The 30th bi-annual FATAG conference was held at the Charity Centre, Directory of Social Change in Euston, a warm and labyrinthian venue which nicely reflected the tone of the conference itself. Layered staircases inside led you through intriguing corridors and new heights were gained as you finally found the place you were looking for. The seams of charity and social change also underpinned the narrative of today's two sensitive and thoughtful presentations.
The morning presentation was entitled 'The Good Enough Couple' and focused on the containment of conflict and roots of creativity in a music and art therapy group for forensic patients with intellectual disabilities and mental illness. The paper was delivered by Trisha Montague, who has worked as a music therapist for the North London Forensic Service (NLFS) since 2003, alongside her more recent work providing 1:1 sessions as a psychodynamic counsellor and James O'Connell who also works in the NLFS as an art psychotherapist, as well as within the Integrated Community Learning Disabilities Service in Enfield.
Today's paper was based on their work together in the NLFS, a medium-low secure forensic setting, with a small closed group of three patients that has been running for two years. The idea to first run a joint arts therapy group came about four years ago, they candidly reveal, at least in part due to a strategically prudent effort to find new ways of engaging patients. This admission brought a topical perspective to their presentation; directly addressing the issue of the struggle to find funding for arts therapies in the current economic climate. But the introduction of a cross-modality psychotherapy group also calls into mind many deeper questions and possibilities.
Much of the focus of the paper was on exploring the surrounding complexities and anxieties triggered by working simultaneously within two different modalities. The creative duality presented an interesting dilemma both for service users and therapists in the group- and in some sense provided a form of leveller in their therapeutic relationship-as both experienced feelings of not being 'good enough' in response to being asked to engage with two different art forms. Both Montague and O'Connell described concerns about the potential for splitting in the group, which had to be addressed in the way that it was structured. Any opportunity for splitting could be deeply disorientating for patients, particularly in a client group already vulnerable to psychic fragmentation, as they did not want to reinforce service users internal disintegration.
To help contain these anxieties, both conceptual and therapeutic frameworks were constructed. Firstly, the importance of clear constant variables, versus those that could be worked with more flexibly were decided between them. Perhaps the most important of these was the structuring of time, along with the allocation and delineation of space. The division of the session between music therapy, art therapy and group discussion was crucial. Sessions would begin with music therapy, which was facilitated using more directive techniques, such as body and vocal soundscape, drumming and paired instrumental work. After this, the group would move across the space to a different part of the room, where they would engage with non-directive art therapy which provided opportunity for reflection on feelings triggered by the musical intervention.
The presentation was given flavour and brought to life by colourful creative excerpts, including both live musical recordings of clients playing together in the group and examples of patients' artwork, which helped to give us a real sense of their process. As well as this, Montague and O'Connell shared a number of clinical vignettes which provided a fascinating insight into the development of trust in the group, both between facilitators and service users. The final musical excerpt played was from the most recent session, held the previous week and demonstrated a much greater sense of flow and togetherness-indicating the progression in the group working and thinking collaboratively over time. The clinical vignettes were divided between both Montague and O'Connell, which provided a sense of integration in the presentation and demonstrated an insight into their ability to hold the split as therapists in the group.
Both practitioners communicated a powerful sense of the despair and hopelessness which can be present when working in a forensic setting, as well as the dangers of this becoming overwhelming. Managing damaging projections from patients is a painful experience, but essential for the development and survival of a group. The pair's reflections revealed the potential strength inherent in a shared holding process -along with the imperative need to trust each other, face uncomfortable feelings and talk honestly together. This frank discussion of the complex counter-transference that occurs in a secure, clinical environment proved especially illuminating; particularly within the context of a group run jointly by male and female facilitators. The parental projections and associations from patients can prove toxic, and there is ample opportunity for genderising. This raises important questions about giving service users permission to think about gender and what their fantasies may be about the relationship between therapists in a co-facilitation dynamic, as well as how therapy can offer a potential space to redress earlier experiences of family.
This morning's presentation strongly highlighted the benefits of working collaboratively and the therapeutic opportunities afforded by cross-fertilisation between art forms. This seems important in a profession which can feel very isolated, as we tend to work across multiple institutions and wards, which can lead to practitioners feeling split off. At a time when limited funding and increased public sector cuts could create competitiveness and potential conflict between modalities, this paper provided a poignant reminder of the importance of working together to create containing spaces for rehabilitation.
