The Art Therapy Manifesto
notes on the potential of art, mess, and non-verbal approaches in psychotherapy
emotional ability
“People with Learning Disabilities are often dismissed, intellect holding such veneration in our society, and yet these people seemed emotionally intelligent, more aware of their emotions and the emotional state of others, and how to express this in the subtlest of ways”
“Hi, I’m Simon”
“Yes …. Simon and Tony … you’re Tony’s boyfriend”
“Er, no …. no I’m the new … arts worker …”
A staff member interrupts and takes me to one side.
“Oh, it’s OK Simon, don’t worry about him, he lives in a world of ‘Eastenders’. We try not to collude with it, we’re not sure it helps him”
The staff member lightly touches my new friend on his back smiling with a look of tired but genuine deep concern.
The young man in question with a moderate level of Learning Disability proceeded to tell other enlightened truisms about the world around him through the lens of a popular TV soap opera, with the support staff all appearing to take on scarily accurate TV aliases. It was genius at work. The whole of his life and ongoing experiences mapped out using an existing and familiar narrative. It appeared to allow him to engage with people emotionally. I played along.
I’ve continued to work with people like this young man for the last ten years. Most people with Learning Disabilities, now ‘Intellectual Disability’ live relatively independent lives, some with families, some in their own homes. Most are hidden people. Until recent years, society hid them in asylums and now we pay less than minimum wages to care staff to care for them ‘in the community’ and when times are hard, we cut their benefits. We often act as though they have no contribution to wider society.
I work with the most vulnerable, who struggle with behaviours or thoughts that prevent them from being kind to themselves. Like any therapist I am perhaps there to encourage resilience, support them to find safe boundaries and safe ways of holding what appear overwhelming thoughts. Much of this relates to issues of loss that are profound and distinct for this group of people so entangled with the lives of others for care and meaning. Some, in their loss, express a sense of being a financial burden on their families, and indeed on society.
Before becoming a therapist I worked with a community for people with Learning Disabilities, where ‘carers’ and the ‘cared for’ lived together. I ran an afternoon art workshop. The community leaders expressed an expectation that I would plan a group activity each week. Planned activities are not my strong point, and so each week I would arrive feeling utterly inadequate. All of the community members already seemed happy making art of differing varieties, and so I would sit with each, one by one and talk about their art work, making suggestions and playing with materials. Over time they seemed to respond, becoming more engaged, their mood lifting. The community staff appeared somewhat unimpressed, and would often give me subtle and sometimes less subtle pressure to conform and design a group activity, to keep everyone active and occupied.
One week I gave in and planned a beach-combing exercise, gathering found objects for a sea-themed window display. In my middle-class mindset I imagined pretty pebbles, bleached driftwood and the making of some papier-mâché sea creatures. On our return from the beach the residents emptied their bags of found objects into the middle of the garden. In front of us lay a vast pile of stinking seaweed, old coke cans, plastic bottles and fish bones. Had we arranged a beach clean-up, we couldn’t have done a better job. All of the members stood around the pile smiling at their catch.
As a therapist I now look back and wonder with curiosity whether the residents were unconsciously or maybe not so subtly expressing something of how it feels to be different in a society obsessed with perfection; found lost objects, the detritus and waste of life now collected and given new hope as a collage. Or maybe they just found the richness of colours and smells fascinating and enlivening in a world sometimes sterile to imagination. Maybe this was an act of social defiance.
People with Learning Disabilities are often dismissed, intellect holding such veneration in our society, and yet these people seemed emotionally intelligent, more aware of their emotions and the emotional state of others, and how to express this in the subtlest of ways. In the therapy room we can be broken together, both human, both looking for clues, trying to subtly pin hope and meaning in place long enough to grow into the demands of that which is beyond us. Beyond words we work, but not beyond emotions.
Occasionally mentally stressed people from London would come and stay with the community for a week; people without disabilities who were looking for respite, or moments of meaning in anxious lives. On leaving the community the visitors appeared calmer, more open, less depressed, less anxious. I don’t believe this was just some kind of social relativism. The wave of emotional ability experienced in the community appeared to go deeper than any cognitive understanding of affect. It touched deep, like a deep hug. I was touched deep, and can speak of the lasting effect in my life. We are a lessor society if we miss the fragile, gentle and yet incisive emotionally able contribution that people with intellectual disabilities embody.
killing monsters
“Killing monsters is powerful stuff. Swords, guns, light sabres, death pits, and magic rings have all found their way into my Art Therapy sessions … the acting out of violence in play seems to form a rite of passage, like ‘make-believe violence’ in comic books”
“Oh, it needed to die” I said, stating the obvious.
