Art therapy's role in strengthening parent–baby connection (part 2)

You run a group for women who’ve experienced perinatal loss. Can you tell us more about it?

My work has evolved over time, so I’ll give a bit of background to the evolution of APPLE – which stands for Art Psychotherapy Perinatal Loss Experiential. During the Covid-19 pandemic, the Perinatal Parent-Infant Mental Health Service was one of a few services selected to pilot a perinatal maternal mental health service. I’m glad to say that, four years on, this kind of service is now being rolled out more widely across the UK.

The service has expanded my scope of art therapy work. It has given me the opportunity to develop my practice with women suffering from anxiety, depression and other mental health issues throughout the full spectrum of the perinatal period. This includes offering therapy treatment to those experiencing fertility treatment, perinatal loss including miscarriage, medical terminations, stillbirth, neo-natal death, pregnancy anxiety including fear of giving birth, birth trauma and postnatal illness.

Perinatal loss, particularly the death of a baby, can be a profoundly painful experience. It can leave women feeling deeply isolated and alone with their emotions. That’s where creativity and art therapy felt like a natural fit. The APPLE group was formed to provide a safe space to meet others who have similar experiences and where they can safely express common feelings. It originally ran as an in-person intervention at one of our clinic sites. Due to the service covering four large London boroughs, the attendance was low. While I was sceptical about running art therapy online, it transitioned well – partly because women feel more able to attend from wherever they are, and because there is a level of emotional safety in being behind a screen. They know they can participate, but also feel in control of retreating if they need to.

I take referrals directly from our therapy waiting list. There’s no hierarchy in the group – women come with all kinds of loss experiences. The group is closed and, to a large extent, participant-led. Given the nature of the subject, I provide a loose structure for each session. There are eight consecutive group sessions. We usually start with a check-in, then move into some form of artmaking – sometimes aligned with a theme, sometimes just based on what’s been said. The artmaking becomes a meditative experience (I do conduct other kinds of meditations too). This then becomes the entry point for conversation and reflection.

I’ll occasionally introduce templates­ – like the body mapping taught by Neil Springham, for example – to help participants tune into where they might feel pain or joy in their bodies. One thing I’ve learned is that women – understandably – don’t want to be re-traumatised. They’re not looking to hear detailed stories of others’ experiences. The group holds a shared understanding – we know why we’re here – and that allows the focus to remain on personal emotional expression, not comparison.

I also make a point of including myself in the group. I’ve found it really helps to reduce the feeling of isolation. It becomes a space where we can all relate to the emotional landscape of loss, even if our stories are different. It’s a fine balance – sharing just enough to connect, while being mindful of others’ capacity.

Loss brings with it a whole range of emotions ­– from deep sadness, loneliness and hopelessness to anger and rage. What I’ve seen is that the group helps women realise they’re not alone. Just knowing others have had similar experiences can be incredibly validating. Seeing participants reflect on this with others, even in a virtual space, adds another layer of connection and healing.

APPLE combines this group experience with up to (and occasionally beyond) twelve one-to-one sessions.

What unique benefits are there to combining group art therapy session with one-to-one sessions offers in APPLE?

That’s a great question. I have found the individual sessions allow women to fully process their personal journeys, which may include how it might feel for those with living children to have a sibling die, or with pregnancy following loss. Pregnancy following loss can be incredibly fraught – full of anxiety, guilt and fear. Women ask questions like How can I carry this new life while still grieving the one I lost? The emotional complexity is immense.

Group work can set a foundation for exploring deeper layers of trauma that may be hindering the current grieving process. I’ve collected a series of surveys evaluating the group experience and am compiling the results in the hope of publishing them.

I’ve been fortunate to work with some women who have used art therapy for a longer term. One woman has recently given written permission to record an audio-image recording (AIR) tracking the significance of her artmaking during this extended experience.

One thing that keeps emerging is how surprised women are by the helpfulness of art therapy. Many hadn’t expected it to work for them but found that the act of creating something slows down their thinking and enables them to think differently and reflect on their emotions in a new way. Another woman, for instance, coloured blue gloves to express the numbness she felt in her hands (in her sense of touch). It’s these kinds of embodied art images that are powerful. They can speak volumes, often before the words come.

It would make a lovely exhibition to share some of the women’s journeys.

Yes – that is a wonderful idea.

Do you think there’s potential for any kind of longitudinal follow-up with participants – to see how the group may have impacted them over time?

Yes, definitely. I’ve thought about this with many of the women with whom I’ve worked. Follow-up is important, and I do try to stay in touch when an opportunity arises.

