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International Journal of Art Therapy

Formerly Inscape
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Art materials and processes - a place of meeting art
psychotherapy with a four-year-old boy
Julia Meyerowitz-katz

Online Publication Date: 01 July 2003

To cite this Article: Meyerowitz-katz, Julia (2003) 'Art materials and processes - a
place of meeting art psychotherapy with a four-year-old boy', International Journal of
Art Therapy, 8:2, 60 - 69
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ART MATERIALS AND PROCESSES - A PLACE

OF MEETING
Art psychotherapy with a fourcyear0old boy
by Julia MeyerowitpKatz

Abstract
This article explores the complex role of art materials and Countertransference was used as a tool for understanding the
processes in art psychotherapy with a four-year-old boy with boy’s interactions with the materials, for finding meaning in
developmental delay. Individual art psychotherapy sessions apparent mindlessness and for providing containment in order
were conducted over an eighteen-month period. By focusing in to lay the foundations of a sense of self. This assisted the
detail on work done in the first seven months of his therapy, the development of his language and ability to play in the sessions
author is able to highlight the multifaceted role played by art as well as supporting his social development in his family and
materials and processes in supporting therapeutic change. The elsewhere. The author’s arguments are contextualised in
pivotal role played by engagement with the art materials - current art therapy theory as well as with reference to
paint, water, sand, whiteboard and clay - is described in detail. psychoanalytic concepts, child psychotherapy and art
Initial negotiations that focused on the boy’s use of and education.
relationship with the materials laid the foundations of a
relationship with his therapist in which he was able to develop Key words: art materials and processes, art psychotherapy,
an internal space that was separate from outside experience language development, therapeutic relationship. transference
and so begin to develop an independent identity. and countertransference, young children

Introduction 1990;Case and Dalley, 1992; Waller and Gilroy, 1992;

Argulle, 1992). Consistency in the setting means that
By desaibing in detail aspects of work done with a
changes within it reflect changes within the internal
very young child in art psychotherapy, this article
worlds of the child and therapist and in the changing
explores how the meaningful communicating
relationship between them; the therapist’s attunement
possibilitiesinherent in art materials and processes
to the child’s internal world is vital, as is the
can provide an area of concrete negotiation that
understanding that there is an intermingling between
fosters the development of internal structures leading
the psyches of art therapist and child (Case, 1995).
to therapeutic growth. The article begm with a
discussion of the relevant literature before describing Communication in the art therapy setting is
the clinical work. This is followed by a discussion of multilayered and complex. Dubowski (1990) and
the main themes from the therapy that are thought to Milavic and Fenton (1995)discuss a link between art
have contributed to the child’s progress. making and verbal development. Actions and
movements made when drawing or painting are
Very little has been published that refers to art
important to the growth of thinking and feeling and
therapy with preschool children; Deco (1990),
the development of the capacity to symbolise
Milavic and Fenton (1995)and Reddick (1999) being
(Matthews, 1999;Smith, 1993).The resulting images
notable exceptions. An unpublished research project
reflect the child’s understanding of the world as well
which explored art therapy with pre-school children
in the UK revealed that although very few art
as their internal developments (Matthews, 1999).
There is potential for art materials and processes to
therapists were working with this age group, those
provide opportunities for communication between
that were, considered art therapy to be a valuable
therapist and child by being the focus for the
intervention, whose basic principles could be adapted
relationship (Argyle, 1992).Commenting on the
to suit the needs of this client group (Meyerowitz-
child’s absorption in their task and feelings validates
Katz, 1999a).Some respondents desaibed offering
their experience, and verbalising for them what they
materials in a manner that allowed for easy access to
are doing and what effects their movements have on
young children and that facilitated their movement
their images can help them develop an awareness of
when painting. Art therapy was considered to aid the
what they are doing and help them think (Smith,
development of communication skills, symbolisation
1993).
and speech.
Communication can be both conscious and
In the literature referring to working with older
unconscious and projective processes can feel tangible
children, ideas of containment inherent in the setting
as feelings can be projected onto the art object and the
and materials are desaibed as providing the
patient’s thoughts can be felt by the art therapist
necessary safety for creative activity in which
(Case, 1996).A r p l e (1992) and Case (1995)refer to
children can extemalise unresolved inner conflicts or
the creativity of the ‘artist’ in the art therapist as well
renegotiate particular areas of development (Deco,

