Dr. Erica Scott — The Fine Art of Addiction Therapy

A nationally certified counselor who has worked with a variety of patients to combat mental illness and addiction for nearly 24 years, Ericha Scott takes personal pride in helping people become their best possible selves. Her career has seen her adopt many disparate roles, from college professor to art therapist to television host. Scott, who in 1983 began recovery from co-dependency in a Terry Kellogg workshop with her father and brother, possesses a unique understanding of the healing process. In an interview with ABILITY Magazine’s Chet Cooper, she explains her unique ability to synthesize art, expression and psychology in a continued effort to improve and save lives.

Chet Cooper: My first question is a pretty basic one: how do you define art therapy?

Ericha Scott: In very general terms, it’s the process of creating and using an image to help heal the mind, body, and spirit. Poetry, sculpture, painting, drawing. Any kind of expressive process.

Cooper: And how is this art used as a form of therapy?

Scott: I use many modalities. When I was working at Sierra Tucson, I helped facilitate psychodrama therapy.

Once I was working with a woman who was the wife of a diplomat, and she was very polite and she smiled a lot, but actually was not very kind when she spoke to people. She alienated her peers with that contradiction in her personality. She had been abused in a concentration camp when she was very small, but she denied having a traumatic history. She also denied having any talent for art, but I noticed that when she moved, she walked very gracefully. She walked like a dancer walks, with a certain poise and beauty, really.

Unfortunately, she was so stuck in herself, so stuck in her past. So to facilitate her process of healing, I asked her if she would dance her experience in the concentration camp. At first she said, “No, I can’t dance,” so I offered to dance with her. I can’t dance, myself, but I offered to dance with her to help reduce her fear and shame. I stood up to dance with her, but she, from some place, rallied the courage to do it herself, and she asked a peer to make the sound of the concentration camp sirens, you know that [whistles]?

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Cooper: Oh, you were in a group?

Scott: Right. And she began to dance. I was a little worried that she would do a dance like you might experience from a junior high school skit, but that’s not what she did. She stepped into the space and time of dancing her childhood experience: being a little girl, separated from her mother, watching the soldiers beat someone who was looking for her child. She danced the mother, she danced the soldiers, she danced herself, she danced the whole scenario. The room was totally silent. People were so moved by the authenticity of her presence and by the truth of her story.

Cooper: And that kind of therapy is called psychodrama? Scott: That’s right. It’s a use of the theatre. Normally we don’t have people dance in psychodrama, but for her, it turned out to be the perfect modality. The peers she had alienated came to have compassion for her as they watched her dance.

Cooper: That sounds like therapy for everyone, then.

Scott: Everyone. It softened the hearts of the people watching, it helped her quit denying the truth of the tragedy of her experience, it helped her move through some assignments I had given her. She began to actually do her assignments, which helped her move forward and heal. I would even say it was therapeutic for me, because I witnessed someone move past her prison into something profound and beautiful.

Cooper: That sounds great.

Scott: There was another great experience, when I was still working in that same unit at Sierra Tucson. We had a client who was young and very beautiful. She had been raised in a very religious home and yet had gone awry with alcohol, drugs, and had been a strip-tease dancer. She had begun to toy with prostitution. Obviously this was a problem.

A woman at the unit named Carol Roth was the facilitator for those people who came to us for treatment of sex addiction. Most of the people in her group were men. We did psychodrama with the two groups, which, as you can imagine, are fairly intense groups of people. We were all very concerned about this young woman, and we talked about how to set up her psychodrama. Ultimately we decided to set up her stages of life, her youth, her innocence, her budding sexuality and passion for life, and her experiences as part of a very restrictive, judgmental religious family, and then to move into the pole-dancing and the prostitution aspects of her life.

As it turned out, we didn’t have enough women in the group to play her in all the ages of her life, so she asked a few of the men who were sexually addicted to play her. At first I thought, “Oh, this is not good! This is going to be a comedy, and not a good one!” So I just held my breath and literally prayed.

