Od múzyk psyché

III. medzinárodná arteterapeutická konferencia27. – 28. 5. 2017 v Bratislave

OZ Artea

Od múzyk psyché

Zborník príspevkov z III. medzinárodnej arteterapeutickej konferencie konanej v dňoch 27. – 28. 5. 2017 v Bratislave

Organizátor: OZ Artea 2017

Autori a autorky:Albrich Beate (Nemecko, Česko)

Bodiš Peter (Slovensko, Veľká Británia)Liebmann Marian (Veľká Británia)

Merhautová Jana (Česko)Park Tae Jung (Južná Kórea, Veľká Británia)

Valachiné Geréb Zsuzsanna (Maďarsko)

Autorka koláže na obálke:Anita Bartos

http://anita-artandcollages.tumblr.com/

Editorka:Katarína Mihinová

Grafická úprava:Ľubica Švolíková

Vydalo: OZ Artea 2017

Vydanie: prvé

Publikáciu možno nájsť na stránke: www.arte-terapia.sk

ISBN 978-80-972846-0-2 (PDF)

Dostupné od: 11/2017

Z verejných zdrojov konferenciu podporil Fond na podporu umenia.

Copyright © 2017 by OZ Artea, Sibírska 65, 83102 Bratislava Všetky práva vyhradené.

Toto dielo ani jeho žiadnu časť nemožno reprodukovať, ukladať do informačných systémov alebo inak rozširovať bez súhlasu majiteľov práv.

Za odbornú a jazykovú stránku tohto zborníka zodpovedajú autori a utorky príspevkov. Rukopis neprešiel redakčnou ani jazykovou úpravou.

Úvod

Albrich Beate, Dipl. KT (Nemecko, Česko): Stretnutie arteterapie a dramaterapie

Bodiš Peter, Mgr. (Slovensko, Veľká Británia): Art psychoterapia a na mentalizácii založená terapia (MBT).Použitie arteterapie v skupinovom prístupe zameranom na mentalizáciu

Liebmann Marian, Dr. (Veľká Británia): Time-limited Art Psychoterapy in a Community Mental Health Team: Individual Work

Liebmann Marian, Dr. and Lynne Francis (Veľká Británia): Time-limited Group Work in a Community Mental Health Team: A Short-term Art Psychoterapy Group for Asian Women

Merhautová Jana, Mgr. (Česko): Kreativita v supervizi

Park Tae Jung MA, PhD. (Južná Kórea, Veľká Británia): Art Therapy with Migration – Art Therapy with Korean Migrant Women in a Korean Community

Valachiné Geréb Zsuzsanna (Maďarsko): Thematic Symbol Focused-based on KIP- Short Term Art Therapy in Schools and Year Long Program in a Counselling Centre Comparation

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Stále častejšie sa arteterapia využíva spolu s  inými kreatívnymi modalitami a je integrovaná do rôznych terapeutických smerov. Práve z týchto spojení vzišla inšpirácia pre tretiu medzinárodnú arteterapeutickú konferenciu, ktorú zorganizovalo občianske združenie Artea v dňoch 27. – 28. mája 2017 v Bratislave. Zároveň nešlo len o  povrchné spojenie rôznych modalít. Zámerom bolo pozvať ľudí, ktorí vedia načrieť do hĺbky a rozumejú dôvodom takýchto spojení. Ako v  predchádzajúcich dvoch konferenciách, aj teraz členky OZ Artea dôkladne preskúmali domáce aj medzinárodné vody arteterapie, aby našli odborníčky a odborníkov, ktorí vedia zaujať a priniesť inšpiráciu zo svojej praxe. Na konferencii sme privítali hostí z Južnej Kórei, Veľkej Británie, Maďarska, Česka a  Slovenska, ktorých príspevky sú spracované v tomto zborníku. Prínosom lektorov a lektoriek bolo predstavenie arteterapie v kontexte časovo-ohraničenej terapie (M. Liebmann), v kontexte práce s menšinami (TJ Park), v kontexte mentalizácie (P. Bodiš), v kontexte

supervízie (J. Merhautová), prepojením arteterapie s katatýmno-imaginatívnou psychoterapiou (Z. Géreb Valachiné), arteterapie v spojení s dramaterapiou (B. Albrich) a tanečnou terapiou (L. Šuplatová a L. Šoltys Kočalová - workshop).Podnázov III. Medzinárodnej arteterapeutickej konferencie „Od Múzy k Psyché“ napovedá o  schopnosti umenia transformovať ľudskú dušu, čoho dôkazom boli prednášky a tiež inšpiratívne workshopy. Obraz s rovnakým názvom od slovenskej výtvarníčky Anity Bartos dotváral vizuálnu podobu konferencie a jej rozmerné koláže počas dvoch dní konferencie vyplnili prednáškovú sálu a očarili mnohých účastníkov a účastníčky.Naše poďakovanie patrí všetkým prednášajúcim, vďaka ktorým sme získali nové impulzy, všetkým zúčastneným, ktorí svojim záujmom a nadšením naplnili zmysel tohto podujatia a Fondu na podporu umenia ako hlavnému sponzorovi konferencie za finančnú pomoc pri realizácii.

Zuzana Krnáčová za OZ Artea

Som arteterapeutka, vyštudovala som to a robím to veľa rokov. Hovorila som si, že táto téma mi trochu pôsobí úzkosť, pretože ja som chcela byť herečkou. To bol môj veľký sen. Hrala som v skupine Anti, pro a ko. Divadlom som sa dosť zaoberala, maturovala som z  umenia a  tak. Nikdy som nezvažovala možnosť ísť na akadému umenia, pretože som si myslela, že tam budú samí super-výtvarníci a  ja až taká dobrá nie som. Ale myslela som si, že som dobrá herečka. Išla som na prijímacie skúšky a nezobrali ma. Veľká trauma, frustrácia! Nechceli ma, pretože neviem spievať, čo je pravda. Tak som s  divadlom skončila. Nemala som ho rada, nezaujímalo ma. Roky som o divadle nechcela nič vedieť. Keď som doštudovala arteterapiu, začala som pracovať v  Prahe ako arteterapeutka a  dostala som na starosť denný stacionár. Riadila som zdravotnícke zariadenie, hoci som nebola zdravotníčka, bola som žena a  cudzinka. Veľmi zvláštna kombinácia. V tom čase sa na stáži objavil Michael Reisman, Američan, DvT dramaterapeut, a ja som ho zamestnala. Začalo ma to baviť, pozerať

Stretnutie arteterapie a dramaterapie(voľný prepis prednášky z češtiny preložený do slovenského jazyka)

Dipl. KT Beate Albrich

Dipl. KT Beate AlbrichPromovaná arteterapeutka. Od roku 1992 žije a pôsobí v Prahe. Ďalšie profesijné vzdela-nie: akreditovaná psychoterapeutka (PCA), školiteľka školiteľov pre oblasť psychosociál-nej rehabilitácie (CAReEurope), akreditovaná supervízorka a mentorka supervízorov (EASC, ČIS), senior-lektorka psychoterapie a arte-terapie v Českej republike. Od 1992 - 2008 pracovala v dennom sanatóriu Fokus Praha, v rokoch 1996-2002 h ako riaditeľka viedla. V roku 2002 založila ateliér Extraart špeciali-zovaný na kreatívne terapie, v súčasnej dobe DADA Extraart. Od 2008 má privátnu prax.

Je predsedkyňou výboru Českej arteterape-utickej asociácie (ČAA), členkou Európskej asociácie supervízorov (EASC) a Etickej komisie pre supervíziu (ČIS), Arbeitskreis Kunsttherapie (D) a Asociácie dramatera-peutov Českej republiky (ADCR). Spolu-organizátorka medzinárodnej konferencie kreatívnych terapií – Space for Art Thera-pies, 2010/2013/2016 v ČR.Špecializuje sa na tieto oblasti: duševné zdra-vie a komunitná starostlivosť, individuálna a skupinová psychoterapia a arteterapia, indi-viduálna a tímová supervízia, vzdelávanie v ob-lasti psychoterapie, arteterapie a supervízie.Kontakt: beatealbrich@seznam.cz

Definujme slovo terapia, pretože terapia znamená starať sa, uzdravovať a slúžiť – aby sme vedeli, kde sa nachádzame. Téma mi bola daná: arteterapia a dramaterapia. To bol pre mňa šok.

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sa na to ako to je, a-ha tak to je. A v jeden deň prišiel jeden pán a povedal, že robí cirkus, a že je to skvelé, obzvlášť pre našich klientov – duševne chorí ľudia alebo ľudia s psychiatrickou skúsenosťou. Tak som začala s cirkusom asi od roku 1998. A predstavte si, čo som tam bola, čo asi? Klaun. Prekladateľka a  zároveň ten, čo riadi celé okolie. A  potom sme zistili, že tam robíme veľa umenia. Pretože robíme masky, tvary, kostýmy, šminkujeme sa a  vlastne je tam veľa umenia. Zároveň to ide do pohybu, hudby, rituálov. Tak som zamestnala ešte tanečnú terapeutku a  muzikoterapeuta. Na biblioterapiu som nikoho nenašla. Tak sme začali prvú skupinu, ktorá sa volala štafeta. Dramaterapeut tam bol celý čas. Bol ním Viktor Dočkal, s  ktorým sme teraz kolegovia vo výcviku a  druhá modalita do toho vždy prichádzala. Drama – art, drama-muziko, drama-tanec. Začalo ma to zaujímať viac a  viac. Absolvovala som veľa kurzov, organizovala som veľa kurzov (ktoré som garantovala a nie viedla, nie som dramaterapeutka). Založili sme centrum DADA-Extraart, kde je kombinácia arteterapie a  dramaterapie. V  súčasnej dobe máme výcvik, ktorý je skôr dramaterapeutický a  arteterapia sa tam objavuje.

Arteterapia je pre mňa často dvojmodalita, pretože v  arte-psychoterapii sa po tvorbe hovorí. Potrebujeme k  tomu dvojaké vzdelanie, aby sme mohli o  tom, čo tvoríme aj hovoriť. Vždy mi to prišlo trošku zvláštne, pretože verím v to, že výtvarná činnosť sama o  sebe, keď vhodne intervenujem a  keď idem skrz proces a  dobre sa sústredím, môže byť liečivá. Mimochodom arte znamená šikovnosť, tvorivosť, výtvarnosť. Drama, je z gréckeho slova jednanie. To ma zaujímalo, pretože ja som chcela jednať, ja som chcela vidieť zmeny u  ľudí. Ja som nepotrebovala vedieť ako boli nešťastní v minulosti alebo ako budú šťastní neskôr. Nepotrebovala som len definovať stav skrz maľbu, ani som to nepotrebovala dať do reality. Môj prístup je dynamický, analytický a mám PCA výcvik, som veľmi na človeka zameraná. A tá fascinácia, že dramaterapia a  arteterapia funguje spolu sa u mňa odohráva, je tu a teraz.Včera som zažila na tanečnom workshope zrkadlenie. To má aj muzikoterapia, arteterapia, dramaterapia. Zrkadlenie je taký „evergreen“. V arteterapii arteterapuet zrkadlí očami. Ja sa stále pozerám a dávam pozor na to, kedy intervenujem. Kedy môžem meniť tému, veľkosť, farby, formát,

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materiál, čokoľvek. Musím rešpektovať, byť empatická, akceptovať a zároveň byť na tom dobre v  sebe a  bezpodmienečne prijímať. Čo robia dramaterapeuti? Robia dosť podobné veci. Hovoria tomu „faithfull randering“, tiež zrkadlia, lákajú a ja tiež lákam na výtvarnú tvorbu, pretože je ozaj dobrá. A provokujem. Tak som si povedala, že to pasuje k sebe. Ale ako by sme to mohli spolu robiť? Akúkoľvek si niekto z  nás vyberie, ktorú sa učí, v nej by mal zostať. Opäť sa vrátim k včerajšiemu workshopu, kde sme pracovali s  hlinou so zavretými očami, 10 minút, nejaká postava... dôraz bol na tanec. Hlina bola využitá k tomu tancu. Ja by som povedala, zavrite si oči, nájdite si rytmus, cíťte dotyky, používate dlaň alebo končeky prstov? Ja by som postupovala takto, veľmi do kvalít, pretože kvalita o  mne veľa hovorí a  s  kvalitou sa môžem vyvinúť.Pracujem tak, ak pracujem čisto arteterapeuticky, že spravím najprv „rozohrievačku“ (warming up). Môže byť výtvarná alebo telesná a  potom idem na hlavnú časť, ktorou je výtvarná tvorba u arteterapeuta a potom to môžem opäť reflektovať s  nejakým pohybom alebo dramatickým dejom. Čo robím často sú masky, práca s farbami, pohyb. Na papieri sa tiež pohybujeme, robíme krátke ťahy, dlhé ťahy, čokoľvek robíme. S  kolegom dramaterapeutom sme zistili, že máme trochu iný proces. Kreatívna kríza je u  výtvarného projektu na začiatku. Najprv sa vydesíme, keď dostaneme papier – je prázdny, je veľký, hrubý, drahý.. a teraz mám niečo robiť a prejdem svojím procesom, kedy nastávajú ďalšie krízy. Mám končiť, chcela som to inak, kam to vedie.. musím prekonať túto krízu, čo je úžasné na arteterapii, že pri každom aj pri tom najmenšom artefakte musím prekonať krízu a potom sa dopracovať ku koncu.Keď toto urobím, dramaterapeut môže odísť. Pretože na koniec, my arteterapeuti máme objekt, máme obraz, masku, máme niečo. Čo už on môže robiť? My už sme proces urobili. Môj kolega je veľmi nahnevaný, keď robím objekty. Hovorí, ja nemôžem nadviazať, to už by bolo veľa. Môžeme začať novú hodinu... tak sa snažíme posledných osem rokov to kombinovať tak, že môžeme ísť od jedného do druhého. Prehlbujem to, reflektujeme, ale inak. Môj prvým dojem bol z dramaterapeutického výcviku, mali sme hrať Shakespeara alebo niečo a  k  tomu Sue Jennings, jedna zo zakladateliek dramaterapie navrhla spraviť masky. No to by ste sa divili - za desať minút boli hotoví, sadrové masky,

plácali sa na tváre a  ja som zalamovala rukami. Žiaden ochranný priestor, žiadne masáže tváre, žiadne premýšľanie o  farbách! Mali sme masky a šli sme na Shakespeara a bolo to hotové. Tak oni nás využívajú! Ja by som robili s maskami hodiny a možno potom trochu hrala. To je to, čo sa deje, keď skúsime tieto dve modality. Tiež si myslím, že moment katarzie je trochu neskôr v dramaterapii ako v  arteterapii. Krízu a  a-ha moment máme v prostriedku. Tieto dve modality dať dokopy, aby udržali tú tenziu, aby sa podporovali a živili. Keď som sama, využívam dramaterapiu k prehlbovaniu, reflektovaniu k  začiatkom. Čo ma na areterapii veľmi baví je tu a  teraz. Dramateraput nič nepotrebuje, on má prázdnu miestnosť a stačí mu to. Ja mám plné auto a som upratovačka, predtým, potom, prinášam, odnášam. A k tomu patrí nejaký setting, pripravím si to vopred. Fascinuje ma, že sa to dá spraviť aj inak. Že môžem tu a teraz byť a  že môže mať nejaký stôl bokom a  keď vidím, že skupina potrebuje niečo iné, že je tam tenzia, môžem povedať – teraz ideme na hlinu alebo teraz si ideme lepiť priestory na zem (tape art). V  tom sa teraz dosť trénujem, to ma veľmi baví. Využiť potenciál a istotu, že výtvarná činnosť sama o sebe je veľmi liečivá. Ja si myslím, že vyvolať zmenu u človeka – môj cieľ je tomu napomôcť.Mojou prácou je tomu napomôcť. Zmenu ľudia len tak nechcú. Musíme k tomu prísť, že chce tú zmenu. Musí mať toľko potenciálu rásť a byť akceptovaný, aby bol pripravený pre zmenu. V arteterapii zmenu vidieť hneď, niekto vezme tučný štetec namiesto tenkého – zmena, veľký formát namiesto malého – zmena. V  dramaterapii je tiež neustále vidno zmenu. Tam sa nepracuje s objektom, ale s telom, s abstraktnými vecami. Ako to kombinovať a ako výtvarný prejav nedať do slov do myslenia, ale ešte ho prehĺbiť. Na výcviku sa stáva, že na arte skupine si ľudia po maľovaní chcú ľahnúť, odpočinúť. Vôbec nie sú aktivizovaní. Pretože vytlačia niečo, môžeme sa o  tom rozprávať a  tak vytlačíme ten obraz. To je tiež v  poriadku. Art je otváračom k tomu kognitívnemu. Ja chcem ale ostať v liečení... pekne to bolo včera v príspevku o mentalizácii, kde to bolo o tom ako ostať v kontakte, byť s klientom, vidieť ho, napodobniť ho, neustále mu dávať spätnú väzbu že taký aký je, je v poriadku, si skvelý taký aký si, či si v invalidnom dôchodku. Ty s tým musíš žiť a poďme hľadať ako s tým budeš v poriadku. To je ako s emigráciou, raz emigruješ, tak si emigrant, nedá sa ním nebyť. Musím sa naučiť s tým žiť.

