Art Therapy and Aging
I am in the prime of my life: late 30's, not quite mid-career art therapist, a new mother, healthy, relatively fit. I have the energy to approach my life tasks with enthusiasm and realism flavored with optimism. I have the life experience to not make hugely unwise leaps of faith and the confidence to take some risks. I have enough lines around my eyes that people don't really try to take advantage of me anymore. In short, it's a great time in my life. I am aware that I will continue to age but also aware that I am still quite young.
My parents and in-laws are approaching old age. Their parents are dead and they are slowing down in expectations and activity while still doing a lot. Major life ambition for themselves is a thing of the past, and hopes and aspirations for their children and grandchildren are vibrant. They share modulating interest in current events: deep interest in events of self, family and local community, varied levels of interest in national and global ones. They speak of family present and gone and past experiences that carry a lot of meaning for them.
Meaning making: a critical part of every life stage, but a crucial one for those nearing the end of life. What have become of the choices I made, the relationships I sustained or did not sustain? Did I contribute positively to the world? What has it all been for? On what terms do I accept my aging mind and body and the greater limitations in what I can do and where I can go? What will happen to me when I die?
The end of life is described by psychologist Erik Erikson as Ego Integrity versus Despair. In brief, people of this age are tasked with determining if they have lived a life of meaning on their own terms. If they feel that they have contributed somehow to the betterment of the world, if their achievements outweigh their regrets, if they've had close relationships that are/were generally positive, then most are able to approach death with some degree of acceptance. If not, then they may feel despair and hopelessness as they approach the end of life.
Some of the ways to support aging clients in making meaning of their lives, both past and present, address the broad scope of life issues relevant to their time of life. Below are some of the key themes in psychotherapy with aging adults:
As a younger clinician, I believe it is important to acknowledge one's age when working with older clients. As wise as I may feel, I have not experienced a lot of what my aging clients have been through and are currently going through. I believe it's important to claim that and offer my skills to work in tandem with the client's experience and not defend against what I don't know.
Art therapy directives for these themes are presented below. They are offered to trained art therapists: if you are not trained in art therapy, please only consider doing these directives with an art therapist co-facilitator or under the supervision of an art therapist.
A Life in Images This directive can look very different depending on the abilities and preferences of the client. It can be a simple timeline with collage images and/or personal photographs. It can be a series of paintings, sculptures, or collages depicting major life events. I have seen a client paint a gorgeous and huge mural on doors, where life events were not only depicted but painful events were resolved and made sense of in the process. And this is what can happen with art: in the making, in the facing of pain while assuming the powerful role of (re)creator, we can claim life events on our own terms. Directive: It is likely that an aging client has been already talking about their life in therapy. Ask client to depict their life over at least several sessions through art, offering a variety of media and options (be sensitive to client's ability status and offer doable projects or your help in the execution). This directive can expand and last for months or be the entire focus of treatment if client is so inclined.
*Milagros Milagros are votives, small replicas of body parts, animals, objects, etc. made with various materials (tin, gold, silver, clay, bone, wood, among others). They are popular in Latin American and some European cultures, and are associated with some forms of Catholicism. They are quite popular where I live in the Southwest. These small votives are used in a variety of ways, but the most well known use is as an aid to a prayer directed at a saint. For the purposes of this directive I will focus on the milagro's use as a symbol of a body part that may need actual or metaphoric healing. When using another culture's practice in treatment, I acknowledge this as an appropriation and variation on its original purpose to the client. Directive: Ask client to chose a part or area of the body where they experience pain (physical, emotional, spiritual). After explaining the use of milagros [if unknown to client], work with client to create their own milagro with the intention of directing love, compassion, prayer, healing, relief, or acceptance toward the chosen body part(s). Offer a variety of materials: clay (I like sculpey-style clay for this as it's easy to travel with if working outside the office and simple to bake), paper clay and paint, or actual milagros to add to a small picture or box. This can be deeply emotional for an aging client who may not likely experience any healing or relief, so be aware that presence and validation are key here. If the client wishes to bring their milagro to a religious institution or sit in prayer with their artwork, support the client in doing so and pray with them if asked to.
