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Presenting Forensic Arts Therapies

23 March 2016

Review of the 34th Arts Therapies Forensic Conference at The House of Lords.

Review of the 34th Arts Therapies Forensic Conference at The House of Lords 

Hosted by FATAG (Forensic Arts Therapies Advisory Group), winter 2015 at The House of Lords, London.

 Image: Reflections on the pictures in the Conference Room, House of Lords

 

Introduction

The day began with a warm welcome from Kate Rothwell and an expression of the honour and privilege to be in the House of Lords. Special thanks were given to all delegates in attendance as well as acknowledgement of all those who could not be there.

 

Morning Presentation

‘In Here’ and ‘Out There’

Lulu Falbe-Hansen has worked in the mental health sector for over ten years and trained as an Integrative Arts Psychotherapist at the Institute for the Arts in Therapy and Education, qualifying in 2014.  She is currently establishing a private practice, running Community Art Psychotherapy Groups and working as a Creative Wellbeing Adviser for an arts and mental health Charity in South London.

Christopher Burke trained at the University of Hertfordshire, qualifying in the summer of 2015. He starts an honorary contract with CNWL NHS foundation trust this October, and hopes to start a group at the Queen Mary hospital in 2016.

Christopher and Lulu gave an enjoyable and immensely engaging presentation of a piece of work they completed as trainees on placement in the context of a low secure Forensic Mental Health Setting.  Through an impressive and innovative visual montage / collage style slide show, the audience was invited to walk through the landscape of their journey establishing a recovery-model focused 12-week art psychotherapy open group in a low secure male ward. They explored key aspects of the group and evaluated the impact of the group on the participants, the ward and themselves with great depth, clarity and insight into the recovery paradigm and its application to short-term art psychotherapy groups.

Lulu and Christopher began with their pre-group process. Their placement of themselves as paper cutout silhouettes poignantly captured and contextualized the co-therapist couple as a recurrent theme in their presentation. They referenced Trisha Montague and James O’Connell’s presentation at the 30th FATAG conference commenting that tension in the co-facilitator relationship could also be valuable. As trainees from two different institutions, the presenters felt their different training styles would be complementary. Lulu cited Marian Liebmann’s seminal Art Therapy for Groups in the reassurance she found from this as a trainee, new to group work, that there could be many different ways of running a group.

The presenters then gave an excellent overview and evaluation of the recovery model, which underpinned the focus of the ward and the therapeutic frame where all participants were close to discharge. Their critical analysis of the three-prong approach (hope, choice, opportunity) was acute and perceptive, calling into question the reality of these guiding principles for forensic patients and whether such a broad approach was appropriate for forensic services.

The presenter’s reflections on the phenomenon of “Gate Fever”, where patients close to discharge are in danger of relapse and finding themselves in more intense services were situated with images of their therapist parallel process on post-group walks passing a fire exit next to a rotting bridge. This was evocative and illuminating in what it came to symbolise of their experience.

Christopher and Lulu explored the room, materials and structure of the group with great depth and clarity. I found their slides gave a feeling of looking into a doll’s house or the internal world of the group. They described how the windows in the room enabled a gesticulation of “in here, out there”. Their use of a hospital chimney to order the materials on a scale of intensity was innovative and effectively resounded with a heat metaphor also reflected in their idea of using a check-in period to test the temperature of the group in terms of how far or how deep they could go.

The presenters gave excellent care and focus to exploring the imagery made in the group. The presentation of these in ornate, gold frames almost pre-empted the grandeur of the House of Lords conference room, but also seemed to signify the value of the work. Here the presenters demonstrated interventions that showed considerable sensitivity to issues of difference and inclusivity, through, for example, their provision of postcards, and speaking about Muslim art. They also acknowledged the unspoken dialogues of culture and identity that they were unable to tap into in terms of group members’ lives “out there”.
The creative use of the pool table, a massive and immobile obstacle in the room, showed therapeutic ingenuity in its use as a “potent visual statement” on which group members placed images on a metaphoric pathway through transition and discharge.

Some of the imagery was immensely powerful. Their description of the production of a clay penis, which had escalated beyond containment in the group, effectively recapitulated the idea of clay as high material intensity in its viscerality or invitation to make body parts. A later image seemed to suggest a shift or transformation in the group from eroticized acting out to a more subtle and contained erotic transference in a striking portrait of a flushed female actress.

