The Arts in Psychotherapy, Vol. 25, No. 3, pp. 183–187, 1998 Copyright © 1998 Elsevier Science Ltd Printed in the USA. All rights reserved 0197-4556/98 $19.00 1 .00 PII S0197-4556(98)00011-2 THE CREATIVE ARTS IN COUNSELING: A MULTICULTURAL PERSPECTIVE DONNA A. HENDERSON, PhD, and SAMUEL T. GLADDING, PhD* The creative arts have the power to arouse and inform emotionally and physically. These arts forms have been used to better mental health since antiquity. Ancient Egyptian, African, Chinese, Greek, Hebrew and Indian cultures employed the media of drama, music, visual art and literature in the prevention and treatment of mental disorders (Gladding, 1998). In each culture, people with mental disturbances were urged to become involved through active or vicarious participation in a particular art form for health’s sake. Thus, the Greeks sometimes prescribed music as a cure for the insane (Sutton, 1994). In modern times, the creative arts have continued to permeate societies throughout the world, enriching the lives of ordinary people in mentally healthy ways (Gladding, 1998, 1995). For example, music is composed and performed in all cultures; people in varied settings express and interpret themselves through this medium. Thus, creative arts are a positive force in transcending cultures and advancing growth (Lewis, 1997). People from various cultural traditions can enjoy the creative arts in many ways. While differences in cultural backgrounds emerge in creative expression and interpretation, unity, harmony and positive interactions dominate the process. In the therapeutic contexts, the creative arts provide individuals, including clients and counselors, an appreciation for their own cultural heritage and experiences. For instance, reading Lorraine Hansberry’s play “A Raisin in the Sun” (1989) or Maya Angelou’s book I Know Why the Caged Bird Sings (1969) can help all individuals recognize the frustration, anger and resilience African Americans have experienced throughout history and even now. This connection unifies and strengthens a bond of kinship among people of similar backgrounds and experiences, as well as heightens the sensitivities of those who differ from them to their struggles and strengths. Of importance to this paper is the ability of the creative arts experience to assist in the rehabilitation of those with mental disorders regardless of their cultural background. For example, Pennebaker (1991) has found that people who write daily about distressing events in their lives are physically healthier and more resistant to disease than those who do not. The cultural heritage of the writer makes little difference, rather, it is the process of the creative expression that works in a therapeutic and preventative way (Riordan, 1996). It appears, therefore, that the creative arts can offer an approach to counselors who become skilled in their usage. These techniques allow counselors to assist clients in understanding their own connections and differences in relation to others. The creative arts make clients aware of not only the complexity of the individual but also the complexity of society (Pedersen, 1991). The creative arts soothe, as well as stimulate. Thus, the arts offer a bridge that can span many dimensions of human existence and therapeutically link people to one another. From a multicultural perspective, this particular feature of the creative arts is vital in counseling, for practitioners are increasingly being asked to work with people from diverse backgrounds. To be able to appreciate cultural differences, as well as draw on cultural strengths, are essential to a multicultural counseling perspective. *Donna A. Henderson is an Assistant Professor of Counselor Education at Wake Forest University, Winston Salem, NC. Samuel T. Gladding is Professor of Counselor Education at Wake Forest University. 183 184 HENDERSON AND GLADDING Consideration of subtle, as well as intricate, strengths of using the creative arts in counseling with different groups, is presented in this article. The focus is to give counselors from diverse backgrounds universal tools which they can employ in both reaching and enhancing the lives of clients from multiple cultures who seek counseling services. The Creative Arts in a Multicultural Counseling Context Different cultures and clients within these cultures have preferred ways of expressing creativity. Counselors are challenged to help clients discover what works best for them at a particular time. Such experiences can be prompted by the counselor providing materials and examples for clients to utilize, as well as the counselor being attuned to culturally preferred ways of dealing with problematic situations. Some practitioners have relied on creative arts to enhance the counseling process for multicultural clients. A review of these methods of using creative arts demonstrates the strength of the creative arts in different cultural settings. Y The creative arts draw people out of self-consciousness and into self-awareness by having them express themselves in a symbolic manner. Ozimo and Ozimo (1989) conducted an experimental study with the aim of determining whether art activities would be helpful in moving children from self-consciousness into self-awareness. These authors reported on a series of small group counseling sessions with native Hawaiian children who ranged from 8 –11 years old. These sessions were designed to determine if participating in a group using art activities would help the participating children feel better about themselves. The hypothesis of the authors was that the art activities, specifically the employment of photographs, mobiles, murals and drawings, would be useful in the children understanding themselves better and expressing themselves effectively. The results were based on pre- and post-test scores on a measure of self-esteem, which