I am a state registered art therapist who has been attending training in Provocative Therapy over the past 6 years. Currently I am developing ways in which Provocative Therapy can be incorporated into my art therapy work. I have established a series of art therapy workshops for the general public that use Provocative Therapy strategies as both stimuli and responses to image-making. In my private practice, I am developing a dialogue to enable me to work effectively with clients.

Before Provocative Therapy can be used with one-to-one clients, an initial art therapy assessment must be made. I will take a full case history, including any psychiatric episodes, and will sometimes recommend an additional consultation with a clinical psychologist or psychiatrist to define any organic causation and/or to exclude borderline personality disorder. Once I have defined the clinical parameters of working with my client, I may tentatively suggest that I incorporate some Provocative Therapy into the art therapy. I will describe to the client what this involves and make an assessment as to the client’s general openness to this sort of approach. I will only proceed if the client gives me permission to work in this way.

In the following case history the client, Jake* was interrupted, asked irrelevant questions and then given absurd suggestions, until he was provoked to talk authentically. The nature of a dialogue with a 16 year- old ‘drop-out’ might come across as politically incorrect. The language is abrupt without frills. The questioning is unsubtle. This is client-centred work. With another client my language might be impeccable, or mumbling, or even contradictory. The provocative therapist aims to mirror the client to reflect back an absurd picture of aberrant behaviour. This is also provocative. However, it is necessary to repeat the maxim, “this is always done with a twinkle in the eye and affection in the heart.”

Jake’s images show how the direct and sometimes crude dialogue has enabled him to move from a state of fragmentation to one of integration. The following conversation, plus image, all happened within a one hour art therapy session.

Jake, age 16
Jake was referred to me for an art therapy assessment by his psychotherapist who had been seeing him weekly for a couple of months. She informed me that Jake liked art and that perhaps the art therapy process would help him open up.

Jake arrived 10 minutes late. I phoned him on his mobile phone 5 minutes into the start time, to check that he was coming, and he asked for clarification of the address.

Jake came in looking dishevelled and dirty, with holes in his clothes. He wore old jeans, black scuffed boots and a loose fitting long-sleeved shirt. His ginger hair was shoulder length and greasy. He wore it like curtains over his face. The only aesthetic accessory was his very elegant and trendy glasses. A decent haircut would improve his overall look enormously. In short, he looked like a regular student-type!

After taking down some initial details (name, address, date of birth etc.) I asked him why he had come. He said: "I need to express myself creatively". I suggested he start painting using his non-dominant hand (his left hand) and without using any brushes, rollers or other tools. We carried on chatting throughout the hour-long session, while he simultaneously painted with his left hand.

I knew that my conversation with Jake would have to 'cut to the chase'; that my provocative therapy training would help me find and share the comedic images that would enable Jake to be amused by his self-defeating predicament and behaviours, (rather than depressed and disempowered by them). I was not going to be mocking him, but I would be mocking and teasing his situation/lifestyle/attitudes. Provocative Therapy training has given me the confidence to humorously reflect the harsh truth of his situation and deliver it with love, warmth, respect and congruence.

Thus, I found myself working with a depressed 16 year-old 'drop-out' with a history of drug abuse (he started smoking marijuana at age 10). Jake was, in many ways, an ideal client for an art therapy process with a provocative therapy dialogue.

During our provocative therapy-type conversation I asked lots of questions, I sometimes interrupted him (but never when I heard his ‘authentic voice’), and I painted verbal pictures while Jake painted on the paper with his left hand. Jake never consciously illustrated what we were talking about, and yet each part of his image correlated with the content of our discussion. He was amazed and surprised when I pointed out the synchronicity of words and paint marks.

The last detail for consideration, before I describe elements of our conversation, was that Jake had started painting on one side of the large piece of A1 -sized paper, and as he filled up that area, he asked if could turn the paper round, which he did. Each time he 'filled up' the area, he turned the paper round, so that the painting's evolutionary cycle mirrored the rotation of a clock. At the end of the session, I pointed this out to him and suggested that since he had turned the paper round clockwise, the prognosis was good!

More importantly, the evolution of the paint marks followed a narrative progression from fragmentation to integration. This is the completed image. (To view the 'clock rotation', start at 12pm and end at 9pm)

1. On his Family
Parents divorced when he was 4. Has seen his father weekly since then. He lives mostly with his mother and step-father, and two younger half-brothers. His mother ‘kicked him out ‘of home 2 years ago. He understands her reasons for kicking him out but has not quite forgiven her. He has since made up with her and lives mostly at her house. He occasionally lives at his father's house, and occasionally with friends, or in a squat.