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ART MATERIALS AND PROCESSES: A PLACE OF MEETING

as to to the creativity and aliveness of the therapist in thinking for the patient that can lead to
responding to the child’s engagement with the symbolisation.
materials and imagemaking process. Case describes KiUick (1993) postulates the existence of a protective
the nature of the unspoken and unseen structure, a psychotic ’shell’, which coexists with and
communicationsbetween the child and the therapist protects and prevents the healthy development of a
that often occur in silences (Case, 1990,1994,1995, sense of self, which she refers to as a ‘blob’, using
1996). terms identified by a patient when describing his own
Therapeutic work is frequently carried out on the experience.KiUick (1993)suggests that art therapists
basis that the child can distinguishbetween inner and can make use of boundaries in order to facilitate
outer reality, and can understand and use symbolic relationships with the ‘blob’ and avoid becoming
communication and can speak. In contrast, Rabiger incorporated into the ‘shell’s‘ psychotic structure.
(1990)discusses working in art therapy with children With repeated experiences of art making within a
whose developmental delay and impaired sense of therapeutic relationship with an art therapist who is
self results in their inability to play, to learn or to attuned to their patient’s experiences of catastrophe,
make constructive use of art materials. She advocates communicated in the concrete nature of art processes
working with children without any expectation of and images,fragmented, persecutory experiences can
their being able to make representational or figurative be transformed into meaningful interactions which
images,stressing the importance of beginning work occur within a shared area of meaning (Killick and
with the child’s developmental level in mind. Greenwood, 1995; Killick, 1997; Meyerowitz-Katz,
Successful normal infant development resdts in a 1999b).
separate individual who has a sense of self An understanding of the nature of the experiences
(Winnicott,1965,1974), is able to interact creatively that are being communicated through interactions
and playfully with outside reality and can think with the materials can be achieved through the
(Bion, 1962). This .means that early unintegrated therapist’s monitoring and understanding of their
infant states (Bick, 1968)have been gathered together countertransference. Alvarez (1992))Briggs (1997)
(Winnicott, 1958)into an inner self.This occurs and Wells (1997)stress the importance of
through repeated experiences of taking in and countertransferenceas a therapeutic tool; suggesting
subsequentlyidenhfymg with the holding function of that all behaviour in the transference has meaning
an object. This happens physically and symbolically, (Wells, 1997).It is possible to make sense of non-
generating the fantasy of internal and external spaces verbal communicationsby one’s readions to them
(Winnicott, 1965)and, through the mother’s ability to (Briggs, 1997))and bear the feelings that patients
absorb and then return the infant’s digested primitive cannot bear, whilst simultaneously thinking about
emotional experience through her reverie, providing them until they can do it for themselves (Alvarez,
the apparatus for thinking @ion, 1962). 1992).Sessions can contain different emotional states
at different times:Briggs describes how a ‘continual
The theme of an impaired sense of self is addressed
movement between nameless anxiety states,
by Winnicott who suggests that an individual may
+ychotic confusion acted out or represented and
develop a protective ’shell’, a False Self as a result of
straightforward perceptions of everyday realities‘ can
defensive reactions to impingements and as ’an
occur (Briggs, 1997, p. 124).
extension of the impinging environment’, instead of a
developing ’core of personhood‘, a True Self
(Winnicott, 1958).Bion (1962) suggests that failure of Alex
the mother-infant relationship results in an impaired This article describes work done during art
ability to think,in which thinking and linking psychotherapy sessions with a four-yeardd boy,
functions are attacked and split into persecutory here called Alex. Alex lived with his parents and his
fragmentswhich are evacuated outwards. This means six-yeardd brother. His parents were both
that when the potential for symbol formation and immigrants, from different countries, which
thinking and speaking about experience is hampered, complicated the family situation; three languages,
so is the ability to interact meaninghlly and including English, were spoken at home. Alex’s
appropriately with the outside world. The outside weekly art psychotherapy sessions began a few
world includes art materials; this means that it is weeks after his fourth birthday and continued for
possible that engagement with art materials may be eighteen months. In order to highhght the role of the
expressions of fragmentation and evacuation.In this art materials and processes, the work described here
case, Killick (1993) suggests that a patient‘s focuses on the first seven months of thisprocess.
engagement with the concreteness of the art materials Alex’s developmentalpaediatrician was concerned, as
combined with the therapist’s live responsivenessto were other health care workers and his mother, that
this engagement can provide an interm- area of although his early milestones had been normal, he

