Art Psychotherapy Groups

Between Pictures and Words

SALLY SKAIFE, Val Huet

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317725268
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

A growing number of art therapists are also trained in group analytic psychotherapy. This book explores the new theories and models for practice arising from the merging of these two disciplines.
Contributors ask whether a model can be applied universally to art therapy group work with diverse client groups. They present in-depth case studies looking at work with the following: -
* children
* drug and alcohol abusers
* forensic patients
* patients on acute psychiatric wards
* the cognitively-impaired elderly
* institutionalised patients moving into the community
A common theme which emerges is that the physical use of art materials and the space of the art room offer a possibility for communication of feelings which is not possible in purely verbal groups. This allows clients who would not normally be considered for group therapy to benefit from a psychodynamic group process.

Chapter 1
Introduction

Sally Skaife and Val Huet

Art therapy group practice is part of most art therapists' clinical work. This has been the case since the beginning of the profession when art therapists worked with groups of patients from large psychiatric institutions within art studios. Yet, considering the amount of experience developed in group work, there is a dearth of literature about it in comparison to the amount of publication on work with individuals. That is not to say that practice has not been developing, as is shown in the chapters in this book, which we feel is long overdue since it describes art therapy groups in a number of settings with different client groups.

Two main factors have influenced the development of models of art therapy group: the context in which they have been practised, which historically has been within adult psychiatry, and the parallel development of group analytic psychotherapy, which has occurred chiefly in the private sector but also within therapeutic communities, and in the 1970s within psychiatric units in general hospitals. To start with, art therapists practised what are now called studio-based art therapy groups within large psychiatric hospitals. With the development of psychiatric departments within general hospitals, art therapists became influenced by other professionals' use of groups often working alongside occupational therapists and a theme-based, or projective, art group developed as a form of practice. In more recent times group analytic art therapy and group interactive models (McNeilly, 1983, 1987, 1990; Waller, 1993) have developed and this has paralleled the move of art therapy practice to within the community, and to a widening client group. This evolution has happened within a very short time span, and the work of most art therapists who have written about groups encompasses this development.

Other issues have also been at play. As Klein (1995) states, 'ideas do not usually become accepted and disseminated purely for reasons of logic or evidence. Style of presentation, personal and political influences, the thirst for new and tasty experiences, chance factors, all play their part' (Klein, 1995: 217).

These various factors have been significant in the development of art therapy group practice. We are aware that various 'ingredients' such as personal interest, political leanings, work experience, chance meetings, friendships, etc., have played their part here too. Through editing this book and writing our chapter, we have become aware that our respective professional development reflects the evolution of art therapy practice and of the profession itself: at the time of writing this, art therapists, along with music and drama therapists, have just been granted State Registration, a prospect that certainly felt out of reach when we both began our careers.

Sally Skaife first undertook art therapy training when it was an option available as part of a post-graduate art teaching certificate at Goldsmiths' College in 1975 (for further description of training, see Waller, 1991: 219). On placement in a therapeutic community, she encountered the 'projective art group' in which the focus was on the end product of the art work and how it related to the clients' problems. She experienced this as quite a culture shock, as her own interest in art therapy stemmed from a belief in the therapeutic possibilities of art making. She later understood that art therapy was influenced by the occupational therapy department of which it was part. Later, when working in a psychiatric unit, she experimented with various types of art therapy groups with the intention that art making should be at the centre of the therapy. Some of these included discussion of well-known art works, taking patients out to art galleries and craft making. In 1977 she undertook postgraduate study in art therapy, which was becoming established as an independent training (Waller, 1991: 232). Group work was not then formally taught as part of the curriculum although students participated in art therapy groups. These introduced different art-based exercises and themes.

A noticeable change had taken place by the time Val Huet trained at Goldsmiths' College in 1984: the profession had aligned itself more closely with psychotherapy practice. The training addressed group work, which was increasingly perceived as important. Three staff members, Diane Waller (Head of Unit), Gerry McNeilly and Joan Woddis had undergone, or were completing, group trainings. Hence, there was a clear sense of a coherent approach to groups amongst staff. A mainly non-directive psychodynamic model was used in the experiential art therapy workshops. Mostly, no themes or time boundaries were set and the group was responsible for determining the content of the sessions. Verbal experiential groups were also conducted; these were the precursors to 'the large group' which later became part of the training.

Although interest in, and commitment to, group work was strong, the length of art therapy training (a one-year intensive course until 1992) did not allow for the in-depth teaching of art therapy group work and trainees learnt about group dynamics mainly within experiential workshops and with client groups on their placements. Art therapists interested in working with groups often undertook group psychotherapy training and, as Waller (1991: 14) points out, an increasing number of art therapists are doing so. It is worth noting that this was the case for most of the contributors to this book. It will be interesting to evaluate whether a longer training time helps students to be better equipped for group work, or if they feel the complexity of such work still calls for the grounding of a purely group-oriented course. This complexity is further compounded by the fact that art therapy group practice has always been in a state of evolution as a review of the literature shows.

