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Group Interactive Art Therapy

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The first edition of Group Interactive Art Therapy presented the first theoretical
formation of a model integrating the change-enhancing factors of both inter-
active group psychotherapy and art therapy, demonstrating its use in practice
through a series of illustrated case examples. This long-awaited second edition
updates the content of the original in light of the major social, cultural and polit-
ical changes of the past two decades and presents new examples of the model in
practice.
The new edition includes a brand-new section on the use of group interactive
art therapy in research with people with dementia, people with schizophrenia and
those in rehabilitation from a stroke. The book also features two chapters on the
use of the model in a broader context. The book is presented in four parts:

• introducing group interactive art therapy;

• the model in practice: case examples;
• developments of the model in social contexts;
• group interactive art therapy used in research.

Each part demonstrates the flexibility and adaptability of the model in different
cultural and social settings and with a variety of client groups. The development
of knowledge about the skills required for conducting an interactive art therapy
group and its suitability for different clients has been incorporated throughout
the book, alongside practical information on working in areas where there is
limited access to art materials.

Diane Waller, OBE, is Emeritus Professor at Goldsmiths University of London.

Extensive travel and study with her late husband Dan Lumley contributed to her
commitment to promoting intercultural understanding in the arts therapies. She has
been a pioneer of training in art psychotherapy and intercultural therapy and is the
author and editor of many previous books, including Arts Therapies and Progres-
sive Illness and Treatment of Addiction: Current issues for arts therapists.
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 Group Interactive Art
Therapy
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Its use in training and treatment

Second Edition

Diane Waller

Routledge
Taylor & Francis Group
LONDON AND NEW YORK
 Second edition published 2015
by Routledge
27 Church Road, Hove, East Sussex, BN3 2FA
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2015 Diane Waller
The right of Diane Waller to be identified as author of this work
has been asserted by her in accordance with sections 77 and 78
of the Copyright, Designs and Patents Act 1988.
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All rights reserved. No part of this book may be reprinted or

reproduced or utilised in any form or by any electronic,
mechanical or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
First edition published by Routledge 1993
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Waller, Diane, 1943– author.
Group interactive art therapy : its use in training and treatment /
Diane Waller. – Second edition.
p. cm.
Includes bibliographical references and index.
I. Title.
[DNLM: 1. Art Therapy–methods. 2. Psychotherapy, Group–
methods. WM 450.5.A8]
RC489.A7
616.89'152–dc23 2014019570
ISBN: 978-0-415-81575-8 (hbk)
ISBN: 978-0-415-81576-5 (pbk)
ISBN: 978-1-315-74428-5 (ebk)
Typeset in Times New Roman
by Wearset Ltd, Boldon, Tyne and Wear
 In memory of my late husband Dan Lumley whose
contribution to this work is invaluable.
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 Contents
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List of figures x
List of plates xii

PART I
Introducing group interactive art therapy 1

Introduction 3

1 Groups and art therapy 7

2 Interactive group psychotherapy 26

3 Curative factors in groups 39

4 Conducting an interactive art therapy group 45

5 Practical matters: materials and rooms 54

6 Using themes or projects within an interactive model 62

7 Short-term interactive art therapy groups 75

8 Group interactive art therapy with children and adolescents 83

PART II
The model in practice: case examples 93

Introduction 93

9 Case example 1: rooms and materials 95

 viii Contents

10 Case example 2: the unwilling participant(s) 103

11 Case example 3: developmental processes in a group

painting 107

12 Case example 4: life processes in small group

environments 111

13 Case example 5: images of the group 113

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14 Case example 6: catharsis 116

15 Case example 7: power and domination 119

16 Case example 8: splitting in the group 126

17 Case example 9: expressing anger symbolically 130

18 Case example 10: example of a theme arising

spontaneously 132

19 Case example 11: boundary violation and scapegoating in

a training group 135

20 Case example 12: working through a crisis 143

21 Case example 13: ending the group 148

PART III
Developments of the model in social contexts 151

22 The theatre of the image and group interaction

Francesca La Nave 153

23 The visible city and the invisible shame

Jenia Georgieva and Roumen Georgiev 165
 Contents ix

PART IV
Group interactive art therapy used in research 181

24 Using group interactive art therapy with older people with

moderate to severe dementia: 1996–2005 183

25 Using the model with people with long-term

schizophrenia 185
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26 Using the model with patients in rehabilitation from

stroke 187

Concluding thoughts 189

Bibliography 191
Index 197
 Figures
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6.1 Example of a ‘self-box’ 63

6.2 Example of a ‘self-box’ 64
6.3 Image of the conductor 67
6.4 Image of a group member as a cat 67
6.5 Preparing to make a life-sized portrait (body image) 68
6.6 Preparing to make life-sized portraits (body images) 68
6.7 Reflecting on each other 69
6.8 Fixing up a body image 69
6.9 Body image 71
6.10 Clay model of family group with a stork and mask 73
6.11 Clay model of family in a ring 74
8.1 Two figures from a young people’s group 89
8.2 Two figures from a young people’s group 90
9.1 Conference room, Medical Academy, Sofia 100
9.2 Studio at Netherne Hospital in the 1950s 100
9.3 Attic and greenhouse, Torvaianica Therapeutic Community 101
9.4 Hut used for art therapy workshops, Art Psychotherapy Unit,
Goldsmiths College 101
13.1 Group as a fountain and bullring 115
13.2 Conductor spying on the group 115
15.1 Small group themes: making individual objects 120
15.2 Group talking and making 120
15.3 Group making a ‘welcome house’ 121
15.4 Power struggles: black man and white man 122
15.5 Image of pregnant woman with food under her skirt 124
16.1 Devilish body image 126
16.2 An unwilling icon 128
17.1 ‘It’ won’t let me . . . 131
17.2 ‘It’: a devilish figure 131
18.1 Egg and bird. 133
19.1 Making an environment 140
19.2 Making an environment 141
 Figures xi

20.1 Going away to the West 145

20.2 Detail of ‘Going away to the West’ showing gun, passport,
cheque book and dictionary 146
21.1 The end of a week-long workshop 149
21.2 Clearing up 149
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 Plates
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1a Different body images

1b Body image
2a Body image
2b Body image
2c Body image from a young people’s group
2d Group image, including dolphin and vulture
3a King and Queen on Castle 2
3b Tribe
3c Abstract 1
3d Carrier
4a Making an environment for self-boxes
4b Making an environment for self-boxes
5a An example of an environment: ‘childhood’
5b An example of an environment: ‘secret room’
6a The power of the State
6b The psychiatric hospital
6c The eye of the therapist
6d Group as a train
7a Devil mask
7b Racing car
7c A trio of body images
8a Henrietta
8b Environment with plants
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Part I

Introducing group
interactive art therapy
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 Introduction
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A brief definition of group interactive art therapy

It is, astonishingly, more than 20 years since this book was first published. In
that time, many of the people who were so central to its conception and birth
have died. Some of the countries where I developed the model have experi-
enced major change and even civil war. It has thus been a particularly difficult
and painful emotional experience to return to the original text and to do the
necessary revisions. The world has changed, the structures of and the language
of health and social care have changed, and so have I. I was glad to be able to
write a brief but updated paper for Cathy Malchiodi’s Handbook of Art
Therapy (Waller 2003 and second edition 2012: 353–67) which gave a chance
for some of the feedback from colleagues, a new case study and my own
reflections to be included. This helped in the current task, to review and add to
the original 1993 manuscript, to update the literature and to include thoughts
on the kind of training and experience needed to practise the model, develop-
ments of the model in a social context and how it can be adapted for research.
I have though left most of the original Case Examples intact as they continue
to illustrate the theoretical points.
The model of ‘group interactive art therapy’ is based on concepts from group
analysis, interactive (or interpersonal) group psychotherapy, systems theory,
process sociology and art therapy. It is an evolving model which in its theoret-
ical base incorporates the work of Foulkes, Stack Sullivan and Yalom; and lat-
terly Agazarian and Peters and Astrachan, who have introduced a ‘systems
approach’ to group psychotherapy. A period of study in the mid-1990s at the
University of Leicester’s Centre for Research into Sport headed by Professor
Eric Dunning (famous for his studies of football) was the unlikely location I dis-
covered for bringing together the ideas of many of the above people and theories
which are so important to me. Being very interested in sport and responding to
an advert for a distance-learning MSc in the Sociology of Sport, I discovered the
Centre’s commitment to the process or figurational model of sociology
developed by Norbert Elias, a colleague of Sigmund Foulkes, who as we know
was a very prominent figure in the evolution of group analysis in Britain. I had
 4 Introducing group interactive art therapy

used a process model of professions in my PhD thesis, completed in 1990,

without being fully aware of the connections between Elias, his former student
and colleague Eric Dunning, and Foulkes. I had also done my group analytic
psychotherapy training under the eagle eye of Dr Ilsa Seglow, without knowing
that she had been a student of Elias’ and written her PhD on ‘The profession of
Actor’. Later I found that Earl Hopper, who has developed Bion’s theories of
Basic Assumptions, was a student of Eric Dunning! So I can truthfully say that
the model of group interactive art therapy continues to evolve, with both con-
scious and unconscious influences and a fair measure of serendipity. These kind
of discoveries are such a part of the creative process, and they are at the heart of
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both art therapy and group psychotherapy as I understand them.

Group interactive art therapy draws on fundamental principles of art therapy.
These are: that visual image- (or object-) making is an important aspect of the
human learning process; that image-making (and this includes painting, drawing,
clay-work, constructions, etc.) in the presence of a therapist may enable a client
to get in touch with early, repressed feelings as well as with feelings related to
the ‘here-and-now’; that the ensuing art object may act as a container for
powerful emotions that cannot be easily expressed; and that the object provides
a means of communication between therapist and patient. It can also serve to
illuminate the transference (that is, feelings from the past which are brought into
the here-and-now and influence the way that we experience others) between the
therapist and patient.
I began the exploration of this model by giving an idea about the way in
which concepts of group psychotherapy and art therapy have evolved from about
the 1940s. I included discussion of the work of art therapists who have written
about groups, particularly the group analytic or interactive models. I have drawn
attention to the early debate in art therapy literature about ‘directive and non-
directive’ approaches to art therapy and their relative merits, which was launched
by McNeilly in 1983, and shown how this gave rise to an interesting discussion
about the role of theme-centred interaction in art therapy groups and about struc-
turing the group’s time between image-making and talking. I have discussed
more recent texts which explore using art therapy in groups. Throughout the first
edition I drew fairly extensively on those authors who have presented and
developed the ‘interpersonal’ approach to group psychotherapy (for example,
Yalom, Ratigan and Aveline, Bloch and Crouch) and this has not changed in the
revised edition.
Introducing art therapy to an interactive group changes the dynamics of the
group. I have pointed out aspects of the interactive group which are generally
held to be curative and described how art therapy may enhance its treatment
potential. At the same time, the introduction of art materials makes specific
demands upon the conductor and the group members and I have explored what I
feel are the main issues involved in the leadership of an interactive art therapy
group, expanding in this edition on particular skills that are needed to ensure the
effectiveness of the model.
 Introduction 5

The theoretical elements of the book are illustrated by examples from practice
– my own and others – to show how the model can be adapted for use with train-
ees from different backgrounds (medicine to art) and clients (from more or less
well-functioning adults to people with learning difficulties and progressive
illness).
As one of the most important learning experiences for me has been in
working abroad in societies and cultures very different from that of the UK, and
I firmly believe that therapists need to be aware of their own cultural and racial
biases, I have tried to give the book a ‘cross-cultural’ flavour. I have tended to
use ‘client’, ‘patient’, ‘participant’ and ‘member’ to describe group members,
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depending upon the context of the group.

Names of all participants and, in some cases, the location of the group have
been changed in order to protect confidentiality.
I would like to acknowledge the following, with grateful thanks:

All the group members and interpreters,

Centro Italiano di Solidarieta, Rome,
Art Therapy Italiana, Bologna,
Inper, Lausanne,
Fausto-Sergei Sommer, Bern,
Centre for Arts and Therapy, Athens,
Medical Academy, Sofia, Bulgaria,
Department of Psychiatry, University of Zagreb,
Teresa Boronska,
Netherne Hospital, Coulsdon, Surrey (photograph of the studio),
Nick Tipton (photograph of the Art Psychotherapy Unit hut),
Juan Corelli,
Nizetta Anagnostopoulou,
Professor Mike Crawford and Professor Helen Killaspy, Matisse Group Art
Therapy research project,
Professor Jenny Rusted and Dr Linda Sheppard, Apollo Group Art Therapy and
Dementia research project,
Barry Falk, Finlay McInally, Tony Gammidge, Art psychotherapists and
researchers,
Dr Khalid Ali, Art therapy in stroke rehabilitation research project, members of
the art therapy group who made the Juggling Clown image on the front cover,
and the film Circus Dreams,
My friends Dr Istvan Hardi and Dr Guy Roux whose support and encouragement
for the past 30 years has been invaluable.

Sadly, in the past 20 years the following friends have died:

Dr Maria Belfiori (Director, Art Therapy Italiana, Bologna)

Fr Mario Picci (President Centro Italiano di Solidarieta, Rome)
 6 Introducing group interactive art therapy

Juan Corelli (Vice-President Centro Italiano di Solidarieta)

Dr Irene Jakab (President of the International Society for the Study of the Psy-
chopathology of Expression and Art Therapy – SIPE, New York)
And my husband, Dan Lumley, who had worked with me on many occasions,
taking the photographs, leading the art practice workshops and providing a
warm and down-to-earth presence.
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 Chapter 1

Groups and art therapy

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Some brief background notes on group

psychotherapy and art therapy
The theory and practice of group psychotherapy, in its many forms, has been
well documented; that of art therapy increasingly so. Events following the
Second World War led to group psychotherapy and art therapy being integrated
into rehabilitation movements – especially into the rehabilitation of war-
traumatised victims. In 1942, Wilfred Bion from the Tavistock Clinic was placed
in charge of the military training and rehabilitation wing of Northfield Hospital
where he had to rehabilitate and return up to 200 men to the army. He used
‘group dynamics’ to encourage the men to learn a way of coping and adapting to
inter-group tensions. Although Bion and his colleague Rickman were successful
in rehabilitating many patients, their approach was not appreciated in the pre-
vailing military-oriented system and they were transferred. Foulkes went to
Northfield in 1943 where he joined Harold Bridger, Joshua Bierer and Tom
Main. They too made use of group psychotherapy but took care to integrate their
approach into the overall treatment philosophy and hence were able to stay on,
with much success (see Bridger, 1946; Foulkes, 1948; Aveline and Dryden,
1988a). After the war, Bion, Sutherland and Bridger went to the Tavistock Clinic
and were joined by Henry Ezriel. Foulkes went to the Maudsley and Main went
on to the Cassel Hospital where he developed the concept of an analytically ori-
ented therapeutic community. Joshua Bierer organised social clubs among
patients, using Adlerian concepts as a basis for his work (see Bierer, 1948). He
was responsible for forming the British Association for Social Psychiatry which
emphasises the importance of patients’ own contribution to their treatment
programmes.
In 1952 the Group Analytic Society was formed, together with a journal, Group
Analysis, and later the Institute for Group Analysis was established by Foulkes and
played a central role in developing training and standards of practice.
In the USA, important advances, deriving from social psychology, were made
by Kurt Lewin and his colleagues. Lewin proposed that an individual’s personal
dynamics are bound up with the social forces which surround him or her (Lewin,
 8 Introducing group interactive art therapy

1951). Just after the Second World War, Lewin used his model to train com-
munity leaders who were trying to work with multi-cultural groups where there
was much racial tension. The National Training Laboratory was formed in 1950.
The aim of the laboratory was to provide a training for participants from many
different professional backgrounds in group work and interpersonal dynamics so
that they might more effectively conduct their own groups. This was the begin-
ning of the ‘Sensitivity’ movement, which led to the ‘Encounter’ movement and
to the development of ‘Esalen’ in California in 1962. Numerous similar centres
developed all over the USA and elsewhere, including in Britain (e.g. Quaesitor,
in London). The Encounter movement was to have a strong influence on some
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British art therapists in the late 1960s and early 1970s.

Ruitenbeek (1970) points out that, regardless of claims made by various
people as to them being the ‘inventors’ of group psychotherapy, it is clear that
no one person was the originator and that in itself might have been a reason for
group psychotherapy being conceived and developed in a fairly ‘open’ context.
In contrast, even though the situation has obviously changed to some extent in
the past two decades, not only because of the changing attitudes among
‘orthodox’ psychoanalysts but because of the changing sociological context in
which treatment of mental health problems takes place, individual psycho-
analysis was and is still tied to the heritage of Freud and many techniques and
styles are part of his work and inventive spirit.
Ruitenbeek suggests, and I am inclined to agree with him, that in a dynamic
and pragmatic society like the USA, orthodoxies do not last long, or they are
questioned and new models arise as a result of the synthesis of old and new.
Experimentation within the confines of traditional psychoanalysis is difficult but
group psychotherapy provided the right kind of framework for such experimen-
tation – for example, in time (not being tied to the 50 minute hour), in manner of
approach (psychodrama, encounter, etc.).
Individual analysis, confined as it often is to the wealthier strata of society,
has been less able to cope with problems engendered by the pressures of change
and breakdown of secure networks in modern day life – not only in the West but
worldwide – which leads people to feel alienated and unable to make close rela-
tionships. Many patients who are referred to, or refer themselves to, psychother-
apists, have problems which turn out to be mainly societal in origin, and
although there is usually also a personal component, it is not helpful to ‘patholo-
gise’ the patient’s problems. This is particularly important when considering the
treatment of persons from different cultural or ethnic backgrounds from the pre-
vailing one, and recent research (begun in the UK by Littlewood and Lipsedge,
1982) reveals the dangers inherent in failing to take this into account. One of the
most telling conclusions of their current research is that mental illness can be an
intelligible response to racism and disadvantage. Farhad Dalal has written elo-
quently about such matters in Race, Colour and the Process of Racialization
(2002). Given the huge shift in populations that are happening all over the world,
many as a result of war and economic hardship, it is almost certain that art
 Groups and art therapy 9

therapists and group psychotherapists will work with clients from many different
races and cultures. It is imperative that sensitivity to cultural issues is included in
training – not as an ‘add on’ but as a central aspect.
Group psychotherapy could prove an important medium in which to explore,
come to terms with and, more importantly, change an intolerable situation in
one’s life through intimate contact with others. It could also present an oppor-
tunity to enrich those relationships already existing, even if limited by physical
disease or mental health problems. There is still a lack of awareness among
general practitioners and other referring agencies about the value of group
psychotherapy. This, combined with the reservations and anxieties that people
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may feel when a group is mentioned, means that many people who could benefit
from groups are instead referred for individual psychotherapy or counselling.
Worse, they might be referred to a group because it is ‘cheaper’, thus giving the
impression that it is an inferior form of treatment, which it most emphatically is
not. It is to be hoped that through increasing training in group psychotherapy for
health care professionals, teachers, social workers and other workers engaged
with the general public, such attitudes will change.
As far as the history of art therapy is concerned, it too depended partly on the
Second World War rehabilitation movement for its development in Britain.
There had been, however, a tradition of artists going to work in hospitals (both
general and psychiatric) throughout the early part of the century. Often their aim
was to provide a relaxing and creative release from the tedium of convalescence
following a serious operation or during a long-term illness such as tuberculosis.
Occasionally artists were asked by doctors to stimulate patients to produce paint-
ings which could be used as an aid to psychiatric diagnosis.
The term ‘art therapy’ is thought to have been coined in 1942 by the artist
Adrian Hill to describe the work he was doing with recuperating tuberculosis
patients at the King Edward VII Sanatorium in Sussex. He discovered that not
only did painting provide patients with a way of passing the time but it gave
them a medium through which to express anxiety and trauma. Being an ener-
getic, well-known public figure, Hill conducted successful campaigns to have
‘art therapy’ used more widely, in general and psychiatric hospitals as well as
sanatoria. The Red Cross picture-lending library of the Second World War in the
UK was a trigger for the artist Edward Adamson to be employed at the Netherne
psychiatric hospital. The studios he developed, together with a large collection
of artwork from patients were the inspiration for many a beginning art therapist
in the 1960s and after.
It was also in 1942 when Rita Simon, an artist and illustrator, ‘accidentally’
began to work in Joshua Bierer’s patients’ social club in north London. Her
developing interest in Adlerian psychology and later her own analyses, com-
bined with her deep involvement in art, led to a long and distinguished career in
art therapy with her special contribution being to the initiation of training and
practice in Northern Ireland where she lived throughout the wartime period
named ‘The Troubles’.
 10 Introducing group interactive art therapy

In the 1940s and 1950s, it is fair to say that, within hospitals art therapy was
not practised as a form of psychotherapy, but it provided a valuable expressive
outlet for patients who could not respond to verbal therapy (e.g. long-stay,
chronically ill, psychotic). It was however incorporated into a psychodynamic
model of treatment in some private centres, notably the Withymead Centre,
which was founded by Dr Irene Champernowne, a Jungian analyst, and her
husband, in 1942. Other psychoanalysts also made extensive use of drawings as
a central aspect of their work (Milner, 1950, 1969; Winnicott, 1951, 1971).
Art therapy developed two parallel strands: art as therapy and art psycho-
therapy, with Hill representing that aspect of art therapy which emphasised the
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‘healing’ potential of visual art activity and Champernowne the importance of

the relationship between the therapist, the patient and the art object – which
included paying attention to transference phenomena. These two strands have, to
some extent, merged over the years but there was still a lively debate in progress
(focussed on the name of the profession: art therapy or art psychotherapy) as to
the ‘true essence’ of art therapy. The matter was resolved by the Health Profes-
sions Council1 which regulates art therapy under the Health Act, when in 2005
art therapists were able to choose their own protected title: either Art Therapist
or Art Psychotherapist. There is no doubt (according to the literature at least)
that art therapists today place more importance on the dynamics of the therapist–
patient–object interaction, which in no way detracts from the power of the image
to communicate, express and aid integration of conscious and unconscious
processes.
(See Waller, 1991, 2013 and Hogan, 2001 and www.baat.org for a detailed
account of the history of art therapy and the issues touched upon above.)

Using art therapy in groups

In the following section I will outline some of the main developments in the use
of art therapy in groups, mainly by reference to the literature in Britain and
the USA.
The work of some of the pioneers of art therapy certainly involved group
work, usually in open studio settings, with an informal structure rather like that
found in art school studios of the time (1950s and earlier). Edward Adamson
was a notable example, pioneering art therapy within Netherne Hospital in the
1940s, initially as a participant in a research project with Drs Cunningham-Dax
and Reitman and then developing his approach within the spacious studios of
this Victorian asylum. When they worked in hospitals, the majority of art thera-
pists were reliant on their own experience of studio groups, or of teaching in
adult education classes or school. In the hospital groups, patients would come
and go, paint and draw in their own time when the studio was open and the ther-
apist present. The interaction between the tutor/therapist and the individuals in
the room reproduced a familiar art student–tutor dynamic: individuals could
discuss their work with the therapist and as this was supposed to be ‘private’ it
 Groups and art therapy 11

often consisted of whispered conversations in a corner of the room to the exclu-

sion of other patients. Patients were often subtly influenced by each other’s pro-
ductions in the shared space of the art room. The space became like the artwork
itself – personal yet at the same time public and shared – and could be entered at
the discretion of the artist–tutor/therapist.
Art therapy groups (as opposed to studio sessions) evolved in the late 1960s
out of an understanding and growing awareness on the part of the tutor/therapist
of the effect of their presence on the members of the group. Art therapists were
becoming aware of and curious about new ideas in group dynamics stemming
from movements in the USA, particularly in California, such as Encounter,
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Esalen and their British counterparts, mentioned earlier on. Some embraced the
‘growth movement’ to such an extent that they temporarily abandoned art
therapy though the majority of art therapists were wary of (at least the extremes
of ) these movements. Jungian trained art therapists tended to be vociferously
against the use of groups in art therapy. The advent of ‘performance art’ and
interactive exercises in the art school curriculum led some artists to try and
incorporate these approaches into their work as therapists. Those who became
interested in groups found that unconscious themes of the group were often
reflected in the images made by group members, allowing a powerful group con-
sciousness to develop. (This phenomenon is known as ‘resonance’ and is
explored further on p. 18.)
In the 1970s, more formal small group sessions developed in which the thera-
pist paid attention to boundaries of time and space – that is, the group would
happen at a set time, in a set place each week rather than taking place in an open
studio at the convenience of the individuals. These groups had defined member-
ship and a commitment was expected. Sometimes the formation of these groups
met with resistance as they aroused strong feelings and lacked the informality of
the studio groups. Gradually, in the 1980s and 1990s, some art therapists trained
in group psychotherapy and either practised these two professions separately or,
more often than not, tried to combine the insights from both.
Many art therapists now work with groups but only a few have formally
trained in group psychotherapy and made attempts to synthesise the models.
These tend to be mainly but not exclusively associated with the former Art
Psychotherapy Unit of Goldsmiths College which used to offer training in both
Art Therapy and Group Psychotherapy. Unfortunately by 2010 all the group
psychotherapy provision was closed – the postgraduate Diploma closed in 2008
after 20 years, and the MA in Group and Intercultural Therapy closed in 2010.
The Diploma in Art Psychotherapy (since 1994 the MA) at Goldsmiths used
models of group analytic or interpersonal group therapy as a basis for much of
the teaching and experiential work initially included a large verbal psycho-
therapy group and now includes an ongoing large group art therapy experience
for all art therapy trainees.
Such emphasis had been present in Goldsmiths’ training from its beginning in
the mid-1970s. I own that this was influenced by my design of the first
 12 Introducing group interactive art therapy

programme, requested by the head of art teacher training, John Hart, at Gold-
smiths while I was working part time as an art therapist at the controversial NHS
Paddington Centre for Psychotherapy, which prioritised group work in its Day
Hospital. I began my own group analytic training at the London Centre for
Psychotherapy in 1975, selecting LCP for its dedication to low cost psycho-
therapy services. This training included a two-year foundation course in psy-
chodynamic interaction, covering family therapy, psychodrama and
theme-centred interaction alongside the group analytic workshops and super-
vision. In the following three years I was extremely fortunate to have as super-
visors and therapists staff who were willing to support my ‘experiment’ in
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bringing art therapy into the group analytic framework. The group analytic bias
at Goldsmiths increased when Gerry McNeilly, an art therapist, joined the staff
in 1979 and shortly after began training at the Institute of Group Analysis (IGA).
Later, Joan Woddis and Sally Skaife, both practising art therapists and tutors,
trained in group analysis, and Sally Skaife replaced Gerry McNeilly as a work-
shop leader, making a group-oriented team which included Andrea Gilroy, an art
therapist with experience in work with people with psychosis, Terry Molloy,
experienced in group work with adolescents, Jane Dudley, a Goldsmiths’ art
therapy graduate who had many years’ working experience at the Henderson
Therapeutic Community and in the NHS in South London, Terry Prendergast
and Kevin Power who ran verbal large groups. Other graduates from this time,
include Val Huet who, together with Sally Skaife, edited Art Therapy Groups
(1998) and Kevin Jones and Sally Skaife who conduct the current large art
therapy group, and Francesca La Nave, contributor to this book, is another active
contributor to the field of group art therapy. However, with the demise of the
group psychotherapy programmes at Goldsmiths with their emphasis on explora-
tion of socio-cultural phenomena and backed up with process sociology, the
possibilities for further explorations of the integration of art therapy and group
psychotherapy within one unit were lost. It may be that the priorities of art
therapy training in general are moving in another direction, which could include
taking art therapy into non-traditional areas such as galleries and museums,
incorporating theories such as ‘mindfulness’ and returning to a new version of
the studio-based model.
All art therapy training does, though, involve some group work, the main
element of which is an art therapy training workshop running throughout the
course. This was declared by the British Association of Art Therapists (BAAT)
Training and Education Committee in 1992 as an essential aspect of the core
course requirements, in that art therapists are usually required to work with
groups in subsequent employment and they need to have at least basic know-
ledge and skills in conducting. The BAAT curriculum formed the basis of the
Arts Therapists Standards of Proficiency and Standards of Education and Train-
ing, issued by the Health and Care Professions Council with whom art, drama
and music therapists are statutorily regulated under the Health Act of 2000.
These were recently revised (2013) and still include the requirement for
 Groups and art therapy 13

involvement in group work. The universities offering the threshold level for
entry to the profession – an MA or MSc – will interpret their group work
standard in different ways according to their theoretical orientation, some
tending towards the psychodynamic-interactive, others more studio based. This
flexibility within the Standards is greatly to be welcomed. Art therapists are also
required to be in their own personal therapy throughout training and many
choose group psychotherapy.

Developments in art therapy groups: the 1980s

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onward
McNeilly wrote eloquently and provocatively about the process he described as
‘group analytic art therapy’ which he began to formulate whilst at the IGA in the
late 1970s. McNeilly’s article entitled ‘Directive and non-directive approaches
in art therapy’ was first published in the American journal Arts and Psycho-
therapy in 1983, and later in Inscape, in December 1984. McNeilly criticised art
therapy practice in which the therapist gave the group emotive themes to work
on – rather like a ‘recipe book’ of themes which he felt only reflected the thera-
pist’s defences. His criticisms were partially based on findings from Marion
Liebmann’s (1979) research: ‘A study of structured art therapy groups’, which
resulted in a booklet called Art Games and Structures for Groups (1982) and
later a book Art Therapy for Groups (1986). I will now discuss Liebmann’s early
work so that we can understand the basis of McNeilly’s criticism and the ensuing
debate.
Liebmann made a survey, as part of her research towards an MA thesis in
1979, of the group work of 40 art therapists, and she found that most of the
groups had a similar format. She describes this in a chapter in Dalley (1984:
160–1) as being composed of an introduction followed by an activity (the art
making process) and then by discussion. Thus the groups are highly structured.
Under ‘introduction’ is included welcome to new members, setting boundaries,
re-capping on previous sessions, sometimes a physical warm-up. Then:

The main activity or theme for the session is then introduced. Usually the
therapist chooses the activity, according to what has gone on in previous
sessions, or the issues that are important at that time. Groups which have
been together for some time often play a significant part in choosing the
activity for a particular session, and also take on more responsibility in other
ways, helping new members, for example.
(in Dalley, 1984: 160)

The ‘activity’ Liebmann said, usually takes about half the available time:

Art therapists have to decide to what extent they will participate at this
stage. This decision depends on several factors, such as personal philosophy
 14 Introducing group interactive art therapy

and orientation of the therapist, the kind of group, and the particular activ-
ity. Some therapists do join in, because it helps to break down barriers – if
they are asking group members to reveal themselves, then participation by
the therapist facilitates this process within the group.
(in Dalley, 1984: 161; see Yalom, 1985: 216–26 for a discussion of the
advantages and pitfalls of therapist ‘transparency’)

The discussion usually takes the second half of the session and sometimes each
person has a share of the time available, or contributes to the discussion of one
or two paintings; or relates how they felt during a group painting. Liebmann
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comments that there are many ways of discussing the art products according to
the philosophy and theoretical orientation of the therapist, the setting and the
particular group.
Liebmann later introduced the concept of ‘games’ and drew attention to the
literature on games of all sorts for groups which are concerned with enhancing
people’s experience of themselves and others. She pointed out that in the sphere
of ‘personal growth’ a game is any activity which is based on rules that define
the framework of that activity and can be used to play. The rules are flexible
enough to be interpreted in different ways to allow for many levels of response
and the rules can be changed by agreement of the participants. A game consti-
tutes a ‘real-life’ situation in microcosm and provides a ‘parallel frame of refer-
ence which operates alongside “real life” but does not become confused with it’
(in Dalley, 1984: 163).
She gave several case examples of art therapy groups, including those using
games. She described groups in an alcoholics unit, a women’s group in a day
hospital, a one-day workshop with a community group, at a day centre for ex-
offenders, a peace conference and on an art therapy course. In all these groups,
the conductor introduced the group, sometimes by suggesting a warm-up, and
directed the activity. (Over the years she has developed her model, often working
in conflicted societies, such as post-civil war Yugoslavia. She discussed the
rationale and structure for using games, activities and themes in art therapy
groups, writing about this work in Malchiodi, 2003 and 2012.)
She describes how the themes arose:

Often these themes were derived from intense emotional experiences such
as love, hate, dependence, independence. On these occasions the focus
became conflicts arising from such polarities. Variations on the theme illu-
minated the individual’s difficulties in dealing with such problems and
finding solutions.
(1986: 7)

McNeilly felt that such direct suggestions led to a tendency for too powerful
feelings to be uncovered too quickly making it difficult for the group member,
the group and the therapist to contain and understand the material. Also, the
 Groups and art therapy 15

theme might limit the extent to which the group can develop and this, McNeilly
suggests, might be a way in which the therapist controls the depth the group goes
to. He criticises the literature on theme-centred art therapy groups as lacking any
exploration of interpersonal relationships:

What occurs in the majority of theme centred groups is a didactic process

between separate members and the therapist . . . In this process the therapist
is seen as the provider or good mother who gives all the goodies. The thera-
pist has here fallen into a dependency basic assumption from the start. He/
she has agreed to feed the group and let it depend on him/her like a mother.
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(McNeilly, 1984: 7)

In the non-directive approach, which McNeilly termed ‘group analytic’, themes

do emerge but over a period of time:

Themes on the whole are more subtle in their development, and may be
stronger and more dynamic as their emergence has not been through a direct
demand. A synchronistic process may be seen through the production of two
or more of the same, or closely related symbols by members of the group.
Also in such an approach one can focus on the universality in the group and
its symbolic life.
(1984: 8)

Yalom’s comments on anti-therapeutic norms (1985: 190–1) back up this criti-

cism in that artwork is often discussed by members ‘taking turns’ or being pres-
sured into premature self-disclosure by being required to work on a theme which
may be, for some, too highly emotive at that moment in the group; or entering
into what Yalom calls the ‘Can you top this?’ format in which members engage
in a ‘spiraling orgy of self-disclosure or a tightly knit, closed pattern that
excludes outlying members and does not welcome new ones’ (1985: 191).
McNeilly’s article was strongly criticised, perhaps not surprisingly given that
many art therapists were using a theme-centred approach. Roy Thornton (1985:
23–4), and a group of art therapists in the Bristol area, including Marian Lieb-
mann, offered another view. Thornton argued:

Does it not occur [to McNeilly] that themes can be used with careful thought
for clinically based purposes, as suggestions, quite free of obligation, in full
knowledge of transference issues, not evasively, but to create intensity, and
that the technique is supported by ample evidence of fruitful, wide ranging
interchanges full of meaning, with good effect.
(1985: 23)

Thornton disagreed that the use of themes was inevitably harmful but acknow-
ledged that a ‘themes-off-the-shelf ’ approach in the hands of a novice could be.
 16 Introducing group interactive art therapy

He concludes that direction that was openly acknowledged, rather than implicit,
required a high degree of sophistication in understanding and action and a high
degree of effective compassion and was certainly not an easy option. He agreed
that it was possible for a therapist to stand in the way of his or her availability
for transference and impose their own personality by using techniques defen-
sively. On the other hand, it was possible to be skilled in the

knowing use of oneself and one’s technique, awake to both the economic
value of themes and yet their inherent dangers: and so to avoid using these
skills could be, paradoxically, the very cop out we are being invited to
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adopt.
(p. 25)

Wadeson, although not directly participating in this ‘British’ debate, had the
following to contribute:

The most significant question regarding structured art activities (including

guided imagery) is not what to use, but whether and when one should use
them at all. Recently I sat in on a class of about 20 art therapists and a few
art therapy students. The group went ‘round’ three times, each telling of an
art therapy technique he or she used. In a short time, we had heard about 60
techniques. Most people took notes. The student next to me titled hers,
‘Recipes for Art Therapy’.
Art therapy isn’t a piece of cake. An art therapist isn’t there to provide
projects. If she trusts the power of imagery and the healing forces within her
client, she will allow her groups to flow naturally and organically. She will
trust herself to be sensitive to their emergence so that she can foster their
exploration and encourage the growth potential of the art therapy group and
its individual members.
(1980: 158)

The debate has continued, with polarisation appearing to have lessened in favour
of more considered discussion of the role that the image-making process can
play within group art therapy and indeed of the potential for extending the
boundaries of the group into public settings, such as galleries and museums –
and into the ‘outdoors’ – the last an increasingly popular movement spearheaded
by those inspired by ecology and ecopsychology and ‘land artists’ such as
Richard Long and art psychotherapist Mary-Jayne Rust. Boundary setting in
these ‘outdoor’ groups presents a considerable challenge not only to the therapist
and clients but to the orthodoxy of working within a clearly boundaried space –
such as the art therapy studio and the consulting room.
It is interesting to reflect on why so many art therapists – at the least the
cross-section that Liebmann interviewed – chose to run their groups on what
seems to be a therapist-led model. It may simply be that, as her research was
 Groups and art therapy 17

carried out way back in the mid-1970s, this was the model they inherited from
non-group trained tutors at college, or had absorbed from occupational therapy
colleagues’ ‘projective art’ groups. A few words on the latter: these groups
depended upon the therapist presenting an emotive theme to which the patients
were expected to respond visually and then discuss in the group. Theoretically
the model seems to derive from psychological tests which use images (Thematic
Apperception Test, Rorschach, etc.)2 except that the patient is expected to
‘project’ his or her emotional response through a personal image rather than
responding to a given image. It also may derive from experience of a once-
common practice in art lessons at school, where the art teacher gave the class a
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theme (e.g. Christmas) and during the course of the lesson would walk around
the class commenting on the progress of the painting. There was no discussion
of the psychological meaning of the resulting images, however, unless the chil-
dren happened to be attending a ‘special school’ where art classes sometimes
had a ‘therapeutic’ flavour. It would be interesting to carry out another survey to
see how art therapists approach group work some 30 years after Liebmann’s
research.3
It is hardly surprising, though, given the lack of formal group training, that art
therapists at that time adhered to a highly structured model, in which the group
process could be monitored and controlled. When group interaction is combined
with image making and the group process takes control, very powerful forces are
unleashed. Without the confidence that a thorough training and experience in
group dynamics should impart, art therapists were probably wise to try and ‘keep
the lid on’ even though, conversely, setting a theme might arouse unexpected
emotion. They were often working with severely damaged people for whom
interaction might present a high level of anxiety – perhaps too high to handle.
Nevertheless, the criticism McNeilly made was timely as it drew attention to
what might have become a ‘habit’ in conducting groups rather than a seriously
considered and theoretically sound approach, based on the patients’ ability to
participate and on recognition of the therapist’s own level of skill. It also drew
people’s attention to the fact that setting themes could be damaging in certain
situations.
In 1987 McNeilly wrote ‘Further contributions to group analytic art therapy’
in which he expanded on his previous controversial ‘Directive and non-directive
approaches’. In this paper, McNeilly related his work closely to Foulkes’ ‘A
basic law of group dynamics’ (1983: 29–30). McNeilly says that in applying
Foulkes’ work to group analytic art therapy, the merits lay in the high level of
involvement with the whole learning process, with the interchanging of
members’ positions in the group. He pointed out that he had been criticised for
appearing to give the artwork a secondary or incidental position or value but in
fact this was not so. Rather, he did not ‘chase the in-depth symbolic nature of the
individual image’ and ‘may not comment on some of the pictures’. Yet, as
Foulkes had pointed out, the individual was a ‘nodal’ point in the system and
therefore either an interpretation of the collective imagery or an individual
 18 Introducing group interactive art therapy

interpretation would resonate with all on different levels. However, he con-

cluded, communication was more important than interpretation.
By this time, McNeilly seems to have moved rather towards the ‘inter-
active’ pole in emphasising the interactions between members in the here-and-
now. He also concedes that there may be groups of people for whom the
analytical approach would not be beneficial ‘if applied in its purest form,
although I believe many of Foulkes’ principles may be used in any group’
(1987: 9). He mentions mentally handicapped people (sic), hyperactive chil-
dren, certain adolescent groups, severe psychopaths and long-stay psychiatric
patients as needing higher levels of structure and boundary, thus calling for
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‘greater directive and teaching input from the leader, as an apparent lack of
direction by a leader tends to stir up insecurity and bring intra-psychic pro-
cesses more to the fore’ (1987: 9).
In his earlier article (1984), McNeilly had introduced the concept of ‘reson-
ance’ which was elaborated by Roberts (1985). The term ‘resonance’ is an ana-
logical term derived from the science of acoustics and defined as the
reinforcement or prolongation of sound by reflection or synchronous vibration.
According to analytic theory, a deep unconscious frame of reference is laid down
in the first five years of life and predetermines associative responses from then
on. A person may become ‘fixated’ or ‘regressed’ and on entering a therapeutic
group, becomes associated with others functioning at different levels of the
psycho-sexual scale. Each member in the group will then show a tendency to
reverberate or resonate to any group event according to the level at which he is
set (Foulkes and Anthony, 1965: 152). The term is used by them to describe a
group process which appears to be determined by two factors: the interactions
between people and the reactions of individual people to the current theme of the
group. Foulkes spoke of a ‘chain of resonances’ indicating the consecutive
manner in which the ‘resonant’ material emerged. In an art group, however,
members express themselves through images simultaneously and so the resulting
artworks become available as tangible representations of what was happening
simultaneously in all the members (Roberts, 1985: 17).
Resonance occurs when each member of a group responds to a stimulating
input (such as the impending group break) so that the group as a whole becomes
highly charged with energy. Very powerful emotions may be evoked – for
example, a theme of separation may emerge in a group, evoking powerful
responses in each member who produces his or her own material relevant to sep-
aration or avoidance of it. Thus the member ‘resonates’ to the group theme at his
or her natural frequency (Roberts, 1985: 17). The paper draws attention to a phe-
nomenon which Roberts had noted from his close observation of or participation
in several art therapy groups, namely, that half or more of the members spontan-
eously produced a picture or article making clear reference to a single theme.
This was, however, a theme which had emerged through the group process as
opposed to being offered by the conductor at the beginning (see Case Example
10, pp. 132–4).
 Groups and art therapy 19

In the same issue of Inscape in which McNeilly developed his group analytic
approach (1987), Helen Greenwood, an art therapist, and Geoff Layton, a com-
munity psychiatrist, described one of the art therapy groups they were conduct-
ing in a day centre. This was a once-weekly group with eight patients, all of
whom had suffered major psychiatric disorders and many of whom had been
readmitted several times to hospital. They set a regular time (12 hours) and place
for the session, using a large room with comfortable chairs, tables that needed to
be erected, art materials – paper, paint and clay. This group was structured and
the art therapist encouraged group members to select paper and begin an explora-
tion of materials. Themes were
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intermittently introduced by the therapists with caution that the group did
not depend on a suggested theme. These themes were non-threatening. An
example could be ‘water’, giving a wide scope of images from a dripping
tap, to a raging waterfall, a tranquil lake or the expanse of the ocean.
(Greenwood and Layton, 1987: 13)

When everyone had finished drawing they went to sit in armchairs with the pic-
tures in front of them on the floor and about 50 minutes was spent in verbal dis-
cussion. Common themes evolved in discussion which were pursued verbally.
A culture developed in the group, which was as follows: the start of the
session developed into a five to ten minute chat during which time themes spon-
taneously emerged which were taken up as the subject for exploration in art or
sometimes group members presented a theme that they had thought about during
the week. They found that the theme gave a focus for the projection of anxieties
and that the group members would suggest difficult and threatening themes and
scorn those non-threatening ones previously suggested by the therapists (1987:
14).
They make the point that by personal choice they would not work with
themes, preferring a more spontaneous approach. They felt, however, that this
might increase anxiety and confusion and lead to further disintegration in this
group of potentially psychotic patients (p. 14). There seems to be disagreement
here with Yalom’s point (and McNeilly’s) that the setting of themes might actu-
ally increase anxiety and certainly lead to pressure for premature self-disclosure.
Rather, it appears that themes in an art therapy group are generally considered as
a way of containing anxiety (within the art object) and giving a focus for its
projection.
The authors refer to W.R. Bion’s Learning from Experience (1962). There are
three phases – projection, digestion and re-introjection in the process of contain-
ment which may be fulfilled within the act of art-making. The authors say:

Using Bion’s concept of containment when we consider what happens in the

process of art therapy in this group, it is as if material is projected and given
some form in the art product. This is worked with in the art process itself,
 20 Introducing group interactive art therapy

and also by the group in the verbal discussion. When the group and the ther-
apists become the container, the projected material, the picture, is acknow-
ledged and explored, and then work is done to relate this to the artist with
reference to previous artwork, and also to the group. Once the projected
material can be seen in the context of a structure, symbolising internal
mechanisms, then it can be reintrojected, acknowledged and accepted as
part of one’s self.
(Greenwood and Layton, 1987: 16)

Thus although Greenwood and Layton use a broadly ‘theme-centred’ approach,

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they also make use of interpersonal or interactive models – especially in the

degree to which they become transparent by engaging in the art-making process
themselves, and they draw on insights from group analysis to understand the
material.
If we accept that the art object can act as a container for strong and even
unacceptable emotions, it may be that there is less ‘danger’ (i.e. from premature
self-disclosure, etc.) in using themes in an art therapy group, given that the art
object can remain exactly as that – i.e. it need not be talked about. However,
there is usually pressure to disclose, especially if the group time is structured to
include discussion.
The pressure to describe feelings in words is one which most of us experience
in groups, even art therapy groups which are described as ‘non-verbal’. David
Maclagan (1985) writes that according to what he calls the ‘mythology’ of art
therapy, there is the assumption that through spontaneous painting and drawing
a person can relax their conscious controls and enter directly into contact with
unconscious material. He says that even the choice of techniques – big brushes,
sloppy paint and other devices to eliminate skill – must aim at spontaneity
without which it will not be possible for unconscious processes to come through.
Some art therapists, he says, believe that the image must be protected and not
reflected upon too consciously for fear of disturbing ‘the fragile balance between
the voluntary and involuntary’. There is a strong anti-verbal tradition in art
therapy which regards explanation or interpretation with extreme suspicion. He
asks, then, how can art therapy play anything other than a compensatory (or pos-
sibly subversive) role in a programme based on group psychotherapy?
Maclagan says that he makes a basic assumption that art therapy is a kind of
‘net’ for images and that the images have meaning and value not only for the
person who created them but also for the group. The images do not have to be
aesthetically pleasing: they may in fact be chaotic, aggressive, unstable or imper-
sonal or contain ‘psychotic’ features. The image has to be looked at and accepted
for what it is, first by the person who made it. The structure of the art therapy
group provides a frame within which feelings and fantasies can be discovered
and communicated without being depersonalised. Maclagan continues, com-
menting that psychotherapy is ‘enormously dependent upon the capacity to allow
symbolisation and relax the boundaries of common sense’:
 Groups and art therapy 21

