Original article DOI: 10.1111/j.1473-6861.2008.00211.

The art therapy large group as a teaching

method for the institutional and political
aspects of professional training
Sally E. Skaife MA Dip Psychotherapy ATC, AsT(A)* &
Kevin Jones MA Dip Psychotherapy (IPSS UKCP) AsT(A)
Lecturer, Art Psychotherapy, Professional and Community Education (PACE), Goldsmiths, University of London, Deptford Town Hall,
New Cross Road, London SE14 6NW

Keywords Abstract
art, large group, This paper discusses a unique experiential teaching method in the context of training
political, professional,
for art psychotherapists and raises issues relevant to teaching for all workers in health
therapy, training
and social care. The art therapy large experiential group of all the students and all the
staff (80+), which is held six times a year on the 2-year full-time/3-year part-time
programme, is identified with three educational components: learning about art
therapy processes, learning about the educational process of becoming a professional,
and learning about institutional and political issues relevant for the work-place.
This educational method engages the unconscious dynamics of both students and staff
and brings this together, through creative activity, with a critical engagement in social
and political issues. The group has implications for all health workers in its attention
to non-verbal communication, activity as a means to learning and agency in
institutional issues in the work-place. The paper brings together a case example in
which students were able to process the impact of a nationwide, union strike in the
university, with relevant literature from large group theory, small art therapy group
theory and performance art. Discussion is given to the process by which the art therapy
large group meets its learning objectives.

method of teaching about art therapy processes,

Introduction
and the generic skills in health and social care that
This paper describes an innovative teaching method are relevant to all health and social care professions.
for trainee art psychotherapists at Goldsmiths, It does this through engaging students in a
*Correspondence author. University of London. The paper looks at how an psychodynamic process held within an educational
Tel: 020 7919 7598;
fax: 020 7919 7236;
experiential art therapy large group of staff and frame. Its conception as a group standing at the
e-mail: [email protected] students, that is 80 plus people, can be an effective interface between college and the wider community

ª 2009 Blackwell Publishing Ltd. Learning in Health and Social Care, 8, 3, 200–209
 The art therapy large group 201

and the smaller groups in the programme and clinical

Method
work, enables learning to pass from global issues
to the minutiae of clinical practice and back. The Our research method is action-based research
art therapy large group (ATLG) raises political (Reason 1994), a method which mirrors the same
issues general to all health and social care principles as that of the art therapy training as a
professions. whole, as well as the clinical work that we are teaching
The theoretical base of the ATLG raises political about. Macleod (2001) describes the following key
issues from the start. In it, the individual is under- principles of action-based research: learning is irrevo-
stood as inseparable from the social group, a contrary cably linked with action, understanding is generated
position to the notion of individual pathology which through practical activity, knowledge is intrinsically
is the current focus of mental health provision. collective and relational, and true knowing involves
Similarly, art is understood as arising from the embracing the subjective dimension of experience.
dynamic relation between art performers and Creating knowledge is a cyclical process, reflecting on
involved spectators, instead of originating from an experience, generating hypotheses, testing hypotheses
individual inner self. The coming together of all the in action, reflecting on the experience produced by
students at their different stages of learning and this practical action, and challenging these insights
from their different countries of origin to make art, with others. The goal is objective subjectivity and
raises political issues, such as: relating with others disciplined reflexivity.
who are different, the significance of active agency, Our method had involved cycles of reading,
and what becoming a professional health worker reflecting on the impact of the insights gained as
entails. The ATLG is also a very good way of they apply to an understanding of the activities of
bringing issues in art therapy theory and practice to the large group, discussion with the staff team, lec-
students’ attention as it magnifies concerns present turing to students on the large group, writing and
in one-to-one and small group art therapy. reflecting on our written texts and relating findings
There is a small literature on verbal large groups to the experience of the large group. The data we
which describes its origins in a military hospital dur- produced were our written process notes following
ing the war, and its continuation in psychiatric ser- the large group described. We amalgamated our two
vices in the 1970s and 1980s. Although the large accounts of the session described to draw up one
group has largely disappeared in the National Health coherent story.
Service, it is now an accepted part of many group We have analysed our case material with ideas
analysis training events and conferences (De Mare, from the following literature: art therapy group
Piper & Thompson 1991; Trampuz 1993; Blackwell theory (Waller 1993; Skaife & Huet 1998; McNeilly
2000; Pines 2003). 2006; S. Skaife, University of London, London, in
Although most of the writers on large groups prep.), large and small group analytic theory
draw from their experiences of large groups in edu- (Kreeger 1975; De Mare et al. 1991; Schneider &
cational or experiential settings, there is little in the Weinberg 2003), and various texts on performance
literature that addresses educational method. There art (Goldberg 1979; Etchells 1998; Schechner 2002).
is no literature of which we are aware on large art We will now introduce the ATLG at Goldsmiths,
therapy groups. University of London.
We will first describe our method and then go on
to introduce the Goldsmiths’ ATLG and the litera-
The art therapy large group
ture which contextualizes it on verbal large group
at Goldsmiths
theory, art therapy group theory and performance
art. Following this we will present a case example,
Context in the programme
a single session of the group, then draw out issues
relevant to meeting the learning objectives and The ATLG takes place in the context of the Masters
relate these to relevant literature. in Art Psychotherapy, a training programme which

