International Art Therapy Practice / Research Inaugural Conference report - Day Two: 12th July 2019
29 January 2020
The inaugural International Art Therapy Practice / Research Conference report on the conference’s Keynote sessions and Round Table discussions: Conference Day Two - Friday 12th July 2019.
The inaugural International Art Therapy Practice / Research Conference was organised by BAAT in partnership with AATA (the American Art Therapy Association). It was attended by more than 700 delegates from over 35 countries around the world. Each day of the conference began with delegates coming together for a keynote session. Thereafter people could choose from a diverse programme of research and practice paper presentations, round table discussions, masterclasses, and workshops. The conference included a small exhibition of facsimiles of works from the Adamson Collection. The International Art Therapy Practice / Research Conference (IATPRC) is now set to become a biannual event. Report on the conference’s Keynote sessions and Round Table discussions by Simon Richardson with photos by Samantha Jayne Fawcett and Lex Bágust.
Conference Day Two - Friday 12 July
Morning keynote session
Dr Rodney Adeniyi-Jones
Interpersonal Biology in Health and Wellness
gave a preamble to Dr Adeniyi-Jones’
s talk on the importance of lived experience in developing art therapy theory. Lived experience can challenge the concept of mental health and its basis in a disease model. Springham suggested that art therapists should approach working with clients not by asking what is wrong with them but rather what has happened to them. This makes the art therapist address issues that go beyond themselves and requires them to experience other ways of looking at things. People who provide services have their own lived experience: Springham is Adeniyi-Jones’s patient. He described the physiological and psychological issues he has had and how he came to be being treated by Adeniyi-Jones. Subsequently, Springham has found that the ideas about the relationship between mind and body he had been reading up about as an art therapist had clear links with Adeniyi-Jones’s work on cellular health. This integrated approach to health and wellbeing was to be the subject of the keynote session.
Dr Rodney Adeniyi-Jones began by talking about how past experiences affect both our physical and mental health. The magnitude of this is often not realised. When working with patients he finds that fifty per cent of what influences a person’s current condition is what has happened in their life and the other fifty per cent is physiological issues. How then do our experiences shape our situation? Adeniyi-Jones talked about the importance for him of going ‘outside the box’ of what is accepted by the medical profession. In the 1990s he looked into the alternative or complementary approaches to healthcare that the medical profession dismissed. Even though there is more evidence for their efficacy now the General Medical Council and National Institute for Health and Care Excellence are still very opposed to them.
Adeniyi-Jones proceeded to outline what is meant by functional medicine. A central aspect of this approach is addressing the underlying causes of disease rather than just focusing on symptom management. How does this work in practice? In training in functional medicine doctors are taught to listen to the patient’s story, look for antecedents that predispose them to illness, identify trigger factors that have set in motion the events towards being unwell, and discover the mediators and perpetuators of the individual’s symptoms. There are two simple questions to be answered: causes and functions. Does the person need to be rid of something or do they have some unmet individual issue that needs to be addressed to enable them to function? Adeniyi-Jones explained the importance of restoring function in the right order so that the body is on side. Doing the right things but in the wrong order can cause any number of problems. Therefore he works to seek the cause first and learn how to diagnose and treat that. Then he works on the ingredients for optimal function which includes things like movement, rhythm, love and meaning.
Adeniyi-Jones then talked about mind body medicine. Every single cell in the body has neurotransmitter receptors, which regulate the way the organs work, and this relationship influences the brain (affecting emotions and cognition). The process of how we perceive what is happening through our bodies - which we refer to in things like gut feelings or other somatic responses to situations - is called interoception. Adeniyi-Jones cited the work of the neuroscientist Candace Pert and, in particular, her book ‘Your Body is Your Subconscious Mind’. Dysfunctional interoception is associated with mental illness. When looking at the mind body relationship the issue of placebos inevitably arises. There is clear evidence that placebos work but what might this mean for the way that doctors treat their patients?
