Drawing on Difference

Art Therapy with People who have Learning Difficulties

Mair Rees

• Publisher: Routledge
• Year: 2003
• Print ISBN: 9780415154796
• eBook ISBN: 9781134733002
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book reveals how art therapy can support and validate the emotional and mental health needs of people with learning difficulties. Case studies present work with adults and children with differing degrees of difficulty such as personality disorder, autism or severe learning difficulties and discuss the needs of people with learning difficulties who have experienced traumas such as rape or bereavement. Particular emphasis is placed on service evaluation and standards and on the client's personal experience.
Contributors discuss practical, professional and political issues such as:-
* the practical challenges of providing an art therapy service within and beyond the hospital setting
* the similarities and differences between art therapy and other allied professions such as music and dramatherapy
* clinical effectiveness and clinical supervision
Drawing on Difference brings together for the first time discussion from leading professionals in this increasingly popular area of specialisation within psychotherapy.

Part 1: Background

Chapter 1: A personal journey

Richard Manners

Central theme

• A subjective account of a 17-year career as an art therapist working with people who have learning difficulties.

Key points

• How historical changes in legislation and the philosophy of care have impacted on my work as an art therapist.
• My evolving perception of the role of an art therapist.
• Areas of conflict, challenge and success in the ongoing development of art therapy provision.

‘What is most personal is most general’

(Carl R.Rogers 1961)

THE BEGINNING—FIRST EXPERIENCES OF ART THERAPY

It was 1976, one of Britain’s hottest summers ever. I was in the second year of my Fine Art Degree at Newport College of Art and Design. I did not like art college much. I got really fed up with the way that the lecturers seemed to want to categorise everybody into an ‘ism’. In their infinite wisdom they decided to call me an Abstract Expressionist Impressionist, whatever that means! I just wanted to shout back at them: ‘No. I am not an Abstract Expressionist Impressionist-ism. I am really Richard Manners. What about looking at the real me?’ However, for whatever reason, I found that I had become trapped in a system that left me feeling essentially inarticulate. So, rightly or wrongly, I remained silent. It seemed to me that if one did not easily fit into a category, or an ‘ism’, which was contemporary or easily slotted into a historical context, one was invalidated.

One day Edward Adamson, a pioneer of art therapy in this country, came to Newport and presented a lecture intriguingly titled: ‘An introduction to art therapy’. It was a breath of fresh air to me. I was reminded of the time when, as a boy, I had visited a local artist to get some advice on a career as an artist. We talked about art being part of the community, the artist having a function just like a bricklayer, a plumber, a teacher, an electrician or a whatever and we talked about artists having as much value as those professions, rather than the romantic perception of artists being individuals who live and work in ivory towers, separate from communities. Through Edward Adamson I saw, for the first time, the possibility of art functioning in the community in a way that I felt empathetic towards. It was this revelation that really intrigued me. The images that Edward Adamson presented fascinated me. Each was unique to the individual. He did not attempt to understand the images in an art-historical context. Rather, he viewed them as a sensitive exploration of the relationship between two people, the therapist and the patient, and made it a journey of discovery based on an individual’s life.

SETTING OUT—THE FIRST JOB

After college, and after a few false starts on various Youth Opportunities Programmes (remember YOPs?), in 1979 I got a job in Llanfrechfra Grange, Cwmbran, Gwent, a hospital for people with learning difficulties (as an occupational therapy assistant). This was an opportunity for me to explore the idea of a career in art therapy.

At this time I had very romantic idea about art therapy. The hospital was in a beautiful rural setting cut off from the rest of the community. It had 403 residents including twenty children, the wards were split into male and female, people were categorised as high-dependency, low-dependency, male-one, male-two, female-one, female-two, etc. Each lived in wards according to their category. At this time an art therapy department did not exist at the hospital.

For a year I worked with seventeen very severely handicapped men with learning difficulties and challenging behaviour. I set up art activities for all those who used the occupational therapy department. People were interested in what I was doing, although I was not really doing art therapy at all because I had no idea what it really was but, at this time, the powers that were had sufficient interest in art therapy to employ the first art therapist in learning difficulties in Wales at Llanfrechfra Grange, who built on my naive beginnings to establish an art therapy department.

GATHERING INFORMATION—TRAINING

In 1980 I left to undertake a Postgraduate Diploma at what was Hertfordshire College of Art and Design, St Albans (now the University of Hertfordshire). I was one of the youngest on the course at just twenty-two. The average age of the other art therapy students was about thirty-five. It was the fastest growing up that I have ever done. It was a very intense postgraduate course, but also most enjoyable. Everything that I previously could not have articulated, I could begin to articulate here.

