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Art and the Brain: Effects of Dementia on Art

Production in Art Therapy
a a
Laura T. Safar & Daniel Z. Press
a
Boston , MA
Published online: 27 Sep 2011.

To cite this article: Laura T. Safar & Daniel Z. Press (2011) Art and the Brain: Effects of Dementia on Art Production in Art
Therapy, Art Therapy: Journal of the American Art Therapy Association, 28:3, 96-103, DOI: 10.1080/07421656.2011.599734

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 Art Therapy: Journal of the American Art Therapy Association, 28(3) pp. 96–103

C AATA, Inc. 2011

articles
Art and the Brain: Effects of Dementia on Art Production
in Art Therapy

Laura T. Safar and Daniel Z. Press, Boston, MA

Abstract
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In this article the authors integrate perspectives from neu- Background

rology and studio art therapy as they apply to the art production
of an individual with dementia. The main areas of the brain Brain Areas Involved in Art Production
involved in art production, and the art-related consequences of
brain deterioration in different types of dementia, are discussed. Art production is a complex cognitive, emotional, and
The case of an artist with corticobasal degeneration is examined sensorimotor process that recruits activity from several brain
with respect to her neurological symptoms, changes in her art regions simultaneously, representing a complex conglomer-
over time that occurred as a result of her dementia, studio adap- ate that is more than the sum of its parts (Zaidel, 2005).
tations and interventions, and therapeutic progress informed by Art can originate from the peripheral stimulation of dif-
neurological knowledge of her illness. ferent sensory modalities (e.g., when painting a still life);
from complex cognitive activity involving thoughts, emo-
tions, and internal imagery (e.g., when painting from mem-
Introduction ory); or from a combination of these processes. Different
parts of the nervous system play a role in the creative pro-
In the neurology literature numerous case reports de- cess, including the motor system, the somatosensory path-
scribe changes in art production among individuals with var- way, the visual pathway, the affective processing system, and
ious neurological illnesses. The general aim of these reports the cognitive symbolic system. Individual expressive styles
is to understand the connection between the localization of may emphasize one or more of these systems over others.
certain brain lesions and the art product. In the art ther- Painting is predominantly a visual process (Miller &
apy literature, on the other hand, such case reports tend to Hou, 2004). Two visual pathways in the brain are essential
include a dynamic perspective on the therapeutic process, for art: a ventral pathway, which is involved with recognizing
artistic manifestations over the course of treatment, and vari- “what” is seen, and a dorsal pathway, which localizes “where”
ous psychological aspects. In this article, we attempt to bring an item is in space (Ungerleider & Haxby, 1994). Visual
these two worlds together. The case presented reflects, in scenes absorbed over the course of a lifetime are perceived
part, the different roles of the two authors involved: one as by components of the ventral pathway situated in the oc-
a psychiatrist with art therapy training and the other as the cipital and temporal cortices. These internally represented
consulting neurologist to the case. As also happens in our pictures of people, animals, objects, and scenes constitute
interdisciplinary team meetings, art therapy and neurology the creative soil for many artists, and are ultimately repre-
have quite different traditions and language, and their inte- sented in the form of paintings and other media. The ven-
gration is not always smooth on the edges. We believe, how- tral pathway integrates form and color so that an object can
ever, that improved integration of our theories and practices be recognized. The dorsal pathway, mostly localized to the
results, in the end, in better patient care. parietal lobes, is used to internally frame items perceived in
the ventral stream, to place them onto a canvas, and to see
Editor’s Note: Laura T. Safar, MD, MA, is a psychiatrist and a scene as a whole; it responds to spatial locations so that a
art therapist at Brigham and Women’s Hospital, Boston, MA, and person can act in space (Goodale & Milner, 1992). Because
an Instructor of Psychiatry at Harvard Medical School. Daniel Z. of this important role in perceiving and representing space,
Press, MD, is a physician at the Parkinson’s Disease and Move-
and acting in it, the posterior parietal lobes are central to a
ment Disorders Center and the Cognitive Neurology Unit of the
Department of Neurology at Beth Israel Deaconess Medical Cen- person’s ability to produce art.
ter, and an Assistant Professor in Neurology at Harvard Medical Both hemispheres of the brain process visuospatial in-
School. Correspondence concerning this article may be addressed formation and are involved in making art (Malchiodi, 2003;
to the first author at lsafar@partners.org Zaidel, 2005), although some authors have proposed that
96
 SAFAR / PRESS 97

