Group Art Therapy With Incarcerated Women

Bonnie ]. Erickson and Mark E. Young

Art therapy in groups with incarcerated individuals may be effective when participants are defensive and possess limited education. The authors provide procedures, techniques, and case examples from the New Beginnings program for working with women in a detention facility.

Art tberapy is often tbougbt of as an adjunct to counseling; bowever, because of its unique ability to bypass defenses, in some situations, art tberapy may be a treatment of cboice to allow clients to discover and express feelings tbat are often difficult to express verbally (Ferszt, Hayes, DeFedele, & Horn 2004; Gladding, 2005; Malcbiodi, 1998, 2003). Using art as tberapy does not require tbat tbe tberapist or tbe client be an artist because tbe finisbed products are not evaluated for tbeir artistic merit. Ratber, tbe focus is on a discussion of tbe process of creating and on the feelings that arise while working on tbe exercise. When used in tbis way, group art tberapy is a way of stimulating introspection, building self-esteem and self-awareness, and allowing insigbts to come to tbe surface (Gladding, 2005; Malcbiodi, 1998). We begin tbis article witb a literature review, discussing potential benefits in stimulating creativity and tbe use of art tberapy groups witb incarcerated populations. Next, we discuss tbe special needs of incarcerated women when using group art treatments. Finally, we describe tbe New Beginnings program, a residential substance abuse program for incarcerated women that includes group art tberapy as a major component. Procedures, tecbniques, and a case study are provided. Incarcerated Clients and Creativity Incarcerated clients are ideal candidates for art tberapy interventions because tbeir ability to express emotions is often severely limited by tbeir setting and by tbeir verbal skills (Eisdell, 2005; Ferszt et al., 2004; Young & Bemak, 1996). Even witbout encouragement, creativity emerges in tbe form of drawings, tattoos, carvings, and crafts. According to Harrington (1997), art is one of tbe few legitimate profit-making enterprises in inBonnie J. Erickson and Mark E. Young, Department of Counselor Education, University of Central Florida. Correspondence concerning this article should be addressed to Bonnie J. Erickson, Department of Counselor Education, University of Central Florida, 4000 Central Florida Boulevard, CUE Building, Suite 322, Orlando, FL 32816 (e-mail: bonnie.erickson@ymail.com).

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carcerated settings. Inmates create a variety of items including portraits, crafts, and greeting cards that are traded for commodities and personal items (Harrington, 1997). Creative activities allow inmates to experience autonomy, self-expression, and self-exploration and provide them with opportunities to express emotions in an institutional setting that is rigid and controlling (Ferszt et al., 2004). Verbal expression of some emotions may be viewed by correctional staff and other inmates as a weakness or as a threat, but it is viewed as appropriate when expressed through images (Ferszt et al., 2004). Besides the therapeutic reasons for including expressive arts treatment, research has demonstrated that creative activities can be beneficial to both the individual and the correctional institution. For example. Gibbons (1997) found that inmates who were able to engage in creative endeavors showed improvement in their mental health, attitudes, and behaviors. Similarly, Gussak (2005) concluded that the use of art therapy with inmates led to a decrease in depressive symptoms and an improvement in mood. Gussak also found that the art therapy participants' attitudes improved, their acceptance of one another and the environment increased, and the interaction between staff and peers was better. There was also evidence of better compliance with directives and an improvement in behavior. Harrington (1997) observed that inmates on death row who engaged in creative projects were better able to cope with the passage of time. For example, Eisdell (2005) referred to an interaction with a death row inmate as a "visual conversation" (p. 8) that began with collaborative drawing, where the inmate and therapist alternated in contributing to the drawings. Through drawing, the inmate began to develop an emotional vocabulary that served as a preparation for later psychotherapeutic verbal interaction. In short, creative activities, usually solitary or in a one-on-one therapist/client setting, have shown some success in reducing symptoms and behavioral problems.