My client looked at their finger, at the remnants of an insect now black jam on the tip, a few legs sticking out.
“Yes, it died”
They looked away from me down at the ground on which we sat. They were a child, but fast growing up. They wiped their finger on the dirt, then pushed it in, burying it briefly between shards of broken pavement. Their support staff stood a little distance away, like prison officers, themselves awkward and seemingly unsure. My client said a definitive goodbye, session over for this week. In just a few moments my client had made a killing.
As a child I had a toy rifle, you could cock it like a real rifle, and when you pulled the trigger it let out a bang and a whiff of oily smoke for authenticity. I also had a wooden crossbow that I managed to smuggle in my hand-luggage from Italy, age 12. My father was fascinated with the wild-west; books, films, ‘spaghetti westerns’; Clint Eastwood was his hero. Weaponry was part of my life, spud guns, pistols, darts and even a bout of archery. Where other kids played football and pool, I stood alone and shot at targets.
Killing monsters is powerful stuff. Swords, guns, light sabres, death pits, and magic rings have all found their way into my Art Therapy sessions. I have written before about finding an image of myself being pushed down into a bucket of water, at my clients insistence that I needed to die. Some of my clients will have experienced horrors at the hands of powerful people, remnants of abuse that may remain as real and resonant in adulthood. For some there is an important level of control in making non-verbal statements, refusing to leave their bed, or stomping about, but killing does something else. Here the art-making swallows the death, it makes it safe, it turns it to concrete and allows it to be witnessed.
It’s not only taking control that seems to be important here. The acting out of violence in play seems to form a rite of passage, like ‘make-believe violence’ in comic books, where my clients appeared to use weapons and create all-powerful monsters, and insert themselves in stories of super-heroes in which they discover feeling ‘big and strong’. The American comic book writer Gerard Jones talks about the ubiquity of play-violence in his book “Killing Monsters”;
“In every culture, children always develop some fantasy of projecting destructive power across space … in societies where guns aren’t part of the local symbology, kids play similar games with bows and arrows or spears.”
Boys in particular but not exclusively can create and identify with superheroes, who overcome adversity despite being ‘freaks’ on the periphery of society, enabling for the child a belief in personal invulnerability, a perception of the world as meaningful. This hero-play reduces the ambiguity of every-day life into a contained fiction, a revised story in which they have control.
These fictions can also be stories of anger, where the enacted violence represents anger that outside of the session is directed at someone close, a parent, their carer, with the therapist acting as substitute. Anger can be seen as a normal and healthy part of separation as a child grows up. It was John Bowlby the father of modern Attachment Theory who observed that “…almost every separation has a happy ending, and often a small dash of aggression will assist this outcome”. The violent play becomes an agent of transformation, more a magic wand than a weapon.
One client wielded a large pair of scissors like a magic wand. They were dress-making scissors, sharp, adult. I told them that they were special scissors and that I trusted them to use them, but at the end of each session they would go back in the box for sharp things. At times the scissors became a sword, stabbing into card “the vorpal sword went snicker snack” in Lewis Carroll’s fantasy poem Jabberwocky. The monster is slain, the land now safe, the child a hero. After forty weeks of treatment my client no longer used violent acts at home and school as a way of getting what they needed from others; love, attention, and support. They were a lot kinder to themselves. They described the scissors as ‘awesome’ - in my client’s hands they truly were.
and what of hope?
“Now after several years working as a therapist I struggle with an idea of hope that for some appears more about wishful thinking, or the imposition of an expectation upon a client that we can wish for that may never happen, as though we can hope our clients lives into existence”
Small nods, slight movements, silence and barely a word between us in the eighteen months of treatment. Each week we sat quietly, both almost nodding off in the overly warm room. Sometimes they rearranged the art materials, laying them out neatly as though expecting others to join us; other times they painted broad strokes on paper, the colour chosen matching that of the table causing the sheet to disappear. It was as though we both spent the session struggling to be obvious, to be known.