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What happened that surprised me is that I had underestimated how much the men cared about her and how much they were worried about her. Here were these heterosexual men who really played their hearts out in her role. I mean, they put lace on and pretended that they were shimmying up and down a pole and rolled their pants up and there was not a joke or a wink or not one second of inappropriate action there. And it was incredibly moving.

She provided them with the thoughts that often went through her mind when she was dancing, which included, “You stupid sucker, you think that—”

Cooper: “—you’re in control of me”?

Scott: Exactly. “You think you’re in control? I’m in control.” The blessing of psychodrama is that it heals everyone in the room. For the men, this broke their fantasy about what they thought they were seeing when they went to the dance club. And for her, this allowed her to see herself played, to see that the role she was playing wasn’t real for her. She saw that it was painful and dangerous, because she was so young. So that was a particularly moving psychodrama. And I’m surprised that I’m talking about psychodrama so much, because that’s not my primary modality.

Cooper: What is your primary modality?

Scott: I use a lot of imagery because my background is in art. I have a bachelor’s degree in art and I studied art in southern France with Sarah Lawrence, and I had been an artist well before I became an art therapist. So when I first worked as an addictions therapist in 1985, my supervisor said, “Why don’t you use art therapy?” And believe it or not, I said, “What’s that?” I had no idea— even though I’d been an artist and was working with addicts—I had no idea what that was.

Once I started making use of art therapy, I was stunned that art was able to say more than the clients could say about their addictions. Art seemed to bypass their cognitive defenses. And what I really liked is that I didn’t have to confront the client. The art confronted the client.

Cooper: It sounds almost like a third party that you deal with.

Scott: Yes. It was almost as if the art paper, the colors, the lines, the images were all another therapist. That enabled me to align with the client and support him, rather than become adversarial in trying to get through his denial and minimization and defenses.

One of the things I often do in my therapy sessions is, I use miniature figurines in a sandbox. Those allow the client to very quickly access his subconscious and his archetypal image, a role, a place in the world. It’s especially helpful for those who are afraid of art, or who are afraid they might not be talented or creative.

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Cooper: You’re calling this art therapy, but in some sense this figurine activity might not be described as art, per se. It’s more as if you’re using these figures as avatars.

Scott: That’s exactly true. I’m a board-certified art therapist, but I’ve found there are often parallels between art therapy and sand play therapy. The sand play therapists have their own certifications separate from art therapy, but many art therapists also use sand play. Sand play therapy and sand tray therapy are just two different theoretical ways of facilitating therapy.

Over 20 years ago, when I was designing a project for children in a museum, I noticed that children who were given open-ended art projects—like making mobiles, for example—were engaged and were amazingly creative if no one interfered with them. They were calm and behaved properly. We had no problems with discipline in those cases, because for the kids it was great, it was fascinating. But I find that many addicts who come to treatment have a hard time concentrating and focusing. They’re shame-based and often have learning issues, if not learning disabilities, so you can lecture to them until the cows come home, but it likely won’t get you very far.

Cooper: In a sense, this basically advocates for the opposite of what we all usually talk about: thinking outside the box. You have your patients think inside the box with sand therapy, it seems. As long as they stay in that box, they’re really doing well and they’re engaged. But how do you keep them in that box and also help them build a well-balanced life?

Scott: It’s difficult. I became hooked on art therapy in 1985, when my brother had developed some sort of brain mass. We don’t know what it was. The doctors had done a CAT scan and could see a mass, but they weren’t sure if it was a tumor or what. My brother was slurring his words. His ability to walk and to speak were affected.

At the time, I had recently heard of art therapy. I was excited about it. I had read a little bit and was in my first year as a therapist at that time. So I took a sketch pad and some pencils and asked my brother to draw the brain mass as a monster. I didn’t really suspect anything. I just thought it might help reduce his anxiety.

He drew. I turned the page. I had him draw it smaller. I turned the page. I had him draw it smaller again. And overnight, the brain mass disappeared. He was discharged the next day. So I choose to believe that that was a miracle or was somehow facilitated by art therapy. The power of that potential really grabbed me. That’s why I went on to get a doctorate and to study art therapy as long as I have. I’ve seen that kind of turnaround with people repeatedly, using not just words but image or shape or color as ways to tell their story.

