Adolescent Telehealth Group Art Therapy During a Global Pandemic: Creating a Virtual Therapeutic Space
Domenica Mastromatteo (MSc)
North Vancouver, BC
Domenica is an art therapist, educator, advocate and mixed media artist working and living on unceded territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) peoples, redefining life with words and art. She brings an understanding of the therapeutic process, with the fine arts (as professional artist), educator and advocate (empowering children and families) to her career as an art therapist.
Adolescents face unprecedented stress during the COVID-19 pandemic. Widespread lockdowns and physical isolation ordered to prevent the spread of the virus have a profound impact on global mental health, including adolescents’ development (Ellis et al., 2020) and adolescents with preexisting mental health difficulties are at greater risk (Liang et al. 2020). This paper outlines my experience as a practicum student facilitating a telehealth art therapy group to support adolescents and young adults with pre-pandemic mental health issues. The group was a regular stabilizing presence in the new world of worry and uncertainty. The program held space for feelings and experiences. As we worked on issues of isolation, fear and anxiety, we honoured the painful disharmonies of life. At a time when we were all asked to isolate to avoid the spread of a virus, telehealth art therapy created a space of psychological safety and community.
Introduction
“In December 2019, patients in Wuhan, China, reported having viral pneumonia due to an unknown microbial pathogen. A new corona virus was subsequently identified as the pathogen” (Liang et al. 2020, p. 842). In January 2020, the World Health Organization (WHO) described the emergence of the virus as a public health emergency of international concern. Infectious diseases have become one of the major threats to global public health, impacting both physical and mental health (Liang et al. 2020). Due to the financial, social and psychological stresses of living through the COVID-19 pandemic, it is expected that anxiety, depression, and traumatic stress will increase dramatically and “exacerbate symptom distress in individuals with preexisting mental health difficulties” (Madigan et al., 2021, p. 6). Toll and Mackintosh (2020) lay out the paradox: “The more we socially distance ourselves from one another, the more we also require social connections and community” (p. 3). It is imperative “to develop creative and art based virtual spaces for therapeutic work” (Miller & McDonald, 2020, p. 160) to promote self-care and healthy outlets for heightened emotions.
A Virtual Therapeutic Space
“Art therapists have many tools at their disposal to evolve the field” (Nolan, 2019, p. 77). They can adapt and build creative opportunities to counter isolation through creative (online) spaces for emotional resilience. In the first year of the global pandemic, I served as keeper of a virtual therapeutic space. My intention was to instill a sense of safety with rituals and the predictability of my background space. The camera’s sightline contained artwork to inspire creativity. My camera was pointed in a corner where the background would never change during sessions and between sessions. My laptop was set in the same spot and can be tilted down to show my own art process. The scene visible to participants when entering my virtual art therapy temple is predictable and safe. Although I cannot control the space the participants physically sit in, I explain to each participant, as they begin their process of working with me, that it is their responsibility to secure as safe a space as possible and to ensure that others in their physical space were not listening in on the sessions.
At the beginning of the first session with the Adolescent Telehealth Group (and whenever a new member joined the group) I explained the goals, procedures, and expectations of the program. I offered and modeled clear guidelines for giving and receiving feedback, discouraging judgment, and asking that group members’ respond to what they experience while compassionately observing their peers’ artistic expressions.
“I served as keeper of a virtual therapeutic space. My intention was to instill a sense of safety with rituals and the predictability of my background space.”
My practicum with the adolescent group was such that I simply joined the Zoom meeting as a member. The co-facilitator and permanent employee of the non-profit was the “host” and as such, dealt with accepting participants into the online platform. Clients were informed of alternative communication procedures in case of technology failure. The co-facilitator was also available between sessions to ensure that group members would have a way of coping with strong feelings that may arise and not be resolved during sessions.
Art Therapy Rituals
Rituals are an important part of art therapy especially when holding a space on a telehealth platform. Creating rituals for myself and for the group allowed for a safe space to offset the “challenges in establishing client rapport and therapeutic alliance” (Madigan et al., 2021, p. 7) that is common with telehealth therapy. I truly missed the ritual of preparation: laying out material and making a physical space welcoming for participants, but it became part of my personal structure to spend some time setting up my own personal space before opening the Zoom application. I honoured the rituals of welcoming, sharing, and closing, in hopes of contributing to the safety and predictability of each online group session.