After a quick coffee break to reflect and refresh, the conference continued with an outline of FATAG business. This commenced with a look at the distribution of art, music, dance and dramatherapists present in the audience. It was observed that there was a higher proportion of music and dramatherapists present than in previous years, which seemed to nicely reflect the themes of the morning's presentation regarding collaboration. FATAG is one of the only groups which is made up of all four modalities from within the arts therapy sector and a brief discussion ensued about the differences and commonalities in the way we work.
After this, apologies were given by those unable to make the conference, as well as announcements regarding the content of future conferences and a call for papers for forthcoming events. The creation of the new FATAG logo was discussed, along with the importance of promotion of the website. Papers from conferences may be uploaded to the website in future, depending upon any issues regarding copyright.
An update was provided on ongoing efforts between BAAT and FATAG to create a separate forensics special interest group and devise new clinical guidelines for art therapists working in prisons, with the aim for these to be included in the current prison service guidelines. These would better outline art therapy practice in order to promote better understanding of how art therapists fit into the service. If practitioners would like to be involved in the development of this process, please contact Tobias Arnup on: email@example.com
An open invitation was put out for people to attend Saturday Forensic Forums. These are held monthly in Hampstead on Saturdays from 10.30am-12pm and are fantastic for furthering CPD. The forum provides a reflective thinking space and advisory group. Practitioners are welcome to submit papers to present. Cost £10. For more details, please check out the website at: http://saturdayforensicforum.com or email: firstname.lastname@example.org
The next FATAG conference will be held in June 2014, specific date to be decided, and presentations will be research based, including a paper from Helen Short on the use of rap music with adolescents in music therapy and a presentation from representatives of the Philadelphia Association. The November 2014 conference will involve a series of film presentations and a call is currently being put out for any practitioners who would like to contribute films to this based on their client work.
Thanks were also given to Heidi Jockelson for all her hard work as administrator for FATAG.
Review written by Roanna Bond
PM Presentation - ‘In and Out of Control’ - An exploration of Art Therapy within a Prison Based Programme
Shaun Wassall is currently the Art Therapist at HMP Low Newton as part of the Primrose Service for female personality disordered offenders. He also offers Art Therapy within a Female Forensic Service in a hospital setting. The provision of Art Therapy over both sites was established by Shaun in June 2012. Shaun provides both group and individual Art Therapy.
Grahame Greener is currently a serving Prison Officer at HMP Low Newton. He has been a Prison Officer for 22 years, with the majority of his career spent working with Female offenders. For the last 5 years, Grahame has been working on The Primrose Service, which is a programme that offers assessment and treatment to female offenders who are diagnosed with a dangerous and severe Personality Disorder. The Primrose Service is the only female DSPD unit and is integrated within a prison population. Grahame’s work on the unit includes facilitating both groups and individual session.
The Primrose Programme was founded in 2006, and is located within HMP Low Newton. The aim of the Primrose Programme is to “reduce the risk of harm posed by severely personality disordered female offenders”.
Art therapy at the Primrose Programme.
The Primrose Programme has space for 12 women who agree to take part in the treatment programme. They first enter a 12 week assessment period, followed by a 16 week treatment needs analysis period and then they move into individually tailored treatment programme. Art therapy is one of the 9 therapeutic services available.
Shaun and Grahame (unless he is not on shift) co-facilitate an art therapy group. The group operates under a slow open format with the maximum number of woman being four at any one time. The group is reviewed every three months and there is a culture of the oldest members introducing the newest members to the group when they join.
Shaun’s challenges as art therapist
Some of the challenges described were: introducing art therapy to the prison; co-facilitation between art therapist and prison officers; promotion of the service; adapting the service and disclosure, acceptance, scepticism and containing difficult clinical material.
A challenge that repeated through out the presentation was about how to enable the prison officers to think positively about art therapy. Grahame reminded us that you can’t make others change and some people will never be interested in thinking about art therapy.
An art therapy workshop was set up for prison officers to get a closer look at art therapy. It had been timed by the prison officers to start late in the day so that they might be able to get off from work early rather then them being interested in finding out more. However, during the session they were totally engaged and after being asked to draw somewhere where they felt safe, two of the four prison officers were in tears. They had been able to connect with themselves through art making and had found the experience quite powerful.
In the context of the prison, Grahame made some comments which capture important aspects that art therapy has to offer,
“Just because she has drawn it doesn’t mean she is going to do it!”
“Art Therapy allows the women to shout without making a noise.”
Art therapy was described as a point where the prison staff could be split and manipulated. There was a lot of difficulty where “the women would make good use of the session but go back to the wing and tell a different story”. A way that this has been overcome is by handing over the session in front of the women when they are brought back to the wing. This benefits the prisoner’s therapeutic process but also the staff’s understanding of what goes on in art therapy.