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Práca s ohňomUkážem vám prácu s ohňom u  ľudí s psychiatrickou diagnó-zou. To sú ľudia, čo dlho pri ničom nevydržia. Fakle si vyrobíme, tancujeme s ohňom a robíme ohňové obrazy. To je neuveriteľná vec, pretože prejdeme všetky fázy procesu. Najprv sa ide do lesa, kde si nájde každý palicu, ktorá je len jeho, ktorú si on pripraví. Niekto má veľkú a niekto zas malú, ideme do art. Potom to celé zostavím, občas si rozprávame príbehy a na záver si tie fakle za-pálime. Všetci títo ľudia prešli psychózu a pre ľudí s psychózou je to krásny obraz. Pretože oheň je nebezpečný a preto musíme dodržiavať nejaké pravidlá, lebo inak seba alebo niekoho iné-ho popálim. Zároveň ako vidíme cirkus, ako sa to pripravuje, musím sa spoľahnúť na druhých a  to je tiež skupinová práca. A  je jedno či som terapeut alebo klient. Pretože vo chvíli keď

urobím nesprávny pohyb, druhého popálim. Musím mať veľkú kontrolu a zároveň neuveriteľne krásny oheň, s ktorým môžem robiť krásne obrazy. Ideme pol na pol, na konci býva predsta-venie, nie vždy. Na začiatku máme iba jeden oheň a ten oheň sa predáva, to tam tiež patrí, že je to vždy slávnosť. Vnímam to aj v obrazoch. Musíme to osláviť, my sme niečo vytvorili, niečo, čo nikto predtým nevytvoril. Nie je to divadlo, je to drama.. vzniká to na mieste, v tejto chvíli. Každý robí to, čo chce a čo vie.

CirkusAj to ako pracujem, vzniká z atmosféry, čo sa deje a každý terapeut ide podľa potreby toho, koho vidím. On my hovorí, kam ideme, on mi ukazuje cestu. V tom je terapia, v tej chvíli, keď so mnou niekto ide, niekto mi rozumie, môže so mnou ísť, môžem niečo zmeniť –som dobrý.Túto jar sme tancovali so šatkami a niekto povie: „Slnko, keby už aby bolo slnko, ja by som chcel slnko.“ A tak sme si začali robiť masky slnka, aby sme uvítali tento rok. Každý po svojom, kaž-dý so svojím nápadom. A potom vo dvojiciach, jeden pripravil druhého. Naštylizoval ho tak, ako sa mu zdá, že sa to k nemu hodí. Výtvarná práca je v tom celom veľmi pokojná. Boli sme tak hrdí na svoje slnká, že sme sa slnku chceli ukázať. A tak sme šli von a ukázali sme slnku, že aj my sme slnko. Týmto ľuďom nikto nikdy netlieskal... Naraz jeden z našich artistov (my im hovorí-me artisti) povedal, že aj my sme slnko. Potom sme robili fotky tak, že my sme slnko. Potom si niekto všimol, že má tieň a pove-dal: „Ja mám teň, sme tu dvaja, som psychotik, tik...“. A začal celý nový príbeh o tieňoch. A šli sme do ďalšej transformácie - do našich tieňov. Tu by sa dal tieň aj maľovať a ďalej s ním pracovať, no to sme my už nerobili. Ten impulz ako to fotenie bol od jed-ného nášho človeka a aj ten tieň bol zas od niekoho iného, ako aj námet slnko. A arteterapia a dramaterapia išla pol na pol.

Popis práce v rámci Cirkusu Bombastico Praha– komunita ľudí, ktorí prešli či prechádzajú psychickou, prípadne psychotickou krízou. Od r. 2013 sa tento projekt osamostatnil od n.o. Fokus Praha a pokračuje pod hlavičkou DADA Extraart, z.s.

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Na úvod by som rád upozornil, že táto metóda je súčasťou širšieho programu a jej efektivita v liečbe Hraničnej Poruchy Osobnosti bola meraná v rámci širšieho liečebného progra-mu, ktorý má rôzne podoby uplatnenia založené na špeci-fickom prístupe a kompetenciách terapeutov v širšom multi-disciplinárnom tíme.

Kľúčové pojmy: Hraničná Porucha Osobnosti (HPO), Art Psychoterapia, Na mentalizácii založená terapia (MBT), vzťahová väzba, men-talizácia Ako uvádza Heretik (2007): Emocionálne nestabilná porucha osobnosti je typická výraz-nými a dlhotrvajúcimi výkyvmi v oblasti prežívania emócií a správania. Veľmi často sa vyskytuje výrazná impulzivita, problém kontrolovať, usmerňovať a plánovať svoje správanie.Pri impulzívnom type emocionálne nestabilnej poruchy osobnosti sa vyskytuje najmä problém ovládať svoje hnevlivé impulzy, čo často môže viesť k výbuchom, agresii a násilné-mu správaniu. To potom často znamená, že jedinci s touto poruchou sú trestne stíhaní. (pozn. autora)Pri hraničnom type emocionálnej nestabilnej poruchy osob-nosti je v popredí striedanie silných a opačne nabitých emócií vo vzťahu k blízkym, chronické pocity prázdnoty, dlhodobá ambivalencia ohľadne seba samého, svojich emócií, plánov či preferencií. Prítomné býva zdravotne rizikové správanie – napr. striedanie sexuálnych partnerov, zneužívanie návyko-vých látok či iné rizikové správanie (rýchla jazda autom za

Art Psychoterapia a na mentalizácii založená terapia (MBT)Použitie arteterapie v skupinovom prístupe zameranom na mentalizáciu

Mgr. Peter Bodiš

účelom vzrušenia a podobne). Pomerne často sa vyskytuje aj sebapoškodzovanie a rôzne suicidálne tendencie či pokusy. Podľa výskumných údajov asi 2-4% dospelých, najmä žien, môže trpieť emocionálne nestabilnou poruchou osobnosti (častejšie tzv. hraničného typu). Viac informácii k tejto poruche je možné vyhľadať v Medzi-národnej klasifikácii chorôb (MKCH-10)Art terapia/Art psychoterapia sú v Spojenom Kráľovstve Veľ-kej Británie a Severného Írska chránené tituly. A táto profe-sia je regulovaná v HCPC (Health and Care Professions Co-uncil) ako pridružená zdravotnícka profesia (Allied Health Profession) rovnako ako napríklad fyzioterapeuti, logopédi a ďalších trinásť profesií.

MBT je pomerne nový koncept vyvinutý P. Fonagym a A. Bate-manom, ktorí sa spočiatku snažili nájsť odpoveď na bujnejúce publikácie v oblasti techník Kognitívne Behaviorálnej Terapie, ktoré ohrozovali pozíciu hlbinne orientovaných psychoterape-utických smerov. Hlbinne orientovaná psychoterapia má veľa prístupov a teoretických konceptov a techník, ktoré sa však nezainteresovaním zdajú plné komplexných teórií a žargónu. Fonagy a Bateman sa zamerali na skúmanie konceptu men-talizácie, ktorý nie je nový - ale je zároveň podstatou medzi-ľudskej komunikácie a vzťahov. Na základe poznatkov z výskumu vypracovali koncept MBT. V Slovenskej literatúre sa mu venuje Profesor Jozef Hašto, ktorý publikoval aj na túto tému.

Väčšina arteterapeutických prístupov vo Veľkej Británii vychá-dza z teórie vzťahovej väzby (attachment theory). V rannom

Mgr. Peter Bodiš Vyštudoval Liečebnú pedagogiku na UK v Bratislave. Počas štúdia nadviazal kontak-ty v Škótskom Aberdeene v Camphillskej komunite a potom pôsobil v Aberdeene ako manažér rôznych zariadení pre ľudí s men-tálnym postihom a duševnými poruchami, poruchami osobnosti a post peninterciárnej rehabilitácii a re-integrácii. Etabloval sa ako Art psychoterapeut počas stáže v Art Psycho-therapy Department pri Royal Cornhill Hospi-tal a neskôr s pomocou dotácie zo škótskeho parlamentu založil organizáciu Arts therapies for all (http://aberdeenarttherapy.org.uk) poskytujúcu arteterapeutické služby na se-vero-východe Škótska.

V roku 2015 sa presťahoval do Anglicka a pôsobil v terapeutickej komunite v Exeteri na Špecializovanom oddelení pre poruchy osobnosti pod NHS (National health servi-ce). Momentálne pôsobí ako arteterapeut v súkromnom nemocničnom zariadení na predmestí Londýna.Odborne je orientovaný psychodynamicky, absolvoval na Mentalizáciou založenený prí-stup MBT výcvik pod Anna Freud’s Centre v Londýne. Špecializuje sa na terapiu po-rúch osobnosti, výskum v Art psychoterapii a meranie klinickej efektivity.

Kontakt: arttwork@gmail.com

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veku sa naučíme zdieľať našu pozornosť s matkou alebo inou dôveryhodnou osobou v senzitívnom období budovania po-citu bezpečia a dôvery. Táto schopnosť sa dá zlepšiť aj v ne-skoršom veku. A práve tu sa nám naskytá príležitosť pre arte psychoterapeutov pri vysvetlení procesov v individuálnej aj skupinovej psychoterapii. Drobné interakcie, podstatné vo vzťahovej väzbe a ich výz-nam popisuje Dr Edward Tronick vo videu. https://www.youtube.com/watch?v=apzXGEbZht0. Podobné interakcie vedome využívame aj v terapeutických sedeniach a ako je zjavné zo ‘still face experiment’ (experi-ment nehybnej tváre) – nezáujem signifikantnej osoby v blíz-kom vzťahu má dôsledky v strate kontroly nad vlastným ko-naním, ktoré sú tak typické pre ľudí s poruchami osobnosti.

Ani účinnosť kognitívno behavirálnych terapeutických techník neprináša dlhodobú zmenu v správaní jedincov ak nie sú facilli-tované v prostredí dôveryhodného terapeutického vzťahu.

Práve mentalizácia definovaná v Oxfordskom slovníku (2010) v dvoch významoch: 1. vytváranie obrazu/predstavy v mysli alebo dávanie mentál-

nej kvality niečomu; 2. mentálne vyvíjanie alebo zveľaďovanie a tiež stimulácia

mysle niekoho. A tento proces je možný len ak je si človek vedomý vlastných mentálnych procesov a stavov a ich vplyv na interpersonálne vzťahy.

V klinickom kontexte, schopnosť mentalizácie môže byť vnímaná ako istá úroveň reflektívneho fungovania (Reflec-tive functioning). Podľa manuálu Reflectivneho Functioning on the Adult Attachment Interview - Fonagy, Tagert, Stee-le a Steele (1998) keď je definícia vnímaná v kontexte škály reflektívnej funkcie. Tu mentalizovanie znamená kapacitu vnímať a chápať vlastné a cudzie stavy mysle (pocity, pre-svedčenia, zámery a túžby). A tiež kapacitu obhájiť a vysvetliť –vlastné aj cudzie spávanie v kontexte stavov mysle – reflexie. Ešte by bolo možno vhodné pridať, že kapacita pre reflexiu je vnímaná vo vzťahu ku kvalite prežívania psychickej reality jedincov – a pridáva na hodnote a pestrosti vnútornej skúse-nosti. (tamtiež)

Ako uvádza Neil Springham(2012): Z pohľadu pacientov je arteterapia dôležitou súčasťou pomo-ci pri rozvíjaní schopnosti mentalizovať. Výskum ukazuje, že zakotvením mentálneho obsahu v externalizovanej podobe – arteterapia ponúka pružnosť spomalenia procesu explicitnej mentalizácie na zvládnuteľné tempo. Tieto nálezy boli spojené s podobnými výskumami v štúdiách zahŕňajúcich pacientov v Nórsku a USA. V klinickom poňatí v rámci MBT nie je termín ‘mentalizá-cia’ definovaný ako forma psychoterapie, ale označená ako základný ľudský proces, ktorý môže byť podporovaný kon-krétnymi ľudskými interakciami. Svojím spôsobom je men-talizácia mechanizmom zmeny bežným vo všetkých formách psychoterapie, pretože adresuje základnú ľudskú kapacitu, chápania vlastnej mysle a mysle druhých, pomocou kalibrá-cie pacientovho vlastného vnímania cez chápanie pohľadu druhých na nich samotných. (Fonagy, Bateman, & Bateman, 2011, s. 102)

Podľa MBT manuálu - MBT je zvyčajne sprostredkovaná súbežne vo forme skupinových aj individuálnych sedení. Pri individuálnych sedeniach je cieľom explorácia intra-psychic-kých problémov a pri skupinovej práci - medziľudské fungo-vanie. Tento model je jasne zadefinovaný a kladie si za úlo-hu prekonať špecifické prekážky v liečbe Hraničnej Poruchy Osobnosti. (Allen & Fonagy, 2006).Terapia predpokladá, že psychoedukácia (MBTi) spolu s ná-cvikom tejto schopnosti “in modus operandi” sa pacient do-pracuje k aktivácii schopnosti mentalizovať a tiež k schop-nosti využívať túto funkciu mimo klinického prostredia - v bežných každodenných situáciách.

Zhrnutím veľkého množstva výsledkov výskumu mozgu, Fo-nagy and Luyten (2009) ukázali, že dospelí pacienti s diag-nózou HPO majú značne nižší prah pre aktiváciu núdzové-ho systému (útok-útek) a pridruženú schopnosť deaktivácie mentalizácie. A tento jav má nesmierny dopad na účinnosť terapie ako napríklad terapeutickú spoluprácu (therapeutic allience). Podrobnejšie sa tomuto javu ako aj epistemickej dôvere a ne-dôvere v tomto príspevku nebudeme venovať, aj keď vychá-dzame z premisy, že terapia bez týchto základov má mini-málny vplyv ak dokonca nepôsobí kontraproduktívne bez vybudovanej vzájomnej dôvery v terapeutickom vzťahu.

Zo štúdie vyplynulo, čo si samotní pacienti myslia o užitoč-nosti arteterapie v procese ich liečby.

