Art Therapy

Journal of the American Art Therapy Association

ISSN: 0742-1656 (Print) 2159-9394 (Online) Journal homepage: http://www.tandfonline.com/loi/uart20

Enhancement of Body-Image: A Structured Art

Therapy Group with Adolescents

Stanley Schneider Ph.D. , Shelley Ostroff M.A., A.T.R. & Nancy Legow M.A.,
A.T.R.

To cite this article: Stanley Schneider Ph.D. , Shelley Ostroff M.A., A.T.R. & Nancy Legow M.A.,
A.T.R. (1990) Enhancement of Body-Image: A Structured Art Therapy Group with Adolescents, Art
Therapy, 7:3, 134-138, DOI: 10.1080/07421656.1990.10758908

To link to this article: http://dx.doi.org/10.1080/07421656.1990.10758908

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Enhancement of Body-Image: A Structured
Art Therapy Group with Adolescents
Stanley Schneider, Ph.D., Director, Summit Institute, Jerusalem, Israel
SheZZey Ostroff, M.A., A.T.R., Director, Vocational Rehabilitation Center, Summit Institute,
Hebrew University, Jerusalem, Israel
Nancy Legow, M.A., A.T.R., Intern in Art Therapy, (1986) Summit Institute, Jerusalem, Israel
Abstract
This paper presents a structured,
short-term a r t therapy group de-
signed to enhance the self and body
image of adolescents with emotional
disturbances. The concept of self and
body image is reviewed with a focus
on the developmental phase of ado-
lescence. The focused exercises uti-
lized in the group is described w i t h
explanations and descriptions of
purpose.
The influence of the group on the
development of the self concept is ex-
plored in general, and the specific
therapeutic use of the group in this
context is emphasized. This art ther-
apy group has been developed and
used a t the Summit Institute, a psy-
chia tric residentia 1 treatment facility
for emotionally disturbed adoles-
cents and young adults in Jerusalem,
Israel, and has been found effective
in providing group members with an
experience whereby they can begin to
perceptually, emotionally and cog-
nitively work through conflictual
issues related to their self and body
image.
Self ImagelBody Image: Theoretical
Formulation
The first written description of
body-image disturbance was from a
neurological frame of reference and
is found in the works of Ambrose
Pare, a sixteenth century surgeon.
He wrote about phantom limb dis-
turbances in patients following am-
putation (Kolb, 1959); a unique neu-
rological phenomena whereby the
inner neurological percepts belie the
outer reality of a missing limb. How-
ever, it was not until the writings of
134 ART THERAPY, Fall 1990
Head, the neurologist, in 1920, that
the basic concepts of the body-sche-
ma, as we know it today, began to
take shape.
The application of body-image
theory to psychiatry was pioneered
in the works of Paul Schilder (1950),
who conceived of a tripartite, tri-
dimensional unity: a physiological
and sociological basis, and a li-
bidinous structure. Narcissism, ex-
pression of emotion, social relations
and identification were some of the
psychological concepts he intro-
duced to the body-image literature.
He suggested that “the development
of the body-schema probably runs to
a great extent parallel with the sen-
sori-motor development” (Schilder,
1950).
With the works of Melanie Klein
(1946), Bion (1962), a n d Guntrip
(1968), object relations theory moved
forward; we now note an articula-
tion of the interaction between sub-
ject and object not only on a phys-
ical level, but also on a feeling level.
Sandler (1976) carried this further
with his concept of role-respon-
siveness.
In the literature we find various
terms that are used interchangeably
with body-image: ”self awareness,
self-concept, the self, body-ego, self-
identity, and body-schema” (Schon-
feld, 1969). Torras De Bea (1987)
notes that in the field of psycho-
analysis, the term most frequently
used has been ’body-schema.’ ”This
is probably because the term ’body-
schema’ has been used to denote the
representation of the body in the mind
. . . (and is) the identity factor that
represents the body (1987)”. This
holds true for the parent as well as
for the child’s conceptualization of
the body percept. The introjection
and projectives (including projective
identification) that take place be-
tween mother and child, will influ-
ence not only the emotional devel-
opment of the child, but also the
body schema of the child which is
part of the object relations realm.
