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Basics for the Therapeutic Use of Art

I think that art or results of creative processes in general may best be understood as a form of communication. It is a kind of communication mostly extending the verbal border by often using nonverbal techniques according to which the specific type of art is classified, e.g. painting, sculpture, music and so on. Postmodern research on mechanisms of communication has made it clear, that the brain works as a system without a direct contact to the outer world and hence is limited to constructing a picture by relying on the stimuli it gets from the sensory system of the body. Therefore any construction and with it any perception of the world (which necessarily only can be a construction itself) is subjective. Objectivity is fiction.

Nevertheless we all do communicate and at least to some extend seem to understand each other with the help of that communication. The explanation of this postmodern dilemma is the existence of structural parallels between all brains, resulting in similar if not close to equal perceptions of equal stimuli. A certain sound arouses the same brain-area in two people, though the side effects /associations to that stimulus may vary significantly. This leads us inevitably to the conclusion that the brain indeed does have a characteristic structure, a hypothesis first developed by Freud in 1920 and contrasting early concepts of behavioral therapy defining the brain as black box.

Specificity in the brain does not exist by a differentiation in the kind of nerve-cell arousal, but only through the localization of interconnected areas into which a stimulus of a sensory organ is transmitted, and these locations are similar in all human beings. Otherwise communication between people would be impossible. To me it seems important to stress the factor, that those structural parallels not only exist because of the similarities in the genetically, hence biologically determined brain structure, but also due to the same experience in early life of all human beings (for example prenatal life inside the uterus). In the same way due to parallels in the brain structures of animals and human beings also between those different species a certain extend of communication is possible.

If we construct everything, (we assume) we perceive, this certainly also is true for creative processes, including the creation of art. In order to be creative a brain needs a capacity to construct, and it needs material to construct from, which makes any artistic construction essentially a reconstruction of previously stored material. The creative potential of a person depends on his or her ability to reconstruct, to dissolve existing structures and to rebuild them in a new way. This is how art happens.

At the same time we now are able to understand, why art may be a means of psychotherapy. If any construction of the world depends on a reconstruction formed by 1. the stimulus of the perception itself and 2. by an internalized former experience projected onto that perception, and in this way modifying it subjectively, art as well as any function of the brain depends on the brain’s structure, which has built itself up through former experiences inside the biologically given framework. Art therefore becomes a clue to the inner structure of the brain, as well as it allows interacting with it, becoming a means of potential transformation, a therapeutic tool.

But what actually is the stored material like, what does the structure of the brain look like?

As already mentioned, there are two major levels of the brain functioning being highly interactive:

1. The biological basis, derived from the about sixty billion brain cells, their constructive structure and their order, and
2. The connective network between those cells, formed by stored experience through links of which every cell has up to ten thousand, which is the reason for the endless possibilities in the variation of stored information

While the first level mostly determines those genetically given psychological features like the temper, instincts and drives (the Id of the Freudian structural model), the second level mainly consists of the stored information (the Ego of the Freudian structural model, including the Super-Ego aspects). Both are necessarily and constantly interactive and influencing each other.

But let us go one step further. According to experience derived from psychoanalytical Ego-psychology, it is plausible to define a basic unit, out of which the second level, the structural part of the brain, the Ego, is built. This basic unit consists of a specific internalized relationship-experience. A subjective experience on the basis of the already existing brain structure leads to the formation of a specific dyad, formed by the image of the subject and the image of an object (which can be anything the person interacts with, another person, thing, situation, even the person himself) in a specific interaction with each other, accompanied by a characteristic affect to this interaction. Any new experience is perceived through the filter of those dyads already existing. An everyday example may elucidate this: If we meet a person for the first time, we automatically compare this person more or less subconsciously with other persons we know (X reminds us of Y), and attribute their characteristics to that new person, unless and until we learn different and in that way manage to create a new experience.

Hence any communication first of all takes place inside our brain as a communication between ourselves as the subject in a certain role and the other as the image of an internalized object. A similar dynamic must be active in the creation of art. Based on biologically determined qualities (e.g. the human brain likes symmetry or prefers a mixture of new and known information) art also is a communication inside the artist between himself and several images of internalized objects which he potentially addresses with his art (mostly subconsciously, sometimes consciously constructing fictive potential viewers), including again himself, as a viewer of his own art.

