Running head: ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
The Effectiveness of Art Therapy and Mindfulness for At-Risk Youth
A Master’s Project
Presented to
The Faculty of the Adler Graduate School
________________
In Partial Fulfillment of the Requirements for
the Degree of Master of Arts in
Adlerian Counseling and Psychotherapy
________________
By:
Matthew James Darnold
________________
Chair: Nicole Randick
Member: Erin Rafferty Bugher
________________
May 2016
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Abstract
At-risk youth face a number of challenges, including violence, poverty, substance use, mental
illness, and lack of support and resources in the community. A void and lack of services allow
art therapy and mindfulness to address the needs of the at-risk youth population. This literature
review will explore the needs of at-risk youth, define and explore art therapy techniques and
directives, as well as define mindfulness and review interventions as they pertain to at-risk youth.
Mindfulness assists at-risk youth to cope with intrusive thoughts and stressors and promotes
awareness, calmness, and emotional wellbeing. Art therapy can provide a safe environment for
at-risk youth to find a voice, empowerment, and a sense of community to begin their journey
towards recovery. A presentation will then be informed by the research to be used with this
population in a mental health treatment setting.
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Table of Contents
Introduction ..................................................................................................................................... 5
Alfred Adler and Individual Psychology ........................................................................................ 5
Courage to be Imperfect.............................................................................................................. 6
Safety .......................................................................................................................................... 6
Significance................................................................................................................................. 6
Sense of Belonging ..................................................................................................................... 7
At-Risk Youth ................................................................................................................................. 7
Services and Interventions .............................................................................................................. 8
Art Therapy ................................................................................................................................... 10
Art Therapy and At-Risk Youth ................................................................................................... 10
Art Therapy Techniques and Directives ....................................................................................... 12
The Open Studio Process .......................................................................................................... 12
Mandalas ................................................................................................................................... 13
Magazine Photo Collage ........................................................................................................... 13
Kinetic Family Drawings .......................................................................................................... 13
Art Therapy and Mental Health .................................................................................................... 14
Art Therapy and Posttraumatic Stress Disorder........................................................................ 14
Art Therapy and Attention Deficit Hyperactivity Disorder ...................................................... 15
Benefits of Art Therapy ................................................................................................................ 15
Self-Esteem ............................................................................................................................... 16
Resiliency.................................................................................................................................. 16
Mindfulness................................................................................................................................... 17
Mindfulness Techniques and Directives ....................................................................................... 19
Check-ins .................................................................................................................................. 19
Walking Meditation .................................................................................................................. 19
Mindfulness and Mental Health .................................................................................................... 20
Mindfulness and Anxiety .......................................................................................................... 20
Mindfulness and Mental Health ................................................................................................ 21
Benefits of Mindfulness ................................................................................................................ 22
Prosocial Behavior and Self-Regulatory Skills......................................................................... 23
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Teaching Mindfulness to Homeless Youth ............................................................................... 23
Mindfulness and Suicide Prevention ........................................................................................ 24
Mindfulness-Based Art Therapy ................................................................................................... 25
Cultural Considerations ................................................................................................................ 25
Conclusion .................................................................................................................................... 26
References ..................................................................................................................................... 27
Appendix ....................................................................................................................................... 31
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
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The Effectiveness of Art Therapy and Mindfulness for At-Risk Youth
Introduction
This project will define and explore the use of art therapy and mindfulness with the
population of at-risk youth. A number of services and interventions will be explored that are
being utilized by mental health providers with this particular population. Art therapy and
mindfulness fills a gap in the current treatment interventions used in this population, utilizing
strategies to engage at-risk youth and promotes skills to manage their mental health needs. Little
information was found on specific treatment and service options for the at-risk youth population
and more research may prove beneficial in support of effective treatment options. Art therapy
and mindfulness were conceptualized through Individual Psychology within 3 pillars: safety,
significance, and belonging. The culmination of the information explored within this project
informed an art therapy and mindfulness curriculum for working with youth who are considered
at risk.
Alfred Adler and Individual Psychology
Alfred Adler, a medical doctor and psychologist, developed the concept of Individual
Psychology. Adler collaborated alongside Sigmund Freud during his early years. Adler differed
from Freud in many aspects, such as viewing people as socially embedded, goal directed,
decision-making, and indivisible (cannot be broken up into parts) beings. Each person is an
individual in their social environment and has their own capacity to make decisions and choices
within that context, reinforcing that all behavior has social meaning and cannot be studied in
isolation (Green, 2013). Several of his concepts that are important to this project include the
Courage to be Imperfect, Safety, Significance, and Sense of Belonging.