Názor pacientov na účinnosť arteterapie v MBT programe: • Nesúťaživý pokoj v skupine • možnosť sa sústrediť na vlastné mentálne obrazy• podpora v hľadaní osobného výrazu v obrazoch • odozva od iných pacientov a terapeuta na umelecké výtvory• vnímanie iných mentálnych obrazov • pomoc pri chápaní a reflexii o vlastnej mysli v porovnaní

aj v kontraste s mysľou iných (Karterud & Pederson, 2004)

Podieľanie sa na tvorení a umení založenom na spoločenskej aktivite ponúka úroveň stimulácie, ktorá rozptyľuje utrpenie z pocitu blízkosti druhých. Zmysluplné spojenia sú živené prostredníctvom ”väzby k umeniu” a “väzby cez umenie”. Tieto procesy umožňujú sústredenie skúsenosti v konverzá-cii, ktorá napomáha ľuďom pri angažovaní sa v terapii zni-žujúc tak ich odlúčenie od spoločnosti. (Turner et al., 2011, s. 342)

Napätie vo vzťahu s terapeutom, alebo aj v skupine sa môže rozptýliť pomocou prenosu cez umenie, alebo aj efektom prenosu pomocou čiernej ovce (scapegoat transference). Napríklad: Osoba(1) v skupine mala výhrady k určitým postojom druhej osoby(2) v skupine. Zlosť a hnev, ktoré sa týmto nahromadili v pocitoch tejto osoby(1) vo vzťahu k osobe,(2) sa v arteterapeutickom skupinovom sedení preniesli do vehementnej kritiky umenia osoby(2). Takáto konfrontácia by bola v otvorenej konverzácii neúnosná pre obe zúčastnené. Avšak použitím umeleckého výtvoru ako obetného baránka, dokázala osoba(1) vyjadriť svoje pocity v prítomnosti osoby(2). A tá si túto kritiku vypočula bez nadmerného vzrušenia – ktoré by pri takejto konfrontácii

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bolo pravdepodobne viedlo k disregulácii a strate kontroly, alebo aspoň k zvýšenému tónu hlasu a podobne. Umenie akoby absorbovalo interpersonálny prenos. Emočný tlak nebol mierený na nikoho v skupine priamo, ale na výtvor na papieri.

Ciele: Ako sa dočítame v manuále MBT - Cieľom art terapie v MBT je alternatívny spôsob podporovania procesu mentalizácie, niekedy označovanej ako externá mentalizácia. (Allen, 2003)Umelecká tvorba umožňuje vnútorným obsahom, aby boli vyjadrené externe a potom verbalizované s odstupom cez al-ternatívne médium a z novej perspektívy. Skúsenosti a pocity sú umiestnené mimo myseľ a poskytujú príležitosť pre expli-citnú mentalizáciu.V takýchto podmienkach sa mentalizovanie stáva vedomím verbálnym, zámerným a reflektívnym. Pacienti vygenerujú niečo svoje, ale to sa stáva externým a zároveň oddeleným - na jednej strane je to reprezentácia ich osobného stavu a zá-roveň je to len kresba, maľba alebo kus hliny a podobne. Art terapia vytvára prechodné objekty (transitional objects) a te-rapeut má za úlohu vytvoriť priestor, kde sa v skupine pod-poruje sebavyjadrenie a zároveň sa udržiava stabilita men-tálnych stavov. Rozdielom medzi tvorivou terapiou a  inými časťami terapeutického programu je, že pacient vytvorí kon-krétny produkt. Tento produkt umožňuje skupine a pacien-tovi sústredenie sa na špecifickú časť reflexie. Niektorí pa-cienti potvrdzujú, že v expresívnych terapiách nepodliehajú úzkosti, ako keď sa snažia priamo pracovať na sebareflexii, alebo vo vzťahu k druhým. Produkt ako časť alebo aspekt Ja (self) - je umiestnený vonku a preto sa javí menej nebezpeč-ný, menej kontrolujúci a tiež menej neprekonateľný. Pocity sa stanú znesiteľné a vlastné chápanie a chápanie druhých je tolerovateľnejšie vďaka odlúčeniu v procese tvorby. Pri iných pacientoch, najmä keď ich dominantnou funkciou je modus presvedčenia o jasnozrivosti‘ (psychic equivalent mode), môže mať tvorivá terapia úzkosť vzbudzujúci účinok. Pro-dukt, ktorý vytvoria, sa tak stáva príliš reálnym aspektom ich vnútorného prežívania. Takéto zážitky môžu mať zdrvujúci dopad na prežívanie jedinca. Preto je veľmi dôležité, aby ar-teterapeut prispôsobil požiadavky individuálne pre rôznych pacientov v rôznych fázach terapie.

Metóda: Arteterapia je vedená v malej skupine, jeden alebo dvakrát do týždňa. Sedenia trvajú 75 minút. Forma sa môže líšiť od individuálnej práce na osobných cieľoch v skupine, individuálnej práce na skupinovú tému, až po skupinovú prácu – spoločný projekt. Každé sedenie sa začína sústredením sa na vnútorné prežívanie a na čom by pacient/ka chcel/a pracovať počas sedenia. Niekedy terapeut prinesie relevantnú tému, niekedy tému vygeneruje skupina. Potom ako sa ustanoví forma sedenia (téma, individuála alebo spoločná práca a pod.), pacienti si zvolia, kde v miestnosti budú pracovať najbližších 30 minút. Po skončení sa pacienti opäť zídu v skupine a diskutujú o svojej tvorbe. Počas tejto diskusie, tak ako počas celého programu, je terapeutovou úlohou stimulovať mentalizáciu sústredením sa na afekt, jeho identifikáciu v osobnom i interpersonálnom kontexte. Terapeut by sa mal tiež usilovať o to, aby sa pacienti zamysleli nad zmyslom expresívnych snáh ostatných a pomôcť im vnímať rozdiely vpozorovaniach iných členov skupiny

a  ich alternatívne perspektívy. Umelecká expertíza nie je dôležitá sama o sebe, ale proces vyjadrenia sa a diskusia o práci na vyjadrení je viac signifikantná. Je veľmi dôležité, aby arteterapeut neustále prinášal do diskusie sústredenie sa na dohodnutý zámer skupiny pred nasledovaním hlbšej explorácie, ako by to bolo žiaduce v iných MBT skupinách, alebo individuálnej terapii. Zámerom je zvýšiť pacientovu aj terapeutovu schopnosť venovať sa úlohe bez rozptýlenia inými témami a snaha posilniť vedomú kontrolu. Často sú pacienti vyrušení vlastnými emocionálnymi reakciami a strácajú kontakt s dominantnou témou skupiny – pokiaľ sú zadumaní v subdominantných témach.

Diskusia o výtvoroch je štruktúrovaná a o každom výtvore sa diskutuje osobitne a v tejto následnosti:• Umelec je prizvaný opísať svoj obraz – často spôsobom ako

napríklad: ‘Povedzte nám, čo si myslíte o obrázku teraz keď je hotový – skúste ho opísať ako keby nebol Váš.’

• Arte terapeut potom vyzve ostatných členov skupiny, aby komentovali alebo prebádali zámer autora. Obyčajne otáz-kami typu: ”Čo chcel autor týmto vyjadriť? Ak neviete, po-vedzte čo je pre Vás zjavné.”

• Arte terapeut potom pozve umelca aby sa sústredil na odo-zvu skupiny s otázkou: “Čo to pre nich znamená?”

• Arte terapeut komentuje výtvory len po týchto sekvenciách a ponúka len ďalšiu perspektívu a snaží sa uviesť rámec prí-spevkov na danú tému – vyhýba sa zaujatiu pozície experta.

Potom poďakuje umelcovi a skupina pokračuje k ďalšiemu umelcovi/pacientovi.

Skupina špecializovaná na poruchy osobnosti v rámci Brit-skej Asociácie arteterapeutov vyvinula v roku 2012 sumá-rum profesionálnych pokynov práce s pacientami s porucha-mi osobnosti.

Podľa nich má arteterapeut:1. Zariadiť jasnú formuláciu terapie, vytvorenú s pacientom

a spojenú s celkovým balíkom starostlivosti. Toto musí za-hŕňať zhodu v chápaní problému, sústredenie sa na liečbu a pacientovu voľbu. Forma psychoterapie použitá v arte-terapii, musí byť na evidencii založený model a zdieľaný v širšom liečebnom tíme.

2. Zaistí aktívnu spoluprácu v liečebnom tíme a súdržnosť v prístupe liečby. Toto musí zahŕňať zdieľanie rizík a ich manažment, súhlas o vymedzení dohodnutých pravidiel a pokiaľ je to možné - tímovú supervíziu.

3. Sprostredkuje úsudok o skupine alebo jedincovi podmie-nený pacientovými špecifickými vlastnosťami vo vzťaho-vej väzbe (attachment). Typ vzťahovej väzby pacienta je určujúcim faktorom pri výbere vhodnej intervencie a pri rozhodovaní o začlenení do skupín aj pri individuálnych sedeniach. Terapeut musí venovať pozornosť najmä kon-com, zmenám a časovému rámcu.

4. Propaguje umenie ako stredobod pozornosti počas terapie a ako externalizáciu rôznych stavov mysle. Týmto predpo-kladá, že problematické pocity a postoje a tiež pacientove vlastné prejavy sa odrážajú v tvorivom počine a sú spoloč-ne zvážené.

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5. Podporuje umenie ako fyzickú aktivitu s potenciálom re-gulácie vzrušenia (affect) a kontrolu pozornosti. Umelecký výtvor konkrétne zaznamenáva proces vyjadrenia v bez-pečnejšej forme.

6. Sústreďuje pozornosť na umelecké výtvory aby podnietil verbáne sústredenie na prítomnosť. Počiatočné štádium tohto procesu vyžaduje vyhýbanie sa komplexnému pou-žívaniu metafor alebo interpretácie. Minulosť je braná do úvahy v súvislosti so súčasnými pocitmi a nie pre podporu opakovania predpojatosti.

7. Napomáha zdieľaniu čo možno najväčšieho množstva perspektív na umelecký výtvor. Pokiaľ prvoradým cieľom diskusie je pochopenie vyjadrenia autora prostredníctvom jeho umeleckého výtvoru, zároveň sa snažíme objavovať rozličné pohľady ostatných a aj ich umelecké vyjadrenia - čím prispievame ku kladnému chápaniu seba samotného.

8. Poskytuje úprimné odozvy na umeleckú tvorbu a udalosti v terapii – slúžiace terapeutickej komunikácii. Artetera-peut sa angažuje v polohe spolupracovníka a otvorenými otázkami sa vyhýba stanovisku “expertného ponúkania vhľadu”.

9. Aktívne zaisťuje zrozumiteľnosť komunikácie v skupine. Vyhýba sa viaczmyslovosti významov aj príliš dlhým mo-mentom mlčania

10. Aktívne objavuje riziká a výrazy s úmyslom raniť seba ale-bo druhých. Toto môže vyžadovať závažnú zmenu v lieč-be – napríklad pridaním terapeutických sedení alebo kontraktu alebo aj možnosť ukončenia liečby. V prípade potreby formulovať krízový plán.

Záver: Cieľom prednášky a workshopu, bolo priblížiť zúčastneným a zaintersovaným – špecifický prístup a použitie artetera-pie v rámci širšieho intenzívneho terapeutického programu MBT pri terapii hraničnej poruchy osobnosti. Zámerne som sa vyhýbal pokusu o vysvetlenie princípov a špecifík MBT, keďže táto téma presahuje rámec, v ktorom som mal priestor a príležitosť venovať sa najmä aspektom liečby spojeným s arte psychoterapeutickou praxou. Spätne hľadiac na prie-beh workshopu – myslím, že som mohol štruktúrovať tento priestor a využiť ho napríklad na cielené vysvetlenie modu-sov nementalizovnia – ktoré sú jedným s kľúčových termínov v tomto koncepte terapie.

Použitá a odporučená literatúra:ALLEN, J. a FONAGY, P. 2006. Handbook of mentalization-based treatment, Chichester: John Wiley & Sons Inc.

BATEMAN, A., BALES, D., HUTSEBAUT, J. 2014 A Quality Manual for MBT

FONAGY, P., BATEMAN, A. a BATEMAN, A. 2011. The widening scope of mentalization: A discussion. Psychology and Psychotherapy: Theory, Research and Practice, 84: 98–110.

FONAGY, P. a LUYTEN, P. 2009. Developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21: 1355–1381.

FONAGY, P., TARGET, M., STEELE, H., STEELE, M. 1998 Reflective functioning manual – Version 5 For application to Adult Attachment Interviews, University College London. Publikované v Anna Freud pre porteby výcviku

HERETIK, A., sr. Poruchy osobnosti. In: HERETIK, A., SR., HERETIK, A., jr. (eds). Klinická psychológia. Nové Zámky: Psychoprof, 2007. – všeobecný úvod k poruchám osobnosti, s uvedením symptómov rôznych porúch osobnosti.

KARTERUD, S. a PEDERSON, G. 2004. Short term day hospital treatment for personality disorder: Benefits of the therapeutic components. Therapeutic Communities, 25: 43–54.

TURNER, K., LOVELL, K. and BROOKER, A. 2011. ‘… and they all lived happily ever after’: ‘Recovery’ or discovery of the self in personality disorder. Psychodynamic Practice, 17: 341–346. SPRINGHAM, N., DUNNE, K., NOYSE, S., SWEARINGEN, K. 2012; Art therapy for personality disorder: 2012 UK professional consensus guidelines, development process and outcome, International Journal of Art Therapy Vol. 17 , Iss. 3.

SPRINGHAM, N. 2012; D. Findlay, A. Woods & J. Harris; International Journal of Art Therapy, Inscape. Volume 17. Číslo 3; s.115

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Introduction I work for the Central Recovery Team, a community mental health team based at Brookland Hall in the inner city of Bristol, an area of considerable diversity including white British people, immigrants from Europe, Asia, Africa, the West Indies and the far East, and their children born in Bristol. As a port, Bristol has had minority ethnic people settling there for several centuries.

The community mental health team is multi-disciplinary and includes psychiatrists, community psychiatric nurses, mental health workers, psychologists, liaison workers with other agen-cies and a part-time art therapist (me). Several staff are from minority ethnic groups, with knowledge of many languages. Clients are visited at home or in counselling rooms at the team base. My art therapy room doubles as a multi-purpose room when I am not there. From time to time I run theme-based groups on specific topics, but most of my work with service users is with individuals, usually weekly appointments for one hour, sometimes fortnightly.

Rationale for short-term workWorking in a community mental health team means work-ing under pressure for much of the time. It is good that art psychotherapy is now much more well-known, but the result is often too many referrals for the capacity available. When art therapy was less well-known, art therapists could work for many years with the few referrals who came their way. They worked with people until they were able to cope on their own and lead meaningful lives free of mental health symptoms, often taking many years. This is no longer the case. Art thera-py is now also offered to a much wider range of service users, as the benefits have become better known, and sometimes other treatments have had little impact.

When I started work in my community mental health team, I was aware of a short-term counselling service in the inner

TIME-LIMITED ART PSYCHOTHERAPY IN A COMMUNITY MENTAL HEALTH TEAM: INDIVIDUAL WORK

Dr. Marian Liebmann

city, attached to primary care, offering up to 12 sessions of counselling, mainly for mental health problems around life events, such as bereavement, divorce, unemployment, and so on. Ours was a secondary service, for those whose needs could not be met by the primary service. Clearly I needed to offer more than 12 weeks – but if I offered an open-ended contract, I was aware that, after accepting the first handful of service users, I could be booked up for years. I therefore of-fered individual service users a year, which could be renewed up to two years. This was useful in sorting out those who proved capable of using the service well, and those for whom it was not achieving very much.

