The goal is to help elders recognize the strengths they have.
When you are young, you have the courage of innocence. In middle age, you tend to become a little pedestrian and cautious. In old age, you have the courage of experience.
-Edith Kramer, Childhood and Art Therapy
Making art can have a significant effect on an older adult's mental health and self-esteem. As an art therapist, I have worked with a variety of older men and women, from healthy elders to those with late-stage dementia and others suffering from physical impairments. In each case, working with the visual arts has often been the most successful way to reach a frail individual or empower the healthy elder to seek further creative growth. Older adults face a staggering number of life changes associated with loss: They may lose family, friends, homes, and cognitive and physical capacities. Art therapy can help the older adult cope with, adjust to, and adapt to age-related changes. It can elicit a cathartic and creative experience, give support during loss or crisis, or provide care related to physical loss, such as loss of memory, mobility, sight, or hearing. Art therapy is a useful modality in working with well elders, those who are physically disabled, and those with dementia, using methods that draw on the strengths and abilities of each person.
The art-making process is creative, with the potential to evoke a multitude of emotions and memories. As such, art therapy can be a caring process with a variety of benefits. It can serve as a visual link by which the individual may explore past and present experiences-a powerful tool that assists an older adult with reviewing his or her life. In addition to fostering exploration and emotional growth through creative expression, art therapy can be a means for older adults facing increasing physical impairments to relate to their environment in new ways.
I believe that in the last stage of life, "fixing problems" as a goal of therapy is of little value. Radier, it might be more beneficial to help elders recognize the strengths they have, those that have successfully carried them to old age. Perceiving aging from a positive perspective shows that we value life experience and wisdom (Cohen, 2000), and so art therapy is most effective when it stems from the belief that aging provides the opportunity to draw from life's riches and find meaning. Art therapy can provide an opportunity for self-expression and introspection, allowing the individual to build on his or her strengths and life experience.
Art therapy can be very useful in facilitating life review, broadening the scope to include far more than just a cursory look back at one's life. As Robert Butler (1963) outlines in his theory of life review, an older person naturally reflects back on his or her life. Unresolved issues, disappointment, or regret, which can cast a negative shadow over a life, are not unusual. To feel comfortable looking toward the end of life, a person must come to terms with both the good and bad in his or her life and allow for a final separation and acceptance of that history. Making art provides a safe, symbolic arena in which to explore, allowing topics to emerge safely once they are removed from the immediacy of verbal language. The resulting artwork simultaneously serves as a representative of this journey and a point of admiration or discussion tor curious others with whom the elder wishes to share.
To best serve the needs of older adults, art therapists should understand the ways in which elders think about and make art, which are different from those of younger people. These differences occur on the physical, creative, and psychological levels. Luckily, one of the greatest strengths of the creative arts is the number of ways they can be adapted so as to be appropriate for anyone, regardless of age or ability. The loss of physical faculties, as a result of disease or disability, may significantly impair the individual's ability to engage in self-expression. The painter who no longer has the use of his hands must find a new way to use a brush, or adopt a new expressive modality altogether. Likewise, a sculptor who can no longer see might learn to rely on other senses to inform her creative inspiration and execute her artistic expression. The artist's method becomes highly individualized as it relates to personal abilities and limitations.
Elderly clients are often unable to fully execute their creative ideas, so they require the use of the therapist's mobility, imagination, or technical knowledge. Edith Kramer (1986) illustrated how the art therapist's artistic abilities and imagination are used to cmpathically carry out the creative intention of the client. Naming this type of therapeutic assistance the "third hand," Kramer described it not as an intervention, but rather as an extension of the client. She explained that the third hand is "a hand that helps the creative process along without being intrusive, without distorting meaning or imposing pictorial ideas or preferences alien to the client" (Kramer, 1986). In this manner, the art therapist must rely on his or her artistic abilities to execute the artistic intentions of the client, yet must subdue his or her own artistic style when carrying out the work of the client.
The following example illustrates how the creative process encourages and supports life review. I had the opportunity to work with an 89-year-old woman in recreating her personal experiences in the form of a written narrative with illustrations. "Johanna" was partially paralyzed and had poor vision as a result of a stroke. Her long-term memory was more reliable than her short-term memory, and Johanna retold the story of her travels as a young girl fleeing Europe with her family in the 1920s. Johanna's memories as she told them were those of a young girl, beset by fear and confusion but also experiencing youthful hope and lightheartedness. Johanna began telling her story during one session in a conversation with another woman who had also fled Europe as a young child. I recorded her story verbatim on paper each week as she elaborated on the details of her perilous journey. I then asked her to recount her visual memories, asking her how things looked, what colors, shapes, and overall impressions she remembered. The translation of images was significantly more problematic than simply transcribing speech into the written word. Sketching became the tool by which I, as the third hand, attempted to recreate the images Johanna verbally described to me. As Johanna was physically unable to execute the work herself, I transcribed her words into text and translated her visual imagery into illustrations.
The process of writing and drawing her story lasted many months. Throughout the process, she reflected on her past-on these events in particular and many more that were triggered in her memory along the way. Though she at times struggled with memory and her story was not always consistent from week to week, the therapy provided an important connection to her life history. Johanna s family was present during part of this process. While they provided clarification on some details that Johanna couldn't remember, more important was that the process provided them a forum in which to share Johanna's life from her perspective and to engage in valuable communication that encouraged support and reflection. The book and the process of its creation are a rich source of information that can be used as a springboard for discussions about life review and end-of-life issues. Outside of the therapeutic realm, Johanna's book gives the external world a symbolic link to understanding her inner life, and reflexively allows Johanna as an artist an expressive outlet to share lier ideas and experiences with others.
In summary, art therapy can be an empowering tool that strengthens the older adult client by revealing his or her inherent abilities and uniqueness as a person, honoring life experience and gained wisdom. Art therapists strive to assist elders in expressing their unique and valued voice through the creative process. Adapting an art technique for a physically impaired client gives the person the experience of tapping into the senses. It also encourages the life review process and may give the client an audience. Successful art therapy with older adults should stem from the belief that aging provides the opportunity to mine life's riches in the artmaking process. As such, the hope is to empower older men and women through creative expression and to encourage them to draw from their wisdom and experience as valued members of society.
Butler, R. 1963. "The Life Review and Interpretation of Reminiscence in the Aged." Psychiatry (26): 65-76.
Cohen, G. 2000. The Creative Age. New York: HarperCollins Publishers.
Kramer, E. 1986. "The Art Therapist's Third Hand." American Journal of Art Therapy 24: 71-86.
Kramer, E. 1998. Childhood and Art Therapy. Chicago: Magnolia Street Publishers.
Raquel Chapin Stephenson, M.A., A.T.R., is on the faculty of the Graduate Art Therapy Program and program coordinator and clinical supervisor for the Creative Aging Therapeutic Services, both of New York University. She is also the an therapist on the geriatric psychiatry unit, St. Luke's Hospital, New York, New York.