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
Courage to be Imperfect
Life can often bring about challenges and demands, especially for the at-risk youth
population. Adler argued that courage consists of two elements, activity and social interest,
promoting movement towards goals and connectedness with others (Mosak & Maniacci, 1999).
Some risk-taking can be expected and an encouraged person may be more willing to engage in
courageous behaviors. Art therapy interventions encourages at-risk youth to engage in the art
making process, which can be intimidating and leave an individual self-conscious at times. The
act of making art supports youth to take safe risks within a nonjudgmental environment.
Mindfulness interventions also reinforce the idea of courage by promoting awareness.
Safety
Safety and stabilization should be the foundation of any therapy session. Adler believed
that people’s behaviors are in part a result to insure their safety and ward against feelings of
failure (Mosak & Maniacci, 1999). He coined the term Safeguarding Behaviors. These
behaviors are created by people to help protect themselves against harm to the physical self,
social self, or loss of self-esteem (Mosak & Maniacci). For example, Millar (2013) used
grounding and anchoring strategies to get an individual in a place to address safety before
progressing into their trauma history. This can be particularly important for at-risk youth who
can experience violence, homelessness, abuse, and poverty. Art therapy and meditation can
address these needs and promote an environment where safety is paramount.
Significance
Family is the first group that an individual seeks to find significance, with the goal to
develop a unique identity. Adler concluded that an individual might strive for significance and
superiority in the sense of self-improvement and greater competency (Green, 2013). He viewed
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people through the lens of moving from a perceived minus (negative) situation to a perceived
plus (positive) situation (Mosak & Maniacci, 1999). Art therapy and meditation encourages an
environment where at-risk youth can build relationships and connection with peers, family, and
community, moving from this minus to plus situation. Promoting significance and belonging
with at-risk youth, may also promote engagement and increased participation in mental health
services.
Sense of Belonging
Adler spoke about the goal of belonging and how it can be fundamental to human nature
(Mosak & Maniacci, 1999). Feelings of inferiority can also be associated with a sense
belonging, leaving at-risk youth feeling a low sense of worthiness and value. Adler argued that
one’s mental health correlated with one’s ability to engage and connect with others. Happiness,
success in life, and overall mental status can all be affected by the social connectedness we have
with others (Green, 2013). This is particularly important in at-risk youth due to an increase in
familial problems and homelessness.
At-Risk Youth
At-risk youth, described by Sutherland, Waldman, and Collins (2010) may include youth
“living in communities where there is poverty, unemployment, reliance on welfare, and
exploitation can result in powerlessness and a lack of self-worth and self-esteem” (p. 70). These
variables can lead to violence and aggression within families, communities, and schools. At-risk
youth face increased stressors, “including violent neighborhoods, substance abuse, poverty, lack
of support, and limited resources. They also have increased risk of entry into the juvenile justice
system” (Oparaji, Nwachuku, & Rosenstock, 2015, p. 104). There are several programs within
the literature that have tried to address the complex needs of this population. Through the
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context of this art therapy and meditation; at-risk youth can develop a sense of significance and
belonging in a safe environment with their peers through creativity and mindfulness. The
courage to be imperfect, an Adlerian concept, will be defined and reinforced through art
directives that focus on empowerment and mindfulness interventions that promote awareness and
non-judgment.
Services and Interventions
Oparaji et al. (2015) developed The Healthy Minds program, a curriculum that focused
on stress management, coping with trauma, family planning and sex education, body image, and
professional development with the at-risk youth population. This program was also developed to
address the lack of resources and affordability to bring these services to school systems instead
of juvenile centers. Participants in the program reported that the favorite part of the curriculum
were the interactive activities, suggesting that interactive teaching was more effective than
traditional lecture style.
Youth who were considered at-risk also have a high prevalence for mental health
problems. Dolgin (2014) described how the daily stressors of adolescents (e.g., social, academic,
and familial problems) could develop into long-lasting mental health issues if this population is
unable to adapt and cope. He developed a wilderness-based group intervention program to
educate youth in stress-coping strategies. Ultimately, through working in the wilderness, youth
were able to develop strong connection, understanding, and social support. As these connections
were developed, “the opportunity for authentic expression and engagement is increased through
structured therapeutic interventions and activities” (Dolgin, 2014, p. 85).
Engagement and participation with the at-risk youth population can likely be an essential
aspect of any successful intervention. French, Reardon, and Smith (2003) reported that the lack
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of engagement with at-risk youth population may be due to difficulty accessing mental health
services, homelessness, lack of family support, substance use, and social isolation. During the
engagement phase, youth are drawn to several components depending on the attractiveness and
accessibility of the service provided. Feeling understood, confidentiality, choosing level of
disclosure, physical environment, maintaining contact, based in community, and outreach
available were categories identified by at-risk youth to promote engagement.