Dealing with non-verbal imagery, or rather with the translation between

nonverbal and verbal, throws this issue into sharp relief: the literalness, con-
creteness and rationalisation of some patients appears in all its rigidity, not
only in the way in which they represent their feelings but in the degree to
which they can accept alternative readings of their images.
(Maclagan, 1985: 8)

I take Maclagan to mean that the patients are seeking a direct rendering of words
into images and vice versa. In other words, not being able, or willing, to let the
images have a life of their own, or to ‘free associate’ to them.
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Working within a therapeutic community, where the art therapy group is

unusual in containing material objects which are loaded with metaphoric and
symbolic meaning has its problems: in particular, the question of how to use the
material from art therapy within the community. There is the problem of con-
tinuity between one week’s group and the next and what Maclagan refers to as
the ‘lizard’s tail’ syndrome, whereby powerful and significant images are effect-
ively cast off and left behind. Wadeson also comments on the image that gets
‘left behind’ (by ‘conventional group therapy’ she means verbal interactive
groups):

Although in conventional group therapy sessions there may be material that

gets postponed due to lack of time, such issues aren’t usually recognized in
such a way as to incur the frustration that an unexplained, provocative
picture does. In conventional group therapy, at any particular session, some
members may be relatively passive or simply reactive to others rather than
introducing issues of their own. When each member creates an art expres-
sion, however, each introduces material, so there is much out on the table,
so to speak. In another respect, this phenomenon is advantageous in groups
with members who otherwise are withdrawn. Through their art productions,
they capture the group’s attention, which helps to integrate them into the
group.
(1980: 238)

I am not clear why this is such a problem because in a long-term group the
material will still be available for use by the individual and the group whenever
it wishes. There may be a difference though in the fact that all the images are
‘out’ and available and may have strong projective potential. Group members
have to carry these visual projections with them until the next session.
Wadeson (1987: 147–8) mentions that an important aspect of the utilisation
of art in group therapy is its important place not only in reflecting group process,
as previously described, but in its advancing group process. This advancement
occurs simultaneously with the sort of reflection that group images provide. For
example, when group members draw pictures of the group, awareness becomes
magnified. Each person has shared his or her view; common constellations are
 22 Introducing group interactive art therapy

identified; different perceptions are recognised; feelings about the group are
communicated; each member has access to the position he or she holds in every
member’s conception of the group. Usually there has been risk in divulging these
perceptions. All this information and sharing of feeling adds substantially to the
growth of the group. As a result, the group ends the session in a far different
(psychological) place from where it began.
When coming across a group which is apparently so permissive and tolerant
of the bizarre and irrational, staff and patients may become suspicious of what is
going on. Participants may be ‘playing’, making a mess of the room, and
laughter and physical activity (such as lying on the floor to be drawn, pounding
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clay, building structures) are commonplace. I have encountered this suspicion,

or anxiety perhaps, myself when working within the therapeutic community
structure in Rome (there are very few left in the UK now) and within institutions
where art therapy is a very new modality. It is one which produces objects and
images which are difficult to ‘read’ by those outside the group. It is essential that
good relations between the conductor of the art therapy group and the other staff
are fostered if art therapy is not to go out to the margins and be dismissed as ‘not
really part of the work’.
In the special edition of Group Analysis ‘Group Analysis and the Arts Thera-
pies’ (September 1990) it became clear that the approach of group analytic or
group interactive art therapy was being modified to suit a wide range of client
groups from people with learning difficulties in a long-stay hospital (Strand,
1990), to women with eating disorders (Levens, 1990) and day centre clients
(McNeilly, 1990).
Strand points out that it is easy to reinforce the notion of dependency and
childishness among people with learning difficulties if the focus is always on
staff teaching skills and setting standards which the clients have to fulfil. She
draws attention to the lack of opportunities for clients to express emotions, espe-
cially anger and frustration, in behavioural programmes which stress social con-
formity. She established a closed art group of seven clients which met weekly
for one hour and 45 minutes. All the clients had spent most of their lives in care
and some had been in that particular hospital from childhood. They were all ver-
bally able.
Strand and her co-therapist (also an art therapist) saw their role as encourag-
ing members to communicate with each other and: ‘to learn that our expectations
of them were not to please us but concerned with their recognizing their own
needs and emotions’ (1990: 259). It was a difficult shift as the members had
tended to direct all questions and responses to the conductors. The group was
structured so that the first hour was spent in image-making and the remaining 45
minutes in discussion. As members became familiar with the structure, the con-
ductors observed a greater degree of interaction. There was a high level of
motivation to show work and gain the attention of the group.
The fact that the group was closed established it as a significant event in the
week. It provided a sense of consistency and continuity in an institution which
 Groups and art therapy 23

had a high staff turnover and where residents were to some degree at the mercy
of external events – i.e. being moved to different wards and into different pro-
grammes. Thus it was difficult to form and retain close relationships.
Strand saw one of the most important elements in this interactive art therapy
group as enabling members to take responsibility for their own images and for their
own emotional responses. One very powerful theme which emerged from the group
was that of loss: of family or friends; a sense of being rejected and abandoned; the
realisation of being ‘different’ and not ‘normal’; the fear of death. Feelings associ-
ated with loss had little opportunity for expression in the day-to-day lives of the
residents. Through the art therapy and interactive process, they were able to
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acknowledge sadness and loneliness. They were not obliged to ‘keep cheerful’.
This article is a most important contribution to the development of group
interactive art therapy. It shows trust and confidence in these long-stay, institu-
tionalised residents and great sensitivity to their situation. Although verbal, their
articulation was limited, and the image-making process provided an essential
‘key’ to communication. Strand’s article stimulated other art therapists working
with people with learning difficulties – either in the few remaining long-stay
institutions or in the community – to introduce such groups.
It is clear that both group psychotherapy and art therapy are flexible modali-
ties, able to be adapted in work with people whose emotional needs are often
dismissed in favour of more rigid behavioural models.
In 1998 Sally Skaife and Val Huet, art and group psychotherapists, edited Art
Psychotherapy Groups. They discuss both theoretical and practical elements of
art therapy groups, extending the models of both group interactive and group
analytic approaches and include chapters which discuss how these can be
adapted to practise with a range of different client groups. They look at the way
therapists structure the group, in particular considering how the time may be
shared between talking and art-making, questioning how such decisions are
made and reflecting on whether talking in the group is as much a part of the cre-
ative process as the art-making. They point out that art therapy groups can fre-
quently feel overpowering due to strong countertransference responses, the
regressive nature of using art materials and the primitive feelings that can arise.
Images may be, and indeed often are, very disturbing – once seen by the group
members they cannot be un-seen and there are examples of people saying ‘I
couldn’t get that image out of my head’. All this has to be contained by the con-
ductor who needs to ensure there is sufficient time to process all the material and
ideally ensure that processing can continue in the next group if necessary. This
is a word of caution to well-meaning organisations who like the idea of an ‘art
therapy group’ or ‘an art group’ but have no understanding that to be effective a
group will also produce powerful material and to place an untrained member of
staff in such an explosive situation could be very dangerous. Some of the case
studies I discuss later on in the book reinforce the need to think through the aims
and design of any proposed interventions – art is not always fun and relaxing or
‘good for you’, as it is sometimes understood.
 24 Introducing group interactive art therapy

Moving into the more recent literature: in Group Analytic Art Therapy (2006)
McNeilly revisits his model and elaborates on its use within the context of Por-
tuguese art therapy training to which he has made a very significant
contribution.
There is lively personal material about his own transition from a student
art therapist at the Henderson Therapeutic Community, setting up an art
therapy service there and subsequently to training as a group analytic psycho-
therapist – and integrating aspects of the two disciplines into the model which
he named Group Analytic Art Therapy. In Part II of the book, entitled ‘The
Portuguese Papers’, McNeilly focusses on the influences he encountered
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during his frequent visits to deliver art therapy training within the context of
the Portuguese Art Therapy Association – which I believe it is fair to say is
committed to group psychotherapy, mainly but not exclusively to group ana-
lytic psychotherapy. Discovering the work of Portuguese analyst Cortesao
(1967) on ‘patterns’ has led him to review his thoughts about the matrix and
how these might shape further developments in theory and practice of group
art therapy.
There are many similarities in McNeilly’s approach to that presented in the
most recently published book (to my knowledge), Group Analytic Psycho-
therapy, which focussed on groups with affective, anxiety and personality
disorders (Lorentzen, 2014). It provides a useful description of both long- and
short-term versions, demonstrating how the ‘long-term model’ that had
developed substantially in private practice or specialist centres, can be
adapted to the demands of public services for ‘short-term’ practice. Impor-
tantly, it includes a section on clinical research, citing the challenges and out-
comes of running a control group study. This would be a useful book for art
therapists as it clearly outlines both the theory and practice of this model but
sadly does not reference UK work, possibly because the author does not know
about, or attempt to discuss work that uses both groups and art therapy. This
is a not uncommon issue within the psychological therapies which have until
quite recently been characterised by strict adherence to modalities. However,
with ever increasing pressure to demonstrate the ‘effectiveness’ of our work
through well-conducted research trials, it will be essential to share our learn-
ing with others who have similar concerns. Indeed, a substantial literature
review of related papers and books, internationally focussed, will of necessity
provide us with a much more solid clinically based set of evidence than cur-
rently exists.
Having explored some of the ways in which art therapists have worked with
groups from the 1940s up to the present (with sincere apologies to the author of
any work in the UK or elsewhere which has been accidentally omitted) I will
outline in the following chapter the theoretical approach to groups which is
known as ‘interpersonal’ or ‘interactive’ group psychotherapy.
 Groups and art therapy 25

Notes
1 Since 2012 renamed the Health and Care Professions Council after regulating social
workers.
2 The Rorschach ink blots and the Thematic Apperception Test elicit imaginal produc-
tions which may be rated in terms of their originality as well as in terms of their per-
sonal meaning to the subject. They are, of course, far from ‘objective’. For further
information see Barron (1968).
3 The most recent survey of art therapists’ approach to working in groups and individu-
ally with people with schizophrenia was carried out as part of a large research project
in 2012 (see Patterson et al., 2011).
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 Chapter 2

Interactive group psychotherapy

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The interactive or interpersonal approach to psychotherapy derives from the

work of the neo-Freudians and in particular Harry Stack Sullivan (1953). Stack
Sullivan believed that an individual’s history influences every moment of his
life, because it provides a dynamic structure and definition of his experiences.
He saw anxiety as arising from threats to an individual’s self-esteem. The indi-
vidual uses well-tried defences to deal with these threats. Stack Sullivan did not
agree with Freud’s idea that the basic personality structure was laid down in
early childhood: rather he felt it developed, through interaction with significant
others, right through to adulthood and was therefore open to change. A person’s
psychological growth, then, depends on a concept of the self which is largely
based on how a person experiences himself in relation to others (see Ratigan and
Aveline, 1988: 47).
A very informative account of group interactive psychotherapy is given by
Yalom (1985) and the model is well described by Ratigan and Aveline in Group
Psychotherapy in Britain (1988: 43–64) and several therapeutic features of the
model are explored by Bloch and Crouch (1985). More recently, Rutan and
Stone (2001) have elaborated on the benefits of psychodynamic group psycho-
therapy with reference to Yalom’s contribution. I shall not try to reproduce their
work in this chapter, but merely attempt to highlight some of the points that they
make. I would recommend a thorough reading of these sources for further eluci-
dation of history, theory and practice of the model.
Group interactive psychotherapy focusses on the actions, reactions and
characteristic patterns of interaction which constrain people in their everyday
lives and for which help in modifying is sought in the group (Ratigan and
Aveline, 1988: 45). A fundamental of the approach is that each person constructs
an individual inner world which is continuously being reconstructed through
interactions with others and which determines that person’s view of himself and
others and affects expectations of others. In group therapy, the individual gradu-
ally realises how inner assumptions may determine the patterns of interaction
that develop. Exploration of these patterns and willingness to modify them in the
safety of the group enables the person to try out new ways of relating in
the ‘outside world’. Clearly, then, the model places the main source of change
 Interactive group psychotherapy 27

in the interaction between group members and depends upon the participants
learning from each other.
There are five concepts central to the interpersonal approach. These are expli-
cated in existential philosophy and psychology and therein, the authors suggest,
lies the difference between this approach and analytically oriented group psycho-
therapy. The concepts, as cited by Ratigan and Aveline, are as follows:

1 Human actions are not predetermined; freedom is part of the human

condition.
2 The corollary of this is the importance of choice in human life.
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3 It is essential to take responsibility for one’s actions.

4 Death is inevitable; but the fact that we shall all die can paradoxically
give meaning to life.
5 We are each engaged in a creative search for individual patterns that
will give meaning to our existence.
(1988: 45)

The concepts of responsibility, freedom and choice are central to the interactive
model. The approach provides:

a clinical context where group members can move from being trapped in a
personal world view in which they are passive victims of cruel circumstance
to a self-formed one where they can take more responsibility for their lives,
relationships, symptoms and difficulties. The central therapeutic effect is not
just an intellectual appreciation of an active world view but a lived experi-
ence in the group of enlarged freedom through experiences of new personal
acts or refraining from maladaptive acts. This is not an absolute freedom but
a tension towards a greater freedom within the context of a person’s
circumstances.
(Ratigan and Aveline, 1988: 46)

Each member, then, is expected to take responsibility for his or her own participa-
tion in the learning experience of the group, to have a sense of their own influence
on events and not see themselves as passive victims of circumstances. Members do
not simply talk about their difficulties in the group but actually reveal them through
their here-and-now behaviour. In this model, the ‘here-and-now’ is where the
therapy takes place and ‘reporting’ on past experiences is discouraged. Disclosure
does, however, take place: that is, revelation of ‘secrets’ or significant events from
the past and present outside the group and this may be important in understanding
the behaviour of that individual in the group. The act of disclosing releases tension,
usually brings the member closer to others and enables defences to be lowered and
eventually dropped (see Case Example 8, pp. 126–9).
Feedback from members of the group illuminates aspects of the self which
have become obvious to others but which are not recognised by oneself. The
 28 Introducing group interactive art therapy

emphasis in an interactive group is on members giving accurate feedback and

owning their feelings (Ratigan and Aveline, 1988: 49). Feedback is often hard to
take, despite being apparently desired by members, but to be effective it has to
be well timed and preferably delivered with some sensitivity for it is useless if
the member is unable to hear or to deal with it.
The preparedness of members to take risks – i.e. to put themselves in an
exposed position by behaving differently from usual – is essential to this model’s
effectiveness. I sometimes refer to the group as a ‘rehearsal ground’ where ways
of relating may be tried out without fear of ridicule or retaliation. If members
feel safe enough to ‘be themselves’ or in other words to acknowledge the
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thoughts and feelings they are really having as opposed to those they feel they
should be having, then they will demonstrate the patterns of behaviour which
have led them to therapy and in turn receive assistance in changing these pat-
terns. Members do, however, tend to avoid the ‘here-and-now’ relationships ini-
tially, in favour of talking about life outside the group, as these inter-group
relationships can be powerful and even frightening for some members, and most
people have not learned to be direct about what they are thinking and feeling.
Yet these relationships can be the most therapeutic.
In an interactive group, the process of projection involves group members
having feelings and making assumptions about other members which are not
based on their here-and-now experience. For example, one member experiences
another as his stern father and makes assumptions about that person’s feelings
towards him. Mirroring entails a member having strong feelings and emotions
about another’s behaviour which is in fact an aspect of theirs. Projection and
mirroring are often accompanied by splitting – i.e. by experiencing a group
member, the conductor or the whole group as all good or all bad; and scapegoat-
ing, when the group tries to put all its difficulties on to one member and to get
rid of them (see Case Example 11, pp. 135–42). The members’ tendency to
distort their perceptions of others (parataxic distortions) provides valuable
material for the group to work on.
Another phenomenon of these groups is projective identification, which can
result in one member projecting their own (but actually disowned) attributes on
to another, towards whom they feel ‘an uncanny attraction-repulsion’ (Yalom,
1985: 354). These attributes are projected strongly into the other person, so that
that person’s behaviour begins to change. For example, murderous feelings may
be projected so that the other person begins to feel murderous, whereas the pro-
jector has no awareness of such a feeling.
The group itself, as a social microcosm, also gets into patterns of behaviour
as if it were an individual. According to Ezriel (1950) the group may take up a
‘required’ relationship with the conductor or with each other, which safeguards
them from the ‘avoided’ relationship which they fear may in turn lead to a
‘calamitous’ relationship. For example, the group may never challenge the con-
ductor lest he or she should become angry and terminate the group or retaliate in
some other way. It is important for the conductor to understand when these
 Interactive group psychotherapy 29

processes are in action and to comment on them. Members may then learn to
make such connections themselves, later on.
If we accept that patterns of behaviour are learned and that it is possible to
unlearn or relearn more effective or rewarding ways of being, then there is much
to be learned from interpersonal interaction within the boundaries of a group.
Bloch and Crouch (1985:68) state:

there is a fundamental therapeutic factor which is a direct consequence of inter-

action, variously labelled as interpersonal learning and learning from interper-
sonal action. As these labels imply, we are concerned with a learning process
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in which the emphasis is on learning from actual experience; more specifically

from new efforts – tantamount to experimentation – at relating to others.

They point out that the early pioneers of group therapy were ‘virtually oblivious’ to
the potential advantages of promoting interaction either between group members
themselves or between members and the therapists. With the application in the
1930s of the psychoanalytical model to groups, interaction did begin to occupy a
prominent place but this was largely confined to the relationships that evolved
between the analyst and each patient. In other words, group treatment was regarded
as comparable to individual analysis, with attention being paid to the analysis of
transference. The dimensions of transference were substantially wider than obtained
in classical psychoanalysis as it was possible for a patient to become strongly
attached not only to the therapist but to other group members and the group as a
whole. A separate therapeutic factor, interaction, was considered by Corsini and
Rosenberg (writing in 1955) as the most difficult factor to understand and classify.
They produced a limited definition which Bloch and Crouch suggest was not sur-
prising as they were relying on scattered writings, mainly from the 1940s:

Clinicians were then only beginning to perceive that relating between group
members, including the therapist, might carry therapeutic potential above
and beyond transference. Such terms as interaction, relationship, contact
with others, and interstimulation had made their appearance but their con-
ceptual basis was ill-understood and rudimentary.
(1985: 69)

In the 1950s, representatives of the humanistic psychology and human potential

movement – e.g. H. Stack Sullivan, Karen Horney and Erich Fromm emphasised
interpersonal issues and the subject of interaction was:

tackled head on and its qualities identified. At the same time, the strict
Freudian mould that had been applied to groups began to soften. Transfer-
ence was not the sole form of relating in group therapy; other forms existed
alongside it and were of equivalent importance.
(1985: 69–70)
 30 Introducing group interactive art therapy

Irving Yalom, whose work I have already referred to, developed concepts of
interpersonal learning which are thoroughly and clearly outlined in his book, The
Theory and Practice of Group Psychotherapy, first published in 1975 and still
being reprinted due to its continued relevance and accessibility. According to
Yalom, the group provides a forum in which the patient can explore and develop
his relationships with others, resulting in greater trust and improved social skills.
Yalom based his theory of interpersonal learning on Stack Sullivan’s interper-
sonal theory of psychiatry. He maintained that psychiatric symptoms and prob-
lems originate in and express themselves as disturbed interpersonal relationships.
Yalom emphasises two concepts: (a) the group as a social microcosm and (b) the
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corrective emotional experience.

‘Social microcosm’ refers to a group process which resembles customary
everyday functioning, in which patients tend to behave in their usual maladap-
tive way. It is by observing and drawing attention to these behaviour patterns in
the group that the therapist and other group members can have a ‘corrective
emotional experience’, thus helping each other to change. This process has been
summarised by Bloch and Crouch as follows:

the patient takes the risk, emboldened by the group’s supportive structure,
of expressing some strong emotion to one or more group members, includ-
ing, perhaps, the therapist. Within the context of the here-and-now, the prot-
agonist is able to reflect on the emotional experience he has undergone and
to become aware, with the aid of fellow-members, how appropriate his reac-
tions were. This awareness paves the way for an improvement in interper-
sonal relating.
(1985: 77)

In summary then, the interactive model proposes that:

1 The patient’s symptoms are derived from disturbed interpersonal relation-

ships, probably at a very early level. These symptoms usually adversely
affect interpersonal functioning and the major presenting problem is there-
fore difficulty in relating to others.
2 The therapist promotes a climate in which the patient can learn about and
understand those patterns of behaviour which are causing distress.
3 Awareness leads to the possibility of change. This is more likely to happen
if the patient is committed to the group, that is, attends regularly and parti-
cipates, and is willing to take risks.
4 The patient experiments with new behaviour in the group. Feedback from
therapist and other group members as well as self-observation enables him
to judge the effectiveness of his efforts.
5 The new behaviour is tried out by the patient – with family, friends, work-
mates, etc. – and the results reported back to the group. If all goes well:
 Interactive group psychotherapy 31

An ‘adaptive spiral’ is set up which severs the previous circular link

between symptoms and disturbed relationships. More adaptive interpersonal
behaviour generates greater self-esteem. The possibility for further reward-
ing relationships is encouraging and boosts self-esteem, promoting yet more
change.

Thompson and Khan (1988: 75) consider that the patient tries to recreate in the
group the original ‘network’ of relationships in which the conflict was first
experienced, using different individuals, including the leader, to represent dif-
ferent protagonists. They also point out that the group itself might symbolise a
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person, an idea or an object or situation – for example, mother. The roles that the
patients take up might resemble those in their original family and thus the whole
network is transferred on to the group. They suggest that the language used to
describe the effect of these transferred relationships will vary according to
whichever theory is being used. So the pattern of the communications in the
group will be influenced in some way by the theoretical position which the group
leader holds.
In this model, then, it is not considered necessary for the patient to delve into
their past history to try and understand why they are like they are, but they are
encouraged to learn to observe their own patterns of behaviour in the group, their
effect on others and how the patterns serve a purpose. In this sense, there is a
difference between the analytic and interactional theoretical schools, although
many therapists use elements of both. The main difference seems to be that the
group analyst encourages the patient to acquire insight through the examination
of transference within the framework of emotional interaction. The interactional-
ist emphasises reciprocal action or influence between members and argues that
interaction is the chief agent for change.
In both schools the therapist is regarded as a central figure but the interaction-
alist views him or herself as a relatively transparent catalyst and model, whereas
the analyst sees him or herself as an opaque, neutral observer. The interactional-
ist works mainly in the present; the analyst makes liberal use of historical data
and the ‘there-and-then’. The interactionalist puts much emphasis on the group
experience being a positive one from the outset, whereas the analyst believes
that resistance to learning must first be removed before patients are capable of
benefiting from positive experience. I would add that the interpersonal model is
highly influenced by the process model of sociology (Elias 1978) and others
from the Chicago School of Sociology who conceptualised human beings as part
of a network of connections, some known, others not, thus the conductor of an
interactive group could use this concept of ‘network’ to explore with the group
the interaction between the here-and-now of the group and its members and the
‘outside world’.
Not all workers see much difference between group analytic and group inter-
active models. For example, Cohn (1969), while conceding that differences do
exist between analytic and experiential (or interactive) models, especially in
 32 Introducing group interactive art therapy

relation to the therapist’s role and the temporal framework, does not believe they
constitute a dichotomy. She considers that the therapeutic process involves both
interactional here-and-now experience plus the there-and-then of past and future.
Bloch and Crouch point out that it may seem that Cohn wants to have her
cake and eat it:

For an analytically oriented therapist to act as transparently as an experien-

tial therapist and continue to make interpretations about transference is a tall
order both clinically and theoretically. We suspect that Durkin comes closer
to the truth than Cohn when she contends that despite any overlap, the
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nature of the therapist–patient relationship in the two approaches differs

markedly. But the question then arises as to whether aspects of each may be
moulded into a completely new theory, a theory in which interaction retains
a prominent place.
(1985: 80)

From my reading of case studies by group analytic psychotherapists, I am con-

vinced that in practice there is often as much overlap as Cohn suggests.
Cohn’s work is interesting and relevant to this book in that she was a pioneer
in the area of theme-centred interactive group psychotherapy. Her interest began
when she initiated a workshop in countertransference which was designed for
the study and treatment of countertransference through self-analysis, in a work-
shop setting. She found that the therapist who revealed their relationship with
the patient to the group through free associations stimulated interactional
responses in their listeners, to useful effect. Cohn developed other workshops
with a single theme as a result of this initial experiment and extended these to a
wide group of participants, including the business community. Some of her
themes were directly related to major news events, such as the murder of Pres-
ident Kennedy, and she incorporated people’s responses to this event into her
workshops.
Cohn would sometimes ask patients to be silent at the beginning of the work-
shop and concentrate on the given theme and on the feelings it aroused. A spe-
cific example might be: choose one of the people in the group and fantasise in
silence something important you might say to him. Cohn reported that, as a
result of this reflection in silence, many communications proved to be intuitive
and meaningful to the receiver of the message. (We may note that the beginning
of an art therapy group is often characterised by people working on their images
in silence.)
Cohn felt that theme-centred groups moved back and forth between intellec-
tual considerations and emotional experiences, between intrapsychic and inter-
personal involvements and intra-group and outside world phenomena, and
between strict adherence to the theme and free associations and interactions. In
the case studies which illustrate some of the theoretical points in this book, I
have tried to show how this is a feature of the interactive art therapy group where
 Interactive group psychotherapy 33

an open-ended theme is presented and from which free association develops (see
Case Examples 6, 7, 8 and 11).
Ruitenbeek (1970: 21) comments on the variations on Cohn’s work which
started appearing in the late 1960s. One of these was the time-limited, theme-
centred group. One conductor, Buchanan, used devices such as playing music,
reciting poetry, etc., so that participants would use their sensory equipment, intu-
ition and perceptiveness of others. The introduction of a theme to be realised
through art materials has already been discussed in Chapter 1 and as we have
seen, is or was the most usual way of conducting an art therapy group.
Ruitenbeek suggests that the presentation of a single theme1 might be attrac-
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tive for contemporary patients:

They live in a fragmented society and it often seems difficult for them to
place all of their problems in a personal and societal context. The attack by
a group on a single problem might at least provide the patient with some
focus and perhaps offer him a small perspective in his own confused life.
(1970: 213)

Astrachan (1970) who, rather like Cohn is another ‘synthesiser’, proposes that
all the major models of group therapy which could be defined as ‘leader-centred’
and stress the relationship between the therapist and members, and therapist and
group as a whole, neglect important interactional patterns. In the patient–
therapist model, the therapist’s behaviour prevents a peer culture developing, so
while patients may learn about the relationships to authority they miss out on
improving relationships with peers. Conversely, in the member to member
model, more effective interpersonal relationships may develop but dealing with
authority figures will not be adequately tackled.
Astrachan claims that a model based on general systems theory would enable
therapists to appreciate the many diverse aspects of their role as ‘regulatory agents’
and be attuned to all parts of the therapy system. They would therefore be well
placed to modify their regulatory posture in the light of the system’s specific needs
at a particular time and to recognise the likely repercussions on the system of the
regulatory behaviour they adopt. Among the therapist’s tasks would be to define
and maintain the boundaries of therapy – to decide what is pertinent for the group’s
agenda, what is in the group and what is outside it, and how patients relate to each
other. The therapist would thus attend to all systems relevant to the patient and not
only the therapy one – e.g. the patient’s work, marriage, relationship with parents,
relationship with a wider social circle, and to social and political events. In adopt-
ing a systems approach, the therapist would be flexible in the role as group leader
because he or she would not be bound by a segmental view of the therapeutic
process vis-à-vis the learning that stems from interaction. All forms of interaction
would be potentially useful and none would have priority over the rest (Bloch and
Crouch, 1985: 80–1). This links with the point I made above about using the
concept of the network of interactions proposed by Elias et al.
 34 Introducing group interactive art therapy

Bloch and Crouch find Astrachan’s arguments persuasive and in his advocacy
of general systems theory he is supported by prominent theorists such as Kern-
berg (1975), Fried (1975), Skynner (1976) and Durkin (1982). His theories are,
however, yet to be tested.
Astrachan’s proposals for a model based on general systems theory are, I find,
very compelling and creative in their attempts to break new ground, or rather to
build a new model from the best of the existing interactional models: much as art
therapists have tried to do when introducing visual media to a group. Each
member brings to the group a social system of which he is part and from which
he is only temporarily disconnected while the session is in progress. Exploration
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of the patient’s ‘inner’ world, its relationship to the ‘here-and-now’ of the group
and to the social system of which the group is part can be very valuable and
quite reassuring to individual members.
To give an example, during the week in which ex-prime minister Margaret
Thatcher was removed from office, one group attempted to displace me by dispar-
aging everything I said, my approach to conducting the group and so on. They
attempted to choose another ‘leader’, a male who was fairly willing to take on the
role. The attacks were quite ferocious, particularly from the men and including one
who had always found difficulty in being assertive. I made an observation that
perhaps female leaders were in for a rough time from now on. The group spotted
the connection – although they had been very deeply involved in the displacement
and apparently unaware of any outside influence. They went on to explore how
they felt about having me as a female leader and whether they saw me as mother or
father. The usually unassertive man said he had never felt comfortable about
having a woman ‘in charge’ and he had suddenly felt a great urge to attack me. The
fact that he had done so without actually killing me off was a great relief. He was
able to get in touch with fears about women in general and their power over him,
which made him very angry and depressed and made him feel like a small child.
Some other group members said that they experienced me like a father, as ‘men
should be in authority’. They also discussed, in dynamic terms, the actual displace-
ment of Mrs Thatcher. This is an example of the ‘outside world’ being brought in
unconsciously by the group, linking up with transference to myself, to people’s
individual issues with female authority figures and interaction among members
dealing with a change in the group ‘system’ – i.e. a previously unassertive male
actively challenging the leader and a shift in the ‘balance of power’ in the group.
Agazarian and Peters (1989) have developed a model of interactive theory
that makes use of important and relevant aspects of psychoanalysis and group
dynamics and links it with systems theory. They draw on Kurt Lewin’s field
theory (1951) and general systems theory, turning to field theory to describe the
process by which the group-as-a-whole emerges from the interaction among
individuals. They suggest:

The major advantage of field theory is that its constructs are compatible
with psychoanalytic constructs. But whereas Freud was mainly concerned
 Interactive group psychotherapy 35

with motivation and drive, and how motivation explained a person’s percep-
tion of the world and his behaviour in it, Lewin was mainly concerned with
behaviour, and how behaviour could explain a person’s perception of the
world (and by inference, his motivation). As most of the group-as-a-whole
phenomenon is implied by group behaviour, and as none of the group-as-a-
whole phenomenon can be explained by individual motivation, field theory
and psychoanalytic theory provided us with two different but compatible
ways of describing our observations.
(1989: 33)
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General systems theory was the second element that contributed to Agazarian
and Peters’ notion of the ‘invisible’ group. They suggest that, since systems
theory and field theory have a common ancestor in gestalt psychology, systems
analysis is compatible with field theory, which in turn is compatible with psy-
choanalytic theory.
Lewin’s theory is important to consider here, especially his proposal that an
individual’s behaviour can be predicted from knowledge of his ‘life space’.
Lewin depicted life space as an egg-shaped ‘map’ that portrayed the individual
in interaction with his perceived environment:

to understand an individual’s life space is to understand his goals, the

tension system related to the goal, the barriers between him and his goal,
and the probable next step that he will take along his path to his goal.
Driving forces are the applications of energy moving him towards the goal,
and restraining forces are the quantums of energy that serve to restrain him
from reaching his goal. Lewin stated that to draw an accurate picture of an
individual’s life space was to be able to predict his next behaviour.
(Agazarian and Peters, 1989: 34)

The life space definition, when applied to the individual perspective, serves to
illustrate some important dynamics. Agazarian and Peters argue that in the group
situation, the interactions of the members create the environment within which
they continue to interact. Thus, for group members, their behaviour is a function
of their particular psychodynamics, their outside socialising experience, the
resultant set of selective perception tendencies plus that group culture of which
they are a part. For the therapist, there is an extra factor explaining behaviour,
which is the theoretical model through which the therapist is selectively perceiv-
ing. So the therapist’s behaviour in a group is a function of the same factors that
govern a member’s behaviour plus his or her ability to cognitively structure the
group phenomena through his theoretical discipline, training and experience
(1989: 37).
Agazarian and Peters (1989: 40) and Agazarian (1997) make interesting
points about defining a system in relationship to its environment (of which it is a
component sub-system). Such a definition, they say, depends on what you want
 36 Introducing group interactive art therapy

to understand. If, for example, one is talking about a group in relationship to the
group’s environment, such as a psychotherapy group in a clinic, then the group
can be usefully talked about as a sub-system of its environment: transactions
from the clinic affect the group and vice versa. It is valuable in this case to think
about transactions across the boundary (input and output relations between the
group and the clinic) and to pay close attention to the character of the bound-
aries. But if you are interested in exploring the relationship between the group
and its members, then you will talk about the input and output relationships
between the group as a system and the individual group members as sub-systems
(see Case Examples 5 and 12 in particular).
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The issue of the therapist’s ‘selective perception’ within a system is a most

important one and often overlooked, I believe. Agazarian’s point was well illus-
trated during an experiential workshop I attended in Zagreb, Croatia, when it
was part of the former Yugoslavia, conducted by two American group analysts.
The purpose of the workshop was to demonstrate their model of supervising
trainees. The group was multi-cultural but predominantly made up of people
with English as first language. One Croatian woman, whose English was very
slight, was hesitant about speaking and when heavily challenged by the conduc-
tors pointed out her difficulty in understanding and communicating in English.
This was interpreted by the conductors as ‘her problem’, i.e. using the lack of
language not to participate fully. Yet, we were guests in her (then) Serbo-
Croatian speaking country! This is a somewhat crude example of the kind of
imperialist attitude which can be transmitted by conductors who are not taking
into account the context, or the system, within which they are operating. I mean
by this the tendency to pathologise behaviour rather than try to understand it
within particular social and cultural norms – and indeed where one language is
privileged over another! The political dimension of psychotherapy can easily be
overlooked, and needs to be more fully addressed within the training and prac-
tice of all psychological therapies.
Blackwell, writing in The Psyche and the Social World (Brown and Zinkin),
makes his position very clear: ‘I believe there is no position within the social sci-
ences or humanities that is not a political position; no theory nor form of know-
ledge devoid of political implications’ (1994: 27). He presents a critique of systems
theory, pointing out that it was developed within a certain context that challenged
the way traditional psychiatry and psychoanalysis located their definitions and
explanations of symptoms and problems within individuals. Blackwell notes:
‘However group analysis is now well placed to pursue the synthesis of these two
movements (psychoanalysis and systems theory) and to develop an understanding
of psychotherapy as an intersubjective dialectical process’ (pp. 45–6). I would
suggest that we are yet to see more evidence that this is the case.
I have already referred earlier to Lorentzen (2014) in relating his work to
McNeilly’s. As well as providing useful descriptions of both long- and short-
term practice, its section on clinical research highlights the challenges and out-
comes of running a control group study. We are now living in a world where the
 Interactive group psychotherapy 37

concept of ‘evidence-based practice’ predominates, with the assumption that

control group studies (RCTs) are the only ones really capable of demonstrating
‘effectiveness’. Later in this book, I will briefly discuss a large RCT using group
art therapy which, in my opinion, raises important questions about the differ-
ences in research trials and clinical practice, not least in the matter of ‘patient
choice’ and motivation within psychological therapies.

Can interaction be anti- therapeutic?

This is a question which has to be addressed as, obviously, any treatment can be
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effective and successful or, on the other hand, have no effect or, worse, be dam-
aging. Bloch and Crouch (1985: 82) draw our attention to Slavson’s suggestion
that interaction may not always be helpful, pointing out the potential for height-
ened discomfort in the interaction between members. An example would be of a
very aggressive member ‘terrorising’ a very timid, nervous member, or of inac-
curate and sadistic feedback. It is up to the therapist to manage the group
dynamics appropriately so that their therapeutic effects will predominate and
help members gain insight into their own and others’ behaviour.
Scapegoating is another example of anti-therapeutic interaction (see Case
Example 11) as is victimisation of any group member. Bion (1961) mentioned
anti-therapeutic interactions in the form of so-called ‘basic assumption’ groups:
that is, members resort to primitive strategies which deny reality and are irra-
tional, even magical in quality. In a ‘dependency’ stage, a group may choose a
leader (an alternative to the actual leader) who they fantasise will rescue them
from their plight. In the process, the ‘leader’ is stuck in a position in which he
cannot gain help for himself, and must even ‘sacrifice’ himself for the others. In
another group, the members may persist in experiencing the conductor as all-
powerful and hence themselves as powerless. (This is one of the dangers of
certain kinds of ‘theme-centred art therapy groups’ pointed out by McNeilly.)
Another basic assumption is ‘pairing’ where responsibility gets delegated to two
members in the hope that out of their union will arise the solution to everyone’s
problems.
Bion’s work is important as it emphasises the ‘group-as-a-whole’ in relation
to and containing the therapist. He identified factors, such as those mentioned
above, which interfere with the therapeutic potential of a group. These have to
be identified in order for the group to do its curative work.
Another anti-therapeutic element which could apply to any group is prema-
ture termination of members caused by external pressures, lack of understanding
about the nature of the group, scapegoating and even being referred elsewhere
by another clinician! Surprising as it may seem, this has been known to happen.
The conductor’s role in understanding, possibly predicting and feeding back to
the group about these anti-therapeutic processes is clearly vital. (See Yalom
(1985: 190–1), who mentions such processes as ‘taking turns’ in speaking which
can force members into premature self-disclosure or into extreme anxiety as
 38 Introducing group interactive art therapy

their turn approaches, or to devoting the whole group to the first issue; collabora-
tive collusion in avoiding certain issues, and so on.)
Then there is the skill of the conductor in modelling interaction, for example,
drawing attention to similarities or differences in the artwork, in experiences of
the clients, encouraging reflection and sharing of it, so that the full benefits of
the approach can be experienced. When a conductor becomes reticent about this,
worried about being ‘too active’ or ‘interfering’ from an assumption that the
clients could not manage such interventions, then the group may dissolve into a
gathering of individuals locked in their own space and not able to benefit from
many of the curative elements of the group. This may not actually cause harm
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but at best it is a waste of the potential of a group and deprives the patients of a
probably rare opportunity to receive some therapeutic benefit. Adequate time
needs to be made for processing the material arising from the group and prefera-
bly regular opportunities to reflect on the life and history of the group and its
members need to be offered.
Having explored some of the theories and manifestations of interactive
groups, I would now like to focus on those aspects which are held to be ‘cura-
tive’ and how the introduction of art materials and the making of images in an
interactive group can add to or enhance the process of positive change. I shall
also look at some of the problems involved in extending the model in this way,
and at the particular responsibilities for the conductor of an interactive art
therapy group.

Note
1 Theme-centred interactive workshops are still fairly widely used – in
London an organisation ‘Will’ was active in promoting this model in the
1980s. A central requirement is that all members must undertake to be their
own ‘chairperson’ and begin their observations with ‘I’.
 Chapter 3

Curative factors in groups

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This chapter will first summarise what are usually considered to be the specific
advantages or curative factors in interactive groups and ask the question: Why
introduce art therapy into the group and what might be the advantages, and prob-
lems, of doing so?

Introduction
There are several features of psychotherapy groups in general which are con-
sidered by most workers in the field to have curative potential. In summary,
these are:

1 Giving and sharing of information. This happens in the early stages of a

newly formed group when members impart information about themselves
and the therapist helps members to understand the task of the group, namely
that the members should interact, share thoughts and feelings and give feed-
back to each other as honestly as possible.
2 Installation of hope. New members need to see that the group is worth
joining and that others have benefited. Usually the other group members
will ‘initiate’ a new member and point out positive changes that have hap-
pened to individuals and to the group. Members usually reassure a new
person that the group is valuable and worthwhile (although on occasions a
member who is angry with the conductor and with the group will deride the
group in an attempt to form an anti-conductor sub-group, which will need to
be picked up by the conductor or, preferably, other group members).
3 Patients help each other. It is difficult at first for patients to feel that they can
be helped by other patients and a common fear is that they will be adversely
affected by each other’s neurosis, so they look to the leader to ‘give the
answers’. Gradually they find that they can be helpful to and helped by other
patients and it is of course up to the therapist to encourage this to happen
and not to collude with the fantasy that he or she is all-powerful.
4 Patients discover that others have the same problems, anxieties and fears.
They are not alone with their problem. There may be someone in the group
 40 Introducing group interactive art therapy

who has overcome this particular difficulty who can provide hope that it can
be resolved or changed.
5 The small group acts as a reconstruction of the family: members can use
each other to work out feelings about brothers, sisters, mothers, fathers, etc.
One of the big advantages that groups have over individual therapy is the
access to a network of relationships, thus the multiplicity of transferences
which occur and can be examined. Medium and large groups have specific
features and tend to echo the community or our larger social group.
6 Catharsis. When a member confesses to a state of mind which they had pre-
viously hidden, to desires and fantasies they had been deeply ashamed of or
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relives a traumatic event in the group, it usually brings great relief. It often
leads to similar ‘confessions’ by other members and helps to bring the group
members closer.
7 People can learn how they interact with others and have some feedback
about this. They can practise different ways of relating within a safe struc-
ture. Of course the member must feel sure there is no question of ‘retali-
ation’ by another member outside the group, and this is why members are
advised not to have social contacts outside as it could interfere with their
freedom to interact in the group. Sometimes this is unavoidable and the
therapist would then ask patients to bring material from interactions
outside into the here-and-now of the group. In a training group, this
material can be very useful to the students’ overall learning about group
interactive processes. ‘Assessment’ by the conductor and by peers is
liable to be a major preoccupation in a training group, giving rise to
members’ questioning what information may safely be shared. Provided
this is acknowledged right from the start, it can be useful material and not
inhibit interaction.
8 Group cohesiveness. The group is valued by its members as a safe place
where deepest feelings can be shared without fear or retribution and where
confidences can be shared and trust established. The group could be said to
take the place of the ‘super-ego’ and can act as support or reinforcer during
the week and when new behaviour is being tried out. The group – and the
conductor by modelling a non-judgemental attitude – may also modify the
super-ego of patients who tend to treat themselves and others very harshly.
9 Interpersonal learning. The group provides an opportunity for the past to be
replayed in the present with the opportunity for feedback and change. Old,
unsuccessful and frustrating patterns of behaviour can be uncovered, exam-
ined and hopefully improved.

The overall aim of group therapy is, of course, for members to uncover their
unconscious feelings and how these affect their lives in the here-and-now. Only
psychotherapy groups can perform this task effectively – other groups, such as
activity groups, work therapy, social skills, do not have this primary task,
although incidentally unconscious attitudes are often uncovered.
 Curative factors in groups 41

Introducing art therapy into psychotherapy groups

There are several ways in which introducing art materials into a group alters the
dynamics of the group. Maclagan (1985: 7), writing of his experience of con-
ducting art therapy groups in a therapeutic community where verbal groups were
the ‘norm’, makes the following comment:

Art therapy represents a potentially dangerous encounter with the irrational

and the uncontainable. It also involves a shift of competence, from a verbal
domain that is to some extent an instrument of rationalisation and control, to
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a nonverbal (or marginally verbal) area that is unfamiliar (I can’t draw), of

dubious value (It’s just a picture), and potentially humiliating (It’s all turned
out wrong). Nonetheless, it does address itself with a paradoxical intention-
ality – to those very areas of experience (dream, fantasy, imagination) that
are usually kept hidden behind veils of literal or anecdotal subject matter:
indeed, the real struggle of Art Therapy is not so much with language as
such, as with the concretising, proprietal tendencies to which it gives most
emphatic expression.

