The question I am asking is: should I include this chapter in my book, Making Sense: Art Practice and Transformative Therapeutics ? The content is a basic overview of what art therapy is and what it can do, which leads into laying down some case studies of particular examples of art therapy episodes, which I recount from my own experiences. This chapter is called ‘Making Sense inside the clinic: episodes of creative arts therapies’. In it I want to develop my central notion of transformative therapeutics and show how art can provide healing and relief in a clinical setting. I go on to questioning this setting, and sourcing a similar method of healing and relief outside the clinic, but before I get to that stage I need to set down a base understanding of what art therapy is. I could not think of a better example to use than my own experiences. But this is tricky territory, and I do not know whether I am taking too high a risk by including it in a largely academic volume. In my proposal (which was reviewed and accepted by Bloomsbury) I said that I was going to include vignettes of my own experiences of different kinds of art psychotherapy (painting, music, dance and movement, creative writing). Since I include narration of my own aesthetic experiences of viewing/making artworks, to also include a section on my using art to recover from illness is not so out of place. But what do you think? I want to make my book accessible to the public beyond academia, and to encourage and inspire my reader. But I also want to make it stand up to critique. Is that possible? Please read — it’s not a long chapter, and there are images…
Chapter 2. Making Sense Inside the Clinic: episodes of creative arts therapies
This short chapter is written in a different tone to the rest of the book and is based largely on personal reflections of my own experiences of different forms of creative arts therapies. I do not mean to digress into uncritical, merely self-reflexive anecdote, whilst it remains important to reserve a critical distance between these experiences and this book, which is largely an academic text. But I present them as (further) material evidence to demonstrate that art-making has the agency of transformative therapeutics, and I show how this can have a positive, clinical effect, specifically in relation to psychiatric illness. In this chapter the integration of my own case studies advances the thesis of transformative therapeutics by showing how art practice can relieve suffering and provide a coping mechanism in relation to psychiatric illness. This is situated in the clinical situation of a patient (in this case, myself) utilizing art during their admission in a psychiatric ward.
Thus I will here examine how the agency of transformative therapeutics, which is offered by art practice, occurs from a clinical perspective. By describing examples of different forms of creative arts therapies, I will show how making art in a clinical setting (during therapy groups in the psychiatric hospital) can be seen to alleviate forms of suffering and psychiatric illness. This will show how art is therapeutic, and transformative, in the way that the creative process communicates, brings to light and then alters inner feelings or emotions and problematic behavioural patterns or attitudes.
This chapter is split into two halves: firstly I lay a ground by defining art therapy, which will become useful in chapters 3 and 4. Secondly, I recount my experiences and consider how they open a method of Making Sense, inside the clinic. This will raise critical questions about the clinic, which are considered in later, more theoretical chapters. Here I wish to generate an empathic, psychological (rather than necessarily aesthetic or theoretical) sense of the ways that participating in creative arts therapies can help to relieve symptoms as they become manifested during periods of hospitalisation in the psychiatric clinic.
1. Defining art therapy
There are many different forms of art therapy, which conglomerate under the term of ‘creative arts therapies’. Examples of this term are different forms of psychotherapy that involve painting or drawing, dance and movement, music, creative writing, drama or sand play. The general term of ‘art therapy’ usually refers to sessions of painting and drawing images, or using clay, which I will define further. In the second section of this chapter I will also discuss other creative arts therapies, such as dance and movement and music therapy. To a large extent, the same principles apply across these different therapies.
Art therapy is a form of psychotherapy that uses the creative process of art-making as a mode of communication between the therapist and patient. The clinical exercise of art therapy does not require any technical know-how or specific talent on the part of the patient, who is encouraged to express their feelings by using art materials in the safe environment of the art therapy studio. This space is often set apart from the ward in a psychiatric hospital, as a special place for art materials and where the patient can be creative, feel contained but also set free. Of course, art therapy also occurs outside of the psychiatric hospital, and outside of the clinical setting, but in this chapter I focus on its usage and merits inside the clinic. That being so, the art therapy studio itself seems to be a space outside (but inside) the clinical setting, because of the way it has special facilities for art-making and provides a haven for patients to go to, set apart from the usual rooms on the ward. It can in this way provide some form of relief from the (plausibly) hegemonic structure of time and space that often makes spending time on a psychiatric ward unbearable.