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202 S.E. Skaife & K. Jones

harnesses students’ previous experience of art and free floating dialogue is used as a means to elicit
draws on psychoanalytic and group analytic theory. unconscious concerns among the learning
It is structured and conceived according to systems community of the programme.
theory (Agazarian & Peter 1981). The programme
engages experiential, self-directed and didactic
The history
teaching with an emphasis on learning through
doing (Dies 1980; Hobbs 1992). There is continuous The implementation of the ATLG at Goldsmiths
assessment throughout the course on placement and was linked to the fact that some of the staff had
in teaching sessions, as well as of academic essays. trained in group analysis and had also participated
Students’ engagement in the large group is formally in large groups in the National Health Service.
assessed by their ability to write, and therefore think When circumstances arose to reconsider the input
reflectively about their experience in the group in a of verbal psychotherapy groups in the course, we
written assessment at the end of each year. decided to offer instead a model of group work
which integrated with the whole course model.
Choosing the ATLG, this method reflected a move
Structure
in the historical and hierarchical relations between
Students are first introduced to the ATLG in a verbal psychotherapy and art psychotherapy on the
written explanation with aims and objectives in the course. We looked to the large group literature and
student handbook, and in introductory teaching to small art therapy group literature for a theoretical
sessions at the start of the programme. The group base. We found that the mode of art work which
meets twice a term for an hour and a half per seemed to flourish in the ATLG was performance
session, giving six sessions per academic year in all. art, so we looked to its literature to develop our
Dry art materials, crayons, pens, paper of various thinking.
sorts, string, fabric, are put out in large crates in
the centre of the empty space in the middle of the
Context in the literature
circle of chairs one or two deep depending on the
size of the room. As in group analysis, the group
Large group theory
are encouraged to express themselves freely while
respecting each others’ space and well-being. Unlike De Mare et al. (1991) emphasize the social and
in group analysis, however, moving about the room political possibilities of the large group. Comparing
and non-verbal communication is part of the the large group to small groups and one-to-one
activity of the group. The objectives of the group are psychotherapy, they talk about engaging dialogue in
spoken to at the start of the first session of each year. place of the group association and free association
As in the other groups on the programme, the that are utilized in small groups and psychoanalysis,
students are asked to stay in the room during the respectively. Whereas in the small group, members
whole of the session and to attend regularly and work on becoming aware of their feelings in relation
punctually. to their roles in the family, in the large group they
struggle to think about the social issues that
determine family life. The goal of thinking together
The facilitators
through dialogue attempts to galvanize and
The group is facilitated by the total staff team, transform unconscious primitive feelings into a
currently that is nine members. Staff understand sensitive thinking apparatus (De Mare et al. 1991).
their role to be threefold: facilitating the objectives, Unlike in structured forums for political debate and
keeping the boundaries and role modelling. The staff institutional decision-making, all voices are given
meet for an extended post-group following each equal weight which levels out hierarchy resulting in
session and, where possible, the staff also meet strong group cohesion, inclusiveness and true
before the group. During these staff group sessions, democracy.