At St Albans I was fortunate to meet Patsy Nowell-Hall, my personal tutor. She had ideas firmly rooted in Jungian, Gestalt and holistic therapy, using art, music and drama—whichever medium was appropriate to the needs of the client group. Hers was an eclectic approach that was flexible to meet whatever needs and demands we were to meet in the client group. Her guidance gave me a good foundation for my future development as an art therapist.

ESTABLISHING AN ART THERAPY PRACTICE IN A LARGE HOSPITAL

Following St Albans, I gained my first post as a Basic Grade art therapist in 1981, at Ely Hospital in Cardiff, a hospital dedicated to people with learning difficulties. I launched into this job with all the ideals that had enthused me at college. I had a burning desire to change the injustices I perceived were affecting people with a learning difficulties in the system, but I was brought up very short. Then only two, maybe three art therapists were working in Wales, and there had been an art therapist at Ely working for a short time just before I joined. The art therapy ‘section’ was in an open-plan warehouse set-up, where 120 people would come in every day to participate in industrial therapy and various other diversional activities. The room was not private and everybody could see inside. The hospital management classed me as part of the occupational therapy department, and I was subject to the financial and clinical priorities of that department. Art therapy was perceived then as a natural extension of the role of occupational therapy—to be a provider of diversionary and interesting day activities. It was expected that I would take in groups of clients, like taking classes at school. Another expectation was that I should teach arts and crafts, as a part of an activity-based curriculum that got the clients off the ward on a daily basis.

Community activity was limited to the occasional bus trip to the seaside, or wherever. The predominant ‘therapy’ was one of containment, behaviour modification and drug regimes. It was a profoundly controlling environment. Again, the patients (we call them residents now) were categorised and labelled, which defined which ward they lived on and which part of the Rehabilitation Unit they sat in (we called the warehouse the Rehabilitation Unit or Rehab for short). The Rehab did not help personal growth or educate the residents for rehousing in the community. Although many staff had this aim in their hearts, they were as frustrated as I was by the prevalent institutional culture. Industrial therapy was not a therapy at all. Companies who packaged and distributed items, such as wood screws, sent along the packaging and the loose screws to the Rehab to be packaged in sets of ten or twenty, and so on, before distribution to shop outlets. The residents were paid extremely low wages for this so that it would not affect their welfare entitlements. Wages were regularly stopped, or enhanced, as punishments, rewards or incentives, for appropriate behaviour.

ACCEPTANCE AND UNDERSTANDING

It was a long, long battle to influence the culture at Ely Hospital to accept art therapy as a psychotherapeutic model, and it took many workshops, talks and working alongside other professions (doing many things that I had never had to do before, and didn’t know I had within me). I began to gain appropriate referrals, I started to regulate my own caseload, and my interventions were taken seriously alongside other treatment programmes.

About the same time as these developments were happening I put some walls around the art therapy section in the Rehab unit, and a door that could be opened and shut, to afford some privacy. However, the walls were flimsy and fell short of the ceiling and constant noise still surrounded us from the rest of the unit. Nevertheless, the walls were a step forward. I was getting good referrals from the other professions in the multi-disciplinary team. The fact that they were for dual diagnosis, challenging behaviour, communication difficulties and any combination of these, and for other clinical reasons and not because the resident was ‘good at art’ showed that there was some understanding about what it was all about.

SCEPTICISM

Yet the scepticism persisted. Why does he want to be secret behind those walls? Why isn’t he telling us about what is going on in the therapy? Why has he got these strange ideas that put the patient first, asking them what they want, and what they feel? Those who came from a medical model, and those who had a behavioural background, found a person-centred, client-led approach hard to accept in a culture where their models of care were control or cure. Some had a vested interest in keeping art therapy under their control in order to achieve larger budgets and staff. Each year departments were encouraged to bid for the same pot of money to maintain or expand their establishment, which caused intense competition—usually the services with the most powerful voices won. Service development was therefore based on power, and not on residents’ expressed or identified needs.

Perhaps there was basic human threat, a feeling of inadequacy when faced with the residents’ often seemingly untenable aetiology and prognosis. Art therapy offers a tenable way in to communicate on a level with residents, often nonverbal, often playful and ‘childlike’, requiring the therapist to drop the more usual social graces. Many staff had long ceased to use these modes of expression or, indeed, kept them suppressed in a coat of socially acceptable armour, and therefore found art therapy embarrassing or ‘childish’.