I find quiet therapy sessions like these the hardest, with few words to calm my insecurities. I stay still and run through lists of things in my head. I fall back on what I instinctively know; I am here to be a witness. Each time I observe the slightest hint of movement, a look, a flick of the fingers, a change in appearance then I verbally acknowledge this, allowing the client to know that it has been seen and that it has meaning.
I had a sense that my client’s living situation was a struggle, or maybe worse. I felt empathy, and sometimes quite sad; no change appeared possible. Flourishes of creativity disappeared after one session and we went back to silence. I tried to elicit verbal responses. They only appeared to know the word ‘yes’ or slience. I increasingly tried to provoke a ‘no’ as this appeared to be the role of the silence. I really wasn’t sure. One week I went on holiday and returned to numerous phone messages. In my absence the client had spoken to a carer, and said a definitive ‘no’. Their living situation was abruptly changed. Someone who was believed to have little sense of being able to influence their own life had taken control with one simple word, they made it happen.
Many of my clients live in situations that may appear hopeless, born with or acquiring learning disabilities that are incurable, without being ‘normal’ in a society that worships normality in all it’s banality. When I meet them I have no obvious sense that things can get better for them; hope can appear elusive. However by just walking across the threshold into the art therapy room my clients show me something of themselves. It is subtle, almost invisible, but it is there. Is this hope? A resilience perhaps that is communicated non-verbally, unconsciously. Sometimes this non-verbal communication can show as behaviours that elicit emotions in others around them. In his book ‘The Child, the Family and the Outside World’ Donald Winnicott describes “a child’s antisocial behaviour as expressing an unconscious hope for management by the wider society, when containment within the immediate family had failed”. Hope is not straight-forward.
One of my Art Therapy lecturers once commented “I see therapy as ‘holding the hope’ for the person you are working with”. Here they appeared to suggest that therapy is about holding an idea of hope for someone who is too overwhelmed, vulnerable or unable to hold it for themselves or indeed see it for themselves, gradually negotiating the passing of this idea of hope across to them until eventually they can walk away full of hope. I hear hope often talked about by therapists.
Now after several years working as a therapist I struggle with an idea of hope that for some appears more about wishful thinking, or the imposition of an expectation upon a client that we can wish for that may never happen, as though we can hope our clients lives into existence. We can all hope for change, as though hoping by itself made anything happen.
Václav Havel (poet, dissident and statesman) shines a light:
“Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”
Not so much as ‘holding the hope’ for others I have come to see my work as recognising hope in myself, and discerning what I need to get me through the day, and what my client might need, paying attention to the subtle language of resilience, a capacity to survive and to then encourage it to the surface. I recognise that like many that come to work in therapy I have held onto utopian hopeful beliefs, a modernist mindset that may not serve my clients well, that may attempt to speak for them. It is perhaps in this constant work of becoming a therapist and encouraging the client to become more of themsleves in which we can truly find hope, a journey in which we both pay attention and play our part regardless of how things turn out.
therapist as novelist as monster
“In the quiet of the therapeutic space I find much privilege in experiencing the stories of my clients, painful and unnerving as this can be for both of us. At times I tug and pull on information, teasing it out, at others I am guiding, enclosing, ‘making safe’ as waves of information are thrown around the room in all colours and all materials. We are weaving the stories, co-creating”
“All therapists are frustrated novelists”
… a comment made by novelist Fay Wheldon that I heard in a radio interview some fifteen years ago, before I even trained as a therapist. She went further, blaming the collapse of her thirty year marriage on her husband’s psychotherapist, declaring them as dangerous, ‘wielding enormous power’ attempting to rewrite the lives of their clients as though characters in a novel they are too ill-adept to write. She cleverly then went on to write a book about her experience.
Most of the clients that I work with through the Learning Disabilities Service are unable to read, have never learnt, would be unable to learn, or chose not to. At some level being a novelist wouldn’t be much direct help to them. Yet, they are all incredibly adept story-tellers.
One of my clients made clay pots, crockery, utensils, the painted design of each only changed so very slightly each week. They created a lot of work. It would fill boxes, that would fill the cupboard, but each piece was contained in it’s form, varying in size, but always recognisable by it’s utility. It never felt beyond my ability to cope; the work never overwhelmed me or apparently my client. Each session was quiet; a workshop, productive. It only occurred to me after many weeks how much useful, purposeful artwork was being created by someone regarded by society as ‘un-useful’, useless, or as a burden on a country’s wealth. My client had told me a story about being disabled, and I could only imagine that the later shattered, unrepairable pots that appeared as treatment progressed told me something of how they might feel about their apparent uselessness.
