ECOLOGICAL/NATURE-ASSISTED ART THERAPY WITH WAR VETERANS AND THE ISSUE OF ECOLOGICAL IDENTITY
Art psychotherapist, Psychotherapy Department, War Veterans Hospital, senior lecturer, Department of General and Clinical Psychology, Volgograd State Medical University (Volgograd, Russian Federation)
Doctor of Medical Sciences, Professor, Department of Psychology, St. Petersburg Academy of Postgraduate Pedagogical Studies (St.-Petersburg, Russian Federation)
This paper presents the application of the nature-assisted approach in the context of clinical art therapy with war veterans. The work was carried out in the psychotherapy department of the hospital for war veterans. Some nature-assisted art therapy techniques using natural objects and taking photographs were applied during a short-term art therapy program in order to reveal and support clients’ ecological identity as a healthy and resilient aspect of their Self. Examples of nature-assisted creative activities used in group art-therapy sessions are given.
Keywords: nature-based art therapy, ecological/(eco) identity, environment, stress-related disorders, ecotherapy, war veterans
Against the backdrop of military campaigns that involve many countries across the globe, the challenges that medical, therapeutic, and other helping professionals face in their work with veterans and military personnel can be considered universal. The social groups known as war veterans and military personnel are comprised of individuals that present a broad spectrum of mental disorders. Although a certain percentage of them have been identified as suffering from PTSD and other stress-related disorders, some of them reveal behavioral and mood disorders, addictions and even psychotic states. Many of them are characterized as having high levels of emotional tension and instability, low impulse control, difficulties in interpersonal relations, distorted reactions to others, ambivalent and inadequate self-perception, and difficulties in securing existential meaning [1, 10]. They may have a retrospective orientation towards life, or may organize their lives around those values and norms that were acceptable in combat situations while feeling lonely and unsafe in civilian life [1, 16].
There are currently many different ways that art is used therapeutically with military personnel and veterans that vary depending on the professional background and theoretical orientation of practitioners, as well as the particular settings providing services and other contextual factors. The range of existing approaches and models of art therapy applied with military and veteran populations is impressive and includes unstructured studio and gallery experiences [8, 11, 18] group interactive art therapy/art psychotherapy [2, 12, 13], along with individual and family art therapy .
Environmental factors of veterans’ and military personnel health and well-being
The use of the therapeutic potential of nature-assisted practices with different categories of clients, including war veterans and military personnel, is relatively well known and is taken advantage of in multiple therapeutic interventions. These factors were often a part of treatment and rehabilitation programs with these client groups long before trends like environmental psychology, ecopsychology, and ecotherapy entered the mainstream, along with their concepts and practices.
During World War II, gardening was used as occupational therapy for US veterans. This eventually led to the development of the horticultural therapy profession . In the last two decades a significant increase in the use of various nature-assisted therapies applied with military populations and other groups of post-traumatic stress sufferers has been observable.
Some veterans and military personnel report being more willing to engage in an active form of treatment than conventional modes of therapy. Those of them who engage in outdoor recreational activities have begun to rediscover their resiliency and have tapped into leadership skills they learned during military service. The aim of ecotherapy programs and services is to help veterans reconnect to nature in a way that will conjure positive emotions and elicit a sense of confidence when reintegrating into the civilian world. This form of treatment is a way to garner the benefits of supportive therapy while being out in the wider environment. It encourages veterans to get out, connect with others, both humans and the more-than-human world.
An increasing number of creative arts/expressive therapists also strive to implement ‘green’ and environmental practices in their work with military populations and other client groups who suffer from post-traumatic stress [4, 5, 6, 11, 15] and beginning to pay more attention to a complex ‘field of interactions’ established not only by the client, the therapist or an art object, but by many other objects and processes both inside and outside the therapy room.
Treatment setting, brief group art psychotherapy program and procedure
Some nature-assisted techniques have been implemented into group interactive art therapy used at the specialized psychotherapy department at Volgograd Regional Clinical Hospital for War Veterans, Russian Federation, since 2003. The Hospital belongs to the Ministry of Public Health and provides holistic treatment for war veterans. The psychotherapy department was established there in 1997, in accordance with “The Law on Veterans” and Order #373 (07.01.1997) to provide high quality medical and psychosocial support to war veterans residing in Volgograd city and the Volgograd Region, who were involved in the military campaigns in various “flash point areas,” and whose mental problems cannot be treated outside the hospital setting due to their severity.