Lulu and Christopher ended their presentation with an expression of regret of not using an outcome measure for the work and highlighting the value of co-facilitation and highly charged dynamics of Forensic Services. Their evaluations were lucid and measured concluding that Art Psychotherapy could suit the recovery model, but within this one must accept the unknown.

 

 Image: Reflections on the pictures in the Conference Room, House of Lords

 

Afternoon Presentations

The composition of the three presentations that afternoon was novel and brought staggered angles on some complex issues. There was a shuddering sense of the dynamic drama and of therapeutic ethics in action.

 

1. Restorative Justice Project

Marian Liebmann has worked in art therapy with offenders, women’s groups, community groups, and most recently in the Inner City Mental Health Team in Bristol, UK, where she developed work on anger issues, and work with asylum seekers and refugees. She lectures on art therapy at several universities in the UK and Europe. She also works in restorative justice, mediation and conflict resolution, and has run workshops on art, conflict and anger in many countries. She has written/edited ten books, including Art Therapy and Anger (2008). In 2010 she was awarded her PhD by publications from Bristol University, and in 2013 she was awarded an OBE for services to art therapy and mediation.

Marian brought her wealth of knowledge and expertise on the subject of restorative justice and its application to practice in a highly informative and inspiring presentation. Her consideration of the historical and global context, underlying principles and process brought great depth to the subject and was particularly useful for those who were unfamiliar with restorative justice. Her descriptions of case examples and of her innovative training programmes were compelling in their potential implications for restorative justice as an alternative to punitive judicial systems.

Restorative processes bring those harmed by crime or conflict, and those responsible for the harm, into communication, enabling everyone affected by a particular incident to play a part in repairing the harm and finding a positive way forward.
(Restorative Justice Council)

Marian began by elaborating a paradigm shift from justice founded in punishment, and which prioritises the processing of criminals, to justice founded in restorative processes, which prioritises reparation, victim support and healing. She demonstrated how a restorative model could be achieved through collective group processes, which brought victim and offender together in dialogue through Conferencing or Mediation. Her example of a burglary and family photographs was both poignant and evocative in illustrating that putting a face to crime could bring about reparation for both offender and victim.

Marian’s presentation of the history of restorative justice illustrated this as a practice which was not only growing on a global sphere and in many contexts, but also as being closer to traditional justice or informal courts run without the paraphernalia of punishment. For example, Marian spoke about villages in the Congo Republic where offenders must give a statement of how they will make amends at village assembly. This effectively captured Marian’s idea of restorative justice as a social microcosm.

Marian used case study examples to illustrate the use of mediation or conferencing in the criminal justice system. These were quite moving and succeeded in demonstrating how a reintegration of the voice of the victim in the process could bring about a deep felt remorse and potential for reparation. In her examples of smashed milk bottles and robbery at toy gun point, the integration of victim voice made the destructive human impact heard.

Marian finally guided us through the process of her three-day Restorative Justice Training, which combined a fascinating combination of didactic technique and role-play. This crystallized the many interesting ideas in the presentation into their practice.

Arts therapists are familiar with the concept of reparation from the influence of the British school of Object Relations. Marian’s presentation was compelling in its scope from the individual to the group collective. These ideas are highly relevant to Forensic Arts Therapists.

 

2. Working Agianst the System

Tony Gammidge is a freelance artist, filmmaker, art therapist, lecturer and arts in health practitioner. He has been running video and animation projects in secure and psychiatric settings for the past eight years. In that time he has been involved in the making of thirty short films, eleven of which have won Koestler arts awards. These films have been screened in galleries and arts centres and international conferences including in London, USA, Brighton and Edinburgh. His own films have been screened in the USA, UK and Europe in film festivals and galleries. www.tonygammidge.com

Lucy Gibson-Hill graduated as an Art Psychotherapist from Goldsmiths in 2012.  YOI/HMP Isis was the first experience of working in a secure setting where Art Therapy was delivered through a charity within a pilot programme. Prior (and subsequent) to this Lucy worked as a therapist at an Anna Freud unit for Personality Disorder, a drug & alcohol service, and with addiction and mental health for Kids Company. Lucy also works with young offenders in the community.