Art Therapy in Groups

Creating art in a group setting adds unique benefits to working alone (Malchiodi, 1998). Waller (2003) stated that producing images in a group setting added a dimension to communication and expression. Art therapy can be used effectively in group settings because it allows individuals to work at the same time to illustrate their feelings and then find support from others as they share these feelings verbally (Gladding, 2005). Because all of the members of the group have shared the experience of creating the art, they are more likely to be empathetic and receptive to giving and receiving feedback to one another (Waller, 2003). Malchiodi (2003) suggested that participation in art therapy groups evokes the curative factors identified by Yalom (Yalom & Leszcz, 2005), including

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instilling hope, enhancing interaction, promoting universality, providing catharsis, and allowing altruism. Because of the isolation of incarcerated individuals, group work can be an important therapeutic tool for those who are in detention facilities. When coupled with the known benefits of creativity for this population, a strong case can be made for continuing to investigate group art therapy in detention facilities.

Working With the Female Incarcerated Population

Women make up a small proportion of the nation's incarcerated population, yet their numbers are on the rise (Singer, Bussey, Song, & Lunghofer, 1995). This growing population is treated in facilities and programs originally designed for men (Wellisch, Anglin, & Pendergast, 1993), but female inmates differ from men in their physical, emotional, and social needs and require a different treatment approach (Wells & Bright, 2005). One difference between incarcerated men and women is that a higher percentage of women have both a mental health diagnosis and a substance abuse disorder. Approximately 75% of female inmates fit this picture (James & Glaze, 2006). Many female inmates began using drugs at an early age, often on a daily basis, because of a life-disrupting, traumatic experience that occurred when they were in middle or high school; frequently, they did not complete high school (Wellisch et al., 1993). The majority have a history of frauma (sexual, emotional, and/ or physical abuse as children and adults), which is linked to long-term substance abuse (Mageehon, 2003). Compared with men, women are more likely to be incarcerated for nonviolent crimes, such as fraud, larceny, burglary, drug-related crimes, and prostitution. Many of these crimes are linked to obtaining drugs (Pomeroy, Kiam, & Abel, 1998; Wellisch et al., 1993). Bouffard and Taxman (2000) found that women's substance abuse is often related to their relationships with male sexual partners and a need to self-medicate, especially from traumas. Prostitution, for these women, often becomes the means to provide financial support, increasing the likelihood of poor health, severe substance abuse, increased trauma, and sexually transmitted diseases (Gibbons, 1997). A cycle of drug use and prostitution is created: The women are involved in prostitution to provide for a means to obtain drugs, and the drugs are used to cope with prostitution (Norton-Hawk, 2001). Recovery from substance abuse is difficult for women because of the negative social stigma, low self-esteem issues, lack of good support systems, and the responsibilities of caretaking roles (Mageehon, 2003). Most female inmates are unemployed, single mothers (Wellisch et al., 1993). Compared with men, women have stronger attachments to their children; have more separation anxiety; and express more concerns about their parental responsibilities, child care, and parenting issues. Gibbons

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(1997) found that female prisoners experience the physical loss of separation from family and express feelings of loss, guilt, and shame. To address these issues. Wells and Bright (2005) advocated for an increased emphasis on reentry issues that focus on helping women address these concerns upon release. This approach was also expected to contribute to a reduction in recidivism by focusing on parenting and relationship issues and providing linkages to services in the community (Wells & Bright, 2005). On the basis of the kinds of issues that female inmates face, use of the creafive arts has great potential. Besides helping to express and thereby reduce negative feelings, the creative arts may aid clients by helping them to focus on their own sense of self-direction and autonomy. Because many of their issues are interpersonally based, such as relationship issues, child care and parenting issues, addiction issues, and family of origin issues, a group setting with those facing similar difficulties seems to be the ideal vehicle for delivering an expressive arts treatment. Creativity allows for needed expression and feedback and can help individuals imagine a constructive future (Gibbons, 1997). In the prison culture, a variety of elements exist that can lead to calm, creativity, and catharsis or to discord and violence. The use of creativity can help encourage the positive and focus on future issues of reentry (Gibbons, 1997).