The staff of the psychotherapy department includes psychiatrists, psychotherapists, clinical psychologists, and nurses. Art therapy (art psychotherapy) is provided by a clinical art psychotherapist, who was trained as a psychiatrist and psychotherapist and later took his art therapy training. He is a member of the multi-professional team working at the hospital. The team provides patients with a combination of medical and psychosocial interventions including occupational therapy, counseling, individual and group therapy and group interactive art therapy (art psychotherapy) in order to enable not only a reduction of symptoms, but to provide multifaceted psychological and social support and the chance for veterans to work through their personal issues.
Group interactive art therapy sessions took place three times a week (every two days) in the afternoon and lasted for two and a half hours. They consisted of warm up activities, a main art-based activity with a discussion, and an ending. The beginning of each session included some warming-up and introduction to the theme of the session, after which participants were involved in art making, usually for 45 - 50 minutes, and the remaining time of 30 - 40 minutes was reserved for discussion. Participants were encouraged to interact with each other through the use of materials and the process of discussing their artwork.
The process of the art therapy program involved four stages that materialized naturally in the group interactive context and synchronized with the phases of group dynamics (“forming,” “storming,” “performing” and ending). Groups were usually formed of 5 – 8 patients. The group art therapy program lasted for one month and included 12 to 14 sessions. Various art-based activities were used throughout the course of art therapy in connection to the stage of treatment and group dynamics, and were aimed at achieving different therapeutic goals.
The issue of ecological identity in art therapy with war veterans
Nature-assisted art therapу can involve experiences of becoming embedded in the ecosystem and empathic attuning to the living environment and forms of life. The results of this include improved health, well-being and support for our perception of ourselves as ‘ecological subjects’ and our eco-identity [20, 21]. Nature-assisted art therapy can bring changes to humans’ perception of themselves in their interconnectedness with the life web.
According to environmentally-grounded personality theory, one’s relationship with nature occupies a special role and is a vital factor in healthy personality formation and functioning. Thus, establishing an Earth-based sense of Self, an eco-identity based on human identification with the world of nature, has the same significance as one’s relations with people. Our emotional bond with nature and the attachment of human beings to nature, together with our bonds with other people, are integral to the psychological growth of a person, beginning with the early developmental phase and ending with the final stage of the human lifespan.
Healthy personality development takes place within a wider matrix of being, “the web of life,” and involves relationships that enable the formation of eco-identity. The notion of eco-identity challenges most “conventional” personality theories and can be defined as the interiorized dynamic structure of our relationship with nature that embraces both the human and more-than-human worlds and serves as one of the significant foundations for self-perception and self-conception. This is the kind of self-understanding that is linked to one’s mutually sustaining relationship with the living environment and implies one’s responsibility and care for nature. Ethical and aesthetic perception of the world of nature and practical action aimed at its preservation and cultivation of the world on nature serve as important factors in one’s own health and well-being.
The concept of eco-identity was adopted by ecopsychologists (T. Roszak, R. Metzner and others) and is often used to explain the reciprocity between planet and psyche [14, 19, 23, 26]. There are four primary components to ecological self-experience: cognitions, emotions, spiritual experiences and behavior. The cognitive aspect of ecological self-experience includes perceptions of being “similar, related to, or identical with other life-forms” [7, p. 95]. The emotional facet of ecological self-experience includes feelings of emotional resonance with other life-forms . The spiritual aspect of ecological self-experience involves cognitions and emotions related to the broad and more universal, planetary or cosmic Self. Finally, the physical behavior characteristic of ecological self-experience includes “physical reactions of defending or nurturing other beings as if they were one’s own self” [7, p. 96].
The subjectification of the environment and the development of eco-identity
According to the ideas of ecopsychology, certain forms of creative/expressive environmental activities can serve as acts of creating eco-identity, and move an individual psyche from a more limited sense of oneself to the wider environmental sense of self. Ecopsychology justifies the specific subjective mode of perception of the world around us, often defined as the subjectification of the world of nature and natural objects (i.e., the perception of the environment and objects as having their own subjectivity). Subjectification plays a significant role in the process of eco-identity formation, and enables an ethical perception of nature.