Grahame’s challenges and perspectives as a prison officer
Grahame described a prison officer’s job as ensuring prison safety and discipline. He found that art therapy challenged the prison officer’s position because the process of art therapy can explore unsafe feelings which are acted out through art making within the therapeutic relationship.
Grahame’s dual role of thinking with his “discipline head and his therapeutic head” was suggested by an audience member as being like that of a parent where you are the one giving hugs and also instilling discipline.
The questions that were raised for Grahame were
“What do you challenge? What is right and wrong? Who makes the decisions? Am I qualified? Can I comment? What if I say one thing that undoes what Shaun has said?”
Shaun described a clinical case study of his work with one of the prisoners. This enabled us to think together about the highly potent feelings that can be brought up in this area of work. It highlighted that supervision and group thinking is paramount for the survival of the art therapist, prison officers and the prisoners.
Questions and comments.
What did they think about male facilitators working with female prisoners? Is it better with two males? They had not thought very much about it. Perhaps this was because it was such a common set up in a prison.
Was there as loss of interest? Grahame suggested that in contrast to sewing groups that are put on for the women, art therapy was not only for the women but also about them, which supported continued interest.
It was important to have a safety valve where by the therapist could recognise when a break was needed for the survival of himself or the prisoner.
Hate is very important.
Survival is a valuable thing to experience.
To Grahame- How has art therapy changed or informed prison officers? It has changed the way he views prisoners. “They are just like me”
Comments, words and thoughts from the plenary:
Visitors from Holland were welcomed.
How much can we trust each other? (between co-facilitators).
How honest shall we be? Rupture and repair.
Couples- same sex verses mixed sex couples.
It’s not often that prison officers get to say how difficult it is to do their job. Masculine verses feminine. Maternal but maybe not- gender transcends art. We (therapists) become a mythical being- male/female/therapist.
Towards the end Marian Liebmann was congratulated for her OBE and she responded by quoting an African saying, “it takes a whole village to raise a child” which was a great way to end a day of sharing and thinking together.
Review written by Rose Hall
Review of the 29th FATAG Conference held in London on Friday 16th November 2012
Alongside the generous refreshments laid on, the 29th FATAG Conference provided much food for deliberation and reflection. The day opened with a thought-provoking and timely presentation by Professor Nigel Beail on using psychodynamic psychotherapy with clients who have intellectual disabilities and putting an evaluative framework around therapeutic practice. The focus of the discussion was on how to integrate practice based research measures to help assess the effectiveness of psychodynamic interventions. Much of the contemporary literature in this somewhat neglected but vital field has been written by Beail throughout the course of his long career working as a clinical psychologist in South Yorkshire.
Beail proved a highly engaging, witty and dynamic speaker, frequently seasoning his presentation with colourful anecdotes from his professional life. However, his talk struck a meaningful balance as he eloquently offered a persuasive argument for why the psychodynamic field needs to move beyond the realm of the case study and into the brave new world of facts, figures and quantitative assessment to substantiate what we do; despite the difficulties this form of research inherently poses for the therapeutic process.
The presentation neatly guided us through the evolution of the research base surrounding working with clients with intellectual disabilities; from case reports and case studies to open trials and experimental studies. Despite this seemingly wide spectrum, the talk clearly demonstrated how thin the evidence base currently is. Beail and his colleague’s commitment to the field ensure that progress is being made in the area, but the developments are relatively slow. Partly, this is due to methodological issues and a lack of controlled studies being completed, but much of the limited headway appears primarily to be down to attitudes within the therapeutic community. A large contributory factor is the inadequate regard from funding bodies which support the research taking place; who, in the current climate often prefer to lay their money down at the door of CBT practices. But Beail also gently and courageously criticised the resistance of those practicing within the psychodynamic and psychotherapeutic communities to outcome their research, voicing how important it is that those working in the field begin to do so if we are to validate what we do. Crucially, this lack of existing evidence also seems to mirror society’s attitude towards those living with intellectual disabilities; who so often get overlooked and forgotten in today’s world.
The concluding aspect of the presentation focused on Beail’s efforts to develop a research scale specifically designed to measure the role of psychological therapies in addressing key presenting problems in clients with intellectual disabilities. In discussing this next phase of his research, Beail highlighted many of the fundamental difficulties encountered when embarking upon the quest to quantify. Some vital, challenging, even existential questions come into play when attempting to measure outcomes of psychotherapeutic work. How do you break down a person’s experience of their internal-world into dependent variables? How do you quantify quality of life or wellbeing? Perhaps most significantly-in a practice that is wholly focused on process, how do you begin to demonstrate how ‘satisfaction’ and ‘results’ relate to outcome, without moving away from the humane core of our work being client-led? At a time when funding remains scarce, Beail’s reflections provided us with a sensitive and thoughtful meditation on the dilemma of funding bodies demanding our long-term work be condensed into a short term process. There are no easy answers to the questions posed by this research, but Beail offered an articulate exploration which challenged our immediate and ingrained reactions to an age-old inflammatory topic.
