Using the Creative Arts in Therapy

and Healthcare

Using the Creative Arts in Therapy and Healthcare provides a practical intro-
duction to the uses of arts and other creative processes to promote health and
encourage healing.
This latest edition includes newly edited chapters from the original and
second edition covering the therapeutic use of dance, drama, folklore and
ritual, storytelling and the visual arts. Information on guidelines, prepar-
ations and practical hints for leaders and facilitators has also been updated.
New chapters provide an international perspective in the field of the arts and
healthcare, and show how the artist can alleviate distress for patients through
art, music and drama.
Illustrated throughout with ideas and examples of how the arts can be used
in a range of healthcare settings, this book will be essential reading for cre-
ative arts therapists and healthcare professionals throughout the world.

Bernie Warren PhD is Professor of Drama and Education in the Community

in the School of Dramatic Arts, University of Windsor, Ontario Canada. He
is also the Artistic Director of the Fools for Health clown-doctor program.
Using the Creative Arts in
Therapy and Healthcare

A practical introduction

Edited by Bernie Warren

First published 2008
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada
by Routledge
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This edition published in the Taylor & Francis e-Library, 2008.

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© 2008 Selection and editorial matter, Bernie Warren;
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British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

Using the creative arts in therapy and healthcare / edited by Bernie
Warren. – [3rd ed.].
p. ; cm.
Rev. ed. of: Using the creative arts in therapy / edited by Bernie
Warren. 2nd ed. 1993.
Includes bibliographical references and index.
ISBN-13: 978-0-415-40403-7 (hardback)
ISBN-13: 978-0-415-40404-4 (pbk.)
1. Arts–Therapeutic use. 2. Movement therapy. 3. Creation (Literary,
artistic, etc.)–Therapeutic use. I. Warren, Bernie, 1953– II. Using
the creative arts in therapy.
[DNLM: 1. Sensory Art Therapies. 2. Creativeness. 3. Laughter
Therapy. WM 450 U851 2008]
RM931.A77U75 2008
616.89′1656 – dc22
2007032798

ISBN 0-203-88526-0 Master e-book ISBN

ISBN: 978-0-415-40403-7 (hbk)

ISBN: 978-0-415-40404-4 (pbk)
Contents

List of illustrations vii

Notes on contributors ix
Acknowledgements xiii

1 Looking backwards, looking forwards: A preface and

introduction to using the creative arts in therapy and healthcare 1
BERNIE WARREN

2 Guidelines, preparations and practical hints: A brief checklist

for workshop leaders 8
BERNIE WARREN

3 Don’t forget to breathe and smile: Breathing exercises as

warm-ups for art activities in healthcare settings 19
BERNIE WARREN

4 Folklore and ritual as a basis for creative therapy 31

ROB WATLING AND VERONICA JAMES

5 Using the visual arts to expand personal creativity 43

ROBERTA NADEAU

6 Dance: Developing self-image and self-expression

through movement 64
BERNIE WARREN AND RICHARD COATEN

7 Expanding human potential through music 89

KEITH YON
vi Contents

8 Drama: Using the imagination as a stepping stone for

personal growth 115
BERNIE WARREN

9 Storymaking and storytelling: Weaving the fabric that creates

our lives 135
CHERYL NEILL

10 Creating community: Ensemble performance using masks,

puppets and theatre 160
WENDE WELCH

11 Arts for children in hospitals: Helping to put the ‘art’ back

in medicine 181
JUDY ROLLINS

12 Friends’ arts in Healthcare Programs at the University of

Alberta Hospital: Fostering a healing environment 196
SUSAN POINTE AND SHIRLEY SERVISS

13 Healing laughter: The role and benefits of clown-doctors

working in hospitals and healthcare 213
BERNIE WARREN

14 Songlines: Developing innovative arts programmes for use with

children who are visually impaired or brain injured 229
MAGDALENA SCHAMBERGER

15 LaughterBoss: Introducing a new position in aged care 250

PETER SPITZER

Appendix: Resources 262

Name index 265
Subject index 267
Illustrations

Figures
3.1 Opening and Closing Breaths: lotus flower opening 24
3.2 Opening and Closing Breaths: lotus flower closing 25
3.3 Opening and Closing Breaths: petals floating on the water 26
3.4 Crane Stepping into Water 27
4.1 Schematic relationships between context, function and
traditional material 34
7.1 Duplet and triplet pulses 92
7.2 Absence acknowledgement 93
7.3 Framing 94
7.4 Good morning signed 94
7.5 Rhythm modification 95
7.6 Forwards–backwards rocking in duplet pulse 96
7.7 Forwards–backwards rocking in triplet pulse 96
7.8 Rocking sideways 96
7.9 Duplet becoming triplet 97
7.10 Pull the boat, push the boat 97
7.11 Toe song 98
7.12 Body blues 99
7.13 Football chant 105
7.14 Soccer chant 108
9.1 Storytelling techniques 145
10.1 A neutral mask 168
10.2 Half masks 175
11.1 Mirroring allows the dancer to support the child’s
choices physically and verbally 192
12.1 For those patients unable to create, the artists will paint
to request on windows, sculpt creations to patients’
specifications or draw portraits 203
12.2 Over 100 handprints and messages written by patients line
the installation 207
viii Illustrations

13.1 ‘You’ll never know, really know what your visits have meant
to me . . .’ 220
13.2 Oncology: ‘Boy, you’ve got to carry that weight!’ 221
14.1 A musical rupture 236
14.2 A non-verbal conversation 243
15.1 Love heart tennis – score: love all 256
15.2 Rub my back and I rub your back 258

Tables
6.1 How you move 85
6.2 Basic descriptors 86
11.1 Sampling of visual arts activities 189
Contributors

Richard Coaten trained initially in dance and theatre at Dartington College

of Arts. Since then he has specialised in a range of different arts based
practices involving management development, street theatre, community
dance, and arts/health work having been an Arts Co-ordinator in hospitals
in Sheffield and Stoke-on-Trent in the UK. In 2000 he became registered as
a Movement Psychotherapist and now works part-time for the South West
Yorkshire Mental Health NHS Trust in Older People’s Services in Calder-
dale. Richard is also in the last year of a doctorate in “Dance &
Dementia” at Roehampton University, London and is Training Pro-
gramme Director for Woldgate College’s Dance Development Team in the
East Riding of Yorkshire, pioneering the use of free-movement play &
dance in early year’s settings in the county.
Veronica James was born in England and has lived in Wales and Scotland.
She is Professor of Nursing Studies at the University of Nottingham hav-
ing previously worked in hospices, law courts and prisons, and with home-
less street drinkers. Veronica works as a practice nurse in the community,
and is undertaking a five-year course on transactional analysis.
Roberta Nadeau was born in the western United States and emigrated to
Canada in 1973. She studied psychology and sociology as an undergradu-
ate, graduating cum laude. She pursued graduate studies at Purdue Uni-
versity in the sociology of art, and is a painter who has exhibited her works
across Canada, a writer and an arts therapist. She taught part-time at the
University of Calgary and at the University of British Columbia and
lectured in the United States, Canada, Europe and the Middle East. Until
recently she worked as an art therapist in private practice in Vancouver,
British Columbia where she also taught painting. Her own art work has
been exhibited internationally. Sadly Roberta died in 2007.
Cheryl Neill is a musician, storyteller and teacher living in Montreal, Canada.
She has over 20 years experience teaching people of all ages and abilities.
She has extensive experience in conducting professional development
x Contributors

workshops in storytelling and drama and is the author of many original

musicals. A published poet and author, she has taught developmental
drama and storytelling at Concordia University. Currently she works full
time as a storyteller and singer/songwriter.
Susan Pointe directed the McMullen Gallery, Art Collection and Artists On
the Wards for eight years. Pointe left her position as Art Advisor to work
with Cohos Evamy Integratedesign on the Lois Hole Hospital for
Women in Edmonton. She has since opened S. Pointe & Co. Inc., an arts
consulting business to assist other healthcare organizations and private
corporations in integrating original artwork into their facilities and profes-
sional artists into staff and client wellness programs.
Judy Rollins is a researcher and consultant with Rollins and Associates, Inc.,
in Washington, DC. Initially trained as a nurse, she has a BFA in Art,
an MS in Child Development/Family Studies, and a PhD in Health and
Community Studies. She is on the faculty in the Department of Health
Sciences at Montgomery College, adjunct faculty in the Department of
Family Medicine at Georgetown University School of Medicine, and
associate editor of Pediatric Nursing. She developed ‘ART is the heART’, a
program for children and families in hospice care, and ‘Arts for Children
in Hospitals’, a course for medical students, both of which are being repli-
cated worldwide. She developed and directs arts-in-healthcare program-
ming for children and families at Georgetown University Hospital and
Hospital for Sick Children in Washington, DC. Dr Rollins consults, writes,
and researches on children’s issues internationally, with a special interest
in the use of the arts for children with cancer. She currently serves as
Treasurer on the board of the Society for the Arts in Healthcare.
Magdalena Schamberger is the Executive Director of Hearts&Minds, a regis-
tered charity established in 1997 to promote the quality of life for people in
hospital and hospice care. It promotes clown doctoring for children’s ser-
vices and an Elderflowers program for elderly people with dementia in
hospital. Last year Hearts&Minds benefited over 10,000 children, older
people and their families in Scotland. Schamberger’s experience in visual/
physical theatre companies covers three continents. She has worked as
a director in her native Austria, as a performer in New York as well
as performing and directing with many leading UK companies, such as
Théatre sans Frontières and Benchtours and Hullaballoo Children’s
Theatre, in Scotland, where she now lives.
Peter Spitzer is a western trained physician who also actively uses acupuncture,
hypnosis, counseling, psychotherapy, provocative therapy, nutrition, vita-
min therapy and herbal medicine in his general practice. He is the founder,
chairman and medical director of The Humour Foundation Australia, for
whom he works as a professional clown-doctor (Dr Fruit-Loop). In add-
 Contributors xi

ition, he is involved in the training of clown-doctors in hospital issues and

establishing clown-doctor teams. A sought-after speaker worldwide, he has
presented papers and workshops to the corporate sector, community
groups and medical students. In 2001, Dr Spitzer was awarded a Churchill
Fellowship to study the international impact of hospital clown units on
the healthcare system.

Bernie Warren was born in England. He has worked as an actor, choreog-

rapher and musician. As a community worker, drama teacher and drama
therapist he has worked with people of all ages and abilities. In addition
he has studied Chinese and Japanese healing and martial arts for more
than 35 years. His research and practice brings together his Eastern and
Western training in his work with children with disabilities, seniors and
people living with life threatening conditions (e.g. cancer). In 2001 Bernie
was the recipient of the University of Windsor’s Alumni Award for Dis-
tinguished Contributions to University Teaching, and has been included in
Canadian Who’s Who since 1994. Currently he is Professor of Drama in
Education and Community at the University of Windsor and Director of
Fools For Health clown-doctor programs, Windsor. He regularly works in
hospitals and healthcare facilities as Dr Haven’t-a-Clue.

Rob Watling was born in England. He began his career as a drama therapist,
before working in community arts, local government, higher education,
and the BBC. He studied English and folklore at the University of
Stirling, media studies at the Polytechnic of Wales, and leadership at
Ashridge Business School. He wrote his PhD at the University of
Nottingham on the links between education and community development.
He has written extensively on these subjects and is particularly interested
in the role of the arts in tackling social exclusion. He has worked with
European, national and local government departments; a range of com-
munity groups and trade unions; Southern Arts and the Welsh Arts
Council; the Universities of Leicester and Nottingham; as a Learning
Executive at the BBC; and most recently as an educational consultant for
the BBC World Service Trust. He now runs his own consultancy, provid-
ing coaching and facilitation services for individuals, teams and whole
organizations.

Wende Welch trained as a dancer, actress, puppeteer and mask-maker and

has an MFA in theatre performance from York University, Canada. She
has worked as a performer, designer and director with a number of
professional companies in Canada and the United States most notably
50/50 Theatre Co. – a company dedicated to integration through the
theatre arts. In addition to her professional work, she has taught theatre
performance at Concordia University, Montreal and at the University of
Windsor.
xii Contributors

Keith Yon was born on the island of St Helena and received his professional
training in England at the Royal College of Music, the Guildhall School
of Music and Drama, and the Central School of Speech and Drama. His
work bridged the boundaries between dance, drama and music and he
employed his innovative and eclectic style of working with a broad spec-
trum of people, covering a wide range of ages and abilities. Yon worked
for over 20 years at Dartington College of Arts, Totnes, Devon where he
taught acting-directing and voice music. Sadly Yon died in 2002.
Acknowledgements

Many people were involved in the genesis and evolution of the current book.
First, I wish to mention Bert Amies, George Hu, George Mager, Peter Senior,
Caroline Simonds and Keith Yon, whose work and friendship have influenced
and inspired me in my work over the years.
In addition, I wish to thank all those who contributed to the develop-
ment of previous editions of this book, especially Donna Harling, Roberta
Nadeau, Julie Ortynsky and Kerrin Patterson. I must also mention Tim
Hardwick (Croom Helm) who first suggested I write this book and Edwina
Welham (Routledge) who suggested the second edition.
For several reasons this third edition took a lot longer to put together than
either of the previous ones and as a result many people helped me. First,
I wish to thank Joanne Forshaw and Routledge for first suggesting and later
agreeing to publish this current edition. I also wish to thank Claire Lipscomb
and Jane Harris and everyone at Routledge who has helped transform an
idea into a manuscript and finally into this book.
I wish to thank all those assistants who over the past two years helped to
do various tasks in the development of this volume. In particular I wish to
thank Candace Hind who was given the task of reading everything and
commenting on it critically from a reader’s perspective: her observations and
comments were invaluable. I also wish to thank Mandy Boreskie who did an
excellent job correcting the proofs and creating an index for this book.
My greatest praise and thanks go to my research associate, Nicole Gervais,
who has worked on all my research and literary projects for the past four
years. Sadly this project will be her last with me before she takes up her new
job. Without her sage advice, her eye for detail and her persistence I doubt if
anything would have been completed!
Lastly I would like to take this space to express my sincerest gratitude to all
those people with whom I have worked as facilitator, teacher, therapist and
friend. The amount I have learned from you, about the strength of the human
spirit struggling against adversity, is truly immeasurable.
To all these people (friends, students, colleagues and clients alike) I dedicate
this book.
Chapter 1

Looking backwards,
looking forwards
A preface and introduction to using the
creative arts in therapy and healthcare
Bernie Warren

What follows is a personal retrospective in which I briefly look back at the

first two editions of this book, try to place them in context and introduce the
changes in this new edition.

The more the world changes

This book was first conceived over 25 years ago. In 1982 when I was first
approached by Tim Hardwick to write this book the world was a very differ-
ent place. The United Nations International Year of the Disabled Person had
just finished. I had just completed my work with the LUDUS Dance-in-
Education company’s Special School Project ‘Learning Through Dance’ and
had recently moved to Canada to begin what has turned out to be my career
as an academic.
So much has happened since then. There have been incredible discoveries
in technology and medicine that have positively affected people’s lives. At the
same time, the events of 11 September 2001 and its aftermath have changed
the world immeasurably. Moreover, if all leading experts are to be believed
we seem to be facing potential ecological disasters of incomprehensible
proportions.
Yet while the world may have become a scarier place, the arts not only
continue to exist but also, with the advent of new technologies and media,
continue to evolve. Throughout all the many changes to the world and our
place within it, the arts in all their forms (visual, performing, electronic,
written, mixed media) remain expressions of personal vision and belief, ways
of conveying emotion and thought.

Expanding human horizons

The focus of the first editions

When this book was first considered, it was against a backdrop where, for the
first time, persons with a disability were seen as human beings who should be
2 Using the creative arts in therapy and healthcare

empowered, enabled and encouraged to express themselves creatively. The

subtitle for the original book, ‘The Power of the Arts Experience to Expand
Human Horizons’, in part reflected this.
The goal of the first edition was to provide a practical introduction to the
use of the arts not as therapy or treatment but rather as a way of expressing
each individual’s humanity. Most particularly it was focused on working with
persons with a disability to help them find a creative voice and to use it to
express themselves. In 1984 I wrote the following:

We have created the concept that artistic creation is the responsibility of a

few gifted individuals. In so doing, we have denied the majority of indi-
viduals within our urban and technologically advanced society their
birthrights: that, as a human being, everyone has the right to make his or
her own ‘unique creative thumbprint’1 – one that no one else could make.
We all have a need to make this ‘mark’, not because we necessarily wish
to be the reminders to a future generation of a long-lost culture but
because each creative mark reaffirms the self. It says ‘I am here’, ‘I have
something to express.’
(p. 4)

In the 1993 edition I elaborated on this point:

In using the creative arts in health care, rehabilitation and special educa-
tion settings, and seeing the resulting growth in self-image, self-esteem
and healthy social interactions, society as a whole is being handed a
mirror concerning what is possible for all its members if only they are
given the opportunity. . . . Slowly people are becoming aware of their
creative potential, their need to make their mark. As a result more and
more individuals, who because of birth, crisis or accident had previously
been denied their rights as ‘full members’ of their society, are finally
gaining access to the arts. The results, in some cases, are quite staggering.
Individuals, previously seen as useless, incapacitated or catatonic, have
begun to speak, move more freely and in some cases, over a time, take a
full and active part in society.
(p. 4)

In 1983 when I began writing the first edition, there was no internet. When
I was writing the revised edition, the world wide web was only just begin-
ning. Now in 2007, it is possible for anyone to place their personal blogs,
videos and music on the web enabling them to share their thoughts and
creativity instantly with anyone who wishes to hear. Some may still ques-
tion the ‘quality’ of these transmissions. Nevertheless the ability to make
this mark certainly provides the opportunity for individuals to reaffirm
themselves.
 Looking backwards, looking forwards 3

‘You say potato, I say . . .’

A few words about ‘arts for health’ and ‘arts therapy’

From the beginning I actively fought against using the word ‘therapy’ in the
title of the book – a battle which I lost. In 1993 I put my disagreement with
the notion of the arts being used as therapy with persons with a disability into
the Introduction:

As the workplace has become increasingly dehumanising and sterile

(with fewer and fewer outlets for creative expression) it is not surpris-
ing that the arts have come to be seen as therapy. However, Therapy
(which implies a prescribed course of treatment with predetermined
expected results for a specific diagnosed condition) and the Art(s)
(which at least in part suggests an exploration, one that usually finds
the notion of predetermined expectation anathema) are strange bedfel-
lows. Art is not a medicine that must be taken three times a day after
meals. However, it can feed the soul, motivate an individual to want to
recover and, in certain circumstances, cause physiological changes in
the body.
(pp. 3–4)

These comments did not endear me to some arts therapists. However, it must
be noted that I have always believed in the therapeutic power of the arts.
What I took and continue to take issue with was the practice of calling any
artistic experience or exploration therapy simply because the participants had
disabilities. I did try to clarify this point by penning a working definition of
‘creative therapy’:

the use of the arts . . . and other creative processes to promote health and
encourage healing. Implied in this working definition is the use of artistic
and creative activities to help individuals accommodate to a specific
disability; or recover from a specific medical or surgical procedure; or
simply improve the quality of an individual’s life.
(p. 8)

However, in the revised edition I did also observe that there had been more
opportunities for people to participate in arts activities, not because they
necessarily wanted to be a professional dancer, painter or singer but because
participating in the process made them feel good about themselves:

More and more people are becoming aware that being involved in the
process of artistic creation is every bit as important as and in many cases
more important than the end product. . . . The recent move towards
4 Using the creative arts in therapy and healthcare

‘Arts for Health’ (which suggests the benefits of participation in creative

activity) as distinct from arts therapy (which implies the treatment of a
condition that produces ‘ill-health’) is a healthy and honest extension of
these developments.
(p. xi)

Since the publication of the original book there have been huge developments
in the fields of arts therapy and arts for health.2 Over the past 25 years there
has been a rise in the use of the arts therapies in healthcare and with it a
concomitance to professionalism and organizations to promote it.3 Parallel to
this there has been an upsurge in the role of the arts and artists in healthcare
settings and organizations dedicated to their work.4
While some jurisdictions have clearly articulated their different scopes
of practice (most notably in the UK),5 professional organizations represent-
ing these distant ‘cousins’ often still eye each other warily. Nevertheless,
many professional artists and arts therapists not only work amicably shoul-
der to shoulder in the same healthcare structure, but are also members of
organizations representing both approaches to the work.

Putting the arts into professionals’ practice

In 1984, I was hoping that the book would encourage professionals to
incorporate arts activities into their practice. It was designed as a practical
introduction to be accessible not just to trained artists and arts therapists but
also for occupational therapists, nurses, psychologists, social workers and
others working with persons with a disability or individuals who were in some
way disadvantaged. Over the years I know that some professional arts therap-
ists took issue with this. In part the problem can be attributed to the book’s
title which still contained the word ‘therapy’. However, I wholeheartedly
agree with their argument that therapists need to be trained in therapeutic
procedures and should not be in the hands of untrained ‘amateurs’. It should
nevertheless be noted that the book’s intended readership were already
trained professionals. Nevertheless, in 1993 I did try to address what I felt
were the therapists’ concerns:

It is important to realize that this book does not provide a panacea for all
problems, nor will it make the reader an instant creative specialist. How-
ever, it will give an insight into some of the techniques, originating in the
creative arts, that have proved beneficial in health care, rehabilitation and
special education settings in aiding individuals to gain better understand-
ing and control of their bodies and emotions. One outcome of this is that
they are better able to explore their own ‘unique creative thumbprints’
within the fabric of their daily lives.
(p. xii)
 Looking backwards, looking forwards 5

However, it is important to remember that the arts do not stand in isol-

ation and are most definitely not in themselves a cure for all ills. Never-
theless, in each individual’s act of creation, the arts engage the emotions
and free the spirit. This can encourage individuals to do something
because they want to and not just because someone else decides it is good
for them. The arts can motivate in a way possibly no other force can. It is
only through making a mark that no one else could make, that we express
the individual spark of our own humanity.
(p. 4)

Changes to the second edition

While the world has changed markedly in the last 25 years, much of the
material contained in the original and second editions remains relatively time-
less. Included in this volume are edited chapters from the original and second
editions of the book. Some such as Cheryl Neill’s chapter on storytelling
(Chapter 9), my own on drama (Chapter 8), and Wende Welch’s chapter
on masks and puppets in ensemble performance (Chapter 10) have only had
superficial editing. The chapter on dance (Chapter 6) once again has been
updated and revised.
Sadly, Yon’s sudden and unexpected death in July 2002 not only robbed the
world of one of the most dynamic, innovative and interdisciplinary teachers
of the arts, but also meant that he could not revise his own chapter on music
(Chapter 7). I have tried my best to be true to the essence of my late friend’s
work while streamlining his chapter.
Roberta Nadeau’s chapter on visual art (Chapter 5) has also been stream-
lined a little,6 while Rob Watling’s chapter on the significance of folklore
and other traditional material has been added to and brought up to date
by Veronica James to include reference to rituals within modern society
(Chapter 4).

New chapters in the third edition

The chapters in the third section provide stories with an international per-
spective in the field of arts in healthcare that focus not so much on activi-
ties (the focus of the original book[s]) but rather on the area of developing
programs in hospital and other healthcare settings.
Judy Rollins’ ‘Arts for children in hospitals: Helping to put the “art” back
in medicine’, and Susan Pointe’s and Shirley Serviss’ ‘Friends’ art in health-
care program at the University of Alberta Hospital: Fostering a healing
environment’ look at the ways in which artists can alleviate distress for
patients in the hospital, regardless of their age.
My piece on ‘Healing laughter: The role and benefits of clown-doctors
working in hospitals and healthcare’ takes a look at Fools for Health’s
6 Using the creative arts in therapy and healthcare

clown-doctor and familial clown programs and suggests ways that readers
may develop similar programs even if they do not live in a large urban
centre.
These themes are picked up in Magdalena Shamberger’s ‘Songlines:
Developing innovative arts programmes with children who are visually
impaired or brain injured’ and Peter Spitzer’s ‘LaughterBoss: Introducing a
new position in aged care’. They show some of the other ways in which
clown-doctor programs have branched beyond solely clowning in the
hospitals.
The contributors to this book are from many different professional
backgrounds (psychology, nursing, medicine and the arts), but all have
seen the therapeutic benefits of the arts at first hand. Whether they work in
Scotland, Australia, England, the USA, Canada or elsewhere, the authors
cite examples of how their work has touched the lives of the people with
whom they work and where possible link their experiences to the appropriate
research.

Final thoughts
Using the creative arts in therapy and healthcare, like its predecessors, is con-
ceived as a practical book written in easily readable language that weaves
theory into practice; distills research and theoretical models into simple con-
ceptual frameworks; and then provides easily accessible ideas and examples
that may be used by readers in a wide range of professional settings (e.g.
seniors centers, hospitals, etc.) around the world.
As the observant reader will notice, the language used throughout this
book is not uniform. However, it is important to note that finding socially
acceptable language concerning ‘disability’ is always problematic and has
changed many times during the last 25 years. Some early readers suggested I
unify the language. However, as this volume is intended for a broad reader-
ship of people, from many geographical locations, each with its own particu-
lar political, cultural and linguistic concerns, I chose not to go into each of
the chapters and tinker with the words used by individual authors – who are
themselves from different professional backgrounds, geographical locations
and times. I appreciate that some of the authors may use words differently to
your usual experience. I hope that any minor inconsistencies will not get in
the way of the essential fact that each writer believes passionately in the
power of the arts experience.
The authors believe, and research tends to support, that providing arts
and arts therapy experiences within healthcare settings improves the delivery
of healthcare, helps healing and improves an individual’s sense of well-
being and quality of life. Moreover, if we succeed in providing everybody
irrespective of age, ability or state of health with access to meaningful
avenues for creative expression, there will be a noticeable reduction in stress
 Looking backwards, looking forwards 7

levels, increased feelings of ‘wellness’, a perceived improvement in quality of

life and ultimately fewer healthcare visits for clinical interventions, surgery
and medication.
Bernie Warren
Harrow, Ontario
Canada
September 2007

Notes
1 All human beings, irrespective of their abilities or limitations, are capable of mak-
ing their own ‘thumbprint’, that is a ‘mark’ made in sound, line, color, form, shape
or movement that no one else could ever make in exactly the same way. It is this
mark which states, ‘I exist. I have meaning’ and it is a reflection on an individual as
a unique human being. Most importantly, this unique creative thumbprint can be
thought of as the essential building block of all creative expression.
2 To illustrate this point, here is a selection of ‘classic’ and recent writings on the arts
for health and the arts therapies:

E. Feder and B. Feder, The Expressive Arts Therapies, Englewood Cliffs, NJ:
Prentice-Hall, 1981.
P. Jones, The Arts Therapies: A Revolution in Healthcare, London: Brunner-
Routledge, 2005.
L. Moss, Art for Health’s Sake, Dunfermline: Carnegie Trust, 1987.
F. Turner and P. Senior (eds), A Powerful Force For Good: Culture, Health and The
Arts – An Anthology, Manchester: Manchester Metropolitan University Press,
2000.

3 For example: National Coalition of Creative Arts Therapy Associations USA

(http://www.nccata.org/); Irish Association of Creative Arts Therapists (http://
www.iacat.ie/links.html), as well as a multitude of organizations representing indi-
vidual arts forms, e.g. British Association of Art Therapists (www.baat.org), Dance-
Movement Therapy Association of Australia (http://www.dtaa.org/), Canadian
Association for Music Therapy (http://www.musictherapy.ca/), National Association
of Drama Therapy USA (http://www.nadt.org/).
4 For example: in the UK, Arts For Health (http://www.mmu.ac.uk/artsforhealth/);
National Network for Arts in Health (http://www.nnah.co.uk). In the USA, Society
for the Arts in Healthcare (http://www.thesah.org).
5 In 1997, the UK Health Professions Council was revised to include art therapy as a
government regulated profession (Health Professions Council: Art Therapist. March
26, 2006, www.hpc-uk.org). In 2002 the state of New York recognized creative arts
therapy as a legitimate mental health profession, the first US state to do so (New
York State Office of the Professionals: Creative Art Therapy Licence Agreement.
March 22, 2006, http://www.op.nysed.gov/catlic.htm). However it should be noted
that at this time (2007) in most parts of the world the arts therapies have yet to be
acknowledged as a legally recognized profession(s).
6 Since writing this Introduction it was with great sadness that I learned by chance
that Roberta Nadeau had died. Roberta was a great champion for the arts, espe-
cially for persons with a disability, and will be missed by many, especially her family.
As I write this my thoughts and best wishes are with her children.
Chapter 2

Guidelines, preparations and

practical hints
A brief checklist for workshop leaders
Bernie Warren

Some basic guidelines

Before we begin
While it may it may be obvious to some, it bears stating that:

• What follows is not intended to be a substitute for proper training and

will not make any one an instantly successful ‘creative therapist’.
• Given the professional and geographical diversity of this book’s reader-
ship, some of the points presented below may be different to what is
considered ‘best practice’ in your area.
• Before you begin any practical session make sure that you are familiar
with your own professional association’s guidelines concerning code(s)
of conduct, ethics and best practice.1

A few thoughts on the ethics and politics of healthy touch

• In an age where we work with a wide range of people it is essential that
time be taken to consider individuals’ personal cultural and religious
beliefs concerning touch.
• In many countries, because of the odious, inappropriate and wholly
unacceptable behaviour of a few, touching another individual has become
a minefield fraught with legal difficulties.
• However, it is important to note that touch is a natural human activity,
essential to healthy development. As Dr Roy Brown used to remark ‘in
some ways touch is like a scalpel’. For while a scalpel is a very sharp
instrument and in the wrong hands can do a lot of damage, you wouldn’t
want to take it away from a skilled surgeon.
• As physical contact is often an essential element of working in the
creative arts, here are a few things to consider when navigating the
‘minefield’ which will go a long way towards preventing awkward mis-
understandings:
 Guidelines, preparations and practical hints 9

– ‘There but for fortune’: treat others as you would wish to be treated
yourself, namely with dignity and respect
– Be aware: whenever possible get notes from the relevant contact
person regarding each individual’s cultural and religious beliefs on
touch.
– Be sensitive: ask permission wherever possible of the individual,
prior to any physical contact.
• In this era of ‘superbugs’ (e.g. MRSA, VRE, C. Diff, etc.) when working
in hospitals and other healthcare facilities you cannot wash your hands
too often.2
– Wash with soap under warm water for as long as it takes you to sing
the ‘ABC Song’.
– If water and soap isn’t available, use a hand sanitizer.

A few words about contracts and clarity

• Most creative specialists are employed by public or private institutions
or organizations, to deliver programs within very specific limits with a
particular group. Before agreeing to any ‘program’ it is very important
that you clarify the conditions of your contract. Always ask yourself:
– Who will I be working with?
– Why am I being employed?
– What am I expected to achieve?
– When are we expected to meet?
– Where do these meetings take place?
• Make sure, in establishing the why and what of your contract, that you
are willing and able to do what is asked of you. In this era of account-
ability and malpractice suits, and simply to avoid misunderstandings, it is
essential that you clearly identify your expertise and orientation. There is
no point pursuing a contract where you are doing something beyond
your experience and training or where it is just not your way of working.
In both cases you, your group and your employer are unlikely to benefit
from or be satisfied with the situation. The result is that your contract is
likely to be a short and unhappy one.
• Always remember that each group, and each individual within a group,
has specific needs; sensitively choosing material suited to those needs will
go a long way to making your sessions both enjoyable and successful.
• Try not to become so entrenched in the goals you are seeking to achieve
that you stop being sensitive to a particular individual’s immediate needs,
or lose sight of the importance for all your group to become actively and
enthusiastically involved in the session.
• If you are working in a clinical setting, always remember that the games,
10 Using the creative arts in therapy and healthcare

activities and ideas presented here are merely starting points for thera-
peutic work and they do not transform you magically into a ‘therapist’.
This requires many years of training, something that can neither be
substituted by nor conveyed in a book.
• Activities in any session should above all else be enjoyable.
• Often when working with the creative process, individuals will do some-
thing that is not only unexpected but also beyond their previously
exhibited capabilities.
• Enabling individuals to enjoy each session, to have fun with you, goes a
long way towards the transformation of these sessions from simply being
labeled as therapy to being truly beneficial, enabling participants to
overcome their limitations:
– There are times when this guideline may be broken as some of the
material that may surface might be anything but pleasant.
– However, there is little benefit to be gained from participating in a
creative therapy session if it is viewed in the same light as having to
take medication.
• Volunteer help is essential when working with individuals with profound
disabilities:
– I have enlisted help from janitors and kitchen staff as well as the
more obvious professional colleagues, interns and students.
– While extra helpers, whether volunteers or paid aides, can be a great
help, often so much time is spent helping the helpers understand a
particular way of working, or an individual’s specific needs, that a
moment is lost.
– Nevertheless, sensitive or well-trained helpers who support those in
greatest need without becoming too obtrusive can make the leader’s
job so much simpler.
• To be a successful leader you need to be a ‘creative detective’.
• Read the information given to you about the group briefly before the first
session; try to ‘forget’ it, or at least not refer to it consciously, during the
running of the first session.
• Always try to pay attention to everything you see and hear in each session.
Where appropriate, keep notes!
• Try to place the information you gain first hand in context.
• Try to make your first sessions simple and fairly undemanding but try to
employ one exercise that can act as a diagnostic tool. ‘Diagnostic tool’
describes any activity that provides some insight into the capabilities and/
or feelings of the group, allowing you to build a picture of the individual
that supplements and quite often contradicts the existing clinical reports.
• After the session is over, compare your perceptions of the group members,
based on observations during the session, with those given to you before
 Guidelines, preparations and practical hints 11

you started. It is surprising how happy, co-operative and creative some

individuals, whom others see as aggressive, withdrawn or disturbed, can
be when given a warm and friendly environment in which they have a
chance to express themselves. Also, it is important to be aware that an
individual’s talents or abilities may lie dormant for a long period,
surfacing only when a particular activity engages them.
• Developing your own personal style and making the material used your
‘own’ is often as important as the material itself.
• It is important to model each activity wherever and whenever possible.
• Remember that discussions after activities are often as or more important
than the activity itself.