Let us look, then, at some of the advantages and problems involved in this
‘potentially dangerous encounter with the irrational’:

1 Most people, unless they have severe speech difficulties, are used to com-
municating in words and not in images. Our grasp of non-verbal commun-
ication is therefore less sophisticated than spoken language, so we have
fewer established defence patterns. Although as children we may have
drawn and painted freely, and this activity is vital to our overall develop-
ment (see Matthews, 1989), we tend to give it up as adults. Coming into an
interactive art therapy group may present adult patients with their first
experience of using art materials for many years – or their first ever experi-
ence. Wadeson (1987: 143) comments that making art may give rise to ‘per-
formance fear’ – not being good enough and, for this reason, group members
may feel more at risk and need much trust in each other in order to share
private, not easily controlled imagery. However, once having risked expo-
sure of a vulnerable image, a member usually feels more trusting of the
group and the whole group develops an atmosphere of trust (1987: 143).
2 The art materials give a means of expression additional to or alternative to
words; they can be used in an experimental way and here it is up to the ther-
apist to provide the kind of materials that can be used flexibly and do not
have too many connotations of the classroom or art academy (see Chapter
5). The patient can be encouraged to ‘play’ with the materials. Of course
many people feel very inhibited to start with, but someone in the group is
usually willing to start and this encourages the others. Patients are often
very surprised by the work that they and the group produce when they had
 42 Introducing group interactive art therapy

felt themselves to be ‘not good’ at art. Conversely, art graduates often

experience much difficulty and embarrassment about being in an art therapy
group and will try to differentiate between their ‘real’ artwork (made
‘outside’) and that made in the group: i.e. that work over which they can
exercise conscious control and that which is made spontaneously and as a
result of the group process. As time goes on, the distance between the two
sets of work often decreases and, ideally, they may become freer both in
their artwork and in their interactions.
3 Image-making within a group is rather akin to ‘free association’ or ‘dream-
ing on to paper’. It can lead to forgotten or repressed incidents being re-
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enacted in a very powerful and cathartic way. These incidents can be shared
with the group and hopefully exorcised of their power (see Case
Example 6).
4 The art objects are full of symbolic meaning, both to the individual who
produced them and to the group. These meanings are not necessarily the
same. As in verbal group therapy, the use of metaphor and symbol is very
important. Wadeson points out that the message of the images is received
visually by other group members and affects them, whether or not they can
describe their reactions. Words are often inadequate to convey an entire
experience, whereas images tap into aspects of being that are not necessarily
able to be articulated verbally (1987: 144).
5 The artwork also aids understanding of the here-and-now of the group.
The group can reflect on all the images made by each individual from the
perspective of how the image relates to the individual and also to the
group as a whole. The therapist can draw attention to similarities among
images and to specific issues – e.g. polarisation. Wadeson (1987: 47)
points out that the process of the group may become illuminated through
images as well as words and additionally through reflection on the images.
Individual feedback may be eloquently given as group members make
pictures of one another. The development of the group as a whole may be
seen in each member’s view of the group at a particular time or an issue
facing the group presented in art expression (see Case Example 5). By
reflecting and by observing content and affect respectively, a group’s
theme or mood may be revealed. Sometimes the artwork is so dramatic-
ally revealing that there is no need for a therapist to make a process
comment (as in a verbal group). On the other hand, when group processes
are not so evident, the art may serve as a useful reference point for the
therapist’s commentary.
6 The group’s attitude towards the conductor at any particular time may be
illustrated by several individuals quite concretely: e.g. hearts and flowers
just before a break accompanied by scenes of destruction and despair (see
Case Example 12).
7 The artwork is the focus for projection. Sometimes the use of certain mater-
ials, like finger-paint or clay, and more recently, iPads, can cause very early
 Curative factors in groups 43

feelings to emerge and the group members to regress accordingly. Members

can identify with (or ‘resonate’ to) each other’s work. It might not be pos-
sible or even necessary to talk about this work, but members might want to
return to it at a later stage. Work is stored and can be brought out again and
again, and perhaps changed or even wiped out (as with iPads) or destroyed.
This process can continue for several weeks if necessary, or for as long as
time is available (see Case Example 3).
8 The artwork is a focus for interaction. I have found that when people are
unfamiliar with the art therapy process, they expect that the therapist will
give interpretations of the artwork: what does it mean? Please diagnose my
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condition. These are early requests. Somehow, having the art object avail-
able invites these requests, even from sophisticated patients. The question is
put back to the patient and the group – how did you feel about that? How
did you feel when making it? What do other people think? What does it
mean to the group? The therapist’s task is to encourage interaction between
members, and to make comments to the group as a whole – by identifying
similar elements in people’s paintings, by linking the themes of one week
with those before, etc. It is entirely unhelpful for the therapist to collude
with wishes to interpret the paintings (rather like reading tea-leaves) as this
disempowers the group.
9 The practical nature of the group provides a structure which is for many
people less threatening than a verbal group. They can, if they need, preoc-
cupy themselves with the materials and feel less exposed than in a verbal
group. They can, for the time being at least, say ‘It’s just a picture.’ This is
helpful to people who have the potential to benefit from a group but find the
exposure to others too threatening to begin with and might be likely to
leave.
10 Because using art materials always contains an element of play, the group
can have a ‘fun’ aspect as well as being serious. When adults can let them-
selves go enough, or regress sufficiently, to enjoy play, it can quickly help
them to get in touch with patterns of behaviour which are causing problems.
For example, the person who was never allowed to play at home, or got left
out of games with other children. The one who always had to dominate, or
the one who could never make themselves heard. The shared processes of
making, as in a group painting, quickly reveal family patterns, and each
individual will respond according to their experience in the family (see Case
Example 4).
11 The imagery left behind after each session is of great value to the therapist
when reflecting on the process. It is a container for so much that has gone
on, a reminder of each individual and of the process of the group. However,
knowing what to do with the imagery – i.e. where to store it safely, etc. –
gives an additional responsibility to the conductor (see Chapter 5). What to
do with the imagery – and the room – when the group has finally ended
gives further useful material for interaction (see Case Example 13).
 44 Introducing group interactive art therapy

12 The group process may be intensified through the introduction of art materials.
A feature of using art therapy as part of a group process is that processes may
develop very quickly, and are made visible, more tangible and available for
working on. But it is precisely because of the speed and intensity provoked by
image-making in an interactive group, that the conductor must be firmly in
control, through their own training, and able to slow the process down if it
seems that too much material is being produced without adequate processing.
The group may be trying to avoid experiencing the emotion of a particularly
difficult or painful event (e.g. a long-standing member leaving, the Christmas
break approaching) by producing vast amounts of imagery which is left in
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undigested piles. At such times, the conductor’s role may feel similar to that of
a conductor in a psychodrama group (see Holmes, 1991: 7–13 for a useful
introduction to classical psychodrama).
13 The value of creative activity. This element of the group process should not
be overlooked. For many people, engaging in the art-making process is in
itself challenging, rewarding and stimulates learning. Quite often greater
flexibility in using materials goes hand in hand with a willingness to experi-
ment with relationships in the group. Many of the objects and paintings pro-
duced in art therapy groups are remarkable for their originality. Even people
who consider themselves ‘clumsy’ and ‘uncreative’ can, through the group
process, open themselves up to the possibilities of the art materials.
14 The potential for including technology: young people are very familiar with
the world of information technology and may find it easier to use a computer
or an iPad to generate images whereas older adults may possibly find this more
challenging. Flexibility in the provision of materials (budget allowing) is thus
very important and as the examples from the art therapy with stroke patients
will demonstrate, can be essential in enabling even those with limited physical
ability to participate. Access to a printer enables images made on the computer
to be physically accessible, used as a starting point for further development or
to be shared more easily with others in the group.

In summary, the above curative factors are contained within a group interactive
model, in which the making of images facilitates interaction among members
and the therapist and stimulates the creativity of participants. The model also
involves awareness of the group as a ‘system’ and willingness to use the social
and cultural context of the group and its images as material for the group. As in
verbal group therapy, the conductor avoids focussing on the individual, or on the
overt ‘content’ of the session, but encourages the members to interact, being
aware of the symbolic, metaphoric messages arising both from the images and
the relationships among the members themselves.
Having suggested ways in which the group interactive process can be
enhanced or changed by the introduction of image-making, in the following
chapter I shall explore some of the specific responsibilities involved in conduct-
ing an interactive art therapy group.
 Chapter 4

Conducting an interactive art

therapy group
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The extent to which a conductor believes that participants in a group are able
to make their own choices, i.e. of themes or in structuring the group, is one of
the main factors influencing their approach. In Chapter 1 we have seen how
the discussion about theme-centred versus ‘non-directive’ groups dominated
the art therapy literature on groups for some time. Personally I believe it is
possible to work with themes which arise in both the artwork and the verbal
interaction at the same time as drawing on insights from group analytic and
interactive models. I think it would be very difficult, though, for the conductor
constantly to provide emotive themes (i.e. draw your family) and work with
transference or even with group-as-a-whole issues in any meaningful way.
This would seem to limit the potential of the group to arrive at its own themes,
or ‘resonances’ in its own time. It is possible, as I hope to show later, in a
short-term training group for example, for the conductor to introduce open-
ended projects designed to promote interaction such as ‘introduce yourself
visually to the group’ which leaves members plenty of scope to be as open or
closed as they feel able at that time. The conductor can also encourage expres-
sion of feeling around doing this task at the request of the conductor. In the
early stages of a group, this constitutes ‘information sharing’ visually and ver-
bally, and the conductor opens up the possibility of members being able to
react freely to him or herself. The group interactive art therapist accepts that
group members are at liberty to ignore any suggestion he or she makes in
favour of their own resolutions.
Aveline and Dryden have succinctly described the features of an interpersonal
or interactive group:

The philosophical underpinning in existentialism in the interpersonal group

leads to a distinct emphasis on members taking responsibility for their
actions, being authentic and exercising their freedom of choice, a feature of
practice of gestalt group therapy too. This serious note is balanced by an
emphasis on humour, an element shared with psychodrama and gestalt,
which in turn, stresses the vitalizing force of creativity and spontaneity.
(1988a: 144)
 46 Introducing group interactive art therapy

On a light note, they mention a categorisation scheme developed by a literary

critic, Northrop Frye in the 1950s and 1960s, which was later applied by Schafer
to psychoanalysis in a book on language (Schafer, 1976) and subsequently by
Messer (1986) to psychoanalytic therapy and behaviour therapy. Life’s possibil-
ities are divided into four themes: the romantic, ironic, tragic and comic visions.
In applying these thematic structures to small group therapies, Aveline and
Dryden see the analytic group therapies as predominantly tragic, with their
emphasis on underlying unconscious conflicts which have to be faced; and
romantic in their belief that full human potential can be realised. The conductor
is the spokesman for the ironic vision because he or she helps the group look
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below the surface. The interpersonal approach is also tragic and romantic but
leavened by the comic: ‘In its humanism, the approach is hopeful about the indi-
vidual and what that person may achieve with the help of the group, but its exis-
tential heritage confers a tragic realisation of the inevitability of death and
unfulfilled ambitions’ (Aveline and Dryden, 1988a: 145). The leaders of analytic
and interpersonal groups have much in common – i.e. they do not actually lead
(as, say, in gestalt or psychodrama groups) but the analytic leader interprets the
communications of the group and the social matrix, remaining in the background
as much as possible and helping the group take responsibility for itself: ‘The role
is austere and highly professional; it is not to give comfort or be real – hopefully
members will give this to each other’ (Aveline and Dryden, 1988a: 148). (By
‘real’ I take the authors to mean revealing the true feelings that the conductor
may have in the group.)
Whereas:

the interpersonal leader is seen as a facilitator of interpersonal transactions

and as a fellow-traveller in the journey of life; taking an increasingly back-
ground role, he attends to the language, both verbal and physical, that is
used in the group and its meaning.
(Aveline and Dryden, 1988a: 148)

Aveline and Dryden also discuss personality characteristics of effective leaders of

the various small group approaches: the analytic leader, they say, demonstrates his
‘analytic love of truth even when unpalatable’ and the interpersonal and gestalt
leader ‘acts as a model of good membership: he tries to be open, shows willingness
to change, takes risks and is relatively undefended’ (1988a: 149).
According to Ratigan and Aveline (1988: 54):

The leader as a facilitator of interpersonal transactions is neither passive nor

claims the centre stage but will be both observer and reflector of what is
going on in the group. The latter role obviously has echoes of the psychoan-
alytic perspective. The leader also models helpful group behaviour to the
members and in this perspective is linked with social learning theory.
(Bandura, 1977)
 Conducting an interactive group 47

Thompson and Khan (1988: 77–8) point out that the conductor is as subject to the
influence of the group culture as the members (and indeed helps to create it) but he
or she must be sufficiently detached from it to be aware of what is going on and be
able to intervene when necessary – for example, to prevent scapegoating, as in Case
Example 11). The conductor needs to recognise group processes and the way in
which they and other members are contributing, for every intervention that a group
psychotherapist makes, or does not make, is significant. It is through the attitude and
behaviour of the conductor that a group can learn tolerance and a permissive and
accepting attitude (and conversely, of course, an authoritarian and punitive attitude).
Through their own experience in therapy, the group leader should have learned how
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to tolerate distressing experiences and to enable the group to do the same.

To sum up, the major functions of the group conductor are to:

1 establish and sustain the group’s boundaries (selection and preparation of

members, organising of the group room, receiving apologies, etc.);
2 model and maintain a therapeutic group culture; i.e. one in which tolerance
and a permissive, accepting attitude prevails;
3 provide an understanding of the events of the session and encourage group
members to do the same;
4 note and remind members of their progress and change since being in the
group;
5 encourage members to take responsibility for their actions;
6 predict (and possibly prevent) undesirable developments, such as scapegoat-
ing, victimisation, acting out, premature termination of member, misleading
feedback being given;
7 involve silent members – preferably by pointing out how the group process
has enabled a member to remain ‘the silent one’;
8 increase cohesiveness (by drawing attention to similarities between
members in the group);
9 provide hope for members (it helps members to realise that the group is an
orderly process and that the leader has some coherent sense of the group’s
long-term development).

The leader also has to be aware of the ‘culture’ of the group and here Thompson
and Khan draw a parallel between the group and the nation state. They point out
that disruptive elements in the state can be dealt with either by tolerance of
rebellious or subversive activity in the case of a confident state or by repression,
censorship and insistence on conformity in the case of a divided or threatened
state. Groups may also develop a culture which discourages non-conformity and
makes certain subjects ‘taboo’ areas or only to be discussed at certain times (e.g.
when the leader is absent).
Having looked at some of the general features of a conductor’s role, let us
now turn to the conductor of an art therapy group and see what some art thera-
pists have said about this.
 48 Introducing group interactive art therapy

Wadeson (1980), writing as an art therapist who often conducts groups,

believes that the sort of leader one chooses to be depends on such factors as type
of client population, size of group, treatment goals, length of treatment, setting,
structure of sessions and personal style.
In common with verbal group conductors, Wadeson sees part of her role as
modelling behaviour for the group – demonstrating dedication, acceptance,
respect for others and empathy. She is aware of and pays close attention to
power issues involved in conducting (1980: 240). As with verbal groups, she has
a management role in determining the length of sessions, admission of members,
fees, etc. She pays attention to time boundaries – she arrives on time and encour-
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ages others to do the same. She maintains the ending time of the group. She tries
not to be judgemental and does her best to create a climate in which everyone’s
insights and observations are valuable.
Writing about her experiences in a day hospital run on therapeutic community
lines in the 1970s, the late Patricia Nowell Hall saw art therapy groups as pro-
viding ‘a necessary balance to the somewhat heavy emphasis on verbal, interpre-
tive and analytic groups’ (1987: 157–87). She conducted two art therapy groups
each week, one open to everyone and the other an intensive group for six to eight
people with a commitment for a fixed length of time. She structured the art
therapy groups in three stages: first, people would come together for a short
general discussion and have the chance to express how they felt at that time;
second, they would find a space and paint, usually working alone for about an
hour; third, they would come together as a group, with a turn for each person to
show and talk about their paintings if they wished. Sometimes exercises were
suggested – generally designed to facilitate self-exploration rather than prescribe
areas to explore. Usually the sessions were ‘open’ and relatively ‘non-directive’.
Nowell Hall kept the paintings in folders and encouraged group members to look
at them again regularly in the following months, individually and in series.
She said of her role as conductor:

As the art therapist in the groups, I aspired, as Champernowne (1969) said

‘to provide the protective conditions to let things happen’, and to enable the
ideal that Carl Rogers (1957: 95–103) claims as ‘the necessary therapeutic
climate’. This would be one that allows both psychological safety and
freedom – through unconditional positive regard, warmth, genuineness and
accurate empathy, thereby maximising the chance of openness to play, to
experiment, and to change and for constructive creativity and growth to
emerge.
(1987: 159)

She went on to say that she saw the role of the therapist as being like a ‘psychic
midwife’ helping to bring things to birth, or a ‘gardener’, enriching the ground
and helping the seeds to grow. In this respect, she echoes the attitudes of
the advocates of ‘child art’ such as Franz Cizek, Wilhelm Viola, Marion
 Conducting an interactive group 49

Richardson, who believed that, given the right conditions – space, non-judgemental
attitude, art materials – the inherent creativity of the child would emerge. (See
Waller, 1991: 16–24 for further information on the ‘child art’ movement.)
It goes without saying that the art therapist conductor should be thoroughly at
home with a wide range of art materials, enjoy the process of visual creativity and
be open and flexible in his or her approach to making images. If the conductors do
not themselves have an extensive background in visual art, then they should co-
conduct with someone who does. It is unlikely that the important element of
enhanced creativity will be present in a group if the conductor is entirely inexperi-
enced in the use of materials or has rigid preconceptions about art.
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The conductor of an interactive art therapy group has the responsibility of pro-
viding and maintaining a suitable room which is large enough for participating in
art-making. This room will need suitable furniture for the purpose and the conduc-
tor needs to provide a stock of basic art-making materials. The conductor has to
ensure that work can be safely stored after each session and that the artwork is
named and dated. He or she also has to see that health and safety precautions are
upheld – e.g. firing kilns, seeing that pottery glazes, knives and other instruments
are properly used (see Chapter 5 for discussion of these important issues).
The issue of using time within the session for talking and/or making images
is also one which exercises the leader of an art therapy group. In a verbal group,
members have a clear task – to communicate through words, usually sitting in a
circle. Generally they speak one at a time and though they may interrupt each
other, several people are not normally trying to communicate at once. In an art
therapy group, the conductor has to decide whether to influence the structure of
the group – i.e. by suggesting how long to paint for and to talk for, or letting the
group make this decision. Some members may be painting, others talking, some
working individually, others sharing a piece of paper. There are many interac-
tions for the leader to be aware of at once. Skaife and Huet (1998: 17–43) in
‘Dissonance and harmony’ explore the issues of focus, structure and time with
reference to a group of self-referred clients, making interesting references to
musical structures.
McNeilly (1990), while a student at the Institute of Group Analysis, presented a
seminar to his peer group on the adaptation of group analysis to his own work as
an art therapist. Although he has evolved a group-analytic art therapy approach, his
findings are, I believe, equally applicable to an interactive approach. McNeilly
reported the following observations made by the student group:

It was more demanding for the group-analytic art therapist to sit watching
and remain alert for the first forty-five to sixty minutes (the image-making
period) while many simultaneous expressions occur. Perhaps it was at this
seminar that I began to develop my view that this part of the art therapy
group is like ‘classical free association’, whereas in conventional group ana-
lysis ‘group associations’ occur throughout the session.
(1990: 217)
 50 Introducing group interactive art therapy

McNeilly points out that at the beginning of his groups, members create their own
images concurrently. If people were all speaking at once in group analysis this
would be chaotic or nonsensical. Therefore the verbal group analyst works through
consecutive verbal inputs. He found that his colleagues were surprised that:

so much resonance and cohesion could be reached when people had the
freedom to create their separate imagery, to emerge in the verbal section united
or fighting, like the best of groups. There was a prior view that the opposite
would occur – that people would become more isolated from one another.
(1990: 217–18)
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For Nowell Hall (1987: 165–6):

The art therapy session offered a balance of privacy and sharing: first to
withdraw, reflect and explore, through the art materials, alone, intrapsychi-
cally and silently; and then to ‘come out’ and come together with others for
showing and talking – each with his own individual and unique creation to
show and/or talk about. In this way the private world of painting became
linked to the public world of language, and with an intermediate stage of
being able to communicate with and confront oneself first, before sharing
with others. This was commented on as very important, especially in a
milieu that was in a sense based on a more extroverted and interpersonal
group therapy culture.
In this way the art therapy activity offered an opportunity to begin to
develop the vital capacity to be separate and alone (all-one) in order to be
healthily together with other people.

One can see from these quotes how Nowell Hall’s basic Jungian and Rogerian
philosophy influenced the way she perceived the function of this group, how she
structured it and her role within it. The interaction in this art therapy group is
mainly between herself as conductor and the individual members, and the
members and their artwork. This group might well have served an important
function in enabling patients who would otherwise have found the verbal groups
too confrontative to make use of them subsequently if they so wished.
Sally Skaife has explored the issue of structuring the group’s time for art-
making and for talking in her article ‘Self-determination in group analytic art
therapy’ (1990) in which she describes an art psychotherapy group which
attempts to combine two types of therapeutic practice, free-floating verbal inter-
action and individual involvement in visual self-expression, allowing the group
to decide when and how they change activity. Skaife says:

The art activity adds a new dimension to the ‘work material’ of the analytic
group, allowing as it does for feelings to be expressed in an alternative way
and metaphorical and symbolic language to stay on in the group in a
 Conducting an interactive group 51

concrete form. As well as this, feelings that are not easily expressed in
words can be played with in their symbolic form, for instance, colour and
shape, and thus worked on in a way that can make them more accessible to
language and thus to consciousness. As in other art therapy settings, group
members are encouraged to use the art materials to express themselves
freely; this work is then looked at as both belonging to the history of the
individual and as an expression of the dynamic of the group.
(1990: 237)

The art activity adds a new dimension to the ‘work material’ of the analytic
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group. Skaife questions the conductor structuring the group time. She considers
that if she decides how long the group should paint for and talk for, there is a
danger of her being too controlling or interfering with the transference; that she
may interrupt the group process and curtail important interactive therapeutic
work. The method she tends to use is to leave the group to decide on when and
how they should paint, the processes that influence these decisions then being
subject to analysis in the same way as other aspects of group life.
Skaife has found that one positive outcome of this approach is that members
can reflect on their own contribution to decision-making and thus develop
greater understanding of their own ways of negotiating social relations. In addi-
tion, Skaife points out, issues particular to ‘creative activity’, such as the ability
to ‘let go’, tolerate chaos and so on, emerge frequently for discussion as
members are responsible for their own actions.
Her article contains a case study vignette of a group in which there was pres-
sure for her to structure the time. She makes the important point:

In group therapy individuals repeatedly lose themselves in the group iden-

tity and then find themselves as unique individuals. Painting, however, is
essentially an individual activity. When the group stop talking and begin to
paint energy becomes focused away from others and on to the self (though
group painting alters this to some extent). By allowing the group to decide
how and when they should change activity one is bringing into focus issues
such as the use of time, being alone and being part of a group. Letting go of
the group to go and paint was likened by E. to entering chaos.
(1990: 243)

The art-making process, then, adds a complex other dimension to group psycho-
therapy, whether group analytic or group interactive or a combination of both
(these ideas are further explored in Art Therapy Groups (1998) edited with
Val Huet).
I mentioned in Chapter 3 that, at certain times in the group, i.e. when the
group is producing vast quantities of images and showing no signs of wanting to
‘digest’ these or reflect upon them, the conductor’s role may resemble that of a
psychodrama conductor. There is a high degree of ‘drama’ in an interactive art
 52 Introducing group interactive art therapy

therapy group (see Case Examples 6, 7, 8, 11 and 12 in particular) and the con-
ductor may need to be particularly vigilant in reinforcing boundaries and encour-
aging members to move into a different mode of enactment, to slow the process
down. Personally, I would recommend participating in several sessions of psy-
chodrama for any conductor of interactive art therapy groups, so that they may
feel more secure about that aspect of their role which is concerned with keeping
the group members ‘in role’. As Case Example 11 shows, images are sometimes
so powerful that they overwhelm both the maker and the group and the sym-
bolic, or ‘as if ’ qualities are likely to be lost.
At such times, I would tend to think that the conductor of an interactive art
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therapy group, requires, like Aveline and Dryden’s psychodrama group conduc-
tor: ‘an uncommon blend of extroversion and sensitivity, as well as energy and
the ability to think on one’s feet and to tolerate the scrutiny of the group in the
prominent role of director’ (1988a: 149).
The question of what to do with the productions after the session has ended
is one which always faces an art therapist conductor and is particular to their
role. Art therapists normally have a ground rule that images are left in the
room, i.e. they are not taken away by the members, nor are they interfered
with between group sessions. In Case Example 11, I shall describe how dev-
astating a violation of this rule can be for a group. Members leave their ‘sym-
bolic selves’ in the safe-keeping of the therapist. The therapist has the problem
of how to store the images. This is particularly difficult if space is very limited
or if the room is to be used soon after by others. Indeed, the scope of image-
making itself may be limited by such reality factors: it is a problem if the
group create a structure which needs to be left up if others are going to use the
space. Spontaneity in the process usually has to be curtailed by these practical
considerations and this is a serious limitation in the potential of the interactive
approach. It is, however, one which is difficult to solve, given that there are
usually space problems in most institutions. The ideal would be a room which
was used by one group, perhaps over a limited period, and in which the group
could create its own environment.
Possibly the fact that space has to be shared and is usually limited contributes
to most art therapists talking about drawing and painting in groups, as opposed
to sculpting or building environments. I believe it is an important issue to be
addressed. Working on small sheets of sugar paper with felt-tipped pens in
someone’s office may certainly be of use but is bound, in my view, to limit the
therapeutic potential of the group. Using tables in the dining room prior to lunch
being served is also inhibiting and although one can say that it is useful to work
with limitations of reality and to see how group members circumvent them, it is
unreasonable to see this as anything but part of the potentially more vital and
energy-releasing process which could develop with appropriate resources. I
speak from experience here: as we shall see from some of the case examples in
this book, I have conducted interactive art therapy groups in a variety of spaces,
some ideally suited to my purpose, others almost impossible. I have therefore
 Conducting an interactive group 53

learned ‘the hard way’ and will be sure to ask for minimal working space and
conditions before undertaking to run a group.
One of the important functions particular to an art therapist conductor then, is
the practical one of ensuring that art materials are available and a suitable space
in which to use them can be provided. That this task is not always straight-
forward will be clear from the examples in the next chapter.
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 Chapter 5

Practical matters
Materials and rooms
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Art materials
In Britain, trainee art therapists are usually art graduates. In any case, they have
extensive practical experience of using art materials and most people have had
art education in their school curriculum. This is by no means the case elsewhere.
For many years I conducted art therapy groups in various institutions in eastern
and western Europe. These institutions have actively sought to introduce art
therapy into their training or treatment programmes and the following observa-
tions are offered as a result of the experience gained from this work.
In parts of Europe and certainly elsewhere in the world, art education is not in
the school curriculum and trainees who undertake art therapy are often psychia-
trists, psychologists and nurses who have little or even no practical experience of
art. This is not seen as a problem, because art therapy is part of a medical tradi-
tion, and therapists are not artists. The concept of ‘lay’, i.e. nonmedical, psycho-
therapists is not always accepted. It is possible that as a result of the European
Union and greater movement between countries within Europe, the training and
background of art therapists will become more ‘harmonised’. Just now, though,
we have to accept that there are differences in basic education and that trainees
approach art therapy with very varied backgrounds. Art therapy trainees increas-
ingly come to the UK from overseas countries where there is no tradition of art
therapy and they may find the art-based culture of art therapy particularly chal-
lenging although exciting.
It is a strongly held view in Britain and in the USA that art therapists should
either have been art trained or have ability in and commitment to the practice of a
visual art. This gives confidence in the image-making process, an understanding of
the symbolic language of art and its power to communicate. It gives the therapist
greater freedom to respond to a patient’s images, and I have mentioned the import-
ance of this in Chapter 4. Without such ‘visual confidence’ there is a tendency for a
‘reductive’ attitude to be taken to the image: that is, a search for equivalence in
words and for a judgemental approach to underlie an observation: ‘This is not art.’
That is not to say that all artists are immune from these attitudes or that all
non-artists will have such a reaction to an image. It is rather that the long, often
 Materials and rooms 55

lonely road that the art student travels in their struggle with drawing, painting,
sculpting, video and film, photography or whatever visual art form they have
chosen, can, perhaps, be compared to a personal analysis. The unknown has to
be faced: the blank sheet of paper or the canvas or the concept has to be grappled
with; ideas are difficult to put into forms. The artist is faced with themselves,
their attitudes and assumptions, and has to draw on their own resources. There is
also the development of art within a social context to be studied – movements
such as Surrealism, Pop Art, Abstract Expressionism, Happenings, Conceptual
Art, the increasing use of technology and so on. Images have a social and cul-
tural context; colour has different symbolic meanings according to its cultural
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context; very young children are liable to use materials in a different way from
the elderly – and so on. I believe, from experience, that the artist is less likely to
‘pathologise’ images – that is, search for signs of ‘mental illness’ – but to relate
the image to the person who made it and seek their response. This is hardly pos-
sible if the art therapist has no experience of image-making themselves. As
artists, we may have been deeply influenced by certain ‘schools’ of art – perhaps
the one that was most prevalent when we were at art school; we may have biases
and subtly encourage patients to paint, make pottery and so on when we need to
be encouraging them to find their own most appropriate medium. We have to try
and be aware of this and it isn’t always easy. It is also not easy for an artist to be
a participant in an art therapy group.
David Maclagan makes a pertinent point in his discussion of the ‘mythology
of art therapy’:

The mythology of Art Therapy is, like so many other myths, a tactical exag-
geration; due, perhaps to its need to defend itself against being used as an
accomplice of psychiatric diagnosis. Amongst patients the fear is still there,
that therapeutic painting or drawing is a kind of imaginary ambush, in which
their relaxation will be taken analytical advantage of: this fear is all the
more easily aroused in Art Therapy since, unlike the transitory verbal
material of other groups, pictures are ‘fixed’ and thus far more exposed to
scrutiny.
(1985: 7)

How can participants express themselves visually, though, when they have no
idea of the potential of materials and when their idea of Art is painting by Rem-
brandt or Leonardo da Vinci or other ‘old masters’? This, in countries so rich in
traditional art forms, which have been undervalued by reason of association with
‘the past’, which often means ‘the village’. Or when Art may mean classical
music, poetry, architecture or picture restoration . . . the use of the term ‘art
therapy’ has uncovered many different understandings of the meaning of the
word ‘Art’.
This problem became clear when I first worked with a group of psychiatrists
in Bulgaria. Only two people in the group had any experience of visual art
 56 Introducing group interactive art therapy

whatsoever and that was a little painting at school. The reasons for them choos-
ing to enter art therapy are complex and have been described elsewhere (see
Waller, 1983/84, 1990). They were enthusiastic, all had an interest in ‘Art’ but
had no idea about art materials, which, for art therapy trainees, is (or at least
was) unthinkable in the UK.
There is an assumption in art therapy – perhaps also part of the mythology
described by Maclagan – that the greater the range of choice in materials avail-
able the greater the range of expression and communication available to the
patient. In an interactive group, such flexibility of expression, using art media, is
a big plus.
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There is also an assumption that each material has its own character and
patients will respond to some materials rather than others at different times. If
we accept these assumptions, then we must accept the responsibility of provid-
ing as wide a range of materials as is feasible. However, too great a range of
unfamiliar materials can cause inhibition.
As a result of working in countries where art materials are very hard to come
by and expensive, I have explored the concept of ‘art materials’ in some depth. I
ask myself ‘What are art materials? What assumptions have I been making?’ In
fact, reading Studio International, I wondered if materials were even necessary
to make art, such was the emphasis on words! I asked for people’s views about
art materials in the first meetings of the Bulgarian training group. People replied:
‘Oil paint, canvas, paper, watercolours, sable brushes. This is what art-making is
about.’ I asked, ‘Is it possible to get hold of these materials, then?’ They replied,
‘No, not unless you are a member of the artists’ union or a student in the art
academy.’ I asked, ‘How are we going to work this week because we have no
canvas, oil paint, etc.?’ Some people suggested paper and pencil, readily avail-
able. Others, watercolour blocks, which could be bought in toy shops. I sug-
gested we would need an immense number of these blocks to do work of any
size. One doctor said, ‘But we always give children little pieces of paper because
we don’t have room to put up large paintings.’
From this interaction there were many important issues raised: first, the
concept of real art being done on canvas with oil paints or with watercolour.
Second, you could not buy these materials unless registered as a professional or
trainee artist, or unless you had a contact in the network. They were also
extremely expensive. Third, most Bulgarians at that time (1980s) lived and
worked in cramped public and private spaces. Literally, there was not room for
hanging up large works in most institutions, flats or houses. Fourth, being an
artist is seen as a highly professional activity, like being a lawyer. It was only in
the 1980s that art was included in the high school curriculum and then it tended
to be art history or teaching about architecture or similar. Practical art classes
traditionally took place in out-of school centres, and children who showed talent
were directed towards the art ‘gymnasium’ at 14-plus. Although the population
in general were very well informed about art and flocked to see exhibitions, very
few people had ever participated in art-making themselves.
 Materials and rooms 57

In discussing these issues with participants and members of staff in the

Medical Academy, we came to the conclusion that media workshops needed to
be provided as part of the training. They are, in fact, provided within British art
therapy training courses, but are more often used for extending one’s range of
skills. For example, learning about pottery or printmaking, attending a life-
drawing class, making sculpture and so on. These media workshops would need
to start at the beginning, looking at the nature of materials, fundamentals of
mark-making and so on.
The media workshops were an integral part of all the training courses I have
conducted abroad and were run by the late Dan Lumley, an artist and art teacher
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with much experience of art therapy. They were clearly set up to focus on mater-
ials and were not therapy groups although sometimes participants tried to turn
Dan into a therapist! The introduction of these groups into training courses was
enormously beneficial according to the feedback from participants. We observed
a ‘freeing up’ in the practical work. After all, if you have absolutely no idea
what to do with any particular material it is hard to make it work for you! It is
too easy to say that experimentation is part of the process. That is true, but I
firmly believe that it’s possible to be more creative and experimental if starting
from a secure, if modest, base. This has led me to consider whether having
media workshops for patients in hospital, alongside art therapy sessions, would
be a good idea. The movement ‘Artists in Hospitals’ together with Arts for
Health has led to many artists wanting to use their skills with groups of patients
and others who don’t usually have access to the arts. Cooperation between artists
and art therapists may provide a most valuable additional resource for patients. It
would also leave the art therapist freer to concentrate on their role as group con-
ductor, knowing that the patients had a basic knowledge at least of how to use
materials. It is a thought that needs more exploration in practice. Recent innov-
ative work with older people with dementia and their carers in a Sussex hospital
has demonstrated the benefits, in terms of decreasing isolation, of holding work-
shops in local art galleries where participants could share in discussions about
the work on show and be stimulated to make art work of their own afterwards.
The ATIC project (ATIC, 2010) is a good example of an art therapist using her
group work skills and sensitivity to people with dementia and their carers in a
novel way. Feedback from the group confirmed that this was an important crea-
tive opportunity, enjoyed by all, and one which the group hoped to be repeated.
There are other examples of art therapists using their art skills, and working with
colleagues from arts in health projects, to conduct groups in major art galleries
and museums.
Many different ways of working with materials can be demonstrated through
the media workshops, and assumptions about art can be questioned. The aim is
to provide participants with a choice about how they use the material. Different
perspectives on the image from various art historical and cultural standpoints
may be presented. At the end of the workshops, we did not expect the particip-
ants to have absorbed all that had been presented and in no sense were these
 58 Introducing group interactive art therapy

workshops designed to be equivalent to a full art training. But we hoped that the
participants would be in a state we can call ‘fertile disorientation’ which may
prepare them for the group art therapy sessions and stimulate them to engage
more deeply in art practice in the future.
Being educated in and conducting groups in Britain, where all manner of
materials and all kinds of styles of art are easily accessible, it is easy to forget
that this is not the case in some other countries. The definition of ‘art’ is so broad
as to include all manner of images, constructions, landscapes – and it was a Bul-
garian artist, Christo, who wrapped buildings, bridges, cliffs, in plastic and
called it Art!
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The tableaux and assemblages of Edward Kienholz and Bruce Conner, and
the Magic Realism of Peter Blume are art, as are the brillo pads of Andy Warhol,
the metal constructions of Anthony Caro, the wooden sculptures of Louise Nev-
elson. ‘Happenings’ are art, murals by Banksy are art, taking a walk in the
country or planting daffodils is also art. Visual art can encompass a high degree
of dramatic interaction. The collection ‘Art Brut’, brought together by the artist
Jean Dubuffet and now housed in Lausanne, reveals an incredible range of ideas
and imagery. Some of this work was produced by people who happened to be in
psychiatric hospital; others worked away on their own and were considered to be
‘eccentric’: hence the term ‘Outsider Art’. Sometimes I feel that as art therapists
we can get stuck with paint and paper not only because we are usually short of
space but because we may be a little trapped in the conventions of the traditional
‘studio’ and the convention of ‘art as expression’, when it refers to art therapy.
These experiences led me to develop a series of papers which have questioned
how looking at the way that artists like Kienholz, Arte Povera, Young British
Artists conceptualise their art might useful to art therapists. Developments in
eco-psychology could also be studied – the work of Richard Long and others
who use the ‘natural’ environment in creating their work, the movement towards
‘taking psychotherapy outdoors’ (the basis of PhD research by Martin Jordan at
the University of Brighton) draws on inspiration from art therapist and Jungian
psychotherapist Mary-Jayne Rust and others.
However, because it seems that we do need to have some materials to use in
making images in art therapy, in Case Example 1, I will return to more ‘down to
earth’ problems of finding them in places where there are no convenient art
materials shops.

Rooms
With the exception of those lucky people who have access to varying sizes of
studio space in hospitals, art therapists have always had difficulty in finding suit-
able places to work. They have found themselves in disused laundries, wash-
rooms, store-rooms, corridors. This problem is highlighted following moves into
‘the community’ as a result of the closure of large psychiatric hospitals. Many
fine spaces have been lost and adequate substitutes often not found in day care
 Materials and rooms 59

centres (see Wood, 1992). When running verbal small groups, it is possible to
use a moderately large office, complete with chairs and carpet, but art therapy
can be messy, people need to move around and have access to water. Sometimes
art therapy groups cannot take place because there is no suitable room. This
seems a great pity but even purpose built day centres usually don’t take the
needs of art therapy into account. Elegant, hygienic kitchens, neatly carpeted
small-group rooms, dining rooms with pine furniture, but no pottery or empty
room with tiled floor and a sink! Even when resourceful art therapists put down
plastic sheeting and carry buckets of water back and forth, there is still the
problem of what to do with the work after the group.
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This is where it is important to have a place to store what might be quite large
objects. When two or more art therapy groups are using the same space at dif-
ferent times, they are likely to have a territorial competition by producing large
objects that are difficult to move, or which have to be left in the room because
the paint is very wet, the clay is wet, the objects are fixed to the walls and so on.
This is all useful material for the process (looking at the system in which the
group takes place), although it does give the art therapist conductor certain prob-
lems, especially if a colleague is to use the room later! It is one reason why
working in unsuitable spaces in hospitals is frustrating.
For example, in one hospital, the only possible space for a trainee to hold an
interactive art therapy group was the dining room. The trainee brought the
problem to supervision and the group explored whether this was, in fact, the only
space and, if so, if it was possible to run a group there. There was the possibility
of interruptions, of patients associating the space with eating, of having to clear
everything up and scrub the formica tables before lunch. Work could not be left
on the tables, which limited the range of materials to be used. The trainee
decided to accept the limitations, paying particular attention to ensuring that
there would be no interruptions during the group. She provided only ‘dry’ mater-
ials with the exception of watercolour paints; these included felt tips, old maga-
zines, fabric, different coloured paper, glue, crayons, charcoal. She considered
self-hardening clay, but decided against it. She had a ‘junk’ box, with odds and
ends assembled from the hospital store.
Her patients were elderly people whose mobility was limited. They felt secure
with the ‘dry’ materials and were able to work in these conditions. It was still
difficult, though, as despite attempts to make the space private for the duration
of the group, several people came in and out and clearly it was not very hygienic
to use an eating place for artwork. The elderly people could not experiment with
unfamiliar materials. All signs of the group had to be removed each time, so an
important element of the process was lost.
Art therapists are, however, able to make use of spaces which other staff
might not want: for example, huts. At Goldsmiths in the 1990s, the Art Psycho-
therapy Unit had the use of three somewhat battered huts, put up as temporary
accommodation several years back. There was plenty of light, plain white walls
and wooden or linoleum floors. Large and ancient square sinks were installed, as
 60 Introducing group interactive art therapy

were heaters and plan-chests for storing drawings and paintings. Folding tables
and stools could be erected as the group members wished, or propped up against
the walls. There was room for storing largish objects at each end of the hut. It
did not matter if paint was spilt: it could easily be mopped up or scraped up later.
As the huts were only used by art therapy trainees, there was a respect for other
groups’ work (despite the territorialism referred to above). The life of the huts
came to an end eventually when they more or less fell apart and were declared
hazardous by a programme approval body! The replacement workshops were a
little warmer and dryer but lacked the ‘atmosphere’ of the old huts surrounded
by trees and flowers.
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Maintenance of the rooms is important as health and safety laws must be con-
formed with and as time has gone on these have become stricter, meaning prac-
tices which were considered safe in, say, the 1980s, are no long possible. Art
materials can be dangerous: for example, clay and glaze dust can be inhaled; and
although all glazes used for teaching purposes are lead free, they could be dan-
gerous if accidentally swallowed. Sharp knives and scissors are potentially lethal
weapons and if working with patients who have a history of violence, much care
must be taken. Patients may cut themselves and it is imperative that full precau-
tions are taken to avoid serious injury. Patients who have cognitive impairment
may not understand that paint and clay are not edible.
If using a kiln, this must be in a separate room or guarded by a special locka-
ble kiln guard. Great care must be taken when glazing and firing pottery. When I
recall the days in the art therapy department of Paddington Centre for Psycho-
therapy, I do regret the obsession (if I dare call it that) with Health and Safety
that would now prevent patients engaging in such an active way with the prepa-
ration of and application of glazes and firing of the kiln with the important sym-
bolism attached to ensuring the ‘safety’ of the object within it.
All this – as well as conducting the group and understanding the processes of
individuals and group-as-a-whole – is the responsibility of the art therapist
conductor.
I have found it essential to ask what space is available, before agreeing to
conduct any interactive art therapy group. In the past I have accepted statements
like ‘There’s a really large room’ without checking exactly what size is large. I
have naively asked: ‘Is it suitable for art therapy, does it have water in it?’ and
been assured that it is, and that there is water. On arrival I have discovered a
well-carpeted seminar room, complete with smart chairs and tables, large enough
to seat 16 people who will not move around and with a small wash-basin and tap
in the corner! In the same building was a magnificent attic, being used as a store-
room, complete with terrace and hose-pipe point, with a lino floor, next door to
toilets and wash-basins! Tactful negotiations resulted in this attic being given
over to the art therapy group for a whole week and the community used it when-
ever they had an art therapy group subsequently.
During an interactive art therapy group, I feel it is very important that people
can move around freely, be active with the materials and each other if they so
 Materials and rooms 61

wish. They can, of course, sit quietly in one space if that is appropriate at the
time. I’ve realised that the image people often have of art therapy groups is of a
class sitting at desks – because, especially for older people, this is what art was
like at school! It was at my school – we used a hall several minutes’ walk away,
in which there were desks and chairs. We had an ‘art cupboard’ and painted still
lifes and themes. This school did not rate art very highly and I know of schools
with magnificent suites of studios. But I think that many people’s only experi-
ence of art was like mine at school, so it isn’t surprising that ‘art therapy’
confuses.
All the examples given in this chapter point clearly to the fact that art therapy
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is a new discipline in many countries (it can even seem so in the UK where it
has been practised since the 1940s) and to the strangeness of having art activities
in places designed for care and treatment of patients. It was not such a problem
in the old psychiatric hospitals with their rambling wards and huge spaces, and
sometimes old craft rooms which had been converted to art therapy studios.
There is a very different atmosphere in a group which can move freely and use
materials creatively – working on large or small pieces when needed and not
having to worry about the curtains – than in a group which is restricted to felt
tips and paper or instant-dry clay in an office in a day centre. I am in no way
denigrating work which is done in these circumstances but have emphasised this
point because it is one which other professionals, quite understandably, tend to
overlook when planning treatment centres or inviting an art therapist to run a
group workshop. It is up to the art therapist to make their needs quite clear.
The way that a group modify and use a space and the materials available does
constitute useful content for the group to work on. As I have tried to show,
though, there are minimal requirements without which it is unreasonable to
expect that the process of group interactive art therapy will be effective.
 Chapter 6

Using themes or projects within an

interactive model
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So far I have discussed groups in which themes tend to arise spontaneously out
of discussion among group members. There are times, though, when I have
decided to present the group with a theme, or perhaps project is a better descrip-
tion, right at the beginning. This is usually when conducting time-limited work-
shops in which the participants need to understand about the potentiality of art
therapy for themselves. On these occasions I have obviously stepped away from
the group analytic end of the interactive spectrum. On the other hand, having
presented the group with the idea for the project, it is up to the individual
members and the group how they interpret it and how they subsequently use the
material.
I have used the following open-ended projects with trainee art therapists,
other professionals wanting an introduction to the process of interactive art
therapy, patient groups – mainly of functioning out-patients with problems such
as drug and alcohol addiction, eating disorders, depression and phobias. I have
found them useful ways either to begin or to continue a time-limited workshop.
They can be developed by each group according to its preoccupations at the time
and to the level of the participants’ abilities. All the projects give ample oppor-
tunity for exploration of simple visual media – which in the case of non-art
trained participants can be extremely useful for confidence building.

Self- boxes
This is a project which is useful to introduce at the beginning of a new group.
It encourages members to focus on how they present themselves to the outside
world and how they feel ‘inside’. It requires them to reflect on how much (if
at all) they hide or disguise their feelings (or ‘real selves’) in the interests of
conforming to others’ expectations (or expectations of their own). The project
makes use of ordinary cardboard boxes as a starting-point and requires a
range of easy-to-use materials. There is something quite reassuring about a
cardboard box. There is nothing intrinsically precious about it. It can be
obtained from any store or supermarket. This fact is quite important when
working with people who are unused to group psychotherapy or have no
 Using themes or projects 63

experience with art materials. The time taken to make the box can vary
according to time available for the group: in a one-off, boxes can be made
very quickly and spontaneously, with little attention being paid to the details.
Participants can say what they would have done had they had more time, etc.
The important thing is that they respond quickly and are prepared to discuss,
in general terms, how they felt about the project. In a one-off group (say two
hours) there will not be adequate time to go into detail of each person’s box
but it begins the process of reflection which can be continued later by parti-
cipants on their own. I tell the group that it is up to each person whether or
not they close the box up, and if they do, it is up to them if they open it to
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show the group in the discussion period. This is a caution against premature
self-revelation and gives timid or reserved members permission to have a
private space for as long as they wish.
See Figures 6.1 and 6.2 for examples of self-boxes made by participants in an
introductory art therapy workshop. Both these women chose to make both the
inside and outside visible: in the ‘house’, the roof can be opened and one can
peep through the open windows and doors.
There are several ways of continuing this project, depending on time and
group membership: either I might suggest to the group that they make individual
environments for their boxes, or that they choose others to work with and make
a communal environment, or we select names out of a hat for random small
groups; or that the group decide themselves what to do with the boxes.

Figure 6.1 Example of a ‘self-box’.

 64 Introducing group interactive art therapy
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Figure 6.2 Example of a ‘self-box’.

For example, an ongoing women’s group had made boxes, discussed them and
they were still in the same place in the room the following week. When the group
came in, someone said, ‘We had better get these boxes out to make more space.’
The group moved towards the boxes, ready to take them outside. I asked them to
pause and reflect on why they were doing this. Someone said, ‘We’ve finished with
that project last week.’ Another said, ‘Well I don’t feel very happy putting my box
outside. I felt last week that I didn’t really say much about it.’ Another said, ‘I felt
we talked so much about them I am bored with it.’ A fourth person suggested that
they might have another look, from the viewpoint of a week later. There was much
discussion among the eight members: to put outside or not. I suggested they con-
sider the boxes as symbolic selves and try to find a way forward from there. They
decided not to put the boxes outside but to store them in a recess in the room,
where they could still be seen. Having stacked them up hurriedly and spontan-
eously, they then began to look at the resulting structure. One said, ‘I am totally
squashed by your box and in fact, I’m at the bottom of the pile!’ This person
replied, ‘I can’t move my box because P.’s will fall down . . . and so will J.’s.’
Everyone looked to see where they had ended up in the pile of boxes and for the
rest of the session, the group discussed this ‘accidental grouping’ and whether or
not they were satisfied with it. They moved the boxes round, took the whole pile
down and began to reassemble it, negotiating who wanted to be where. It was a
 Using themes or projects 65

valuable experience as they had thought carefully about their position in the group
and if that related to their position outside – i.e. were they always feeling ‘bottom
of the pile’, or, alternatively, having to prop others up. They also thought about the
culture which had developed in the group: tending to ‘give up on’ themselves
rather than persevere and see a task through to the end. (Other examples of the
development of ‘self-boxes’ are given in Case Examples 4 and 11.)