the right hemisphere plays a larger part (Lusebrink, 2004; her preserved capacity to make realistic art despite the fact
Mendez, 2004). People with right hemisphere damage tend that she was nearly mute. As with Alzheimer’s disease, there
to have problems with the spatial arrangements between the are exceptions, however, to the general rule. Finney and
parts of an image, whereas those with left hemisphere dam- Heilman (2007) discussed a decrease in art novelty, and
age tend to oversimplify the elements in a drawing while Budrys, Skullerud, Petroska, Lengveniene, and Kaubrys
maintaining overall spatial organization (Warrington, James, (2007) suggested a turn from abstract to symbolic concrete-
& Kinsbourne, 1966). Because linguistic information is pro- ness in the paintings of artists affected by FTD.
cessed predominantly in the left hemisphere, it plays an im- Corticobasal degeneration (CBD), also known as corti-
portant role in depicting symbolic concepts in art. cobasal ganglionic degeneration, is an uncommon type of
Regarding the frontal lobes, the dorsolateral prefrontal dementia characterized by lesions in both the brain cor-
cortex helps with the planning and organization of artistic tex and the subcortical structures (Feinberg & Farah, 2003;
effort. Thus, the frontal cortex has a facilitatory function Yudofsky & Hales, 2008). Cortical manifestations of the
in the creative process; research also suggests that it has an illness may include apraxia, cortical sensory loss, and alien
inhibitory role (Bogousslavsky, 2005; Flaherty, 2005). One limb sign (a limb that moves outside of volition). Subcorti-
example supporting this claim is the increased capacity for cal symptoms due to lesions in the basal ganglia may include
visual creativity observed in individuals with frontal lobe asymmetric stiffness and slowness of movements. Kleiner-
atrophy due to frontotemporal dementia. In addition, the Fisman and Lang (2004) discussed the case of a profes-
motor and premotor frontal regions (along with the basal sional artist with CBD who started to create distorted images
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ganglia and cerebellum) carry out the precise movements with bright vibrant colors, disproportionately sized body
needed to create art. parts, and uneven applications of paint. He also exhibited
The somatosensory pathway is involved in the manip- left-sided neglect, depicting a greater number of detailed
ulation of art tools. The limbic system participates in the images on the right side of the canvas. Right parietal dys-
emotional responses invoked while producing and looking function resulted in impaired visual-constructive abilities,
at art. whereas frontal dysfunction contributed to the loss of in-
hibition manifested in his previously uncharacteristic use of
bright colors and coarse strokes.
Changes in Art for Different Dementias
Art Therapy and Degenerative Brain Illnesses
Because the brain plays an active role in art produc-
tion, brain degenerative illnesses will affect the product and Art therapy is an important method to address the psy-
process of creation according to where the brain lesions chological and emotional needs of patients with chronic
are located. Certain types of dementia follow a character- medical illnesses (Malchiodi, 1999). When working with el-
istic pattern of brain lesions; individuals with the same ill- derly adults, art therapy may augment the skills that many
ness tend to show similar changes in art production. Artists older persons retain (Callanan, 2004). Wadeson (1987) dis-
who have Alzheimer’s disease, for example, have been ob- cussed the effect of art therapy on quality of life, social
served to produce artwork that declines in a fashion paral- and emotional growth, and rehabilitation of physical prob-
lel to their decline in visuospatial, motivational, mnemonic, lems in elderly patients. Cohen (2000) studied the potential
and organizational skills (Crutch, Isaacs, & Rossor, 2001; for increased creativity in the aging brain and linked this
Cummings & Zarit, 1987; Maurer & Prvulovic, 2004). with the brain’s plasticity, noting that the brain’s capacity to
Fornazzari (2005) discussed a case of an artist whose cre- change in response to environmental challenges continues
ativity was relatively preserved until late in the course of her with aging.
disease, and likely due to relative preservation of right pari- Kamar (1997), Stewart (2004), and Galbraith, Subrin,
etal and right temporal lobes with respect to other brain ar- and Ross (2008) discussed the confluence of art therapy and
eas. In most cases, one can expect that the artwork of indi- neuroscience when working with patients with dementia,
viduals with Alzheimer’s disease will become gradually more and demonstrated that art therapy is especially suited to en-
simplistic. gage patients in relationships with others and to increase
In contrast, the opposite may happen with frontotem- their motivation and self-expression. Patients with demen-
poral dementia (FTD). There are several case reports (Drago tia have shown more interest, sustained attention, pleasure,
et al., 2006; Mell, Howard, & Miller, 2003; Miller et al., and self-esteem while attending an art program compared to
1998) of individuals with FTD who developed new artis- other activities (Kinney & Rentz, 2005).
tic skills after onset. It may be that in FTD both the In the case that follows, we discuss the effects of corti-
anterior temporal lobes and parts of the frontal lobes degen- cobasal degeneration on an artist’s art and art therapy pro-
erate (therefore reducing their inhibitory power) while the cess. One important treatment goal was to help the patient
entire visual system in the right posterior part of the brain overcome the psychological and neurological obstacles that
remains intact (Miller, 2008). Seeley et al. (2008) described impeded her from continuing to make art. With this pre-
a case of a woman with primary progressive aphasia (a form sentation, we expand the literature in two significant ways.
of FTD) whose dorsal and ventral visual pathways still func- First, we were able to observe and analyze changes in art pro-
tioned close to normally late in her illness, which explained duction concurrently as they appeared. Second, we were able
 98 ART AND THE BRAIN