The overall aim of art therapy is to enable a patient to change and grow on a personal level through their use of art materials. A key factor in this process is the relation between the therapist and the patient, as mediated by the artworks (images, sculptures, or movements in dance, for example) that are made by the patient during the art therapy sessions. The art therapist is not concerned with making an aesthetic assessment of the patient’s products, nor are they necessarily trying to regard it diagnostically. The therapist uses the artwork as a method of communicating with their patient, since art therapy is based on the assumption that visual symbols and images are the most accessible and natural form of communication to the human experience. Patients are encouraged to visualize, and then create, the thoughts and emotions that they find difficult to talk about. In this way the artwork often expresses what is inexpressible in words. The ‘interpretation’ of this artwork, during its review, is a mutual conversation between the patient and therapist, which typically allows patients to gain insights into their feelings and work through these issues in a therapeutic manner.
The creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behaviour, reduce stress, increase self-esteem and self-awareness, and achieve insight. The transformative therapeutics of art therapy is obtained through the phenomenological process of interacting with art materials and using them to create some kind of form that responds to what is on the patient’s mind. The consequent conversation and process of sense-making that the artwork prompts between the patient and those who see this work furthers its agency.
From a psychoanalytic perspective, art therapy has historically been seen as a useful method of interpreting symptoms of neuroses as they are manifested in the unconscious and drawn or painted in images by the patient. Freud discusses the drawings of Little Hans (1905) and in the case of ‘the wolfman’ (1916), which play a key role in the revealing, unravelling, understanding and integrating of repressed elements from the unconscious. The idea that dreams have meaning, which can be expressed and then interpreted through drawing images, has become one of the foundations of a psychoanalytic approach to art therapy. Freud writes: ‘we experience it [a dream] predominantly in visual images […] part of the difficulty of giving an account of dreams is due to our having to translate these images into words. “I could draw it,” a dreamer often says to us, “but I don’t know how to say it”’ (Freud 1916-17: 90). This idea, of drawing things that are impossible to put into words, provided the catalyst for the development of the different forms of creative arts therapies.
The therapeutic action of creative arts therapies can be understood from a psychodynamic model, where: ‘inner states are externalized or projected into the arts media, transformed in health-promoting ways and then re-internalized by the client’ (David Read Johnson 1998). In this reading of art therapy, the patient/client’s process of art-making involves the projection of aspects of the self onto the artworks that they create. As an ‘attributional’ process, the artwork then has a subjective or personal meaning. The psychodynamic model involves the concept of transformation, because this personal material, which is developed by artistic expression, is transferred and altered. This occurs with the externalization, representation and then expulsion of unwanted or painful aspects of the patient’s self, which occurs during the creative process. In this way, nonverbal expression through making an artwork involves the symbolic ‘acting out’ of inner feelings. Giving them some kind of form in the artwork made alleviates their emotional pain. The creative process, and its subsequent review, then leads to the patient developing insight into whatever is troubling them, whilst it also engenders verbal communication and plays a large part in initiating change.
We find a similar reading of art therapy in Schaverien’s work on Analytical Art Psychotherapy, which revolves around the concept of transference, whereby the art object transfers, holds, transforms and evokes attributes and states, causing growth and transformation for the person who makes this object (as we saw in Chapter 1). From Schaverien’s clinical perspective, the picture is ‘a vessel within which transformation may take place and this involves the picture as an object of transference’ (Schaverien 1992:7). Schaverien says that this happens through ‘a clearly defined treatment regime’, which involves the mediation of the patient’s experiences, through the creation of art object, and via the art therapist’s intervention, as it is takes place in a clinical setting (Schaverien 1995: 120). The picture that is made is not examined solely symptomatically or as a projection that illustrates a feeling; it is also ‘a formative element in the establishment of a conscious attitude to the contents of the unconscious mind’ (Schaverien 1992: 11-12). In this way, the artwork made in the context of an art therapy session is as transformative as it is therapeutic.
