The art of creative arts therapies
Pioneering practitioners of this still largely unrecognized discipline find fertile ground in Montreal
by Patrick McDonagh
Graduates of creative arts therapy programs need a healthy dose of the frontier spirit. The field "has been around for almost as long as psychotherapy but we're still involved in pioneering work," says Stephen Snow, coordinator of drama therapy in Concordia University's department of creative arts therapies.
The field uses a deep understanding of art, drama, dance or music as a basis for psychological therapy. "You really need a passion for creative arts therapy, because the requirements to get into this program are so demanding," says master's student Sarah Brodie. "And once you graduate, you often have to create your own job."
Concordia has the country's only graduate programs in art and drama therapies approved by the American Art Therapy Association. (Wilfrid Laurier offers a master's program in music therapy.) Undergraduate programs are no easier to come by, with just a handful of universities offering diploma courses or concentrations in the field. One of these is neighbouring Université du Québec à Montréal, which offers a music degree with concentration in music therapy. All this activity has placed Montreal at the centre of creative arts therapies practice and research in Canada, with a steady stream of interns and graduates transforming local therapeutic services.
Creative arts therapies use artistic practices to explore psychological issues that people may be unable to confront directly. Sometimes the process can be structured - drama therapists ask clients to use role-playing activities to address specific issues. Other times, it can be more free-form, such as clients using painting or drawing to help them unlock underlying problems. Both the creative activity and discussion that follows contribute to the therapeutic process. The therapies can be used to address any number of critical problems such as suicidal depression, anorexia or violent behaviour, as well as less-disabling interpersonal issues.
Ms. Brodie first learned of art therapy while working on a story as a researcher for CBC Radio in Toronto. She was immediately fascinated. "I enrolled in a psychology class the next day," she recalls. But getting into Concordia's program took considerably longer: one year to pick up the necessary psychology credits and another of focused art training to complement her experience as a photographer.
Students entering the program are required to have some background in both psychology and either drama, art, music or dance. "We have people who have been actors for 25 years coming into this program," says Concordia's Dr. Snow, who himself had a stage career in New York and earned a PhD in performance studies before heeding the call of drama therapy.
Intensive training in one discipline sets creative arts therapy apart from its cousin, expressive arts therapy. "In the latter, all disciplines are blended together, and the therapist doesn't really need full training in a single art form," says Dr. Snow. "But creative arts therapies are built on a deep understanding of the practice of a specific art."
Students in the Concordia program are required to do 800 hours of internship in the community over two years. As 12 students are accepted into each of the drama and art streams each year, at any given time there are up to 48 interns working in and around Montreal. First-year students are placed in well-structured environments, such as geriatrics wards, in palliative care or at Concordia's Centre for the Arts in Human Development. The centre, known as CAHD, runs a program for people with developmental disabilities. By second year, students choose their own internship locations, including hospitals, community clinics, schools, women's shelters and prisons.
Ms. Brodie served as an intern working three days a week in the psychiatry unit of the Montreal Children's Hospital, where she had a steady caseload of troubled youth. "It's been an incredible experience," she says. "I've reached some pretty deep places with some of these kids and have come to know them very well. I don't know how I would have arrived there without the art to facilitate communication."
Ms. Brodie's graduating paper will be a case study of a young person's attempt through art therapy to come to grips with death and bereavement. In previous years, students explored such issues as the efficacy of art therapy to help children who are living in shelters because of domestic violence and the capacity of drama therapy to improve the quality of life for people with Alzheimer's disease.
Many students in the Concordia program are from Quebec and remain there after graduation, but not everyone. Magdi Tournier, a drama teacher in her native Hungary, came to Canada to pursue a master's of education at the University of Victoria. While there, she discovered the potential of drama therapy, and after graduation she entered the Concordia program, focusing on ways of using drama to change violent behaviour in children.
"Playing different roles is like a life force for children," she says. "There are very few kids who do not want to get involved." After graduation, she spent two winters working in a small aboriginal community 160 km from Inuvik, and is now a mental health clinician based in Fort Nelson, B.C. She says archetypal imagery is used a lot in drama therapy and is especially significant in Native communities. "Because archetypes are culturally inherited, they are best invoked within that culture. A lot of mental health problems could be addressed if cultural archetypes, now lying dormant, could be revived."
Mythology and archetype play important roles in creative arts therapy, agrees part-time faculty member Nicole Paquet. "Art therapy asks what creates meaning for someone - you could say it looks for the psycho-mythological rather than the psycho-pathological," says Dr. Paquet, who practices in Quebec City and is president of the Association des Art-Thérapeutes du Québec.
Yehudit Silverman, a drama and dance therapist and professor in the department, plans to draw on the myth of Demeter and Persephone in a film on suicide she's making with the adolescent clinic of the Montreal Children's Hospital. "People who are attempting suicide usually suffer from depression, which can be considered an underworld like that into which Persephone descends - so how do they get out again? I believe myths and fairy tales can be used creatively and effectively to help us understand these issues."
Quebec has one of the highest suicide rates in Canada, she notes. "There is a real problem, particularly among adolescents." The film will follow three pairings of mothers with daughters who are in their early teens and who've made at least one serious suicide attempt. "Of course, the girls have to be at a stage where they are not emotionally fragile, as this process can be difficult."
