Marianne Pillsbury's debut pop-rock musical, Depression: The Musical, is a thought-provoking and emotion-eliciting demonstration of the relationship between creativity and depression and, ultimately, such as in the case of the protagonist, of their ally-like coexistence capable of giving birth to a relatable theatrical piece.

I was lucky enough to attend the opening night which benefitted from the raw, heartfelt and emotional sincerity that comes with presenting your work in front of an audience for the first time.
What made this particularly special was that this was an autobiographical account of some of the protagonist's deeply personal experiences with depression. These experiences were communicated through a series of monologues, songs and “call and response” moments between the main character and the "committee in her head." 

The musical touched upon some very poignant topics involved in the discussion of depression: common misconceptions about the term depression and how it is tossed around in every day life, the “two steps forward, one step back” process which is characteristic of the treatment for depression, the complexities of understanding the causes (Is there a genetic component? Is parental dismissiveness of our thoughts and feelings a factor? Is it the stressors associated with a fast-paced metropolitan city?)

Finally, in what seemed to be an “art imitates life” approach, the musical chronicled the protagonist's creative process as she went through fluctuating levels of motivation and commitment to the completion of the script and the music for her 1st theatrical musical performance.

“Depression:  The Musical” made me think of the winding journey of creativity, especially when it is shaped by energy-sucking bouts of depression. What might begin as a deeply rooted need to manifest an inner conflict can become a meaningful drive to document (often at the validating presence of an audience) one's experiences. The pressure of completion, complicated by the distorting effect of a depressed outlook, can give rise to great ambivalence regarding one's ability to keep going and even the worthiness of the creative work itself.

What begins with and, hopefully, comes full circle to a cathartic experience is often interrupted by low motivation, hopelessness, insecurities and self-doubt. It is when the authenticity of the need for catharsis leads the way, that one can find and sustain their voice. In the case of Marianne Pillsbury, her voice found an outlet through well-written songs such as "Medicated" and "The Boo Hoo Blues." In the play, and hopefully in real life, Marianne achieved therapeutic healing and succeeded in sharing with the audience a very touching expression of creativity both in spite of and because of her experiences with depression.
  

An article was published last month on BBC news discussing the differences in brain structure between artists and non-artists. 

"The research, published in NeuroImage, suggests that an artist's talent could be innate" says the article, which can be found here. Hearing this statement probably comes as no surprise. The idea of "a natural talent", "being gifted from an early age", having an "innate inclination" are all phrases we use to describe what sets writers, musicians and visual artists with exceptional skills apart. 

However, there is something that can be perceived to be rather deterministic about this statement. A graphic illustrator, who gave up a career in sales to pursue illustrating in her mid 30's, came to my office and discussed this article. With a slightly pessimistic tone she said "maybe I should just give up if I'm competing with all the people who were born to do this." This article triggered some disheartening childhood memories in my client. She recalled always feeling slightly behind and at a marginal disadvantage, compared to her peers who seemed to put less effort into their artwork but consistently received more positive feedback. Experiences such as these influenced my client to want to pursue a more "steady" career in which she would be able to rely on other factors rather than just talent. However, after a decade of being in sales, she came to terms with her persistent desire to do more creative work and made a drastic change leading her to seek out freelance work as a graphic illustrator. 

There are three main reasons why I would encourage my client to resist the urge to tick the "innate vs acquired talent" box. 
1. The first reason has to do with the complicated relationship between genetic influences, brain characteristics, early socialization of skills, motivational or mood based traits and environmental factors involved. In other words, brain characteristics alone do not account for the successful nurturing of creativity characteristics. One of the reasons I often explore the impact of growing up in an anti-art environment with my clients, is because hindrances such as these can be a detriment to a person's ability to think and behave creatively. 
2. The second reason has to do with the subjective nature of aesthetic appreciation. While some artists may benefit more from innate cognitive skills such as having novel, "overinclusive" thinking and being highly imaginative, other artists value creative ideas resulting from precision, and a more traditional style of creating. In the example of a painter whose style is surrealistic versus a painter who uses a more formal and realistic approach, the degree to which brain characteristics play a determining role may vary substantially.
3. Finally, productivity is a fundamental indication of eminence in a creative field. A "naturally gifted" person who spends time "here and there" working on art may produce some innovative paintings, but an artist who is motivated, committed, and who is willing to remain consistently productive will perfect his/her skills and create a large scope of work rendering him/her a "successful artist." 

I would encourage my client to accept the discovery of facts about the "artist's brain" in a way that acknowledges factors beyond her control, at the same time being careful not to draw conclusions  implying that there are no controllable factors. 

