“When we share our experiences and personal responses to treating clients’ trauma with a group of energetic, supportive colleagues, the group can see more, process more, hold more, and give us more space to process what we’re dealing with.”
Patrick Dougherty, 'Therapists Peer Groups, the "Emotional Lifeboat"'
The gadget I rely upon embodies a Tree of Wisdom; roots, branches, mycelium, stretching across time and space in the twinkle of an eye. It is not human, yet this matrix is forged and driven by human desire and the need for connection, information and growth. I am not describing the endless online resources that I wade through daily, struggling to categorise and integrate. While the internet is incredible and vast, it is disorganised, disconnected, dehumanised. The very nature of it leads me invariably to turn away and revert to this Tree of Wisdom that I have come to depend on in ways I never expected. What is it? Where is it? It is a WhatsApp group on my smartphone and a monthly gathering in a therapy space. Let me introduce you to the ‘DublinPeerCats’, a Creative Arts Therapy (CAT) Peer Consultation Group (PCG). 'DublinPeerCats’, in person and in cyberspace, embodies the collective knowledge of a small group of CATs in South County Dublin, Ireland. Presently, our members are made up of art and drama therapists and we hope to be joined by music, dance and expressive arts therapists.
Image 1. DublinPeerCats Group Art Detail, digitally altered using Photoshop*. Mixed Media. February 2020
While the WhatsApp group acts as an extension of who and what we are, our group’s roots took hold in a therapy room almost six years ago, where I held part of my private practice. As is often the case for private practitioners, I was experiencing a sensation of increasing isolation. I was grateful and lucky enough to have supportive non-CAT therapists around me to lean on, learn from and share camaraderie with in the organisations I worked at. However, I had a strong desire to obtain similar support from Creative Arts Therapists. There were elements of my practice and clinical processing that only they could fully understand, given our shared trainings, approaches and professional challenges. The integration of using the arts together was also of utmost importance. Utilising different modalities to explore the clinical work effectively mirrors, supports and confirms what we do with our clients. This type of collaboration could potentially assist my further growth as a ‘good enough’ CAT and reflexive practitioner. In addition, I suppose there were elements of needing validation in the work I do. For me, the importance of a connection with other CATs who believed in their work as therapists or struggled in the changing psychotherapy environment in Ireland because they were CATs was a crucial connection. Regulation and recognition of our particular fields of psychotherapy is presently lacking.
The arts therapies (ATs) are often not taken as seriously in Ireland as they are in the UK. Posts do exist here in organisations as part of multidisciplinary teams but they are few and far between and organisations often seek self-employed individual arts therapists. What seems to be happening now is that a trained psychotherapist or counsellor here can do a short CPD module in the creative arts therapies and then bring it into their practice. This in and of itself is not such a big deal. As therapists we all like to learn other approaches to inform our work and what we can offer our clients. The problem is that CATs themselves are often not recognised as psychotherapists. Posts are advertised in organisations that do not allow CATs to apply. They are posts for psychotherapists using CAT skills. This can be extremely disheartening and diminishing. Many of us have studied our core modality for 3-4 years (sometimes longer), and then we go on to do a three-year masters in art/drama/dance/music/expressive psychotherapy, which requires hundreds of hours of clinical practice with clients, intense clinical and managerial supervision and rigorous academic study and research, all intertwined with our arts practice and personal therapy. And, like other psychotherapists, we never stop furthering our training. In the UK, not only are the ATs established as integral parts of multidisciplinary teams across the National Health Service (NHS) with adults and children, they are also legally established with protected titles (i.e. art therapist/art psychotherapist) and recognised and regulated by the government body, Health and Care Professions Council (HCPC), like other healthcare professionals. More than ever, we need to support one another and be part of strong professional groups. Peer consultation groups are a great start.
Having thought about setting up a PCG for quite some time, I finally bit the bullet, so to speak. It was a charged undertaking for me. My nerves were frayed. I didn’t want to start a group with sole responsibility for it. I wanted to be part of something. There were plenty of doubts around whether or not others would be interested in such a group or if I truly had anything of relevance to offer other CATs: What did I know about these things? Why would other CATs want to be part of a group with me, wet behind the ears and somewhat directionless at that time. And truth be told, while I had some idea of what I was searching for in a group, the full understanding of what that was yet was lacking. But, as is my way, I just did it. To begin with, a call was sent out through the IACAT (Irish Association of Creative Arts Therapists) bulletin and to my shock and horror, people responded. Panic struck. Somehow the panic turned into action and my research into peer supervision constructs began with a clearer understanding of their function and how best to set one up. The first meeting would be crucial in creating something that other CATs would wish to continue to be part of, but I also knew that I had to establish an autonomous, self-regulating group so no one member would have to carry it.