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ART MATERIALS A N D PROCESSES: A PLACE OF MEETING

was not toilet trained and his speech development spite of the intense silence, Alex did not seem to
was delayed. In addition, he was given to tantrums notice noises from neighbourjng rooms and traffic on
and head banging and was unable to tolerate the the road outside. During this phase, he frequently lost
slightest frustration; he was disruptive, unable to bladder control and would seem unaware that he had
share and unpredictably attacked other people. She done so;he would suddenly look down, confused, at
therefore referred him to a child and family mental his wet legs.
health seMce when he was three-and-a-half. After an He displayed great ambivalence in his attempts to
initial multidisciphaq assessment, and weekly connect with me; there were times when he asked
attendance at a therapeutic playgroup with his me, through gestures and monosyllabic speech, to do
mother, in which he made little progress, he was physically maternal things,like helping him to dry
referred for one-to-one art psychotherapy. His art his hands, and times when these interactions would
psychotherapy was supported by his mother's provoke unpredictable, physical attacks on me. The
weekly consultations with a psychotherapist on the intensity of the emotional impact of his attacks
team and by regular reviews to which his parents always took me by surprise and left me feeling
were invited. drained. Through my countertransference, I
Alex's art psychotherapy sessions took place in a understood that with these interactions Alex was
carpeted, multipurpose room that sigruficantly lacked showing me how difficult it was for him to connect
a sink: water for washing up was provided in a bowl. with me without my becoming identified with an
A variety of art materials offered a range of impinging, attacking part of himself, which led him
possibilities for negotiation and communication. to retaliate. The work that needed to be done in order
Materials were laid out in a manner designed to be to provide a therapeutic experience was to absorb
easily accessible to a small childs curiosity, i.e. on these attacks, on a feeling level, and because of his
low tables or on the floor. These included a box age and developmental level, through physically
containing paints, brushes, palette, pastels, felt-tips, caring for him when appropriate.
string, glue, scissors and soap bubbles. Clay was During this phase, I experienced intense feelings of
always available, as were a few toys, including a depression and pointlessness that were accompanied
doll's house and dolls, soft toys, a small soft football, by difficulty in concentrating in the sessions. I was
cars, a sand tray and a whiteboard with pens. As well often left at the end of a session feeling sad,
as providing a variety of materials, materials were depressed and hopeless. This, together with the
offered in different forms inviting different ways of degree of exhaustion I felt, meant that I began
using them, in the belief that this would offer dreading the work. Alex, in contrast, would sit
extensivepossibilities for exploration, thinking and expectantly in the waiting room when I went to
learning. For example, bottles of ready-mixed paint collect him,and would greet me with a smile. I
ind large sheets of paper were laid on the floor and reflected on whether this was because I was
paint pots with brushes and paper were provided on experiencing Alex's unbearable feelings for him and
an easel. A folder in which Alex's completed that he was looking forward to being heard and
drawings and paintings were stored, was provided understood.
and was present in each session.
In the sessions, much of Alex's activity at this time
was solitary, boring, repetitive and seemed
Art Psychotherapy sessions 'unplayful', foreclosing opportunities for engagement
In the early months of his therapy, Alex's sessions with me, e.g. silently and repetitively pushing cars
were charaderised by fragmented, apparently backwards and forwards. His initial engagement with
meaningless activity and a silence that filled the room bottles of ready-mixed paint seemed to echo this
in an almost physical way. I often felt myself trapped meaninglessness: he would mechanically empty paint
in the silence, as if deep in mud, feeling that it was from the bottles onto the large sheets of paper that I
extremely difficult to think or speak. When I did had placed on the floor until the bottles were empty. I
speak, it was as if into a vast emptiness.Alex would felt that he was connecting with the runny,
not reply, or visibly acknowledge that I had spoken. formlessnessof the paint that could be emptied out,
When he did speak, for instance drawing my that he was showing me that things-inside are
attention to his activity, he spoke monosyllabically, formless and shapeless and come out in a formless,
e.g. saying 'sand' when indicating that he wanted to out-of-control way. In response, by providing paper
play in the sand. Through my monitoring of my and halting his pouring, I was able to show him that
countertransferencefeelings I understood that the inside things could be directed and, when
embedded within and communicated through the appropriate, stopped in a way that created a shape,
silences were Alex's feehgs of despair and and which dried into something solid. These
desolation and a helpless inability to make words. In interactions gave him the experience of the possibility

