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The Creative Arts in Palliative Care

br2009_098Hartley, Nigel & Payne, Malcolm (Ed.)(2008). The Creative Arts in Palliative Care. London: Jessica Kingsley Publishers. ISBN 9781843105916.

The Creative Arts in Palliative Care is a forward-thinking text which integrates management, treatment and community building aspects of creative arts in palliative care. My first impression of the book was that it would be too general for creative arts therapists and I wondered how the editors could responsibly, ethically and effectively blend therapists, artists and volunteers’ perspectives into a comprehensive service and subsequent focused text. As I read the book, my fears were dispelled not only through the generous historical understanding of the Supportive Care legacy that has developed at St Christopher’s Hospice through the past forty years, but also through the continuous adherence to the view that the editors take in seeking to understand the role that the arts play in the continuum of life and community. At the core of this understanding is reflexivity in how the role of life is maintained through arts collectively and furthermore how a growing understanding and appreciation of art can, in turn, influence society. The overriding premise of this philosophy adheres to the fact that all members of society and mediums of art evolve within this continuum (Chapter 1, Hartley & Payne).

My trust of the presented theory was firmly built in the strong foundational opening chapters where the editors present a philosophical stance for how and why they combine models of arts therapies with community arts programs amidst education and training ventures. Their model was presented humbly in a context of: “I do not claim that St Christopher’s can show other organizations how to do it” (p. 21, Chapter 2, Hartley). Yet, their careful highlighting of unique aspects of care and management, which have served as meaningful to the growth of their arts services through the years has a strong balance of clinical and managerial material. This balance is not often presented in the creative arts therapy literature and it is a unique feature of the book. As a director of music therapy and a clinician who is faced with managerial and treatment aspects of care on a daily basis, I found the balance realistic and head-on in its application to program sustenance and building ventures.

Nigel Hartley’s (2) opening presentation through a self hermeneutic of how his musical performance training led him to examine the dynamics of his own relationship with art (p.25) serves as an honest heart-felt inquiry. This serves as exemplar for any clinician to consider, especially those who venture into using the ‘self’ in an art-dynamic relationship in end of life care. Hartley enlightens the reader to consider the impetus behind what draws one into the work and furthermore calls on us to examine the potential value and motivation for sharing one’s art. In Chapter 3, he defines settings, contexts, populations, and common goals. I wondered if this chapter might have included a more detailed description of the differences between artists, creative arts therapists and volunteers. I was conscious that the question presented on p. 45: “Some artists worry that asking patients how they are feeling should be left for the therapist” was not completely addressed in terms of the importance of psychotherapeutic training. There is an existing issue of “music therapy” being utilized by those who lack training and/or skills and therefore it being depicted as simply implementing music into healthcare treatment, by virtually any healthcare provider. This concern is elicited throughout the medical literature where research is conducted under the guise of ‘music therapy’ and yet no therapy or therapist is part of the intervention. I wondered if a bit more discussion of training and boundaries in ‘treatment’ might have been presented.

It was interesting to me that “exhibiting, promoting and funding” was presented early (Chapter 4) in the book. This seemed unusual, as most often the ‘showing’, funding and marketing comes after the presentation of cases and descriptions of programs. One could certainly make the case that artists and creative arts therapists need the most work in this area. How many times we learn about programs that lose funds. Increasingly there is a need for clinicians to become more hands- on in developing the tools and language necessary to obtain grants. The notion of exhibiting arts to elicit promotional opportunities is a forward thinking aspect of this book, and a good point is brought forth, namely that perhaps there are missed opportunities when the ‘product’ (a recording or piece of art) is spared exhibition in the name of protecting the process. The case for marketing is outlined succinctly and its impact is well taken. One of the many gifts this book offers is Hartley’s sample funding proposal description (Chapter 4). This template is versatile and can be helpful for artists, therapists and managers. Chapter 5, outlines Research and Audit in Palliative Care. This chapter, though quite general gives options for methods that may serve useful for evaluating and demonstrating the value of the work.

Part II of this book takes the reader into the actual projects and mediums of the artists and therapists. I loved Lynn Harmer’s chapter (7) on Pottery and Painting because she so clearly and personally outlined how she instituted her craft. The options she presented were ones I think I could use and she kept herself transparent in the description of the work, which seemed to have a credible experiential view for the reader to latch onto. Adrian Butcher’s Craft Work chapter (8) is more of a ‘how to’ work with step by step lesson plans in how to use mosaics, silk and ceramic painting as a means to creating works of beauty that were appreciated by his patients and families. Marion Tasker’s chapter (9) on digital arts was probably the most difficult to read. I found myself appreciative of the author’s honesty and at the same time I was somehow worried about the outcomes of the experience, especially amidst the numerous elements particularly the amount of time and energy it took to develop the partnerships in the project. I wondered how and why this group replaced “a well-established and popular gardening group club.” The frantic feeling on ‘the day of the show’ in particular from the author led me to think about what resources are available to staff outside of the frequent meetings, and/or case presentations. Working with people who are in palliative care can elicit many feelings of fear, anxiety and sorrow for the professional caregivers. I wonder if the community of workers and artists had opportunity for on-going interactive resources available to them for self care. Tasker’s work seemed novel and certainly provides food for thought in working within this delicate medium.

Samantha Dobbs (10) chapter on art therapy was comprehensive and using the arts as a means of self care was addressed through a poem she wrote to conclude her case presentation. This was creative writing that related to her clinical work experience. It addressed personal self-care described by Dobbs herself as the internal voice of “self supervisor.” Virginia Hearth’s chapter (11) on community arts addressed this through journaling. The ‘Arts for Life’ project described the importance of arts advocacy, self support systems and team work. I found it intriguing that part of the role of the newcomer to this work, composer and musician Mick Sands’ (12) was to raise awareness in the community about the work. The parallel process of educating children on illness, death and dying was new and novel. Doing this through the fresh and apparent sensitive eyes of this writer was unique. Tamsin Dives (13) chapter succinctly describes how music therapy supports care homes local to St Christopher. The results of her work are tender and far reaching. In this chapter, accounts of allied staff impressions are notable. This is not as pronounced in other parts of the book, and speaks to a need that Abi Gill’s (14) chapter on evaluation study reflects: “….that 7 staff had referred patients to music therapy while 12 had not.” It interested me that one of her outcomes, the staff’s own experiences with music, was the element that had the greatest influence on their understanding and belief of music therapy. Gills study outlines this and other features, and behind the findings the data seems to indicate a potential need that music might serve for professional caregivers. Using music in the professional community might increase referrals while also assisting in providing relaxation and release opportunities for doctors and nurses, and may provide for collaborative staff interchanges amongst a stressful environment.

In conclusion, I highly recommend The Creative Arts in Palliative Care. This book is a must read for artists, therapists, volunteers, managers and directors who specialize in working with patients and caregivers who are facing end of life. The theories, detailed case studies, methods, models and ‘how-to’ hands on experiences presented throughout the pages of this book are generous and have far reaching implications which cross social and spiritual domains of treatment, development, marketing and program-community building aspects of palliative care.

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