Participants are accepted into the Zoom platform and the ritual of welcoming begins. I greet them by name. In a physical space, eye contact, a smile and a simple hello may be enough, but it takes extra thought to greet someone virtually. There is no eye contact, so I draw out participants with their name. I still find myself trying to make eye contact, but the only way to properly do that is to stare at the dot (that is my camera) at the top of my screen. This makes my virtual eyes connect with participants, but I’m just looking at a dot. It doesn’t feel right. Saying their names welcomes them fully into my space. Participants may be asked questions such as: How are you all starting out today? What feelings are you bringing into this room?
“I still find myself trying to make eye contact, but the only way to properly do that is to stare at the dot (that is my camera) at the top of my screen. This makes my virtual eyes connect with participants, but I’m just looking at a dot. It doesn’t feel right. Saying their names welcomes them fully into my space.”
After everyone is welcomed, I announce my intention to start. I explain the directive and participants may begin to make art with whatever material they have available. The adolescents have agreed that they would like music played and the co-facilitator chooses a playlist from her Spotify account.
After 45 minutes of art making, I welcome the group back into the space and announce that it is time for the interactive discussion of the artwork. Because adolescents can be terrified of the potential for self-disclosure and intimacy in the therapy sessions (Linesch, 1988), discussion is voluntary. Participants don’t have to show or talk about their art, but I remind them that sharing is part of the therapeutic process. “In art-based therapy groups, clients create meaning in their lives by being open to one another. Discovering personal meaning is not a private process” (Moon, 2016, p. 155).
“Who would like to start?” I announce. Silence usually follows. Group discussion over Zoom is awkward and I often say this to the group. The silence is awkward. I concentrate on my breathing as I wait for someone to begin. Linesch (1988) suggests that open-ended, undirected spontaneous participation may feel too threatening for adolescents, so after one long minute, if no one has volunteered, I choose someone at random. The group may decide that the person who shares then gets to tag another to go next. This is helpful with the flow.
“While we were not in the same room, knowing that others were embarking on the same activity gave us a sense of community... I could not control the overall ambiance of each client’s room or the availability of materials and equipment, but I could take advantage of the container quality of the virtual platform and create a therapeutic space.”
Endings are difficult. Because I often feel rushed and need grounding myself, I usually chose to end sessions with a recorded guided meditation. All of these rituals repeated weekly, established patterns and allowed group members the “sense that the art therapy group environment is a safe and predictable place” (Moon, 2016, p. 54).
Conclusion
Facilitating group art therapy over Zoom has many benefits, including the ability for the group to function as a container. The clients enjoyed making the art for its calming properties and were able to slowly develop a safety within the virtual art group and begin to work through and express thoughts and feelings.
Individually, clients were able to make art together. While we were not in the same room, knowing that others were embarking on the same activity gave us a sense of community, reducing feelings of isolation. At a time when individuals were ordered to isolate, it was possible to create the social microcosm that usually develops in art therapy by entering the common virtual space from their different individual homes. I could not control the overall ambiance of each client’s room or the availability of materials and equipment, but I could take advantage of the container quality of the virtual platform and create a therapeutic space.
References
Ellis, W. E., Dumas, T. M., & Forbes, L. M. (2020). Physically isolated but socially connected: Psychological adjustment and stress among adolescents during the initial COVID-19 crisis. Canadian Journal of Behavioural Science, 52(3), 177-187. http://dx.doi.org/10.1037/cbs0000215
Liang, L., Ren, H., Cao, R., Hu, Y., Qin, Z., Li, C. & Mei, S. (2020). The effect of COVID-19 on Youth Mental Health: Psychiatric Quarterly, 91, 841-852. https://doi.org/10.1007/s11126-020-09744-3
Linesch, D. G. (1988). Adolescent art therapy. Brunner/Mazel.
Madigan, S., Racine, N., Cooke, J. E., & Korczak, D. J. (2021). COVID-19 and telemental health: Benefits, challenges, and future directions. Canadian Psychology, 62(1), 5-11. http://dx.doi.org/10.1037/cap0000259
Miller, G. & McDonald, A. (2020). Online art therapy during the COVID-19 pandemic, International Journal of Art Therapy, 25(4), 159-160. DOI:10.1080/17454832.2020.1846383
Moon, B. L. (2016). Art-based group therapy: Theory and practice. Charles C Thomas Publisher.
Nolan, E. (2019). Opening art therapy thresholds: Mechanisms that influence change in the community art therapy studio, Art Therapy, 36(2), 77-85. DOI: 10.1080/07421656.2019.1618177
Toll, H. & Mackintosh, D. (2020). Weaving community through creative expression in our home spaces, Canadian Journal of Art Therapy, 33(1), 1-4. DOI: 10.1080/26907240.2020.1753480
Photo: Chris Montgomery for Unsplash.