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ART MATERlALS AND PROCESSES: A PLACE OF MEETING

~

of colour [seeFigure 11. WhileI

was doing this, he tnade
handprints on the back of the
pieces of paper.
Figure 1is one of several
prints that I made of the
results of Alex's engagement
with paint in his early
sessions. I made this and
other prints in order to
demonstrate a receptive,
containing response to his
activity, and, realising that
the quantity of wet paint that
Alex habitually poued
would tear the paper, thus
destroying any possibility of
an image, to add to his
thickening folder of images.
Figure 1is a mirror image of
the pourings and splashes
that Alex made. It shows a
large mass of white paint
Figure 1. with irregularly shaped edges hovering across the
middle of a piece of paper. The large white mass is
of boundariedness that he intemalised and began to barely contained by the verlicd sides of the paper, its
explore, meaning a small measure of control could be undulating edges reaching almost to the paper's
achieved. As the following extract shows, he began borders. There are some lines extending diagonally
exploring the possibilities of limiting the pouring down from the large white mass, towards the left-
himself, thus indicating that he was responding to my hand comer. There are some smaller round blobs
actions and to me: dotted across the lower half of the page, some small
. . . he poured out some white paint and then appeared to enough to look like they have been sprayed on.
decide to stop pouring. He was ambivalent about whether As I made the prints, I explained to Alex what I was
to continue pouring or to stop - he stopped and then doing. He responded by making handprints with his
changed his mind and then started again. This happened a white-paint-covered hands on the back of the image
few times. I began tofie1 anxious about what he was going shown in Figure 1. There was therefore a shared
to do with the paint. 1 was aware of the carpet and the interaction between us, a fragde alliance, occurring in
difficulty of cleaning up any mess. . . . He became very a transitional space and focused on the art materials
interested in allowing the paint tofall just at the edge of and what could be done with them. This experience,
the paper and toyed a bit with keeping it there or letting it however, lead to an increase in his anxiety, which
fall onto the plastic mat. I eventually helped him to stop was communicated to me:
pouring. Pools,puddles and splashes o f white paint lay on Z was conscious of my high h l ofanxzety thatfocused on
the paper. the uncontained mess. He walked around leavingfootprints
His subsequent engagement with the pouring and on the carpet. 1 led him over to the mat and said he could
poured paint, and his absorption in investigating the make prints on the paper, but not on the carpet. He tried to
effects of his own actions on it, allowed strong dash across the room.He jumped into the white paint and
feelings to surface, and provided opportunities for then on to the paper, leaving hisfootprints. 1 did not want
useful therapeutic interactionsbetween us: him to walk on the carpet in his paint mered shoes again.
He put his hands info a big pool of white paint and 1 showed him the soles of his shoes and explained that we
smeared it around. His concentration was very intense. He would have to clean them. While we were cleaning up, he
was silent, totally preoccupied. He splashed white paint flicked painf at fhe wall, on the counter and me and then
onto his trousers and shoes, enjy'ng the effect. By this flooded the counter zoith water, by tipping the bowl over. 1
time there was a lot of paint lying in pools on the paper, as prevented anyfurther spilling and tried to clerm his hands.
well as splattered on him. 1 knew the paper would tear if1 When he was fairly clean, he went straight over to the
tried to pick it up and that 1 would ham to throw it away, drawing table, saying that he wanted to draw. He selected
so, explaining what I was doing, 1 began printing the pools
a pink felt-@ and began drawing. I was confronted with