Tony Gammidge and Lucy Gibson-Hill presented their work delivering the art psychotherapy strand of the interventional programme. Bringing together their experience of the men’s engagement in art psychotherapy with reflections on the issues they faced both from the institution and the charity that employed them, they individually elaborated their shared theme: “Working Against the System”

 

Working Agianst the System Part 1: Tony Gammidge

Tony Gammidge delivered a highly engaging presentation with a developed critical stance through ideas from the forensic literature, and his own experience and reflections of The Prison. Stating initially a need to disentangle what had happened within this complex, he gave an excellent analysis of the three-strand interventional frame and some startling views of the challenges to an art therapist working against the system.

Opening with an intriguing image taken of vanishing point through a system of girders and reflections on paned glass recalled the vortex motif of classic images of prison corridors and served as an effective visual articulation of the theme of system and its embedding in physical and psychological structure. Situating this alongside a reference to Hillman’s imaginal psychology seemed to invite a deconstructive gaze.

Tony began by commenting that Art Therapy doesn’t happen in a void, but within an institutional frame.  He followed with an excellent overview and critical evaluation of the three-strand approach as interventional framework. Here his particular focus on the mentoring strand, which included both academic definitions and participant comments on their experience of mentorship, was effective in elucidating some of the relational nuances and interventional blurring in the programme. Tony highlighted the absence of art therapist voice in a recent evaluation report as significant and concluded that little (or no) communication between the three strands produced an interventional system where all were working against each other.

In the following part, Tony brought together his own initial experience of the category C prison with ideas from forensic literature in some fascinating reflections on issues of physical and relational security and containment. His idea of the Key Lecture as culture carrier was acutely perceptive, whilst his theoretical elaboration of symbolic aspects of “The Fence” poignantly demonstrated the psychological impact of physical boundaries specific to forensic environments. Here his use of James Gilligan, American psychiatrist and author of the series “Violence”, was particularly well placed in drawing parallels between behavioural and psychological aspects of violence and paranoia as respective partners, and their bearing on the dynamics of shame, which reverberated through the case examples and the culture embedded within the literal, physical and relational boundaries of the prison.

In the final part of his presentation, Tony guided us through two case examples of individual art therapy, focusing particularly on 12 sessions with “Andy”. He drew out the key themes in the work of shame, trust, mistrust, loyalty, betrayal and Andy’s view of himself through the critical eye of the other. The descriptions of the sessions demonstrated a working with and through paranoia and its defences. Here the absence of pictures of the artwork was compensated for by images Tony described, which effectively gave an impression of depth in the work.

Tony’s final conclusions and considerations were hard-hitting in the many questions left unanswered, an uncertainty still entangled with some poignant ethical concerns.

 

Working Agianst the System Part 2. Lucy Gibson-Hill

Bringing together descriptions of art therapeutic group work, context, process, and outcomes, Lucy delivered an intensely engaging presentation, in which she reflected on “the success of Art Therapy despite the system” with some agonizing conclusions. Lucy’s chosen style of absolute genuine honesty was at once brutal and brilliant and gripping from start to finish. This approach was extremely powerful in evoking the complex dynamic texture of the work.

Lucy began with a detailed description of the context and background information, which helped the audience to grasp the immense challenges of the work. This held echo and resonance with Tony as she voiced concerns of being misquoted in a recent report and continued the question of ethics as a thematic undercurrent in the content of their presentation. Lucy showed how she had used her art therapeutic process with image to hold onto hope in spite of the many difficulties being signalled from the beginning.

Lucy introduced the idea of the “gang matrix”, a traffic light system used by Metropolitan police, and reflected on the ambiguities in determining gang membership. This raised some important ethical concerns around participant consent in the interventional programme. Her descriptions of group numbers and membership were excellent and evoked at once her compassion for the men she was working with and a vivid picture of the immensity of the workload.

Lucy demonstrated a mentalization-based approach to the art therapy group work. She described how she was clinically transparent with the men in the  groups and how this approach had enabled intimate themes to be explored, shifts in paranoia and freeing up in the paint allowing a softer side to emerge. Here a level of therapeutic brilliance using this approach was clearly demonstrated, and reflected in an awe-inspiring 90% attendance.

Some of the paintings could be described as visceral, beautiful, and a creative breakthrough given their production with spreaders, as paintbrushes had been prohibited. Lucy responded to the clear expressions of shock and surprise in the audience commenting that the men had paintbrushes inside their cells.

Lucy evaluated the impact of art therapy on other arms of the intervention reflecting that ownership of action and capacity to change in art therapy enabled a shift in restorative justice.

The last part of Lucy’s presentation was immensely moving as she described the premature ending to her work and the implications for both the men she was working with and for herself. It might be described as a testimonial laid bare which left a profound impact of something tragic, unfathomable, brave and heroic.