Preparation and planning

Below I have outlined some observations and questions that I feel are import-
ant to the running of a successful session of creative therapy. The following
checklist reflects my personal concerns:

• being clear on my responsibilities as leader

• treating the people I work with, irrespective of age or ability, as unique
human beings
• providing a structure in which people can enjoy themselves, be cre-
ative and work towards overcoming the mental, physical or emotional
conditions that they face in their daily lives.

The checklist, which is annotated, covers the three basic phases of running a
practical session of creative therapy, that is before, during and after each
session:

• Some of the items reiterate points made above.

• Many of the points may be obvious to you, some you may think about
only occasionally, and others you may not have thought about before.
• After a while, most of the suggestions and questions that follow become
so much an integral part of a leader’s way of working that you can strike
them from your checklist, as you will be doing them automatically.

Questions to be answered before starting

the session

1 Who am I working with?

(a) How many people will be in the group? Will this number be constant?
• Often this number will fluctuate. Someone may be ill, need to go
12 Using the creative arts in therapy and healthcare

to surgery, X-ray, dentist, hairdresser, or a million and one other

places.
• Be patient and be prepared for these changing numbers.
(b) What are the ages of the group members? Are they approximately the
same age?
• Knowing the ages of participants is particularly important as this
will be a factor to be considered when choosing your material.
(c) What are the abilities of the group members? Wherever possible, try
to get specific information about each individual who will be in your
sessions:
• All too often you will be provided with a very sketchy outline of the
people with whom you are expected to work. In many cases this will
provide you with little or no useful information.
• If someone uses vague terms to describe an individual’s behavior,
such as ‘she exhibits schizophrenic tendencies’, try to get them to
explain what they mean.
• Also, try to find out under what circumstances any described
behaviors occur.
The kinds of basic questions you need to ask are:
• How many people will be in the session?
• Does anyone use a wheelchair or other ambulatory aids?
• Is everyone able to communicate?
• Do any individuals have difficulties with speaking, hearing, seeing?
• Does anyone have epilepsy? A heart condition?
• Will I have any professional or voluntary assistance in my sessions?
• Is there a common link between members of the group? For
example, are all the individuals in the group recovering from a
stroke?
(d) Do I know everything I need to know about the members of this group?
For example, are any members of the group on medication that will limit
their creative potential (e.g. heavy sedation)?
• No two groups are ever exactly the same, but obviously experience
gained with similar groups is very valuable.
• It is always important to plan specifically for your group.
• The key is in choosing activities that allow group members to
succeed.
• It is highly unlikely that you will know everything you would like to
know before the start of the first session.
• You will almost certainly gain valuable information from your own
work.
 Guidelines, preparations and practical hints 13

2 What are my responsibilities as leader?

(a) In what capacity am I being employed: teacher, facilitator, leader,
therapist?
(b) What am I expected to do with the group? Is my job to engage the group
directly in creative activities, or am I employed to seek actively to change
specific behaviors?
(c) If my job is to change specific behaviors, what is the time frame in which
I am expected to do this? Is this realistic?
(d) Am I capable of carrying out what has been asked of me?
(e) Do I need to renegotiate my ‘contract’? That is, what I am expected to
achieve with the group through my creative medium (see also ‘Questions
to be answered after the session is over’, p. 17).
• If your job description and your duties clash, there is a need to
clarify exactly what is expected of you.
• There is also a need for you to make clear to your employer/super-
visor what skills you possess.
• There is a vast difference between accepting a challenge and mis-
representing your abilities.
• Often you may need to re-educate your employer or supervisor about
why you work creatively and what skills you possess in relation to the
perceived needs of your group.

3 Pre-session planning
(a) When is the session scheduled? How often do I see the group and for how
long each session?
(b) Do the group members know where and when we meet? Do the other
professional staff who work with them also know this information?
• Often you will have no say in the frequency or timing of your sessions.
• If your sessions are too long, allow time for simply talking and being
with the members of the group. If the session is too short, allow
yourself time before and/or after the session to be with the group.
• This unstructured ‘talk time’ is often essential to allow an individual
to develop a trust in you. It also provides a time to share what has
been happening in the group’s lives.
(c) What space do I need to work in? Does the space I have been allocated
meet these needs? For example, does it have running water and enough
chairs? Is it comfortable? If not, how can I make do with the space
allocated?
• It is essential that you make clear to the person dealing with
scheduling and administration exactly what your needs are.
14 Using the creative arts in therapy and healthcare

• Demand the impossible – go for what you would want ideally and
barter from there!
(d) Will I have any assistants? Will they be volunteers or professionals? Do
they know the group members? Do they know my way of working?
Do they know what my goals are?
• It is not unusual for your assistants to know the group better than
you. This can be an extremely valuable asset. Make use of these
people.
• Wherever possible, run workshops for them before working with your
group. Take them into your confidence; share ideas and information
with them.
• One word of caution – always remember that, no matter what hap-
pens, you are responsible for the running of the creative sessions,
consequently when push comes to shove you must have the final word.

4 Planning the session

(a) Given all the information I now have, how can I best achieve my
goals? These may be different from those suggested by your employer or
supervisor.
(b) What activities will best match my strengths with the perceived needs of
the group and their abilities?
• Plan for ability: always seek to plan for what people can do.
• Accept that everyone has some limitation or other; however, as John
Swann said, ‘I am not my disability, I am me.’3
(c) How much structure do I need to provide for the group so they can
actively engage in these activities?
• Much of this may have to be left open until after your first session.
• Try to provide, in the first few sessions, activities, structures and
language systems that allow you room to change direction without
breaking the trust and security you are developing.
(d) What equipment will I need? Is this to be provided for me? Am I expected
to take my own art supplies? Tape recorder? Musical instruments?
• Many creative specialists always carry their own materials around
with them. It is perhaps the one way of ensuring you have exactly the
materials you need.
• Try to be reimbursed, or given an equipment budget to cover these
costs.
(e) Is the room with which I have been provided still going to function well
for me? Do I need to negotiate another space?
 Guidelines, preparations and practical hints 15

• This may be difficult, but always try to get the room that suits you.
• If you need a sink for art work, or a piano, or a clean floor to roll on,
keep on pressing for your needs.
• It may be difficult explaining to someone unfamiliar with your
creative medium why you need these facilities, but keep on trying.

Points to look for and questions to ask yourself

during the session

1 Immediately prior to the session

(a) Is all the equipment I need for this session here?
(b) Are all the group members here? What is the general mood of the group?
Is it in keeping with my plans for this session?
• In some cases you may want to keep that mood. In others, you may
wish to dispel it. Either way, you may feel the need to change your
plans.
• Flexibility of approach is one of the keys to successful and creative
leadership.

2 Running the session

(a) Did I introduce myself ? Does the group know why I am here and what we
will be doing together? How do they react to this?
(b) Do I know the individuals in this group?
• Every group is different.
• Every individual in every group is unique. Each makes their mark
differently. The medium in which they are most creative differs.
• Name games, sharing information and allowing group members to
feel they are part of the group’s decision-making process is essential.
• All too often, leaders do not even consider asking a group what they
would like to do.
(c) Am I warming up the group for the activities to come?
• The warm-up sets the tone for the rest of the session.
• If the session is to be ‘physically strenuous’, it is important to warm
up the joints and muscles.
• If imagination is to be the focus of the session, exercises to warm up
the imagination will be needed.
• If there is lethargy at the beginning of an active session, it’s very
unlikely that your group will be prepared to expend any energy
without being coaxed.
16 Using the creative arts in therapy and healthcare

(d) How are group members responding? Who is outgoing? Who is shy?
(e) Am I introducing the activities in a way that people can understand? Am
I working at their pace?
(f) Am I providing the right amount of structure to allow the group to be
creative?
(g) Am I meeting the individual needs of the group? Am I aware of changes
occurring in these needs throughout the session?
• Throughout the session, no matter how actively involved you are,
you must be sensitive to the needs of the entire group.
• This requires tremendous amounts of concentration and, in particu-
lar, paying close attention to all the observed behaviors of your
group.
• Make sure you are using language that the group understands.
You may need to vary your language level (that is, the complexity
of words) and your language system – the way you put sentences
together, and try to reinforce your requests with gestural clues to
communicate with all the group’s members.
• Always remember to work at your group’s pace, but also always start
each activity at the beginning and not just where you finished last
time with this or some other group.
• As to the structure, you will have to sense if you need to let go of the
reins or pull them in even more. This is something one learns with
experience and unfortunately experience can not be gained from any
book.
(h) Am I simply filling up the session with ‘busy time’?
(i) Am I enjoying myself ?
• If you are not enjoying yourself, it is almost certain that no one else
will be.
• However, be careful that you are not the only person enjoying your-
self. Remember who the session is for; it is often important to remind
your assistants about this too.
• If you do get caught in a ‘playing to the crowd’ mentality, the session
may degenerate into ‘busy time’ with a lot happening but nothing
being done.
(j) How can I end this session on a positive but relaxing note?
• Lying on the floor, listening to tranquil music, gentle rocking in
pairs, telling the group a story, while they lie on the floor with their
eyes closed, working with a parachute, are all examples of ends to a
session that are both relaxing and positive.
 Guidelines, preparations and practical hints 17

3 Immediately after the session

(a) Does everyone know when the next session will be? Do I need to send
notes back with certain individuals?
(b) Does everyone have all the possessions they arrived with?
(c) Do I have everything I came with?
(d) Have I checked all the lights are out? Water turned off? Is the room in
reasonably the same state I found it?
• This is particularly necessary as janitors and cleaners are possibly the
most important professionals we encounter.

Questions to be answered after the session is over

1 Evaluating the session

(a) How did the group respond? To me? To my material? To other members
of the group? Was this as I expected?
(b) How did I feel about the session – good, uneasy, bad? Can I pinpoint a
reason for this? The room? My presentation? My contract? My material?
(c) Did I meet any of my goals this session? Did I identify new goals during
the session?
(d) Have I made a written note of my observations and feelings about the
session yet?
• Even in this age where ‘personal privacy’ is protected by ‘legislative
acts’ I feel it is extremely important to keep written records.
• However, I also suggest you seek counsel from your employers
concerning who may have access to your session notes.
• Session notes should not just be a clinical account of what happened.
They should include observations of what went on, how the group
members participated and how you felt the session went.
• I have kept a journal of every session I have ever run and these have
proved invaluable, not only during but also after the sessions have
finished.

2 Planning for the next session

(a) Am I on the right track? Do I need to change my approach? My material?
My medium? Do I need to renegotiate my contract?
(b) Who are the individuals in the group who need special attention? How
can I best meet these needs without disturbing other members of the
group?
(c) What shall I do next time? How can I link it to what we have already done
so that it builds on these experiences?
18 Using the creative arts in therapy and healthcare

• The answers to these questions will be extremely specific.

• The only observation I will make is that it is essential that you link
your material to your own personality and to the personalities in
your group.
(d) Have I scheduled time for a break between sessions?
• In the long run it is essential that you timetable ‘space’ for yourself to
replenish the energy you have expended. You cannot pour from an
empty cup.
(e) The most important thing to remember is that everyone in the room is a
human being.
• You, your assistants and the members of your group all have good
and bad days. All of you will experience frustration and elation,
failure and success.
• If you can bear that in mind, you will be a long way down the road to
allowing the people you work with the opportunity to expand their
own horizons through creative activity.

Notes
1 For information related to training, accreditation and other related matters see the
Appendix.
2 Any toys, props or instruments you are using should also be washed and/or
disinfected after each use.
3 Quoted in H. Exley, What It’s Like To Be Me, Watford: Exley Publications, 1981.
Chapter 3

Don’t forget to breathe

and smile
Breathing exercises as warm-ups for
art activities in healthcare settings
Bernie Warren

A thousand mile journey begins with one step.

(Lao-tzu)

I began my study of the Eastern martial arts in 1970. Since that time I
have continuously immersed myself in the forms, philosophies and healing
applications of various martial arts, particularly Taoism and the Chinese
internal martial arts.1 In 1975 I began to pursue a career in the performing
arts with a particular focus on the applications of these arts in education,
healthcare and therapy. For many years I kept these two aspects of my life
separate.
In 1991 on a research trip to Britain, a dear friend and I engaged in a
discussion about our root discipline. We both had studied various aspects of
the performing arts and taught courses that crossed disciplinary and artistic
boundaries. After some discussion he proclaimed that while he taught drama
and dance, his discipline was music. He then asked me what my discipline
was. For a few moments I was completely speechless. However, as we con-
versed it became clear to us both that all my creative work was (and still is)
based on notions of breath and energy rooted through my training in the
internal martial arts.

Wei wu wei – ‘do without doing’

One must transcend techniques so that the art becomes an artless art,
growing out of the unconscious.
(Daisetsu Suzuki)

There are many similarities between studying the internal martial arts and the
creative arts. An artist seeks a meditative state in which mind, body and spirit
are balanced; for effortless action is one of the goals of both the martial arts
and creative activity. To accomplish this, one must let go of conscious
thought (for all too often thinking gets in the way of doing) and step beyond
20 Using the creative arts in therapy and healthcare

technical knowledge (e.g. the physical repetition of steps) and seek the
balance between inner knowledge and external form.
When an individual is immersed in creative activity they can become lost
in a creative moment, a liminal state that may potentially bring together
physical, intellectual, emotional and spiritual aspects of our being in a way
that offers unique opportunities for transformation and healing to take
place. Moreover, this immersion provides opportunities for the participant to
achieve a meditative state remarkably similar to that of the martial artist.
From a Taoist perspective creative moments provide a way of creating a
double balance: a time when the energies of the body are in balance with
themselves and the body is in harmony with its surroundings. At this time,
when we are ‘lost to the world’, it is also possible that we may become open
to change. Within the balanced stillness of the creative moment, individuals
focus all their being into a unique creative act and it is in that creative moment,
when Qi2 flows freely, that they may be provided with the catalyst through
which they may transcend their limitations. The potential exists for changes
to take place, ‘in spite of ourselves’.

Taoist concepts of health and healing

Pure energy is the root of the human body.
(Lu 1978)

For the Taoist the universe is alive with a kind of primal power, a force they
refer to as Qi. In traditional Chinese medicine, Qi is said to flow through
meridians in the body and blockage of the flow of Qi through these meridians
is believed to be one of the major causes of illness.
Qigong is a Chinese system of fitness and health promotion. It is one of
the ‘three pillars’ of traditional Chinese medicine3 and the use of exercises
for health and physical development that are now called Qigong has a docu-
mented history of over 2000 years.
There are many different Qigong exercises. Each exercise uses a specific
posture and breathing pattern to stimulate hormone secretion and immune
function, oxygenation of body cells and to generate bio-electrical energy for
healing purposes.
Research pertaining to Qigong indicates remarkable results for persons
with medical conditions such as high blood pressure, cancer and even spinal
cord injuries. Regular Qigong practice helps to prevent illness, sustain an
active lifestyle and increase longevity.

Breathing and the creative arts

When done correctly all will appear effortless.
(Taoist proverb)
 Don’t forget to breathe and smile 21

My practical explorations with creative artists into the relationships among

breath, thought and action lead me to believe that:

• sound must come from and return to silence

• movement must come from and returns to stillness.

More than this, movement and sound must be a purposeful expression of the
feelings and thoughts which the artist is experiencing. To achieve this, ideally
artists need to work in a relaxed state of creative tension so that their breath
preparation and the physical process of breathing shape their thoughts and
feelings.
From this perspective, breathing (something we do most usually without a
conscious thought) is perhaps the most important skill that any artist must
learn irrespective of the social, professional or therapeutic context in which
they work.

Simple Qigong exercises

Concentrate entirely on your breathing, as if you had nothing else to do.
(Kenzo Awa)

For more than 20 years I have been using Qigong exercises with people with
life-changing conditions and in the training of actors, dancers, musicians and
visual artists. Below I present some simple breathing exercises that not only
help individuals prepare for creative endeavors but also if done regularly can
help reduce stress and prevent many illnesses.
All creative arts demand a great deal of physical, intellectual and emo-
tional energy. The primary purpose of the exercises presented here is to help
individuals to develop, control and shape the personal energy that in large
measure is needed in any creative undertaking. These exercises emphasize
self-discipline and concentration and will help you slowly become more
attuned to your own body and can help you improve posture, breathing pat-
terns and energy flow.

When may I use these exercises?

The exercises presented below are simple forms that you may perform for
health benefits at any time during the day. In addition, here are some guide-
lines for their use during a creative activity session:

• Opening and Closing Breaths is a good exercise to start or finish any

creative session.
• Crane Stepping into Water may be used as a break from periods of
sedentary work or long periods of sitting.
22 Using the creative arts in therapy and healthcare

• Tranquil Sitting or Standing like a Tree are good exercises either as a

pause point in the middle of a physically demanding or energetic session
or in the cool-down.
• Lighting the Candle may be used as part of a guided imagery session or
as a means of calming an individual or group.

All the exercises can be done indoors in a room with good ventilation or out-
side. They can be performed in silence or you may want to play quiet medita-
tive music. Throughout your experience, try to quiet your ever-questioning
mind. Keep the following very important aspects in mind while performing
the exercises:

• Breathe in and out through your nose, quietly and softly so that you can
barely hear your breathing.
• Never force or hold your breath.
• If at any time you start to feel light headed or faint, think about but do not
look at your feet.

Standing like a Tree 4

Don’t just act; stand there.
(Elia Kazan)

This self-healing exercise, one of the so-called ‘Medical Treasures’ of classical

Qigong, is a simple but potent weapon in the fight against stress and stress-
related diseases. Moreover, research suggests standing for five minutes in this
position has the same cardiovascular effect as walking for 20 minutes on a
treadmill at a moderate pace:

• Stand with your legs hip width apart and your feet flat on the floor
parallel to one another.
• Bend your knees but do not let them extend beyond your toes.
• Keep your shoulders relaxed and your spine straight but not rigid.
• Imagine that your head is suspended from the sky by a silken thread, that
there is a small cushion of air between each vertebrae and that your chin
rests on a silken pillow – so that your eyes remain parallel to the floor.
• Move your hips slightly backwards, as if sitting down on a high bar stool,
so that your shoulders are slightly forward of your hips.
• Point your elbows away from your body with your palms facing towards
your thighs. (Pose 1 in Figure 3.1)
• Do not tighten your stomach muscles; rather keep the front of your body
soft.
• Throughout this exercise think of your head ‘floating up’ and your tail-
bone ‘drifting down’.
 Don’t forget to breathe and smile 23

• When properly aligned you should feel a gentle stretching sensation in

your inner thighs and buttocks.
• Close your mouth, so that your teeth touch and your tongue lightly
touches the roof of your mouth.
• You should imagine that you are like a tree rooted to the ground through
your legs and feet, and reaching upward to the sky through the top of
your head.
• In the beginning, hold this position for about 30–45 seconds. As you
become more comfortable with the position, you can slowly increase your
time in this position until you can stand like a tree for five minutes.

This posture can be done while waiting for a bus or in a line up, before or
after doing the dishes or anywhere where you are standing.

Opening and Closing Breaths

I begin my daily Qigong practice with a physical clearing and cleansing using
a set of three linked exercises which together are known as the Opening and
Closing Breaths. These exercises help to ‘guide’ Qi through the main merid-
ians, energize the body and expel ‘stale’ air.
This set of exercises is also referred to as the Three Healing Breaths
because they help to strengthen the immune system, cleanse the body of
impurities and in traditional Chinese medical practice are used to help pre-
vent and treat cancers and stress-related diseases.

• These exercises are best performed at the beginning and/or at the end of
every session.
• Ideally breathe in (IN) or breathe out (OUT) through your nose where
indicated below or breathe naturally without holding or forcing your
breath.
• Repeat each exercise three or more times; then proceed to the next.

Assume the Standing like a Tree posture described above (Pose 1 in Figure
3.1).

Lotus flower opening

• (IN) Lift your arms up from floor, elbows pointing away from your body
so that your palms move towards the sky.
• At your navel turn palms down, pointing your fingers towards the ground
(Figure 3.1.2).
• Slowly lift your hands above your head until your fingers point towards
the top of your head (Figure 3.1.3).
• Open your hands outwards, your palms towards the sky (Figure 3.1.4).
24 Using the creative arts in therapy and healthcare

Figure 3.1 Opening and Closing Breaths: lotus flower opening.

Photographs taken by Nicole Gervais

• When your hands reach shoulder height (OUT), turn your palms down
towards the ground (Figure 3.1.5).
• Continue until your arms are at your side (Figure 3.1.6).

Lotus flower closing

• (IN) Open your arms away from your body with palms pointing to the
ground as if a large balloon is inflating underneath them. (Pose 2 in
Figure 3.2).
• At heart height turn your palms towards the sky (Figure 3.2.3).
• Lift your arms in an upward circular motion until your palms face the
top of your head (Figure 3.2.4).
• Bring your elbows together so that they face forward.
 Don’t forget to breathe and smile 25

Figure 3.2 Opening and Closing Breaths: lotus flower closing.

Photographs taken by Nicole Gervais

• (OUT) Slowly move your elbows towards floor with your palms facing
your body and your fingers pointing towards the sky. (Figure 3.2.5).
• At navel height open your elbows sideways and move your hands towards
the ground.
• Continue until your arms are at your side (Figure 3.2.6).

Petals floating on the water

• Raise your hands to navel height turning them until your palms face
towards your navel (Figure 3.3.1).
• (IN) Float your elbows away from your body; your palms follow the
motion of your elbows (Figures 3.3.2, 3.3.3).
26 Using the creative arts in therapy and healthcare

Figure 3.3 Opening and Closing Breaths: petals floating on the water.
Photographs taken by Nicole Gervais

• (OUT) Begin to bring your elbows towards body with your palms follow-
ing the motion of your elbows (Figures 3.3.4, 3.3.5).
• At end of exercise cover your navel, one palm on top of the other.
Breathe naturally (Figure 3.3.6).

Crane Stepping into Water

There are hundreds of walking exercises. Here is an exercise adapted from a
version of Hua To’s Five Animal Frolics.5

• Stand with your legs straight, your heels together with your toes pointing
away from one another at a 90-degree angle (do not lock your knees).
 Don’t forget to breathe and smile 27

Figure 3.4 Crane Stepping into Water.

Photographs taken by Nicole Gervais

– Let your arms rest against your body, palms towards your thighs.
Imagine your arms are wings (Figure 3.4.1).

Moving to the right

• As you breathe IN:
– Bend your left knee.
– Turn your hips to the right.
– Pick up your right heel (Figure 3.4.3).
– At the same time, float your arms away from your body up to shoul-
der height keeping your palms towards the ground.
– Take a small step out at a diagonal to your right (Figure 3.4.5).
• As you breathe OUT:
– Place your right foot on the floor heel first (Figure 3.4.6).
– At the same time float your arms back towards your thighs (Figure
3.4.6).
28 Using the creative arts in therapy and healthcare

– Bring your left leg in to meet your right leg so that your heels return
to rest (Figure 3.4.7).
– Turn your hips back to the centre (Figure 3.4.8).

Moving to the left

• As you breathe IN:
– Bend your right knee.
– Turn your hips to the left.
– Pick up your left heel.
– At the same time float your arms away from your body up to shoul-
der height keeping your palms towards the ground.
– Take a small step out at a diagonal to your left.
• As you breathe OUT:
– Place your left foot on the floor heel first.
– At the same time float your arms back towards your thighs.
– Bring your right leg in to meet your left leg so that your heels return
to rest.
– Turn your hips back to the centre.

Continue walking forward alternating right and left legs. At the end, return to
the Standing like a Tree posture or try the following exercise, Tranquil Sitting.

Tranquil Sitting
Seated Qigong exercises can be done anywhere: at home, at the office or when
traveling. Any chair will do; however, for best results choose a straight-backed
armless chair.

• Sit comfortably on the chair with your legs hip width apart and your feet
flat on the floor in parallel.
• As for Standing like a Tree, keep your spine straight but not rigid with
your shoulders slightly forward of your hips. Do not tighten your stom-
ach muscles; rather keep the front of your body soft.
• Place one hand on top of the other resting just below the navel, palms
toward the body.
• Close your mouth, with your teeth touching and your tongue lightly in
contact with the roof of your mouth.
• Breathe in and out through your nose, quietly and softly so that you can
barely hear your breath.
• Never hold or force your breath.
 Don’t forget to breathe and smile 29

Lighting the candle

Qigong helps lower stress levels and helps us to relax. This exercise can be
done lying back in a recliner chair or lying flat in bed (if lying flat in bed,
place a small pillow under your head) and can help you rest and sleep:

• Do not cross your legs, as this blocks circulation.

• If you wish, play soft calming music during this exercise.
• Place your left hand palm down, at the top of your breast bone just
below your collar bone.
• Place your right hand palm down, just below your navel.
• Allow your elbows to rest close to your body.
• Close your eyes.
• Breathe slowly and regularly through your nose.
• Never force or hold your breath.
• Imagine there is a lighted candle in the space under your right hand.
• As you breathe in, imagine the flame of this candle extending upwards
towards your left hand.
• As you breathe out, imagine this flame returning to its original position.

Don’t be surprised if during this exercise your palms get very warm. You can
continue in this position for as long as you like or until you fall asleep.

Endnote
Unfortunately words are no substitute for experience and trying to capture
the essence of Qigong on paper is like trying to catch the wind, one may feel it
but never contain it. So if all else fails:

DON’T FORGET
BREATHE and SMILE
FOR THIS IS THE ESSENCE OF QIGONG

Acknowledgements
I shall always be indebted to my teacher Master George Ling Hu who, since
our first meeting in 1993, has opened my eyes to the real essence of the
Chinese martial arts.
I must also acknowledge my late friend Yon who opened my eyes to the
connections between the performing and the martial arts and whose work has
always been an inspiration to me as I struggle to find my way along the path.
Finally, I wish to thank John Taylor who ten years ago came to me as a
student and from whom I have learned at least as much as I have taught.
30 Using the creative arts in therapy and healthcare

Notes
1 Since 1994 I have studied and taught primarily Chinese forms such as Qigong, Tai
Chi.
2 Qi (also written as Chi, or Ch’i) has no direct translation in English. It is often
translated simply as ‘energy’. However, ‘vital force’, ‘life force’ or even ‘creative
force’ more accurately describe it.
3 The other two are acupuncture and healing with food and herbs. Some occasionally
refer to a fourth pillar, namely bone setting and manipulation.
4 This is the basic standing exercise for all stationary Qigong.
5 The Five Animal Frolics, introduced by Hua To, is an ancient exercise based on the
natural movements and postures of five animals: the Crane, Bear, Monkey, Deer,
and Tiger. It is reputed to be the oldest written exercise program for preventive
medicine.

Further reading
Cohen, K. (1996) Qigong: Traditional Chinese Exercises for Healing Body, Mind and
Spirit, Boulder, Co: Sounds True (DVD).
Lam Kam Chuen, (1991) The Way of Energy: Mastering the Chinese Art of Internal
Strength with Chi Kung Exercise, New York: Gaia.
Ling Hu, G. (1996) Swimming Dragon Chi Kung and 6 Simple Chi Kung Methods for
Health, Houston, TX: Hu Ling Instructional Video Series (DVD).
Requena, Y. (1996) Chi Kung: The Chinese Art of Mastering Energy, Rochester, VT:
Healing Arts Press.
Sheng Keng Yun, (1997) Walking Kung: Breathing for Health, York Beach, ME:
Samuel Weiser.
Chapter 4

Folklore and ritual as a basis

for creative therapy
Rob Watling and Veronica James

Folklore is formal, performative and thematic and becomes delightfully,

dynamically alive as it is integrated into life and custom through ‘the sieve of
communal approval’.1 Folklore is that active part of any culture which is
transmitted by word of mouth or by habit and practice. Predominantly
passed on in daily life through oral, physical and written traditions, and
increasingly through the media, it is a moral repository which is renewed
though repeated folksay (proverbs, riddles, rhymes, dialect), games, folk lit-
erature (folktales, poems, songs, dramas), customs and beliefs, music, dance
and ethnography (the study of arts, crafts and the manufacture and use of
artifacts). Folklore is as much part of the modern urban cultures of indus-
trialized societies as it is of American Indians, Australian aborigines and
ancient and modern Greek and Egyptian cultures. It is something we all do,
not just ‘the things our grandparents used to do’ for it is a vital part of the
way all societies operate. There is folklore for children and adults. It can be
found at home, school, hospitals and work; in politics, religion and banking;
in self-help and therapeutic groups; in cities, towns and rural areas and in
both complex and simple organizations. By convention folklore draws on
themes that are anonymous, but universally shared, although it is given life
and continuity through individual communities and groups.
Wherever it is found, folklore belongs to the people who use it. They have
devised it when they have wanted it and needed it, transmitted it down and
across generations, adapted it when necessary, and discarded it when they
have no further need for it. Interestingly, the internet is replete with folklore.
Archived material gives new and international access to old materials whilst
also offering new applications and projects for teaching and therapy. In add-
ition it generates its own folklore – such as the contemplative story of the
young man addicted to an internet game which ruined his life and led to his
death, which is reminiscent of ancient tales of isolation and the struggle for
survival. Here we can see that folklore is constantly adapting, and almost
infinitely variable. While folklore is often considered to be ‘traditional’, in the
sense of being handed down from the past, it is also generated anew. The
custom of passengers clapping when a plane touched down was a measure of
32 Using the creative arts in therapy and healthcare

the wonder of flight, but one which passed as flying became taken for
granted. Above all, folklore is functional and strong folklore stands the test
of time because familiarity, predictability and repetition can bring the com-
fort and ease of generating structures which are critical to the facilitation of
communal engagement.
Making use of the functionality of folklore, we believe that clients can be
assisted to tackle their problems by applying folklore to enable safe, trusting
connectivity and shared experience, as well as for creative therapeutic chal-
lenge. Without making a romantic appeal for some sort of return to a simpler,
more ethnocentric way of life, we believe that there are important lessons to
learn from tradition and ritual. We have found that a working knowledge of
folklore is invaluable in engaging with a range of groups and individuals.
It has served both as a source of material and as part of a theoretical model
of what happens in creative therapy sessions. However, before we look at
some of the applications of folklore we need to know a little more about the
subject.
Many of the early folklorists, working in the nineteenth century, concen-
trated purely on collecting large quantities of material. They wanted to list
the things people did – the songs they sang, the rituals they performed, the
tales they told or the tools they used. Collections of this information were
compiled but it was some years before people began to realize that the
material was not enough by itself. It was not sufficient to know that ‘Waly
Waly’ was a Scottish ballad. They wanted to observe it freshly, and connect it
with how it was expressed, who sang it, to whom, where and when. Where
was it learned, how was it remembered and why does it exist at all? Is it just
a sad song? Is it a cautionary tale? Is it a record of an important event in a
society unable to perpetuate its history with pen and ink? This new gener-
ation of students wanted to know about how folklore exists in social reality,
looking at the context and the function of the living material. It is the social
reality of context and function that interest us, too.
Folklore can serve an enormous range of functions. A simple folktale can,
in certain contexts: relate the history and wisdom of a society; reinforce cus-
tom alongside taboo and prejudice; teach multiple skills by example; offer
personality types against which to understand our personal hopes and fears
and responses; explain the mysteries of the universe and our place within it;
amuse and entertain; warn of danger and keep us safe; offer solutions to
personal and family problems, as well as suggesting activities to solve prac-
tical issues. The list of the contributions of folktales can be made very long yet
other types of material increase the range of these varied functions. To illus-
trate some of these are five examples. Four are old and established. The fifth is,
apparently, a new one, but incorporates the forms seen in the previous four.
The Anang in Nigeria, like many other African peoples, use proverbs as a
central part of their judicial system. Plaintiff and defendant quote proverbs
(widely used as the embodiment of tribal wisdom) to support their cases.2
 Folklore and ritual as a basis for creative therapy 33

In China, while the tyrannical Chin Shih Whang was having the Great
Wall built, folksongs emerged as one of the few possible expressions of the
people’s feelings: their grief at the death of so many laborers, their fury at
the enforced break-up of so many families as men were sent away to build the
wall, their opposition to the capital punishment of those who refused to go.
Popular protest songs, passed on by word of mouth, are still around today.
In Norse mythology, combatants indulge in an insult-flinging competition
as a precursor to a battle. Here the idea seems to be to goad your partner into
action and to prepare yourself for victory.
The Inuit of North America will sometimes have a singing duel to settle
a dispute in a non-violent way (violence is not welcome in the close confines
of a winter settlement). The combatants sing songs at each other with the
intention of ridiculing their opponent into submission. They channel their
antagonism into a functional, conclusive ritual.3
Spectators of competitive team sports combine the use of ritualized sport-
ing sayings to explain how the team will or will not perform well and as a
defense against the anxiety of losing; ritual actions and dance (the New
Zealand All Black Rugby team using a Maori chant and dance before the
start of a game); and channeled antagonism through ritualized insult-flinging
at the opposition, with singing duels and chanting duels aimed at undermining
the opposition and enhancing team spirit.4
The notion that folklore can and should be studied in terms of its context
and function is central to us if we wish to apply traditional material to
creative therapy. We could sit in a circle and sing war chants. We could per-
form traditional Swiss dances, tell each other Russian fairy tales or play
Welsh street games. However, as leaders we need to understand what it is we
are doing and with whom. We too need a firm notion of the context and
function of our material and the way in which these elements relate to each
other. This relationship can be described by a simple diagram (Figure 4.1), in
which the shading denotes areas of change and mutual influence. When any
one of the variables in the figure alters, it may affect one or both or neither of
the others.
Take, for example, the game of London described later in this chapter.
Traditionally when played by a group of children, it is ‘just a game’. Its
context might be described as a backstreet game, played by friends in their
leisure time. The function of the game appears to be fun; something to pass
the time; perhaps a chance to consolidate friendship or to practice com-
petitiveness. If we change the context by playing this game in a creative
therapy session, what else do we change? Perhaps we change nothing, as
we can play this game for its own sake. However, we could decide to use
this game with a group who need to develop gross motor control. Now we
could add the function of teaching people to stop quickly and to control their
balance to our list. It is still the same material but now with new context
and function. We can go further (as in the ‘collective’ version of the game
34 Using the creative arts in therapy and healthcare

Figure 4.1 Schematic relationships between context, function and traditional material.

described below and change the rules of the game. It is no longer everyone for
themselves but an exercise in co-operation. Context, function and material
are variables for us and the group to alter as we wish.
Folklore is a powerful, accessible, adaptable source of material, which
offers us insights into the way people act and interact with each other and the
environment. Once we understand some basic principles of the way in which
it operates, we are able to apply some of this material in a therapeutic way.
The rest of this chapter outlines some practical ways in which this can
be done, with particular reference to traditional games, folk narratives and
simple rituals.

