Practical developments - Group Analytic Art Therapy

Therapeutic community

I recall my first contact with the Henderson Hospital Therapeutic Community in 1976 when I was on placement as a student art therapist. This was probably the best-known therapeutic community in the UK at the time.

It was set up to work with people who were diagnosed with personality disorders. I was given a brush (no, not a paintbrush) and was told to sweep the floor. What was I letting myself in for? This led to one of my most inter-esting learning experiences as a student. It equipped me, somewhat crudely, to take on my first art therapist position some months later. From a very naive position at the Henderson, I had to begin my trade as an art therapist while being involved in both large and small psychotherapy groups and various work groups (cooking, maintenance, gardening, cleaning), and contextual-izing this as a whole. Not an easy task! Throughout this book, I will expand upon art therapy within the therapeutic community. Henceforth I will use the term ‘community’ in place of therapeutic community. In Chapter 2, I began the line of enquiry concerning art therapy development within this community. In this chapter, I shall elaborate the more practical and technical components.

The community where I worked from 1975 to 1986 had been estab-lished in 1954 and followed the ideas that had been developed by Bion, Foulkes and colleagues at the Northfield Hospital, Birmingham, England.

Unlike the (sociotherapeutic) Henderson model, this community was psychotherapeutic. A simple way to describe the differences between the two is to point out that the social model was more concerned with how people interacted and changed their behaviour, while the psychotherapeutic model, although concerned with similar issues, dealt more with internal psychic change. Neither model was exclusive, with a blurring of philosophical/the-oretical approaches.

Although the community’s original purpose would be seen on a par with that of the Northfield Hospital, many changes occurred over the years.

Various schools of therapeutic theory and methodology had been used, but the core of the community, with its large (community) meeting and small groups (creative therapy, art therapy, psychodrama), had formed the psychotherapeutic community framework (matrix).

It was my original task in the community to create a new art therapy service. I had been told that my predecessor had functioned in an individual manner, which kicked against the group and therapeutic community model, in the same way as I described in Chapter 2. During these early days, I had little sound theoretical knowledge, working spontaneously (impulsively in disguise at times) and firing on all cylinders.

I began with numerous techniques in attempting to establish art groups and projects. Over the years, this developed into the small group analytic art group, which I elaborated on in Chapter 2. The following structures were part of this process.

Open art group

This was a three-hour session in which the community members, including staff, came to the art room to create freely. The full range of media was available. My main role was to act as a facilitator, but I also created images.

These sessions were often enjoyable, but at times they were difficult to contain. Often, people would use this session to act out pent-up feelings.

With this in mind, one had to be continuously aware of the complex community dynamics. As the task of this group was activity-based, the creative image-making being foremost, it was not appropriate to take up these acting-out issues verbally in situ. However, sometimes this was unavoidable and the group was misused as a way of ‘splitting off ’ thoughts, feelings and actions from the mainstream of the community. It was necessary for me to facilitate a bridging of many of the healthy and unhealthy issues that arose in this open art group with the other parts of the system. There were often times when my free-floating role was changed by a request to become the art therapist and individualize with one of the people in the room. For example, I might be asked to contain a crisis evoked through the image created or to pass some interpretive comment. Often people would feel they were not getting enough from me in the small art group.

I recall many people over the years going through the process of splitting and re-engaging, and issues of transference were played out (I will return to this

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in Chapter 4). I recall that two women would produce 40–50 images in one morning, with an expectation that I would talk with them about each picture. At such times, I was uncomfortable and became more convinced that this was not art therapy. At times of these patients’ distress, it would have been unkind of me not to respond, but the rather blinkered idea of me dealing with such polarized positions seemed to be creating an illusion that therapy was an action between two people to the exclusion of all that was happening around us. In fact, I have my doubts about the whole concept of such an open art group being a form of art therapy. I would suggest that it be more appropriately described as art activity in groups. When I was called to step forward in my capacity as art therapist, this could be seen as an inadver-tent attack on the task of the group’s personal image-making.

I developed different techniques to deal with these struggles for individ-ual attention in the open art group. At critical times, people made direct requests for me to talk with them or discuss their picture. At such times of difficulty, I would call a stop to what was happening in the room in order for the group to deal with this issue. Later, we would bring this event into the community groups, which was the accepted forum for wider discussion.

Another method in response to the wish for individual attention in this setting was to accept what was being offered but gradually to extend my attention to include others. I would talk with others at the same time, gradually making links between myself, the requesting patient and others.