 

Special thanks:

A special thanks to Janet Gibson, Parliamentary Researcher to Lords McKenzie of Luton and Young of Norwood Green and Lucy Gibson-Hill for organizing an exceptional venue at The House of Lords.

Review by Alice Myles, Honorary Art Psychotherapist, Forensic Directorate, East London NHS Foundation Trust, and Freelance Art Psychotherapist, adult mental health.

 

References and Bibliography:

‘In here’ and ‘Out there’, Lulu Falbe-Hansen and Christopher Burke

Recovery Model References:

Allan J., Barford H., Horwood F., Stevens J., Tanti G. (2015) ‘ATIC: Developing a recovery-based art therapy practice’. International Journal of Art Therapy: Vol. 20, Iss. 1, 2015

Boardman, J and Roberts, J. (June, 2014). Risk Safety and Recovery. Implementing Recovery through Organisational Change programme, a joint initiative from the Centre for Mental Health and the NHS Confederation’s Mental Health

Department of Health (2005) NIMHE Guiding Statement on Recovery.  National Institute for Mental Health in England

Drennan, G. and Wooldridge, J. (2014) ImROC Briefing 10: Making Recovery a Reality in Forensic Settings. Centre for Mental Health and Mental Health Network, NHS Confederation.

South London and Maudsley NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust (2010) Recovery is for All. Hope, Agency and Opportunity in Psychiatry. A Position Statement by Consultant Psychiatrists. London: SLAM/SWLSTG.

Short-term Art Therapy References:

Paola Luzzatto (1997) Short-term art therapy on the acute psychiatric ward: The open session as a psychodynamic development of the studio-based approach, Inscape, 2:1, 2-10, DOI: 10.1080/17454839708413038

Wilson, C. (2002) A Time-limited model of art therapy in general practice Inscape Vol. 7, Iss. 1

Group Art therapy and Co-facilitation References:

Dudley, J. (2001) The Co-therapist Relationship a Married Couple? Inscape  Vol. 6, Iss. 1

Liebmann, M. (2004) Art Therapy for Groups: A Handbook of Themes and Exercises: A Handbook of Themes, Games and Exercises. Brunner-Routledge

Montague, T. and O'Connell, J. (2013) The Good Enough Couple. Presentation of the 30th FATAG Conference

Useful Websites:
http://www.imroc.org/
http://www.mentalhealth.org.uk/help-information/mental-health-a-z/R/recovery/
http://www.signpostuk.org/recovery/recovery-model

Requests for further information are welcome. Please contact: lulufalbehansen@gmail.com

Restorative Justice Bibliography, Marian Liebmann

Edgar, K. and Newell, T. (2006) Restorative Justice in Prisons: A guide to making it happen. Winchester: Waterside Press.

Graef, R. (2001) Why Restorative Justice? London: Calouste Gulbenkian Foundation.

Johnstone, G. (2011) Restorative Justice: Ideas, Values, Debates. (2nd edition) London: Routledge.

Liebmann, M. (ed) (2000) Mediation in Context. London: Jessica Kingsley Publishers.

Liebmann, M. (2007) Restorative Justice: How It Works. London: Jessica Kingsley Publishers.

Shapland, J., Robinson, G. and Sorsby, A. (2011) Restorative Justice in Practice. London: Routledge.

Sherman, L.W. and Strang, H. (2007) Restorative Justice: The Evidence. London: Smith Institute. www.smith-institute.org.uk/publications.htm

Wallis, P. and Tudor, B. (2007) The Pocket Guide to Restorative Justice. London: Jessica Kingsley Publishers.

Wallis, P. (2014) Understanding Restorative Justice: How empathy can close the gap created by crime. Bristol: Policy Press.

Wright, M. (1996) Justice for Victims and Offenders. (2nd edition) Winchester: Waterside Press.

Zehr, H. (2002) The Little Book of Restorative Justice. Intercourse, PA, USA: Good Books.
Useful web sites

Restorative Justice Council, UK
www.restorativejustice.org.uk
European Forum for Restorative Justice
www.euforumrj.org
Web site on world-wide restorative justice. Run by Prison Fellowship International.
www.restorativejustice.org

Working Against the System, Tony Gammidge

Gilligan, J. (2001). Preventing Violence (Prospects for Tomorrow). Thames & Hudson

Hollis, J. (1993). The Middle Passage. Inner City Books