Working Across Modalities in the Arts Therapies

Creative Collaborations

Tasha Colbert, Cornelia Bent

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317196594
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Working Across Modalities in the Arts Therapies: Creative Collaborations offers an in-depth insight into cross-modality and transdisciplinary practice in the arts therapies. Including contributions from drama, music, dance movement and art therapists, as well as professionals from related disciplines, it vividly demonstrates how the alchemy of these collaborations produces innovative interventions and new approaches to working with clients.

Compelling examples of collaborative practice cover a variety of client groups, ranging from Syrian refugee children and women with eating disorders, to homeless war veterans and sex offenders. Together, the authors make the case for the effectiveness of cross-modal and transdisciplinary approaches when working with otherwise hard-to-reach and complex populations.

This book is a guide to good practice and an invaluable resource for both experienced arts therapists and those new to the field. It will also be of benefit to healthcare and education professionals, arts practitioners, and anyone with an interest in the subject.

PART I

Cross-modality practice and research in the arts therapies

1

Not what it says on the tin

A family awareness group in a high security hospital

Alex Maguire, Martina Mindang

Introduction

In this chapter, we relate the narratives of the Family Awareness Group, run in a high security hospital with men who have committed violent crimes. This was a cross-modality group facilitated by a music therapist and art therapist, together with a third professional of various disciplines. We discuss the creative collaboration between therapists in this slow-open group over six years, presenting the themes that emerged, and noting parallels between the lives of the men and the clinical setting. We also illustrate the therapeutic relationships forged in the group, through a clinical vignette. We conclude with our reflections on this kind of work.

Our experience in this group was often one of struggling to establish and maintain a sense of ordinary domesticity, given the patients’¹ own chaotic, traumatic family histories. The group came together in an extraordinary setting, that of a high security hospital. Although most group members reported that the experiences of their own families were at odds with the accepted idea of what makes a ‘good family’, they were nevertheless prepared to defend their families to the last, despite the vicissitudes and separation they had experienced. For these ‘family’ members, used to a high expressed emotion within interpersonal relationships (McCreadie and Phillips, 1988), the experience of the Family Awareness Group challenged the idea of what ‘family’ can be about, and offered an opportunity to look at what tests the ordinary, consistent and predictable (if alien) values of the group.

We attempted to provide what Yalom termed the ‘corrective recapitulation of the primary family group’ (Yalom, 1995: 13–15), wherein the dysfunctional patterns or roles the patients play or adopt in the group can be challenged and changed by – in this case – playful and symbolic use of art and music. Via the pro-social act of adopting a position in the group, attending regularly and committing to the group rules, the group fostered a therapeutic space safe enough for ‘serious play’. In this way, we hoped to encourage a sense of relational security, and offer an experience of tolerable intimacy amongst members, which had both been absent from their families of origin.

This chapter also considers the role of the high secure environment in this endeavour. Paradoxically, for this group of men it was only within the safe embrace of such a ‘brick mother’, a term Henri Rey used to describe the Maudsley Hospital and its concrete containment (Rey, 1994), that the experience of ‘family’ could be described and shared with others who may have had similar experiences. One of the group members described how being physically incarcerated had provided a sense of emotional liberty for his complex family: ‘We can all say we love each other now, because we are separated; my brother is in a cell next to my mother’s boyfriend, my little brother is in hiding because of what I have done, and I am in here.’

Family history and the Family Awareness Group

A problematic family background is often present in the histories of patients in high secure care, and frequently highlights some of the long-term antecedents to offending. The men who became Family Awareness Group members were no exception, with histories of interpersonal violence and trauma in their families. Prior to admission, each member had committed a violent offence against another person, including serious assaults and homicide.

It was in response to such a need for work on ‘family’ that this high security hospital had long provided group and individual psychotherapy, raising an awareness of the impact that past experiences have on our understanding of mental health and acts of violence. Group dynamics can be thought about in terms of processing the difficulties of being either part of or separated from a complex or difficult family, and provide an opportunity for considering current relationships with peers and authority figures. We hoped that through group acknowledgement of early disturbed or volatile family dynamics (leading to disturbed or volatile mental states), the men might be helped to transcend this cycle in the formation of new, healthier relationships.