As a therapist who works with many performing artists, I am always very interested in contemporary research addressing clinical methodologies to treat performance anxiety. In the March 2014 issue of Medical Problems of Performing Artists Vol 29, No 1, pp. 3-7 there is an article discussing the effectiveness of ISTDP (Intensive Short-term Dynamic Psychotherapy) for Severe Music Performance Anxiety. To find out more about ISTDP you can go here. 

The article discusses how psychological defenses, developed in early childhood to protect us from disrupted attachments with caregivers, are rendered completely useless during the vulnerable process of performing in front of an audience. As a result, anxiety becomes the manifestation of the body and brain's perception of a threat. As we have seen in past blog entries, such threats can be external i.e. "if I don't do well I will not get the gig and will not make money/will not succeed" or internal i.e. "being judged or evaluated is shameful and an inherently negative experience." 

I was glad to see that the article made references to the concept of attacking the self, a process in which one directs aggression to the self in order to avoid directing it towards the external source. As seen in the article's description of a 10 week ISTDP treatment, the goals of treatment were to help the patient become aware of the aggression and develop transference with the therapist, resulting in the effective resolution of previously misdirected emotions. Now, what does all this have to do with performance anxiety? For one thing, performers who experience severe anxiety often go through some form of self-attack when they experience thoughts such as "I'm not good enough", "I will fail", "they will laugh at me" etc. In addition, the relationship between performer and audience may be one that symbolizes pivotal relationships in one's past, particularly during childhood. Unresolved feelings, such as anger, neglect, embarrassment etc, which are primarily dealt with by repressing, pushing and turning inwards, may become triggered by entering a relationship where one is assessed, evaluated and judged. The goal is to become both intellectually and emotionally aware of such emotions in order to resolve them through the process of transference in the therapy room. By safely expressing negative emotions in the presence of an external agent and by redirecting them effectively externally rather than internally, the performer will be able to diminish the powerful impact of dropping the defenses - since there will not be such a need for these defenses in the first place. 
In the study described, all this took place within 10 sessions. In my experience, these complex stages tend to take a lot longer; but nevertheless, I am pleased to read about the success of ISTDP in this particular case.

You can read the full article here.   

Performance anxiety is the most common reason driving performers to seek out help from performance coaches, counselors and therapists. It can be debilitating and severely hinder performers' experience and enjoyment from being on stage. 

In a previous blog entry we looked at how therapy can benefit performers. The most common techniques to overcome this type of anxiety involve breathing and meditation exercises, focusing on pre-performance preparation, exploring what each performance means to the performer (what am I getting out of it?), magnifying emotions in order to feel that we can control them and, finally, embracing the feeling and, if possible, using it creatively during performances (for example a spoken word performer may allow their vulnerability and anxiety to come out during the performance).

A new study from the Harvard business school has a new recommendation. It involves reinterpreting the feeling of stage fright and labeling it excitement rather than anxiety. The idea is that this positive spin to the experience will decrease arousal and physical symptoms such as sweaty palms, shortness of breath and dry mouth. In fact, saying things such as "calm down" may not be as effective as telling oneself "you are so excited right now! you love this feeling!"


You can find a summary of the study and an interview with clinical psychologist, Guy Winch, here.  And you can go here to read that study itself. 

Last night I co-facilitated a workshop on Creative and Entrepreneurial Blocks as part of the Staten Islands Arts initiative to help artists share their visions, to problem-solve, confront obstacles and discover new resources. 

I wanted to share, in the form of bullet points, some of the topics that were addressed and to highlight the universality of certain themes that seem to come up in many discussions among artists. 


The portion on Creative Blocks addressed:

• blocks as a force of resistance which, though normal and frequently occurring, can become a great problem when the artist remains in the "low motivation" phase for too long or when deadlines, pressure to sell and turn work in becomes overwhelming.
  
• blocks as filters with which artists view what the work or the creative process should look like. For example, "I have to have complete silence during the creative process" or "the work needs to pay the bills" and so on.
• the need to adopt new thinking patterns and innovative ways of doing things in order to manage and overcome blocks. Creative individuals, already being at an advantage due to their creative nature, will hopefully be able to use their flexibility in thinking and perceiving as useful tools to change behaviors and thoughts which contribute to creative blocks.
• the importance of understanding different types of blocks before attempting to overcome them. For example, is my block related to the way I think about myself, related to past experiences, to the meaning and value I assign to my product, my environment which is not conducive to creativity?
• Steps such as 1) developing an inner dialogue to respond to negative thoughts 2) visualizing desired goals 3) acknowledging fears or anxieties and practicing relaxation or mindfulness 4) taking actionable small steps towards new goals etc.

