Words for Wellbeing – facilitating therapeutic writing groups in the community

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Within the healthcare system there has been a growing interest in and awareness of the role of social prescribing (Thomson et al: 2015) in addressing a wide range of health and wellbeing needs. Participatory arts activities are a consistent theme within social prescribing and writing – whether that be creative writing, journalling, expressive writing – often features. A quick Google search brings up several courses and training opportunities (see links below). I was interested in finding out more about this type of work.What opportunities exist for writers and how can one get involved in this field? I sent out a simple survey to writers’ networks to find out just how widespread the practice was and followed this up with five in-depth interviews with writers who are working specifically in the areas of health and wellbeing.

Survey results

My survey yielded only 17 responses, but those that responded had many years experience of this type of work and the responses showed that there were broadly two types of groups – groups that had been established by the writer and/or group members and groups that were commissioned by another organisation (local authority, NHS or third sector).

In my follow-up interviews with five writers who responded to the survey I was interested in finding out more about how and why they had got involved in this work and what advice they would give to other writers aspiring to work in the field of writing for wellbeing.

Motivation

A common motivation was a recognition of how writing had been of benefit to them personally, either through a specific experience – such as dealing with a cancer diagnosis, redundancy or the death of a parent – or more generally, in providing an opportunity to express themselves regularly and building resilience and self-reliance which had positive impacts on health and wellbeing. Having experienced and understood the benefits of this for themselves they were keen to find ways of sharing this with others.

‘I have always written, it’s what I do. And when I was ill, I realised that my writing was an important part of my recovery. So it seemed the right thing to do, to offer that opportunity to other women, to help them through it.’

‘I’ve found that writing sustains me when I’ve been through difficult times. I went through a spell of having a lot of bereavement – friends and family – and writing was a way of getting through that. I don’t work with people with specific conditions or anything, but I say that if you can get into the habit and practice of writing, it will sustain you when life gets hard, which it does for all of us.’

One of the writers saw her work as complementary to her main practice as a doctor:
‘Writing provides an outlet for dealing with the emotive subjects raised in my work and my writing practice allows me to share book titles, individual poems and writing exercises with patients where it feels appropriate or relevant.’

Most of the writers I spoke to had not begun this work in a specific health care setting but had set up their own groups in the community, although they had subsequently been funded by other organisations either on a one-off or ongoing basis. There was one exception – a writer who began her practice in this field by working within a hospice, alongside a bereavement counsellor.

All of those interviewed had also run what we called general creative writing groups – not specifically focusing on health or wellbeing issues.

‘Both types of group are about writing – that’s the starting point. But in the mainstream creative writing group I probably focus more on the craft of writing, though it’s still not teaching. It’s about finding inspirations for people for a creative piece.’

‘The groups I run won’t look any different to an onlooker, but there is a difference in my mind. A different focus, in what I’m expecting.’

‘But you never know what might come up in any writing group, so the work I do in health is really useful. Being conscious of people needing to take care of themselves. Of providing a safe space for writing – you never know how someone might respond to a particular exercise or prompt so those skills of being able to hold the space are really important in any group.’

Opportunities and contexts

Reading poems with AmandaThe range of writing for wellbeing contexts described by the writers I interviewed was very wide and included working with women with breast cancer, women with any cancer diagnosis, people who had been bereaved, carers, people who had had a stroke, mental health in-patients, people living with low-level mental health needs in the community, young people with eating disorders, people with dementia, young parents, people with substance use problems and general community groups. The settings in which the groups met were equally diverse – within a cancer unit in an acute hospital, in a Macmillan centre, in a mental health hospital, in care homes, memory cafes, community centres, at festivals. Writers who had been working with wellbeing for a long time spoke of a ‘feast and famine’ experience:

‘It was quite hard, no-one really understood what it was about and they weren’t interested. And then about 10 years ago, maybe longer, suddenly there was all this funding around for the arts – and hospitals and councils all started supporting new projects and there were a lot of opportunities – and a lot of hope about it being part of mainstream service. But the last few years, it’s all dried up again. I have to find the funding myself for any projects. It all seems to go in and out of fashion.’

‘I was always going to Lapidus things, hearing about so many great things happening and I was really excited to be part of that. But it’s been really hard to get things off the ground – I’ve had to do a lot of work for free to try and get some enthusiasm and support going.’

Experience and training

There are a range of courses available for people wanting to work in the field of health and wellbeing but no single recognised accredited qualification. Of the five people (all women) that I spoke with, one was a medical professional who had undertaken an MA in writing, one was a writer who had undertaken the Cruse Awareness in Bereavement Care (ABC) course and the other three had many years of experience as writers and had attended a range of workshops and events relating to their work as writers in wellbeing. Lapidus is an organisation that ‘promotes the practice of writing for wellbeing and the benefits it brings’ and provides networks, resources, training and information for people interested in writing for wellbeing either personally or professionally. In 2004 Lapidus produced a guide on core competencies for writers in healthcare (Flint et al: 2004) which advises – alongside a range of personal skills, understanding and experience – that writers should have ‘completed an approved counselling or therapy course’. Four of my five interviewees were members of Lapidus but none agreed with that particular recommendation.