indicated a significant increase in the positive self-esteem of children who had participated in the group art activities compared to the measure of self-esteem of children in the control group. These authors concluded that using art activities can be useful in improving self-esteem and suggested that the intervention strategy may be beneficial to other children of minority groups. Landy (1997) described the process of drama therapy that created a play in Taiwan, but also taught him a great deal about himself. The elements of role theory of role and counter role, the Taoist spirit, and the profound understanding he and the group participants gained are documented in his anecdotal account. Y The creative arts call attention to the process of expression and the universal and unique nature of strategies employed in this process. In a descriptive article that addressed issues facing counselors who work with Native Americans, Heinrich, Corbine, and Thomas (1990) reviewed previously published recommendations and then described the sweat lodge and vision quest experiences, traditional healing practices used in a number of tribes. These rites of passage served to allow the individuals involved to answer personal “crises of meaning,” questions involving the universal struggles that all humans face at some time. Yet the unique strategies and symbols of the sweat lodge and vision quest remain as expressions related to the Native American culture. These authors suggested that counseling services to Native Americans would improve if counselors were familiar with some of the relevant metaphors of a traditional healing processes and would include these in their counseling practice. They noted that the sweat lodge and vision quest experiences continue to be excellent metaphors which may enhance counseling with Native Americans. An example of this inclusion is the sweat lodge ceremony as a part of many Indian Health Service alcohol treatment programs which Hall (1986) investigated. Her purpose was to provide an account of contemporary alcohol treatment for Native Americans and to describe the relationship of the sweat lodge to other treatment services provided. She reported that 50% of the alcohol treatment programs she surveyed either offered a sweat lodge at their site or provided access and encouragement to use a sweat lodge at a nearby site. Her description is focused on the prevalence of the practice rather than on the effectiveness of it. Y The creative arts provide a set of concrete experiences clients can carry with them to help them relate to others and themselves. Constantino, Malgady, and Rogler (1986) have reported an experimental study investigating the use of cuento therapy in working with Hispanic children. This therapy involved the telling of folk tales to trans- CREATIVE ARTS IN COUNSELING 185 mit cultural values, to provide models for beliefs and behaviors and to illustrate appropriate relationships. The purpose of this procedure was to reinforce adaptive behavior in these children and to reduce the children’s anxiety. The authors used outcome measures such as behavioral observations and the Trait Anxiety scale of the State-Trait Anxiety Inventory (STAI: Spielberger, Edwards, Lushene, Montouri, & Plutzek, 1973) to determine the effectiveness of the treatment. The results of a multivariate analysis of covariance indicated a significant main effect due to treatment (Wilks’s Lambda 5 .72, F[39, 374] 5 1.52, p , .05). Children who received cuento treatment scored significantly less anxious after the intervention, as well as 1 year later in a follow-up post-test. The authors concluded that the techniques are recommended for the treatment of young Puerto Rican children. Linden (1997) used a case study to relate the recovery process achieved by drama therapy. This description of the change, which occurred for a Japanese woman, was depicted by a review of the client’s history, her journal entries, summaries of the interventions and a recounting of the final performance. Vontress (1991, 1996) considered the traditional healing practices in Africa during his travels and studies there. He suggested implications for counselors based on his observations and studies. Vontress provided four categorical distinctions for different approaches to healing, as well as the historical background, for these approaches. He noted that loud music, chanting, dancing and other activities often accompany the healing process in these traditional practices and suggested that counselors investigate using those activities. According to Vontress, the presence of African artifacts and music may help African American clients alleviate anxiety. He also concluded that an extremely valuable lesson to be learned from South African counselors is how they contributed to the hope and support of clients who existed in a system of injustice and Apartheid—a hope that was finally rewarded. His studies have shown how psychological healing with traditional practices bridge the past, present and future for clients. Y The creative arts help clients develop new ideas and interests to use in relating to themselves and others outside of counseling. In an anecdotal account, Woodard (1995) described his experience when he was challenged to counsel the 10 worst-behaved boys in an inner-city school. He presented this case study which detailed the use of a model based on traditional African values and principles of character that are indicators of the beauty and wisdom of the African culture. One part of this counseling process involved a recreation of the Karamu (feast), as well as additional rituals. Another session was spent considering African proverbs. Over the course of their meetings, the behavior of the boys improved, resulting in less fighting and fewer suspensions for the 10 boys. An anecdotal account of a protocol designed to help Native American