Therapy has always made many uncomfortable. The mere thought of sitting with a stranger and pouring our hearts out to them just makes many of us wiggle about. Plus, we seem to feel we are doing a good job of taking care of our mental health, so why bother?
Reaching the art space in downtown Cairo where Shima Youssef was holding her art therapy session, I was asked to paint three posters. "Just paint whatever," Youssef told me.
I painted random shapes and objects; then Youssef pinned my paintings to the wall staring at them as she sat, her forefinger on her mouth, deep in thought. Youssef brought to the surface fact after fact about myself; all through questions which she gave the option either to talk about or skip. She mentioned anxieties and thoughts that I had not even communicated to my closest friends. Perhaps what was most appealing is that the feeling of discomfort was no longer there.
What is art therapy?
"An art therapist is a mirror in which you can see yourself clearly. Through this mirror you can know who you are and feel you are more tangible to yourself," Youssef explained. "It is not our job to guide you or give advice," she added.
Art psychotherapy involves a process where a client or patient draws or paints, then an art therapist analyses these artistic expressions, through one or several conversations with the client.
Youssef and Dr Suzan Radwan, have been practicing art therapy in informal settings such as cafés, cultural centres, festivals, as well as on-call since October 2011. They were both mentored in art therapy under the late Dr Magdi Refaat, Egypt's most prominent art therapist who passed away a few years ago.
"The analytical, Freudian, approach of art therapy we use depends on the fact that the person making the art work imprints their personality, conflicts and subconscious on the art work," said Radwan, an art therapy practitioner who is a licensed therapist currently working in a rehab centre. "We look at the work as a whole in relation to the person we are sitting with, from the way they carry out the art work, to their choice of colours, tools and materials," she elaborated.
"It's not a recipe," Carol Hammal art psychotherapist explained. "Art reflects who you are from the inside out. You create the artwork’s pictorial elements the way they are driven by your unconscious mind, and literally externalise what’s inside of you."
Hammal, is the only licensed art psychotherapist working in Egypt. After completing her Masters Degree in one of the American Art Therapy Association's (AATA) approved courses in Drexel University in Philadelphia, she returned to Cairo. She currently works at Behman Hospital for psychiatric care as their art therapist and art therapy consultant in several units, including their large addiction unit. Hammal had previously worked with the late Dr. Magdy Refaat, at Behman Hospital. "Art expresses what is so deep in the psyche and provides clues," she asserted.
"Art therapy helps us get through to clients," Radwan explained. "In classic therapy it takes 1-3 sessions for a therapist to break the ice and gain the client's confidence to get them to really start to talk and express their issues. In art therapy you bypass all this, and the issues are already expressed."
According to Johari's Window model – initially developed by psychologists in the 1950s – human awareness is divided into several parts: What I know and others know; what I know and others don't (our secrets); what others know and I don't know (our blind spot); what neither I nor others know (our black spot).
"Art therapy is the way to get to this dark area of the black spot, which is the same black spot that Freud said can be reached through dreams," Radwan said. "This dark spot can be sensitivities, traumas that have been suppressed and can resurface through certain catalysts."
"Art is an expression of the subconscious."
Therapy and Egyptian culture
In Egypt, therapy is still very much a taboo. People who regularly visit therapists often hide the fact, and if someone has any sort of nervous breakdown families go to extreme measures to hide it from society rather than reach out for professional help.
"In Egypt, very few will refer to a mental health professional if they need help," Hammal explained.
Hammal believes a person needs to be healthy both physically and mentally. "People need to be aware of their lives, analyse their experiences to be able to help themselves and develop," she said.
"In Egypt, we are all going through political trauma at the moment," Hammal comments. "We experienced a constant level of violence, grief, loss, chaos, and pain for over a year, on a very personal level, whether it’s because we lived through it, or witnessed it. That alone is a major stress factor that can lead us to experience high levels of anxiety."
Hammal explained that in these extraordinary circumstances, which add to the everyday stresses of work, social life and so on, people need to take care of their mental health, and should seek help if they need it without shame or guilt.
"If you have a car, you can either take it for regular maintenance to check on its oil, tyres and other components, or you can wait until the car completely breaks down and by then, fixing it can sometimes be a much harder and a more costly task," Hammal said comparing taking care of our mental health with the process of maintaining a car properly.
"Art therapy decreases defenses a lot faster and quicker as it deals with non-verbal expression which is innate within us from the day we are born," Hammal said stressing the fact that art therapy is a perfect way for Egyptians to accept the concept of mental health help.
History of art therapy
Art therapy is relatively new. The concept dates back to the 1940s with two different approaches to using art in the therapeutic process. The mothers of Art Therapy are Margaret Naumburg who created Art Psychotherapy, while Edith Kramer conceputalised art as therapy, whereby the process of creating art works helps boost people's ego. This kind of work is not uncommon in Egypt’s social development work where art is used as a tool to empower communities to self-develop.
However, it was not until 1967 that Myra Levick founded the field of art therapy and turned it into a profession. She founded the American Art Therapy Association (AATA) in 1969, which currently is the only international association for all licensed art psychotherapists around the world and organises an annual conference.
