Group Interactive Art Therapy

Its use in training and treatment

Diane Waller

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317591658
• Edition: 2
• Topic: Psicología
• Subtopic: Capacidad creativa en psicología

The first edition of Group Interactive Art Therapy presented the first theoretical formation of a model integrating the change-enhancing factors of both interactive group psychotherapy and art therapy, demonstrating its use in practice through a series of illustrated case examples. This long-awaited second edition updates the content of the original in light of the major social, cultural and political changes of the past two decades and presents new examples of the model in practice.

The new edition includes a brand-new section on the use of group interactive art therapy in research with people with dementia, with schizophrenia, and those in rehabilitation from a stroke. The book also features two chapters on the use of the model in a broader context. The book is presented in four parts:

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• Introducing group interactive art therapy

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• The model in practice: case examples

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• The wider context

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• Group interactive art therapy used in research

Each section demonstrates the flexibility and adaptability of the model in different cultural and social settings and with a variety of client groups. The development of knowledge about the skills required for conducting an interactive art therapy group and its suitability for different clients has been incorporated throughout the book, as well as practical information on working in areas where there is limited access to art materials.

Part I Introducing group interactive art therapy

DOI: 10.4324/9781315744285-1

Introduction

DOI: 10.4324/9781315744285-2

A brief definition of group interactive art therapy

It is, astonishingly, more than 20 years since this book was first published. In that time, many of the people who were so central to its conception and birth have died. Some of the countries where I developed the model have experienced major change and even civil war. It has thus been a particularly difficult and painful emotional experience to return to the original text and to do the necessary revisions. The world has changed, the structures of and the language of health and social care have changed, and so have I. I was glad to be able to write a brief but updated paper for Cathy Malchiodi’s Handbook of Art Therapy (Waller 2003 and second edition 2012: 353–67) which gave a chance for some of the feedback from colleagues, a new case study and my own reflections to be included. This helped in the current task, to review and add to the original 1993 manuscript, to update the literature and to include thoughts on the kind of training and experience needed to practise the model, developments of the model in a social context and how it can be adapted for research. I have though left most of the original Case Examples intact as they continue to illustrate the theoretical points.

The model of ‘group interactive art therapy’ is based on concepts from group analysis, interactive (or interpersonal) group psychotherapy, systems theory, process sociology and art therapy. It is an evolving model which in its theoretical base incorporates the work of Foulkes, Stack Sullivan and Yalom; and latterly Agazarian and Peters and Astrachan, who have introduced a ‘systems approach’ to group psychotherapy. A period of study in the mid-1990s at the University of Leicester’s Centre for Research into Sport headed by Professor Eric Dunning (famous for his studies of football) was the unlikely location I discovered for bringing together the ideas of many of the above people and theories which are so important to me. Being very interested in sport and responding to an advert for a distance-learning MSc in the Sociology of Sport, I discovered the Centre’s commitment to the process or figurational model of sociology developed by Norbert Elias, a colleague of Sigmund Foulkes, who as we know was a very prominent figure in the evolution of group analysis in Britain. I had used a process model of professions in my PhD thesis, completed in 1990, without being fully aware of the connections between Elias, his former student and colleague Eric Dunning, and Foulkes. I had also done my group analytic psychotherapy training under the eagle eye of Dr Ilsa Seglow, without knowing that she had been a student of Elias’ and written her PhD on ‘The profession of Actor’. Later I found that Earl Hopper, who has developed Bion’s theories of Basic Assumptions, was a student of Eric Dunning! So I can truthfully say that the model of group interactive art therapy continues to evolve, with both conscious and unconscious influences and a fair measure of serendipity. These kind of discoveries are such a part of the creative process, and they are at the heart of both art therapy and group psychotherapy as I understand them.

Group interactive art therapy draws on fundamental principles of art therapy. These are: that visual image- (or object-) making is an important aspect of the human learning process; that image-making (and this includes painting, drawing, clay-work, constructions, etc.) in the presence of a therapist may enable a client to get in touch with early, repressed feelings as well as with feelings related to the ‘here-and-now’; that the ensuing art object may act as a container for powerful emotions that cannot be easily expressed; and that the object provides a means of communication between therapist and patient. It can also serve to illuminate the transference (that is, feelings from the past which are brought into the here-and-now and influence the way that we experience others) between the therapist and patient.

