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TRAINING: FROM APPRENTICE TO PRACTITIONER

The History of Art Therapy Training In The UK

Although the question of what kind of training an art therapist should receive was a matter of some debate during the 1950s and early 1960s, it was not until the formation of the British Association of Art Therapists in 1963 that the task of devising suitable programmes of training began to receive serious attention (Waller, 1992). During the following decade a num-ber of trainings in art therapy began to develop which, although having many common elements, also had notable differences in emphasis. For example, in 1969 an option in art therapy had been introduced into the Postgraduate Certificate in Education (PGCE) course at the School of Art Education in Birmingham (Byrne, 1980), and in 1970 a Certificate in Remedial Art course had begun at St Albans School of Art (Evans, 1979). In 1974 Goldsmiths College in London introduced an option in art therapy to its PGCE course (Waller, 1979). By the late 1970s the courses at both Goldsmiths College and (then) Hertfordshire College of Art and Design (now the University of Hertfordshire) had been converted into full-time Postgraduate Diploma in Art Therapy courses. Regrettably, the course at Birmingham Polytechnic failed in its attempt to become a discrete Postgraduate Diploma in Art Therapy and had DHSS approval withdrawn in 1985

As the differences in emphasis between the three then centres of art therapy training have been written about elsewhere I shall not attempt to describe them in detail here; see Waller. It is, however, nec-essary to acknowledge that two of the art therapy training courses were initially offered as an integral part of an art teacher training course, while the course at St Albans School of Art was intended to equip those offered

places on it (including nurses, occupational therapists and other health care professionals, as well as artists) with the necessary practical and theoretical skills relevant to the practice of art therapy. This practice was also seen as being an ‘essentially Health Service orientated activity … concerned with working with the mentally ill and handicapped’ (Evans, 1979: 4). Thus a split existed between those trainings which were allied to, and clearly identified with, art education, and the St Albans course which courted academic approval through its links with the medical profession.

One significant feature of these differences in emphasis within the train-ing courses was that they reflected conflicting views within the emerging profession of art therapy itself. Many of the more prominent art therapists at the time were strongly influenced by the anti-psychiatry movement and were consequently ‘reluctant to see art therapy being allied to psychiatry’ (Waller, 1992a: 214). Tensions in the relationship between art therapy and psychiatry have, as previously noted, shaped the development of the pro-fession in a number of ways, both positive and negative. At the heart of this issue, especially during the developmental phase of art therapy training, was the question of professional autonomy. That is to say, whether or not the training art therapists received should equip artists to work as inde-pendent therapists, or whether other health care professionals, without necessarily possessing a background in the visual arts, could be trained in the therapeutic application of art as an adjunct to the work of more estab-lished professional groups like psychiatrists or clinical psychologists. The development of art therapy training in the UK and in other countries has been of crucial importance in resolving this matter .

The Role of the British Association of Art Therapists Registration and Education Sub-Committee

In an attempt to reconcile the differences between the training institutions, along with other issues concerned with art therapy training – primarily that an understanding of artistic practice was seen as central to such a training, not an optional extra – the British Association of Art Therapists established a Registration and Education Sub-Committee in 1976. The committee con-sisted of representatives from the three existing training courses, along with a number of practising art therapists, and had the aim of arriving at a ‘core course’, which all the training institutions would be required to deliver. This step was fundamental in establishing a unified and coherent profession. The recommendations made by the committee stipulated:

That entry to training should be at postgraduate level, with intending students ‘normally’ having a first degree or its equivalent in the visual arts. That the training should consist of a balance of theoretical, clinical and experiential learning.

And that students must ‘spend at least 60 days on placement in appropriate institutions under the supervision of persons with responsibility for the clinical application of art therapy’ .

The ‘core course criteria’ drawn up by BAAT and the art therapy courses in 1978 were subsequently approved by the Department of Health and Social Security in 1982 as an appropriate training for art therapists employed in the NHS. These criteria continued to determine the nature and duration of the training art therapists received until the mid-1990s. However, from the mid-1980s, the British Association of Art Therapists, and representatives from those academic institutions which trained art therapists (including, from 1984 onwards, the University of Sheffield) initiated, through BAAT’s Training and Education Committee, a review of the existing core course criteria. This process culminated in 1992 with the adoption of revised Core Course requirements for postgraduate art therapy training (BAAT, 1992a).

The Core Course Criteria’ for Art Therapy Training in the UK

Though retaining many of the criteria for training previously listed – that, for example, training should continue to be at a postgraduate level – the revised core course requirements contained a number of significant differences.

That only nationally validated institutions of Higher Education are appropriate venues for art therapy training.

That training should be rooted in psychotherapeutic concepts.