This non-manualised group was the first Family Awareness Group to run for longer than nine months, and the use of arts psychotherapies approaches was in response to the fact that offender patients’ beliefs about family are highly defended, and consequently difficult to articulate. Family is seldom spoken about due to a real fear for their safety, and because it represents an idealised ‘other’ to the incarcerating authority. In earlier, directed groups it was noted that the men often invented their family situation, complete with cast, set and plot.

In those nine-month groups, patients were only beginning to volunteer authentic information about their families as the groups concluded. A decision was made to run the group as a slow-open group, which we hoped would allow for a period of ‘gestation’ and the development of trust, growth and disclosure, prior to the men completing the group.

Modalities and rationale for co-working

The offender identity is one for which it could be said that one’s family is ‘sacred’, and it is understood that ‘no man may speak of another’s mother’. In reality this code, although sentimentally represented in the media, serves as a sound piece of advice in the offender community; withholding information about their own families protects not only themselves, but their families too.

The arts therapies approach provided alternative media within which complex and emotional material, with the overall theme of relationships, could be addressed in a way that felt safe and potentially productive. Patients were encouraged to share their experience of ‘family’ – its impacts, secrets, traumas, comings and goings, consequences, resiliences, and beginnings and endings – without necessarily naming names or using words. In their own time, unspeakable traumatic experiences could be both acknowledged and shared in the group. Patients experienced, between them, extensive memory loss, considerable substance misuse and episodes of dissociative states of mind. These are linked both to psychopathology (Hayes et al., 1996), and to a need to disavow the emotions associated with disturbing thoughts and memories.

We hoped to provide a ‘container’ (Bion, 1962), or a state of ‘holding’ (Winnicott, 1945), as we strove to use our media to hold the unconscious phenomena as they manifested in the group dynamic. The non-verbal creative processes of music and art were to be a container in and of themselves. Within this framework, the patients were encouraged to reveal only what they wished to, so ameliorating the pressure, to simply ‘release’ their distress before they were ready.

Therapeutic approach

Patients were encouraged to share their family structures and wider social networks, using musical instruments and art materials as well as discussion. The materials and instruments were objects for reflection, providing a non-directive structure and adding an experiential dimension to the group. Particular anxieties about being required to share ‘private’ material in this work were addressed in the process of becoming a group, and were further held by the psychotherapeutic boundaries of the sessions.

A feeling of curiosity, articulated by a free-associative approach to the media and the material, was proffered by the facilitators from the outset, although, as will be seen, this was neither always welcomed nor accepted. The idea that as a group we were a type of ‘family’ was often strongly resisted.

Sessions ran for an hour and a quarter on a weekly basis, with patients brought to and from the sessions by dedicated escort staff, maintaining the physical boundaries of the group. Over its lifetime the group moved location four times due to external pressures, eventually settling in the art therapy room, where it stayed for its last four years. Each group started with a brief check-in, and a chance for patients to reflect on the preceding week. They were given as much notice as possible if a session was to be cancelled, and feedback was provided to the patients’ clinical teams via a Care Programme Approach report, or by more direct liaison with the ward if needed. Preparation for new arrivals and leavers was made in collaboration with the group and clinical teams over a number of weeks, although abrupt endings did occur when patients were discharged from the hospital.

The art materials and musical instruments were provided each week, so even if the music therapist was absent, the instruments were still there. All facilitators were expected to handle and use the creative objects to model sharing, creative experimenting and getting-it-wrong-to-get-it-right. Thus the art therapist played instruments, the music therapist made images and the third therapist did both, seeking symbolic form through holding of the therapeutic space.

A group in this setting can only ever run with at least two facilitators. Having a third facilitator in this group was not only for the sake of continuity, but was also a response to the need for considerable ‘thinking power’, where these patients and their families (and associated projections) were concerned. The role of third therapist was initially taken by a forensic psychologist, then a psychodynamically trained clinical nurse specialist, followed briefly by a psychiatric nurse and, for a time, a trainee art therapist. All facilitators had an equal and active role in the group and contributed according to their competencies.

