New graduate Rafael Cohen interviews Art Therapist Ani Buk:
Ani Buk, MFA, MA, LP, LCAT, is a New York State Licensed psychoanalyst and art therapist in private practice on the Upper West Side of Manhattan, where she works with children, adolescents, adults and couples. She has twenty years of diverse clinical experience, and is a graduate of Yale University School of Art, NYU's Graduate Art Therapy Program, The Training Institute of the New York Freudian Society, as well as The Institute for Child, Adolescent and Family Studies. A nationally recognized trauma specialist, her work and recommendations have been featured in The New York Times, US News & World Report, The Chicago Tribune, Scholastic News, and Rosie Magazine. She is a co-author of Human Rights Clinic: Training Manual for Physicians and Mental Health Professionals, and A Facilitator’s Guide: Training Health Care Providers to Work with Refugees, published by Doctors of the World and the Office of Refugee Resettlement. Ms. Buk is on the faculties of the Graduate Art Therapy Program of NYU and the Department of Psychiatry of Albert Einstein College of Medicine. She has been a consultant for Doctors of the World, Safe Horizon, The Children's Advocacy Center of Manhattan, and other agencies in the New York area. She has presented at numerous local, state and national conferences, universities, hospitals, and other organizations, including the United Nations, on a wide range of topics related to parent guidance, trauma, vicarious traumatization, refugee issues, art therapy, and the psychology of the artist.
1. How did you decide to become an art therapist?
Like many art therapists, I took a circuitous route. Once I stumbled upon the field, I realized that it was what I'd been looking for all along. And, as I think is typical for people whose career path has not been a direct one, each part of the path has informed my subsequent undertakings in essential ways. [for a detailed description of Ani's career path, as well as several illustrated case summaries, see http://www.tufts.edu/alumni/magazine/summer2006/features/feature4.html ] Even though I've gone on to become a psychoanalyst, I'm still strongly connected to my identity as an art therapist. In fact, I'm certain that my work as an art therapist has made me a much better psychoanalyst that I would have otherwise been.
2. How would you characterize your style as an art therapist?
Whether I'm functioning as an art therapist, play therapist, psychoanalyst, family therapist or couples therapist, I work from what I would call a humanistic psychoanalytic foundation. I look at symptoms as symbolic representations of feelings and memories that cannot yet be expressed in any other way, and that originally arose in an attempt to adapt to or cope with a particular set of complex circumstances. I do a lot of work around "de-pathologizing" symptoms so that their multiple meanings can begin to be understood in an atmosphere of compassion and respect, which is where true healing can take place. I try to help patients find the safe place that is somewhere deep inside them, where no trauma can touch, and which allowed them to survive the circumstances of their lives and to seek help. Because profound trauma may have caused them to feel that the safe place was completely destroyed, or was never there to begin with, helping them gain a sense of control over how and what they express is often the first step in building that sense of inner safety.
As an art therapist, I work on the "art as therapy-to-art psychotherapy" continuum, depending on what each patient seems to need in the moment. Some patients may never be able to speak directly about certain issues, and the healing process is embedded in the witnessed art making process and product. But I do believe that the deepest healing comes out of being helped to experience one's feelings consciously and eventually to process them verbally, and the use of the metaphor and art process and product often provide an essential, intermediary bridge to developing that capacity.
3. Your speciality is trauma, when and how did you choose it?
As I discuss in my course at NYU, when the concept of trauma is placed on a continuum, as it should be, I think that all psychotherapists are trauma therapists. Not everyone will develop a specialty in working with profound trauma, as I have, but all therapists attempt to help their patients cope with the many ways that a spirited and fundamentally sound connection with themselves and others and life can be derailed. And it is the hallmark of our species that our exquisitely complex minds must attempt to grapple with our awareness that life is so fragile and that our time on earth is limited. If that's not traumatic, I don't know what is!
