Creative Drawing, Storytelling, and

Symbol StrategiesDavid A. Crenshaw, Ph.D., ABPP, RPT-S

Clinical Director, Children’s Home of PoughkeepsieFaculty Associate, Johns Hopkins University

Wittgenstein: “You can’t enter any world for which you don’t have a language.”

“You can’t build loving relationships without a language for affection” (David Whyte, 2008, The Three Marriages, New York: Riverhead)

You can’t build therapeutic relationships without a language for healing. Distinction between healing and treating.

Introduction

Self-Calming Rituals Centering Stones “Sandy Bottom” (Siegel, Kabat-Zinn) Creating Safe Places

◦ Build with materials in the room◦ Create in fantasy◦ An internal space◦ With Clay◦ In Sand◦ Make a collage◦ Family Puppet Play

Goal 1: Making Therapy a Safe Place

Coping with Dissociation (Yvonne Dolan)◦ Counting second hands on a watch◦ Counting fingers◦ Counting books with blue jackets◦ Rule of 2/3rds (Kevin O’Connor)

Timing and Pacing◦ Metaphor of Family Photo Album (Joyce Mills)◦ Box of “unmentionables”◦ “Garbage bag” (Beverly James)

Goal 1: Making Therapy a Safe Place (continued)

Affect Regulation◦ Volcano Drawings (Eliana Gil)◦ Storm Drawings (Rage or Terror Expression and

Modulation)◦ Angry Monster◦ Fire-Breathing Dragon◦ Raging Bull ◦ “Party Hats on Monsters” (Crenshaw, 2001)◦ Projective Drawing and Storytelling: “Blow-Up

Bernie” (Crenshaw, 2008a)◦ “Downshifting”

Goal 2: Coping, Psychoeducation, and Social Skills Training

Play Strategies◦ “Alligator goes Ballistic”◦ “Passport Protected Coping Club”

Cognitive Strategies◦ Problem solving and develop laminated “Menu of

Best Coping Strategies”◦ Problems solving and develop laminated “Menu of

Best Coping Statements”◦ Safety Plan

Goal 2: Coping

Learning the Language of Feelings◦ Feelings Map (Drewes)◦ Heartfelt Feelings Strategies (HFS)◦ Expressive Cards in the Heartfelt Feelings Coloring

Card Strategies

Education about Specific Symptoms◦ Flashbacks (voluntary vs. involuntary subjective

experience—Jay Haley)◦ Dissociation (when it is helpful—when it is not)◦ Teach about Defenses (Metaphor of “Fawn in Gorilla

Suit”)

Goal 2: Psychoeducation

Role Playing Behavioral Rehearsal Social Skills Training Groups Empathy Training Exercises Recognizing Social Cues Reading Facial Expressions Starting and Maintaining Conversations (last 3

particularly valuable with Asperger’s and Non-Verbal LD, but aggressive and traumatized child, highly anxious children as well)

Importance of Humor

Goal 2: Building Social Skills

Honoring Strengths and Validation◦ Personal symbol of Unique Genius (David Whyte)◦ Symbols representing Strengths or Redeeming

Qualities◦ “Badge of Ability” (Hardy & Laszloffy, 2005)◦ Projective Drawing and Storytelling: “The Ballistic

Stallion” and “The Wise Ole Owl” (Crenshaw, 2008a)

◦ “Mountain of Strengths” (Crenshaw, 2006)◦ “Cumulative Strength List (Mordock)◦ “Superheroes” (Larry Rubin)

Goal 3: Facilitating Positive Idenity

Reframing Suffering as Basis of Strength (Ben Furman)◦ “Courage Tapes”◦ Stories of Sports Heroes (Crenshaw & Barker,

2008)◦ “Three Doors” (Door #1, Crenshaw)◦ Shifting Identification from Aggressor to

Empowering Helper Role (Kevin O’Connor) Developing Capacity for Gratitude

◦ “Coins in Fountain”-An exercise in appreciation (Crenshaw)

◦ “Giving Thanks”

Goal 3: Facilitating Positive Identity

Directed Drawings

◦ “Inside/Outside” (Beverly James, 1989)◦ “Color-Your-Life” (O’Connor, 1983)◦ “Boat in Storm” (Oaklander, 1988)◦ “Your Place” (Oaklander, 1988) ◦ “The Cave” (Crenshaw)◦ “Serial Drawings” (John Allen, 1988)