Traditional games 5
We have tried to suggest games of different types in this section, varying from
the energetic to the slow and contemplative. All of them, we hope, contain the
essential element of fun referred to in other parts of this book. By way of
explanation, we have used the term ‘It’ to describe the player who is working
against the rest of the group, usually in an effort to catch them. ‘It’ is often
called ‘He’, ‘Her’, ‘On’ or ‘On it’ in Britain.6

Stick in the mud

This is an excellent game with which to start a session with young active
people and one that is always a great favorite. It is also called Sticky Glue,
Release, Ticky Underlegs, Underground Tag, Ice Witch, and in Latvia is
known as Salt Posts, where it used in everyday language to describe someone
who is too scared to move.
One player is ‘It’ and chases the others. Anyone ‘It’ touches must stand
with their arms outstretched and their legs apart – they are ‘stuck in the mud’.
 Folklore and ritual as a basis for creative therapy 35

They must stand still until another player frees them by crawling between
their legs. They may then run off again. Sometimes players are required to
call ‘SOS’ or ‘Release’ while they are stuck in the mud. ‘Its’ job is to get
everyone stuck in the mud, which is not easy. Having two ‘Its’ helps make the
game less frustrating. The first and/or last people to be caught are ‘It’ next
time round.
This is a fast, energetic game involving a variety of movement and body
shapes, basic teamwork and usually quite a lot of noise. It can be useful as an
exercise for those needing to develop simple spatial awareness and can easily
be adapted for different ability groups. Slowing the game down to a walking
pace can be useful, so can changing the ‘freeing’ act for a simpler maneuver.
Some people find it easier to stand near a wall when they have been tagged
and to hold up an arm or a stick to form an archway. They are released when
someone goes through the arch (this is sometimes called Tunnel Touch).
Alternatively, the game can be made more demanding: players must move
around the room in a particular way; you must crawl backwards through a
captive’s legs to free them; play the game linked to a partner so that pairs of
people have to crawl through two sets of legs. As ever, the possibilities are
endless and can be matched to the abilities of your group or used to lead them
into new areas of movement and activity.

Sun and frost

This is a version of Stick in the Mud played in Stornoway on the Isle of Lewis,
Scotland and was collected by the Opies from an 11-year-old girl who said:

You all stand in a row and one person picks the nicest face for the sun,
and the rest that’s left they all put on ugly faces and pick the ugliest [for
the frost]. The people that’s left all go out and the frost goes after them
and if they’re caught they have to stand still till the sun tips them and
they will get free. That’s how you play the Sun and Frost.7

The obvious symbolism in this game can be of use to many groups over and
above the physical benefits of movement. Rob has sometimes extended the
idea and asked the Frost to ‘really freeze’ the players and the Sun to thaw
them out with a warm hug and a nice sigh. There are many other traditional
games where quite intimate body contact is perfectly acceptable, and they can
be used, among other things, for the recognition of body parts.

London
A game with exceptionally wide circulation, this is known in various parts of
the world as Red Light, Green Light, Ochs am Berg, Eros zwei drei – sauer
Hering! Uno, Due, Tre, Stella, Grandmother’s Footsteps or simply Freeze.
36 Using the creative arts in therapy and healthcare

Originally played across a street or a yard, ‘It’ stands facing a wall with
all the other players on the opposite side of the road. The object is for
them to creep up and tap ‘It’ on the shoulder, but at any moment ‘It’ may
suddenly turn round. Anyone ‘It’ sees moving (even a hand) is sent back to
the start. ‘It’ may look round any number of times but is often required to
count silently to ten between each go or to say a short phrase in his or her
head to give the others a chance. The first player to get right across is the
next ‘It’.
This game is immensely popular and nearly always played with complete
equanimity. This has much to do with the quality of the ‘It’ role, for ‘It’ has
considerably more control over the proceedings than in chasing and tagging
games. This is one of those rare games where ‘It’ is the coveted role, but has
the additional advantage that everyone else can feel that they are succeeding –
even the ones who are sent to the back, for they are now hidden by the people
in front of them and can move forward more quickly. A headstrong dash for
the finish is rarely successful and the quiet individual can often win by stealth.
We have seen many players delight in the attention they receive in being sent
back over and over again. It is rare for players to accuse one another of
cheating or to refuse to accept ‘Its’ verdict.
In creative therapy sessions the game is useful in a number of ways. It is
fun, of course, and can relax a group very quickly, helping to create a good
working atmosphere. It improves concentration and alertness and can be
used to develop body awareness, balance and gross motor control. Faced with
a group of adolescent boys who were having difficulty making group
decisions and acting co-operatively, Rob developed a variation called Group
London. There was still one ‘It’ but the rest of the group had secretly to select
one of their number as the one they wanted to ‘make it’ to the other side.
Their job was to help him get across by shielding him from view, or by
‘sacrificing’ themselves and drawing ‘Its’ attention away from him. The
dynamic of the game changed dramatically and it was used on a number of
occasions as a link between more self-centered games and exercises to
develop group cohesion. A more gentle variation is from Italy, called Beauti-
ful Queen in which the Queen faces the children and calls the name of an
animal and the number of steps and children approach in small or big steps
as befits the animal. The first one to arrive is next Queen.
As a widely known game, London also serves as a good example of
another benefit of traditional material. Many people playing these games
will remember their own variant and can make a positive contribution to
the session (something they might otherwise find difficult). Whole sessions
can be run with all the activities suggested by group members from their own
repertoire of traditional material.
 Folklore and ritual as a basis for creative therapy 37

Muk
This game is part of the traditional winter activity of the Inuit. The players
sit talking and joking in a circle with ‘It’ in the centre. Suddenly ‘It’ will say
‘Muk’ (the Inuit word for silence) whereupon no one must make a sound.
However, ‘It’ is allowed to tell jokes, fool around, pull faces or whatever until
someone breaks the Muk. Then the group gives that person a comic name
(traditionally the name of an animal). This person then either replaces the
‘It’ or joins them as part of a growing team of animals who will eventually
descend on the last silent member of the group.
Ostensibly a game about the breaking down of barriers between indi-
viduals (one of the social functions for the Inuit), in our society this game can
easily become an exercise in reinforcing these barriers. This is particularly
likely in a group where people have problems with communication and self-
presentation and ‘It’ can quite quickly feel threatened and ostracized. The
leader is at liberty to make capital out of this (perhaps moving on to more
intensive work) or to defuse the situation by having more than one person in
the middle. You may wish to stop the game when there are still three or four
people in the outer circle to avoid the group applying all its coercion on one
individual, but this last breakdown can have a unifying effect on the group
and restore the element of fun.

Irish wake games 8

The traditional Irish funeral was a fascinating mixture of solemnity and
joviality. In common with the funeral rites of many cultures, it served as an
opportunity not only to pay respect to the dead but also to celebrate life and
the living. Most if not all of the amusements have now been separated from
the modern Irish wake, largely in response to the disapproval of the Church,
but we still know enough about them and the way they were played to under-
stand at least some of their functions in this context.
The wake itself, where relatives and neighbors would watch over the coffin
until the funeral, was partly a chance for people to express their respect and
to show their mourning. It also served to guard the coffin overnight from evil
influences – which could mean spirits, the devil, bodysnatchers, or all three.
There would be much drinking and eating at a wake and there was as much
singing and dancing as at any other Irish gathering. However, there were also
these games to help people stay awake and relatively sober at their task. There
were riddles, trials of strength and dexterity, tricks of all sorts and forfeits
galore, all acting as a confirmation, a celebration of the living at a time of
deep respect for the dead.
38 Using the creative arts in therapy and healthcare

Pig in the sty

One person (traditionally a woman) stands in the middle of a ring of players
who link arms as securely as possible. Outside the ring is another player
(usually a man). His job is to kiss or tag the girl in the middle either by
reaching over the ring of linked players or by forcing his way through. (At
this stage the ring may decide to let the girl escape and to keep the man
prisoner.) All the other players try to frustrate the man’s attempts until he
is successful or resigns.
This game can be used in a number of ways: to act as a warm-up, to
channel physical aggression, to develop co-operative energy, to break down
barriers to physical contact (which can here be intimate but safe), to illustrate
rejection and corporate disapproval or to promote a discussion of traditional
sex roles. The game can easily be adapted by encouraging different techniques:
use no hands; everyone has eyes closed; tickling is allowed; use persuasion to
gain entry into the circle; cheat; etc.

Do the opposite
This was a common amusement at the wakes and one that has been popular
with all sorts of groups, the object being to trick people into making simple
mistakes. Two players, for example, hold a scarf between them and are told to
do the opposite of any instruction you give them. You tell them to hold it
tight and they should let go, you tell them to pick it up and they should leave
it alone, you tell them to keep it away from other people and they should give
it to a new couple. Any mistake (and there are many) is punished with a
forfeit – a hit on the head with a balloon is a cheerful option. The game is,
once again, infinitely variable and can easily be adapted to the abilities and
concentrative powers of most groups. It is great fun to watch, for humor is a
great leveler. Once everyone has been fooled (including you, for the leader
should join in whenever possible in these games) the whole group has greater
access to each other as individuals.

Cumulative games
Another adaptable concentration exercise is the cumulative memory game.
The first player in a circle, for example, says ‘I went to market yesterday
and bought a cow.’ The second player says, ‘I went to market yesterday and
bought a cow and a sheep.’ The third says, ‘I went to market yesterday and
bought a cow, a sheep and a sack of corn.’ This continues with each player
adding something new to the list. Again it must be used at an appropriate
level for the group. Some groups will be able to go round the circle several
times without making a mistake. For others it will be a considerable achieve-
ment if they can repeat what their neighbor has just said. Be prepared to use
 Folklore and ritual as a basis for creative therapy 39

memory aids (pictures, mime, sound clues) and look for ways to develop
additional skills in the same game (recognizing the idea of ‘sets of things’,
counting, non-verbal communication, etc.).

Narratives

Storytelling, recounting and ritualised metaphor 9

Storytelling can be a fulfilling experience in its own right. Traditional tales,
fairy stories, family stories, poems, ballads and dramas, as well as some mod-
ern literary ones, embody all sorts of wisdom: teachings, history, parables and
advice; for folk narratives are often the living encyclopedia and life manual of
an oral society. Even the simple act of being a member of an audience can be
calming and nearly everyone loves to be told a story. We need not limit
ourselves to straightforward tale-telling sessions, however useful they may be,
but can reinforce their meanings and messages in a number of ways. It can
often be valuable to ask groups to externalize their reactions to a narrative in
discussions, in paintings and sculptures, in a dance perhaps, or by acting out
some of the scenes. Ask your group to project their ideas of what happened
before the start of the story and what happens afterwards. Use the narrative
and its accessibility as a platform for all sorts of expression and discovery.
Since it is often the hero or protagonist with whom we are meant to identify,
who encounters our own predicament and symbolizes ourselves, it can often
be valuable to use a traditional narrative as the basis of a guided fantasy. In
this exercise each member of the group listens to the story and acts out the
part of the central character as the adventure unfolds: doing what the pro-
tagonist does; ‘seeing’ what he sees; ‘feeling’ what he feels; and learning (often
intuitively) what the hero learns. A whole wealth of human experiences can be
fed into each group member, who need not be self-conscious about the quality
of their performance as it is directed inwards rather than out at an audience.
A version useful in a mixed-sex group, or mature group, is getting an
individual to identify themselves as a folk hero or heroine and tell a very short
story (45–90 seconds) about an incident that is an example of them in that
character. Children’s storybook characters are often favorites, for example,
being Snow White and getting lost. Following this, the same story is repeated
one by one by each member of the group. During the retellings, the initial
storyteller hears minor differences which can help them see their experience
or their hero/heroine in a different light, while the rest of the group enjoy the
creativity of their own storytelling, or ‘picture making’, and hear how the
same event can be heard or seen differently. An adaptation is for other group
members to tell the same story but as different characters: the witch, the
animals in the forest, the dwarves, the prince, the night-time, the sun. At the
end the group may want to discuss what it felt like from their own character.
An ‘Oh, I didn’t realize’ is often the mark of new insights.
40 Using the creative arts in therapy and healthcare

As a development of these applications, the use of ‘modernized’ sporting

rituals and metaphors, albeit with ancient origins, can help access hard to
reach groups such as young men with depression.10 The group leader can be,
but need not be an expert in the particular sport, as asking naïve questions
can encourage the rest of the group to work together to explain. In the group,
a post mortem of a recent match is initiated, and working with the language
of the group – ‘he was useless’ – discussion of what the player might have
thought and felt about being ‘useless’ can be explored, often using banter and
humor. Without danger of the issue becoming personalized to an individual
or their family, this can encourage group contributions, ideas, solutions and
activities. The same group technique, with optional extras such as getting the
group to use flipcharts to draw team diagrams or giving a commentary as the
player, uses sporting stereotypes as a metaphor to explore what it is like to live
alongside such people, or be such people. The brilliant goalkeeper, central to
team success, but also at the back of the team, taciturn and a loner can be
used to discuss the strategies and feelings that the goalie might employ, and
how others might feel about the strategies being used off the field.

Ritual and creative therapy

Rituals have always formed an important part of the collective and individual
actions of people throughout the world. From the Indian dance to the swinging
of Catholic incense, from the blood sacrifice on a new boat to the distribution
of sweets on the birth of a baby amongst some South Asian communities,
from the rain dance to the children trying not to step on the cracks of the
sidewalk, rituals are anchors of certainty in a precarious sea. Rituals are
endemic because at the moment of ritual we know exactly where we stand.
There are many times every day when an individual or group needs to
know where they stand. With groups this can be: at the start of a session;
when a new member joins the group; when a group member faces a crisis or
shares a moving experience; at the close of the session; or when someone
leaves the group. At moments like these it can sometimes be helpful for a
group to use some sort of ritual as a collective expression of a shared experi-
ence. The predictability of ritual can help to take the slightly frightening edge
off uncertainty. There was one regular weekly group that Rob attended whose
members were comforted not just by the occasional use of simple ritual but
by the predictable, almost ritualistic use of traditional games as a mainstay of
their work. They knew what to expect from the sessions and learned to under-
stand their place within them.
But a word of warning. We have been members of several workshops and
sessions where a ritual has been artificially imposed on a group, actively
discouraging the authenticity it sought to generate. ‘We are now going to
show our unity for each other’s feelings and experiences by joining with
everyone in the room and silently communing with each other,’ said the ther-
 Folklore and ritual as a basis for creative therapy 41

apist. Unfortunately, it was obvious that the group wanted, on this occasion,
to reflect individually on their own experiences. They were a square peg being
tapped remorselessly into a round hole. Any worthwhile ritual expression must
have its roots in the nature of the therapeutic experience. It is material that
must be appropriate to the context and personalities of the participants, and
suited to its intended function. It is not hard to develop rituals with and for a
group, but we must insist that our modern-day material takes a lesson from its
traditional counterpart. All creative activity must work as an expression, not
as an imposition, and folklore (the carrier of wisdom, faith, joy and learning
for thousands of years) has never successfully been imposed on anyone.

Notes
1 D. Ben-Amos, ‘The idea of folklore: an essay’, in I. Ben-Ami and J. Dan (eds)
Studies in Aggadah and Jewish Folklore, Folklore Research Center Studies VII,
Jerusalem: Magnes Press, 1983, pp. 11–17.
2 J. C. Messenger, Jr, ‘The role of proverbs in a Nigerian judicial system’, in
A. Dundes The Study of Folklore, London: Prentice-Hall, 1965, pp. 299–307.
3 K. Burket-Smith, Eskimos, New York: Crown 1971.
4 A. Pringle, ‘Can watching football be a component in developing good mental
health in men?’, Journal of the Royal Society for the Promotion of Health 124(3),
2004, 124–128.
5 Over 35 years old and still the international definitive work on the traditional
children’s games from England and Wales is the Opies’ (1969) Children’s Games in
Street and Playground. There is an enormous wealth of material in the Opies’
work, including versions of the first three games in this section.
6 P. V. Gump and B. Sutton-Smith, ‘The it role in children’s games’, in A. Dundes
The Study of Folklore, London: Prentice-Hall, 1965, pp. 329–336. This chapter
contains a fascinating preliminary discussion of some of the possible functional
applications of selected it games.
7 I. Opie and P. Opie, Children’s Games in Street and Playground, Oxford: Oxford
University Press, 1969, p. 111.
8 For a fuller study of this material in context, see S. O’Suillebahn, Irish Wake
Amusements, Cork: Merrier, 1969.
9 For a more elaborate discussion see Cheryl Neill, Chapter 9 this volume.
10 A. Pringle, ‘Can watching football be a component in developing good mental
health in men?’, Journal of the Royal Society for the Promotion of Health 124(3),
2004, 124–128.

Further reading
Bettelheim, B. (1978) The Uses of Enchantment, Harmondsworth: Penguin.
Briggs, K. (2002) British Folk Tales and Legends, London: Routledge.
Brunvand, J.H. (1998) The Study of American Folklore, 4th edn, New York: Norton.
Brunvand, J.H. and Hickman, R. (2001) Encyclopedia of Urban Legends, New York:
Norton.
Burket-Smith, K. (1971) Eskimos, New York: Crown.
Child, F.J. (1965) The English and Scottish Popular Ballads, 5 vols, New York: Dover,
(original 1882–1898, papers held at Harvard. CD version available in USA).
42 Using the creative arts in therapy and healthcare

Clark, E.E. (1960) Indian Legends of Canada, Toronto: McLelland and Stewart.
Ferretti, F. (1975) The Great American Book of Sidewalk, Stoop, Dirt, Curb and Alley
Games, New York: Workman Press.
Frazer, J.G. The Golden Bough, London: Macmillan.
Grimes, R. (1965) Readings in Ritual Studies, New York: Prentice Hall.
Opie, I. and Opie, P. (1969) Children’s Games in Street and Playground, Oxford:
Oxford University Press.
Orlick, T. (2006) The Cooperative Sports and Games Book, 2nd edn, London: Readers
and Writers.
O’Suillebahn, S. (1969) Irish Wake Amusements, Cork: Merrier.
Pringle, A. (2004) ‘Can watching football be a component in developing good mental
health in men?’, Journal of the Royal Society for the Promotion of Health 124, 3:
124–128.
Van Gennep, A. (1960) The Rites of Passage, London: Routledge.

Websites:
Useful search terms include: folklore, legends, myths, traditional, children’s
games; children’s folk games; therapeutic games, as well as country or group,
e.g. Canada, Eskimos/Inuit. Examples include: children’s folk games
(www.estcomp.ro/~cfg/), wonderful examples from round the world; Native
American and Canadian legends and myths (www.kstrom.net/isk/stories/
myths.html).
Chapter 5

Using the visual arts to expand

personal creativity
Roberta Nadeau

Because of the quiet contemplative, personal approach needed to produce in

the visual arts, there are large expansive areas of inner exploration that go
hand in hand. These inner experiences are of particular value to those who
are using the arts with persons with a disability. Most other art forms require
another person to have a full encounter with what that particular art form
can give. In the visual arts we can provide tools, knowledge of materials and
experience with drawing and painting, which can allow individuals to take with
them, wherever they go, the potential for further work. We have the wonderful
opportunity to enrich their lives and creative potential.
Even in a crowd, the visual arts encourage a capacity to work in solitude.
The artist’s eye is always seeing, sensing and feeling the atmosphere around at
that moment. If the inner peace for such exploration is not present in the
person or persons we are working with in our initial contacts, we can at least
see such peace of mind as part of our goal in introducing visual arts sessions.
In this hectic, fast-paced world, all people can gain from knowing greater
inner peace. Such peace comes from self-knowledge and an appreciation of
each person’s unique, individual, creative mark which may in turn provide
opportunities for increasing self-confidence and self-esteem.
The wonderful beauty of the arts, in all forms, is that human emotion is
involved in a raw and uncensored manner. Feelings flowing are essential for
artistic experience. The professional artist and the inexperienced participant
have in common the fact of being at their best as creators of visual imagery
by their capacity to tap the unconscious and, as a result, to present in line,
color and form a mark that is individually their own, unable to be produced
by any other individual in exactly the same way, ever.
All artists will testify to the fact that in producing one drawing or painting
ideas are therein born for another ten or more works. The finished product
may at times be a great success or a great failure. It does not matter. What
does matter is the continuation of discovery. This process is what we have to
share with the people with whom we work. As Fred Gettings has said: ‘Art is
of value for the way it improves the mind and sensibilities more than for its
end products.’1 Because of this exciting process and all-inclusive seeing and
44 Using the creative arts in therapy and healthcare

feeling, which are essential, it becomes easier to understand the enormous

value of encouraging experience in the visual arts for those persons with a
disability. Through teaching individuals to see what is around them, to express
their feelings and constantly affirm the fact that they, and only they, can make
those particular marks on paper or canvas, you increase opportunities for
those people to know more about themselves and their unique rights for
respect and self-love.
The uses of line, form and color are emotional encounters. There is even
greater emotion involved once color is introduced. It is important to know
and to feel sure about the fact that art deals with human emotion, as quite
often the act of putting line or color on paper can produce cathartic emotional
responses for the individual producing the work. Their excitement, tears and
frustrations are to be dealt with sensitively – not in any way dismissed. For
they are an integral part of the art process, and the arts play a vital role
allowing for increased quality of life experience for those with whom we are
working.

Preface to practical activities

I believe in the arts. My intense personal conviction regarding the healthiness
of the arts experience for all people relates to their essential nature, to provide
for every person irrespective of their age or ability an avenue of personal
expression. The visual arts have a hand-in-hand friendship with craft or, as
I prefer to call it, the applied arts. The trap is that too many people adminis-
trating, giving economic support for arts programming, have in mind some-
thing very different. For so very many ‘arts programs’ kits are seen as the root
of creative action and the final products can be sold as commodities in gift
shops. These kits, green ware, paint-by-number sets, etc. do not allow an
individual to express his or her feelings, to expand his or her capacity as a
human being to feel, see or respond. Wherever possible, such kits should be
avoided as they tend to lead to the stereotypical reproduction of emotion.
Our aim is to allow participants every opportunity to discover how wonder-
fully unique and special is the fact that they have known life and can share
their feelings with us. To that aim, all our work should be directed.

Art materials
The art materials of concern to me in this writing are those that allow for
two-dimensional expression: graphite, charcoal, conte, ink, pastels, paint,
paper, pens, brushes, canvas and board. For a person who already has a
limitation in physical or mental skills, it is essential not to create more bar-
riers by improper selection of materials. The materials should be of the best
amateur artist’s quality available to you. Papers, canvas or boards must be of
good size and quality. How destructive to say that you care to share the visual
 Using visual arts to expand personal creativity 45

arts experience with a person with a disability and then to see only frustration
because of easily torn paper, limp or lifeless colors, or ‘self-destruct’ creations,
which are a pain to produce and a sorrow to the individual as their work is
deposited in a waste can.

Pencils (graphite)
Art pencils range from very hard leads to soft and very soft leads. For the
purposes we are talking of here, purchase and use only HB, 2B, 4B or 6B
pencils. Art pencils can be purchased from the HB end of the range to 10B;
however, too soft a lead will defeat your purposes as the work created too
easily smears. The importance of the soft leads is that it takes less physical
pressure to produce a mark and even the most inhibited person will not find it
difficult to deal with having once begun. We all are guilty of concluding that
we cannot do something and of being terrified to try. A simple well-chosen
pencil and a large piece of drawing paper can provide hours of exploration
and accomplishment.

Charcoal
Like graphite pencils, charcoal comes in varying weights or degrees of hard
to soft. Again, buy large sticks, which are easy to grasp, soft and, as a result,
quick to make distinctive marks and absolutely excellent for the intense black
areas that can be created. Charcoal does get messy and for some people that
alone can be a healthy and constructive experience because ‘institutional’
preference is for ‘clean at all times’. For a person to be told, ‘You have done
nothing wrong, all will wash off when we are finished’ is to be allowed to feel
good, and is an affirmation of your belief in the individual’s right to experi-
ence the joys at all levels of the tactile beauty and pleasure which the creating
of visual art allows.
Charcoal can also add new dimensions when an art gum eraser is employed
to lift areas of black away. The ‘positive space’ imagery or design can be created
through the efforts of working into a large black space. Positive space is the
actual design area. Negative space is the artistic term used for the space
around the initial or essential design. For some people this can be particularly
gratifying, for they are creating an element of magic. I try to employ as much
fantasy and magic-related conversation as is fitting to inspire and excite
exploration.

Conte
Conte is a stick resembling a unique blending of oil pastel and charcoal.
It is available in a variety of soft to hard selections and in raw sienna and
burnt umber (beautiful earth tones), black and white. Here, as before, buy the
46 Using the creative arts in therapy and healthcare

softer, easier to use materials. The beauty of conte is the feel of silk in your
fingers and the tremendous variation of marks, designs, lines and forms that
can be made. The sticks, as with charcoal, have great versatility. A stick
worked on its side gives wide sweeping flows of color. The conte is easily
smoothed or varied in intensity with the fingers or a tissue rubbing the paper.
Persons with limited muscle control can achieve delightful results because of
the fluid capacities of the medium itself, and you will be happy to know that
there is not as much washing up needed as happens with charcoal.

Pastels
These come in the form of chalk pastels or oil pastels. I use both in my work
and recommend that both be a part of your art supplies. Poor quality in choice
will lead to two unfortunate problems: (a) the colors will be pale and bland;
(b) there will be great difficulty for some people to experience the goals you
wish to achieve, in that the pigment simply will not move easily over the
paper. One of the great beauties of pastel is that you are working with pure
pigment, which has been rolled with a limited amount of oil to create a
medium of pure color. There are many varieties of good pastels for student or
amateur work. Before buying, however, make certain that the colors are
bright and the pigment is easily transferred to whatever surface would be
worked upon. Even the most frightened or restrained individual can be
moved to do preliminary explorations, purely by the excitement of the bril-
liant colors. The chalk pastels are soft and chalk-like in their feel in your
hand. The oil pastels are more similar to crayon in feel, and yet are pastels,
with all their wonderful qualities of color intensity and capacity to be
manipulated or mixed using fingers or tissues.

Paint
Painting is a joyous experience that, as you will read later, must be introduced
at the correct time to people to avoid frustrations and thus limitations to the
gains that can come from the process. Again, your purchases must be made
with concern for intensity of true color and the manufacturer’s quality of
pigment transfer. I choose to buy tube watercolors, as so often the cake
watercolors are difficult for many of those with whom I work to be able to
know the fun of flowing color as it explodes before them.
I repeat: in working with people who already have imposed physical, men-
tal or emotional difficulties, it is essential that we as facilitators for the arts do
not put more barriers in their way by poor choices of materials. I never work
with oil paints with groups. If a certain person wants to paint in oils, that
becomes an individual decision between myself and the person involved. The
turpentine needed as medium for moving the pigment in oil paints is very
poisonous, and if an individual has allergic reactions to the turpentine, you
 Using visual arts to expand personal creativity 47

have great problems on your hands. Acrylic paints are water based, and water
is used as the painting medium to vary thickness of paint and to clean
brushes or hands. For many people interested in moving to thicker paints,
I advise the purchase of acrylics.
Watercolors, particularly from the tube, are most adaptable. You can teach a
person or group how to obtain gradations in washes or to paint in wild, bright
colors. To produce a gradient of washes, you take a brush fully loaded with
pigment. Strokes are made on the paper, and then, adding only water to the
brush, a progressively lighter wash can be obtained. This provides, in work
with persons with a developmental disability or persons with dementia,
opportunities to spark imagination with suggestions of a certain element of
magic, which has become theirs with the use of the paints, the brush and water.

Brushes
As mentioned before, buy good quality brushes. If cared for well, they will
provide years of service to the artist’s hand. I am not suggesting the purchase
of sable brushes, but I hope to make it clear that a cheap ‘bargain’ will soon
leave parts of the brush on a person’s work. Efforts to remove a bristle can
lead the way to the famous ‘self-destruction’ activity, which frustrates and can
be heartbreaking. Also, brushes must be large – at least size ten or larger –
with adequate handles. There are some brushes produced by art supply com-
panies that have a plain, unpainted and unvarnished handle. If you are able to
buy a variety of these brushes, you will see how their less slippery finish is a
true blessing for certain individuals. The brush is an extension of the hand or
foot of the person painting, and should be introduced as a tool. I will speak
later of the importance of this understanding. As a tool, the brush can add
variety to the experience with paint. It can provide unlimited variety in stroke,
and in dabbing, pulling and swirling of color. If you are unfamiliar with all a
brush can do in your hands, I advise many lovely hours of exploration and
fun before you introduce paintbrushes to a person with a disability. As with
any element of knowledge or experience, we can only teach what we know.

Inks
These come in many colors and can be applied with pen or brush. The uses of
inks as a medium of expression should be judged according to the people you
are working with and their particular interests, capabilities and desires to
express themselves in various media. Inks, rather like oil paints, take closer
supervision or, at times, a one-to-one working relationship. Inks can produce
great delight when used in mixed media works, and again, for certain indi-
viduals, much excitement when waterproof inks are used and then watercolor
or pastel is painted ‘magically’ over the original line. For individuals with
limited imagination, you as the facilitator may at times need to suggest media
48 Using the creative arts in therapy and healthcare

and approaches that can unlock some of the imagination that is simply lying
dormant, since no one before has given it much of a chance. This is true for
everyone, not simply those with a disability. The opportunities provided to
people all through life to explore their creative potential are so very limited
that they seem proof enough to me that we are tapping a powerful source.

General beginnings

Medium
Introduce one art medium at a time and allow for full exploration and under-
standing of all the things one can do with a pencil, charcoal, pastel, etc.

Paper size
Encourage an end to timidity by only providing large pieces of paper – paper
at least 18 by 24 in (45 by 60 cm). Even the person with extreme limitations in
movement will be able to feel the desire to extend their reach. In my experi-
ence (as facilitator of such extension of motor skills) I have quite often seen
attempts to reach the top and sides of the paper that have surprised the care
professionals in charge of the particular individuals on a daily basis. Such
extension was seen as unlikely if not impossible.
Some people can be assisted if you keep Velcro as part of your supplies, to
wrap around the hand of someone who has little muscle extension to assist in
holding a drawing medium or a paintbrush. Also, putting mixed watercolors
or tempera paint in empty liquid soap bottles (any plastic bottle that can
easily be squeezed) may enable those with little fine motor control to enjoy all
the glorious feelings of the painting experience.

Remain aware
Remain continually observant of persons in need of help or encouragement,
but please constantly remind yourself that the beauty of the visual arts is the
essential nature of quiet inner discovery. Constant interruptions or comment
can break the inner peace of another person. We have been given a birthright
to produce. We have not been given the right to disturb another’s creative
space. In my experience I have found that, presented with a quiet, mutually
respectful atmosphere, the individual or group with whom you are working
will wish to create an atmosphere respectful of all in the room. For some
people, just to feel such mutual regard for their own thoughts, work and
capacity to think can be as beneficial to them as the entire creative process or
their finished products.
 Using visual arts to expand personal creativity 49

Music
Classical music, well chosen and played softly, can be a tremendous aid in
producing an atmosphere conducive to creative activity. Here, however, I warn:
know the music you choose and why it will work. If you are unsure or
uncomfortable with the music, you can do harm rather than good. Bach’s
music for classical guitar and lute have been standbys for me, in that they
produce steady, quiet, soothing conditions of great musical beauty.

Storage and transport

Provide a means of storage or transport to protect the creations of the people
with whom you are working. Very few individuals have financial opportun-
ities to buy proper portfolios. However, these can be made by you and the
persons in the group by saving all cardboard, sheets from packing cases,
backs from drawing pads, etc. These simple materials and a little masking
tape and time provide the person creating with a means of safe transport, and
in some cases the only storage they personally can know, as this packaging
protects their work while it is stored under their beds or in a closet in one
particular type of institution or another.
If you have an arts or crafts room to work in, it is essential to provide
storage for works finished or in progress. Some ‘special populations’ require
that you find a way to lock up their work safely. Destruction or misuse of
their completed works by another person, no matter how innocent or acci-
dental the initial cause of such damage, may mean months of effort to
re-establish the same quality of freedom in their artistic expression.

Plentiful supplies
Have plenty of supplies and a large amount of paper. There is at times
nothing so inhibiting to artistic creativity than to see limited supplies and
thus, for example, to fear using the last remnant of a stick of red pastel.
Having adequate supplies available has also, in my experience, produced a
mutual regard and patience within a group. They know that even if they must
wait a few minutes for the use of a certain material, it will not be gone.

