Art as Therapy

Since starting my training I have often wondered where feelings reside from within the body and to what degree do they inform our reasoning and decision making. Damasio suggests emotions are inseparable from the idea of reward or punishment or reward, of pleasure or pain, of approach or withdrawal that are integral to our survival (1999: 41). Yet how can we, as trainee therapists, begin to work in a safe and contained manner with clients who express difficult emotions or are ill-equipped to manage their own emotional experiences?

Emotional development takes places in the limbic centre of the brain, an area situated in the right hemisphere where a group of linked structures develop social and emotional intelligence (Liebmann, 2008: 90). The amygdala, for instance, is important for emotional responses to threats and impulses whereas the hippocampus stores emotional memory.

Robert Plutchik’s psychoevolutionary theory of emotion identifies that there are 8 primary emotions: anger, fear, sadness, disgust, surprise, anticipation, trust, and joy. These primary emotions are all characterised by their adaptive action tendencies, which are designed to change the organism’s relationship with their environment. For instance, ‘In anger we puff up and become larger, thrusting forward; in fear we shrink away, in sadness we lower our eyes and close down, whereas interest and happiness open us up to the world’ (Greenberg & Paivio, 1997: 17).

In a therapeutic context, it’s important to help clients attend to their own bodily-felt experiences, drawing attention to their breathing, signs, posture, vocal quality, and facial expressions. Enabling clients to adopt this internal focus, rather than focussing on changing their environment, can be self-empowering (Greenberg & Paivio, 1997: 17).

References

Damasio, A., (1999), The Feelings of What Happens: Body, Emotion and the Making of Consciousness, London: Vintage

DEEPER MIND, (2011), The Search for Basic Emotions, Available at: http://www.deepermind.com/02clarty.htm, (accessed: 19.10.14)

Greenberg, L. S. & S. C. Paivio, (1997), Working with Emotions in Psychotherapy, New York: Guilford Press

Imgkid (2014), Limbic System and Emotion, Available at: http://imgkid.com/limbic-system-and-emotion.shtml, (accessed: 14.11.14)

Liebmann, M., (2008), Art Therapy and Anger, London: Jessica Kingsley

During the summer I met with Heather Aberdein who graduated from the MA Art Psychotherapy course at Roehampton University two years ago. Heather works within a private health care company that provides specialist secure hospital and residential services to adults. She replied to an advert for clinical health workers, interviewed well, and after a two-week induction persuaded the company to allow her to pioneer a new art therapy service, paid at the appropriate professional grade. She has now been within the company since October 2012, supporting adults with learning disabilities, associated mental illness, autism and Aspergers, personality disorder and/or challenging behaviour.

Meeting with Heather was a real opportunity to pick her brain about the rigours of working within the field and the hardships of finding work following graduation. As well as discussing her current role she also talks about the rationale for choosing to train as an art therapist in the first place, and offers advice for anyone thinking about Art Psychotherapy as a career. Here’s what she had to say….

Can you briefly tell me a little about your current role as an art therapist (e.g. setting, client group, referrals, assessments….)?

Sure. I pioneered this art therapy service for a private healthcare company which offers support in hospital and residential units to adults who have a dual diagnosis of learning disability and mental health. I currently work part-time between four separate units across North East London offering one-to-one and group work. I receive referrals for support from the managers, clinical services team, social workers, outside agencies and families.

With the group work do you have someone who helps facilitate that work with you?

Well, to begin with I had members of the support staff helping, and so I had to train them up, but I found that it was getting really difficult in terms of adhering to boundaries. This was because the space I had to work with was the patients’ lounge so there were lots of people coming and going. And the group of women I was working with were diagnosed with personality disorder and psychosis so it was a really challenging client group. As a result, I employed a voluntary art therapist, one of my mates, and she worked with me for six months which was invaluable because we would be thinking about things in a similar way and we could hold the space more coherently. So if I were to run groups again I’d definitely want to build in qualified support staff.

How do you conduct assessments for people wanting support?

Depending on the client and their needs, I’ll tend to do a four to six week assessment. I’ll then talk to my team to decide how long we’re going to work together for and then we’ll review it. My basic pattern is to work with patients for six months initially, although many continue, and some I’ve worked with for the whole two years.

Are you often required to work with other professionals?

Yes.  Every day when I go in I have a handover meeting of up to half-an-hour, where I’m able to liaise with all the support staff. I attend CPA (Care Programme Approach) meetings, I attend clinical services meetings and also sometimes chair them. I contribute to peer supervision, meeting with the company’s assistant psychologists, speech and language therapists and occupational therapists.  It’s very much a matter of working together as a team.

Within this multi-disciplinary team, is there an awareness of art therapy and how do you describe your role to other people (e.g. clients/ service users, other professionals)?