We have chosen to review the British literature only, as we feel the practice described in this book was chiefly informed by this. We refer the reader to Waller (1993: 8) and Prokofiev in this book for some discussion of the American literature.

Development of Art Therapy Group Practice in Britain: Review of the Literature

Waller (1991, 1993) writes on the historical development of the art therapy profession and of art therapy groups. She discusses the evolution of the open studio model within psychiatric hospitals, which mirrored the art school setting. Patients were then encouraged to use art materials within an individual space in the room and work was discussed privately in 'whispered conversations in a corner of a room to the exclusion of other patients' (Waller, 1993: 8). Waller traces the departure from this model to the late 1960s, when new ideas about groups began to influence art therapy group practice. From then on many art therapists seemed to develop a stronger sense of group dynamics and of the need for formal boundaries such as time, space and frequency of meetings. It is interesting to note that this process happened whilst the British Association of Art Therapists (BAAT) was becoming established as a professional body for art therapy and focusing on criteria for registration and training (see Waller, 1991). There seems to be a similar move away from informality and ad hoc arrangements in order to define and strengthen both practice and professional identity.

Until the early 1980s, British literature on art therapy groups is sparse. In 1982, Liebmann published a compilation of Art Games and Structures for Groups following a survey involving forty-two art therapists. There is a paucity of theoretical material in this initial pamphlet, apart from a brief introduction focusing on the meaning and importance of games. Liebmann assumes a directive and theme-centred approach as the group leader is responsible for selecting the right game and making it work. Following this initial pamphlet, a book on Art Therapy for Groups: a Handbook of Themes, Games and Exercises was published by Liebmann (1986). Mainly a practical description of art-based exercises, the book straddles the boundaries between art therapy groups and 'projective' or 'therapeutic' art groups run by many occupational therapists and teachers. It is offered for use by any interested professionals who may follow the exercises detailed in the book.

Reactions to the publication of this book were mixed: some art therapists saw it as a threat to their still fragile professional identities and as a disappointment because it did not address in-depth theoretical issues encountered within theme-based groups, others welcomed it as a source of practical ideas (see McNeilly, Thornton and Molloy below).

Inspired by the work of Foulkes on Group Analysis, McNeilly (1983) challenged this directive, theme-centred approach. In 1983, whilst training in Group Analysis, McNeilly published an article on 'Directive and non-directive approaches in art therapy' in which he challenges the use of themes as creating a risk of uncovering material too quickly and of taking away from the interactions between group members by focusing too much on the group leader. McNeilly warns that 'with a nondirective approach the attacks can be intense' (McNeilly, 1983: 215) and wonders if by setting themes the art therapist may be evading transference issues. This paper stimulated a debate within the profession concerning art therapists' practice in groups: Thornton (1985) defends the use of themes in art therapy groups and Molloy (1988) warns of their potentially invasive quality.

In 'Further Contributions to Group Analytic Art Therapy' (1987), McNeilly addresses some of the criticism made of his previous article. This concerns an apparent lack of space for in-depth work and the diminishing importance of the art work which appears left at the background. McNeilly states that he does not see the need for giving his own comment to all images, feeling that 'communication is more important than interpretation' (McNeilly, 1987: 9). He stresses again the potential dynamic quality of a non-directive approach and that providing themes may be a means of allaying the anxiety of the art therapist as well as of the patients. McNeilly refers to the 'Group Matrix' as defined by Foulkes (1964), which comprises all the shared conscious and unconscious knowledge, interactions and experiences in the group. He feels that the art therapist needs to be able to tolerate uncertainty and to let the group evolve in the matrix, until some shared theme emerges from the material brought by the group members.

Greenwood and Layton (1987) describe a community-based art therapy group for people with severe mental health problems which seems to integrate a loose theme-centred approach with an awareness of group dynamics. The therapists ensure the maintenance of basic boundaries such as regularity of time, safety of space, consistency of therapists' presence and warning of any changes such as breaks. Greenwood and Layton comment that although basic practice for many psychotherapists, these boundaries are often overlooked by art therapists.

Non-threatening themes are offered to group members for optional use by the therapists, although often themes emerge from the group discussion which takes place in the first ten minutes of the group. Greenwood and Layton mention agreeing with McNeilly's views on the danger that setting themes might meet the therapist's needs rather then the clients. However, they feel that themes offer some containment for the anxieties of clients who find any increase in stress difficult to cope with. They describe a process during which the art therapist picks up the theme from the group discussion and gives it back to the group in a moderated form. They feel that 'it is as if the "intolerable" is put into the therapist in the form of a theme' (Greenwood and Layton 1987: 14).

