Date of Award

Spring April 2013

Access Restriction

Campus Access only Research Projects

Degree Name

Master of Arts


Marital and Family Therapy

School or College

College of Communication and Fine Arts

First Advisor

Einat Metzl


This study explores a beginning clinician’s use of art and journaling to process case material, clarify countertransference, identify signs of compassion fatigue and illuminate instances of personal growth. The clinician used a mixed methodology in her research including both quantitative and qualitative analysis. The quantitative analysis consisted of a battery of valid and reliable, evidence-based, self-administered tests at the beginning and end of data collection to measure compassion fatigue and compassion satisfaction. The qualitative analysis involved the clinician making art and keeping a journal over 10 weeks’ time as tools to process and clarify case material and countertransference. These materials were then converted into data sets for comparative analysis. Research questions were adapted from two previous studies related to a beginning clinician’s experiences of countertransference (Arbas, 2008, Karner, 2011). To inform this study the literature review discusses special considerations for clinicians working with dying patients and their families. These include, but are not limited to, the need for an existential, humanistic, and flexible therapeutic approach; grief interventions for bereaved clients and clinicians; and specialized approaches and considerations related to transference and countertransference. The study also discusses how art and journaling can not only be used to process clinical material but also as an effective method of self care for the beginning clinician. The personal art made in response to case material and countertransference as well as the journal entries conveyed the responses of a beginning clinician working in a second-year practicum with dying patients of all ages and socioeconomic levels, and their families. The analysis identifies themes of countertransference relating to personal loss, personal family dynamics, and personal existential issues. It also shows evidence of an increase in both compassion fatigue and compassion satisfaction. The data analysis in the study indicates that art has helped the beginning clinician clarify case material, identify countertransference, reduce emotional buildup, become aware of personal growth as a result of the work, and better attend to clients and clinical work. These findings correlate with findings of several other authors (Arbas, 2008, Deaver & Shiflett, 2011, Fish, 2012, Hardy, 2008, Harter, 2007, Karner, 2011, Miller, 2007, Wadeson, 2010)