Arts Therapies and the Mental Health of Children and Young People

Contemporary Research, Theory and Practice, Volume 1

Uwe Herrmann, Margaret Hills de Zarate, Salvo Pitruzzella, Uwe Herrmann, Margaret Hills de Zarate, Salvo Pitruzzella

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000394535
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Arts Therapies and The Mental Health of Children and Young People presents innovative research, theoryand practice in the arts therapies. Thedifferent social, cultural and politicalcontexts and developmental age groups illustrate and underscore the richness and diversity of contemporary arts therapies' creative response to the needs of childrenand young people in contrasting locations.

The book represents an acknowledgement of the high rates of mental disorders in children and young people and addresses this subject. In presenting an array of responses from arts therapists working with children and young people in different contexts and countries, the book highlights the particular features of distinct art forms, yet also points to the potential dialogue between disciplines. Chapters show how the expressive potential and appeal of the arts, when facilitated within the therapeutic relationship, are crucial in fostering hope in the future and the capacity for trust in self and others.

This book will be of great interest to arts therapists as well as academics and postgraduate students in the fields of arts therapies, social work, psychotherapy, health psychology, and education.

1

‘BEANS OF HOPE’ – BUILDING RESILIENCE THROUGH PLAY PSYCHOTHERAPY FOR YEAR-SIX PUPILS TRANSITIONING INTO SECONDARY SCHOOL

Di Gammage

‘Resilience is the human capacity to face, overcome and be strengthened by or even transformed by adversities of life. Everyone faces adversities, no one is exempt … With resilience, children can triumph over trauma; without it, trauma (adversity) triumphs.’

(Grotberg, 1995, p.10)

As a teacher you have to believe in your children – that anything is possible in their lives, however dire, desperate, barren they might be.

– (Head teacher ‘Beans of Hope’ Primary School)

Introduction

Psychotherapists know the impact of chronic stress on their clients anecdotally. This is supported by the negative impact of chronic stress on the cardio-physiology system (Porges, 1995), on the immune system (Benschop et al., 1994) and mental (Esch et al., 2002) and cognitive functioning. The CoC Programme, devised by Derek Roger (1995, 2002, 2005, 2007), is a proven effective intervention that benefits cardio-physiology (Roger, 1998). Although the programme is specific to adults in the workplace, and there is no reference to children in school, the author recognised a link between adult characteristics that support or compromise resilience to characteristics seen in children. Vulnerable children struggling with trauma, difficult relationships, and school pressures are more likely to engage in unhelpful ways of thinking that severely compromise their capacity to learn. Such habitual ways of thinking, defined as rumination (Roger, 1995), trigger a defensive reaction and, at times, the survival mechanism of fight-or-flight. As such times, it is extremely difficult to think clearly.

There are real dangers in life that demand a fight or flight reaction; however, hyperalert or hypervigilant children are much more likely to ruminate. Defensive ways of being are contagious and will have a negative impact on a child’s learning, relationships with peers, and how they are viewed and experienced by teachers. The chapter’s title, ‘Beans of Hope’, is based on an interaction between one of the children and the author that reflects children’s capacity to adapt, learn and develop habits that support their emotional resilience, given the opportunities to do so. According to Becker (1997), resilience is considered the single most significant predictive factor in living a successful life beyond education, training and experience. With an increase in the number of primary-aged children in the UK being diagnosed with anxiety and depression (4% of children between the ages of 5 and 16) (Green et al., 2004) to around one in eight children aged 5 to 19 (Baker, 2020) and the established links of such mental health conditions to stress (Roger, 1995) resulting in ever-growing demands on child mental health services, attention must be given to prevention and early intervention.

For many children, primary education can provide a much-needed safe and predictable sanctuary. The transition to secondary education can be overwhelming and disorientating for the more vulnerable children. Furthermore, how children establish themselves in year, seven can set the trajectory for academic achievement and educational satisfaction.

This study’s focus is a pilot study conducted by a therapist/researcher offered to year 6 pupils developed in conjunction with a new primary school. The school has three times the national average of children with an Education Health and Care Plan (EHCP) and a significantly higher ratio of children (information from school register) on the Child Protection Register than other primary schools in the county.

This was an action-based enquiry (Lewin, 1946; Robson, 2002), involving 16 children, in which the purpose of the intervention was to identify habitual factors that indicate children’s levels of resilience before and after a 20-session programme in a small group setting drawing on a questionnaire based on the CoC Training Programme.