to intervene and modify the effects of CBD in art making vene while she was working on her art in her daily work
through art therapy, integrating knowledge from the neuro- space. The first author, a psychiatrist and trained art ther-
logical field into art therapy treatment. apist, conducted art psychotherapy at Ms. B.’s studio. The
second author, a neurologist, met with Ms. B. periodically
at the Cognitive Neurology Unit, an ambulatory care cen-
Case Description ter which provides treatment to individuals affected by var-
Ms. B. (pseudonym) was a 57-year-old artist with symp- ious neurological conditions with emotional, cognitive, and
toms that mostly involved difficulties with her visuospatial behavioral manifestations. The two authors maintained fre-
function, which had started 2 years before and developed quent communication throughout the course of Ms. B.’s
gradually. Initially, she felt off-balance, finding that at times treatment at the weekly interdisciplinary team meetings and
things appeared distorted and that she could not draw as well in individual consultation as needed.
as before. She presented with “dressing apraxia,” a right pari-
etal lobe sign that is characterized by difficulties with spatial Art Therapy Treatment
manipulation of clothes and subsequent difficulty getting
dressed. She also had difficulty positioning herself when sit- I (first author) met with Ms. B. monthly for 2 to 3 hour
ting, and with getting into a car because she would reach for sessions at her art studio. She clearly expressed her goal for
the wrong side of the door. It troubled her to read and write treatment: She wanted help in continuing to paint. She did
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because she would lose track of the line she was working on. not want to discuss her art, but rather wanted to make art.
She felt very tense and had insomnia. This desire became a significant part of therapy. Art therapy,
A cognitive examination revealed that her general intel- in this sense, provided a means for “the unsayable to be said”
lectual ability was estimated in the high average range. She (Miller, as cited in Kamar, 1997, p. 128).
had mild to moderate deficits in tests of attention and ex- Together we reviewed her personal history as an artist.
ecutive functioning. Her language skills were intact and she For 35 years she had worked in different media including
generally performed well on tests of verbal memory. How- acrylics, sculpture, and works on paper. She was commer-
ever, her visuospatial memory was impaired. She presented cially successful and had exhibited her work. Three years
severe deficits in visuospatial functions with reduced con- earlier she had started a series of large acrylic paintings of
struction and nonverbal reasoning skills. When given the abstract landscapes (e.g., Figure 1). The images show vast,
task to copy a figure, she was unable to judge the orienta- open spaces; some depict lines of a road escaping into the
tion of lines in space. She also was unable to draw a clock or horizon. Even in the paintings without perspective lines, a
a cube, having trouble connecting the three lines in a trian- sense of depth is achieved by the use of transparencies and
gle. An MRI of her brain showed mild diffuse atrophy that changes in light and color. After starting this series, Ms. B.
was more marked in the parietal lobes, particularly the right had gradually began to experience a decline in her capacity
parietal lobe, which is fundamental to art making. Given her to draw perspective and to convey a sense of space. Attempt-
symptoms and imaging findings, her diagnosis was probable ing to overcome her deficits, she made dozens of drawings
CBD.
Six months later, Ms. B. had significant apraxia that was
much worse in the left hand. She was able to reach into
space to her right with her right hand but had problems
with her left hand, and could not reach into space to her
left accurately with either hand. When shown a large let-
ter A comprised of smaller letter E’s, she was only able to
see the smaller letters. This deficit suggested the presence of
bilateral parieto-occipital lesions that may result in Bálint’s
syndrome, characterized by a triad of ocular apraxia, optic
ataxia, and simultanagnosia (an impaired ability to perceive
parts of a visual scene as a whole). Simultanagnosia also man-
ifested in her difficulty in grasping a painting as a whole
when looking at a canvas in front of her. Ocular apraxia is
the difficulty in voluntarily directing one’s gaze toward ob-
jects in the visual field. Optic ataxia is the impaired ability
to reach for or point to objects in space, under visual guid-
ance. Ms. B. showed these symptoms when she was unable
to locate and reach for items in her studio.
Ms. B. was very distressed and perplexed at the changes
in her art, and was psychologically paralyzed by her illness.
It appeared that helping Ms. B. continue to make art would
be an important intervention and that having sessions in her Figure 1 Abstract Landscape (2007) (Color figure
studio was the best approach, as it would allow us to inter- available online)
 SAFAR / PRESS 99