They were all agreed however that an understanding of psychosocial practices, the importance of boundaries and the recognition that, whilst there may be therapeutic benefits from writing, writing for wellbeing is not a therapy and the facilitator is not a therapist, were essential to safe practice. There are a number of links below for writers interested in gaining experience and training in this field.

Support and supervision

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All the writers I interviewed spoke of the importance of ensuring that if you run a writing for wellbeing group you should have access to appropriate support and supervision. For those people who were facilitating groups within, or commissioned by, other organisations, that could be provided by those organisations, but it was not routinely offered and writers spoke of the need to be very clear and explicit about those supervision needs.

‘It should be there, free to you, because you are working in their service [a mental health service] but I had to really push to get access to someone who could provide supervision. I didn’t really need it in the end, but I needed to know that someone would be there if I was concerned about someone, or if I needed to offload.’

With many writers setting up their own writing for wellbeing groups in the community however, consideration needs to be given to how the writer will access the support they may need in working with heightened emotions. Peer support was valued highly and Lapidus was mentioned as a useful networking organisation, where connections could be developed. One of the writers spoke about the value of facilitating groups in pairs.

‘I really enjoy working with [name]. We take it in turns to lead the sessions and it means we share the responsibility. And we can talk afterwards about how it’s gone, what worked really well, what we could change. And if something’s come up that you weren’t expecting, well, you can talk about that too. We share the money too, though, so it’s not as lucrative!’

Advice for writers

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As I mentioned at the start of this piece, there seems to be an increasing interest in and awareness of the contribution of writing to improving health and wellbeing, but writers I spoke to were frustrated at what appear to be reduced funded opportunities for this work, with financial constraints in the public sector being the most commonly cited factor.

All of my interviewees had begun this work for free, although four out of the five said it now made a contribution to their income, despite it being more difficult to find funding.

Their advice for writers wanting to work in this area?

  • Be sure you really want to do it – it can provide additional income but it is demanding and you have to be totally focused on the needs of your group
  • Do some training, read some books, shadow someone with experience to see how they approach it
  • Think about the groups you would be most happy to work with (One of my interviewees came to this work through her own experience of cancer but realised that she would be better working with people who had different health needs – she didn’t want to be ‘locked into cancer’)
  • Join Lapidus – it puts you in touch with people already expert in this work
  • Make sure you’ve got a support system and/or supervision
  • It’s okay to run a few sessions for free to get experience and generate interest but make sure you put a value on what you do and look for it to be funded
  • Link up with arts and health organisations – the National Alliance is a good start but there will be regional and local networks too
  • Work with an organisation who can provide you and your group with additional support – look to your local charities, voluntary and community sector organisations and think about how you can add value to what they already provide
  • It’s rewarding and inspiring work and there is growing awareness of its value so although the current funding climate is difficult, there will be opportunities

 

Resources and Links

http://www.artshealthandwellbeing.org.uk/

http://www.lapidus.org.uk

http://www.metanoia.ac.uk/training-programmes/special-interest/msc-in-creative-writing-for-therapeutic-purposes/

http://www.orchardfoundation.co.uk/

https://www.profwritingacademy.com/courses/therapy-and-personal-development-writing/

http://thepoetrypractice.co.uk/home/training/

Books

The Therapeutic Potential of Creative Writing by Gillie Bolton, Jessica Kingsley Publishers 2005

Prompted to Write edited by Victoria Field and Zeeba Ansari, Fal Publications 2007
Writing in Bereavement – A creative handbook by Jane Moss, Jessica Kingsley Publishers 2012

Writing Works: A Resource Handbook for Therapeutic Writing Workshops and Activities by Gillie Bolton, Victoria Field and Kate Thompson, Jessica Kingsley Publishers 2006

References

Flint, Rose; Hamilton, Fiona and Williamson, Claire (2004) Creative Writing in Healthcare Settings – Core Competencies for Working with the Literary Arts for Personal Development, Health and wellbeing, Lapidus

Thomson, Linda J; Camic, Paul M and Chatterjee, Helen J (2015) Social Prescribing – A Review of Community Referral Schemes, University College London

Freespirits of Penryn

One of my favourite projects, which demonstrates the contribution of creative play in community development, was the Freespirits of Penryn project. A collaboration between Arts for Health Cornwall, artist Lizzie Stevens and film makers Pseudo Haiku, the project aimed to lift the spirits of individuals and communities in Penryn through engagement and participation in a public arts project.

Sparked by Lizzie’s creation of the character Eliza Freespirit we invited individuals and community groups to make their own characters to begin the installation ‘Freespirits of Penryn’. Over 150 figures were created in this way – by older people in local care homes, memory cafe and day centre, Penryn College pupils, people using the Community Cafe, students from overseas and people working at in the town.

During the week of the festival everyone was invited to make their contribution to the artwork which will grew during the week, building further connections between all the makers. Over 100 people of all ages came into the Arts for Health Cornwall office to join in.