Symbolic portraits
Often without realising it, we absorb a lot of information about each other
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through our visual and sensual experience. We take note of body language,
colour of clothes, hair, facial expressions, smell and these impressions can be
immediate and happen before we have spoken to a person. This is often known
as a ‘gut reaction’. If I am running a time-limited group or series of groups, I
might ask participants to begin by making ‘symbolic portraits’, trying to catch
their first impressions of either all the group or a few members visually, using
whatever medium comes to hand. I might suggest using a colour or a shape or
‘ready-made’ images from magazines. I do not exclude myself, as conductor,
from being ‘portrayed’ and it is surprising how often the ‘symbolic portraits’
include the conductor, or how the different ‘portraits’ contain elements of the
conductor. The group may discuss them after making, or leave them till the end
of the group to see if their first impressions have been modified as a result of
getting to know other members, and the conductor, more intimately.
For example, during the first group of an introductory programme with
medical staff who had no art experience, most chose to use felt-tipped pens
although one or two selected paint. I had asked them to do the task as a way of
thinking about themselves and each other at the beginning of the group and
trying to record these important first sensations. I had not specified whether the
group should make portraits of all members or just a few. It turned out that this
was significant because there was one member who nobody had chosen! This
was a most difficult and tense situation because the member felt, quite rightly,
ignored and that there must be something wrong with her, and the group felt
guilty. We discussed this at length. I felt a bit responsible for her distress
(because I had presented the idea in the first place) although I did realise that
there was something important for us all to learn. I suggested that maybe the
group had linked the ignored member to myself – she was very quiet and slightly
‘out’ of the group, which resembled my role as conductor at that time. Perhaps
there was something difficult to deal with and although people had made pic-
tures of me, there was the ‘unknown’ bit which they couldn’t tackle. This inter-
vention opened up the discussion to consider people’s frank terror at the prospect
of the week ahead, whereas previously they had denied any nervousness or
anxiety. It pulled in the ‘ignored’ member as she could then share her extreme
anxiety with the others: the powerful anxiety had radiated from her and other
members had backed off, not wishing to acknowledge this in themselves.
 66 Introducing group interactive art therapy

See Figures 6.3 and 6.4 for examples of ‘portraits’. Figure 6.3 is clearly meant
to be the conductor and Figure 6.4 is a portrait of one prominent member of the
group, which could stand for an image of the conductor, too.

Body images (or life- sized portraits)

This is a shorthand term for a fairly complex task. It requires preparation as large
sheets of paper, suitable for making life-sized portraits are required and suffi-
cient space for working on them and fixing them on the walls. The best paper to
use seems to be brown parcel wrapping paper as this is strong, inexpensive and a
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useful width. Occasionally I have introduced this project in what seemed like an
unsuitably small area and it has been exciting how the group have managed to
negotiate the space. This in itself is valuable for interaction purposes.
The project is flexible and can be adapted to suit any client or training group
(see Case Examples 6 and 8 and the case example in Chapter 8). Briefly, group
members divide into pairs, either randomly through names out of a hat, or they
choose. Usually people prefer names out of a hat as it avoids the problem of who
to choose and who to reject, and I point this out when it happens.
There are then two possible ways of proceeding: either I suggest that each
person makes a life-sized image of the other as they see them, or as they would
like them to be. The outline can be drawn by each person lying on a large sheet
of paper, and it is up to the artist, in each case, to say how they want their subject
to lie (see Figures 6.5 and 6.6). This stage of the project usually produces much
laughter and a little embarrassment as people have to get close to do the drawing.
If anyone is really unhappy about the intimacy of the outlining, they can find a
way round it by fixing the paper on the wall and standing up against it to be
drawn. The next phase usually consists of reflection (see Figure 6.7) and some-
times verbal communication between the two before the painting begins.
Another way is for each person to tell the other how they would like to be
painted. In this case, the artist must follow the subject. If the subject wants to be
painted sitting down, or in an abstract way, then the artist has to follow suit (see
Plates 1a and 1b, 2a and 2b for examples). Each person is alternatively the artist
and the subject. This project illustrates how we project our fantasies on to others,
or how we may use another to fulfil our fantasies of ourselves.
The next phase, once the paintings are finished, is to hang them on the walls
around the room (Figure 6.8) so that a ‘symbolic’ group is formed. There are
many uses for this group, according to how the actual group are feeling at that
time. I usually suggest a period of time to discuss how the group members felt
about the task and the results of the paintings. It is for most people quite a liber-
ating experience to use large sheets of paper and plenty of paint, and gratifying
to be the subject of someone else’s careful attention. It can happen, though, that
‘old scores’ get settled by people who know each other outside the group, or one
member chooses to ignore the task and paint themselves rather than their partner
(see Case Example 8).
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Figure 6.3 Image of the conductor.

Figure 6.4 Image of a group member as a cat.

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Figure 6.5 Preparing to make a life-sized portrait (body image).

Figure 6.6 Preparing to make life-sized portraits (body images).

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Figure 6.7 Reflecting on each other.

Figure 6.8 Fixing up a body image.

 70 Introducing group interactive art therapy

All this will come up in the discussion. The next phase may be involving the
whole group in looking at its symbolic self. I may suggest that members add or
change certain aspects of a painting according to how they see that person. I
might suggest that they negotiate with the painter first of all, before changing
anything as obviously the images have become very important and meaningful
to both partners. On one occasion I did not do this, and one group member who
was containing much of the rebelliousness of the group and was, in fact, more
daring than the others, went round adding very frank visual comments on all the
paintings. This resulted in a furious discussion group in which he was in danger
of being scapegoated as his behaviour had been perceived as provocative and
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even hostile. He was able to defend his position well and was not at all daunted
and his frankness enabled the other members to interact more freely with each
other. I stress the importance of periods of time for reflecting on the process as
the images become laden with powerful projective material.
This can give rise to some negative as well as positive feelings and it is at
these times that the process comes near to psychodrama in its realisation.
Again, there are many ways in which the project can continue. In a long-term
group, the group itself would probably decide how to go on. In workshops of
one or two weeks, the ‘symbolic group’ may remain on the walls and be avail-
able for further projection, changing aspects of each person and so on.
With patients who are not very articulate, this project can provide an exciting
channel for expression and communication through the paintings. The outline
body shape gives safety for those who require it; whereas the more adventurous
can take liberties with the boundaries. (See Figure 6.9 for an example of the
variety of images resulting from this project.)

Small group themes

This is a very flexible project and often follows on well from ‘body image’ in a
short-term group. According to the number of people in the group, they divide
into small groups. There would usually be around four to five in each. The
project is simply to decide on what to do in that group. I might introduce a few
limitations such as, use the clay, discuss what you are going to do with the group
beforehand, but otherwise it is entirely up to each group. Some groups have
lengthy and profound discussions and decide to make a group project, others
speak briefly then go straight into making, others decide to work on their own
image, etc. Sometimes the groups are competitive with the other groups, and
sometimes the members of each small group admit to feeling competitive within
their group.
Depending on what has been going on before in the group, it might happen
that small groups are formed by people choosing each other – which can produce
fears about being left out (someone said, like being chosen last for team sports at
school), or sometimes names are drawn out of a hat. Whichever way it happens,
there is useful material to work on (see Case Example 7). In one workshop, the
 Using themes or projects 71
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Figure 6.9 Body image.

groups chose each other on the basis of knowing each other previously; then
later they decided to move around and work with people they hadn’t met. So the
small group projects can continue for as long as the group decides. If names
come out of a hat, it can feel like being in your family: you didn’t have a choice.
If you choose people, you are then responsible for getting on with them, or not.
These small sub-groups contain important elements for the group as a whole
and it is useful to have periods when the whole group is together to reflect on the
process.

Group painting
I have never actually suggested that a group make a painting together but this
has often been suggested by a member. If it happens right at the beginning, I
 72 Introducing group interactive art therapy

would simply query why the suggestion has emerged then. Perhaps it is an
attempt to make the group cohere very quickly? If, after thinking about it, the
group decides to make a painting together in the first session, the results are
often a bit stilted and ‘polite’, and each person keeps to their own area of the
paper. Sometimes a group painting will happen when members have been
working on their own or in pairs and is a way of bringing the whole group back
together. It can also be suggested when the group is in conflict, as a way of
trying to resolve the conflict by working together. A group might decide to work
on a painting for several days, or weeks, and the painting will become a visual
history of its life and process (see Case Example 3).
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Group sculptures
There are times when a group might be reflecting on itself, and the individuals
on their role in the group. It may be helpful at these times to make models of the
group as the individuals see it. Working spontaneously with, say, clay, can
produce some very powerful representations and lead on to discussion about the
family. The group may then decide to sculpt their family. One example of this
happened during a weekend interactive art therapy training group in Bulgaria in
the early 1980s. I have left this example in this current revised edition of the
book because I believe, despite the social and political changes in Bulgaria,
many fundamental issues remain the same, such as the importance of family.
There had been much discussion about families, which was somewhat intel-
lectualised. At my suggestion this time, the members made sculptures of their
family out of clay. They were completely engrossed in this process.
When everyone had finished, they sat back and started to talk about their own
(verbal) patient groups, in which people were very reluctant to talk about their
families. They found this irritating and could not understand why this was so.
The discussion continued for some time, very intellectually, with much reference
to family therapy literature, etc. I noted that they had not talked at all about their
own sculpted families. After the break, we reassembled and I made this observa-
tion. Someone said, ‘Let’s start talking about our families!’ This was an attempt
to ‘do what the conductor said’ but when it came to the point of starting, nobody
wanted to speak. We sat in awkward silence, a rather gloomy atmosphere in the
room. Then someone pointed out a feature of someone else’s family and how
they felt about it. I said it seemed easier to project one’s own feelings on to
another’s family sculpture and perhaps they would find it easier to do this. The
person whose family was being discussed was at liberty to correct, add some-
thing or be silent. The group came to life at this point and moved around the
room, sitting in front of another member’s family, projecting freely and receiv-
ing plenty of feedback from the rest of the group. After some time, we reflected
on what had been happening and some important insights emerged.
In Bulgaria, family networks are essential to survival. They are extensive and
many generations are included; third and fourth cousins are known and valued.
 Using themes or projects 73

For example, if you want to visit another part of the country, you check to see if
a relative lives there. If so, you will stay with that relative and not in a hotel. The
family exists to help and support each other and forms a layer underneath ‘the
State’. It is where real interaction takes place. Therefore, it is inadvisable to
speak critically of any member of one’s family, as you do not know if they might
at some time have a connection with a member of the group. To acknowledge a
problem in the family to strangers would be to lose face. These strong interac-
tions served a vital purpose during the 500 years of Ottoman rule in Bulgaria.
Non-relatives may be adopted as family and are then subject to the same protec-
tions. In the Caucasian republics, where there are similar cultural features, a host
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is obliged to protect his guest while that person is in his home, so strong are the
laws of hospitality. These are very deeply ingrained responses and although
things are changing now – families are split up, urban living has taken over from
country life – the group members felt the force of them during the workshop.
They were not sure, for instance, of my role. Was I actually a member of the
(equivalent to) KGB and would spy on the group and report on their families?
Were there members of the group who would do this? That issue was never
resolved – but the members realised very clearly why their own patients had
problems in discussing their families and were much more in sympathy
with why.
See Figures 6.10 and 6.11 for examples of work produced: in Figure 6.10, the
family is shown on the left, with mother the large figure in the middle around

Figure 6.10 Clay model of family group with a stork and mask.
 74 Introducing group interactive art therapy
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Figure 6.11 Clay model of family in a ring.

whom the rest of the family revolve. She has somewhat octopus-like arms. The
family is frequented by a stork (which traditionally brings babies and good luck)
and a mask has been included to show how the family hide themselves behind an
inscrutable mask. In Figure 6.11, the family is shown together in a ring, but
outside is a dead sibling. A spoon has been included as a symbol of food and
hospitality, and a hat which could act as protection if necessary. I have described
this particular incident to show how powerful such a theme can be and how it
can develop in unexpected ways. The same can be said of most projects and
themes: they can provoke much powerful emotion. The fact that there are objects
to contain these is an important element in art therapy, but the objects can take
on a life of their own and be invested with enormous ritual significance.
I conclude this brief exploration of themes and projects by mentioning that I
have found the study of anthropology and particularly of cultural artefacts and
their ritual significance has been valuable to me as an art therapist. The import-
ance of ritual in our lives is often lost or played down. In art therapy we may
find it again.
 Chapter 7

Short-term interactive art therapy

groups
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Art therapists were traditionally employed in large psychiatric hospitals where

they often worked with groups of in-patients on acute admissions as well as
long-stay wards of which there are very few these days. They have tended to run
so-called ‘open groups’, which consisted of a studio-type room into which
patients may wander at various times of day, sometimes painting, sometimes not.
Alternatively, ‘projective art groups’ were held, where one-off themes might be
set by whoever happens to be running the group. Often this is not a qualified art
or group therapist. In either case, little attention is paid to the dynamics of the
group.
Conducting groups in acute admissions wards has been seen by most workers
as difficult, given that the patient population changes frequently and patients are
very disturbed and often heavily medicated. Yalom, in In-patient Group Psycho-
therapy (1983) points out that workers are generally only familiar with the long-
term model of groups (based on groups in private practice or out-patient groups
consisting of more or less well-functioning individuals). Currently, there is no
coherent, commonly accepted method for running in-patient groups so there is
often confusion and ineffective conducting, whereas it would be possible, by
adapting the model, to run short-term interactive groups.
Such groups as there are in acute wards are often run by non-trained person-
nel. There is competition for time and the groups are not taken very seriously.
Sometimes they are set up without full knowledge and permission from the ward
administration and this can lead to tension and even sabotage. In my experience,
art therapy groups are no exception and art therapists have reported being frus-
trated by the ever-changing population in the ‘open’ groups which they have felt
obliged to run.
Yalom’s research on the effects of groups run on three different wards in dif-
ferent institutions revealed, not surprisingly, that the more highly the group is
valued by all the staff, the more effective it is for the patients. If a group is run
by non-trained staff and seen to be less important than other activities on the
ward, patients will feel it is not worth making a commitment. What usually
happens in such groups is that they are held irregularly, there are many interrup-
tions and cancellations, the task of the group is not clear, doctors, nurses and
 76 Introducing group interactive art therapy

other staff may ‘call out’ their patients from the group. In those wards where the
group is valued, patients sense this and gain greatly from the experience. To
achieve this much attention must be paid to timetabling (which needs to be
agreed by all staff ), explanations to colleagues and firmness in establishing the
boundaries and the task of the group.
In psychiatric units catering mainly for the acutely ill, the trust and cohesion that
are important elements in long-term groups are impossible to attain in the short
term, due to the instability of the patient population and greater disturbance and
poorer functioning of most participants. Yalom (1983: 32) drew the conclusion
from his research that group therapy is an effective treatment on in-patient units. It
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demonstrably improves outcome, and patients treated in hospital are likely to go on

to out-patient groups. Major modifications of the ‘long-term’ technique are essen-
tial, and the technique must be fitted to the type of patient population.
Yalom firmly believes that it is worth the difficulties involved in establishing
an interactive small group. The great majority of patients have come into hos-
pital bedevilled by chronic interpersonal problems – e.g. isolation, loneliness,
poor social skills, sexual concerns, authority problems and so on. The therapy
group gives an ideal opportunity to explore and hopefully correct patterns of
behaviour which had led to misery and hospitalisation. Patients can be helped to
understand how their behaviour prevents them from developing their desired
interpersonal relationships (Yalom, 1983: 33). Art therapists, with their long
experience of working in acute wards, are well suited to take on the challenge of
running groups. As we have seen from Chapter 4, there are particular respons-
ibilities involved in this task. The physical arrangements of the room and the
kind of art materials used are an important influence. Whereas it is possible to be
flexible about individual sessions, a group must be carefully timetabled. In a hos-
pital unit there is the question of escorting a group of disturbed patients from one
part of the hospital to another, requiring active cooperation from other staff, par-
ticularly nurses. However carefully the art therapist informs other staff of the
time and place of the group, it is seldom possible to adhere to the given times.
Despite the problems likely to be encountered, some art therapists have tried
to run ‘closed’ groups for a limited time. For example, in Art Therapy in Prac-
tice (1990) Drucker describes her work with elderly patients in a setting where
neither art therapy nor group work (other than social skills) was a usual form of
treatment. She mentions that in working with the elderly:

There seems to be an emphasis on doing things to and with older people –

rather than just letting them be and do for themselves, and allowing them to
set their own pace and explore from within, even if it doesn’t reach staff
expectations.
(1990: 94–5)

She felt that both individual and group art therapy could provide a space for such
exploration.
 Short-term interactive art therapy groups 77

As far as the structure of the groups was concerned, she generally ran ‘open
groups’, but there was one group which was an exception to this: ‘the same eight
people (two men and six women) remained in the group for a period of six
months consecutively. I shall not describe each individual within the group but
instead how they changed within the group dynamics’ (1990: 99). Drucker
points out that because of the high anxiety level, she ‘needed to be directive for
the first couple of sessions so that anxiety would not get the better of them’
(1990: 99). By the middle period the group had become cohesive and noticed if
someone was missing: ‘There was a feeling of belonging and caring.’ At the end,
some of the patients were discharged to a variety of out-patient social groups.
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Drucker concludes that the elderly people were able to use the structured art
therapy sessions to express their feelings, explore their difficulties about ‘being
old’ and share together or confide in her.

Getting through their resistances and insecurities about not being able to
draw or paint resulted in opening up expressions of negative and positive
feelings. It also gave these people an opportunity to have a sense of belong-
ing, and I felt privileged to belong with them.
(1990: 102)

Art therapists seem to have an additional difficulty in setting up ‘closed’ groups in

that many staff have little idea of the nature of the process. Art therapy groups can
suffer from a mistaken notion that they are ‘recreational’ despite much groundwork
by art therapists in explaining about the groups to the staff. Molloy (1984: 7) makes
this point in relation to an individual session in a rehabilitation ward, although it
could equally well apply to a group in an acute admissions ward:

I remember conducting an individual art therapy session with a patient in

the side-room of a rehabilitation ward. The patient was engrossed in his
painting when two men from the hospital works department walked in
saying ‘Excuse us’. They then made a brief inspection of the plumbing and
went out again. As they left one of them, who recognised the patient, came
across and said, ‘Hello Bill – doing some sketching. That’s nice.’ The whole
incident was over in less than a minute, leaving me angry, distracted and
wondering if I would ever be able to get reasonable boundaries established,
as this sort of casual interruption had happened many times before.

Molloy goes on to say that he was able to explore this with the patient usefully
afterwards but nevertheless, persistent interruptions were very destructive. When
he reflected on the incident, he found it difficult to direct his anger appropriately
as staff were following a system that had always prevailed. He concludes:

That is why it is so important to get psychodynamic work and thinking into

rehabilitation departments. Until staff have experienced the power and depth
 78 Introducing group interactive art therapy

of such work, they will simply not believe in the effects that seemingly
casual actions can have upon it. Art therapy is particularly effective for
demonstrating this. . . . If they [staff] can follow a series of paintings and see
how a patient’s internal world is deeply affected by the intrusion of seem-
ingly trivial events, then they may begin to become more sensitive in their
interactions.
(1984: 7)

Rapid turnover is inevitable in an acute admissions ward where by the nature of

the ward, patients stay only a short time. The patient may only attend for one or
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two meetings, there is no time to work on termination in such a short space of

time and there is usually great disturbance in the patient group – for example,
psychosis, substance abuse, acute alcoholic crisis, anorexia, severe depression,
suicidal tendencies. Patients are, as the name suggests, acutely uncomfortable
and in despair. They are generally not seeking personal growth or self-
understanding but looking for ways to alleviate their distress. Often they receive
medication and are discharged when the crisis has passed. Many of the patients
in the group may be unmotivated, ambivalent about attending, having come
because they were ‘sent’ by their doctor. The therapist has little time to prepare
or screen patients so has minimal control over group composition. The group is
unlikely to become cohesive (an important curative factor); there is no time for a
gradual recognition of subtle interactions among members or for working
through these, and no chance to focus on transfer of learning in the group to situ-
ations outside.
The primary goal of the therapist then, must be to engage the patient in
therapy. The group aims must be realistic and relate to the patient’s current state.
All, or most of, their problems cannot be solved during a stay in acute
admissions.
Anxiety is one of the most over-riding emotions for the majority of patients.
Going into hospital is itself traumatic and the patient probably feels ashamed and
‘weak’ and even ‘crazy’. He or she sees people who are looking strange and
acting in a bizarre manner and is frightened by this. Anxiety, depression or
another acute state may have the result of rendering someone incoherent. They
might well be confused in speech and manner. They are certainly not in a frame
of mind to contemplate long-term personal growth!
An art therapy group can offer an alternative to verbal groups or to endless
sitting, smoking, watching television, heavy medication. The art therapist has to
be persistent in acquiring time for a group as it may be seen, as in the example
given by Molloy, as a way of passing the time and not very significant. Yet art
therapy can provide a valuable means of communicating for patients who are
deeply distressed, whose grasp of reality is somewhat tenuous, and for whom
coherent verbal interactions in a group would be difficult or impossible.
Molloy says (again of rehabilitation) that the art therapist will need to make
constant efforts to show how art therapy can be valuable to staff, too, in
 Short-term interactive art therapy groups 79

providing insights into individual and social pathology which would not other-
wise be available (1984: 7). These comments ring true for practice today (2013),
despite the fact that art therapy is now an established profession in the NHS.
There are, according to Yalom (1983: 14–19), complex issues around who
leads an in-patient group and a wide range of professional disciplines are repres-
ented by in-patient group leaders. The debate about group leadership is often a
debate about power, prestige and professional territory rather than leader com-
petence. However, most disciplines receive no training in groups in their profes-
sional lives. Art therapists can at least claim that they have been regular
participants in groups throughout their training, there is much emphasis on the
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ability to conduct a group effectively and in most centres an interactive or group

analytic style is taught.
So how does the conductor cope with a group in which the membership may
change from day to day? The focus must be on the ‘here-and-now’ for that is all
the group may have, and on how members relate to each other in the group.
Focussing on the there-and-then – for instance, why a patient came into hospital,
his or her life problems or complaints for which he seeks solutions from the
group – is not useful. Such problems cannot be solved by the group which leads
to demoralisation of the group and thence to loss of faith in the group process. It
is not helpful for a therapist to try to establish a common theme as this often
results in a very ‘intellectualised’ discussion which may or may not relate to
most group members.
The group leader must, then, turn the attention of the group on to its own
process and encourage interactions. In other words, he or she must be more
‘active’ as there is no guaranteed ‘life’ for the group outside that session.
Yalom feels that many therapists fail to focus on interaction because of their
lack of training in traditional group methods. The ability to facilitate member-to-
member interaction and to help members learn from observing their own process
is an acquired therapeutic skill that requires group training and supervision rarely
available in most professional educational curricula (1983: 23). He also suggests
that many therapists are frightened by an interactional approach, and this would
appear to be borne out by the literature on art therapy groups where there is an
emphasis on individual art productions and discussion through the medium of
the painting rather than using the paintings in a more direct, interactional
manner. There also seems to be an assumption that because people are homeless,
drug addicted, have had psychotic episodes, have learning difficulties, they are
incapable of sustaining this approach.
On discussing patients who are having psychotic experiences, Yalom sug-
gests that psychotic patients may be made worse by non-directive leaders who
focus on insight rather than interaction. On the other hand, a carefully thought
out small group can provide such patients with the only possible place where
efforts may be made to ameliorate their disruptive behaviour. In the therapy
group the ward members can offer the patient constructive feedback in carefully
modulated doses about the effects of his behaviour on them. It is the task of the
 80 Introducing group interactive art therapy

therapist, Yalom says, to create an atmosphere in which feedback can be per-

ceived as supporting and educative rather than attacking and punishing
(1983: 64).
Sometimes even the most acutely psychotic patients are able to offer accurate
and important observations about other members of the group – they can do this
much more easily than they can receive feedback. Patients in a psychotic state
have ready access to primary processes which can be expressed spontaneously
through art materials. They can express feelings, thoughts and fantasies in a way
that other, more defended patients, may find reassuring or liberating. All patients
have frightening, incoherent feelings or fantasies and the ability of the psychotic
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patient to identify and express these may actually be more reassuring than fright-
ening (1983: 65).
Nevertheless these groups are often characterised by considerable disruption,
interruptions from within and without. Psychotic patients are often restless and
not able to stand the whole session. Patients who suffer from a lack of inner
structure are often highly threatened by being thrust into a situation that seems to
be out of control. It becomes difficult for the therapist to impose a tight structure
on the group and, at the same time, provide a level of work that is meaningful
for all patients, whatever their level of functioning.
The aim of a group for patients who are confused, anxious and have short
attention spans might be to provide support and facilitate communication. This
would have a different structure from a group which aims to explore and analyse
feelings. It would not threaten fragile defences and is less challenging.

Case example
An in-patient, interactive art therapy group, held twice weekly, on an acute
admissions ward, was attended by 12 patients. There was a core of eight who
had been together during the past two groups, one in the previous week, and one
early in the week, and four new members. The group was held in a disused side
ward and had plenty of art materials and space available. The conductor saw her
role as trying to encourage the group members to find a way to communicate
through the materials, paying attention to how they felt in the here-and-now.
Several of the patients were receiving medication. One of the new members, R.,
wanted to talk about his problem with his wife, whom he blamed for all his life
problems, including his admission and recent suicide attempt. He spoke in a
loud, whining manner and tried to engage the conductor in a one-to-one relation-
ship, ignoring the other members, including the three new people who had come
in with him that day. One of the older members asked him ‘What does she look
like, your wife?’ and he started to describe her, whereupon the member said: ‘I’d
rather see a picture of her’, in an attempt to bring him into the group ‘culture’.
Reluctantly R. picked up some felt-tipped pens and began to draw, half-
heartedly. One or two members made straight for the art materials and got on
with something of their own or sat watching. R. got stuck and looked around the
 Short-term interactive art therapy groups 81

group for inspiration. He started to draw J., a young woman who was passively
sitting, staring into space. She said ‘Stop staring at me, I don’t want to be your
wife.’ Then she covered up her face and started to cry, sobbing ‘No I didn’t
mean it . . .’ L., an older woman who had joined the group with R., got angry
with him, saying she didn’t want to be in the same room with him. The conduc-
tor suggested she might try to draw herself in relation to him, in an attempt to
keep her in the group. L. cursed a bit under her breath but went on to draw him
as a fat worm and herself as a blackbird. He was shocked and said that was how
he felt about himself in relation to his wife – that she was always about to peck
him and eat him and he was powerless to do anything about it. He really did
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seem to take on the characteristics of the worm. Other members were intrigued
by this sense of powerlessness in relation to women and some had actually pro-
duced images of being helpless. One woman had drawn a huge white-coated
figure towering over a tiny female figure. She said, ‘That’s how I see doctors and
all doctors here are men. Men are the problem, not women. Women have no
power.’ (That morning she had learned that a doctor she had grown attached to,
a Registrar, was about to leave and she was very upset and angry.) I. produced
her painting which was covered in red blotches: she said, ‘That’s what my
husband gave me, he beats me up.’ R. thought she was insinuating that he beat
his wife and said that he had never thought of such a thing. In the meantime he
had doodled a large block of wood which covered the faint drawing of a woman
he had started earlier on. The conductor mentioned that he had drawn the idea of
‘beating up’, i.e. with a large block of wood, or alternatively, crushing. Did he
want to crush I. at that point? Referring the issue back to the group, the conduc-
tor wondered if the alternative to being helpless was seen as crushing or other
violent behaviour. She was aware that some of the in-patients had histories of
giving out or receiving violence, for which two had been in prison before. She
also wondered if, as female conductor, there was a sense of her being ‘all-
powerful’. P. intervened quickly and felt that she could not tolerate R.’s picture
and wanted him to change it so that the female figure was sitting on top of the
block and not being crushed by it. He said: ‘Do it yourself ’ offering his painting
to her. She held back, there being a ‘taboo’ on interfering with others’ work
which the core group members had been operating. He said: ‘Go on, I dare you.’
She snatched the picture and painted a large, strong-looking woman sitting on
the block. She said: ‘There, she’s sitting on you!’ He said: ‘You are just like my
wife, always sitting on me, always using me like a *** prop. I can’t do anything.
She’s a dead weight but I can’t get rid of her.’ She said, ‘Well, you told me to do
it for you! You’re the dead weight if you ask me . . .!’
The interactions among members continued throughout the group with the
conductor drawing attention to overall themes. By the end of the session, male–
female power relationships had been explored even by some of the most inco-
herent members as a result of their paintings. Despite the angry exchanges
among people who hardly knew each other, there was also plenty of humour and
some group members had obviously gained useful (if painful) feedback.
 82 Introducing group interactive art therapy

Clearly, conducting interactive art therapy groups with patients whose grasp
of reality is, at least at times, very tenuous, requires much skill and confidence
and support from other staff in the institution – not least for the conductor, who
is likely to be extremely stirred up by the material of these intensive groups. It
goes without saying that training and regular supervision is essential.
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 Chapter 8

Group interactive art therapy with

children and adolescents
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In many centres responsible for the care and treatment of disturbed children and
adolescents, the aim is to get the children back into school and to their homes, if
at all possible, so that the worst effects of being in an institution are avoided.
There are therapeutic communities where group work is the norm, but in child
and family centres and schools, it can be difficult to establish a group for various
reasons: timetable, group work not being part of the ‘culture’ whereas individual
work is, the children not being in the centre for more than a few months. Some-
times it happens that there is nobody on the psychotherapy staff with group work
expertise. So the only groups that the children participate in are in the classroom,
where the task is to improve their school work. In the majority of placement
centres where our postgraduate art therapy trainees do their art therapy practice
with children, it has been up to the trainee to introduce group work. This has
often been difficult to set up and has ceased once the trainee finishes. The
reasons for having a group with children and adolescents are much the same as
for adults. It is a very different experience from being in the classroom.
Foulkes and Anthony (1965), in their chapter ‘Psychotherapy with children
and adults’ make the point that age and natural group formation to some extent
dictate the therapeutic techniques used with children and it is essential that thera-
pists familiarise themselves with the developmental phases of childhood and the
sequential changes that occur in the child’s intellectual, emotional, social, moral
and linguistic spheres. This presupposes, they suggest, a good understanding of
child psychology and development as a background to group therapy with chil-
dren (1965: 190).
There are many similarities with play therapy, especially when working with
very young children, and it is obvious that the therapist needs to adapt his or her
technique and language when working with different age groups. Foulkes and
Anthony recommend about 30 to 40 minutes per group, twice a week. Art
therapy would seem to offer an excellent opportunity for interaction as children
readily use materials, and do so spontaneously, except in rare cases where they
are very withdrawn and inhibited and need special encouragement.
Interestingly, a very influential book Working with Children in Art Therapy
(Case and Dalley, 1990) focussed almost entirely on individual art therapy
 84 Introducing group interactive art therapy

sessions. In Art Therapy in Practice (Liebmann, 1990), one group with children
is described by Trish Fielden, a psychotherapist and art therapist, who gives an
account of an art group with dyslexic children in a school for children with
learning difficulties.
This group was set up for the given reason that the ‘resource of individual
therapy was both relatively expensive and scarce’, rather than because of any
obvious acknowledgement of the value of groups in themselves (1990:104).
Fielden’s hope was that the group would establish its own identity and that its
members would encourage their peers to join in. There was a problem in getting
the children to join the group, in that art was associated with formal art lessons
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and therapy was an unfamiliar or threatening term to most pupils. It might also
have been that the group was seen by staff as a ‘poor relation’ to individual
therapy and not highly rated.
The group was entitled: ‘Self Expression through Art’. It appeared to be
‘informal’ and emphasis was on the individual child’s experience rather than on
interaction or group dynamics. Fielden says:

At first I spent my time working with individuals, engaging with the process
as it emerged from sharing their pictures, clay models, scribbles or forlorn
and angry attempts at self-expression. As the group gelled, more of this
sharing happened in the group.
(1990: 106)

Despite the initial justification for running a group (that it was ‘cheaper’ and
more children could be accommodated than in individual therapy) the group
proved an important place for shared communication. The ‘curative’ factors of
the group went into operation. Fielden reports:

Some individuals may need encouragement to stay with their discoveries,

and support to integrate these into their lives. In the group the kind of
‘games’ we all play in defence of our feelings can be captured, shared,
examined and maybe discarded. Group interaction is an important part of
this learning, which for the group described, then needs to be transmitted
into the everyday life of the school.
(1990: 110)

Linesch (1988: 133) an American art therapist writes more positively about
group work:

It has been suggested by some that group therapy is the modality of

choice with the emotionally disturbed adolescent. . . . Group therapy, as
one component of a multimodality approach, does have an important role
to play in the treatment of troubled youngsters. However the selection of
group therapy, either alone or in combination with other treatment
 Children and adolescents 85

approaches must be responsive to the needs and conflicts of the particular

adolescents involved.

She goes on to say that group therapy with adolescents is often difficult and
draining for therapists and can even become countertherapeutic and destructive.
Harnessing the adolescents’ creativity and expressive potential, as in art therapy,
can, however, direct and sustain positive interaction.
Linesch quotes Blos (1962: 210) who considers that group therapy is
important for adolescents because it helps the adolescent to separate out pro-
jective components of their behaviour from objective facts. This happens within
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the contained environment of the group, in which the adolescent can safely wage
his or her battle with authority figures.
Linesch concludes that since the struggles of adolescence revolve around self-
expression and peer interaction, it seems obvious that a combination of art and
group therapy techniques will be particularly effective with this population:

The group modality touches the needs of the adolescent and the art modality
facilitates the group process. It is a complementarity that is both curative
and exciting and underlies the effectiveness of the group described in the
remainder of this chapter.
(1988: 135)

She then goes on to describe her group of four adolescent girls who had diffi-
culty with self-expression and peer interaction. All had experienced abuse and
neglect and their behaviour was aggressive and hostile. They met once a week
for 18 months, as a closed group. Linesch used an interactive approach to the
group, drawing on Yalom for her theoretical structure. She began by asking each
girl to introduce herself by making a collage. She structured the first four ses-
sions to introduce the girls to the art materials and help them understand how the
materials could be used expressively. She points out that, although the four girls
all knew each other from living together in their centre, the group gave them an
important new interactive arena and the fresh introductions emphasised the sense
of beginnings (1988: 136).
Linesch found that the art process allowed discussion of the here-and-now of
the group process: diagrams, symbols and metaphors allowed the adolescents to
distance themselves from the potential anxiety in this task (1988: 142). Transfer-
ence issues were also able to be explored through the art materials. A central
feature of the adolescent state is the struggle with his or her own separation and
individuation, so the transference interactions with the group leader may be par-
ticularly powerful. Often the adolescent is resistant and hostile towards the ther-
apist and there is a tendency for ‘gangs’ to form to defeat the therapist. The art
materials give the members an opportunity to express these feelings indirectly
and safely. The art objects themselves give the group a focus for exploring and
reality testing their relationships with the therapist.
 86 Introducing group interactive art therapy

Of course, peer relations are of central importance to adolescents and the

interactive art therapy group gives ample opportunity for these to be explored.
Malchiodi (2003 and 2012) includes a useful section on Clinical Applications
(of art therapy) with Children and Adolescents in which art therapists discuss
their group practice with a range of troubled young people, including how they
make use of the sometimes violent imagery that can be produced.
The following case example, with young adolescents, shows how, even in a
very short-term group (four sessions) much useful work was done.
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Working with a group of young teenagers

The following case work was carried out by an art therapy trainee, now a fully
qualified art therapist. She did her art therapy placement in a school for children
with communicational and emotional difficulties. Group work was not normally
used, timetabling problems and lack of enthusiasm among staff being reasons
given, but T. felt that the children would benefit from an art therapy group and
decided to try to set one up.
She found many difficulties for reasons already stated: timetable complica-
tions, staff ambivalence, lack of understanding on the part of the children of the
benefits they might gain. The only period of time available for the group was 45
minutes, once a week, for four weeks. After hesitating about starting with such
unpromising conditions, she decided to go ahead and five children, aged between
11 and 14, committed themselves. In discussion, we felt that a focussed, theme-
centred interactive model would be most useful, given the limitations surround-
ing the group. T. reported as follows.

Week 1
The theme for this session was to make portraits of each other, using objects,
shapes or colour. The group were quick to start, Ann, John and Lyn waiting to
see what Sue and Fred1 would do, as if taking the lead from them.
I experienced the group interacting very soon into the session and was rather
surprised at the free rein of emotions which were expressed. They did not seem
to hold back on their feelings. Laughter was used to cover up any embarrassment
which they felt concerning the fantasies that were being portrayed in their por-
traits. A feeling of competitiveness to see who could make the funniest picture
became evident in the session.
Fred portrayed the group most honestly and fully, giving the group plenty to
laugh at, but also showing them how much thought and sensitivity could be
given to such a theme. An example of his observation on Lyn was to cause the
most poignant and demonstrable feelings in her and cause the group to reflect
and feel his honesty and her reaction.
He had used her name to pun with his picture, drawing a house which smoked
through the chimney. He had given her many rooms, one of which he had left
 Children and adolescents 87

empty, as he explained that it represented the part of her brain which she did not
use. Lyn became adamant in telling the group that she did not smoke but was so
angry to be seen as an empty room that she stood up, faced the wall with her
back to the group and gave a monologue as to how she did not like her name
being taken in vain. There was complete silence, as if the group were frightened
to see what would happen next. I voiced this fear and Fred continued with real
sensitivity, explaining that Lyn’s house was made of strong red brick. That it
needed to be strong to contain her strong feelings. This comment seemed to
explain a lot about how he found Lyn. The group were now in fits of laughter.
It was now John who decided to talk about his pictures. He was laughing so
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much that he could not begin. I asked him whether he was too scared to start
because of the strong reaction in the group to Fred’s descriptions. This seemed
to acknowledge what was being felt in the group.
The theme had allowed for all sorts of fantasies to be explored. They had
been quite volatile: Sue and Lyn responding directly to their feelings. Laughter
had persisted throughout the session. I felt exhausted after the group, as the level
at which they operated amongst themselves had been confrontative, and much
energy had been exerted in dealing with these feelings through their laughter.

Week 2
They were asked to choose partners and then make an object in clay together.
These would be kept secret until the end of the session, at which point they could
then guess what each team had made.
The feeling in the room was quick to change to one of competition, as the
girls went into one group and the boys in another.
The two teams decided on making an object each. Each team knew what was
being made by the other member of the team. As the session progressed, the
teams tried to guess what each were making. There was a feeling of great excite-
ment in the air as the objects were being made.
Lyn had instigated the idea that they each make their own object and that they
should be related to containers. Sue had tried to get the team to make something
together, but Lyn would not agree. Ann made a vase, Sue a casserole dish and
Lyn a basket. Lyn’s was the largest of the objects and she had made sure she
would use up all the clay, hence a new bag of clay which usually takes a year to
be used up in the art therapy department took three-quarters of an hour to be
used. I felt that this seemed to express symbolically Lyn’s neediness to the
group, and her need to be in control.
Fred and John had agreed to make monsters from the film Ghostbusters. John
had twice tried to instigate them both making something together, but Fred
would not agree.
I drew their attention to the fact that they had not directly stuck to the brief
and asked them why. Lyn quickly replied that she felt that there would have
been arguments if they had made something together. So the element of
 88 Introducing group interactive art therapy

competition had not only existed between the two teams but also against each
other. I felt that the issue of hierarchy was very much being battled out between
themselves. Lyn was the most forceful, but the boys tenaciously tried to keep
themselves separate from her.
The objects appeared to be stereotyped. The boys made monsters and the girls
containers. The objects suggested that the boys were more into overt fantasy
than the girls. They managed to guess what the girls had made. The monsters, on
the other hand, were more difficult to guess as they wanted the girls to guess
which film they came from. The elements of hierarchy and competition were
much enjoyed and this was acknowledged by both teams.
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As time was short I explained that we would start the next session by talking
about them. They expressed their enjoyment at having made the objects and said
they would like me to bring them in for the fourth week so they could paint them
and take them home.

Week 3
I began by asking them to choose another person’s object and say what they
would add to it.
Lyn chose Sue’s casserole dish which she said she would add some food to.
This became the container for the group to deal with the issue of hierarchy. She
said that she would then cut me up into small pieces, add me to the dish with
some poison, which she would then feed to Sue. Fred instantly replied that if she
was to do that then they would have to kill her as they could not have her (Lyn)
leading the group. The casserole dish was the vehicle for their fantasies of hier-
archy to be symbolically dealt with in a direct way which seemed very primitive
and overtly cannibalistic.
John had been left with Lyn’s basket. He did not want to choose it, so he
chose Ann’s vase instead. As Lyn’s basket had not been chosen, I asked the
group if anyone would like to choose it. Lyn quickly opted to choose her own,
but Sue responded saying that it could be used as a shopping basket. John very
quickly replied that of course it could not, as it was far too heavy already.
The group did not hold back on their feelings and, in being so direct and
honest, they seemed to be able to break down barriers that could stop a group
from moving on.
The theme of the session was then given, which was: to choose a name out of
a hat, thereby choosing a partner at random. Once chosen, the theme was to draw
around your partner, and think about how they would like to be seen, so that you
then fill in the shape with this in mind (see Plate 2c and Figures 8.1 and 8.2).
Sue and Ann were chosen as one group, John, Fred and Lyn in the next group.
Lyn did not seem to be wanted by Fred and John. They took a long time decid-
ing who should draw around whom. The whole process of drawing around each
other was very embarrassing. Whether it was the issue of Lyn being the only
female and having to draw and be drawn by one of the boys and vice versa
 Children and adolescents 89
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Figure 8.1 Two figures from a young people’s group.

seemed all too difficult for them. Their physical boundaries were being tested
and therefore the theme of the session seemed to be lost. What remained was
their difficulty and having to come to compromises which were difficult. The
actual process seemed to be what was crucial here in this session.
The session was to go on into the fourth week. I was asked again to bring in
their clay objects so they could paint them and take them home.

Week 4
The group were to finish the portraits. They could then choose what they would
like to do.
The portraits were very soon finished and then talked about. There was some
avoidance in this, descriptions were kept on a very safe footing and spoken about
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Figure 8.2 Two figures from a young people’s group.

 Children and adolescents 91

in terms of colour and what they wore. Maybe the leap to visualisation had been
too difficult. I certainly felt that they had not really used their imagination. The
session felt very rushed. Maybe because there had been so much to fit in, in such
a short space of time. They all chose to paint their clay objects as soon as they
could. I said that we would keep five minutes at the end to discuss their feelings
around the sessions and how they felt about the ending.
Lyn, who had involved herself emotionally, seemed to express her difficulties.
She had twice outside the group tried to tell me that she had missed swimming,
and again in this last group, expressed the same thing. I acknowledged this,
saying that I realised that she had felt that it had been very brave of her to last
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the four weeks. John said that he had valued the group immensely, had found it
fun and wished that it would continue. Fred had commented on punctuality,
stating that he too valued the group. (It had been Comic Relief day at the school
and John had arrived five minutes late but had apologised, saying he really had
not wanted to miss the beginning.) Sue and Ann also voiced the wish that they
would have liked the group to continue. Over the four weeks the group dealt
with many issues concerning hierarchy and competitiveness, the testing of
boundaries and the process of interaction through their fantasies and difficulties
with one another. They were able to contain their strong feelings through the art
and also to express themselves directly in the contained space of the sessions. I
feel the process of art therapy with an adolescent group manages to deal with
many issues which in normal circumstances might be difficult to confront. They
managed to do so symbolically through the art, which was by no means easy, as
was shown by the interaction with Lyn and Fred. The artwork in the adolescent
group seemed to provide a safe container for many feelings. There had not been
many silences, and each group member seemed to play a very particular role in
the group. This had been challenged: for example, in week three when partners
were chosen at random to work on life-sized portraits. Emotions ran high yet
they managed to survive their difficulties.

