Patients’ Artwork Speaks Volumes : Therapy: To the trained eye, the colors and shapes and themes of the drawings express hidden feelings.

The man had made a monster, evil-looking, crouching, with forked tail and claw-like hand. When the clay dried, he painted it black, with red eyes and red mouth. Along its side, he made finger-fitting indentations--he said they allowed him to get a grip on it, gave him some control over it. But into its claw, he put a tiny representation of himself.

“What do you want to call it?” art therapist Ruth Ross recalls asking him.

“Mother,” the man said.

To the therapist, the monster spoke volumes about the roots of the patient’s present problems.

“Verbally, we’re skilled,” says Ross, president of the Maryland Art Therapy Assn. “We know how to go around and avoid what we don’t want the other person to know. But we don’t know how to cover up with art, so it all hangs out.”

In art, people “reveal what they’re feeling that they don’t consciously know,” adds art therapist Gail Fenster of Walter Reed Army Medical Center in Washington. Fenster has been using art to help AIDS patients express the emotional turmoil that comes with the diagnosis, the occurrence of new infections, a change of medications, and uncomfortable procedures. Feelings of fear, anger, isolation, loss--and, eventually, peace--come out in the artwork, she reports.

In private offices and hospitals, in psychiatric care and general medicine, in diagnosis and treatment of children, adults, individuals and families, and in enhancement of work relationships, art therapy--just as traditional psychotherapies--requires talking.

Art therapy is, in some cases, a springboard to communication, helping patient and therapist see what they’re going to be talking about. If the topic is too painful and the patient too reticent, art therapy can allow them to focus on what’s represented in the art before they aim, more directly, at what’s happening in life.

Sometimes it helps patients clarify issues for themselves. For instance, says Linda Gantt, a West Virginia art therapist who is president of the American Assn. of Art Therapists, asthma patients can sometimes draw their concept of how they feel as an attack begins. The illustration triggers recognition of an impending attack, and the patient can do whatever the doctor has recommended to avert or minimize it.

Ross tells of a child caught in a custody battle who drew himself on a fence between a powerful father and a mother who seemed to have more symbols of growth--plus the jury--on her side. A week or two afterward, the child decided he’d rather stay with his mother.

Art is believed to be empowering: If you make something, you can control it--and then you can use it. At Walter Reed, where the nine art therapists on staff are believed to be the largest such group at any one institution in the country, formal goals include having angry people draw themselves taking part in peaceful activity, encouraging people stuck in repetitive behavior to use different kinds of art materials and having addicts draw themselves involved in more responsible activities.

And, adds Paula Howie, director of creative arts therapy at the military hospital, cancer patients are being taught to visualize their immune systems battling their disease. They are instructed to express what they visualize in an art form. “It helps them ‘concretize’ their visualizations,” she explains.

The base on which art therapy builds is Freudian.

“Human beings operate on a symbolic level, sometimes on many layers of symbolism,” Gantt says. In art--as in dreams, stories, body language, clothing and other nonverbal communications--we create symbols and receive messages that are less guarded, less self-serving and sometimes more basic than the overt messages of our normal language, she says.

Or, as Ross points out, “One picture is worth a thousand words.”

It’s only worth it if you decode it, of course. Images--such as monster mothers--are fairly obvious, but Sigmund Freud once said, “Sometimes a cigar is just a cigar.” Art therapists also warn about the dangers of overgeneralizing: “You can’t make a big case out of every airplane,” Ross says, pointing to the planes and rockets on her “graffiti wall,” a large canvas where child patients have put their pictures.

Because she knows the youngsters, however, she can point to the expression of power in this or that rocket, the powerlessness of the figure in the spider web cage, the anger in the knives and guillotine. There’s a little house on the canvas, in which the child artist has written, “No Budy Home.” There’s a bulbous, tentacled alien, which one child drew and another copied, but the copy is clearly weaker than the original, and that tells something about the artist too.

“Each person has his own themes; there are personal and cultural differences,” says Howie, who also cautions about drawing too many conclusions too quickly. “You would think that dark colors mean depression, but that’s not always true, sometimes yellow means depression.”

Similarly, notes Gantt, in our society, white is the color for celebration, as in weddings. But in Asian cultures, white is the color of mourning. And in India, red is the color for brides.

Nevertheless, she points out, these are “intense colors and they are most often associated with intense feelings, like anger, rage, hatred.”

Shapes and their relationships to each other are important too, says Fenster. Sharp-edged forms and colored lines suggest anger; separation of figures signals feelings of isolation; emptiness is depression; fragmentation of the pattern is shock, confusion, distress. Flowers and rainbows are more hopeful symbols.

Some of the pictures are very pretty, which is emotionally rewarding to many patients. But aesthetic accomplishment is not the point. According to Gantt, therapists must often say to patients, “We do not expect you to be an artist. This is not art class. Very simple marks can convey a lot of meaning. You don’t have to be Leonardo to pull it off.”

To the therapist, process is as important as product. In the ways that people create artworks, experts can find clues to their general work habits, their sense of organization, their relationships and general dominance: Does one person lead and others follow? Does one person impose bizarre images on the others, or does the group try to produce a rational pattern?

For the patient the process can also be therapeutic. “It’s kind of self-soothing,” Gantt says. “Sometimes chronically ill patients go almost into a trance; they focus their attention on something other than the body.”

Sometimes, too, it’s a release. The acquired immune defiency patients Fenster works with face losses no one can ever make up. In their art, she says, “They make restitution to themselves. The creative act allows for restitution, healing, regeneration. With the art, you’re tapping into emotion. They’re hurting inside; they get the hurt out on the paper, and they can leave it there, all nasty, or they can turn it into something beautiful.”

The nastiness is hard to miss: Short, angry color strokes; sterile trees, storms and coffins appear as disease first strikes, and as it worsens.

Then, as acceptance comes, there’s beauty: An angel rises, flowers bloom, peace returns in remembered pleasures and love transcends despair.