At the same time, the endowment of natural objects with subjectivity can be viewed from different perspectives. One of the positions, thoroughly described and investigated by Sergey Deryabo , is associated with the recognition of natural objects as a means of reflecting human subjectivity; the Self-image of the individual. According to Deryabo, the process of human subjectification of natural objects has the following basic functions: a) to provide persons with an experience of their own personal dynamics, b) to act as an intermediary in a person’s relationship with the world, and c) to act as a subject of joint activity and communication.
Ecopsychology [22, p.13] also proposes a subject-generating interaction as such a process whereby the psyche takes on actual existence, passing from “being in possibility” to “being in reality” through the human interaction with the environment. In this case, the psyche embraces both human and environmental parts in order to produce a new aggregated quality:
…the psyche appears as the emerging quality (property) embracing the whole “human-environmental” system, which (since it is systemic) is not reduced to the actual properties of either “human” or “environmental” as components of the specified system, but is determined by both of them. This means that the formation of psychic reality as a quality of this specified system occurs in the functional range, the limits of which are set by the relevant properties of its components, that is, an individual and the environment. [22, p.14].
In consequence, this type of interaction between humans and their environments establishes a new subjectivity that is not reducible to the subjectivity of the individual and the qualities of the environment that were present before the start of the process.
Case example 1: Natural objects as a representation of ecological identity
This work was done during the 13th session of the art therapy program which lasted for one month and included 14 sessions. Initially there were 8 participants in the group, but three of them had already been discharged from the hospital. The remaining part of the group included four men and one woman. Though all other patients were staying in the hospital for the first time, one client (G.) had previously been hospitalized and had participated in group art therapy several times. He had more experience of participating in different groups as compared to other members and was often very active in art-based activities.
During the 12th session participants made their “personal coat of arms”. This session was quite resourceful and helped patients to express inner strengths and created some link to the 13th session. During the 13th session the therapist encouraged the participants to use found natural objects within a nature-assisted activity. Between the 12th and 13th sessions he involved the participants in an outdoor activity, during which they searched for natural objects as a part of their art therapy program.
His idea was that through the use of some environmental assignments the patients could be facilitated to go through a termination phase of therapy and to move to a more open space as a new symbolic ground of their more autonomous functioning. This activity could also help the patients to frame and reframe their self-perceptions, so that their ecological identity strongly related to their vitality and resilience could be more revealed.
In order to help clients to prepare for the 13th session the therapist suggested a ‘homework’ during the 12th session. He invited them to look for some natural objects while outdoors on the hospital territory between the sessions and bring them to the art therapy room. The therapist encouraged the participants to either work with an open-ended format with no particular topic chosen beforehand, spontaneously responding to the environment and choosing any natural objects that they find attractive or meaningful, or on the basis of a theme, such as “Self-image object”. While walking outdoors they could ask themselves: Is there some natural object (objects) in the environment I feel connected to, have some affinity with, or which can represent my personality?
When they arrived for the 13th session, there was a selection of natural objects, such as sticks, branches, cones, stones, etc. present in the room. However, the spectrum of objects was rather limited. One of the clients, G. demonstrated the two marble stones with cleaved sides that he found at some distance from the hospital building (Fig.1). He perceived these stones as a symbolic representation of some of his personal traits.
Figure 1: The two stones brought by G. that represent his perception of himself
When the therapist invited the participants to show and comment on their findings, G. said that he liked the stones very much and associated them with himself, his reliability and endurance, the ability to steadfastly cope with difficult, stressful situations. The life history of this patient was indeed full of stressful situations, in particular, due to his chronic physical illness which required several serious surgeries.
The patient said that the two stones, though similar, signify somewhat different sides of him. There was a natural sequence of light and dark lines that the patient associated with sea waves on the top of the first bigger stone. He also associated the whole stone with a ship steadily going to its destination. The patient suggested that this object could serve as a symbolic cornerstone of his stance in life, which includes his will and ability to strive for his place in life despite many challenges and limitations. He also declared that his optimism and belief in a “better future” helps him to go on a journey though “the turbulent sea of life’”. He found that the alternating light and dark lines on the edge of the stone could represent “his life credo”: “There is the sun behind any dark cloud”. His observation was that, though he had intuitively followed this life credo for quite a long time, his participation in the art therapy program helped him to recognize it and even consciously use it on a daily basis, not only for the sake of himself, but for the sake of the people who surround him.
