Category Archives: therapeutic alliance

Hide and seek

kids art040

It’s a joy to be hidden but a disaster not to be found. -D.W. Winnicott

True in any game of hide and seek, and meaningful in deeper ways. Winnicott, the British pediatrician/psychoanalyst, was a wise and playful man, and an important influence for me in work with kids.

A fifteen year-old girl comes into my office and refuses to speak, to draw, to do anything. We have known each other for years, have seen each other every week in art therapy sessions, and have lots of history together. Ours is a strong relationship, but these days she’s pretty unhappy, and having to come to therapy makes her feel even worse. She barely even bothers to roll her eyes at me when I talk to her, just puts her head down on the table. It’s going to be a long 50 minutes. So I start drawing her. There’s really not much else I can do. For a long time, she doesn’t stir. But she has been listening to the scratching sounds of the colored pencils I’m using, and she is curious about what I’m drawing. Eventually it’s too much for her, and she lifts her head.

at015She is visibly pleased by the drawing, or maybe just by the fact that I drew her, and we chat a little bit, nothing heavy, before she leaves. She thinks I ruined the drawing with those spikes coming out of her arms, and I can’t disagree. She laughs when I tell her I was just trying to draw her porcupine quills. Things feel comfortable, things feel safe. We are both relieved.

The following week she’s not talking again.

It’s a joy to be hidden but a disaster not to be found. Sometimes the best gift we can give is to be present, and wait until someone wants to be found. And find a way to remind them that they probably really DO want to be found.


I am counting my many blessings this Thanksgiving, and also feeling kind of sad. I sometimes get happy holidays texts from teens that I saw in art therapy, and today I heard from a former client who is not doing so well. She’s an amazing girl, very dear to me, and we have a lot of history together.

In psychology jargon, our relationship would be described as a strong therapeutic alliance. The term describes a relationship between therapist and client in which a sense of safety, trust, and common therapeutic goals is present. It has been said that a strong therapeutic alliance predicts better outcomes in therapy. But I say that a strong therapeutic alliance IS the therapy, and that therapy can’t happen without it. How much a client feels you care always trumps factors such as treatment method.

And so, a deep relationship led to a long Thanksgiving Day conversation with someone that I haven’t seen in a year and a half but care deeply about. And I am thankful for that.

Below is some artwork by kids depicting the therapeutic alliance. I’m the one with the purple hair and glasses.


This child shows how the sun and rain help a flower to bloom (the yellow arrow from the sun to the flower is hard to see, easier if you click to enlarge). What I love about this picture is the blue arrow, her awareness of how important the relationship is to me, too, how our relationship is a circle, and not at all one-sided.

flowers and sun

Flowers are a common metaphor in pictures about relationships.


Cheers! The clinical term may be therapeutic alliance, but often the word friendship better describes it.

friendship juice

Bottle jar box can

Bottlejarboxcan was the name of an old blog that I kept for awhile. It got its name from my penchant for constantly collecting all kinds of containers, which I use a lot in my own work.

OLYMPUS DIGITAL CAMERAContainers also figure big in art therapy. A lot of importance is placed on the establishment and maintenance of a therapeutic container or frame. Therapists strive to provide a place of containment, a safe space to explore, express, and experience all feelings, a relationship of trust and collaboration. This is an important component of all therapeutic theory, particularly for those working with children or others who become easily overwhelmed by affect because they lack internal controls. An important theoretical concept here is D.W. Winnicott’s holding environment.

In the particular context of art therapy, the artwork itself also acts as a container, something outside of the artist that safely holds and reflects emotions. Sometimes providing a concrete metaphor by supplying  an actual container to work with can help a child to feel more safe in expressing difficult feelings.

The possibilities for containers are endless. To bottle, jar, box, and can, add book, frame, nest, teacup, basket, egg carton, or pretty much anything else you can think of. It’s pretty easy to accumulate tons of great containers without spending a cent. Any recycling bin is filled with them.