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Restorative Art and Recovered Moments

07 April 2017

Art Therapist and BAAT member, Kimberley Iyemere tells us about Recovery Focussed Art Therapy for Older People living with Dementia...

 

 

In this article I am providing an example of how Art Therapists in my Arts Therapies Service are pioneering a relatively new approach to Art Therapy which is ‘Recovery Focussed Art Therapy’. Although the service covers Adult, Older People’s and Children’s services I will focus on how we are supporting  Older people to experience recovery in the moment and where appropriate to work towards their own recovery goals by themselves or with their Carer in Recovery Focussed Art Therapy. Recovery Focussed Art Therapy not only facilitates well being as an aspiration but also can be a discovery of enjoyment in the moment.

Recovery Focussed Art Therapy places the person in therapy at the centre providing them with a chance to take ownership of their recovery, and gives them the chance to make their own goals which may include their aspirations, strengths and hope for the future. Recovery Principles focus on the person and their potential rather than putting diagnosis at the centre of the work. Recovery Focus Art Therapy still ensures Art Therapy remains a vehicle for people to express their difficulty or trauma, however simultaneously encourages the person to look at positive aspects, to find solutions, to gain confidence and move forwards. The therapist and the person in therapy form an alliance in the moment, celebrating creativity, and where possible find ways to move together through the goal setting in the therapy, coproduction is an important part of this process.

In addition to the overall Recovery Focussed Art Therapy approach there are particular considerations that are pertinent when working with Older People. The Goals inform the Older Person’s overall care plan for recovery and are listed below the service user ‘strengths needs and expectations’ in their care plan. We support the Older Person to create their goals. When assessing an Older Person living with dementia, their carer may also be invited when appropriate and the carer may contribute to goal setting. Both the carer and the Older Person living with Dementia can have meaningful experiences in the present moment. This process can move the Carer out of the caring role and back in to enjoying playful creative aspects of having a relationship with their partner again. The Art Therapist may encourage the Older Person and the carer to find ways to take the experience of art therapy home and share their creativity with family, carers, and friends and in local art groups. 

I have witnessed the following examples of goal setting with Older people and  their carers 
The carer supporting the older person to continue with their art at home by setting up a studio or art table at home.
The carer realising through the creativity of the assessment that art does not have to be skilful to play creatively with art alongside their partner by for instance doodling.
The carer realising through experiencing a creative moment that other moments with their partner can be enjoyed rather endured

The difference between Therapeutic Alliance and Therapeutic Relationship is crucial in Recovery Focussed Art Therapy. This joint enterprise will include the opportunity to air difficulties, and grow from them. The Art Therapy is time focussed, concentrating on transcendence from trauma and a movement forwards. Creativity becomes a transformative medium full of restorative potential, in Beyond the storms – Reflections on Personal Recovery in Devon, Malcolm Learmonth states the painter Braques said “ ‘Art’ is a wound turned light’.

Myself and my colleagues have questioned ourselves with our Recovery Focussed approach; ‘is it ok to encourage positive image making in Art Therapy, is it ok to find ourselves having fun, to even laugh along with the client within a session, and to celebrate the moment and the positive potential we witness in our clients’? The answer we have found is that this work is restorative and is receiving excellent feedback from our clients. Art work may move quickly beyond illustrating trauma to illustrations of hope, aspiration, pure enjoyment and creativity in the moment and celebration of life and living. Older People living with dementia can gain confidence, orientation, meaning and purpose through their art, as in Figure 1 which was created by an Older Person living with Dementia in a series of time focussed Art Therapy sessions.

Figure 1

Figure 1 is an example of a restorative image created by an Older Person living with Dementia in a series of time focussed Art Therapy sessions, the following quote is from the Service User ‘Art Therapy helps me in that it gives me time and space to make drawings and paintings and gives me confidence as I can follow the picture and painting each week and be able to make sense of the picture when I pick it up again’.

Recovered moments put together become minutes and hours especially when shared and understood by other professionals, Service Users, families and friends providing a better quality of life overall and Art Therapists can have an educative role here. These recovered moments may inspire a wider range of diverse recovered moments in other forms from moments in the garden to moments of laughter.