Reddy et al., (2013) developed a cognitive-based compassion therapy intervention that
addressed themes of psychosocial functioning, hopefulness, and generalized anxiety for at-risk
adolescents. Part of the intervention consisted of meditation and mindfulness practices, as well
as promoting loving-kindness, empathy, and compassion. Discussion of the study suggested that
the 6-week program did not result in significant improvement on self-report measures of
psychosocial outcomes. The study suggested more time for participants to learn and practice and
participating in an 8 weeks or longer program would be more appropriate time length for
participants to engage and find benefits.
A study conducted by Greco, Baer, and Smith (2011) looked to fill a void regarding a
lack of research in evidence-based data that supported the use of mindfulness in children and
adolescents. The Child and Adolescent Mindfulness Measure (CAMM) created by Greco, Baer,
and Smith (2011) was developed, looking at the skills of observing, acting with awareness, and
accepting without judgment. The CAMM appears to be a developmentally appropriate measure
for the reliability and validity of mindfulness with children and adolescents.
Art therapy and mindfulness interventions can provide engagement and expression in an
urban environment when other intervention programs are not available. Art therapy is defined,
including the benefits of art therapy to childhood development, self-esteem, and mental health
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problems. Next, mindfulness is defined, and it’s benefits to youth and their mental health are
discussed. Specific techniques are described for each of these interventions to demonstrate the
effectiveness of art therapy and mindfulness with at-risk youth.
Art Therapy
Art therapy is defined by Malchiodi (2007) as
a recognized form of treatment in health and medicine. Art therapy is based on the idea
that the creative process of art making is healing and life enhancing and that it is a potent
form of communication. It utilizes the creative process, which exists within every
individual, to promote growth, self-expression, emotional reparation, conflict resolution,
and transformation. (Introduction, para. 4)
Art therapy began to grow interest in the 1960’s when artists from several backgrounds,
including formal art, psychiatry, and art education began incorporating psychiatric training and
the assistance of other mental health providers, to include art in the psychology field. As more
art therapists were trained, the use of art therapy grew to other populations such as those in the
correction facility. Art therapy had its roots as a mental health discipline, but has continued to
grow as a field and discipline helping those with both cognitive and physical limitations (Junge,
2010).
Art Therapy and At-Risk Youth
The primary goal of art therapy with the at-risk youth population is to address the social,
cognitive, and emotional needs of each youth. Art directives can promote growth and recovery
through art mediums and creative expression while reinforcing the courage to be imperfect by
focusing on the process of art making instead of the product produced. Engaging in art making
can reduce anxiety, while “helping the child feel comfortable with the therapist, increasing
memory retrieval, organizing narratives, and promoting the child to tell more details than in a
solely verbal interview” (Malchiodi, 2013, p. 7). Art therapy techniques can assist children in
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learning and practicing developmental tasks and coping skills. Art therapy directives can also
help youth express feelings and build interpersonal skills in a safe and creative environment,
supporting the ideas of Individual Psychology of safety, belonging, and significance. Art
therapists can assess the developmental level and age-appropriateness of youth’s physical,
cognitive, and social skills based off of art directives, as well as to observe the effect of youth
during a session. An art therapy session will ultimately encourage and promote the youth to
develop and work on these skills while promoting empowerment and self-efficacy (Malchiodi,
2013).
A program developed by Sutherland et al. (2010) brought together the ideas of Alfred
Adler and art therapy to develop “The Art Therapy Connection” (ATC) in the inner city of
Chicago, Illinois. Utilizing an Adlerian perspective, the ATC developed group identity, group
cohesion, and group cooperation; while also promoting feelings of belonging, trust,
encouragement, and social interest. These ideas were also reinforced by providing a safe
environment that met the needs of at-risk youth and their mental health needs.
In a group art therapy format, students build a sense of belonging and begin to understand
the needs of others, as well as their own. Developing positive and rewarding experiences to
these students also promote connection, a change in negative attitudes, and a want and desire to
stay in school. These attitudes are also reinforced back at home and their relationships with
family, friends, and throughout the community. The effectiveness of the ATC was noted in the
graduation rates for those students who participated in the program. A 56% graduation rate was
noted for the entire student body, whereas a 78% graduate rate was noted for the students who
participated in the ATC program. The presentation informed by this review will promote many
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of the ideas discussed through the ATC, incorporating the techniques and directives discussed,
and integrating the philosophies of Individual Psychology of safety, belonging, and significance.
