Author: Kathleen Slade Hofer, MS TRS

Art can be used as a powerful therapy to help a woman recover from an eating disorder. In the process of creating her own art, she must participate in her own therapy, and thereby her own recovery. The initial commitment to paper is also a commitment to the recovery process. Art works are not found, they are created, and they require a person to initiate action. While in an intensive therapy relationship, concentrating on a painting removes the focus from the patient and provides a safer, non-threatening arena for disclosure. Pictures can facilitate personal exploration and provide a safe vent for strong emotions such as anger, depression, fear, anxiety, or hate. They can help the patient to “express the mess.” Women with eating disorders hate their emotional “mess” which is often symbolically flushed down the toilet in secret. “Purging” on paper can become an important transitional tool for the therapist and the patient as she unlocks her hidden inner world.

The actual process of painting helps to break down defense mechanisms as projected images often escape internal censorship. Art images have a boundary that can contain whatever feelings of chaos may be expressed within them. Artwork by a woman with an eating disorder can become a container for unconscious material that begins to bridge the gap between inner and outer worlds. It can be an intermediary between the racing thoughts in the head and the numbed emotions of the heart. The patient can begin to express her needs and feelings through images and words rather than through her body and behavior. Art used in therapy may provide the first experiences of safety, and the first expressions of pain.

Through the art process and the relationship with the therapist, the perceived empty and unlovable self can be safely experienced. The patient can begin to give up her hateful, defective self-image as she discovers her creative potential. The process of creating art is a means of experiencing the true authentic self — the self as a whole. Growth and progress are recognized and supported. Self-acceptance and self-soothing are taught and encouraged. The patient is validated as the authority concerning the meaning and interpretation of all her own artwork. Mastery over the art materials often correlates with mastery over fears. Experiencing the self in art increases self-cohesion over the course of time and strengthens the sense of boundaries.

The activity of creating art often brings back early memories of playing, and the inner child has a space in which to come alive, to vent frustration, and to express sadness. Like play, art is a symbolic, pictorial communication. If the patient does not feel she had enough nurturing and has not learned how to listen to her own needs, she will be both hungry for more and at a loss to know how to feed herself, literally and metaphorically. Images, the basic form of memory, hold important information that relates to perceptions of self, the world, and one’s self in that world. Art facilitates the emotional repair of the psyche and the empowerment of spiritual reconnection.

“Utilizing imagery, creativity and the arts in the healing process is an age-old practice that transcends time and culture…it is a means to gain self-awareness, reconnect to the strength of soul/spirit and to influence desired change. Creative experience breathes life back into what has often become an empty routine of existence.”

Sue Kimball M.A., Art Therapist

A woman obsessed with the size of her body may be expressing the fact that she feels uncomfortable being female in this culture. Art provides a means for a young women to give “voice” to the pain of becoming an adult woman, crossing thresholds unknown to their mothers. Societal assaults on female bodies and minds fill young women today with shame and fear of their own rage. Many of the young women I work with have a terrifying fear of becoming mature and independent as they associate being independent with being alone and alienated. They need adult females who model assertiveness, self-acceptance, self-nurturing, spirituality, and joy. I have found, as an experiential therapist, that I must often become an auxiliary ego for the patient who is developing ego strength. I can provide empathy and soothing, and I can mirror the patient through verbal reflection and repetition of themes in their art. The mirroring of the patient through art confirms the individual’s uniqueness.

A trained eating-disorder professional with a respect for experiential therapy, the art process, and a personal involvement in creativity can use art as therapy. Emphasis must always be on the patient’s own interpretations and self-understanding. In moving to symbolic, kinesthetic expression we are agreeing to speak the patient’s own language. Women with eating disorders adopt complex, metaphoric means of expressing their emotional pain which suggests they have difficulty articulating it. I have found that I can provide an experience which helps the patient “show” what she cannot “tell.” Often, the only time a patient is truly honest and non-defensive is in her artwork. Art can also provide visual evidence of a patient’s strengths and progress, providing hope to the treatment team.

Art can, at times, be used as a defense by anorexic patients. Empty, stereotypical art is often used as an anorexic patient seeks to please others or to intellectualize reactions. When the patient is threatened by emotions that seem out of control, defensive art can provide a sense of safety. The therapist can accept, but not encourage stereotypic artwork. As trust increases, the patient can be invited to experiment with experiences of losing control with the art materials. Patients can be gently encouraged to “color outside the lines” and let go of pencils, rulers, and rigid art making. The creative act especially provides for adolescents who need a means of safely handling anxiety, tolerating conflicts, and exploring alternative solutions. Art gives form to chaos and a way to work through the struggle of separation. Creativity operates in the service of maturation in development. Creativity is a human birthright and accessing this power of life force energizes the creator. Control over art materials provides an outlet for wishes of control.

Art materials such as soft pastels, oil pastels, and acrylic paint promote the expression of affect, encouraging self-expression. Finger paints may encourage regression because of smearing and its similarity to body fluids. Clay can also invite regression, yet can also support reintegration. Regression presents the possibility of reworking early unmet needs. Making collages with magazine pictures is usually perceived as safe and is encouraged if the patient becomes too apprehensive. Body tracings can be made and the patient then asked to create an “emotion self-portrait” in order to explore their inner world. Face masks can be created and painted to reflect the identity of appearance, as well as what is internal underneath the mask. Feelings concerning the physical body are related to feelings and experiences of the psychological self. The patient often fears that if another person “gets inside her” she will lose any sense of self that is still there. Art making can provide a safe place to let others see inside the eating-disorder sufferer’s world.