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This chapter will focus on theoretical, clinical and personal challenges surrounding my work as an art therapist in an adult outpatient service of a psychiatric hospital.The evolution of my thinking pervades my clinical work with the client discussed in the vignette, as I sought to integrate desublimation from art theory and philosophy with psychoanalytic theory.(Thompson, 2007).When I first met Evelyn, who is diagnosed with Schizoaffective Disorder, she was hospitalized, constantly agitated and psychotic with auditory hallucinations, severe labile mood, disorganization in cognition and behavior and paranoid delusions, linked to her experience of the polarizing states of grandiosity and inferiority.She constantly sought to expel the experience of being belittled and hurt by projections and hostile attacks on other patients and clinicians.As a result, she was frequently expelled from verbal group psychotherapy after vicious angry attacks on peers and therapists.She could frequently be seen pacing the hospital corridors while engaged in an angry verbal monologue of diatribes.Evelyn's physical appearance was also notable for her reliance on trailing scarves, jewelry, and numerous bags and necklaces, strung impossibly around her body.Staff and fellow patients at the center would consciously avoid her when she approached, anticipating the inevitable hostile barrage of affect, fueled by paranoid ideation.In this chapter I will describe the process, challenges and outcome in our work together over a four-year period.I hoped that the seemingly impossible task of developing a meaningful relationship with Evelyn, one, that might support therapeutic growth through the intermediary container of art, could be accomplished.Ironically, some of the later breakthroughs of our time together were the direct result of a Derridean deconstructive approach to initial models of art therapy.(Derrida, 1997).Evelyn had become part of the complex narrative of the institution, the psychiatric hospital, which co-creates shared meanings.In the case of Evelyn the hopelessness surrounding her pervaded the milieu and was mirrored leading to a shared sense of marginalization and failure.This was a familiar narrative when I met her and it extended to her tentative and abortive relationship with art and art therapy.(Fig. 1) Traditional models of art therapy that are quintessentially modernist employ some basic assumptions regarding pivotal aspects of art and creativity.These will be explored in the chapter and include the Symbolic Order, sublimation, desublimation, and embedded in these areas are the roles of regression, repression, selfidentity, rationality and the irrational.www.intechopen.com
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