That the length of training should increase from one year full time to two years full time or its part time equivalent.

That the length of the clinical placement should be increased from a minimum of 60 days to a minimum of 120 days.

And that for the duration of the course each trainee must undertake some form of personal therapy on a minimum basis of one session per week. (BAAT, 1992a)

A notable anomaly arising from these changes was that the academic qualification awarded on successful completion of the extended training remained that of a Postgraduate Diploma. At the present time a number of the UK art therapy courses are in the process of increasing the academic content of the training with a view to awarding a degree at MA level following an additional period of research-based study.

Currently there are six postgraduate training courses approved and accredited by the British Association of Art Therapists. These are based at Queen’s University Belfast; the University of Derby; Queen Margaret College in Edinburgh; the ; Goldsmiths College,

University of London and the University of Sheffield. See Appendix 2 for further information about these courses. The Postgraduate Diploma awarded by these courses is recognised by the Health Professions Council as entitling the holder to apply for state registration (see Chapter 7).

Training as an Art Therapist

As art therapy established itself as a profession, interest in it as a possible career option for arts graduates has resulted in a significant increase in both the number of training courses available nationally, and in the number of enquiries and applications for places on these courses. The motives applicants have for wishing to train as art therapists vary, as do their age, personal qualities and background. It is difficult, therefore, to generalise about this, although many applicants are attracted to the profession because they have found image making helpful in gaining a better understanding of their own emotional conflicts, as well as those of clients. Successful applicants for art therapy training courses are usually fine art graduates who are able to demonstrate a sound understanding of, and commitment to, the practice of visual art. Only in very exceptional circumstances are other qualifications accepted.

The insistence that applicants have acquired this background in the visual arts prior to training has been, as Waller (1991: 256) acknowledges, ‘fundamental in defining art therapy as a ‘profession’ rather than an occu-pation or a craft’. As Case and Dalley (1992: 148) comment, ‘Without this foundation, the art base of the profession of art therapy is eroded’. Despite being subject to criticism – that, for instance, it is merely a matter of polit-ical expediency or that arts graduates may be overly concerned with the formal qualities of an image rather than its psychological content (see Birtchnell, 1986) – this stance is important for two main reasons.

Firstly, a background in art is important in that it helps students to begin applying their familiarity with art and image making in therapeutic relationships from the outset of their training. In addition to having acquired an in-depth knowledge of art media and materials, along with a familiarity with the dynamics of the creative process, graduates from fine art courses in the UK also tend to be independently minded and socially aware. The kind of education typically provided on an undergraduate fine art course is certainly very different from that on offer to most medical and paramedical students. Nevertheless, while acknowledging the importance of gaining a grounding in the visual arts prior to training, one of the ironies of art education in the UK is that fine art students are often actively discouraged from using their art for anything remotely resembling self-exploration. Many do, of course, but this is frequently unrecognised or unacknowledged (Rawcliffe, 1987).

The second reason a sound understanding of the visual arts was considered important is that many art therapists felt, and continue to feel, that

this commitment to art was essential in ensuring that art therapy ‘offered an “alternative” view of treatment to the prevailing “medical” model’ (Waller, 1991: 256). Having gained a degree of understanding of the cultural context, traditions, technical and psychological processes operative in making and responding to art through their undergraduate education, art therapists are generally less inclined to view the images made by clients in purely psychological or diagnostic terms than their medical colleagues.

In addition to having a grounding in the visual arts, those accepted onto the art therapy training courses are usually mature, flexible people who have substantial experience in the therapeutic application of visual art and of working in mental health, education, special needs, or social services prior to training. As most art therapy students will normally need to fund part or all of their training themselves, they also need to be resourceful. While many of the applicants for the Postgraduate Diploma courses possess the foregoing qualifications and personal qualities, their familiarity with art therapy itself is often limited. For some, reading around the sub-ject or talking to art therapists about their work fills this gap. Others may have attended talks, workshops or art therapy ‘schools’. Both kinds of experience may have led directly to the decision to train. In recent years the need for opportunities to acquire a fuller appreciation of art therapy, both experientially and theoretically, has provided the impetus for the development of introductory or Foundation in Art Therapy courses. In addition to providing a good grounding in the subject for individuals intending to pursue a career in art therapy, these introductory courses have also proved to be popular with those working in other professions who are interested in finding out more about the theory and practice of art therapy (see Dudley et al., 1998) for a thoughtful discussion of the kind of issues touched upon and explored on such courses.

The Aims Of Art Therapy Training

The principle aim of the training offered through the postgraduate Diploma courses is ‘to enable graduates to undertake the clinical practice of Art Therapy in which visual art and the process of making images play a central role in the context of the psychotherapeutic relationship (BAAT, 1992a)’.