The transformative affect of art-making is generated when an internal, unconscious feeling is expressed and brought to light through the creative and material process of making the artwork. The manifestation and materialisation of elements in the unconscious contents of the self, during their expression in the artwork, develops a mode of thinking and a way of understanding that leads to transformation. The movement from unconscious pain to the emergence of conscious visualisation, separation and mediation, engenders healing, growth and change. It is a form of psychic epistemology, in that making produces an embodied and intuitive form of knowledge concerning what the artwork reveals about the person who created it. To some extent the fulfilment of this epistemology relies on the therapist’s surveillance, empathic response, and interpretative guidance in relation to the non-verbal communication vessel set up by the artwork. The therapist helps the patient put into words what they express in their artwork. This process develops insight and knowledge concerning their condition and state of mind.
This is a Jungian analytic psychology. Jung was interested in his patient’s images of dreams, fantasies and unconscious imaginings, because of their ‘endless and self-replenishing abundance of living creatures, a wealth beyond our fathoming’ (Jung 1946:14). He says that these images are impenetrable, and ‘are capable of infinite variation and can never be depotentiated. The only way to get at them in practice is to try to attain a conscious attitude which allows the unconscious to cooperate instead of being driven into opposition’ (Jung 1946: 14). The transitional process of delivering unconscious material into consciousness is what produces healing. The artwork acts as a ‘scapegoat transference’, whereby it splits off, changes and atones for the darkest elements of the patient’s psyche (Schaverien 1992: 30-61). In this way the patient’s use of art materials is an alchemical procedure: they mix and concoct different substances and apply them to a surface, until they are transformed into an artwork that may correspond to and then transform some aspect of the patient’s psyche.
We can see this in Schaverien’s psychoanalytic theory about the artwork as a ‘transactional object’, or an object through which negotiation (between the patient and therapist) takes place (Schaverien 1995: 121-140). Schaverien introduces the transactional object in relation to a case of anorexia in a male patient. She interprets anorexia as:
[…] an extreme form of denial of desire. The desire for food and so nourishment of the body is transformed, through a supreme effort of self-control, into abstinence. Desire pre-supposes an Other towards whom there is a movement; thus, it is to do with relationship. Anorexia is a turning away from the Other and, through a false sense of power, it is a movement away from life and towards death. (Schaverien 1995: 62)
The anorexic’s restriction of food is a method of ‘acting out’ unconscious and existential feelings, which are often to do with obsessive-compulsive fears of losing control, or strong emotions such as anger or shame. They control and restrict their intake of food to find a way to face the world and displace or repress these feelings, which have become too hard and painful to consciously express. It is possible to redirect this displacement and channel it through art materials. The creative act and the artwork that the patient makes then draws up the original feelings to consciousness, which begins the process of relieving them. Schaverien argues that the pictures that the anorexic patient creates act as temporary transactional objects, because they have the capacity to initiate a movement of unconscious feelings towards their becoming conscious and possibly transformed. As Schaverien says, ‘Art offers an alternative, a way of enacting and symbolising the inner conflict’ (Schaverien 1995: 133). In this way the anorexic’s restrictive or their ‘acting out’ with food, becomes an enactment, which brings this behaviour to consciousness. As a consequence, ‘The art process, mediated within the transference, may facilitate a journey from a relatively unconscious or undifferentiated state, through stages of concrete thinking, to the beginnings of separation’ (Schaverien 1995: 140). Once the patient is able to separate the elements of the unconscious that are causing them to have difficult and painful feelings, they are then able to move forwards with insight and grow a new healthy attitude and set of behaviours.
I will now think further about the growth and transformation that are made possible by engaging with different forms of creative arts therapies, in relation to my own case studies of suffering (and healing) from anorexia and schizoaffective disorder.
2. Case examples of creative arts therapies
We can see illustrations of a successful use of art therapy by looking at my own example of recovering from a complex psychiatric illness that was a combination of anorexia and schizoaffective disorder. Art was instrumental in the improvement of my psychotic and neurotic symptoms because of the way it enabled me to express myself and find a new language with which I could show and share my sense of the world. More than that, creating art provided me with a safe way of being in the present so that I could accept the here and now that has caused me such distress, and learn to grow away from the illness. Art helped me build a new life. This has developed, so now I paint every day and this practice helps me take stock of myself and my experiences of reality, as I learn to flow with the drips of paint and their swift connection with the present. My own experiences do not involve an actual art therapist anymore, since I practice my art independently, and whilst I was in hospital I usually worked on my own. But my practice was opened to me by a therapist, who encouraged me to dare to express myself, and opened a safe space where I could be creative. In this space I developed my art practice until it became a coping mechanism to help me deal with the symptoms that defined my illness.