Cooper: How’s your brother doing now?

Scott: He passed away. But the brain mass never returned. He lived for five years with AIDS and he died. But the brain mass had never become a problem again.

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Cooper: And you’ve found that art therapy helps with a wide range of clients?

Scott: It does. I once facilitated sand tray therapy with a client who had relapsed multiple times in front of his therapist. At the end of the session, the therapist said, “I have never seen him concentrate or stay engaged in a project for such a long period of time. Ever.” The therapist was just amazed. What was interesting was, this client was a young man who had been in trouble with the law and who had been in every kind of trouble you can be in, but he treated my miniature figurines with reverence. That was very touching. He took it seriously, without cynicism or sarcasm or any disrespect whatsoever.

Cooper: What kind of figurines are these, exactly? How do you use them?

Scott: I have well over a thousand rubber figurines. Some of them I’ve bought from traditional sand play figurine shops. For example, I have human figures of five different cultures and three generations. Some of them are elderly. Some are young. Some are professionals. Some are babies. Asians, African Americans, Caucasians.

Cooper: And you use figurines that match up with individual clients?

Scott: What I try to do is find a wide spectrum so no one’s left out, so no client will feel left out when she comes to look at the selection that I have. I don’t change my selection for different people. I just ask my clients to choose figurines, as well as a theme or an issue to address. Sometimes I ask them to choose a polarity in their lives.

Cooper: Can you explain that?

Scott: For example, addiction-sobriety might be a classic polarity for an addict. Happiness-sadness might be a polarity. I ask the client to choose the polarity. Sometimes I ask her to portray her first drinking experience or the first time she ever used drugs. It depends on the client and what she needs and what she’s bringing to the session. I ask the client to choose figurines that seem to call to her. It’s an intuitive process.

A lot of art therapy revolves around the idea of projection, the idea that art is a mirror. When I was in Arizona, I worked with a woman who had an eating disorder. She was extremely anorexic. It’s very difficult to help an anorexic break her delusion of her fatness when she is very, very emaciated. I had this woman do a series of self-portraits, body maps, body tracings, as well as what I called “blind contour” self-portraits.

Eventually this client said things such as, “I’m too thin.” So, again, the paper was the other therapist in the room. If I had told her that myself, she would have argued with me. She said, “What have I done to myself?” Those are statements that emanated from her spontaneously in the therapeutic process. Those were her “Ah ha!” and “Eureka!” moments of awareness.

Cooper: After a situation of discovery like that, does a client ever relapse?

Scott: There’s a high rate of relapse. I do know that, since I’ve been in the field for 25 years, I’m finding that the rates of relapse seem higher than they did when I was younger.

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Cooper: What do you think the causes or the triggers are for people to find themselves in that situation of relapse?

Scott: I can’t say for sure. I know that when I began as an addiction therapist in 1985, I had the lowest relapse rate of any therapist in my two-hundred-bed hospital. But that was 25 years ago. While there was profound addiction and profound trauma in ‘85 and through the ‘80s and the ‘90s, it seems as if there was a better community to support people back then than there is now. I think there’s more alienation today.

Cooper: Was there a financial trigger for that change?

Scott: I don’t think that’s all of it, but some. The drugs used today are more toxic. Children are starting drugs sooner. For example, in ‘85, if I saw someone with brain damage, it would be someone who had been drinking for 30, 40 years and was in his sixties. Now I’m seeing kids in their twenties with evidence of brain damage from methamphetamine and crack cocaine.

I work with multiple addictions so, in my opinion, if someone comes in with a drug and alcohol addiction and doesn’t address his secondary issues, he’s more likely to relapse. If someone comes to me to work with chemical addiction, I ask about other potential addictions. Maybe he’ll quit drinking and taking drugs, but if he also has an eating disorder, things escalate. If there’s a gambling addiction, things escalate. We have to look at addiction across the board. It’s one thing to have a neurological impact later in your life, after you’ve had children, after you’ve had a life and a career, but now I’m seeing it earlier. That concerns me.