Figure 2 Skyscrapers (Early 2008) (Color figure avail- Figure 4 Skeleton of a Painting (December 2008)
able online) (Color figure available online)
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depicting urban landscapes and skyscrapers (e.g., Figure 2). peared repeatedly in her later paintings despite her efforts to
Finally, drawing in itself became difficult. She could not find depict three dimensions, supporting the latter hypothesis.
lines previously drawn on the paper or connect lines to each When we began our sessions, the last, unfinished paint-
other. She said that she was “trying to find the magic line.” ing that Ms. B. had created consisted of only a few strokes of
The last acrylic painting she had completed depicts two dark green (Figure 4). She called it a “skeleton of a painting,”
large bodies of color, a darker one on the lower side of the and felt mortified and scared when she looked at it. Dur-
canvas and a lighter one on the upper plane (Figure 3). The ing our second meeting she chose to work on it some more.
colors are flat, without lights or much variation in hues. The Her painting method was to load a sponge with paint, dip
image appears concrete, as if a wall impedes the viewer from it in water, and then use it to paint wide transversal move-
seeing anything beyond the immediate. Decrease in color us- ments that covered the width of the canvas. Suddenly the
age, size of forms, and spatial arrangements may signify de- piece that had remained untouched for months was being
pression (Wadeson, 1980), which in Ms. B.’s circumstances modified, causing her to exclaim with joy and celebration.
could have expressed her sense of a foreshortened future. Ms. B. worked on this painting over several weeks, adding
On the other hand, the flattening of the images she started new layers over time. She completed it the following spring.
producing at this stage may implicate a deterioration of her The finished painting (Figure 5) consists of several overlap-
parietal lobes, which are instrumental in the perception and ping layers or dark colors. She finished another painting of
depiction of three-dimensional space. This flat quality ap- similar characteristics later that year.

Figure 3 Things Have Flattened Out (2008) (Color fig- Figure 5 Skeleton of a Painting, Finished (Spring 2009)
ure available online) (Color figure available online)
 100 ART AND THE BRAIN

A comparison of the three paintings (Figures 1, 3, and

5) shows the progression of deficits related to CBD, with
a gradual decline in Ms. B.’s ability to portray space and
ultimately a substantial deterioration of her capacity for rep-
resentation. As we continued to work together, it became
apparent that “trying to find the magic line” had another
meaning: she was trying to find her very own artistic “line,”
the personal mark that represented herself as an artist. There
was a double sense of loss involved, in both her technical
ability to draw and her artistic identity that she expressed
in visual form and saw reflected in her art. She was keenly
sensitive to whether the art she was creating was her own
or an unfamiliar product of her brain. Therefore, my inter-
ventions alternated between assisting Ms. B. to reproduce
images similar to those she had made in the past, and other
times encouraging her to “let go” and paint in whatever way
she could in the present.
When Ms. B. struggled to make a certain line and ap-
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peared committed to it, I would try different methods to