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ART MATERIALS AND PROCESSES: A PLACE OF MEETING

been acting just like he would have

expected his mother to act. On the
other hand, I could also understand
that my cleaning up may have
provided a containing function for
Alex because it was a way of
absorbing his emotional experience
held in the materials and
processing this communication at
the level at which it had been
communicated, i.e. concretely
engaging with the poured, spilled,
printed paint/water was a way of
engaging with the feelings,
thoughts and communications
intrinsically linked to his
experience of spilling, pouring and
printing.
His drawings (Figures 2 and 3),
made while I was cleaning up the
Figure 2. mess, revealed a similar awareness
with boundaries, insideness and
outsideness. While drawing, he
repeatedly drew beyond the edge
of the paper onto the table, and I
repeatedly affirmed the ‘keep to
the paper’ boundary. His drawings
contain traces of his movements,
recording his explorations and
awareness of boundaries. This
investigation and exploration of
spatial relationships on paper were
possibly linked to a developing
inner identity and reflected
ongoing internal fantasies of
looking for and finding boundaries
through his relationship with me. I
felt that this process was a result of
repeated experiences of my
stopping his pouring, thereby
presenting the possibility that
messy pouring stuff could be
contained, and he was beginning to
experiment with it himself.In this
session there seemed to be signs
Figure 3. that Alex was beginning to
recognise some boundaries
theflooded counter and water driming onto the carpet and (pouring paint at the edge of the
was coflscious of the mess in the room and thought I’d paper), some ‘insidenessand outsideness’.
bett.9 do something about it - Zue W e on~yfifeenminutes At this time in his therapy, 1 referred to the paint and
ZntO the Session and the mesS SeeMed overwhelming. whik the m m and did not make any interpretations, or
1 wiped up the paint that had spilt over onto the mat and refer to feelings - thus focusing on the form of the
cleaned up the spilt wafer,I realised that he was very relationship, materials and physical environment. I
contained in his drawing [seeFigures 2 and 3). provided containment concretely at the level at which
On reflection, I questioned why I needed to clean up he Was communicating through the matfxials. I set
just then. I think that it was partly a boundaries and offered experiences of reality by
countertransferenceresponse, and that I may have asserting that he keep paint on the paper, not walk

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ART MATERIALS AND PROCESSES: A PLACE OF MEETING

of sand, resulted in his feeling not being

thought about and evoked experiences of
failure of maternal holding, producing
unthinkable anxiety. Not being thought
about equalled an absence of holding
which evoked catastrophic, intolerable
feelings that he had to evacuate:
He continued tofrantically throw sand onto
the carpet. It seemed as if his panicky throun'ng
ofthe sand would not stop until the sand tray
had been emptied. I stopped this by holding his
W t s , making eye contact and said that I
knew that throwing sand was showing me
what it felt like inside him. I said that he could
learn to keep his feelings inside himseF we
could clean up the sand together, which we
then did.
I verbalised the idea of insideness and the
idea that as we gathered up the grains of
Figure 4. sand together, we were symbolically
reassembling his feelings, gathering him together.
with paint-laden shoes on the carpet and I He suaiienly ran over to the easel and by using his whole
demonstrated cause and effect by showing him the body in order to move his arm, painted the outline of a
paint on his shoes and the resulting prints. I closed shape with three dots inside it, surrounded by two
understood that my high anxiety about containing concentric lines [seeFigure 41. I commented by describing
the mess was a countertransferenceresponse and that what he was doing. He then suddenly put his paint-laden
I was therefore processing some of his unconscious brush into his mouth and turned to show me.
experience. This was the first session in which he did From this sequence of events, I understood that he
not mention weeing and toilets, he did not visit the was aware of being gathered together, of a
toilet and nor did he wet himself.I wondered if his developing internal space, and that by investigating
controlled pouring was related to his achieving the objects in the room, was continuing exploring and
bladder control. His activity with paint had been playing with a mother/therapist who was absorbing,
transformed from a 'letting things pass through' kind processing his experience and offering it in a form
of experience, through the use of paints and paper that he could in turn reabsorb. Puttins the brush in
within his relationship with me, into an experience his mouth was like putting me inside, i.e. concretely
that offered the possibility of containment. During intemalising me as mother/therapist.
this session he said 'I play sand' - it was the first time A few weeks later he again showed me how although
I had heard him use the pronoun '1', and to me this he wanted to connect with me, he found the
indicated his awareness of a developing identity. experience very invasive:
As the following vignette demonstrates,his Alex played in the sand. Ifilt that he was very aware of my
interactions with sand allowed experiences of presence and of my concentration on him. He asked me to
frag&entation to be communicated thereby offering make him some balls ofsand by saying 'ball' and gesturing
him the possibility of being gatheed in. Once again, towards me. I made a ball o f sand by c u p ' n g my hands.
my understanding of his non-verbal communications He suddenly threw some sand at me, while looking directly
was achieved by thinking about my reactions to him: at me. I had been aware as a subliminal flash that he was
He played silently in the sandfor a while. I concentrated considering throwing sand at me, but was still taken aback
on him, but then my attention wandered. Hef2kked s m at this attack andfelt deeply shocked, hurt, confused and a
sand at me,accompanied With a strong, clear feeling of bit angry with him.I responded by attempting to contain
panic. him physically in order to contain him emotionally. I
firmly and gentry held his hands as I spoke to him, looking
Paralleling his responses to the formlessness of paint, him in the eye and tying to connect with him.
Alex's response to the intrinsic fragmentary qualities
of gains of sand was to experience himselfas being I realised that although he had asked me to help him,
fragmented. My wandering attention, which I he had experienced my physical proximity and
thought was a countertransferenceresponse to his engagement with the sand (felt as an extension of
idenbfymg with the fragmentationinherent in grains hunself)as an attack and had literally thrown his