The latter group of service users included people who failed appointments to the extent that work with them lost coherence; those who hardly used the art materials (of course using art materials every session is not obligatory, but if someone does not find them at all useful, they would be better off being referred to verbal therapy); those whose needs turned out to be far from art therapy, e.g. sorting out practical problems week by week; and those who just did not seem motivated to make any changes in their lives, looking for a ready ear to repeat their story. I did not turn these people away, but when the agreed year was up, we simply finished our work and reviewed what they had done and what they needed next – work on alcohol or drugs; a community care worker; advice on voluntary work, and so on. However, if someone was working hard and making progress with their issues, I offered them another six months, and maybe a further six months. Some of the most successful work has taken two years, occasionally more.

With the pressure of referrals, these times have been revised downwards, and I now am able to offer only six months in the first instance. Again, some people finish their six months, and I do not offer more, as they do not seem able to use the space or the medium in a constructive way. Some

Dr. Marian LiebmannPracovala arteterapeuticky s rôznymi skupina-mi ľudí ako napríklad delikventi, ženské skupi-ny, žiadatelia o azyl, utečenci alebo komunity. 19 rokov pracovala v Inner City Mental Health Team v Bristole, kde vyvinula krátkodobú prácu s klientmi s problémami so zvládaním hnevu.Ako lektorka arteterapie pôsobila na nie-koľkých vysokých školách vo Veľkej Británii a v Európe. Pracovala taktiež v oblasti nápravy

spravodlivosti, mediácie a riešení sporov. Vied-la workshopy na tému arteterapia, konflikty a hnev v mnohých krajinách Európy, USA, La-tinskej Ameriky a Afriky. Je autorkou 12 kníh, vrátane knihy Arteterapia a hnev.V súčasnej dobe má súkromnú prax, venuje sa supervízii, vedie rôzne workshopy a zúčastňuje sa konferencií.Kontakt: marian@liebmann.org.uk

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I offer another three or six months, then we finish after a year. Occasionally we continue for more time, but this is discouraged in our Psychological Therapies Service, unless we make a case for longer term work. We now see our work as providing ‘episodes’ of treatment, working as part of a multi-disciplinary team, rather than seeing a person through to the end of their treatment on our own.

We are also now much stricter with people who fail appoint-ments. There may be many good reasons why people can-not keep appointments, but with the pressure of referrals, we need to work with those who are able to come. So there are several people who are referred but never show up. This is probably more of an issue in our inner city team than the other teams, but it is a problem there too. Generally two (or occasionally three) appointments are offered, then if they do not make contact, they are taken off the list.

Sometimes I am asked to do a short-term piece of work with a service user, around a particular issue, for instance anger; or relapse prevention; or looking at sexuality using art therapy; or work issues (for the few service users who are in work). Then I agree with the service user to offer 8 to 12 sessions, and we keep to that. This was the case with the service user I will describe.

Cathy: work issuesCathy was in her early fifties and had been sacked from her job as a nurse for making a mistake with medication, and was trying to come to terms with the end of her career and livelihood as a nurse and midwife, and find a way forward. She had asked for assessment by a psychologist, as she had not had one before, and felt this might help. However, the psychologists were booked up, so I offered her 12 sessions of art therapy. Although somewhat dubious, she agreed to give it a try, as it seemed to be the only thing on offer.

Cathy told me something about her background. She de-scribed her problems starting when she was born, and said she had been depressed from the age of 14, receiving little help and support as a child. She had a brother two years younger, and said that he had similar problems, being unable to communi-cate, resulting in aggression and violence. The family moved to Wales when Cathy was aged 6, and at the age of 12 she was sent to boarding school in Oxford, because it was the school her mother went to. Her brother stayed at home and she was jealous of him, and felt excluded from the rest of the family. But she enjoyed boarding school, and felt she was better off there than at home, because of the tensions with her parents and brother. Her mother was very authoritarian, resulting in many arguments; even now that she was in her late seventies, it was clear that she had a lot of power over Cathy.

Despite this shaky start, Cathy had tried to make a go of her life. She had trained initially as a nurse and then as a commu-nity midwife, working in a variety of places, with some peri-ods of unemployment, during which she had returned home. She had then attempted a degree in environmental manage-ment, but had left after the first year. A more recent job had been with a drug and alcohol team in Birmingham, where she had felt unsupported and succumbed to anxiety and de-pression. She had received nine months’ counselling, which

had given her the strength to carry on. But the depression and fatigue ultimately led her to resign from the job. She applied for the job in Bristol because it sounded good, with adequate support – but the reality had been different. She experienced the same lack of support and crashed into depression. She made the mistake with medication while under extreme stress. She took extended sick leave and was in the process of being dismissed when she resigned. Later she decided she had been ‘constructively dismissed’ and went to an employment tribu-nal. At the time of my involvement, she was waiting for this, and also taking advice from MIND (a mental health charity), and writing to her member of Parliament.

Art therapy assessmentWe discussed the issues Cathy was facing. I often give service users two forms, which they can fill in, or ask me to act as their secretary. The first one lists problems and how severe they are, giving each a score out of 10 (where 0 is terrible, and 10 is fine). Cathy’s list was as follows:Coming to terms with what has happened as regards mental breakdown (8).How I am going to live because I’ve lost my livelihood (0).Worry as regards elderly parents as they are supporting me at the moment and their health is not too good (8).Worry about losing my flat due to loss of income and having to move in permanently with my parents (6).Stress outside my control as this can lead to fatigue which is the route to depression. Fear that medication might stop working (2-4).Top of Cathy’s list was clearly her loss of income, followed closely by stress leading to fatigue and depression.

The second form has a ‘future focus’ and is more orientated towards solutions. I asked Cathy to say how she would know when she was better. She wrote:1. Being able to cope again despite depression which I might

always be susceptible to.2. As the months go by and being on medication I can feel the

difference – I can feel ‘lighter and brighter’.3. I remember how bad I was when my mental health broke

down.4. I’m able to remain calmer for longer under stress (reason-

able). I don’t withdraw into myself so much.5. Coping skills are returning and this time are becoming

more positive and changing somehow.

Finally I asked her what strengths/ personal qualities she had which helped her cope with difficult things. She wrote:Inner strength and resilienceThe ability to search out information and beaver away in an attempt to understand my breakdownGardening – having created a garden out of the jungle that had become my garden.Ability to withdraw in a positive way – going for long walks, gardening.Finding ways to rebuild my life through social history pro-jects, as a consequence of walking and tree-gazingI usually find that the more someone can say how they would know they are better, the more likely they are to achieve that. Many service users cannot do this at all. The fact that Cathy could do so was an optimistic sign.

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ART THeRAPy SeSSIONS

Session 1Cathy talked about her current state of mind and her anxiety about getting depressed again. She used pencil and felt-tip pens to draw four windows showing this:Top left: plain green – representing normality/ natureTop right: plain light blue – representing peace/ seaBottom left: black downward spiral on grey, surrounded by black – representing depressionBottom right: black coals and orange flames, surrounded by red – representing turmoilBetween the windows, she filled in yellow between the green and blue, and grey between the rest.

I asked Cathy if she was aware of any signs of looming de-pression, and she said she withdrew. She thought other peo-ple could see this, but they had not responded as she had hoped (e.g. asking how she was, a kind word or sympathy) and Cathy had felt hurt by this. I wondered if she had consid-ered the many possible responses to someone withdrawing, depending on the other person’s state of mind – this seemed a new idea to her.

Session 2Cathy asked to look at the previous week’s picture and start-ed tracing with her finger what led to what. This led on to her next picture. Cathy used coloured pencils, felt-tip pens and oil pastels, which she enjoyed for the variety of textures they could portray. She used elements of her first picture, but showed more clearly how one state led to another. She again drew a block of light blue for calmness (top centre), which

could get upset and ruffled (different shadings of blue, and blue spiral), leading to a black downward spiral finishing in black depression at the bottom left. But somehow Cathy usu-ally managed to find her way to emerge through fiery flames and ‘phoenix rising’, through a tunnel back to blue calmness (bottom right). I remarked that she must be a tough survivor, and dealt with some difficult situations – to which she re-sponded, ‘That’s what everyone says.’ I wondered if we could find a way of interrupting the cycle whereby she doubted her-self and spiralled into depression when things went wrong. I also wondered if she could find ways of asking for support in such a way that she was more likely to receive it. Cathy said that doing the picture was useful in helping her to focus, as she could see more clearly what was going on.

Session 3We looked through the picture from Session 2 to try to find clues how to break the cycle, but Cathy was adamant that there were none. She then mentioned the ‘green space’ from Session 1 as a place/ state she never reached, so I suggested she might focus on that. She chose light green paper and drew a rural scene with a house, a barn, a church, birds, ani-mals, trees, meadows, hills, the sea, a fence and a gate. It was a real place, where friends of hers lived. She was quite tearful while doing this, as she felt it was an inaccessible dream that had been dashed time and again. She told me she was waiting to hear about a course on administration – she had spotted a ‘gap in the market’ of admin workers in health settings with medical knowledge. She had seen that the turnover of admin workers was quite high, so thought she might get a job in medical administration without too much difficulty, if she re-trained in admin work. She had also received a date for her employment tribunal.

Current state of mind(Author’s sketch based on Cathy’s picture)

Depression cycle

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Session 4We looked at the previous week’s picture again. Cathy noticed that there was little connection between the blue and the green, so her next picture set out to explore this connection. It included some of the black square too. She used broad strokes of felt-tip pens to draw a scene of hills, meadows, sun and sea, then added details of a village using coloured pencils (see figure below). The connection seemed to be the sea and a boat connecting the two halves of the picture, and we discussed how this might be a metaphor for life – navigating the flowing and unpredictable waters, with rain clouds above (top right). Cathy also talked about the special quality of light in estuaries, as she was a keen photographer. She had been offered a place on the admin course, so we needed to renegotiate the times of our sessions.

Session 5Cathy had started her admin course, and was feeling posi-tive about it. It finished at 3 pm, so we arranged our sessions for 4 pm. Cathy did not do any art work in this session, but looked through her pictures again, and talked about her family, especially her mother, and how to fend off her mother’s negative comments, as she homed in on Cathy’s problems. Cathy had reframed these with, ‘No, I don’t have problems, I have solutions.’ and seemed optimistic about devising her own ‘virtuous circle’ to replace the vicious cycle of negative events leading to depression.

Session 6Cathy seemed well, and had recognized the patterns of com-munication from her mother, and was detaching herself from it. She was also beginning to recognize triggers to depression and deal with them differently. She drew two pictures, using

soft pencil. The first was of a tangled ball of string, signifying the tangled state she had got into, but with a thread pulled out and laid neatly in folds to show issues clarified and dealt with. She added arrows and a hammer near the tangled ball, to show the pressures she had experienced in the ‘knotted-up’ state. She started a second picture using coloured pencils to draw a positive scene of sea, sun and hills.

Session 7Cathy was enjoying her course, although there were a lot of new things to take in. She reflected that admin work did not carry as much responsibility as medical work, so she was less worried about it. She completed the picture she had started in Session 6, paying great attention to detail, and enjoying the colours of the sea, sun, clouds and varied mountains. She was very engaged in doing the art work.

Session 8Cathy had not slept well and was tired. She reported an incident on her course, in which she had failed to complete a task in the approved way. This led her to feel that her brain wasn’t functioning, and in turn led her to withdraw. She felt things were falling apart again ‘in the same old way’, but I encouraged her to think of it as a gift, because we had the opportunity to examine what was going on in a real-live situation. So we tried to pick the incident apart. Cathy wrote down her feelings in capital letters in boxes, with arrows showing how one thing led to another. She included: attacked/ stupid/ trying too hard/ rigid & alone/ withdrawal/ shut down/ judged/ should be doing better/ fear/ anxiety/ failure/ others being better/ assumptions/ competition (see figure below). We discussed strategies she could use, such as deep breathing, and telling herself that she could take her time, that she was not stupid, and that she could do it.

Examining what happened

Connecting green and blue

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Session 9Cathy brought a drawing she had done, of the effect of stress, showing herself split between serenity and stress. We then focused on more incidents on the course, this time looking at ways of stepping back to think what’s going on, using ‘I-statements’ to ask for help, instead of spiralling downwards into depression. Cathy worked out an I-statement for one situation: ‘When you go too fast, I feel lost because I can’t take in the information at that speed.’ Cathy also remembered a childhood incident, at the age of 10, when she felt stupid because she didn’t understand something, and thought that everyone was looking at her, especially a particularly bully-ing teacher. She made a pencil drawing of this, with arrows showing pressures on her. This link provided a very useful insight for Cathy, who commented that previous counselling had not got ‘beneath the surface’ in this way.

Session 10Cathy was fine, almost wondering if things were going too well. But the intervening time had been quite eventful. She had experienced another crisis shortly after the previous ses-sion, when she had felt bad but forced herself to attend, came unstuck with a computer package, and ‘flooded’ with feel-ings of inadequacy and hopelessness. But this time, instead of withdrawing into depression, Cathy went to see the uni-versity counsellor, and then talked things through with the course tutors the next day. She was surprised and pleased to receive a lot of support, because she had managed to ask for it in a more direct way. She also managed to talk herself down from anxiety and feeling that she was stupid and everyone else was better – realising that her slow and meticulous ap-proach would pay off in the end, rather than rushing through things in a ‘quick and sloppy’ way. She also received a boost in confidence from a writing course she attended at the week-end, and from the way she had represented herself at the first hearing of her employment tribunal.

Session 11We looked at the forms Cathy had completed at the begin-ning of our sessions, and reflected on Cathy’s progress. For two of the items there was no change (coming to terms with what had happened; worry about elderly parents), but for the other three (livelihood; worry about flat; stress leading to de-pression), there was substantial movement, 2-5 points in the direction of ‘not a problem’. Looking at ‘How will I know that I’m better’, Cathy realized she had achieved many of these. Cathy said the art therapy sessions had been very beneficial. We made a list of achievements, tools, challenges and risks, outlined below.

Progress made:Understanding the process of how you became depressedComing to terms with the realization of itExploring the connections between different states of mindMaking sense of the cyclical nature of your depressionFinding a sense of hope once moreNo longer feeling so overwhelmed, so that you are able to stay in control of your emotional stateAs a result of this, coping better with problems as they arise, without beating yourself upCoping better with your mother’s emotional response to youLearning to ask for support in such a way as to receive it (something you have not experienced in the past)Handling the preliminary case conference for the tribunal on your own, doing it well and achieving a positive result

Tools developed:Stop, calm down, get focused againKeep thinking my way through thingsTake things one step at a timeBack off, go out, take a breakTalk to someone, talk things throughCup of tea and relaxRemind myself not to beat myself upIt’s OK to fail, it’s not the end of the world

We listed the challenges ahead (re-engaging with the world of work, a further tribunal hearing, achieving stability, com-ing off medication at the right time) and the risk of relapse.

Session 12In our last session Cathy seemed fine. We said our goodbyes, and Cathy took her pictures home.

ConclusionThis piece of work shows how it is possible to use art psy-chotherapy to do a time-limited piece of work, accomplish-ing some insight and progress. I am sure that Cathy will have experienced further challenges, but hopefully with the help and support from our 12 sessions, she will be better equipped to cope with these. One of the great benefits of using art psy-chotherapy in this case was the opportunity for Cathy to show the cycle of depression so that she could see it, focus on it, and derive further images from it, leading to developing some new strategies to interrupt the process.