Summing up
I would have liked a longer time for the sessions – maybe one-and-a-half hours.
There did seem to be a rush to fit in as much as we could into the sessions.
However, due to the school’s timetable this had not been possible. I also feel that
the theme-centred approach had worked well, giving the group a safety net. Had
there been more sessions, it would also have been interesting for the group to
have experienced a more ‘non-directive’ approach. It was the consensus of the
group that they would have liked it to continue.
This case study shows how much is possible even in a few short sessions. The
children were able to benefit from the intense interaction which the group stimu-
lated and it positively influenced the way they later behaved in the classroom.
It is a pity that there does not seem to be more appreciation of the value of
interactive art therapy groups for children and adolescents. Children who are
 92 Introducing group interactive art therapy

very shy and withdrawn and attract bullying could benefit from being in a safely
contained interactive group, as could children who are aggressive and badly
behaved in class (to give two extremes). A knowledge of group dynamics would
seem to be invaluable for all teachers, yet surprisingly little time, if any, is spent
on this during teacher training. Art therapists trained in group work could give
much support to teaching staff, as well as to children, in schools and centres for
care and treatment of children and adolescents and this is an area of work which
needs to be further researched and developed.
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Note
1 These are not the real names of the children.
 Part II

The model in practice

Case examples
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Introduction
When preparing this book, I spent a lot of time trying to decide how to incorp-
orate the case examples. Should I intersperse them among the theoretical sec-
tions of the book or put them all or most of them in one part. I decided to put the
majority into this part, but have cross-referenced so that theoretical points made
earlier on can be illustrated by easy reference to a case example.
Included in this part are case examples from training groups which consti-
tuted elements in introductory or ongoing art therapy programmes, from mixed
staff–resident workshops in a therapeutic community, and from patient groups in
different settings. My role as conductor obviously changes according to the func-
tion of the group, although there are many features in common between training
groups and patient groups.
When preparing introductory courses which contain experiential art therapy
groups, I am careful to structure the programme so that these groups are firmly
contained: that is, participants have plenty of theoretical and small group discus-
sion periods to process the material. As will be clear from the examples, the
dynamics of interactive groups are powerful. Herein lies their effectiveness in
teaching trainees about the process of group art therapy: either for groups or for
individuals.
The same precautions apply to patient groups: as others have confirmed,
much care needs to be taken in ascertaining that the patients themselves and
other colleagues are clear about the nature of the group; that they don’t think it is
‘recreational’; that they are aware that patients will be stirred up by the process
and that this can be positive, requiring support and understanding from other
staff and not increased doses of medication.
One aspect of working abroad which I had to get used to is having an inter-
preter present throughout the training groups. This was a strange experience at
first, not being able to communicate directly with participants. I did not want to
specify that people should speak English as not only might this requirement
exclude people in their own country, but it is difficult to express oneself at a
deep level, unless one is more or less fluent in a foreign language. It is better to
have an interpreter, and then we are all ‘in the same boat’.
 94 The model in practice: case examples

As my knowledge of some languages increased, and as a result of having

everything repeated from one language to another, my ‘passive’ understanding
improved and I was at least able to understand some of the verbal interactions
during the art-making process as well as in the discussion periods. But in some
cases (e.g. Greece) I understand nothing of the language and find this extremely
difficult and frustrating. It has made me realise how devastating it must be to be
deaf and/or dumb. I gradually got used to making spontaneous remarks in the
feedback sessions (and hearing these interpreted!) and indeed we were fortunate
in having interpreters who were interested in and sensitive to the art therapy
process. The interpreter becomes a member of the group with an essential func-
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tion: if she or he isn’t there, it is as if the group is ‘stuck’ until we begin to make
the best of our lack of communal language. The interpreter is rather like a co-
conductor!
Art therapy is not a ‘non-verbal’ process – or at least, only in the image-
making part. This does not mean that images have to be transcribed into words.
On the contrary they have their own life and direct emotional response. But there
is an interaction between the visual and the verbal, and this is what I miss when I
don’t understand the language. I would not have been without this experience,
though, as despite the frustrations, it has taught me much about the complexities
of communication, as well as improving my knowledge of the languages in at
least some of the countries I’ve worked in.
I want to stress that these examples are not presented as: ‘the best way to run
an interactive art therapy group’. Rather, they are examples of the way in which
the process of the group has developed and the way that I, as conductor, and the
group experienced them. My own theoretical background and personal per-
spective obviously influences my selection of issues to focus on. But the material
of each group is so rich and there are so many levels of verbal and visual inter-
action going on, that the ways of interpreting what is happening are endless. I
still find, several years later in some cases, that I discover something new when
looking at the photographs and thinking about the processes. This is exciting and
I hope that this element in group interactive art therapy communicates itself to
the reader.
 Chapter 9

Case example 1
Rooms and materials
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Room and materials: I

I was asked by the director of a therapeutic community treating drug and alcohol
abuse to run an introductory art therapy course for his staff, which included
many people from other countries training in methods of treating substance
abuse. I gave an outline for a week-long programme which included several
experiential (practical) workshops. I described the method I would use and the
materials needed; the maximum number of participants to be 12.
I met the director. He explained it was the first time that art therapy would be
introduced and everyone was excited. He asked me to take 30 trainees, as had
been the case with previous courses (e.g. psychodrama). I explained that my
approach, which was experiential and required working with art materials (some-
thing the participants had never done), was not suitable for such a large group. I
could present a seminar or lecture to a larger group but the course participants
would be limited to 12. We compromised on 14.
I said we should need a large room as people would move about. Also that it
should not be carpeted as it could get messy. Water should be easily available. I
gave a list of materials required for the practical workshops.
On arrival at the centre two days before the course, I found I had been alloc-
ated 16 participants and an interpreter. The room was the main seminar room for
the centre, complete with carpet, chairs with folding writing block and one or
two small tables. The nearest water was in the kitchen, a few minutes walk away.
It was exactly the kind of room which should be kept clean and tidy and which
was totally inhibiting for our purpose!
I checked with the staff at the centre how far I could go in reorganising the
room, beginning with removing the carpet. That was agreed. I asked for several old
tables, newspapers and plastic sheeting for the floor, plastic buckets, a mop and a
large amount of rag. There was very little wall space uncluttered but I checked the
possibility of blue-tacking and pinning paintings to walls and curtains. I set up two
tables in an accessible part of the room and began to lay out the materials. Unfortu-
nately, even though the person who had acquired them had been identified as an
‘artist’, the materials were far from appropriate. There was a large roll of graphic
 96 The model in practice: case examples

design tracing paper, children’s watercolour sets and tiny brushes, some oil paints
and pastels, small packets of instant-dry clay. There were also scissors, kitchen
knives and spoons and plastic water pots as requested.
I thought: I have two days to get materials for 16 people together in a small
town in the mountains or possibly with a quick trip into the city. I was annoyed
with myself for not having been absolutely specific as to my needs. It was clear
that the ‘artist’ had his own ideas as to what the materials should consist of. It
was my own fault for not being absolutely specific.
First, I raided the kitchen and stores at the centre for paper plates, kitchen towels,
cardboard boxes, packaging, string. I found cling-film, wrapping paper, plastic
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cutlery in the stores along with discarded polystyrene chippings and packing. I
asked staff to bring in old magazines for collage. A visit to the town revealed a
well-stocked stationers with plenty of coloured tissue paper, ordinary white car-
tridge, parcel paper, Sellotape, charcoal, coloured pencils and felt-tipped pens.
There remained the problem of the paints, so a visit to the city and to a decorators
shop was necessary to buy a huge can of white emulsion, powder colours, house-
painting brushes and wallpaper paste. White parcel-wrapping paper was obtained
by the office – enough for all 16 participants to make life-sized paintings. The one
problem remaining was the clay but this had been promised for the first workshop.
By this time the staff and residents at the centre had the feeling of something
distinctly strange about to happen.
(Note: The art therapy workshops continued at this centre till 2002. In the
later years a block training was introduced for key staff. The store of materials
grew and so did the projects, many of which were carried out in three-
dimensional life-sized models and tableaux. More information about this experi-
ence can be found in Waller and Mahony (1999).)

Room and materials: II

I was asked to run a series of art therapy workshops over five days for psychi-
atric staff of a large hospital in Bulgaria. I limited the group to eight but on the
day 14 turned up, including one visitor from a hospital over 200 miles away!
The room, an office in the department of psychiatry, was big enough for six
people to work in comfort so we had to extend the boundaries by going out into
the corridor and on one occasion into the garden (through the window). The
weather was extremely hot. There was a small washbasin in the corner (it was a
consulting room). The room had the advantage of no carpet and nothing on the
walls so that they could be covered in paper and used to paint on. It was also
ours for the week, so work could be left undisturbed. The room reflected the
crowded conditions in which Bulgarians in the city were obliged to live and
work and this issue emerged many times in the group.
As for art materials, I suggested we take a look at what was readily avail-
able in the town and especially in the area around the Medical Academy. We
have to bear in mind that packaging was, at that time, not a feature of this
 Rooms and materials 97

economy and that things we take for granted in Britain (plastic bags, foil, cling
film, string, lavishly illustrated magazines) are hard to come by. There is a
chronic shortage of building materials. It was not a ‘throw away’ society, at
that moment, anyway.
We discovered the following without going into the ‘artists’ shop’.

Two- dimensional
mark making materials such as pencils of varying thickness, soft, hard, black or
coloured
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felt-tipped pens and ticket markers of varying thickness

biros
crayons
pens and ink
charcoal from the traditional charcoal burners
conte crayon
lipstick ends
decorators’ brushes
paint rollers
printing ink

Paint
(essentially a pigment containing glue)
tempera – egg white as the glue
children’s paint boxes
acrylic wall paint
decorators’ colours in tins or packets of raw pigment
glue to mix with this
emulsion or oil-based gloss (latter not recommended because of drying
problems)

Surfaces
(any flat surface not too absorbent)
cardboard from boxes
fibre board
old packing paper
newspaper and newsprint (ends of rolls available from Print Union)
wallpaper
backs of posters
‘sugar’ paper from toy shop
coloured wrapping paper from florists
brown paper from post office
 98 The model in practice: case examples

Ready- mades
magazines for a store of images
old posters
newspapers
unwanted photos

Three- dimensional
boxes of various sorts from hospital store and supermarket
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newspapers for papier mâché

toilet roll centres or cardboard tubes
remains of exhibition displays (friendly museums and trade centres)
plaster of Paris (from hospital store)
bandages (these may not be easily available as medical supplies are precious)

Clay
No problem in Sofia or anywhere there is a ceramics factory or local potters
working; or brick works; may be dug up and prepared; impossible to obtain in
certain areas – e.g. coast.

Junk
A large box of odds and ends; included packaging material, leftover bits of
fabric and leather, pine cones, beads, bits of wood, toys, remains of broken tran-
sistor radio, old car parts, old clothes, polystyrene blocks, broken necklaces,
sequins, dried-up fruit (especially prunes) and other objects which appealed to
people’s imagination.
wallpaper paste
scissors
old knives
spoons
plates
plastic cups
yoghurt pots for water

Fabric
remnants obtainable from dressmaker, factory
bits of leather from shoe factory
old clothes wool (expensive but can also use nylon or acrylic fibre); visit farms
for fur and wool
cotton wool (not always obtainable)
 Rooms and materials 99

string
shoe laces (cheap)
feathers from local market
straw from farmyard

Very difficult to come by was scotch tape (Sellotape) but heavy brown parcel
tape could substitute.
It was more difficult to find materials when we worked on the coast, but there
were: sand, stones, driftwood, irreparably torn fishing net and a more plentiful
supply of old posters could be found in addition to many of the items above.
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Hotels had a good supply of cardboard boxes.

Part of the value of an art therapy group is in the collection of and experimen-
tation with materials. The enhancement of creativity is an important aspect of art
therapy and the interaction between members around the art materials and their
subsequent mastery of image-making in different dimensions was an important
learning experience for them.

Room and materials: III

This was the first of a series of week-long training programmes in art therapy in
Bulgaria. Participants were mainly psychiatric personnel, over half of the 14
being doctors.
The room assigned was in the Institute of Hygiene, which as its name sug-
gests, was not accustomed to having art activities on its premises. We had been
given the Conference Room as a base because it was the biggest room in the
building. So the issue of size had been acknowledged. The room was thickly car-
peted with a long table in the middle covered with a green baize cloth. There
were armchairs along the length of the table (about 12 on each side). At one end
was a space for hanging coats and behind this a washbasin and cupboards. At the
other end was a clear space with a blank wall behind it. There were several
advantages: the size, the washbasin, the blank wall space. The problems were:
the huge table and its green baize cover, the armchairs filling the room, the thick
(obviously new and precious) carpet.
The first task with the group was to reorganise the room and make it habitable
for our purposes. We removed the green cloth and discovered several smaller
tables making up the large table (see Figure 9.1). We moved these around the
room, immediately creating more space. We determined a sitting area and moved
the armchairs there and piled the rest up in a corner. We designated the area
round the washbasin the materials and cleaning up corner. We obtained several
large sheets of plastic and covered the carpet and remaining floor space com-
pletely. We put newsprint on the tables (which had metal tops and thus were
washable).
The space was thus transformed from a very formal conference room to one
where many different kinds of interactions were possible.
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Figure 9.1 Conference room, Medical Academy, Sofia (used as art therapy
room).

Figure 9.2 Studio at Netherne Hospital in the 1950s.

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Figure 9.3 Attic and greenhouse, Torvaianica Therapeutic Community.

Figure 9.4 Hut used for art therapy workshops, Art Psychotherapy Unit, Gold-
smiths College.
 102 The model in practice: case examples

Figures 9.1, 9.2, 9.3 and 9.4 give examples of the kinds of rooms art thera-
pists might use. Figure 9.1 shows the main conference room in the Institute of
Hygiene, Sofia, subsequently converted into a group interactive art therapy
studio for one week. The studio at Netherne Hospital, one of the first hospitals to
employ an artist (1946), is shown in the 1950s in Figure 9.2. (Grateful thanks to
the hospital management of Netherne Hospital for permission to print this photo-
graph.) Figure 9.3 shows the attic, Torvaianica, near Rome, and Figure 9.4
shows one of the huts used by the Art Psychotherapy Unit, Goldsmiths College.
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 Chapter 10

Case example 2
The unwilling participant(s)
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Transference, countertransference, projective

identification and all . . .
I was often asked to deliver intensive introductory programmes in countries
where art therapy is not established but where there is willingness and intention
to do so. For practical reasons, the programmes usually last for a week. Mostly
the participants are professional workers and can be given ‘time out’ for this
period. I emphasise that I believe that a combination of theory and experiential
work is the most effective method of learning about the art therapy process and
that I use a group interactive approach to teaching and conducting experiential
groups. I also emphasise that the introductory programme is not designed to
enable them to practise art therapy afterwards but to enable them to understand
its potential as a treatment modality. Some may wish to go on to further training
of course.
This way of working is unfamiliar in many countries, as I have come to
realise. Terminology familiar in one place is not in others. I quickly realised that,
in one centre I was working in, ‘workshop’ meant ‘seminar’ – that is, a verbal
description and demonstration of the fundamentals of art therapy, whereas I
meant an involvement of the participants in the actual process of working with
materials in a group. This was naive on my part, but fortunately could be sorted
out before the course started and people were eager to become involved in a
‘hands on’ experience. I am now very careful to point out that active participa-
tion in the process is part of the course and that the experience is almost certain
to stir participants up emotionally. Therefore, as participants are usually selected
by directors of training, heads of department or hospital chiefs, it is essential
that, in so far as they are able to predict, these selectors do not expose people
who are likely to be damaged by the course.
Unfortunately, it still happens that people join the course who are seeking a
lecture format and to be told ‘how to do’ art therapy on patients. Others are
coming for personal therapy. I have found it important to spend some time in
individual discussion with each participant prior to the course to establish their
aims and expectations. It is worrying that some people do not read or understand
 104 The model in practice: case examples

the course description beforehand, such is their enthusiasm to attend. Appreciat-

ing that it is possible to want to know ‘how to do it’ and acquire some personal
insight at the same time, it still concerns me lest the purpose of the course has
not been understood. The case study which follows is based on an early experi-
ence I had of presenting an introductory short course in art therapy to a confer-
ence of art teachers over a weekend. It took place in the UK. I have included it
because I think it is one of the worst fears beginning (and perhaps even experi-
enced!) therapists have, that is, of people walking out of the group or ganging up
on the conductor.
A group of art teachers at a conference were offered a short course in art
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therapy as part of the conference programme. There were other workshops avail-
able, such as 3-D design, curriculum development, photography. The short
course consisted of a lecture and discussion on the general principles of art
therapy and two practical, experiential workshops. The nature of both inputs was
clearly described. The lecture was to the whole conference but the workshops
had to be selected. Two groups of eight persons had opted to do the short course
workshops (two hours each). One of the groups consisted of eight people, six
women and two men, plus myself. I decided to present an ‘open-ended theme’
and, having pointed out the materials available, invited the group members to
make a visual introduction of themselves – putting in those aspects which they
felt fairly represented them and using colour, shape, collage, etc. to do it.
One man, P., who had previously let us know he was in an advisory position
in the art education world, objected immediately and vociferously to the surprise
of other group members. He declared that he had thought the workshop was
going to be a continuation of the lecture and he had several questions to ask me.
I was very new to running workshops and my heart sank at his extremely aggres-
sive stance. I pointed out that this was a chance to experience the process, albeit
for a very short time and in highly structured conditions and I hoped it would
illuminate some of the points raised in the lecture. It was up to each participant
how they presented themselves. There was much unease in the group and
whereas previously people had seemed eager to try the task, now they sat
glumly, staring at me and waiting for me to do something (or so it seemed). I
remained quiet, hoping very much that he would relax. He said ‘This is a waste
of time. I propose that we continue the discussion from this morning.’ He was
joined by a woman who felt my suggestion of making a visual representation of
herself was ‘stupid and childish’. She delivered an angry lecture about the perils
of the advertising world and was surprised that I had given a theme which
seemed to be asking people to advertise themselves. At this point I wanted to
escape very much. I was tempted to say ‘OK, let’s have a discussion!’ I felt the
kind of rumblings familiar from adolescent groups, when a gang is about to form
and try to demolish the conductor! Looking back on this situation, I wish I had
had the experience of Yvonne Agazarian who might have said something like:
‘Anyone else here want to join this sub-group?’ As it was, I was desperate for
someone to start working with the art materials, fearing a mass walk-out, and
 The unwilling participant(s) 105

indeed it was the man’s wife (I found out later in the group) who reached for
paper and felt-tips and said she wanted to try the task. He was by now furious
and demanded she stop. She looked from him to me and put down her paper.
Some other people picked up paper and crayons and began to draw.
I reminded him, and at the same time, other group members, that they did not
have to remain in the group if it really was not what they wanted. He could
choose to leave. Or he could choose to do nothing. He said it was now too late to
go to another group and that in any case he had wanted to continue the discus-
sion about art therapy. It was clearly obvious that nobody wanted to do this
stupid task, so why did I not get on with the discussion? He felt he wanted his
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‘money’s worth’. I was in danger of getting drawn into a fight for by now I was
getting angry and, being inexperienced, felt responsible for the ‘mess’ the group
was in. I could have taken up his ‘ambivalence’ as representing the group’s but I
did not dare. In fact, I didn’t even think of it, as I was so overcome with anxiety.
I sensed though that other group members were getting a bit tired of this
aggression and were feeling left out. They all looked fed up and disconsolate. I
could not have cared less whether they did the task or not at that point and just
sat without saying anything further. He then revealed his considerable authority
in the art world and declared that he was disappointed in art therapy if this was
what it was about. I began to understand that a big power struggle was going on.
I remembered that the group were all art teachers (I hadn’t actually forgotten but
in being taken so by surprise by the hostility I experienced I had temporarily put
this information aside) and that they were probably experiencing divided loyalty.
He was determined to hold on to his power in the group even if it meant
rubbishing me.
I was feeling much panic and was not sure if it was mine or the group’s (prob-
ably both). I swallowed hard and said that it might be difficult to be in such a
group where you knew people outside and did not know what might come up in
the group (I had said in the lecture that people were often surprised by images
they made and how they were affected by them). I supposed that as teachers they
were expected to know what was going on and it must be strange to be in this
situation where they were not at all sure what was expected. I didn’t add that
they might feel like children at school but in fact one woman burst into tears and
said she had experienced me like her head teacher who always made her sit on a
low chair when she went into her study, while the head sat on a high chair. When
I’d mentioned visually introducing herself, she couldn’t think of anything; her
mind went blank and she literally ‘wiped herself out’. Other people joined her,
saying they were undervalued by society, being teachers. Some said they thought
they should be artists and not art teachers and that they had ‘failed’ by going into
teaching. Someone said that being an art therapist must be more interesting than
teaching.
P. sat in stony silence, with his arms folded, representing a stern authority
figure, apparently scornful of the self-revelations. I realised that he could see
himself as losing face if he joined in. He was, apparently, powerless to leave.
 106 The model in practice: case examples

The male–female power clash was centred on ourselves and right up till the end
of the group, he sat like that. The tension emanating from him was almost
unbearable and not even his wife could reach him.
I repeated a comment about the unfamiliar process of art therapy, despite
image-making being familiar to the group members, and drew attention to the
way that members had felt themselves like children. One woman commented ‘I
feel trapped in teaching but I can’t do anything else now. It’s too late.’ Someone
else said ‘I thought art therapy was supposed to make you feel relaxed!’ (I had
certainly not given that impression in the morning’s lecture . . .) I suspected that
P. was feeling both these feelings but he was not about to admit it and I was cer-
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tainly not going to suggest it. He, through being stuck in a role (lecturing)
wanted me to remain in that familiar role and when I did not, became angry and,
moreover, scared. He then tried to lead the group into demanding I take that role
and when the attempt failed, withdrew into silence.
The group came to an end with some people having doodled with crayon and
felt-tips. It had been a most uncomfortable and painful experience and after-
wards I felt exhausted and somewhat deskilled. It was only in reflecting some
time after that I realised how much this reflected how the art teachers felt most
of the time, but asking for support seemed to them ‘weakness’. It was acceptable
to ‘learn about’ art therapy, but being in the group had offered a chance for low-
ering defences, desirable but terrifying at the same time.
The next day (it was a residential conference) I learned from one of the organ-
isers that the group had gathered together in the bar that evening and talked ani-
matedly about their art therapy experience, P. included! We had not talked about
the images at all. A group of art teachers had avoided the image-making process
(‘wiping out’ their art) but the presence of the images ‘in abstract’ had seemed to
lead to some insight about their personal situations outside the group and how
these had been reflected in the group. They had also engaged in some ‘conductor
battering’ which might have relieved angry feelings about authority.
 Chapter 11

Case example 3
Developmental processes in a group
painting
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I conducted a group interactive art therapy training workshop over a period of

one week during a residential conference open to health care workers, including
practising art therapists.
As the conductor of an ongoing group, in which firm boundaries, interper-
sonal relationships and group dynamics are central features, I found it important
to clarify my own personal boundaries during the week. It is clearly impossible
that members do not meet each other outside the group, and obviously I shall
encounter them at breakfast, lectures and at social events where I will have a dif-
ferent role from that in the group. I feel, however, that within this model of train-
ing it is necessary to remain in a fairly ‘formal’ relationship with group members
– exactly as I would if working in a therapeutic community where I would see
patients outside small groups and would even, perhaps, be preparing a meal with
them. I feel it is important that the group can use the conductor for transference
purposes, and even though in an interactive group the role of the conductor is
less opaque than in an analytic group, the conductor is still available for projec-
tion, transference, etc. It can be confusing if the conductor is intimate with one
or two group members (e.g. drinking with them in the pub) during the life of the
group.
I shall describe a situation where maintaining my ‘role’ was important, where
both the group and myself had to negotiate some tricky boundary questions, and
where the group clearly demonstrated a developmental pattern of birth, latency,
adolescence, adulthood and death.
On the third day of the group, which consisted of eight members, four men
and four women, several members wanted to make a group painting following
the suggestion of one member. I drew attention to the eagerness with which the
group followed this suggestion, made by one of the men in a very positive and
enthusiastic manner. They did pause to reflect for a short time but were deter-
mined to work together on a painting. They took some time discussing how to
make the painting and what shape the paper should be. They decided to make a
very large circular shape and about half an hour was spent in preparation of the
paper, cutting, Sellotaping, deciding who would work where, etc. There seemed
to be some verbal discussion but much non-verbal signing about who was to be
 108 The model in practice: case examples

next to whom. I felt like a teacher or a parent watching the children at play. They
worked freely and energetically, splashing paint but staying in their own ter-
ritory. Eventually a dolphin emerged in the centre of the painting. There were
flowers, trees, fruit, birds and sunshine – altogether a joyous, happy atmosphere
prevailed. There was much giggling and chattering. I was more or less ignored,
but felt I had become the dolphin in the centre. The group continued to paint
almost to the end of the session. There was a sense of innocence, rather like the
Garden of Eden.
On the next day, the group assembled in a sullen mood. Some members
looked angry and there was a sexual charge. They decided to return to the paint-
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ing and some dissatisfaction was expressed with it. The dolphin stayed but two
members began to paint what looked like a vulture intertwined with it. There
were attempts to cross over boundaries and invade territory. Adam and Eve
appeared and snakes coiled round the trees. It began to look menacing. The
group were totally absorbed in the painting, walking on it, moving across it,
changing images and arguing with each other.
From time to time, members would glance across at me angrily. I felt very
uncomfortable, hot and in the way. I wanted to shift my position and walk round
the room, but felt rooted to my stool. The imagery filled the room, sexual,
aggressive, yet contained on the large circle. There were still remnants of the
previous day’s work, notably the dolphin which now appeared to be wrestling
with the vulture. I wondered if I was the dolphin ‘rescuer’ and the vulture
‘devourer’, rather like Kali in Hindu mythology, and representing the division in
the group between male and female power, positive and negative forces and
other dualities which may have been present. I did not put this to the group at the
time lest I interrupt the intensity of the painting.
Several minutes before the end, I drew attention to the approaching time
boundary and asked group members if there was any reaction they wished to
share before we finished for the day. Most expressed being totally absorbed in
the painting and feeling a bit stunned at what had come out. They went away
quietly.
That evening there was a social event involving much drinking of alcohol
and discharge of much emotion through disco dancing and possibly some
sexual activity. I stayed on the edge of the event, feeling slightly ill at ease
about the effects of the event on the group members. I knew that powerful
feelings to do with adolescence and sexual awareness had come up in the
group that day. It felt like a teenage party, such was the intensity of the drink-
ing and rather manic activity. I wondered about the wisdom of having such an
‘officially organised’ event during a conference containing psychodynamically
oriented experiential study. As far as my group were concerned, I felt a bit
like a parent being excluded from the teenagers’ party. I felt a spoilsport but
nevertheless avoided attempts by the group to pull me in. The process of the
group was very strong and we had much to work through in the remaining
days of the course.
 Group painting 109

Most people arrived on time next morning, tired but willing to work. The
sullen mood of the previous day had lifted and people expressed dissatisfaction
with some of the things done the day before. They negotiated how to improve
the situation and worked again on the picture. It was as if some of the adolescent
feelings of the previous day had been discharged – partially in the painting but
also, I suspect, acted out in the social event.
I wondered if anyone would discuss the party. They did not. Much seductive
interplay had gone on the day before and also at the party. They discussed
feeling tired. They did not talk much but set to work on the painting together,
making some quiet comments and suggestions to each other. I felt they might be
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a bit embarrassed at the rather violent imagery of the previous day and were
attempting to smooth it over. It certainly felt quiet in the room as the painting
entered its third day of being. I said very little and the workshop ended. I noticed
that the vulture and the dolphin had hardly been touched yet they were inter-
twined as opposed to wrestling.
On the final day, the group assembled and sat for several minutes in silence.
They discussed the possibility of continuing with the group painting but decided
against it. One person said he wanted to do a painting on his own and others
agreed. They did not move, however. Then a discussion began about the paint-
ing and about the week in general. I was asked to comment and give my impres-
sions about the workshop. They wondered about my role and how it felt not
joining in the painting (perhaps a reference to my not joining in the party, or at
least not wholeheartedly!). Without me giving comments, members started to
discuss my role and how they felt about the approach. I was perceived as ‘laid
back’ but necessary to the group’s functioning. I made a comment about the
dolphin and the vulture and wondered if my perception about them representing
two aspects of the conductor/mother – rescuer and devourer – was shared.
Members spent some time contemplating this, and the likeness to the Garden of
Eden of the picture. One member asked what would happen to the picture and
the rest of the workshop was devoted to discussing each person’s contribution
and how it had formed ‘the group’. A suggestion came that the painting should
be photographed with us all holding it and there was unanimous agreement that
this should happen after the end of the workshop when a camera could be found.
The person with the camera who offered to take the photo then said she would
send copies to all participants. I commented that this was one way in which the
group could be prolonged – that we were not actually facing the ending which
was rapidly approaching. This seemed to give permission for members to feed-
back to each other and myself and the group ended with a rather sad silence.
Afterwards, we did take photos of the painting. The organisation of addresses
and contributions to costs was done by two members and in due course, the
photos arrived.
I have often wondered how the group process would have developed had the
social event not taken place. Given that the participants were not patients, and
the advice not to meet outside the group could not apply, it is possible that the
 110 The model in practice: case examples

group boundary was maintained. I think though that important learning for the
participants may have been lost by them ‘acting out’ features of that day’s group,
rather than coming back to experience and exploring them through the painting
and in the contained space of the group. I have offered some suggestions here
about the painting (see Plate 2d) in the context of the group’s development. It is
a piece of work which contains numerous layers of meaning and which could
have been worked on by the group for many weeks, if not months. Note the
dolphin and the vulture in the centre of the painting.
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 Chapter 12

Case example 4
Life processes in small group
environments
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I had the idea during a three-day training workshop in Greece, to ask the parti-
cipants to continue working with their ‘self-boxes’ by dividing into three small
groups of four and making an environment for their boxes. They selected who
they wanted to work with and went to different parts of the room. One small
group then decided to go into the anteroom where all the materials were kept.
They announced this to the rest of the group, saying that people should get
materials out straight away (which they did without much protest!). Then they
shut the door, thus effectively cutting themselves off from the rest and from
myself, unless we chose to open the door and enter. Nobody did.
Group 1 decided to suspend their boxes from the ceiling. D. had the idea of
making a mobile so they fixed some string across the room to hold the boxes.
First they suspended A.’s box, which was full of cotton wool, then took a pole
and fixed F.’s and N.’s at either end. D. (the only man in the group) put his box
in the middle ‘for balance’. He called out ‘This is the balance of power’ (see
Plates 4a and 4b).
Group 2 created a ‘play room’. They fixed large sheets of paper on the wall
and painted a nursery. They made a shelf and put toys and the TV set in. They
cut out paper dolls and filled the space with scenes of childhood (see Plate 5a).
Group 3 remained a mystery. There were many comings and goings and
laughter. At one point, they went out of the building (breaking the boundaries),
it transpired to buy a tape of music. It was interesting that Group 3 had blocked
the materials off (the ‘goodies’ provided by the parents) as well. With the whis-
pering and laughter coming from behind the closed door, there was a strong
feeling of sexuality – taking over the parents’ bedroom, perhaps.
At the agreed time to finish the art-making process, the groups visited each
other’s environments. The main focus was Group 3. They had created a
sensual environment, complete with candles, dishes of burning incense, a tape
of sultry music was playing (Arabic music). An incredibly dark, secret and
seductive space. A skirt was draped on a chair together with a mask and crash
helmet! Other members felt the sexuality of this space and someone described
it as ‘forbidden pleasure’. It had a hypnotic, Eastern feeling to it and another
comment made was that it was like a very early Greek or Byzantine setting
 112 The model in practice: case examples

(see Plate 5b, but this is taken in daylight and does not reflect the sultry quality
of the environment).
In the discussion which ensued, T. pointed out three stages of man: child-
hood, adolescence and adulthood. D. said it was ‘play’ and ‘play’ in Greek also
means ‘toy’ and ‘game’.
I wondered how it had happened that the three groups had decided what to do
when it seemed the grouping was fairly random. Sharing the men was an issue
because Group 3 had two men and two women behind the doors, contributing
more to the notion of secret sex. Members said that in Greek society, it was
difficult to have relations with the opposite sex if they were not intended to lead
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to marriage. It is still a society in which women find it difficult to feel equal to

men. The issue of ‘secret sex’ was therefore very pertinent to the group.
It was stunning, though, how different phases of development had been
represented unconsciously by the groups as there was no prior discussion
between them and they were not aware of what each was doing until the end.
Of course there were many other issues to be discussed from these small
groups, such as the decision-making process in each group, working together,
the presence of the conductor and so on, let alone the rich metaphoric and sym-
bolic content of the imagery and its meaning for each member.
The following day the group worked together to de-construct the environ-
ments and this in itself was an important process. The small room, in the day-
light, had lost its seductive power and became once more an anteroom for
materials. The group had taken in and used its symbolic meaning on the previous
day: the objects had been internalised during the highly emotional discussion
about sex and its particular meaning to the participants, so what remained could
easily be de-constructed.
 Chapter 13

Case example 5
Images of the group
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Spontaneous images of the group often arise during art therapy workshops. They are
often linked to preoccupations of the group at that time – with the conductor, with
their lives outside, with their interpersonal relationships elsewhere on the course.

Case A: ‘the State’

During the final stages of a block training programme for medical personnel in
Bulgaria, one member produced Plate 6a, which he described as a symbol of ‘the
State’. It is a huge bulldozer which is about to crush two small people. They are
standing rather precariously on top of two spheres which are themselves perched
on somewhat fragile bases. The image is complex because the two people could
be the intended future co-ordinators of the art therapy project or the two conduc-
tors or symbolic of male and female about to be overcome by the power of the
group or the larger society outside.
The group were preoccupied at this time with the first phase of the training
coming to an end. It was a very new venture for Bulgaria at a time when people
felt themselves at the mercy of bureaucracy and ‘the State’. The group discussed
the image and they were concerned that their new-found insight and enthusiasms
(represented by the male and female conductors as they saw the two figures)
would be crushed once the training had finished. They did not know if they had
sufficient skills or ability to make the necessary changes in their situation to
practise art therapy. The bulldozer was built to be heavy and difficult to move
but it only has to move a short distance to crush the figures. The figures are
holding out their arms – as if they could be offering a welcome to the heavy
machine or on the other hand, asking for help. Someone said that perhaps the
machine would stop there and leave the figures safely ‘on top of the world’.

Case B: the psychiatric hospital

This image (Plate 6b) was made by four doctors, preoccupied with their role in
society. They were not sure if they were the rescuers or wanted to be rescued.
They have made a personification of the hospital, which they said was more like
 114 The model in practice: case examples

a prison. They did not know if their role was custodial or therapeutic. The ‘head’
of the hospital has a red cross hat on (symbol of rescuer) and a large ear, which
could either be used for listening sympathetically or listening in order to punish.
They wanted their role to be therapeutic but felt constricted by what they experi-
enced as that particular society’s expectations of psychiatrists.
It also felt as if the walls of the hospital were a safe container and perhaps it
was easier for everyone to stay in that situation rather than risk ‘breaking out’.
There were further discussions about the role of ‘the State’ and its protective as
well as restrictive aspects.
The group discussed their perceptions of psychiatry in their own country and
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in ‘the West’. They saw more scope for using therapeutic skills in the West, but
they were also very keen to change things in their country. There are similar ele-
ments in both A and B, in that ‘the hospital’ is both imprisoning and containing,
and the ‘bulldozer’ is threatening but potentially merciful (i.e. it hasn’t squashed
the figures, yet). There was transference to the conductors in both structures:
they were both powerful yet vulnerable. The group were unsure whether the con-
ductors were going to ‘listen sympathetically’ or imprison them through divulg-
ing information to ‘the wrong people’.

Case C
The group in Plate 6c has been portrayed as a life belt. Art therapy is symbolised
by the brush (which someone said was like a penis). The group is also on top of
the life belt which is actually ‘the eye of the therapist’. So the group is in the eye
of the conductor where it will be kept safely. There is food on the life belt and
the group can survive until it is eventually rescued.
There was a powerful pull on the conductor to ‘rescue’ the group and strong
feelings about the ‘freedom’ of the West as opposed to the ‘imprisonment’ of
the East.
These images from the examples A, B and C illustrate how individuals’ per-
sonal experience links into the group’s experience of each other and the conduc-
tor and their experience of the society ‘outside’.
Plate 6d and Figures 13.1 and 13.2 show images of the group, made in small
groups using clay. Plate 6d shows the group as a train, and the participants going
on a journey. The model tells a story of the group; it symbolises coming out of
the tunnel (unconscious) and into the light. The members of the small group told
the rest of the group what the passengers had seen on their journey.
Figure 13.1 shows the group as the fountain of life and a bullring. It can be a
place of peace and tranquillity and nourishment, or a place where violent scenes
take place. There were many other symbols meaningful to the makers of this
model, to do with their life in Spain and South America.
Figure 13.2 shows the conductor standing on a cliff, looking down at the
group through her binoculars. The member who made this picture had a feeling
that the conductor could ‘see everything’.
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Figure 13.1 Group as a fountain and bullring.

Figure 13.2 Conductor spying on the group.

 Chapter 14

Case example 6
Catharsis
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This example is taken from a short-term training group aimed at introducing art
therapy to people working with substance abuse. The group, which consisted of
20 people, some staff and some residents of therapeutic communities in Italy and
South America, had been working in pairs on life-sized portraits of each other
(see description of body images, pp. 66–70, 126–9). In the interaction I shall
discuss, one of the men was a priest and the other a worker in a closed com-
munity. Both came from South America and were training in Italy.
One of the men, S., had been very nervous from the beginning of the week
and was always anxious to ‘do everything right’. He felt himself to be very
clumsy and indeed his whole bearing was unconfident and hesitant. This applied
to his painting of C. which he worked on carefully and with much checking out
with C. to see if it met with his approval. C. also put a lot of care and thought
into S.’s painting. He was having a lot of difficulty with the feet and asked S. to
stand close to the painting so he could make the feet right. By this time the feet
had gone decidedly wrong and were out of proportion to the body. They were
also two left feet. This would not have been important in itself except that it was
obviously causing distress to both men. At this stage in the group, all the pairs
were intensely involved in the process with their partner but the tension between
S. and C. was communicating and some people went over to offer advice. Even-
tually C. drew a pair of feet which although looking awkward, satisfied him for
that moment. Several minutes later I observed S. moving to get some paint. He
passed by C.’s water pot and somehow the dirty water got knocked over and
spilt all over C.’s careful rendering of the feet. There were gasps of horror all
over the room. C. looked distraught and S. sat down, put his head in his hands
and cried. I felt an intervention was important and between the three of us we
concluded that it would be possible to place a clean piece of paper over the lower
part of the legs and re-do the feet. In fact, C. decided to paint the feet and stick
them on and they certainly looked more sturdy and in better proportion. (This is
an example of how reparation can take place symbolically through reworking a
painting when it has ‘gone wrong’ in the eyes of the painter.)
When the group as a whole paused to reflect on the process so far about an
hour later, S. said he had something very important to tell the group. He was
 Catharsis 117

flushed and excited. He said he had suddenly remembered an incident from his
childhood. One day his mother asked him to go down to the village to fetch the
day’s milk in a large pitcher. He was thrilled at being entrusted with this task.
On the way back, however, he tripped, fell and broke the pitcher. He lost a whole
day’s milk which was very precious and expensive. His mother was furious and
beat him, calling him a clumsy fool. He was so ashamed and humiliated at
failing his mother in this way and it seemed had spent much of his life atoning
for this accident. When he spilled the water over C.’s picture of him, he felt
overwhelmed with shame. He felt he had destroyed something precious which
C. had given him. It was a very moving moment in the group. It was true that S.
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had been experienced by several members as irritating because of his somewhat

obsessional manner. He was also inclined to want to control the group. It was
quite incredible that the accident with the water had brought back an incident
which he had repressed most of his life. From that moment of catharsis he was
able to relax much more, joining in the ‘play’ of the group instead of being on
the outside.
The symbolic re-enactment of a deeply repressed trauma through the process
of image-making and interaction with another is not entirely unusual in such a
group.
Another example happened in an introductory art therapy workshop I was
conducting for a group of medical personnel. All the group spoke good English
so I was able to interact freely with them. Several members in the group of 12
were ambivalent about being in a practical workshop and would have preferred
more lectures. They were also ambivalent about art therapy as a treatment
process. It was not a profession in that country and some of the participants still
believed it was a form of ‘arts and crafts’ which kept patients happily occupied,
despite having had a lecture and seminar on theory and practice.
I had stressed that people should wear old clothing, or overalls for the work-
shop, as the art therapy process can be messy. However, some turned up in their
white doctor’s coats and others in smart clothing! They were engaged in a
similar task to the one described above, although I had modified it slightly
because the group was a ‘one-off ’.
Two men worked together but I noticed that one of them, J., although starting
off his painting by discussing and observing his partner, had become engrossed
in painting a very careful portrait of someone looking completely unlike either
his partner or himself (sometimes – indeed often – people make the portraits as
they see themselves). He had withdrawn into the painting and worked fast, as if
he had a vision of the person in his head. At a point when everyone had finished
the paintings, I asked them to fix them on the walls and invited them to say how
they had experienced the task. I did not invite them to speak about the paintings
themselves, although that was quite possible if people wished.
J. immediately said he was shaken by what had happened to him. He said he
had not wanted to come to the group as he thought art therapy was ‘not serious’
and he had no talent in art at all. He also felt that, as a psychiatrist, it was strange
 118 The model in practice: case examples

to be in a group where he had to paint. However, he was a little intrigued as he

had heard a lot of people talk about art therapy so that was why he had come.
When he started to make the life-sized portrait, he found himself painting
someone who used to be his best friend, but with whom he had quarrelled over a
girl when they were first in college. The quarrel was very serious and was never
resolved. Shortly after, the friend was killed in a car crash. He had blotted out
the pain of all this but it came flooding back while he was painting. Although his
partner in the group was not much like the friend, there were some similarities
and he thought it was for this reason he had created a true likeness of his friend.
He cried in the group and said he would never have believed the power of art
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therapy. The group were very moved by this and he felt supported and liberated
by the cathartic experience. He said he felt he could now mourn the loss of his
friend.
It was important during the discussion stage of the workshop for me to refer
to this incident which clearly illustrated the power of the art therapy process and
the necessity for clear boundaries and adequate time and space for processing
the material which often arose. The participants, who were mainly psychiatrists
and psychologists, were no longer under the illusion that art therapy was to be
taken lightly, or that they could offer it to patients without having proper training
themselves.
 Chapter 15

Case example 7
Power and domination
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Clay workshops and sub- group themes

The group divided into four small groups, people choosing who they wanted to
work with. The experience of the life-sized portraits was still active and the
‘symbolic group’ now occupied the walls of the studio. The task was to use the
clay in any way the small groups wished.
In Group 1, five members from the closed community had chosen to work
together. They had a brief discussion and I noticed that B. had made a sugges-
tion which appeared to be accepted. The clay was pounded with much enthusi-
asm and loud banging. A structure was created with a wall around it. There was
much arguing followed by scooping up of the clay and pounding it back into a
large block. Then the group sat contemplating the ball of clay and each other. B.
again seemed to take the lead and was offering a suggestion which was accepted.
Everyone took a piece of clay and started working individually. Then they joined
B. who had flattened out a large piece and was shaping it. I saw they were
making a mask, using elements of the painting which A. had done of B.
earlier on.
When they were satisfied with the structure, they began to paint it. Normally,
clay needs to dry, be biscuit fired and painted with special underglazes, fired
again and glazed. There was no possibility of carrying out this procedure here so
it was ‘good enough’ to use the acrylic paints for the purpose. The group were
preoccupied with the painting, especially B. who was clearly enjoying himself.
In Group 3, it seemed that individuals had chosen to work on their own pieces
without much discussion or interaction (see Figure 15.1).
In Group 4, people also worked individually, although they had spent a lot of
time talking before using the clay (see Figure 15.2).
When the making process was complete, groups visited each other and a
discussion began. Group 1 explained that they had started by making a prison
but they themselves felt trapped by it and wondered why they had chosen the
topic. They thought it was because their community was ‘closed’ and they had
chosen each other and chosen the topic for this reason. They felt resentful of
the other group members who were not in this position. They’d decided – or
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Figure 15.1 Small group themes: making individual objects.

Figure 15.2 Group talking and making.

 Power and domination 121

rather B. had suggested – making a ‘devil mask’. They were very pleased with
the outcome and proposed to leave it to the ‘open community’ hosting the
workshop! They had expressed a lot of envy and hostility to members of this
community during the week and the ‘devil’s mask’ was a container for this –
but at the same time, it was something powerful and attractive to give to their
rivals (see Plate 7a).
Group 2 had spent a lot of time deciding what to make before having the idea
of a house on which they had written ‘welcome’ in many different languages.
They felt that the group was like this house, full of different languages, different
people, different problems. They wanted to make a comfortable and safe place
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for the group. It transpired that not all of them had felt welcomed in Italy (see
Figure 15.3).
Group 3 had decided on ‘love and hate’. N., who was a South American
Indian, had made a model of a white man dominating a black man. He said that
this was his symbol for ‘hate’. The white man sat on a chair while the black man
crouched on the ground (see Figure 15.4).
P., another black man, had made a model of an old man dressed in black. He
said that for years his people had been dominated by white men.
The two black women in the group were in Group 2. They were also nuns and
did not join the two men in the discussion about white domination. There was a

Figure 15.3 Group making a ‘welcome house’.

 122 The model in practice: case examples

general discussion in the group about which nationalities dominated others.

I drew attention to my role as a white woman conductor, from a nation which
had a history of dominating others. This comment was accepted and my position
acknowledged. P. said he had not really been aware of his ‘blackness’ till he saw
N. making his figure and that led him to feel angry and wanting to make a
statement about it. I mentioned again the question of my role as conductor,
bearing in mind Yalom’s point:

The leader is [thus] seen unrealistically by members for many reasons:

true transference or displacement of affect from some prior object is one
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Figure 15.4 Power struggles: black man and white man.

 Power and domination 123

source; conflicted attitudes toward authority – dependency, autonomy,

rebellion and so on – which become personified in the therapist . . . still
another source is the tendency to imbue the therapist with superhuman
features so as to use him or her as a shield against existential anxiety.
One further source lies in the members’ explicit or intuitive appreciation
of the great power of the group therapist. Your presence and your impar-
tiality are . . . essential for group survival and stability. You cannot be
deposed; you have at your disposal enormous power; you can expel
members, add new members, mobilize group pressure against anyone you
wish.
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(1985: 210)

Yalom goes on to remind us that the sources of intense, irrational feelings

towards the therapist are so powerful that transference will occur come what
may. It is important to turn it to therapeutic account and to help members to
recognise, understand and change their distorted attitudinal set towards the
leader. P.’s strong and clear statement about power and domination did, I think,
contain much of the group’s fantasies about my own power. This was particu-
larly complex because of the composition of the group, containing as it did
people with differing degrees of actual power (staff and residents from a ‘closed
community’). The ambivalence of the group towards me, expressed by Group
1’s devil mask and the desire to be protected (the ‘welcome’ house) were all fea-
tures of my role as conductor of this complex group.
In Group 4, people had chosen to work on their own theme. One woman said
she had to stop because she was making a mother and child, but she could never
have a child as a result of serious drug abuse. The realisation of this upset her, so
she stopped making the figure and sat quietly in her group. Another woman,
pregnant, made an elegant panther, and other group members made a child, a
dog and a figure looking like Julius Caesar. I also felt the ambivalence towards
‘Rome’ as the place of training through the Julius Caesar figure. He is murdered
in the forum, the place of democratic decision-making (group-as-forum where
betrayals may take place and leaders be assassinated). I think my role as conduc-
tor was also included in this figure. There was another contrast between the
fertile woman’s panther and the sad image of the other woman whose fertility
had been curtailed and between the child and dog (very friendly and nice) and
the panther and Julius Caesar.
The discussion of all the material from the small groups took the whole of the
next day. The sub-groups reflected aspects of the group-as-a-whole and particu-
larly fantasies about the power of the conductor.
Following on from the symbols of power and domination contained in P.’s
image of the white man dominating the black came the issue of sexuality. This
discussion was reckoned by the group to be a difficult one for the following
reasons:
 124 The model in practice: case examples

• Some members were priests and nuns and therefore other members per-
ceived them as being ‘shocked’ by talk of sex, although they were not.
• Some members feared HIV and AIDS as a result of sexual activity and drug
abuse.
• Several had always had profound anxiety about sex.
• One woman (staff member) was pregnant and was envied by others; there
was a fantasy that she would have a ‘virgin birth’. She was perceived as a
mother figure (her portrait had been given plenty of good food by group
members – interestingly enough, under her skirt) (see Figure 15.5).
• One member was both a Catholic and a homosexual and this was experi-
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enced as a sin.

Figure 15.5 Image of pregnant woman with food under her skirt.
 Power and domination 125

The general feeling was that sex belonged in the ‘evil’ camp. At best it was unre-
warding (with the notable exception of H. who was happily pregnant) and at
worst it killed you (AIDS). These issues were able to be discussed as a result of
the images now filling the room. Because sexuality was seen as the most difficult
topic for the group, they left discussion of it until they were safe with each other
and myself.
When it was time for that session to end, someone made the suggestion that
the final session should be used to decide what to do with the artwork.
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 Chapter 16

Case example 8
Splitting in the group
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Forces of good and evil

This group is the same one mentioned in Case Example 7. The stage of the group I
want to discuss follows the completion of the life-sized portraits and discussion of
that process and focusses on the point where group members reflect on the sym-
bolic selves around the room and decide what they wish to add or change to them.
One man, B., had made a portrait of himself instead of his partner (see Figure
16.1). He described it as absolutely right and he was satisfied at the negative

Figure 16.1 Devilish body image.