*An Empty Chair This directive can be about resolving issues with any relationship in one's life: a friend, an ex wife, a cousin, a caregiver. But more often than not it is the key familial relationships - parents, partners, siblings, children - that often cause people the most pain if they are broken or strained near the end of life. This is inspired by the Gestalt intervention called "Empty Chair," but it moves the concept into actually constructing a chair. This directive can focus on a living or dead person of importance. Directive: After discussing a specific relationship that is troubling client, suggest creating a small chair that makes a space for that person in the client's life. These chairs can be made with small pieces of wood and glue, tin foil, cardboard, or pipe cleaners; also, pre-made, unfinished dollhouse chairs can be purchased at a crafts store. After making or acquiring the chair(s), it is time to add paint, crafty items (string, sequins, beads, etc.), or even small figures to further define the chair. Ask client: What kind of space does this person take up in your life? What qualities does this chair need to have so that you feel good about this person being in [or gone from] your life?
Memorial Altar This art directive is a visual testament to what a person has irrevocably lost. It also functions as a framework in which to clarify and strengthen one's spiritual or religious beliefs. It can be a literal altar, set up in a special section of a client's house, yard, or bedroom. It can be made inside of a box or album that can be taken out and put away when desired. What is important is that the client gets a chance to grieve and honor who and what is gone from their lives. Directive: After determining client's desire to make a memorial box, album or altar, help client brainstorm the best place for altar or box to be set in (the location will help determine size and materials for altar). Help client acquire materials needed for altar: choosing cloth, unpacking photographs, finding or making symbols for that which is gone, etc. This may take a single session, or it may take many: like the Life in Images directive, this project could be the focus of treatment over the course of weeks or months if the client wishes. During the making of this project there will be many opportunities to deepen the conversations about what is lost and to clarify the client's spiritual or religious beliefs. Take those opportunities when they present themselves.
*art therapy directives created by author
My parents and in-laws are approaching old age. Their parents are dead and they are slowing down in expectations and activity while still doing a lot. Major life ambition for themselves is a thing of the past, and hopes and aspirations for their children and grandchildren are vibrant. They share modulating interest in current events: deep interest in events of self, family and local community, varied levels of interest in national and global ones. They speak of family present and gone and past experiences that carry a lot of meaning for them.
Meaning making: a critical part of every life stage, but a crucial one for those nearing the end of life. What have become of the choices I made, the relationships I sustained or did not sustain? Did I contribute positively to the world? What has it all been for? On what terms do I accept my aging mind and body and the greater limitations in what I can do and where I can go? What will happen to me when I die?
The end of life is described by psychologist Erik Erikson as Ego Integrity versus Despair. In brief, people of this age are tasked with determining if they have lived a life of meaning on their own terms. If they feel that they have contributed somehow to the betterment of the world, if their achievements outweigh their regrets, if they've had close relationships that are/were generally positive, then most are able to approach death with some degree of acceptance. If not, then they may feel despair and hopelessness as they approach the end of life.
Some of the ways to support aging clients in making meaning of their lives, both past and present, address the broad scope of life issues relevant to their time of life. Below are some of the key themes in psychotherapy with aging adults:
- Reviewing and making meaning of one's life.
- Managing pain via mindfulness and cognitive behavioral approaches.
- Repairing or strengthening existing relationships where it is needed and wanted.
- Coping with loss of friends and family, life roles, physical health, mental acuity.
- Clarifying and/or reinforcing spiritual beliefs.
As a younger clinician, I believe it is important to acknowledge one's age when working with older clients. As wise as I may feel, I have not experienced a lot of what my aging clients have been through and are currently going through. I believe it's important to claim that and offer my skills to work in tandem with the client's experience and not defend against what I don't know.