SPEAKING FOR OURSELVES

It was an uphill battle still. Inherent to the basic values of art therapy, the sessions provided an environment where residents could speak for themselves and take choices for themselves (this later became a semi-sanctioned movement called self-advocacy that I will elaborate on later). There was an agreement between myself and the client about the nature of what would go on. But the resident then returned to a ward situation where the culture was one of a controlled environment, of a misused behaviour-modification regime where there was little choice, and often in single-sex wards. Often the client was acutely aware of his or her differentness and had the simplest wish to be treated as normal. (I find ‘normal’ a difficult word in this context as I do not believe normality exists in the first place as a concept; it also serves to alienate the person with learning difficulties even further into their perceived differentness. I have played around with terms such as ‘more usual’, but this does not quite work either, so I will continue to use ‘normal’ as a term, with these reservations.) Statements like these often punctuated sessions: ‘You do it, Richard; you are the teacher. I can’t do it; you are the boss. You tell me!’. The residents perceived me as the controller, and themselves as passive participants, yet yearned for independence and ownership of their own lives. This is a debate that continues throughout my clinical work today. The loss of normality is a persistent theme of bereavement, which the institutional culture I have described here tends to perpetuate. I felt that my clinical practice was in jeopardy. Every day I was trying to work in a psychodynamic way in a culture that seemed unable to accommodate it. Very often I felt in despair; I felt anger and frustration; I realised that the culture in the hospital needed to change in order for the therapy to be effective. Looking back on things now, I feel that the nurses and the doctors were also in a very difficult situation. The community at large had an expectation that the residents and any difficulties they presented should be contained and controlled. I suppose what I was suggesting was perceived as anarchical and a threat to the status quo, given those expectations.

SUCCESS—DEVELOPMENT OF AN ARTS THERAPIES DEPARTMENT

I did have some success. After some time I was able to employ another art therapist and a music therapist, the waiting lists and the demand proving that there was a need. I was eventually able to gain a voice through the annual bidding system for finance. I had a growing support from sympathetic professionals, who could see the clinical benefit through the improvements to the residents. We began to develop alongside other services like Special Needs. Eventually, I gained promotion for myself and this led to separation from occupational therapy and clarification of the role and function of Arts Therapies as a distinct department in its own right with a dedicated budget. The biggest boost was in 1984 when the special school left the hospital to be integrated into mainstream education. They vacated a dedicated building, and I had an opportunity to move out of Rehab to develop an Arts Therapies service. We called the building the Greenfields Therapy Centre.

At Greenfields Therapy Centre we now had a private space of our own—and our own door that we had control over. We could carry confidential sessions out in privacy—we did not have to shout to make ourselves understood! The department had some status, internally, and after a while began to attract national and international interest through student placements and connections with the International Youth Service. Ironically, the hospital management used to wheel us out as a service to show how good and innovatory they were when local and international dignitaries were being shown around. However, the dignitaries actually found us really interesting and invited us to teach! We began to do lectures and workshops throughout Great Britain and abroad. Yet, despite this growing reputation for excellence and innovation, we still faced, for example, bizarre situations such as the residents, because of alleged misdemeanours, being routinely prevented from attending sessions, in order to deny them what was perceived to be a pleasant hour or two having fun with paints.

INTEGRATION

The Welsh Office published a ten-year strategy in 1983 in a document called ‘The All-Wales Strategy for the Development of Services for Mentally Handicapped People’ (mental handicap was the preferred label at that time). This paper was prepared as a result of extensive consultation with people with learning difficulties, parents, relatives, carers, service providers and the voluntary sector. Its core values were:

• people with a mental handicap have a right to ordinary patterns of life within the community;
• people with a mental handicap have a right to be treated as individuals; and
• people with a mental handicap can expect, and have a right to ask for, additional help from the communities in which they live and from professional services to allow them the opportunity to develop their maximum potential as individuals.

(Welsh Office 1983:1–2)

At the strategy’s heart was the philosophy that people with learning difficulties should be encouraged and supported to advocate (self-advocacy as opposed to legal advocacy or citizen advocacy) for themselves and that the community be supported to facilitate this. Where the person with learning difficulties was not able to self-advocate, an independent advocate was asked to support the individual where there was such a service available.

This was the philosophy that underpinned much of the change for learning difficulties services in the past fifteen years although, in recent years, even among those of its most ardent supporters it has been recognised as a document written from idealism rather than realism. However, it was something that, for the first time, provided a supportive context for art therapy and demanded immense cultural and practical changes in how and where services were currently provided.

I believe that for people with learning difficulties, the learning difficulty is not a pr...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Contributors
• Acknowledgements
• Introduction
• Part 1: Background
• Part 2: Art therapy at work
• Part 3: Allied approaches
• Part 4: Professional issues