Art Therapy in a Correctional Facility

One of the first things a counselor learns when working with inmates is that correctional facilities, unlike community agencies, are not designed to be supportive and promote rehabilitation; they are designed primarily for the purpose of punishment. Thus, those exercises that are designed to encourage creativity, while producing and encouraging unity, self-esteem, and empowerment, are viewed by some as contrary to the primary purpose of correcfion facilities (Stanford, 2005). Just as the focus and direction of counselors appears contrary to that of correctional staff, inmate behaviors and attitudes appear on opposite ends of the scale. Incarcerated people can be creative, intelligent, and capable. On the other hand, they can also be manipulative and dishonest, having learned to recognize and take advantage of the sympathies of others (Mageehon, 2003). Despite these limitations, group art therapy in a correctional facility is still possible and potentially beneficial to the incarcerated client and the institution. In the following section, we describe the practical and therapeutic considerations in delivering a group art therapy treatment to incarcerated women.

New Beginnings New Beginnings is a residential substance abuse program in a large, county female detention facility in the southern United States. It is

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a modified therapeutic community. New Beginnings is conducted in one dormitory (where up to 64 inmates reside), and all activities are held in this dormitory and a small adjacent classroom. A portion of the participants are ordered by tbe judge to participate in the program, whereas the remainder enter on a voluntary basis. Tbe staff consists of one clinical supervisor and four counselors employed by a local substance abuse agency that holds a contract with the county to administer the program. Psychoeducational and experiential groups are scheduled and conducted during available time slots from early morning until evening. Successful completion of the program requires a minimum of 6 months participation. Art therapy is one of several weekly groups offered in the New Beginnings program. Art therapy group attendance varies according to the number of women in tbe dormitory and ranges from a minimum of 25 women to a maximum of 64. Although therapeutic groups are usually much smaller, Yalom (Yalom & Leszcz, 2005) suggested that the size of a group is best determined by the number of individuals who are able to "profitably engage" (p. 277) in the group. Because individuals work independently and then share, group size has not seemingly interfered with its effectiveness. Still, we have found that positive interaction in the art therapy group is optimal when the group is around 30 participants. Session Structure Art therapy sessions were offered weekly in a psychoeducational format that lasted 2 hours, with a short break in the middle. During the first 15 minutes of the session, a therapeutic topic (e.g., fear, self-esteem, selfdefeating behaviors, self-sabotage, barriers to recovery, or treatment goals) was discussed and an exercise related to the topic was introduced. Clients were seated at tables of four and worked on tbe exercise for 45 minutes. During tbis time, the therapist went from table to table working with clients. This work entailed encouraging clients to explore deeper thoughts, answering client questions, helping clients clarify their thinking, giving positive reinforcement and feedback, and instilling confidence. After a sbort break for clean up and storage of materials, group members participated in a group-processing session in wbicb clients shared their work and their accompanying thoughts and feelings. Clients were especially encouraged to respond to the work of others. Group Dynamics The art therapy group became the favorite group of the inmates in the program as evidenced by positive client responses. Discipline issues were few, and the clients appeared anxious to participate, often requesting to be the first one to give a verbal response to the exercise. As clients experienced catharsis and engaged in sharing, they became more con42 journal of Addictions & Offender Counseling October 2010 Volume 31