 Splitting in the group 127

image he had portrayed. Group members pointed out that he had ignored the task
and his partner and he said he didn’t care. He was very pleased with his painting.
He sat with folded arms, looking both defiant and cheerful. Several members
pointed out the devilish appearance of the painting and wondered why he had
made it so evil-looking. It was covered with a huge spider’s web which did look
quite menacing.
The group were generally rather annoyed with his refusal to contemplate why
he had ignored A. so that in fact he had two paintings of himself, one which A.
had done and one he himself had done. (They had been used to working in
groups where confrontation was the norm and where lack of consideration for
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others was discouraged.) B. had very elaborate tattoos on his arms and A. had
put these on the painting. B. was not happy about attention being drawn to them
and wanted A. to remove them.
When it came to the time after the discussion when members could negotiate
to work on any portrait, B. stood in front of his painting and said nobody was to
touch it. Several people tried to persuade him to let them add something ‘light’
to the darkness of the painting but he refused angrily. One woman approached
with a cut-out figure of a child which she wanted to place on the painting. He
shouted at her to get out. She was the only one to persist in trying to interact
with him and the painting and eventually he relented enough to draw a line
across the bottom of the picture and allowed her to place cut-out figures there.
The group were interacting freely around the portraits. One man had negoti-
ated with a pair (male and female) to place his painting between them, so they
created a trio (see Plate 7c). Others negotiated to add, change, etc.
The end of the session came and the room was left ready for the afternoon
session.
When the group resumed, there was still some amending to be done but even-
tually people seemed satisfied that the ‘symbolic group’ was ready. We sat down
to discuss the outcome. Much attention immediately focussed on B. for his atti-
tude to others and his insistence on having all but a tiny piece of his painting
untouched. He remained implacable and fought people off. Other people dis-
cussed how they had felt about the process and about changing images made by
others. Then C. said that he felt very upset because nobody had been near his
picture. He felt ignored by the group. C. was a priest, working in very difficult
conditions in South America. He was a quiet man – the same man who had been
involved in the spilling of water by S. He wondered why nobody had wanted to
touch his painting. Members could not give him any response. They seemed to
want to ignore even his request for feedback. There was more interest in pursu-
ing B.’s refusal to have his painting touched.
I intervened to say that I felt that B. and C. represented two aspects of life –
and of the group – and that they had become polarised in the paintings. B. was
clear that his painting was ‘all evil’ and he was not prepared to accept the
positive feelings (in the form of additions and changes) that group members
might have about him. A member intervened here to say that she had passed C.’s
 128 The model in practice: case examples

picture but hadn’t dared touch it. It looked so ‘perfect’. Others agreed and
someone said the picture was like an icon. C. asked if it was because he was a
priest that nobody dared touch him. He felt upset. He felt he had a problem in
always looking after others throughout his life. Now he felt the group had made
him into a saint and he did not want to be like that. He wanted to be a real
person. He actually felt like a child. The group felt depressed and flat at this
point, having split itself into two. As far as the group-as-a-whole were con-
cerned, I felt the two images reflected the lack of integration in the composition
of the group as well as a division into ‘all good’ and ‘all evil’, neither of which
could be touched.
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The group consisted of several sub-groups: staff and non-staff; residents of

two different communities; Italian and non-Italian; ex-drug addicts and non-
addicts; priests and nuns; men and women. There was also my position as con-
ductor: good or evil, kind or punishing (similar to the dolphin–vulture images in
Case Example 3). I put this to the group in connection with the group’s paint-
ings. The group were able to discuss their reactions to ‘differences’, especially

Figure 16.2 An unwilling icon.

 Splitting in the group 129

between staff and residents and the polarities of ‘good and evil’. During the dis-
cussion two people got up and added some marks to C.’s picture. One woman
put a cut-out picture of a woman over his stomach, just under a heart, which
someone else had drawn: she sensed he had some ambivalence about his chosen
celibate role. Later he added a moustache, eyes and black spirals coming out of
his head – taking a few ‘devilish’ elements from B.’s painting, making him feel
less ‘saintly’. Finally, a cut-out of a mountaineer appeared, placed underneath
the woman’s picture (see Figure 16.2).
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 Chapter 17

Case example 9
Expressing anger symbolically
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A group of seven women, all with eating disorders, had been meeting for over a
year in a once-weekly group, for one-and-a-half hours. There had been many
problems in attendance and punctuality with excuses usually being that the
woman had to attend to someone else (e.g. husband, children, mother) at the
time of the group. The group was therefore somewhat fragmented and character-
ised by angry, envious feelings towards the therapist alternating with compliant,
timid behaviour. The women found it difficult to confront each other verbally
but did so through their artwork. A recurring complaint was of not being able to
do what they really wanted, of being victims of circumstances outside their
control. The word ‘It’ kept cropping up: ‘It’s not possible’; ‘It won’t happen’; ‘I
can’t do It’; ‘It’s making me fat’; and so on.
The group noticed this word recurring over and over again in one session
and decided to try to visualise exactly what ‘It’ was. The illustration (Figure
17.1) shows how ‘It’ looked to one group member, using torn up pieces of
paper layered on top of each other. Another member drew an angry little devil
on her shoulder. His claws are digging into her savagely (see Figure 17.2).
Another drew a bomb exploding, and another a boulder rushing down a cliff.
The feeling of these paintings was of tremendous energy being let loose,
which the women felt was anger. They experienced anger as very dangerous,
tended to dam it up and then to stuff themselves or alternatively starve them-
selves as a way of coping with it – or, indeed, with any strong and potentially
creative feelings. The woman who drew the devil said she quite liked him
after all but he should sit on her shoulder rather than claw her. Gradually, as
the women got more familiar with the ‘It’ in each of them, they began to see
that ‘It’ could be useful to them in providing them with more energy and vital-
ity: which would be preferable to depression and stuffing or starving them-
selves (see also Levens, 1990 for an account of an interactive art therapy
group with eating disordered clients).
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Figure 17.1 ‘It’ won’t let me . . .

Figure 17.2 ‘It’: a devilish figure.

 Chapter 18

Case example 10
Example of a theme arising
spontaneously
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The art therapy department consisted of three rooms: one in which patients could
use a wide variety of materials – paint, clay, mosaic and glass, and various other
3-D materials such as wood, cardboard boxes, ‘junk’. One small room contained
a kiln which was in constant use, and the other an easy chair and a couch, to
which a patient could retire if feeling particularly emotionally drained or in need
of privacy. The large room operated as a studio and patients could come and go
as they wished during the time it was open. There were two part-time art thera-
pists working on different days, and they were joined by a trainee who had
expertise in pottery.
It was usual practice for the art therapists to make their own artwork. Now-
adays, art therapists differ on this issue: some feel that if the therapist is engaged
in their own image-making, they will not be ‘available’ for the group, others that
the therapist can make statements visually about the group process as well as
verbally. I have already explained that attempts to introduce more ‘formal’
groups into the art therapy department structure had not been popular but that
more attention was being paid to interaction. The trainee, Jill, was persuaded by
some of the male patients (who predominated in the centre and in the art depart-
ment) to show them how to make moulds, out of which they could cast ‘useful’
objects. I had mixed feelings about this, fearing a ‘production line’ ethos devel-
oping in the art department which would be safer for the patients of course, as
they would not risk being surprised or overwhelmed by unconscious material
arising out of their image-making. It was a time of great insecurity in the centre
as it had been threatened with closure once again and there were many disagree-
ments among staff as to treatment policy. It was not surprising, then, that patients
felt vulnerable and wanted to engage in a ‘safe’ activity. The group were divided
into those who wanted to make moulds and do slip casting and those who wanted
to continue with their own image-making.
I was absent from the centre for two weeks, but Jill had continued to use the
art room with our colleague. When I returned I found the room full of plaster
eggs, which had been cast from balloons – that is, a balloon is inflated and fine
liquid plaster or slip is poured into it and allowed to set, then the rubber is peeled
off leaving a fragile egg shape. This was a technique which Jill had
 A theme arising spontaneously 133
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Figure 18.1 Egg and bird.

demonstrated, for fun, and which had caught on so that egg production had flour-
ished and threatened to overwhelm the room. There was a competition to see
who could produce the largest egg. There were, needless to say, many casualties.
I wondered what to do about this proliferation, and sensed it had an important
meaning. On asking about it, the patients pointed out that Easter was fast
approaching and they were making them for that reason! I said that eggs usually
contained embryo chicks and did they intend to make the chicks as well? Amid
much mirth, all the group members joined in making chicks – having discovered
a large bag of brightly coloured feathers in a cupboard. So the room became
filled with eggs and chicks (see Figure 18.1). Then one man, who had been at the
centre for three years and who had severe relationship difficulties, especially
with women, suggested making a ‘large bird’ and requested my help. The other
members were intrigued as to how he would make it. He decided on papier
mâché but first had to build a structure to support it. While the papier mâché was
‘mulching’ he found cardboard tubes and some wire and after discussion with
myself, Jill and the other patients, built a slightly precarious base for the bird.
There was the question of what to call it. Someone suggested Henry. As the
papier mâché went on and the bird took shape, P. suggested it had better be
called Henrietta as it was a female bird. There was then a group debate about
whether or not it should be male or female. It became female. All group
members took a turn in putting on the papier mâché and Jill and I also
 134 The model in practice: case examples

contributed. P. was asked to give her a ‘sharp beak and beady eyes’. After the
papier mâché dried, Henrietta got her feathers, beak and beady eyes (see
Plate 8a).
Then there was the question of what to do with her. M., who had played a
central role, with P., in the making, suggested suspending her from the ceiling so
she could ‘have a good fly around’. Someone else said ‘She can keep an eye on
you, then!’ I had a strong sense that Henrietta was myself and/or my colleague. I
had been absent for two weeks and the Easter break was approaching. The centre
felt insecure. The making of Henrietta seemed to be a way in which the group
were creating a ‘symbolic mother’ in the form of a bird who, although she had a
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sharp beak and beady eyes, would always be present in the room ‘to keep an eye
on things’. So she was fixed up on a piece of string and moved in the breeze
created whenever the door was opened. The group then became concerned that
she might be lonely up there, so K. suggested making a large spider to accom-
pany her. P. said ‘Henrietta will eat it!’ They decided to make the spider after all
and suspended it at a short distance from the bird, so that neither could get at the
other. Someone asked ‘Is it poisonous?’ But the question was not answered. My
colleague and I had the feeling that we were both represented in the spider and
the bird – the spider seeming to be female also. We contained both dangerous
and protective elements.
This is an example of how an apparently ‘mechanical’ activity, such as
mould-making, may develop into an important interaction within the group, and
one which can contain the anxiety of a group at a particular time. The making of
the bird and the spider, although suggested by individuals, obviously resonated
with other group members as all were involved at some level in the process.
They remained, moving gently in the breeze, and were still there when I left the
centre some two years later.
 Chapter 19

Case example 11
Boundary violation and scapegoating
in a training group
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This was a group of nine in an introductory art therapy programme lasting one
week. It consisted of daily art therapy workshops run on an interactive model but
with some initial setting of open-ended themes by myself. Some theoretical and
practical media sessions were also included.
Many of the trainees had an art or art teaching background and were clear that
the course was an introduction after which they might be able to consider taking
further training in an Art Therapy programme. There were seven women and
two men.
It is usual in this centre for the trainees and the conductors to have meals
together and on the Sunday evening I encountered some of the participants in the
dining room. I am usually friendly and willing to talk about art therapy in
general but careful not to get involved in any more ‘personal’ discussion as it
makes holding the boundaries of the course somewhat complicated. The parti-
cipants sense this, as a rule, and normally we manage well over the week.
However, one participant wanted to engage me in intensive discussion. She
did not speak English, however, and my understanding was fair but not good, so
she asked another participant who spoke French to translate. She asked me for a
critique of her artwork from the point of view of an art therapist. She had
brought her work to the course for this purpose. I gently said that it was not part
of my role to do this, and added that were I to see her artwork, my response
would merely be a personal impression of the work, from one artist to another,
so to speak. She was not happy with this and urged me to find time to see the
work and offer her an ‘analysis’ of it. I repeated my previous comment and
excused myself from the table. She was clearly put out by this and for a moment
I wondered if I should have a look at the paintings but quickly concluded that I
felt uncomfortable at the request because it implied she had not understood the
purpose of the course (clearly advertised as an introductory course in art therapy
with emphasis on group work) and wanted her own personal therapy. I made a
mental note to stress in my introduction that the course was not therapy but that
some personal learning may take place; that I should not be conducting the group
as a therapist even though the group may wish to experience me like that from
time to time.
 136 The model in practice: case examples

On the first morning of the course I met the participants individually. One
man was missing but I was told he would come later. I gave an introductory talk,
with some basic theoretical material on art therapy and groups. I gave out the
timetable, stressed the importance of time-keeping, no smoking, the limits of our
working space and outlined the aims of the programme and my role in it. Dan
then conducted a session on using art materials as they were not familiar with
the nature of the materials on offer. I had found out during the brief interviews
that some were studying architecture, one painted icons, one was a graphic
designer, two were dancers and so on. ‘Art’ was interpreted in a broad sense.
For the first workshop, by way of an introduction to the process, I suggested
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that the participants think about themselves and the others in the group and
without discussing it, select four members and make ‘symbolic portraits’ i.e.
choose colours, shapes, images which suggested some aspects of those people. I
said they would have the opportunity to talk about these pictures at the end of
the week, if they wished to do so (to see if their perceptions had changed as a
result of knowing each other better) and there would be a few minutes at the
beginning of the next session to express feelings about the task itself. The aim
was to encourage them to use the materials to make a spontaneous, based on
initial impressions, non-verbal comment about others in the group.
They worked enthusiastically, and I noticed that they were experimenting
with materials. When the end of the workshop approached, I advised them of the
time and they finished on time.
The next morning the session began at 8.30 and a few people asked for some
time to complete the previous day’s work. I said perhaps this could be negotiated
and they agreed among themselves to take half an hour including time for
feeding back how they had felt about the task.
The next stage of the workshop was beginning the ‘self-boxes’ (see Chapter
3). While the group were finishing their ‘portraits’ Gina, the interpreter, said
quietly that M. had asked her to ask me to look at her paintings and make an
analysis of them as she was going to have an exhibition and wanted to use my
comments. She had felt that I didn’t understand what she was asking the
previous day so asked the interpreter to tell me in English. I was annoyed by this
and let G. know that I could not deal with her request during the group. Later M.
took G. aside and was obviously pressurising her to persuade me. This felt to me
like M. was not only ignoring what I had said to her the previous day but also
breaking the boundaries of the conductor–interpreter relationship.
She was also again using an intermediary to ask for something: albeit there
was a logical reason for the first request being translated as I did not speak
Italian adequately (my problem) but on this occasion there seemed to be some
desperation in her wanting my attention to her paintings. I wondered if I should
bring it into the group but decided it was inappropriate at this point. I supposed
the same issue would come up later, in the group. I felt M. was extremely
anxious and was having difficulty being in the group. She was trying to deal with
this by establishing a special relationship with myself. She also seemed to need
 Boundary violation and scapegoating 137

the intermediary to communicate and so I thought that art therapy might be a

useful form of therapy for her outside the course as the art object could serve as
an intermediary. Gina must have said that I wasn’t prepared to engage myself on
this problem during the group. She was, fortunately, very sensitive to the bound-
aries herself. We carried on with the next part of the workshop, which was for
each participant to select a box from a large and varied pile in a corner of the
room.
Two women immediately had an altercation over the boxes as they both
wanted the same one. One of them conceded to the other but took several boxes
instead of one.
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M. took a square box and stuffed it full of torn paper and a dead branch (drift-
wood which had been brought in as part of the ‘junk box’), covered it up then
wrapped it in tissue paper, brown sticky tape, Sellotape so it was completely
enclosed. Then she punched a hole in it and inserted a big tissue paper flower.
They all worked fast and energetically, using a lot of material. When
everyone had clearly finished, S. asked if others would join him in talking about
their boxes. One of the women, P. immediately started and a lively discussion
followed in which each of the participants jostled to get a word in. They knew
the end time but after R. had finished speaking I said it was time to end, giving
the time of the next workshop session. M. immediately said she wanted to talk
about hers. I said that the session had now ended. She said it was related to the
previous box. I said the boxes would be there the next day and asked her to hold
on till then. She was clearly furious with me.
The next session was a practical art materials workshop led by my colleague
and in the evening there was a theoretical session during which time I showed
some videos on art therapy.
The next morning we talked about the boxes again. M. brought in her box and
banged it down in the centre of the group. It was tightly tied up and bound with
only the bright blue flower sticking out. She said she felt the box was her and
didn’t want to speak about it but wanted others to comment. This provoked some
anger from the group, especially S. and J. who asked ‘What do you want of us?’
W. was also angry. S. said he couldn’t imagine opening the box and he didn’t
want to. This feeling seemed to be shared. The group members had seemed to
draw back from the box. I was concerned that M. might be alienating herself and
attracting the group anger. She seemed to see herself as the conductor, more
experienced than the others, and I felt a strong challenge to me who had disap-
pointed her and perhaps, she felt, rejected her by not providing her with an ana-
lysis of her paintings. Several group members pressured M. to share something
about her box and she remained adamant that she only wanted others’ comments.
At this point it felt as if the group was ‘stuck’ with M.’s box and some particip-
ants said they were getting angry with her and not wanting to give their
responses to her. I wondered if M. had only been able to introduce herself yes-
terday, at the end, in terms of R.’s openness and me reminding her of the end
time had been experienced as ‘cutting her off ’. I tried to open the issue up by
 138 The model in practice: case examples

drawing attention to the different methods group members used to establish their
role in the group and suggesting that perhaps M. was very anxious about getting
into the group. At the same time I felt concerned about M. and her readiness to
provoke the group’s anger.
A. then said that my comment had modified what she had to say, which at
first had been very judgemental. She felt able to make a less judgemental
comment now because anxiety about being accepted belonged to her too and she
thought to all the others.
M. couldn’t take up this gesture to ‘join’ the group and dismissed A.’s comment
angrily. The group tried to bring M. in to share in the anxiety about revealing them-
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selves to each other. She would not budge from her previous position and suddenly
tore and cut open her box. It was physically painful to watch and I felt a pain in my
stomach and shortage of breath at that point. I looked round the group and saw
other people holding their breath and looking shocked. A. commented that she
thought M. could only open up in hostile conditions and it felt like rape or some
kind of violence to the person. M. said, yes, she had been in that kind of situation
in her family. M.’s box was spewing out torn up paper and a hunk of dead branch.
People asked if the flower which had been sticking out was attached to anything or
if it was superficial. There was a very tense atmosphere in the group, and it felt
split between the dead branch and the flower. People seemed anxious to hear it was
still growing. I pointed out this polarisation as a general point to the group and R.
said ‘That’s enough of her box!’ I was trying to hold on to the boundaries of an
experiential group which was determined to become a therapy group. I made a few
comments about the differences between the two, avoiding making a direct
comment about M.’s drastic action but reminding members that it was up to each
individual how much or how little – if anything at all – they said about their boxes.
After a short pause, shuffling and a sense of settling back, M. roughly brushed
her box and its contents out of the centre and A. brought in hers. By contrast this
was neat, made out of white polystyrene, lined with wallpaper. There was a little
doll inside with pillows. She talked about her flight from ‘sweetness’ and started to
cry. This was a total contrast to M.’s angry, hard presentation. The group were
much involved in her story and there were positive, reinforcing comments made in
response to her sadness and vulnerability as opposed to M.’s anger and mistrust.
When A. had finished talking about her box, she gave M. the little doll with the
comment: ‘something tender to hold’. P. seemed very uncomfortable and kept rest-
lessly silent. I sensed she found M.’s anger easier to deal with. E. brought her box
in, half-open, half-closed with wings and flaps on top. She described punching
holes in it with scissors which she had found liberating. There was a question ‘Can
some kinds of violence be liberating?’ M. had opened her box with violence, but E.
didn’t want to open hers. I asked if the group had set a new a rule about having to
open boxes. They said no, but they felt a pressure to do so and explored this for a
while. I commented about the power of these previously mundane cardboard boxes
to be symbols of so much, thus illustrating the point about the power of the object/
 Boundary violation and scapegoating 139

image. I felt as if these comments were a bit banal in the face of so much emotional
outpouring, but they did have the effect of maintaining the boundaries.
The group wrestled with the decision whether to carry on talking about the
boxes or to stop and move on. There was concern that three people hadn’t
spoken about theirs. They remained silent. I said that perhaps it was permissible
for this to happen. After a silence I suggested some of the themes which the
group had been dealing with as a result of the boxes: polarisation; being an indi-
vidual in a group; trusting or not; being open or not; being angry and hard – or
being hurt and vulnerable. Also the important question which was raised – could
violence ever be positive? Someone said feelings of anger and vulnerability
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often went together and it was confusing to experience these strong emotions
together. The discussion moved on to relationships and how you could love
someone but be angry and vulnerable with them.
A. and S. said they wanted me to make comments – to clear up the confusion.
S. said perhaps the end of the week would provide the revelation! There was
laughter after which I pointed out where and why I had intervened and said that I
felt they had plenty of resources too. The group ended with people going off
quietly and thoughtfully.
In the next workshop we took the theme of relationships and maintaining
individuality in a group a bit further. I asked them to work in three groups of
three and proposed that they could either group together (choose each other) or
pick names out of a hat. Everyone wanted to do the latter. So Gina pulled the
names out in threes. The task was to find some way of building an environment
for their boxes which would involve negotiation and perhaps some compromise.
Interestingly, one of the groups consisted of M., P. and E. who had had the most
angry exchanges during the previous workshop. They were not pleased at
working together and went off sulkily. All the groups spent quite a bit of time in
discussion, and it was clear that M., P. and E. were having difficulty in working.
The other two groups appeared to have made decisions. One group checked with
everyone that it was permissible to go on to the balcony and the other to the back
of the room among the potted plants. M.’s group eventually started to construct
an environment in the middle of the room and they worked on it in a polite but
cool manner. The other groups were laughing a lot and seemed engrossed in the
task. I wondered about the ‘luck of the draw’ as far as M., P. and E. were con-
cerned. The session ended and everyone went off. I noticed that M., P. and E.
avoided each other after the group ended.
Early the next morning the elements made the decision ‘where to start’ for the
group. There was a huge storm brewing: high wind, very dark sky, menacing
atmosphere. The group on the balcony anxiously went to look at their environ-
ment. They said they had trusted that it would remain intact overnight but if the
elements had affected the construction that was fine because it was OK for it to
be changed by the elements. They had made a path going from the door of the
studio towards the sea and put a large sheet of paper, like a flag, on the railing of
the balcony. The wind had torn some of it but most was still intact. They had
 140 The model in practice: case examples

brought the boxes inside overnight, just in case. They said their environment felt
hopeful – exposed to sun and wind but rescued just before the storm. They
laughed and said ‘This is the calm before the storm!’ I had a sense of forebod-
ing. They said they had arrived at an environment which took care of everyone’s
wishes and were satisfied with it (see Figures 19.1 and 19.2).
When we went inside, I had a shock as I felt something had changed from the
previous day. In fact, although I was sure, I persuaded myself my memory was
defective. It was not, however. There were big problems about M., P. and E.’s
group and it turned out that M. had gone back to the studio late in the afternoon/
evening (we were away from the centre at that time) and had totally changed the
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group’s environment. She had made it her own by painting a huge blue area, repre-
senting water, on which was an island, adding the piece of dead branch and arran-
ging it so it crushed a small doll (which A. had given her from her box). M. sat on
a chair, away from P. and E. who were standing to one side looking upset and
angry. She said for her the therapy finished yesterday evening. She then proceeded
to go through the events of the week in a very detailed way, in an aggressive tone –
a monologue. I intervened to point out that she was delivering a lecture and was it
relevant to the work done together? I wondered, further, why M. had taken on, and
been allowed by her group, to take on the position of spokeswoman and what had
happened to her two colleagues? I also pointed out that a boundary had been
broken and that a space was no longer safe if boundaries were violated in such a
manner. I repeated the boundaries of time and space which I’d stated clearly at the

Figure 19.1 Making an environment.

 Boundary violation and scapegoating 141
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Figure 19.2 Making an environment.

beginning. I had not actually said that nobody should enter the studio in between
sessions. It was kept locked but M. had got the key from the centre staff! She
denied that there was a problem and said she didn’t know it was not ‘allowed’ to
use the studio outside course sessions. E. was furious with M. for ‘wiping out’ their
communal work and for not even acknowledging the fact. A. was extremely upset
that the doll she had given M. the previous day had been treated in such a way. She
felt it personally. There was an interesting difference between the changes in the
environment brought about by the wind in the first group – who had made the deci-
sion to leave it exposed and able to change – and those made deliberately but
without negotiation by M. The whole group turned on M. who sat defiant on her
chair, hitting out at everyone. I felt myself becoming angry with her too so thought
it was time to draw attention to the group dynamic of polarisation again. I was con-
scious that M. did not have a sense of her own boundaries and feared that she had
deeply distressing early material which was coming to the surface in this training
group, which was not the right arena to deal with it. Had it been a therapy group,
the personal material would no doubt have been brought in and worked through by
M. and the group over a period of time. This was a course with experiential groups,
lasting one week, after which the group would cease to exist. It was hard to keep
maintaining didactic boundaries. I had felt M. in particular, was trying to lead the
group into a therapy group again, having failed to establish a one-to-one relation-
ship with me earlier on. I felt decidedly anxious about containing her in the group
 142 The model in practice: case examples

as her personal boundaries seemed very disturbed and I sensed she was holding on
to highly distressing personal material, almost wanting the group to ‘guess it’.
I put forward the notion of ‘taking on roles’ in a group and asked P. and E. to
reflect on their own role as well as M.’s. I suggested M. was investing a lot of
energy in keeping separate from the rest of the group, even though she was a
member of it. I tried to find M. some companions, i.e. to see if there were other
participants who would have liked to change their environment after the work-
shop. She was now in serious danger of becoming scapegoated as several people
said they didn’t want to listen to her any more. I felt it was important to make
whole-group interventions, which would prevent M. from becoming isolated and
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charged with the rage of the whole group. Nobody said they wanted to change
the environment – indeed several people were adamant that they had spent a lot
of time in negotiating theirs and were satisfied with the result. I was conscious of
M.’s two colleagues’ fury (and with some justification of course as their joint
efforts had been wiped out by M.) to one side of me. It was clear that they were
disappointed by her implacable denial of their position and lack of understand-
ing about their hurt and anger at their joint work being erased. There was nothing
more to be done at that point; the group had to ‘live with’ the wretched feelings,
and after my brief ‘lecture’ on roles it felt appropriate, and indeed a relief, to
move on to the final group’s work.
This group was a total contrast in its lack of obvious conflict and indeed some
members suggested that all the ‘bad feeling’ was in the neighbouring environ-
ment. This led to a discussion of war and projecting all the negative on to
another country or people or neighbour or spouse, etc. R., S. and T. said they
had become conscious of the anger in the nearby group and wanted to withdraw
to a quiet place and make an ‘idyllic’ landscape with flowers, trees, sea and sun.
There was, however, a large, spiky, phallic cactus in the centre of the scene
which members pointed out as the sexual element intervening (like the serpent in
the Garden of Paradise) (see Plate 8b).
A general discussion of the three groups followed in which the main issue
was boundary violation, clearly acted out by M. but also discussed in terms of
war and trespass on others’ space. The storm had broken and the outside
environment was being torn down by the wind and rain – elements outside our-
selves – the cactus reminding people of the power of sexuality and that it could
be abusive (as in rape or inappropriate sexual relations) or creative. The session
ended with these reflections.
The teaching points were numerous from these workshops but the group had
totally absorbed the importance of maintaining the boundaries as a result of the
‘acting out’ and being able to discuss it symbolically through their environments
and actually by reference to how they themselves felt when it happened. They
were able to link it to the ‘outside’ i.e. to social conflict, sexual abuse, violation
of others’ physical and emotional space, and finally to war among nations. They
had also learned about scapegoating and feeling powerless to change a situation.
 Chapter 20

Case example 12
Working through a crisis
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The group were in the second phase of a three-part intensive block training in
Bulgaria, based on three participating centres. The week had been very fraught
for the following reasons.

a The course was taking place in a hospital far from the capital. Relations
between the medical centres were somewhat strained.
b There had been problems with materials and no clay could be found in the
city; it was not certain that we could have a video-playback machine.
c The weather was unusually cold (snowing) for that time of year and the
heating was inadequate or non-existent in places.
d The conductors and course co-ordinators had a very bad journey from the
capital, as all direct flights had been cancelled and they were obliged to take
a plane to the nearest city and find alternative means of transport to the hos-
pital. Thus they arrived late, tired and very cold on the night before the
course started.
e The conductors and co-ordinators were staying in the hospital whereas the
participants were staying in hotels in the city, some several kilometres away
with infrequent transport.
f The participants had not been advised of the timetable, in particular the
starting time of the course!

The course started late on the Monday morning due to accommodation and
transport problems and on Tuesday none of the Sofia participants arrived!
Another participant rushed in late to say that the Sofia group had had to leave
their hotel because the management wanted to give their rooms to Western tour-
ists with hard currency. (This, unfortunately, was not an unusual situation as the
economy was in trouble and the country desperately needed convertible
currency.)
The Sofia group were now wandering around the town looking for accom-
modation which apparently was very scarce. There was anger, confusion and
chaos – I was angry about the appalling disruption to precious training time and
with the ‘system’ for permitting such callous treatment. I felt my only course of
 144 The model in practice: case examples

action was to speak to the hospital chief as he might have been able to intervene.
In fact, by a joint effort we managed to get the Sofia group restored to their hotel
but of course we lost most of that day’s coursework.
Being an interactive course, however, the situation gave rise to material which
could be used in the groups. On the following morning, everyone arrived still
angry and depressed at their overall situation: this included the participants who
lived in the town or had been staying elsewhere. There was some hostility
between these different groups of participants. We sat in silence for a while until
one participant suggested making a painting about the group’s experience of this
incident at the hotel. Everyone fell on the suggestion and the group worked
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feverishly for the rest of the workshop. The resulting painting was very violent
and the Greek visitors had been thoroughly destroyed. The event had aroused
memories of old conflicts with Greeks. There was rage that the Greeks could
take precedence, just because they had hard currency. I felt very uncomfortable
during this painting time because I knew that the group were also furious with
me for having privileges, although they also knew that I was opposed to the
‘second class’ status these people felt, and experiences, in their own country.
There were similarities in this situation to the ‘Julius Caesar’ issue in Case
Example 7.
In the next session people said they felt exhausted but very good as a lot of
anger had been discharged into the painting. They also felt guilty because they
had taken their anger out on the Greeks who were not actually responsible per-
sonally. I raised the issue of Westerners coming in and taking over and won-
dered if they had some feelings about myself, as the conductor. There was debate
as to whether or not I was really a Westerner. Were all Westerners superior and
exploitative? The conclusion was that I was only partly a Westerner! On the
other hand, they brought hard currency and some good things (like art
therapy . . .). This feeling was reflected later in the week. Much time was spent on
the group’s inability to resist being thrown out of the hotel because of fear of
reprisal (not a fantasy, I should say). However, as a group of psychiatrists in a
high level project, they could have made an attempt to explain their situation.
Very useful discussion took place about power relations and taking out anger on
people who were not responsible for the situation.
On the following day, they decided to paint as a group and had much fun
dribbling paint and using finger-paint, etc. It seemed as if the group had
regressed to early childhood and were enjoying themselves. Yet there was a
large spider’s web, which grew and somewhat dominated the picture, slightly
menacing.
On the final day, the group decided to make an image of a woman (see Figure
20.1) who was going to travel to the West. It was decided to send her to New
York. They discussed what she should look like and what she should take with
her. She was given a smart dress and boots, an English-Bulgarian dictionary, a
headband with the colours of the Bulgarian flag, passport, cheque book, cash,
food and a gun (see Figure 20.2).
 Working through a crisis 145

The person who made the gun said there were a lot of criminals in New York
and she needed to protect herself. I felt that this woman was actually me as I was
going away – to the West – but I would go back because I still had my Bulgarian
passport. There was laughter and tears – I felt moved and also close to tears, and
very much part of the group. The woman was a bridge between East and West
and the image was so loaded with meanings on so many levels – personal and
political. I felt part of me was really in the image and compelling me to go away
yet go back – even though the whole week had been difficult and ‘heavy’ with
impending crises. I was actually relieved to see she had a return ticket. It was a
powerful example of the image taking one over, or, technically, of projective
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identification.

Figure 20.1 Going away to the West.

 146 The model in practice: case examples

In writing up this piece now, and reflecting on it some 20 years later, I still
feel very moved and aware of the massive changes that have happened since that
workshop. The fantasies about ‘the West’ as a place where all was good (except
for the criminals) and ‘the East’ so bad were very strong. Of course, the fantasies
were fed by events such as the one described above, by effective propaganda
from Western media and by a deteriorating economic situation. Now in the UK
media we hear daily about the ‘invasion’ of Romanians and Bulgarians, full
members of the European Union, once bombarded with propaganda about the
joys of the West and now seen as ‘coming to take our jobs’ or, worse, to commit
crimes and live on welfare benefits. Sad.
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Figure 20.2 Detail of ‘Going away to the West’ showing gun, passport, cheque
book and dictionary.
 Working through a crisis 147

As a conductor, with my own personal history of involvement with ‘the East’

I could not feel myself totally identified with ‘the West’. Yet undeniably I could
move in and out freely whereas the group members could not. This was reality,
not fantasy on their behalf.
So I could be both of ‘the East’ and ‘the West’. I believe these elements were
magnificently portrayed in the final painting of that course.
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 Chapter 21

Case example 13
Ending the group
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What to do with the images and objects

Of course, each group finds its own way to resolve this problem. Unlike in a
verbal group, when participants take themselves out of the room and out of the
process, the interactive art therapy group has usually produced a large number of
objects – symbolic selves, in fact.
Deciding what to do with these objects is an important part of the process, I
believe. The objects belong to the group: they have reflected its process as well
as the process of each individual. Who do they really belong to?
If they are simply left behind, the onus is on the conductor to dispose of them.
This is rather difficult as they may still contain powerful symbolic content –
apart from the practical difficulties of disposing of many large constructions and
paintings.
One can never know what objects will be made and how they will occupy
space. The ending has to include the objects. Some will have lost their symbolic
content during the group – a picture that was so frightening or difficult to deal
with on the first day may be seen in a different perspective at the end.
Groups can be very creative about resolving this problem. One student group,
after a year’s experiential workshops, decided to burn all the paintings in an end-
of-year ceremony. Building the bonfire (containing it safely was important) and
placing the work on it was like a ‘happening’. I believe that some people saved a
few pieces which they wanted to work on further themselves, but the group
celebrated its end by the ritual fire.
A less dramatic way was as follows. All the paintings were removed from the
wall by their original painter; they were rolled up. Boxes were assembled in a
corner with space enough in between each for them to be picked up by their
maker. Clay objects were placed on a board. Constructions made by the group
were de-constructed carefully and the bits laid to one side. Individuals decided
what to keep and what to throw away. Joint works had to be argued over but
usually got thrown away. Some pieces were offered to the host community.
After the selection was made and unwanted pieces discarded, the room was
thoroughly cleaned by all concerned. Even the floor washing became a ritual in
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Figure 21.1 The end of a week-long workshop.

Figure 21.2 Clearing up.

 150 The model in practice: case examples

itself, and appeared as a piece of choreography (see Figures 21.1 and 21.2).
When the room was entirely stripped of all remnants of the group, all left
together.
This is, to my mind, an essential aspect of an interactive art therapy group.
The interactions between members at this stage are often very moving and lead
people gradually out of one stage and into another (the outside world). This is a
very important transitional stage and when structuring a course – or working
with a time-limited group, I always make sure there is adequate time for this
process. I try to end a training group by reflecting back myself on some of the
processes that have gone on, and encourage the group to do the same. It is useful
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at this point to make some connections with the theoretical underpinning of the
group.
When ending a patient group, it is often the case that the patients themselves
want to look back and review how much they have changed over the period of
the group. Usually they want to take their individual pieces of artwork away.
The group may offer group paintings to the conductor, or decide other ways of
taking or leaving composite works. It can happen that a member doesn’t turn up
for the last session – separation still being far too powerful to face in reality, in
which case the group has to deal with this issue and the conductor and the group
with their remaining artwork. In practical terms, I would write to the member
asking if they want individual pieces of work, but, in dynamic terms, there is
little that can be done at that stage.
Sorting and reflecting on the work, tidying and cleaning the room, breaks the
spell of the powerful group process and enables each member to claim back and
take responsibility for their contribution to the work and to the changes in their
lives.
 Part III

Developments of the
model in social contexts
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The case examples in Part II remain, with a few additions and amendments, as in
the previous book, as they represent illustrations of the theoretical points made
earlier in the book. They remain important as an essential aspect in my own
development of the model and as a tribute to the participants who helped shape
the work. However, this model was never meant to be a static one and I have
myself adapted it for a variety of situations, especially for research. It is, though,
very reassuring to know that others have done the same and extended the bound-
aries into more ‘social’ and ‘community-based’ environments without losing the
integrity of the basic model. I thus include two recent examples – one by Fran-
cesca La Nave, art psychotherapist and group analyst, and one by Jenny and
Roumen Gheorghievi, the Bulgarian project leaders in our WHO project in the
1980s from which some of the case examples in Part II are taken. Jenny and
Roumen have continued to develop art therapy in Bulgaria, within the very chal-
lenging social and political changes that have happened and continue to happen
there. Influenced also by systems theory, the process psychology of Arnold
Mindell and the approach of Milton Erikson, they have managed to transform
the model of group interactive art therapy into one that can be used both to
explore individual and group processes in a socio-political setting, and also to
reflect on the painful transitions within a whole nation symbolised by objects,
such as statues and monuments, that contain highly conflicted and often danger-
ous meanings. I was privileged to see an exhibition of the artwork from a project
they had carried out in Sofia in 2006, asking citizens to explore their thoughts
and feelings on the changing city, past, present and future. Some of the insights
from this project are included in their paper. They continue to reflect on the out-
comes. Francesca La Nave has explored the use of group interactive art therapy
within social contexts, using her interest in drama and social dreaming to
produce a new and exciting version of the model. Francesca has drawn on her
extensive clinical and teaching practice and illustrates her paper with vignettes
from this practice.
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 Chapter 22

The theatre of the image and

group interaction
Francesca La Nave
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Introduction
Group interaction is mobilised and strengthened through the application of
certain techniques, regarding the way images are jointly viewed and considered.
This chapter argues that maintaining conceptual tension between individual and
collective ownership, in respect to the images made in Art Psychotherapy
groups, is important in developing emotional and intellectual contact within
these groups. It also suggests that images made in groups are functional builders
of culture and carriers for meaning, not just in the present and individually, but
collectively and in ways which examine meaning found in the past, through the
lens of the present.
Clinical examples will be used to describe ways in which individuals can
become freer as they move deeper into a culture where access to their imagi-
nation is possible and it is expressed through the making of art, in the
company of others. Art therapy distinguishes the possible therapeutic effects
of art-making in social contexts from the clinical applications of art therapy,
whose overarching objectives could perhaps be described as recapturing
patients’ attention away from their symptoms, through helping them to break
the bond their energy and attention have made with anxiety and channel it
towards new kinds of possible objectives. However, it also recognises that
there is something universal, and therefore transferrable, between clinical and
social settings, about the human ability to transform fears about personal per-
formance into incentives, such as curiosity about others and ourselves. This
can translate into the experience of creating and receiving of meta-narratives,
such as those of the stories woven through the making and the viewing of art
in art therapy groups.
In such groups, art has a place, not as an adjunct to, or an illustration of,
verbal narratives, but as the visionary core of the therapeutic situation, which
Bion would have us enter without memory or desire (Bion, 1970). The openness
predicated by such statement comes to life in the unplanned and contingent way
often images come into being in groups, even when guiding thematic and struc-
tural processes intervene.
 154 Developments in social contexts

Directives that guide how images are made and viewed, balance the openness
described above and provide reliable shapes into which interpersonal contact can
be arranged. For one thing, they address process rather than content and often
focus on physical elements such as where people and images are positioned in
relation to each other. But the real heart of the interactivity is in the connection
between images, as building blocks of meta-narratives; horizontally to illuminate
links between each other and the people who created them, and vertically
through the historical continuum of the group, to contribute to the present from
the past and to the future from the present.
Clinical examples will provide practice-based evidence of how relying on a
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measured use of directives, with respect to group structures and to interventions,

can encourage a culture of interactive enquiry. I draw examples from two groups
in different settings, with patients’ kind permission to use their images. Names
and specific settings have been obscured and changed to protect confidentiality.
The clinical vignettes are not exhaustive; in the course of writing, a number
of new themes and questions have emerged which I could not consider here.
Several aspects of both, images and exchanges, exceeded the remit of this
chapter and could not be discussed, despite having played a part in the actual
clinical work. Among these, the theme of opposites repeatedly emerged with
poetic force. While not making an in-depth examination I note its recurrent
appearance and that it deserves a more systematic study of the ways in which it
manifests in Art therapy groups. In this chapter, I limit myself to observe that
they are set on grounds of contrasting notions: private and collective, implicit
and explicit, personal and public, concrete and symbolic, material and psychic,
physical and metaphysical. Art therapy groups actually rely on divergent poles,
each the extremes of their own continuum set of values, to set off and maintain a
dynamic flow of energy and this would suggest that the alchemy of opposites
plays a crucial part (Edinger, 1994).

Image as central player

The phenomenon of interactivity is a constitutional component of group art
therapy: it is an intrinsic attribute of the way group processes function, as well as
being one of a number of specific objectives sought by these processes. Although
serving to define specific modalities of work (Waller, 1993) the concept of inter-
activity essentially underpins elements connected with strategy and objectives in
general group art therapy practice. Aside from duration and membership options,
specific therapeutic attributes are related to different modalities, such as studio
or group analytic art therapy and are based on how interaction stimulates and
privileges different aspects of interpersonal contact (Caboara Luzzatto, 2009),
through physical, emotional, and symbolic fields.
Arguably, the most distinctive mark of art psychotherapy is the central posi-
tion it gives to making and viewing images; these are the crucial players in a
network of dynamic contacts. The logistics of image-making call for practical
 Theatre of the image and group interaction 155

solutions, but in the context of therapy things such as personal space, choice of
tools, the feel of materials, manipulation of concrete matter, individually or
jointly, shape the way people interact, and operate in ways which are not unques-
tionably physical, but also psychological, symbolic and emotional. By conjoin-
ing physical and emotional notions of personal space, the institution of group art
therapy has brought into existence systems where concrete attributes of experi-
ence routinely translate into social ones. In such groups, people need to come
into a healthy state of separation to make art and to relate. This is a distinguish-
ing aspect of the art therapy process, which presides over opportunities for learn-
ing new, interactive skills, such as modulating between making art and taking
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part in interpersonal exchanges.

These competing positions are managed through moving cyclically between
different activities resulting in an oscillation between connection and disconnec-
tion (Sarra, 1998). The pendular motion between being alone and being with
others is not an optional add on, but the ordinary way art therapy groups accom-
plish interaction. In a way we could say that group art therapy is a methodology
of opposites; of comprehensively and dynamically contrasting positions. The
exercise of a degree of choice between distance and proximity, gives us an
opportunity to shape group cultures around these conditions.
Over the years and in different psychiatric day services, I conducted groups
which combined studio and analytic configurations (Caboara Luzzatto, 2009).
Within set times patients could leave and return, in the full knowledge that the
last 20 minutes, or so, would be dedicated to image-viewing. Being able to leave
made some feel able to participate without feeling trapped, reduced their anxiety
level and placed them in charge of aspects of their treatment. Patients were able
to self-regulate, in relation to time spent working, conversing and on breaks,
typically increasing their presence over periods of time. Leaving their work in
progress to mark their place, was an important sign of their growing sense of
control and confidence that they belonged there; these conversations were taking
place in the sessions; people said they felt they had a place there. There was
evidence that the dual aspects of contact and distance, contained within a reliable
structure, replicates, at a constitutional level, the theme of opposites: flexibility
within a predictable container accomplishes the task of helping patients to toler-
ate intimacy, by reducing anxiety.
Both Caboara Luzzatto (2009) and Michaelides (2012) observe the congru-
ence between group art therapy and the development of a capacity for observa-
tion and reflection. Accordingly, this environment becomes a training ground for
interpersonal relations by, on one hand, offering individuals opportunities to
adjust personal contact and, on the other, translating distance and proximity
between people (Deco, 1998) and their images, into psychodynamic experiences
of separation and its corollaries such as collaboration, dependence, etc.
Thinking structurally about the interplay between the physical world of senses
and the world of emotions, leads the way to a view of group art therapy defined
by the dynamic exchanges between people through their art, between them and
 156 Developments in social contexts

their art and between the art pieces themselves. Linking this to group analytic
principles, working models for group art therapy need to reflect the centrality of
the image in the group network of interactions, by letting images be at the roots
of the art therapy group matrix and the pivotal point on to which the discourse of
the group as a whole revolves. From this central position image-making can then
go on to inform all aspects of group life. Since it can literally be seen, the image
holds a continuous role as an agency for expression, documentation and informa-
tion about the status of the group.
Image-making is the dynamic and creative process underpinning the inter-
personal aspects of the clinical practice of group art therapy. Attention to how
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specific group facilitation techniques, including directives, interventions and

procedures, affect creativity and outcomes has been less marked, until
recently. A combination of concerns about documenting an evidence base for
health services in general and for art therapy in particular, have promoted a
growing interest in studying the efficacy of certain interventions compared to
others (Springham et al., 2012a; Franks and Whitaker, 2007). In art therapy
the interplay of image-making and viewing is neither linear nor neutral and
remains subject to external and internal organisational influences, such as
service context and therapeutic objectives. Whatever the conditions imposed
by external realities, the combination of observed art-making and joint
viewing, in a collective situation, is likely to open the way to intrapersonal
and intersubjective phenomena, and to give origin to events of symbolic and
even poetic nature. The therapeutic efficacy of these phenomena, however, can
be weakened or made vigorous by the way we manage our intervention and
procedure options.