Art Therapy Techniques and Directives
The Open Studio Process
The open studio time concept is based on The Open Studio Project (OSP) explained by
Block, Harris, and Laing (2005). The OSP offers year-round afterschool and summer programs
to at-risk youth in the Chicago area. The OSP consists of the four main concepts of intention, art
making, witness-writing, and sharing. Through these concepts, a safe environment is developed
that promotes youth to express themselves and build trust in the art process. The intention
begins the session, with students writing in a journal or sketchbook their goal or target. The
intention is intended to encourage responsibility, ownership, and resolution to the art pieces the
youth create. Materials are provided and laid out for the youth to discover, such as drawing,
painting, sculpture, and collage. Humor, freedom, creativity, and respect are encouraged during
this time of art making. The next step consists of a “witness” time, where each youth begins by
writing about their work. This is a time to reinforce the ideas of mindfulness, where youth are
invited to sit with the art piece they have created and to be nonjudgmental and noncritical,
respectful, and attentive. The writing process is open and spontaneous with any healthy words
being encouraged. The final aspect of the OSP is the sharing of the artwork with the group.
Each youth is promoted to decide on what aspects of their writing they want to share with the
group. The group is encouraged to listen with empathy and appreciation to the piece and writing
without responding to the piece shared. Through this OSP model, the ideas of Alfred Adler are
demonstrated with each student feeling significant and with a sense of belonging to the group
(Block et al., 2005).
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Mandalas
A study by Curry and Kasser (2005) reported that coloring a mandala, a pre-drawn
circular geometric design, was more effective than free-form coloring in terms of reducing
anxiety. The effects found in the pre-drawn mandalas were also the same as those who colored a
square plaid design, noting both the mandala and plaid design provided structure and direction.
These results suggested that completing a structured and complex design may have drawn the
participant into a meditative state, whereas the open drawing required the participant to structure
their own time, which may have been more anxiety inducing.
Magazine Photo Collage
The magazine photo collage directive allows the youth a chance to pick imagery from a
selection of pre-cut magazines. Client conflicts, defense mechanisms, and styles of functioning
are pieces of information that can be generated through this directive. The magazine photo
collage can allow for cultural significance to be addressed, by providing imagery that matches
with the youth, which can allow for a stronger relationship between therapist and client (Brooke,
2004). A theme can be developed or left with free choice to the collage, resulting in both
conscious and unconscious material to be discussed and processed. “Completed collages allowed
the therapist to confront the meaning of the images, make an intervention, offer an interpretation,
or simply note the content” (Brooke, 2004, p. 136).
Kinetic Family Drawings
The Kinetic Family Drawing (KFD) is a directive, focused on addressing child
development, self-concept, and interpersonal relationships (Burns & Kaufman, 1970). The
directive asks the client to draw a picture of everyone in their family, including themselves,
doing something. The participant is encouraged to draw whole people and avoid stick people or
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cartoons. Family dynamics are also a significant aspect that this directive can address. An
evaluation of the directive suggested that this directive can be sensitive to mood changes of the
participant with the completion of a retest and does not indicate any personality traits. This
directive does not allow a distinction between emotionally disturbed and well-adjusted children
(Brooke, 2004). It should also be noted that this directive should be considered with the at-risk
youth as family and may not be involved or can evoke negative and powerful emotions.
Art Therapy and Mental Health
Art therapy and mental health work with at-risk youth can offer a safe space for youth to
engage in a process of expression and communication that can often be difficult and
uncomfortable. Malchiodi (2012) described art therapy reaching six specific factors (i.e.,
perceptual, emotional, imaginal, social, physical, and spiritual) that should be focused on when
working with and addressing the mental health needs of the at-risk youth population. Art therapy
can also be modified to work in a variety of settings, with many mental health diagnoses, and in
different forms of treatment to meet the individual needs of each client.
Art Therapy and Posttraumatic Stress Disorder
Gerteisen (2008) explained that clients who have experienced trauma, may experience
their memories as images, as well as a cognitive experience. Art therapy allows clients to
express their trauma experience in a sensory experience, while providing a safe space to do so.
These traumatic memories are reported to be held in the right hemisphere of the brain, the same
side of the brain closely connected with creativity and nonverbal language. Art therapy provides
an outlet for clients to express their memories through images, instead of relying on verbal
methods of treatment. Art directives that were primarily focused on self-expression showed
greater effectiveness than the art directives that were chosen to focus on a certain issue. This
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allowed the client a sense of autonomy and ability to find their own path.