help her achieve it. For instance, I would ask her to describe
in words the line she wanted to produce. I would show her
some of her older paintings that had similar lines. Or I would
mimic the arm and hand movement needed to produce such
a line, and ask her to imitate it. I had her draw lines on a
smaller piece of paper, making it easier for her to see what
she had drawn in a smaller section of her visual field. We dis-
covered that when drawing with her eyes closed, she was able
to make a larger and more complex shape. This supported Figure 7 Drawing by Memory of Movement (2009)
the theory that due to her visuospatial deficits it would be (Color figure available online)
best not to rely on her eyes for guidance and to pay more
attention to somatosensory input instead. vited her to draw the road by moving her pencil on the paper
Her insight on her deficits and capacity for problem to reproduce the movement from muscle memory instead of
solving were very much intact during this stage. She was in- using her eyes, because she could not see the image in front
ventive in the methods she utilized to try to overcome her of her (Figure 7).
limitations. For instance, to create images of buildings that We also changed the orientation of objects in her studio,
she no longer could draw, she tore pieces from her older placing her easel and art materials on the right side where she
drawings with this subject matter and collaged them (e.g., had better reach. Her apraxia made it difficult to squeeze a
Figure 6). When she wanted to create a landscape with a paint tube with her left hand so she switched to her right
road going to the horizon, as she had done in the past, I in- hand. As her apraxia progressed, she used larger cylindrical
paint containers instead of paint tubes; she dipped a long
stick into the container to obtain paint and then transferred
the paint to a sponge for painting. Later on, she skipped the
use of the stick and dipped the sponge directly into the paint
container.
While she painted, at times Ms. B. would talk about ex-
periences from the past or how her illness was affecting her
life and her loved ones. I would respond with questions or
interventions in the tradition of verbal psychotherapy. Other
times she chose to work quietly. I would then offer unobtru-
sive support to allow her to connect with her creativity while
providing a holding environment and being available if she
needed me.

Discussion
This case study illustrates the effect of a particular de-
Figure 6 Drawing With Collage (2009) (Color figure mentia (CBD) on the art production of an accomplished
available online) artist. When working with neurologically impaired patients,
 SAFAR / PRESS 101

understanding the brain areas affected by their illness may ing effects of art making in itself or focusing on art products
facilitate greater comprehension of their limitations and ca- and processes as elements in a psychotherapeutic frame. It
pacities, and provide guidance for interventions that may clearly was important for Ms. B.’s treatment to be inventive
include encouraging them to overcome a deficit or to grieve and flexible, and not restricted to a traditional approach. I
a loss and shift focus to the functions that are still intact. found that I would alternate my roles as an art and verbal
It was evident from Ms. B.’s clinical exam, neuropsycho- psychotherapist and physician, using the latter when dis-
logical testing, and MRI that her disease had significantly af- cussing aspects of her illness or medications. As an art thera-
fected the parietal lobes of her brain, especially on the right pist, I drew from Moon’s (2002) conceptualization of “studio
hemisphere. Consequently her dorsal visual pathway, which art therapy,” which situates art as the center from which we
is fundamental in perceiving and depicting space, was clearly may not only understand ourselves as art therapists but also
impaired. This impact was demonstrated by her initial dif- understand our clients and the therapeutic process. Moon
ficulty to draw three-dimensional objects such as buildings based the therapeutic relationship on a relational aesthetic
and the gradual progression to an extreme difficulty to draw model that recognizes art in its capacity to foster and deepen
at all. She switched from representational drawings to scrib- relationships to the self, the art object, other people, and the
bles, which over time became more elementary in form and environment. As art therapists, our artistic perspective allows
style. In her paintings she showed progressive impairment us to develop a therapeutic alliance that respects the client’s
in her capacity to depict space. As illustrated in Figure 3, identity as artist, which was a central concern for Ms. B.
Ms. B. initially continued painting landscapes but they had a An example of how art and verbal psychotherapy were
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flat quality. Later on, due to progressive cortical compromise combined within a relational aesthetic can be seen in the de-
with the development of Bálint’s syndrome, the representa- velopment of our therapeutic relationship. Ms. B. quickly
tional quality in her paintings worsened further (e.g., Figure agreed to work with me in her home studio in part because
5). She covered the whole canvas from top to bottom with a she had a positive institutional transference toward the med-
predominance of dark hues. Occasionally, she showed signs ical center where I worked, based on interactions with her
of left-side neglect and favored painting on the right side of primary care physician and her neurologist. During our first
the canvas. She also was more likely to miss objects situated two sessions, however, she presented a more cautious view
on the left side when describing a painting from an art book. of our working together due to negative experiences with
Ms. B.’s impaired mobility—both due to cortical symp- psychotherapy years before. Thus, it was important to es-
toms such as apraxia and subcortical symptoms such as tablish a therapeutic frame where she felt safe—even more
Parkinsonism—contributed to the changes in her art tech- so because she was opening her home to me. Her vulnerabil-
nique and the art product. When no longer able to use a ity was further accentuated by her neurological and physical
brush, she switched to a sponge. Later on, when squeezing a symptoms. We approached this challenge of greatly want-
paint tube became difficult, she switched to larger paint con- ing yet fearing or resisting help in several ways. We verbally
tainers that allowed her to dip a sponge inside. Her painting processed the information she was sharing and its potential
technique became simpler. In her last two paintings, she cov- connection with our relationship and our work together. In
ered the canvas with repetitive lateral movements to a great response to her questions I disclosed some basic personal in-
extent, going from one side to the other. formation including my own artistic activity and my rela-
Home studio–based art therapy helped in unique ways tionship with art. The expectation, which she confirmed by
in this case and allowed for interventions and results that her therapeutic response, was that these selected pieces of
would have been difficult to achieve with verbal therapy self-disclosure would act as catalysts contributing to a devel-
only, medications, or art therapy in a clinic. Neurological opment of trust. That my self-disclosure was meaningful yet
knowledge about Ms. B.’s illness helped me to understand quite limited also appeared important; too extensive a disclo-
her difficulties in perceiving and depicting images, finding sure could have dissolved boundaries and reduced her sense
and manipulating art tools, and moving her body in space. of safety. It appeared that my disclosure of my love of art al-
Integrating neurological knowledge in her treatment made lowed her to experience me as a fellow artist. Our therapeutic
it possible to emphasize her strengths, for example, in adapt- alliance was thus established in part on respect for the thera-
ing to changes in her art production and aligning them with pist’s identity as artist (Moon, 2002), which in turn gave Ms.
her current capacities. By focusing on her remaining capac- B. some guarantee that I would understand her relationship
ities Ms. B. was able to recover the pleasurable aspect of with her artistic process and the objects she made. Lastly, the
the experience of art making, which in itself can be healing development of trust was fostered through my very careful,
(Lusebrink, 1990). In this individual who was not interested respectful, and deliberate actions in her home art studio. I
in “explaining” her paintings, the act of painting in itself and intentionally communicated, through words and body lan-
self-expression in the art product appeared to be important guage, that despite her physical limitations Ms. B. was em-
to her emotional health. At the same time, given her pre- powered with the choice at any given time to proceed with
served verbal abilities and intellectual curiosity about her ill- a session or not, to allow or deny my access to her space.
ness, education about the neurology of her illness helped her Dementia may dramatically and in actuality change the
adjust to the changes in her art, grieve the losses, and strive self. For many artists, their work plays a mirroring func-
to find ways to continue creating. tion; there is a component of self-recognition when look-
In working with clients in special clinical circumstances ing at their own art. A degenerative brain illness confronts
art therapists may use eclectic approaches that are especially the individual with troubling questions: Is this me or my
suited to their clients’ needs, whether emphasizing the heal- brain? Is this my art or my brain’s art? The therapist needs
 102 ART AND THE BRAIN