Erasers
Erasers should be viewed as tools and not as means of instant correction. Far
more exciting results can be obtained by looking at other options of correc-
tion, such as darkening negative space or creating variations in shape and
form that may not have been thought of if there were not a desire to change
a form.
50 Using the creative arts in therapy and healthcare

Volunteer help
There is a great need for volunteer help if you are working with a group larger
than three or four in number. Also I have had occasions where sisters,
mothers, fathers, etc. have come along to a session to observe, as they also
provide transport. After numerous occasions on which comments were made
such as ‘No, that isn’t the way a tree looks’, or ‘No one has hair that color’
I decided that all volunteers or visitors would be given paper and encouraged
to work. Suddenly, they too were having the same explorations and discover-
ies; soon negative and sometimes destructive comments stopped. Do remem-
ber that your volunteers are there to help you. Give them clear directions
and encourage them to learn by doing what the artistic process involves.
Otherwise they are more of a hindrance than a help.

Written records
Keep written records for yourself of your interactions with the various people
with whom you work. These records are essential to your personal effective-
ness as a leader and to your preparation in creating the proper time-and-
space elements for each individual. The goal of one aiding others through the
visual arts is to see positive change in self-esteem and self-expression, and an
increase in motor skills and the quality of physical and emotional health of
the persons with whom we work.

Patience
Be patient, very patient, if you have an individual who sits back only watching
for a number of sessions. There have often been so many terrifying experi-
ences piled one upon another to cause true and justified alarm when intro-
duced to a new situation. Having created an atmosphere respectful of creative
work, we then must learn to accept the flow of individual personalities. The
rewards for such patience are great. An elected mute surprised all when she
began to speak to me during an art session. She had sat watching for four
sessions before participating. A severely handicapped young man made the
first efforts ever to do things by himself and was so convinced that he had
found his special way of successful expression that he asked if I could arrange
a proper exhibition for his works. His family took him on holidays and he
took all his completed creations in the makeshift portfolio I provided to show
everyone. He had sat watching for five weeks before becoming involved.
These are but two examples of the success that comes with patience and
understanding. As certain people sit around the room watching, for sometimes
even three to five sessions, when they, of their own will, approach you there is
a rush of excitement and creative expression. For as they have watched, they
have come to terms with the situation and have answered for themselves all
 Using visual arts to expand personal creativity 51

the ever so important questions regarding how far to trust you as a person.
Once the gift of trust has been exchanged, there is no end to the opportunities
for creative self-expression.

Name recognition
The recognition of a person’s name and the time spent in helping others to
know names can be very important. All that some individuals may have that
they can truly call their own is their name. By recognizing the importance of
their name, you recognize the value you place on their existence. Start each
group art session with introductions. These exchanges of names can vary as
the weeks of sessions move on. For example, members can give their name
and then state their favorite color or name of their favorite medium or image to
draw or paint, etc.

Art history
As many people in the populations we work with have been isolated from
society, the sharing and showing of art history books can be time well spent.
There is a whole other world within the realm of the visual reproductions of
other artists. Too many people are exposed to nothing other than calendar
art, television and a few, poorly done, entertainment-geared publications.
Select the best and share the names of artists and the time in history in which
they lived. Talk about what kind of painting you are looking at or what the
sculpture was carved from, etc. One or two pieces of work to share each
session can be an amazing catalyst. If you are still working in pencil, charcoal
and conte, show black and white drawings. Once working in color, move into
sharing reproductions of paintings.
I had one young woman in a group of people with developmental dis-
abilities ask me very honestly one session, ‘Roberta, could you help me make
a Mona Lisa?’ I responded with the gentle remark that it would help us both
if one of us were a Leonardo da Vinci. That exchange led to many small
discussions: never present too much to absorb at any time about Leonardo da
Vinci. The purity of her keen interest was a true joy. Many an art history
professor should be as lucky as I have been with students so enthusiastic and
thirsty for knowledge.

Respect
It is essential, in helping others create art, that you have respect for the
independent and unique mark they, and only they, can make. Even in a
clinical setting, it is essential not to intrude, ask unneeded questions or inter-
rupt unethically the process of which we are privileged to be a part. If a
person wishes to tell you about their work, you have received a double gift.
52 Using the creative arts in therapy and healthcare

You were initiator of the process and are included in the individual’s enthusi-
asm and emotions about what they are producing or have produced.
One such exchange I shall cherish always. There was a severely multi-
handicapped young man of 24 years who was in a group art session. He
always arrived ready and eager to start. At this time the Falklands war was in
full turmoil and he seemed to produce nothing but images of what he felt was
going on. These images began to flow once we had worked together for a
couple of months and he had all the media, except the paints, to choose from.
One painting in pastel had a dark stormy sea, a dark troubled land, and a
number of buildings. One of those buildings was a brilliant mix of pink,
orange and yellow. The structure absolutely glowed from the paper. He asked,
‘Do you know why that building is there?’ I had no idea. ‘That building
is where the peace talks are going on.’ This exchange opened a door for us to
discuss all his many weeks of battleships, tanks, etc. He had hoped that by
drawing all these images he could get the war to stop. His words were, ‘War is
such a horrible waste of life.’ Interference in his process of emotional release
regarding the war, which was getting so much press and television coverage,
would have been unethical. Possibly such interruption might even have
stopped his process of slowly creating adequate visual armies displayed on
sheet after sheet of paper until he was ready to create the peace talks within
his gloriously colored building. Then there was, in the news media, only
discussion of future peace talks. This young man was ahead of the politicians
and more capable of producing honest images than some professional artists
I know about.

Encouragement of honest expression

Lastly, an important element regarding the value of the creative process upon
which I could easily write an entire chapter: do encourage honest expression.
Even if a person has ugly, angry feelings, which are finding their way to the
work, you are succeeding, for these expressions are real. Work towards integ-
rity and quality in the work of all people, and encourage truth of experience
and sight. There is great damage done through allowing overly sentimental
and stereotypical art to be produced by any individual. The value of involv-
ing anyone, particularly those defined within ‘special populations’, is lost
if you passively allow the ‘pretty’ images. Because of lack of or limited
exposure – and then at times only to the ‘kit’ art experiences, some people can
easily arrive in your session knowing no other imagery than the sickly sweet-
ness of stereotyped art forms. By encouraging the reawakening of inner self
and presenting activities that remove one immediately from such production,
you can begin to encourage expressions of truth and personal satisfaction.
 Using visual arts to expand personal creativity 53

Practical activities
My focus in this section will be on the use of the visual arts with a variety
of people, with suggested activities which readers can adapt to their own
particular theoretical frameworks or job descriptions. Personally, my profes-
sional approach is to offer actual experience within the visual arts and to
know that the individuals involved will need to be attended to differently and
responded to differently, and that the use of the arts in their lives must be
individually defined.

Initial experience
People are often concerned and reluctant to participate fully when presented
with a new experience. We must judge carefully what we introduce to an
individual as a first visual arts experience. There are very few people who have
not known, experienced, the use of the pencil. Even people I have known
lacking arms have used a pencil from very early in their lives. A good graphite
pencil, as I have described, should be used on large sheets of paper. Have
everyone begin with drawing circles all over the paper and, depending upon
their individual abilities, encourage them to try to make the circles as similar
in size as possible. The same should be done with ovals, lines and scribbles,
the effort being to make the person comfortable with producing a line
another person is seeing, and to break down all barriers to the famous saying
‘I cannot do art’.
These elemental forms are basic to most motor efforts used in writing. The
fact is that such simple efforts can bring true feelings of accomplishment and
are worth every minute spent. Every experience from there forward will
reduce further and further an individual’s inner fear. My own years of work
with others has shown that there are people who will repeat, over and over
again, the same imagery because they received such true pleasure from the
first encounter. The circles or ovals will recur in works in pastel and paint
enhanced or matured through other experiences, yet a reminder of how
important the first good feelings were.

Pencil
Pencil circles, rectangles and scribbling all over the page. Tell the group: ‘You
can do nothing wrong. Art gives you freedom to express yourself as you
wish.’ If I see a person being particularly withdrawn and afraid to begin, I ask
them to hold the pencil or other drawing or painting medium. Then I slowly
begin to move that person’s hand (or foot). There will come a point where
you can feel the person begin to take over the action. At that point I slowly
release guidance and simply let my hand go for a ride. It will be obvious when
you can lift your hand away and not have to give such assistance. For an
54 Using the creative arts in therapy and healthcare

individual with a limited range of muscle movement or motor control, this

can be most important in assisting their efforts.

Charcoal and conte

After a session or two with a pencil, I then introduce charcoal, a messy
breaking-free experience which renders on paper intense blacks and assorted
variations thereof. Charcoal should be demonstrated as used in a direct draw-
ing form; then with the stick on its side with the wonderful swirling effects
that can be produced; smudging of the charcoal once laid upon paper; eras-
ing – ‘lifting’ of charcoal with an art gum or charcoal eraser; encouraging
people to feel the exciting fun of rubbing the charcoal on their fingers and
then using their fingers as tools to create design elements. Hours of much
pleasure to all can be spent. Simply make certain you have taken soap and
towels.
Conte, although a different medium, can be used in much the same man-
ner. The stick on its side can produce wonderful areas of variation. Into that
area of pigment a person can again utilize the art gum eraser, or a tissue,
to produce a variety of special effects. Actually, conte is more easily manipu-
lated than charcoal.

Pastels
The chalk pastel is my personal choice as the medium through which I intro-
duce people to color. I have very specific reasons for this. When we as artists
are working with a person with a disability, there is great advantage in keep-
ing, for as long as necessary, the pigment in contact with the fingers or toes.
Not only are we, as people, more aware of the feeling of the medium against
our skin, but we are also closer to the transfer of color to paper, canvas or
board. The intimacy of this process can be cathartic for some people experi-
encing the arts for the first time.
Colors can be layered, mixed, smudged or wiped away, leaving hints of
pigment. All varieties of creative activity with color teach fundamental
understanding about color and about mixing. The rich pigment of the chalk
pastel allows for easy demonstrations and explorations of the primary colors:
red, yellow and blue, and the secondary colors: violet, green and orange,
which are derived from the mixing of the primary ones.
Each person responds differently on an emotional level to color. The emo-
tions and feelings evoked by certain colors are good to discuss. Small dra-
matic activities can be introduced where a person shows how a color makes
them feel – by the use of facial expression or body movement.
 Using visual arts to expand personal creativity 55

Oil pastels
Oil pastels are easily over-layered, smudged, rubbed, etc. However, their par-
ticular qualities create unique results and experiences. For the individual
clearly desiring to rub a drawing medium clear through the paper this can be
of great benefit, in that layer upon layer of color can be added and the
product will only become richer – that is, as long as you have provided paper
outside the ‘self-destruct range’.
For a group of people working together over a number of sessions and
who have been introduced to oil pastel, I have a ‘trust game’. This activity is
to present to the group a large and sturdy piece of paper. The paper is
passed from one to another as they individually work on their own creations.
Each person should be given an adequate amount of time with the paper so
as to make the contribution they wish. Their name should be signed on the
bottom, with your help if necessary. Once everyone has added to the image
of color and form, the paper should be clipped to a drawing board. Then,
gathering everyone around you, put turpentine on a rag and begin to rub
the work. Turpentine acts upon oil pastel as upon oil paints; it is the
medium for moving the pigment. Under a turpentine rag and with a little
directed guidance on your part, a fascinating and beautiful group project
can result. This is particularly pleasing to those persons with severe limita-
tions to their muscle movements. Even the energy expended in one small
corner of the paper by a person with a severe disability has added equally to
the overall beauty of the finished product. Such group projects I try to hang
where they can serve as a reminder of group cohesion and of the elements
of ‘magic’ that we, as leaders, can put to our service. This activity usually
leads to people wishing to experiment on their own drawings. I agree, as
long as they will allow me to move the rag with their direction. ‘Poison’ is a
word even the most severely limited individual understands. It is simple.
You care enough for them to help them, but not to see anyone be ill or
injured.
Oil pastel can also serve as a ‘resist’ for other media and greatly increases
the opportunities for some people to experience the joys of the unexpected in
the visual arts. When the person, or group, is ready to move on to experiences
with paints, I first add oil pastels in mixed media work. I will speak more
about this shortly. Once the individuals you are working with have experi-
enced both chalk and oil pastels, it is advantageous to present both for
exploration. As each medium responds differently to smudging, rubbing and
intermixing, the results of beauty and fun can be delightful. Also you will
soon be able to see how quickly certain people choose certain ways of work-
ing that provide them with the most successful route to the goal they desire to
reach, even if it appears to be not far removed from play to the observer.
Picasso once said: ‘To draw you must close your eyes and sing.’ Working with
certain persons within the range of our interests gives us increased insight
56 Using the creative arts in therapy and healthcare

into how much truth is in Picasso’s understanding of the uniquely tactile,

sensual and direct process of drawing.
Many works in pastel are known to us, through art history books, as paint-
ings. Such a definition is largely the result of the paint-like quality of many
pastel works. It is also related to the fact that pastels are such pure pigment.
As I have said before, allowing the relationship between mind and hand to be
as close as possible to the drawing or painting medium has many advantages
for all who have a desire to experience color. The emotions are more easily
tapped because the paint-like flow of pigment on paper is so immediate.

Painting
I have already pointed out my particular desire for the use of tube water-
colors. Egg cartons (of the plastic variety) or small cake tins can allow hours
of unending enjoyment and exploration. Always begin by giving each person
only the primary colors. By this time there has been an introduction to color
mixing during our time spent with pastels. However, a new experience results
the moment you put a brush into the hand or toes of someone you are
working with. The paintbrush is a tool and it must be remembered that it can,
for some, be a new barrier to creative activity. The brush allows new sensa-
tions but reduces the sensations of tactile immediacy with the medium.
Assistance and patient, steady, guarded care must be taken, depending on the
needs of the individuals with whom you are working.
I begin painting experiences by putting a bit of yellow, red and blue into
spaced areas of the egg carton. We look at what happens when yellow is mixed
with a bit of blue. The element of magic, or capacity to feel a power of control
over a painting medium, can be, for some, the first experience with feelings of
accomplishment and self-destination ever known. As I write I smile with
delightful memories of the expressions on the faces of some people with whom
I have worked and their incredible pride: ‘I made purple! Look, it is purple.’
I help them see how the brush, loaded with pigment, gives a very intense
color, and how adding water alone to the brush will produce lighter and
lighter washes. A bright red can become the faintest pink hue so simply, so
pleasantly. One spring as the lilacs were in bloom and a group with which
I had been working had begun explorations in paints, the demonstration of
washes led a young woman with a developmental disability to produce the
loveliest, softly whispered interpretation of spring blooms I think I have ever
seen. She was not a master artist, with all the knowledge and understanding
of the medium she was working with, yet the emotion that flowed on to the
paper made some of my professional colleagues’ work look quite weak by
comparison. She expressed the wonder of light, color, fresh new smells of the
earth and the blossoms on the trees in a way I would be proud to approach in
my own work.
There are many ways to use a brush: as a wash – the brush on its side,
 Using visual arts to expand personal creativity 57

utilizing the point to draw clear distinct lines, or by using the tip of the brush
dotted straight down on the paper to produce spots, leaves, parts of a flower,
a person’s curly hair, etc. The brush, as a result, begins to offer extensions to
creative process.
Slowly I add more colors from the tube watercolors to the palette of the
people I am working with. Patience is truly a virtue in working in the visual
arts, for if your excitement for a person to know more media or colors
exceeds good judgment, you can end up with frustrated and sometimes
frightened people – some who never return to the visual arts experience.
Also, depending upon the individual or the group, you may have to limit
experiences with color totally to pastel or colored pencils. This may be neces-
sary, as I have found, when the group you are working with is very large and
your support staff is small or non-existent. Painting in such situations could
lead to utter frustration for all, especially as there is a probability of water
jars being knocked over or paints being confused. Spilt water is spilt water,
granted, yet such spills can destroy the work of many and are not worth the
risk. The objective of the arts facilitator/leader is to provide creative experi-
ences in self-exploration and it is of the greatest importance that we under-
stand that we must consciously be aware of preventing situations which, by
their nature, produce feelings of guilt or failure. If a person is angry with
himself or herself or his or her own work, and purposely destroys what he or
she has produced, we must accept that as their right. Group annihilation of
all work within range of the running water of an overturned jar is avoidable.
In working with people with emotional disabilities, we may often see out-
ward destruction of the work produced. The anger is directed at their product
and releases or responds to the emotions expressed in the process of creating
the work. Conversation, one to one, about the work and your response can
often provide insights important to the success of further creative activity
with that particular person. Your own analysis of such behavior depends
entirely upon your training and your ‘contract’.

Mixed media
After all media have been introduced and dealt with individually, then and
only then do I introduce mixed media investigations. After this point all arts
media will be presented for a person’s choice. The desire to experiment and to
have fun is basic to human nature. There need be little direction given, simply
your constant availability if there are problems, and your capacity to help and
to encourage excitement in the people around you to try something new.

Collage
Collage work can be very rewarding for certain people, depending upon the
restrictions they personally bring to an arts session. I save magazine photos
58 Using the creative arts in therapy and healthcare

for their beautiful array of colors and other assorted papers for their textures.
Tear them up before presenting them if you are aware that people will only
see the imagery and not the colors. Give a sturdy piece of paper or illustration
board as a back surface and, with rubber cement from the jars, allow for
imagery creation from torn shapes and areas of color. To individuals with
cerebral palsy, or those paralyzed in other ways with limited use of their
arms, this can be a most beneficial experience.
The frustration of struggling to have color stay where one wants can be
overcome with the assistance of yourself or a volunteer to wipe on the rubber
cement for the people you are working with. Then as many variations of form
or imagery as they desire can be explored. The fumes from rubber cement can
be a problem for some people. Thus here, as in all cases, do know well the
group or individual with whom you are working.
Rubber cement is pleasant to use for, once dry, the clear extra glue can
simply be rubbed from the surface of the work. Some of the white nontoxic
classroom glues can be used as well. However, they have one severe problem:
many cause great wrinkling and here again a beautiful work becomes a sad
completed work as it turns into a relief map. I imagine we have all tried the
ubiquitous flour and water and we know of the discouraging crinkling and
wrinkling of which I speak.

Working with music

Some people are truly frightened to begin making marks on a piece of paper.
They are afraid of judgment, of ridicule and exposure. I find that the intro-
duction of music to the atmosphere of the session is most helpful. If you are
going to use music, please know what music you are choosing and exactly
what you expect to be the positive results of such a choice – as some music
can be an unforgivable interruption to the creative process. Certain classical
music, folk music and guitar can provide an avenue of personal transform-
ation from a state of fear to one of actually flowing with the elements of the
music itself. One young woman with a developmental disability I worked with
asked, as a piece of Allan Stivell’s Celtic harp music finished, who it was and
how the name was spelt. I wrote the name on the blackboard for all to see,
and she actually signed her particular finished pastel work ‘Allan Stivell’.

Partner ‘trust’ exercise

If you have persons who are finding it difficult to get along, who possibly live
in the same group home, work in the same sheltered workshop, or are in the
same permanent care unit, then possibly via an arts experience exchange
some of their feelings towards one another can be dissipated. In addition, it
can help those concerned to understand better, or even to appreciate more
their own capacity for patience. I must, however, add a warning: please know
 Using visual arts to expand personal creativity 59

your group well and the two particular persons whom you involve in the
activity, and expect no miracles. If you are unsure, change your own ‘mind
frame’ to make sure you see this activity as a game and nothing more – a game
to be experienced for the fun and artistic exploration.
We all feel rather possessive about our own work. It is natural and healthy.
In fact, it is what I have spent the last number of pages writing about. If you
have any questions about the following activity, work through it with a fellow
artist or interested party before using it with a specialized group.
The specific activity consists of pairs of people who will work together.
One piece of paper is given, and conte, pencils, chalk and oil pastels are
provided. The instructions are as follows. First, you, Billy, will begin. John is
asked to watch and feel what might be the thoughts, color desires and mood
(these descriptive terms must be adjusted according to the group with which
you are working). John watches silently and observantly. Then, at your discre-
tion, you ask Billy to give the paper to John and for Billy to observe in the
same concerned way. The paper goes back and forth several times, John and
Billy making their own reinterpretation of their response to the imagery
already on paper. The finished product should be hung in the arts session
space or the exercise repeated at another time so that the participants can each
have an agreed product as a possession.
I ask the reader to remember that some distances between individuals are
there for reasons. At times unknown to us, cruelties have occurred that are
too inhuman for us to deal with in creative arts sessions. We must be percep-
tive and never ask more of an individual than he or she can give at the
particular moment. Also, we must understand and show compassion towards
those in our sessions who have been hurt so deeply as to be unable to respond
to another individual at all. Sometimes we only know who these people are
from behavioral signals, for which we must constantly have our antennae out.
We are not to be judges, only to recognize that, even among ‘normal’ people,
cruelties may be imposed by a person which make respect for that individual
impossible, in fact unethical. If we can understand this fact of life, why, then,
do so many arts specialists, social workers and psychologists feel that such
problems do not affect those people who are described by some as handi-
capped, retarded, deaf, blind, and so on? Human emotion is our common
denominator. If one cannot hold total respect for individuals who do not
want to work with those who have hurt them, then we had better go into
another field where we are not dealing with the arts and with human beings
and their emotional ‘backpacks’, which have collected survival equipment we
shall never have the privilege to know.

Group ‘trust’ exercise

In this activity, I always use music and involve the entire group. The activity
begins with each person being given a large piece of paper. Then they choose
60 Using the creative arts in therapy and healthcare

the media they want to work with. Once everyone is set and ready to produce,
I explain the rules of the game:

1 Names are put on the back of the paper and the paper is turned over. The
drawing will now be placed on the surface facing you.
2 Then each person is to work along with the music I put on the tape
recorder until the music stops. Once the music is stopped, then each
person passes the paper on which they are working to the person on their
right. Each person again begins when the music starts. Music is stopped
and the papers are passed again.

This continues until all the pieces of work have moved in a full circle. Simply,
choose one member of the group and watch carefully for when their paper
returns to them. At this point all members will again have their original work.
It is important to select lively music. ‘Stage show’ music seems to work the
best in creating an atmosphere of gaiety and fun. There will be some indi-
viduals who always watch their drawing as it moves around. I have even had
people who are less than friendly say to another, ‘Don’t ruin my picture.’
Even though there may be a few interpersonal problems, you should keep
your eyes on the exercise as it is so very valuable as a shared activity, as an
exercise in sharing. The success of the game will depend on your ability to
allow people to know the great pleasure in all participants sharing and in
being able to take home or back to their room a piece of work that has been
produced by everyone in the arts session. I have done this many times with a
wide variety of people with a disability and have seen nothing but pleasure
and goodwill increase among members of the group.

Music and drawing game

In this game people are again placed in pairs. Each has his or her own piece of
paper upon which they are working. If the person sitting facing another
decides to add a form, color or design to the other’s work, they simply reach
across and work on the other drawing. Again, lively, spirited music should be
used, which creates a feeling of fun. There are very few times in which any
negative behavior has been exhibited. If you handle the game’s explanation
well, it will be understood to be a game and as an experience most beneficial
for all. However, some people need to be individually encouraged to touch
the other’s paper. We learn as human beings through such exchanges that new
ideas often follow as a result of the inspiration given by another person’s
interpretation. Also, the opposite paper is always upside down to yours and
the perspective is automatically changed as a result. The goal is to encourage
trust and understanding through the exercise, which is structured in such a
way as to encourage patience with another person reaching over and putting
 Using visual arts to expand personal creativity 61

their mark upon your work. This effort to reach can be a physical extension
activity as well.
One only has to be involved for a few minutes in any work to have a
personal identification that says ‘this is my drawing’. To relax with another
person’s intrusion upon our space has implications that go far beyond the art
session itself. Goals such as these are a large part of the beauty of the arts as
human exchange. We learn much about ourselves and other people, and the
knowledge that we gain is essential for producing good art as well as for
healthy relationships.

Creating pictorial images through suggested fantasy

For some individuals, if not a large majority of all people, there has been
limited use of the imagination. We need, as arts facilitators, to have tricks up
our sleeves to unlock creative thinking, or to remove blocks so long in place
that it becomes a major part of our professional intention with certain
persons.
One way I have found successful as well as most pleasurable for everyone is
to select a fairy tale or other story that is rich in visual imagery. Then, giving
everyone paper and a selection of media, I begin reading the story with
interest and excitement. As they listen to my reading they are to produce a
work that expresses the way they pictured the story or the way they felt.
Images, colors and emotions, all are interpreted through each person’s own
perceptions. A well-chosen story can unlock many of the blocks to creative
thinking. The elderly person quite often finds great imagery provoked by
stories that are historical-traditional in their nature. The great richness that
can be shared from having lived through so much of human history can be
a beginning for awakening the creative spirit of a folk artist.
If the people with whom you are working have had little exposure to some
of the great beauty of imagery provoking stories, you should not panic as
they sit engrossed in the story and unable to work. The images will flow later,
with such an obvious receptiveness for storytelling that you will have an
indication of the likelihood of success, should the exercise be repeated.

Summary
In this chapter it has been my desire to provide an introduction to art
materials and their use. I have included only a few of the many games and
exploratory exchanges that can be employed. I purposely left out any of the
psychologically oriented games or personal activities. My decision is related
to my firm belief in the visual arts experience as a first-quality emotional
experience for all people. I also have a concern for the specific intent of
many such activities and the necessary psychological training that should
accompany such work.
62 Using the creative arts in therapy and healthcare

Also, I have not spent much time in dealing with the art-related activities
that are known so well by everyone, for example, the gluing of macaroni in all
shapes and forms to create designs, or of cracked eggshells on a surface to be
painted. I know the reader can think of many more. Simply look in any
elementary teacher’s art directives and you have loads of such ideas. I am
concerned with allowing emotional release and personal growth through the
visual arts.
Your job is to provide good supplies, enthusiasm and creative inspiration.
You will be needed as a keen and conscientious observer. Most difficulties can
be overcome with a little help from you.
If you are fortunate enough to be working with a group of people in a
situation where an exhibition of their works can be organized, that each
selected as their own choice to represent them, you have the opportunity for a
grand ending to what can be anything from weeks to months and sometimes
years of working together. Such exhibitions should have a good accessible
space and an ‘opening’ where others are invited and refreshments are served.
This is a wonderful way to show people your appreciation for their efforts and
to encourage further work and self-development through the visual arts
experience. When such opportunities are not available, because of the condi-
tions of the working situation, I have found that a finale can be accomplished
through enjoying refreshments together. I give a present of pastels, paper,
paints, or whatever would mean the most and be most needed. Then the
highly emotional experience of having created art together does not end on a
low note with simple goodbyes exchanged. You have been able to continue the
inspiration.
I close with a reminder. We are working with other human beings through
an emotional and highly expressive medium. We must always remain
extremely humble in our interactions with others during working sessions.
Openness to new experience is what we are encouraging and we too must
remain open. So very much of what I have learned has been in response to
what I have been taught by those whom I teach.
It is often thought that art is a form of recreation, indulged in by those who
shun hardship. True artists are never at rest. Like Rodin, they labor at their
work with passionate devotion, from early morning until dark. Indeed, after
daylight fades, the dreaming muse begins to torment the mind until it can
plunge again into manual expression.
The principles on which art is built are fundamentally the same as those of
life itself. Sincerity of soul, accuracy of the outward and inward eye, con-
stancy and patience are indispensable to any real accomplishment, be it art or
merely living – perhaps the greatest art of all.2
 Using visual arts to expand personal creativity 63

Acknowledgements
For wisdom gained from working with other people I am forever grateful to
Dr Dolores Armstrong and Dr Walter Hirsch. I thank them and all who, by
their example, have given me such wonderful insights into the human spirit.
I thank Robert Whyte, Donna and John Harling, Sara Widness and Robert
McInnis for always believing in me and my work and all the artists, writers
and poets of all time, for their unending inspiration.
Lastly I thank my children, Joe, Pat, Anthony and Noelle, for enriching my
life and understanding of human existence, for always keeping my viewpoints
fresh and clear and for returning to me so much love.

Notes
1 F. Gettings, You Are an Artist: A Practical Approach to Art, New York: Hamlyn,
1966.
2 M. Hoffman, Yesterday is Tomorrow, New York: Crown, 1965.

Further reading
Abraham, R. (2005) When Words Have Lost their Meaning: Alzheimer’s Patients
Communicate Through Art, Westport, CT: Praeger.
Arnheim, R. (1969) Visual Thinking, Berkeley and Los Angeles: University of
California Press.
Atack, S. (1980) Art Activities for the Handicapped, London: Souvenir Press.
Edwards, B. (1979) Drawing on the Right Side of the Brain, Los Angeles: J. P. Tarcher.
Feder, E. and Feder, B. (1981) The Expressive Arts Therapies, Englewood Cliffs, NJ:
Prentice-Hall.
Gettings, F. (1966) You Are an Artist: A Practical Approach to Art, New York:
Hamlyn.
Kramer, E. (1971) Art as Therapy with Children, New York: Schocken.
Liebmann, M. (1986) Art Therapy for Groups, Cambridge, MA: Brookline.
—— (ed.) (1990) Art Therapy in Practice, London: Jessica Kingsley Publishers.
Ludins-Katz, F. and Katz, E. (1989) Arts and Disabilities: Establishing the Creative Art
Centre for People with Disabilities, Cambridge, MA: Brookline.
Malchiodi, C. (2003) Handbook of Art Therapy, New York: Guilford Press.
May, R. (1979) The Courage to Create, London: Bantam.
Pavey, D. (1979) Art-Based Games, London: Methuen.
Simon, R.M. (2005) Self-Healing through Visual and Verbal Art Therapy, London:
Jessica Kingsley Publishers.
Ulman, E. and Dachfinger, P. (1975) Art Therapy in Theory and Practice, New York:
Schocken.
Chapter 6

Dance
Developing self-image and
self-expression through movement
Bernie Warren and Richard Coaten

All living organisms, at least once in their lives, exhibit behaviors that could
be called dancing. Human beings are no exception. We are constantly pursu-
ing movements that have repetition and rhythm and can be subdivided, by an
outside observer, into movement themes or phrases. Many modern chor-
eographers often build on these natural movement sequences to create dances
that audiences pay money to watch.
The movements we make as human beings are so intricately linked with
dance that learned authorities spend hours debating when an action, or series
of actions, ceases to be movement and starts to enter the realm of dance.
Academic discussions concerning the physiology, mechanics and aesthetics
of movement are mainly irrelevant to the individual wishing to employ dance/
movement in special education, rehabilitation or health care. It is important,
however, to realize that dance/movement serves many very important func-
tions for all human beings. While it is unlikely that most of us will ever
perform for others in hopes of reward, money or applause, nevertheless our
everyday movement sequences not only have special meaning for us but also
reaffirm our being.
For all of us the body is an instrument of expression and in childhood it is
through the movement of our bodies that we start to build a picture of our
world. As we develop we explore our capabilities and start to learn what our
bodies can do. This exploration and movement of our body parts leads to a
growing awareness of our body’s structure and to the growth of body image.
Not only is this early corporeal exploration important to the developing self-
concept of young children, but also throughout life this testing and usage of
our bodies would appear to be linked to cognitive, physical and psychosocial
development, particularly in the areas of health and well-being.
More important still is the link between dance/movement and emotion.
The movements we initiate, the body shapes we form and the responses we
present to external stimuli usually reflect our inner emotional state. The way
we move, the way we stand, our gestures, all express (sometimes more accur-
ately than the words we speak) what we feel at any given moment. In essence
they express the subtext below our verbal communications. The belief in
 Dance 65

subtextual communication through movement has created the concept of

dance as a mirror of the soul. This in turn has led to many referring to dance
as the mother of all tongues because movement cuts across all language
barriers and speaks to individuals at a primal, emotional level. For some
people, particularly those born into highly technological and industrialized
societies, which increasingly shun the expression of emotions, this can be
very threatening. As a result emotional energy, instead of being naturally
expressed, becomes pent up and is often dissipated through destructive or
antisocial behavior.
At its simplest level, a dance is a statement of emotion expressed through
movement. To control the statement, to make it more specific, to produce color
and texture within the emotional statement, so that an observer responds,
empathizes or understands, requires a great deal of training, technique and
emotional integrity. This is the arduous route undertaken by the professional
dancer. However, as already mentioned, at any one time we all have at least
one dance within us. Often people with a disability have a great need to allow
their dance to see the light of day, for both physiological and emotional
reasons. Yet all too often it is these individuals who are denied the chance to
explore this emotional release through dance and movement.
For people with a disability, the dance experience can be particularly valu-
able. For the person with a cerebral palsy, dance/movement can offer an oppor-
tunity to gain control over muscle spasms creatively. For the person who is
withdrawn, the process of making a dance may allow them the opportunity
to make a creative statement about themselves. For those of us making use of
dance/movement in special education, rehabilitation or healthcare it is impor-
tant to be aware of the positive benefits of dance/movement for gross and
fine motor control, neurological functioning, circulatory stimulation, psycho-
social development and so on. However, it is equally important to remember
that the movements which form part of an individual’s unique dance are
an emotional response. It is this emotion that lifts the sequence of actions
beyond the purely mechanical level of physical exercise, such as can be gained
through racquetball or swimming. Dance allows an individual the chance to
make a personal creative statement about their feelings through the move-
ments they carry out. This will often have other benefits in more physiological
areas, particularly for those people who have a physical disability.
The implicit benefits that can be gained through dance/movement sessions
are not easily achieved. For these benefits to be gained by individuals, it is
important to engender a sense of fun and personal achievement throughout
the sessions. If a sense of enjoyment and personal satisfaction is lost, it is
likely that the physiological and neurological benefits that can ultimately
occur as a result of dance/movement sessions will also be lost: as interest,
motivation and self-satisfaction will give way to boredom, repetition and
alienation from being just another trained dog jumping through the same old
hoops.
66 Using the creative arts in therapy and healthcare

Practical activities
What follows is a selection of exercises, games and ideas that we have
employed in our work with special client groups. The activities do not have
some mystical power that can transform the neophyte into a dance/movement
specialist. However, the material is enjoyable, easy to use and normally ‘suc-
cessful’, even in the hands of individuals with little formal training in dance
or movement. While some of the material is universal, and is also used by
drama and music specialists in their work, the roots of all the activities are in
movement.
The examples presented cover four of the basic goals a dance/movement
specialist may be seeking to achieve with a particular client or group, namely:
gaining greater control of isolated body parts; improving body image; achiev-
ing controlled emotional release; and becoming more socially adept. In many
cases these goals are interlinked; with greater control of individual body parts
in turn comes a better appreciation of the body schema and therefore, an
improved body image. This knowledge, and control of the body and its
extremities, in turn facilitates the channeling and releasing of emotion through
movement expression.
All the activities outlined require little in the way of practical equipment.
For most, a selection of percussion instruments, and/or some way of playing
‘canned’ music (a CD player, MP3 player or tape recorder) are all that is
required. In choosing music we suggest that you select music that you like and
that you know creates in you the response you wish to stimulate for indi-
viduals in your group. To this end we also suggest that you bring to each
session a variety of musical styles and tempos that can encourage a wide
range of movement possibilities. Certain activities may require specialized
equipment and in these instances mention is made of this in the text.
As always, plan for the needs of your group. In this regard movement
observation and analysis1 (such as the rudimentary example, based on Laban
Movement Analysis provided in the Appendix to this chapter) are invaluable
tools for the dance/movement specialist. They give you the ability to learn
very quickly how confident individuals are at relating to each other, to the
material presented and to their own bodies, etc. Through careful movement
observation, it is possible to gain an insight into the abilities and attitudes of
participants in a relatively short space of time with little need to resort to
clinical files or other sources of information.
As a final basic practical hint, we suggest that participants attending
dance/movement sessions should wear loose comfortable clothing, wherever
and whenever possible. However, for some people, particularly in the first
few sessions, wearing ‘special’ clothes can be very threatening and often
counterproductive. Nevertheless, so that participants can achieve the greatest
range of personal movement, it is important to work towards this simple
goal.
 Dance 67

The dance/movement activities are presented here under four subheadings:

warm-up, body awareness, group awareness and dances. It should be noted
that this way of categorizing activities is purely a matter of convenience, as
many of the activities could just as easily have been put under at least two of
the other headings.

