The beginning of the profession of art therapy in England was after the Second World War; the first NHS appointment was in 1946, but the profession was not officially recognized in the UK health service until 1981. Therapists are now working in a wide range of services—acute psychiatry, addiction and alcohol counselling, social services, education, the hospice movement, intellectual disabilities, and in independent agencies and voluntary organizations. More recently the establishment in Ireland of an MA qualification in Art Therapy has been established by the Crawford College of Art And Design (validated by the Cork Institute of Technology), thus allowing greater access to Irish students to qualify in this form of therapy. It has brought a widening of our psychological services to address issues for clients, particularly those where verbal therapy is not appropriate or, indeed, where emotional release is difficult to express within other more established therapies. With an estimated 200 art therapists now working in Ireland, it is a growing field.
The framework of art therapy in practice has become established within the firm base of psychotherapeutic principles, drawing on psychology, psychotherapy and counselling—but with art as the main form of therapeutic intervention—there is a current call for the profession to be called ‘art psychotherapy’. It is felt by some people that this term describes the work more accurately, but the professional association (IACAT) has yet to agree collectively.
Art therapy differs from other therapies in that it employs various art media such as paint, clay, crayons, sand etc, to help the client to express and conceptualise areas of their experience, which may be beyond words alone. The influence of early analytic writing, such as that of Jung, gave support to the idea that art was an important means of both unconscious and conscious communication. It is in the nature of image-making that most people are capable of making marks and can use art therapy in some way. For those who find difficulty even holding a pencil, they can develop the coordination and capacity to draw, fill in areas of colour, allow the brush to carry an emotional register of their feelings. To those who might resist the activity of the group and the boundaries and limits of the art therapy session, a development of transference can be allowed to occur, where strong infantile feelings that originate in childhood experiences or early relationships are transferred onto the therapist, thus replacing some earlier person by the person of the therapist.
Another very important aspect of art therapy is the ‘third object’. This refers to the art object made within the therapeutic session, which is equally important and it is this that makes art therapy a distinct practice from verbal psychotherapies. As only the client within the session creates the image from the materials, the interpretation and understanding of their image is not imposed on them, but guided by the therapist. Containment within the therapeutic alliance enables anxiety to be held, providing a suitable environment for the safe expression of feelings though the image-making process.
What Art Therapy is Not
Art therapy is not art teaching. The therapist does not seek to impart skills, nor is it necessary for the client to be artistic in order to participate in the process—although the development of artistic ability can of itself be therapeutic. The use of creativity, metaphor and play in art therapy can provide a means for clients to explore difficult issues, which may not have been expressed or verbalised before, even to themselves. This can be a powerfully integrative process. Art therapy can help change set patterns of how people respond. The person’s use of their own visual imagery provides an alternative to the verbal constructs which may have reinforced destructive patterns in the past. All of this requires a safe non-judgmental environment by the therapist, which will allow the client to explore, through the media, those parts of the self which require recognition and integration.
Intellectual disability settings
Traditional settings for art therapists were found in large treatment settings of psychiatry, ‘mental handicap’ and other specialised units. Within these client groups, the needs and concerns differ. In the case of intellectual disabilities, traditional Victorian institutions were used as settings of care, but slowly and more recently in Ireland their function as institutions has been gradually eroded, as more and more individuals are being moved into the community. Art therapists are increasingly required to provide outpatient and community service, which has meant the art therapy room becoming less of a sanctuary and more of a place for resolution and acceptance of dynamic change.
Working with a client who may have been a resident in such an institution for many years will require a different approach. The condition of these clients may have become more chronic in that they have had to adapt to being what is commonly termed ‘institutionalised’. The work that art therapy seeks to address here is areas of independence, fears of isolation and loneliness, addressing issues of independent living outside in the community and facing demands of the real world. Clients might spend some time working on a variety of media in different images, tapping into their fears and positive feelings around these issues, and, in the process, developing a sense of their own self-esteem and identity. Working with more able clients, an intellectual disability group can help focus on these issues, and the sharing by fellow colleagues can help to build up support and commonality of purpose. Learning to relate to others and identifying through sign language, picture cards both of objects and emotional states—all help to give a voice to their needs and being able to seek and ask for them.