Goal 4: Accessing the Inner World (Creating Portals of Entry)

Projective Drawing and Storytelling◦ “The Misunderstood Mouse” (Crenshaw, 2008a)◦ “The Secret Life of Nicole” (Crenshaw, 2008a)

Clinical Use of Symbols◦ Symbol Association Therapy Strategies (SATS-C)

(Crenshaw, 2008a)◦ Directed Symbol Work◦ HFCCS (Relational Strategies)

Child Directed Play◦ A Case Example: “Stitches are Stronger than Glue”

Goal 4: Accessing the Inner World

Spontaneous Drawings◦ Clinical Example: “The Dragon in the Well for 150

Years”

Creative Writing

Poetry

Music

Journal Writing

Goal 4: Accessing the Inner World

Loss and Grief

◦ “The Magic Key” (Crenshaw, 2008a)◦ “The Puppy in the Animal Shelter” (Crenshaw,

2008a)◦ “The Bunny seeking her Mother” (Crenshaw,

2008a)◦ HFCCS Relational Strategy (“Person who will be in

your heart forever”)◦ “Heart Symbol Strategies” (Crenshaw)

Goal 5: Addressing Issues of Loss, Grief, and Traumatic Grief

“The Linking Object” (Crenshaw, 2008a)

◦ Based on psychoanalytic writing of Volkan (1983)

◦ Rationale: Traumatic grief that the child can’t access, detached or cut-off from feeling. This disconnection is causing problems in the child’s functioning and other less evocative strategies have been tried.

◦ This is an intervention (not a strategy) that should only be used under supervision or in close consultation with a colleague

Goal 5: Traumatic Grief

Projective Drawing and Storytelling Strategies◦ “Fourteen going on Twenty” (Crenshaw, 2006)◦ “Mike’s Version of Russian Roulette” (Crenshaw,

2008a)◦ “Eli and Zuko in the Land of Endless Hope”

(Crenshaw, 2006)

Project Approach with Adolescents (unsafe sex, dangerous driving, alcohol and drug abuse, eating disorders, self-mutilation, and suicidal spectrum behaviors)

Goal 6: Addressing High-Risk Adolescent Behavior

Projective Drawing and Storytelling◦ “Jake the Boy who sit alone in the Cafeteria”

(Crenshaw, 2008a)◦ “The Pig who Didn’t Fit” (Crenshaw, 2008a)◦ “Behind the Closed Door” (Crenshaw, 2008a)◦ “The Fair Trial” (Crenshaw & Mordock, 2005b)

Soliciting Prideful Stories with Child and Family (Fiona True, Ackerman Institute for the Family)

Goal 7: Addressing Social Rejection, Stigma, and Shame

HFCCS (“Relational--Person who was once in your heart but no longer is”)

“The Three Doors” (Door #2, Crenshaw, in press)

Child-Directed Symbolic Play Clinical Use of Symbols (“The 140lb. Weight

on my Back”) Projective Drawing and Storytelling

◦ “The Tree on the Hill” (Crenshaw, 2008a)

Goal 8: Creating the Trauma or Life Narrative (Cohen, Mannarino, & Deblinger, 2006)

“Hope can be Dangerous” (Walter Bonime, M.D. Senior Training Psychoanalyst)

“Magic Stones” (Crenshaw, 2006) “The Three Doors” (Door #3, Crenshaw, in

press) Scaling Techniques (Solution-Focused)

“House of Hopes, Dreams, and Promises” (Crenshaw, 2008a)

Goal 9: Facilitating Hope

“Story of Jose and Pete on the Mountain” (Crenshaw, 2006)

Countdown Album Talk Show Letter “One Last Conversation”

Goal 10: Facilitating a Positive Termination

“Doing” is the easy part (Crenshaw, 2006, 2008a)

Conversations with Ken Hardy, Eliana Gil, and Garry Landreth

“Being” is much harder. It takes a certain maturity and ripening as a therapist to appreciate the importance of “being” as well as to realize just how difficult it is to be fully present in the midst of a child or family’s raw pain (Crenshaw (ed.) 2008b

Difference Between “Doing” and “Being”