Image- based culture

The terms of our engagement with patients, it starts with what we choose to priv-
ilege in the therapeutic situation, what we think counts and needs protecting,
beyond obvious things such as boundaries, confidentiality and trust. The way we
refer to the art made in art therapy expresses more than a little about the nature
of the expectations with which we approach the therapeutic situation; it actually
sets the parameters of the breadth and quality of expressive means our patients
will ultimately allow themselves to have. In my experience it is common for art
therapists to talk of ‘painting’ as shorthand for images, of ‘paper and paint’ to
indicate the media used. While it is done innocently and it is true that a great
deal of art therapy images are paintings and drawings, our casual use of terms
could have the unintended effect of limiting how art therapy is thought about
and what is produced in session. The circular relationship between eclectic and
unconventional materials and imaginative interactive work has been documented
(Waller, 1993) and we see innovation introduced in the art therapy room, such as
Tony Gammidge’s and patients in a Forensic unit’s spectacular collaborative
pieces of animation (Gammidge, 2011).
 Theatre of the image and group interaction 157

Often service users present us with vague, small, unimaginative images, of

which nothing, it would appear, can be thought or said. These may function as
defensive barriers behind which to hide, but also they belong to a body of evid-
ence, telling in concrete and direct analogies, of what the experience of having
one’s life impoverished by mental illness may be like. Often we face the need to
provide meaningful reception to metaphors of loss and absence, expressions carry-
ing such degrees of distress as to leave therapists, as well as patients, marooned in
a kind of sterile and speechless state. Situations such as these are common in art
therapy; the tyranny of symptoms leaves both therapists and patients in a state of
hopelessness, the former feeling unable to help and the latter unable to be helped.
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Such states are not usually amenable to improvement through addressing the symp-
toms directly.
The way forward from this point is through promoting a group culture of curi-
osity towards the images: first of all to turn our gaze away from the symptoms and
towards images as sources of information, and, having done that, to turn away from
individual explanations and towards a possible understanding through collective
experience. While accessing the core pain (Caboara Luzzatto, 2009) remains the
ultimate objective, it requires an approach encouraging interpersonal and transper-
sonal work. The ground from where such an approach can thrive is one that accepts
as true that images made in group settings are at the starting point of the group’s
enquiry, not its end products. Consistently images are thought of as holding
information, which can lead to increased knowledge, within a culture where the
analysis of art therapy is concerned with a range of manifestations besides content,
honouring notions of process and inter-subjectivity over individual accounts. Such
group culture would progressively educate its members to pay attention not only to
their actual, visual products, but to all manners of engagement with such objects.
Likely or unlikely this culture as it may be to develop, in the context of any art
therapy group, we, as practitioners, bear a responsibility in collaborating with our
service users, to promote it. Extending Maclagan’s (2005) view that the therapist’s
imagination sets the tone to the possibility of patients entering into a therapy of the
imagination, I would add that our attitude towards image-making needs to dwell
assertively beyond the limits of traditional art. Whether causal, or circular, there is
correlation between mental illness and the loss of the imaginative side of things. We
often learn of this in patients’ stories of breakdowns and social isolation, where it
seems there is nothing left, but risk management and medical routines, while what
is really at stake, beyond the symptoms and the diagnoses, is a malaise of the spirit.
If patients are to meet with a renewed sense of hope that they can be restored
to a manner of creative life, we must meet them with a sense of trust in what we
are offering, allowing for its unconventional nature. What it amounts to is a
method of meta-visual communication, based on interplays of physical and non-
physical processes, open to eclectic notions of representation, multimedia and
sand-tray narratives, interpersonal exchanges realised through the impermanence
of drama and body enactment, and the traces left by the dreams that people tell
and which, from time to time, generate more art.
 158 Developments in social contexts

Ownership and its consequences

The tension between notions of individual and collective ownership of images
made in groups, while problematic, is also the springboard for innovative ideas.
Returning to the theme of opposites, here we have another fruitful opposition,
underpinning art therapy’s intermediate position, between personal and public,
intra- and interpersonal. Earlier I spoke of group art therapy as the metaphysical
breathing space for individuals to come closer and still find a distance from each
other, through degrees of intimacy and separation. I now want to extend this
dichotomy to the ownership of images.
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If we accept that images made in the group are the content and charter of its
discourse, we cannot separate their function as individual expressions from that
of guides to the collective understanding of those expressions. Accordingly, the
optic groups need to adopt in order to develop and form a view of internal rela-
tionships, which will privilege interactive freedom over the hierarchy of indi-
vidual ownership. This optic does not see images as separate items with
meanings sanctioned by their authors, or as visual prefaces to individuals’ verbal
subtexts. Instead, it sees images as phenomena born from the group and of the
group; accordingly the group’s joint attention (Isserow, 2008) is the true author-
ity through which the group knows itself. Confidence in such authority can only
exist in a culture that actively values the group as a whole focus, not just in terms
of ideas, but also in terms of interactive access to images.
Such culture relies on a number of interrelated directives and practical strat-
egies and I wrote previously (La Nave 2010) about what structures could support
art therapy’s claim of being an image-based therapy. In brief they are:

• Groups either make or view images, with no time when images are not
present. In practice, this means having images made during the previous
week already available and visible at the beginning of analytic art therapy
groups and all types of groups including studios, having dedicated viewing
periods.
• Groups consider images in relation to one another and as forming active
sub-groups. This means not prioritising individual accounts of images, but
eliciting multiple views of all images.
• Images are reviewed over time, through repeated screening. This means
there will be an understanding that images may be recalled into view when-
ever relevant. Consent for this to happen even in absence of the author needs
to be sought and if not obtained confidentiality needs to remain a limitation
to this practice.

One of the central questions and still relevant here is how do we ensure that
images are valued and used to their full potential? Patients and I have often had
a sense of group sessions as systems of shifting narratives, of which we managed
to know only portions; of things always being on the brink of becoming
 Theatre of the image and group interaction 159

something else and of things being left, somehow, unfinished. Not just in the
sense that time boundaries intervene, to stop things in their flow, but also that
much is left unexplored because it cannot be reached, as though under a translu-
cent membrane, nearly visible yet unreachable.
The way forward is to strive to make a more intensive use of the art. Images
only examined in the aftermath of their making, retain, in my view, much neg-
lected potential. In a clinical vignette, a patient (Holmes, 2004) talks of ‘things
being cleared away’ as a way of describing her experience of being forgotten
between sessions. In art therapy this goes beyond being a simile, as we con-
cretely put images away each time. This putting away, however, should not be
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confused with putting images out of our mind and should not prevent them from
being brought back, into the here and now of any session.
Returning to the idea that meaning is not absolute, but fluid, I extend to art
imagery what Armstrong says about dreams’ available narratives being used as
grounds for negotiations and formulations of emotional experience (2005 p. 64).
Within a group it is possible to make significant intrapersonal and interpersonal
discoveries, through returning to images repeatedly, either as part of individual
reviews, or simply by integrating them into current experience of the group.
Practically it means that any patient, remembering images made by them and
others in the past, because they resonate with themes in the present, can request
them to be brought back into view. Paradoxically it is through their endurance in
time that images can become subject to physical as well as interpretative altera-
tions. Groups’ democratically negotiated access to such interventions, rests on
the consensus that images made in the group belong to the group. Each time
images are re-examined in a different context they explicate information, which
had been previously held in latent form. This can get us closer to the material
referred to earlier as being in sight, but out of reach. In relation to the group’s
vitality, this restorative practice is the psychological equivalent of keeping vital
nutrients in circulation, rather than evacuating them. Although conceptually
simple, educating groups to think about images as creative entities in time as
well as in space, helps them to expand their interactive range, to truly test the
potential of images’ physical longevity and their prerogative of being, like
dreams (Armstrong, 2005), containers for meaning, rather than of meaning.

Vignette – the tribe

In a Day Centre studio group (Plates 3a and 3b), the King and the Queen masks
had been made by Jade to accompany the image of a castle, made by another
patient. The masks wore complementary gold and silver, another current theme
for the group at the time: Jade had decided to leave them as a parting gift, before
her discharge from the group. She left her bequest while expressing gratitude to
the group, where she had felt accepted and valued. Using her work as a gift
implied she had arrived at a sense of trust that it was going to be well received
and, by extension, that her self-esteem had increased.
 160 Developments in social contexts

I actively support a more intensive use of imagery by, for example, asking
groups whether there are any images made in the past the group needs to bring
back into view in the present. The group described here kept King and Queen in
active use for a number of sessions, preceding and following Jade’s departure.
Specifically they became complements for drawings of castles and fortresses,
such as the one in Plate 3a. Their association with notions of authority, allowed
for a pliable use of the masks at a point in time when the group needed to work
around issues of cohesion, safety and survival, but, due to their complexity, had
to find a way of processing symbolically and visually, before any discussion
could take place.
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There were intersubjective and transpersonal themes in these exchanges,

linked by a circular correlation: through positive interpersonal experiences, Jade
had internalised the group and my authority as good objects and, in turn,
expressed and validated this experience through her gift, which remained active,
after the author had left, through its continued use by the group itself. We must
not assume, however, that everyone else always found the group easy, or safe.
One of the roles assigned to the King and Queen was to function as a quasi-
totemic presence; a point of reference crossing the line between the time when
their maker was present as group member and when she was not. Supported by a
working model encouraging the prolonged use of images across time and owner-
ship boundaries, the group was able to introduce and keep using a symbolic
image, of transpersonal value, capable not only of expressing feelings and of
ideas around safety and authority, but of developing and beginning to articulate
notions of identity.
Membership and belonging are crucial themes in group formation and
important social outcomes for psychiatric service users. From a transpersonal
point of view the group in this example used and implicitly valued the gift to
underscore the group’s credentials as a viable system for the elaboration of emo-
tional and interpersonal states. In the transference, the group showed identifica-
tion with authority, rather than with dependency, by practising its prerogative of
using images as res publica. There could be further levels of analysis, such as
that of the Coniunctio Oppositorum and the Alchemical symbolism of opposites
(Edinger, 1994) which cannot be examined here, but which occurrence in group
art therapy may need further investigation, as I noted in the introduction.
Over a period of about two years and in the same group, several people had
made or painted masks. Individually and at different moments, the masks
worked as containers for personal change. Collectively, however, they repres-
ented important metaphors for personal and collective identity and once actually
viewed in concert they felt like a mirror, a group of alter egos, which patients
called a Tribe (Plate 3b). Significantly, this sub-group, like the King and Queen,
at once connected and separate from the group that generated it, became invested
of a quasi-totemic role for inspiration and support, at a time when the group was
learning of the imminent closure of the day service, within which the art therapy
group was located. The masks were resources, whose potential as transitional
 Theatre of the image and group interaction 161

phenomena was attained through being handled as a sub-group of symbolic

imagery, by the group. Collectively, they became an active metaphor for a sense
of unity and belonging, in the face of adversity. The group had worked interper-
sonally and transpersonally in building a platform from where to meet the reality
of change and the experience of loss, through using images in ways that had
transcended their individual status and freed them from their bonds to their
makers.

Viewing images and becoming known through the

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other
Moving on in the discussion about reliable protocols to support groups in using
images interactively, the most effective way I have found to view images has
been to form semicircles, like the Greek amphitheatres, to consider all images
gathered in a cluster, as if in a gallery, or on a stage. Such an arrangement, syn-
ergically reinforced by a culture of collective ownership, can lead to an increased
capacity for playing (Winnicott, 1971) by diverting individuals’ attention away
from their anxiety about personal performance and towards other stimula, such
as curiosity about possible narratives. I have found this to be particularly fruitful
with patients with attachment problems, such as those with borderline personali-
ties, because it extends some of the attributes of art therapy group work men-
tioned earlier. The amphitheatre (LaNave, 2010) sets the scene for interaction
marked by fluctuation between ‘side by side’ and ‘face to face’ work. The former
position can free up communication by recreating the physical conditions of the
emotional experience of being united with others in joint attention (Isserow,
2008), which, typically in childhood, but also later on in life, is key to develop-
ing an emotionally sustaining view of the world and of the relationships
within it.
A consequent, but important gain of approaches nurturing curiosity about
what images show, over what we describe through them, is the exercise of our
researcher faculties; in educating patients to direct their curiosity towards images
as a group, and therefore less likely to be blocked by personal anxiety, we
support them in developing an investigative mindset, resulting in a more flexible
view of themselves and others. Faculties such as curiosity, inquisitiveness, flex-
ibility and so on are not only prerequisites of a mind which can mentalise
(Bateman and Fonagy, 2006), but also explicit attributes of interventions used to
help patients towards mentalisation (Springham et al., 2012a, 2012b; Franks and
Whitaker, 2007).
What distinguishes this approach is an emphasis on inquisitiveness, cultivated
through conceiving of art therapy groups as systems with capacity for creativity
and emotional literacy, but relying on the collective and enduring strength of the
images as the starting point to build the necessary frame for their maturational
processes. In practice, patients are invited to intervene and play around with
ideas and narratives; to approach their own stories, by way of those that can be
 162 Developments in social contexts

created by using images as frames in a storyboard. This may involve patients

actually moving images, discussing possible interpretations or looking at how
they support or contradict one another. Sometimes exchanges can be quite
simple and brief, such as noticing common themes, commenting on personal
styles. Some just benefit from the knowledge that a dedicated space for looking
at images exists, but one still allowing them to hide within the group if that feels
necessary.
The art therapy group exists through people coming together to connect and
work through meta-visual processes, of which images are products and compon-
ents. However, if we consider images as capable of expressing and influencing
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states of mind and as containers for information, not only about current but also
future relationships, we need to conceive them as distinct and temporary sub-
groups, with differences and similarities mirroring those already present in the
group, but also effecting narratives not definitely under the control of their
makers.
This views the art therapy group as a theatre where human and images sub-
groups interact as if in a dynamic dance. Initially one generates the other, but as
people view the images they have made, roles change and something else begins
happening between the sub-groups. As information flows back, from the product
to the maker, the experience of joint attention becomes another form of making,
of ideas perhaps, but nonetheless linked with those other, recent experiences of
making art.
In this model, an important factor is the absence of pressure to account for
one’s own images, while still benefiting from the opportunity to have a voice.
There is also the opportunity for something about oneself to be seen, while not
necessarily recognised, or declared. Nevertheless, when seeing and being seen
are done through the agency of art, understandings can be differed with and dis-
tanced from, or, at any rate, thought about. The theme of opposites is here again
in the idea that, by interacting with other group members’ images, people recon-
nect, not with something other, but with something personal to them, which had
become unavailable. Having introduced this form of interactive viewing to exist-
ing groups, I was able to observe changes such as increased levels of interper-
sonal contact, group cohesion, mutual support and emotional intimacy; all of
which are indicators of improved conditions for a more robust tolerance of con-
flict with healthier exercise of social skills.
A final clinical example shows how images can shape the view we have of
others and be at once literal and symbolic vessels for change.
Abstract 1 is a bundle of materials, bound insecurely, yet impossible to
unravel; it includes a small cutting from one of the art therapy room’s plants (see
Plate 3c). This image is one of a number of multimedia pieces Miriam, a patient
with profoundly disrupted early attachments, emotionally unstable personality
and body dismorphic disorder, made during the initial months of her therapy in
one of my groups. Her prolific image-making was typically the product of forag-
ing and scavenging round the room and the surrounding grounds for debris and
 Theatre of the image and group interaction 163

objects of impermanent duration, such as leaves, soil, flowers, tied with tradi-
tional materials such as glue, paint and tape.
Her verbal communication was a meandering, convoluted and endless attempt
to colonise all available time and attention and the effect on the group was one
of anxiety, irritation and boredom. Miriam’s fear of rejection and a synopsis of
her survival strategies were comprehensively communicated through projective
identification with the result of recreating in the group the very experience she
desperately tried to avoid. This became tempered and balanced by the metaphors
of her images, which were more efficient in transmitting her experience of emo-
tional disorientation, entanglement and chaotic self-representation. These were
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visually articulated and, by implication, more mature forms of emotional com-

munication. They posed veiled questions, which became eventually overt, about
ambivalence and conflict, not just within her, but about her in the others’ minds
and, in so doing, they earned Miriam a safe place in the group. My own feelings
of disquiet in relation to the green cuttings left to die at the margins of her
images, like sacrificial offerings, proved to be mirroring the circumstances of her
improbable existence, which, she eventually informed us, was the result of a
failed abortion.
Plate 3d reminded people of many things: canoe, pod, sawn mouth, shell, leaf,
boat, prison, to name but a few. Made by Miriam in the latter part of her therapy,
it became the resting place for the fragment of another group member’s very first
image, which through different incarnations and modifications had inspired and
presided over important changes. Now ritually broken up and yet held by the
group, its fragments lay to rest in the vessel, as he prepared to end his therapy
and leave the group.

Conclusion
I have considered interaction as an intersubjective phenomenon, particularly
fruitful when taking place through the agency of the image and in the context of
collective ownership. Groups trusting the collective authority of images as a reli-
able base for exploration and communication focus on discovering what ties the
images have and what disorganises them, using this way of making and seeing
as a springboard for new ideas and connections. Accordingly, images are con-
sidered within the framework of visual clusters, related and yet distinct from the
group of people who created them. Groups are encouraged to regard all images
as group property and to approach the unknown in them, rather than the already
known.
Whatever their attributes, images carry overt information about states of
mind, together with a wealth of data, often about unconscious and pre-conscious
ideas, which can generate new meaning, if they are given the opportunity to be
seen whenever deemed necessary and at different times, throughout the group’s
history. Older images, seen again in current sessions, can explicate information,
which had previously remained implicit. Clusters of images made in art therapy
 164 Developments in social contexts

are mirrors for the group that created them and can help patients, in a non-
threatening way, to tolerate being at the edge of the unknown. By engaging
patients’ curiosity, images stimulate the group’s collective mind and remind the
group of how vast its imagination can be, and how prolific.

Francesca La Nave is an art psychotherapist and a group analytic psychothera-

pist with more than 20 years of experience of working in the NHS and in special
education. She has developed art therapy services within adult psychiatry and
many other different settings. She now also works privately, providing indi-
vidual and group treatments to adults and children, and clinical supervision for
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art psychotherapists.
 Chapter 23

The visible city and the invisible

shame
Jenia Georgieva and Roumen Georgiev
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Introduction
When in 2005 we accepted the proposal of a German couple of artists (partners,
just like us, both in the profession and in life) for a joint project ‘Sofia – City in
Transition’, many of the ideas they had in mind were inspired by Gary Bridge
and Sophie Watson ‘City Imaginaries’, 2002.

Cities are not simply material or lived spaces – they are also spaces of repres-
entation. How cities are envisioned has effects. . . . The public imaginary about
cities is itself in part constituted by media representations as much as by lived
practices. Ideas about cities are not simply formed on a conscious level; they
are also a product of unconscious desires and imaginaries.

When working on the project we hoped to turn some of the invisible reality
into visible one. So we titled the ‘book’ about that project: ‘Sofia time travel
experiment: speaking with the unconscious social mind’. The book was self-
issued in 2006 and contained the paintings of the participants, the transcripts of
their stories and the full transcripts of the five group sessions conducted.
We will deliver the present text in two sections: the past view on the general
project (the five pages of text that Roumen and I wrote for that ‘book’ just after
finishing the group work in 2005); and a concrete present view (2013). The latter
will give a more detailed idea of how we worked with the groups as well as trace
something that we have discovered now, going back to the paintings and the
stories of the group and the whole process – something we had had a blind spot
about. Namely, that when the visible reality is rigidly avoiding any substantial
change, people choose to turn it invisible. By going ‘blind’ to it! And vice versa
of course. When people choose to go blind, to avoid seeing visible reality, the
latter becomes more and more rigid about making space for change as well as
for the invisible realm of feelings.
When working on the project, we considered it to be mainly a research project
using therapeutic tools and in this respect we accepted the definition of its
sponsors.
 166 Developments in social contexts

It could also be looked upon as a psycho-social intervention project. Some of

the ideas it was based on – actually the ones that were most connecting for the
two parts of the international team, enabled it to be seen in that capacity. Those
ideas were the ones which drew on the Palo Alto team paradigm which, in turn,
had been profoundly influenced by Milton H. Erickson, the father of modern
hypnotherapy.
Erickson used mental time journeys in order to evoke pictures from the past,
to install a view from new angles, and bring such a view to the development of
visions for a possible Self in the future.
Initially Roumen and I were chosen to participate in this project by Mathias
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and Ute in our capacity as Directors of the Milton H. Erickson’s Institute of

Sofia, Bulgaria. It was a pleasant surprise for them as artists, that we proposed to
combine techniques of group interactive art therapy with theories borrowed from
Erickson, guided imagery and systems approach.
Let’s proceed now to the two sections of this text. The one written in the past,
2005, and the one written in the present, 2013. And leave the future . . . open.

View on the project in the past – 2005: SOFIA

TIME TRAVEL EXPERIMENT; speaking with the
unconscious social mind
While doing this project we felt in dialogue with the Bulgarian ‘social mind’ (that
is to say, the felt sense underlying the thoughts, feelings, perspectives, conversa-
tions of people we encountered in the city). It was telling us things that were
varying drastically from what one can read in the results of sociological inquiries,
or hear in everyday talking. It was as if the amalgam of our team had melted the
metal doors protecting some old, roundabout route that leads right into the heart of
Sofia’s citizens. It had accessed not the conscious, the using-self-defending-
mechanisms and routine-phrases social mind, but the unconscious one.
When a joint German–Bulgarian interdisciplinary team explores the percep-
tion of and attitudes towards Sofia – the capital of Bulgaria in its past, present
and future and is doing that 16 years after the end of the totalitarian regime, and
one year before Bulgaria joined the European Union – the team is indirectly
exploring a complexity of dimensions to a larger or lesser extent. Among which:

• the attitude towards the social change and the whole process of socio-
political transition the country has passed through;
• the attitude towards Europe; the Bulgarian experience of the attitude of ‘the
West’ towards itself; the attitude towards the upcoming integration of Bul-
garia in EU; the pattern of interaction between Eastern and Western Euro-
pean spaces;
• the way the Bulgarian ‘social mind’ refers to itself; Bulgarian self-
consciousness, Bulgarian identity, its conscious and ‘shadow’ (in the
meaning of C.G. Jung’s term) aspects.
 The visible city and the invisible shame 167

As this is also an experiment that took place in a group setting, in a hetero-

geneous group consisting of representatives of different generations, professions;
and differing in their families of origin, too – some belonging to families where
the parents had been high nomenclature figures, others to families where parents
and/or grandparents had been killed during totalitarianism – at least the follow-
ing dimensions can also be held in mind, as having indirectly expressed
themselves:

• the interplay between the individual and the group; the capacity of the indi-
vidual to open his (her) personal boundaries and become part of the group;
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the capacity for exchange and mutual influence between the individual and
the group versus the prevalence of one of those levels, suppressing the
other;
• the interweaving in present-day Bulgarian life of opposite attitudes; the
degree of presence of old stereotypes, modes of thinking and patterns of
relating, inherited from the totalitarian past;
• the degree of resolution in the social mind of the victim/victimiser problem
of the near past, the degree of presence of guilt and accusation; the capacity
of the present generations to come closer than the previous ones had been
able to do;
• dealing with differences;
• capacity for individual and group creativity; and
• the level of suspiciousness versus trust towards outside observers.

Had the team confined itself to only traditionally ‘scientific’ or only direct ways
(i.e. questionnaires, interviews) of gathering data about the attitude towards
Sofia, this rich multitude of dimensions, wouldn’t have even been touched upon.
For instance, interestingly enough, our German colleagues found out there’s
a big gap between what Bulgarians typically tell to a foreigner about their
capital – being prone to focus mainly on dirt, traffic jams etc. and expressing
explicit disbelief if the foreigner says he or she actually likes the city – and
what came up as an attitude to the same city when the team took the indirect
approach, that characterised the experiment: drawings, stories, memories,
imagery in trance-like states. This finding gave rise to a hypothesis about the
primary identification of Bulgarian social mind being more connected with
negative features, while positive features, bearing on wisdom, warmth, roman-
ticism, beauty, depth etc. remained in the ‘shadow’ – as secondary (uncon-
scious) characteristics of the identity. There seems to exist a strong ‘edge’ (in
the meaning of Arnold Mindell’s term) to saying openly something positive
about oneself, treated by that social mind as an equivalent of ‘self-
conceitedness’, which can feed gross misunderstandings in inter-cultural
discourse.
Such a gap can also feed a proneness of Bulgarian social mind to oscillation
between depressive-like and manic-like states.
 168 Developments in social contexts

The topic of dealing with differences became quite central for the content of
the group process, taking such creative paths as in the ‘pictures’ of the future of
Sofia: building different lines for those who are in a hurry, and those who would
like to walk slowly. That same topic in itself proved to be one of the strongest
points of the team. An international, interdisciplinary team either manages to
deal with differences in a flexible, creative way, or remains stuck to a mechan-
istic exchange, which stagnates the group and affects the final results too.
The very mentioning of our profession of psychotherapists tends, in our
experience, to usually exert some negative effects on inter-professional contacts.
People from other professions often expect manipulation from this contact. In
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the same time, East–West team relations are often fraught with the expectation
of manipulation that the Eastern counterparts expect from the contact. So, this
working relationship between two artists and two psychotherapists from respec-
tively Germany and Bulgaria didn’t have an objectively easy and positive pre-
disposing basis. It had to overcome already existing prejudices, built by the
larger contexts, as well as by some subjective experiences. In the same time, it
had the chance (if it chose to, and managed) to ground itself on positive seeds of
pre-existent international and inter-professional past relations. It passed through
phases, allowing for both good protection of own boundaries and of opening of
boundaries for exchange. Maybe the refined inner sensitivity and intuition that
both professions tend to embrace helped us trust each other to a degree that sur-
prised ourselves. What is unique for our experiment is that it did not pre-decide
on a rigid structure or procedure to be strictly followed, but was planned flex-
ibly, in a process of complementary inputs, with the possibility to change at each
subsequent point. The latter required quick consensus decisions, on the spot,
which allowed for the team to be each time relevant to what the alive process of
the group was offering. In this way the project was coherent to the intensely
dynamic, up to somewhat chaotic tendency of the larger context we worked in, a
tendency that became prevalent after decades of extremities of discipline, struc-
ture, schemes, planning. Tolerating the insecurity that such an openness brings
at each step, we arrived at a product that was not pre-conceived, but created
itself through the interaction, in an autopoetic manner (in the meaning of the
systems’ epistemologists Maturana and Varella’s term ‘auto poesis’).
Another unique aspect was the self-exploration of the team, the lack of rigidly
distributed roles. Each one of us was both an included participant and an outside
observer. The exchange between us led to a project, that itself synthesised some-
thing of the qualities of science (for instance, our approach was grounded on
principles of human transaction, that stimulate a constructive and creative group
process, while leaving aside the usually much more structured nature of scient-
ific approaches), as well as something of the qualities of art (the evolving nature
of its product). If we are to use a metaphor for the living system we formed
together, it was like creating a picture through following constant feedback from
each other, something like an artist starting painting on a canvas, stopping to
hear the comment of a psychologist, then continuing a while with this feedback
 The visible city and the invisible shame 169

in mind, after which the psychologist is painting on that same canvas and the
artist is observing and gives a comment, that the psychologist stops to listen to
. . . until something unpredictable, alive has formed itself through their inter-
action and shared activity, in which they have undressed the typical professional
roles/definitions and put them like coats on a nearby chair.
In this connection, one of us shared after the first phase of the project (when
we applied the methods we were to apply to the group, to ourselves as a team)
that it was a question of one of the artists to one of the psychologists (not vice
versa) that brought the psychologist to an ‘insight’. This turned out to be that of
a fear, which, on a conscious level, she was rejecting and was very critical about
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when sometimes hearing it from other people (the fear that Bulgaria might lose
something important of its specificity when integrating into Europe) was present
in her unconscious mind and had ‘popped up’ in a vague image of hers, that she
was prone to neglect, of a Catholic church being the tallest building in future
Sofia (Bulgaria’s predominant religion being Orthodox-Christian).
We keep receiving feedback from the members of the group on the personal
effects the process of exploring the perception of the outer space had on them in
reference to overcoming inner-space barriers and finding new potential deep
inside themselves; in reference to connecting inner and outer spaces; and some-
times most unexpected ones – on their citizenship activities, like one woman
who, after the experiment, will, for the first time, not refrain from voting at the
upcoming (end of October 2005) local elections in Sofia, as: ‘I feel more tan-
gibly now that this is MY town.’
We used a combination of methods and techniques of group interactive art
therapy (among which drawing of a joint group picture – at the end of the last
session with the Bulgarian group) with some borrowed from an Ericksonian
approach (non-traditional, indirect trance induction, ‘utilisation’ technique,
‘seeding’) and with methods and techniques from ‘guided imagery’ (Korn and
Johnson, 1983), from Arnold Mindell’s (1988) process work (‘unfolding’ tech-
nique) and from systems approach (subsequent individual inputs to a group’s
story-telling over a joint group picture (Vassiliou and Vassiliou, 1985).
One of the methods we used in the experiment, the Synallactic Collective
Image Technique (developed by the Athenian Institute of Anthropos), the
meaning of the Greek word ‘synallage’ (as described by the authors of the tech-
nique (Vassiliou and Vassiliou, 1985)) being: ‘one entity in process, in mutual
alteration, with another’, did work in our experiment. This was not only because
it is by itself a powerful tool, allowing for arrival at what is the common (col-
lective) image, built by the whole group, through following the overlapping of
the subsequent individual images, but also in order for it to work so well, there
was another factor: the operation of constructive transaction, of ‘mutual altera-
tion of the entities’ in between the team’s entities, themselves.
The analysis of the product was based on a group-analytic and ecosystemic
approach. The main tool was sequence analysis both of the symbols and of
the sequence of stories, offered by the group of participants. Analyses were
 170 Developments in social contexts

undertaken in reference to the variant ‘peripheral’ directions, some of which

were mentioned in the beginning of this text, as well as to the more ‘central’ dir-
ection of the perception and attitude to Sofia. (‘Sequence analysis’ will be
applied in its form, as modified and described by V. Vassiliou (Vassiliou and
Vassiliou, 1985).)

A view on the project in the present – 2013: visible

objects and invisible people and feelings
In order to arrive at being able to write on this project now, we passed through a
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difficult process. The lack of energy to return to it was quite inexplicable, having
in mind that the emotion preserved about it in both of us was very warm and
positive. There was something we weren’t seeing. The moment we saw it, we
started writing without stopping. . . . Needless to say, it turned out that this
repeated something inherent in the group process.
The first session with the Bulgarian group – the one about the past – was
fraught with the very same emotion: warmness. The bitterness that even the title
of the project ‘Sofia – City in Transition’ evokes from the present perspective,
was for a long time invisible for us. A friend with whom we shared our puzzle-
ment and guilt feelings over not being able to write, immediately said: ‘No one
can write about a transition that did not take place.’ Something clicked.
Next thing that came out in my mind was the fact that during this project,
after the work with the group that Roumen and I were responsible for, and before
the interactive exhibitions that Ute and Mathias organised in Berlin and in Sofia,
my father passed away. There is something about this project, as well as about
the inner barrier experienced to write on it now, and about our transition from
totalitarian to democratic society, that for 24 years has led to the . . . middle of
nowhere, that has to do with death. And the fear of it. The unconscious strive to
avoid it – taking nearly superstitious forms. Let us say something about the way
we worked.
Each session started with a painting, as spontaneous as possible representa-
tion of the present feeling of its author who would then title it and name the
feeling that evoked it and that it evokes in her. After which she would be invited
to allow for an inner exchange with her painting to take place as a starting point
for a group trance-like state induction. The imagery of the participants was then
guided to travelling in Sofia.
During the first session there was a venture back in time, to find out early
memories of places, faces, figures, stories within that city. In the second one a
travelling in the present. And the third one: in the future. Around the end of each
‘travelling’ they were to pay attention to some message the city had for them,
and probably they had for it, too. After coming out of the trance-like state they
were to preserve the experience by giving it some expression on paper – in the
form of drawing(s), writing or both. Then each would share with the group her
experience and the expression it took on paper, saying as much as she felt
 The visible city and the invisible shame 171

comfortable with. Others could ask questions in connection with the picture, the
process of the journey or react or connect to the memory the place evoked, or to
the place itself. It was left to them to pick the moment to speak about their
picture. The session would usually end with some generalisation on what
appeared and with gathering of the group’s feelings.
There was a special symbol that we used for the beginning of each travelling.
It was proposed by the German part of the team. On their very first arrival in
Sofia, Mathias and Ute had been impressed by small towers at some crossroads,
many of which were not used any more, and they had to ask about them quite
repeatedly, until learning that during communism those towers had mainly had
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the function for a traffic militiaman to climb inside and stop the traffic, freeing
the road for government cars and/or foreign delegations’ cars. The two German
artists were very insistent that this symbol should be used by being transformed
from locations of control to locations opening up and freeing imagination. In our
time experiment those towers were rendered the function of a time machine that
the participant imagines climbing into.
One of the sessions finished more specifically. At the end of the third session
the group produced a joint painting and figured out a joint story about it.
The three sessions took place on a Wednesday, Friday and Sunday of one
week, lasting three hours each. There were ten Bulgarian participants, two men
and eight women, from different generations (aged 21 to 50), most of whom had
had some previous experience with experiential methods with the same conduc-
tor, Roumen. The place we worked in was new for all of us. It was a hall in the
Goethe Institute in Sofia that was equipped with the technical equipment neces-
sary for taping and filming the sessions.
Besides the three sessions with the Bulgarian group, there was an initial
session with the project team, conducted again by Roumen, working with Jenia,
Valia, Ute and Mathias, and a final one with a German group, in which besides
Ute and Mathias (as visitors to Sofia), four German women living in Sofia, most
of them working for the Goethe Institute, participated (aged 32 to 43).
Those additional sessions were similar as to the methods applied, but the time
dimension of the imagery was left more free. The work with the team concen-
trated more on the focus of finding ‘my place’ in the city. In that concrete work
the technique of George Vassiliou (the Synallactic Collective Image Technique
of the Athenian Institute of Anthropos, AIA), with elements of which each
session of this project started, was more fully applied (i.e. after creating a
drawing of their own, the participants chose by voting which drawing they were
to all work on).
Sequence analysis, was applied by the Bulgarian part of the team after each
session, as well as after the sequence of the sessions, to trace the group mes-
sages, and attempt to synthesise the inputs of the different members and the
more generalised ones, of the different sessions.
The interactive process was very vivid. During the first of the three sessions
with the Bulgarian group, the pictures and places brought in from each
 172 Developments in social contexts

participant’s travelling would evoke memories in another person from that same
place, or some participant expressing astonishment that she had never known
what had previously been at the place of the present Palace of Culture, for
instance; or the mentioning of the Central Universal store in the travelling; and
the picture of one of them would immediately stir in another a quickly men-
tioned memory of the only two toys (one of Tom and one of Jerry) that were to
be found in the toy store, when her mother once took her to buy a present for
her, and how she had to choose one of them, and it took her a long time to decide
whether it should be Tom or Jerry.
The journey into the imagery of Sofia in the past piled an absolutely undifferen-
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tiated mass of such striking reminiscences (like the one with the toy-buying, or ‘in
the yard of the small church nearby my home in which me and my friends, as chil-
dren of communists weren’t allowed to ever enter, for that would mean enormous
problems for our parents in their jobs’ – the latter, brought out by a 45-year-old
woman, whose parents had not only been high communist nomenclature, but also,
both of them, high Secret Service officers, who actually was the only one to
mention the word ‘communist’) mingled with most pleasant and warm childhood
experiences and loved places. The warmest and longest and most detailed child-
hood memory, shared with deep excitement, was brought up by a 50-year-old man,
who actually started with timing his memory through the Caribbean Crisis!
Often such dual tendencies coexisted in the picture and memories of one and
the same person, wrapped up in a most positive tone. Only one of the particip-
ants dwelt entirely in her memory on a place in Sofia that had been a strictly
communist building (one that had been removed after the 1989 changes, in fact
detonated by the municipality), telling us about an early childhood visit to the
mausoleum of the Bulgarian communist leader Georgy Dimitrov. The story was
given in a humorous way, with the questions that crossed a young child’s mind,
like: ‘Well, my granny died and she isn’t here any more, how is it that he died
and is still here?’ or, ‘Why are those two guards in front of the building guarding
him, since he is dead and cannot run away?’ Then someone would respond with
something about what an unpleasant and threatening and suffocating experience
it had been for her to visit the mausoleum as a child with her classmates, another
would mention the long queue before it, but the prevailing tone wouldn’t change
much, remaining the one going along with a funny experience. And the daughter
of high communist nomenclature parents would find it important to quickly
sneak in an assurance that she ‘doesn’t miss the building of the mausoleum,
because she had always liked the garden behind it . . .’
She was also the person to use explicitly, however, a comparison in favour of
the past and with an emotion, showing she was aware this was a risky statement:
‘Many places were better then, than they are now.’ It received no support as an
explicit generalisation, though in many of the stories there had been a vivid emo-
tional accent on past positives: rabbits you could see near your house, the close
relations with relatives, the leaving of the key under the entrance mat, even when
leaving home for days. The group’s generalisation was rather: ‘There were many
 The visible city and the invisible shame 173

megalomanic projects at that time’ – brought in just as a notice towards the end
of the session, in connection with the speed the National Palace of Culture
(NPC) had been built. The fact that the space for its building was cleared by
taking down the Memory Wall of Bulgarian soldiers from a specific regiment
had been mentioned before, extracting surprise from some of the members. (We
should add here that this regiment was the one who fought victoriously against
Russian troops during the First World War – in the one and only battle in history
in which Russian–Bulgarian armies fought.)
In the initial paintings of the participants, the same coexistence of opposite
feelings was present. For instance one participant had titled her drawing ‘Calm-
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ness’, while the feeling expressed and evoked by it in her was ‘tension’. The
titles and feelings of the sequence of paintings ranged from the title ‘Wound’,
accompanied by feeling of rage and the sense as if someone has squeezed me
with a large metal instrument, to spaciousness, light feelings, enjoyment, joy.
As elements of striking contrast were appearing mingled in mostly nostalgic
character memories and stories, it was the group’s interaction, actually, that took
care of differentiating them, as the elements of an individual story that touched
upon repressive characteristics of the past reality, received more immediate
response and the group energy somehow lined up those elements as belonging
together.
The warmth and the enjoyment of the places encountered and the stories
stirred, were preserved as dominant and at the end of the session the participants
shared they had been moved by memories that had not visited them for a long
time, very intrigued by each other’s memories of different places: ‘that Sofia has
been something that existed in a different way for each of us’, as well as of
learning things they had never heard before (referral to learning of the taking
down of the Memorial Wall in the centre of the city in order to be replaced by
NPC as to a simply cognitive acquisition).
So, the first session showed that at each point when something that bore refer-
ence not only to the personal past, but to our social past, was touched upon, there
appeared disconnectedness between the content and the emotion. The differenti-
ation of those two lines was never made on the individual level, but through the
group interaction, that delineated the social past as a somewhat separate topic.
On the group level the social line was getting more energy and attracted more
responses, while the personal line dominated the emotional atmosphere.
The positive aspects of the past were often depicted as a combination between
characteristics of a city and of nature with a hint to the combination city–
province. ‘Living in this quarter of the city was like living both in a city and in a
forest – you could meet a deer, rabbits. It turned out they were coming for the
carrots planted before the house.’
Some very clear stress was put through the members’ stories on a distinction
between living in the centre of the city and living in the periphery. (Which was
even reflected in the fact that in the ‘book’ Ute and Mathias included this
information in an otherwise very short description of each participant.)
 174 Developments in social contexts

This might as well have reference to the German–Bulgarian presence (centre

and periphery of Europe). It also seemed through other elements of the discus-
sion that an important dimension the group was referring to was the presence of
foreigners and especially the apprehension about how they could be perceiving
our city and us. In the very beginning of the story of the first participant a figure
of a black baby appeared. She remembered asking her mother ‘why is this baby
black?’ and the mother’s answer was ‘There are such people.’ Some figures of
Roma people appeared in two of the stories, in both of them in a positive role:

In the grass before the House of Culture there was a Roma couple with a
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bear and her baby and my little brother went to see the bear, but fell near it
and got very frightened, crying without end and the gipsy woman told my
parents to hold him in the air with his head down and shake him a little, so
that he forgets the experience. And they did it and he stopped crying and
later he had no memory of it.

We might relate here to the tendency of the group not to connect to the adequate
emotion of the social-related experiences that were popping up here and there as
peripheral elements of the individual stories. The coping mechanism being
searched for in the manner: we need to be taught how to forget the traumatic
experiences of our past.
(Let us remind ourselves here that Russia is sometimes referred to as ‘The
Russian Bear’. For Bulgarians, actually just saying ‘The Bear’ is enough to
replace ‘Russia’. In the context of this group conversation, of course there was
no conscious referral or reflection to that meaning of the symbol.)
The second session – the one on the present city – went on to demonstrate the
mechanism of ignoring a huge reminder of the social trauma and its foreign
inflictor in the top centre of the city.
Avoidance to notice, denial, brought up to the extent of as if having a neg-
ative hallucination becomes quite understandable, though, when not only forget-
ting of the trauma is made impossible, but any movement of its reminders
towards the periphery of the social mind, as well. It is being constantly brought
to notice, imposed to the core centre of that social mind.
In the second session Ute and Mathias asked to join the group work as parti-
cipants and were accepted by the group for this specific session. In it the juxta-
position ‘centre–end-most district’ was unfolded. One participant who in the
previous session had told us that her family moved from the centre to an all-
grey-blocks district, which she perceived as really horrible (the same young
woman who had brought the story of the bear and the lesson of the Roma woman
as to how to forget a frightening experience), now gave a touchingly beautiful
full of romantics picture of herself sitting at a window in the late evening when
the blocks become invisible (disappear) and only the stars and the other
windows’ lights remain. And the feeling of connectedness with the people who
are across there in the light windows, each doing their own thing.
 The visible city and the invisible shame 175

Told with a rather even voice, it was the story that acquired the capacity of an
emotional group focus. Actually the whole session could be named: we are not
to see something that remained with us from the near past, so that beauty and
connectedness appear. (Or: only when something of the past that continues to be
always with us disappears, people can connect among themselves, as well as
with their feelings.)
The participation of Ute and Mathias in the group brought more to the surface
the uneasy feelings about how we (our capital) are perceived by them. As
Mathias’ journey had brought him into a distance from the centre district, he
shared some fear that he might have unexpected meetings and may be even with
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people who might be dangerous. This evoked a quick negation from two people.
The second utterly obvious to be self-defending: ‘What does it mean end-most
quarters?! I, myself am more afraid from children begging [skipping mentioning
those are Roma children] – more afraid in the centre than in end-most quarters!’
Mathias had actually met a dog lying on the ground – a lonesome dog. And
mentioned the water that had gathered in the holes, as it was raining in his
journey, and sort of recommended ‘looking to the ground’ rationalising it with:
‘The ground is different everywhere.’ The group became more able to bring in
some of the things we feel somewhat ashamed of (without mentioning the
feeling) – the dog’s excrement one should be careful about when walking, the
broken tiles of the pavement of the most beautiful and central street of Sofia,
making it a street you ‘MUST not walk on when it’s raining’. Then a man
brought up his journey and the paintings he reflected it in, his input giving (on an
entirely unconscious level) another reason to ‘look to the ground’ – not in order
to miss seeing something ‘dangerous’ on it, threatening to dirty you, but in order
to not to see something up there – above you. . . . He introduced his first painting
as a representation of the whole of Sofia as ‘a boiling water, bubbling, with this
smog over it’ (stating he has not grown up in this city and his sense of it is dif-
ferent) and passed to a second painting that he ‘didn’t mean to be like that, but it
happened to form like this’ when he tried to represent two places he liked in
Sofia (the second a garden in the centre of which a monument of the saint Sofia
university is named after, Kiril Metodi). The first of those two places that he
took the group to through this picture (that was the painting that stuck out most
from all the group’s paintings), was a garden again – also near the university. He
said it is a place whenever he passes through, he likes to stay for a while and
look at the youngsters who are skateboarding in it.
We will comment here that by staying especially to look, he managed to not
‘see’, so did the group, as well as Roumen and myself too – up to this moment in
time, the highest monument in Sofia, in its top centre, the most shame-provoking
material object in the city, shooting 37 metres into the air. The Soviet soldier in
the middle, of course, is like a giant in comparison to the Bulgarian worker and
woman-villager, whose heads are at the height of his shoulder, the highest point
being the gun he holds, his arm raised high above the university and the people
in Sofia. The monument with a ‘dirty’ inscription, as it is reverting the role of an
 176 Developments in social contexts

occupier into the role ‘liberator’ (though encrusted with golden bronze letters,
that are vigilantly kept clean and fresh): ‘To the Soviet Army–Liberator from the
grateful people of Bulgaria’. At that time, in 2005, in fact the garden he was
talking about had no other name, but ‘the garden of the monument of the Soviet
Army’.
Its name was not mentioned either, and the feeling (and the image of that
monument) was displaced by the image of bagpipe (a typical folklore Bulgarian
instrument). In the other garden (with the Saint’s monument), actually, from
time to time there was a person coming to play a bagpipe: standing with his back
to people who passed and were throwing coins into the hat behind him. The
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author of the painting shared he felt very inspired the moment he saw that his
painting could turn into a bagpipe. Then he united the two places by saying there
is dynamics and ‘pulse’ in both of them.
A woman commented, suddenly turning attention to the fact that the bagpipe
is made from the stomach of an animal. So, she said, it is as if Sofia swallows
you (us), digests the person and then spills them out transformed in some way.
Reminded that one might come out as a very nice sound, she felt obliged to
explain she didn’t mean one had to come out ‘in the form of what comes out of a
stomach’, just that Sofia makes you different, affecting everyone in a
different way.
The auditory channel (singing, playing an instrument) was very present in the
imageries of this session. As well as differences (people who walk too fast, hust-
ling when one feels just like walking and vice versa – being ‘too slow, and that
hinders me, as I am in a hurry’).
The man with the bagpipe painting then pointed out specifically to the ‘stick-
ing out items’ of it (the wooden parts, that are blown when playing on it) being
like the roads of Sofia through which one gets in and gets out, which he likes a
lot. It is in one of ‘the sticking out items’, that one can actually see (today) a
quite fine drawing of the entirely unmentioned monument of the Soviet army.
The need for transformation of that space, the utter symbol of the repression, of
the foreign army that came into Bulgaria and enforced the regime that was respons-
ible for the fear we were looking for ways to forget (the bear incident and the
advice of the Roma woman), for the prohibitions to enter a church, for the grey
blocks that block you from being in contact with people and beautiful feelings, for
the desperately limited choice (the two toys in the children’s store), the division of
things that go together (Tom and Jerry), for the bringing down of the Memorial
Wall of Bulgarian soldiers, with no memory of it in many of the people, found
expression and was ‘satisfied’ entirely on an unconscious level. Neither the monu-
ment, nor the victims, put down – deep in the shadow it casts with its very presence
and the praising delivered on behalf of the people of Bulgaria – were mentioned.
(Over 30 000 deaths inflicted only in the first days after the coming of that army by
Bulgarian communists following the Soviet instructions.)
The transformation of that space into something connecting to the roots and
essence of old Bulgaria (symbolised by folklore music) was carried out on
 The visible city and the invisible shame 177

tiptoes, without casting a glimpse to the feelings of humiliation and shame for
the presence of that symbol in the heart of the city, untouched by change. No
expression was given either to any of the feelings of helplessness, lack of
freedom, confusion, suspiciousness, fear, indignation, inferiority from the fact
that a single phone call of the ambassador of the state which inherited the non-
existent any more Soviet Union (Russia) to the Bulgarian minister of interior had
been enough (and was still holding effect) to stop the execution of the decision
of Sofia City Council in 1993 for the deconstruction of that monument. In fact,
we cannot be sure how many of the people in the group knew at all about that
prolongation into the present of the acts of the ‘liberator’ freeing us from our
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own free will. Most were probably remembering that in 1993 the machines hired
from the Municipality for the deconstruction had gone to the monument that a
group of partisans of the ex-communist (re-named socialist) party (a member of
the ruling coalition of parties at the time the project was conducted) had occu-
pied the monument of the occupation army, titled ‘the army–liberator’ and that
the machines returned. And that then silence followed.
The reverberation in present day of the trauma, the continuing hold to the
imposed definition of the victimiser as to his role, the inexplicability of how can
such a monument and an engraved gratefulness of the victim to the victimiser be
still staying, was too heavy not only to be given voice but even to reach to our
own consciousness. The feelings were left to ‘the stomach’ to digest and to never
go out. Which meant poisoning of the whole organism.
The group marched on with the seductive (for the two foreigners) bagpipe
image, that was thrown. Ute said to the man who brought in the image that this
bagpipe touches her so much that she feels like touching it and sensing it, asked
him if it evoked in him such an idea of touch, he answered it wasn’t very hard,
but wasn’t soft either. That it gives him a feeling of security, tenderness in the
curves, a sense of things getting in order.
Very sensual feelings were brought by the others, then one drew attention to
that instrument as a negation of any warrior type of music. Then the man who
painted the bagpipe who had said at the beginning Sofia was boiling and bub-
bling rendered Sofia’s capacities similar to the mountains of Rhodope (spacious
and contained) and from there jumped back to rejecting (without referring to
them) the words of Mathias by saying that he feels very well and calm when
walking in spacious peripheral quarters, it doesn’t even cross his mind to fear
criminals.
Then Ute brought in the group the material from her journey. She said expli-
citly during the trance-like state, while three pictures of places were before her
eyes, she couldn’t choose for quite a while, as she had the insecurity-raising
thought of how she, the foreigner ‘would have to then present to you that choice
of mine’. And here came at last the name of the monument of the Soviet army –
just named out loud without stopping at it for a second, while enlisting the three
places. Then she spoke a little of the History Museum, but there were signs of
displacement she had ‘chosen’ to make with making this choice, as she started
 178 Developments in social contexts

having the feeling that she cannot see Sofia as real, it was turning into a mini-
ature model. Then she just fed a quite dirty stray dog, that in her imagination
turned into a beautiful black dog that was hers. The sausage she gave him smelt
good. The message Sofia had given her was that Sofia is a city that wants to be
loved. Which helped the woman (who later told us after that project that she, for
the first time, went to vote at local elections) to remember that the city told her
that it needed our love. ‘The way it sounded was like we have been negligent
to it.’
The next person talked about looking from above the crossroad before the
university – and again, all the views seen from there, but the highest monument
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of this city, situated at few meters from there.