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ART MATERIALS AND PROCESSES: A PLACE OF MEETING

unconscious linking of feelings to

paint became more conscious, I
began to introduce a language in
which talking about feelings and
paint were linked. He began to
understand that feelings could be
expressed, heard, accepted and
explored, i.e. that they could be
processed and shared. In parallel
with this process, his involvement
with paint became more complex:
He became very angry with me and
kicked his art materials box. When I
commented on his anger, he
immediately denied it. I suggested
that he might like to put his feelings
into a painting - he liked the idea
and went straight over to the easel.
He painted vertical strokesfrom right
to Zq?across the page, first orange;
dipping the brush a few times to
Figure 5.
reload the brush, then green, then
purple. Then he found the black and began covm.ng the
stripes. He became very absorbed in this actiuity. I was
feeling of being attacked, deeply shocked, hurt and absorbed in watching him, in sharing and witnessing his
confused, back into me. Once I had received, experience. He carefully covered almost all of it and then
experienced and contained them, and engaged with put his hands on the surface and began smearing the black
him in actively collecting himself,he was calm and around in a very sensual way. He was completely silent.
could continue engaging with me. The silencefelt creative and productive. He stopped, looked
at me,and said he was finished and appeared satisfied [see
After five months of weekly art therapy, evidence of Figure 51.
an incipient ability to symbolise began to emerge in
Alex’s sessions. His activity became more playful and The inage that he created is very dense and its
his play was accompanied by verbalisations. He also denseness alludes to the feelings embodied within it.
began to relate sigruficant events to me, although his It reveals some, although not all, of the strokes of
language was halting and difficult to understand. which it was constructed and which lie underneath
When he spoke he made good eye contact and the black surface. As Matthews (1999) and Smith
appeared to be thinking and searching for words. (1993)have pointed out, making art in the presence of
When he could not find the right word he paused other people is a validating experience for children. I
and stood still, thinking for a long time, while I felt that my presence and focused concentration was
waited attentively, until he found the word he an important part of the experience for him.He was
wanted. Finding a common language through able to be alone with me and was contained by my
negotiations focused on the materials appeared to be attentive atunement to his experience.
providing a model which he intemalised and was His ability to be alone with me indicated that his core
able to use in order to develop speech. of personhood, his sense of self, was developing and
Alex began to use the buses and cars to symbolically that a defensive psychotic shell was less active. My
portray relationships (mummy cars and children cars perception was reinforced by his changing
grouped together) and to reveal that he was relationship to the bowl of water, when after
processing experiences. There were times when being completing this painting, he said he would wash his
in the room with him conveyed a sense of a person hands:
who was experiencing an outside reality and . . . he went over to the bowl and immersed his hands in the
communicating this experience: for instance, in water. He was very interested in the patterns made in the
contrast to earlier sessions, he became aware of noises water by the paint coming olff his hands. He moved his
outside the room, for example when a truck rumbled hands through the water, looked at me and said ’It‘s cold‘.
past, he would look up and ask, What’s that?’
In other words, he was experiencingwater as
As Alex’s core self became stronger, his expression of something outside himself,to be experienced and
and awareness of his feelings became clearer. As his investigated in its separateness and not as something