This chapter discusses the relationship between play and mindfulness and the role of these disciplines in building emotional resilience (Gammage, 2017). Play psychotherapy brings together the depth psychological understanding of child psychotherapy and well-established creative methods of play therapy, including story-making, role play, art and projective play. The four steps of the CoC programme were incorporated into the play psychotherapy through mindfulness exercises and relaxation. This chapter concludes with reflections on this pioneering study and draws recommendations for furthering emotional resilience work in primary schools.

Theoretical background

Resilience is understood to be linked to ‘overcoming the odds, sustaining competence under pressure and recovery from trauma’ (Fraser et al., 1999, p. 136). In the CoC programme, a clear distinction is made between pressure and stress: pressure is described as ‘the demand to perform’ and ranges from, for instance, getting out of bed in the morning when the alarm rings to sitting an exam; the CoC programme defines stress as rumination. In the CoC programme, emotional resilience is a skill which allows us to avoid turning pressure into stress. Individual characteristics, such as genetics contribute to emotional resilience (Werner, 1989); however, a significant factor is thesocial environment. There is still much debate around a definitive definition of resilience. It is recognised as a trait, process and outcome strongly influenced by a relationship as nature and nurture both play a part in the development of resilience. Crucially, resilience is not about blaming an individual or shifting the burden of responsibility onto the individual; in this context, the child, to change their life circumstances.

The Challenge of Change Resilience Programme©

The author, a play psychotherapist, is accredited to deliver the CoC programme. In the 1980s, whilst based in the Psychology Department at the University of York, academic Dr Derek Roger was invited to undertake research on resilience with North Yorkshire police amongst other organisations. Focusing on the question ‘What is it that makes some people more vulnerable to stress and others more resilient?’ he was able to recruit a number of doctoral students with the intention of identifying specific ways of thinking that either supported emotional resilience or, conversely, had a negative impact upon it. Roger and his students noted that these factors could be measured by monitoring the cardiovascular and immune systems, thus creating a body of knowledge based on empirical research that linked stress to the physical body and clearly showed the damaging effect of chronic stress on mental and physical health. Roger subsequently collated the individual studies devising a training programme which he called the CoC.

Mindfulness

The CoC programme is fundamentally a mindfulness programme. According to Flood 2017, sales of books relating to mindfulness rose by 13% in that year against a backdrop of falling book sales in practically every other genre. A well-known online bookseller is currently offering over a hundred titles of mindfulness books and activities for children and adolescents. It seems we are desperately eager to pursue mindfulness for ourselves and our offspring and perhaps for a good reason. Lama Surya Das observes, ‘Learning to maintain mindfulness and perspective when we are facing personal upheaval is extraordinarily relevant to modern times’ (1997, p. 372). Yet Roger would ask us to consider the question, ‘What is your mind full of?’ What is key is being able to recognise certain habitual ways of thinking and to be able to take charge of our minds. The CoC programme is simple, but it is not easy because old ways of thinking are ingrained and tenacious. Being able to control our minds is a moment-to-moment practicThe aspect of taking charge of our own minds, and in particular the area of self-regulation, was a core feature of the Beans of Hope project. Self-regulation is understood as the ability to respond to a situation with socially acceptable emotional reactions and to be able to inhibit emotions that lead to unacceptable behaviours. In order to self-regulate emotionally, it is necessary both to recognise and to calm one’s emotions. One of the most comprehensive longitudinal psychological studies carried out strongly suggests that early childhood emotional self-control is a significant predictor in mental, physical and social wellbeing in adults (Moffitt et al., 2011).

The inevitability of change

The programme is called the CoC because, mostly, as long as life is stable, predictable, and safe, we generally manage well. The challenge is when we experience change, especially change we ourselves do not initiate and/or feel we have little choice in influencing. Change is an inevitable aspect of life. It can be both exciting and fear-provoking, presenting new opportunities and new challenges (Coffey, 2009, 2013). The shift from primary to secondary school can be a shocking, lonely and isolating experience, due to the differences in culture and size of the school and expectations placed upon children (Ganeson, 2006). Children are required to adapt and cope as they face these significant changes as well as losing the relative intimacy of their primary school and established relationships with teachers, auxiliary staff and sometimes friendships. Primary and secondary schools have increasingly collaborated to support children in making this ‘rite of passage’ (Pratt and George, 2005), so called transition programmes. (Ganeson, 2006) inline with a growing body of evidence, suggesting that early disengagement can lead to poorer academic success, school attendance and increased antisocial behaviour (Chadbourne, 2001; Daly et al., 2009; Rudzinskas, 2008). Levels of stress are observed even in children who successfully navigate this transition (Roeser and Eccles, 1998).