Regular review of each client’s progress is undertaken with staff, while at the same time holding the confidentiality of the therapeutic alliance between client and therapist, helping to hear their observations over the period of the therapy and for the therapist to make suggestions in their reports of practical changes which help develop further aspect of learning, needs expressed and (most importantly) emotional issues that may require attention. This sense of being independent and taking decisions, as much as is possible, depends much on the environment within which the client lives on a day-to-day basis. Unless care staff and policy makers, family and community around the client are reinforcing these principles, the aspect of change will be held in dread. Ideally, the art therapist should be part of, and contribute to, an overall plan for the safe and successful transfer of clients from institutions to living in community—being part of the early planning phase, deciding the steps to be taken, and contributing what art therapy can offer by way of therapeutic intervention suitable for each client. Allowing the art therapist to coordinate best practice with colleagues who are equally preparing clients for their transfer into community will help ensure the use of the maximum strengths of art therapy.
For more severely challenged clients, the approach would be one of using the art materials for experimentation, play and physical coordination. The therapist is there to facilitate the process, but refrains from doing anything for the client. The therapist needs to be receptive to the needs of the client and contain the feelings of frustration and anxiety that will be generated by the challenge of the process of using art materials. It is important to understand that medium (the materials used in art) is well known by artists to carry a coded way of feeling, an emotional message. It is not only the image as revealed in a ‘picture’ that tells the story, but the way medium is chosen, used and worked that reveals much about the emotional states any given client experiences during the image making process. This is not generally understood, possibly because we have been generally used to viewing an image in a frame with a recognisable form that relates to our understanding of it, and so we respond to this. However, in art therapy, as stated above, we are not in the world of making pictures for the public viewing or commercial return, but firmly in the therapeutic field of art.
This aspect of how art medium can serve, in a very special way, the emotional release is being further researched by art therapists. Medium has a special quality and ability to allow the client to build up tactile surfaces either with thick paint, glue sand etc. We understand from research in the field of neuroscience that touch, one of our earliest developmental stages, has the ability to trigger our senses and that of our emotional memory. Art can serve to bring into being in a concrete way an image of an inner experience that is not necessarily recognisable as form, but symbolises feelings and possibly memories. This aspect of the image making can serve so effectively the release of emotions for more profound clients in intellectual disabilities. Not only do we have the obvious skills in coordination at a more fundamental level—using brushes, carrying water, choosing paint etc, being used—but the experience of touch with finger tips, hands over surfaces that might be sticky, smooth or rough. The emphasis on the unconscious communication of the client is worked through in the relationship with the client and therapist and great care must be taken to ensure safekeeping of the images. This helps to serve feelings of safety and establish feelings of trust around the boundaries and the continuity of the sessions over time.
Working in the community
As day services within the community develop to address the needs of both former residents of institutional care and more community-based clients, they provide supportive networks for their rehabilitation, integration and maintenance into society. Many will need help on an ongoing basis, owing to difficulties and vulnerabilities which prevent some from obtaining employment or being fully engaged outside their local environment. Art therapy, when integrated into the programmes of activities, can be used for individual work with clients, workshops and closed groups. This last category can give an opportunity to allow the clients some sense of self-discovery by experimenting with art materials on their own, designed around skill acquisition which can help build self-confidence and can run alongside the more intensive enquiring therapeutic approach of an art therapy session. It can be viewed as a resource for service users to approach either for group sessions over a set period of time to address issues in their ongoing adjustment into community, or addressing significant emotional issues.
Hopefully, art therapy will be seen and used effectively by staff as a resource that can assist and contribute in a therapeutic and healing way, in the development of community care in Ireland.