New experiences lead to new dyads. Repeated experiences strengthen those dyads already existing. The brain, being conservative in its nature as shown in the example of our reaction when meeting a new person, tends to wish to repeat experiences in order to adjust everything to what it had already learnt, which is why it is much easier to repeat a dyadic experience, than to create a new one (We already see, how important the consequences of this structural model become to practical therapeutic work).

Those millions of stored dyads are complexly connected, so far too complex to follow, though it looks likely that one day they will become visible to us. The content of any stimulus is nothing more than an unspecific arousal of nerve-cells. Specificity is solely defined by localization and interconnection of those cells activated in macro- and micro-areas. While brain-mapping allows us to identify some of the macro-areas already, the latter are still out of reach for us.

Nevertheless the brain’s network does not function like a trivial machine, in which a certain stimulus leads to a certain effect. Due to its complexity the brain works like a nontrivial machine according to the rules of chaos theory. While a certain outcome never is predictable, certain reactions nevertheless are more likely than others, depending on the given structure at that moment.

If we now look at the consequences of such a biologically based postmodern model of the brain, what are the consequences for psychotherapy in general and for art-therapy in specific?

Obviously any type of therapy intending to be effective has to address the brain’s structure, the dyads of object-relations and the affects linked to them, which define every little aspect of our perception and interaction with the surrounding world. It is therefore plausible to consider that only new experiences allow a modification of those internalized dyads. In order to be effective these new experiences must take place within a relationship and they have to be affectively activated to allow a  formation of new or a reactivation of old but hidden dyads to replace the dominance of those dyads that consist of pathological models of relating and lead to symptomatic patterns.

Art can be a mediator of such new experiences in two principle ways, which correspond Morgenthaler´s definition of dream analysis:

The contents of the work of art itself

The meaning of the work of art within the therapeutic relationship (which Morgenthaler in relation to dreams calls the formal aspects), including the moment of its production, the affect accompanying it, the way it is presented and so on

But how exactly does therapy work, which of its aspects differentiate it from other ways of human communication?

I think that there are three fundamental levels of psychological interaction which form the basis of a therapeutic process in contrast to any non-therapeutic communication, which can be summarized as: Holding, Understanding and Experiencing

1. Holding
The patient’s experience of being accepted within a lively, empathic and honest therapeutic relationship in all his facets, even in those he probably rejects in himself, is of fundamental importance to such an extend, that Rogerian therapies claim this aspect as being the one and only relevant factor in therapy. This view though seems too limited, as the other two aspects of therapeutic interaction described below also are of key importance. Nevertheless the relationship experience (including the verbal and nonverbal communication within) is the basis of a truly effective therapy, as it builds up the affective and emotional level of a therapeutic process, which is essential for constructing experiences in the form of object-relation-dyads, being effective on the structural level of the brain.

2. Understanding
If therapy is nothing more than the acceptance of the patient within a relationship, this likely leads to an endless perpetuation of his earlier patterns, of his structural image of the world and of the relationships within, without transforming them. There is no progress towards a life free of the old limitations due to those subconscious models of former experiences stored in the structure of the brain. Therefore the content of the therapeutic interaction must extend the mere creation of a lively and warm relationship. The therapist must understand the structural rules of the relationship which is brought to life by the patient, and he must explain them to the patient without judging them (from a position of technical neutrality), so that the patient can slowly get to know the subconscious laws of his psyche and start to decide consciously which ones to keep and which ones to abandon. This aspect of therapy is focused on in the contemporary forms of cognitive behavioral therapy.
 
3. Experiencing
But understanding alone, even if it happens within a relationship is not sufficient enough to bring about fundamental changes. Due to the form in which the basic unit of stored information in the brain is constructed (the object-relation-dyad plus the accompanying affect) it is necessary to experience all three aspects of a new dyad to achieve a structurally effective change in the psyche: subject, object and affect. Cognition, emotion and relationship-experience have to be brought together which is the essential strategy in contemporary postmodern psychoanalysis.

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