to be aware of the effects of dementia when assessing a pa- Applied understanding of the neural framework of dorsal
tient’s symptoms or artworks. In the case of Ms. B., I needed versus ventral stream spatial processing can inform the na-
to consider whether the black flatness of her painting was ture of deficits in art production and allow for therapy tar-
indicative of brain deficits or a successful rendering of her geted at the specific impairment. Knowledge of the brain
view of the world in light of her illness, whether her insis- areas affected by corticobasal degeneration and their func-
tence on drawing buildings was a neurological sign of per- tions is essential in providing effective treatment. It also is
severation or a psychological need to defy her illness. In important to understand how a brain degenerative illness
viewing artwork produced by individuals with neurological may affect a person psychologically.
deficits it also is important not to “over-read” as a conse- In the case described, studio-based, neurologically in-
quence of neurological deficits style changes, which may in- formed art psychotherapy obtained results that would be un-
tentionally or unconsciously express creative needs. likely to occur in an office setting or with verbal treatment
When working with patients with severe degenerative alone. Close consultation with the patient’s neurologist pro-
disorders we face the question of hope and its meaning in the vided a frame that helped in designing specific treatment in-
context of a terminal illness. At the time of our first meet- terventions. Therapeutic interventions, although they may
ing Ms. B. felt paralyzed. The meaning she constructed for not change the neurological course of the illness, may ame-
“hope” was “to paint.” Due to her insight, knowledge about liorate the effect of the illness on an individual’s daily life
her illness, and preserved language capacity, she was a keen and provide a sense of hope.
witness and reporter of the progress of her symptoms. While
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paralyzed by her grief she only wanted to draw buildings,

which she was unable to do. Later on she developed some References
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The process of psychotherapy unfolded in parallel with brain disorders. European Neurology, 54, 103–111.
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ing together took place. Ms. B. had many psychological Budrys, V., Skullerud, K., Petroska, D., Lengveniene, J., &
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