Capturing the importance of this Recovery Focussed Art Therapy work is essential to demonstrate how this form of Art Therapy does provide a distinct specific specialist treatment and contributes greatly to the overall wellbeing for Older People living with Dementia.

Art Therapy makes use of creativity and imagination and facilitates non verbal means of communication which enables people living with Dementia to reach out to others creatively, and can contain the anxiety often experienced in Dementia.

We are using the outcomes measures Inspire and Canterbury Wellbeing scales to outcome our Recovery Focussed Art Therapy sessions and qualitative service user feedback, with regular review.

Figure 2

A restorative image using art as a cathartic activity held by the paper frame to contain challenging behaviour.

In Recovery Focussed Art Therapy my Art Therapy may be informed by a free flow approach when working with Older People living with Dementia as the use of other arts forms can sometimes also be useful facilitate communication. The important issue in the recovered moment is reaching the person and that may be through the therapist creating an opportunity for or responding to a mark, a sound, a movement, and object or a shape in the sand. In our service music and art therapists run joint sessions on the dementia ward in a creative fusion. Having an adaptability and contemporary outlook is very important when working with people living with Dementia, and the art therapist who can incorporate art, sound, object play and movement in their toolkit has the potential to reach out with diverse options of communication, and this is so important when Dementia may have taken someone’s ability to communicate away on many levels. Art Therapists working with Older People for example Angela Byers paper ‘Beyond Marks’ have moved beyond standard art making for a long time now. The journey  myself and the person living with Dementia have embarked on together in art therapy has often led us in to singing, laughing, exploring objects, movement, silence, sensory space and stillness together, all have been important elements of the Art Therapy and in the recovered moment. It has been important to celebrate great qualities and creative moments in the therapy. This approach highlights the positive in the art materials, energy, joy for life, and life experience. The art work and goals can be internalised and/or kept as art and either way be referred back to when necessary. 

Restorative Images have been made in the form of murals creating uplifting environment for people. This began in an open studio group I ran for Older People attending a day hospital in our Trust along with my volunteer artist Catarina Clifford, Figure 3.

Figure 3

The group also painted a stained glass mural of butterflies to uplift the environment on the Dementia ward. Service users in the community group were motivated to improve the lives of their fellow service users who were in hospital. 

Figure 4

Catarina has also gone on to make more uplifting large scale art works for display within the hospital. Her work has been recognised by a neighbouring hospital, Addenbrookes General Hospital and she has been offered an exhibition space there coinciding with the World Mental Health Day along with an Arts Therapies stall which will profile Recovery Focussed Arts Therapies. 

Figure 5: Restorative Art Work by Catarina Clifford.

Gathering evidence is always important in our work. Currently we are using the outcomes measures Inspire and Canterbury Wellbeing scales to outcome our Recovery Focussed Art Therapy sessions and qualitative service user feedback.

Art Therapy makes use of creativity and imagination and facilitates non verbal means of communication which enables people living with Dementia to reach out to others creatively. Once creative contact is established, people living with Dementia can have moments when they feel orientated, heard, supported and acknowledged and in control of that moment. This moment which potentially could be one of isolation, loss and disorientation can be one that supports self- esteem, self expression, hope, aspiration, strength, unique creative potential, communication, and opportunity in the moment, as Crystal Ehresman stated.  ‘Personal growth through artistic activity is possible at every stage of life’ This shared recovered moment can be led and owned by the person living with Dementia. This can give permission to the Carer to reconnect as Partner in the sharing of creativity promoting new experiences and new beginnings together.

Written by Kimberley Iyemere 
The Cambridgeshire and Peterborough NHS Foundation Trust



Supporting literature

Byers, A (195)’ Beyond Marks: On working with elderly people with severe memory loss’ Inscape 1 (1995) pp 13—18

Ehresman C, ‘From rendering to remembering: Art therapy for people with Alzheimer’s disease,  International Journal of Art Therapy: Formerly Inscape 
Volume 19, Issue 1, 2014 

Learmonth M, ‘Beyond the storms – Reflections on Personal Recovery in Devon’, 

Recovery is for all – ‘hope agency and opportunity in society’ December 2010

Further literature on recovery is available at www.IMROC.org