One of the themes that often comes up in discussions among artists is the motivation or meaning attached to the creative process and the work. In particular, the search for what art means to each person can be a bumpy road. It may start off as a form of venting, self-expression, facilitate identity search, become a way of connecting to others and eventually turn into a means to paying the bills; a product to be sold. This shift can create somewhat of a cognitive dissonance and create unsettling feelings about the subjective value and use of art. 

It is important to explore how each artist feels about making the shift from "art for me" into "art for money" and what this may bring up. For some, it may be a forbidden path which leads to the artist keeping their "day job" as a source of income in order to have complete freedom in their art. For others, it may simply mean establishing boundaries about what compromises the artist is willing to make in order to make money from art. For others, it may be about compartmentalizing their art pursuits in different categories, i.e "this art is for art's sake, whereas this art is there to achieve another goal, and I'm aware and fully ok with this distinction."

Either way, having open discussions that facilitate sharing these concerns, blocks, dreams and goals is an extremely vital part of becoming successful - whatever one's definition of success may be!

One gets a feeling of academic satisfaction when coming across a research study, published in a scientific publication, examining the connections between emotions and creativity. 
During this month's journal of Aesthetics, Creativity and the Arts, examines whether or not post-traumatic growth (in a nutshell defined as the positive outcomes resulting from an adversity) contribute to increased, self-reported, creativity.
A very popular question is whether or not the stereotype of the "suffering artist" has merit. This is not just a question of intellectual curiosity; it has practical implications about counseling approaches utilized when treating artists and creative individuals. As discussed in previous entries, the answer to this question is multi-layered: it considers the varying definitions of creativity, the causal versus correlating relationship, and addresses the therapeutic effect of art

Working with artists and being a performer myself, I was captivated by an extraordinary find on Netflix called The other F word (referring to fatherhood). Written and directed by Andrea Blaugrund Nevins, this documentary gives viewers a very revealing insight into some of the inner and outer conflicts experienced by punk rock musicians. It also tells their personal stories of the circumstances that led them to seek out a sense of belongingness in the world of punk rock and skater punk. The documentary  focuses on how, ironically, the same performers who have developed their artistic identity around themes of anti-authoritarianism are seen trying to set rules in their own homes with their children. 
A fascinating theme that came up, is that of maintaining the punk rock personality in an effort to continue to connect with old and new fans who have certain expectations about what it means to sing songs against authority, the system and the mainstream. In this documentary, there also seems to be a need to smoothen the transition from dad to punk frontman which, for some of the singers, is more easily achieved through excessive drinking or having to make more comfortable sleeping arrangements when touring.
Having to balance two contrasting worlds, the world of the eternal adolescent and the world of having to raise one, seems to be a source of tension that can potentially lead to creative blocks and band conflicts. The documentary ends with Jim Lindberg from Pennywise (who also wrote the book "Punk Rock Dad") quitting the band to spend more time at home. While watching the scenes with him pushing his daughter on a swing, I couldn't help but wonder how long he would be able to stay away from the world he had known for 20 years. One filled with the adrenaline rush of performing, the constant changes that come with touring and breathing and living music. It turns out, he is now back with the band and they are working on a new album and tour.  
Overall, this documentary brings up many fascinating issues regarding the emotional needs met by the punk rock scene, the psychology of the performer, what happens when the "I don't care" attitude clashes with caring about one's own kids and keeping the spirit of punk young while growing up.  

Do professional visual artists carefully calculate and filter what they present on canvas? Or are they subject to the same kind of subconscious manifestation of their "inner world" that art therapy clients are? Is there a use for professional artists' art pieces in the counseling session? In my work with visual artists I have seen that timing and perspective might play a role in answering the above questions. 

During the moment of creation a professional artist needs to be focused, with a clear intent and purpose. There is a large degree of intellectual processing involved in the artist's decision-making of what to show and how to show it. In contrast to non-professional artists, we often hear them state that they are not making art for therapeutic benefit and that they have complete control of the process and end result, with little room for subconscious significance. An artist recently told me the art she makes when feeling very "emotional" is not the kind of art that best represents her professional goals. Others report not wanting to read very much into why they do what they do because it takes the fun away from the process.

However, very often there is something interesting that happens over time. Artists who develop distance from their work, often look back and identify a solid relationship between the artistic choices they made and their psychological state at the time of creation. Choice of medium, colors, easily recognizable versus ambiguous symbols and subject matter, all may have helpful implications about the artist's emotional state, conflicts, sources of inspirations, and way of perceiving the world. It is these kinds of manifestations of the subconscious which, discovered over time, may be of use in a session.
The role of the counselor working with an artist who seeks psychotherapy might include:

• exploring patterns and symbolisms
• putting the artists' works in context of their past/current life's circumstances
• helping artists articulate what the images reflect
  
• revealing beliefs and attitudes, more easily accessible to the artist through art
• exploring the artist's willingness to even talk about the emotional significance of the work

These counseling goals will hopefully result in the development of emotional clarity and self-awareness. They will help both counselor and artist gain more insight into the artist's psychological condition. If this process may seem irrelevant to the artist in the moment, one may want to explore past works in order to see what comes up through hindsight accuracy. 

