~ Michelle Saleeba
I'm super excited to be sharing this fascinating Creative Insights Q&A with you. Juliet King is an Adjunct Professor of Neurology in the Indiana University School of Medicine, and holds the position of Associate Professor or Art Therapy at George Washington University. Professor King’s research seeks to understand creative expression and its effects on the therapeutic process using imaging techniques.
I hope you enjoy this extensive, insightful meander through the interconnected worlds of brain science, art therapy and creativity with one of the leading researchers across these fields.
Michelle Saleeba: It has been said that creative expression is fundamentally tied to our sense of vitality and wellbeing. Why do you think this is?
Juliet King: I think that there are many ways to answer this question!
My mind goes initially to the brain and the neuroscience of creative expression. Although very difficult to define, we can see that many areas of the brain are activated when a person is involved in creative acts. This is a reason why creativity has been so difficult to study; it is difficult to distil and test the many components of brain function.
I think about this scientifically and also metaphorically, in that the creative process allows for the activation of multiple networks at the same time. If we translate this science to metaphor, we can understand that creativity helps to de-silo otherwise distinct definitions and pathways. For example, we can embody creativity in professional collaborations and use divergent methods to develop a shared language that can be used across disciplines to foster translational research.
There are many ways to conceptualize wellbeing. I think that engaging the whole brain in the creative process, be it music, art, dance, allows for whole-body engagement as well. Creativity helps us connect our heads to our bodies, our minds to our hearts and allows us to become more whole human beings. Although not always the easiest thing [to measure], I think we are healthier when we strive to be the most authentic version of ourselves and integrating our range of cognitions with the movement of our bodies in the present, real world is what gets us there. The creative process makes this more accessible and attainable, facilitating integration in the action of the making itself.
MS: If there is intrinsic therapeutic benefit to engaging in creative pursuits, how is art in therapy or art psychotherapy different, and why is it beneficial?
JK: All psychotherapy relies on an inter and intra-personal exchange for psychic shift and growth to be achieved. Traditional (verbal) psychotherapy is innately limited to the linear expression of language to access and express a range of perceptions including feelings and thoughts. The art making process and the products that emerge allow us to objectify these perceptions and within an attuned therapeutic relationship it becomes possible to dialogue with the image and the way it was created. This provides more information for both client and therapist and is potentially less frightening to approach. Seeing ourselves with clarity is not an easy endeavour and usually carries with it anxiety, and as Freud named, an unconscious resistance even when we choose to be in treatment and to work on what is problematic. The distance afforded through art psychotherapy facilitates this process in a safe way and allows us to see beyond our defenses in the efforts of seeking truth.
MS: Why art therapy?
JK: In that art therapists are trained as masters level clinicians who also are proficient with verbal psychotherapy, I am often tempted to consider and thus describe the profession as ‘talk therapy plus.’ We have an extra set of tools in our toolbox and these mechanisms help to facilitate the treatment through both verbal and nonverbal methods.
I have been in the field for two decades and it is often trying to have to explain and define what it is that we do to the lay public, healthcare stakeholders and even our counselling brothers and sisters on pretty much a daily basis! It is important that I am able to effectively describe the profession as one that is separate from other healthcare professions, and also from well-intentioned people who use art in their daily practice. This stance carries with it both an ethical responsibility and a responsibility to explain and educate on how and why art therapy is a distinct and stand-alone profession.
I realize that it is simplistic to define the profession as one that merely has a specific set of additional tools, and am remiss if I do not note the specific training that is involved to become an art therapist. The educational guidelines set forth by the previous Education Program Approval Board of the American Art Therapy Association which has evolved into the Accreditation Council for Art Therapy Education identifies specific curriculum requirements and applied supervised clinical work [training and registration guidelines vary from country to country, see local requirements].
Art therapy education includes in-depth training in the areas of creativity and symbolism, the use of materials and application of methods/interventions, in addition to human development that pertains to the value of artistic expression and informed capacities that the art making and artwork encompass.
MS: How is art therapy responding to our increasing understanding of neuroscience?
JK: There are many factors that contribute to the success of art therapy, which I believe can all be underscored with neuroscience principles. It has been my goal for the last 15 years to work towards a systematic integration of neuroscience into art therapy theory and practice, and I have the vision of contributing to the redefinition of art therapy as a neurotherapeutic practice.
