Connecting with the image: how art psychotherapy can help to re-establish a sense of epistemic trust

The International Centre for Arts Psychotherapies Training (ICAPT) was established by CNWL NHS Foundation Trust in London in November 2011. The centre was set up to further research and advance clinical practice within NHS mental health settings. At the la unch of the research arm of ICAPT in July 2012, Professor Peter Fonagy spoke on the subject of the future of research in arts psychotherapies. This paper is a response to Professor Peter Fonagy’s presentation (The ICAPT 2012) on the potential arts psychoth erapies have to enhance the development of the therapeutic relationship. During the presentation Fonagy suggested to a group of arts psychotherapists that: ”˜the future of research is trying to understand what you guys do that actually helps re - establish in our patient a sense of epistemic trust, a sense that human knowledge and human communication, as communicated by fellow human beings can be trusted, can be relied on ... ’ A recording of this presentation is followed by a discussion section in which two art p sychotherapists explore and expand upon the ideas presented by Fonagy. They explore his question about what the processes of making and reflecting on images in a therapeutic context can add to the development of ”˜epistemic trust’ within the therapeutic rel ationship. It is suggested that creative arts have the potential to enhance the development of epistemic trust within the therapeutic relationship by offering opportunities for contingency and joint engagement. Individual, group and dyadic art psychotherap y allow for the creation of an external object which is congruent with the maker's internal world. The art making process and the art object itself can create an additional channel of communication which helps the art psychotherapist to understand the client’s inner world. This greater understanding can support the psychotherapist’s capacity to respond in an attuned way to the client. The authors explore the idea that joint engagement in art making can lead to opportunities for enhanced mentalizing and that with sufficient research and theoretical underpinning, this type of model could help to define clinical practice for arts psychotherapies in mental health

Developing a logic model to support creative education and wellbeing in higher education

Copyright © 2023 The Author(s). University students are at higher risk than the general population of becoming mentally unwell. Dominant risk factors are to do with relationships, work load, the university environment and approaches to learning and teaching. Over recent decades higher education has been increasingly influenced by rules of commodification, however less commercially driven foci relating to wellbeing and mental health are increasingly being prioritised in higher education. This paper describes the development of a multifaceted logic model that can be adapted to university contexts to support wellbeing and creative approaches to learning. A socioecological approach refers to considering the group as a microsystem representative of larger systems and integrating emotionally focused and creative learning experiences that enhance subject relevant content. We implemented and evaluated a series of workshops to improve psychological safety and learning experience. We used a logic model design as an evaluation framework to map the inputs, activities, outputs, and outcomes. The pre and post outcome measure of psychological safety demonstrated significant change, where students could be more open and explorative in their learning experience. We also used a survey evaluation that demonstrated students found the project acceptable, delivered to a high standard, and that the content was relevant to their subject area. Given that the changing culture and ethos of a University can have a major influence on the wellbeing of the students, a flexible programme design as mapped through a logic model, provided us with a framework for introducing and evaluating a complex model for improving learning and wellbein

Bridging Diversity: Do We Have A Shared Language?

Presentation at ECARTE : 13th European arts therapies conference [16 Sep 2015 - 19 Sep 2015] How is qualitative and quantitative patient experience linked, and what language do we use to describe the arts therapist’s role in that change process? ICAPT, in collaboration with the University of Hertfordshire will present phase 1 of the ‘Horizons Project’. Phase 1 mapped the language used by arts therapists to respond to the patient’s relational experience. Arts therapists were interviewed using a repertory grid technique to map the therapist’s personal perspectives in the context of clinical scenarios. The hypothesis being tested was that there were different theories that influenced each arts therapy in such a way that language was contingent on context and profession. The initial results collated by the categorising process suggested there was specific terminology that could capture generalised actions across the arts therapies. A focus group was established to examine the outcomes further and the results demonstrated that only a few of the constructs were interpreted differently according to different professional groups. The process and the surprising results of the repertory grid process will be presented, and how a shared language was further refined in a research collaboration between therapists and patients. The implications for this type of work are numerous. Whilst this project was examining clinical practice within a specific range of mental health services in London, the method that was developed offered a tool for establishing a ‘map of descriptors for clinical actions’. From this further work can be conducted about the occurrence, timing and impact of clinical actions in specific therapeutic contexts. This first stage of research suggests that there could be underlying ideas about therapeutic change across the arts therapies. A challenge to the researcher’s hypothesis, this first step of the Horizons Project unexpectedly bridged diversity. Biography Dominik Havsteen-Franklin is Consultant in Arts Psychotherapies (CNWL) and Head of ICAPT. Since 1999 roles undertaken have included team manager/clinical lead and interim head of profession. As Consultant he is responsible for developing and implementing arts therapy clinical training, leading on research and development for arts psychotherapists within, and external to, the trust plus leading the research arm of ICAPT. His research interests centre on severe mental health disorders and psychological therapies in the NHS. He is currently engaged in doctoral research studying the relationship between in-session interventions and occurrences of metaphor in art psychotherapy, supervised by Prof. Robert Hinshelwood at the University of Essex. Philippa Brown is Programme Leader MA Art Therapy and Professional Lead Arts Therapies at the University of Hertfordshire. She has extensive experience as a consultant and academic in art therapy education and training across the UK and Europe. Her research interests extend to the qualitative and experiential research approaches that address the nature of artistic practice in relationship to art therapy. Miriam Usiskin is Senior Lecturer on the MA Art Therapy and Programme Leader for the Foundation Certificate Art Therapies at the University of Hertfordshire. She worked for a number of years in the NHS as a Head Art Therapist in adult mental health with particular clinical focus on working with PTSD in Children and Adolescents. Research projects include collaborative project work with CNWL trust on the Horizons Project and the efficacy of art therapy in treating PTSD and domestic violence