Art therapy directives for these themes are presented below. They are offered to trained art therapists: if you are not trained in art therapy, please only consider doing these directives with an art therapist co-facilitator or under the supervision of an art therapist.
A Life in Images This directive can look very different depending on the abilities and preferences of the client. It can be a simple timeline with collage images and/or personal photographs. It can be a series of paintings, sculptures, or collages depicting major life events. I have seen a client paint a gorgeous and huge mural on doors, where life events were not only depicted but painful events were resolved and made sense of in the process. And this is what can happen with art: in the making, in the facing of pain while assuming the powerful role of (re)creator, we can claim life events on our own terms. Directive: It is likely that an aging client has been already talking about their life in therapy. Ask client to depict their life over at least several sessions through art, offering a variety of media and options (be sensitive to client's ability status and offer doable projects or your help in the execution). This directive can expand and last for months or be the entire focus of treatment if client is so inclined.
*Milagros Milagros are votives, small replicas of body parts, animals, objects, etc. made with various materials (tin, gold, silver, clay, bone, wood, among others). They are popular in Latin American and some European cultures, and are associated with some forms of Catholicism. They are quite popular where I live in the Southwest. These small votives are used in a variety of ways, but the most well known use is as an aid to a prayer directed at a saint. For the purposes of this directive I will focus on the milagro's use as a symbol of a body part that may need actual or metaphoric healing. When using another culture's practice in treatment, I acknowledge this as an appropriation and variation on its original purpose to the client. Directive: Ask client to chose a part or area of the body where they experience pain (physical, emotional, spiritual). After explaining the use of milagros [if unknown to client], work with client to create their own milagro with the intention of directing love, compassion, prayer, healing, relief, or acceptance toward the chosen body part(s). Offer a variety of materials: clay (I like sculpey-style clay for this as it's easy to travel with if working outside the office and simple to bake), paper clay and paint, or actual milagros to add to a small picture or box. This can be deeply emotional for an aging client who may not likely experience any healing or relief, so be aware that presence and validation are key here. If the client wishes to bring their milagro to a religious institution or sit in prayer with their artwork, support the client in doing so and pray with them if asked to.
*An Empty Chair This directive can be about resolving issues with any relationship in one's life: a friend, an ex wife, a cousin, a caregiver. But more often than not it is the key familial relationships - parents, partners, siblings, children - that often cause people the most pain if they are broken or strained near the end of life. This is inspired by the Gestalt intervention called "Empty Chair," but it moves the concept into actually constructing a chair. This directive can focus on a living or dead person of importance. Directive: After discussing a specific relationship that is troubling client, suggest creating a small chair that makes a space for that person in the client's life. These chairs can be made with small pieces of wood and glue, tin foil, cardboard, or pipe cleaners; also, pre-made, unfinished dollhouse chairs can be purchased at a crafts store. After making or acquiring the chair(s), it is time to add paint, crafty items (string, sequins, beads, etc.), or even small figures to further define the chair. Ask client: What kind of space does this person take up in your life? What qualities does this chair need to have so that you feel good about this person being in [or gone from] your life?
artwork by author
Memorial Altar This art directive is a visual testament to what a person has irrevocably lost. It also functions as a framework in which to clarify and strengthen one's spiritual or religious beliefs. It can be a literal altar, set up in a special section of a client's house, yard, or bedroom. It can be made inside of a box or album that can be taken out and put away when desired. What is important is that the client gets a chance to grieve and honor who and what is gone from their lives. Directive: After determining client's desire to make a memorial box, album or altar, help client brainstorm the best place for altar or box to be set in (the location will help determine size and materials for altar). Help client acquire materials needed for altar: choosing cloth, unpacking photographs, finding or making symbols for that which is gone, etc. This may take a single session, or it may take many: like the Life in Images directive, this project could be the focus of treatment over the course of weeks or months if the client wishes. During the making of this project there will be many opportunities to deepen the conversations about what is lost and to clarify the client's spiritual or religious beliefs. Take those opportunities when they present themselves.
*art therapy directives created by author
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