To move this vision forward, I have developed a succinct set of tenets to describe the profession and offer a template for further inquiry and research that spans a continuum of quantitative, qualitative, mixed-methods and arts-based research designs. These tenets help to define a profession that has historically been ambiguous and has lacked clarity in scientific terms:
1) The art- making process and the artwork itself are integral components of treatment that help to understand and elicit verbal and nonverbal communication within an attuned therapeutic relationship.
2) Creative expression is healing and life enhancing.
3) The materials and methods utilized effect self-expression, assist in emotional self-regulation, and are applied in specialized ways (King, 2016).
Although often a treatment of choice (Tripp, in King, 2016), the profession of art therapy needs more scientific proof to quantify specific benefits to patients and be further integrated into the mainstream of clinical medicine.
MS: How did you get interested in brain science?
JK: I have worked with a range of populations including (but not limited to) child and adolescent behavioural health, inpatient and outpatient psychiatric settings, eating disorders, prison population, neuro-rehabilitation, and veterans. I first became interested in brain science when I was trained as a neurofeedback clinician. It was at this time, about 15 years ago, that I learned about electroencephalogram (EEG) and qualitative electroencephalogram (qEEG) as a potential method of mapping brainwave activity. At this time we were limited in the capacities of EEG to assess cortical activity in the brain but in the last decade or so there has been an emergence of contemporary neuroimaging which allows us to track brain wave activity in real work environments. This is called Mobile Brain/Body Imaging (Makeig et al, 2007) and holds great promise to test the aspects of creative expression in the context of the therapeutic relationship.
MS: Where are you working now?
JK: I maintain the position of Adjunct Professor of Neurology in the Indiana University School of Medicine (IUSM) and in this capacity, I oversee the art therapy program at the IU Health Neuroscience Center (IUNC) in Indianapolis, Indiana. This program emerged out of the ongoing development and implementation of the inaugural graduate art therapy program at the same university, for which I was hired as director in 2011. The program has been made possible by the Indiana Clinical Translational Health Sciences Institute (CTSI) and the IUSM Dept of Neurology.
Collaborations between myself as representative director of the graduate art therapy program at the art school and the IU School of Medicine fostered a strategic plan that I wrote with the IUSM chair of neurology Dr. Robert Pascuzzi in 2015 and included a number of primary goals, including to conduct exploratory studies and outcomes research on art therapy and neuroscience to establish and quantify the value of art therapy with selected patient populations.
Although I have achieved tenure at IU and have moved on to become an associate professor of art therapy at The George Washington University, I continue to oversee the clinical program at the IUNC in my capacities as adjunct associate professor, the program provides art therapy services to patients with neurological conditions including Parkinson’s Disease, Myesthenia Gravis, Traumatic Brain Injury and dementia. This position also allows for multi-site studies and potential to conduct research at the interface of art therapy and neurology.
This program also provides workshops for neurology residents in physician stress and burnout and is expanding to service provision at the Rehabilitation Hospital of Indiana.
MS: Research has shown the therapeutic relationship between therapist and client as paramount to positive outcomes. In art therapy there is a third element in the relationship, the artwork, how does this alter the therapeutic process?
JK: Absolutely; as I touched on earlier, the art work itself is a third entity in the therapeutic process and carries with it, its own dynamic information and presence. The work of Shaun McNiff and Bruce Moon expands on this and helps us further articulate the value of the art product being an active part of treatment in and of itself.
Artwork also helps to demystify transferential responses and bypass resistance, and circumvent defenses from both therapist and client.
MS: Often therapists have a defining professional experience that enhances or solidifies the why of their practice. Have you had any formative experiences, or lessons that have impacted on you as an art therapist?
JK: At this point in my life I would say my experience building an art therapy program in a neurofeedback treatment center. I developed a family support program that helped the clients integrate the changes that were being made with their neurofeedback, and helped family members communicate with one another through the art therapy process. Although the neurofeedback was impactful for the alleviation of client symptoms (primarily in this case those of ADD, ADHD and Learning Disabilities), there was often a need to ‘humanize’ the behavioral shifts with verbal and symbolic processing—helping the parents, for example, understand their child’s behaviour and helping the children synthesize the brain wave changes as a result of the neurofeedback.
