Interview with: Eva-Marie Stern
An artist, therapist, and educator, Eva-Marie Stern earned her Master’s in Art Psychotherapy from Goldsmiths College, University of London. Twenty-five years ago she returned to Toronto and co-founded the Women Recovering from Abuse Program (WRAP), and later the Trauma Therapy Program, at Women’s College Hospital.
She is currently Adjunct Lecturer in the Department of Psychiatry at U of T’s Temerty Faculty of Medicine, and a Harvard Fellow in Museum-based Health Professions Education.
An enthusiast of experiential teaching, she has developed many seminars about trauma and its treatment. She’s often busy cooking up new ways of facilitating looking at and making art so that people can grow their relationships with themselves and with others. Recently she’s been involved in projects that mix-and-match art + teaching + therapy to help us help each other – for instance:
• using Graphic Medicine (or comics) to explain the strangeness of memory in trauma treatment, and to teach about the placebo/nocebo effect;
• writing about what “visual literacy” means for doctors and other health professionals; and
• looking into the limits of conventional narrative to understand our emotional life.
She enjoys hosting “art hives”: gatherings of colleagues and friends who come together to make things or go out on the town and look at art together. She maintains a private practice in psychotherapy, art therapy, supervision and professional consultation in Toronto at her studio-office, called artandmind.
Q: You’re a psychotherapist and also an art therapist. What inspired you to pursue this career path and this calling?
Oh, wow, big question. I grew up believing wholeheartedly that I would be an artist. But I went to art school and I soon dropped out because it felt too lonely. The emphasis at the time was on individual artists doing individual artworks and I felt like I didn’t belong in that. So, I quit art school and I had no idea what I would do. It took many years before I heard the term for the first time “art therapy”. I think I saw a flyer for a conference and I had never heard or read the term before, but it lit up all my sparks and I decided to pursue that. It was one of those epiphanies that you read about but you can’t believe until it happens. It happened. I became an art therapist with a two year diploma and then I got a Master’s in Art Psychotherapy at the University of London at Goldsmiths College. Overall, however, what inspires me is that it just seems so right to put art together with therapy–helping people make sense of themselves and their world and their relationships through art. It intuitively made sense. I then had to learn all the academic and more verbal ways to express how it makes sense, rather than just go on this intuitive feeling.
Q: I was curious if you could expand on those very briefly. Is there anything that was notable academically or research-wise in this field?
I’ll tell you first about psychotherapy. There are different schools of therapy. What really drew me was the relational school of psychotherapy. Within the relational school of psychotherapy, what we understand to be a basic, essential drive in human beings is our need to connect with ourselves and one another. Relationships are a basic necessity, as much as air, food and water. To connect, you need expression and communication. How that happens, how it breaks down, how to make it better is the bread-and-butter of relational therapy. From there, it was a really short jump for me to think about expression and communication through art. Hence, art therapy.
Q: I saw this quote on your website: “Nothing matters more than relationships. They make us and break us and remake us.” In terms of relational therapy, is that something that is present in all forms of therapy or is it something that you find very specific to art therapy?
There are so many different ways of doing art therapy. You can apply a relational approach whether it’s art therapy or more conventional verbal therapy. Relational therapy is sort of my template–my guiding directive when I practice art therapy–so I consider the relationship between my patient or my client and myself to be central. I also consider their relationship with their artwork to be very, very important, and the ways that I relate to their artwork is also extremely important in the therapy. Overall, I’m always looking at the quality of relationship between myself and my client and their artwork–and helping my client so we can look at it together, explore it and learn from it together too.
Q: How do you evaluate progress in your sessions?
Great question. I see progress when I see someone trusting me and trusting the work we do. So if someone, continuously from session to session, is able to tell me more or reveal more, or find more, relate more to their own artwork, I know we’re making progress. Safety is the baseline. It’s the ground that we stand on in therapy to make progress. If there is safety, progress is likely to happen. There are always, of course, disconnects in a therapy like there are in any relationship. In therapy however, we have this crucial mandate to try to repair disconnects, and through repairing disconnects, we make the therapy and the relationship stronger. We learn about ourselves and each other. We make more trust, more safety. And that leads to more progress.