For example, I’ve been supporting one woman who had great difficulty becoming pregnant and who eventually decided to adopt. I understand she is currently in the process of becoming approved as an adopter. Another woman who almost lost her prematurely born baby has been in touch each year since her therapy intervention ended. A third is currently part of our patient participation panel helping to promote art therapy in the perinatal period and shape our maternal mental health service. This kind of continuity matters greatly.

Yes, because a lot of research doesn’t include longitudinal work, and yet we know the impact often continues.

Yes, exactly. We see this quite often in our service – lack of time and funding are often a barrier to research and service reviews.

Another area I feel strongly about, and I want to make sure I mention before we wrap up, is birth trauma. I continue to be struck by the large number of women I’ve assessed who have experienced the birth of their child as traumatic due to systemic issues. This is not just the trauma of medical complications such as an emergency C-section – they might also describe the ambiance of a hospital as stressful, staff shortages, exhausted staff or the emotional unavailability of staff. I’ve heard women speak of the powerlessness and lack of control this causes them as well as the terror or panic projected by a staff member’s face in a moment of crisis. All of these factors can contribute to an increasingly fraught and terrifying birth experience.

What I mean by this is that the trauma isn’t always rooted in the birth itself –­ it’s in how the experience was held, or not held, by those around the birthing person. Staff are under so much pressure which the birthing person can feel too. They can end up feeling abandoned or unsafe and when services are overstretched or burned out. Then afterwards many women don’t feel they get justice for what they’ve been through. They’re sometimes left with long-lasting physical and emotional aftermath, while trying to carry on as they manage their life with a new baby.

Yes, and while it’s not the same as justice, the process of making art or externalising those experiences through creative means can offer something like a vicarious justice – a way of making sense of it, giving it form, and reclaiming some of that power.

Yes, but while that’s one of the key strengths of art therapy – giving people a safe way to express difficult emotions like anger, fear and grief or by finding feelings of empowerment and choice – it should not always need to be vicarious, especially if the system is truly trauma-informed.

Pregnancy and birth are massively powerful experiences. Take, for example, a C-section – yes, it’s common, but it’s also major surgery, with all the associated risks and recovery. And for some women there’s this strange juxtaposition – they had a baby but feel like they didn’t give birth. That disconnect can be really hard to reconcile.

Yes, I remember that coming up when I had my children. Some people who had C-sections felt like they missed out on the experience of giving birth. They had their baby, but also felt like something had been taken from them – it was a strange, in-between kind of feeling.

That’s very common. But thankfully, there’s been more awareness in recent years. While there are still gaps in implementation, trauma-informed practice based on the recommendations that came from Theo Clark’s cross-party Birth Trauma report (2024) will hopefully go some way supporting the system.

It’s so important that theatre staff, consultants and maternity professionals understand the emotional side of birth. If a woman needs a C-section, the experience can still be empowering – it can still be hers. With planning, support and care, she can remain part of the moment and feel connected to her baby. That touch, that emotional presence – it still matters, and it can still be honoured.

What are your thoughts about the future of art therapy in perinatal health? Are there areas you feel need more attention or development?

Art therapy in this specialist area is growing. With perinatal and maternal mental health services being funded and developed all over the country, we’re starting to see more opportunities for art therapists to get involved – and that’s fantastic.

Sue Bulmer and I co-founded the Art Therapy Perinatal Network, and the response has been very encouraging. We’ve had a lot of interest – women therapists particularly seem very keen to work in this area. I think we’re up to about 50 members now.

It’s also been great to see art therapy students in training coming through the system, some contributing greatly to the research landscape in this field. I’ve read dissertations on relevant topics – particularly around touch and the sensory aspects of art therapy. There’s a real emerging curiosity in this area of work.

In terms of what needs more attention, I think awareness is key. There’s still work to do around helping other professionals understand the value of creative processes – why art therapy is more than just ‘making something’. It’s about expression, regulation, reflection – all vital aspects in perinatal care.

I’d love to see more visibility for this work. Exhibitions, as you mentioned earlier, would be such a powerful way of showcasing what women are creating ­– what they’re expressing – and how that intersects with their personal journeys. It would help move art therapy more into the foreground of research and development of the perinatal art therapy service.

Another area I consider to be really promising is reflective practice groups. Some art therapists are running these for perinatal staff – midwives, health visitors, mental health practitioners. It’s not just helpful for them: it also helps spread understanding of what art therapy can offer. It’s a gentle but powerful form of education which should be expanded and encouraged.

Upcoming course: An introduction to perinatal art therapy

Learn more about perinatal art therapy in our upcoming course.

Find out more

Read part 1 

If you missed part 1 of this interview, you can read it in the previous issue of InSight.

Read part 1