Tento článok bol pôvodne uverejnený v knihe Rose Hughes: Time-Limited Art Psychoterapy - Developments in Theory

and Practice, Routledge 2016, p.195 - 206.

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IntroductionThis piece of work took place in the Central Recovery Team, a community mental health team based at Brookland Hall in the inner city of Bristol, an area of considerable diversity in-cluding white British people, immigrants from Europe, Asia, Africa, the West Indies and the far East, and their children born in Bristol. As a port, Bristol has had minority ethnic people settling there for several centuries.

The community mental health team is multi-disciplinary and includes psychiatrists, community psychiatric nurses, mental health workers, psychologists, liaison workers with other agencies, a part-time art therapist (Marian) and often a trainee art therapist (Lynne at that time). Several staff are from minority ethnic groups, e.g. Europe, Asia, Africa, black British, with knowledge of many languages. Clients are vis-ited at home or in counselling rooms at the team base. The art therapy room doubles as a multi-purpose room when art therapy is not taking place. Most work with service users is with individuals, usually weekly appointments for one hour. From time to time it is possible to run theme-based groups on specific topics.

This group came about in response to Marian’s offer to run an art therapy group for the team, if there was an identified need. Nazlin, an Asian Specialist community care worker/ transcultural counsellor in the team, asked for a group for some Asian women who had been in the mental health ser-vice for a long time and were quite stuck. She thought an art therapy group might help them to move on. Following dis-cussion with Nazlin, it was agreed that the theme would be ‘Moving On’, that it was to be a closed group of eight Asian women who already knew each other and who were well known to Nazlin, and that help with translation would be provided by Nazlin.

The ‘moving on’ groupWe therefore planned a series of six sessions around the theme of ‘moving on’, co-facilitated by Marian and Lynne, and helped by Nazlin, who acted as translator and role mod-el. We planned two sessions looking at the past, two at cur-rent concerns and two looking towards the future. The series was as follows:1. Introductions. My start in life.2. An event in childhood or adolescence that had a lasting

impact on my life.

A Short-term Art Psychotherapy Group for Asian Women

Dr. Marian Liebmann and Lynne Francis

3. Problems I have encountered in my life. 4. Things that have helped me move on. 5. The future I would like — and one personal goal.6. Review of pictures — and one strength I have. Evaluation

and closing. After each session we reviewed how the group had gone and planned the next one in detail, making any amendments we thought necessary. In our initial discussions about the group we agreed that we as facilitators would also participate in the art-making, as we hoped this would encourage group mem-bers.

The group consisted of six women who were mental health service users, an extra Asian women’s worker, and the three of us as facilitators. This meant we had four workers and six service users, who all participated in the making of art to-gether and in the sharing afterwards. The group ran for six sessions over an eight-week period, in the art therapy room at Brookland Hall. Each session ran for two hours, including a short period for coffee or tea at the beginning and a shared lunch together at the end. Art materials were provided in the art therapy room: paper, paints, brushes, pencils, pastels, oil and wax crayons and coloured felt-tip pens. All the different art materials were used over the duration of the course.

Cultural issuesAlthough all the women were originally from Asia, they did not necessarily share all aspects of culture or language. We started the group by together devising our own ground rules and an introductory round where everyone introduced where they originally came from. Including ourselves, this covered India, Bangladesh, Pakistan, Kenya and the UK. As we did this exercise, women also spontaneously introduced their religion - Islam (at least two varieties), Hinduism, Christianity, Buddhism, Sikhism - so we discovered we had most of the major religions in the world present. It was also a very mixed group in terms of background and economic status. The women had very varying degrees of ability in Eng-lish – some were fluent, whereas others still struggled, despite having lived in the UK for many years.

We were very grateful to have Nazlin’s help with translating from English into several different Asian languages and vice versa. It was an enormous amount of work and quite drain-ing. She had hoped that the women’s English would be good

TIME-LIMITED GROUP WORK IN A COMMUNITY MENTAL HEALTH TEAM:

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enough for that to be the medium of exchange. The fact that the group’s communication had previously been in Asian languages may have made it difficult to switch to English. But it has also been found that in intercultural therapy situations, people often need to use their emotional language, which is usually the one they grew up with (D’Ardenne and Mahtani 1989; Thomas 1995).

Attendance Attendance was excellent at 83 per cent, with all women bar one attending all or most sessions. This was helped enor-mously by Nazlin working hard at encouraging them before-hand and reminding them between sessions.

The following account of the group sessions is divided into reflections on the sessions focusing on the past, then current concerns, then moving towards the future. A case study of one member of the group is interwoven into the account.

The past: images of the natural world

Session 1: Introductions. My start in life.In our first session people were slow to start painting and seemed to find it difficult to share information about them-selves. In all the women’s pictures, images of the natural world stood out - flowers and trees were present in almost everybody’s pictures. One woman painted a large blue sky with clouds and birds; another painted a yellow sun, birds, a red sunset and two flowers from her homeland; another pic-ture depicted flowers, a buffalo and an orange tree. Another woman painted herself as a child with a flower, and added a moon and a butterfly. Several others painted flowers and trees that they remembered from childhood. Houses and liv-ing rooms from the women’s childhoods were also depicted, and they remembered chalk boards they had drawn on in school. Several women also put themselves and their fami-lies in their pictures. Many pictures were evocative of rural life and climates very different from that in the UK, with hot skies and colours, something now missing from their lives.

RashidaRashida was the eldest of nine, with five brothers and three sisters. She got married in Pakistan and then came to the UK with her husband. Her parents remained in Pakistan. Her husband was the Imam of the Muslim community, she ac-companied him to prayer meetings. She had been married for 16 years and had seven children, four daughters and three sons, all living with their parents in a three-bedroom coun-cil house. One of her daughters was especially supportive in helping to build up Rashida’s confidence.

Rashida had a long history of depression, especially in win-ter, with some psychotic symptoms. She had problems with sleep, and had dreams of snakes and dead or naked people. These dreams kept her awake. She became anxious and pan-icky in unfamiliar places or crowds. At times she was house-bound due to severe headaches. She felt there was an insect in her brain, moving about and causing her pain. She felt her

eyes were burning and was sometimes tearful. At times she felt she was going to die.

She also suffered from physical problems, especially arthritis, giv-ing her constant pain in her joints. She had had a hysterectomy, and this had led to stress incontinence and urinary infections.

Rashida spoke Urdu and Punjabi, and some English, although she found it difficult to express herself in English, finding it easier to make herself understood in Urdu. She had poor memory and concentration, often jumping from one thing to another in conversation. She was grateful for the support of mental health services.

She attended all six sessions of the art therapy group.

In her first session, Rashida was not shy about using the art materials and chose paints. Her picture shows her grand-mother’s orange tree in Pakistan on the left, two flowers (top left and bottom right) a black buffalo (top right), which they used for milk, and her own face in faint pencil (bottom right), looking quite sad. At the top she painted a moon and stars, and the sun at the very top right – a theme which was repeated in several of her pictures.

Session 2: An event in childhood or adolescence that had a lasting impact on my life.In this session there were several pictures of childhood homes, family members and traditional cooking implements - plates and beds, domestic tasks, large families, landscapes and plants. Most people had depicted happy times from childhood. These were tinged with an element of sadness be-cause they were from times they could not go back to, and countries they no longer lived in. Again, things from the nat-ural world figured in most people’s paintings - skies, moons, flowers, birds and butterflies.

Most of the women found it difficult to talk about their pic-tures but were drawn out a little by others’ questions and com-ments. The atmosphere soon became quite lively and some had to be reminded not to interrupt others. At first we were tempted to interpret this as individuals not having heard the

My start in life

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ground rules or misbehaving a little, but in supervision after-wards we considered whether this was a western expectation of how to behave. In some cultures interrupting and talking over others is an accepted norm (Tannen 1990). We also dis-cussed the preponderance of natural world images. This had also occurred in another art therapy group that Marian had run for Asian clients, where plants and animals were common features in their paintings (Liebmann 2002 and 2004).

Almost all the scenes depicted were of everyday life as they grew up, and it was not clear what impact this had had on their lives, so we asked them. Some seemed sad that things had changed but found it hard to explain how it had affected them. However, two members in the group shared the sad-ness from childhood of a close family bereavement and the impact that it had had on their lives. One member cried when she shared the memory of her mother’s death but was able to talk about it and be supported by the group.

In supervision we discussed how most women seemed to be finding it difficult to express feelings and thoughts about the past. We wondered whether this was because they had not understood the theme or whether there was a constraint in Asian culture concerning talking about problems. We also thought it could be because the group was very new or we were very new to them. We also remembered the tendency for many immigrants to ‘put their previous lives in a box’ to enable them to deal with their new lives – sometimes this box can become inaccessible.

As facilitators, we had all thought carefully about what to share about our own histories in the group. Lynne selected some-thing about her father’s mental health background, to facilitate others. Marian chose to share an early family bereavement, which felt difficult but formed a common bond with some of the women in the group. It also enabled Nazlin to use us as role models and explain that even therapists encounter prob-lems and find it difficult to share feelings at times.

Rashida used paints again, with pencil for the detail of the faces. She depicted her mother and father on the left, and said that her mother was cooking. The stove is next to them. On the right she painted circles for her eight brothers and sisters, and a large flower. She painted herself lying down sleeping. She said this was a happy memory, but she was sad because she was not together with her family any more. She said she dreamt nice dreams of this period of her life, and preferred these dreams to reality.

Current concerns: developing common ground

Session 3: Problems I have encountered in my lifeDuring this session, when people were painting, the atmos-phere felt quite weighty. When we shared our pictures later, things started to spill out and the atmosphere lifted. Com-mon themes arose as several women talked about feeling lonely, sad, crying a lot, with family difficulties and problems with children. We seemed to have established some common ground which acknowledged the difficulties of bringing up children even amongst those that did not feel able to share. It felt to us that the group had broken down barriers, and despite our different cultures we had found some universal themes for women. The group ended as usual with us shar-ing lunch together. Discussions that had started in the group spilled into lunchtime which began to feel like an extension of the art therapy group

In supervision we agreed the group had gone very well and was starting to gel. However, the initial plan for us to facili-tate the sharing of information, and Nazlin to translate, had become blurred. Although all the women spoke some Eng-lish, they seemed to find this difficult in the group, and Naz-lin had to translate more than she had initially expected. The translation task itself was very complex - Nazlin explained that she had to translate not only from Bengali into English, and vice versa, but also translate between some of the women who spoke other Indian languages. This was complicated fur-ther by the fact that Nazlin knew the women well and fell naturally into a facilitation role, taking the lead. It was often difficult for us to tell whether Nazlin was talking to people because they found it hard to speak English or because she was trying to encourage them to move on. At times when discussion became animated, the task became almost im-possible for Nazlin, and the discussion was very difficult for us to follow. In a brief conversation after the group, Nazlin said that she was finding the pressure on her in the group very hard, so we arranged to meet before the start of the next group to see what we could do.

The meeting with Nazlin proved very useful. She said she was surprised how much the women were depending on her to speak for them, and she was finding the translation be-tween so many different languages so hard that she ‘felt as if her head was going to explode’. She was also getting rather frustrated with a few of the women for not talking more in the group about their problems, as she was concerned about them and wanted them to move on.

We suggested that Nazlin should try to let Lynne and Mar-ian do a bit more, and ask the other Asian worker to help by making teas and helping with translating at times. Nazlin agreed with these suggestions and before the next group told us that she had asked another Asian worker to join us for more support.

Rashida used coloured pencils for this picture. She showed herself crying (top right), a bed with a pillow (top left), a house (mid-left), a large sun with a face (mid-right), a blue moon below that, and a garden at the bottom. She also drew

An event in childhood with a lasting impact

21

some strange creatures (monsters and gravestones) from bad dreams, and a knife (lower left), with which she had tried to kill herself. She talked about having seven children and two miscarriages, and described herself as ‘crying for 10 years’ while having them. She also remembered being beaten for being late for prayers, and for being late for school, where she had been bullied.

Session 4: Things that have helped me move on.In this session, leaving their original homes featured strongly in women’s individual stories, as did accounts of loneliness and isolation when they first moved to the UK - and the relief they experienced when people helped them learn English. Religion and prayer were also things that helped them when things were difficult, and this was common to all the religions in the room.

As it happened, at the beginning of this session, Nazlin was tak-en up with one member of the group who was very upset, so one of the support workers naturally stepped into the gap and made the teas. We agreed to start the group without Nazlin and the Asian worker translated for us. Although some of the women were initially concerned about Nazlin’s absence, they seemed to relax once we reassured them she would arrive soon.

We then introduced the theme ‘Things that have helped me move on - people, events, courses, activities, personal qualities.’ This week the women needed little prompting to get started and when Nazlin came in soon after, she found people working intently in a calm and quiet atmosphere. It seemed some women were now worrying less about what they were doing and starting to use materials more freely,

which was lovely to observe. The woman who had been upset also joined us but did not participate in any artwork, just sat with the group.

Religion was mentioned by nearly everybody as a form of support. A trip to Mecca, reading a holy book, a prayer group, meditation on their own, prayer to God, prayer to the sun, moon and stars – all were mentioned by different women.

In this session Rashida used felt-tip pens and coloured pen-cils. She drew herself crying again (top centre and top right), when she had her children. We tried to find out what she meant by this, but she did not elaborate. She drew symbols of prayer and going to Mecca on the left (top and centre – the black square represented the Ka’aba at Mecca). In the centre she drew herself sleeping in bed, and reading magazines and books. At the bottom right she drew the sun, moon and stars, and said she prayed to them. She drew flowers at the bot-tom of the picture. She said all these things helped her, as did learning English. She also spoke about helpful friends.

Thinking about the future In the last two sessions, the concept of ‘moving on’ and the future seemed to cause some problems for people. We were not sure if this was a mental health issue or a problem of translation between languages - or even cultures. We won-dered if the whole idea of ‘individual goals’ and ‘moving on’ was too much of a western concept, which might not always mesh with the acceptance of the present expressed in many religions (Fernando 1991). The women’s acceptance of their lives and discussion of the present could also be seen as a re-alistic assessment of their circumstances.

Problems I have encountered

Things that have helped me move on

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Session 5: The future I would like — and one personal goal.People started their artwork and worked intently and quietly again on their own pictures, showing even more engagement with the materials than last week, some people’s pictures be-coming more elaborate. At the end of the art-making time we shared our hopes for the future together.

Rashida used brightly-coloured felt-tip pens to draw all the things she wanted to include in her life: a tree and flowers (top), a jungle (bottom), which she worked on in detail, and a house with a big garden by a river. She hoped it would be in Pakistan, as she said she liked living in hot countries. She added that she wanted to catch the ‘genie causing suffering’ and put an end to it. Possibly the little shape on the right might be the genie.

Session 6: Review of pictures — and one strength I have. Evaluation and closing. The last session seemed to come round all too soon. There was quite a lot to cover in this session. The first task was for all of us to individually review our work by looking through all the pictures we had done. We asked the women to look for any recurring themes and also to look for strengths or things they could appreciate about themselves, their circumstances or their lives. There was quite a lot of chatter and bustle as people looked through their work and seemed genuinely sur-prised by how much they had done. We then asked them to do a final image that gathered these things together, and also to try to identify one strength.