children discover new ideas and interests through the use of art was provided by Appleton and Dykeman (1996). A group of boys and girls, ranging in age from 7–17, met for seven sessions. The art activities that were chosen progressed from those using a highly controllable medium such as a pencil, to those requiring a less controllable media such as water colors. During the meetings, the group members were presented with various stimuli such as “draw a house” or “create something you have imagined or dreamed.” The students then explored themes of family, tribe and the non-Native society. The summary of the responses from the participants illustrated their discovery of new interests and ideas, such as their ability to create some order from a chaotic form and their expressions of a sense of powerlessness. The children’s evaluation of the group experience was positive. Y The creative arts bring clients together by giving them experiences that link them together with their past, their present, and their future. Y The creative arts help clients appreciate the beauty and wisdom of cultural backgrounds. Y The creative arts promote positive feelings and affect within people that can be tapped when celebrating and coping with life’s highs and lows. Ishiyama and Westwood (1992) provided multiple ideas for helping culturally-diverse clients adjust when they are dislocated or discouraged. Many of their suggestions included the creative arts. Some of these ideas involved using games, poems, scrap books, imaginary trips and cultural artifacts. These suggestions served to help the counselor participate as an active agent in validating the client. This validation should aid in clients recognizing deeper feelings, as well as helping them appraise their present situations HENDERSON AND GLADDING 186 and inner resources more realistically. In a previous article about the communication process as a critical intervention in counseling, Westwood and Ishiyama (1990) have also stressed using alternate modes of communication such as acting, drawing, using music, story telling and collage making to increase clients’ comfort and involvement. Y The creative arts engender hope, confidence, and insight into persons who have never realized their potential for living life to the fullest. Kalish-Weiss (1989) provided a description of an intervention designed for ethnic minority children and their families in Los Angeles. In this project, a treatment team implemented art and play therapies in order to improve services to seriously emotionally disturbed children, many who were not able to speak English well. The art modalities were used to overcome the language difficulties of the children and to capture the creative expression of the children. After defining problems of ethnic minority children, the team decided which combination of art and play therapy would be most effective for each client. The team then provided the combination of group and individual sessions for the intervention procedures. The success of this approach was evidenced by reductions in depression and poor academics, as well as by the children’s gain of self-confidence. The positive outcomes reflected in these examples resulted in increased hope and maximized potential in the educational setting. Alexander and Sussman (1995) present multiple ways to integrate creative arts into multicultural counseling. The citations above provide similar suggestions, as well as specific situations, in which the arts have been used in effective and successful counseling processes. Therefore, these examples strongly suggest that using creative arts in multicultural counseling is an excellent means of entering the world of the client and building on the client’s personal strengths. A case example provides even further evidence. A Case Illustration Jorge was 4 when his grandmother, Teresa, 55, and mother, Maria, 30, brought him to the United States from Mexico. The transition into a new culture was not too difficult for Jorge. His experiences at school helped him learn English and become acculturated, while he continued to speak Spanish and interact in more traditional ways at home. His mother and grand- mother struggled much more with the move. Maria learned enough English to get by and became accustomed to American habits through her work as a domestic servant. She developed friendships within and outside the Spanish speaking community. Teresa was more isolated; without work or avenues for developing relationships, she became depressed. She spoke only to a small group of people in her neighborhood who conversed with her in Spanish. As the depression grew worse, Teresa was urged by Maria to see a counselor, who in this case was also a priest, for help. The counselor, although not fluent in Spanish, did know enough of the language to establish a rapport with Teresa. Equally important, the counselor had a jade carving of a burro from Mexico on his desk. In talking with the Teresa, he mentioned this carving as one of his most prized possessions and handed it to her. The grandmother examined the carving briefly and then said to the counselor: “Esta es yo.” The identity which Teresa revealed of being the one who carried the burden for the family of moving into a new land gave the counselor an opening to inquire what the grandmother missed from Mexico that she could recreate in her new environment. The grandmother spoke of the dances she had attended and missed. The counselor seized the opportunity to have the grandmother demonstrate dance steps and compared the process of counseling to being an accomplished dancer. Subsequent sessions would begin with Teresa’s demonstration of dance steps and some movement experiences. Teresa took pride in her ability to remember and teach; she began working with Jorge at home to instruct him in dances from Mexico. She also began to move beyond the