In the realm of significant trauma or ‘moral injury’ we now understand how narrative and being able to rethink or perhaps retell your trauma are important in normalising experience and avoiding the depths of Post Traumatic Stress Disorder (PTSD). In a study of Second World War veterans (The Grant Study, Harvard Medical School) those who did not develop PTSD, which was the vast majority, tell very different stories when they were tested in the 1990s than immediately after the trauma in 1945. Their experience had now been retold as one of camaraderie, of shared experiences, or patriotism and how it helped them grow as individuals. Those that hadn’t found this new retelling of experience lived with the trauma as though it was happening to them still.
Those without PTSD had literally rewritten their experience, embellishing it with adventure, heroism and meaning. They had also recounted stories that were shared; memories emerging of common enemies and joint action. In his therapeutic work with refugees Renos Papadopoulus notes that there is a shared story of survival for pre-migratory refugees; a process incredibly important for how they can later make sense of their experience. He notes how Nelson Mandela and his fellow ANC members spoke of surviving imprisonment on Robben Island through ‘understanding what the authorities were intending to do to us, and sharing that understanding with each other’; a shared narrative that offered for those involved a place of shared security.
In the quiet of the therapeutic space I find much privilege in experiencing the stories of my clients, painful and unnerving as this can be for both of us. At times I tug and pull on information, teasing it out, at others I am guiding, enclosing, ‘making safe’ as waves of information are thrown around the room in all colours and all materials. We are weaving the stories, co-creating layers of paint and encrusted clay bringing safe-shape to memories that otherwise would be overwhelming, disrupting abilities to have normal relationships with themselves and others.
As I look through my bookcase of novels at home, it occurs to me that the books that I keep that haven’t ended up in the charity shop are those in which questions are asked that help me to look at the world beyond myself, to weave my memory and experience with others. They bring me safely into the world. I am not attracted by writers that tell me how it is, how life should be, or always was. I am not attracted by novelists with large axes to grind, or weighty egos to share. I think I could say the same about therapists, but then I am the one writing this blog; shaping, editing, embellishing my memory as I go …
30 second therapy
“A friend recently asked me whether there is such a thing as collective art therapy. In response I talk about studio sessions, large groups where I work with each client for a short time, but it’s clear he’s talking about something less organised, with no therapist, but a gathering of people involved in creative activity that might intuitively have some therapeutic benefit for all. We talk about group dynamics. It reminds me of Jung’s ‘collective unconscious’, the collective mind figuring out and arranging the gathered people by type based on our primordial experience and then we navigate our paths in and around one another accordingly”
“We were just talking about the Edinburgh trams …”
“Seriously? Well I guess it’s either that or independence …”
The barista at the kiosk smiles and draws me into the conversation …
“Oh no, it’s my German friend here, she’s heading to the airport to meet her boyfriend and I was telling her how to get there. I wasn’t complaining about the ‘tram fiasco’ really, but I could if you let me.”
She smiles again and leans forward, her elbows on the counter.
I often feel anxious around strangers but here I am feeling strangely at ease.
A young man steps up and orders an ‘Americano’; he smiles, hands in pockets.
A middle-aged American woman walks into our circle,
“…like, are there any toilets up here?”
“Sorry none up here” says the barista as amidst the chat she delivers me a perfect Flat White, “I get asked that so many times” she says, “I wish I could put up a sign, but I’m not sure how welcoming that would be”.
We talk some more; politics, travel and then I smile, nod and move on to walk around the hill.
The German girl waves goodbye. We will most likely never meet again.
The American woman stops me and points with enthusiasm to the view across the city,
“so that’s where it is, that’s the view I see in all the famous photos”.
The young man from earlier is now sat alone at the single cafe table, he smiles and raises his hand ever so slightly, a wave, not too high, not too friendly, and I smile and nod back, swallowing my social anxiety, just enough to make a connection … we are connected, we are all connected.
All of this happens within the space of 30 seconds. I leave the hill feeling affirmed, acknowledged, warm inside on a caffeine rush; I have what I need. I wonder if maybe Edinburgh City Council could just fund someone to wander about up there, someone with good eye contact, a smile and affirming chat - they could probably save a bucket on Counselling services, if only for the tourists.