This installation represented the diverse communities who live and work in and around Penryn and their positive views about the town. It was about celebrating and enhancing connections, linking people and spaces and promoting social well-being for individuals and the community as a whole.

The process was documented through film to provide a lasting reminder of what people can make together and to demonstrate the role of participatory community arts practice in strengthening and sustaining communities.

‘Drink the sun, walk while eating the moon’

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I was delighted to be part of a delegation spending a week in Tokyo exploring arts and ageing. The aim was for us to learn, share and make connections with others focusing on practices, partnerships, impact outcomes and evaluation. I was fortunate to be sharing the tour with colleagues from across the UK all doing fantastic work with older people and we learned a lot from each other during the week.

Japan has a declining population, with the proportion of elders set to increase so that by 2050 almost 40% of the population will be over 65. This has sparked discussion about what this will mean for the Japanese economy and society; the 2020 Tokyo Olympics and Cultural Olympiad offer an opportunity to engage with artists and arts organisations in shaping responses to this demographic change.

One of the highlights of the week for me was our session at the Saitama Arts Centre, just outside Tokyo. We were introduced to the work of the renowned theatre director Yukio Ninagawa who has been artistic director here since 2006 and the founder of Saitama Gold Theatre. Saitama Gold is a theatre company comprising people aged over 55, people who were not professional actors but then undertook full-time professional training. Ninagawa’s vision was of a company, neither ‘amateur’ nor ‘professional’, but whose performances would be ‘based in the personal histories of people of age’. As artistic director he was interested in how these elders would express themselves and their stories. The company currently comprises 33 members, aged between 63 and 89, with an average age of 76. We were privileged to meet two of the current actors who talked of their life-changing experience at a mature age from engaging with Saitama Gold and then, when I didn’t believe it could get any better, we were taken into the rehearsal space and had the privilege of meeting Yukio Ninagawa and watching a short rehearsal of the opening scene of Saitama Gold’s production of Richard II.

“Drink the sun, walk while eating the moon” were dancer and choreographer Yuki Aoki’s instructions to a group of homeless men, encouraging their self-expression through dance. Yuki Aoki spoke about his motivation for giving up a successful career as a dancer to work with homeless people and other groups, including older people in care homes. A very moving and powerful presentation and his passion was clear to see. Other presentations explored a range of creative workshops – how can design principles be used to solve social problems? In what ways do we and can we continue to learn as we age? And how can music and dance in particular benefit older people?

The many group discussions we had with Japanese colleagues over the week, together with the impressive ‘Future Session’ event with about 100 people from across sectors, left me feeling positive about the future for arts and ageing there. Time and again we were hearing from people from different sectors about the need to address the quality of life for older people, whether in care homes or in the community. There is also understandable concern about the number of people likely to be living with dementia and opportunities to create dementia friendly communities are being pursued.

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The two topics we discussed on our last day were evaluation and research and collaboration. It was good to see universities represented in these discussions and it may be that links between universities in Japan and the UK can be forged and research interests shared. The need for academic research to be made more relevant and widely available to those in practice was discussed. The question of demonstrating clear evidence that the arts have positive impacts on health and wellbeing of older people was discussed again and it seems that the pressure is on to prove clinical improvements in individuals who participate not just improvements in quality of life.

Moving On

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As I launch this new venture I reflect on my time with Arts for Health Cornwall and Isles of Scilly which closed its doors in January 2016. I was privileged to have been Director there for over 11 years and it was, without doubt, the best job I had ever had. In my last few weeks I had the unenviable task of clearing the office and came across papers going back to my early days with the organisation, reminding me of how much was achieved. The first office we had was more a glorified cupboard, with a window that opened on to a grim fire escape, shared with pigeons who were banished there by virtue of the barbed wire and spikes on the roof.

Many of the artists whom I met in that tiny office are now working regularly in arts and health contexts; we have all come a long way since then and it is really rewarding to see so many people working in this field and the improved understanding and recognition of the arts for health movement.

I took so many memories away with me – interviews with artists where I got to write poems, sniff lemons and listen to the accordion – that never happened in the NHS! Marvellous moments such as the lady with dementia, who had not spoken for many years, suddenly bursting into song; a man who had been isolated by his social anxiety and depression standing proudly in front of his artwork having his picture taken; young children living in difficult circumstances expressing their joy and optimism through performance. And some illustrious occasions too – winning national awards with the King’s Fund and the Guardian; hosting an exhibition in Truro Cathedral raising awareness of homelessness in the county – one of the projects of which I am most proud; hearing people speak about the impact our work has had at our heart-warming AGMs and sharing our office with over 100 people from Penryn who took part in our Freespirits of Penryn project at the first joyous Penryn Arts Festival – just one of the many highlights in my years with Arts for Health Cornwall.

These memories have been instrumental in encouraging me to continue working in this field – whether this is through supporting the work of other organisations through advice, training or consultancy, or developing my own programmes and projects, collaborating with others, that address identified needs. Although the arts and health movement has come a long way, there is still much that needs to be done, especially in a time when our health and social care services are under such pressure, and I want to contribute my experience, knowledge and skills to benefit individuals, groups and communities in improving health and wellbeing.