Art Therapy and Attention Deficit Hyperactivity Disorder
A study designed by Smitheman-Brown and Church (1996) to connect the effectiveness
of mandala drawings and lowering the symptoms of Attention Deficit Disorder and Attention
Deficit-Hyperactivity Disorder, found that these drawings increased attentional abilities and
impulsive behaviors in children diagnosed for more than one year. The session began with a free
choice mandala drawing, which lasted for 5 minutes at a minimum, the client could then choose
to continue on with the drawing or choose another artwork and art medium. The study found
that mandala drawings assisted in increasing attentional abilities and decreasing impulsive
behaviors. The drawings may have also taught better decision-making, completion of task,
expression of growth in developmental level, and an interest in personal aesthetics.
Benefits of Art Therapy
Art therapy is used to address mental health disorders, but can also address aspects of atrisk youth that promote mental health and a positive outlook towards life. Self-esteem and
resiliency was discussed and how art therapy promoted these skills in at-risk youth was also
explained, as well as promoting other areas like assertiveness, self-mastery, self-control, and
flexibility. Incorporating the concepts of social interest, social awareness, and self-regulation,
the concepts of Alfred Adler appear to reinforce the skills and values learned through art and
mindfulness. Guzick, Dorman, Groff, Altermatt, and Forsyth (2004) explained that
incorporating Adlerian psychology may assist with developing optimism and interpersonal
relationships with youth, while lowering alienation and maladjustment. The presentation,
informed by this review, addressed that youth may feel inferior and self-conscious about art
making and focus on building an environment that is safe and encouraging, while also promoting
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a sense of community and group cohesion.
Self-Esteem
When working with at-risk youth, lack of self-esteem may be one of the most common
aspects that these students might be suffering with. Franklin (1992), referred to self-esteem as
one of the core senses when trusting in personal ability and creating an attitude of self-worth.
Abused children experienced considerably lower self-concept, reduced ambition, and fewer
friends than those of children who did not experience abuse. It should be the goal of the
therapist to assist in solidifying this sense of personal qualities and unique abilities to at-risk
youth. Providing an environment that allows at-risk youth to tell their story in a safe and
contained space is another goal of the art therapist. “When creating art one can not help but look
inward and participate in decision making that is targeted at the resolution of various emotional
and cognitive processes” (Franklin, 1992, p. 79).
Assertiveness, empowerment, and self-mastery are skills that may start to develop and
build while creating art. Art making provides a safe place where old thoughts and ideas can be
challenged and new ones can emerge. It is also important to remember that shame, a feeling
related to low self-esteem, may result in anger and violence.
Resiliency
Prescott, Sekendur, Bailey, and Hoshino (2008) looked at the connection between
resiliency and creativity. Creativity and art making can be used as a sort of safe haven when
dealing with stress, pain, or hardships. “Creative people tend to have strong coping skills and
other inner resources such as flexibility, high ego strength, responsibility, tolerance, self-control,
intellectual efficiency, and openness to new experiences” (Prescott et al., 2008, p. 158). The art
process can be used to validate and empower youth in the pieces that are created in the studio,
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allowing them a chance to voice and cope with their experiences.
An art therapy directive specifically designed to address aspects of resiliency is the
bridge drawing (Hays & Lyons, 1982). Participants are asked to draw a bridge spanning two
places, promoting youth to address their transition from childhood to adulthood. The bridge
drawing directive can also encourage participants to provide insight into their own identity and
independence and open up a conversation with the art therapist (Prescott et al., 2008).
Mindfulness
Mindfulness in a clinical setting is both inspired by the Buddhist tradition and teachings,
as well as the work of Jon Kabat-Zinn. “Mindfulness is awareness, cultivated by paying attention
in a sustained and particular way: on purpose, in the present moment, and non-judgmentally”
(Kabat-Zinn, 2012, p. 1). Mindfulness can be broken into the three core elements of intention,
attention, and attitude. Intention is understanding why one is practicing mindfulness and being
clear about one’s intention. Valuing the practice and understanding if the intention is wholesome
or unwholesome or for the benefit or harm to self and others. Attention involves paying
attention to one’s moment-to-moment experiences. By attending to the surrounding world and
interpreting experiences in the here and now, one can learn how to cultivate attention that is
persistent and concentrated, perceptive and nonreactive. The last core element of attitude
promotes one to bring an openhearted and compassionate quality to mindfulness practice. An
acronym of COAL can often be used to assist with this element, standing for similar qualities of
curiosity, openness, acceptance, and love (COAL; Shapira & Carlson, 2009).