There are a number of components to the placebo effect. Adeniyi-Jones described an observation of the use of sham acupuncture with three groups of patients. Group one was people on a waiting list for acupuncture; group two was people given sham acupuncture; and group three was people given an augmented consultation and then sham acupuncture. At the end of the study group one showed improvement just because people knew they were on the waiting list for treatment. Groups two and three showed a bigger difference between them in improvement than there was between groups one and two; it was clear that the sham acupuncture showed a better result when the placebo was augmented. Obviously, in clinical work with patients a doctor would not give a sham treatment. However, the evaluation showed how the mind affects the body and the benefit to treatment if a doctor works with an awareness of the value of the relationship they create with their patient.
Adeniyi-Jones then discussed mirror neurons (which were first discovered during a study of primate behaviour). They fire both when a person acts and when the person observes an act performed by another. The neuron ‘mirrors’ the behaviour of the observed other, as though the observer were themselves performing the action. This does not only happen with physical actions. Experiments have shown that if a mouse suffers a painful stimulus it has a pain spike. If it sees another mouse suffer pain it has a similar mirror neuron spike. Mirror neurons have a lot to do with understanding empathy. If we see someone in pain we do not just sense / emotionally respond to them but have a bodily / felt response to their situation. This process enables us to determine other people’s intentions as well as their actions. In every interpersonal interaction there is a ‘two-way chatter’ between the brains and bodies of both participants which is beyond consciousness. If as doctors or art therapists we know this is happening, how might it be used in our interactions with patients?
Adeniyi-Jones talked about how our thoughts affect our genes. Thoughts affect both the signalling that goes on in the body and what neurotransmitters tell the body. Signals go from the membrane into the nucleus and affect the expression of the genes. He explained how stress accelerates telomere shortening; a telomere is a region at the end of a chromosome which protects it from deterioration or fusing with another chromosome. Numerous studies show that telomere shortening happens when people are severely stressed. Diet, sleep, and exercise can mitigate the shortening of telomeres. The opposite happens when someone is relaxed and the relaxation response alters the genome in protective ways. Adeniyi-Jones cited a study that looked at long term meditators and those who have never meditated. Considerable differences were noticed between the genes of the two groups. The people who had never meditated were then taught to meditate and the effect measured eight weeks later. While it was found there were still differences between the two groups, the ‘never mediated’ group were already showing positive improvements.
Short term stress can be a powerful, useful stimulus but it is the longer term maladaptive stress that causes damage. Adeniyi-Jones explained that the majority of mechanisms by which stress causes damage to health involve inflammation. This is an appropriate bodily response when someone has a physical injury, such as bruising, but when inflammation results from long term stress it can be very damaging. Immune cells in the brain produce the same kind of inflammation that the body does. Inflammation of the brain makes depression worse, which in turn worsens the inflammation and so on in a vicious circle. Treatment could involve working to break out of this cycle both cognitively and chemically. The autonomic and endocrynomic systems are the mediators of the effects of the mind on the body. They regulate all metabolic control mechanics in a very finely balanced way. The vagus nerve (one of the cranial nerves that connect the brain to the body) is often used as a surrogate marker for the state of the autonomic nervous system.
Adeniyi-Jones showed how this links to the spontaneous repair and recovery that happens throughout a person’s life. This is going on all the time; for example, knocks and bruises are the body repairing and healing itself. The body does the healing even when there has been a medical operation to repair a physical health issue. Functional medicine and psychological interventions can facilitate self repair. Adeniyi-Jones talked about stem cells and how they can be activated. There is a process of continuous repair that replaces aged or damaged cells. Our thoughts affect our stem cells. He described how the organ reserve of stem cells can be seen to have diminished before the onset of illness. Because of this, building or rebuilding the organ reserve is a key factor in sustaining wellness.
Neuroplasticity is the brain’s ability to change neural synapses and pathways in response to factors like behaviour, environment or neural processes. Adeniyi-Jones explained that this process is highly fluid and dynamic, happens throughout a person’s life, and shows that the brain is much more open to repair than was previously thought. The production of neurons mostly happens in the hippocampus and the amygdala and these are the areas where, with appropriate treatment, significant changes can be made in an individual’s physical and mental health. Adeniyi-Jones cited the case of a forty-four year old patient. Before meeting with him she had been treated for fatigue and told she was cured, but felt no better. Adeniyi-Jones did tests which showed anti-bodies to twenty-five foods out of two hundred and seventy tested. Every time she had one of these foods it was causing inflammation and illness. She also slept wih a mobile phone at her bedside. He began treatment with these aspects of her lifestyle in mind.
