allow individuals with

profound impairments to compose music that could be performed not only by computers, but

even by able-bodied musicians, creating one more level of empathic relationship through

expressive arts.

Motion tracking is just one interface possibility. Communitas, a tool designed by Patricio

Gonzalez Vivo, an expressive arts therapist from Buenos Aires, uses an infrared camera to create

a multi-user, multi-touch tabletop screen (Vivo). In a video depicting the device on his website, a

group of five or six young kids crowd around the table drawing with their fingers. It resembles

finger painting, but as the kids draw, the entire surface appears to be rotating, so that the work

each child is doing moves on for the next child to add to with a different color. In this case the

technology does not enable children to do something despite impairment, but instead makes the

generally solitary practice of drawing into a highly interactive and collaborative experience. As

the work continues to rotate it eventually disappears, a reminder of the ephemerality of art and

on a deeper level, of human lives. This is an example of how technology can deepen the

experience and enhance the lessons of expressive arts therapy for the able-bodied as well.

Similar touch based drawing tools are a perfect match for clients with kinesthetic difficulties that

preclude holding a brush or a pencil.

Other performance tools that were developed for use by able-bodied individuals could be

further refined into powerful tools for impaired artists. In a 2010 video posted by user

ComputerHistory on YouTube, late computer music pioneer Max Mathews demonstrates his

invention, the Radio Baton, a system designed to simplify musical performance. The system

consists of two batons that resemble timpani mallets, used with a flat desktop pad which is

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around eleven by seventeen inches in size. The batons contain radio transmitters and their

positions over the pad are tracked in three dimensions. Mathews performs his interpretation of

the first few bars of Chopin’s Prelude in C Minor with the batons, by striking the pad to trigger

each chord in turn. The position of the stick held above the pad, or dragged along the surface

provides additional information to the synthesizer that plays the piano chords.

A device of this nature seems like an excellent fit for clients interested in performing

music, but who have unsteady motor coordination or difficulty producing subtle motion. The rich

kinesthetic value of striking the relatively indestructible pad with padded mallets could also

provide an opportunity to release powerful emotions, and could still work through headphones to

minimize the potential disruption of others sharing clinical or rehearsal space. Video projection

or LCD screen technology could be incorporated into the interface to provide even more

feedback and interactivity to the performer.

These are just a few examples of many currently available technologies that can easily be

adapted to enable those without a voice to sing, or those without arms to paint. There is a

tremendous opportunity for researching the efficacy of these tools, developing clinical protocols

for their use, and fine-tuning the interfaces for the greatest flexibility for disabled artists. Other

affordable and flexible interface devices such as the Microsoft Kinect sensor and gesture

tracking device, the Emotiv Epoc electroencephalogram-based neuroheadset, and novel music

interfaces like the Ableton Push or the Roli Seaboard all offer significant promise. In addition,

still unreleased technologies when combined with therapy could open even more doors for this

kind of research.

Two major new consumer interfaces are scheduled for release in 2013 that could have

significant impact in this direction. These tools are currently only available to software

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developers, making this a perfect opportunity for programmers who wish to contribute to the

development of creative orthotics. According to the corporate website, the Leap Motion

Controller allows hands free three-dimensional computer control with ten-micrometer resolution

in an 8 cubic foot space, and will only cost around eighty dollars (“Our Device”). If the device

works well, it would make a reality of accurately controlling a computer by simply waving one’s

hands in front of it. This device could serve as a very interesting interface for creating digital art

in two or three dimensions, playing music through hand gestures, and even for transcribing sign

language for deaf clients.

In addition to the Leap, the Oculus Rift display headset developer’s kit is scheduled for

shipping in May 2013. The Oculus Rift is an affordable, lightweight, low-latency, binocular,

head-mounted display. Designed for games, the Rift provides an immersive 3-D environment.

The developer’s kit is available for presale for $300, and the final consumer product is planned

for around the same price. By allowing clients, therapists, and audience members or gallery

attendees to simultaneously occupy the same virtual environment, this kind of technology could

radically change the understanding of digital art and may have significant ramifications for

nonlocal therapy and group art therapy experiences. When suitable interfaces are designed,

disabled clients could craft environments, build virtual sculptures, or even use avatars and speech

synthesis to present themselves to audiences in very different ways than they might appear, and

with very different capabilities.

As technology makes even greater access to the creative and expressive process

available, everyone stands to benefit. Understanding the inner world of those with serious

mobility or developmental issues deepens our empathy. As our empathy comes to encompass

greater definitions of our collective human identity we pay more attention to those who have

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been marginalized by our dis-ease with their bodies or their minds; and we learn to make greater

accommodation for their needs and have greater recognition of their abilities. Technology is

enabling greater expressive options for individuals struggling with a variety of impairments, and

thereby extending our understanding of what it means to be human.

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Philip Glass & Dan Deacon." Omusicawards.com. O Music Awards Blog, 18 Jan. 2013.

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