A road to art therapy in six works

Road to hell
Things did not start well. At primary school I was described as a 'slow coach' and bedevilled by mistakes in my written work (only labelled as dyslexia many years later). However, I did well in the 11+ exam and got into the local grammar school. There, my reports every year exhorted me to take part more in class, but my diligence in studying made me a 'good all-rounder'.

It has been my lifelong quest to understand how things work, and my research path began in pure science. Initially, I thought that it would lead to outer space. But after a brilliant summer research assistant job at the then Royal Greenwich Observatory at Herstmonceux Castle in Sussex, and sailing through my first year at university, I experienced 'a mental breakdown'. I discovered that psychology was about more than just perceptual illusions.

My artwork Road to Hell (above) was, in retrospect, an inkling that trouble lay ahead.

Self portrait
From an early age I'd been into painting and drawing. I often became absorbed in these activities; they were a form of escape, as was reading, especially science fiction novels. Sometimes I made images of myself when I experienced confusing feelings (e.g. Self-Portrait), and I looked at the images as if I could discover what they said to me. I am not sure what they said in words, but there was something that was different from just looking in a mirror; something pinned down that would still be there the next day.

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In pieces
Perhaps I was trying to understand the disparity between an apparently calm exterior and what I felt inside. When I experienced serious mental distress, my drawing and painting took on new meaning, as I tried to deal with the inner maelstrom.

This is not inconsistent with the testimonies of the service users England's National Institute for Health and Care Excellence (NICE) drew upon, and quoted in the 2009 guidelines on treatments for psychosis and 'schizophrenia'. Several people said that creative activities had been helpful to them. This seems to have led, alongside evidence from the few small controlled trials that had been done at the time, to a recommendation that all people with these diagnoses be offered arts therapies.

My mental health needs were initially to understand where my emotional pain came from, and then to find a pathway forward, be it winding, bumpy and crumbling in places, and sometimes needing sections to be built before they could be traversed safely. I have experienced a lot of psychological therapy, much of it psychodynamic but also CBT and third-wave CBT. Yet therapists were often interested when I showed them artworks. I remember one psychotherapist saying that she felt moved by a cartoon strip I drew of my life (unprompted).

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OK, yes I'm angry
In the 'patient' role, one can often feel at the mercy of decisions made by doctors and nurses. Initially I thought that a diagnosis of severe depression and prescriptions of medication would be helpful. However, psychiatric labels can harm as well as help, and various medications can become props that are difficult to cast aside (I am still on one). Over the years I have had more hours of talking therapy than I can count.

That is not to say that none of the talking was helpful. Apart from one early period of therapy from which I came out worse than when it started, I feel I have benefited from being able to bare my damaged soul and to experience compassion from a string of therapists over the years.

A stay of several months in a therapeutic community was also helpful early on, especially in terms of experiencing the power of mutual support, both practical and emotional. I think this power was sometimes undermined by the need of doctors and nurses to exert their own authority. Whilst not intended to be harmful, this was not always therapeutic. Then again, they had some very troubled charges to care for, who they recognised often needed to acknowledge suppressed anger or sometimes control it better, and throughout my stay there the hospital was under threat of closure. Perhaps that's why I've developed a research interest in the conditions that help mental health professionals to contribute most helpfully to their clients. Their surrounding systems and supports are so important.

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Retrospective depiction of my younger self
My lived experience suggests that psychological therapies never quite work in the way that the theories say they do. Understanding how therapy 'really works' seems a never-ending and fascinating quest. It has drawn me, amongst other work, to Ray Pawson's writing, and to the work of Psychologists Tony Roth and Peter Fonagy. For more than 20 years now,

I have been based in a clinical psychology programme, teaching research methods and supervising clinical psychology doctorate research and PhDs. One of the areas I often supervise is concerned with psychological therapy processes and practices.

This brings me to art therapy. I only met art therapists in the last 10 years and have worked closely with the British Association of Art Therapists (BAAT) in the past five years doing research in relation to art therapy for people with a psychosis-related diagnosis. I have assisted the BAAT in its development of new guidelines on art therapy for people with these diagnoses, available via www.baat.org. We have studied the most recent research evidence, and we have also listened to both experienced art therapists and service users, and incorporated their reflections and service users' artworks. We have reported what service users say art therapists should not do, as well as what they find helpful. We want the guidelines to support research as well as assisting people to understand art therapy.

In order to understand art therapy better, six years ago I attended the BAAT foundation week in London, entailing lectures and art-based workshops run by art therapists. Meeting new people scared me, as always, prompting Retrospective depiction of my younger self. I often echo in my head others' exhortations to ignore my fear or play it down. Sometimes it seems more important to me that I depict and acknowledge it.

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Tickled
I still make art, and it has a range of feeling tones and subjects. Through my work with art therapists, I have learned to approach other people's artworks with curiosity and respect rather than as objects to be scrutinised and analysed. The most valuable interpretations are those of their makers when they look back at them. The artworks we have included in the guidelines, sometimes along with the artists' statements about their work, add a special dimension to the document.

My experience of working with both psychologists and art therapists is that they often walk a line between over-rationalising and over-mystifying what they do in their work with clients, and I see potential for greater collaboration and mutual benefit between psychologists and art therapists working in mental health. There's so much to learn, and we can be creative about it. Writing stream-of-consciousness reflective diaries and allowing someone to interview you helps in articulating unexamined and sometimes deeply-held passions that may influence your work. If you've never tried it, perhaps doing a squiggly line on paper and then filling it in with what you see could also help. Random ink or paint splodges can work as your own Rorschach test (with your own system for interpreting them). However, as one of my participants in a research study once said, reflection can be valuable but not if you are only ever reflecting with others who have perceptions and experiences that are too similar to your own.

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So let's listen to the users of mental health services. In what are termed audio image recordings (AIRs), people who have attended art therapy talk about their experience of it, as a voice-over to pictures of two to three artworks they made at different stages of therapy. Find these AIRs via www.baat.org.

I've sought to do something similar here with the written word. Let's listen to what people are saying with the help of their art.