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Art and Recovery - article in CCA

Article written by Deborah Hancock, Art & Wellbeing Practitioner at Milton Park Therapeutic Campus.  Article first appeared in the Spring Issue of The Approach, CCA.
 
The concept of recovery has been achieving greater prominence in all care settings which address mental health needs, and the 2011 government document ‘No health without mental health’ states that “More people with mental health problems will recover” as one of the key objectives of their mental health outcome strategy.
 
For most people the term ‘recovery’ will encompass relief from distressing psychological symptoms, and opportunities for genuine social inclusion, such as being able to live as part of a local community and maintain their wellbeing through meaningful activities and autonomy. 
The cultural shift towards a recovery ethic has seen the development of initiatives such as the Tidal Model, Clan Unity and more recently IMROC (Implementing Recovery through Organisational Change) which supports both NHS and independent mental health service providers to become more ‘recovery orientated’ in accordance with the 
three key principles:
  • the continuing presence of hope that it is possible to pursue one’s personal goals and ambitions
  • the need to maintain a sense of control over one’s life and one’s symptoms
  • and the importance of having the opportunity to build a life beyond illness.
In my role as an Art Tutor working on a therapeutic campus for individuals with Autistic Spectrum Conditions and mental health needs it has been rewarding to see patients utilise their Art sessions as a means for achieving and maintaining wellbeing in congruence with the key principles.

 As Autistic Spectrum Conditions are essentially pervasive and present throughout life, it seems to be more constructive to view recovery in terms of optimal social functioning; and we use the ‘Spectrum Star’ to measure outcomes, as it is aimed at identifying which therapeutic interventions are most effective, and informing discussion at CPA meetings so that planning of the care pathway can be balanced between meeting needs and developing the individual’s inherent abilities.
 
It has been observed that Art sessions have made a significant contribution to therapeutic progress as promoting creativity can reveal, resolve and provide empowerment for positive change. Art is a versatile discipline and can be satisfying and productive in terms of helping patients achieve purposeful activity in educational, recreational and therapeutic contexts; and in some cases it has been extremely beneficial as a means for patients to explore complex psychological issues within the guidance of a multi-disciplinary team approach.
 
Many Autistic clients have specific deficits in verbal communication which can hamper their ability to express themselves in discussion with professionals, but can compensate for this by using visual and sculptural forms.
 
The following examples of the ways in which Art sessions have contributed to aspects of ‘recovery’ for different patients are intended to illustrate the gains that they have made in areas such as practical skills, self-esteem, educational attainment and social inclusion.
 

J: A female patient in her twenties with a diagnosis of Autistic Spectrum Condition, has good artistic ability, and had previously attended two terms of an Art & Design course at College level. She is primarily affected by a high level of anxiety in most social contexts and also experiences episodes of low self-esteem. When she began to attend Art sessions, she expressed a view that she only did well when “told what to do”, and otherwise she felt that her skills were “rubbish”.
 
We agreed to start with a process led print making activity, as she had some familiarity with this, but would also acquire new skills in producing a collograph (printing from a varnished collage plate) based on her interest in the shapes and contours of musical instruments. This work was displayed within the hospital environment, stimulating interest and discussion among viewers, which helped to reinforce a belief that it would be worth continuing to develop her skills.

 
J then felt sufficiently confident to enter the competition to design a cover for the CCA quarterly magazine ‘The Approach’. She produced a Lino Cut, which gave her the opportunity to use a technique that she had learned on her College course, and she was pleased that she had been able to recover her skills so effectively. J seemed to become more decisive in regard to her art making, and revisited the seasonally themed work to experiment with colour variations. This piece was highly praised, and although it was not successful in the competition, for the first time she acknowledged that she personally liked and valued some of her work. 
 
J was motivated to extend her art activities by sketching on the grounds of the campus, which meant that she did not isolate herself in her room. She experimented with ‘wax resist’ painting, and used this technique to develop one of her observational drawings into the lively and delicate image ‘Spring Flowers’.
 
J started to draw regularly, and enjoyed displaying her work on the wall of her room, demonstrating a more positive attitude, which extended to her entering ‘Spring Flowers’ into the 2014 CCA competition. It was selected for the cover of this, the spring edition 2015, and this recognition has helped to promote a sense of herself as a competent artist.
 
In her own words, “I do the art because it helps me to forget things. I’ve always enjoyed Art and being creative. It’s a way of expressing myself which maybe I can’t always do socially. Doing these sessions has helped me stay connected to Art and finish my Level 3 BTec Extended Diploma.”
 
J has now moved on from hospital and having resumed her course passed with Distinction in 2015. Although she still experiences psychological symptoms, and needs to achieve an optimal social adjustment to life as an individual on the autistic spectrum, she remains focused on her ambition to undertake a degree in Fine Art. She is currently applying to Fine Art Degree courses.
 
Other patients have begun art sessions as recreational activity, but then sought to approach therapeutic objectives as they become more engaged, and art making allows them to explore complex and distressing psychological pre-occupations using a means of their choice. This can vary from a young man severely affected by psychotic symptoms, to an older autistic man with problematic gender-identity issues, or a highly intelligent individual on the autistic spectrum profoundly affected by difficulties with social understanding.
 