In practice, training as an art therapist requires that students acquire a knowledge and understanding of the self, the client and of the nature of psychotherapeutic relationships as mediated through art and its processes. Linking theoretical and experiential studies with clinical experience tends to be an intellectually and emotionally demanding business for all concerned.

One of the dilemmas inherent in becoming an art therapist is that the process is as much a matter of learning about feelings as it is about acquiring theoretical knowledge and technical skills. This can, initially, be a frightening prospect and it is not unusual for the sense of anticipation and excitement felt by students at the beginning of their training to be

replaced by feelings of confusion and anxiety. During training this discomfort may find expression in a number of different ways. It may, for instance, take the form of an envious attack on course tutors or placement supervisors for appearing to withhold ready-made solutions to the problems they are grappling with. Such feelings often originate in the hopes and expectations the student felt in relation to parents or previous teachers. Commenting on the student’s expectation that the teacher fulfil the role of provider and comforter, Salzberger-Wittenberg et al. comment,

A body of theory can of course be taught, but it would be a purely intellectual acquisition likely to delude its possessor into believing that he knows something about the mind when all he has got is a tool for categorising people. This is a dangerous attitude and a far cry from an understanding based on empathy. It is also totally useless if the task is to learn to appreciate the individuality of each person and to provide a relationship that gives students the opportunity to develop.

By its very nature therapeutic work of the kind art therapists are engaged in is often paradoxical, and the complexities of integrating theory and practice, intimacy and distance, words and images, can come to feel intolerable. Within the student group this may lead to a polarisation of attitudes towards theory and practice. For some students, acquiring a theoretical understanding of the work may be felt to be of paramount importance. For others quite the opposite may apply, with theory coming to be seen as a threat to spontaneity. It is largely for these reasons that central to the teaching philosophy on UK art therapy training courses is the belief that effective learning about the process of therapeutic change, and the role image making may play in promoting this, requires that students explore and share their own feelings and perceptions.

Course Structure and Organisation

All the UK art therapy training courses are run in two modes, full time over two years, or part time over three years. The taught elements of these courses follow the standard academic year and are usually run over two 15 week semesters. Clinical placements and personal therapy, however, involve a time commitment throughout the year. Although there are variations in the way the art therapy training courses are organised and structured, all consist of a mix of lectures, seminars, workshops, placement experience and written work.

Lectures and Seminars

The precise content of the lecture and seminar programmes often vary from course to course, and from year to year, depending upon the needs of the

student group and in response to developments within the profession. In general terms, however, lectures and seminars aim to cover the following areas:

Basic psychotherapeutic concepts concerned with establishing and maintaining the therapeutic frame and relationship.

An overview of the theory and practice of art therapy; including the theoretical and historical background to art therapy.

An introduction to different therapeutic approaches to working with images and work with different client groups.

An exploration of group and institutional dynamics.

An examination of the political and cultural contexts in which art therapy takes place.

In line with the attention now paid to professional ethics, research and evidence based practice, these issues have also come to assume increasing importance within the curriculum .

These components of the course are supported by tutorials and assessed through the submission of written work.

In addition to attending lectures and seminars, all students are required to undertake a number of experiential units of study.

Training Groups

During the first year of the course students spend time each week in a training group working together with an experienced art therapist. The groups usually have a membership of seven or eight students and last for two or more hours. The purpose of these groups is to enable students to gain an understanding of how art may be used therapeutically, and how image making may inform group psychodynamics (Gilroy, 1995). To this end, the training groups involve:

Self-exploration through image making.

Learning about group interactions and the role of image making in rela-tion to this.

Working with unconscious processes.

Experimenting with different ways of image making, different materials, themes and approaches. (Swan-Foster et al., 2001)

The training groups seek to combine experiential and didactic approaches to learning. That is to say, they may include instruction on group dynamics or different approaches to working with images in groups, in addition to working with more personal material. However, although personal material and inter-personal issues inevitably surface in such groups, the training group is not a substitute for personal therapy.

Workshops

At different points during the course students may also participate in art based workshops on specific themes or issues. These workshops often involve visiting art therapists and may be scheduled to last for a whole morning or afternoon.

Supervised Clinical Practice

Students are required to complete a minimum of 120 days supervised clinical practice during their training. This is intended to provide students with a continuous, in-depth experience of psychotherapeutic work with clients using image making. This element of training is of central importance to each student’s learning on the course and examines their ability to learn through experience and link theory to practice. While on placement, students work closely with a supervisor who meets with them on a regular basis to discuss their work with clients. In most situations the supervisor will be a senior art therapist. Where this is not the case the supervisor will usually be a therapist who has a sound understanding of art therapy and the training requirements of the student. One of the paradoxes of supervised clinical practice is that while it offers a potentially rewarding opportunity for the trainee to reflect upon and learn from their experience, it also involves a degree of self-exposure and the revealing of perceived fears, vulnerabilities and weaknesses. At the mid-point, and again towards the end of their placement, students are required to submit a case study or clinical report based upon their work with one or more clients.