The four steps of the Challenge of Change Resilience Programme©

There are four steps in the CoC Resilience Programme – Waking up and Staying Awake, Focusing Attention, Detaching and Letting go. ‘Waking sleep’ is a term coined by Roger to describe a state of being awake still, not in the present moment, an example of which would be driving the car but having one’s mind on the meeting just attended, or about to be attended, or sitting in a classroom and staring out of the window watching the clouds go by. Being in a state of waking sleep is not stressful per se; however, if one is not present behind the wheel of a car, one could argue that there are significant potential risks involved that could easily result in dire consequences. Waking sleep is the place of daydreaming which can at times be a highly enjoyable and productive pastime. It entirely depends on the circumstances. In the classroom example, the child will miss the teacher’s instruction, not know what to do and possibly be identified as time-wasting or badly behaved. Besides the obvious risks involved in ill-timed waking sleep, when we are in this state of mind, we are clearly not in the present moment and thus are unable to control where we place our attention. In waking sleep, our attention can be snatched away by any whim. These might be quite harmless and of little or no consequence, or the daydream can become a nightmare as we begin to ruminate on past events or future imagined events. In the nightmare, these are accompanied by powerful upsetting feelings. This is rumination and one of the core factors understood to adversely affect our emotional resilience. These are the if onlys and what ifs that occupy many minds that can lead to depression and anxiety, respectively.

It is only when we are truly awake that we are able to control where we place our attention. From this state of being wide awake, we can stop ourselves disappearing down the rabbit hole of past events that cannot be changed. Many people confuse rumination with reflection: they believe themselves to be problem-solving when in effect they are dwelling on unresolved issues in habitual patterns of thought or worrying about events that may or may not take place in the future. It is extremely difficult to think clearly when we are being bombarded with angry or upsetting emotions.

Detachment, that quality of putting things into perspective, is the third step of the CoC programme and understood to be one of the most valuable factors in developing emotional resilience and therefore, included in the psychometric assessment known as the Profile.

The fourth step of the CoC programme is Letting go. This means letting go of the ruminative thoughts and accompanying emotions that prevent us from having that presence of mind and being able to employ the WIN technique (What’s Important Now) as we are only able to give our attention to one task at a time (excluding the tiny minority of individuals known to possess a super brain).

Play

Play brings us into the present moment. We can only play in the ‘here-and-now’, and presence of mind is an essential aspect of play. As true play has a focus on the process rather than the product or end result, it is a natural antidote to ‘Toxic Achieving’ – one of the factors recognised in the CoC to seriously compromise emotional resilience. According to Panksepp (2004), opioids and dopamine are activated during playful interactions. These powerful chemicals suppress pain and distress and promote feelings of enjoyment and pleasure. Play is also known to stimulate the higher, ‘upstairs’ regions of the brain responsible for cognitive and reflective functioning (Panksepp, 2004; Pellis and Pellis, 2006). An important aspect of resilience is recognising what is and is not within our power to change, according to Kernberg (in Knowlton, 2001), play is a powerful medium for healing as a child can control, formulate and change the events of his or her play. In play psychotherapy, it is possible to process or metabolise a traumatic event and transform one’s relationship to that event in the present.

The play opportunities made available to the children in the Beans of Hope Project included embodiment, projective and role play. The three stages are known as the Developmental Play Paradigm (Jennings, 1999). Embodiment play relating directly to body and senses was supported by activities such as mindful breathing, clay work and work through gesture. Projective play was addressed through exercises that included identifying metaphors to describe emotional states, drawing, story-making and storytelling, and role play was used by the children to enact the stories they had written.

Design

This was an action-based enquiry (Lewin, 1946; Robson, 2002). However, there was also a spiral quality to it – th...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Contents
• Figures
• Tables
• Boxes
• Contributors
• The arts therapies and the mental health in children and young people: an introduction
• 1 ‘Beans of Hope’ – Building resilience through play psychotherapy for year-six pupils transitioning into secondary school
• 2 Bridging parents with their children with autism in music therapy – The music-oriented parent counselling model
• 3 ‘What are these irruptions of the spirit?’ Exploring (the elusive) therapeutic properties of puppetry and puppet-craft within dramatherapy clinical practice with children and adolescents
• 4 Dance movement therapy with children and adolescents
• 5 Participatory ethnography to explore the relevance of cultural arts practices to the psychosocial wellbeing of adolescents affected by violence in Trinidad and Tobago
• 6 How Pippo got to drive a precious car: dance movement therapy in a centre for young offenders
• 7 From emptiness to symbol: researching the congenitally young blind child in music therapy
• 8 Drama, youth and change: the dramatic self hypothesis as a tool to understand personality disorders in adolescence
• 9 An art therapy clinic for children with heart conditions: towards interdisciplinary research of an innovative service
• Index