fident in tbeir ability to express tbemselves botb visually and verbally. Wben someone attended for tbe first time, tbey were wary of drawing and often refused to sbare tbeir work. After one or two sessions, tbey no longer said "I can't draw" and waited impatiently to make comments. Group members' ability to accept eacb otber and to disclose personal information increased as tbey recognized tbeir own issues in otbers' work, often commenting about a similar experience or responding by nodding agreement. Tbe opportunity to talk casually as tbey worked increased tbe camaraderie and reduced tbe tendency of group members to isolate tbemselves and to align in small exclusive groups, botb in tbe art tberapy groups and in otber program activities. Group cobesion increased as inmates sbared perspectives on tbeir own work and on tbe work of otbers. Having a tangible product of tbe tberapy proved to be beneficial because it could be displayed, generating continued discussion and tbougbt about tbe tberapeutic topic, and served as a record of past tberapeutic work (Hanes, 2001). Practical Issues in Delivering Group Art Therapy The Environment Tbe pbysical environment, especially in group settings, can infiuence tbe ability of tbe group to function (Yalom & Leczsz, 2005). In situations wbere it is possible, Ugbt, sound, temperature, and seating arrangements need to be considered to maximize the effectiveness of tberapy (Young, 2009). Depending on tbe intervention, tbe environment can be Hgbt, full of conversation and bumor or subdued, quiet, and conducive to introspection. In a jail environment, tbe options are limited, emphasizing tbe importance of counselor awareness and planning. Yet, tbe counselor needs to insist on some basic necessities, sucb as tables for working and tbe ability to arrange seating wbile providing an adequate supply of materials. It is important, wbere possible, to eliminate distractions inberent in tbe jail surroundings and to use every resource available to provide an effective tberapeutic atmospbere. Suggested Art Materials Tbe use of art materials can be intimidating to tbose wbo are not experienced and can sometimes get in tbe way of tberapy. In most cases, medium weigbt drawing paper (11 x 18 incbes) provides a durable drawing surface and can readily be folded smaller for tbose wbo may find a larger sbeet intimidating. The paper sbould be of adequate quality to allow for durability and manipulation but inexpensive enougb tbat clients are not afraid to use it. Art mediums are used tbat clients are familiar witb and comfortable using. A well-stocked art tberapy room migbt include sucb tbings as crayons, pencils, erasers, colored pencils, water-based

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markers (both wide point and fine point), small scissors, glue sticks, and construction paper. Materials such as watercolors, acrylic paints, poster paints, printmaking materials, and clay may be used as well; however, caution must be used because more sophisticated materials require additional instruction, skill, and cleanup, which may take time away from the therapeutic aspects of the session. Communicating After the Art Session Sharing following the production of an artisfic product may take place within the same small group sitting at a table or with only those who wish to share in a larger group. Dealing with the issue of confidentiality early on will enhance commxmication. Alternately, the counselor may encourage the group to share their work as a group display. Works may be displayed on a bulletin board for some time or just during a class to give group members more time to reflect. As with other group interventions, those who may not verbally process their own work will relate to someone else's work by listening to and observing the process. Interventions Some interventions may be designed to be a collaborative experience in which each individual creates something that later becomes part of a larger composition. For example. New Beginning clients created fallcolored leaves from construction paper on which they drew symbols that represented something in their lives that they wanted to leave behind. These symbols included such things as domestic violence, drugs, poverty, pain, self-defeating behaviors, sorrow, guilt, and incarceration. The leaves were then displayed together on a bulletin board with words that read, "Leave it all behind." Inmates looked for their own pieces, studied the work of others, and enjoyed the overall effect of the composition. Clients gained personal insight through observing and discussing the ideas expressed by themselves and others. After a short time, the display was disassembled and the leaves were returned to those who created them as a reminder of the work that each person needed to do. Dealing With Stage Fright To begin with, clients are not comfortable with the idea of participating in art therapy groups. In the beginning, nearly all clients exhibit resistance to drawing, often saying that they "cannot draw." In reality, the client may not have attempted to create anything visually since childhood, and even then, they did not feel confident in doing so. It is helpful to emphasize that the object of the exercise is not the end product but the process: Even if the incarcerated clients believed they caruiot draw, they can think and feel, which is the primary objective of the exercise. After

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making a few attempts at drawing and receiving encouraging comments from peers, most clients became comfortable with the medium and enjoyed the activity. It is not necessary for the counselor to be an artist or to have had experience in art therapy to be able to make it an effective treatment medium. However, counselors should also be prepared to experience uneasiness like that of their clients as tbey make their first attempts at visual expression. As with the clients, counselors' uneasiness lessens with time and success.