As before, it seemed difficult for the women to identify a  strength, but they were able to explain what it was they wanted to do to move on. One woman painted a picture of her dream house with carefully selected fireplace curtains and flowers - we suggested that her strength was her arrange-ments of form and colour. Another woman did a picture of the past with an Indian bed and a Tandoori oven - she ex-plained that she had recreated the past in her imagination, as this was a place she could no longer go to in real life. Most women included flowers and fields or gardens in their pic-tures. Two women’s pictures had big gardens as gardening was something they enjoyed. One of these women described ‘working on her husband’ as something she needed to do, in order to leave the past behind. One woman put herself in the picture for the first time and another did a dynamic image of herself ‘more happy’ and moving on, quite different from pictures she had done before.

Rashida used the bright felt-tip pens again, and completely filled her paper (see figure below). She drew a house with a big garden (centre right), a river (top and centre right), the sun (bottom right), flowers (at the bottom and all around the pic-ture), the genie (centre), animals, village life, and herself (bot-tom right), but not crying this time. She was surprised by the review to see how much she had done. She talked about her love of gardening as her strength, and other members of the group pointed out her strength in bringing up her children.

evaluation We did this verbally with the group, as Nazlin suggested this would be more appropriate than written evaluations. We asked four questions:1. What did they enjoy? Responses included: being in the group, doing the artwork, an opportunity to look inside themselves, developing insight, getting things out on paper, looking at the past and the fu-ture, sharing in other women’s lives.2. Did the sessions help, and if so how? The women said the group had helped them try to deal with things, given them ways of managing themselves, enabled them to think about the past, to remember their skills and to face things on paper.

The future I would like Review and a strength

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3. Was there anything you would have liked to be different? The only things mentioned were: bigger paper, more space and more time (it was true that it had been a squash for 10 people to get round the table in the art therapy room). 4. Is there any way you would like to take this forward? The women suggested some possibilities: do art at home, be referred for individual art therapy, and arrange another group.

engagement with art materialsIt was noticeable that the women started off very tentatively with limited materials, unsure how to use them or to express themselves. Over the six sessions they began to experiment with a greater variety of media, and their pictures became fuller and more interesting. Some women who still found it hard to talk, nevertheless gained a lot from being able to ex-press themselves through the art materials.

Conclusion It was a lot of hard work for all of us to plan, organise and fa-cilitate this themed art therapy group, including the difficulties involved in translation. But it was very worthwhile in provid-ing an avenue of expression not available through words — as evidenced in the colours, the shapes, the enjoyment, the tears, the engagement with the art materials and the group. The theme of ‘moving on’ proved an interesting theme to work with. It was not always clear that the women fully un-

derstood some of the components that we had used to make up the overall theme. On some occasions the focus of the ses-sion seemed to go a bit astray and we seemed to be working on the topic of the previous session. Even so, each session still seemed to provide a valuable forum in which to work. However, more research could be done (with more time) into what ‘moving on’ might mean in Asian culture. It is also dif-ficult to know what can be expected and achieved in a six-session group, but by the end Nazlin (as group facilitator in the longer term) felt she had a clearer idea about what the women in the group needed next.

For ourselves, we felt we had been given a rich insight into the positive aspects and the difficulties of some Asian wom-en’s lives. It gave us a better understanding of how difficult it can feel to leave somewhere you think of as home, travel a long way away, and try to adjust and settle somewhere com-pletely new and alien. We learnt about the barriers that some women have to overcome in order to express themselves even a little - economic barriers, those of gender, cultural language, prejudice, stigma and lack of confidence. We also learnt how satisfying it can be to see such women gradually gaining in confidence, and how a little change can seem to go a long way.

Tento článok bol pôvodne uverejnený v knihe Rose Hughes: Time-Limited Art Psychoterapy - Developments in Theory

and Practice, Routledge 2016, p.207 - 220.

ReferencesD’Ardenne, P. and Mahtani, A. (1989) Transcultural Counselling in Action. London: Sage.

Fernando, S. (1991) Mental Health, Race and Culture. London: Macmillan.

Liebmann, M. (2002) ‘Working with Elderly Asian Clients’, Inscape, the Journal of the British Association of Art Therapists, Volume 7, No. 2 (2002), 72-80.

Liebmann, M. (2004) ‘Working with Elderly Asian Clients’ Generations Review, Journal of the British Society of Gerontology, Vol 14 No. 2 (April 2004), 8-11.

Tannen, D. (1990) You Just Don’t Understand: Women and Men in Conversation. London: Virago.

Thomas, L. (1995) ‘Psychotherapy in the context of race and culture: an inter-cultural therapeutic approach.’ In S. Fernando (ed) Mental Health in a Multi-ethnic Society: A Multi-disciplinary Handbook. London: Routledge.

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EKO ARTETERAPIE přináší netradiční pohled na artetera-pii i její možnosti. Propojuje arteterapeutické techniky se sil-nými prožitky a tvorbou v přírodě i poznávání sebe skrze ní. Krajina umí poskytnout zpětnou vazbu na naše otázky, stává se projekčním plátnem. Vnitřní svět se odráží ve vnější realitě a my ho můžeme snadno přečíst pomocí symboliky. Vzhle-dem k tomu, že příroda není lidmi uměle vytvořená a je v ní přirozenost, tak to má silný vliv také na přirozenost, která je uvnitř každého člověka. Pokud pochopíme paralelu vnitřní-ho a vnějšího světa, nebo-li krajinu vnitřní a vnější, dovolí nám to více vnímat sebe i okolí v souvislostech. Navíc tím posilujeme vlastní citlivost vůči vnímání přírody a  schop-nost poznávat širokou paletu smyslů (práce s 54 smysly podle Dr. Cohena). Propojení vlastní otevřenosti vůči citlivému vnímání životadárné přírody a schopnosti sebevyjádřit se pomocí tvorby v přírodě můžeme objevit nový rozměr umění v sobě. Díky zrcadlení krajiny je možné detailněji zahlédnout sebe sama v nejrůznějších variacích a odstínech. Příroda nám zároveň poskytuje prostor pro meditaci, ztišení se, ale také in-spiruje a motivuje. Naše možnosti dokonale objevíme, pokud zvládneme překonat výzvy vystoupením z komfortní zóny. Naši schopnost v přírodě se orientovat, chránit se, poznávat ji celkem rychle zjistíme, pokud v ní nějaký čas zůstaneme sami se sebou.

• Supervize – profesionální podpora pro pracovníky z po-máhajících profesí, kde vzniká bezpečný prostor pro refle-xi, zpětnou vazbu, jiný úhel pohledu i podporu

• Kreativita - propojena s fantazií a svobodou vyjádřit se netradičním způsobem, probouzí větší emocionální anga-žovanost a přináší nadhled.

• Možnosti: Využití metafor – “těžký náklad”, “jako tank”, “růžové brý-

le”, “plné zuby”, “dusí mě to” Pomůcky - flipchart, barevné lístečky, dřevěné figurky,

zvířátka, dopravní prostředky, kameny, mušličky, projek-

Kreativita v supervizi

Mgr. Jana Merhautová

tivní obrázky, přírodniny, využití prostoru (místnost, pros-tředí místní krajiny), jednoduché hudební nástroje

Techniky - hraní rolí, focusing, mentální mapování, video-analýza, komunikační trénink, sociografické mapy, psy-chohygiena, emocionální sebevyjádření zvukem, hudbou, tancem, pohybem

Vlastní tvorba – výběr a vybarvování tematických obráz-ků, koláže, artefakty, malování

TVOŘIVOST A SyMBOLIKA• Symboly, používané prostřednictvím umělecké tvorby, hovoří

vlastním charakteristickým jazykem, odhalí skryté informace a dovolí nahlédnout za oponu běžně uvědomovaného

• Symboly nám otevírají cesty do krajiny nevědomí. Přichází jedinečná příležitost zahlédnout celistvější obraz, jiný úhel pohledu

Mgr. Jana MerhautováVyštudovala sociálnu prácu na Univerzite Jana Evangelisty Purkyně v Ústí nad Labem, super-vízny výcvik na Karlovej Univerzite v Prahe. Absolvovala 5-ročný sebaskúsenostný výcvik v hlbinne orientovanej psychoterapii so zame-raním na arteterapiu, výcvik v metóde Aura-So-ma organizovaný Medzinárodnou akadémiou farebných techník (ASIACT) v Anglicku. V období 2006-2015 bola členkou výboru Českej arteterapeutickej asociácie, kde je akreditovanou supervízorkou. Externe vyučuje kreatívne prístupy v supervízii, skupinovú prá-

cu a supervíziu organizácii na fakulte humanit-ných štúdií na Karlovej Univerzite.V roku 2008 založila akreditovanú vzdelávaciu inštitúciu s mnohými programami pre oblasť sociálnych služieb. V roku 2016 založila spolok - Institut Eko Art Therapy, kde vedie odborné i laické výcviky, kurzy, semináre, zamerané na arteterapiu, ekopsychológiu, krajinné umenie.Sústavne sa celoživotne vzdeláva, aktívne sa zúčastňuje odborných konferencií a venuje sa aj publikačnej činnosti. Kontakt: jana.merhautova@seznam.cz

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• Dialog nad symbolickým procesem nám umožní zahlédnout celistvější obraz, lépe pojmenovat a uchopit téma, objevit dynamiku, inspirovat se

AURASOMA V SUPeRVIZI• Vicky Wall – autorka anglické metody barevného spektra

lahviček• Výtažky rostlin, bylin a minerálů, obsahují vůně a oleje na tělo • Pracuje se s nimi jako s barevným indikátorem emocionál-

ního rozpoložení nebo jako s projektivní metodou

LÉČIVÉ eSeNCIÁLNÍ OLeJe dóTeRRA• Certifikované, čisté oleje (terapeutické třídy “Certified

Pure Therapeutic Grade)• Kvalitní čisté éterické oleje pomáhají v navození psychorela-

xační atmosféry, podporují multismyslovou terapii• Jsou blahodárné při uvolňování stresu, napětí• Výrazně uvolňují emoce, působí blahodárně proti únavě

a  stavům vyčerpání

SUPeRVIZe ORGANIZACe• Probíhá v rámci celého organizačního systému, je zaměře-

ná na podporu pracovníků i organizačních procesů• Důležitou roli hraje organizační struktura, potřeby, kultura

organizace a dojednaná zakázka. • Je nástrojem zvyšování kvality poskytovaných služeb, pod-

pory a zpětné vazby zaměstnanců, učení a rozvoje v rámci kontextu cílů a poslání organizace.

• Kreativní techniky, dále např. videoanalýza (lze vidět věci, kterých si běžně pracovníci v reálném čase a pracovním procesu nevšimnou, je to důležitá zpětná vazba často vy-užívaná při tvorbě individuálního plánu uživatelů služeb obzvláště u obtížně komunikujících uživatelů).

VÝJeZDNÍ SUPeRVIZe• Kreativní a vyhledávaná forma supervize, která se odehrá-

vá mimo pracoviště zaměstnanců. Jedná se o supervizi vý-jezdní, zpravidla několikadenní, při níž se hojně využívají kreativní techniky práce.

• Přináší efekt týmového setkání, postavený na společných zážitcích a možnosti analyzovat týmovou spolupráci, zdro-je, slabá a silná místa. Orientace na podporu dobrých vzta-hů, loajality, zdravé a pravdivé hodnoty firmy Je vhodná pro týmy, vedoucí pracovníky či vrcholný management a spočívá v jedinečnosti poznat se navzájem jinak než je na pracovišti běžné.

• Tato forma supervize obvykle probíhá v krajině Kaňonu Labe, neboť divoká příroda Českého Švýcarska pomáhá dotvořit atmosféru nezapomenutelného zážitkového způ-sobu týmové práce.

eKO ARTeSUPeRVIZe• Zažít supervizi netradičním způsobem, silným zážitkem je

propojení pobytu v přírodě s intuitivní uměleckou tvorbou• Pohybujeme se v denní i noční krajině divokých lesů

a pískovcových skal Národního parku České Švýcarsko

26

• Pracovníci mají příležitost zažít sebe v různých exteriéro-vých situacích, vnímat své reakce, instinkty, emoce a nau-čit se dávat okamžitou zpětnou vazbu

• Přináší příležitost více rozvíjet kreativitu, prohloubit schopnost vyjádřit se jinými výrazovými prostředky než verbálními a racionálními

KRAJINA – PROJeKČNÍ PLÁTNO A MOUDRÝ UČITeL• Necháme krajinu, aby se stala projekčním plátnem, nasta-

vila nám zrcadlo, předpokládá to určitou citlivost a také umění se zastavit, ztišit, pozorně se dívat i naslouchat

• Metoda EKO-ART jednoduše zobrazí situaci, rychleji ob-jevíme, na jakých principech fungujeme, pomáhá nachá-zet možnosti, řešení, přirozené zdroje podpory,

• Můžeme více zapojit vlastní smysly a krajinu objevovat jinak např. nasahávat, očichávat, ochutnávat, naslouchat zvukům, zaměřit se na vnímání detailů i celku

TVORBA V PŘÍRODĚ• Máme příležitost objevit nový rozměr umění sami v sobě • Větší prostor pro symboliku uměleckými vyjadřovacími

technikami, rozvoj fantazie a emocionální angažovanost • V přírodě se vyskytuje nepřeberné množství výtvarného

materiálu, můžeme vyzkoušet, čím vším lze tvořit

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This presentation is about art therapy with migration based on my PhD research, explored the question: how art therapy might be applicable for Korean migrants in a Korean community in the cultural, social and political context characterized by migration. The motivation for this research came from my own experience of being a Korean migrant in Britain because personally and professionally, the experience has profoundly informed my understanding and awareness of dealing with difference since I came to Britain to be trained as an art therapist. I learnt a new belief system of psychoanalysis and psychodynamic orientated art therapy in development and practice. I studied and experienced the value of art therapy; in particular, getting in touch with the unconscious and the significance of the relationship with art work in art therapy through the whole journey of the training course as well as while I was practicing as an art therapist. However, I sometimes felt I lacked the understanding of cultural issues; in particular, through the experience of being in a different country, I realized and became conscious of how people communicate and understand differently within different cultures, traditions and customs between East and West; for example, between collectivism and individualism. I had many experiences of working with different ethnicities and migrants from different countries and these experiences made me feel that understanding different cultural values was one of the most important issues to consider when thinking about clients’ emotions and feelings in therapy. To begin with I started to challenge my assumption that if understanding cultural values was one of the most important considerations, I as a Korean art therapist may be better with Korean migrant clients as we came from the same cultural background. I approached one of Korean communities outer

Art Therapy with Migration -Art therapy with Korean migrant women in a Korean Community

Tae Jung Park, MA, PhD

London and tried to find out the availability of working with them. However there was no such thing like mental health support system in the community at all. There was no record that Korean migrants went to mental hospital in the area. I  was wondering how Korean migrants in the community deal with their mental well-being and whether they know Art therapy. Art therapy seems to have become more recognized in South Korea through the media (TV programs, newspapers and magazines) educating the public of mental health issues. Through watching Korean TV I thought migrants would feel less ‘cut off ’ from home and, therefore, more connected with the current issues of South Korea than ever before. Plus a  growing number of new art therapy training courses in universities and art therapy services in South Korea suggest that there is more awareness of mental health issues and art therapy than ever before. Another assumption was that art therapy might be successfully applied to this particular social group of Korean migrants, living in a Korean community in Britain. Koreans traditionally tend not to show their emotions and often bottle up their feelings as having a mental health problem is considered shameful. I thought that art therapy might be easier for them, as an intervention, if they wanted to express or talk about their feelings or emotions and experiences, about their lives as exiles or cultural collision, and offer them the opportunity to do so in a gentle, indirect and non-threatening way. I also thought that it would be beneficial that I, as the art therapist, would be using the same language and would share an understanding of the values of Korean culture.I approached a few organizations, which is located in the Korean community. Korean migrants began living in the community in the 1980s. Except mental health organizations like art psychotherapy provision or service, there were many

Tae Jung Park, MA, PhD

Vyštudovala arteterapiu na Goldsmiths v roku 2007 a má rozsiahlé skúsenosti z práce s klientmi s rôznymi duševnými problémami a v rôznych vekových kate–góriách. Napríklad s deťmi s poruchami učenia v dennom stacionári a v špeciálnej škole, s dospelými s duševnými problémami v rôznych organizáciách ako sú vzdelávacie

odvetvia, komunity, psychiatrická liečebňa a taktiež pracovala so seniormi v opatrova-teľskom dome.Dr. Park sa od roku 2008 intenzívne venu-je v praxi aj vo výskume práci s migrantmi a táto oblasť sa stala významnou pre jej prax.