Warm-up
There are many ways to warm up a group. As with all other performing arts,
a warm-up period is an essential part of each session. The warm-up is par-
ticularly important for people who rarely use their bodies, and well chosen
warm-up activities will greatly reduce the chances of physical injury.
Ideally, the warm-up should meet the needs both of the group and of the
activities that comprise the session. If the activities to follow are to be physic-
ally demanding, then a thorough body warm-up is necessary to avoid sprains,
strains or muscle tears. If the activities are to be more contemplative, empha-
sizing sensitivity rather than activity, then a suitable warm-up is necessary.2
The warm-up also provides a time for the group to become accustomed to
your style and this helps with building trust, a sense of adventure and a
shared energy. At a physical level, warm-ups also help to improve circulation
and neuromuscular stimulation.
If at all possible, warm-up activities should provide you with an insight
into the capabilities of the individuals in your group. This information may
prove useful during the rest of the session. Activities such as those presented
here enable you to elicit information about the basic capabilities of the group
early on. For example, does everyone in the group know where their knees
are? Can everyone isolate a single movement such as moving their thumb?
Can they carry out more than one task at any one time? Does everyone
understand ‘control’ words such as stop, wait, listen, etc.? Do they laugh at
your jokes? If an individual fails to carry out a command, there may be a
number of reasons. For example, he or she may not understand the request.
He or she may not associate the word ‘thumb’ with the relevant body part, or
may be bored with the activity or deliberately disobeying – the possibilities
are almost limitless. As always try to listen with all antennas up.
Themes, ideas and movement motifs begun during the warm-up can read-
ily be developed later on, helped by your own creative alertness which helps
provide the means to create dances from a different place of knowing; one
that neither imposes an external technique which entails learning move-
ment and dance by imitation, nor is tied to current social and cultural ideas.
Instead through observation and being in tune with both yourself and the
group we create our own questions, images and material for exploration
through dance.
Here are three simple warm-up activities. Unless otherwise stated, all
activities are described from the point of view of the group leader.
68 Using the creative arts in therapy and healthcare

Rob’s little finger game

This is an excellent preparation for tag games or a physically demanding
session, although the title itself is perhaps a little misleading. You can use this
activity not only as a physical warm-up but also as a means of getting people
to smile through the use of a dose of ‘humor of the unexpected’.
Tell the group they are about to participate in a very strenuous activity and
ask if they think they are ready to do this. Then ask the group to stretch out
their right hands. After a brief pause to allow people to wonder what will
happen next, tell them to wiggle their thumbs. Always ask the group to be
careful, not to strain themselves. After a short wiggle tell the group to drop
their right arms. As soon as they have their right arms by their sides, ask them
to stretch out their left hand and wiggle that thumb. Inform them of the
importance of working both sides to balance out the body energy – ‘You
might look lopsided if you only exercise one thumb.’ Slowly increase, without
stopping, the parts of the body that are being moved, adding to the thumb:
fingers, wrist, elbow, shoulder on one side, and then the other thumb, fingers,
wrist, elbow, shoulder on the other side, finally adding the head, neck and
hips until people are moving all their body parts at the same time and hop-
ping from one leg to the other around the room singing the national anthem.
The effect is a chaotic mass of arms, legs, fingers and hips, counterpointing a
rather august and nationalistic tune and almost invariably creates a light and
humorous atmosphere.
This game is a good work-out for all the body. It can also become quite
physically demanding. Most importantly, it can be a very valuable diagnostic
tool.

I Am Me – a name game
This game can be played in two stages. In the first stage, the group stands
in a large circle. In turns, each member of the group jumps in the air and
as they land they say their name, for example, ‘Bernie’. The pace of this
can slowly build until as soon as one person has landed the next person
starts to jump, creating a ‘jumping jack wall of sound’. This leads on to
the next stage, where the group moves as individuals around the room
observing the following ritual. The ritual consists of a linked pattern of
movements and words, for example, to make a personal statement about
themselves:

Movement Stomp Stomp Jump

I AM SUSAN
Statements I FEEL HAPPY
I WANT ICE CREAM
 Dance 69

This sequence is repeated until you feel the group has had enough. The first
part of the triad is always ‘I am’, but the second and third parts can be
varied: for example, I NEED, I HATE, I LOVE, I FEAR or whatever are the
needs of your particular group. In each case the statements are linked to
the movement:

Movement Stomp Stomp Jump

I AM JOHN
Statements I LOVE SLEEPING
I HATE WORK

In each case the statements are always individual personal statements.

This game can be particularly valuable in enabling people to express their
emotions strongly without becoming ‘spotlighted’ or having the group focus
on their problems, because their statements will be part of the group’s ‘wall
of sound’.
Should you wish to bring the statements ‘into the open’, to be shared with
the group, you can get the group back into a large circle and then ask each
member of the group to cross the circle in the prescribed ritualized manner.
As leader you can choose which emotions you wish each person to describe
or this can be left up to members of the group. This can lead to group
discussion or simply increase your store of information concerning the group.

Follow My Dance I
This is an adaptation of Follow My Leader using music and is a very enjoy-
able activity to follow on from an unstructured or loosely shaped beginning.
Bring the group into a circle either sitting or standing so that each person
has a good view of everyone else in the group. It may be helpful to play a
name game immediately before starting Follow My Dance I just to jog a few
memories. In the dance there is a ‘dance leader’ who responds to the music
playing. The rest of the group then tries to copy your actions.
This leadership role is then rotated among all the members of the group.
The role is passed on by making eye contact with someone in the group (for
example, Sheila) and saying, ‘Let’s all follow Sheila.’ Another way is to pass a
scarf round the circle. Here, you walk round the inside of the circle holding
out the scarf for the new leader to take. This encourages choice on the part of
the participants. The whole group then watches and simultaneously tries to
copy Sheila’s actions.
In certain cases it is helpful to take control and suggest it is time to pass
on the leadership role, or that an individual should continue for a little
longer. This is an extremely valuable and enjoyable dance and can be used as
a diagnostic tool.
70 Using the creative arts in therapy and healthcare

An extremely important part of this dance is that it enables each member

of the group to be ‘spotlighted’. For a time, everyone is the centre of attention
and has power over the group. There is the safety mechanism that, should this
be too threatening, as soon as the person starts to feel uncomfortable they can
pass the leadership on to someone else. Also, when someone has been the
leader for an excessively long time, it is possible to ask him or her to pass
on to someone else in the group. The time an individual wishes to lead the
group is as important as the actions they do. This amount of time very often
changes in response to a group meeting regularly over a long period.
It is important that you model the activity to get the group going. Remem-
ber that you must work slowly and in small stages. It is perhaps rash to
overgeneralize, but simple linear staccato movements, such as stretching right
hand and arm out to full extension in slow small stages, tend to be easier for
most groups to follow than large elliptical or circular movements, at least in
the early stages of the process. Groups can find sideways rhythmic patterns
particularly difficult early on. This is perhaps a result of the mirror effect; that
is, instead of copying actions we tend, in the initial stages when facing a
person, to mirror them.
It is also particularly important to be aware of individual efforts, particu-
larly when working with people with physical disabilities. For one person,
simply moving an arm may be a great achievement, and negative pressure to
‘copy’ the exact action may be very detrimental. In contrast, for others the
inability to copy may simply be laziness or lack of commitment. Coaxing may
be helpful at such times and very often a slight movement made by the
participant can be echoed or exaggerated slightly, drawing attention to the
quality of movement or gesture. It is helpful not to intervene too early on,
which can sometimes inhibit the participant by focusing on their ‘inability’ in
contrast to their ‘ability’.
The insights gained in this way can then help in the process of deciding
who needs help and in what way: coaxing, pressure, stretching, etc. It is then
possible to choose music suitable for Follow My Dance II or for the next
session. In addition when leading it is possible to make the leader’s dance
include actions that stretch individual group members in a way that expands
their movement vocabulary. Try to use music with a happy bounce during
your first sessions of Follow My Dance I. Then try to choose music that
meets the specific age and ability of the group. World music often makes a
good choice. However, music can include works by a whole range of artists
and styles, e.g. Van Morrison, Buena Vista Social Club, Salif Keita, Oyub
Ogada, Peter Gabriel, Paul Simon, Bluegrass and klezmer, classical (piano,
harp or flute), the Beatles, Sugar Hill Club Classics (hip-hop) and Chango
Spasiuk (chamamé) – the list is endless.
 Dance 71

Further examples of warm-up activities

• Find different ways to greet each other.
• Sign your name in the air; dance it as a pathway on the floor; run with it;
stretch it; do it backwards.
• Walk on the out-breath, pause on the in-breath, change direction, repeat.
• Run full tilt making sure you avoid one another.
• Follow someone, allow yourself to be followed.
• Follow without being followed yourself.
• Dance with different parts of the body in contact with someone else,
hands, wrists, elbows, backs.
• Draw how you feel, dance the pathways, dance someone else’s pathways.
• Become fascinated by your own movements.
• Dance focusing on changing direction, levels, pathways and planes.
• Pass objects and props to one another and play with them.
• Let your head take the body on a journey.
• Repeat an action until something else happens.3

Body awareness
Almost all movement requires at least a limited awareness of how the body
works. To a certain degree, each movement exercise helps develop an aware-
ness of how the body moves. The activities presented here not only emphasize
body movement but also help focus on body image. In addition, many of these
activities allow individuals to experience the link between body image, body
movement and emotional response. These practical activities represent the
soma/psyche linkage that dancers know all too well and reinforce references
to dance as ‘emotion in motion’.
So that individuals may become aware of their full body potential, I feel it
is important to help them feel comfortable with their surroundings, and gain
greater awareness of the articulation of their body joints to enable them to
start linking their kinesthetic actions to their internal emotions.

Electric Puppet
There are various ways of introducing this game, depending on the age and
ability of the group; perhaps the most common is the idea of the electric
puppet.

• Split the group into pairs and then introduce the idea of the puppet. Tell
them that we will be working with a puppet that responds to a small
electrical charge.
• Ask one member of each pair to be the lifeless puppet and the other to be
the puppeteer.
72 Using the creative arts in therapy and healthcare

• Introduce the concept of the ‘electric baton’. A garden cane with a circum-
ference of slightly less than the size of a dime or an English penny works
well, although at first it may be worth using larger sticks, particularly
with groups who have poor muscle control or kinesthetic awareness.
• Let the group know that the baton generates a small electric charge which
is powerful enough to move individual parts of the inert puppet’s body.
• Demonstrate how this works: e.g. when the baton touches the puppet’s
right arm lightly, it moves quickly away from the baton and returns
slowly to its original position.
• Ask the puppets to stand as still as possible with their arms relaxed by
their sides. The puppeteers then go to work to see how efficiently their
puppet responds to the baton’s charge.
• Always ask the puppets to close their eyes and concentrate on exactly
where the electric charge touches their body, and then to move that part
of the body quickly away from the charge, then smoothly and with the
minimum of effort, as there is no more electricity left to power the
muscles and thus the body part must work under ‘gravity’, back to its
original position.
• After a while allow the pairs to change roles.

Despite its dramatic framework, in essence this is an exercise in body control.

It can be an extremely difficult exercise for some people, as it requires a great
deal of body awareness and control. Often the puppeteer starts with whole
arms or legs, and moves to more specific areas, for example, little finger, big
toe, and more difficult directions. It soon becomes obvious to all involved that
certain movements are impossible. Also, slowly the puppet learns to move
away from the stimulus – often at the beginning people move towards it. This
can be reduced by asking the puppeteer to leave the electric baton where it is
until the puppet moves away from it.
This game can cause problems. As a leader it is important to be aware of
people who like to ‘poke’ or tend to work at head level. With children, par-
ticularly those with emotional problems, it may be wise, at least at first, to
limit the use of the baton to the torso, legs and arms and to use an index
finger as the baton. If the puppet is relaxed and focusing on the sensations of
the body, it is not unusual both to sense the charge before feeling it and to
achieve a meditative state.

Magic aura
It is always helpful to try to find dramatic or imaginative frameworks to use
with physical activities. This often helps to suspend disbelief by stimulating
the imagination so that the whole body can be totally involved. This is not a
plea for individuals to be consciously thinking during kinesthetic activities as
all too often this leads to cognitive blocking of feeling sensation. However, in
 Dance 73

order for the mind to be engaged, switched on if you like, individuals must
want to be involved. Often a suitable dramatic framework helps to do this.
This game is no exception.
Split the group into pairs. Explain that on the word ‘Zing’ (or other suit-
able word, abracadabra, shazam, etc.) a magic spell will take hold of the
group. The effect of the spell is that one member will become a frozen ‘statue’
but the other person will have the power to free their partner. However, the
power will only work if the ‘healer’ works slowly and goes as close as they can
to their partner’s body without touching, so they can feel the statue’s body
energy. If the ‘healer’ touches the frozen ‘statue’ they have to start again.
When the magic word is said the ‘statue’ assumes a standing star shape.
This allows for a large area to be ‘healed’. Ask the statues to close their eyes
and both members of each pair to try to sense the body energy – to feel the
aura. Once freed, the pairs reverse roles. Once both have explored the sensa-
tions and have been both ‘statue’ and ‘healer’, ask them both to keep their
eyes closed during the healing process. It is often during this part of the
exercise that the healer can ‘see’ their partner’s aura,4 even though their eyes
are closed. If the pairs have a good rapport, the process can be repeated using
more difficult and convoluted frozen shapes.
Again, this exercise can be particularly soothing. It requires a slow and
sensitive approach by the healer and a relaxed but fixed posture of the statue.
Children at first tend to want to rush through this game. Along with the
obvious benefits to be gained in terms of body schema, muscle control, etc.,
this is a valuable sensitivity exercise, with the selection of suitable pairs often
being crucial to the quality of experience that individuals receive.

Ninja
The Ninja were a breed of warrior-assassins reputed to be able to perform such
superhuman feats as walking through walls, becoming invisible and breathing
under water. All these feats were generated as a result of their extremely
disciplined training, which emphasized mind-body co-ordination and con-
trol. This exercise is adapted from Ninja training exercises, and variants of
the exercises are found in many martial arts systems.
Everyone is spread around the room with space to themselves. Inform them
that the floor is made of rice paper and that great care must be taken if the
rice paper is to remain intact. Then introduce the following stages one at a
time, allowing the group to progress to the next stage only after mastering the
basics of the previous one.

1 Point of absolute balance

• Stand ankles shoulder-width apart so an imaginary line can be drawn
from the centre of the heel to the centre of the armpit.
74 Using the creative arts in therapy and healthcare

• Turn feet out 45 degrees, knees slightly bent, hips rotated to straighten
spine.
• Keep back straight – imagine a straight line drawn from the centre of the
earth through the body up to the sun.
• Breathe in through nose and out through mouth.
• Weight can now be transferred easily in any direction without losing
balance.

2 Forward walk
• Transfer weight slowly totally on to left leg, so that ball of right foot is
last to leave floor.
• Place right foot back on floor so that weight is transferred from heel
to ball to toe until the whole of the right foot is on the floor. The
weight is then transferred totally on to the right foot as the left is
removed.

This process slowly gains fluidity until the walker moves forward without
consciously having to think about the movement. If ‘stop’ or ‘freeze’ is called
during any of these moving exercises, individuals should be on balance and
able to return to ‘absolute’ balance with a minimum of effort. Throughout
the exercise, emphasize fluid and light movements – no jerky or heavy moves
or else the rice paper will be torn.

3 Backward walk
This is the opposite of the forward walk. Transfer weight to the left leg – the
ball of the right foot is still the last to leave the floor but weight is transferred
back to the right leg from toe to ball to heel.

4 Sideways walk
This should be done as if you were walking with your back to a wall casting a
four-inch shadow. Mastery of the sideways walk, done in the shadow of a
wall, was one of the techniques that created the Ninja’s famed invisibility. To
move to the left:

• Begin in point of absolute balance.

• Transfer your weight to right leg.
• Lift left foot from floor, lifting foot from heel to ball to toe.
• Move your left foot sideways behind right leg (a crossing motion) and
place back on floor toe to ball to heel.
• Keep your hips ‘square’ with the wall.
• Transfer weight on to left leg.
 Dance 75

• Simultaneously, lift right foot from floor heel to ball to toe.

• Move your right foot sideways in front of left leg and place back on floor
toe to ball to heel.
• Repeat motion.

Fluidity is achieved by simultaneously shifting weight from stationary leg as

foot of moving leg starts to ‘grip’ the floor.

5 Half-turn jump
• On the in-breath jump up and turn 180 degrees.
• Breathe out on the return to the floor.

A very small jump is all that is needed to create the turn. Often energy is
wasted trying to jump high or through not linking movement to the breath.
Once the basic movements of each component of this exercise have been
mastered, then participants can be asked to keep their eyes closed and to sense
where other people are in the room. Also, it is important to get participants to
try to synchronize their breathing with their movements. This reduces the
amount of energy expended in achieving fluidity of movement, leads to par-
ticipants being more relaxed and creates a more meditative inner awareness
of the body’s movement. Many students, particularly those who have experi-
ence of Eastern religions and/or meditation techniques, describe this exercise
as ‘a moving meditation’.
Besides the reflective aspects of the exercise, this is a great way for people to
gain control over locomotive muscles of the body. Once the group has gained
a sense of confidence controlling the jump movements, you can add the release
of explosively exhaling the word ‘kiai’ on the jump turn, as participants touch
the floor.

Group awareness

Parachute
Very little is needed in the way of equipment for dance/movement sessions.
However, a parachute (which may often be purchased at army surplus stores)
is a valuable piece of equipment to have around. The qualities of the material,
the feeling of group contact and the sensation of movement to be gained
from working with a parachute are quite unique.
There are many different parachute games, all for different purposes. This
exercise is one linked to sensation. The group stands in a circle. If there are a
number of individuals in wheelchairs, start by sitting in a circle. Everybody
holds on to the parachute with both hands, if this is possible. Try to work as a
group, raising the parachute as high as it will go and then letting it return to
76 Using the creative arts in therapy and healthcare

the floor. Work together to try to make the rise and fall of the parachute
smooth and rhythmic.
When the group has achieved this rhythmic flow, ask each person to say a
word or sentence to describe what the parachute makes them feel. Ask them
to say this when the parachute is at the top of its travel. This allows that
individual to make eye contact with other members of the group. Then ask
the group to repeat the word or sentence as the parachute returns to the floor.
Sometimes the feeling described is a simple emotion, for example, happy;
sometimes the feeling described is a sensation evoked by the movement of the
parachute, for example, light and airy. In this way not only do participants
express the sensations they feel, but they are also exposed to new vocabulary.
In addition to working on linking sensation to expression, the parachute is an
excellent tool for extending physical limits.
As an example, in one session I (BW) was working with a young woman
who had a cerebral palsy. As a manifestation of her condition she was unable
to hold up her head for more than a minute or so at a time. She became so
involved in the parachute activities that she maintained focus and control
over her neck muscles and her head remained erect throughout the activity.
Not only this, she was able to extend the reach in her arms way beyond their
normal extension. Professionals who had worked with her remarked on the
fact that they had never seen her so involved in an activity and commented
that she was doing things they thought she was not capable of.

Reed in the wind

This is often referred to as a trust exercise. However, it is an exercise in sensitiv-
ity. Unfortunately, all too often group leaders allow exercises such as these to
become an excuse to ‘scare’ participants; to see if they will trust the group to
let them drop almost to the floor. Instead, use this exercise to reaffirm the
group and to accentuate its sensitivity, care and concern for its members.
One person (the reed) stands in the middle of a tight circle formed by the
rest of the group who stand shoulder to shoulder. The reed stands eyes closed,
hands by their side and ankles close together, with feet stationary, throughout
the exercise.
The outer circle (the wind) place their hands gently on the reed. The ‘laying
on of hands’ – the point where the wind touches the reed – is very important.
Before any movement starts, and again after the reed’s movement has
stopped, there should be a time when there is a silent, non-verbal communica-
tion through the hands of the wind with the reed. The length of this com-
munication should be dictated by the needs of the group – particularly those
of the reed. At the start it is a time when the wind can reassure the reed,
through touch, that they will look after him or her during the exercise.
In this exercise it is important to remain as silent as possible and the wind
should always keep their hands in contact with the reed. Occasionally the wind
 Dance 77

may want to hum a soothing tune quietly, for example, a lullaby. It is essential
that initially the movements are extremely small and made very gently and
smoothly. The distance the reed is moved may be increased gradually and
smoothly. After the reed has reached its maximum point of travel (this need
not be much – a few inches is quite enough), it is returned slowly to the
central starting position. With each new person in the middle, it is important
always to begin slowly and not to fall into the trap of ‘starting’ from where
the last reed stopped.
This is an exercise in which the entire group is able to participate. Everyone
who wants to should be allowed to be the reed. If group members feel hesi-
tant, they should be encouraged to try being the reed but they must always
have the option to pass – without being made to feel guilty about it, either by
the group or you. In many cases the simple ‘laying on of hands’ is as valuable
as, if not more valuable than, the gentle swaying motion.
This exercise, carried out with a sensitive group, can practically illustrate
the power of faith healers who are reputed to be able to ‘cure’ simply by
placing their hands on people. The sense of well-being and caring generated
by a supportive and sensitive group is very powerful.

Change
This is adapted from a Marian Chace exercise and can be seen as a further
adaptation of Follow My Dance I. The game is based on group cohesion and
following a leader as exactly as the group’s capabilities allow. (Obviously,
when working with a group whose individual physical disabilities are diverse,
allowances must be made to acknowledge that certain movements may be
impossible for particular individuals.)
The group stands, or sits, in a circle. Tell the group that you will do a
repetitious action(s) that the group has to copy exactly. When everyone is
synchronized, call ‘change’. At this point the person on your left will be the
new leader. Each time the new leader must try to subtly change the action(s)
and then repeat it (them) until the group is following exactly, and then call
‘change’. In this way you pass around the circle.
It is helpful to start this game without music. When the group has grasped
the idea, then add music. The music that can be used is extremely varied;
almost any music will do. Again this game allows individuals to be spot-
lighted and works towards emphasizing group identity. The group dances
created in this way are often every bit as fascinating as some of the tightest
show choreography – and nowhere near as expensive.

Dancing
An individual’s response to an internal and/or external stimulus is extremely
personal. Often there is little structure that can be imposed, for there are no
78 Using the creative arts in therapy and healthcare

easily stated rules as there are with the dance/movement games. Many dance/
movement specialists use or teach technique to their groups. For the well-
trained ex-professional dancer, allowing the group to learn these techniques is
certainly a legitimate option for you. However, people without this training
should be extremely wary of attempting to teach ‘technique’. All too often in
unskilled hands it is synonymous with rote learning and as such bypasses the
emotions.
All that is needed to create an urge to dance is some form of internal or
external stimulus and so it is very important to have a wide range of stimuli
available. For example, music, photographs and painting can all be used to
create a mood or to generate a response. The choice of a particular painting
for the specific needs of the group is important. Having shown the group a
painting, you can allow them to create a dance from the emotions engendered
by the image. This may require choice of suitable music or may be better
suited by silence.

Dance In/Dance Out

This is a useful activity for groups with whom you will be working for long
periods of time. It allows you a chance to see what the general mood of the
group is before and/or after each session. Simply play a selection of music
before the session proper begins and after it is finished. Allow the group to
respond to the music in any way the music takes them. Asking them what sort
of music they would like to hear at that time can be beneficial. It is very
important to have a wide variety of music with you. However, after a few
meetings the group will have a good idea of the range of music you carry. In
later sessions ask the group to bring their own music selections with them to
the dance/movement sessions.
Observation of this free-form movement activity can be used to supple-
ment other information you have about group members. Your job is often
detective work, trying to piece together a three-dimensional jigsaw full of
emotion, where many of the pieces are lost or unknown. Any activity that
allows you to step back and just observe provides a potential store of infor-
mation in a much shorter time than most of the more directive activities.
However, as a cautionary note, it is very important to beware the ‘this obvi-
ously shows . . .’ trap. Although certain behaviors may indicate a particular
emotion or state of mind, a single observation is not sufficient to enable
anyone to make a definite statement concerning one individual’s capabilities.
Humans are extremely complicated beings, not easily willing to oblige linear
cause-and-effect hypotheses!
 Dance 79

Feather dances
For a long time I (BW) was stumped. I kept being asked to do workshops
with youngsters with severe and multiple disabilities and I felt much of my
material to be unsuitable. Then my assistant, Jane Newhouse, introduced me
to peacock and ostrich feathers. From that day on I have been using these
feathers not just with children with severe disabilities (where they often form
the bridge to my other material) but with all groups.
For this activity I usually use one of three pieces of music: Allan Stivell’s
‘Renaissance of the Celtic Harp’, Howard Davison’s ‘Music from the Thunder
Tree’, or Deuter’s ‘Wind and Mountain’. Ask the group to lie, or sit, comfort-
ably with a peacock feather in their hand. In the case of children with severe
and multiple disabilities I work one to one with an ‘able-bodied’ person cradl-
ing and supporting them. Those unfamiliar with either the technique or the
importance of cradling should read Veronica Sherborne (1990).
When the music starts ask the group to follow the eye of the peacock
feather as it moves to the music. The feather often appears to have a life of its
own and will take the person holding it dancing. Please note that some chil-
dren and adults can be extremely disturbed by this. If so, use an ostrich
feather.
With groups of children with severe disabilities, ask their supporter to
work through stages. First, the feather is moved so that the eye catches the
child’s attention. This necessitates making very small and fluid movements.
Once the child’s attention has been caught, place the feather in the child’s
hand and manipulate the hand so that the feather moves. As the child
becomes more aware that it is his body moving the feather, the manipulator
slowly releases the grip on the hand until the feather is moving totally under
the child’s control. The children may drop the feather – if so, simply put it
back in their hands.
Lastly, add a second feather, so that there is one in each hand. These three
stages may be traversed quickly or may take an extremely long time and much
patience on the parts of the supporters and you.
The combination of peacock and ostrich feathers allows an extension of
movement; a small movement with the peacock feather creates a huge and
fascinating effect for a severely restricted child; the ostrich feather, while less
of an ‘attention getter’, has a textural quality that fascinates many. The group
can be placed so they work in pairs or, in the case of more able groups, they
can freely interact.
One word of warning: always be on the lookout for children who try to eat
the feathers. It not only damages the feathers but can also severely injure the
child. Finally, be aware of the other materials that can extend small move-
ments of physically restricted individuals. Experimenting with different types
of cloth, string, ribbons, etc. can often find the materials best suited to your
group’s needs.
80 Using the creative arts in therapy and healthcare

Follow My Dance II
This is a variation on Follow My Dance I. It illustrates a way of taking a
name game into a group dance and then into a partner or small group dance.
It also helps participants to experience the difference between movement as
exercise and movement as dance: a felt act of communication – an emotional
response.
The group makes a circle. This time individuals are asked to close their eyes
and have a sense of how they feel in their bodies. What follows is a sequence
of instructions to be given by you to the group that are aimed at enabling
participants to switch off the ‘little voice’ in their heads, which continually
gives instructions about what to do and how to think, etc. The purpose is to
allow participants to listen to messages from the body instead:

• Allow yourself to stand.

• Listen to your breath (without changing it).
• Become aware of any aches and pains.
• Allow your body to balance around a central axis.
• Feel the support of the earth.
• Imagine a cushion of air between each vertebra, how does that make you
want to move?
• Your back is wide, allow it to support you.
• Imagine an electrical field of energy around your body. How wide is it?
• Say your name quietly to yourself and create a way of moving that is
unique to yourself.

There are many ways of framing these questions. Explore them and find ones
which work for you and for the group. Now find a shape or gesture that
expresses how you feel right now or allow the shape to find you. This idea of
allowing ‘the shape to find you’ suggests a non-directive way of working. As
in ‘waiting without expecting’, this idea implies an allowing or waiting for a
new movement idea to arise – one that is not consciously thought out or
directed.
Each individual is then asked to share their shape with the rest of the group
by saying their name and making the shape. The saying of the name can vary
from coming at the beginning to coming at the end. After each shape and
name the rest of the group echo that person’s name and shape, finding a
matching tone of voice and quality of movement.
At the end of this task, to help develop a movement memory in the group,
you can walk round touching the shoulder of each person in turn. The rest of
the group then say that person’s name and repeat the movements in turn. The
quality of movement, gesture and tone of voice will be very different for each
person and you may wish to draw attention to any that have a special quality
about them. These movements can often be developed into solo material.
 Dance 81

Follow My Dance III

Split the group into threes or fours, and ask each group to make a dance by
putting together the movements explored in Follow My Dance II in any way
that feels interesting or comfortable to the group.
Each group is then asked to show their piece to the others. Another idea is
to ask the audience if the dance conveys any images, thoughts or feelings for
them. This can be done at the end or, better still, after each dance if there is
the time.
The group may wish to incorporate this new material into developing their
dance and this is the point at which the session can really develop. You may
then suggest a series of ideas; or more appropriately perhaps, encourage each
group to find their own way of developing what they have created. Some ideas
may include:

• One group providing a sound experience for a dance group using their
bodies and voices to make a sound accompaniment.
• Musical instruments could be used. Merge the dance with another group.
• Draw the dance on paper. Dance the drawing.
• Discover an emotional quality or expressiveness to the dance; dance its
opposite.
• Find a moment of stillness in the dance.
• Walk with the dance. Run with the dance. Take the dance on to the floor.
Play with the dance.
• The dance has an identity, give it a voice.
• Write the story of the dance and let the story inform the dance.

The ideas and possible ways to explore each dance are endless. However, your
confidence in trying out new ideas and new ways of moving is dependent on
your own and the group’s state of creative alertness. Other art forms can
be used, including poetry, music and sculpture to encourage this process of
self-expression through dance.

Dance improvisation – Essences

The aim of this dance improvisation is to create a safe and comfortable
environment so that individuals can make a dance that is self-directed. What
is more important perhaps, it is about stilling the mind and ‘climbing into the
body’. This means allowing participants to turn off the self-critical little voice
in the head by becoming fascinated with one’s own range and quality of
movement expressiveness by giving permission for individuals to dance from
a more self-directed place.
Dance improvisation requires a warm-up period before starting. It also
needs an ability to be confident with the elements of dance and movement,
82 Using the creative arts in therapy and healthcare

for example, changing directions, levels, planes, pathways and different

dynamics, etc. Some assistance can be given by you during the dance to
introduce these elements to further develop the improvisation, encouraging
the imagination as well as a rich use of movement vocabulary.
In Essences, individuals visit different places in the room, find a shape or
movement phrase at each place and then join them all together to create a
dance. The dance created is then performed with the group.
The instructions are presented as movement ideas, images, questions and
the ones given here form the essentials only. You will need to fill them out and
present them in such a way as to enable the participants to feel confident
and secure in their personal exploration. A safe environment needs to be
established to enable participants to have ‘permission’ to explore the images,
questions and movement tasks without feeling at risk. Imagery is presented
by you and worked with by the dancer to create a satisfying and enjoyable
experience.