Directive and Nondirective Exercises

Art therapy lends itself to a variety of approaches. Malchiodi (1998) described art therapy interventions as either directive or nondirective. Directive interventions begin with an idea or a direction from the facilitator, witfi the client often working from a basic image or a template (Malchiodi, 1998). Directive exercises give the client a loose structure to follow, while allowing room for creative and individual thinking with a specific end product in mind. Intervention 1: Masks, a mask-drawing activity, is presented later in this article. It is an example of a directive exercise because participants are asked to draw something specific, in this case a mask, creating their own design as the concept applies to them. On the other hand, nondirective exercises concentrate on the development of client insight into his or her emotions and feelings (Hanes, 2001). The nondirective approach is more emotionally arousing, relying on individuals to form something that relates to their feelings. This often results in a final product that may or may not have a representational image and may only include colors, shapes, lines, and patterns. For example, clients may be asked to illustrate the feelings they have after listening to a piece of music. The end results vary from one person to another. Intervention 2: A Happy Place, described later in the following section, is an example of a nondirective intervention. Both types of intervention can be effective iri helping clients express feelings and reflect on past experiences. One strategy is to use more directive interventions early in the art therapy process and introduce nondirective interventions as clients become comfortable and less restrained.

Description of a Group Art Therapy Session and Sample Interventions

The following are examples of directive and nondirective group art therapy interventior\s described in a step-by-step fashion and including objectives, materials, and procedures. Sharing with ead\ activity can take 90 to 120 minutes to complete. Additional activities and guidelines for creating others are contained in Malchiodi's (1998) The Art Therapy Sourcebook and Cohen, Barnes, and Rankin's
(1995) Managing Traumatic Stress Through Art: Drawing From the Center.

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Intervention 1: Masks
Objectives. The purpose of the following exercise is to help clients recognize that individuals create masks or facades that are used as a defense mechanism to conceal inner feelings of inadequacy and fear, thus deceiving even themselves. The rationale for the exercise is that the use of poses and ingenuine guises is damaging to relationships with others and is a form of self-deception. Lack of disclosure blocks personal progress in dealing with the underlying issues, hinders emotional growth, and maintains the status quo. Through participation in this exercise, clients are able to gain insight into their own defense mechanisms and that of others and are able to begin to recognize dysfunctional coping strategies and consider more effective ones. Through introspection, the client is able to portray the self, illustrate feelings, and then verbalize them through the use of the drawing. Initially, it is hoped that clients will gain an understanding of the image they project to others because this relates to how they interact with each other in the group. Through discussion, clients evaluate these images to determine if they have a positive or negative effect on their progress toward therapeutic goals. Finally, clients translate their inner thoughts and feelings to words as they discuss their work. Materials. Each table is equipped with pencils, erasers, 11 x 18-inch drawing paper, crayons, colored pencils, and markers. For convenience, the materials can be stored in a box and placed in the center of each table. Step 1: Group discussion. Clients assemble in a group near a large white board. The facilitator conducts a discussion about defense mechanisms and involves the clients in a discussion about masks. The purpose of masks is to keep secrets and hide the truth. The discussion should include some ideas of masks that people hide behind. Clients are asked to describe their own defense mechanisms and those they have observed in others. Related terms are defined, including attitudes, facades, and poses. Clients may portray themselves as wearing a variety of masks, or personas. Some of the following examples may be identified: overconfidence, know-it-all, tough and unapproachable, a clown, sexuality, apathy, or unintelligence. Step 2: Experiential activity. Clients move to tables of four and use the materials to illustrate the masks they have identified for themselves. For those who would like to use it, a stencil may be provided to outline a mask shape as a place to begin. They are not limited to one mask but are encouraged to identify as many of their personal masks as possible. Clients are encouraged to communicate with one another quietly as they work for the next 45 minutes. In this exercise, verbal interaction seems to help strengthen group cohesion, stimulate more ideas, and increase insight. During this time, the facilitator moves around the room, answering questions and encouraging clients to put their thoughts and feelings into picture form. Because clients