Much of the research coming out of the department emanates from its Centre for the Arts in Human Development, which runs a three-year program for people with developmental disabilities. Twenty participants spend three years coming to the centre, where the program draws on all of the creative arts therapies to build towards a bi-annual theatrical performance.
"They work, eat and travel together, which creates a sense of community," says Concordia's Dr. Snow, who writes and directs the play and makes sure that each performer has a chance to shine. "We come to know them quite well, and out of that we are able to develop individual roles that will be effective in attaining what we see as clinical goals."
The most recent production, Romeo and Juliet on Dante Street - the locale is in Montreal's "Little Italy" - was performed on two consecutive nights at Concordia's D.B. Clarke Theatre. It and other CAHD outreach activities have been supported in recent years by a $250,000 gift from the Birks Family Foundation.
"The program sets up expectations of success rather than failure, which gives confidence to the participants," says Leland Peterson, an art therapist and adjunct faculty member. And its participants agree. "Seeing all the people there [in the audience] made me feel really good. This whole thing has brought a change in me," says Chris Chang, who is nearing the end of his three years at the centre.
Dr. Snow recently wrote an article about his work at the CAHD for the academic journal The Arts in Psychotherapy. He found that therapeutic drama increased the participants' socialization and communication skills, enhanced senses of responsibility and maturity, and reduced feelings of stigmatization. Dr. Snow is also the lead investigator of a study, which received a major grant from the Social Sciences and Humanities Research Council, on ways to use arts media as psychological assessment tools.
This type of research is an important component of the Concordia program, especially as health-care bureaucracies tend to downplay creative arts therapies. But the field is gaining acceptance. "Our biggest advocates are the people we work with, once they learn how useful these approaches can be," says Dr. Snow. "We don't fit perfectly into the predominant health care paradigms, but there is increasing respect, interest and support."
Despite such successes, employment opportunities do not rain down upon the newly minted graduates. "You don't see these jobs advertised in the paper," says graduate student Ms. Brodie, who plans to stay in Montreal. "Often you must create your own position and your own funding as well." Quebec practitioner Ms. Paquet agrees. "It still takes a lot of entrepreneurial skill to develop a practice. But we're pioneers. We're breaking new ground."
Music soothes more than the savage beast
According to Connie Isenberg-Grzeda, professor of music therapy at the Université du Québec à Montréal, "what we learn first is often what we forget last." Do the lullabies we sing to newborns imprint their tiny minds in a way that might make music an effective tool for healing their troubled souls later in life?
Music-therapy applications vary considerably, explains Professor Isenberg-Grzeda. Some involve "active" approaches, where patients express their feelings through instruments or song; others focus on the "receptive": patients listen to music and "play" their own experience on another instrument; and still other approaches aim to help patients relax or to reduce their pain (as part of palliative care, for example).
One of the most touching cases for her involved a geriatric patient who hadn't spoken for years. It took only a few short sessions with the music therapist for the once silent man to start humming, then singing and, finally, speaking. "Believe me," insists Professor Isenberg-Grzeda, "this isn't magic-potion stuff!"
UQAM's music-therapy program opened in 1985 and remains the only one of its kind in Quebec. Roughly 20 students, all with solid musical backgrounds, enter the program each year. Their passion goes beyond entertaining or inspiring: they want to help people heal through music.
The curriculum includes courses in music, psychology and music therapy, as well as supervised practicums. After graduating, therapists move into an array of clinical settings ranging from hospital-based palliative care and psychiatry to homes for the elderly to special-needs schools and group homes.
Since 2003, graduates have been able to pursue master's studies at Wilfrid Laurier University in southwestern Ontario. Of course, this isn't ideal for francophone students, but they may soon have another option: UQAM and Concordia are considering a joint graduate program of their own. - Geneviève L. Picard
Sound comfort
A bereaved family gathers around the bed of a dying relative to sing a hymn. Accompanying them at a nearby piano is Adrienne Pringle. As a music therapist at the Credit Valley Hospital in Mississauga, Ont., her job is to provide patients and family members with comfort and a vehicle for emotional or spiritual expression.
"There's so much satisfaction in this type of work," says Ms. Pringle, a graduate of the only master's music therapy program in Canada at Wilfrid Laurier University.
Ms. Pringle spends most of her work time in an eight-bed palliative care unit where the majority of patients are dying of cancer. If they are well enough, she will sing with them or have them play the guitar, but since they are often too ill she will instead make music for them. "Music seems to create an equal ground," she says. "It strips away the disability. In music there's a place where people can be healthy."
With some patients, she also writes music. It could be a love song a dying man writes to his wife or a goodbye song written by a mother to her children.
Having spent her childhood playing the piano and singing in choirs, she didn't surprise anyone when she decided to study music at Mount Allison University. But instead of pursing a career as a professional singer or teacher after graduation, Ms. Pringle chose music therapy. She enrolled in the undergraduate music therapy program at Wilfrid Laurier, then in 2003 completed her master's, part of the first graduating class in the program.
Ms. Pringle, who had already worked with disabled people, saw music therapy as a way of bridging her love of music with her desire to help those with special needs. Finding work in her field hasn't been difficult, she says. In addition to working part-time at Credit Valley, she teaches music therapy at Laurier and works with special needs children in schools. "There's a new level of awareness [about music therapy] that wasn't here five years ago," she says. - Allison Lawlor