1 Centering: lie on the floor. Become aware of the breath without changing
it. On the out-breath release your weight into the floor. On the in-breath
rest.
2 Images of: opening in the back, spreading, lengthening. Feeling the
wholeness of the back. Opening to your tiredness, releasing, allowing.
3 Questions about: stilling the mind to connect with the body:
• Find a place in the room where you feel most comfortable.
• Explore that place in a way that is most comfortable for you.
• Express that place in a shape or movement phrase.
• Move to another place in the room where you feel comfortable and
repeat the experience.
• Move to the first place again and explore the transition.
• Move to the second place. Discover its essence.
• Repeat the movement phrase. In what way has it changed?
• Move to a third place and repeat.
• Move to a fourth place and repeat.
• Now return to the first place.
• Move between places. Exploring the different qualities of movement.
• The essence of each place, each movement, each feeling.
• What images come to mind? Dance with the image.
• Create a movement phrase that is repeatable and made up of the four
shapes or movement phrases.
• With paper and soft pastels, draw the essence of the dance on paper.
• Quickly and intuitively write any words on the drawing.
• Incorporate the image into the dance. Use the words in the dance.
• Allow the dance to be witnessed or shared with a partner or the
whole group.
 Dance 83

• Share the experience in words with a partner or with the group. Or

with both.

Repeat at a different time in a different place. Enjoy the dance, creatively alert
to new possibilities for self-expression, healing and renewal.5
The sharing can take a variety of forms in pairs, threes or in a large group.
In the process of allowing this development of personal creativity, many
different ways of moving are possible. It is a dialogue between stillness and
movement, between a form that is understood and a form that is emerging or
put another way, as a colleague used to say, not to know, but through search
to find a way. There is complexity and simplicity and in the sharing of the
dance these paradoxes will no doubt emerge. Your task is to enable the indi-
viduals to dance in a way that is most expressive of themselves and then to
reflect on the result of that experience. The task of the participant is to have a
really satisfying and enjoyable experience with comfort, ease and enjoyment
the main starting points.
It is not possible in these pages to transform the movement experience into
a complete written picture that will give the same result every time. If used
with sensitivity, intelligence of feeling and in a spirit of adventure it is likely
that Essences will encourage further self-exploration through dance.
People who have worked with Essences have commented on its ability to
enable them to free up and dance from the inside/out rather than vice versa.
This means dancing from a different place of knowing and understanding, a
place that has brought insight and clarity as well as embodied experience.
After the sharing or performance, the dance is often shared with a partner
when it is possible to talk objectively and subjectively about the experience,
exploring its personal relevance and meaning, giving clarity and insight.

Postscript
Dance offers individuals a path to developing a greater sensory awareness,
while at the same time releasing restricting or non-aligned patterns as they
appear in posture, everyday movement patterns and expressive gestures.
Developing this sensory awareness enables people to begin to create their own
unique dances: ones that can help to clarify, extend and define an emerging
sense of self. This may in turn help to promote an independence of thought,
bodily functioning, concentration, focus, and more spontaneous, less routine
behavior.
The expression through dance of our unique self is a momentary fleeting
embodied thing, one that cannot be fixed or easily captured in all its complex-
ity. It can only really be sensed as a living entity and certainly not captured in
print. It is a coming together of shapes, movements, thoughts and feelings,
rhythms and sensations, all of which make up an emotional response, a
response that brings together many seemingly disparate elements, without the
84 Using the creative arts in therapy and healthcare

use of words. There is no doubt, however, that working with dance creatively,
as a way to explore space, shape, rhythm and our own bodies in movement, is
a very fulfilling, enjoyable and challenging task.
Watching for those special moments of aliveness when the individual is in
tune with themselves requires a creative alertness. Being creatively alert for
the group means being alive to dance as a felt act of communication. How-
ever, it is also necessary to have an understanding of the overall framework
within which dance/movement activity is taking place and how one’s own
dance group or session contributes to the overall picture. Also, keep in mind
that the ideas expressed in this chapter are in no way fixed rules about what
should be done. They have their history in what has gone before – movement
and dance ideas that have worked in many different settings, and ones that
have been worked with, changed and developed along the way. Always
remember that you are working with other human beings, their emotions and
their well-being, and not simply playing or performing. It is likely that during
improvisations some people may encounter emotional blocks. You need to
establish your own ways of helping people break through the blocks. Also it is
possible that some may experience and even relive negative experiences from
their past. In this case you need to establish approach(es) for immediate
comfort and support to help deal with this relived experience.
Finally, dance allows individuals to gain in self-confidence and self-
management by learning about their bodies, their minds and their place in the
world. Dance affects everybody, from the very young to frail older people.
It enlarges people’s imaginations, extends their ability to communicate,
increases their capacity for social action and fosters well-being. Individuals
can be valued for their unique contribution and thus help to increase their
own sense of self-worth. We trust that the material we have presented here,
along with the suggested films and books, will provide ideas and a framework
in which you may continue to expand and develop your work in dance/
movement.

Appendix: movement analysis

Note: This movement analysis is based on the principles of Rudolf Laban
and adapted from LUDUS Dance in Education Teachers’ Pack, The Thunder
Tree, edited by C. Thomson and B. Warren.

The body is capable of a wide range of movement, but all movement can be
broken down into five basic actions. This kind of breakdown is known as a
movement analysis. The five basic actions are:

• travel: redistribution of weight through space

• balance: stillness in equilibrium
• turn: rotation around an axis
 Dance 85

• jump: launching weight into the air

• gesture: movement without change of weight.

Further, the body is capable of three kinds of mechanical action: bending,

stretching and twisting. The quality of any movement can be described by
four movement factors:

• space high–low near–far

• weight light–strong soft–hard
• time fast–slow sudden–sustained
• flow free bound

Actions and their movement factors can be described in many ways, as shown
in Table 6.1.
As well as these elements, all movements involve one or more parts of the
body, have a direction, and are executed in relation to other people or objects.
In addition to the words that describe movement actions and qualities,
there are some basic descriptors, which may be useful in planning, running or
describing your sessions (Table 6.2).
These ways of describing movement are fundamental to movement analysis.
You can use movement analysis to help you recognize and note the movement
capabilities of your group. For example, which parts of the body, if any, can
they move in isolation? Can they travel? Can they balance? Can they travel, but
only on the floor – that is roll, crawl – or can they travel only in a wheelchair?
Qualities drawn from movement analysis, combined with your knowledge of
the individual needs and capabilities of your group, will help you to decide on
your movement aims and structure effectively the content of your sessions. In
addition it enables you to describe and record an individual’s behavior in
movement terms, and to detail the changes that occur in your sessions over time.

Table 6.1 How you move

Actions Qualities

hop rock stab gentle wide lingering

skip crawl stroke weak small dashing
step slither cut heavy tall hurrying
run twizzle pinch firm thin
bounce wiggle throw long fat
leap shake catch short flat
fall carry hold angular stiff
stand push release spiky floppy
rise pull wave bendy delicate
roll kick flutter curved floating
see-saw punch tense rounded flicking
86 Using the creative arts in therapy and healthcare

Table 6.2 Basic descriptors

Body parts Directions Relationships

What you move Where you move How or with whom

whole body up with

head down against
neck in together
shoulders out copying
arms backwards contrasting
elbows forwards in pairs
wrists in front in threes, fours . . .
hands behind in groups
fingers left following
back right leading
hips into the middle joining
bottom out to the side leaving
tummy straight passing
legs sideways taking turns
knees zig-zag containing/enclosing
ankles circle
feet spiral
toes
eyes
mouth
nose

Acknowledgements
I (RC) wish to thank the following professional colleagues for their work,
their vision and for the influence they have had on my own work in this field:
Mary Fulkerson, Wolfgang Stange, Hilda Holger, Joanna Harris, Marcia
Leventhal, Penny Greenland, Janice Parker, Gabrielle Parker, Steve Paxton,
Alison McMorland, Carola Gross, Jasmine Pasch, Gerry Hunt, Bonnie
Meekums, Klaas Overzee, Christina McDonald and Peter Brinson.
I would also like to acknowledge the ongoing support and friendship of
Miranda Tufnell who continues to inspire and influence the development of
dance and movement for health and well-being in the UK.
I (BW) wish to thank the following professional colleagues, some of
whom I am lucky enough to count as my friends, for their work and vision
and for the influence they have had on my own work in this field: Veronica
Sherborne, Keith Yon, Kedzie Penfield, Walli Meir, Steph Record, Veronica
Lewis, Jane Newhouse, Helen Payne; and particularly Lesley Hutchison
and Chris Thomson for their support during my time with LUDUS Dance
Company, and Sensei O’Tani who awakened me to the way of the circle.
However, my greatest thanks go to Dr George Mager and The 50/50 Theatre
 Dance 87

Company for showing me not only the power of the discipline and art of
dance, but also the effect this art form can have on the lives of people with
disabilities.

Notes
1 There are a number of formal and informal methods of analyzing movements. For
further information see North (1972), Bartenieff (1980) or Kestenberg (1999).
2 For example see exercises presented in Chapter 3.
3 Repetition is a key idea for allowing movement material to develop in an organic
way. The movement has some connection with what has gone before and a state of
creative alertness allows the movement potential of that moment to be developed.
4 There can be a number of explanations why the healers see their partner’s aura.
Some require a leap of faith, a belief in the existence of body energy fields. Other
more pragmatic explanations rest on the concept of feeling body heat and creating a
mind’s-eye, heat-outlined picture of their partner.
5 If the reader wants to take this work further, then the publications of Fulkerson
(1977) and Tufnell and Crickmay (1990, 2004) should prove very helpful in
suggesting imagery and ideas for finding the inner dancer.

Further reading
Bartenieff, I. (1980) Body Movement – Coping with the Environment, New York:
Gordon and Breach.
Bernstein, P.L. (1979) Eight Theoretical Approaches in Dance-Movement Therapy,
Dubuque and Toronto: Kendall/Hunt.
—— (1981) Theory and Method in Dance Movement Therapy, 3rd edn, Dubuque and
Toronto: Kendall/Hunt.
Caplow-Lindner, E. (1979) Therapeutic Dance/Movement, London: Human Sciences
Press [expressive activities for older adults].
Fulkerson, M. (1977) Language of the Axis, Dartington: Dartington College of Arts,
Theatre Papers, 1st Series no. 12.
Garnet, E. (1982) Movement is Life, Princeton: Princeton Book Co. [a holistic
approach to exercise for older adults].
Greenland, P. (1987) Dance – A Non-Verbal Approach (A Handbook for Leaders),
Leeds: Jabadao, Centre for Movement Learning and Health.
—— (ed.) (2000) What Dancers Do that other Health Workers Don’t, Leeds: Jabadao,
Centre for Movement Learning and Health.
Halprin, D. (2003) The Expressive Body in Life, Art, and Therapy: Working with
Movement, Metaphor, and Meaning, London: Jessica Kingsley Publishers.
Hanna, J.L. (1979) To Dance is Human – A Theory-of Non-Verbal Communication,
Austin, TX: University of Texas Press.
—— (2006) Dancing for Health: Conquering and Preventing Stress, Lanham, MD:
AltaMira Press.
Harris, J.G. (1988) A Practicum for Dance Therapy, London: ADMT Publications,
Springfield Hospital.
Hartley, L. (1984) Body Mind Centring, London: ADMT Publications, Springfield
Hospital.
88 Using the creative arts in therapy and healthcare

Innes A. and Hatfield, K. (2001) Healing Arts Therapies and Person-Centred Dementia
Care, Bradford: University of Bradford, Bradford Dementia Group Good Practice
Guides.
Keleman, S. (1985) Emotional Anatomy, Thousand Oaks, CA: Center Press.
Kestenberg, J. (1999) The Meaning of Movement – Developmental and Clinical
Perspectives of the Kestenberg Movement Profile, Amsterdam: Gordon and Breach.
Lamb, W. and Watson, E. (1987) Body Code: The Meaning in Movement, Princeton:
Princeton Book Co.
Lange, R. (1975) The Nature of Dance – An Anthropological Perspective, Plymouth:
Macdonald and Evans.
Lerman, L. (1980) Teaching Dance to Senior Adults, Springfield, IL: Thomas.
Levete, G. (1982) No Handicap to Dance, London: Souvenir Press.
Levy, F. (1988) Dance Movement Therapy. A Healing Art, Virginia: American Alliance
for Health, Physical Education, Recreation and Dance.
North, M. (1972) Personality Assessment through Movement, London: Macdonald
and Evans.
Pasch, J. (1984) Creative Dance with People with Learning Difficulties, London:
ADMT Publications, Springfield Hospital.
Payne, H. (1984) Responding with Dance, London: ADMT Publications, Springfield
Hospital.
—— (2006) Dance Movement Therapy: Theory, Research and Practice, (2nd edn),
London: Routledge.
Sherborne, V. (1990) Developmental Movement for Children, Cambridge: Cambridge
University Press.
Torbett, M. (1980) Follow Me, New York: Prentice-Hall.
Tufnell, M. and Crickmay, C. (1990) Body, Space, Image, London: Virago.
—— (2004) A Widening Field – Journeys in Body and Imagination, Alton: Dance
Books.

Videos
American Dance-Movement Therapy Association (1984) Dance Therapy – the Power
of Movement, Berkeley: University of California.
Bernstein, P.L. (1975) To Move is to Be Alive: A Developmental Approach in Dance-
Movement Therapy, Pittsburgh: Pittsburgh Guidance Center.
Corfield, L. (2000) The Thinking Body: The Legacy of Mabel Todd Explained,
Piermont, NY: Teachers’ Video Workshop.
Jabadao (1987) Dance – A Non-Verbal Approach, Leeds: Jabadao Centre for Movement
Learning and Health.
Jabadao (1987) Dancing for Celebration, Leeds: Jabadao Centre for Movement
Learning and Health.
Sherborne, V. (1976) A Sense of Movement, Ipswich: Concorde Films.
—— (1982) Building Bridges, Ipswich: Concorde Films.
—— (1990) Developmental Movement for Children, Cambridge: Cambridge University
Press.
Chapter 7

Expanding human potential

through music
Keith Yon

Why is music of such value to me that I feel others could similarly benefit?
Simply, music lifts me: my feelings, thinking and spirit are extended beyond
the strictures of ordinariness, paradoxically by taking me physically inwards
to my body centre. Having a centre to hold on to allows me to move between
moods which are normally judged as opposites, e.g. happiness and sadness,
the one to be hoped for and the other avoided. In view of the fact that feel-
ing is the source of action, it cannot be so undervalued, especially for those
who find it unmanageable. Rather, the body should exercise its means to
accommodate all feelings with the ability for transcending those that prove
unpleasant.
My personal experience of feelings is like inner movement, self-
understanding, continuously fluid. Words, on the other hand, seem like arti-
culated sounds trying to make objective sense, first to myself, then for sharing.
Music, with its sounds faithfully reproducing both sustained and articulated
movement, and its language, which uses the elements of words, i.e. feeling
vowel and articulating consonant, is, rationally speaking, ‘nonsense’. But, on
the principle that animals sing, whereas humans may speak – speech being
heightened singing – music provides an interim state allowing feelings to be
revealed that may not be defined in words.
Immobility of body, mind, feelings or spirit can constitute handicap; but
seeing that these aspects of an individual may be interrelated, the immobil-
ity, for example, of body and mind, may be remedied or at least alleviated
through the potential of mobility in feelings or spirit. Physical, emotional,
intellectual or spiritual preferences of musical experience evolve from per-
sonal need. I would like everybody to experience what happens to me in music:
the spaciousness of Monteverdi, the self-statement of Bach, the form of
Mozart, the sense of time transcended by Schumann, the vibrant silences of
Webern, the jolt out of complacency by Stravinsky; and to confront, as in
many modern compositions, the relationship between music and life: music
or noise, animate or inanimate sound. But being involved in response to
satisfying personal neuroses, musical taste must, in the educational interests
of allowing others to function as individuals, be questioned in favor of
90 Using the creative arts in therapy and healthcare

underlying principles, directly related to the fundamental concern of indi-

viduality. This concern is to function within the pace, spaces and forms of
society, which may be directly allied to the elements of music: rhythm, tune
and texture. An infant exploring forms in space and time builds imaginative
resources: an elderly individual is a treasury of images that only need forms,
time and space to be realized.
Musical form, not limited by narrative, may take the imagination beyond its
normal expectation and give the individual a greater satisfaction from having
structured a period of time creatively. With my groups I try to induce a sense
of extended form by means of the format of the sessions themselves, both (a)
of the individual sessions, and (b) as stages within an extended program.

Individual sessions
That each session is experienced as a journey or story is crucial: all cultural
groups use stories to reaffirm themselves. A story is a central event, an overall
build-up, climax and release, sustained on a succession of subsidiary events,
each smaller versions of the larger. So the journey through the session pro-
gresses by stages of build-ups, climaxes and releases, through which the
leader, like the storyteller acting beyond their normal body and voice,
attempts to sustain a sense of overall caring.
It is worth making regular weekly visits to map an inmate’s time in an
institution. These may be invigorated into a ‘landscape’ by exploring time,
space and forms; rhythm, tune and textures.
In a north London school in which racially opposed groups had no time or
space for each other, I found that by placing the rival Greek and Turkish or
black and white groups side by side, they avoided confrontation and could
acknowledge at least the presence of the others. Having been encouraged to
sing or listen to chosen songs, interleaving the lines of one group with those of
the other, they had to experience silences alternating with sounds. The silences
were initially antagonistic but, gradually affected by the music, could acquire
a semblance of coexistence. The change in the children’s normal spaces and
sense of time produced a musical form more relevant to their needs.
Play with spaces, time and forms proved effective in other seemingly reme-
dial situations, e.g. actors having to sing, musicians to speak, visual artists to
move and dancers to make sounds. Over the years this has extended to com-
munication therapy with second language casualties, mentally ill patients and
prisoners, arriving at my present concerns, which involve exploring expressive
alternatives with people with a disability.

Extended programs
The length of the program must be agreed. Even if the group is unable to
comprehend fully a time span of eight or ten weeks, I still perform a ritual,
 Expanding human potential through music 91

from halfway through, of a weekly countdown, so that at the end they may
not feel suddenly abandoned: the parting is prepared and mutual. Arts
experience aiming to help accommodate pain should avoid inflicting it. The
final session cannot be the climax of the program, but a time to release myself
gently from their environment.
A class of intelligent teenagers with a physical disability, conscious of
their social prowess and the regard of their ‘non-disabled’ peers, found my
sessions ‘mad’, and in order to be able to undertake the session, which
presumably they wanted to, had to ritualize every meeting by protesting
against what I asked of them. Responsibility for their ‘madness’ being
removed on to me allowed them, within the secret of their play space, to
enjoy themselves and transcend their disability with impressive ingenuity
and individuality.
The parameters of our relationship have also to be recognized. As leaders
we aim to set up an ambience of acceptance, and to provide a microcosm of
society for individuals to test their personal and social expressive skills. But,
in response to particular situations, we may need to limit our parameters to
providing only as much time and space as those with whom we are working
might be able to manage. In extreme situations, as helpers, we may need to
become barely more than their physical parameters. Actual body contact will
allow us to become interpreters of their containment or expression. Within
any learning situation, fluidity between the roles of helper, therapist and leader
allows the artist which is in all of us to be revealed: to contest confinements
of body, society or sanity.

Practical activities
My work model is a matrix, one axis of which is a continuum from handicap
to non-handicap, and the other from individual to group. The individual who
cannot move within this matrix, in any sense, seems to me to be handicapped.
Essentially my work involves expression – gradual rather than sudden, con-
sidered rather than reflex, but I have had to become more concerned for
finding inner resources through music: increasing an individual’s capacity for
feeling to the extent that they are motivated to find, rather than be taught,
their most effective means of expression. My role as reassurer, then catalyst,
changes to reflector to help individuals evaluate their experiences.
Throughout this chapter I make reference to several key ideas regarding
both forms and structures. I make great use of the circle within my sessions.
Circles allow for both containment and for the possibility of a group member
to become an individual within the group, by moving into the circle to per-
form. It also provides the possibility for each participant to become a leader
and possibly to be imitated by the group.
Rudimentary musical experience can be described as the difference between:
92 Using the creative arts in therapy and healthcare

• duplet pulses, i.e. two even beats, e.g. X X, and

• triplet pulses, i.e. two uneven pulses, e.g. long-short, X X, or short-long,
X X; or three beats, e.g. X X X.

I make extensive reference to these two forms for transforming modes of

communication in speech:

• duplet, giving information, generally controlled pulse stresses, as opposed

to
• triplet, expressing feeling, expansive pulse stresses: a pulse = two or three
beats, a stress = two or three syllables.

To give a ‘physical’ example of each form: running = duplet, skipping = triplet.

Alex, aged 19, who normally walked fast, noticing little, became excited by
his self- and environment awareness, being held back by a strong wind. Simi-
larly, changing duplet into triplet pulse to each step made him more open.
Nigel, aged 29, though possessing an extensive repertoire of tunes which he
hummed, only grunted isolated sounds. By encouraging the grunt rebound
‘uh-uh’ for a two-syllable word (e.g. Figure 7.1a), then extending to three (e.g.
Figure 7.1b), I could use the third sound of the triplet as the first sound of a
new stress (e.g. Figure 7.1c).
An initial sound, sign or mark may be comparatively easily prompted. The
problem is encouraging the individual to react to it to make the second:
keeping him alive during the gap.
I also use semicircle formations. This opening of the circle longways is a
crucial learning experience. It is important as a midway point, comparable to
the body opening from self-contained sphere to other-aware erect, by way of
‘demi’, half-open and enclosed: animal alert, martial artist.
The area of play, that is, the space within which to behave beyond the
norm, may be defined by instruments, chairs, etc. Low benches proved useful
as a ‘catwalk’ into a ‘circus’ from the changing rooms, then angled to define a
more manageable space within a large room.
How this all works in practice is best demonstrated in the format of a
typical session of mime:

• Greeting
• Body exercise

Figure 7.1 Duplet and triplet pulses.

 Expanding human potential through music 93

• Sound play
• Reflection.

Greeting
The group, including myself, is seated in a circle on the floor, if possible. Some
people may need assistance from a helper who can act as a physical and vocal
extension and/or interpreter.

Hello
A simple song is used to greet each member: ‘Hello Sue, Hello Hamish’, etc.
‘Hello’ sung allows the ‘lo’ to be suspended as long as is necessary to gain the
nominee’s attention, which is then confirmed by naming: ‘Helloooooooo –
Jim!’ The suspension of the sound may be enlivened by repeating the ‘hello’
as a sustained and articulated phrase.
When it is possible for the list of names to be sung without suspending the
‘lo’, that is, on one breath, an overall intention is set up. But it is more musical
and structurally beneficial to phrase the names in groups of three or four
similar to actions within actions, as in a story. The group, by pointing to each
person in turn being named, might gain in concentration and focus, particu-
larly in the case of those people unable to create sound.

Absent
Having celebrated those who are present, it is sensitive to remember those
who are absent (Figure 7.2). The absence of individuals from the group can
be used as an occasion to acknowledge sadness and thus to extend concerns
beyond immediate confines, raising the status of those present.

Framing
The group members, in turn, name themselves, so that each name may stand
out individually. However, the name needs to be framed, either by the vulner-
ability of a pause (providing an opportunity to manage silence) or by the

Figure 7.2 Absence acknowledgement.

94 Using the creative arts in therapy and healthcare

group repeating the syllables of the name, and clapping them (keeping them
lifted in silence and providing an immediate memory exercise), as shown in
Figure 7.3, resulting in an exciting rhythm.

Figure 7.3 Framing.

Gestures
Each individual sings his or her name accompanied by hand or facial gestures,
which are imitated by the group either after or simultaneously with the singer:
e.g. laughing at oneself, with the group is socially healthy. Simultaneity, e.g.
mirror-image exercise, helps envisaging oneself removed; imitation from the
side when touch or confrontation is impossible.

Good morning signed

This is a more elaborate song accompanied by signing (Figure 7.4a) after
which a contrasting coda is shouted, clapped and stamped (Figure 7.4b): the
rhythm of a football (soccer) chant.

Figure 7.4 Good morning signed.

Parrot-fashion learning is justified here because a football chant is social

currency; it gives a sense of belonging (chorus: David Ward). Gesture or
signing, paradoxically by taking pressure off the eyes and releasing tension
from upper body, allows fuller eye contact.
 Expanding human potential through music 95

‘Oh what a beautiful morning’

This and similar popular songs may be sung to get body and voice moving
together, swaying from side to side:

Oh what a beautiful morning, oh what a beautiful day

LEFT RIGHT LEFT RIGHT LEFT RIGHT

I have a beautiful feeling, everything’s going my way.

LEFT RIGHT LEFT RIGHT LEFT RIGHT

Use familiarity with communal songs to balance rawer, cruder sounds of

creativity. Though still the containing stage of the session, expressive elem-
ents may be introduced through slight modification of regular rhythm, sus-
pended double beat to allow extended reaching, i.e. opposition of left and
right sides (Figure 7.5).
Reaching arms and extending vowel approximation yawning: maximum
longways stretch, anus to soft palate; and sideways, hand to hand, the most
lifted sensation in the body which, sustained, is the basis of singing.
With some disturbed groups, repetition of familiar songs might be the
extent of the session, i.e. confirming manageable space and working within it.
However, a creative dimension (listening, play and formalizing) is possible in
exercising qualities of: loud–soft, far–near; song-dances exploring small–
large circles; fast–slow, e.g. song sung at double and triple speeds; using
major-minor keys to transform moods.

Events
Songs need sometimes to be improvised to cover exigencies, e.g. a birthday, a
cold, a hurt finger, new glasses, an intrusion, a visitor, etc. Use a simple song
structure such as ‘Who has, Who has, Who has come into the room?’

Rocking forwards and backwards

This song accompanies forwards–backwards rocking, first in duplet pulse
(Figure 7.6).
Then rocking in triplet pulse (Figure 7.7), obsessive rocking, reflex motion,
being accepted then extended: pausing long enough to allow the body to
curl into itself enclosed in self-communication, humming an extra layer of

Figure 7.5 Rhythm modification.

96 Using the creative arts in therapy and healthcare

Figure 7.6 Forwards–backwards rocking in duplet pulse.

Figure 7.7 Forwards–backwards rocking in triplet pulse.

‘smell’; allowing the body to fall backwards and straighten out, retaining self-
assurance of curled-up sphere. If some people with disabilities are unable to
rock on their own, work in pairs (with one person cradling the other) to feed
in the duplet and the triplet pulses.

Rocking sideways
Sideways rocking movement allows ‘limitless’ reaching (Figure 7.8). Long lines
of pairs can become ships, shipwrecks, underwater movement and sounds.

Figure 7.8 Rocking sideways.

 Expanding human potential through music 97

The moment of overbalance in reaching is related to a suspended beat, of

duplet becoming triplet (Figure 7.9).

Figure 7.9 Duplet becoming triplet.

Pull the boat, push the boat

This is a modification of a favorite action song (Figure 7.10): exercising seesaw
for two-way action of communication; distinguish ‘push and be pushed’ or
‘pull and be pulled’ from ‘push and pull’. Reach–recoil reflex action of indi-
viduals who compulsively put objects in mouth extended to considered action.

Figure 7.10 Pull the boat, push the boat.

Body exercise
Individuals of limited or no vocal means need to experience song in their
silent bodies (as a self-recognizing container and expresser of feelings, i.e.
self-communication prior to other communication). The musical lift comes
through the feet, if standing, or the bottom, if seated.

Silent song
Sing and dance a song, then dance the song:

• without singing it outwardly,

• without using the arms,
• without using the body or feet. Hear the song in silence.

Humming
The group practices humming – ‘Mmmmm’ – while curling themselves up.
Then, while stretching themselves out, they articulate the sound: ‘Mememe’,
extending the vowel and possibly rising to the octave above. This is similar to
singers tuning up: ‘M’ inward lip movement; teeth kept apart for free jaw.
98 Using the creative arts in therapy and healthcare

Figure 7.11 Toe song.

Toe song
This song accompanies massaging appropriate parts of the body. It can pro-
vide the important sensation of simple syncopation between pulses on ‘big’
(or ‘little’, ‘pink’, ‘brown’, etc.), challenging rigidity of pulses: principle applies
to time between striking instrument; motivation; compare vowel between
consonants (Figure 7.11).
The last verse may be ‘Oh there were ten fingers, etc.’, in which case the
word ‘reached’ may reach up the eight steps of the scale, with the hands
trying to touch the sky and the body coming erect. Then the cadence, instead
of falling, remains open in a flourish of sound, after which the silent body
tries to maintain the sense of flourish.
Contrast this with walking on pointed toes, ‘lordly’, and smooth heels,
‘peasant’, which exercises high and low body centers producing different
qualities of sound, catering for individuals of different dispositions. Also try
this exercise in syncopated clapping:
clap clap clap clap
duplet –
step step step step

clap clap clap clap clap clap clap clap

triplet –
step step step step
Body blues
The sad quality of this song is effective at a containing, turning inwards stage
of a session (Figure 7.12). The song sequence of upwards, heels – knees – back
– fingers, and downwards, sides – bottom, makes a satisfying arc.

Tarzan song
This is a sequence of vocal sounds, duplicating those experienced slapping
the body cavities:

Foot///:Calf///:Knee///:Thigh///:Belly///:Chest///:Neck///:Mouth (Yodel)
 Expanding human potential through music 99

Figure 7.12 Body blues.

An alternative arrival at the top of the body is to roll the head around,
humming in gentle triplet. This should ideally be experienced in the fast
group-regulated version only after individual exploration of cavities’
resonances.

Rockets
Humming drones, as if engines starting up, accompany hands massaging the
thighs downwards to the knee, where they lift off; sounds duplicate their ‘flight’
to its apex, then sparkle, as ‘fireworks’, in a sustained cadenza, the hands, at
length, returning to the knee-base and the voice to its drone. This can create a
warming at the body centre. The sense of centre is reaffirmed from tension
drawn downwards before lifting.

Breath
Whether vocal or silent, individuals may exercise the three basic types of
breathing: (1) breathe in and hold the breath till bursting; (2) breathe in and
out regularly to counts, e.g. one in, one out, two in, two out, etc.; (3) breathe
out for as long as possible.

1 Held breath blocking tension in the muscle here exercised in fun

normally to be avoided; uncontrolled release of energy in aggressive
reflex action may be transformed into considered expression, e.g.
expletives – sentences, grunts – songs, kicks – dance steps, hitting –
gestures.
2 Both shallow and deep breathing need exercise; avoid percussive in/out
motion, raising tension: instead exercising rolling abdominal movement,
i.e. inwards and upwards for exhalation and outwards and downwards
for inhalation.
100 Using the creative arts in therapy and healthcare

3 Extending breath to spread thoughts and feelings out; self – prior to

other – recognition.

Sentence
Build a song based on repeated parts of a sentence, e.g.:

(a) ‘Today . . .’
(b) ‘Today I am . . .’
(c) ‘Today I am feeling . . .’
(d) ‘Today I am feeling very tired . . .’
(e) ‘Today I am feeling very tired because I got up late.’

The principle of sentence is a thing (noun) activated (verb); also sentence

structure is based on Who, What happened, When, Where, How and Why;
and uses polyrhythm of speech stresses, i.e. mixture of two and three; the
essential rhythmic expression in undemonstrative cultures.
Each phrase may be repeated until assimilated by the group, the breath
between exaggerated with the lengthening phrases. Full breath release avoids
frustration build-up.

Interlude
During the first part of the session the group should have experienced sounds
ranging from very loud to very soft, indicating the parameters within which
they may be expressive in the second part. The overall intention so far has
been to treat the body as an instrument: as a group member, tuning it up first
to contain feelings, through close body contact; then for expression: indi-
viduals start to develop a secure physical base for creating sounds which
allows them to venture beyond their bodily confines. An expression echoed
by at least one other voice is the basis of communication. Therefore, like
an instrument, the body-voice has to be sympathetically ‘toned’ to respond
effectively and appropriately.
Individuals concerned only to express themselves may be as wayward as
suits their purpose. But when intent upon communicating, be it with an
audience of one or many, they have to accept the necessity for agreed struc-
tures, e.g. the conductor’s beat, being in tune, being in step and, in social
dance, the agreed feet patterns (over which real communication is played
through eye and upper body contact, etc.). This is how music is normally
experienced and taught: the leader presenting models based on accepted
musical products within which individuals may choose to conform or rebel.
In contrast to this structured practice, music may be taught organically,
beginning with the crude materials of sounds which, through a process of
exploration, become realized in individual forms. The dilemma of whether
 Expanding human potential through music 101

the finished production of a piece of music is more beneficial than the process
undergone producing it, a topic which occupies so much pedagogic discus-
sion, is in practice dispelled. Process is product in a state of transformation,
whereas product is process suspended. Whether structured or organic, the
means for helping individuals to create are only as effective as the leader
employing them. Ultimately I may communicate only the habit of conviction
and motivation, i.e. what keeps me in one piece and what moves me to action:
stillness and action. It is salutary to remember that infants reveal in their
rudimentary language an intuitive sense of symmetry: ‘da-da,’ ‘ma-ma,’ etc.
(The sequence of sound rebound couplet, i.e. ‘uh-uh,’ ‘ga-ga,’ ‘da-da,’ ‘ma-ma’
and ‘ba-ba’ trace infant development from amorphous to self-identification.)
Musical form is simply the dynamic of knowing that a sound will be repeated,
and being surprised when it is.
The relationship between process and product is crucial when working with
people with a disability who cannot manage the sharing of social ‘products’,
i.e. cannot communicate, and who, to ensure that their frustration may be
alleviated, need to be provided with alternatives, forms of expression evolved
from individual rudimentary sounds. It is essential for people with a disability
to experience something of the repertoire of music and songs to increase their
sense of belonging in their society. These received forms, articulated intervals,
structured rhythms, etc., which are the elements of ‘proper’ music, some
people may find difficult to accommodate, but through play they may in time
assimilate them into their vocabulary.
It must be remembered that the musical sounds normally heard are articu-
lated, i.e. played on keyed or fretted instruments, or are formal speech syl-
lables: the gaps between, being sufficient to cause disquiet or excess tension,
are likely to be abhorred by individuals lacking the technique for managing
discomfort. Therefore it is essential to fortify the ability to accommodate
stimuli by having the experience of more readily acceptable sounds, e.g.
unbroken, melismatic intervals, which abound in folksongs, jazz and Eastern
music: a swanee (slide) whistle should be part of every leader’s equipment.
Even more fundamental is the experience gained from playing with free
sound, i.e. unstructured rhythms, microtonal intervals and noise: humming,
grunts, expletives, banging, etc. It is not uncommon to find individuals, not
only those people with a disability, for whom the sensation of noise beating at
their bodies (therefore requiring no response) is more to their liking than the
spaces of rhythm and interval, which demand exposure of feelings. Trans-
forming noise into music is finding the lifting quality of sound. Sound being
an extension of the body must also be three-dimensional (depth, vertical,
lateral) and must reproduce the elements of the most immediate form of
contact which it displaces: smell–touch:

1 Depth. Animal sounds evolved to establish territory, clothing the body in

vibration like an extra texture of skin: purring, humming, hardly more
102 Using the creative arts in therapy and healthcare

than a more intense layer of reassuring smell; by this means the body
may choose either to isolate or express itself.
2 Vertical. Changes in vibration produce notes of different intervals i.e.
tune: the change from one vibration to another, producing a feeling of
suspension in the spaces between the intervals. Lack of interval, however
microtonal, is noise.
3 Lateral. Sound may travel where the body, for either physical or social
reasons, may not: suspending itself in time, either sustained or kept lifted
on articulating pulses, i.e. rhythm, which has the potential to behave with
the dual characteristics of touch:
(a) as if handling, giving information, the one-way traffic of expression,
favoring the control of duplet pulses;
(b) as if caressing, the two-way action of communication, sharing feel-
ings, warmth oscillating in the space between bodies, favoring the
expansive propensity of triplet pulses. The spaces between the pulses
allow the body to be controlled or to soar; over-insistence on the
pulse of rigidity of beat is tantamount to noise. (A lawnmower,
moved by muscular effort, makes sound phrases nearer to music than
the mechanical rigidity of repeated beats from one driven by a
motor.) Rhythmic patterns seem to be the property of the primitive
and young, whereas sustained melody seems to satisfy more mature
natures.