At eight months the patient was much improved but at a year she suddenly relapsed. At fourteen months Adeniyi-Jones did an assessment and detected emotional stresses in her body from 2004. The patient talked about her brother having been ill at that time. He had come to stay with her and she looked after him for several weeks. However, she could not cope with his behaviour and eventually kicked him out. In 2007 he tried to contact her, she rebuffed his approach, and shortly after this he died. The patient described experiencing a ‘heartsore’ feeling following on from this, something she had come to accept as part of her life from then on. Adeniyi-Jones began psycho-sensory stress release sessions with her (working with both her physical and psychological issues) and her condition improved.
Adeniyi-Jones closed by talking about how our cells are symbiotic units but each one of us is made up of a community of billions of cells. They all work together but at the same time they all function as individuals. Equally, the community we live in is a super-organism of which we are an individual part but in which we are totally interdependent. This interdependence is greater now than earlier on in human evolution. Adeniyi-Jones posed the question: how can we as doctors or art therapists use this knowledge? Being in a group has a powerful effect on inflammation. Altruism has a powerful effect on inflammation. He suggested we can all go out and ‘be a placebo’, referring back to the sham acupuncture groups observation he described. Adeniyi-Jones cited the advice of the neuroanatomist Jill Bolte Taylor to ‘take responsibility for the energy you bring’. He concluded his talk by saying that if we come to a personal or therapeutic encounter with the consciousness that our state is being mirrored in the other person, we have the potential to influence their physiology positively.
Neil Springham responded to the presentation by talking about how his practice as an art therapist has been influenced by the ideas and treatment he has received from Dr Rodney Adeniyi-Jones. These included a therapeutic optimism, taking a client’s history and not treating them as symptoms, being aware of how he responds to the client, and not simply being a blank surface for them to project on to. Springham noted that cells specialise but they also communicate. He suggested that, similarly, in art therapy research there is a need to communicate with other disciplines and approaches; not try to become specialists in them but to learn how to work in partnership with the specialists from these other areas.
Watch Dr Rodney Adeniyi-Jones TEDx talk to City University ‘Decelerate and find what works for you
Round Table Discussion
Art Therapy in Education: Challenges, Opportunities and Best Practice
The members of the Round Table panel:
Alex McDonald, BAAT, UK
Deirdre McConnell, One Education, UK
Unnur Ottarsdottir, Reykjavik Academy, Iceland
Gina Alfonso, Save the Children, Philippines
Beth Gonzalez-Dolginko, Private Practice, USA
Chair of the discussion:
Professor Sarah Deaver, Eastern Virginia Medical School, USA
The round table discussion began with each panel member talking about the setting(s) in which they work and then offering a ‘provocation’ to the others. The imbalance between children in need of art therapy services and the sparse or non-existent provision was a core issue in each panellist’s introduction. This was often a result of a lack of evidence for the efficacy of art therapy that commissioners will accept, even though in educational settings the value of children seeing an art therapist is well known. The different ways art therapy can help children with learning, as well as social, emotional and mental health, was also highlighted by three speakers. This can happen in a practical way, through children remembering what they are taught better by drawing what they learn. It can also be an outcome of psycho-social programmes, whereby children traumatised by violence or abuse who access art therapy are subsequently able to attend mainstream schooling. The need for there to be standardised approaches to practice, such as toolkits for art therapists working in schools, was also highlighted.
Sarah Deaver opened the discussion by saying that regular record keeping could be a start for building the case for art therapy in schools because in the US, school counselors have kept meticulous records of the positive outcomes of their work, leading to laws mandating counselors in every school. Lynn Kapitan added that there is a lot of ‘disappearance’ of art therapists in schools, either because they are not licensed or are employed in a generic post. She knew of several programmes for art therapy with children on the autistic spectrum that had been cancelled because of a lack of evidence for its effectiveness. Alex McDonald said a similar situation existed in the UK. She felt art therapy research is being held back because approaches to practice are so individual. She is setting up an evaluation project with four art therapists. They will work with clients in a standardised way, so that outcome data collected can be compared across settings.