A friend recently asked me whether there is such a thing as collective art therapy. In response I talk about studio sessions, large groups where I work with each client for a short time, but it’s clear he’s talking about something less organised, with no therapist, but a gathering of people involved in creative activity that might intuitively have some therapeutic benefit for all. We talk about group dynamics. It reminds me of Jung’s ‘collective unconscious’, the collective mind figuring out and arranging the gathered people by type based on our primordial experience and then we navigate our paths in and around one another accordingly.
During Art Therapy sessions I pay attention to my body and my passing thoughts as a way into paying greater attention to the client with whom I sit; essentially ‘mindfulness’. I then notice what is different about them, what has changed, what has shifted, however subtle. By paying attention to one another we are opening up and practicing an ability to think about one another’s interior thoughts, motivations and desires. It’s a process many of us take for granted, but some of our most vulnerable citizens have grown up without the secure attachment to enable this, and their response to other people and themselves can seem abrupt and violent.
In a recent interview I heard with social psychologist Jonathan Haidt a questioner asked if we could resolve international conflict with mass mindfulness meditation. Haidt’s work in morality suggests that there is an essential dynamic for civic society when both conservative and liberal mindsets engage, mindfully. His response is that research suggests that mass mindfulness could work, but it’s unlikely that you would be able to get the people you really need to be mindful into the same room. Clearly we need a bigger coffee kiosk.
As I sit here writing on the train I look about me … I smile at the woman across from me but she looks away appearing tearful; the young guy with headphones shuts his eyes and bobs his head. There are a crowd of young girls shouting, clearly upsetting a couple sat nearby who appear experts in angry looks with few words. I feel quite invisible. Then a small boy comes running up the aisle. He seems to have run the whole length of the train with his bedraggled parent walking on behind. He stops at my table and hits the hard surface with his open hand looking at me in the eyes, he does it again and laughs and then runs off. I smile at his audacious entrance. The parent apologises, yet for the first time today I have been acknowledged, however briefly; I have what I need.
art, and therapy, and the space between
“I sense that good therapists have always been able to work with the grey areas; the space between art and therapy, yet over the years of my development as a therapist I have often felt anxious that my clinical work does not appear to others as ‘just art’, and that somehow I need to use long psychological language to differentiate myself. “
Before training in Art Therapy I worked as a volunteer Arts Worker with a L’Arche Community, part of the international residential network for people with Learning or Intellectual Disabilities. I was there for just one afternoon session each week. Residents had access to a well stocked workshop engaging in any number of arts activities, including the making of candles that were sold in the shop front. It was an alive, cheerful and welcoming space just one street back from the beach.
I remember staff expressing an expectation that I arrive each week with an organised activity to pull out of the ‘magic bag’; craft and art projects that would occupy everyone for an afternoon. Not only did this raise anxiety in me, it seemed to raise anxiety in the residents.
‘Core members’, as residents were known, seemed happy to work at their chosen activity; painting, weaving, sculpting, mostly individually in the shared space. Rather than introduce new group activities I spent a short time sitting with each person, watching, observing and talking about what they were doing, sometimes suggesting ways in which they might try working differently. I remember one who painted straight lines with staccato brush strokes, many repetitive lines over and over. We tried the brush in more flowing movements, circular motions, loosening up their posture into wide sweeps of their arm. There were smiles. It was an intimate space of quiet activity, only broken when someone struggling to communicate might become more loud or violent, and even then core members would gather round and calm their friend, showing incredible care for one another.
Unwittingly I had facilitated what I would know in the future as a ‘Studio Art Therapy’ session, still one of the most powerful and underrated ways of working.
Apparently over weeks the mood of some core members notably improved. I don’t remember looking for outcomes, I was just looking for justification to not do organised activities each week.
It was a powerfully responsive and healing space. In training as an Art Therapist I sense that I took this process of looking and ‘being present’ and distilled it into a more concentrated version. Through the alchemy that is psychodynamics, my own psychotherapy and three volumes of ‘Attachment and Loss’ I seem to have gained a greater awareness of myself and how in a space I might use my distilled version of 'being present’ to bring a measure of psychological healing for trauma and distress.