The facilitators encouraged the thought that they might represent the ‘parents’ of the group. This concept was particularly challenging to one long-term member, who had been abandoned by his mother at an early age and later been coerced by his father into sharing sexual partners. He often attempted to recreate his family dynamic by undermining the female art therapist, and looked to the male music therapist for approval of this way of relating (as discussed later in the chapter). When enacted in the group setting, this dynamic could be thought about by all facilitators together.

Overview

Play is an important activity through which patients can gain awareness into their authentic emotional selves. However, the Family Awareness Group was characterised from the outset by the patients’ struggle to play and be creative, indeed even to pick up or take any interest in the art or music materials. The facilitators wondered if group members were in part immobilised by the fear of their own destructive capabilities, fuelled partly by fiercely protective instincts when it came to family, and partly by a learned sense that family secrets are simply not to be shared with strangers.

Early sessions were characterised by a refusal to acknowledge, create or ‘do’ artwork, except begrudgingly to appease the therapist, yet we observed that they would bite, mould, pinch and worry their cardboard cups, stopping just short of spilling the contents. At the same time there was a stubborn refusal to make a mess of any kind. We were witnesses to the impoverished creative ability that can result when normal development is hampered in victims of trauma, as energy is spent in warding off further vulnerability (Case, 2010).

To mark the departure of a facilitator, a group piece was made, consisting of individual handprints joined together – at this stage it seemed okay to make a group piece about holding hands, but not to make actual physical contact. We reflected that touch had become taboo for these men, even touch of the materials. The group wondered out loud what kind of life these hands of theirs had had up until now, and what they had done over the years. During this reflection, one member looked at the clock and folded his hands under his armpits, as if the loving acts had been overshadowed by violence, and the instruments of those acts needed to be hidden. ‘Why did you say that?’ He said, ‘It goes without saying – you don’t have to make something of out of everything.’

In supervision, we discussed how the room felt as if it was populated by ‘silent babies’. The group often began in what felt like a cruel silence, the blank paper and silent instruments untouched like quiet and foreboding objects. Accordingly, we began to place the art and music materials closer and closer to the patients; firstly to a place where they would have to leave their seats to use them, then just out of arms’ reach, and eventually beside them where they sat. We introduced Plasticine for its tactile and forgiving properties – not only is it a mutative material, but capable of being ‘broken’ and then reformed. Part of our endeavour was to help our group release the uninhibited child within, and to discover a true sense of being, to animate the ‘silent babies’.

An unwritten rule arose – ‘only a member of the family can be critical of it’ – and this was paralleled in the group. Although this ‘family’ was deeply self-critical, it was also fiercely defensive of its existence at times of institutional threat or change. However, internal denigration was forcefully articulated: ‘what’s the value in keeping this group’s rubbish? It doesn’t add up to anything. . . . it’s boring, morose, like a damp blanket, nothing can catch fire… I won’t join in because I’ll only spoil things’, and a review of the group’s folder of artwork showed that its contents were made up principally of many small pieces, fragments which were either seemingly unrelated objects or repeated images.

If one definition of family is that of a caring group within which a child is engaged and ‘held’ so that trust and safety can be nurtured, this picture did not emerge of members’ families, as for them families don’t ‘do what it says on the tin’. These men had developed antisocial behaviours from having been deprived of any such holding environment in childhood, and these behaviours were maintained by deeply held and ongoing feelings of insecurity.

The group examined itself and found it to be a family that hates itself – it was a ‘family with murder in it – like the Addams family, everyone hates them’. The members displayed a cruel sibling rivalry in their keenness to let fellow members go, often feeling that they didn’t belong in the group in the first place: ‘I bet he never went shoplifting with mum or was beaten by dad or had to take sides.’ Once, when considering new members, the group grimly suggested an initiation ceremony – there was no warm welcome for ‘new’ babies here – and the facilitators were correspondingly seen as careless breeders without any consideration for the existing brood. The group wryly noted that there was ‘no licence required’ to have children.

Over the years, these comments were further contextualised, as the room became slowly populated by ‘violent fathers’, ‘useless mothe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Foreword
• Introduction
• PART I: Cross-modality practice and research in the arts therapies
• PART II: Transdisciplinary practice and research in the arts therapies
• Acknowledgements
• Index