The therapists make images themselves during the group and Greenwood and Layton describe this as a 'side-by-side' approach. Refuting criticism that exposure to the therapist's unconscious might be harmful for the patient or the therapist and that it might minimise transference, and therefore the process of therapy, they write:

Our concept of side-by-side therapy describes how sharing the experience of working on pictures together gives opportunity for servicing boundaries and feeling relationships between individuals. Showing the work and talking about the pictures together provides additional opportunities for development of self in relation to others and sharing and modifying anxieties.

(Greenwood and Layton, 1987: 14)

They use Bion's concept of 'containment' (1962) and describe the group as a container both during the verbal and the art-making part. They see the art work as providing the three phases of containment: projection, digestion and re-introjection. Material is projected and represented in the image. It is then digested within the process of art making and during the group discussion.

Greenwood and Layton (1991) later describe a form of humour, 'Taking The Piss' (TTP), which has a 'dual function of deflating tension and promoting growth' (Greenwood and Layton, 1991: 7). Although they discuss the uses of TTP generally in art therapy, they also describe its effect within an outpatient art therapy group for psychotic clients and in mixed diagnosis and non-psychotic groups.

An approach similar to Greenwood and Layton's may be found in Skailes' work (1990) with psychiatric patients. Skailes describes two art therapy groups: one runs in the day hospital, the other is 'outward-bound' (Skailes, 1990: 68) and based in the community. Both are for clients who may become caught in the 'Revolving Door' effect of psychiatric treatment (Skailes, 1990: 58). In both groups Skailes, like Greenwood and Layton, mixes a non-directive approach with the use of loose themes and story-telling.

Significantly, Waller (1990) edited a special section on 'Group Analysis and the Arts Therapies' in Group Analysis: The Journal of Group Analytic Psychotherapy, this seems to reflect a stronger link between the arts and group psychotherapies, and Waller mentions the incorporation of group psychotherapy training at the Goldsmiths' Art Psychotherapy Unit (Waller, 1990: 211). McNeilly, Skaife and Strand are among the contributors to this special section.

McNeilly (1990) discusses his personal process in training in group analysis and art therapy. He concludes that both are 'two sides of my own theoretical/technical coin' (McNeilly, 1990: 224) and advocates further work on cross-fertilisation.

Skaife writing on 'Self-determination in Group Analytic Art Therapy' (1990) describes a group in which she does not fix time boundaries for art-making and talking, and the group is left to make such decisions themselves. She discusses how existential material that emerges, such as the fear of taking risks, of being alone (with the art work), can be analysed and much gained from the feelings brought up in the process.

Although Strand (1990) works with institutionalised clients with learning difficulties, her approach to an art therapy group run within a hospital differs from Greenwood and Layton's (1987) and Skailes's (1990). No themes are given to the group and the two co-conductors do not use art; the only structure in the group seems to be a set allocation of time for art-making and talking. Strand describes the group as 'closed' with seven members and feels that this helps provide a sense of security and value within an environment characterised by high staff turnover and sudden, unexplained changes. An initial task is to encourage interaction between members who are used to seeking praise and validation by staff but who rarely talk to each other. There is at first a certain amount of direction given by the therapists to the group which Strand describes as 'social skills teaching' (Strand, 1990: 259). It involves showing people how to listen and be listened to, and also encouraging the use of people's names. Strand notes that the need for some degree of direction from the art therapists decreased as people gained confidence in themselves and she comments on their high level of motivation to participate. One of the predominant group themes to emerge is the one of loss:

Loss was discussed in terms of the loss of family or friends; a sense of abandonment or rejection; the realization of difference and not being 'normal'; the fear of one's death.

(Strand, 1990: 261)

Strand's approach seems to straddle directive and non-directive stances and to give emphasis to the importance of interaction between group members.

Case and Dalley (1992) write on different approaches to art therapy group work. Highlighting some of the historical background given above, they iden...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures
• Notes on contributors
• 1 Introduction
• 2 Dissonance and harmony: Theoretical issues in art psychotherapy groups
• 3 Adapting the art therapy group for children
• 4 Connection and disconnection in the art therapy group: Working with forensic patients in acute states on a locked ward
• 5 Return to the open studio group: Art therapy groups in acute psychiatry
• 6 Candles slowly burning
• 7 The Magpie's eye: Patients' resistance to engagement in an art therapy group for drug and alcohol patients
• 8 Long-stay art therapy groups
• 9 Learning from experience in introductory art therapy groups
• Index