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ART MATERIALS A N D PROCESSES: A PLACE OF MEETING

accepted it, decided what to do

with it, and then offered it to
me again in a new form. His
use of the clay offered him
opportunities for
communicatingwith me, of
sharing a n experience of
feeling contained and of feeling
loved and reinforced.
Alex developed an interest in
games of drawing on and then
erasing images from the
whiteboard. His growing
ability to share experience
without panicking was

. demonstrated in his use of the

whiteboard and pens:
In a session a few weeks later, he
Figure 6 (drawn by author from memory). asked to draw-on the whiteboard.
Usingfelt-tips he drew a big circle on the board with great
concentration. He drew parallel lines around it. In order to
that was mixed up with him,or experienced as a draw the lines, he traversed the entire length of the board
threat and he wanted to share his experience with while holding the pen - the drawing reflected his
me. There was much less fear and depression in the movement through space. He was silent while he drew. He
countertransferencethan there had been in earlier then came and stood bes& me and we both stood looking
sessions. There was more of a sense of things being at it. He looked up at me, then across at his drawing. He
contained and development of an exploratory play seemed pleased with it. Z commented on how good hefelt
and an awareness of sharing experience. My sense about his drawing. Z also said that it reminded me of a
that Alex was developing a separate identity and an snail. He returned to the drawing and filled the central
ability to go-on-being was reinforced by his mother’s circle in with dots [seeFigure 61. It began to resemble a
reports that he was talking more, would refer to me nucleus. He then did some more lines until the bottom
in-between sessions and would use me as a reference third of the board was &s-crossed and scribbled all over.
point for other experiences. He began smearing the drawing and wiping it 08He then
As well as developing a stronger core, Alex was asked me to do it. I said ‘You tell me which bits to wipe of
learning to communicate.Clay provided him with a and I did as he instructed until the whole board was wiped
concrete model for exploring the unconscious clean. I sat down. He came up to me and hugged me
containing processes that were happening between tightly. I said, ‘Zdid everything you said‘. He responded
us: with a big smile and a ’yes’. Z said ‘Youfeel happy’;he said
’I happy‘.
He picked up a ball o f clay and threw it to me. Soft clay
changes its shape on impact. Z pointed out to him how my It seemed that towards the end of this phase in his
hand had changed the shape of the ball befoe I threw it therapy, Alex had begun to develop some internal
back to him. Depending on how sop the clay was, and on boundaries. The art materials had provided a
how many times we threw it back and f&h,-it would lose connectionwith me and a concrete experience of
its roundness becoming shaped by the process o f being inside/outside, enabling him to symbolically
caught in our hands. This session’s variation was that he establish a boundaried inner space and begin to
threw them to me one at a time and I caught them and develop a core self. This had enabled his letting go of
piled them up in my hands. Then he instructed me to put his defences to some extent. These were beginning to
them on the table in their pile; he separated them out and be replaced with a real relationship with his
put them back on the table. He then threw them to me in environment and me. He had found that he could
order to repeat the game. In the middle ofthe game, he communicate with me verbally and sometimes made
came over to me witk a big smile and put his hands on my a huge effort to do so. He could tolerate comments
cheeks, awkwardly gentle. and suggestions and could negotiate a shared
experience.
It felt as if throwing the clay was concretely
representing the dynamic of a communication
between him and myself; he offered something, I
accepted it, transformed it, returned it to him, he