I was detained in various psychiatric hospitals numerous times over a period of 12 years. During this time I suffered from anorexia, schizoaffective disorder, depression, and borderline personality disorder – diagnoses that kept on changing as the doctors attempted to label, define and pin down an illness that was largely based on my acute hyper-sensitivity and neurological malfunction (as a result of a chronic brain injury. That’s another story.). This constant mis/re-diagnosis of the psychiatrists, and the structure of the system and the timetable in the clinic, was problematic. But participating in creative arts therapies proved to generate healing. During this time I would paint and write to relieve my suffering. I also participated in groups of dance and movement, music and song. These groups were facilitated by different therapists, and they all contributed to my being able to access some degree of transformation and therapy.
It might be possible to question the success of any of the art therapy groups I attended in the different clinics I spent time in, if my illness lasted over a decade and involved repeated relapses. Clearly art (therapy) has limits, and there were other important factors involved (such as medication) in my eventual recovery. But my experiences of different kinds of art therapy were and continue to be instrumental because they opened up a method by which I could later access the agency of transformative therapeutics from art practice, whether or not I was in a clinic or had access to an art therapist.
My own experiences of art therapy, when it took the form of painting, do not necessarily conform to the art therapy stereotype that was discussed in the first half of this chapter, since most of the painting art therapy groups I attended were largely undirected by the therapist, who did not interfere but allowed the patients to do as they pleased. There was no interpretive discussion or review about the meaning of my artworks. The therapist’s role seemed to be not to interrupt or direct me, but to provide an opening for my own self-discovery through the process of creativity. By laying out a multitude of different art materials and encouraging me to choose and play with whatever I felt like, the therapist was able to simply create a calm space where I could be myself, and pause there. Pausing with the self in a safe environment, and there being creative, was cathartic and healing because of the ways that I had the opportunity to give it some kind of form in the artwork I create. Responding intuitively to the tactile materiality of the paints, pastels, paper, and any other materials I could find (such as sand, wet concrete (from the building works going on in the ward), bark, or bubble wrap), I found that I could express my feelings in a way that brought me an embodied sense of satisfaction and pleasure. The art therapy studio was a safe place where I was able to bring form and living meaning to the pain and suffering that I felt.
My illness was about self-destruction. I had voices in my head telling me to destroy myself, and these strange tactile hallucinations that felt like I was being throttled with barbed wire . Sometimes I would paint or draw these feelings, and my doctor would interpret the image and then gain a greater understanding of my condition. He was then able to diagnose and medicate me accordingly. In this way my art became a clinical tool that was instrumental and transformative in my recovery from psychiatric illness.
Other times I would paint sheer gnashing (often dark) colours and agonising gestures, tearing the paper to pieces, bursting through the bounding contours of each page in my (broken) sketchpad. These works did not represent or symbolise anything, they were pure living energy from my (also broken) soul. Feeling the different materials’ textures through my fingers, and being able to apply them with digital mobility enabled me to stay still with my body and somehow feel connected to it. This was particularly important, since my problems with self-harm made it very difficult to inhabit my flesh. Art helped me sit still and focus, at a time when my body was so weak and wounded from malnutrition or self-mutilation that I was simply unable to concentrate or stay with myself.
Making art played a significant role in helping me recover from body dysmorphia, which is a symptom of anorexia where the patient has a heavily distorted self-image, and cannot see a true picture of their own body. A somatoform disorder, body dysmorphia manifests itself in extreme concern and preoccupation with a perceived defect of physical appearance. When I looked in the mirror I saw an obese, laden woman, whilst I was in fact severely underweight. What I was seeing did not in fact bear any resemblance to my true appearance.
But I was able to learn how to see my body by drawing myself. With the help of physiotherapist Patricia Caddy, who asked me to look at myself in the mirror and draw what I saw, I was able to identify the difference between what I thought I was seeing, and what was actually there. I looked at my body as I would do a still life, and tried to draw an accurate representation of it. This exercise enlightened my self-perception. Gradually my drawings decreased in size as my vision of myself became more realistic. Life drawing in this way opened my eyes.