On Friday 11th July 2014 at 6pm our first meeting took place in a therapy centre in Monkstown where I had my private practice. There were five of us in attendance – more than I could have ever hoped for. It was one of those times in my life where I found myself on a knifes edge with worry; the kind of worry and anxiety one often feels when doing something that holds great personal importance. However, I got through it and the response from all in attendance was positive and committed. Similar needs to connect with other CATs, network and reduce professional isolation (Counselman, 2018) were expressed, so it was great to be on the same page from the start.
Within that first month, based on the group feedback at our meeting, I had drafted a rudimentary contract to work on at our second monthly meeting (where there was an additional member). And so it went, month after month. We evolved, our contract took form and we shaped ourselves into a professional support group of embodied and shared knowledge. What began as a tentative, semi-organised connection weaved itself into cohesion with each subsequent meeting until finally, it seemed to arrive, as if it had always existed. With this interrelationship established in a meaningful and corporeal way, we could transport ourselves, almost three and a half years later, on the 2nd December 2017, into a cyber construct that is the “DublinPeerCats” WhatsApp group, creating additional constituent facets of this interconnected embodiment of know-how and curiosity.
This group is not simply an assembly of individuals. As I’ve mentioned, it is a Tree of Wisdom. It also represents a living archive (in the physical and cyber world), its members the records. Each member has a lifetime of their own personal experiences to bring to the fold. More importantly, for this particular group, each member has many years of experience in their respective creative arts therapies practice. We draw from working organisationally in education, clinical, forensic, government, voluntary sector settings and in private practice, to name but a few. This combined experience is of immense benefit to therapists. So, this living archive plays an exceptionally important role in the safe, effective and evidence-based work we each do as therapists. While the individual record of knowledge that each of us represents through life experience, training and practical application is imperative in our work, it pales in comparison to the archive we collectively and collaboratively contribute to and draw from.
Image 2. DublinPeerCats Group Art. This piece was done as a grounding exercise by eight of our members for the article. Mixed media. February 2020
DublinPeerCats have always called ourselves a Peer Supervision Group (PSG), I think mainly because when setting out on this journey none of us was aware that we were anything other than a PSG. However, after research for this article, it is obvious that we operate as a Peer Consultation Group (PCG), which is how I have referred to us for the purposes of this piece of writing.
Supervision infers a hierarchy and a teaching and educational focus (Marcus et al., 2003), whereby there is a supervisor in authority offering a formal evaluation process of the clinical work (Bernard & Goodyear, 2009). Consultation, on the other hand, is non-evaluative. There is no such person in authority to oversee the therapist’s caseload. Nor is there formal responsibility for the therapist’s clients (Counselman and Weber, 1994). Counselman (2013) states that members of a PCG, “simply offer suggestions, which [other] members can accept or reject.” However, as a supervisee in clinical supervision, I feel I am also free to accept or reject the suggestions of my supervisor, which she would expect as a process of developing my professional autonomy. I would also expect the same from my supervisees. The seniority or experience of any one therapist in a PCG is of no importance in leadership or hierarchy. A PCG could also be called a Peer Support Group.
Peer consultation groups are an optional resource for therapists. Having been part of one for so long, I have come to believe that they would be beneficial as an obligatory activity for any wellbeing practitioner. However, my experience has been overwhelmingly positive so I am biased in my thinking. That’s not to say that being part of such a group is without professional and personal challenges. On the contrary. However, it has become a safe enough environment that these challenges are of benefit. PCGs, while by no means a replacement for clinical supervision, can bolster the work of supervision. Constructive peer feedback from many members can challenge our thinking and offer varying perspectives, additional containment and more space to process (Dougherty, 2019). However, many PCGs fail (Counselman & Weber, 2004). I cannot speak to this as it has not been our group experience. This may be because we paid careful and considerable attention to the initial contract and all it entails. Counselman (2018) postulates that this initial contract can “make a huge difference in helping [them] to sustain membership and thrive”. We continually revisit the contract and have now agreed to an annual general meeting at the start of each year, so that we can discuss how we might like to go forward for the year ahead. This could include new things we may like to introduce and what shifts need to happen to ensure our continued evolvement as members come and go.
There are varying ideas on how many members any group should have. Some determine that four to six members are sufficient (Counselman & Weber, 2004). Previously, our maximum number was eight. We decided on ten in the end because ultimately we rarely have more than six people at any one sitting. We came to this decision after much discussion and decided that the practicality of keeping the group going was more important than keeping it to a small number. Members have taken on further education or personal, family and professional leave, some exiting the group, some staying on. We had to take all of this into account in our slow-open group. This number also keeps the costs down for everyone. Our costs are minimal and can be anywhere from €5-€10 per month based on the number of members in the group, the cost of the room hire, art materials for grounding exercises, and refreshments. We pay this fee annually. We also allow for any member to have one unpaid holiday month a year and we have no fee for January, as we don’t sit then (although our AGM is likely to change this). Our latest exploration is the possibility of joining BAAT (British Association of Art Therapy) as a group, which would be an additional shared cost. Over time, members have come and gone for many reasons but, on reflection, five of our earliest members are still in the group.