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ART MATERIALS AND PROCESSES: A PLACE OF MEETING

Discussion 1993),which existed in an undifferentiated state,

became identified with the formlessness of the
The art psychotherapy environment provided an all-
materials, particularly the ready-mixed paint and the
encompassing container for Alex's different psychic
sand and water. He experienced the spilling, pouring,
states at different times; experiencing these different
formlessness of paint as an extension of himself,
states, which sometimes had a psychotic feel to them,
formless, spilling and pouring. It was as if the room
was confusing (Alvarez, 1992; Briggs, 1997).Clarity
and its objects were a kind of skin for this
was provided by the reliability of my presence - the
unintegrated state (Bick, 1968).The idea and feeling
art psychotherapist - the boundaries of the room, and of a boundary was introduced when I prevented
the provision of materials and toys, which remained
unlimited pouring, setting firm limits.In this way, I
consistent. Changes in the physical objects indicated
was acknowledging his lack of an intemal container
changes in Alex's intemal world and in the
and offeringhim the opportunity of forming one.
interminglingbetween him and myself.
Negotiating experiences with Alex through the paint
Initial sessions were characterised by intense silences. was a way of connecting with the potential for
The atmosphere within the silence was initially the creativity and aliveness in the 'blob' while avoiding
link between us, and the communicatingtool with becoming an extension of the 'shell's' defence
which I had to work (Case,1995).Within this silence, structure (Kdlick, 1993). Gradually, with repeated
I experienced intense feelings of despair and experiences of being alive, the 'blob' began to gather
hopelessness and an inability to speak or think.I felt strength and shape, and the 'shell's' power decreased.
that in this way Alex was communicating to me his I felt this in the countertransference as a lessening in
unbearable feelings, which I had to bear for him intensity of the depressed, dead, dumb feelings, a
(Alvarez, 1992).Within this silence, I was offering corresponding greater range of feelings and a
him the experience of my aliveness as a thinking, stronger sense of creativity and playfulness (Alvarez,
feeling person (Arp.de, 1992;Case,1995).I had a 1992). As this core of personhood gained strength,
sense of what was happening by being attuned to the Alex's awareness of an internal space developed and
transference feelings conveyed in the atmosphere and he began to use the materials to communicate his
by my reactions to non-verbal behaviour (Briggs, sense of separateness,his understanding of the
1997;Wells, 1997). relationship between us, and to engage in creative
The 'shell' (Kdhck, 1993)appeared in the form of activity in which his feelings were explored and
unpredictable attacks on me and on objects in the acknowledged.
room, and was a result of Alex's experiencing The same materials were used by the 'shell' W c k ,
interactionswith me as life-threatening 1993)to communicate catastrophic experiences of
impingements (Winnicott, 1958).The attacks were attack and feelings of terror at being impinged on. I
literal and concrete because of the existence of early understood this different kind of communicationby
infantile states, in which emotions are experienced as my reactions to Alex's actions. Although the threat of
physical sensations and are contained through the 'shell's' presence never left completely, and
physical care (Winnicott, 1958, p. 149).These were otherwise calm sessions could be punctuated by
accompanied by intense pathologically projected attacking outbursts, there was a growing sense of the
feelings of catastrophe, which I experienced as presence of another person with me who was able to
anxiety associated with potential catastrophic damage feel and process emotion and begin constructing a
to the carpet. By processing this anxiety through my structure for thoughts and for thinking for himself.
thinking, cleaning up the mess and by surviving the This was particularly demonstrated in his exploration
threat of catastrophe, I was an 'as if' mother - of water as something outside himself, and his use of
digesting experience and retuming it in an acceptable clay as a way of concretely exploring communication.
form. In this way I preempted an experience of the I was struck by his drawing on the whiteboard that
container being destroyed and provided experiences was reminiscent of a snail - a soft, vulnerable
of containment pion, 1962),which assisted the creature living inside a protective shell (Figure 6).
development of his core of personhood (Winnicott,
Alex began to use the silence to commune with
1965).
himself,to be alone in my presence and to create new
Qualities inherent in the art materials and art process things. He incorporated me into his creative
itself functioned as vessels of containment, as experiences - through making eye contact, by talking,
channels for communication,as indicators of by inviting me to participate, thus providing me with
development in Alex's internal world changes and in opportunities for meeting his needs and providing
the relationship between us. The Merent materials containment. He began to use paint in a more
offered rich opportunities for establishing an aUiance complex way. His language in the sessions, and at
between us and for different kinds of communication home, developed, as did his ability to play, to feel
(Killick and Greenwood, 1995).Alex's 'blob' (Killick, comfortable in a relationship. As he was using

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ART MATERIALS A N D PROCESSES: A PLACE OF MEETING

English to speak to me, he was acquiring a skill that Dub~wski,J. (3990) 'ArtVersus Language: Separate
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Milavic, G. and Fenton, M. (1995) The Greenwich Nursery
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