There’s a lot of pressure on young women, in particular, to be thin and beautiful. Naomi Wolf, in The Beauty Myth, talks quite a bit about the impact of the beauty myth on women and what she calls the “sex industry” or the “sex trade”. It has a profound negative impact on our young women and on women of all ages.

Cooper: In patients who are dealing with anorexia, do you find that they’re only looking at “society’s view” of what women should look like and essentially can’t see themselves in the mirror?

Scott: Yes. And a lot of that comes down to family dynamics. Often young women with eating disorders are very driven and are perfectionists.

Cooper: Is there some obsessive compulsive disorder in there?

Scott: Absolutely.

Cooper: So you have to treat other issues as well. Not just the nutritional problem. You can solve one problem but the overall issue has still not been solved.

Scott: Exactly right. For example, when I was working with eating disorders at Sierra Tucson, we would look at the basic logistics of what clients were eating, how they were eating, and how they were exercising. But we’d also look at issues of self-esteem, at issues of being compulsive and perfectionism. So it needs to be a very comprehensive program.

I came up with my own model of art therapy for people who have addiction and trauma, and often there is a correlation between the two. My model starts with authenticity, because so many people don’t know how to be themselves in their own skin. They don’t know how to tell their story, or they’ve never told their story, or they minimize and dismiss very powerful, impactful events in their lives.

Cooper: This is something you use in your practice?

Scott: This is my own theory. I call it the “Eight Essential Process.” It’s been published. It’s not a stage theory, but it outlines what needs to be attended to with clients when they seek treatment. It addresses projection, helping them see themselves in the mirror of what they are creating, whether it’s writing or poetry or sculpture or painting or psychodrama. And catharsis: the ability to express and to feel some relief from their productions.

A bone surgeon once approached me at one of my workshops and asked, “How do I portray my own surgeries? It’s been difficult for me.” And I said, “I believe you’ll figure it out.” There were 60 people in the room, ripping pages out of their notebooks. I turned to look at the surgeon, and he was beaming. He was joyous. Because for him, the ripping of the paper represented surgery. He had found what he was looking for.

I see that with my clients. The therapy helps bring relief and a chance to express the things that they have suppressed over time. It helps them find a locus of control. Some clients come to treatment and say everything is everybody else’s fault. Other clients come to treatment and are convinced everything is their own fault.

Cooper: Both are victim issues?

Scott: Or perpetrator issues. The irony is, perpetrators tend to talk like they’re victims, and victims tend to talk like they’re perpetrators. So victims will say, “It’s all my fault,” and perpetrators will say, “It’s all everybody else’s fault.” So basically we’re trying to help people come to accountability for themselves and not take accountability for things that other people have done.

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Cooper: Trying to get them to gain control.

Scott: Trying to get a balance. I should take responsibility for what is my fault, but I should also hold other people accountable for what’s their fault. Looking at developmental issues is really important. For example, I ask many addicts to look at their inner children, to begin to nurture themselves. It’s a way of loving. A lot of people can’t look in the mirror and say, “I love you.” But if they imagine their child selves, they are more likely to have compassion for themselves. And they can begin self-love in that way, by loving that concept of themselves.

Cooper: By reconnecting with their more innocent years?

Scott: Yes. And then we begin a process of integrating our polarities: active addiction and sobriety, sickness and wellness, happiness and sadness, and integrating our inner child. It’s amazing, the shift that can happen inside of a client as he tells his story of addiction history or trauma history. And that shift can be permanent. It’s not always permanent, but it can be.

The reality is that using art in addiction treatment really helps keep the clients engaged. Often, if there is art therapy involved, they are more likely to stay in treatment until they finish their treatment goals. That’s enormous. It makes all the difference.

Art Speaks Out Load—Dr. Ericha Scott’s website

In the next article, Dr. Scott interviews artist Alicia Rojas about art’s unique ability to change self-perception

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