Painting pain: An interpretative phenomenological analysis of representations of living with chronic pain

Objective: This study examines patients’ pictorial representations of their chronic pain, alongside their accounts of those images, in order to help our understanding of their lived experience of the condition. Method: The sample comprises seven women in middle adulthood from southern England. They began by drawing what their pain felt like and were then interviewed about their portrayals. The interviews were analyzed with interpretative phenomenological analysis. Results: The participants produce strong, vivid, abstract pictures. In many of the pictures, the pain is objectified as punitive and sinister. This is enhanced through the use of stark colours of red and black. Paintings also often have a temporal element, showing either the movement from self before pain to self since the pain had started, or pointing to aspirations for the possible relief of pain in the future. The analysis of the images is grounded in the participants’ accounts of them. Conclusion: The images and accounts provide a powerful insight into the internal world of the pain sufferer and the subjective experience of chronic pain. We link this work to other attempts to represent patients’ pain and point to the particular contribution our work makes. We make some suggestions for subsequent research following on from what is presented here and we also argue that the methodology outlined in the paper offers considerable potential for research on other health conditions

Drawing on Dialogues in Arts-Based Dynamic Interpersonal Therapy (ADIT) for Complex Depression: A Complex Intervention Development Study Using the Medical Research Council (UK) Phased Guidance

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services. Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services. Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used (Phases I and II) to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach (ADIT), offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment. Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method (ADIT) and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that (i) ADIT was acceptable for patients with complex/major depression, (ii) that they were likely to refer to ADIT in the future (iii) that the use of arts was likely to improve accessibility (iv) the use of arts was likely to improve outcomes and (v) that offering ADIT was an effective use of mental health resources. Discussion: Phase I of this intervention development study (following MRC guidance) demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol.NH

Examining arts psychotherapies practice elements: Early findings from the Horizons Project

Background: Arts Psychotherapies (art, music, drama and dance/movement) have been integral to mental health care services for several decades, however consensus and transparency about the clinical process is still being established. This study investigates practice with a team of six arts psychotherapists working with severe mental illnesses in London, inpatient and community services. The study examines what in-session practice elements are used, whether there is consensus about what the practice elements are and why the arts therapists use them. Method: The methods employed in the first phase of the project are interview-based with thematic analysis; repertory grid technique and nominal group techniques are used to analyse the data with the aim of triangulating results to establish greater validity. Results: The results showed that there is scope for developing a shared language about in-session practice elements within a mental health context. However the research examining the timing and reasons for employing those practice elements is still being undertaken. In this study the first results from an extract of the interviews illustrates a complex relationship between theory and practice. Conclusion: From the findings so far it would appear that within this specific context it is possible to see that there are ways of categorising the therapist’s actions that become comparable across the arts psychotherapies. From the therapist’s personal descriptions of his or her own practice, there also appears to be a close correlation between arts psychotherapies in a mental health community and inpatient context. Additionally, evidence-based practice models such as mentalisation-based therapies appear to have a close correlation

A Systematic Review Using Thematic Synthesis of Arts Therapies Therapeutic Actions and Perceived Benefits in the Treatment of People with a Diagnosis of Cluster B Personality Disorder

The objective of this study was to thematically synthesize literature about arts therapies specific in-session therapeutic actions occurring with this client population and the perceived effect of engaging in arts therapies. Using systematic review methods, qualitative and mixed method studies, reporting on arts therapies treatment for people with a diagnosis of personality disorder (Cluster B) were searched in Embase, Medline, PubMed and grey sources until June 2017. The search yielded 167 records. 32 studies were included in the analysis. Data synthesis was conducted by using extracts from the literature search which were coded and then subject to a thematic analysis and synthesis. The codes were then discussed and agreed by the research team. The thematic analysis and synthesis resulted in seven overarching themes: (1) Processing interpersonal experiences (2) Processing emotions (3) Developing agency (4) Symbolising (5) Structuring experience (6) Cognitive reappraisal (7) Developing a shared experience. This thematic synthesis provides some evidence that according to the arts therapies literature available regarding patients with a diagnosis of personality disorder, there are thematic similarities in terms of primary areas of therapeutic action and the relationship between the therapeutic action and the perceived effects of engaging in arts therapies. Our findings suggest that literature about in-session therapeutic actions focus mostly on processing interpersonal experiences and the largest frequency of coded excerpts concerning the perceived effect of engaging in arts therapies was in the area of processing emotions