Thus, body-image can be seen as
an interactive process between the
structural internalizations and the
object relations dyad. Schonfeld
(1969) defines the structure of the
body-image as being determined by:
”1. subjective perception of appear-
ance and ability to function . . .
2. internalized psychological factors
. . . 3 . sociological factors . . .
4. ideal body-image.” Torras De
Beh’s (1987) object relations view is
that “the child partly ’receives’ its
body schema from the mother and
father and from the sensorimotor ex-
periences with all their relational
and affective components.”
Melanie Klein added ”life” to the
world of objects. Laplanche and
Pontalis (1980) stated: ”Objects (pro-
jected, introjected) actually act upon
the subject-they persecute, reas-
sure him, etc.” In Kleinian terms,
the interrelationship between sub-
jects (objects) is not only a physical-
spatial one, but also an experiential-
emotional one. Identity, in the Klei-
nian view, takes on a feeling aspect.
This parallels the thinking of Federn
(1952) who had differentiated the
ego from the body-image and at-
tempted to separate a mental and
body ego. Bodily ego boundaries
and ego-feeling included not only
somatic but also mental/emotional
phenomena.
Adolescence and Body Image
In dealing with adolescents who
are, developmentally, in the contin-
uous process of ego-identity forma-
tion-the concept of body-image and
its potential disturbance, is of para-
mount importance. Erikson (1964)
wrote of the resolution of the bound-
aries of ego development as part of
the process of adolescence. The
boundaries help delineate the in-
ternal structures and repositories of
feelings from external aspects. On
an emotional level, the ’inner’ and
’outer’ dimension of the identity
process allows the person to recog-
nize himself/herself and to feel rec-
ognized’’ ( E r i k s o n , 1964; cf.
Schneider, Berman, Aronson, 1984).
Body schema occupies an impor-
tant part in the adolescent’s emo-
tional development with a quicken-
i n g of c o n c e r n , i n t e r n a l ( a n d
sometimes, external) conflicts and
fantasies. The physical changes of
adolescence awaken new and un-
familiar feelings with a concomitant
intensification of emotional turmoil.
Parallel development of cognitive ca-
pabilities such as introspection and
abstraction enable the adolescent to
”look at” what s/he is feeling. This
involves perception of self by her-
self/himself as well as concern re-
garding one’s perception in the eyes
of others.
The adolescents’ attempt at inte-
grating the dramatic physical and
psychological changes into a co-
herent self image are largely deter-
mined by the ego strengths s/he
brings to this developmental stage as
well as by the way in which s/he
perceives herself/himself in the eyes
of others. This self percept may be
relatively realistic or distorted. The
generally difficult a n d painful
growth process of formulating a
healthy, positive a n d integrated
body image may be complicated in
the adolescent with emotional diffi-
culties and unresolved conflicts from
previous stages of development, or
in the adolescent with perceptual
and/or learning disabilities.
The adolescents’ preoccupation
with her/his changing body is gener-
ally an intra-psychic process and cer-
tain aspects of the body image which
are unacceptable to her/him because
of real or fantasized deviations from
the norm are often magnified be-
yond proportion. Oftentimes this
may emerge as a fixation on a partic-
ular body part. When the adolescent
has had inadequate preparations for
the physiological changes which
occur, these changes may be per-
ceived a s frightening a n d in-
comprehensible. Information sought
out “secretly” may be internalized in
distorted ways, further impeding the
integration of a healthy body image.
Mocking and scapegoating those
with deviant physical appearances
serves for some as outlets for in-
ternal tension over what is an un-
comfortable and even taboo subject.
While the adolescent is constantly
(overtlykovertly) comparing herself/
himself with peers, the difficulty in
dealing directly with the subject of
body image, and the embarrassment
surrounding it, prevents her/him
from sharing concerns and fears and
confronting them with reality. Par-
ents sensing their adolescent’s anx-
iety and herhis focusing on a certain
body part, may ”adopt” the adoles-
cent’s concern, thus reinforcing it as
a genuine problem. The symptom
then takes on the quality of the
focus of attention rather than the un-
derlying anxiety. Among the more
emotionally disturbed adolescents,
these concerns are often converted
into somatic symptoms. Sometimes
adolescents utilize denial and repres-
sion as defense mechanisms in an at-
tempt to continue being a dependent
child. Fears may be manifested
overtly and may be expressed as sex-
ual acting-out or verbalized concern
about sexual identity.