I began the exploration of this model by giving an idea about the way in which concepts of group psychotherapy and art therapy have evolved from about the 1940s. I included discussion of the work of art therapists who have written about groups, particularly the group analytic or interactive models. I have drawn attention to the early debate in art therapy literature about ‘directive and non-directive’ approaches to art therapy and their relative merits, which was launched by McNeilly in 1983, and shown how this gave rise to an interesting discussion about the role of theme-centred interaction in art therapy groups and about structuring the group’s time between image-making and talking. I have discussed more recent texts which explore using art therapy in groups. Throughout the first edition I drew fairly extensively on those authors who have presented and developed the ‘interpersonal’ approach to group psychotherapy (for example, Yalom, Ratigan and Aveline, Bloch and Crouch) and this has not changed in the revised edition.

Introducing art therapy to an interactive group changes the dynamics of the group. I have pointed out aspects of the interactive group which are generally held to be curative and described how art therapy may enhance its treatment potential. At the same time, the introduction of art materials makes specific demands upon the conductor and the group members and I have explored what I feel are the main issues involved in the leadership of an interactive art therapy group, expanding in this edition on particular skills that are needed to ensure the effectiveness of the model.

The theoretical elements of the book are illustrated by examples from practice – my own and others – to show how the model can be adapted for use with trainees from different backgrounds (medicine to art) and clients (from more or less well-functioning adults to people with learning difficulties and progressive illness).

As one of the most important learning experiences for me has been in working abroad in societies and cultures very different from that of the UK, and I firmly believe that therapists need to be aware of their own cultural and racial biases, I have tried to give the book a ‘cross-cultural’ flavour. I have tended to use ‘client’, ‘patient’, ‘participant’ and ‘member’ to describe group members, depending upon the context of the group.

Names of all participants and, in some cases, the location of the group have been changed in order to protect confidentiality.

I would like to acknowledge the following, with grateful thanks: Sadly, in the past 20 years the following friends have died:

Dr Maria Belfiori (Director, Art Therapy Italiana, Bologna)

Fr Mario Picci (President Centro Italiano di Solidarieta, Rome)

Juan Corelli (Vice-President Centro Italiano di Solidarieta)

Dr Irene Jakab (President of the International Society for the Study of the Psychopathology of Expression and Art Therapy – SIPE, New York)

And my husband, Dan Lumley, who had worked with me on many occasions, taking the photographs, leading the art practice workshops and providing a warm and down-to-earth presence.

All the group members and interpreters,

Centro Italiano di Solidarieta, Rome,

Art Therapy Italiana, Bologna,

Inper, Lausanne,

Fausto-Sergei Sommer, Bern,

Centre for Arts and Therapy, Athens,

Medical Academy, Sofia, Bulgaria,

Department of Psychiatry, University of Zagreb,

Teresa Boronska,

Netherne Hospital, Coulsdon, Surrey (photograph of the studio),

Nick Tipton (photograph of the Art Psychotherapy Unit hut),

Juan Corelli,

Nizetta Anagnostopoulou,

Professor Mike Crawford and Professor Helen Killaspy, Matisse Group Art Therapy research project,

Professor Jenny Rusted and Dr Linda Sheppard, Apollo Group Art Therapy and Dementia research project,

Barry Falk, Finlay McInally, Tony Gammidge, Art psychotherapists and researchers,

Dr Khalid Ali, Art therapy in stroke rehabilitation research project, members of the art therapy group who made the Juggling Clown image on the front cover, and the film Circus Dreams,

My friends Dr Istvan Hardi and Dr Guy Roux whose support and encouragement for the past 30 years has been invaluable.

Chapter 1 Groups and art therapy

DOI: 10.4324/9781315744285-3

Some brief background notes on grouppsychotherapy and art therapy

The theory and practice of group psychotherapy, in its many forms, has been well documented; that of art therapy increasingly so. Events following the Second World War led to group psychotherapy and art therapy being integrated into rehabilitation movements – especially into the rehabilitation of war-traumatised victims. In 1942, Wilfred Bion from the Tavistock Clinic was placed in charge of the military training and rehabilitation wing of Northfield Hospital where he had to rehabilitate and return up to 200 men to the army. He used ‘group dynamics’ to encourage the men to learn a way of coping and adapting to inter-group tensions. Although Bion and his colleague Rickman were successful in rehabilitating many patients, their approach was not appreciated in the prevailing military-oriented system and they were transferred. Foulkes went to Northfield in 1943 where he joined Harold Bridger, Joshua Bierer and Tom Main. They too made use of group psychotherapy but took care to integrate their approach into the overall treatment philosophy and hence were able to stay on, with much success (see Bridger, 1946; Foulkes, 1948; Aveline and Dryden, 1988 a). After the war, Bion, Sutherland and Bridger went to the Tavistock Clinic and were joined by Henry Ezriel. Foulkes went to the Maudsley and Main went on to the Cassel Hospital where he developed the concept of an analytically oriented therapeutic community. Joshua Bierer organised social clubs among patients, using Adlerian concepts as a basis for his work (see Bierer, 1948). He was responsible for forming the British Association for Social Psychiatry which emphasises the importance of patients’ own contribution to their treatment programmes.