Therapist: "So, do you still blame your parents for their divorce?"
Client: "A little"
Therapist: "Well that's OK. You're a teenager. You're allowed to blame your parents, that's what teenagers do. But only for another 4 years, mind you. You've got 4 years left to blame them and then you've got to let it go. You don't want to be one of those grown-up adults that still blame their parents. You know those types..."
Therapist: "Do you go to school?"
Client: "No"
Therapist: "Oh, you're one of those 'drop outs'........So what do you do all day?"
Client: "I sleep"
Therapist: "Where do you sleep? Do you have your own bedroom?"
Client: "I sleep on floorboards in the attic"
Therapist: "Is it one of those filthy attics with cobwebs and spiders and rats and mice and rubbish piled high?"
Client: "No, its not like that dirty...... I don't have a light."
Therapist: "Have you read Harry Potter?"
Client: "No..."
Therapist: "And how his wicked aunt and uncle kept him in a cupboard under the stairs with no light......before he escaped to school?"
Therapist: "Why did you drop-out of school? Was it the people, the course, the teachers, home life, sex life...."
Client: "The people"

He described how, about 2 years ago, he got 'paranoid' in social settings.

Therapist: "You thought they were out to get you?"

Jake smiled, and said he has been on and off anti-depressants that don't really work.

Therapist: "Well, psychiatric drugs aren't so good"

Image detail 1: image of Jake,
within the cavern, feeling loony,
with purple wooden trees.

2. On Drugs
Has done (taken) everything; has taken heroin but not injected it. Mostly smokes ‘weed’.

Therapist: "So how do you get drugs? Do you have any money?"
Client: "Some"
(His mother had sent a cheque for our session)
Therapist: "Where do you get it from?"
Client: "My mother"
Therapist: "Where else?"
Client: "I don't know"
Therapist: " So, how do you get money? How do you support your habit? Do you steal?"
Client: "No, I don't have a habit, I don't do heroin anymore. I sometimes sell dope"
Therapist: "Come on! Sometimes?! How often? Once a month is sometimes. Once a week? Once a day? More?"
Client: "About once a week"
Therapist: "Have you been caught yet? Have you got a record?"
Client: "No... I've been cautioned twice"
Therapist: "So, you're a criminal - who's been lucky so far"

Image detail 2: Jake on drugs

3. On Friends
Therapist: "Do you have any friends, or mates?"
Client: "Yeh"
Therapist: "What do you do, where do you meet?"
Client: "Well there used to be 10 of us and we'd meet and then we grew to a group of 200 or so"
Therapist: "Where do 200 friends meet up? Parties? Raves?"
Client: "We'd meet at High Heath and ...." (other parks mentioned)
Therapist: "What do you do there?"
Client: "Drugs.....but it’s all shit"
Therapist: "So you can have 200 mates stoned, but can't do real life relating?"
Client: "Yeh"
Therapist: "What about relationships, sex?"
Client: "Yeh, I got a girlfriend"
Therapist: "How did you meet her?"
Client: "She found me at one of the gatherings and I was thinking of suicide and she saved me"
Therapist: "What's she doing now?"
Client: "She's doing her GCSE exams, right now as we speak"

Image detail 3: talking about girlfriend and flirting with death. Painted the black sunset or sunrise (he couldn't decide which); then painted the skull; followed by target and spiral (on talking about his mother and himself).

4. On Art
The only subject Jake said he enjoyed and was good at, at school, was art. " I'm good at art." He spoke very congruently about his abilities in this area and tried to describe the sort of technically detailed images that he used to draw. I let him speak without interruption when he described his art. I felt this to be the voice of inner purpose that I was seeking to provoke. He was almost 'in trance' describing these images, as he was reflecting congruent memories.

I went with this belief that this was one area that interested Jake, and the means to some recovery.

Therapist: "Why don't you go to art school and sign up for a foundation year?"
Client: "Well that's what I was kind of working towards in school."
Therapist: "You'd fit in very well. You can look like a slob, you don't need to relate too much to other people. You'd enjoy the creative process."
Client: "I'm scared to be creative."
Therapist: "Do you ever try? Do you have a notebook for drawing in?"
Client: "Yeh, I've tried but I can't do it"
Therapist: "What happens when you start"
Client: "I get blocked"
Therapist: "What kind of block?"
Client: "It's a wall. I just come across a wall"
Therapist: "Well that's quite simple, just draw a ladder....."
Client: "Yeh, I like this idea"

On hearing how he warmed to this idea, I persisted in utilising one of the Farrelly Factors of providing insane solutions.

Therapist: "That's the solution to the wall problem, keep drawing ladders. Everytime you have a block, or a wall, draw a ladder. Then turn over the page, and draw another ladder, and another one until you can get over that wall. And while you're doing this, you can get really good at drawing ladders, flat ones, square ones, round ones..."
Client: "Yeh, I really like that idea. I think it will work"
Client: "Could you write it down for me please so I don't forget..."

