Art therapy and its uses: Knowledge Zone

This article sets out some maps for understanding the arts and health spectrum, the relation of the arts as psychotherapies to other aspects of the arts and health practice, with reference to the Mental Health Foundation’s findings from its Arts Creativity and Mental Health Initiative.

Four pilot arts therapy projects have brought significant benefits to the well-being of people with mental health issues, writes Malcolm Learmonth

The Mental Health Foundation’s publication of the findings of four arts therapies pilot projects in Scotland provides a chance to reassess the role of the arts in health and social care.(1) A vague perception that the arts are in some way “good for us” is often balanced with one that the arts are somehow the “icing on the cake”, a luxury which, in a hierarchy of needs, should come last as the focus of services. What rationale can be offered for placing the arts more centrally?

Powerful feelings
The arts allow the expression and containment of powerful feelings. Non-verbal language, the language of the arts, can embrace and transform conflict and the emotional realities of mixed feelings. The arts aren’t just about meaningful activity but are a part of how we make meaningful narratives of our lives. Who doesn’t have “special songs”? The arts can often engage and include the hardto-engage and excluded.

The report of the pilot projects is convincing in its findings that ordinary people “were positive that art therapy had helped them, especially with improvement to self-esteem and added meaning to their lives”; that a life could be “totally changed by the experience”; and that drama therapy achieves “the kind of learning that lasts and carries over into everyday life”.

Some of the key findings were:

● Participants experienced significant improvement in their mental health and social functioning, in particular self-esteem,  communication skills and social interaction.
● Participants highlighted that the therapy provided a non-threatening and accessible medium. It enabled them to address  underlying issues, which may have been more difficult to explore through more traditional forms of communication.
● Services found that they could have a role to play in supporting the social inclusion of participants.

An unexpected benefit of the therapy was that some participants involved moved on to mainstream activities after trial services.

Not that the arts are a panacea. Certainly, when working on distress and disturbance, things can go wrong as well as right. Not everyone’s experience of art-making has been happy. The arts can expose a nd humiliate. Many people have been brutally taught that they can’t draw, sing or perform. Selecting artwork for show carries an inevitable rejection and hurt for some. At their best, participatory arts can be places of growing self-acceptance and acceptance of others. But they carry the opposite risk. We need to maximise the benefits and minimise the risks. To do this it helps to have a clear idea of how the arts and health are developing.

We can see the field developing around four hubs: environmental; medical humanities; community or participatory arts; and arts therapies.

In the first, the arts intervene in the services environment. A good example of this is the King’s Fund project, Enhancing The Healing Environment.(2)

Practitioner training
The medical humanities are developing the arts as ways of understanding and training for practitioners. When the work of the care-giver often brings us face-to-face with the harsh realities of separation, loss and grief, the arts give us ways of working that retain our own humanity.

The community arts have for years been working with the arts as social and health interventions. There are many crossovers into health promotion, such as The Happy Hearts Lanterns event in Wrekenton.(3)

Over 60 years the arts therapies have developed a practice which marries the understandings of psychotherapy with the benefits of the arts. They have established postgraduate trainings, and these – as well as practitioners’ accountability and ethics – are regulated by the Health Professions Council.

All the hubs overlap. And each has areas of specific expertise, practice, applicability and training. The arts as psychotherapy  bear out the fact that one of the strongest research findings is that a good therapeutic alliance is the best predictor of outcome in psychotherapy.

Two of the aims of psychotherapy have been described as achieving “autobiographical competence”, or establishing a meaningful narrative for our lives with a sense of authorship for it, and “affective processing” – being able to deal with how we feel about it.(4) The arts lend themselves well to both these objectives and, as a therapeutic method, it works.

Clearly there is an overlap between the broader participatory arts and the arts as psychotherapy. The necessary art skills, people skills and duty of care should be in evidence across the spectrum. This can be encouraged by ensuring training, mentoring and supervision resources.(5)

We should be creating services where people can access the right thing at the right time, ranging from service user-led groups to adult education and psychotherapy. Through arts psychotherapies, people often awaken latent creativity and want to carry on with art-making when the therapy work is done. And, through art-making, people often encounter surprising, even distressing, things about themselves.

Converging needs
The need to heal and the need to create are close to one another, and we should encourage this two-way traffic. As the pilot project report states, “where service users are in the fortunate position of having both practices on offer, they are able to see the differences and decide for themselves which practice [is best for them]. In time one would expect an intelligent mental health strategy to encompass both ends of the spectrum and allow the service user freedom of choice.”

With results like those elicited from the Scottish pilot sites we can hope that the forthcoming Department of Health Prospectus for the Arts in Health and Arts Council England’s forthcoming Strategy for the Arts and Health will mark the point at which a coherent, inclusive policy for all four hubs of the arts and health can begin to take shape. If this takes place, then the arts therapies may become referral of first, not last, resort. As a service user put it: “It’s important that the powers-that-be get to know how good these sorts of therapies are for people.”

EXTREME MEASURES
Like many people with an eating disorder Alice tended to see the world and herself in very black or white, good or bad, fat or thin terms. Her struggle with extremes had at times been life-threatening. After working with her art psychotherapist, Alice made a painting in which black and white slowly blended into shades of grey, becoming lighter as they moved down the page.

Tentatively, some yellow appeared at the bottom. The painting looked a bit like dawn. Alice sat back and contemplated her work. “Perhaps,” she said, “If you can stand the greys for long enough, then you do begin to get some colour.”

MALCOLM LEARMONTH is arts and health lead for the British Association of Art Therapists, the lead art psychotherapist in Devon Partnership NHS Trust’s creative therapies team, and an independent trainer and consultant with Insider Art. He is a dual-trained artist and psychotherapist who has worked across community, psychotherapeutic and arts practice.

TRAINING AND LEARNING
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

REFERENCES
(1) Mental Health Foundation, Arts, Creativity and Mental Health Initiative. Report on the Findings of Four Arts Therapies Trial Services 2003-2005, 2006
(2) S Waller, H Finn, Enhancing the Healing Environment: A Guide for NHS Trusts, 2004
(3) M White, M Robson, From Fire to Ice – Arts in Health for Social Inclusion
(4) J Holmes, John Bowlby and Attachment Theory, Routledge 1993
(5) www.dur.ac.uk/resources/cahhm/reports/

FURTHER INFORMATION
● Art therapy
● Drama therapy
● Music therapy
● Dance movement therapy
● Participatory arts

This article appeared in the 11 January issue, under the headline “Hale and Arty”