Q: Have you encountered any challenges?
Oh, absolutely. With therapy there are a trillion challenges every moment. For example, in individual therapy, we’re two people getting to know one another–and it’s very risky. We could be judging each other at any moment. It always feels risky. In art therapy, additionally, the challenge that always almost always comes up is that a person will show up for therapy and say, “I can’t draw. I can’t make art. I’m no good at this.” And that prevents them from getting into the process of finding out what comes out of their hands, making marks, making images, and experimenting with the art materials. There’s usually that challenge to overcome in every art therapy and the way that I help people gain trust, or find safety in the art-making process is a big part of the therapy. So someone’s fear or self-judgment isn’t just a challenge to overcome–it’s therapy itself. People come in judging themselves, finding themselves inadequate. This is a great place for therapy to start. What is it that makes them feel inadequate? What is it that makes them feel that they can’t do something simple? What is it that makes them unsure of whether they can trust me as a non-judgmental person? All of these questions are very rich and productive in any therapy. So it’s not just a challenge. It’s a central part of the work. Therapy is scary for most people. So most people will express some kind of reluctance or fear or reticence or mistrust as they enter. It’s a scary thing to do. That’s part of my job to help them feel more, more safe in the process. Building trust is the heart of it.
Q: Do you collaborate with other health professionals?
I always want to know if someone I’m working with works with a psychiatrist or GP or another health provider. And whenever it’s helpful, I’ll involve that other professional in treatment. For most of the clients in my practice, currently, I don’t have a lot of conversations with their other health care practitioners unless there’s a real crisis, and then conversations are always helpful. But I’ll make referrals to other professionals. I’ll make and take referrals from other professionals and of course, when I worked at Women’s College Trauma Therapy Program, I had constant collaboration within our multidisciplinary team.
Q: Could you talk about your focus on art and trauma?
Art is a particularly helpful modality or approach to work with trauma because if you’ve been traumatized it can often be hard to find words for what happened to you, or how you feel. Sometimes the memories aren’t even clear enough to give words to, especially with childhood trauma. Terrible things can happen to people that really scar and hurt them. These things may have happened before someone even has fluent use of language, and so the traumatic effects are there somewhere, but they’re not in words. They may be in images, they may be in flashbacks. They may be in physiological sensations or gestures. All of that can get expressed with art materials in a way that words can’t really capture. Oftentimes, if people have been abused as kids, they’ve been threatened as well to not tell what has happened to anyone, and that can be a very difficult threat to shake, even as an adult. Exploring what’s happened and especially the impact of it can be easier to start with a nonverbal form. Of course, the fear of judgment comes up whether you use words or art, so you have to be very careful in art therapy as much as in any other form of therapy. Art therapy is an approach that can really help people who either don’t have words. But on the other hand, it can also maybe surprisingly, help people who are very confident in their verbal skills. It can help get beyond words to something more intrinsic, something more emotional, something more deeply felt that one is not used to articulating. Art can be a way around or beyond the verbal defenses that we all have.
Q: Witnessing all of this trauma sounds like it can be very heavy at times. How do you approach self care and manage burnout in your role?
That’s a great and very important question. For me, it’s connecting with colleagues. It’s having a safe space for myself to talk about how it’s affecting me and how I’m feeling and what I’m struggling with. I find that I really need that sense of connection and belonging with other people who do similar work in order to continue doing what I do. It’s a massive source of what we call self care, for me. There’s also my own artwork. So art making is my favourite mode of self reflection and it helps me put me back in touch with my own feelings, my own needs, whatever’s my own story, in the midst of witnessing and exploring other peoples’ stories.
Q: You facilitate a workshop available to medical students called Art is Patient, in which students learn how to relate to art and the world around them. How do you approach a client or patient’s work of art, or even art in general?