He recognized the stone with its delicate layering of blue and white shades as a representation of a significant personal ‘discovery’ which he made as a result of his participation in art therapy program. He explained that he came to a more balanced and nuanced perception of reality, which he developed through his experience of artistic self-expression and communication with other people. When he noticed this stone during his outdoor walk, he instantly realized that it was very special and could be his metaphorical self-portrait, a representation of his new perception of himself as a result of art therapy.
The second stone was also very special to him. He noticed that this stone had a dark blue ‘heart’ surrounded with a lighter peripheral zone. He associated these two structural parts of the stone with different emotions and feelings related to different aspects of his personality. He associated the dark ‘heart’ of the stone with some ‘core’ feelings that he cannot control while the peripheral zone of lighter colors was associated with social, interpersonal skills and positive emotions, sense of humor, in particular, that he can use in order to effectively regulate his state of mind and relationships. G. also showed a third, bigger, brownish stone, which, unlike the two other stones, had no clearly defined meaning for him. He only said that the stone resembles him - ‘a horse with a smiling muzzle’.
Another group participant, A. hadn’t found any interesting object during his walk, but G.’s findings and explanations evoked a strong reaction and inspired him to continue his search until the next session. He brought his art-object, a combination of the three natural creations, to the 14th session. His art-object consisted of the whale’s vertebra, a small figure of a crab made of a walrus’ bone, and a part of deer’s horn (Fig.2).
Figure 2: A combination of the three natural creations with the central small figure of a crab made of a walrus’ bone which was brought by A. as a representation of himself
A. said that a small figure of a crab is the central part of the composition. It caught his attention when he first noticed this object at the market place and he decided to buy it, though it appeared to be quite expensive. When the therapist asked him what was special about this object, A. answered that he was impressed with the skillful elaboration of the figure of the crab and that it could serve as a symbolic representation of himself. He felt an inner ‘attunement’ to this figure and that it implied some meaning and strength. A. became very emotional when he was commenting on his reactions to this figure.
A. explained that a crab is ‘nice and slow’, but it can be a ‘safeguard for his family.’ He associated the platform made of wale vertebra with his family. He added that the crab is very strong and ‘it cannot be easily crushed like a crayfish’. He even recalled that his comrades had given him the nickname Crab when he was in the army. He was often behind them due to his sluggishness. However, his comrades found him to be a trustful and reliable person. When the therapist asked A. which of his other personal characteristics the crab could symbolize, he emphasized such qualities as ‘courage, good temper, safety and ability to defend his family and territory. It can also be very steady and fast if needed’.
Other group participants wanted to support A. They joined the discussion and noticed that crabs are indeed very interesting and resourceful creatures.
Case example 2: Environmental photo-taking assignments as a way to find one’s ecological identity
As a continuation of environmental activities, the therapist invited the participants to use cameras to take a series of photographs while walking outdoors. This activity was introduced as their homework. He suggested them to look for some natural objects or landscapes when they would be outdoors in the hospital grounds between the sessions. They were encouraged to either work with an open-ended format with no particular topic chosen beforehand, spontaneously responding to the environment and choosing any natural objects that they found attractive or meaningful, or on the basis of the theme “Self-image objects/landscapes”.
He explained that they must later make their selection of most meaningful or interesting photos. He suggested that they select, in particular, those photographs that have some affinity to them, symbolically illustrate their personal issues or personality, or present their ‘healing’ or emotionally-loaded experience during their walkabouts.
After completing his environmental photo-taking activity, G. brought some photographs to the next session. He printed them in an A4 format and added a few photographs that he had taken earlier on his own initiative as a response to various objects in the environment which attracted him. He fixed them on the wall, creating a kind of a personal exhibition, and he explained that some of his photographs had been taken spontaneously, with no particular topic chosen beforehand. At the same time, he also made two photographs on the basis of the theme “Self-image objects/landscapes”.