The debate here is not whether one should give individual attention rather than place the group foremost within the dynamics of this type of art group;

it is more a matter of not being seduced into changing the ground rules of it being an open art group for personal expression and, as such, not analysed directly. The art therapist’s dominance here, and the illusions that individual attention equals art therapy, are counterproductive.

Community art group

This group, which ran for two hours each week, had a similar structure to the large (verbal) community group. The basic difference was that the (daily) verbal large group was based on a free-floating group analytic model, whereas the large art group had a beginning, a middle and a conclusion.

In the beginning stage, which lasted for 15–20 minutes, the group discussed what it intended to create. The middle section comprised the creation of imagery. This would last for 45–60 minutes. The final part was a verbal exploration, lasting some 30–40 minutes. The time given to each of

these three stages was not adhered to rigidly; occasionally, the session time was extended by a maximum of 10 minutes. I adapted this three-stage model to the teaching side of my work with student art therapists and other experi-ential workshops. The content of these sessions varied each week, ranging from a large spontaneous group painting on one piece of paper, through large collective paintings on a community topic or theme and individual image-making on a community topic, to writing and performing a play in order to enact a current community issue. Sometimes, at times of crisis, the group was transformed into a solely verbal group.

My own role here was clearer than in the previous type of group. I was the art therapist along with co-therapists. However, I was also an active par-ticipant, making my own images, and as such had a persistent inner struggle as to whether I was being an art therapist at these times. In these art groups, although not fully conscious of it at the time, I was developing group analytic art therapy, theory and practice. One simple link here would be that the group would often portray, either literally or symbolically, the events of the community. My work would then be guided towards exploration of indi-viduals’ and the whole group’s state of being at that time.

Small group analytic art therapy group

Approximately 18 months to 2 years after I had started at the community, we reached a point that required major changes. One of these areas of change involved the small groups and the art therapy component. Part of my own thinking was that there was conflict and confusion between the community art group and the open art group. People were aiming for more individual attention in the open session. The community art group was felt to be too large (with up to 40 members). As a result, we could not cope adequately with the many issues that arose. By now, the art therapy component had become well established in the community. The intention was to modify the art therapy and thus capitalize on the value of the previous two types of groups. The intention was to move the focus on to the smaller group format (no individual therapy was undertaken within the community).

At the same time, we wanted to promote the value of understanding the group process, individual and group dynamics as shown in art groups, and how the art groups portrayed the community dynamics concretely. The next problem was how to create these small groups in order to fit in with the community framework. I felt it could be a mistake to create new groups, as these could be split off from the central core. The end product then would be

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too many groups, which I felt would dilute the community more, when our aim was toward consolidation. The answer was staring me in the face: Why not use the existing verbal small-group framework and I become a part of it?

At that time, four small groups were meeting four times a week. My intention was to use one session of each group as an art group. The aim was to cause as little disruption as possible. This change also allowed the existing small groups to function together on a different level, either on a playfully enjoyable level or on a deeper, symbolic, unconscious way of being. In line with my own development, I was moving the art therapy more into the forefront of a psychotherapeutic approach as well as providing a key thera-peutic venture for the whole community. I would then be the one therapist who had direct links with all the small groups and the large group. In this respect, it was rather like being a linchpin or channel for much of the community dynamics. Each small group was conducted by two therapists, who were now put into an interesting position. The practical way we developed this was to give each small-group therapist the freedom either to attend or not to attend art therapy with their group. For a number of years, one group had only one therapist while the others had two co-therapists.

With the former art group, it was decided that I would conduct it on my own.

With two of the groups, only one therapist came with each group. With the fourth group, both therapists came. As time went by, and I developed and trained as a group analyst, I was often the most senior verbal therapist. One interesting dynamic was that as well as being the art therapist for all the group sessions, I conducted one of the small groups with a co-therapist for the other three days for two to three years and on the art-group days stepped back into my art therapist’s position. Flexibility and blurring abounded.

The reactions to changing to small art groups within the existing small-group system ranged from a warm welcome to hostility and being non-committal. Some of my co-therapists took a passive position if they attended the art therapy session and were critical about what happened in their absence if they did not attend. Others saw the session as having no psychotherapeutic relevance. Others still saw the opposite, doing much more than they could achieve solely through words. Some therapists saw the whole deal as a debasement of art therapy in its purest form.