When exactly five years after this project one of the participants in it (and
technical assistant of the Bulgarian part of the team) created an Initiative Com-
mittee for the dismantling of the ‘Monument of lie’, as the Committee named it,
and two of our daughters joined it, and all the staff (and spouses) of the Psycho-
therapy Institute of Social Ecology of Personality got involved with that cause,
one of the things I (Jenia) said to a TV camera was: it is difficult for the citizens
of a city to feel their love for it, when they have to find a way to turn their eyes
away from the most visible element of it, lest they should feel the enormous pain
that it inflicts in them, fortified by the pain for their city and country, itself.
A sentence with which we can as well finish the description of the group
session on the imagery of present Sofia.
In the third session on the future Sofia the images, though very creative, gave
rather mechanistic resolutions to the differences and conflicting needs mapped
out in the previous one. One example being the invention of different roads for
those who are in a hurry and those who would like to walk slowly.
It is interesting that the same young man who had offered the image of the
bagpipe brought up an explicit idea (dating it for 2015) of a museum at the peri-
phery of the city where as he put it ‘the kind of monuments of Lenin’ are put as
a preservation of the past. The big monument of Lenin in the centre of Sofia had
been dismantled in the very beginning of the changes, so formulated in that way
(without again mentioning the monument that the group unconscious had tried to
deal with in the previous session) the image evoked surprise (especially
expressed on the part of the daughter of high nomenclature family) and he was
almost accused by her in restoring Lenin again in 2015!
After following the dynamics of the first and second session it is no surprise
that perhaps the most impressive image of distant future Sofia that appeared
seemed to be positive, but in fact was representing the city in a sort of capsule,
as a hospital, absolutely clean and run by a very caring old woman mayor, who
was constantly at this function, nobody even thought of conducting elections.
‘And people from all over the world were coming to visit and learn from how
we managed to do that.’
One can imagine this also as an ironic picture, taking the dynamics to
an absurd place. It was given with no humour in it by a woman who is an
 The visible city and the invisible shame 179

anti-communist and has had a grandfather in a communist camp and whose hus-
band’s father had been killed.
This imagery can be seen as a past that we have refused to reject, that gets
projected into the future.
Or as a statement that when traumas are denied, nostalgic feelings for the past
predominate, some of the people not only refuse to hurry, but actually hold to
the past and its definitions, when praise for victimisers has unbearable for human
sight visibility at the price of the victims and their feelings becoming invisible,
when what has to die (be deconstructed) and let go in order to give space to life,
connectedness and beauty, stands rigidly in the centre and refuses to go the peri-
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phery of both inner and outer space, we are all bound to be hospitalised.

Conclusion
We said in the Introduction that Milton Erickson used mental time journeys in
order to evoke pictures from the past, to install a view from new angles, and
bring to the development of visions for a possible Self in the future.
From today’s point of view, if we look at the group we worked with, as a
microcosm of Bulgarian society, we can say our time experiment reflected, pre-
cipitated(?), and forebode that the healing process of the social self was (is to be)
. . . blocked.
In present Bulgaria this is a fact. Especially after the last elections of 12 May
2013 it is more clear than it has ever been in the last 24 years (1989–2013) that
the transition of Bulgarian society from a traumatic for the social mind, totalitar-
ian past to a democratic future did not take place.
In the group process we can localise that the prevention of its transition
started in the ‘travelling’ to the past, where (as a predominant tendency) trau-
matic experiences were kept disconnected from the feelings they evoked.
Its blocking happened in the present. We followed the second group session – on
present Sofia – in most detail. The mechanism used, was: gross avoidance; denial.
Outside psychology (individual, group, cultural psychology), however, there
is a city.
There is a broader social space, which is not the ‘soft reality’ of the inner
world. In which the old definitions stay materialised. In monuments. That show
to be unmovable. The efforts of Bulgarian institutions have proved helpless
before the power of the present day representatives of those inner and outer
forces, who inflicted the traumas and who continue to hold on to the definition
that the past experiences were not traumatic, they weren’t even ‘just normal’.
They are to be praised! When the victimiser has the power to hold the visible
reality and to define any attempt at its change as violence and destructivity, there
isn’t much choice left to the victim, but to screw out her own eyes. And feelings.
So, the refusal to make feelings visible and the forceful introjections of the
material, visible reality on to past traumas, making the feelings around them
simply unbearable, mutually reinforce each other.
 180 Developments in social contexts

Even though being psychologists, let’s behold to pour it all on psychology!

We would prove very one-sided (half blind) and actually totally blind to the
inter-play between inner and outer reality, if we are prone to stick to a view
looking for explanations only in the psychological realm and psychological
mechanisms.
We think it would be a ‘shame’ if even a joint project of psychologists and
artists, a project on the unconscious imagery of a material common space reality
like a city, doesn’t open our eyes somewhat more to the joint influence factors of
inner and of outer reality exert, to their interplay, to the dangers of their mutual
reinforcement.
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Jenia and Roumen Gheorghievi are psychologists with many years’ experience
of developing art and group therapy services in Bulgaria. They were the Bulgar-
ian co-ordinators of the Art Therapy section of a World Health Organization
project to introduce new psychosocial interventions into the Bulgarian national
health service in the 1980s, working closely with Diane Waller and Dan Lumley,
and have played a major role in teaching, supervising and practising art psycho-
therapy in the national drug addiction services, as well as in community-based
projects. They have extended the model of group interactive art therapy by
incorporating approaches from process psychology and systems theory.
 Part IV

Group interactive art

therapy used in research
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Increasingly the requirement for health and care professionals is to demon-

strate that their practice is ‘evidenced’ and ‘effective’. In the UK the national
body, the National Institute for Health and Clinical Excellence, after review-
ing the research literature, produces guidelines which recommend various
treatments and interventions for specific client groups. Art therapy is a regu-
lated profession with many employees in the National Health and Social Care
services as well as the voluntary sector, and is required to demonstrate that it
has benefits in order to justify public money being spent. This evidence-based
agenda has posed many challenges, not only for art therapy but for other psy-
chological therapies, particularly those we might call ‘humanistic’ due to the
high importance placed on the approach still considered to be the ‘gold
standard’ in clinical research, the Randomised Control Trial (RCT). It is not
within the scope of this book to engage in the powerful and even bitter debates
that have taken place and will no doubt continue about the feasibility of or
ethical considerations of randomising clients to a particular psychological
therapy, given that in clinical practice we would take time to ensure that the
client fully understood and had committed to such an intervention. Given the
‘curative’ factors of groups which are outlined earlier in the book and which
are still considered important, how can we really say that placing someone in
a group when the conductor has not been able to check if they are truly able
and willing to participate (bearing in mind the emotional turmoil that we have
seen can arise during the powerful yet healing processes) is ethically sustain-
able? However, perhaps it is only by trying to see what the pros and cons are
of this approach that we can argue either for or against the predominance of
the RCT – and to do this we have to ensure that our clients are sure that they
agree to being assigned to an intervention that may not, in reality, be their
choice. Bearing in mind that the curative factors of ‘coherence’ and ‘con-
tinuity’ are so important, what happens if those randomised to a particular
group decide after all not to go along – or just for one session?
These are serious questions. I have been struggling with them and continue to
do so alongside participating in research projects, some of which have used
RCT. In three of the trials, the group interactive model or a variant has been
 182 Group interactive art therapy in research

used. In a pilot trial (an RCT with people with schizophrenia, Richardson, et al.,
2007) the model was also used and provided sufficient evidence of effectiveness
for a further very large trial to be conducted.
As this part of the book provides simply indications for research, it will be
brief but fully referenced so that readers who want to see the full details can do
so.
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 Chapter 24

Using group interactive art

therapy with older people with
moderate to severe dementia
1996–2005
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This project was conducted in three phases, starting with a pilot exploratory phase
to see if art therapy groups may be helpful for older people with moderate to severe
dementia in terms of improving mood and cognition. It was a multi-disciplinary
project (two experimental psychologists, two art therapists, a music therapist (who
ran the activity groups, not music therapy) and consultant psychiatrist) funded by
the Brighton branch of the Alzheimer’s Society. The design was for two art therapy
groups (six patients in each) conducted over 12 weeks in different settings by the
same art therapist and two ‘activity’ groups – doing the kinds of things that day
centre patients might normally do (puzzles, games, listening to radio) but not
including any art or craftwork. Patients were referred by the psychiatrist and
included those with a definitive diagnosis of dementia. A series of questionnaires
concerning cognitive and mental health status were completed with the help of rel-
atives and staff where necessary. Group interactive art therapy was selected as the
intervention but in a modified form given the physical and cognitive difficulties of
the patients. After 12 weeks the detailed process notes of the therapists were exam-
ined using theme centred analysis and all this together with feedback from staff was
collated. The results were as expected, not very significant but there was a small
improvement in depression scores in the art therapy groups which encouraged the
team to apply for funding for a longer-term project with more patients. We were
successful and using a similar design to the pilot (except with four art therapy
groups conducted by two art therapists and four controls (activity groups) in four
different centres in Sussex and a total of 48 patients weekly for 40 weeks). Similar
questionnaires were completed before and after the trial and the process notes,
which had been written up in a much more detailed format, were put together with
the artwork and the more systematically collected feedback from the staff in all four
centres. The outcome showed small improvements in the art therapy patients in
terms of mental alertness, sociability, physical and social engagement and calm-
ness. These were not matched from the activity groups. Obviously we were working
with patients with a serious progressive illness and during the 40 weeks of the
groups, some died and some became so infirm that they could not continue despite
our best efforts. We could not expect any major changes but were very heartened to
see that there were some small ones. The artwork had been a revelation in that
 184 Group interactive art therapy in research

patients had wanted to engage with the materials and due to the careful maintenance
of the interactive stance, the images had proved to be a good source for communi-
cation, often with much humour. For example, in one week a woman made a clay
elephant which was discussed by other group members with some mirth. In the next
week someone made some clay balls and put them in folded paper – whereupon
another group member called out ‘elephant’s turds!’ These kinds of interactions,
which managed to express the very shameful state of being incontinent or feeling
dirty that all the group members shared, were quite common. Another example was
of a clay pig, which the woman who made it likened to herself, and a cave made out
of folded paper ‘where I can hide’. We noticed also that many of the women
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reverted to their former roles as housewives and cooks, making clay utensils and
‘food’, setting the table as if for a meal. The men made images about their former
work. One man had been a coal-seller and told the group about this through his
drawing, another had been an architect and made drawings with many lines and
geometric shapes. Another man, no longer able to drive, made a racing car out of
clay, (Plate 7b), to which he returned every week, and which served as a poignant
reminder of his lost identity as a driver. It was important to remember that most
group members had perceptual problems and could not distinguish materials on the
table, it was just a blur. So the art therapists had to be more active than usual both in
pointing out the materials and helping the patients to reach them as well as being
active in modelling interaction.
The final part of this project was a two year study of all 140 sessions of art
therapy using the artwork, the therapists’ notes and the feedback from staff to
make a theme centred analysis. Not surprisingly some of the major themes to
emerge were a sense of isolation, stigma, shame, loss of identity and how the
way the institution functioned impacted on the outcome for the patients. The
adaptations of the model consisted in more selective use of materials, especially
fabrics, tissue paper and ‘tactile’ objects, ensuring that clay was always available
seeming to be a preferred material, being prepared to demonstrate more actively
how the materials could be used given that the patients did not know or could
not see them clearly. The art therapists needed to ensure that each patient’s work
was available to them each week as they could not remember what they had
made. When the work was in front of them they could remember and relate to it.
(See Rusted et al., 2006; Waller and Sheppard, 2006; Waller, 2002 for more
information on this project.)
When we carried out this project, very few people used art therapy or indeed
any other form of psychological therapy with older people with such severity of
dementia and there was little attention to this condition. Now in the UK there is
much more interest, funding and awareness that there is much to be done as the
population of people with dementia is rapidly growing. The appalling conditions
we witnessed are unfortunately still not eradicated, but there is a willingness
among the health and social care services to make things better. Further research,
building on our learning from these early projects, is much needed.
 Chapter 25

Using the model with people with

long-term schizophrenia
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This was a five-year very well funded project by the Health Technology Assess-
ment, UK, looking at the use of art therapy with 400 patients with long-term
schizophrenia living in the community, to see if art therapy had an impact on
negative symptoms.
It had three arms – art therapy groups, activity groups and standard (psychi-
atric) treatment. An earlier small project (Richardson et al., 2007) had demon-
strated some positive effects of group interactive art therapy with people with
psychosis so this model was selected as the main intervention for the trial with
activity groups as the comparison (control). The trial took place in four areas of
the UK, with four art therapy and four activity groups in each and patients were
randomised to these or to standard treatment. Needless to say it was an organisa-
tional challenge. The model was, as required by the funder, clearly defined from
the beginning and all the participants signed up to it, but it soon became clear
that the principles were unlikely to be maintained with a patient group who were
decidedly reluctant to participate in anything at all. Expecting that they would be
able to make the effort to travel to and be part of an intervention which they had
agreed to be randomised to but hadn’t actually chosen was highly optimistic to
say the least. As a ‘pragmatic’ trial the model was modified to take into account
the small numbers (in both the art therapy and activity groups) and with erratic
attendance and drop outs, most of the curative factors which we know to be acti-
vated in cohesive groups could not take effect. After a huge amount of work and
commitment on behalf of all the staff in all the centres, plus the trial group itself,
the very thorough analysis showed no changes at all in any of the interventions.
This was a most disappointing but in retrospect not entirely surprising result.
However, a parallel qualitative study which took into account the direct views of
the participating patients showed a rather different picture which reinforced the
significant amount of case study research demonstrating that art therapy had
been and was important in the lives of people with long-term schizophrenia. But,
further research is urgently needed to understand more about which models of
art therapy (perhaps individual or studio based) would be most useful and in
what ways in the lives of these often neglected patients. Given the emphasis on
‘well-being’ for people living with long-term conditions, it may be more sensible
 186 Group interactive art therapy in research

to see how art therapy could have beneficial impact on their everyday lives as
opposed to expecting it will ‘cure’ their symptoms.
If we consider group psychotherapy itself, there are many studies that attest to
its effectiveness with a wide range of patient groups. Montgomery (2002) drew
attention to a meta-analytic review of the effectiveness of group psychotherapy
in the treatment of depression in which 48 studies were examined. Of these 43
showed statistically significant reductions in depressive symptoms following
group psychotherapy, nine showed no difference between individual and group
psychotherapy, and eight showed CBT to be more effective than psychodynamic
group therapy. Interestingly, he cites Tschuschke and Dies (1994) whose
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research found that group cohesion showed a linear positive relationship with
outcome in almost all published reports of group therapy efficacy, suggesting it
is a precondition for therapeutic change. Reflecting on the outcome of the
Matisse study above, it is reassuring to know that:

As an adjunct to the treatment of schizophrenia, group therapy has been

used successfully for the past 70 years, shown to be effective in reducing
social isolation and increasing the use of adaptive strategies. Kansas (1986)
reviewed 43 controlled studies of the use of group therapy in schizophrenia
and concluded that it has a positive effect on a range of outcome measures.
Interpretations that reveal or explore unconscious conflicts have been shown
to be generally unhelpful, but an emphasis on feedback and support
increases an atmosphere of connectedness and cohesion within the group,
which aids interpersonal learning.
(Kapur 1993)

Kapur adds that group therapy is rarely made available for this patient group,
owing to the increasing trend to focus on the ‘management’ of patients with
long-term mental illness, rather than on therapy. We might say that 20 years
after Kapur wrote this, the tendency has increased even more. Fragmentation of
services and the need for hospitals to ‘meet targets’ make it very difficult to
organise for the kinds of cohesive, stable art therapy groups that ironically used
to be delivered within the old psychiatric hospitals. The learning from the
Matisse trial indicates that it is very difficult, if not impossible, to adhere to the
group interactive model without maintaining cohesion. As Montgomery points
out, the most important aspect of a successful outcome is selecting the right
patients for the group, i.e. getting the right mix of problems, personalities and
habitual defence style. Much of the literature on patient selection has focussed
on its role in building cohesion . . . careful patient-screening also serves to
minimise the drop-out rate resulting from patient–group mismatches (Roback
and Smith, 1987).
(See Richardson et al., 2007; Patterson et al., 2011; Crawford et al., 2012 for
more information about the two RCTs referred to here.)
 Chapter 26

Using the model with patients in

rehabilitation from stroke
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A recent pilot project (2012–13) explored the impact of an interactive art therapy
group on six patients in a specialist unit for people recovering from stroke. This
was a new intervention and there is very little research thus far on the use of cre-
ative therapies for people recovering from stroke.
With the full support of the staff in the unit, and following a focus group of
former patients and some carers, the project was designed to include one art
therapy group run over six weeks (the normal period for rehabilitation) with
twice weekly hourly groups. The research nurse recruited and explained to
patients about the group. Six men chose to attend (although it was designed as a
mixed group). There were two therapists, an art therapist and a speech and lan-
guage therapist facilitating each group, the latter very important to support
patients with speech difficulties and to liaise with the ward staff.
It was quickly clear that the men desperately needed a place to express their
deep anxieties and upset about what had happened to them. This was the only
form of psychological therapy available and they all said how hard it was to be
in the unit for days on end, worrying about the future, missing their families,
contemplating possibly not working again (most had physically demanding jobs
such as builders, electricians, sports instructors). The art therapist managed to
engage most of the men in the group, even one who rejected every suggestion
from him or his peers and simply came to sit. The expression of anxiety and dis-
tress was often indirect and they preferred something practical to do. We had
purchased a camera and also an iPad, as well as having basic art materials and
the ever popular clay on hand.
The group members supported each other and a solid sense of camaraderie
with bleak humour developed. The art therapist, being competent with film
making and animation, suggested the group make an animated film – which gave
the opportunity for all to be involved. The men who had difficulty with man-
aging the materials could act as stage directors, others made the clay models to
animate, worked out the script and chose the music. The outcome was a short
film entitled ‘Circus Dreams’ in which a clown is juggling, a man who has fallen
down gets animated and someone is eaten by a roaring lion. As well as being
fun, this film is loaded with the symbolism of having a stroke and living with the
 188 Group interactive art therapy in research

effects. In this case we could say that the small project is a success – according
to the patients’ feedback given afterwards to an independent research nurse. This
is a qualitative project in which the men chose to attend after being informed
about the group, and the analysis is case-study based. It is a very good example
of how the group interactive art therapy model can be adapted for the needs of
sceptical and very anxious men, and shows how new media (for art therapy)
such as iPads and animation techniques can be incorporated into the interactive
framework. Obviously this is a small pilot but provides plenty of learning and
points to the need for a bigger trial in the future.
(See Waller et al., 2013 and Ali et al., 2014 for the Report and most recent
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paper on the project.)

 Concluding thoughts
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Based on the insights from using this model in teaching, training and research
over several years now, it is clear to me that I did not adequately take into
account the need for a particular kind of training, and indeed perhaps for a per-
sonal inclination, for using the approach. Coming myself from a background in
art education, art therapy, art practice and a very thorough and rich group ana-
lytic psychotherapy training and having a strong interest in performance art, I
was fortunate in being able to develop the model in situations where there was
great openness to new ideas. Added to that an attraction to systems theory and
process sociology, I was moving much more into a sociologically informed
method of practice while not abandoning my earlier psychoanalytic training. The
predominating psychoanalytic model of art therapy in Britain which emerged
during the 1980s and which still continues, is a very serious and effective one
and has given rise to excellent theory and practice. It is, though, not always able
to be appreciative enough of the unique role of the creative image-making
process that can make art therapy so special and of the importance of the polit-
ical context in which we practice. The conditions in which we are obliged to
practice are also detrimental to being able to offer the full ‘menu’ – the examples
I have given in this book were often taken from week-long experiential work-
shops in large spaces which even if created from unlikely beginnings (like the
conference room in the Sofia Medical Academy) enabled a whole range of
experimental art practice to take place. We were privileged to be able to return
to the work day after day and create a truly living space. It’s true that many of us
who recall the large airy studios of the old psychiatric hospitals might become
nostalgic as we struggle to work in tiny offices, the carpeted lounges of hospices
with plastic on the floor, the music room where the instruments have to be pro-
tected from curious children, the dining room, kitchen, corridor . . . can it really
not have changed since I did my first job as an art therapist, with disturbed ado-
lescents, in a needlework room?
The stroke patients made do with the dining room that had to be booked, and
vacated immediately after the group. How much more exciting would it have
been to have the room for a whole week undisturbed, to leave materials and pro-
jects in process, and return to them. This is my major worry now in conducting
 190 Concluding thoughts

research (let alone carrying out practice) that we are having to adapt too much,
cramping ourselves into unsuitable spaces both physically and mentally. Being
very limited by time and constraints of ‘targets’ to get patients ‘out’ of hospital.
Movements that take our work into the ‘community’ perhaps into shared spaces
with artists and art centres, into galleries and museums without losing the integ-
rity of our practice could be a way forward. No wonder the ecopsychology
movement is spreading, let’s get outside, take some more space!
But, for anyone who wants to conduct an interactive art therapy group, I can
say it is very rewarding although very demanding emotionally. You need to
enjoy being quite active but also be aware of timing in order to intervene appro-
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priately. Maintenance of boundaries – however and wherever these are set – is

crucial. We have seen from one of the examples how boundary violation can be
dangerous. I would suggest at least some introductory psychodrama training as
helpful, and if the opportunity arises, attend Yvonne Agazarian’s workshops
when she comes to the UK – or runs them at international conferences. At least
read her books. Her active approach to sub-grouping is extremely helpful in
avoiding the damaging tendency to scapegoating that all groups possess. It
ensures that nobody is left alone carrying the group’s material. For art therapists
who did not have a lot of experience in groups during their art therapy training,
there are many short courses and opportunities to become more confident in the
role as conductor. Working with a co-therapist can be really supportive, but be
sure you feel comfortable with that person and able to talk things through very
openly. But, after all, there are many ways of practising art therapy and some
people will definitely prefer the one-to-one engagement. The likelihood is
though that in the public services some group work will be required and
expected. This can be truly exciting if seen as a creative experience, one which
can lessen the isolation that many people with progressive illnesses and/or emo-
tional distress are feeling.
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 Index
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Page numbers in bold denote figures, those with a letter attached, for example 6a, denote plates.

accidental grouping 64–5 rehabilitation movements 7; introducing

Adamson, Edward 9, 10 art therapy into psychotherapy groups
adolescents see children and adolescents 41–4; Liebmann’s survey and research
Agazarian, Yvonne 3, 34–6, 104, 190 13–14; mythology of 55; non-verbal
aggression 103–6 groups 20–1; outdoor groups 16;
amphitheatres 161 pressure to disclose 20; projective art
anger 130, 131, 137–8, 139, 142, 144 groups 17; resonance 11, 18; theme-
Anthony, E.J. 83 centred groups 15–16, 19–20, 32–3;
anthropology 74 therapeutic communities 21, 22; training
anti-therapeutic norms 15 12–13; transference 15–16; use in
anxiety 19, 26, 77, 78; about being groups 10–13; verbal interactive groups
accepted by a group 137–8 21
Armstrong, D. 158 Art Therapy for Groups (Liebmann) 13
Art Brut 58 Art Therapy Groups (Huet and Skaife) 12,
Art Games and Structures for Groups 51
(Liebmann) 13 Art Therapy in Practice (Drucker) 76–7
art materials 54–8, 59; case studies 3c, 3d, Art Therapy in Practice (Liebman) 84
95–102, 100, 101, 162–3; clay 72, 98, Artists for Health movement 57
119, 184, 187; fabric 98–9; flexibility Artists in Hospitals movement 57
41–2, 44; health and safety 60; and the Arts and Psychotherapy 13
intensification of group processes 44; Arts Therapists Standards of Proficiency
junk 98; paint 97; ready-mades 98; and Standards of Education and
surfaces 97; three-dimensional 98; two- Training 12–13
dimensional 97 Astrachan, B. 3, 33–4
Art Psychotherapy Groups (Skaife and ATIC project 57
Huet) 23 attachment problems 162
art therapy 4; accidental grouping 64–5; Aveline, M. 26, 27, 45–6, 52
advancing group process 21–2; anti-
therapeutic norms 15; closed groups Banksy 58
22–3, 77; containment 19–20; ‘basic law of group dynamics, A’
developments in art therapy groups (Foulkes) 17–18
since the 1980s 13–24; dynamic belonging 137–8, 155, 160
exchanges between people, art and art Bierer, Joshua 7
pieces 155–6; games 14; group analytic Bion, Wilfred 7, 19–20, 37, 153
art therapy 13, 17–18; group interaction Blackwell, D. 36
17; history of 9–10; integration into Bloch, S. 26, 29, 30, 32, 34, 37
 198 Index

Blos, P. 85 Cizek, Franz 48–9

Blume, Peter 58 clay 72, 98, 119, 184, 187
body images (life-sized portraits) 1a, 1b, closed groups 22–3, 77
2a, 2b, 66, 68, 69, 70, 71 coherence 181
boundaries 16, 36, 47, 190; personal cohesiveness of groups 40, 47
boundaries 107–10, 135; time Cohn, R.R. 31–3
boundaries 48, 50–1; violation 8b, collective ownership 153, 158–9, 161, 163
135–42, 140, 141 competition 87–8
Bridge, Gary 165 conducting interactive art therapy groups
Bridger, Harold 7 45–53; differences between analytic and
British Association for Social Psychiatry 7 interpersonal leaders 46–7; ending the
British Association of Art Therapists group 148–50, 149; features of an
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(BAAT) Training and Education interactive group 45–6; group analysis

Committee 12 49–50; group culture 47; information
sharing 45, 50; major functions of group
Caboara Luzzatto, 155 conductors 47; modelling behaviour for
Caro, Anthony 58 the group 48; need for conductors to
Case, C. 83–4 have an extensive background in visual
case examples 93–4; boundary violation art 49; need to recognise group
and scapegoating 8b, 135–42, 140, 141; processes 47; open-ended projects 45;
catharsis 116–18; children and psychodrama 51–2; self-determination
adolescents 86–91, 89, 90; 50–1; storing of imagery 49, 52; suitable
developmental processes in a group space and equipment 49, 52–3; time
painting 2d, 107–10; ending the group boundaries 48, 49, 50–1; working
148–50, 149; expressing anger through a crisis 143–7, 145, 146
symbolically 130, 131; images of the conductors 115; art therapy training 12–13,
group 6c, 6d, 6a, 6b, 113–14, 115; life 54–5; background and knowledge of art
processes in small group environments 49, 54–5; challenges to, by group
4a, 4b, 5b, 111–12; power and members 34, 103–6, 137; cooperation
domination 119–25, 120, 121, 122, 124; with artists 57; differences between
rooms and materials 95–102, 100, 101; analytical and interactionalist therapists
short-term interactive art therapy groups 31–2; and feedback on anti-therapeutic
80–2; splitting in the group 126–9, 126, processes 37–8; group members’
128; spontaneous themes 132–4, 133; feelings towards 122–3; leader-cantered
unwilling participants 103–6; working models of group therapy 33; need for
through a crisis 143–7, 145, 146 firm group control 44; own image-
catharsis 40, 116–18 making 132; personal boundaries
Centre for Research into Sport, University 107–10, 135; as regulatory agents 33;
of Leicester 3 selective perception 36; self-exploration
Champernowne, Irene 10, 48 68–9; skill in modelling interaction 38;
children and adolescents 83–92, 172; case symbolic representation in images 134,
example 86–91, 89, 90; child art 48–9; 144–7, 145, 146; visual confidence
childhood memories 172; competition 54–5; working relationships between
87–8; difficulties of establishing an conductors 168; see also conducting
interactive group 83; dyslexic children interactive art therapy groups
84; group therapy with adolescents Coniunctio Oppositorum 160
84–5; hierarchy fantasies 88; need for connection 155
understanding of child psychology 83; Conner, Bruce 58
self-expression and peer interaction containment 19–20
85–6 continuity 181
choice 27 control group studies (RCTs) 36–7
Christo 58 core pain 157
‘City Imaginaries’ (Bridge and Watson) 165 corrective emotional experiences 30
 Index 199

Corsini, R. 29 eating disorders 130, 131

Cortesao, E.L. 24 eco-psychology 58
countertransference 103–6 elderly people 76–7
crisis management 143–7, 145, 146 Elias, Norbert 3–4, 33
Crouch, E. 26, 29, 30, 32, 34, 37 Encounter movement 8, 11
cultural issues 8–9; image-based culture ending the group 148–50, 149
156–7 environment making 8b, 139–40, 140, 141
Cunningham-Dax, Dr. 10 Erickson, Milton 151, 166, 179
curative factors in groups 39–44; art Esalen 8, 11
materials and the intensification of evidence-based practice 36–7
group processes 44; artwork as a focus existentialism 45
for interaction 43; artwork as a focus for experimentation 8
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projection 42–3; artwork as an aid to Ezriel, Henry 7, 28

understanding here and now 42;
catharsis 40; flexibility of art materials fabric 98–9
41–2, 44; fun aspects of art therapy families 72–4, 73, 74
groups 43; group cohesiveness 40; feedback 27–8, 40, 80, 170; on anti-
information sharing 39; installation of therapeutic processes 37–8
hope 39; interpersonal learning 40; field theory 34–5
introducing art therapy into Fielden, Trish 84
psychotherapy groups 41–4; learning to films 188–9
interact and receive feedback 40; foreign languages 93–4
patients having similar problems 39–40; Foulkes, Sigmund 3, 4, 7, 17–18, 83
patients helping each other 39; freedom 27
performance fear 41; potential for Freud, Sigmund 8, 26, 34–5
including technology 44; re-enaction of Fried, E. 34
forgotten incidents 42; small groups Fromm, Erich 29
acting as a reconstruction of family 40; Frye, Northrop 46
storing of imagery 43; symbolic fun 43
meaning of art objects 42; value of ‘Further contributions to group analytic art
creative activity 44 therapy’ (McNeilly) 17–18
curiosity 161–2
games 14
Dalal, Farhad 8 Gammidge, Tony 156
Dalley, T. 13–14, 83–4 general systems theory 33–5, 36, 151, 189
death 170 gestalt group therapy 45
dementia 57, 183–4 Gheorghiev, Roumen 151, 165–80
depression 186 Gheorghieva, Jenia 151, 165–80
Dies, R.R. 186 Gilroy, Andrea 12
‘Directive and non-directive approaches in Goldsmiths College, Art Psychotherapy
art therapy’ (McNeilly) 13, 18 Unit 11–12, 59–60, 101, 102
disclosure 20, 27 Greenwood, Helen 19–20
disconnection 155 group analysis, interactive art therapy
‘Dissonance and harmony’ (Scaife and groups 49–50
Huet) 49 Group Analysis 7, 22
domination 119–25, 120, 121, 122, 124 ‘Group Analysis and the Arts Therapies’
Drucker, K. 76–7 22–3
Dryden, W. 45–6, 52 group analytic art therapy 12, 13, 17–18,
Dubuffet, Jean 58 79
Dudley, Jane 12 Group Analytic Art Therapy (McNeilly) 24
Dunning, Eric 3, 4 Group Analytic Psychotherapy (Lorentzen)
Durkin H.E. 34 24
dyslexia 84 Group Analytic Society 7
 200 Index

group culture 47 value for the group 20; non-verbal 21;

group dynamics 7, 92, 93 openness 153; ownership and its
group interactive art therapy: children and consequences 158–9; protection of 20;
adolescents 83–92; conducting a group sculptures 72–4, 73, 74; storing of
45–53; definition 3–5; developments of imagery 43, 49, 52, 59; symbolic
the model in social contexts 151; older meaning of 42, 130, 131, 132–4, 133;
people 183–4; people with symbolic portraits 65–6, 67; theatre of
schizophrenia 185–6; short-term the image and group interaction 153–64;
interactive art therapy groups 75–82; viewing images and becoming known
stroke rehabilitation 187–8; theatre of through the other 3c, 3d, 161–3
the image and group interaction 153–64; individual analysis 8–9
use of, in research 181–2 information sharing 39, 45, 50
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group painting 71–2, 107–10 Inpatient Group Psychotherapy (Yalom)

group psychotherapy 4; history of 7–9; 75
integration into rehabilitation input and output relationships 36
movements 7; lack of awareness of inquisitiveness 161–2
benefits 9 Inscape 13, 19
Group Psychotherapy in Britain (Ratigan Institute of Group Analysis (IGA) 7, 12
and Aveline) 26 Institute of Hygiene, Sofia 99, 100, 102
group sculptures 72–4, 73, 74 interaction 17, 26–7, 40; as an anti-
growth movement 11 therapeutic concept 37–8; artwork as a
gut reaction 65 focus for 43; connection and
disconnection 155; as a constitutional
Handbook of Art Therapy (Malchiodi) 3 component of group art therapy 154–5;
Health and Care Professions Council 10, 12 dynamic exchanges between people, art
health and safety 60 and art pieces 155–6; group interaction
Health Technology Assessment, UK 185 and theatre of the image 153–64;
helplessness 81 interpersonal interaction in a group 29;
here and now 27, 42, 79 leaving a group 155; peer interaction
hierarchy 88 85–6; in short-term interactive art
Hill, Adrian 9, 10 therapy groups 79
hope 39, 47 interactive group psychotherapy 26–38;
Hopper, Earl 4 attempts to displace group leaders 34;
Horney, Karen 29 concept of self 26; control group studies
Huet, Val 12, 23, 49 (RCTs) 36–7; corrective emotional
experiences 30; defining systems in
identity 51, 84, 160 relation to a group’s environment 35–6;
images 4; as an aid to understanding group differences between analytical and
here and now 42; body images (life- interactionalist models 31–2; disclosure
sized portraits) 1a, 1b, 2a, 2b, 66, 68, 27; feedback 27–8; field theory 34–5;
69, 70, 71; collective ownership 153, group as a social microcosm 28–9, 30;
158–9, 161, 163; directives guiding the group patterns of behaviour 28–9; here
making of images 154, 158; disposal of and now 27; input and output
imagery 148–50, 149; dynamic relationships 36; interaction as an anti-
exchanges between people, art and art therapeutic concept 37–8; interpersonal
pieces 155–6; as a focus for interaction approach concepts 27; interpersonal
43; as a focus for projection 42–3; as interaction in a group 29; interpersonal
gifts 3a, 3b, 159; of the group 6c, 6d, learning 30; leader-cantered models 33;
6a, 6b, 113–14, 115; group painting life space 35; mirroring 28; models
71–2, 107–10; image as a central player based on general systems theory 33–5,
154–6; image-based culture 156–7; and 36; pairing 37; premature termination of
the intensification of group processes group members 37–8; projection 28;
44; left-behind images 21; meaning and projective identification 28;
 Index 201

responsibility 27; risk 28; scapegoating Michaelides, D. 155

37; selective perception of therapists 36; Mindell, Arnold 151
self construction of an inner world 26; mindfulness 12
splitting 28; summary of interactive mirroring 28
model 30–1; transference 29, 31 Molloy, Terry 12, 77–9
interpersonal learning 30, 40 Montgomery, C. 186
interpreters 93–4
interruptions 77–8 National Institute for Health and Clinical
invisible reality 165 Excellence 181
iPads 42–3, 44, 188–9 National Training Laboratory 8
Netherne Hospital 100, 102
Jones, Kevin 12 Nevelson, Louise 58
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Jordan, Martin 58 non-conformity 47

Julius Caesar 123 non-verbal communication 41
non-verbal groups 20–1
Kahn, J. 31, 47 Northfield Hospital 7
Kansas, N. 186 Nowell Hall, Patricia 48, 50
Kapur, R. 186
Kernberg, O.F. 34 older people 183–5
Kienholz, Edward 58 open groups 75
kilns 60 openness 153
opposites 154, 155; Alchemical symbolism
La Nave, Francesca 12, 151, 153–64 of 160; coexistence of opposite feelings
Layton, Geoff 19–20 173; interacting with other group
leadership 79 members’ images 162; ownership of
Learning from Experience (Bion) 19–20 images 158–9
leaving a group 155 outdoor groups 16
Lewin, Kurt 7–8, 34–5 Outsider Art 58
Liebmann, Marian 13, 15, 16–17, 84 ownership 153, 158–9, 161, 163
life processes 4a, 4b, 5b, 111–12
life-sized portraits (body images) 1a, 1b, Paddington Centre for Psychotherapy 12
2a, 2b, 66, 68, 69, 70, 71 paint 97
life space 35 pairing 37
Linesch, D.G. 84–5 people with learning difficulties 22–3
Lipsedge, M. 8 performance art 11
Littlewood, R. 8 performance fear 41
London Centre for Psychotherapy 12 Peters, R. 3, 34–6
Long, Richard 16, 58 play 22, 43, 111, 117, 121, 161
Lorentzen, S. 24, 36–7 play therapy 83
loss 23 polarisation 16, 42, 138, 139, 141
Lumley, Dan 57 portraits: life-sized portraits (body images)
1a, 1b, 2a, 2b, 66, 68, 69, 70, 71;
Maclagan, David 20–1, 41, 55, 157 symbolic portraits 65–6, 67, 136
McNeilly, Gerry 4, 12, 13, 14–15, 17–18, Portuguese Art Therapy Association 24
19, 24, 36, 49–50 power 81, 119–25, 120, 121, 122, 124
Magic Realism 58 Power, Kevin 12
Main, Tom 7 Prendergast, Terry 12
Malchiodi, Cathy 3, 86 production line ethos 132–4, 133
masks 3a, 3b, 159–61 projection 28, 42–3
media workshops 57–8 projective art groups 17, 75
membership 160 projective identification 28, 103–6
Messer, S.B. 46 Psyche and the Social World, The
meta-narratives 153, 154 (Blackwell) 36
 202 Index

psychodrama 51–2, 190 social contexts, theatre of the image and

psychotherapy groups, introducing art group interaction 153–64
therapy 41–4 social microcosm 28–9, 30
psychotic patients 79–80 ‘Sofia - City in Transition’ (project) 165;
attitudes towards Sofia 166–7;
Race, Colour, and the Process of coexistence of opposite feelings 173;
Racialization (Dalal) 8 dealing with differences 168; description
Randomised Control Trial (RCT) 181–2 of group sessions 170–1; feedback 170;
Ratigan, B. 26, 27, 46 group interactive process 171–2;
rehabilitation 7, 77–8, 78–9, 188–9 memories 172–3; methods and
Reitman, Dr. 10 techniques 170; personal discussions
rejection, fear of 163 about the city 174–9; presence of
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research 181–2 foreigners 174; present view of project

resonance 11, 18 2013, visible objects and invisible people
responsibility 27 and feelings 170–9; product analysis
Richardson, Marion 48–9 169–71; project dimensions 167; project
risk 28 title 170; self-exploration of the team
ritual 74 168–70; Sofia Time Travel Experiment:
Roberts, J. 18 Speaking with the Unconscious Social
Rogers, Carl 48 Mind 2005 166–70; working
rooms see space relationships between conductors 168
Rosenberg, B. 29 Sofia Time Travel Experiment: Speaking
Ruitenbeek, H.M. 8, 33 with the Unconscious Social Mind (book,
Rust, Mary-Jayne 16, 58 Gheorghiev and Gheorghieva) 165
space 49, 52–3, 58–61, 155, 189–90; case
scapegoating 37, 47, 70, 142, 190 studies 95–102, 100, 101
Schafer, R. 46 splitting 28, 126–9, 126, 128
schizophrenia 185–6 Stack Sullivan, Harry 3, 26, 29, 30
sculptures 72–4, 73, 74 Strand, S. 22–3
Seglow, Ilsa 4 stroke rehabilitation 187–8
self-boxes 62–5, 63, 64, 111–12, 136–9 Studio International 56
‘Self-determination in group analytic art ‘study of structured art therapy groups, A’
therapy’ (Skaife) 50–1 (Liebmann) 13
self-expression 85–6 substance abuse 95
self-regulation 155 surfaces 97
Sensitivity movement 8 Sutherland, J.D. 7
sexuality 108, 111–12, 124–5, 124 symbolic portraits 65–6, 136
short-term interactive art therapy groups symptoms 157
75–82; anxiety 78; case example 80–2; Synallactic Collective Image Technique
difficulties in establishing groups 76; 170, 171
feedback 80; interaction 79; lack of
commitment for groups on acute wards taboo subjects 47
75–6; leadership 79; mistaken notion taking on roles 142
that art therapy is recreational 77–8; teachers 92, 103–6
need for modification of long-term technology 44, 55
techniques 76; need for therapists to terminology 103
stress value of art therapy for other staff theme-centred groups 15–16, 19–20, 32–3,
78–9; psychotic experiences 79–80; 45, 62–75; body images (life-sized
rapid turnover of patients 78 portraits) 1a, 1b, 2a, 2b, 66, 68, 69, 70,
Simon, Rita 9 71; group painting 71–2; group
Skaife, Sally 12, 23, 49, 50–1 sculptures 72–4, 73, 74; self-boxes
Skynner, A.R. 34 62–5, 63, 64; spontaneous themes
Slavson, S.R. 37 132–4, 133; symbolic portraits 65–6, 67
 Index 203

Theory and Practice of Group Vassiliou, George 170, 171

Psychotherapy, The (Yalom) 30 verbal interactive groups 21
therapeutic communities 21, 22 Viola, Wilhelm 48–9
therapists see conductors violence 60, 81, 137, 138, 139, 179
Thompson, S. 31, 47 visible reality 165
Thornton, Roy 15–16 visual confidence 54–5
Torvaianica, Rome 101, 102
training: art therapy training 12–13, 54–5; Wadeson, H. 16, 21–2, 41, 42, 48
group analytic training 12; media Warhol, Andy 58
workshops 57–8 Watson, Sophie 165
transference 15–16, 29, 31, 85, 103–6, 123 Withymead Centre 10
tribes 3b, 160–1 Woddis, Joan 12
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Tschuschke, V. 186 Working with Children in Art Therapy

turnover, of patients 78 (Case and Dalley) 83–4

United States 7–8 Yalom, Irving 3, 15, 19, 26, 30, 75, 76, 79,
unwilling participants 103–6 80, 123
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Plate 1b Body image.

Plate 1a Different body images.
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Plate 2a Body image. Plate 2b Body image.

Plate 2c Body image from a young Plate 2d Group image, including dolphin
people’s group. and vulture.
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Plate 3a King and Queen on Castle Plate 3b Tribe: clay, paint on paper and
2: paper, graphite, gold and plastic masks.
silver paint on plastic mask.

Plate 3c Abstract 1: 3-D,

multimedia.

Plate 3d Carrier: paper, plastic

straws, tape.
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Plate 4a Making an environment for self-boxes.

Plate 4b Making an environment for self-boxes.

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Plate 5a An example of an environment: ‘childhood’.

Plate 5b An example of an environment: ‘secret room’.

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Plate 6a The power of the State. Plate 6b The psychiatric hospital.

Plate 6c The eye of the therapist.

Plate 6d Group as a train.

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Plate 7a Devil mask. Plate 7c A trio of body images.

Plate 7b Racing car – made by man in Art Therapy group for people with
dementia.
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Plate 8b Environment with plants.

Plate 8a Henrietta.
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