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 The art therapy large group 203

De Mare et al. talk about the large group as indeed, performance is not dependent on an art
offering the possibility for a study of processes object being created (Kaye 2000). Performance art
through the study of a microculture. Certainly, the can potentially oppose the hierarchical divisions
large verbal group is an arena for students to learn between cognition and perception in western society
about the situations that they can find themselves in which are reflected in art therapy group practice.
on placement and later in the work-place. Through participation in the large group as either
performer or spectator, students learn about the
performances that take place on a smaller scale in
Art therapy group literature
both the small group and the individual setting of
There have been various different models for using art therapy and their relationship to making art with
art in therapy groups over the years that are clients. The meaning of a performance work is also
described in the literature with the following names: specific to the particular site in which it takes place,
open studios (Thomson 1989; Luzzato 1997; Moon as is illustrated in the art therapy group example.
2002), theme-based groups (Liebmann 1986), group We will now go on to give an example of a single
analytic art therapy (McNeilly 2006), group interac- session of the ATLG.
tive art therapy (Waller 1993), art psychotherapy
groups (Skaife & Huet 1998). These can be under-
The case example
stood as determined by the institutional and histori-
cal context in which they have developed. However, Before and during the session described, art therapy
in distinguishing the models by the relationship staff were involved in a national union dispute over
between talking and art making in them, one pay and along with other university lecturers were
becomes aware of a hierarchy between cognitive and not marking work that lead to progression on their
perceptual processes which is then associated with courses or the award of a final mark leading to
client categories (S. Skaife, University of London, graduation. The dispute raised general issues of low
London, in prep.). university pay and the marketization of public
The problems in the relationship between art and services that would adversely affect the quality of art
talking in art therapy are magnified in the large psychotherapy education and the wider profession
group, which because of its size shows up the perfor- in the future. The strike highlighted a broader
mative aspect of art making, making the literature struggle over the profession, its status and
on performance art relevant (Schechner 2003). recognition within society.
This session, which was the last in the academic
year, took place in the main college hall for the first
Performance art
time, an extremely large room which actually
Performance art reflects a number of ethical and dwarfed the 80+ members of the large group. There
political preoccupations relevant to a variety of was a platform, and props – a lectern and tiered
health professionals. In performance art, meaning seating on the platform. Among other things, the
arises in the interaction between performer, perfor- hall was also used for graduation ceremonies.
mance and spectator, and the emphasis is on this In the pre-group staff meeting, there were dif-
process of interaction rather than the production of ferences acknowledged between staff over another
an art object. This involves a deliberate ethical financial event, the reduction of hours for those on
stance which aims to change the audience/artist short-term contracts. The subject of persecutors
relationship from one of passive spectatorship and and victims arose and we left for the group holding
consumption, to active participation through these difficult exchanges.
witness or action (Etchells 1998). There was a flurry of art making and activity in
The emphasis is on the process of the perfor- the first 45 minutes. A number of figures had been
mance, with the accent on pleasure and play rather made including a large, flat paper cut-out figure,
than the aesthetic qualities of the art object, and which lay on the floor and a figure sculpture made

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204 S.E. Skaife & K. Jones

from a lectern draped in clothes. A female student students. The argument developed like a boxing
began to make rolls of paper and after she had laid match that was both aggressive and humorous, a
them out on the tiered benches on the stage, they performance which seemed to enact tensions in
looked like graduation certificates. A female staff the group.
member moved a chair into the centre of the stage. Someone kept trying to pile up the water lilies
The paper rolls were now taken up and put by the which would then fall down, others found this very
paper cut-out and then later given to the chair. The annoying. It was a painful performance to watch.
level of noise in the group was now rising and there Sally began to feel extremely uncomfortable unable
seemed to be a lot of activity around the room. to speak or to act.
Another female student was rolling up the edges Towards the end, a student took the lectern figure
of sheets of paper so that they looked like water lilies apart and laid it down on the floor. He said that he
and then throwing them into the circle. A student was leaving this year and that he would miss the
made a placard with the message ‘The End is Neigh’. group. A staff member said that he would miss his
She walked very fast around the inside of the contributions to the group. Other students asked if
circle, holding the placard aloft and then went into the staff member would miss people who had not
the centre of the circle where she knelt bent made any comments. In the meantime, someone
over double with her face hidden, for some time had put a shawl over the lectern figure now lying on
(see Fig. 1). the floor. These acts seemed to visibly resolve the
Kevin, feeling increasingly concerned about the charged atmosphere in the room.
student in the centre expressed his concern and In the staff post-group, some had enjoyed the
discomfort and linked this to the ‘Neigh’, which large space in the main hall, the sense of being at the
he thought could be construed as the end is ‘Nay’, centre of the college, and there was a general excite-
the course will not finish because no one can ment and pleasure in the extended use of the art
graduate. There was silence and then more activ- materials. Divisions suddenly erupted again around
ity, and after a while, the student in the centre sat the question of whether or not we had needed to
up and said that the placard did refer to the end verbalize in the group. Might not feelings have been
of the year, but not to the possibility of not fin- contained in the artwork and performance? The
ishing. Some students then complained about the split quickly became gendered and the polarized
silence being broken. When another male member feelings from the pre-group and the conflict in the
of staff interpreted these comments, an argument large group emerged again. Like the boxing match
started between him and the complaining in the group, this seemed to be a necessary process,