In Egypt, Dr Refaat was the only health professional that practiced art psychotherapy, even though he was never a part of the association.
"He was a school on his own," Youssef explained. "He was almost like a prophet," she said.
Dr Refaat, in addition to working as an art therapist in Behman had an open studio on the rooftop of a building in downtown Cairo where anyone could come paint and have a session with him afterwards.
"It was spiritual. It gave its visitors a utopian feeling as the place was full of positive vibes," Youssef said describing the centre that closed down after Dr Refaat's death. She described the studio as primitive with its walls covered in paintings by the visitors, along with plants, and painting tools around the roof.
In his last years, he mentored Youssef and Radwan. "We were following him like his shadow," Youssef said with a smile. Both used to attend his sessions with him, and he was constantly pushing them to both run sessions on their own.
"He believed art therapy is a talent," Youssef then explained that when she showed interest in studying art therapy, Dr Refaat preferred she worked with him first to nurture that talent before deciding to pursue her studies.
Hammal also worked with Dr Refaat in Behman and visited the art studio a few times. However, she believes that while it is highly beneficial to get clinical exposure, it is not a requirement as a big part of her Masters' degree involved working in clinics and hospitals. During her degree, she assisted art therapists as well as had licenced art therapists shadow her work before she was completely on her own treating patients using art psychotherapy.
Art therapy in the clinics
While art therapy helps those with no mental disorders, but merely psychological issues which we all have, it has also proven to be a useful tool in assisting people with mental pathologies or disorders.
Art therapy is particularly useful when working with disorders such as depression, anxiety, schizophrenia, eating disorders, addiction, as well as others.
"Whether the addiction they are suffering from is substance abuse, sex addiction or they are workaholics, art therapy can be a useful tool," Radwan stated.
When a group of people are suffering from a similar issue, it is common to have group therapy for them in order for the patients to have the ability to relate to one another and to form a support system.
"Your job as an art therapist in group sessions is just like a conductor in an orchestra. You orchestrate what group members externalise and integrate it within the group itself to create a balance between the members and establish trust – just like an orchestra creates a harmony out of a group of melodies," Hammal explained.
Both Radwan and Hammal, who work with art therapy in a medical sphere, explained that an art therapist is part of a team of mental health professionals. As a team they work with a patient to overcome their obstacles and be ready to join society. It is not an art therapist's job to give medication.
Children and art therapy
"Children are the easiest to work with as they have fewer inhibitions about expressing themselves through art," Youssed said. "Give a child paint and paper and they will paint for you."
Schools and community centers can hire art therapists to run a session with the children. The therapist can then provide insight into some of the issues encountered with the children to their parents and the school administration. Art therapists can help determine through the child's painting what kind of anxieties they have, if they are being treated well at home and school, and even determine if the child is transitioning normally through their childhood.
"Children respond really well to art therapy and are sometimes even able to analyse their own work while they are painting," Radwan explained.
She told a story that she experienced with a nine year old girl she was working with. Radwan asked the girl to draw a problem and a solution. The girl managed to create a beautiful colour that made sense to the painting and with Radwan made a mix of colours with hand-prints. The girl then said "Every problem has a solution, if we just be patient and approach it in different ways we can always solve the problem." According to Radwan, with an adult this realisation can take several sessions.
"Children are very fresh and open; they respond very well to visuals," Radwan explained.
Future dreams and plans
Radwan and Youssef dream of opening an open studio, like that of the late Dr Refaat, where people can come in to a positive environment regularly and express themselves. It is a long term plan as they hope to study art therapy further first.
Hammal, on the other hand, hopes to create an art therapy masters programme in Egypt. "That's when we can really benefit the population," she said.
Hammal hopes to get a few people interested in pursuing their Masters Degree in art therapy in one of the AATA approved courses abroad, and from there start teaching and spreading art therapy, and eventually create the programme in one of the Egyptian universities.
- Dr. Suzan Radwan and Shima Youssef hold regular art therapy sessions every Sunday from 5pm till 9pm in Sufi Bookstore (except for Sunday 14 April, as they will be holding art therapy at Dahab Festival)
Sufi Bookstore, 12 Sayed Al-Bakry Street, Zamalek, Cairo
- They hold sessions by reservation in Art Café. To reserve call 01227050753.
Art Café, Maadi Al-Sarayat, Street 13, Villa 62, behind the police station of Maadi
Descriptions for images above
Person Picking an Apple from a Tree (PPAT) assessment: This assessment addresses problem-solving skills and can help a patient identify the level of realism within their coping mechanisms. Here, a patient climbs the tree to reach for the apple in order to pick it. The art process allowed the patient to explore their strengths more easily than they did in other forms of therapy.
Here a patient displays what they need to reach sobriety from their addiction. What is inside the shield, protects the person against addiction triggers that are displayed on the outside of the shield. This task helps patients to identify and to become more aware of their addiction triggers, while also identifying their coping skills that they adapt throughout their treatment.
All images are published anonymously with full consent of the patients and given to Ahram Online by Carol Hammal.