I sense no wide space between Art Therapy and Arts Workers. I am still an artist, but I now have a qualification that brings with it a state registration, a level of governance and accountability to the public for my clinical work; but am I more effective?
A few years ago I worked with the National Health Service in Scotland in establishing a Head of Arts Therapies post in one area board. As a solution to the lack of Health Service funds we worked with an external Health Foundation in establishing a post that is both an Arts Therapies leader managing a clinical arts therapies service, and a strategic leader who will take a governance oversight of Arts in Wellbeing strategy across the region, encompassing Arts Therapies and Arts programmes alike.
I sense that good therapists have always been able to work with the grey areas; the space between art and therapy, yet over the years of my development as a thearpist I have often felt anxious that my clinical work does not appear to others as ‘just art’, and that somehow I need to use long psychological language to differentiate myself. There are a multitude of insecurities here that we all cross, and it has taken me many years to understand that my presence as a therapist exists regardless of the format I use. I sense it matters little to a client what I call myself, but that I am present to them. In a Health Service rightly questioning it’s funding of all treatments I sense that Arts Therapists would do well to show that we can collaborate at the edges of our profession, as well as stand in the knowledge of our own professional dynamic presence, and our consequential clinical outcomes.
I sit with a client, unwilling or unable to speak or show their face. They communicate with their hand; movements made like a puppet without eyes. Intimacies open up, connection is made and a journey of healing marks itself before us. Are we ready? we ask, and we both walk on.
Collaboration and understanding even after years of training remains the simplest and most beautiful thing.
back to the frontline
“Like any of us that work for state funded institutions like the Health Service I find it hard to remove myself from the apparent aims of enabling a healthy, but more obedient, working and hassle free population; curing people who become aggressive and take up valuable time and resources. I try to find the path that is best for my client, but I often find myself listening to the pleas of families and carers to fix people, and of course there in my own inner voice aswell, so desperate to help. “
“Are you going to fix me?”
These were the first words uttered to me by one of my clients. Like so many, they had magically encapsulated a large metaphysical debate in one question and indeed later in just one image. Since then this question has resonated through my clinical practice like a thin red line, twisting and winding itself around the issues presented to me by every client. Am I fixing them? … and if not, then what am I doing?
That client worked with gentle tactile fabrics, using sharp needles that at times appeared dangerous as through awkward movements they tried to sew the pieces together, stabbing and piercing. At the end of treatment they walked away, fixed or not, assuring me they’d had enough therapy for now.
Friends have posed the question to me as to whether Art Therapy is just about enabling disabled people to conform to a more able, controlling world, readying them back for the front line of life, rather than anything about loosening up their true selves. I can’t argue with this.
Like any of us that work for state funded institutions like the Health Service I find it hard to remove myself from the apparent aims of enabling a healthy, but more obedient, working and hassle free population; curing people who become aggressive and take up valuable time and resources. I try to find the path that is best for my client, but I often find myself listening to the pleas of families and carers to fix people, and of course there in my own inner voice aswell, so desperate to help.
I remember in Pat Barker’s novel ‘Regeneration’ the real 1914 psychiatrist WH Rivers has a conversation with the fictional Billy Prior, a soldier back from the front at the Great War being treated for mutism. After what appears a ‘fix’ Prior now able to speak suggests that Rivers has nothing more to offer than mending soldiers, repairing ‘fighting units’ for the front lines, ready for the next push.
As a trainee I was on placement with a day-centre for people living with drug use/abuse. I ran a weekly studio group that was open for any service user to attend as part of their treatment, often part of a Court Order. We started each session sat in a circle. Everyone then found their own space to work, ending again at the circle. Service users chose themes each week based on our circle discussions, such as home and identity. There was a vibrant energy in the room, everyone occupied with their own work but bouncing ideas and jokes off one another before sharing images together at the end. Week by week the faces would change, some would stay for the whole ten week term, some for just one session.
Staff warned me of hardened criminals - knives were mentioned. I was told to watch my back. It felt tribal, tattoos, smoking and gentle ‘gouching’ on each others’ shoulders in sessions.
I had read Neil Springham’s writing on narcissism in drug use and tried to look beyond appearance. The artwork gave this route in, opening mindful discussions that surprised my middle class judgment. Time after time staff appeared shocked at the depth that could open up in just one session; images of stories that appeared long held inside; moments of acknowledgement and maybe nothing more.