Fig. 1 Art therapy large group. Layout of ATLG in main hall of college at midpoint of case example.

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 The art therapy large group 205

holding the very uncomfortable dynamics with In the ATLG, power issues often get played out
which we were all involved. between the subgroups: the performing group, the
The case material in this paper is also found in group making individual art works on the floor or
Jones and Skaife (2009). sitting in the circle and the spectating group. The
possibility of moving between these groups sharpens
up a focus on the different experiences, in particular
Theoretical issues
about the different sorts of power. Taking a dra-
We will now use this example and ideas in the matic action in the group can be felt to empower
relevant literature to consider some processes in some and silence other group members, the power
the ATLG which facilitate the learning objectives. to watch and criticize is another sort of power. Stay-
To reiterate, these are learning about processes in ing with the anxiety, frustration and envy generated
art therapy, understanding what is involved in in this setting gives students an opportunity to learn
becoming a professional art therapist, and becoming to work with difference in the wider world; and in
aware of institutional and political issues. We will mirroring sibling rivalry, these processes can be
look at are the transformational process, ‘making a helpful in understanding relations in staff teams.
mark’ and ‘finding a voice’, becoming a professional, Skynner (1975) talks of a process of group matu-
art therapy processes and the learning process. ration in which the group survives the splitting and
Finally, we will discuss the role of the facilitators. projections of an early phase and goes onto the
remarkable creativity that is possible in the depres-
sive phase. This was illustrated in the action of the
The transformational process
students with the paper cut-out and lectern figures.
At the start of the session described, there was a lot The laying down of the lectern figure by the male
of activity with several simultaneous performances student and the female student draping the paper
expressing issues around power and unbearable cut-out figure put the conflicts around power which
tension as symbolized by the tower of water lilies threatened the group to rest. The performance
which would not stand up. By the end of the group seemed to represent the power of the group itself
session, there had been a change and a sense of over power being invested in the subgroup of the
connection had been achieved. staff. This resolution allowed an ordinary face-to-face
As in all groups which engage a psychodynamic acknowledgement of leaving the course to be
process, a transformational process had taken place expressed. Holding onto the importance of dialogue
through the resolution of conflict (Agazarian 2003). across difference allowed everyone to stay with
In the large group, conflict is created by the feelings the difficult tensions and so to process the external
engendered by its sheer size which frustrates the conflict.
need for intimacy which might itself ameliorate
the disorientating feelings. Hopper (2003) describes
Making a mark, finding a voice
members feeling as though they are lost or swallowed
by an impersonal force. As a result, hatred of others Anxiety provoked by the group and the consequent
arises and the group is likely to form subgroups sense of fragmentation in the individual gives rise to
which enable them to feel less isolated (De Mare threatening feelings in which thinking can feel
et al. 1991). In the session described, conflict impossible. The issue at stake appears to be one of
erupted with a battle between the students and some ‘annihilation or survival’ (Turquet 1975). The size of
staff members over whether or not it was appropriate the group seems to make it hard to conceptualize it,
to interpret the activity going on in the group. The and then to make any action in it seem impossible
staff members themselves formed two antagonistic or pointless (Kreeger 1975; Main 1975; Turquet 1975;
camps based on gender as was later discovered in Thompson 1999) Through their ‘making a mark’
the post-group. The theme of this ATLG session and ‘finding a voice’, students in the ATLG struggle
appeared to be about power. with feelings of alienation and fragmentation and