The following sections isolate the elements of music in an order which is

perhaps more accessible to people with a disability: rhythm, tune, texture.
They attempt to provide: first, scope for both structured and organic pro-
cesses of creativity, which is to say, forms as the bases rather than the ideals
of exploration; second, rudiments for developing from accommodation to
assimilation and finally, group and individual involvement. Throughout, the
essentials of creativity should be kept to the fore:

• Listening going into oneself: is it sound or silence?

• Play – sorting things out: is it noise (inanimate sound) or music?
• Formalizing – moving into expression or action: is it relevant, animated?

Where I have thought it helpful, I have related the elements of music to other
media. Because I firmly support the notion that instrumental sounds should
be related to the body-voice, I shall continue to limit examples to the voice,
hoping that their application to music generally is obvious.
 Expanding human potential through music 103

Sound play

Rhythm
This section explores the lateral aspect of music; breath or sound phrases
conveyed over a period of time, either sustained (1 to 4) or articulated by
pulses (5 to 11), allowing choice of being secure on the pulses or expansive
between them. A breath phrase (a potential step, gesture or sound phrase)
may be sustained or broken up, i.e. articulated with a build-up of excitement
towards the phrase climax in proportion to the relationship of pulses. How-
ever, mechanically regular pulses or beats spell musical death, even within
rhythmic patterns of social dance; a triplet should not be based on three even
beats, but rather on the principles of the suspended duplet.

Tennis
Pairs face each other throwing sounds across to each other, tracing the
‘flight of the ball’ with their hands and voices: transforming antagonism to
co-operation; an essential ‘developmental stage’ for most groups.

Ball of string
In a circle, individuals pass round a ball of string, humming and changing
pitch as the string changes hands. When the string is substituted by sound
being ‘handed’ around, the changing notes may be sung by the group, or
individuals may hold on to their notes, building a block of sound. The chan-
ging notes may simply ‘climb’ the scale: 1 to 8 for the diatonic, and 1 to 5 for
the pentatonic.

Star points
A piece of string is passed across the circle preferably of an odd number
above five, to any but a neighbor. When the string is returned to its beginning
the points of a star will have been created. If the group is numbered consecu-
tively, the passage of the string, picked out on the numbered keys of, say, a
xylophone, will make a ‘star tune’ to which words may be added, for example,
to describe direction: ‘to George . . . to Val’, etc.
The string is best passed through the spokes of chairs, allowing the ‘star’
to be placed near the floor providing ‘hopscotch’ spaces, each space a differ-
ent note. Then, if moved up and down the spokes, the flat, two-dimensional
figure becomes three-dimensional, among the shapes of which individuals
may crawl, tracing the lines of string in sustained and changing notes. This is
a two- to three-dimensional exercise in body image, essential for individuals
who feel they are always on display.
104 Using the creative arts in therapy and healthcare

Star radials
One end of a large ball of string is secured to the floor in the centre of the
circle. Each group member in turn is responsible for creating a radial, point-
ing in the direction he or she wishes their radial to go, and sustaining a note
or gesture for the length he or she wishes the radial to be as the leader moves
the string from centre until the sound terminates, i.e. the radial reaches its
‘point’. The string is secured to the floor and returned to the centre for the
next group member to create a radial.

Support music
The group sits in a semicircle and its members make sounds to accompany
individuals in turn traveling to a spot that may be defined by a large card
on the floor. Different textures of sound may be explored to parallel the
walking, which build in intensity as the traveler nears his or her goal. When
he or she steps on to the card, the accompanying group sustains a sound
for as long as he or she chooses to remain on it: then they accompany his
or her return journey. Distinction needs to be made between sounds that:
(a) duplicate each step; (b) more profitably for extending halting walk, lift
the gap between steps (syncopation), i.e. downwards action of step lifts
body.

Tile-dance chorus
Individuals choose a sequence of colored floor tiles as a step pattern to be
repeated as a dance chorus, e.g. ‘Blue tile, blue tile, red tile, yellow; who is now
a clever fellow?’ Between the choruses individuals may improvise free steps
and sounds.

Stepping stones
The ‘banks of a river’ are defined on the floor and individuals, in actuality and
in sound, try to cross in one go. The river is widened until stepping stones –
large pieces of card – are required to facilitate crossing. Travelers, accom-
panied by group chorus, may either:

• linger on each stone, to admire or reflect on the ‘landscape’ of sounds,

the quality of which is different on each ‘stone’, or
• move across with urgency, which will result in regular steps and the syn-
copated lift taking precedence over the step (creating a ‘communication
dilemma’ whether to advance or reflect).

On reaching the other ‘bank’, the traveler, accompanied by the group, releases
 Expanding human potential through music 105

the tension built up in the crossing, in a cadenza of triumphant sound, par-

ticularly after the second mode of crossing.

Football chant
Four cards are equally spaced in line on the floor. The leader maintains a
regular pulse, singing and/or clicking fingers. The group, in single file, travel
along the cards singing in time with the pulse, each beginning when the one
before has completed the line, resulting in a continuous line of sound.
Another set of four cards is added (Figure 7.13a), card 3 of each set is halved
(Figure 7.13b), card 1 of set 2 is halved (Figure 7.13c), then the cards of set 2
are rearranged (Figure 7.13d), resulting in the rhythm of another popular
British football (soccer) chant. Individuals may arrange a sequence of beats
and half-beats for the others to attempt, either traveling, as described above,
or clapping.

Figure 7.13 Football chant.

106 Using the creative arts in therapy and healthcare

Court dances
Step to a piece of music in 4/4 time, alternating left and right feet or sides of
the body on the first beats of successive bars, which will result in the rhythms
that formed the basis of court and social dances.

Sounds structured and free and silent

The group moves, claps and/or sings a repeated pattern of four beats. Experi-
ence of rhythms is better through sideways movement, i.e. opposition, rather
than clapping:

• structured – on the beat for the four beats

• free – over a period of four beats
• silent – for the duration of four beats. Repeat.

The free section will be anarchic. The leader will have to indicate the begin-
ning and end of the silent section. Experiencing the ‘electricity’ in the silence
after the free section reveals an individual’s sense of control. Managing the
contrast of feelings is dependent, ideally, on an ability to maintain a sense of
centre, or for fast readjustment afterwards.
Groups of more able individuals have, individually, chosen difficult repeated
patterns, e.g. 5 on the beat, 3 free and 11 silent, which when performed together
resulted in a fascinating chorus choreography.

Subdivision
A regular pulse is set up in foot tapping, above which the voice and hands
subdivide, exercising duplet, i.e. half-, quarter- or eighth-beats, and triplet,
i.e. third- or sixth-beats, as much as possible playing off the main beats:
syncopation.
That the presentation of this section might suggest a progression from
individual to group rhythms is not to be interpreted as group member super-
seding individual. The progression could as easily be reversed from structured
to free rhythm.

Tune
This section exercises the vertical aspect of music: the pitch of interval, just
as the important rhythmic sensation is time suspended between the pulses, so
is the experience of space within the interval, i.e. the change of vibration from
one note to the next, intrinsic to music.
 Expanding human potential through music 107

Plainsong
The group sustains a drone, above which individuals ‘take flight’ in sounds,
words and hand gestures, contrasting free play of long and short notes with
structured regular rhythms and coming to rest on the drone. To assist indi-
viduals who have limited sounds, the leader may have to pick up the pitch
of the note and gesture and bring them to earth. The principle behind
unaccompanied song or plainsong is that the drone is understood.

Chords
The group sustains a note and feels the changes in the body as chords are
changed below it, preferably sustained on the organ or accordion, first slowly
then quickened. Chord changes may be gradual, for example:

• I–III or VI, i.e. two notes in common

• I–IV or V, i.e. one note in common
• I–II or VII, i.e. no notes in common.

Songs may be selected with these principles in mind, e.g. (a) Beatles songs;
(b) almost any song; (c) ‘Drunken Sailor’. Predominance of IIV-V chords,
progression one note in common, is related to minimum of sustaining
‘touch’. People with a disability might prefer the security of two notes in
common.

Major and minor

The group sings a song, in major and minor, and the leader inserts suitable
verses in the opposite mode, accommodating change of mood.

Blocks of sound
The leader conducts the group, which sustains notes, changing them as he or
she indicates. Or the leader may play them on the organ or accordion by
superimposing as a listening exercise.
Neil, aged 16, having defined his territory on the piano with toys and spit,
banged relentlessly on two adjacent white notes, i.e. a minor second nearest to
noise on the piano requiring limited response.
I tried to join in playing the same notes further down the piano, i.e.
less vibration, and grouping in two and three, i.e. opening space, without
success.
Moving his hands one note, i.e. two white notes with black note between,
i.e. a major second, presumably because of increased interval space, caused
him to pause. Through gradual play he managed to assimilate this sound.
108 Using the creative arts in therapy and healthcare

I would have liked to develop this principle working down the intervals of
the harmonic scale, i.e. minor third, major third, fourth and fifth, but we lost
contact.

Support music
After standing on a card, accompanied by a chorus, an individual may have
the choice of two, three or four cards (of different colors) to step on to, to
each of which the group sings a different (generalized) pitch, e.g. high or low,
very high or very low, according to his signing. Or a group of five people sit at
the piano: very low, low, middle, high, very high, and the leader-conductor,
facing them, ‘conducts’ them.

Soccer chant
The original four cards may be ‘pitched’ (Figure 7.14a) resulting in the final
chant rhythm as in Figure 7.14b. This is an example of perfect intervals,
essential components to vocabulary.

Grunting
Exercise grunting at different pitches. Each group member grunts a note and
indicates its pitch in the air, which is repeated by the group. Grunts may be
repeated singly at first; then grouped in twos, threes or fours; finally as a
whole sequence, phrased in twos, threes or fours. Related to building group
sentences, one word each, or group stories, one action each.

Articulated intervals
Certain musical intervals, e.g. octave, fifth and minor third, are common
in normal communication, and may be effectively exercised in isolation.
Limiting the pitch may be compensated by inventive use of rhythm and
texture.

Figure 7.14 Soccer chant.

 Expanding human potential through music 109

Octave
Play with the sound of the octave, ascending and descending, by leap and step.

Organum
Sing songs, some verses of which the leader sings or accompanies the fifth
below.

Thumb fifths
Using hand signs, thumb up = 5 and thumb down = 1, the leader improvises
rhythmic patterns, for example:
55 5 5 5
1 1 1 11 1, etc.
for the group to imitate simultaneously, which creates great fun. Decrease in
waiting for group to catch up, indication of reflex and involvement; hand
signs based on tetrachord: upper of scale a fifth above lower half.

Minor third
Play calling games utilizing the natural calling sound of the falling minor third.

Within the interval

The group sings a song, but dwells on each word or note for as long as it takes
them to be fully involved in it. Then gradually the speed is quickened to
normal but still intent upon keeping wholly involved. Take note that some
people may be too slow or too deep to ‘keep up’.

Keening
Improvise a ‘lament’ by sustaining a note and ornamenting above and below
it, sliding from note to note, with hand gestures to help. Perfect intervals
ornamented, e.g. 8 by +7, 5 by −6, 4 by +3 and 1 by −2, produce wild, sensual,
‘archaic’ mode, opposite to ascetic, Dorian mode: 8 −7 +6 5 4 −3 +2 l,
favored in the West; range between ‘archaic’ and Dorian has greater subtlety
than polarization of major and minor.

Ornamented folksongs
Sing a folksong and ornament it lavishly with melisma (a group of notes sung
to one syllable), being aware whether the ornaments are melodic or harmonic.
110 Using the creative arts in therapy and healthcare

Textures
Texture is the ‘depth’ element of sound against a background of silence.
However, terms such as ‘high’, ‘low’, etc. may not be helpful: a blind pianist
describing how he learnt part playing used terms like ‘forward’, ‘back’.

Tactile objects
Play with the textures and shapes of visual objects, lingering over a quality as
long as is desired, looking at it from different angles and height and trying to
translate them into sounds.

Percussive and sustained songs

Individuals stand near to slung cymbals to feel the effect of sound on their
bodies, and respond to the different effects of banged and rolled sound
(a percussive jolt accommodated by gradually increasing tremolo).

Piano quintet
A group – of five at the most – sits in front of a piano, which has its front
removed and the sustaining pedal depressed or is totally stripped down to the
strings, to allow the different qualities of plucked or strummed string sounds
to affect their bodies.

Opposites
Explore materials of opposite qualities of texture, e.g. sharp–blunt, hard–soft,
cold–warm, heavy–light, oily–gritty, rough–smooth, angular–curved, etc. Try
to reproduce these qualities in movement and sounds: sustained–articulated,
smooth–percussive, direct–indirect, etc., exercising slow–fast changes between
qualities.
The opposite qualities of sound–silence may have been related to the nega-
tive–positive cutouts and remnants for a ‘lilypond’. Although given limited
space here, the experience of listening is in some situations more relevant
than activity.

The elements
The floor may be divided into four areas: ‘water’, ‘air’, ‘earth’ and ‘sky’,
which dictate the qualities of sound that individuals may make as they pass
through them.
 Expanding human potential through music 111

Stereophonic sound
Groups of different sizes are placed around a room and make sounds pro-
ducing stereophonic effects, concentrating particularly on feeling the silence
between, and choosing between ‘nice’ and ‘nasty’ sounds with which to reply,
i.e. individual experience of consonance and dissonance.

Calling
Pairs and groups play with sounds of calling from far–near, related to the size
of appropriate gestures, big–small. Confusing loud–near, soft–big, etc. causes
great fun. Alternatively, the use of signing, supplementing speech, alleviates
tension.

Mirrors
Pairs face each other and move towards and away, attempting to make simul-
taneous sounds and gestures.

Sound images
Make up sound images based on textures and qualities (rather than shapes)
of, for example, wind, walking, tree, etc., or of characters, for example, com-
pounds of heavy, symmetrical, short, indirect, percussive, etc., which are
repeated as refrains during the recitation of a story by the leader. Try allow-
ing words to be sustained in near-singing to hold attention.

Vowels
Explore rudimentary animal sounds, for example ‘AH’ – contented, ‘EE’ –
screaming, and ‘OO’ – pouting. Then modify them as human sounds, e.g.
‘EH’ – half-scream, and ‘OH’ – half-pout: constituting the structure of the
five basic or cardinal vowels. Include continental ‘U’ = ‘OO’ + ‘EE’, and ‘Ø’
+ ‘EH’ to exercise facial muscles.

‘Big bang’
The whole group, each with one sound, possibly played on piano or instru-
ment, together make a loud noise and repeat their notes, individually increas-
ing the length of silence between. This will need to be conducted by the leader
from a prepared ‘score’, possibly on graph paper. This is an exercise in man-
aging silences, sustaining climax: of chance composition.
112 Using the creative arts in therapy and healthcare

Name chorus
In a circle, the group sing their names, with choices of:

• high or low pitch, keeping to a regular pulse

• long or short duration, each individual coming in immediately the one
before has finished
• immediate or delayed entry, as soon as the individual before has opened
his mouth to utter, resulting in a chorus of banked sounds and silences.

Reflection
The climax of the session will have been the creation of a piece of music.
Each individual and the group will have to some degree presented a bit of
themselves and will probably be feeling excited and exposed. This is similar
to the post-climax in Greek drama for teaching morality. However, just as
children may tear up drawings after creating them, so they need time to come
to terms after revealing themselves in sound. They will need to be taken back
to normality. Try to include time before and after sessions to take the group
from and return to norm; providing an opportunity for them to take some-
thing from the session, it is to be hoped, to help enrich their lives.
To help some groups of children with physical disabilities be more aware of
floor exercise influencing their normal lives I kept them in their chairs, extend-
ing their activities until they felt they needed to move to the floor. Being
returned, they could recapture what they had done, particularly if there was
the visual record of a ‘map’ of their wanderings (marked in individual colors)
translated into songs and stories. With other groups, exercises were repeated
in different positions, e.g. on the floor, half-erect and fully erect, or sitting,
standing and moving, to reinforce their value.

Memory
The leader recalls the events of the session, probably as a link for the follow-
ing week, as a story (exercising sense of structure; story taking listeners out
of themselves following a narrative and reflecting on the events) in recitative,
encouraging moments of group participation, e.g. recalling in sounds the
ways they had moved, songs from stories or to cover events, the weather, etc.

Grounding
Sing songs of individual choice, gradually reducing the level of activity and
sound to humming and silence.
 Expanding human potential through music 113

Postscript
Throughout, rather than emphasizing the specifics of musical language or
appreciation of musical form, I have concentrated on integrating a sense of
form into the body by experience to find a ‘grammar’ common to the arts, as
an aid towards managing the morass of stimuli in life: a sentence is a thing
(noun) enlivened (verb); a tune is a string of sounds animated by rhythm.
Familiarity with this process of ‘animation’ may help to enliven the individual
for whom the symbols of life have become stuck, including that of oneself as
a cipher. Coming to terms with oneself as an individual functioning within
society may be helped by the experience of singing or playing in a group:

• the same thing at the same time: tune, organum

• the same thing at different times: canon, counterpoint
• different things at the same time: harmony
• different things at different times: ?

The form of a song or symphony is essentially a journey in which feelings are

transformed. For many their source of transformation, awareness of possi-
bilities, is restricted to television soap opera, which is limited both in the
spaces of the imagination and length of involvement.

Acknowledgements
I am extremely indebted to the Carnegie UK Trust who generously funded the
project based at Dartington College of Arts, Devon: ‘The Arts in the Educa-
tion of Handicapped Children and Young People’, which made it possible for
me: to study communication from the other side of normal; to work with
Bruce Kent, who was so generous in sharing experiences relating visual art to
movement and music, and David Ward, from whose music-making with chil-
dren with a very wide range of disabilities I learnt much about the physicality
of music and whose books are compulsory reading for anyone interested in
this area of work; and to meet the many teachers, therapists, helpers and
artists questioning the boundary between handicapped and non-handicapped
people. Special reference must be made to Veronica Sherborne for the illumin-
ating experience of her movement workshops from which many of the body
exercises in this writing are adaptations for group and chorus work.

Further reading
Alvin, J. (1975) Music Therapy, New York: Basic Books.
Bailey, P. (1965) They Can Make Music, Oxford: Oxford University Press.
Feder, E. and Feder, B. (1981) The Expressive Arts Therapies, Sarasota, FL: Feder
Publications.
114 Using the creative arts in therapy and healthcare

Gaston, E.T. (ed.), (1968) Music in Therapy, London: Macmillan.

Kenny, C. (1995) Listening, Playing, Creating: Essays on the Power of Sound, Albany,
NY: SUNY Press.
Michel, D.E. (1976) Music Therapy: An Introduction to Therapy and Special Education
through Music, Springfield, IL: Charles C. Thomas.
Nordoff, P. and Robbins, C. (1965) Music Therapy for Handicapped Children, New
York: Steiner Publications.
Sherborne, V. (1990) Developmental Movement for Children, Cambridge: Cambridge
University Press.
Ward, D. (1973) Music for Slow Learners, Oxford: Oxford University Press.
Chapter 8

Drama
Using the imagination as a stepping
stone for personal growth
Bernie Warren

For many people drama is something that happens on a stage which separates
the performers from the audience, and establishes for the people watching
that the people presenting events are actors. Yet this presentation of imagined
acts on a stage is simply one facet of dramatic activity and although it is
perhaps the most generally accepted view of what drama is, it is not necessar-
ily the most important. It is this misconception in many people’s minds, that
drama is only a presentation on a stage and thus the sole property of skilled
and talented individuals, which has created blocks for individuals seeking to
achieve their full creative potential, and in some cases even prevents their
imaginations from coming into play at all. It is against this often self-imposed
wall that professionals in the fields of developmental drama, personal creativ-
ity and drama therapy have been chipping away for more than 40 years.
The origins of drama are to be found in storytelling and in ritual. In most
cases, spontaneous actions precede ritual. In the creation of ritual these spon-
taneous actions, which are seen to have meaning for the well-being of the
group, become transformed into a symbolic act. It now becomes essential for
the original spontaneous actions to be carried out in a set order and with a
particular style. This specific pattern is believed to be essential to the ritual
‘working’ and, as a result, spontaneity is lost. This is a similar process to the
one most people have, consciously or unconsciously, pursued with their own
creativity. They have lost contact with the source of their spontaneity and
have fallen back on external frameworks that impose boundaries on their
imagination and, more disastrously, often totally remove any emotional reac-
tion and substitute it with conscious control or predetermined outcomes.
Drama is an example of human interaction and rarely, if ever, occurs in
isolation. It is concerned with human beings communicating with one
another: verbally, physically and emotionally. Most importantly, this dra-
matic interaction is part of our everyday lives. Many role theorists have
pointed out that we are constantly shifting roles. Earlier in this book (p.34),
Rob Watling elaborates on the way in which context and function affect
traditional material. In a similar way the roles we take are influenced by their
context – that is, where we are, who we are talking to, etc. – and their function.
116 Using the creative arts in therapy and healthcare

Thus the roles we take are often dictated by circumstances beyond our
control.
Perhaps the most important external influences on our often unconscious
role playing are the people with whom we interact. In everyday interactions it
is not just what we say, but how we say it that conveys not only our meaning
but also our feelings. Preceding every action there is thought, sometimes
subconscious, which in turn is inextricably linked to our imagination. Our
every action, nuance of inflection and gesture is recorded, sometimes sub-
liminally, by the people with whom we communicate. They then calibrate
their actions and the roles they take accordingly. I believe that the essence of
drama is encapsulated in this process.
Courtney (1980) suggests drama is about the process whereby ‘imaginative
thought becomes action’ – in word or deed – and is particularly concerned
with the way that this ‘dramatic action’ affects other people’s actions. In
essence drama is the communication of our imagination, in a way that affects
our interactions with others, whether this be on stage or in our daily lives.
Daily, one of our biggest problems is communicating what we mean. Every
one of us spends a large part of our day talking at but not necessarily com-
municating with others. I use the analogy of human beings as transceivers
each with our own ‘radio station’, created by, among other things, our previ-
ous experience, our vocabulary and our genetic make-up. We each transmit
on a ‘single wavelength’ whose tone, quality and intensity are influenced to an
extent by our choice of language and our relationship to the listener and the
context in which we interact. However, while we have the capacity to receive
an incoming ‘signal’ on almost any wavelength, frequently we are not listen-
ing because we are too busy working on what we are going to say next. As
a result, we miss the point or lose the feeling of what the person talking to us
is saying.
This process relates to all human communications. As I sit writing these
words, displaced both in time and space from you reading them, I am strug-
gling to find those words that will best convey my meaning to you. I am well
aware that what I write, on the basis of my language system and world map,
will have to be interpreted by you and that every reader will have a widely
differing, unique background. So, as I write, I call on my imagination, trying
to be aware of who will be reading these words, what their backgrounds are
and what, if any, common ground they share. I am at the beginnings of the
dramatic process. I am struggling to communicate and my imagination is
affecting my actions. I am searching for the mode by which as many readers
can hear me as possible, and in the process I have to review the roles I have
taken to transmit my meaning in my past.
Drama is concerned with interpersonal communication. Many people have
difficulty communicating. Much of this results from an inability to change
roles or respond to an alteration in external circumstances. This lack of role
flexibility1 may be a result of a number of interrelated factors, for example,
 Drama 117

poor language use, inadequate motor skills, emotional blocks, poor social
skills, etc. These factors often conspire to maintain an individual’s inability to
respond to external changes.
Through drama, individuals are not only being allowed to use their
imaginations, but can also be encouraged to enjoy using them. Through games,
improvisations and theatre scripts, different roles2 can be taken. It is through
this role play that individuals can start to imagine what it is like to be some-
one else. These imaginative leaps can, through enactment and discussion of
well-known job roles (for example, teacher, farmer, lawyer, police officer, etc.),
engender a greater understanding of social roles, or through similar enact-
ment and discussion of more personal material lead to a greater awareness of
one’s self and one’s relationship to family, friends and past life.
It is through dramatic process, by playing other roles and engaging our
imaginations and emotions, that we can increase our role flexibility, develop
our powers of communication and learn to interact acceptably in the society
in which we live.

Practical activities
All the material presented here is ‘track tested’ and requires little or no
equipment. I have divided the material into three sections: name games,
awakening the imagination and creating character(s). Unless otherwise stated,
the games are presented from the perspective of the leader.

Name games
In the beginning an individual’s name is perhaps the most important thing
they bring into a room. For some of the people I work with their name is the
only thing they can share with the group and some find even this too much for
them. Our name is our identity. It tells others who we are and reaffirms our
own existence. Name games allow the group to get to know one another and
establish a sense of group spirit.
I generally play a name game at the beginning of each session, just to re-
establish the group. This is particularly important if the group meets once a
week or less. Name games also allow each individual to be spotlighted, that is,
for a short time individual participants are the centre of attention. Activities
that spotlight need to be set up so that they are non-threatening and support-
ive, so that those involved may gain a positive reinforcement of self-image
and feel secure within the group’s limelight.
A name game sets the tone of ‘we as a group are here and we all have
names, personalities, feelings; we are all individuals’.
118 Using the creative arts in therapy and healthcare

Simple name game(s)

Initially this game and its many variations are best played sitting in a circle.
Start by saying your name. Then ask each person to say their own name in
turn around the circle. First go to your right and then to your left, all the way
round the circle.
A variation is for the leader to walk around the inside of the circle, stop-
ping in front of each group member and saying ‘My name’s Bernie, and
what’s your name?’ On the reply, e.g. ‘My name’s Susan’, you and Susan
shake hands. This continues until the leader has been introduced to the entire
group.3

Mr (or Ms) Engine

Mr Engine is a variation on shaking hands. It is a children’s game I learnt
from Bert Amies that is full of sound, ritual and enjoyment. The group sits in
a circle with the leader standing in the centre. The leader is the engine of the
train – known as ‘Mr or Ms Engine’.
As the engine moves it makes steam train noises, e.g. ‘Choo choo choo
choo, Choo choo choo choo.’ When the engine comes to a halt in front of one
of the group members, it goes ‘Woo woo’, making an action as if pulling on a
lever. There then follows a ritual exchange. The engine starts ‘Hello, little
girl.’ Hopefully the girl replies ‘Hello, Mr Engine.’ Leader then says ‘What’s
your name?’ The girl replies, ‘My name is Sue.’ Leader to rest of group, ‘Her
name is Sue.’ To Sue he says, ‘Would you like to join my train, Sue?’ She
replies (hopefully), ‘Yes, please.’ At this point Sue ‘joins the train’ by standing
behind the engine and putting her arms around Mr Engine’s waist or on
Mr Engine’s shoulders.
Slowly, the number of ‘cars’ behind Mr Engine increases, each linking
around the waist of the car in front. When the engine has cars added, the
name of the new person is said by each member of the train with the last car
saying that name to the rest of the group. So if the train with two cars stops in
front of Brian, the ritual goes like this: engine to first car, ‘His name is Brian.’
First car to second car, ‘His name is Brian (pause). Would you like to join our
train, Brian?’ In this way the person’s name is passed down the train and the
greater the number of cars the train has, the more times the name is said.
This repetition of the person’s name acts as a form of spotlighting and the
extended repetition in some ways compensates for being one of the last cars
to join the train. However, it is very important that the last people to join are
made to feel part of the group.
The structure of the game allows for full group involvement at all stages of
its development. There are ritual chants with the entire group accompanying
the leader on the ‘Choo choo choo choo, Choo choo choo choo’ and on
the ‘Woo Woo, Woo Woo’. The group members can physically become the
 Drama 119

moving train and when the whole group is part of the train, a song can be
sung as the train moves around the room, in and out of the furniture. One of
my favored songs is ‘Chattanooga Choo Choo’.
This is a great game to get people involved, out of their chairs and moving.
If you have the luxury of volunteers,4 try to intersperse them between the
people who might need assistance. Occasionally people will refuse to join
the train, but a little gentle persuasion is often all that is needed. In the case
of someone obstinately refusing to join the train, try not to spend undue
time attempting to coax them because you risk losing the attention of other
members of the group. After moving as a unit, the train can uncouple one car
at a time. Again this can be accompanied by a song or a group chant. This
game is a good way of separating and mixing group members.

Dracula
This is one of my favorite and most theatrical5 games. It is also one that is
asked for repeatedly by groups of all ages and abilities. Over the years this
game has changed quite considerably, mainly as a result of the groups who
have played it.
At the start of the game the group sits in a circle with the leader standing
in the middle. I ask the group about vampires and Dracula. After a very brief
discussion, I tell them that I am going to be Dracula, one of the ‘undead’, and
that they are all in the land of the living. I tell them that Dracula can return to
the land of the living only if he can find a victim to take his place. Dracula
does this by means of an ‘instant blood exchange’ through placing his fangs
(Dracula’s index fingers) at the back of the victim’s neck. The victim then
becomes the new Dracula. Sometimes I tell them that Dracula’s spirit is
always in need of a new host body to avoid the ravages of time – this adds to
the blood exchange idea.
However, Dracula doesn’t have it easy! As Dracula walks towards his
victims, finger fangs outstretched, the intended victim makes the sign of the
cross (by crossing index fingers). As soon as the sign of the cross is made,
the rest of the group shouts the victim’s name. If they are successful and call
the victim’s name before Dracula touches his neck, then Dracula must go in
search of another victim. If Dracula gets there first, then the victim and
Dracula change places and the group has a new Dracula.
Once the group has the general idea of how to play the game, extra rules
can be added. Here are some examples:

(a) Dracula can be given a ‘handicap’, for example, he has to walk with a
limp, take baby steps, close one eye, count to three in front of the victim,
etc.
(b) Victims have to direct their ‘cross’ at one member of the group who then
has to call the victim’s name.
120 Using the creative arts in therapy and healthcare

(c) Adding to (b), if that one member of the group is too slow, it is he, not
Dracula’s victim, who becomes the new Dracula.

This is a great game for generating eye contact, group feeling and emotional
response. Some important points to watch: young children can occasionally
be scared by Dracula; always play a simple name game before Dracula;
beware of violent Draculas (poking in the back of the neck can hurt!); be
prepared to allow Dracula to ‘suck blood’ from the victim’s knees, particu-
larly important for Draculas who use wheelchairs.
My final point about Dracula concerns equipment. I play this game with
the added extra of a cape – Dracula’s cape – a black one with a scarlet red
inner lining. This has really added to the game. It allows Dracula to gain
added movement by using the cape’s material, it seems to enable the more
reticent individuals to ‘become’ Dracula and it allows for a social exchange
between Dracula and victim. At the point of transformation when Dracula
has caught a victim, the old Dracula helps the new Dracula on with the cape
before sitting down as a member of the land of the living. This Transylvanian
valet service is often one of the comic highlights of the game.

Tarzan
This is another one of my favorite and most asked for games. It is often the
first name game I play with a new group. I always tell a story before the game,
about Tarzan swinging through the jungle and filling it with the sound of
his own name. The story can take a number of turns and has a number of
explanations for the famous Tarzan call with the explanation changing to
meet the needs of the group I am working with.
The basic game is as follows. Go round the circle and ask each person’s
name. Then I tell the Tarzan story and say that we are going to fill the room
with the sound of our names. Then go round the circle, stopping at each
group member, who says their name. This is then echoed by the rest of the
group shouting that name while beating their chests. This goes all the way
round the circle until everyone’s name has filled the room, and finally we all
beat our chests and shout the Tarzan call.
This is a great game for spotlighting individuals. Even the shyest person’s
face lights up when they hear the entire group shouting their name and that
sound filling the room.
These are but a few examples from the huge array of simple and dramatic
name games available in the literature. Often a group will have special, favor-
ite name games. These may be ones you have introduced or, more likely, ones
they have adapted or created.
 Drama 121

Awakening the imagination

Many of the people we work with have been actively discouraged from using
their imaginations. Programs that emphasize socially acceptable behaviors
and the facing of reality – in the programmer’s terms – cause the often fertile
imaginations of individuals in our groups to atrophy. I am not suggesting that
individuals should not be helped to face the realities of our often inhumane
and alienating industrialized society: what I am suggesting is that there are
many ways in which this can be achieved. One of these is through the indi-
vidual’s imagination. I feel that in order to help them grasp a sense of the
socially accepted norms of reality, we must first gain a sense of how they
imagine the world, and attempt to see the world through their eyes so that we
do not always transfer or project our world view on to them. Our understand-
ing of their perceptions of the world, gained through imaginative exercises,
can provide a framework in which to initiate a change to more socially
acceptable behavior. The first three games deal with awakening and engaging
the senses, and the others in this section focus on the act of creating some-
thing from nothing, and on the imagination taking a concrete object and
transforming it into something else.

