'A shared love of the arts, dance and creativity has brought us together'

Joanna: My name is Dr Joanna Omylinska-Thurston, I'm a Counselling Psychologist and I've been part of the British Psychological Society for over 20 years. I work for Greater Manchester Mental Health in the NHS talking therapy service, and I'm also a lecturer in counselling and psychotherapy at the University of Salford. 

Together with Vicky Karkou and Scott Thurston we've developed our creative, evidence-based psychological psychotherapy for depression, Arts for the Blues, which we're going to talk about today. I'll pass to Vicky.

Vicky: I'm Vicky Karkou, a professor at Edge Hill University. I'm also an arts therapist and specifically, a dance movement psychotherapist. As part of my role at the University, I'm the Director of the Research Centre for Arts and Wellbeing. I've been working with Scott and Joanna for around 10 years now, right, Scott?

Scott: Yeah, I think that's about right. I'm Scott Thurston, Professor of Poetry and Innovative Creative Practice at the University of Salford, where I've been working for over 20 years. I'm also a dancer, and I incorporate dance movement in my poetry performances. I've recently trained and qualified as a person-centred counsellor. My main role at university is directing research for the English department.

Our origins as a project is a fun story, because we all actually met dancing a movement meditation practice called Five Rhythms in Liverpool. We had lots of vibrant and interesting conversations on the dancefloor without words, and did that for several months, without actually knowing anything about each other's working life and research interests! 

We just enjoyed time spent together in dance. Looking back on it, that seems a perfect way to have begun this work together – by making those connections in a creative context. It's that shared love of the arts and dance and creativity that has brought us together and which informs this work.

Vicky: And this is work that is currently having national and international appeal. My desire was to develop a pluralistic model that was as evidence-based as possible, that uses creative methods in psychotherapy. It was a way of making the experiences I had as an arts therapist, much more widespread and useful through research. 

Arts for the Blues is such a model. It is evidence-based, it's manualised in terms of ingredients and principles of practice. It has four stages, eight ingredients. And it's used extensively for adults, children, and more recently, we started working on a version of that model to support the wellbeing of staff – mainly NHS staff at the moment, with an intention to expand this even further.

Joanna: There are two prongs to the development of this model: a creative element that Scott can speak to, and the more clinical element. It started with a clinical need. I was working in the NHS talking therapies – at the time, it was called IAPT, Improving Access to Psychological Therapies. 

We wanted to provide some alternative to our clients – dance, the beautiful practice that we were encountering – and also experiences of other arts within the frame of psychological therapies. We thought it would be really helpful to bring that to our clients in the services, especially as clients were mostly experiencing CBT as the main model delivered. 

We started with a systematic review of literature, really looking at the evidence base and identifying helpful ingredients for depression in CBT, person-centred, psychodynamic and arts therapies research – what clients were saying, what theories were saying, what outcome studies were saying. 

And from that we identified the key ingredients that are foundational for this model. Then we tested it with the public at conferences, but also within the IAPT services, to see what patients were saying, what staff were saying, to take this further.

Scott: After we'd met through dancing, Vicky had the idea to draw on her Cochrane Review for the uses of dance movement psychotherapy for depression. Initially we wanted to find an artistic way of sharing the research with a broader audience. And so Vicky recruited me and the dancer and choreographer Julia Griffin, to work with four key ideas from that review, which I could summarise as vitality, relationship, metaphor and narrative. 

As artists we felt very much at home using those concepts, even though they came from therapy. The duet we devised – 'Getting Out of Your Own Way' – explored those ideas. But what got interesting for the clinical team was noticing how those ideas had landed with us as artists, beginning a process of integrating artistic and academic ways of doing research.

Joanna: The eight key ingredients that are really important when working with depression include: encouraging active engagement, learning skills, developing relationships, expressing emotions, processing at a deeper level, gaining understanding, experimenting with different ways of being, and integrating useful material. 

That is then structured within a group therapy process within four phases: introduction, building individual and group strengths, addressing the challenges within the group, and then closure. We use a range of creative modalities such as drawing, music making, creative writing and movement to work within the frame of group process and the key ingredients depending on client needs and the therapist's training. 

Each session would include a warm-up, preparatory creative activity, main activity and then reflection in pairs and larger group. So, for example, at the very beginning of the groupwork when addressing 'Encouraging active engagement', we may use rhythmic activities in the group to encourage participation. For 'Developing Relationships' we may use mirroring games to encourage embodied interactions. For 'Expressing Emotions' we may draw to share feelings and so on and so forth.