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206 S.E. Skaife & K. Jones

with how to find a place for themselves in the group. stillness in the centre of the room. Such activity
Their actions in art or talk, recognized by others in allows students to consider their own action in rela-
the group, allow them a sense of belonging in a tion to their position in the life cycle of the
community. The boundary of the arena, which programme and in their personal lives.
creates a space like an empty page, allows for a At Goldsmiths, the large group is the one arena in
response to an action or visual statement to be which all the art therapy students meet together.
observed, noted and reflected on. Each time though, The rhythm of the academic year marks beginnings
students are faced with the risk of feelings of alien- and endings clearly and the arena of the large group
ation or pointlessness in the group, the challenge of is the life space in which cohorts join, work and play
surviving the group, and the option to make a mark and then leave in batches, full-timers before part-
on it. Whether or not action is taken is therefore timers. Students at the end of the course have
about agency and thus becomes political. Passing understood and integrated things that students at
through this process can enable students to learn the beginning of the course are just being introduced
about both surviving institutions and finding to. Although sometimes painful, it is possible for
themselves an effective role within the institutions in students, through revisiting the questions with
which they will practice. De Mare et al. (1991) think which they started out, and seeing what has
that the number of individuals who can speak happened to themselves in their learning process, to
and be heard by such a large number, is itself the witness the process over time of what learning to
goal as it is this that creates ‘Koinoia’, a community become an art therapist actually means.
or fellowship. De Mare et al. talk about dialogue and they mean
The ATLG has students from all around the world, verbal intercourse, where does this position art mak-
from different class backgrounds, from different ing? We can extend dialogue to include art and per-
year groups, as well as the staff student difference. formance and other non-verbal communication
These differences apparent in small groups can lead although the question remains as to whether the
to feelings of paranoia and stranger anxiety in the purpose of the art/performance is to facilitate verbal
large group (Frosh 2008). However, the possibility of dialogue or whether it is enough in itself as dialogue,
addressing them in this large forum where ‘everyone’ as was apparent in the case example.
is present allows their visibility making it possible to
look at them in a more detailed way in the smaller
Art therapy process
arenas of the supervision group and experiential
group. In the case example, the sense of threat posed by the
ATLG experience itself was amplified by the strike
action and produced a flurry of individual activity,
Becoming a professional art therapist
subgroupings, a proliferation of images and objects
It was notable that it was the finalist students who and a fracturing of the circle, culminating in an
engaged in the play around graduation, while the escalation of movement and rising noise. The
mid-course students were concerned with staff writing on the placard highlighted the disjunction
power and with frustration in their play with the between the visual and the verbal and acted as a
lectern figures and the water lilies. The session was hinge point for the transition from visual to verbal
the end one of the year, and became a forum in representation, which brought out an enactment
which this passing through could be acknowledged of conflict. The verbal conflict turned into a
together by staff and students, not by a party (that performance.
came later) but in a way which allowed existential The relationship between the art and verbal
issues about life and death to be expressed and language or between the perceptual and the cog-
thought about. The student who knelt with her sign nitive is historically hierarchical and mirrors
which prophesied death – ‘the end is nigh’ (which is divisions in race, class and gender which is reflected
what she had meant to write) enacted a death in her in the low status given to the perceptual and

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 The art therapy large group 207