We convene once a month for two hours. While we don’t follow the “true” Spice and Spice (1976) triadic model of therapists working triads and rotating between the roles of commentator, supervisee and facilitator, we do assign roles for every meeting which include chair/facilitator, timekeeper, grounding facilitator and tea person. This gives everyone an opportunity throughout the year to hold boundaries in different roles. It is a place where we share leadership, engage in self-care, have reliable and continued professional development, support and combat professional isolation. We network among ourselves and gain referrals from each other and the group offers interpersonal learning from peers.
Our practice is somewhat similar to Benshoff’s (1992) dyadic model of peer supervision groups, in that we receive support and critical feedback from the members. Between the chair and timekeeper consulting with the other members it is determined who needs what time in any particular sitting. Members bring a mix of client work, clinical presentations, professional queries, referrals, updates on our respective practices and so forth. Our latest addition is the introduction of reviewing contemporary articles prior to a meeting and discussing them when we are together. The WhatsApp group is an extension of this but far more limited. Indeed, I cannot imagine discussing an article via text, or making art for that matter!
Image 3. DublinPeerCats Group Art Detail. Mixed media. February 2020
To elaborate on the digital aspect: We did not consciously hold off on setting up a WhatsApp group for so long. After all, we did communicate as a group via email from the start. Perhaps WhatsApp was not in widespread use back then. On reflection, it is no harm having space between the setting up of a group dealing with clinical content and the setting up of a subsequent WhatsApp group. It meant that we were well established as an entity embodying shared knowledge and understanding, and were able to carry this over to cyber presence.
Knowing that our group is there every month without fail has been a constant comfort to me and the other members, especially if it falls in between clinical supervision sessions and we are in need of information or containment. These benefits have expanded further since the setting up of the WhatsApp group. At any point, each member can call on the group for their knowledge. It is a simpler and more boundaried construct than the monthly sitting due to ethics and other practicalities. For example, it is impossible to get into the nitty-gritty of a clinical case, share client images or explore any work that may be sensitive due to confidentiality and General Data Protection Regulation (GDPR). These considerations occurred naturally and were never really discussed. In retrospect, however, we have agreed that it would have been prudent to explore the ethics, guidelines and practicalities of this from the outset. In fact, since beginning to write this article the issue has arisen and some members have attended a CAT workshop in digital technology and GDPR. This continuous professional development will assist us in looking at the WhatsApp group with the view of writing guidelines into the contract, which we revisit annually. Perhaps I, or another member, might write a paper on it in time. Nonetheless, the WhatsApp PCG is invaluable in that it is an extended professional assistance, creative clinical container and point of reference with the very specific purpose of professional support and information between meetings.
One thing I have failed to mention throughout is that through this group I have gained the friendship of some of the most amazing people I know. While we are not the type of friends who hang out socially (except at our Christmas meetup and summer picnic) or call each other on the phone for a natter, or lean on for personal support, we do bring our personal lives, to a degree, and offer compassion and empathy and awareness around how it may affect our clinical work or interactions within the group. The friendships are based on mutual respect and appreciation of one another within the context of our profession. It is a friendship based on trust and care and support in our professional goals.
Working in this “impossible” profession, as my own therapist often reminds me while quoting Freud (1937), there is always room for more support. If you have ever thought that you might like to be part of an intimate network of therapists or you are thinking about it now, I say just get started. Take the first step and reach out through your professional association. Who knows where it might lead.
I would like to extend a huge thank you to our Tree of Wisdom for making this article possible.
*The entire Group Art Work (image 2) was created using a section of A3 paper for each member, ten in all. They were masking taped together and the artwork began. Everyone chose a section to start (mine is image 1). Most of us moved around using our section as a base and added significantly or not so significantly to one another’s sections. Mine had quite a few additions from other members so it became very colourful and complex. There were two members missing on the night so my section moved into one of the empty spaces. Photos were taken before the masking tape was removed. I then scanned my section into Photoshop, piece by piece, and reassembled it digitally. I wanted to show the seams of the scan, where each piece overlapped, to illustrate the multi-layered use of the PCG and to represent the interpersonal dynamics.
Louise Gartland, BA (Hons.), MSc., Cert. CAT Supervision, MIACAT, MNIGAT, MEEAI, has worked in mental health for over 15 years. She is an Art Psychotherapist and Creative Arts Therapy Supervisor trained in the UK and practicing in Ireland. She is elected Vice Chair of IACAT since 2018. Louise is co-founder and Director of Artonomy, a therapy organisation in Dublin providing various therapies including art and eco-art therapy.
At Artonomy Louise works privately and through organisations with adults and adolescents dealing with a variety of issues, some of which include anxiety, depression, addiction, self-harm, suicide and sexual trauma. She has worked in many settings, including educational, clinical, foster care, residential treatment, forensic and international voluntary organisations. Louise believes in peoples innate wisdom and hopes to help them explore this in therapy so that they may listen to and trust in their own voices, gaining personal autonomy in their lives.
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