Meditation showed promising efficacy in working with school-aged children living with
symptoms of anxiety. Meditation can promote children to learn how to concentrate and
intentionally shift their attention. For example, a recent study by Lee, Semple, Rosa, and Miller
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(2008) examined the feasibility and acceptability of mindfulness with this population. Through a
6-week trial, children were able to demonstrate the ability to “understand the concept of
mindfulness, utilize the techniques taught in the program, and integrate mindfulness into their
every day lives” (Lee et al., p. 16). Furthermore, an assessment, The Mindfulness-Based
Cognitive Therapy for Children (MBCT-C) was developed by Semple, Reid, and Miller (2005)
to address the needs of children and adapt programming to the developmental differences of this
population. Shorter and more repetitive sessions reinforce ideas and techniques, while being
attentive to a child’s memory and attentional competencies. The MBCT-C consists of a 12-week
program with each session lasting approximately 90 minutes. Each session was designed with an
opening brief sitting meditation; the group then would review last week’s session, following up
with a group discussion about the home practice exercises. Techniques learned in the MBCT-C
are focused on bringing in multisensory, attending to the need of limited verbal fluency.
Techniques used in the MBCT-C program to enhance mindfulness were designed to be
participatory and interactive, offering a wide variety of multisensory experiences.
Experiential learning exercises focused on awareness in a specific sensory modality, such
as mindful seeing, hearing, touching, tasting, and smelling. (Lee et al., p. 20, 2008)
Guardian participation plays a primary part of the program, reinforcing the use of home
practices, but also promoting mindful intentions, speech, and behaviors at home. Participants
were encouraged to practice these new skills with guardians, siblings, and peers, and incorporate
them into their daily lives. Participates were instructed to record these practices and complete
about 15 minutes per day. Reviewing the study, a sense of community appeared to have
developed and providing the participants a safe environment to become more aware of their
thoughts, feelings, and body sensations.
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Mindfulness Techniques and Directives
Mindful techniques can include check-ins, walking meditation, standing and sitting yoga,
and mindful eating. These techniques can assist youth to bring awareness of breath, movement,
posture, thoughts and emotions. Each participant will be promoted to engage in the activity as
best they can, listening to the body’s flexibility, and practicing the intervention with wisdom and
compassion (Stahl & Goldstein, 2010).
Check-ins
A 3-minute mindful check allows clients to re-center themselves and engage in the
present moment. The technique encourages each youth to find a space, either lying down or
sitting up, to focus on their breath and inner experience to connect their mind and body (Stahl &
Goldstein, 2010). An example of a check in script by Stahl and Goldstein (2010):
Take a few minutes to be still. Congratulate yourself for taking this time for meditation
practice. Begin this mindful check-in by feeling into your body and mind and simply
allowing any waves of thought, emotion, or physical sensation to just be. There is no
need to judge or figure things out. Just allow yourself to be in the here and now, amidst
everything that is present in the moment. Spend about three minutes simply checking in
with yourself in this way. (p. 21)
Walking Meditation
A walking meditation promotes the participant to get out of a stressed or anxious mind
and ground themselves with their feet on the earth. Bringing attention to a task that becomes
unconscious throughout the day, a walking meditation focuses on each step taken (Stahl &
Goldstein, 2010). An example directive of Stahl and Goldstein (2010):
Start off by walking slowly and paying attention to sensations on the soles of the feet as
each part of the sole, from heel to toes, touches the ground. Notice how the body moves
as you walk and how the arms may swing back and forth. If at any point you notice the
mind wandering from walking, just acknowledge this and gently bring the focus back. (p.
59)
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Mindfulness and Mental Health
Martin (2013) explained how mindfulness may be helpful for youth experiencing mental
illness. While practicing the skill of non-judgment, youth may start to begin to cope with painful
and overwhelming thoughts. A core principle of mindfulness is ability to deal with intrusive
thoughts, accepting them as they happen, then letting them go. Avoiding letting these thoughts
have any power and value, including the positive ones, thoughts become part of ones journey and
history instead of being intrusive. The Mindfulness Based Stress Reduction (MBSR) program
reported improved mental health in 11 studies, specifically showing reduction in anxiety and an
increase in positive self-statements. MBCT proved more effective in reducing depression
relapses and symptoms, as compared to standard care. The follow up presentation to this review
promotes mindfulness directives to be used both collaboratively and independently with the art
therapy techniques addressed. Skills like awareness, non-judgment, empathy, sharing, and
emotional regulation can also be utilized within an art studio space.
Mindfulness and Anxiety
Semple, Reid, and Miller (2005) reported that there was little evidence supporting longterm interventions that assist with treating anxiety disorders for anxious children. Mindfulness
may help with impaired attention seen in many children living with anxiety. Mindfulness
interventions promote “recognizing anxious feelings, clarify repetitive or maladaptive thoughts,
minimize avoidant behaviors, and self-monitor one’s coping strategies” (Semple et al., p. 380).