confines of her few associations to a community recreational center where she could participate actively without having to be fluent in English. The key to this transition to better mental health was art. Both the carving of the burro and the recreation of familiar dances aided Teresa in finding new meaning and breaking out of her isolation and depression. While it could be argued that the burro was a simple, fortunate happenstance event, the importance of culturally-competent counselors decorating their offices with works that appeal to clients from many cultures is apparent. Thus, happenstance in this case was planned as it is with other counselors who practice multicultural counseling. Had Teresa not been handed the burro, the counselor could have inquired what specific activities, such as those connected with the creative arts, she participated in when CREATIVE ARTS IN COUNSELING she lived in Mexico. This story helps illustrate the point that the creative arts can be brought into multicultural counseling without being intrusive. Summary and Conclusion The creative arts are ancient and yet contemporary in their use to prevent and remediate situations that may be distressful. Counselors who use the creative arts have, within their grasp, a tool that can help transcend the differences in clients whose cultures differ from their own. By employing selective creative arts that are amenable to clients’ backgrounds and interests, counselors can create a bridge that builds rapport and leads to better mental health for clients with whom they work. The creative arts are a universal language; therein lies their power. By employing the creative arts, counselors can compensate for some aspects of a culture of which they may be unaware and utilize areas of which they have cultural knowledge. In doing so, they can help draw out clients into competencies that build on clients’ strengths and abilities. Such a process empowers clients to relate in ways that are comfortable and effective. Likewise, this type of process helps counselors cross cultures in positive and productive ways. The results, as the research and case illustrations show, are a meeting of minds and a production of events that are beneficial for all involved. References Alexander, C. M., & Sussman, L. (1995). Creative approaches in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed.) (pp. 375–384). Alexandria, VA: American Counseling Association. Angelou, M. (1969). I know why the caged bird sings. New York: Bantam Books. Appleton, V. E., & Dykeman, C. (1996). Using art in group counseling with Native American Youth. The Journal for Specialists in Group Work, 21(4), 224 –231. Constantino, G., Malgady, R., & Rogler, L. (1986). Cuento therapy: A culturally sensitive modality for Puerto Rican children. Journal of Consulting and Clinical Psychology, 54(5), 639 – 645. Gladding, S. T. (1998). Counseling and the arts: The creative arts in counseling (2nd ed.). Alexandria, VA: American Counseling Association. Gladding, S. T. (1995, September). Creativity in counseling. Counseling and Human Development, 28(1), 1–12. 187 Hall, R. L. (1986). Alcohol treatment in American Indians populations: An indigenous treatment modality compared with traditional approaches. In T. F. Babor (Ed.), Alcohol and culture: Comparative perspectives from Europe and America (pp. 168 – 178). New York: New York Academy of Sciences. Hansberry, L. (1989). A raisin in the sun. In M. Meyer (Ed.), The Bedford introduction to literature (3rd ed., pp. 1781–1845). Boston: Bedford Books of St. Martin’s Press. Heinrich, R. K., Corbine, J. L., & Thomas, K. R. (1990). Counseling Native Americans. Journal of Counseling and Development, 69(2), 128 –133. Ishiyama, F. I., & Westwood, M. J. (1992). Enhancing clientvalidating communication: Helping discouraged clients in cross-cultural adjustment. Journal of Multicultural Counseling and Development, 20(1), 50 – 63. Kalish-Weiss, B. (1989). Creative arts therapies in an inner city school. Los Angeles, CA: Los Angeles Unified School District and Los Angeles County Department of Mental Health. (ERIC Document No. ED 341 911). Landy, R. J. (1997). Drama therapy in Taiwan. The Arts in Psychotherapy, 24(2), 159 –172. Lewis, P. (1997). Multiculturalism and globalism in the arts in psychotherapy. The Arts in Psychotherapy, 24(2), 123–127. Linden, S. (1997). Aiko: Drama therapy in the recovery process of a Japanese/Korean-American woman. The Arts in Psychotherapy, 24(2), 193–203. Omizo, M. M., & Omizo, S. A. (1989). Art activities to improve self-esteem among native Hawaiian children. Journal of Humanistic Education and Development, 27(3), 167–176. Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of Counseling & Development, 70(1), 6 –12. Pennebaker, J. W. (1991). Opening up: The healing power of confiding in others. New York: Avon. Riordan, R. J. (1996). Scriptotherapy: Therapeutic writing as an adjunct. Journal of Counseling and Development, 74(3), 263– 269. Spielberger, C. D., Edwards, C., Lushene, R. C., Montouri, J., & Plutzek, D. (1973). Preliminary test manual for the state-trait anxiety inventory for children. Palo Alto, CA: Consulting Psychologists Press. Sutton, D. F. (1994). The catharsis of comedy. London: Rowman & Littlefield. Vontress, C. E. (1991). Traditional healing in Africa: Implications for cross-cultural counseling. Journal of Counseling & Development, 70(1), 242–249. Vontress, C. E. (1996). A personal retrospective on cross-cultural counseling. Journal of Multicultural Counseling and Development, 24(3), 156 –166. Westwood, M. J., & Ishiyama, F. I. (1990). Client validation and communication in cross-cultural counseling. Journal of Multicultural Counseling and Development, 18(3), 163–171. Woodard, S. L. (1995). Counseling disruptive black elementary school boys. Journal of Multicultural Counseling and Development, 23(1), 21–28.