When I learnt to see how underweight I was, it became more reasonable and justified to begin the very difficult process of gaining weight. It also helped me inhabit my body: the quiet, lengthy process of staring into a mirror and sketching my reflection slowly sharpened my perception as I learned how to see what was there. This was an embodied time and I began to feel a sense of desire to see my own, gendered form taking shape. Art enabled me to develop these new senses of my body; it was in this way transformative and therapeutic.
I also took part in dance and movement therapy during one of my admissions at a general psychiatric ward. This form of therapy recognises body movement as an evocative instrument of communication and expression. With similar aims and foundations to the art therapy I defined in the first section of this chapter, dance and movement therapy is a relational process in which patient/s and therapist engage together in a creative process that uses body movement and dance to integrate and embody emotional, cognitive, physical, social and spiritual aspects of the self.
These sessions began by a group of fellow patients standing in a circle, when we were encouraged to think of a single gesture or movement that expressed how we were feeling at that moment. I felt locked in my head in my illness, and my body became my enemy – a war machine – because it was a place I could no longer inhabit and felt that I must destroy. So I stamped my feet and thrust a dagger to my chest, wailing at existence. Other patients curled up into a tight, foetal ball, or fled into a sprint around the room, or simply covered their eyes and sunk down onto their knees. In this single movement we got in touch with our bodies and managed to communicate our feelings to the other members of the group. This lead to a sense of inhabiting the body and feeling at one with it, whilst we were able to express ourselves through these simple movements.
During this group we were asked to create another simple movement and give it to another person in the room, by dancing our movement in front of them; whereupon this other person would watch, receive and repeat your movement and create a response, then giving their movement to another person in the group. This exercise would go around the room until everyone had expressed and shared their movements with the group as a whole. This sharing developed a sense of taking care and building support so that we were no longer alone with our bodies of suffering; we collaborated and found a sense of lightness and growth in the interconnection we made by dancing individually but together.
Then the group leader brought out some props – swathes of cloth, lace, silk and blown up florescent balls – and we were invited to choose one of these items to help us make another movement to express to the group. I chose a long silky cloth. I felt enamoured by touching it, pulling it through my hands and around my body. It was as though the material was asking me to hold it closely, and I found myself dancing around the room. My movements quickly became jagged and violently sharp, as anger burst forth and I wrapped the cloth around my neck several times, pulled it taut, and then fell down heavily onto my knees, as if this was the only way to break free. My theatre was tortured by the voices inside me that told me to destroy the beauty of these movements. But during this group I could give the violence of my movement and the cloth to someone else, and they received it and took it away from me. Then they did their own movement with the cloth and through this gesture my pain was instantly transformed into a new person’s own creative feelings. Not everyone danced with destructive pain, but there was visible catharsis to all of our movements. It was liberating to move the body to express ourselves, share pain or suffering, and feel it recede in the caring and collaboration of the group.
My experiences of music therapy are based around the way that music triggers memory. During groups of singing and percussion I found that I was able to remember words and tunes from my childhood. When the group leader asked if anyone had any songs they’d like to sing I kept quiet because I couldn’t remember any songs at all. I was only doing this group because I was bored, I thought, and there was nothing else to do, locked up in this awful psych ward. I don’t like singing and I’ve got an awful voice. But then the leader of the group began to twang her guitar and murmur through a few tunes and I found myself listening increasingly intently. I recognised some of the tunes and before I knew it I found myself singing. Words erupted from my mouth and I did not know where they had come from – I couldn’t remember the words, or I could not remember remembering them, but something brought it back to me and here I was singing them, heartily now. It was fun. This distracted me from my illness as – after a while – memories grew out from these songs to distinct senses of where I had actually encountered and sung them before. This was more than mere nostalgia, since I began to feel a sense of wholeness in my hole-y soul.
Other groups of music therapy I participated in used a range of instruments. One in particular was held in a large room full of different instruments and we were encouraged to choose whichever one we liked and begin to improvise. There were a lot of percussion pieces like drums, bells or African instruments that I had never seen before, and also a piano, a guitar, and some other more well-known instruments. The beauty of the group was the way that the leader conducted us to improvise together. At the beginning most of the participants were too scared and shy to dare to make much noise, but gradually we began to tinkle with sound. We created together a cacophony that was at times sheer, ugly, loud noise, which was awful to hear, but then this developed into peaceful tingling and a communal sense of rhythm, companionship and harmony. All this was entirely improvised, since we had no music. It was the group leader who held us all together, the sound that built this ‘together’, and there we shared a moment of freedom. This moment was beautiful.
