Figure 1: L.J. Han, Heartache, 2024, ink, old pages and threads, 152 ×152mm

Artist statement

As an art therapist, I engage in writing and art-making to reflect on clinical work and navigate the impact of vicarious trauma from witnessing clients’ traumatic stories (Gibson, 2016). Response art-making uncovers the unconscious material that arises from therapy sessions, shedding light on the sensory, nonverbal, and intersubjective elements of therapy work. Creative expressions offer fascinating insights into clients, the therapeutic relationship, and countertransference dynamics (Fish, 2019). In this reflection, I share how I used poetry and art-making to process a lingering heartache. A sensation of my heart breaking with emotions had perplexed me for months until response art-making after sessions brought respite and insights. Both works A profound heart connection and Heartache (Figure 1) delved into the compelling connections I formed with my clients and the transformative effect it had on me.

Poem

The poem A profound heart connection emerged from experiences where I shared strong emotional bonds with clients. The poetic inquiry led me to see the true impact of my clients’ arresting stories on me. It was impossible to be stoic and unmoved. Poetry served as a medium for exploring the intensity of feelings experienced during and after sessions, as articulating the nuances of therapist-client relationships can be challenging. Through poetry, I found a succinct yet powerful way to synthesise and respond to the complex emotions I was feeling (McCulliss, 2013). The words and stanzas recounted a joint journey of discovery with my clients, illuminating how the encounters enabled my heart to grow exponentially with a myriad of sensations, reviving the parts that have been hurt, scarred, and hidden away.

Artwork

Accompanying the poem is an artwork titled Heartache (Figure 1), capturing the visceral sensations I embodied during therapy sessions and the unexplained pain that I carried afterward. My heart often felt like it had been broken, slowly stitched, and sewn back together. Initially a black ink drawing, the heart motif gradually took a more three-dimensional form. While stitching, I felt it needed more veins for blood to flow. I riddled the heart with hues of pink, and red, followed by purple. The purple veins represented the scars I brought back to life. Fervently, I restored the dormant parts, extending the network of veins outward. Subsequently, I attached vintage book pages to cradle the pulsating heart. The weathered pages felt familiar, like an old mentor, battered but strong, imbued with words of wisdom. In this tender cocoon, the heart nestled in reassuring comfort. I found the use of symbolic materials, like yarn and old book pages, critical in elevating my art-making experience. Without the metaphorical and sensorial landscape provided by these materials, I could not contain, excavate, and wrestle with my bewildering emotions and find closure.

Vicarious trauma

Through the creative process, I realised that I needed to tap into deeper parts of myself to analyse and fully fathom the array of feelings emerging from therapy sessions (Hyatt, 2020). This is especially true when working with clients with traumatic lived and living experiences. Their narratives often resonate on a deeply personal level, prompting affective responses and introspection (da Cunha & Vandenberghe, 2024). Addressing vicarious trauma is necessary for therapists to expand perspectives and facilitate personal development (Hatcher et al., 2015). Many therapists report shifting their philosophy toward life and relationships because of their learning from clients, becoming less judgmental and more appreciative of how hard change can be (da Cunha & Vandenberghe, 2024; Hatcher et al., 2015). Tending to the impact of vicarious trauma and confronting relevant personal history can lead to therapist growth, while a lack of reflection and adaptation can perpetuate symptoms of compassion fatigue and burnout (Gibson, 2016). 

A heart and soul relationship

In traversing the emotive terrain of therapy work, I have noticed the curative power of incorporating my own lived experiences and past wounds. Instead of minimalising my emotions, I learned to lean in and draw strength from the depths of my being to stay present with each client. Connecting at a human-to-human and heart-to-heart level was essential to foster the optimal environment for healing. I found myself tapping upon my heart and soul. While the heart serves as the conduit for emotions, the soul represents the essence of one’s being – a sacred space where the mind and heart converge. The soul can be a wellspring of spirituality and a source of vitality (Hammer, 2019). By cultivating this inner sanctuary, therapists can create a haven of refuge and compassion for clients (Hammer, 2019; Howard, 2008). From my poem, my soul offered a sturdy space to bear the weight of my clients’ trust when my heart was engulfed.

Defence mechanisms, rehearsed boundaries, and fear of being overwhelmed by personal history can create barriers to client empathy and connection. However, once I acquired a safe way to access my vulnerable parts, and draw on reservoirs of resilience, relating with clients became a compelling experience. Instead of shutting out hard emotions and uncomfortable topics in sessions, I began to embrace them. Howard (2008) asserts that it is the therapist-client relationship that provides the opportunity and context for change. When the therapist uses himself or herself within the relationship and accepts the vulnerability and volatility of changes, healing conditions are activated. Through mirroring, listening, and reciprocity, mutual trust and attachment take root. The client sees the therapist as a fellow sojourner on life’s passage, lighting their paths, not only a clinician.

A soulful therapist

Reflecting on my response artwork and poem, I am reminded of the boundless capacity of my heart to grow and hold space for others. My heart needed to break for it to feel, heal and expand, alongside the clients – they are not alone on the change journey. I, the therapist, needed change too. I made time to tend to my wounds outside of therapy, in the privacy of my self-care time. This restored and strengthened my ability to care for others.

The willingness to put myself out and feel fully allowed therapy work to take on more depth. I hope my clients felt free to share the entire burden of their trauma and found shelter during the storm. While acting as a safe space, my heart and soul were challenged to grow and mature, to contain, soothe, and transform the plethora of emotions that transpired in sessions. By embracing authenticity and vulnerability, the therapeutic alliance was built. Between therapist and client, a quiet mutual understanding emerged. A profound heart connection and Heartache (Fig. 1) serve as a testament to the transformative power of therapist–client relationships. This remarkable experience of lingering heartache has inspired me to continue evolving and growing as a wounded healer and soulful therapist.

References

da Cunha, O., & Vandenberghe, L. (2024). Improved self‐and relational regulation: The relationship with the client changes the therapist. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12745

McCulliss, D. (2013). Poetic inquiry and multidisciplinary qualitative research. Journal of Poetry Therapy, 26(2), 83–114. https://doi.org/10.1080/08893675.2013.794536

Fish, B.J. (2019). Response art in art therapy: Historical and contemporary overview. Art Therapy: Journal of the American Art Therapy Association, 36(3), 122–132. https://doi.org/10.1080/07421656.2019.1648915

Gibson, G. (2018). A visual conversation with trauma: Visual journaling in art therapy to combat vicarious trauma. Art Therapy: Journal of the American Art Therapy Association, 35(2), 99–103. https://doi.org/10.1080/07421656.2018.1483166

Hatcher, S., Kipper-Smith, A., Waddell, M., Uhe, M., West, J., Boothe, J., Frye, J., Tighe, K., Usselman, K., & Gingras, P. (2015). What therapists learn from psychotherapy clients: Effects on personal and professional lives. Qualitative Report, 17(48), 1–21. https://doi.org/10.46743/2160-3715/2012.1702

Hammer, D. (2019). Cultivating soulfulness in psychotherapy. Spirituality in Clinical Practice, 6(2), 139–143.  https://doi.org/10.1037/scp0000173

Howard, S. (2008). The heart and soul of the therapist: Rage, fear, desire, loss and love in the psychotherapy relationship. University Press of America.

Hyatt, L. (2020). From compassion fatigue to vitality: Memoir with art response for self-care. Art Therapy: Journal of the American Art Therapy Association, 37(1), 46–50. https://doi.org/10.1080/07421656.2019.1677423