Kontakt: cerajjang@gmail.com

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other services were available from the organizations which ran different classes, supported by the local council and volunteers, as well as an official service from the Korean embassy. One of the organizations (KS) seemed to be a central point for Korean people in the community and, with the permission of the head of the organization, I planned to set up an art therapy service for them. As it was to be part of a PhD research project, I documented my observation in the community as well as organizations, the process and the changes and development of an art therapy service at KR, situated as it was within its particular cultural paradigm. Although the project was planned and agreed, there were some serious internal political conflicts, power struggles and financial problems in the KS. As time went on I realized how these conflicts were very much connected with the current politics in South Korea and how they impacted on the project. These challenges included 1) radically different understandings of mental health issues between myself, the staff of the KS and people in the community. Particularly there was a problem with getting funding from the local council as they thought that migrants needed to have more practical support such as English language lessons rather than having therapy. 2) a lack of support from the KR and from the community; for example the receptionist did not have enough understanding of art therapy although I run a few talk about mental health awareness and art therapy before running the service in the organization. 3) a reluctance to access therapy although art therapy service was advertised in a few Korean newspapers for a long time, around a year. These factors resulted in the art therapy service finishing prematurely.Over the period of project I obtained three different cases; art therapy group, art activity group and individual art therapy in two different organizations.From the analysis of the cases a few question emerged in order to explore the main question. Why was establishing an art therapy service for Korean migrants so difficult? Is art therapy inappropriate for Korean migrants in the community? Is art therapy relevant to the issues Korean migrants face when they come to the UK? What are the key issues to consider when providing art therapy for Korean migrants in this particular community? I found that many issues and categories have developed via the understanding of migratory process and no single theory of migration can explain the characteristics of migration found in the case material (Massey, Aranggo, Hug, Kouaouci, Pelleri and Taylor, 1998). This is because migration is linked in complex ways to class, gender, generation, ethnicity and other social cleavages, which are embodied in hierarchies of power and social statues, in positions in home and host communities, and in work and domestic relationships all of which may be transformed in the course of the migratory process (Van Hear, 2010: 1531)Through the ethnographic analysis five conceptualizations discovered, which was vital to understand Korean migrants in the community and to think about offering a culturally appropriate art therapy for them.

1. Cultural transition or not: I discovered that Korean migrants were developing their own culture, distinct from their original home culture to one that is created by the process of surviving migration, acculturation

and adaptation by making choices of keeping tradition or not. Korean migrants’ culture was very complex as individuals’ acculturation and adaptation was very selective (Richerson and Boyd, 2008) in relation to their choices of what to keep and what to adapt, whether consciously or unconsciously. For example, traditional Korean values, habits, and thought remained deeply ingrained, even unchanged, although alongside this there were adaptations such as becoming Christians, learning a new language, new systems, customs, ways of thinking and behaving to a greater or lesser degree. • Korean Confucianism: The ideal of Korean Confucianism regarding relationships within the family, such as maintaining distinct roles between husband and wife, is ill-suited to modern Korean society as the latter has gradually changed as a result of modernization and westernization. However, according to some of participants in the art activity group, their family members continued to play out roles within Confucian ideas of traditional relationships in that generation although they had blended into Western society for years. Traditional Confucian ideas about how people from different generations and of different status should relate to each other were also in evidence. For instance, when participants of the two groups were asked to introduce themselves in the first sessions of the two groups they mentioned their ages, as if telling me their hierarchical social order and status; this does not happen in Western society. Although generational issues can occur everywhere in modern society I found it striking from this particular group of Korean migrants that they revealed their age, and it really made visible the gap between them and me. However this culturally-expected manner for older generation seemed to be one of the considerations when working with older Korean migrants in the community. • Collectivism: The cultural complexity of Korean migrants’ new social context in the UK included not only maintaining traditional values and then experiencing conflict as a result of social change and generation gap but also embracing new systems of belief. Particularly church going activity was one of significant culture in the community, which I had not anticipated at all. This lifestyle gave these Korean migrants a sense of continuity, particularly relating to the collectivistic culture of South Korea in the individualistic host country of Britain. Korean collectivistic culture stresses the importance of cohesion, harmony, and balance within social groups and prioritizes group goals over individual goals. In a session of the art therapy group I felt strange about participants’ behavior, as they were reading each other’s faces and were sacrificing themselves to the group to maintain harmony within it. In another session one member of the art therapy group was talking about her difficult feelings but some other members were almost punishing her rather than being understanding. I felt in a way that it was also related to and based on the Confucian way of thought and behavior, as in Confucian society putting up with their discomfort and emotions reflected maturity, wisdom and respect, and they perhaps expected that maturity (Essame, 2012). These examples showed how the individual ego in Eastern culture is strongly linked to the group. • Language: speaking the Korean language was essential in creating a relationship with the Korean migrants during the project in the community. Although I believe that non-verbal

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arts therapy can reduce the language difficulties of migrants as quite a few authors talked about (Wolf and Hall, 1971; Wong-Valle, 1981), when the Korean language was spoken in the groups and in the individual therapy it seemed to be a great opportunity or benefit for the participants to engage with the process of the groups or individual art therapy without encountering the problem of language. Although using the Korean language in the midst of a larger community of English speakers can also be a way of bringing the subject of difference into the group – thus enabling discussion/expression of the experience of migration and being an immigrant – the availability of a Korean-speaking therapist might be a priority when establishing art therapy for clients in terms of the local and socio-cultural context in the community. 2. The relationship between migration

experience and mental health: I found that Korean migrants’ issues were closely connected and related to three stages of migration: pre-migration, migration and post-migration. V from individual art therapy expressed a lot of issues related to the migration experience and dealt with them in the process of art therapy. In relation to cultural bereavement, V was suffering from feelings of guilt over leaving behind her ex-boyfriend and family, and familiar surroundings. In particular for V, issues such as the language difficulty, isolation, loneliness, homesickness and the issue of cultural difference between her and her English boyfriend were rooted in and affected by migration experiences and intensified her stress and she wanted to talk about it in the process of art therapy. She came to art therapy at a good time to deal with the issues as she had one more year to study in the UK, otherwise the experience could have been traumatic, resulting in deterioration in her mental health, as the literature has shown (Bhugra and Gupta, 2011). This example suggests that art therapy is relevant to some younger Korean migrants based on the evidence of V’s individual art therapy, as the mental health issues of some vulnerable individuals are likely to be influenced by their migratory circumstances while they are still in the process of acculturation and adaptation in the host country.The older generation of Korean migrants from the two groups presented different issues although they denied the value of art therapy in the art therapy group in particular, as they felt that they already had a way of dealing with difficulties in the community. They had mostly been living in the host country much longer and had been developing their own systems of social adjustment, such as meeting Korean people and gaining support from them in a Korean church in the community. It was not only one of the cultural aspects explained earlier but also seemed to relate to their mental health as they were also venerable when they arrived in the host country and went to church. This was evidenced in the art therapy group when some participants described how they had converted to Christianity as they found it difficult to survive in a different country; in a few session, two participants talked about the lack of necessity for having therapy because they could manage their emotional difficulties by believing in God and everyone agreed – that they had all been cured by God so that they did not need therapy.Interestingly despite the fact that their church-going activity had helped, participants in the art therapy group

unconsciously or consciously revealed some of their ongoing difficulties decades after they originally migrated. For example, in a few sessions of the two groups, participants discussed a lack of power and control experienced by the older generation of Korean migrant women in comparison to the younger generation, such as my status in particular; this was also apparent in the transference to me. Personal conflicts between family members regarding socio-cultural issues between East and West as well as religious experiences were also evident in the two groups. Their artwork unconsciously and consciously exposed difficult feelings and experiences which had not been talked about before.

Their artwork unconsciously and consciously exposed difficult feelings and experiences which had not been talked about before. Slide-3photos For example J did not intend to draw a stone-like shape but it came out looking like a  stone with silver glitter color and she realized her agony and confusion about her religion through another member’s comment (Figure 1). H also consciously expressed her fear by drawing a giant bird (Figure 2).

3. The influence of religion on migrants’ mental health:

As I mentioned previously, religion seems to have a very close relationship with mental health for these Korean migrants. All the Korean people I met – including participants in the groups and my individual client, staff at the different organizations, and people who gave me any information during the research period – were committed Christians. It seemed that the initial purpose of going to church was to meet Korean friends and gain support in order to survive, the church providing comfort and a familiar environment that was like being in Korea, including speaking in Korean, sharing Korean food and receiving practical support from church

Figure 1 J’s artwork

Figure 2 H’s artwork

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members. And, Going to church was almost an initiation to the acculturation process for these Korean migrants. They talked about how they used to be Buddhists in South Korea but felt that it was necessary to go to a Christian church when they arrived in the UK. Through going to church they gained a sense of belonging to a continuing collectivistic culture and found a way of keeping up their Korean cultural identity through speaking Korean, maintaining traditional values in the churches and celebrating Korean national holidays together. All this seemed to give Korean migrants a communal bond in their new community in the UK. And although they initially became Christians due to its convenience as a migration survival process as time went by and due to the support they gained Christianity became the key activity of their lives; it was a way of life that provided meaning. Church-going activity seemed to explain why there was no record of Korean clients in mental health hospitals in the community. It was not only that treating mental health is taboo in Korean society and there is a lack of understanding of mental health issues, but also perhaps to do with their religious activity, as the participants of the two groups insisted.Religion was a central factor, but interestingly other issues were revealed in the process of art therapy such as negative feelings about emotional support from the Korean church in the two groups. The participant in the individual art therapy mentioned that she did not want to share her personal issues with other people in the church. I thought that perhaps art therapy can be accessed by those who need non-religious intervention and so people can talk about their personal issues freely without consciousness of other people, which as I said earlier I considered was related to the negative side of collectivism in the Korean church.

4. The relationship between Korean art education and art therapy:

Participants’ experience of art materials in both groups and individual art therapy was very closely related to Korean art education throughout the data. Due to the historical, political and cultural upheavals in Korea, such as the Korean War in South Korea in 1950, the people who were children and adolescents at the time of the Korean War, or even people who were born after the war were not able to get a proper education as many people were in poverty in postwar South Korea. One member of the art activity group even spoke about being an artist as only for special people.• Familiarity with art and art materials: Participants from the two different groups were reluctant and hesitant to use art materials as most of them did not have an experience of art and therefore they kept asking for lessons throughout the sessions. This was also related to their understanding of art therapy, which they confused with an art class offering lessons. In particular, a participant of the art activity group talked about Korean traditional ink, brush and special papers as familiar traditional art materials and said that they would have been useful for her. It reminded me of my calligraphy lessons with my grandfather in my childhood; the traditional materials that I used were the popular art materials for public use at the time. I developed my creativity from calligraphy lessons although Western art was already influencing South Korean education after the Korean War. It seemed to me that it was not only that the group members, on average aged in their

60s or 70s, who asked for traditional Korean art materials, but the request for traditional materials indicated that their primary association, connection or memory of art was Eastern (Korean), and not the art and art practices of the West. Interestingly, although group members talked about traditional materials, what they made, drew or copied in the art activity group were within the Western style of art, and they loved it (Figure 3 and 4). In comparison the client from individual art therapy studied Western-influenced art at school in South Korea, and found the materials I provided in sessions were familiar and she was excited about using them without feeling hesitant (Figure 5). This indicates how important it is to recognize art in historical and educational contexts, as it is closely linked with their experience and need of materials in art therapy.

• Making art and culturally-based assumptions about making art: Another element was that participants throughout the sessions of the art activity group saw and treated their artwork as ‘art’ only when it was perfectly completed; they did not like unfinished work or artwork with mistakes or which had a childish quality. In the last session of the art activity group in particular they allowed me to take photos only of completed works. My view is that this reflects

Figure 3 Artwork in Art activity group

Figure 5 Artwork by individual client

Figure 4 Artwork in Art activity group

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how Korean people view ‚art‘ and this accounted for their demand for art lessons in the two groups. This tendency to value only completed works was also evident in the individual art therapy; she always ensured that her artwork was completed in her own style, even when she was late. Throughout the art therapy group, participants were gradually able to accept the process of art making and, in particular, the quality of their artwork in order to express their story or issues according to the themes. However, they continued to find it difficult to work freely at the beginning of the group and did not like the artwork they made. Although these might be common issues with clients who come to art therapy, it made me think about whether it was to do with the different style of learning between East and West. I thought that direct engagement with art-making perhaps is more appropriate as there were cultural demands of wanting to be led, and it can lead to slow engagement in the therapeutic process. Checking out Korean clients‘ art education in the process of assessment seems to be also useful in order to provide an appropriate and flexible art therapy for them.

5. The influence of socio political issues in the Korean migrants’ community:

I was surprised to find that there were many North Korean refugees living in the Korean community. Due to the particular history of Korea and ongoing political tensions, the reasons for migration differ between South and North Koreans, the movement of North Korean refugees to different countries having only started recently, and living together in a community was a new experience for both North and South Koreans.This issue was discussed by participants of the art activity group; they discussed their mixed feelings towards the North Koreans in their community. They expressed uncertainty relating to and living next door to North Koreans in the community as they thought that North Koreans did not trust people whereas a few of them showed compassion for them.

Although my suggestion of including North Korean refugees in the art therapy group was rejected by the KS at the beginning of the research journey, I observed that South Korean migrants had unofficially been including North Korean refugees in their community-based celebrations of Korean national festivals e.g. Korean New Year’s Day, Chuseok (Korean Harvest festival) and Independence Day. I heard from the South Korean people in the festivals that this had been going on for several years. It seemed to me that the common issue of being migrants living in a different country made both North and South Koreans feel a sense of kinship. There seemed on the surface to be few problems in their relationships, yet since they had started to live together, South Koreans tended to be those who provided jobs and support. However, I was aware that North Korean refugees who settled in South Korea had many issues and difficulties with discrimination, different cultural identities, prejudice towards them and feelings of being outsiders, so these issues would need to be considered when working with North Korean refugees. Sensitivity around this issue was evident in the art activity group where the participants discussed the tendency to hide their identity by saying they were Chinese Koreans. The especially current tension between South and North has been rising these days this issue is important to consider when working with Korean migrants in the community.

ConclusionArt therapy is predominantly a Western practice; therefore, it was also worth undertaking a critical exploration of how art therapy might be applicable to different cultures, particularly as art therapy has started to spread into many cultures profoundly different to those in the West, in particular Eastern cultures. What emerges from the findings suggests a notion of considerations and ways of working in art therapy that is relevant, significant and pertinent to particular social groups of Korean migrants in the community in the UK, as well as across the globe.

BibliographyBhugra, D. and Gupta, S. (2011). “Conclusion” in Bhugra, D. and Gupta, S. (eds.). Migration and Mental Health, Cambridge: Cambridge University Press, pp. 337-338.