Most of the photographs he made were related to the animals whose images he recognized while meditating on the trees that were abundant in the hospital grounds. He mostly concentrated on parts of the trees such as tall broken branches and stumps. As he explained, his preoccupation with these parts was evoked by the first natural object that he met right after he left the hospital building. This was a tall branch that was cut, but gave life to young shoots. It evoked an illusory image of a deer with horns in G. (Fig.3)
This image signified a central theme of the whole series of G.’s photographs related to his perception of himself as a person who is able to cope with life’s challenges and traumatic experience. This theme was already well represented in the example describing G.’s found objects.
Figure 3: A tall cut branch with young shoots which G. perceived as a deer with horns
Initially, G. spontaneously responded to this object without any relation to himself. When he concentrated on the image, he noticed that ‘this creature has a smiling muzzle’ and appears to be comfortable and friendly to the world around. At this moment G. realized certain associations between this image and himself. He discovered a complex meaning in it which embraced both dramatic, painful, life-affirming and positive sides of his life.
G. became sympathetic towards ‘the creature’ that he recognized in the image and accepted a considerable similarity between deer’s and his own qualities. Like him, the creature was damaged, but survived and is still full of life. As already mentioned, beside psychological trauma, G. suffered from severe physical illness and had undergone serious operations, but he did not let despair and pessimistic feelings dominate him. Even during the most painful and dramatic periods in his life, he searched for sources of positive feelings and relied on his sense of humor, connections with his family and friends and even physical exercises. His life-affirming philosophy has proved to be helpful in coping with challenging situations with which he has been confronted and this is eloquently illustrated by the image of the 'deer’.
Some other group participants actively supported G.’s stance in the world during their discussion of his photographs. They found it similar to their own perception of life and themselves.
Figure 4: The tree trunk which G. associated with a woodpecker
Another his photograph represented a part of the tree trunk with a chaotic combination of cut branches. He associated it with a woodpecker and not only identified the type of the bird, but mentioned its name, ‘large variegated woodpecker’ (Fig.4). He later explained that this bird is very special and that he feels certain affinity to it. He even demonstrated a photograph that he had made earlier and brought to the session from home (Fig. 5).
Figure 5: A photograph representing the real large variegated woodpecker
G. said that it was difficult to take a photograph of the large variegated woodpecker, since this bird doesn’t like people’s attention. He explained that this kind of woodpecker is very cautious and intuitive and does not let people approach it. G. was very proud since he had made many unsuccessful attempts to take a photograph of this bird in its natural environment, but eventually had managed to take a good photograph. He believed that the woodpecker noticed him, but was trusting this time and let him come closer.
G. also said that he shares with this bird characteristics such as intuition, diligence and a sincere wish to do good things for society. He believes that the woodpecker benefits the environment when it ‘heals’ the tree by clearing it from pests and that this can serve as a metaphor of his own public activity motivated by his wish to make the world better. He said that he does that naturally, following his inner need and responding to the world around. He explained that intuition for him is not so much about caution, but rather a quality such as attention to the environment and people around him, their needs and feelings and that it is impossible for him to live without being ‘intuitive’ in this sense of the word. He presumed that as a result of his participation in the art therapy program, he had been able to recognize such an altruistic and active position to be very practical and helpful for him to improve his well-being and health.
Another group participant, a woman (N.), demonstrated her photograph taken while she was walking outdoors, spontaneously responding to the environment and natural objects she found most attractive or meaningful to her. She recognized that the germinating flower she came across her way can be her “Self-image object”.
Figure 6: Photograph with the unopened flower growing right on the road which N. recognized as her “Self-image object”.
There was the unopened flower growing right on the road which N. recognized as her “Self-image object” on her photograph. In the discussion, she associated this image with an assortment of her psychological qualities projected onto this image, including such attractive ones as vitality, resilience, strength, courage, love of life, beauty, creativity, etc. She also associated it with her will to help and support, shelter and care for others in need. To illustrate this idea, she specifically highlighted the presence of a small beetle on the stem of the plant, as a representative of the local fauna, receiving help and protection from it.
She later recalled her earlier metaphorical self-portrait with an image of the thistle flower and the two figures of small animals hiding under it. Comparing the photographic image and her metaphorical self-portrait allowed her to further relate herself to these powerful images representing some vital qualities of her eco-identity and her value orientation to strive for life and beauty and to support and protect lives of other people and creatures, too.
