“That’s my stroke”: Expressive Arts Therapy with a survivor of stroke

Rose Stanton

Arts Therapy is a form of psychotherapy which connects with a variety of theoretical frameworks. It is more focused on the creative process and self-understanding than on art as an end product. I practise the multimodal approach. This is the use of two or more expressive therapies to foster awareness, encourage emotional growth, and enhance relationships with others. The expressive arts therapies can be defined as “the use of art, music, dance/movement, drama, poetry/creative writing, play, and sandtray within the context of psychotherapy, counselling, rehabilitation or health care” Malchiodi (2005, p. 2).

The following case study was undertaken during my clinical training as an expressive arts therapist through Whitecliffe College of Arts and Design, in Auckland. The client has given consent for this work to be used and has expressed a wish that it will benefit others. A pseudonym has been used.

A brain injury or stroke impacts on many aspects of life, changing a person’s physical abilities, communication and cognitive function, personal relationships and roles in the world. Often, people living with the effects of brain trauma feel a need to find new meaning in life (Weston, 2008).

Grace was in her mid 40s when she suffered a life-threatening stroke in the right side of her brain. At the time of the arts therapy work, she lived in residential care. The stroke had resulted in severe short term memory problems, an inability to organise some thoughts, as well as considerable gaps in emotional and social communication. She could be intolerant of others and, reportedly, they could be irritated by her repetitious communications. She used a wheelchair and was not expected to be able to walk again.

Our initial meeting revealed that she had an interest in collage, handwork, music, word games and math games. Grace agreed that using visual arts and language or music therapeutically would be interesting for her. The treatment plan included a safe structure to promote creativity (in a private space), and at the same time help her to develop her own imaginative resources and encourage some expression of her experiences of stroke.

The first session used collage as an introductory mechanism and focused on the question “How do you see yourself at this moment in time?” This resulted in an informative and colourful collage (Figure 1) which provided the basis for a conversation about her family and interests. The next session built on her evident love of gardening by using plants and flowers to create an image of a garden. She expressed interest in the symbolism and hope of spring time, but also expressed her loss of relationship with her family. The next three sessions explored personal expressions such as “I’m very hard on myself”. Then I introduced challenges related to things that she couldn’t do now because of stroke, such as cooking for her family.  In session five, the work moved to a more personal account of her life history. At the end of session five she reported that her focus in a recent scrabble game had improved. I observed that her hands and arm movements appeared to be more coordinated, and her work indicated improved spatial awareness.

The sessions included movement, music and poetry writing. In session six Grace was beginning to make creative suggestions and had expressed pleasure in her creative work and movement.

By session eight, Grace was pleased that her daughter had arrived home from overseas and that life was getting better. In the warm-up, her hands started “dancing”. I mirrored this, amplifying the movement. Grace said it was “like rain” and that it reminded her of “glitter”. I suggested making a glitter picture. Grace requested black paper, and made a spread-out image with glitter glue, to which she stuck stars. She then created a poem using the words Serenity, Trees, Air and Rest (STAR), which we discussed. Looking at the black paper with its glitter cloud, she said, “That’s my stroke” (Figure 2). Following that she initiated some discussion of anxious thoughts but didn’t dwell on these for long. She was enthusiastic about writing to the theme of her picture: “every cloud has a silver lining”.  At the end of that session she asked to rest quietly and silently in my presence, an indication that she was beginning to feel safe in the therapeutic environment. “Silence supports reflection and contact with emotion. Silence allows the client’s self-awareness to venture deeper” (Pearson & Wilson, 2009, p.81).

Session nine included a review of her work and focused on one symbol that had emerged as important for her. She chose a tree (Figure 3). Sessions ten to thirteen included making a greeting card and then completing her first altered book: removing some of the original contents, painting the pages, inserting photos of her arts therapy images, and doing some creative decorating. She said the whole process gave her a great sense of “satisfaction”.

Acknowledgement: I would like to acknowledge Spark Studio in Auckland, in association with the Stroke Foundation, for some of the themes and ideas which I adapted for use with this client.

Rose Stanton is a Learning Advisor in Student Success, at Otago Polytechnic. She has worked for many years as an English Language teacher and trainer both in New Zealand and overseas. She has a Masters in Arts Therapy (Hons) and is a Registered Expressive Arts Therapist.


Malchiodi, C. (Ed.). (2005). Expressive Therapies. New York: Guilford.
Pearson, M., & Wilson, H. (2009). Using Expressive Arts to Work with Mind, Body and Emotions. London: Jessica Kinglsey.
Weston, S. (2008). Art Therapy and Anger after Brain Injury. In M. Leibmann (Ed). Art Therapy and Anger (pp211-225). London: Jess


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