There are many books focusing on the arts and therapy . A Google search on the number of titles of books with âart (and) therapy â numbered 1.7 million, with three-quarters of a million titles on âfilm therapy â, followed by 229,000 titles on âdrama therapy â and 226,000 titles on âdance and therapy â. Indeed, Malchiodi (2005, 2013) traces a long history of using arts in healthcare. Less common are texts written by clinicians and academics from faculties of medicine and psychology who themselves express an additional, personal passion for the visual and/or performing arts. Many of the contributors in this book are professionals working in both domains. Every contributor to this book was invited to begin their chapter by describing their personal motivation for participating and, more specifically, what inspired them to pursue their interest in visual and/or performing arts alongside their primary professional commitments as clinicians or academics. Each author was asked to conclude their reflections and their reviews of relevant literature with some key points relevant to clinical practice. I will begin by outlining my personal reasons for deciding to edit this book.
At the age of about 15 years, my English grammar school education required me to direct my learning towards either the natural sciences (biology, chemistry and physics) or the arts and languages. This was the passive acceptance of a dichotomy which would have a significant influence upon my educational and occupational pursuits over my lifetime. My ambition was to enter medical circles, so I felt committed to select the sciences. As a consequence, from the age of 16, I felt compelled to forgo all pursuits related to my interest in the arts, for example, no more handicrafts, paintings , literature or foreign languages. Looking back, this represented a form of âalienationâ or âemotional distancingâ from my more creative side, which to some extent I now sincerely regret. Over the following years, from entering university and pursuing undergraduate learning, I focused on biology, chemistry, physics and physiology. However, after my second year of university studies, I gained exposure to the arts and social sciences through psychology and philosophy. Fortunately, I had been able to transfer faculties from the pure sciences to the social sciences (psychology was not then recognised as a pure science discipline). I possessed a strong proclivity for the arts and the subject of human movement after graduating with a masterâs thesis on âExpressive movements as a psychodiagnostic techniqueâ. After graduating, I received the offer of a scholarship to attend as a graduate and researcher at the Laban Art of Movement Centre in London. I declined, opting instead for a research associate position at the University of Birmingham carrying out animal research into stress and allowing me to increase my expertise in biometrical statistics. Even then, what interested me more in stress research were those aspects of qualitative movement , such as ambulatory responses and the grooming behaviour of animals. My decision to leave the United Kingdom in 1977 and begin work at the Psychology Institute of the German University of Sport Sciences was also a shift towards an interest in human movement and sport and leisure pursuits.
Almost 20 years after graduation and having worked in diverse fields in academic research in various institutes (Medical Research Council project at the University of Birmingham, German University of Sport Sciences, Rehabilitation Clinic of the Medical School at the University of Cologne, Psychosomatic and Psychotherapy Institute of Cologne University Clinic, Westphalia Clinic for Child and Adolescent Psychiatry and Psychotherapy, Marl-Sinsen), I decided to move into clinical practice.
Whilst in Germany, I had trained as a clinical psychologist and also completed professional training as a behavioural therapist whilst completing my doctorate in psychology at the University of Giessen. However, my refocus into clinical work was delayed in part through concerns about my German language abilities coupled with an enduring anxiety about public speaking. Nevertheless, with a young family to think of and the need for financial security, I was motivated to make the move into clinical practice, and âthenâ (1994) some 17 years had elapsed since I came to Germany, during which my language skills had significantly improved. The experiential learning through my clients over the years has given me an increased insight into the fragility and anguish of the human condition, and I have been able to incorporate ideas from the visual arts, photography and film therapy , dance and movement therapy , music and drama therapy , and the creative arts, including literary and narrative therapy . I have found value in asking my clients to bring photographs of themselves as children, adolescents , young adults and in successive phases of their life, including from major events such as weddings, birthdays and graduation days. I also encourage clients to complete a genogram wherever possible to gain insight into their ancestral history, including dates of births and deaths, marriages and divorce. This work includes, where possible, clients providing three adjectives to describe extended family members and indications of alcohol or substance misuse and/or mental illness in family members.