A Structured Therapy Group
Our plan was to create a carefully
structured art therapy group on the
subject of the human figure which
we hoped would encourage the for-
mation of a more positive, healthy
and integrated body image. The art
materials and structured exercises
provide media with which the group
could actively explore, confront, and
create images of the human body.
The m e t a p h o r i c a n d symbolic
qualities of art provide a safe realm
in which the participants can begin
to cognitively, tangibly and emotion-
ally work-through distortions, anx-
ieties, confusion and conflictual
issues related to their own body im-
ages and identity.
Because of the significance of the
peer group in the formation of the
adolescent’s self image, we utilize
the group as an important part in
the therapeutic process. Concepts of
self-image and body image are inter-
related as a complex perception by
the individual of herselflhimself
based on physiological, psychologi-
cal and social factors. Self and body
image are directly related to the
feedback an individual receives from
others. A person feels a stronger
sense of herhis own existence when
s/he is related to and not ignored by
others. Her/his attitude toward self
is, in a large part, based on past ex-
periences of positive and negative
feedback.
Even though art work is, in many
ways, perceived as an extension of
self, it nonetheless provides a less
threatening transitional medium for
communication and feedback on the
subject of self and body image. The
group meets for twelve sessions.
Each of the sessions ends with a
group discussion where members
are encouraged to relate to their own
art work as well as to that of others.
Many adolescents are so nar-
cissistically preoccupied with their
own self image, seeing themselves
as inferior or different and perceiv-
ing the other as superior, enviable,
etc. that they are often not real-
istically aware of the individual dif-
ferences among others or of shared
anxieties. Being confronted with dif-
ferent “body images,” emotions, fig-
ures, portraits and facial expressions
as expressed in the art work, forces
Fall 1990, ART THERAPY 135
a confrontation w i t h differences in
terms other than “good’/”bad”, ”ac-
ceptable”Y’unacceptab1e.” When the
group has established a safe, inti-
mate sense of cohesion and trust,
these differences are often spon-
taneously related-back from the art
work to the group members. How-
ever, this occurs on their own ini-
tiative and only at the level with
which they feel comfortable. As an
example, if a person places her/his
clay figure apart from the clay fig-
ures of others and says that the fig-
ure is alone s/he may continue by say-
ing that maybe it is because s/he too
feels alone.
A range of activities involving a
variety of media were designed to
focus on different areas of cognitive,
perceptual, and motoric functions
and skills and emotional conflicts re-
garding body image. In addition, the
group provides the adolescents with
an enriching and ego-building en-
counter with art activities. A descrip-
tion of the activities is presented in
chronological order. Because of the
emotionally conflict-laden aspect of
the theme of this group, resistance
was initially anticipated. Participa-
tion in the group is voluntary, al-
though, after the initial commit-
ment, obligatory as a therapeutic
activity. Indeed, certain adolescents
rejected the idea outright. Yet, the
majority in this setting accepted it
enthusiastically, particularly after
hearing about the group from pre-
vious participants, as a rewarding
experience. The activities were care-
fully designed so that they pro-
gressed from more simple and less
threatening to a more direct and
complex confrontation with the sub-
ject matter.
Activity 1 (session #l)-Colluge
Materials: colored paper, scissors,
glue
Description of activity:
Construction of a collage figure using
colored paper and involving the cutting-
out and pasting of simplified shapes of
136 ART THERAPY, Fall 1990
the body onto a background of colored
paper.
Rationale:
This activity allows for a simple ex-
pression of the body. It requires the
basic steps of identifying and placing
parts of the body, taking into considera-
tion their relationship and proportions to
one another. This exercise is somewhat
non-threatening in that it permits a su-
perficial approach without evoking the
need to defend against relating to more
emotionally laden areas of the body in a
detailed manner. The colorful materials
and relative simplicity of the task ensure
an aesthetically pleasing outcome with
little performance variability among
group members based o n talent or
sophistication.