This article examined some nature-assisted techniques based on the use of natural objects and taking photographs were applied during a short-term art therapy program with war veterans in order to reveal and support their ecological identity as a healthy and resilient aspect of their Self. The concept of ecological identity (eco-identity) has been considered as a prerequisite of healthy and environmentally-friendly life-styles and personal resilience helping, in particular, to more effectively cope with stress. A variety of experiential elements required in order to provide eco-identity formation and develop environmental consciousness was embraced in particular in nature-assisted creative activities implemented in the group art therapy with war veterans.
The construct of eco-identity is based on the understanding of human subjectivity as being shaped not only in the societal and cultural domains, but also in a wider living environment, in particular, in the process of the creative interaction between humans and the world of nature.
Based on the experience of using nature-assisted art therapy techniques with war veterans who are treated at the psychotherapy department of the hospital, the following observations and conclusions can be made.
It is possible to conclude that while working with found natural objects and taking their photographs clients related them to their traumatic experience, they were also able to reveal a significant life-affirming potential, resilience and beauty in those objects. As Bat Or and Megides  explain, collecting damaged or discarded objects in therapy ‘…may evoke identification with their wounded aspects within clients. As a result of trauma and /or loss, the individual literally experiences themselves as damaged, wounded. On a metaphoric level, it can be said that those broken objects may give voice to the injured and painful parts in us that were caused by the trauma. In the realm of mental functioning, they also serve as representations of those elements, which the traumatized person tends to dissociate, repress and/or mute’. (p.12)
At the same time, according to Shapiro , there is an inherent message in inviting clients to use broken, useless, or ruined objects as raw materials for creative work. Specifically, it communicates non-verbally that deconstruction holds potential to create the new (p.13).
In the presented examples the use of natural objects and taking photographs of them helped the clients to appropriate, subjectify and find resourceful meanings implied in them. Patients were able to get involved in the ‘subjectification’ of natural objects with the following basic functions: a) providing patients with an experience of their own personal dynamics, b) acting as an intermediary in a person’s relationship with the world, and c) acting as a subject of joint activity and communication .
It is possible to conclude that through their nature-assisted creative activities clients materialized their subjective mode of perception of the world of nature, which in turn is based on the ecopoietic function of the soul.” [17, p.10].
The main process was connecting and integrating objects, either real or represented in the photographs, into a new construct and elaborating on a personal narrative. Traumatic events and later problematic life situations of the clients had affected their systems of attachment and meaning. By actually connecting the objects and creating narratives, which are loaded with emotional content, the medium enabled the mending of broken connections in the patients’ inner world. This phase inherently consisted of combining the objects to create a new construct, which can be seen metaphorically as the opposite of the psychological splitting and fragmentation that are well-known reactions to trauma.
As Bat Or and Megides  explain, ‘Finding the right words for describing the subjective meaning in the readymade art may thus be a real therapeutic challenge and achievement for the client, similar to finding meaning in their suffering as the only thing that helps them bear it’. (p.19). The case examples demonstrate that the group explored different perspectives on how a life situation can develop according to their story. As a result of their activity, they experienced new insights.
Some positive outcomes observed through the use of environmental, nature-assisted practices included improved interpersonal communication, greater appreciation of underlying themes of psychological trauma and recovery, hope, enjoyment in utilizing new art media, successful completion of projects that reflected personal meaning for clients, and recognizing personal resilience revealed through clients’ relationship to the environment.
Clients learned to use the restorative, healing potential of their interaction with the environment and natural objects and the power of nature-assisted creative activities to express themselves and uncover important underlying themes. The nature-assisted activities facilitated additional benefits for the war veterans, such as sensory and emotional stimulation and the experience of joy and pleasure as a result of their immersion in ‘the green’ space. They were able to mobilize and effectively use their creative resources during their acts of subjectification of the environment as a significant resilience and coping strategy.
Based on the outcomes achieved through nature-assisted art therapy intervention with the use of found objects/ready-mades and photographs, it would be pertinent to develop a special program of nature-assisted art therapy with war veterans in order to more fully realize the potential of this therapeutic medium with this particular client group.
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Reference for citations
Lebedev, A.; Kopytin, A. (2023). Ecological/nature-assisted art therapy with war veterans and the issue of ecological identity. Ecopoiesis: Eco-Human Theory and Practice, 4(1). [open access internet journal]. – URL: http://en.ecopoiesis.ru (d/m/y)