imaginative in treatments for psychiatric conditions groups beyond the programme (Agazarian 2003).
(Skaife 2008). Shifts between talking and art making As such, it is a subgroup itself. Learning is under-
thus involve students in an active engagement with stood to take place at the interface between the
issues around power. It was significant that the groups. The permeable boundaries between different
female staff appeared involved in the non-verbal subgroups, when stable, allow in new material which
performances and male staff with the verbal. This is is worked through to enable the new material to be
not always the case in the large group but this integrated. Learning then passes from group to
subgrouping could be understood as an enactment group. Just as the ATLG magnifies processes in small
of power divisions. groups, learning from the ATLG passes into the
In the ATLG, everything happens simultaneously smaller groups in the training. Discussion about
and it is impossible to see all that is made or to hear what has happened in the ATLG is related to institu-
everything that is said. This requires a different sort tional issues that are brought into supervision
of attention to that in individual or small group groups. Similarly, performance aspects of the ATLG
therapy. The tensions between talking, art making affect the way students view art practice in the small
and looking become exaggerated as people find experiential groups, allowing students to consider
equal frustration and satisfaction in both finding their art work with clients differently and explore
meaning through talking and in art making. issues that have arisen in relation to the large group
The larger physical space necessary for the ATLG dynamics.
poses the room as an interactive stage, and the art
materials and people’s bodies, as performers or spec-
The role of the facilitators
tators, become art works. The relationships between
the student and their art work, the art and the group In order to facilitate the learning objectives of the
all become mixed, inviting new ways to consider the group, the staff must keep the boundary of the
role of art in therapy. If we understand all activity in space, ensure that there are no intrusions by people
the group as interrelated performances and apply not meant to be in the group, keep the time and take
this to the small group, it helps confront the issue of care that no one individual is ‘in trouble’ without
art and the perceptual being thought of only as a recognition. Kevin broke the verbal silence because
bridge to the more important verbal interaction. he was concerned about the student with the plac-
ard. These basic functions of the art therapist enable
the group to take on intensity, and a sense of play
The learning process
and theatre. At the same time, staff need to be more
The experiential containment in the ATLG of the than just keepers of the space. They also need to role
mixed feelings of anger, envy and sympathy about model a willingness to allow the group to move
the strike allowed thinking and learning in other them, to have faith in the process which they are
more didactic teaching contexts on the course. teaching the students. Their engagement with art
Discussion in business meetings connected students materials allows them to be in communication with
to support from the National Union of Students and the non-verbal aspects of the group. Some staff
a new sense of the place of the course in the wider involved themselves in the students’ play around the
college. Working with the staff, some students figures of power. Thus staff in the ATLG act both as
published their own account of the strike in the performers and spectators in the group, making
newsletter of the professional association. This sure a suitable balance of roles, keeper or observer of
learning may also have empowered students to the space and actor in it, is distributed among them
organize among themselves to mount a challenge to at any one time. However, the staff’s engagement in
the college in a different context the following year. the group must always be in the service of the
Learning in the ATLG is understood to happen groups’ objectives despite the fact that they too will
through its relationship with other groups within experience the ‘annihilation and survival’ dynamic
the programme and its relationship to even larger (Turquet 1975).

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208 S.E. Skaife & K. Jones

Main (1975) and Thompson (1999) comment smaller groups within the course and recording the
that the key thing is to stay with the anxieties and ATLG over the course of a year.
learn to communicate from within them. They say
that it is helpful if facilitators speak from their own
Conclusion
personal experience of being in the group, rather
than make interpretations that try to summarize the The ATLG adds a new dimension to large groups
whole group experience as these tend to amplify a as it introduces a focus on agency and creativity in
sense of observer and observed, increasing feelings the group. Although each profession might use
of fragmentation. The staff member who attempted their own medium, the ATLG introduces the
to interpret the group’s activity then involved him- potential of large groups for teaching about and
self in a verbal contest with students thus moving working through institutional, political and social
from a figure of power to a performer. issues of practice, including the common dilemmas
The ATLG is the only place that all the staff work as health and social care professionals that we all
together as a team with all the students. This allows face.
students to see that staff have differences in The ATLG shows that working with the power
approach and gives students confidence in their own relations between students and teachers can be an
capacity for team work and to find their own way of important part of learning. It may seem most
working. As the staff work differently in the ATLG as obviously suitable for arts/psychotherapy trainings
compared with the small art therapy experiential but the focus on non-verbal process is relevant for
groups, students can learn about different ways of all healthcare professionals when working with
working in different contexts. colleagues and clients. It may be that a one off or
weekend ATLG experience, suitably modified to
reflect particular circumstances, or a small group art
Discussion
therapy experience, may be helpful on other profes-
This paper is part of the culmination of the first sional trainings.
stage of our research process. There have been some The ATLG example shows how students gained a
limitations which we hope to address in the next new understanding of their political agency and
stage. For example, there are no images, as for about the power of acting collectively to represent
reasons of confidentiality no photography is allowed their interests, in a way that is effective and relevant
in the group at present. Our account of the session to future activity in their professional organizations
is limited, as we have had to bear student and trade unions.
confidentiality in mind; it also only represents the
personal viewpoints of two authors taken from two
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