Activity 2 (session #2)-cluy fig-
uye
Materials: Clay, clay tools, wooden
artist’s mannequin
Description of activity:
After a demonstration by the art thera-
pist of two methods of building clay fig-
ures, the parts of the body are pointed
out using an artist’s wooden manne-
quin. The participants decide on the
movement of the figure and the feeling
expressed in the movement and then
demonstrate on themselves the position
they choose. They then create the clay
figure. The closure of this activity in-
volves the group members placing their
figures on a clay base, in relation to one
another.
Rationale:
Clay is provided to encourage and de-
velop a three-dimensional, tangible, tac-
ticle sense of the body‘s mass and to
consider it from less familiar perspec-
tives. Clay does not require fine coordi-
nation but is geared towards a grosser
conceptualization of the figure while still
allowing for the avoidance of details.
The bodily movement exercise invites
group members to begin to relate to their
own bodies, how they move and to ac-
tively think about the body as a dynamic
mass in space. The placing of the figures
in relation to each other is designed to
stimulate the awareness of, and interac-
tion with, other members of the environ-
ment. The group members, in a “story-
like manner,” discuss their figures’
actions a n d feelings in relation to
“other” sculptures, and, in doing so, in-
teract indirectly with each other on a
symbolic level.
Activity 3 (session #3)-Two por-
traits in color expressing feeling
Materials: 8%’’ X 11” paper, pencil,
eraser, oil pastels
Description of activity:
Two portraits in color are drawn in
order to convey two different emotions.
The expressive, rather than realistic,
quality of the picture is focused on, and
portraits of famous artists are shown
with a discussion of the use of line,
color, expression and composition. Mir-
rors are available so that group members
can study their own faces and changes
in expression. Emotions expressed by
the group members in
this session are explored in this context.
Rationale:
At this stage, the group is beginning
to experience itself as a cohesive entity
with a strong involvement in their
shared group experience. It is felt impor-
tant to allow for and encourage an open
airing of some of the feelings and emo-
tions existing in the group. The face is
the most expressive part of the body,
and the most important center of com-
munication. The ease and familiarity
with which the face is drawn provides a
non-threatening stepping-stone for later
drawings of the full figure.
Since group members are often over-
whelmed with a particular feeling (sad-
ness, anger, anxiety, etc.), they ”forget”
the experience of other feelings at that
time, so the portrayal of two different
emotions and the exposure to the nu-
merous expressions of other group
members encourage the awareness of,
and identification with, a variety of emo-
tions. This allows for the exploration of
the complexity and ambivalence of feel-
ings, permits a sense of universality and
engenders feelings of not being alone.
By seeing other group members’ pictures
and by receiving feedback to their own
pictures, group members can see and
hear other feelings rather than being
“stuck” within their own dominant feel-
ing of the moment.
Activity 4 (session #4)-Sketching
group members
Materials: 8Y2“ x 11”paper, pencil,
eraser, charcoal
Description of activity:
The group does a movement exercise
to music where the possible directional
movements of the various body parts are
explored. The group members take turns
posing in different positions while the
others do quick (approximately two min-
ute) sketches. This is repeated a second
time. The focus is on achieving a very
rough sense of the movement of the body.
Another round of longer (ten minute)
poses follows.
Rationale:
The movement exercise is designed to
stimulate thought and awareness about
the different parts of the body and the
way in which they can move, by simul-
taneously and experientially combining
physical, visual and cognitive processes.
The sketches are meant to continue this
theme by focusing attention on, and vis-
ually re-creating, a variety of movements
on paper. Drawing the other members of
the group stimulates awareness of the
other. The discussion afterwards may re-
late both to the experience of becoming
aware of others and to the feelings relat-
ing to being the focus of attention (being
watched, judged, etc.). The rounds of
two minute sketches prior to the ten
minute sketches, function as practice-
rounds to train the eye to take in the
complete body movement in a general
sense. This facilitates a more integrated
perception by the time the second round
is accomplished. The swiftness of the ex-
ercises and the intense concentration on
the gestalt of the movement frees-up
group members from previous stereo-
types and fixations on particular conflict-
laden areas of the body, evident in pre-
vious figure drawings.
Activity 5 (session #5)-Picture of
a human figure in color
Materials: 14” x 16” paper, pencil,
eraser, oil pastels
Description of activity:
The way in which movement ex-
presses feeling is discussed and various
artworks are displayed to show how art-
ists use movement, color, line, composi-
tion and environment to convey a cer-
tain mood a n d character. Group
members are asked to choose and depict
a character, h i d h e r personality and
mood while considering the above men-
tioned factors in the picture.