Beth Gonzalez-Dolginko offered evidence based research about the efficacy of art therapy in public schools in New York State and strongly suggested art therapists needed to publish about the work they are doing in schools and to communicate more with other professions about how they work, even though some would inevitably ‘borrow’ some of the techniques they were shown. Deirdre McConnell agreed with this. She emphasised that the bias in educational systems themselves privileges cognition over affect. So art therapists are called to an advocacy role in helping school and other staff understand the power of relationality and of creative nonverbal therapy work, in processing emotion. When early trauma manifests later as 'behaviour' that schools find difficult to cope with, new languages have to be found to help different staff and professionals understand their pupils. This is a powerful dynamic process and can avert permanent exclusions from school. McDonald also noted that it is important to give the children a voice in the evaluation and commissioning of their own services and suggested that participation in research is essential in this process, as they have much to contribute as experts by experience. Deaver added that licensing (in the USA) assists the process of differentiating approaches, meaning art therapy is clearly delineated as a practice.
A contributor from the floor talked about the situation in Israel. Most of the schools have an art therapist; there are over three thousand working across the country. However, nobody seems to be interested in finding out how art therapy works and there are few if any grants available for research. She is working with colleagues doing a participatory research project to see what people are finding is effective in their workplaces. One problem they have had is being able to set up a control group. As all children in Israel have access to art therapy it is difficult to find any who have not had it. McDonald agreed that evaluation studies can sometimes show mixed outcomes for art therapy and it is then important to look at the control measures being used.
Gina Alfonso was asked about the use of GNOWBE apps for micro-learning, which she had mentioned in her introduction. She explained that training teachers to integrate the arts into their classrooms with Save the Children, often in post-conflict or post-disaster zones, means that follow-up support to teachers is not accessible after the trainings. The app enables you to upload prompts for art activities and other visual material, and seemed to have potential, particularly for sharing success stories, etc. Unfortunately, the app was too hard to use. The questioner talked about her use of similar types of apps in her practice in Australia with children in remote areas. Because of the size of the country, she was trying out various apps to see which were most useful. A colleague from Canada talked about similar issues for her in working with children in isolated communities. She had been using digital versions of therapeutic board games to help the children build skills in social awareness and citizenship. Another contributor, from Chile, talked about her experience of using visual apps in schools; they can be helpful because there are high rates of immigration and many children speak Spanish as a second language.
An art therapy colleague from Zambia talked about working with adolescents and the stress they often experience. She recalled working with a class near the end of term where the students still had a lot of work to complete. They were set the task of drawing anything they wanted and within thirty minutes were talking about a host of issues not related to their course work. While these students were present in the classroom they were not really ‘present’ at all. Art making helped them talk about external issues affecting their school work but she also felt they could benefit from the kind of apps and support mentioned earlier.
Chris Woods asked Unnur Ottarsdottir about her research (in her introduction) which shows that drawing can help children remember what they are taught better than just writing it down. Woods asked if there is any research evidence to back this up, as it seemed so obvious to art therapists. Ottarsdottir described the research she had done in 2000, which was the first time the phenomenon had been systematically studied. She felt that both the subject and the method needed further testing and research. Woods thought this was something educationalists ought to be interested in and wondered why they seemed not to be. Ottarsdottir talked about the challenge involved in training other practitioners so they will become aware of the art therapy thinking regarding the emotional content involved in memory drawing. Kapitan closed the discussion by suggesting that art therapists work within an ethical framework. Explaining this framework to other professionals was the way to show what art therapist are trained to do.
You can find the Conference Report from Day One on 11th July 2020 here
The International Art Therapy Practice/Research Conference was held on 11-13 July 2019 at Queen Mary University of London, Mile End Road, London.
You can see highlights from the conference on Twitter using #ArtTherapyIntConf
Find out about The 10th Attachment & the Arts Conference: The Relational Human Body on 10th July 2020 at Mary Ward House Conference Centre, London here
You can see highlights from the Attachment & the Arts conference 2018 on Twitter using #AttachmentArts