My focus on profound trauma arose in a natural way out of my work with highly traumatized populations - medical rehabilitation patients, chronic and acute psychiatric patients, and children who had been sexually and physically abused. In 1995, I was the Director of Creative Arts Therapy at North Central Bronx Hospital. When I learned that a clinic for torture survivors seeking political asylum had been started there, I approached the director to discuss the use of art therapy for that population. After I conducted an inservice on the topic for his Primary Care Residents, he brought me in to teach the biopsychosocial impact of profound trauma to them, referred some of the patients to me, and helped me get my faculty appointment at the medical school (Albert Einstein College of Medicine). The Human Rights Clinic, as it was called, was affiliated with Doctors of the World, and I became a member of that humanitarian organization's multi-disciplinary training team and co-wrote their training manuals. I fully believe that being an art therapist was an advantage for me, because, as you know, works of art bring theory to life in ways that transcend words. Presenting a case where art therapy has been used successfully is as close as you can get to being in the mind and heart of the trauma survivor during the training session.
4. Private practice is something we don't hear much about in school. Can you tell us a little about how that works and what it's like for you? Insurance, publicity, anything...
I did not start my private practice until I'd worked as a therapist for many years in a variety of settings, and was enrolled in my first post-graduate institute, the Institute for Child, Adolescent and Family Studies. I think there's a tendency for new clinicians to romanticize private practice - I know I did - and in doing so to underestimate the responsibility and the risk and attendant stress of working without the protection of the agency or hospital. The structure afforded by classes, case requirements, and the kind of supervision you receive at a rigorous institute was critical for me when I opened my practice, as was being in analysis myself. Institutes are typically good referral sources to their candidates, which is important when you're starting out. Most people have to work full-time and then see patients in the evening before making the transition to a part-time job and then to full-time private practice, which can take years to build. Personally, I would not have wanted to start a private practice without having already worked on acute psychiatric inpatient units. It's not always possible to assess how fragile someone is when you begin working with them, and for me being fluent with the full continuum of neurotic to psychotic processes has been very important. When you're in private practice you need to be able to work closely with psychopharmacologists, and possibly to have to facilitate hospitalizations, and having worked on inpatient units makes this easier.
Of course, the stressful aspects are counteracted by the luxury of being able to do intensive, long-term work with people. No matter what the setting, it's always incredibly moving and rewarding to participate in the deep healing that the psychotherapeutic relationship can engender in people. However, there is a kind of freedom that private practice affords the therapist that does not exist when you work for an agency. There's no bureaucracy to deal with - unless you choose to join managed care panels, which I have not - and for the most part you control your schedule and your environment. My patients pay me directly, and about 60% of them are reimbursed by their insurance companies for my services. My referrals come from a wide range of sources. For example, colleagues, former teachers and supervisors, physicians, and clinicians with whom I've collaborated on other cases or who have attended workshops I've given refer to me. I've always done a lot of public speaking on a wide range of topics, which I think is important when you're in private practice. You're more likely to receive referrals when people have a good sense of how you work.
5. How has the art therapy program at NYU changed since you were a student here?
The concept of vicarious traumatization - a relatively new concept - was not really addressed when I trained here in the mid-80's. There was also a wonderful course, taught by the previous director of the program, Laurie Wilson, called "Psychology of the Artist." It was profoundly influential in my thinking, and continues to inform my work with artists in my private practice.
6. What is one thing you wish you knew then, that you do know now, that you could share with us as art therapists about to graduate?
I don't remember post-graduate institute training being mentioned when I was getting ready to graduate. In retrospect, I think I would have begun that training a bit earlier in my career. Not right away, though, because I think it takes several years to adjust to working as a full-time therapist. Every therapist needs time to make the transition from intern to paid professional, adapting the mass of information he or she has studied in graduate school to the real world in a unique way. However, it takes more than two years of study to learn how to be a psychotherapist and talk with patients in any specialty. Art therapy is not "non-verbal therapy" because, in my opinion, there is no such thing as purely non-verbal psychotherapy. Creative arts therapists certainly have so much more to offer patients in the non-verbal realms of expression than other specialties, and we are more fluent in non-verbal communication, but we still need to be able to speak to our patients, and help them feel safe to speak to us. The skill of verbal intervention, like any skill, is one that can be expanded and refined for a lifetime. I would say the same thing about refining one's skills as an artist - the more competent we are in the modalities we use in our work with patients, the more effective we can be as healers.
