Neil Springham

Neil Springham

Continued professional development (CPD) is a social process: ideas meet when people meet. I find the effect creative but also disruptive. My CPD in mentalization did more than add tools into an existing skill set. Over time it altered the basic assumptions of what therapy is and resulted in me discontinuing some of the approaches I learned during training. I then offered practices emerging from new learning as CPD sessions at BAAT, where I meet art therapists who work in situations very different from my own NHS role. These sessions further challenge the validity of those practices in other settings.

A fortunate by-product of this CPD cycle is that such encounters can offer a rare window into changes as they occur within the profession. For example, I have offered CPD in four areas which appear to have high uptake, namely: mentalizing; psychoeducation; co-production (with Ioanna Xenophontes); and formulation (with Alex McDonald). These practices are linked because they use structured, transparent communication to support active equality between therapist and service user. I notice such practices are no longer perceived as adaptations to "proper art therapy", which used to be typically defined as non-directive. Yet CPD often has a lag between practice innovations and the production of literature to support those innovations. The recent publication of Mentalizing in Group Art Therapy: Interventions for Emerging Adults has helped the CPD I offer in this respect. I believe it represents an important development not only in content but also for the way it used co-production with service users in its construction. I review it here for this reason.

I suspect the context that sparked the innovations described in this book will be very familiar to art therapist readers. Moore and Marder work in the Menninger clinic in the USA, which has a prestigious history for both art therapy and mentalization. The clinic was the setting where Mary Huntoon developed art therapy in the 1930s in much the same way as pioneers such as Adamson and Hill in the UK. That legacy was then built upon by important US art therapy figures such as Don Jones and Robert Ault through the 1950-60s.

However, a series of changes at the clinic slowly relegated art therapy from this fuller provision to the confines of an eight-week model within psychiatric rehabilitation for emerging adults. The authors acknowledge initial despondency at these constraints but they then did what art therapists do: they reached out to make new relationships and so shifted the paradigm. Key to this was the link to the clinic's director of psychology, Jon Allen, a key collaborator with UK mentalization-based treatment developers Bateman and Fonagy. Allen had developed a Psychoeducation program called "fostering secure attachments and mindfulness of mind", but found the intervention needed more dynamic forms of learning to engage participants who respond poorly to verbal-didactic styles of delivery. This provided the opportunity for reciprocal exchange: art therapy could offer experiential approaches that worked for emerging adults and the psychoeducational aspect of mentalization-based treatment offered therapeutic coherence within the short time frame the art therapists had. The book presents the resulting development of a novel form of art therapy and mentalization-based psychoeduction.

Whilst art therapy-based psychoeducation has latterly developed in UK (Thorne, 2016), I believe this beneficial practice was delayed by the historical positioning of directive and non-directive art therapy as US and UK approaches respectively (McNeilly, 1983; Byrne, 1987). I recall accepting that overly directive approaches would risk resulting in a "highly controlled treatment where the work is therapist-led with little attention paid to the unfolding of the client's process" (Gilroy & Skaife, 1997, p. 58). I wonder now at my lack of exploration of the potential benefits of art directives. Kula and Moore's publication goes beyond such dichotomisations. Trained in the US, they made contact with Dominic Havesteen-Franklin at the International Centre for Arts Psychotherapies in the UK to share developments in directives and mentalization-based art therapy. The result is a practice which seems to me to integrate the best of US and UK art therapy. Directives are offered, but with transcripts of how the interaction and relationship was negotiated. Practice descriptions are clear and triangulated with therapist reflection plus service user and colleague feedback.

Perhaps this example of reciprocal learning is emblematic of a new era in art therapy theory building. It is mirrored at the macro-level by how BAAT and the American Art Therapy Association recently opened access to each other's journals. Both associations combined to support the first International Art Therapy Practice Research Conference in 2019 which gave a platform for more than 35 countries to learn from each other. If it is correct to see this as a trend, then the embrace of diversity in art therapy would be a welcome rebuttal to the political forces currently separating people around the globe.

The practices described in this publication may not be applicable to all art therapy situations because they are focused on a specific population and context. How the principles outlined might be applied to different client groups or longer forms of therapy may require some translation by art therapy readers. In this sense what is generalisable is, appropriately in my view, limited. However, to my reading, the text addresses one question art therapists share: how can the making and sharing of art be a proportional response to the enormity of adverse experiences that bring people to use our services? An answer is offered by art therapy service users in words I cannot improve upon. When asked how they experienced the intervention, they responded:

"Group member #1: I didn’t think we were going to derive as much about ourselves from responding to someone else’s art, but there’s a lot of information there.

Group member #2: I think its super-cool that I can make something that I thought was meaningless while making it. I thought I was just doing it to do it. But then it gains importance and significance as I discuss it with other people.

Group member #1: That’s really how I felt about my life before I got here. Like everything I did didn’t have any significance.

Reading this book we learn here that mentalization-based art therapy focuses on the process of thought over its content. Structure in sessions helps communicate the intention of the therapeutic relationship to people whose attachment neglect otherwise leaves them struggling to read support offered as benign or salient. By developing the skill to identify intentional minds through art this way, participants can then generalise that newly gained social learning process to other aspects of their experience. As epistemic trust is strengthened, lives become meaningful and risky behaviour reduced. Art helps people meet so ideas can meet.