Wherever patients felt a need to paint or express their difficulties in pictorial form, this would be encouraged, as well as in narrative texts, for example, writing four consecutive days for approximately 15 minutes about their problem and self-character sketches and so on. In addition, I try to gather information about the leisure and sporting pursuits and interests of my patients, and encourage them wherever possible to engage in social activities, including drama and theatre . I have also compiled an array of books which could best be described as âbiblio-therapeuticâ: giving clients homework assignments which involve reading books such as biographies or self-help manuals supportive of facilitating personal development. In contrast to my earlier work in the domain of empirical research and the use of psychometric questionnaires, the second half of my career has almost gone full circle, with a return to my earlier interest in the arts, including integrating this into my therapeutic work with clients.
Whilst reflecting upon the four decades of my career to date, I could not summarise my feelings better than McNiff (1981), examining the arbitrary distinction between sciences and arts: âThe separation of the arts in therapy is rooted in the product orientation of technological culture âŠ. The artistic mode of perception keeps the mind in touch with a world possessing both archaic continuity and infinite novelty . The arts offer a valuable operational polarity to the use of discursive language in psychotherapy, and they allow us to communicate with the emotions in their own language. Their multisensory rhythms must be kept intact rather than be absorbed within the more conventional verbal exchange of psychotherapyâ (pp. xiiâxiii).
Although not dismissive of the first half of my career and the focus on publishing empirical research papers, I have become witness to a growing critical stance towards the biomedical model of physical and psychological healthâincluding the perceived overreliance on evidence-based medicine (EBM). Poignantly expressed in an article in the Lancet, Charon and Wyer (2008) observe that
EBM has earned the reputation of dismissing the importance of the singular predicament of the patient and the individual judgment of the doctor. EBM has inflamed clinicians who feel belittled by it, calling it elitist, authoritarian, imperialising, and even fascist⊠the fields of narrative medicine and literature and medicine have reminded doctors that illness unfolds in stories , that clinical practice transpires in the intimacy between teller and listener, and that physicians are as much witnesses to patientsâ suffering as they are fixers of their broken parts. More and more clinicians and trainees are being encouraged to write about their clinical practices so as to develop the capacity for reflection. New clinical routines that provide patients with copies of what their doctors write about them or that encourage patients to contribute directly to their medical records are challenging traditional notions of authorship of the clinical record.
Clinical practice has taught me the value of narrative texts and the benefits of âstory-tellingâ, so benevolently expressed by Meza and Passerman (2011): âAlthough telling stories is a normal part of our culture , medical practitioners are trained to think predominantly with the biomedical disease-oriented story. Doctors seem to have lost their ability to listen to illness stories . Learning how stories are constructed and the internal relationships within the story to discover the meaning is referred to as narrative competenceâ (p. xix).
Extending this further to the arts in general, the Australian Centre for Arts and Health (2017, www.âartsandhealth.âorg) cites the research literature shedding light on the impact of the arts and humanities on enhancing staff morale and work satisfaction in the healthcare sector, promoting skills among health professionals (e.g. nurses and physicians), achieving clinical outcomes for the patientâs benefits, improving quality of life of mental health users and enriching the quality of healthcare. The survey further reviews literature showing the value of the arts in cancer care, cardiovascular and intensive care units, medical screening and diagnoses, and pain management and surgery (Staricoff 2004). Moreover, Staricoff explores the different art forms, for example, creative writing, poetry and literature, resulting in significant benefits for patients and mental healthcare providers.
The focus in this book was to consider the domains of visual and performing arts as an âalternative point of entryâ in uncovering potentially useful and powerful forms of therapeutic intervention . Completing this ambitious project within a single volume was made possible only through the participants who agreed to share their visions of psychotherapy; this included pioneering clinicians and research academics. Their task was to provide insightful overviews of the contemporary li...