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are accustomed to using text rather than images, it is natural for them to rely on words to express their thoughts. Art therapy is more effective when the use of images is encouraged. In those instances where text is allowed, clients can learn to use color, size, and texture of the text to reflect the meaning they intend to express. Another common pitfall is that clients may fall back on the use of clich images, such as hearts and flowers. It is important to discourage this by letting clients know that clichs do not express their personal meaning and can hide one's real feelings. Step 3: Transition. After materials are collected, and following a short break, clients assemble in a group to process the exercise. Because of correctional facility rules, materials such as pencils, markers, crayons, erasers, and extra drawing paper need to be collected and accounted for at the end of each drawing session. This is necessary to avoid theft and the unsafe use of the materials. In addition, when materials are left at the table, the clients continue to work on their drawings during the processing and are not fully engaged in the discussion. Step 4: Processing. Clients return to the group discussion area with their work and are given the opportunity to share the feelings and thoughts they experienced during this exercise. To alleviate feelings of inadequacy, it is important to stress the fact that this exercise is not about creating great art but about the process of thinking and gaining personal insight. The processing portion can be conducted in a variety of ways: The facilitator may choose a client to go first and then proceed around the room or may ask one client to call on the next person to share. As in most group settings, there is often a leader who wants to begin and others who are less anxious to share. During the next hour, the facilitator ensures that all clients have an opportunity to share their work and respond to the work of others. This usually consists of a description of the piece (while displaying it for the group) and then an explanation of the images and colors chosen. The session concludes with a discussion about strategies to eliminate, replace, or alter dysfunctional behaviors that have been identified. Wbere space is available, it is beneficial to display the masks for a limited time before returning them to their creators. This allows the group to review the work and identify new thoughts concerning their own work and the work of others. A display also serves as a reminder and reinforcement for the therapeutic growth. The following process questions can be used to help clients express more about their work: 1. How does your mask help you and how does it get in the way of making positive changes? 2. Do you remember when you first started to use this mask? 3. What does the mask conceal? 4. Did you experience any surprises in doing this activity?

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Intervention 2: A Happy Place

Tbis nondirective intervention is designed to increase client personal awareness and gain a sense of peace and safety by focusing on a bappy time or place. Altbougb tbe exercise may seem elementary and tbe pbrase "bappy place" is a clicb, for tbese clients, it can be a revealing and empowering exercise. Tbe development of a personal bappy place can be used as a means to cope with difficult emotions and situations. Objectives. Tbe main objective is to increase personal awareness and identify a bappy place tbat can be used in future visualizations to belp control sucb feelings and experiences as anger, anxiety, fear, and relapse. Materials. Drawing paper, crayons, paint, brusbes, and colored pencils or markers are distributed to the individual tables and are ready for immediate use. Procedures. Clients are directed to sit comfortably and close tbeir eyes. As music plays, tbe facilitator engages tbe group in a relaxation exercise. Clients are tben asked to concentrate on a time in tbeir lives wben tbey felt bappy and safe. If it is difficult for clients to identify a specific experience, tbey are encouraged to imagine one. Clients tben concentrate on tbeir memory by thinking through eacb of tbeir senses associated witb tbe experience. Wbat can tbey see? Wbat can tbey smell? Wbat sounds do tbey bear? Wbo else is present? Are tbey aware of otber feelings tbey migbt have experienced at tbe same time? Following tbe relaxation/imagery exercise, clients are instructed to open tbeir eyes and illustrate tbeir tbougbts and feelings using tbe art materials. Because tbis is a more introspective exercise and because it may color tbeir own experiences, tbey are instructed to refrain from talking witb otbers. Clients are encouraged to listen to tbe music and select colors, lines, textures, and images tbat illustrate tbe tbougbts and feelings tbey are experiencing. Processing. After materials bave been gatbered and are accounted for, and following a sbort break, clients move to tbe discussion area witb tbeir drawings to process tbe experience. Clients are asked to volunteer to sbare feelings about tbe experience and describe tbeir art work. Discussion includes tbe value of visualization and its use in dealing witb addiction and otber self-defeating bebaviors. Tbe following process questions may belp to facilitate clients' insigbt into tbeir drawings: 1. Were you surprised by wbat you felt? 2. How can tbis image be used in a positive way? As a result of tbis exercise, clients often express a new awareness about tbemselves. Tbey bave also reported bringing tbe images to mind later as tbey dealt witb tbe loneliness, craving for drugs, self-critical tbinking.