I also worked for some time in inner city Philadelphia with children and families. I worked as a clinician and also returned to spearhead the rehabilitation of a behavioral health program in the capacities of clinical director, to ensure that quality healthcare services were being provided in the home, school and community. The power of the arts and art therapy to help people connect with one another and understand themselves and each other more completely is unparalleled.
MS: Do you feel there are perceived barriers to participation in art therapy? How might these be over come?
JK: I see the barriers are primarily that the profession is often not recognized as one that is independent of other psychotherapy and counselling and thus lacks adequate funding for both service provision and research. I attempt to address this through my ongoing collaborations and personal advocacy, program development, teaching, and research.
MS: There is substantial research about the importance of social connectivity for health and wellbeing. Art therapy is often delivered as a group process. Does making art with others enhance social connection and a sense of belonging?
JK: Absolutely—and has since the beginning of time. The arts allow for increased communication, engagement, understanding, symbolic representation and expression, they provide a context where people can approach one another and dialogue about the issues at hand. The literature in art therapy is rich with examples of art being used as a way to foster greater awareness, social justice, and approach discrimination and marginalization (See for example the work of Jordan Potash).
MS: Part of the therapy process is empowering clients to identify the ways in which they are already resilient. How does art therapy do this?
JK: Resilience is an exciting area to explore. Masten and Powell call resilience ‘ordinary magic,’ and I am forever intrigued by the many ways that humans have to heal themselves. The neuroscience of resilience is just now tapping into the great capacities that the brain has to respond to, and heal, from myriad traumas.
I believe any thoughtful and well-trained therapist works to support the client to recognize their strengths and capacities. Art making and creativity makes this a little easier to grasp.
It was Ernst Kris who talked about Adaptive Regression in Service of the Ego—he was interested in the Psychoanalysis of creativity— how dipping in and out of the unconscious in the process of creation helps us become more resilient. Kris discussed how the process of regression, which is a part of sublimation (and can be further explored with the concept of flow) helps us become stronger. Arieti called this the ‘Magic Synthesis’ of creativity— the integration of primary and secondary drives into a third, the tertiary process, where something new is formed, which is an integration of both conscious and unconscious motivations and content.
This is highly analytic language that likely gets dismissed in current society but holds great value when considering the multidimensionality of the creative process and the many aspects that contribute to why, and how, creative expression is so important and valuable to humanity.
MS: Lots of art therapists have their own art practice, which we don’t often hear about! Describe your art practice are there any consistent themes, metaphors or stories in your work?
JK: People! Heads, faces….the use of metaphor and symbol to investigate and explore the self. I’m not a great artist, or even a good one really…but have always used art as a way to understand myself and my motivations a bit more clearly. I use art to confront what I might call the ongoing and ever-present angst of the existential chtonic.
MS: What strategies do you employ to help yourself when you feel creatively stuck?
JK: Move! I am all about action. Art therapy is an active process; I think that is one of the mechanisms of its success. Stuckness is met with mobility. Being in and around nature, water, people…interacting through reciprocal exchange…my friendships and relationships….that not only helps me move forward but also is my survival.
MS: Is there a book that has really influenced your development as an art therapist?
JK: I usually find reason to gravitate back to Art Psychotherapy by Harriet Wadeson, Approaches to Art Therapy by Judith Rubin, and Creativity: The Magic Synthesis by Silvano Arieti. Of course, Freud and Jung pepper my collection as they are forever foundational texts and the framework of knowledge for this meaningful profession.
MS: Do you have any exciting news you’d like to share?
JK: I'm excited to announce that I was recently accepted to the PhD in Translational Health Sciences at The George Washington University! This is a competitive program that teaches people how to conduct translational research, which is essentially ‘bench to bedside.’ This means that we take the research that is conducted in the lab and apply it to working with people in a medical and clinical context.
Completion of this PhD program will provide me with the knowledge and tools necessary to explore the interface of neuroscience, neuroaesthetics and contemporary neuroimaging to better understand and test the theory and interventions of art therapy. Applying tools of contemporary neuroscience to study brain structure and function will help to clarify mechanisms, pathways and processing of creative expression.
If this intersection of fields interests you I'd encourage you to explore more of Professor King's writing through her website, comprehensive publication list and her book Art Therapy, Trauma, and Neuroscience: Theoretical and Practical Perspectives