One key worker said that a client had expressed more in one session than in months of case work, enabling them a way in, a connection. I saw that client only once; I don’t know where they went after that. Sometimes I think I see them in the street asking for money. I wonder whether it was worth it, whether anything was fixed. Maybe we just help them back on their feet, another statistic in a government programme, or maybe back to the front line in their own war against the past … and maybe that’s enough, for any of us.
not talking about death
“for families that have spent their adult lives trying to stay alive amidst the challenges of a child with cognitive disabilities then thinking about what has always been in the background, their own mortality and that impact on care for their child appears overwhelming; an ending understandably to be avoided at all costs“
“I just wanted it to end better this time” they say …
They hold their last piece of artwork tightly, a piece that seems in it’s contained and folded way to have encompassed all of the materials used in the months of work. Little bits of it drop to the floor; a small pile of colourful residue that I will soon be brushing away.
For many therapists the last few weeks or months can be the most fruitful and hardest in treatment. The end-point of a therapeutic alliance is a moment of unavoidable death in which the client may integrate their wider internal concept of loss into something tolerable.
When clients request to end treatment it can take a while to convince their care teams that this is appropriate. Partly as caring people we all want to be so sure that the client is safe and that ending treatment is timely, but I’ve also noticed how in these last moments that other people want to ‘get in on the act’ of therapy. Having spent much time being aware of the suspicions of family and care teams about the purpose and efficacy of art therapy, I then spend much time carefully extracting them from the process at the end of their client’s treatment. It’s as though by this final stage they (carers and families) all want a bit of the therapeutic action.
One client made solid, blocky structures out of all sorts of materials. I spent my time with them wondering whether the room or even I could contain the increasing volume and size of the structures, sensing that we may never shift into a different gear. Then they seemed to loosen the process, letting go, playing with mess and allowing the structures to almost dissolve into puddles of fluid emotion.
Support staff appeared to view our work as ‘activity’ and little else … a nice way for the client to spend their time, whilst their medics prescribed medication to the job I clearly wasn’t doing. After a while the client started talking about the length of time they had been in treatment, talking about how much more normal life was for them now. Their work became quite solid again, but with space and fluidity built in. They appeared settled. I felt as though they had instigated an ending, and yet now I found myself being cajoled by those around the client into keeping treatment going -
“it’s the only thing they engage with; they love coming”
“Are you sure? I don’t think they’re ready … we’re not ready to end”.
It’s inevitable that in thinking about endings with clients we are thinking about our own death and mortality. This hopefully isn’t news to any therapist, and yet for families that have spent their adult lives trying to stay alive amidst the challenges and potential confusion of a child with cognitive disabilities then thinking about what has always been in the background, their own mortality and that impact on care for their child appears overwhelming; an ending understandably to be avoided at all costs.
I have raised the issue during reviews with families of ‘succession of care’; a polite and slightly kinder way into the conversation about who cares for your disabled child when you die and the impact that might have on your current relationship. One time the mother became quite tearful and talked about her own mother dying. The death sounded distant, silent; with no exchange of words. It didn’t sound like a good ending. In speaking about this the room became silent. The client appeared calmer as though for a long time they had been anxious about this obvious loss - the loss of their parent. We left with a sense of something having shifted, the mother shaking my hand as though I were there just for her. I was touched by my own sense of loss, of my own mother, of her mother and others before. There was nothing new here, but that didn’t stop this moment feeling like the most profound in months of treatment. I felt extraordinary, useful and full of meaning, if only for a while.
our subtle scripts
“I consider what my client might be saying to their parent, or to me by this subtle yet apparently profound difference in behaviour; one for home, one for the therapy room. I am pleased that my client has found a way of communicating, but mixed with a sadness for the parent who has carefully brought up a child with a disability only now to see them act with the subtlest of statements of independence, or perhaps ambivalence.”
A parent stands at the door to the art therapy room looking on as their fully adult child takes off their coat and hangs it up.
“they’ve never done that before, how did you get them to do that?” they say
“well, they just come into the room each week and …”
“they always wait for me to take it off and hang it up. They can’t do it themselves”
They turn and look at me with a face of sorrow and confusion. They appear to be shaking. They look so very alone. They walk slowly to the waiting area, and sit quietly holding their handbag close to their lap.
