When the arts mirror therapy

In 2019-2020, for my doctoral thesis, I joined and studied the work of Turtle Key Arts, a production company based in London who specialise in outreach arts projects, including several projects for neurodivergent young people. One of my supervisors, Dr Emma Williams, is a researcher in participatory arts and autism, and together we wanted to capture a few thoughts about why the arts might be so powerful for neurodivergent young people and how they might drive change which overcomes some of the challenges in the youth mental health field.

Throughout my career as a Clinical Psychologist so far, I have been inspired by the ideas of community psychology, but at times have felt disempowered by how far away it feels from the conventional clinical space, and how difficult it can feel as a clinician to embed work which is creative or community-led. However, I have also been privileged to be a part of psychological research which seeks to bridge this divide, inviting artists into the seat as both practitioner and researcher in the field of participatory arts-based (PAB) research. An emerging body of work focuses on performance arts (group singing, dance, drama) conducted in a participatory way for autistic children and children more widely.

Using this approach, participants are actively involved in the art form rather than passive consumers, and are active collaborators in the process of arts creation. I have been struck by the power and potential of this approach for neurodivergent young people, not only in the 'community' but perhaps even more directly in the clinical sphere itself.

My small research project reflected the now rapidly growing findings of many others; participatory arts approaches seem to support and increase the wellbeing of young people, including, or perhaps especially, autistic young people. While the research remains slim, I might argue for the potential and pragmatic sense of these approaches for neurodivergent young people more widely. Creating arts together has been widely shown to positively influence wellbeing (All Party Parliamentary Group on Arts, Health and Wellbeing, 2017), which on its own might be an argument for the roll-out of such approaches for a group whose mental health and wellbeing is poorer (Moss et al., 2015), in a context where conventional mental health approaches may be ill-suited, insufficient or more widely stretched. 

However, there is something more specific and substantial about the arts which I think holds hope here. I, like many other researchers, found evidence of musical or creative processes echoing and supporting social processes, like reciprocity, cooperation, connection, resilience and friendship, areas which may be more challenging for neurodivergent young people, within neurotypical societal structures. Arts participation seemed to create a context which enabled social and emotional development and satisfaction.

Further, the participatory arts approach subverts the typical hierarchy, with participants seen as active and equal contributors in a way which may especially suit some neurodivergent young people (such as those who are autistic with a PDA profile who may struggle with systems of authority, or those with ADHD who may thrive in environments where their hyperfocus and creativity can be captured and capitalised upon).

Importantly, this environment and approach allows an experience which steps outside the neuro-normative and welcomes creativity and different kinds of minds. This has immense potential for the self-esteem and identity development of neurodivergent young people, and the practical potential of being applied on a large-scale, community-led level, perhaps through a social-prescribing type model as a welcome and much-needed adjunct to mental health services which so poorly meet the needs of this group.

However, perhaps the participatory arts can offer even more hope than this. Through conversation and work with Emma, I've become aware that as researchers examine the potential processes by which wellbeing change might take place, there are growing indicators that participatory arts processes might mirror therapeutic processes. Could these approaches even go as far as offering an alternative to conventional clinical support? 

Dr Sarah Glew (she/her) is a Clinical Psychologist working in neurodevelopment and Clinical Tutor and Lecturer at the University of Surrey, with research interests in the participatory arts and autism.

I first encountered participatory arts-based approaches whilst evaluating the use of a specific program involving secondary school-aged autistic girls, Playing A/Part. This program, funded by the Arts and Humanities Research Council, was co-designed with students attending Limpsfield Grange School (the only specialist school for autistic girls in the UK) before being employed more widely in various mainstream and specialist settings.

The resulting series of workshops developed through this process of co-production comprised creative activities such as masks, puppetry, music, creative writing, and den building, which were designed to facilitate the exploration of identity and experiences of being autistic, as well as to bring about positive changes in mental health and wellbeing.

As autistic girls can be socially creative and use performative strategies in everyday life, participatory arts-based (PAB) approaches can play to their strengths. The creative practices offer expressive opportunities for these young people to articulate their sense of being in the world, explore their relations to the environment and each other; as well as to find a language for feeling and thinking states that moves beyond words through music and movement.

On witnessing, and hearing reports from teachers about, the positive impacts of the Playing A/Part program, including a sense of growing confidence, community, and self-expression amongst the autistic girls, I became interested in finding out more about the processes (mechanisms) that might be helping bring about these changes. To further my understanding, I worked with a cross-disciplinary team of psychologists and participatory arts-based practitioners on a systematic review of participatory arts practices involving young people, which investigated common and specific mechanisms of change in relation to youth mental health and well-being reported in published PAB studies.

We found clear similarities between clinically therapeutic processes, such as those involved in Person-Centred approaches to Counselling epitomised by Carl Rogers, and participatory arts-processes, in that the therapeutic work in both appears to rest on a critical relational foundation (including relationships between the art practitioners and young people and amongst the young people themselves) and can progress only if a sense of trust is first established. As in therapies such as PCC, participatory arts-based practitioners aim to create a non-judgmental, accepting, 'protected' space for children and young people in which they feel able to take managed social and emotional 'risks' through engagement with arts stimuli and practices in order to help them reconnect to their thoughts, feelings and bodies.

Findings from the qualitative papers included in our review suggested that it was necessary to create a 'protected' social space based on trust before deeper, more sustained, engagement could occur.  As in many clinically therapeutic approaches, this deeper engagement was reported to facilitate an opening up of pathways to the development of a more positive or 'authentic' self-narrative.

A further similarity with PCC is that in participatory arts-based programs, children and young people are supported to express themselves and create their own meanings through embodied engagement with the art activities, restoring or building a sense of agency and self-direction. They were also able to explore difficult emotions, as well as alternative perspectives and identities.

Participatory arts-based programs seem to offer an alternative therapeutic social space particularly well-suited for children and young people. They cultivate a sense of communitas (or community belonging) in organic ways that young people do not resent or perceive as coerced. Working collaboratively as artists involves the pleasure of community engagement in composition, which often involves beneficial validation from practitioners and peers.

Another distinctive element of PAB programs identified in our review is that they offer a 'play-space' that taps into the intrinsic motivation of young people and de-pathologises the therapeutic space. This is really important, as the stigma that CYP associate with mental health problems, their tendency not to seek help for these type of difficulties, and a high level of disengagement with services once accessed (Colizzi et al., 2020), point to reasons why traditional CAMH services may be unable to meet rising youth mental health need alone, even if resources were not so scarce.  

Dr Emma Williams (she/her) is a developmental psychologist at the University of Surrey, whose recent work has focused on the identities and experiences of autistic girls and the participatory arts.

Key sources

All Party Parliamentary Group on Arts, Health and Wellbeing. (2017). Creative health: The arts for health and wellbeing.
Colizzi, M., Lasalvia, A. & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? International Journal of Mental Health Systems, 14(1), 1-14.
Moss, P., Howlin, P., Savage, S., et al (2015). Self and informant reports of mental health difficulties among adults with autism findings from a long-term follow-up study. Autism, 19(7), 832-841.
Williams et al (2023). Practitioner Review: Effectiveness and mechanisms of change in participatory arts-based programmes for promoting youth mental health and well-being – a systematic review. Journal of Child Psychology and Psychiatry.