These experiences of art therapy provided me with ways to inhabit my body during times of desperation and suffering. They enabled me to communicate and share my way of being with the other patients in the group and the therapist, which lightened the agonising load that I carried with my illness. Art therapy in the clinical setting was instrumental in my recovery, because of the ways that it set me free from my symptoms, whilst enabling me to express and understand them. Creating different forms of art during my detainment(s) evoked an agency of transformative therapeutics that enabled me to grow and fundamentally change my sense of self and the world.
This process continues. The artworks I make now still provide me with an agency of transformative therapeutics. But they do not seem to represent or project symbols or archetypal forms from my unconscious mind, and nor are they interpreted by a therapist. I am not using them to communicate with anyone but myself. If my artworks were interpreted now, unconscious elements might be deciphered in them, but the important thing for me is that they enable me to create and evoke powerful expressions of the multiple senses of reality that I experience, in pure swathes of colour (rather than any representative or figurative form). They are expressive rather than hermeneutic.
From these case studies we can see how cathartic and reparative creating art proves to be, to the extent that it provides a clear medical instrument to improve my state of mind, and my bodily awareness, in relation to (and beyond) psychiatric illness. I am able to express my emotions through my body. This alters my feelings and my relationship with my body. In this way creativity is to some extent a homeostatic procedure, which means that it has a regulating, stabilising mechanism that gives me a clearer view of myself. As neuro-psychoanalyst Lois Oppenheim argues, ‘the primary impulse of creativity is homeostatic inasmuch as creativity serves to augment self-awareness and it is on awareness of self that homeostasis depends’ (6). Oppenheim argues for a homeostasis that is as much biological or embodied as psychic, cultural and social. As we can see from the drawings I made in relation to my body dysmorphia, art-making changes the artist by giving them a clearer view of themselves. In this way the artwork activates a process of transformative therapeutics.
The examples of creative arts therapies described in this chapter seem a long away from the stereotypical understanding of psychoanalysis, of the patient reclining on a couch, along with their Oedipus Complex. There are clear differences between (art) psychotherapy and psychoanalysis, based around the idea that the former is about cognitive behavioural methods of solving problems and offering ways of managing symptoms, whilst the latter concerns self-discovery, or locating the ‘why’ that explains a certain behaviour, by conducting a genealogy of the unconscious mind. My experiences of creative arts therapies were in groups, rather than one-to-one sessions, and these groups were incorporated into the strict timetable of the daily routine on the ward. Other elements in this routine included eating, medication, physiological health tests, occupational therapies, case management meetings, and individual time with the psychiatrist or the key nurse that each patient was assigned to. Participating in creative arts therapies provided some relief and distraction during the intense stress that was involved in conforming to this timetable, being a part of the patient community, and in the agonising suffering that lead to this being necessary.
There were indeed problems raised by the power structure and division of time and occupation in the clinic, but the creative arts therapies were to a certain extent autonomous from these logistical, practical and psycho-philosophical issues. We will encounter Deleuze and Guattari’s contestation of the clinic in Chapter 3. Their antagonism towards the clinic is based on the (en)closure Freudian psychoanalysis, which (they argue) causes, rather than cures psychiatric illnesses such as schizophrenia. In this chapter we have seen how activities in the clinic, by participating in different creative arts therapies, have countered the problematic elements of clinical practice, by providing a place of healing for the patient. I will advance this hypothesis further in the following chapter, where I again turn to art therapy, specifically in relation to opening a schizoanalytic and ethical model that expands the ongoing thesis of transformative therapeutics.
 Whilst anorexia has already been defined, by Schaverien, schizoaffective disorder is a psychotic illness defined by hallucinations, delusions and depressive mood symptoms.
 See Patricia Caddy, ‘A pilot body image intervention programme for in-patients with eating disorders in an NHS setting’. International Journal of Therapy and Rehabilitation, April 2012, Vol 19, No 4 190-199.