After a well-earned and enjoyable lunch, the afternoon’s presentation was by Art Psychotherapist Jessica Collier on her work at HMP Holloway using art psychotherapy with a woman with Severe and Dangerous Personality Disorder. The discussion was enormously moving and encompassed many facets of a difficult topic, crucially-questioning whether prisons can provide a psychologically secure base as well as physically secure one. Collier’s talk proved a fascinating counterpoint to the morning’s offering, for it was presented in the form of an extraordinarily absorbing case study. The material perfectly demonstrated why the nature of our work often becomes so hard to quantify-as well as demonstrating how the personal aspect can prove valuable-in deepening our understanding of the therapeutic relationship through the examination of counter-transference. Collier spoke of the need for therapists to be mindful of their own feelings and attitudes within their work and beautifully described the intensive therapeutic journey she undertook with her client.
She artfully drew us into their demanding and sometimes destructive dialogue. Particular high-lights were her portrayal of the importance of image-making in holding over-whelming experiences of trauma and neglect and the power of allowing those experiences to be witnessed, as well as her detailed account of the complex issue of negotiating internal constellations of institutional transference and the dangers of organisation wide acting-out.
The impact of the effect of working so intimately with a client with such acute and involving needs was evident at many points throughout Collier’s presentation, when she appeared visibly moved by the events she was describing, which was extremely touching and added depth and authenticity to her presentation.
Interestingly, the significance of thinking was a major recurring theme in Collier’s material, particularly in reference to working in a secure environment where thinking is often replaced by concrete action. This seemed especially significant in light of today’s presentations, which perfectly encapsulated our current climate. How do we capture the depth and essence of Collier’s experiences working with her client in an effective outcome measure that doesn’t become reductive? Today’s discussions, though on the surface very different in substance, are intrinsically and urgently linked by their relevance to today’s professional world. Our task must be to find the mid-point between the two, so that we can keep offering clients our unique, creative models of therapy, which provide precious spaces other modalities cannot.
After the first presentation, some important FATAG notifications and updates were next on the agenda. This firstly involved a number of general acknowledgements, including recognition and credit for Simon Hackett’s publication of his recent research into ‘reduction of aggression using art therapy’. This was followed by an announcement of a reshuffle of the committee, including the addition of Lorna Downing to the panel as the new representative of Dramatherapy for FATAG.
Jessica Collier also announced that the Saturday Forensic Forum she runs will be hosting talks by Pamela Stewart, a psycho-therapist at HMP Holloway and Kate Rothwell in December. Additionally, the Saturday Forensic Forum, which has regular meetings in Hampstead, is always looking for new papers to be presented and so a call was put out for practitioners looking to present any work to get in contact with Heidi at: Fatag1@aol.com to suggest any new and interesting reflections which would benefit from being shared.
David Cameron’s recent efforts regarding a push for the rehabilitation of offenders was also discussed, alongside an acknowledgement of the difficulties experienced by those affected by the cuts made to arts therapy services in West London NHS Trust.
The next FATAG Conference was also confirmed as being held in June 2013, specific date to follow.
Review written by Roanna Bond
Charity Centre, Directory of Social Change, 24 Stephenson Way, London NW1 2DP Conference Room - Tel: 020 7209 1015 / 07407 732386
The focus of the conference was on research. There were the fewest numbers ofpeople in attendance. For many, the reasons were that a Monday was not a goodday but I also wondered if the topic had put people off. Throughout my training, Ihave got a sense that art therapists are quite frightened of the word ‘research’. Itcan feel a daunting process to undertake as it seems to be a relatively new ideawithin art therapy but the pressure is on to prove that we are worth the money wecost to employ. The underlying theme of the day seemed to be an encouragementto take on research as part of our job and that it can be very interesting stuff. Asa profession we are slowly building a base of research and adapting the way wework in response to a changing job market. The day was positive and inspiring withpresentations from three very different pieces of research at different points of theirjourney. I gained an understanding that research can be a creative process, usingdifferent research methods and evaluation techniques and it demystified and openedup what research can mean.