Scott: Our website has some videos which illustrate the model, but we think the magic of it is two-fold. Firstly, it enables clients to find opportunities for expression which do not rely on having to talk directly about their problems. This was particularly powerful for some of our participants who had been in talking therapy a few times, and said that they had become tired of retelling their story over and over again as they moved from practitioner to practitioner.

Secondly, something very special happens in the transition between art forms and mediums that would be typically used in a session. We might begin with introducing ourselves with a gesture showing how we feel, rather than describing it in words, and then transitioning into drawing. 

On another occasion, we may begin with group movement and then process the experience through a creative writing prompt for a poem, only after which there might be an opportunity for verbal reflection on the process, but one still informed by this creative journey. This kind of approach was also discovered by Natalie Rogers and named by her as the 'creative connection' – the way in which this 'enhancing interplay' in art forms, in Natalie's terms, can enrich the therapeutic process.

Vicky: While we were developing all this work, we had support from our universities, a bit of funding from professional associations, and some regional funding from clinical commissioning groups. However, it was all small scale. A big turning point for us was when we got funding from the Arts and Humanities Research Council, to scale up this model. 

We managed to engage a very large number of partners, particularly in the northwest of England. This generated the momentum that pushed things further. In parallel, we had a big strand of activity in schools. We worked with over 10 schools whilst we were trying to generate evidence of effectiveness of the model in an educational context with children at risk of developing mental health problems.

Scott: We also followed up the earlier creative exploration, through gaining Arts Council England funding to run Arts for the Blues as a creative wellbeing series of workshops at Liverpool Lighthouse, a wonderful community asset in Anfield in North Liverpool. We ran the workshops with members of the local community for six weeks, then we shifted into a devising period. 

Myself and Julia actually took part in the wellbeing workshops ourselves, then held the space following that to work with the participants to devise a performance about our experiences as a group. We then toured the performance through the Northwest during the summer of 2023. 

So, we really tested the model in a different way by enabling those who'd been involved in it to extend the creative and therapeutic possibilities of the workshops out into an engagement with the wider community. That was a really fantastic experience for everybody. Three of the participants from the group also performed in the final version of the piece, which was thrilling.

Joanna: There was another bid that Vicky was involved in, a Wellcome Trust systematic review of what's helpful for clinical staff, and we've adapted the model to use with staff in hospital settings. There was some funding from Edge Hill for that as well. We also have some Strategic Research Funding from Greater Manchester Mental Health Trust to investigate the use of this model with our clients in the primary care setting. I have also been awarded NIHR Fellowship funding that will follow the adult work into a feasibility RCT.

Vicky: We're really putting a lot of effort into consolidating and generating solid evidence about the effectiveness of the model. There's also funding from Health Education England to look at adopting this model for doctors in training. And all this work has fed into a new, large grant from UK Research and Innovation, the largest funding awarded to the arts, arts therapists and children's mental health, called Arts4Us, where we're not just thinking about evidence, but trying to put evidence into practice and change services in a systemic way. So there's a lot of learning from these 10 years of work, and we're trying to share this learning as widely as possible with a growing portfolio of CPD work that Scott can talk about.

Scott: Yes, indeed! Throughout the development of the model, we have run training events to share what we've been doing and to get feedback from practitioners, which has been very valuable. We've developed a CPD training package that has been rolled out to CAMHS practitioners in Greater Manchester, who are now beginning to use the model in clinical practice. 

We recently ran a one-day event in Salford and we're about to run another one at Edge Hill, available to any psychological practitioners who want to learn more about the model. So it's been really exciting. And we're also looking forward to new developments through local agencies in the Northwest like One Point in Bolton and 6 Degrees in Salford, who are also poised to start using the model in treatment as usual.

Joanna: We're also developing and delivering Arts for the Blues within the Counselling Clinic at the University of Salford for clients based in Greater Manchester. It is available for free.

Vicky: So, there are a number of directions of travel! We're also exploring the model, nationally and internationally: we are in discussions about the use of the model in Southeast Asia, Africa, and so on. There's a wonderful growing expectation around putting the model to good use, spreading what we have learned so far, as widely as we can, benefiting as many people as we can. We're coming to a BPS conference as well.

Scott: We're also hoping to find ways of making it available for artists, to see if we can train artists to use it to complement their practice, particularly for community-based arts work.

Joanna: We are very open to collaboration. We really like working with other people! We would also like to see more psychologists coming to our CPD courses: we'd be really excited to share it and to work together!