Art Therapy
Mildmay Hospital's art therapy service supports patients with complex HIV, homelessness and substance use.
Delivered by Brita MacDonald, a qualified Art Psychotherapist registered with the Health and Care Professions Council (HCPC) and the British Association of Art Therapists (BAAT), the service is an integral part of Mildmay's multidisciplinary approach to rehabilitation and recovery.
Art therapy at Mildmay is generously supported by the Mary Kinross Charitable Trust, whose sustained commitment has made this provision possible.
What is art therapy?
Art therapy is a form of psychotherapy that uses visual and tactile media as a means of self expression and communication. Art therapists aim to support people of all ages and abilities and at all stages of life, to discover an outlet for often complex and confusing feelings, and foster self awareness and growth.
Art therapy at Mildmay
Art therapy at Mildmay offers patients the opportunity to understand emotional conflicts, develop social skills, reduce anxiety and improve self-esteem alongside the high calibre of professional care throughout the hospital.
I am interested in attachment, memory and loss and how the art-making process can support making sense of what has happened. In the right circumstances, the art therapy process can recalibrate perceptions of the past, present and future, which in turn can lead to transformation and well-being.
My approach is to offer a safe, contained and confidential space where it is possible to explore thoughts and feelings through the art materials within the art therapy space.
"TY! For the fun and opening and healing art therapy I had with your wonderful lady who saw my eye and heart in the early 90’s. It made the difference. I’m still at it!"
May 2024
Art therapy approach
My approach is to offer a safe and confidential space in which people may feel able to explore thoughts and feelings through the art materials and - hopefully - engender trust in the therapeutic relationship.
My art therapy training was psychodynamic, and I try to combine psychodynamic therapy with a person-centred and non-judgmental way of working. I have worked as an art therapist facilitating groups within a domestic violence refuge, homeless hostel and community settings with people described as having complex needs. My experience of working with people experiencing HIV, homelessness and/or substance abuse has shown me that trust in others, particularly professionals, may not always be available, and this may often be due to attachment issues resulting from a traumatic and painful history and/or adverse childhood experience and/or fear of stigma. In art therapy sessions, there is no obligation to talk, and at these quiet times, there is often a feeling of witnessing in the space.
Art therapist Malcolm Learmonth speaks about the value of ‘witnessing within’. This may be referred to as the triangular relationship of patient, art object and therapist:
"In this triangle, the therapist and client can, if they are lucky, form some sort of witness to a previously inarticulate experience. If this is successful, it can change everything"
(Learmonth, 1994: 22)
For patients who may be experiencing the symptoms of HIV-Associated Neurocognitive Disorder or alcohol-related Wernicke-Korsakoff syndrome, art therapy can help people to cope with feelings of isolation, fear, confusion, anxiety and depression. It can offer the potential to build stronger relationships and help to reconnect fragments of meaning. Making art objects can be an 'acceptable' way of expressing 'unacceptable' feelings, allowing patients to release ambiguous feelings and conflicts within a safe place.
Brita MacDonald
Art Psychotherapist
Who benefits from art therapy at Mildmay?
People living with HIV and HIV-associated conditions
For patients living with complex HIV, particularly those experiencing HIV-Associated Neurocognitive Disorder (HAND), art therapy offers a means of expression that does not depend on verbal fluency or cognitive clarity. Making art can help patients manage feelings of isolation, fear, confusion, anxiety and depression, and
People experiencing homelessness
Many patients admitted via Mildmay's Step-Down Homeless Pathway carry significant trauma histories and deep mistrust of institutions and professionals. Art therapy's non-directive approach, where there is no obligation to talk, and no requirement to produce, can be especially effective with this group, offering a contained, non-judgmental space at a time when trust is in short supply.
People recovering from substance use
Art therapy supports the emotional and psychological dimensions of recovery alongside the medical. It can help patients begin to process the experiences and feelings that underlie addiction, in a setting where the pace is led by the patient.
How art therapy sessions work at Mildmay
I facilitate open art therapy group sessions, meaning that patients can come to the group at any time and leave before the end of the session if they feel they need to, but they can also stay for the whole session if they feel they can manage this.
Physiotherapists, Occupational Therapists or other staff sometimes escort patients they have been working with to the space, and this is often necessary if people are experiencing difficulty with access or they are under a Deprivation of Liberty notice (DOLS) due to safety issues. I am available to work alongside patients in their rooms if they prefer a one-to-one session, find groups difficult or are unable to leave their bed.
In the morning, after the ward handover and before setting up for the group, I visit the wards, introduce myself to patients and invite them to the group in the afternoon. I find this is a useful means of meeting newly admitted patients and a practical way of reminding people who have attended the group before and may have memory or mobility issues. I will accompany patients to the group if they ask for me to do so or if there is a need.
When not in the art therapy space or on the wards, I work with colleagues in the multidisciplinary team (MDT) office. I often gain useful information and referrals from them if they feel a patient may benefit from art therapy. I sometimes show students who are shadowing MDT professionals the space and introduce and discuss art therapy with them.
The art therapy space
The art therapy group takes place in the Occupational Health room on the ground floor.
The space can accommodate ten patients comfortably. The room provides a light, safe and comfortable space offering a good variety of art materials such as paint, clay, assorted paper and card, chalk and oil pastels and more. Art books and postcards are available as are magazines for collage material.
The space has a lockable cupboard in which the art materials and the patients' images are safely stored. Art therapy images and the clinical notes written up after a session are treated as highly confidential,
and are kept in a lockable cupboard. Patients have occasionally asked to take their images up to the ward if they want to put them up in their rooms or show them to others, but more often, they are kept in the cupboard and offered to them when they leave the hospital. Sometimes, patients do not want to take their images with them, and there is often a sense of preferring to leave their images and what they may represent with the art therapist. These Images are disposed of safely after a period of time.
The hospital offers a distinct picture in terms of Intersectionality, highlighting difference and disadvantage much of the time. As a white art therapist offering art therapy to a multicultural group of people, affected by severe inequality and living with its consequences, I am aware of this imbalance (McKoy-Lewen, 2020). I sometimes ask patients about their experience of art making when we meet and mostly people reply that the last time they made art was likely to have been at school. I was surprised to hear one patient say that she had never had art lessons or provision at school and could not remember making art at all. Watching her explore the use of the art materials during her one art therapy session was profoundly moving.
Outcomes
It is difficult to record art therapy outcomes due to the qualitative nature of the work and the short admission period that some patients experience.
Some patients may come for one session only and some come for more. Not everyone In the patient group at Mildmay are amenable to coming to the art therapy group but the ones who do, and who can tolerate the encounter, share their experience and learn from others.
In addition to the current art therapy provision, it would be beneficial to offer the possibility of a few outpatient
sessions to patients who do engage well with art therapy after they have left as it is often difficult to access art therapy elsewhere.
Recommendations are added to patient’s MDT discharge reports with the hope that patients can access more art therapy in future.
Art therapy at Mildmay is made possible by the generosity of the Mary Kinross Charitable Trust, which has supported this service for over a decade.
How you can help Mildmay
Art therapy is one example of the work that NHS contracts do not cover. Mildmay's ability to offer a genuinely holistic service, one that addresses the psychological and social dimensions of complex illness alongside the clinical, depends on charitable income.
The Mary Kinross Charitable Trust's support has made it possible to offer art therapy as a consistent, embedded part of Mildmay's care, not as an occasional add-on, but as a clinical service available to every patient admitted to the hospital. We are deeply grateful for this partnership.
If you would like to help sustain art therapy and other charitably funded services at Mildmay, such as chaplaincy and pastoral care, please consider making a donation.