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boredom, and crowding in the dormitory. A moment's thought about the happy place enabled them to step back from the difficulties of the moment and gain a broader perspective while reminding themselves of the steps they were taking to make changes. Case Studies To give a better feel for the women involved in the New Beginnings art therapy group, two brief case studies are described. The names of clients have been changed to protect their anonymity. Anne, a 29-year-old, African American woman who was arrested for writing fraudulent checks, was incarcerated twice before her present sentence. Because of her chronic cocaine abuse, a judge ordered her to attend the New Beginnings program. In high school, Anne was a model student who received awards for academic performance. She attended a state university on a scholarship and earned a bachelor of science degree in biology. At the time of her graduation from college, she was disappointed when she was unable tofindemployment in herfield,something she had expected to happen quickly and easily. She became involved with a man who was actively using and selling drugs. Her addiction started when she used cocaine with him. She was arrested for check fraud in which she engaged to support her drug habit. She did not have a co-occurring mental health diagnosis. Anne was anxious to change her life and engaged in all of the program activities. Art therapy was not a natural fit for her, so initially she was reluctant to participate. As the group progressed, she learned that her work was not expected to be "museum quality" but to have some personal benefit for her. She was then able to overcome her inhibitions about drawing and began to apply herself more freely to the interventions. Through her art therapy experiences, she became aware of family rules in her family of origin. There was never any negative feedback of any kind. This was a new perspective because she had felt that communication had been open and complete in her family. She realized that she had grown up believing that if she performed well in school, it was natural to expect that the job she desired would appear when she had successfully completed her education. Her insight into this family pattern helped her evaluate the usefulness of this "scripting" and helped to restore confidence in her own ability to make decisions. Susan, a 39-year-old European American woman of average intelligence, had begun using drugs in her early teens and was arrested for prostitution. Her father was physically and sexually abusive, and he allowed men to have sex with Susan at home for money beginning at the age of 10 years. Susan married when she was 16 years old and gave birth to

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three children. Her husband was physically abusive, and when she left the marriage, she lost custody of her children. She attributed her addiction, involvement in drug sales, and prostitution to the grief and loss of losing her children and the abuse she received as a child. She met the criteria for posttraumatic stress disorder and cocaine dependence. Verbal expression was difficult for Susan because of low self-esteem. She was not confident in her written or verbal skills and had difficulty identifying and expressing feelings. Through art therapy, Susan was able to begin to identify her feelings and to express them verbally as she described her work. Eventually, she progressed to the point that she volunteered to share first during the process portion of the art therapy sessions. This led to verbal skills improvement and increased confidence. When asked to draw her mask, she divided the face down the middle with a smiling child on one side and a seductive face on the other, outlined with a heavy dark line. She explained that the outline indicated that she had been forced to wear these faces and was experiencing difficulty as she worked to escape them.