In addition to teaching art therapy students, I've had many years of experience teaching medical students, psychology and social work interns, and psychiatry residents. I can honestly say that the students in NYU's graduate art therapy program have tended to be particularly sophisticated in their understanding of unconscious processes, and more readily able to use that understanding empathically in the service of their patients' emotional growth. The rigor of NYU's program, combined with the comfort art therapy students typically have with right-brain processes, which are the seat of empathy, will serve you well as you enter the field as professionals.
7. I truly don't know if my perspective is representative of the general population or not, but I consider you to be one of the more visible art therapists out there (NY Times article, etc...). What can you tell me about that experience? Do you feel a pressure & responsibility to represent the field in a particular way?
I would say that I'm "conflict-free" regarding the efficacy of the form of art therapy that I have come to practice and teach, and my passion about this has helped me cope with the anxiety that, for me, goes along with doing public relations for the field. I do feel it's my responsibility to represent the field of art therapy as a specialized and sophisticated form of psychotherapy, which is distinct from art making activities that are therapeutic.
8. A few students from my class went to a recent art therapy conference. Do you think its important for new art therapists to go to conferences?
It can be a powerful experience to be in a room with hundreds of art therapists, especially if you're trying to cope with working in a setting that marginalizes the field. It's important to be exposed to the very wide range of approaches within our field, and you can learn a lot if you're careful about what presentations you attend. As with any discipline, the quality of presentations can vary greatly - but sometimes being confronted by a way of working that you don't agree with can be helpful in confirming why it is that you choose to work the way you do, which can increase your self-confidence. However, when I was beginning my career, I had to make a choice between spending money on attending national conferences or paying for private supervision with a supervisor that I really trusted, and I think from a learning perspective that supervision is the priority. I also think it's important to go to scientific programs in other specialties to broaden your understanding of the psychotherapy field as a whole. It's great to live in a place like NYC, where there are so many free presentations to go to.
9. In your class earlier this semester, you spoke at some length about "mirror neurons" and other areas more associated with hard science than with art therapy. Is that where you see the field going?
I think it's essential for art therapists to integrate left-brain modes of understanding with right-brain modes of experience. Each one enhances the other in important ways, and this serves to make us not just better clinicians, but better advocates for the field and for human evolution in general. The more I know about neurobiology, the more I believe in the power of art therapy to heal. When I was working in agency and hospital settings and was dealing with the fact that art therapy can be threatening to clinicians in other specialties, the "hard science" was immensely helpful to me as I fought to deflate the stereotypes.
10. I know that you have experience with low-functioning mentally ill patients. My experience with that population has been mixed in that sometimes it can be hard to feel like I am making a difference. Any advice?
Try to remind yourself that if the stimulation of just one single neuron can activate the ten thousand other neurons to which it is linked, every empathic, life-affirming experience offered to a human being makes a difference.
11. I feel that, depending on the population, art therapy can be as life-changing and revelatory as psychoanalysis or psychotherapy. As interns, we don't always have the experience of working with high-functioning clients. I first experienced my own art therapy (in the role of a patient) during college. Hmmm... I'm having trouble solidifying these ideas into a question... I guess I want to know about the path towards that kind of work. I don't think I am going to start there, but I do have a desire to work in that way, where interpreting images directly with clients is a useful tool and the work follows more of a psychotherapeutic or analytical model.
(I think I sort of answered this one in #6 . . . .)
12. What has been your favorite population to work with?
I feel very privileged to have been able to work with such a wide range of populations, and I've have had so many deeply moving experiences with members of all of them. I especially enjoy doing the long-term work that I do now in my practice, but some of the things that I learned from patients with whom I only had a few sessions many years ago still influence how I work with people today.
13. Do you have a favorite quote about art therapy?
Describing the interface of art and trauma, the psychoanalysts Laub and Podell wrote that "art has the ability to revive the enshrouded past of a trauma through a dialogue in the present. In creating a holding witnessing 'other' that confirms the reality of the traumatic event, the artist can provide a structure or presence that counteracts the loss of the internal other, and thus can bestow form on chaos. Through such form the artist can 'know' the trauma."
[Laub, D. & Podell, D. (1995). Art and trauma. International Journal of Psychoanalysis, 76, 991 - 1005.]