Essame, C. (2012). “Collective versus individualist societies and the impact of Asian values on art therapy in Singapore”, in Art Therapy in Asia: To the bone or wrapped in silk, Kalmanowitz, D., Potash, J.S. and Chan, S.M. (eds.). London and Philadelphia: Jessica Kingsley Publishers. pp. 91-101.

Massey, D., Aranggo, J., Hugo, G., Kouaouci, A., Pellerino, A and Taylor, J. (1998). Worlds in Motion: Understanding international migration at the end of the millennium, Oxford: Clarendon Press.

Richerson, P.J. and Boyd, R. (2008). “Being human: Migration – An engine for social change”, International Weekly Journal of Science, 456: pp.877-878.

Van Hear, N. (2010). “Theories of migration and social change”, Journal of Ethnic and Migration Studies 36(10): 1531-1536.

Wolf, S.R. and Hall, R.C.W. (1971). “The use of psychodrama to diminish transcultural distance in traditional psychotherapy”, Group Psychology and Psychodrama 24(1/2): 17-23.

Wong-Valle, E. (1981). “Art therapy as a tool in the acculturation of the immigrant mental patient”, Pratt Institute, Creative Therapy Review 2: 46-51.

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Art therapy is a developing occupation exists in Hungary since 2007, when the first class graduated at the Pécs University. AT is being used in different circumstances and environments: hospitals, schools, social institutes, counseling centers, youth centers, elderly care system mostly run by Foundations, or individuals, and in some cases depending on the basic diploma of the professional financed by public sources. This lecture gives an overview of a short term therapy sponsored by an NGO organization MMT, and a long term, year program run in a public counseling centre (Budapest X-th district) for families and children (MMT is Hungarian Art-therapy Association, established by the former students of Pécs University, graduated in 2009 ). MOL Hungarian Oil Company, provides fund for civil associations and Foundations forsupporting children healing, mental health and development. MMT has been granted since 2011.

The AT- MOL Program, offered supportive art therapy for children from 1-4 grade at school, living in the countryside, struggling with anxiety, socialization or emotional problems, and bearing an existentially difficult family background. Because the relative segregation of these pupils it was doubtful that they could get psychotherapy, or their teachers would be familiar with their emotional and mental state. So the therapeutic aim was some longer assessment and support through AT. The perspective was to give an experience that gives satisfaction, feelings of success, and provides the possibility of projections of emotions, techniques that are not just serves as methods of creativity but gives a chance of healing through symbols of the unconscious. The program was often facilitated by one AT therapist in a small group and at the end there was a consultation with the teacher or school psychologist in terms for continuation in some cases. The program had a thematic line (12 sessions), based on the katathym imaginary pictures. It was developed by German psychiatrist Hans Carl Leuner, based on his research in guided mental imaginery, „katathymic influences” (the interaction of mental contents and emotional processes), dreams and daydreams. Children because of their openness can call out images without altered state of consciousness, only through meditative drawing.

The Counseling Center was established 30 years ago, there are school psychologists, clinical psychologists, speech therapists,

THEMATIC SYMBOL FOCUSED –BASED ON KIP- SHORT TERM ART THERAPY IN SCHOOLS AND YEAR LONG PROGRAM

IN A COUNSELLING CENTRE COMPARATION ART Therapy in an integrative model

Zsuzsanna Valachiné Geréb

special need teachers working together. The institute offers both assessment and therapy. Art therapy exists from 2010, in many models (kindergarten - adolescence groups) mainly in group model, but in individual therapy as well. The AT-CC program dealt with elementary school students in the district, about the same age, sharing diverse symptoms, but common in social handicap, also coming from mostly low social-economic status multiple-problem families, where supportive parent counseling is advisory. The year long program aimed either behavioral change, or looked for further therapeutic aid. The program was led by two therapists and includes parent consultation. The year is devided into three phases which we call forming, storming, norming. Each phase has its own types of art techniques and methods, the KIP is in the norming and storming phase. Forming is about the framing, opening of the group and play and introduction of the art material. Storming is more about working on the self- awareness, individualism, confrontation. In norming the focus is on group work, working in team the key words are the capacity of waiting, planning, negotiation, reflection (mentalization).Both programs used KIP basic symbols such as the meadow, the spring, forest, mountain, and house supplemented with other symbols (such as tree, flower, treasure, fairy,). We considered

Zsuzsanna Valachiné GerébArteterapeutka a detská klinická psychologička v Poradenskom centre pre deti a rodinu v Kőbá-nya v Maďarsku. Venuje sa diagnostike, terapii pre mladých a deti, poskytuje rodinné a rodičovské po-radenstvo, vedie individu-álnu a skupinovú artetera-piu pre deti a mladých.

Kontakt: gerebzsuzsa@gmail.com

The presentation shows similarities and differences of a 12 session AT school (AT-MOL) program and a year term art therapy program which has been running in a counseling centre (AT-CC) for youngsters. Both programs combine visual arts with psychodramatic play, imaginative work, occasionally music and movement.

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that the represented symbols reflects to diagnostical information, represents level of transference, and serves prognoses. The interpretation or work with the symbols always require a line of processing such as considering the realistic, individual, socio-cultural and at last mythological (Archetypes) level. From the reflections to the symbol or image, attitudes, expectations, wishes, fears, and needs connected to it we can conclude to the transference and attachment to the therapist (and to the group). Since in symbolic work there is often a symbolic act, appeal for transformation there are also signs of progression or defend mechanisms, strength of the Self.

In each session we start and end with a talking circle, sharing thoughts and feelings i.e. How do you feel today? What had happened since we met? What was the most important for you in our work today? Than everybody uses her own method to attune: music plays, movements, doodle, little dramatic, verbal plays (depends on the education of the group leader and the children mentality). Then starts the KIP part, the theme of the session, slowly guided drawing or with older children short relaxation, imagination. Mainly children work individually, but moving towards they start to create in cooperation with each other.

Session

1. tree of emotions10. tree of abilities (in group work)

2. emotional scribble and baromether

Emotional doodle is a decoding ones’ own individual drawing stile, emotional states and those expressions in drawing. Everyone gets a paper folded in 6 or 8 parts and in each part is an emotion what you have to express only with the curves, speed and intensity of your pencil.At the end of the session you can play with the emotions drawn, using them as notes for playing music, or making a montage from them as an emotional barometer. Key words: emotional mapping, introduction into free art

Symbol

Tree

Dynamic meaning

Axis of personality

Body image

act

Grow, reach out vertically

Symbolism of act

confidence, rooting, stability, and grow

Art

Acryl paints, tempera, and mixed techniques

Tree of abilities, creating together, acknowledgement to each other. List of strengths and abilities. Looking at ourselves as a group.

Tree of emotions (we ask to show important events from last week, how he or she felt with using different colors and by these create the leaves)the focus on distinguishing between emotions, playing with forms and colors. Tree is the symbol of the inner axis binding Ego and Selbst together. In the drawing of tree we can see the child maturity, control functions, balance or tense between instincts and intellect so a bit serves as diagnostics.

In the table below shown all the list of sessions and used symbols, with their “meanings”.

3. Splotch, image, story

The task is to integrate visually expressed emotions, to image and to add a narrative background a story to it. Using dense paints, folding, or pressing papers, creating patches, splotches. Then choose a few and complete it to something meaningful. Then the group writes a story of it as it would be a filmstrip of a tale, story. Key words: working in a group, find your inner pictures, find your story, cooperate

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Session

4. Symbolic play: flower the expression of self image

7. Spring or river

6. Forest and finding shelter in the storm

5. Meadow

Symbol

Flower

River

Forest

Meadow

Gardener

Architects

Storm

Animal

Dynamic meaning

Ego image,Symbol of the passive, reflective personality parts

Energy flow, lifeline, libido, sexuality, flow and waves of emotions

Unconscious

Mother existential field, safety, nutrition

Temperance, tolerance, patience

Obstacles, blocks,connections

Conflict, anger

Instincts, spontaneity, strength, impulsivity

act

Grow, blossom

Follow from source to firth

Enter

Find a place, take a rest

Nurture, take care

Observe, remove, clean

Live and hide

Symbolism of act

Seeking for recognition, life and death, rebirth→→ self esteem

Find energy, inspiration,creativity

Open

Presence and relaxation, self assurance

Self-help, healing

Remove emotional blockage

Control, self protection

Art

Pastel chalk or aquarellemixed techniques

Water based paints

Hand paints or clay or some textile, yarn or wool

Anything can be almost

We make masks for the animal figures

Flower and gardener: In the psychodramatic play: one child is a seed of a plant covered by blanket, resting in the soil, the other is the gardener taking care of the plant. While the gardener looks after the plant, flower grows. Nurture, safety, gentleness, rest, peace these are the focus points of the experience. After the play slow meditative drawing comes with instructions what to observe in your experience: roots, leaves, flowers, environment, weather around you, what was pleasant, what was bothering.

Spring: The original KIP symbol uses the spring but we found that most urban children can connect to the image of a river more easily. We start with meditative drawing with slow instructions: Imagine a river from the source, the spring till the sea, the firth. How fast is your river, how wide and deep? What creatures inhabit it? What is the scent and taste of its’ water? What is the riverbed like rocky, or covered by sand? If there any obstacles, bridges, islands or anything unusual? What is on the banks?

Forest and shelter: The session starts with a dramatic play of walking in the woods, and transforming into an animal, imitating its movements and sounds, how it lives. But suddenly a storm is coming look for some hiding place for yourself.

Meadow: The task is to walk around, imagine a meadow, find a good place to take a rest ( or in adult therapy find an object in the grass, or arrange a picnic)Changing viewpoints, what would you are in this meadow, a stone, a grass, an ant or a cloud, look around with the eyes of what you had transformed. Expression of the existential field, can show neglect, abuse, relationship towards the mother

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Session

8. Mountain and treasure

9. Travel to the fairy

11. -12. Working with families and parents

Symbol

Mountain

vehicle →→ balloon (fire, air)

House, village

Treasure

Fairy, witch, magician

Mandala, water crystal

Dynamic meaning

Father , authority, achievement, work, studySuperego symbols

Uplifting Thought and courage, enthusiasm

Safety, body, home, family, civilization

Inner positive self parts

Archetype of inner helper

Totality, oneness, Selbst, spirit

act

Climb up look aroundand walk downVertical movements in the psyche

Fly

Build

find

Make wishes

Have a good wish or complement

Symbolism of act

Change view point, imagine success

Move out of comfort zone

Represent, reflect and respect your own personality and others’

Explore your unused strength

Change, think positively, let go old wounds

Strengthen the attachment in an out

Art

Dense paints or clay

Any art even paper mache

Any kind of paint and montage

Montage, textile, body image drawing, mirror techniques

Mountain: Mountain is the symbol of achievement, efficiency, relationship with the authority and Father. Climbing a mountain is making effort, for some it is extremely hard for some is easy. We are different in the ability to enjoy what we achieved, whether we can take a rest on the top and feel satisfied by watching the view, or some might frightened at the top. Mountains often hide treasures, and of course we expect world to honor our work efforts, with the symbol of the treasure we awaken these feelings.

Fairy: Meeting the fairy is the meeting the ideal Selbst, the inner helper. In this play we make little balloons to fly up to the fairy. We make and decorate the fairy together, boys are often knights protecting the way. At the fairy you can leave three wishes, and also things that you would like to leave behind. Also it is close to say goodbye, and through the fly to the fairy we can look on our previous lands: meadows, rivers, mountains.

There are one or two but at least the last session is open, and parents can play and create with their children. Themes often used: painting a house and a village, mandalas, or water crystals based on the „Wisdom of water” book, painting for music, Winnicott doodle play

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As it can be seen we try to go in a circular way, but also increasing the complexity of the symbols and the creative process, such as from working individually towards working with the group or the group of families. Of course the thematic list is a frame and in some cases it can happen that a theme last two sessions or one has to be left out. But since MMT works with different AT background therapists, we needed to create a basic guideline to maintain the quality of the work, and could compare and share experiences. The therapist 3-4 working parallel a year provide intervision and supervision throughout their work.

The AT-CC year long ProgramThis is a more diverse, and deeper work both with children and parents. Group dinamics can be used. Also the pathology is usually stronger (behavioral malfunction, psychiatric diagnosis. Sadly the risk of falling out is also higher. Framing is the same as at the short therm. In techniques we use many integrative things. What I would like to highlight here is the typical methods of the norming phase.In the norming phase the last three month of the work, we know each other very well in the group. Kids attached to each other, can reflect to each other, the work intensively and we would like them to be able to work together, and show capacity of planning, proceeding, sharing.

Common methods: house and neighbourhood. Children in 2-3 sessons build a community. They create their own house with equipments, special needs, and focuses. We usually use montage and collage techniques. The house as symbol also reflects to the security, family matters, openness, hiding, closing, boundaries, body image. Also it shows the needs of privacy, tranquility. The garden and fences around shows social aspects of the self. Mainly conscious. Something you have already worked yourself through, you identify with, and can show for others as well. Other than the symbol of the house with is more connected to the body and personality. The garden is in between the unconscious (id) and the conscious (ego)…bridge, transit zone. Makes you feel in peace, relaxed, where you meet the nature, but it is safe and comfortable.

We also ask the group to make rules of the community, and social areas, squares, fireplaces, sea shores, streets ect. Somehow a bit the same my country or my planet where we have a common map, where group members have to conquer areas (mainly by negotiation with others, sometimes through some play activity) and on the given territory one must imagine and create: inhabitants and habitats, vehicles and buildings, customs and holidays, food, and feast.Though the most popular especially among younger children is the labyrinth play. The play based on the Greek mythology, what we sometimes read to the children or sometimes we just make a discussion about it. It is a five session thematic play. Where we first imagine and create the ideal self as hero, with suits and weapons and protection as amulets . Than the beast as the symbol of the shadow, who guards the labyrinth. Then on one session we create and find out our treasures, what we would like to find in the labyrinth. Also we need to know how can one win against the beast, what adventure and challenges are expected. Than at the last session we build the scene and activate all fantasies with dramatic play and hold a feast at the end.As a summary I can ad, that in both program there is a strong line of symbolic play and imaginary work which in our experience evokes yet rested areas and healing capacities of the soul. Not always is conscious in our clients what helped and happened. Our task is to see through the creative process the abilities of growth and health and foster them. And also on the other hand to see the needs and the ways we can make the parents, family and the teacher, school to change in advance of the child’s development.

References:- Leuner Hanscarl A katatím imaginatív terápia (A képzelet használata a rövterápiában) /Katathym inaginative therapy, Usage of

Imagination in Short Therapy Animula Press, Hungary 2012

- Leuner Hanscarl A katatím képélmény (Jelképdráma) tankönyve jegyzet /The katathym image experience book (of symbol-drama)notes https://www.google.hu/url?sa=t&source=web&rct=j&url=http://www.integralakademia.hu/data/file/2013/07/30/kip-konyv-szerkesztve.doc&ved=0ahUKEwippL64tMzVAhXF7BQKHSVwCRMQFghSMAo&usg=AFQjCNH3dXpn7tPyHEWExlEEnMvjXKIv3A

- Orsolya Göbel Varázsjátékok Fantázia tengerén ; /On the see of Fantasy L‘Harmattan Press 2007 (based on the ideas of Klaus W. Vopel)

- Heidi Kadeson-Charles Schaefer 101 játékterápiás technika / 101 Playtherapy Technique Animula Press 2009

- Zoltán Wass A közös rajzok pszichológiai értelmezése/ Interpretation of drawing Flaccus Press 2011

- Machiodi C.A. A gyermekrajzok megértése, / Understanding childen drwaings Animula Press 2003

- D. O. Winnicott Playing and Reality Penguin 1971

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