Conclusion
The interventions presented in this article have been applied in group therapy with women in an incarcerated setting and have been found to be an effective tool for mental health and substance abuse treatment. Incarcerated individuals have complex problems as well as limited verbal skills or defenses that inhibit their ability to engage in talk therapy. Institutions employ a small number of mental health professionals, which limits the number of clients who can receive professional help. Although research in this area has been relatively modest, it is evident that art therapy groups can provide an effective therapeutic treatment option for incarcerated clients and an efficient, economical treatment option for correctional facilities.

References
Bouffard, J. A., & Taxman, F. S. (2000). Client gender and the implementation of jail-based therapeutic community programs. Journal of Drug Issues, 30, 881-900. Cohen, B. M., Barnes, M., & Rankin, A. B. (1995). Managing traumatic stress through art: Drawing from the center. Baltimore, MD: Sidran Press. Eisdell, N. (2005). A conversational model of art therapy. Psychology and Psychotherapy: Theory, Research and Practice, 78,1-19. doi:10.1348/147608305X40840 Ferszt, G. G., Hayes, P. M., DeFedele, S., & Horn, L. (2004). Art therapy with incarcerated women who have experienced the death of a loved one. Art Therapy Journal of the American Art Therapy Association, 21,191-199. Gibbons, J. A. (1997). Struggle and catharsis: Art in women's prisons. Journal of Arts Management, Law and Society, 27, 72-80. Gladding, S. T. (2005). Counseling as an art: The creative arts in counseling. Alexandria, VA: American Counseling Association.

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Gussak, D. (2005). Effects of art therapy with prison inmates: A follow-up study. The Arts in Psychotherapy, 33,188-198. Hanes, M. J. (2001). Retrospective review in art therapy: Creating a visual record of the therapeutic process. American Journal of Art Therapy, 40, 149-160. Harrington, C. L. (1997). Time to piddle: Death row incarceration, craftswork, and the meaning of time. Journal of Arts Management, Law and Society, 27, 51-71. James, D. J., & Glaze, L. E. (2006). Mental health problems ofprison and jail inmates (Bureau of Justice Statistics Special Report NCJ 213600). Retrieved from National Alliance on Mental Illness of Minnesota website: http://nami.beardog.net/AdvHTML_Upload/090606DOJReport.pdf Mageehon, A. (2003). Incarcerated women's educational experiences. The Journal of Correctional Education, 54,191-199. Malchiodi, C. A. (1998). The art therapy sourcebook. Los Angeles, CA: Lowell House. Malchiodi, C. A. (2003). Handbook of art therapy. New York, NY: Guilford Press. Norton-Hawk, M. (2001). The counter productivity of incarcerating female street prostitutes. Deviant Behavior: An Interdisciplinary Journal, 22, 403-417. Pomeroy, E. C, Kiam, R., & Abel, E. (1998). Meeting the mental health needs of incarcerated women. Health & Social Work, 23, 71-76. Singer, M. I., Bussey, J., Song, L., & Lunghofer, L. (1995). The psychosocial issues of women serving time in jail. Social Work, 40, 103-114. Stanford, A. F. (2005). Where love lies free: Women, home, and writing in Cook County jail. Journal of Prevention & Intervention in the Community, 30, 49-56. Waller, D. (2003). Group art therapy: An interactive approach. In C. A. Malchiodi (Ed.), Handbook of art therapy (pp. 313-324). New York, NY: Guilford Press. Wellisch, J., Anglin, M. D., & Pendergast, M. L. (1993). Numbers and characteristics of drugusing women in the criminal justice system: Implications for treatment. Journal of Drug Issues, 23, 7-30. Wells, D., & Bright, L. (2005). Drug treatment and reentry for incarcerated women. Corrections Today, 67, 98-111. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York, NY: Basic Books. Young, M. E. (2009). Learning the art of helping (4th ed.). Upper Saddle Ridge, NJ: Prentice Hall. Young, M. E., & Bemak, F. (1996). Emotional arousal and expression in mental health counseling. Journal of Mental Health Counseling, 18, 316-332.

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