I consider what my client might be saying to their parent, or to me by this subtle yet apparently profound difference in behaviour; one for home, one for the therapy room. I am pleased that my client has found a way of communicating, but mixed with a sadness for the parent who has carefully brought up a child with a disability only now to see them act with the subtlest of statements of independence, or perhaps ambivalence.
This reminds me of clients who bring books with them to sessions. The books can be factual, intellectual even, yet carried by someone with an intellectual disability. One client talked about how books bring them comfort. For me they have felt like another person in the therapy room, someone else muscling in on the space. They feel less transitional objects and more part of a learnt behaviour; or rather an implicit action or defense learnt over years since childhood, a role played out to help mediate the difficulty of attachments and inter-relationships, and even boredom. Gradually over months during treatment the books disappear until one day they stay at home, the client appearing able to be present by themselves.
Communicating how we feel and what we want is so utterly complex, subtle and often beyond words, sometimes nothing more than relying on a learnt script or action that we play out; a sense of what happens.
I muse on this as I meet a new client. I have my work bag with me. I don’t need my bag. I don’t need my phone, or wallet, or diary, or headache tablets, or the mass of unread research papers that live in the bag all dog-eared and desiccating over time. I don’t need any of this, but I do need to be present to my new client. Why the bag? What is it doing there? What am I telling my client or their support staff by having this thing attached to my side? What role am I playing out?
I decide to leave my bag in a corner of the room and move closer sitting just in front of them. They give me a cursory glance, I nervously smile and say ‘hello’. I put my hand to my side, searching for my bag, needing to touch it, only to find it gone. It’s OK, I tell myself. It’ll be OK, we’re all OK.
still quiet thoughts
“In this semi quiet my thoughts fly around, spinning in my head and indeed in the therapy room like snow flakes caught silently in a Winter storm, all bright, attractive, floating and then massing into layers of depth as they fall. Layers that can flow into overwhelming emotions. Silence is not easy. Holding onto ourselves, whilst holding our clients is the work of such small transactional moments“
In the stillness of the therapy room every noise around us becomes so loud; kids crying in the waiting area; the anger management group in the next room slamming their door; a man in the corridor on a mobile phone talking about his financial difficulties and assuring the person on the other end “it will be OK”.
In this semi quiet my thoughts fly around, spinning in my head and indeed in the therapy room like snow flakes caught silently in a Winter storm, all bright, attractive, floating and then massing into layers of depth as they fall. Layers that can flow into overwhelming emotions. Silence is not easy. Holding onto ourselves, whilst holding our clients is the work of such small transactional moments.
I look down at my brown brogue shoes, neatly tied, the cosy wool of my socks and the easy comfortable trousers upon which I rest my lightly clasped hands. My shoulders lean forward slightly and then I push them back at the slightest tension. My client looks at me briefly and then looks away at a dark corner of the room. Then they look at the clock beyond my head. I catch their eye, briefly distracting their thoughts as they pass through my body and back again.
There are times for me when clinical supervision is not enough, when only a quiet solitary walk along the crashing waves of a shore can give me the reflective space I need; I bounce thoughts out to the almighty sea and they return to me, the same thoughts but somehow different, lighter, less jumbled.
This reminds me of the adage in mindfulness that ‘we are not our thoughts’. Our thoughts are mere moments, ideas that flow in and flow out and do not make us who we are, they are just thoughts. Philosopher René Descartes has been much criticised for his declaration of “I think therefore I am” - recent practitioners in the field of therapeutic mindfulness have adapted this to a perhaps more helpful “I feel therefore I am” - thoughts are transient, whereas feelings are our full body/mind response. One mindfulness exercise I heard dictated by Jon Kabat-Zinn encourages us to consider a single thought, consciously observing it, like a cat sat in front of a mouse-hole, attentive to what emerges, then watching the thought as closely as possible. I try this now as I sit with my thoughts floating about me - that snow storm blown in hard that maybe rests on the ground for a few days but will always melt and be reclaimed by new thoughts, new movement, new growth.
We haven’t seen much snow in the lowlands of Scotland this year, unlike other parts of the world, but I’ve had more than my fair share of thoughts and emotions. My client looks up sensing my momentary distance and comments on the weather “it’s nice out today”. I think, but do not say, I do hope to see snow soon, so that I can experience the childlike joy of snowflakes flooding around me, overwhelming every other thought if only for a moment.