S: A patient in his early twenties with learning disability, who is on the autistic spectrum and has troubling and intrusive hallucinatory experiences, which are of such an intense nature that he seems to have only transient episodes of ordinary social awareness. He seems to use the art room as a safe space in which to explore ways to gain control of his chaotic behaviour and thought processes.
 
He tends to squeeze copious amounts of paint onto large canvases which he then manipulates using hands, brushes and other tools. This becomes a background on which he will glue pictures of characters and locations from popular TV programmes, although he does indicate through repetitive and anxious questioning that he finds these images disturbing and threatening. He will typically paint a bold frame of contrasting colour around them, before obliterating them with further layers of paint.
 
These sessions are characterised by uncontrolled behaviour, which can result in quantities of paint being splattered across the furniture and floor, with the finished canvas seeming to contain strongly expressed but disparate elements. Clouds of intense dark purples and blues hide pictures so that the unglued edges are partially visible, whilst other pictures are framed in bright yellow or orange as if he is seeking to desensitise himself to their threatening implications.
 
In recent months S has started to appear more lucid and purposeful at times when engaged in art sessions, and has worked under guidance to contribute to a community art competition, using collage and drawings on acetate, which formed part of a ‘stained glass window’ project displayed in a local church.
 
Although S can work in this structured way at times, he continues to use the art room as a safe space to express feelings of anxiety and apparent helplessness in relation to his psychological symptoms.
 
A: This male patient, in his thirties on the autistic spectrum, was primarily seeking a way to process a range of complex emotions around what he described as a “tough” and “terrible” life. He had persistently made requests to be considered for gender reassignment, and presented the idea of constructing a life-size image of himself as a female person. This project was agreed, and with guidance from the psychology team, opportunities for discussion were utilised to explore his thoughts and feelings around the issue of his gender dysphoria. He remarked; “I’ve wanted to do this all my life”, repeatedly expressing feelings of gratitude for support in the creation a life-size fabric ‘doll’ which had detailed facial features but was intentionally not ‘anatomically correct’. The project seemed to represent a means of coming to terms with his unreconciled ideas in regard to his gender identity, and helped to bring more clarity to his ideas of sexuality, allowing him to feel safe and comfortable with a less conflicted selfimage.
 
W: A patient in his early thirties, who is on the autistic spectrum and has strong intellectual abilities, having achieved well in higher education. Unfortunately his difficulties with social skills and forming relationships had led to a sense of emotional loneliness, and he was experiencing a prolonged episode of low mood at the time of his admission to the campus.
 
His first piece of work was a plaster mask of his face, which he later adapted into a ‘jester’ character in traditional headdress. This work seems to reflect negative ideas in relation to his selfimage, which underpin his overall lack of social confidence; however, he went on to develop a strong artistic sensibility, producing imaginative and well executed pieces despite having no previous experience of art making.
 
One piece was an evocative abstract sculpture, mounted on an illuminated plinth, which was reminiscent of an underwater plant whose fronds conveyed an eerie sense of being moved by unseen currents.
 
This sculpture was Highly Commended in the 2010 Koestler Awards, being selected from over 6,000 entries as one of 150 pieces for their London exhibition. He initially did not recognise the level of his achievement, but later acknowledged that his mood and self-confidence had developed in a positive way as his artistic skills gave him more ability to express himself.
 
As an articulate individual, he made the following remarks in relation to his experience of art making:
“Art is an example of personal expression; an idea of the person and their mind at the time. My sculpture ‘Thought Patterns’ shows a time when my mind was in flux. There’s the moment of inspiration, then there’s everything around it. The art interprets the state and flow of the mind. Some things happen out of accident, some things happen that are meant to happen. Art is form of development.”
 
For all the patients whose engagement in art making is described above, it seems that the basic ‘triangular relationship’ between the client, tutor and object (or art work) has made a genuine contribution to their recovery; enabling them to talk and express themselves through the object, practicing the interpersonal communication skills that are crucial for autistic patients in facing “the problems of living”.
 
The patients have discovered hope through their chosen activities, and been able to establish control in the creative process which has led to various opportunities for them, in terms of educational, social, and emotional fulfilment. Some have regained practical skills, and become more socially confident, and others have developed resilience through learning to cope with setbacks, and acquire skills through perseverance and effort.
 
The art making undertaken on our campus also helps to form links with local communities, with work being on display in village halls and churches, and a major exhibition is being prepared for Bedford Borough Hall in early 2015. Receiving acknowledgement of their creativity, from organisations such as the Koestler Foundation has been enormously beneficial for patients’ self-esteem and has provided a sense of community with others who appreciate their work.
 
Deborah Hancock
Art & Wellbeing Practitioner
Brookdale Care
 
References
Barker, P.; Buchanan-Barker P. (2005). The Tidal Model: A Guide for Mental Health Professionals. London: Brunner- Routledge. ISBN 1-58391-801-9. Department of Health, (2011).