Theoretical and practical refinements

In the first year or so, the early stages threw up teething problems for everyone concerned. Conflict arose as a result of my efforts to adapt some of

the structural format of the large art group while others tried to imbue or graft characteristics of the open art group in/or on to the new small art groups. At the beginning of each meeting of the small art group, I would ask the members to sit down and to pool their thoughts to decide what they wanted to do: individual pictures, group painting, a set topic. This decision was to be made in 15–20 minutes, as in the large art group, followed by the same middle and end stages. A difficulty arose when the group attempted to turn these sessions into open art groups. The main issue here concerned the boundaries of the group and the acting out that went with it. (Like the verbal groups, each session lasted 90 minutes.) This would be evidenced through lateness, absence, leaving the session early, making tea in the middle of the session and playing music during the session, to name just a few things.

Some of these actions were not seen as acting out in the open art group, but in the small art group they became boundary issues and part of the ongoing exploration of each session. These early stages were often extremely difficult, until I found an adequate working structure with newer methods of group exploration of boundary issues.

For practical purposes, the allotted time was not conducive to having a three-tier structure. This was out of line with the other verbal small- and large-group methodologies which did not have a requirement at the beginning for people to consciously conjure up a line of direction. It was a mixture of seeing the folly in trying to hold on to this starting component along with my own frustration that led me to the phrase ‘I want you to use the materials in the room to do whatever you want’.

When considering the roots of my frustration, I may not have been fully conscious of the unspoken (unconscious) message at the time: ‘I’m fed up with this continuous struggle. Use the materials in the room; do what you want.’ Let’s just keep it as an interesting thought. Since its inception, I have always used this phrase in the first session of a training course in art therapy and in one-off experiential groups with new patients joining existing groups.

I then suggested that the verbal start of the group be abandoned when people came into the room. Once everyone had finished creating their images, we would reconvene in a circle to share what had been produced. In this way, everyone was free to do individual work, just as they were free to talk or not talk in other small verbal group sessions. This changed the structure of the group to a two-tier process. Techniques such as group paintings and themes were not ruled out but were often suggested at the end

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of a session to be followed up next week. This was rarely initiated by me. By and large, this arrangement maintained itself and is one I have since used generally. It is more in keeping with accepted group analytic methodology than the original models (see Chapter 2).

Another major difference from how I functioned in the earlier transi-tional period was that I no longer created my own imagery, apart from thoughts and words, during the session.

It may be thought that the direct initial statement ‘Use the materials in the room to do whatever you want’ is not in keeping with group analysis. I do not believe this, just as I do not believe that the group analyst religiously refrains from an initial contribution, verbal or otherwise. As psychothera-pists and group analysts, we are silently giving the message to our client/

patient that the space is theirs to use as they wish, just as my statement is not a demand that they must create imagery.

The outcome of this two-tier process was that group members came into the art room at the starting time and began creating in their own way. There were clearer time boundaries adhered to with more discipline. With the final model, acting out had decreased to a minimum, and structure and process were in better harmony. In the end, a greater understanding of the group purpose had come about. The initial teething problems were rife with the threat of freedom and power, but gradually this led to a greater trust and security.

The ‘final model’, as I was to call it, became more refined over the years, until it became group analytic art therapy theory and method. Gradually, I was able to develop my approach until it was accepted as a central modality, which I later went on to describe as one of the four cornerstones/pillars in the general structure of the therapeutic community model – i.e. art, drama therapy or similar techniques, work groups and socialization – with language interweaving all of it (McNeilly, unpublished work, 2003). The foundations are the individual and collective unconscious. I believe that the group analytic model I developed was continued at the community after I left.

In the remainder of this book, I shall elaborate on more complex tech-niques. By showing evolutionary aspects of the art therapy developments, I hope to illustrate how a rather crude system was beginning to find form.

Brief notes on methodology

In the original drafts of this book, I toyed with the idea of presenting a struc-tural breakdown of how the theory and practice of group analytic art

therapy were carried out. This initially revolved around my own personal adaptation and application. Granted, the reader will pick up components of this throughout the book, in the theoretical formulations, illustrations on aspects of technique and the clinical examples.

What emerged was a table of dos and don’ts that compartmentalized stages in the structural and dynamic administration of the group, the activity part of the session when the members are creating, and the verbal section of the session. On one level, this ended up sounding somewhat crude, didactic, prescriptive and almost ungroup analytic. As I developed a whole range of components that had to be considered, complex issues that needed further elaboration before publication were revealed. However, for the sake of brevity, if one considers that the technique in a verbal group is built upon a fairly

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