In looking at clients’ art, public art, or my own artwork, I try to keep in mind two lenses that we practice in Art is Patient. One lens is that of content–the what is depicted in an image. The other lens is the form–the how. These two lenses work together in any artwork, in any person, and in anything that we observe. We have to keep in mind that there are always two lenses and not to forget either one. Usually we tend to approach an artwork by interpreting the story that we think it’s telling us. That’s our first reflex: a quick first impression of what story the image is telling. What’s less reflexive is to look for how it’s speaking. In our Art is Patient seminar what I try to do is help us slow down our reflex to look at content, and notice all the qualities that we can perceive, whether it’s the colors, the shapes, the composition, the patterns, the size of an image, what it seems to be made of…etc. Then, we try to notice all that and let ourselves feel out our own response to those qualities, whether the qualities draw me closer to the artwork, or make me back up. Do I feel intimidated or do I feel protective? Do I feel curious, or a little put off? I try to help people register those feelings in relation to form. And finally, I help them go back and forth between the two lenses: content, that’s more obvious, and form, that’s maybe something to learn.
Q: Going on that note, what inspired you to develop the Art is Patient course?
It got started when I was doing clinical work with people in hospital being treated for trauma. I was in trying to devise a way to make an art therapy group that would be safe from judgment. If you make an image, whether it be abstract or representational, you don’t want someone else to jump in and interpret it, you don’t want someone else to tell you what your image means. And you don’t want someone to jump in and say “Oh, you’re such a good artist. I wish I could draw like you,” when you’re trying to express something meaningful. I wanted to find a process whereby people could respond to each other’s art that wouldn’t be judgmental and that wouldn’t be interpreting. What I realized was, if we could stop looking at the story, if we could stop trying to interpret what somebody else is making, if we could just try and notice what’s there in marks on the page or in the sculpture and how it affects us emotionally, that could be a good way to respond, to convey to the art maker that we’ve seen and been affected by what she’s made. As witnesses, we get to see and respond emotionally to how she’s made her art. She gets to tell the story about what it means. She gets to tell us where it comes from within her. She gets to say, “This is my narrative.” She still gets to feel witnessed, which is extremely important in trauma-focused therapy. The witnessing function of other people is maybe the most helpful thing that a trauma survivor can experience. To be witnessed and not judged is super powerful.
Q: What are some common misconceptions about art therapy?
One big misconception is that art therapy is just for children. Another one, probably the most common misconception, is you have to be an artist to make use of art therapy or you have to enjoy art-making. This is not necessarily so. With those who are new to art therapy I might say: Close your eyes, choose a marker and make marks for three minutes on this page and let’s see what comes up. Feelings and thoughts will come up and we’ll get to explore them. It’s really not about art-making as much as it’s about what I call mark-making.
Q: That’s a wonderful way to put it. It’s similar to music therapy in that you don’t have to be a virtuoso to participate.
Exactly. But of course, it’s intimidating. It’s like how going to an art gallery can be intimidating if we don’t know what we’re supposed to think or see. This approach to looking at art, which I use as an art therapist, and in our Art is Patient seminars to teach looking through these different lenses, has to do with helping people understand that you don’t have to know anything specialized. You don’t have to have any previous knowledge about art to find it meaningful. You can look at art meaningfully, you can make marks meaningfully without any special talent or background knowledge. And similarly, what I hope seminar participants get to: You don’t have to have any previous knowledge about a person you’re meeting as a health provider in order to have a meaningful encounter. What helps is to be open to both form and content.
Q: What do you see in the future for the arts and medicine?
This is where I make a pitch for the Health Arts and Humanities offerings at UofT! Humanities in medicine and other health professions is continuing to grow. A report published by the Association of American Medical Colleges in 2020 is called “The Fundamental Role of the Arts and Humanities in Medical Education (FRAHME).” It recommends the integration of the arts and humanities into all aspects of medical education, research and delivery of care. That’s coming from a body that covers accredited faculties of medicine, teaching hospitals, research centres and academic societies across both the US and Canada. Nothing to sneeze at. And by the way of nothing to sneeze at, our leader at UofT, Dr Allan Peterkin, just won the Visionary Award from the American Health Humanities Consortium. This year I’ve also been doing a fellowship at Harvard– and get this, this blows people’s minds–it’s called the Art Museum-Based Health Professions Education Fellowship. If Harvard is offering a fellowship with this theme, it’s because there’s a lot of interest and traction now. Look out for conferences, workshops, seminars, journals and books! It’s quite a dynamic and growing field.