In 1952 the Group Analytic Society was formed, together with a journal, Group Analysis, and later the Institute for Group Analysis was established by Foulkes and played a central role in developing training and standards of practice.

In the USA, important advances, deriving from social psychology, were made by Kurt Lewin and his colleagues. Lewin proposed that an individual’s personal dynamics are bound up with the social forces which surround him or her (Lewin, 1951). Just after the Second World War, Lewin used his model to train community leaders who were trying to work with multi-cultural groups where there was much racial tension. The National Training Laboratory was formed in 1950. The aim of the laboratory was to provide a training for participants from many different professional backgrounds in group work and interpersonal dynamics so that they might more effectively conduct their own groups. This was the beginning of the ‘Sensitivity’ movement, which led to the ‘Encounter’ movement and to the development of ‘Esalen’ in California in 1962. Numerous similar centres developed all over the USA and elsewhere, including in Britain (e.g. Quaesitor, in London). The Encounter movement was to have a strong influence on some British art therapists in the late 1960s and early 1970s.

Ruitenbeek (1970) points out that, regardless of claims made by various people as to them being the ‘inventors’ of group psychotherapy, it is clear that no one person was the originator and that in itself might have been a reason for group psychotherapy being conceived and developed in a fairly ‘open’ context. In contrast, even though the situation has obviously changed to some extent in the past two decades, not only because of the changing attitudes among ‘orthodox’ psychoanalysts but because of the changing sociological context in which treatment of mental health problems takes place, individual psychoanalysis was and is still tied to the heritage of Freud and many techniques and styles are part of his work and inventive spirit.

Ruitenbeek suggests, and I am inclined to agree with him, that in a dynamic and pragmatic society like the USA, orthodoxies do not last long, or they are questioned and new models arise as a result of the synthesis of old and new. Experimentation within the confines of traditional psychoanalysis is difficult but group psychotherapy provided the right kind of framework for such experimentation – for example, in time (not being tied to the 50 minute hour), in manner of approach (psychodrama, encounter, etc.).

Individual analysis, confined as it often is to the wealthier strata of society, has been less able to cope with problems engendered by the pressures of change and breakdown of secure networks in modern day life – not only in the West but worldwide – which leads people to feel alienated and unable to make close relationships. Many patients who are referred to, or refer themselves to, psychotherapists, have problems which turn out to be mainly societal in origin, and although there is usually also a personal component, it is not helpful to ‘pathologise’ the patient’s problems. This is particularly important when considering the treatment of persons from different cultural or ethnic backgrounds from the prevailing one, and recent research (begun in the UK by Littlewood and Lipsedge, 1982) reveals the dangers inherent in failing to take this into account. One of the most telling conclusions of their current research is that mental illness can be an intelligible response to racism and disadvantage. Farhad Dalal has written eloquently about such matters in Race, Colour and the Process of Racialization (2002). Given the huge shift in populations that are happening all over the world, many as a result of war and economic hardship, it is almost certain that art therapists and group psychotherapists will work with clients from many different races and cultures. It is imperative that sensitivity to cultural issues is included in training – not as an ‘add on’ but as a central aspect.

Group psychotherapy could prove an important medium in which to explore, come to terms with and, more importantly, change an intolerable situation in one’s life through intimate contact with others. It could also present an opportunity to enrich those relationships already existing, even if limited by physical disease or mental health problems. There is still a lack of awareness among general practitioners and other referring agencies about the value of group psychotherapy. This, combined with the reservations and anxieties that people may feel when a group is mentioned, means that many people who could benefit from groups are instead referred for individual psychotherapy or counselling. Worse, they might be referred to a group because it is ‘cheaper’, thus giving the impression that it is an inferior form of treatment, which it most emphatically is not. It is to be hoped that through increasing training in group psychotherapy for health care professionals, teachers, social workers and other workers engaged with the general public, such attitudes will change.

As far as the history of art therapy is concerned, it too depended partly on the Second World War rehabilitation movement for its development in Britain. There had been, however, a tradition of artists going to work in hospitals (both general and psychiatric) throughout the early part of the century. Often their aim was to provide a relaxing and creative release from the tedium of convalescence following a serious operation or during a long-term illness such as tuberculosis. Occasionally artists were asked by doctors to stimulate patients to produce paintings which could be used as an a...