Clinical Supervision

In addition to the supervision received while on placement, students also receive group supervision provided by course staff. The purpose of these supervision groups is to complement the supervision students receive on placement and to assist them with their learning about therapeutic work. Initially the main focus of these supervision groups tends to be primarily concerned with practical matters, such as how the students find suitable clients to work with and how to establish a safe space in which to work. Over time, however, a wider perspective is adopted in order to accommodate issues, thoughts, feelings and images arising out of the placement situation as a whole, in addition to the content of particular sessions (Edwards, 1993c; 1994).

Although the supervision provided on placement, and by course staff, are intended to complement each other, there are important and necessary distinctions to be made between them:

The first, and perhaps most obvious, distinction between the two is that the former takes place in a variety of settings.

The second distinction to be made is that the supervision students receive while on placement is usually provided on an individual basis. A third distinction is that although the majority of placement supervisors are art therapists – by profession or training – not all are.

The final, but very important distinction to be made is that while placement supervisors do have a responsibility to meet the training needs of the student their primary responsibility is to the clients the student is working with.

The quality of the relationship established between supervisors and students is a crucial factor in determining whether or not it is successful in its aim of facilitating learning. Though clearly not the only factor, it is nevertheless one that will largely determine whether or not, at the end of an art therapist’s training, they are able to use art as a means of offering distinct therapeutic help to clients.

Personal Therapy

Throughout the period of training all students are also required to be in personal therapy on a minimum basis of one hour per week. Personal therapy is a mandatory part of the course, but is not assessed. The only requirement is that the student’s therapist informs the course in writing at regular intervals that therapy is continuing. Students are expected to arrange and pay the full cost of their own therapy.

There are a number of reasons why personal therapy has been included as a component of psychotherapeutic training courses:

Firstly, personal therapy offers the student an additional opportunity to learn through experience, and helps to develop his or her overall understanding of the therapeutic process.

Secondly, personal therapy provides the student with an opportunity to recognise and address their own unresolved problems so that they are better able to cope with the stresses of working with clients without undue interference from internal conflict.

Finally, undertaking personal therapy outside the course offers students a level of emotional support that the course itself is unable to provide.

Because the vast majority of art therapists working in the UK are employed in the public sector (i.e. in the NHS or social service establishments), finding an art therapist able to provide therapy privately can prove problematic. The membership directory published annually by the British Association of Art Therapists (BAAT, 2003) does include a list of art

therapists who work privately, but the current level of provision in this area is not extensive. Consequently many students enter therapy with therapists who may have no background in art or art therapy. In these circumstances, it is generally recommended that those forms of therapy which value and are able to work with imagery, be this verbal or pictorial, and which stress the importance of interpersonal relationships are most likely to be relevant and useful.

What is an Art Therapist?

Following their training, a qualified art therapist can be expected to possess a considerable body of knowledge and experience concerned with art, the creative processes and non-verbal communication and be able to provide an environment within which patients or clients feel safe enough to articulate and explore their feelings through the medium of art. In relation to their clinical work an art therapist should have the ability to: Provide art therapy in keeping with the policies of the institution in which he/she is employed.

Establish the necessary physical and psychological conditions for implementing art therapy.

Evaluate and report on the outcomes and effectiveness of art therapy.

Be open and flexible enough to adapt the type and style of therapy offered to a wide range of clients.

Cope with the problems of working in a stressful environment. Provide information on the nature and theory of art therapy to colleagues and other professionals.

Be aware of his/her own emotional responses to clients and be objective and sensitive in handling relationships with them.

Be sensitive to issues of difference (racial, cultural, sexual, class, etc.) and how these may impact upon the therapeutic relationship. Undertake the managerial and administrative tasks for which they have responsibility.

It is this combination of skills and experience that enable art therapists to contribute in a unique way to the multi-disciplinary teams with whom they work. In the UK, the standards of proficiency required of practising art therapists are determined and regulated by the Health Professions Council (see Chapter 7).

Thorough though the training art therapists undertake may be, it is only the beginning of a life-long process of professional development. In addition to maintaining and extending their skills as artists and therapists through further training, attending conferences, remaining up-to-date with

the literature and continuing with their own image making, art therapists often acquire other specialist skills in areas related to their work. This might include the use of computers and information technology, clinical audit, research, supervision and teaching. The continuing professional development undertaken by art therapists is discussed in more detail in the following chapter.

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