That’s one of the challenges [with pioneering a new service]. It takes up a lot of my energy. I’ve had to develop a PowerPoint training package for staff educating them on what art therapy is and it’s potential. When I first started I put together an information pack for each unit just to tell them about the service and how to refer client. .Most of the people hadn’t heard of art therapy before. It’s quite a struggle to keep validating art therapy’s position. As well as that, the company was a family-run business when I started so there was more leeway in terms of what we could do. However, it was then bought by an equity firm so now there’s a lot more corporate pressure on me to provide evidence for what I’m doing. It’s been quite tough.

Is the service you provide informed by a particular therapeutic approach or model of art therapy?

The organisation loosely follows a recovery model.  I am psychodynamically trained and tend to work in a non-directive way to begin with, feeling my way around and trying to work out what’s best for the patient. I have since attended the ICAPT (International Centre for Arts Psychotherapies Training) Mentalisation course for psychosis and borderline personality disorder which has really helped me to offer appropriate direction to ensure that the patient remains engaged and stays in the present as opposed to allowing too much space to think and feed paranoia.

I have also started to use GAS (Goal Attainment Scaling) where the therapist tries to decide on three to five goals that she or he would find useful with the patient.

In thinking about what you said about moving between these different settings (e.g. group work, one-to-one, hospital or residential), are you required to bring along your own art materials or do you have supply of art materials in each of the settings that you work?

That’s something I’m working towards. But at the moment I tend to have a backpack full of materials moving between places.

Does that put a restriction on what you can bring?

Yes, it does.

What sort of art materials do you usually have to hand?

I tend to bring different types of paper (different sizes if possible). I try to leave bigger rolls of paper at the unit if I can. It’s all space-dependent really. Lots of pens, pencils, crayons, paints. Sometimes I might have clay or play dough as well. It’s down to space.

What led you to become an art therapist yourself?

I’d been interested in it since I was a teenager. I remember receiving a psychology book from my dad when I was about sixteen and I was already into art. I’m not sure where the idea came from really. It developed through my own personal issues and my own therapy. And then, when I’d done my first art degree and masters, I realised that I didn’t want a career as an independent artist. I wanted to help people and so I went on to work as a support worker at a residential home for the elderly. I also did some volunteering with young offenders, doing art groups, and eventually I just felt like it was the right time to tie the two strands together. 

What was your experience of training on the MA Art Psychotherapy course at Roehampton University?

Very enriching I’d say, it was really good. What I particularly liked about it was the space they allow for your own personal development and growth. I forged really good friendships whilst I was on the course as well. It was a very intense and very exhausting time in my life.

What advice would you give to someone who is considering training to become an art therapist?

I would really question why you want to do the training. Is it for your own personal development or is it because you want to find a job. The job market is really tough at the moment, as everybody I’m sure realises. I would also encourage you to think about at which institution you want to study art therapy and the differing theoretical approaches. There were seven to choose from when I did my masters training.

Can you say a little bit about your experience of trying to find work in this field upon becoming fully qualified? Has it been difficult?

You don’t quite realise how competitive the market is out there and so when one of your circle of friends gets a job and others don’t, there are feelings of envy and jealousy. While of course you want to support one another, you can feel also like competitors which can be tough.

What about others from the course?

It’s taken a lot of time to find work. Like myself, some people have created an art therapy niche within another role, and some have managed to get jobs with the NHS. For a lot of NHS jobs you’re required to have two-three years post-qualifying experience and getting that experience is hard.

Would you advocate taking on voluntary positions at first, if work is not readily available, or do you feel that this devalues the profession? 

I think it does devalue it. Unfortunately it’s a really tricky, catch-22 situation. A lot of people are offered honorary placements in the wake of their university placements. . Had I not have found my present job I probably would’ve taken a voluntary role I was offered because at least it keeps you current and your skills active.

What advice would you give to someone else currently in this position?

‘Keeping your hand in’ is really important, not allowing too much of a gap after you’ve finished the course. To be honest, there weren’t a lot of jobs coming up when I graduated so I was going further afield and that’s where I found the clinical health worker post. I also looked into doing work abroad. You just have to cast your net really wide.

How do your qualifications translate if you decide to work abroad?

It depends on where you go. In Australia for instance, we’re qualified to work there. But if you were to work in America you’d have to do a one year conversion course because their model for art therapy is different to ours.

I heard a report this week on the growing need for talking therapies in the UK with recent studies indicating that one in five patients in London are made to wait six months or more for therapeutic support. The recent phone-in on Radio London about this issue is really thought-provoking highlighting how, within the NHS,  physical treatments are often given priority over mental health concerns and how the availability of talking therapies within the UK vary greatly from area to area. As a trainee Art Therapist, it’s incredibly encouraging to hear people talk about their positive experiences of meeting with a therapist and why there is a need to shirk the view of therapy as something that is hokey or without any grounding in scientific research (as is the case with art therapy).

The radio phone-in is featured on iPlayer(http://www.bbc.co.uk/programmes/p025yryn)