The first presentation was from Simon Hackett. 'Process – outcome research'using an experimental single-case study design to investigate the efficacy of ArtPsychotherapy with adult offenders who have intellectual and developmentaldisabilities. He started by introducing the question “What is it within the therapy thatworks?” The aim of the study was to measure change, measure processes thatsupport change and see if there is a link between outcome, process and theory. Aliterature search on ‘art therapy’, ‘learning disability (LD)’ and ‘offenders’ broughtup three papers: McKenzie (2000), Manners (2005) and Rothwell (2008). Hackettwent on to describe his “research smorgasbord”. The presentation contained a lotof new information which was incredibly interesting but too much to hold onto torepresent here, hinting at the amount of work it takes to plan and develop a researchpiece. His method was rigorous and was able to produce qualitative and quantitativedata. Psychology students, nursing staff and nursing assistants all collected differentkinds of data which could be cross analysed to get a better understanding of whythere would be a dip in a graph showing someone’s mood level for example. Hisconclusion were: outcome research is a priority; it is possible to look at complexprocesses; we should not only be measuring that our patients are getting better butthat we should also be looking at what it is within the therapy that works; let data tellthe story.
Presentation number two was from Angeles Fiallo Montero. Her research was partof her MA, completed September 2011. 'Acceptance Dance, an inquiry into theprocess of Dance Movement Psychotherapy (DMP) with young people in custody'.This presentation aims to give an insight and introduction of DMP in YOIs. It was aqualitative study of 4 boys in a group aged 16-18 who were serving life sentences.The presentation explored the range of responses to the therapy and there wasan interactive section for the conference attendees which helped to visualise whatDMP can be. After 14 weeks of therapy the participants each had an interview withplanned questions to get feedback. The research was very different to the firstpresentation and juxtaposed, suggested some of the strengths of each. For exampleHackett’s use of a graphs in illustrating change were powerful and Fiallo Montero’sconnection with the humanness of a DMT encounter. It made me wonder how wecan think about using graphs without loosing the human quality that this researchheld as so important.
A short interlude for a business meeting continued some trains of thought about howarts therapies can contribute to the wider picture not just through research but byperhaps inviting people to FATAG conferences to support people in understandingwhat it is that the arts therapies do and why it is so good. Some concerns wereabout confidentiality with the curious general public. It was suggested that perhapsone conference a year could be aimed at interested people and the other at theprofessions. It was noted that art therapies had been invited to other psychologyconferences so could we return the idea?
The final presentation of the day was from Stella Compton Dickinson and VictoriaSieght who are music therapists. 'Developing 'context specific' treatment.'. Groupcognitive analytic music therapy ( g-camt): A mixed methods, controlled feasibilitytrail at Rampton high secure hospital. Stella talked of how she wanted to see if itwould be possible to do some ‘hard science’ research within arts therapies so shefollowed already available medical research guidelines for her research. She hasbeen working on this for 10 years, putting such a lot of time and energy into it andit is still awaiting completion. Cognitive analytical therapy (CAT) techniques wereused in the research alongside music therapy. What they do have now is a highlyapproved research project. On the other hand, because of the nature of research,some things were unable to be controlled that normally would be in a therapeuticcontext. Due to the research methods, the groups were not carefully matched whichwas quite challenging for the music therapists and sometimes people were chosenfor the therapy when they perhaps were not completely ready.
The final presentation by Stephanie Turner was unfortunately cancelled. 'SeeingInsecurity. An exploration of the witnessing act in Drama therapy with male offender-patients'. “This presentation concerns the first ever drama therapy intervention ina high secure forensic facility in Scotland. It aims to illuminate the research andtherapeutic journey undertaken during my final year clinical placement with a maleforensic population, juxtaposing the mirroring and reflective function of therapy withthe surveillance tasks of security. Stephanie Turner has a background in theatreand applied theatre practice. She qualified as a Drama therapist in 2010 havingcompleted her MA in Drama therapy at Roehampton University.”
The day was brought to a close in a plenary by sharing some thoughts andquestions that were raised: What can we do day to day if we do not have researchsupport? Is research helpful or harming to patients? Arts therapies need to bedeveloping research. Is research about keeping our jobs? How we brand ourselvesis important; we can not be seen to be being precious. Getting patients to thinkcognitively is very different to art making. Getting people to think is what artstherapies can do when patients can not. Linking in to neurology is important. Theresearch presented was the beginning of longer journeys into the subject area wheremore research is needed to continue the discussions and improve validity.
Manners. R (2005) “It must be an honour to drive.” Issues of difference, loss of
normality, power and disempowerment. M. Res. Thesis. London: Goldsmiths.
Secure Setting in Art Therapy and Anger ed. Liebmann, M Jessica Kingsley