By returning to the breath, mindfulness will assist with youth learning how to relax and practice
healthy stress reduction. Semple et al.’s research was based on the MBSR and MBCT model for
adults, but modified and integrated to assist with children from the ages of 7 and 8. The program
promoted participation and practicing the interventions, rather than just teaching the children
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about the intervention, then reinforced these interventions with weekly home practice exercises.
An opening breathing exercise started each session, consisting of a 3-minute seated
breathing meditation. Each participant then wrote down on a piece a paper one of their biggest
worries of that day, then threw it into a wastebasket, encouraging separation from any anxious
cognition. Each session followed a structure of each participant coming into the room, removing
their shoes, finding their folders, sitting in their space, reviewing the rules, and then participating
in the exercise. The therapists are thoughtful to their own behaviors, modeling a space that is
quiet and attentive. A chair in the back of the room is provided for any participant who chooses
not to complete the exercise. The summary of this program describes the participants’
enthusiasm about the program and wished it had continued. Improvement in academic
functioning and a reduction of internalizing and externalizing problems were observed in most of
the participants in the program. In conclusion, the study suggested that mindfulness training for
youth may be potentially helpful and that more research may be worthwhile (Semple et al.,
2005).
Mindfulness and Mental Health
In an exploration from Waller, Carlson, and Englar-Carlson (2006) treatment and relapse
prevention in depression using mindfulness was researched using Adlerian concepts. An MBCT
eight-session program was studied, emphasizing stress management and the fostering of
behaviors inconsistent with depression. The program addressed the unwanted thoughts, feelings,
and body sensations associated with depression. Skills including awareness, dealing with
barriers, staying present, and allowing or letting be were incorporated to assist with preventing
any further depression relapses.
Kimbrough and Magyari (2010) explored the benefits of mindfulness interventions with
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
22
child abuse survivors, exploring the benefits of mindfulness in several different mental health
diagnoses including depression, anxiety, substance abuse, and post-traumatic stress disorder
(PTSD). The study incorporated the teaching of Jon Kabat-Zinn and aspects of the field of
positive psychology. Mindfulness may be a less confrontational intervention when working with
a vulnerable population like at-risk youth, where clarity, attention, calmness, and emotional wellbeing can be taught in a safe environment. Relating these skills to Individual Psychology,
encouragement and social interest were reinforced by the group when practicing these skills.
The program was found to be safe and favorably endorsed by the participants. There were
statistical changes in all outcomes by the end of the 24 week program, specifically in depressive
symptoms and PTSD symptom criteria of re-experiencing, avoidance or numbing, and
hyperarousal.
Benefits of Mindfulness
The core concept of awareness in mindfulness practices, offers clients an opportunity to
expand on a multitude of other skills when practicing both formal and informal interventions.
Bringing awareness to daily tasks and living in the present moment can assist with clients who
may seem like they are on autopilot. Learning skills to assist with observing behaviors,
describing emotions, and participating in structured activities promote well-being in the
participants of mindfulness practices (Greason & Welfare, 2013). Integrating concepts of social
interest and social empathy in an Adlerian context may also strengthen the ideas of
non-judgment and awareness taught throughout many mindfulness interventions. Both
mindfulness and Adlerian psychology promotes the concepts of providing a safe environment
where growth can occur in a group setting (Guzick et al., 2004).
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
23
Prosocial Behavior and Self-Regulatory Skills
Prosocial behavior, self-regulation, and executive functioning were the focus through a
12-week mindfulness Kindness Curriculum (KC) designed by Flook, Goldberg, Pinger, and
Davidson (2014). Making the argument that these skills are imperative in the long-term outlook
throughout the lifespan, these skills are not taught in school. Just over a third of the participants
in the study were considered socioeconomically disadvantaged. The core principles aimed
through the KC were cultivating attention and emotion regulation, while also reinforcing
kindness practices like empathy, gratitude, and sharing. A child’s ability to regulate attention
and emotion, the KC provides them with the skills to efficiently learn in the classroom and build
healthy and positive social relationships. By teaching children self-regulation, the KC predicts
that is may also correlate with health, financial stability, and educational attainment throughout
adulthood. The program suggests that the interventions used throughout the KC appear
beneficial in promoting these skills to youth, particularly youth with lower baseline functioning
(Flook et al.).
Teaching Mindfulness to Homeless Youth
Homeless youth may experience a number of stressors including family stress, mental
illness, maltreatment, neglect, violence, substance use, and malnutrition. Socio-emotional effects
like low-self-esteem, aggressive behaviors, non-compliance, shorter attention spans, and poor
educational outcomes are additional aspects that mindfulness interventions hope to address.