If you are a visual or a professional artist, feel free to comment below on whether art involves symbol-making with implications about your inner world. If so, let us know if you have ever explored these implications in order to understand -and consequently improve- psychological functioning.

If you wish to read more about psychological analyses of artists and their work visit this link to read more about the book "Psychological Studies of Art and Artists". 

A recent article in the journal of Medical Problems of Performing Artists caught my attention. The high stress associated with performing artists, in particular dancers, has been documented for some time. This article by Liiv, Jurimae, Klonova and Cicchella looks at perceived stress and recovery following aerobic and anaerobic activity in professional ballroom dancers.
Ballroom dancers are professional athletes who travel frequently for competitions, have short periods of time for recovery from stress and practice many hours perfecting their technique. Also, levels of stress were measured during competition period by looking at circulating cortisol levels, which were found to be three times higher than during a normal training period. This article looked at a number of variables associated with stress and recovery, such as fatigue, emotional stress, injuries, being in shape, and sleep quality. It concluded that there is a strong link between body balance & emotional stress, social stress and sleep quality which affects female professional dance-athletes more than men. 
While further research is needed in these field, it's great to see researchers asking these questions and shedding light on the emotional, psychological and lifestyle aspects of performers' lives. Once we have a better understanding of the holistic connection between body, mind and behavior we will be able to help performing artists achieve improved mental health, and therefore fulfillment in their work.

Counseling interventions for Performance Anxiety:

Unlike professions where being in front of an audience might feel like an occasional nuisance to some (think of an employee who might enjoy every aspect of his/her work "except for having to speak publicly") performers are faced with a task that is integrally tied into their artistic and professional identity. Performing artists are performers; no way around it!

To the best of my knowledge, there is a limited number of evidence-based counseling interventions for performing artists (if you have resources to any please feel free to comment below). Sport psychology, a neighboring field, has approaches of helping athletes perform well. But things become slightly different when a performing artist is expressing an inner state, or trying to convey a message to audiences, and not just trying to improve a skill such as speed, accuracy etc.  Here's a list of counseling approaches one can take when trying to reduce symptoms of performance anxiety, and to maximize satisfaction deriving from self-expression.  

1. Body mindfulness: Using the principles of mindfulness we help performers use conscious attention and awareness as a way of centering and grounding oneself. When disconnected from the process of performing due to anxiety, negative thinking or lack of confidence, performers are encouraged to try sharpening their skill of body-part mindfulness. By doing so, the body relaxes and we feel connected to what physically contains our thoughts in the present moment. 

2.  "Who am I doing this for" exploration: Clients may often lose sight of why their are performing and who they are doing this for. The motivation behind performing may start with a heartfelt "this is what I love doing" and turn into a pressure to satisfy audiences, to prove something to someone, to make a living, to please, to provoke etc. In therapy, we may explore what connects the performer to what they are doing and what they are attempting to express; we find the fundamental essence of the driving force motivating someone to want to perform. 

3. Emotion-magnification: Inspired by the Gestalt approach performers are encouraged to try magnifying the emotions they typically try to hide while performing (this should be done off-stage). For example, actors trying to hide a shaky voice, singers trying to hide shortness of breath, dancers trying to hide low energy etc, are encouraged to exaggerate these behaviors/feelings during practice, and to alternate between the two extremes. This is a way of getting used to "dialing them" up and down and acquiring some sense of control over these involuntary behaviors and emotions. 

4. Goal-setting: Another counseling intervention used with performers is to predetermine a goal for every time the person is about to perform. This may look something like: "today my goal is to hold this note until the end" or "next time my goal will be to make more eye contact with the audience" etc. This helps performers break down the parts they want to work on or achieve rather than holding onto a vague and abstract pressure to perform well.

5. Embracing the feeling: The process of performing involves artistic expression and the display of an inner, emotional or cognitive process. A performer may often feel like their emotional state ought to be suppressed because the audience expects to see a performer who is calm, confident, angry, or expressive etc. Working on counseling for performers often involves identifying the genuine, authentic emotions one is having at the moment, embracing and releasing them during the performance. Thus, instead of fighting sadness I allow it to become part of what I'm doing. It may not be what the audience expects or is used to, but it's genuine and creates less anxiety for the performer. 

These are just a few interventions or clinical approaches that can be used when working with performers. Feel free to comment below or to add your thoughts.