I tore out a large piece of A4 and handed him a pen, he wrote in the middle, 'draw ladders'. Jake had chosen for himself some homework and had asked me, politely, to help him.

I pursued the idea that he could become an artist.

Therapist: "You can be an artist from the age of 16-90. It doesn't matter when you start."
Client: "But I think I'm too affected by the drugs to do anything. I can't think anymore"
Therapist: " Look, I don't know, maybe you are confused in the brain, maybe not, but you can still be an artist. Even if you have a psychiatric breakdown and you find yourself in the 'loony bin', you can be an artist in there. They always have an art group, or art therapy. And, at the other end of the spectrum, you could be an artist selling your artwork in the Cork Street Galleries. There's a position for you somewhere as an artist in society. You can choose to position yourself wherever you like."

Image detail 4: integrated head of an artist. I mentioned this reminded me of a portrait of Van Gogh, with one ear. Jake could not quite remember the image I referred to, but accepted this as a compliment.

5. On Recovery

Therapist: "It's up to you. You have to stop blaming everyone and take responsibility yourself for getting better."
Client: "I'm beginning to think that"
Therapist: "Well no-one else is going to do the work. The psychiatric drugs aren't doing it for you. The recreational drugs aren't doing it for you......I believe creativity is the only way forward. Creative work is the most healing thing to do. You can be an artist."
Therapist: "There's a new movie you should see. Do you go to the moves? It's with Ed Harris and it's about Jackson Pollock, who was also called Jack the Dripper. I don't know what it's like but it's about an artist who I think you'd like. Why don't you take your girlfriend?"
Client: "Maybe" (lightening up at the idea)
Therapist: "Why don't you do something normal, and take your girlfriend to see this movie, as a reward for doing her exams?"
Client: "Maybe"
Therapist: "You could scrub up and go out on a date"
Client: "Yeh, maybe"

6. Final reflection and discussion on the image

Therapist: "Look how you have moved around the page......you've gone from being all over the place, being fragmented, through drugs, your girlfriend with the black sunrise or sunset (we never did decide what it was), to suicide and flirting with death (the skull), to your relationship with your mother (the circle and target, with the adjacent spiral), to finally an integrated beautiful head."
Client: "Yeh....its amazing"

Therapist: "That looks a very together and angry red face......"
Client: "No, I don't think red is an angry colour"
Therapist: "What is?"
Client: "More black"

Therapist: "How did you find the session?"
Client: "Interesting. I was able to talk more about things when doing the painting."
Therapist: "Do you believe things are going to improve for you?"
Client: "Sometimes. Sometimes definitely not"

Before he goes out, Jake asks me a question. I was thinking about how, during the course of one hour, he had become more coherent and clearer. One of the aims of Provocative Therapy is to provoke psycho-social reality testing.

Client: "What month is it?"
Therapist: "May...... " (Was he testing me, or was he needing to touch base with 'reality' ?)
Therapist: "What day of the week is it?"
Client: "um....Thursday?" ( whilst he seemed to genuinely not know the month, he seemed relieved to know that he had got the day of the week right!)

Jake came back to see me 6 weeks later. I was astonished by his new image; clean and ironed t-shirt and decent jeans. I suggested he make an image about his name. He asked if he could do graffiti. As his name, as well as his ‘tag’ is the main feature of the image I cannot show it to protect his identity. It turns out that Jake is a keen graffiti artist in a big city and we had a long chat about criminality. He asked me about confidentiality (and I told him our professional guidelines) and then he told me about a plan to rob a sub-post office. As he ‘graffittied’ and decorated on the art paper I spoke about how they, in the ‘nick’ (jail), would love his ass, and if he thought he was paranoid now, it would soon enough be real fear etc. etc. In fact, I suggested, he could by-pass the nick and go straight into adult psychiatry as his paranoia would be immense, and no doubt justified by the time the job was done, …….We talked, we laughed, Jake painted.

Jake also asked me about preparing a portfolio for art school and which pieces would be deemed acceptable to take along.

I never saw Jake again. His weekly psychotherapist reported to me that Jake was doing exceptionally well. He had been accepted into art school and was looking forward to developing his creativity.

Hephzibah Kaplan
July 2003

* pseudonym

Biographical details
Hephzibah Kaplan is a psychotherapy supervisor and state registered art therapist in a medical practice in central London. She runs a slow-open art therapy group at the Centre for Counselling and Psychotherapy Education in London. She also works as an education consultant providing art therapy workshops for teachers and educators. Her website is www.art4theheart.com