Rationale:
The aim of this exercise is to stimulate
awareness of the relationship between
the psychological/emotional aspects of
the person and hidher body. The en-
vironment is taken into account as a fac-
tor in the drawing and group discussion
in order to stimulate awareness as to the
relationship (or lack of it) between group
members’ feelings and the environment.
Activity 6 (session #6)--Picture of
an interaction between two people, in
color
Materials: 14” x 16” paper, pencil,
eraser, oil pastels
Description of activity:
The same materials and concepts are
used as in the previous activity, but this
time artists’ works are used to illustrate
the nature and mood of the interaction
or relationship between two people. The
group is then asked to imagine and de-
pict an interaction between two people.
Rationale:
The aim of this activity is to explore
various possibilities of dyadic interac-
tions and the feelings associated with
them. Group members at this stage have
become more aware of each other and
are beginning to feel more secure with
themselves and with each other.
Activity 7 (sessions #7--12)Life-
size color picture of human figure
Materials: large paper, pencil, eraser,
gouache paints, paint-brushes, full-
length mirror
Description of activity:
The final activity involves the drawing
and painting of a realistic life-size figure;
not necessarily a self-portrait. Emphasis
is placed on the careful examination and
consideration of the various body parts,
shapes, sizes and colors. Again, the
members are asked to choose a character
to paint, to consider hidher personality
and mood, and to think how these can
best be conveyed in the movement,
choice of line, color and environment.
The focus is on a realistic rendition of a
person which demands close examina-
tion of oneself in the mirror.
Rationale:
This final task is a culmination of the
previous tasks and demands paying
close attention to various parts and de-
tails of the body, their relationship to
each other, their shapes, sizes, propor-
tions and colors on a life-size scale.
Because of the attention paid to these
details, the psychological distancing en-
abled by the metaphoric aspect of the
previous exercises is no longer readily
available. Standing opposite the picture
involves the person ”measuring” and
considering hidher own body parts. By
this stage, all the elements involved in
the activity are familiar so that the proj-
ect is less threatening than it would ini-
tially seem. This task takes place over a
series of five weeks so that time can be
invested in achieving a realistic and sat-
isfying result and the art therapist can
spend time dealing with each person
and with the particular issues which
may arise. The end-product is generally
experienced as a very strong assertion of
the self.
Summary:
The issue of body-image in adoles-
cents is a potentially conflictual
issue. In the emotionally disturbed
and learning disabled adolescent,
this area is even more problematic
due to the perceptual, cognitive and
integrative deficits, as well as con-
comitant emotional adolescent
turmoil.
This p a p e r describes a time-
limited art therapy group whose pri-
mary goal is to work on systemat-
ically developing a more integrated
concept of the body. This structured
art therapy group utilized the meta-
phoric and symbolic qualities of the
art in order to provide a safe realm
in which group members can begin
to cognitively and emotionally work-
through misperceptions, confusions
and conflicted issues related to their
own body-images.
A secondary but related goal of
Fall 1990, ART THERAPY 137
the group was to foster healthy and
positive interaction and relatedness
between group members. Self image
as mentioned is a function of the
way in which others relate to us,
thus the enhancement of social skills
via the group is a central issue.
References
Ajuriaguerra, J. (1965). The body per-
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Bion, W. R. (1962). Learning from ex-
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Erikson, E. H. (1964). Insight and re-
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ton.
Federn, P. (1952). Ego psychology and
the psychoses. New York: Basic
Books.
Guntrip, H. (1968). Schizoid phenome-
na, object relations 6 the self. Lon-
don: Hogarth.
Head, H. (1920). Studies in neurology.
London: Oxford University Press.
Jacobson, E. (1964). The self 6 the ob-
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M a s t e r ’ s Degree Program
Klein, M. (1946). “Notes on some treatment issue with a special pop-
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Laplanche, J. & Pontalis, J-B. (1980). Basic.
The language of psychoanalysis. Lon- Schilder, P. (1950). The image and ap-
don: Hogarth. pearance of the human body. New
Sandler, J. (1976). ”Countertransfer- York: International Universities
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