New reports show hope that mindfulness may assist with past trauma when working with
children in domestic violence shelters. Viafora, Mathiesen, and Unsworth (2015) described how
mindfulness may benefit this population in school classrooms. The main concepts that
mindfulness hopes to encourage are social and emotional growth, strengthening attention,
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
24
learning healthy coping strategies, and supporting mental health prevention. Promoting
kindness, curiosity, and compassionate with oneself, youth learn mindfulness techniques to help
in multiple areas of life. Participants in the study were youth who were currently or had recently
lived in a homeless shelter with their families. The study followed The Meditation Initiative
(TMI), which taught mindfulness and meditation skills to the San Diego area schools.
Participants engaged in an 8-week program, lasting for 45 minutes each session. Each session
was structured with an opening guided breathing exercise, then transitioned to learning new
mindfulness practices. An example of a mindfulness activity taught may have been mindful
listening, mindful pauses, guided mindful breathing exercises, mindful movements, pleasant
experiences, and test taking. “Significant improvements in stress, anxiety, self-esteem, quality of
sleep, interpersonal difficulties, personal goals, awareness, impulsivity, social problems,
happiness, and general improvements in ADHD symptoms” (Viaform et al., p. 1181) were
observed in youth participating in mindfulness programs.
Mindfulness and Suicide Prevention
Mindfulness techniques can aid in the treatment of suicide prevention. “Mindfulness is a
potentially effective prevention intervention strategy for suicide by providing individuals with
important tools to recognize and manage self-destructive thoughts and emotions along with
developing the capacity ‘to be’ with difficult thoughts and emotions” (Le & Gobert, 2015, p. 12).
Mindfulness practices promote an environment of nonjudgement where embarrassment and
stigma may prevent some participants in finding treatment. This specific study utilized the Mind
Body Awareness Project, which was a 10-module curriculum designed from aspects of the
MBSR program. This program specifically addressed the difficult-to-reach and resistant-to-
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
25
treatment at-risk youth population, with the youth participants reporting improved awareness,
relaxation, and calmness (Le & Gobert, 2015).
Mindfulness-Based Art Therapy
Combining art therapy interventions and processes with some of the principles of the
MBSR program, “Walkabout: Looking In, Looking Out” designed by Peterson (2015) looks at
the benefits of these two modalities working together. This mindfulness-based art therapy
intervention combined the use of mindful walking, digital photography, and collages. Through a
number of sessions, participants utilized digital cameras and were promoted to focus on
awareness and mindful attention while taking pictures and reacting to stimuli on a walk. Ten
photos were chosen, ones that expressed both pleasant and unpleasant feelings, and then
deconstructed the photos into a collage. These collages promoted self-expression and bringing a
narrative to personal experiences. Participants were encouraged to practice several mindfulness
practices like breathing, “non-judging, trust, patience, non-striving, beginner’s mind, acceptance,
and letting be” (Peterson, p. 79).
Cultural Considerations
Westrich (1994) explained the importance for art therapists to keep cultural
considerations in mind when working with clients and that sensitivity to the cultural differences
between the art therapist and client promoted the therapeutic alliance that was built. When
working with a client whose ideas, beliefs, and cultural traditions may vary from the therapist, it
was important to become aware of the field of cross-cultural therapy. This type of therapy
becomes important when therapists and clients are “culturally different because of socialization
acquired in distant cultural, subcultural, racio-ethnic, or socio-economic environments”
(Westrich, 1994, p. 189). Art therapists need to remember that any behavioral patterns that come
ART THERAPY AND MINDFULNESS FOR AT-RISK YOUTH
26
off as strange, unfamiliar, or different to them, need to keep in mind the client’s cultural or social
frame of reference when these behaviors are demonstrated. Art therapists should learn about the
traditional art and traditional art materials included in the cultures they may be working with.
Conclusion
Art therapy and mindfulness were explored as an effective and beneficial intervention for
the at-risk youth population. Through an Adlerian lens, the presentation that was influenced by
the research presented addressed concepts of social interest, safety, belonging, and significance.
The at-risk youth population was defined and services provided for this population was explored
to understand if art therapy and mindfulness were able to fill a void in the services specific to this
population. Art therapy was defined and explained in regards to the at-risk youth population.
The mental health needs addressed through art therapy were discussed, including mental health
diagnoses and other benefits art therapy has in the mental health field. Directives and
interventions were explored that were incorporated into a presentation for mental health
professionals. Mindfulness was also defined as a Western secular modality in treatment of atrisk youth. Directives and interventions were explained and the benefits of mindfulness and
mental health were discussed. A combination of mindfulness-based art therapy was explored
that combined the two modalities and cultural considerations were explained to best address the
needs of each individual youth.
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27
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