Neil Springham explains how art school radicalism can shake up the health service.
The arts are increasingly being seriously cited by politicians as a public health issue, not least because of the economic downturn. The arts and health field is gaining in strength, and Arts Therapies’ inclusion in the National Institute for Health and Clinical Excellence (NICE) guidelines for schizophrenia is a real breakthrough. Art therapy started in the 1940s at a time of massive social change. Radical art educationalists and artists in hospitals were challenging elitism in art, driven by a conviction that it should be democratic and relevant to the lives of the most disadvantaged and discriminated against. In order to make progress, these practitioners recognised the need for organisation and standards. In 1964, the British Association of Art Therapists (BAAT) was formed to regulate training, form support and create a collective voice. Its achievements include the establishment of a career structure in the NHS in 1984, and state regulation in 1998.
Setting out
The early practitioners found that participants engaged quickly at a deep psychological level through their art. Given the vulnerability of those attending art therapy, it was clear that skills were needed to contain what was emerged. At that time, psychoanalytic thinking seemed to offer the most freedom and the least reductionist approach to art therapy, and training incorporated elements of this. This was always balanced by the stipulation that to train, art therapists must have a degree in art. A few exceptions can be made to this rule, but candidates must still demonstrate an active engagement with art. This enshrined the principle that art must be learnt experientially and must not merely be an adjunct to psychotherapy. Art therapists have always been committed to understanding and utilising the therapeutic potential of both psychological therapy approaches, and the art form employed. In bringing together the aesthetic and psychological domains, the resulting practice is unique.
This is not to say that there are not tensions between art and therapy. BAAT has developed processes to try to work with these tensions. In 2000, it launched the Art Therapy Practice Research Network where art therapists could share practice and shape research from the ‘coal face’. In 2007 BAAT updated its peer-review model for its house-journal, the International Journal of Art Therapy, ‘Inscape’. These models are important for research but also have an important democratic function because they are more representative of what art therapists actually think. Top of that list is the renewed interest amongst art therapists in exploring the mystery of making art, as an anti-reductionist argument that art is not merely an adjunct to therapy.
Expert witness
This appears to have contributed to a link with the wider arts and health movement. My hope is that this can create the conditions for a respectful exploration of the benefits and risks of different art practices. For example, I was an expert witness in a recent legal case where a participant was seriously injured by an art activity which became psychologically powerful beyond the arts practitioner’s skill. This showed that risk is just as much an issue now as it was for those early practitioners. Such examples must be studied and debated so that we can think about practitioners’ scope and limits as the field grows. Both arts and health and art therapy exist on the same continuum, but we still need to define where the line is between well-being and full psychological intervention. This would make the field generally more credible to authorities.
Open arms
In saying this I would like to restate that I think there is room for everyone in this emerging field, and I do not think everyone should feel they must train in art therapy. Training is a huge commitment of time and money. It is also emotionally draining, and students need to be at a stable and supported point of their lives. But for those who may be interested in training I would like to clarify some points. Age is not a barrier; in fact the main problem is people apply too early because you do need some life experience. Approximately 50% of art therapists are dyslexic (including me), and whilst the training is academic, help is available. Training doesn’t ruin art practice; many art therapists remain artists.
The myth has always been that there are few jobs in art therapy, but the situation is much more complicated. The general picture of health employment has become characterised by fragmentation and open competition for posts, and those professions which had protected career structures are in shock. Welcome to our world! Perhaps because this was never the case for art therapy, the flexibility and creativity we have developed appears to be serving us well. Recent surveys show that one year after training, a higher percentage of art therapists than physiotherapists are employed. There are around 1,300 art therapists in UK, working in a wide array of practice areas. Fifty per cent of art therapists work in the NHS, but the growth area is schools. Many of the current art therapy jobs were started as general care jobs. Art therapists took them, integrated art practice and then converted them. Not all employers or commissioners use the NICE criteria for evidence, which is essentially a pharmaceutical model. Many organisations employ art therapists because they have seen the practice and what it can do or have heard case studies, and increasingly service users ask for it.
Of course some, but by no means all, art therapists have a hard time in organisations, but no more than other professions. In terms of the practice itself, art therapists tend to really like their work. It is rich, inspiring and deeply involving. Training as reflective practitioners, and careful supervision, help practitioners to not take their work home with them, and our burn-out rate is very low. An emerging development is that some art therapy departments are acting as product champions for the arts, creating opportunities for commissions for artists. Both art therapists and arts in health practitioners share common roots in the social radicalism of art schools. We have an opportunity to make changes, and what the field needs now is co-operation
Neil Springham is Chair of the British Association of Art Therapists and Head of Art Therapy at Oxleas NHS Foundation Trust. Information on the profession and introductory days can be obtained from BAAT.
w: http://www.baat.org