Keeper of the keys

A variation on a traditional children’s game. I tell the group a story about
a pirate who amasses great wealth and keeps this in his house. However, the
pirate is often away from his home and needs someone to guard his house and
treasure. He is told of a blind person whose hearing is so acute they can hear
a pin drop in a crowded room. After an embellished preamble, one of the
group sits on a chair in the centre of the circle, closes their eyes and becomes
the Guardian of the Treasure. The rest of the group is seated in a circle
around the Guardian. In front of the Guardian are the keys to the treasure;
for children this is often described as a huge store of candy or chocolate. The
rest of the group tries, one at a time, to take the keys without being heard.
When the Guardian hears a noise he or she points in the direction of the
noise saying, ‘Get out of this house.’ If the would-be-thief is pointed at, he or
she has to go back to their seat. If the thief captures the keys without being
spotted, he or she becomes the new Guardian.
Added complications can be to give the Guardian a gun (extended index
finger) the verbal taunt now becomes ‘Get out of this house, bang!’ This adds
the dramatic element of a theatrical death. The thief can be required to get
the keys from under the Guardian’s nose and back to the thief’s seat; or a
group of two or three thieves can work as a team to get the keys from the
Guardian (this can be very unsettling for the person playing the Guardian
and should not be tried early on).
This game is extremely good for accentuating auditory skills. It is also an
122 Using the creative arts in therapy and healthcare

exercise in control for the thief, who must try not to be heard, and for the rest
of the group who must remain quiet and still.
There is a tendency for Guardians not to keep their eyes totally closed.
However, I am reluctant to use a blindfold. My own experience is that many
individuals are scared by wearing a blindfold. The return to trust – trusting
the individual to keep his or her eyes closed – requires patience and a liberal
dose of turning a blind eye in the initial stages. Slowly, individuals will be less
scared of closing their eyes and will become totally engaged in the game.
Pushing and cajoling them to close their eyes will probably only aggravate the
problem.

Male or female?
This game is a regular favorite. I have found it particularly good when work-
ing with groups of long-stay institutionalized people, especially seniors, as
it seems to provide that essential element of acceptable human contact so
often lacking from these people’s lives.
The group sits in a circle with one member of the group sitting in the
middle. The person in the middle has his or her eyes closed. One at a time
other members of the group go and gently touch the person in the centre,
who then has to guess whether he or she was touched by a man or a woman.
I never force anyone either to sit in the centre or to get up and touch the
person sitting there. I let the game continue until everyone who wants to has
had a go.
This game provides a fascinating experience. When you are in the middle
it is extremely difficult to discern if the touch is that of a man or a woman.
However, it does force you to be aware of other factors, for example, pressure,
warmth, sound – particularly breathing and smell. After a while, when work-
ing with a group over a long period of time, I can generally pick out exactly
who is touching me by the sounds they make coming towards me, their
breathing pattern, the way they touch me and so on. As an observer, the
ways that people approach the person in the middle and then make physical
contact can be particularly informative concerning the dynamics of the
group. Often, individuals hide their feelings behind the words they use to
communicate. In this exercise these feelings are made concrete, often in very
subtle ways.
This activity can also be used as part of work on sex roles and stereotypes.
Often, when working with teenagers, a discussion is an essential close to
this activity. Other groups, particularly those involving people with develop-
mental disabilities, often turn this game into a competition and some indi-
viduals get bitterly disappointed if they guess incorrectly. This disappointment
needs to be dissipated either through group support or a ‘success’ in another
activity, or whatever means is appropriate to that individual in your group.
This is generally one of the first physical contact activities I use with a
 Drama 123

group as it gives me a rough gauge of how individuals in the group respond

to being touched. It also gives a pointer to who will or will not work well
together. This activity can lead into more directed activities dealing with
emotion and physical contact.

The magic box

I often carry with me a large trunk. On the outside, painted in large letters,
are the words ‘Bernie’s Magic Box’. This box has a practical purpose, as it
enables me to carry with me all the equipment I ever use – tape recorder,
tapes, parachute, etc. However, it has another far more important function
and that is to serve as a focus for group members’ imaginations.
The magic box is an extremely simple tool. It is one of those timeless
dramatic activities. Stanislavski used a version of the magic box for training
actors, and many noted drama specialists have some form of magic box
exercise. In essence the magic box is a projective exercise. All I ask as leader is
‘What do you think is in the box?’ The group then responds by projecting
from their imaginations what they think is in the box. The responses of the
group can then be directed or shaped by the leader in a number of ways.
First, I generally employ a free association approach – where I simply allow
the group to come up with as many ideas as possible. When using this
approach I try not to make judgments, although I do make mental notes
of who said what. Also, I attempt to provide an environment that allows the
group to imagine as many things to be inside the box as they want to tell me
about.
Sometimes I am slightly more directive, taking a theme-based approach.
Here I tell the group there is food or treasure or unusual objects inside the
box. This is an approach I take with youngsters with developmental dis-
abilities. I still allow the group to freewheel, but within a given framework.
This can provide the necessary grounding for individuals who are ‘paralyzed’
by a completely open-ended task.
Sometimes I break with a freewheeling or free-association approach and
take a question-based approach. Here, as soon as an individual has a particu-
lar idea about what is in the box, I ask questions related to the object they
have described. For example, if they have suggested there is a purse in the
box, I might ask ‘What color is it?’ ‘How large is it?’ ‘Is it soft?’ ‘Does it have
writing on the outside?’ As a result of these questions, often a clear picture of
this object can be created in a very short space of time.
Once the group has created objects, there are a number of ways of working
with the ideas. Here are two basic approaches. Having created a variety of
objects to be found in the box, take the ‘imagined’ objects from the box one at
a time and pass them round the group. Get the group to take the time to feel
each object’s texture, weight, etc. At some point I might ask one of the group
to describe the object to the rest of the group.
124 Using the creative arts in therapy and healthcare

Another technique is to use two or three objects that the group created
which might link together. For example, one group told me that in the box,
among other things, were a bloody hand, a sword and a dragon’s tooth. I then
asked the group to tell me how the objects got there. In this way, from the
objects a group creates, a story can evolve, which can then be ‘acted out’. The
magic box then, in common with other activities described in this section,
allows the group to use its collective experience as the basis for the dramatic
activity. I will pursue these ideas through description of other activities in this
chapter. The magic box can also be used to reinforce the magical qualities of
objects that are taken out of it, such as the magic newspaper.

Magic newspaper
This is one of my ‘old faithfuls’, which I use at some point in my work with
every group. This game is both a starting point for mime and a diagnostic
tool. I produce from my magic box the magic newspaper. I tell the group that
this may look like an ordinary newspaper, but it is in fact magic. At this point
most of the group is, to say the least, skeptical. I say that the magic of the
newspaper is that, by working with it, the paper can become anything you
want and that, without telling anyone, the group will immediately know what
it is. I then create a telescope, someone in the group says ‘telescope’, I reply,
‘See, magic works every time’ and we’re off. I might then show a few more
examples of the newspaper’s power and then the paper is passed around the
circle. Each person has a chance to work with the ‘magic’. The only rule is
that you cannot pass twice. So if you cannot think or make something first
time round, you must do something the next time.
The way that individuals respond to the magic newspaper is fascinating
and it is for me, as already mentioned, a very valuable diagnostic tool. From
the way individuals use the paper I can gain information that enables me to
make observations about the way that each person’s imagination functions.
In general terms, there are three basic ways of working with the magic news-
paper – moving from the concrete to the abstract use of imagination. First,
people work at a concrete level. The focus is on making the newspaper into
something. Here the paper has to be an actual representation, for example, a
hat, an airplane or a newspaper. What work the individual does with the
paper is related to origami. Further along, people reach a stage where they
are less concerned about what the object looks like and more concerned
about how to use it. The focus is on using the newspaper as something, for
example, a paintbrush, a baseball bat or fishing rod. This marks a mid-point
between the concrete and the abstract uses of the newspaper. At the most
abstract level, the focus is on the newspaper being part of a larger imaginative
picture, for example, the newspaper is the lead for a dog being taken for a
walk. The focus is now on the dog not on the lead. The shift of focus on the
newspaper is from making into, to using as, to being part of something – it is
 Drama 125

a shift from the concrete to the abstract use of imagination. The way each
individual uses the paper can serve as a guide to the level at which other
imaginative exercises might best be started.
Although the way in which people use the newspaper is a clue to the way in
which they use their imaginations, it is by no means a direct cause-and-effect
relationship. People who are able to function at the highest abstract level are
often intimidated during the first sessions of the magic newspaper and appear
to function only at a concrete level. Also, some people appear to be function-
ing at a higher, more abstract level than would at first be expected. There may
also be some who can only copy others. All of these pieces of information
should be made note of and used to help fill out the three-dimensional jig-
saws that are the individuals within your group. No single piece alone can
complete the picture but every little piece of information helps.

Magic Clay
This is an extension of the magic newspaper. Again it can be a starting point
for mime work. I was first introduced to this exercise early on in my training
as part of a mime workshop. The workshop leaders introduced this as an
exercise which allowed the mime to ‘produce’ objects on stage with a mini-
mum of fuss and effort. Magic Clay is my reworking of that simple exercise.
I tell the group that I have a ball of magic clay and that when I work with it
I can create objects. I then stretch the clay, drawing it out and shaping it,
perhaps into a bouquet of flowers that I then present to someone in the
group. When we have completed our transaction, I mould the clay back into a
ball and pass it to the person next to me. The clay is passed around the circle
with each person consciously creating something, using and demonstrating it
so that the group understands, and returning it to the shape of a ball. In this
stage of the exercise the ball is being consciously shaped and manipulated by
the group member holding it.
Another way of using the magic clay is to ask the individuals holding it to
close their eyes and let the clay move them. The skeptics among my readers
will argue that something that does not exist cannot move the individual not
holding it. In a sense they are right, yet what is being asked is for the person
holding the clay to try to suspend the cerebral override that we all employ in
almost any task and let the subconscious take over. The need is to do, without
thinking about what to do. The results can be fascinating. I ask individuals to
describe their experiences as they are happening, telling the rest of the group
what they experienced (the colors, shapes, weight, textures, etc.) when work-
ing with the clay. I always emphasize that there is no need to describe or label
what has been created, as the end of the process does not have to be something
known or tangible.
When the individual lets go of conscious control of the clay, the emotions
and the feelings take over. There must be no criticism or judgment of the
126 Using the creative arts in therapy and healthcare

creation – this is not a work of art, this is a work of emotion, color and form.
The effect of the experience on the individual varies immensely, depending
on their emotional state and the degree to which they allow themselves to go
with the clay. In most cases, people describe it as a relaxing, refreshing and
pleasant experience. For others it can act as a stimulus to open the floodgates
for troublesome or unresolved experience. It is essential that you are aware of
this possibility and timetable Magic Clay so that there is always time to
explore anything that comes up as a result of the exercise and you do not
simply close the session with the activity. This activity integrates well with
various visual arts techniques, for example, ‘painting’ the experience with
the clay.

Tennis–elbow–foot game
The group sits in a circle. The idea is to throw a soft ball from one person to
another. As the ball is thrown, the thrower says a word, for example ‘tennis’.
The catcher must then respond with the first word that comes into their head,
for example ‘elbow’, simultaneously throwing the ball to another person as
they do so. The game is based on an instant response to the word that went
before. There should be no time to pre-plan because you never know what
word you will have to respond to. If there is a break in continuity or if
someone pauses before responding, blocking has almost certainly occurred.
This is an extremely interesting and often entertaining game. It is an excel-
lent exercise to work against blocking and as such to promote spontaneity
and creativity. It forms a good springboard for storytelling exercises. It can
give valuable clues about individuals within the group in much the same way
as the magic box. When working with people with a developmental disability
or young children it is often best to start with a theme, such as colors. So the
task would then be to say the first color that you think of. Again, it is import-
ant to cross-reference information. For example, if a child is stuck with the
response ‘yellow’, certain questions need to be answered. Do they also
repeatedly choose yellow in art work? Do they describe their house as yellow?
If they do, why? Is it the only color they know? Some more deep-seated
reason? It is important to gain as much first-hand information as possible,
but it is also important to cross-refer experiences with the other professionals
who work with that individual.
Earlier in this volume I have made reference to the importance of the
contract between the leader and the group. If the contract is a ‘therapeutic’
one, then the leader will probably want to make note of the pattern, repetition
and blocking of responses. This information in combination with that gained
from other activities and sources, may lead to an ‘intervention’ or ‘strategy
for change’.
In the context above the pattern is the sequence of words exchanged
between group members, for example, ‘on top’, ‘underneath’, ‘blanket’, ‘bed’.
 Drama 127

Repetition is where an individual is stuck with a particular word or limited

response, for example, ‘purple’, or only using words related to touch. Blocking
is what occurs when an individual is unable to respond to a particular word or
topic, such as ‘love’.
The reasons for the patterns, repetition or blocking can be many. One
aberration that should be considered when looking at the pattern is whether
individuals were responding to the penultimate word. This happens when the
game is being played fast and the group members are new to each other.
Repetition is usually an individual problem and may simply be a language
deficiency. This is particularly likely for people with developmental disabilities.
However, with a more ‘verbal’ group the repetition may be psychological in
origin.
Blocking is far more complicated and highlights the problem posed by
evaluating the group’s responses. Certain words or topics, for example, sexu-
ality, may be blocked for a number of individual or collective reasons. One of
the most obvious is that individuals feel a lack of trust and confidence in
other members of the group. The reasons for this lack of trust may be a key
to the direction a strategy for change should take.
In general terms, it is unusual for a group of post-pubescent people not
to mention sex – covertly or overtly – at some point in the game. However,
with adolescents, given a supportive and creative environment, the pattern
may be predominantly concerned with sex. This can lead to very interesting
discussions after the game.

Guided Fantasy
The term ‘guided fantasy’ is one that is used loosely to describe a leader
relating a pertinent tale, anecdote or similar stimulus to an individual or
groups. At its simplest, the guided fantasy has been the stock in trade of all
good storytellers since humankind first started telling stories. At its central
core is the need to engage individuals in the events of the story. Therefore,
there is a need to choose material that is specific not only to the group’s needs
but also to their way of viewing the world.
Traditional material (myths, legends, song, etc.), with its store of wisdom
and knowledge may often be a suitable starting point for a guided fantasy.
The way a story or stimulus is used by a leader can take a number of direc-
tions, with the direction often being dictated by the nature of the intended
outcome of the exercise.
In a guided fantasy the leader’s role can be directive or non-directive, and
the participants may be actively or passively involved. In a non-directive
approach the leader simply provides a loose framework – suggestions to
stimulate the imagination. In a directive approach the leader makes state-
ments that give step-by-step instructions – literally guiding the imagination.
These styles are often mixed, so that statements such as ‘You walk down the
128 Using the creative arts in therapy and healthcare

road and come to a big house. You walk up to the front door’ may be inter-
spersed with questions: ‘What color is the door?’ ‘Is the door open?’ The
leader may even leave the end totally open for individuals to supply the
conclusion that satisfies their needs.
The participants in a guided fantasy may be passive; that is relaxed, lying
on the floor, eyes closed. The leader may use terms such as ‘imagine you are
looking at a large cinema screen’ – suggesting that the story is happening
there and then on the screen, or reference may be made to an environment:
‘You are in a garden full of flowers – brightly colored, beautiful, sweet-
smelling – take time to smell the flowers, feel their texture, look at the colors.’
The emphasis may then be placed on action or sensation or both.
In a guided fantasy where the participants are active, they do what the
story suggests. Thus, if the story calls for the heroine to ride into town, the
participants act as if they were riding into town. If it calls for the heroine
to pick a magical flower, the participants act as if they are picking that flower.
When participants are active, they are like actors responding to the instruc-
tions in the script – they are wide awake and respond in their own creative way
within the restrictions imposed by the script.
Sometimes a guided fantasy may be both active and non-directive. When
used with a group this is often referred to as a community exercise. Guided
fantasy, as with so many other creative activities, is often a stepping stone
to the discussion it creates as a result of participants being engaged in the
activity. This discussion is often as important as the activity that preceded it.

Creating character(s)
The creation of characters, through both storytelling and the act of becoming
someone else, is the natural extension of awakening the imagination. It is
this dramatic awakening, the linking of words to emotion that also forms the
backbone for many of the verbal forms of individualized counseling and
therapy. In the act of suspending conscious control, in the removing of those
blocks that prevent us from being truly creative, we regain contact with the
raw emotions, past experiences and inspiration that are the source of the
personal creative statement – the unique creative thumbprint that only we as
individuals can make. These blocks are the death of personal creativity. We all
have them and we all employ them. They allow us to hide behind a wall. They
also act as barriers to social performers acting on the stage of everyday life,
fully creating the roles that allow them truly to communicate.
In my work I have identified what I believe to be three major blocks to
being spontaneous and creative. I feel they are present in all of us and are in
many ways a necessary defense in certain social situations. However, they are
often more apparent in people who have limited role flexibility and communi-
cation skills. I call the three major blocks ‘the wall’, ‘the censor’ and ‘playing
the crowd’.
 Drama 129

1 The wall. Here, conscious control is so great and people are so desper-
ately trying to be creative that they cannot do anything. A common
response is ‘I had many ideas but when it was my turn to do something,
my mind went blank.’
2 The censor. Here, people are able to do something but it is feeble, half-
hearted. If questioned, common responses are ‘I thought that was what
you wanted’ or, what is more important, ‘I didn’t know what others
would think.’
3 Playing the crowd. Here, the exhibited behavior is of someone frantically
creating. It is, however, surface behavior – attention seeking. The indi-
vidual will use any means of being the centre of the group’s attention.
At the extreme, there is no censoring behavior. Often ‘taboo’ subjects are
played up, with emphasis on cheap laughs and crowd reinforcement.

In exercises or games where the awakened imagination develops a story and

later creates characters, these three blocks are particularly prevalent. The
skilled leader can make use of the blocks, first, by making note of them and
later, often in the same session, providing material that allows a chance for
the individual to overcome them.
The characters created and the stories they tell often provide a three-
dimensional map of where individuals have come from, where they are going
to and, sometimes, where they stopped along the way. The construction of
the sentences, the inflection used, and the body posture assumed are every bit
as important as the content. The leader must be all eyes and ears, sensing the
subtext of what is said both in and out of character. In carefully listening
to, observing and developing the events during the session, the leader is able
not only to establish a creative environment, but also to help individuals
regain contact with themselves and thus start to increase role flexibility and
communication skills.

To be continued (group storytelling)

This is an excellent way to create a script or story that has significance for the
group. The story created can be recorded by means of a tape recorder. It can
then be written down and used as a stimulus for other activities, and can be
used as a guided fantasy, a theatre script or a starting point for developing
reading and writing skills.6
The group sits in a circle. The leader starts a story going, for example,
‘Once upon a time in a large city lived a large cat called Tikka.’ This first
sentence is then built on, a section at a time, by each member of the circle, one
at a time, contributing to the story – a word, a phrase, a sentence or whatever
seems appropriate. Slowly the group introduces new characters and situ-
ations, which develop the action. The focus may shift dramatically as a result
of characters and situations introduced by the group. What is important is
130 Using the creative arts in therapy and healthcare

that each group member is actively involved in creating the story – it is an

expression of their shared, collective experiences and imaginations.
To spice up the activity, with a group who have had experience in creating
their own stories, I take a soft ball and ask individuals, when they have added
their section to the story, to throw the ball to someone else. This makes contri-
butions more spontaneous because you never know when it will be your turn.
Another variation is to have someone in the centre acting out the story as it
is being created. I have a rule that they can sit back in the circle at any time
and choose who will replace them. Again, you never know when it will be
your turn to be in the centre of the circle. The ‘actor’ often decides to swap
with a ‘storyteller’ when the addition to the story is difficult for them to
perform. This forces the ‘storyteller’ to take their own medicine, normally to
the great amusement of the rest of the group.
It is important that less verbal people are allowed to contribute at their
own level. For some people with a developmental disability this may require
the leader asking questions, some of which a court of law might view as
leading the witness, so that each individual can participate. Other individuals
may require the leader to intervene to prevent one person controlling the
story for an extended time. This person is an obvious candidate to be ‘the
actor’ when the time comes to act out the story.

Liar’s tag
The group sits in a circle. The leader starts miming an action, such as brush-
ing his teeth. Number two, the person on his left, asks ‘What are you doing?’
The leader then has to lie, for example: ‘I’m riding my bike.’ Number two
must then mime riding a bike. Number three then asks number two ‘What are
you doing?’ The reply might be ‘I’m taking a bath.’ Number three must then
mime taking a bath, and so on.
The person performing the action must tell the questioner a lie, and the
questioner must then act out that lie. Again, this is an excellent game for most
groups. For some groups with slower than average cognitive skills, the leader
must be patient and allow time for the group to work at their own pace and
within their own limitations.

I’m sorry I must be leaving

This is a standard acting improvisation that is often a riot to watch. I start a
scene with one person in a given situation, such as watching television, a
second person enters and chooses his character, and a scene starts to develop
through improvisation. At some point in the scene a third person joins the
action. At this point the first person must find a legitimate excuse to leave the
scene.
Each time a new ‘actor’ joins the scene the first person in the scene must
 Drama 131

leave. Thus, when number four joins the scene, number two must leave and
when number five joins, then number three must leave, and so on. The effect is
a continuously changing non-stop scene with each new actor choosing his
character and how he will react to the people left on stage.
A variation on I’m Sorry I Must Be Leaving is to start number one with an
action, for example, washing windows. When number two comes in, he takes
number one’s action but changes it slightly into something else, such as
grooming a horse. Number one and number two then interact by number one
joining in number two’s activity until number three joins the action. Number
one must now find an excuse to leave and number two must find a way of
joining in number three’s actions. Thus number three might now be conduct-
ing an orchestra so number two might pick up a violin and be conducted. It is
important for the development of the game that the last person in is always in
control of the scene.
Again there is a fast-changing, free-flowing improvisation being played out
for the audience. This is an excellent game with almost any group. Obviously,
for groups whose cognitive skills are slower than average, the game moves
more slowly and may need more direction from the leader, but having played
the game a couple of times, people slowly gain an awareness of the rules and
create some fascinating scenes and scene changes.

Who owned the bag?

This is a projective exercise and has many similarities to the Magic Box.
I bring in a battered and aged bag. I have two I use regularly. One is an old-
fashioned leather briefcase and the other is a hold-all made from alligator
hide. I tell the group that it is a very old bag and has had many owners. I then
ask the group to tell me who owned the bag. When someone tells me they
know who owned the bag, I ask them to tell me about the owner. Normally
the first piece of information concerns the owner’s job, for example, ‘It was
owned by a doctor.’ Once the group member has started to tell me about the
owner, I start asking questions, for example, ‘What’s the owner’s name?’
‘How old is he?’ ‘How tall?’ ‘What color is his hair?’ ‘How much does he
weigh?’ Slowly, the person is building a physical picture of the bag’s owner.
Then I can start asking questions about the owner’s lifestyle, the sort of
house he lives in, his favorite foods, etc. Once I have done this with one
person, then the group can be involved in asking subsequent informants
about other owners of the bag.
In using a simple stimulus, an old bag, as a focal point, the group is able to
create characters. These characters can be used in other exercises. Owners of
the bag can act out the exchange of the bag from one to another. Scenes can
be played with the bag’s owner as the central character. The character can be
used in a situation that is yet unresolved by his or her creator, and so on.
The leader can always ask questions about the bag’s owner that may help
132 Using the creative arts in therapy and healthcare

the person describing him. If the description is very concrete, questions relat-
ing to emotion can be asked, such as ‘How does he feel about his job?’ If the
description is very abstract, the leader can ask questions that ‘anchor’ the
group member, for example, ‘What size of shoes does he wear?’
It is important to let the group member describing the bag’s owner know
that they are always right. They cannot say ‘I think he is five feet six inches’
for they are creating the character. The way the individual creates the char-
acter, the points they describe, the ones they avoid, particularly those dealing
with the character’s emotions, can be very valuable clues to completing the
three-dimensional jigsaws I have spoken about throughout this chapter.

Postscript
As mentioned elsewhere it should be stressed that the games and ideas pre-
sented here are starting points for therapeutic work, they are not the work
itself. This requires many years of training, something that can neither be
substituted by nor conveyed in a book.
However, in this chapter I have described some of the ways in which drama
can be used with people to awaken the imagination and create characters.
I have tried to emphasize throughout the close link between imagination and
dramatic action. Many groups are thought of as being incapable, unable to
take part, and yet my experience is that in almost all cases this belief is
unfounded. There are many with whom the process is a long, hard one but
when the results occur, when someone is able to allow their imaginative
thoughts to become action, to participate in dramatic activity, the wait and
the effort all seem worthwhile.
In working with any group, the only real limits to an individual’s taking
part in dramatic activities are time, patience and the limits of the leader’s
imagination. It is within the power of the human imagination to overcome
mental restrictions, physical limitations and emotional barriers and, in so
doing, truly to move mountains.

Acknowledgements
I wish to thank all the professional colleagues and friends for their advice,
encouragement and inspiration over the years and my students who have
taught me more than they will know; and above all my first mentor, the late
Bert Amies MBE, who is the single most important influence on my way of
working and my current profession.

Notes
1 Role flexibility can be seen as both a change of ‘social role’, e.g. from husband to
teacher to shopper to father to son, etc., but also it can be seen in terms of a change
 Drama 133

in ‘social status’ – dominant, equal or subordinate. In any set social role we may be
required to change status not only frequently but also rapidly during interactions
with others. Role flexibility is not only an essential skill for actors, but also invalu-
able in facilitating everyday communication. See Johnstone (1981) for a different
perspective on status interactions in relation to theatre.
2 Role and character are frequently used interchangeably in the literature. However,
when I speak of role play, I am referring to improvised dramas created by the
meeting and interaction of set role types, for example, student and teacher, traffic
cop and motorist. The responses of the types are left to the imaginations of the
individuals playing the role, but are based on experience and their general percep-
tions of that social role. However, the more information that is given about the role,
for example, name, age, favorite color, gender, marital status, occupation of parents,
etc., the closer one gets to a character with a known past history and probable
emotional responses to any given situation. The greater the detail, the more the
individual must respond ‘as if’ they were that character. This is, in essence, the basis
of naturalistic acting.
3 You cannot wash your hands too often. Wash with soap under warm water for as
long as it takes you to sing the ‘ABC Song’. If water and soap are not available, use
a hand sanitizer.
4 Extra helpers, whether volunteers or paid aides, can be a great help, but they can
also be a pain in the – ! Often, so much time is spent helping the helpers understand
a particular way of working, or an individual’s specific needs, that the moment is
lost. However, sensitive or well-trained helpers who support those in greatest need
without becoming too obtrusive can make the leader’s job so much simpler. Volun-
teer help is essential when working with individuals with profound disabilities.
Much of my time is spent recruiting and educating voluntary help from janitors and
kitchen staff as well as the more obvious professional colleagues and students.
5 When a player enters the circle, they enter a space where anything can happen.
When they become Dracula they transform the other players into both participants
in and spectators of the dramatic action. The game involves a costumed player
creating a character that involves the emotions of all other participants. As such,
this game demonstrates many of the quintessential elements of theatre.
6 From the recording of the group’s story a storybook can be produced. This book
can be used for people to read from. It can also be produced with large script and
lots of space between each word to allow the person to copy the word. This is not
new educational practice, but the material the person is learning from has been
created by them and this can affect the motivation to learn. Good results have been
achieved using this method with adolescents from inner city areas who are streetwise
but ‘learning disabled’.

Further reading
Boal, A. (1992) Games for Actors and Non-Actors, London: Routledge.
Courtney, R. (1980) The Dramatic Curriculum, London: Heineman.
Emunah, R. (1995) Acting for Real: Drama Therapy Process, Technique, and Perform-
ance, New York: Brunner/Mazel.
Gordon, D. (1978) Therapeutic Metaphor, Cuperdine, CA: Meta.
Grainger, R. (1990) Drama and Healing, London: Jessica Kingsley Publishers.
Jennings, S. (1973) Remedial Drama, London: Pitman.
—— (1997) Creative Drama in Groupwork, Bicester: Winslow Press.
—— (2006) The Handbook of Dramatherapy, London: Routledge.
134 Using the creative arts in therapy and healthcare

Johnstone, K. (1981) Impro, London: Eyre Methuen.

Landy, R. (1986) Drama Therapy, Springfield, IL: Charles C. Thomas.
Shaw, A., Perks, W. and Stevens, C.J. (1981) Perspectives: Drama and Theatre by, with
and for Handicapped Individuals, Washington, DC: ATA.
Spolin, V. (1963) Improvisations for the Theatre, Evanston, IL: Northwestern
University Press.
Warren, B. (1996) Drama Games: Drama and Group Activities for Leaders Working
with People of all Ages and Abilities, North York, Ontario: Captus Press.
Way, B. (1969) Development Through Drama, London: Longman.

Films
Breaking Free (1981), directed by Chris Noonan.
Feeling Good Feeling Proud (1981), directed by Richard Heus.
Chapter 9

Storymaking and storytelling

Weaving the fabric that creates
our lives
Cheryl Neill

Introduction
There are really only two kinds of stories: those that we tell to others and
those that someone else tells to us. While all stories are true (in the sense
that all are a reflection of different states of the human mind), they are
also metaphors for life experience; for they are mirrors in which we see
facets of ourselves. Good stories, like our dreams, are full of symbolic images
where different aspects of the psyche are highlighted. Our subconscious often
recognizes these symbols while our conscious mind does not.
When working with people in healthcare, rehabilitation or special educa-
tion settings, traditional methods of healing and therapy can be greatly
enhanced by storytelling and storymaking. Many of these individuals have a
preconception of the world, a rigid set of unconscious ‘truths’ which can stop
them from moving forward. The unconscious mind is very difficult to reach
by rational argument alone.
A reason for this is that opinions and views of reality are extremely well
guarded by what William James referred to as the ‘sentiment of rationality’.
This is the feeling of ‘rightness’ given to an opinion that then becomes the
only one accepted as rational. Although other opinions and explanations
may exist, the one chosen is the best liked and defended against all others.
Since it is best liked, it is rational. Here is a simple example: ‘I am overweight
because my mother overfed me as a child.’ Other obvious arguments could be
put forward such as I just like to eat, but because I like my argument I will
rationalize it and defend it.
This is what happens to some individuals who believe that the way they
view the world and their behavior is the only ‘rational’ way of seeing or
behaving. Arguing against such a view usually only causes them to cling more
stubbornly to their opinion. In fact, this ‘sentiment of rationality’ is very
resistant to logic and rational talk.
Herein lies the value of stories. Stories do not tackle these barriers head on;
they circumvent them by appealing directly to the unconscious. Stories are
also non-threatening since on the surface they seem non-invasive. After all, at
136 Using the creative arts in therapy and healthcare

any point in a story, listeners can decide that the story is not about them!
Even when the conscious mind has made such a decision, the unconscious
side may not agree.
Stories work on two main levels. One level appeals to the intellectual,
rational, left side of the brain that absorbs the plot and the spoken language,
dream imagery and symbols. This side is not interested in moralistic prin-
ciples and rational arguments. It is also not swayed by interpretive language,
rather it has an instinctive vocabulary and is the least guarded against new
ways of seeing or outside help. This phenomenon and other aspects of story
will be examined in this chapter, as well as how to choose, prepare and tell
stories to others.

The beginning of story

One spring I was working with a group of 11-, 12- and 13-year-olds in a
storytelling session. I had just finished a tale that described the great Greek
pantheon of gods – the one that speaks of the birth of Athena from Zeus’s
head and gives details of the magical hall of the deities on Mount Olympus.
I had no sooner finished when a young man, a serious thoughtful boy,
spoke up.
‘Now that makes sense to me,’ he said excitedly, ‘a god to look after
different areas of the world.’
‘What do you mean?’ I queried, knowing somehow where this was leading.
‘Well,’ he answered enthusiastically, ‘how can one god look after the whole
world and the universe too? I’ve always thought that there was something
wrong with that! It makes much more sense that there are lots of gods – each
of them having their own specialty – wind, sun, grass, animals – you know?’
‘Yes, yes,’ chorused others in the group. ‘That does make a lot more sense.
It’s too big a job for one god.’
The discussion went on a while longer and I thought of the phone calls from
disturbed parents I would be receiving as a result. To my surprise (and relief)
this didn’t happen, but still I was struck by the struggle of these modern
children, this enlightened progeny acquainted with ‘new science’, computers
and cellular phones, trying to understand, to make sense of their 2000-year-
old mythology. It reminded me of a quotation that came from the Gnostic
period: ‘The trouble with Yahweh [god] is he thinks he’s god.’ Obviously,
these children had come to the same conclusion.
One might not think that in today’s modern world anyone is much con-
cerned with these spiritual matters, but it has been my experience, working
in storytelling sessions with both children and adults alike, that symbolic
material, myths and legends in particular are not only firm favorites but seem
to feed a real need, especially as people feel more and more cut off from
nature, society and self.
Participants in my storytelling classes consistently choose to tell American
 Storymaking and storytelling 137

Indian and Eastern myths when given the assignment to prepare a story of
their choice to tell for others. Given the wealth of folkloric material available
to them, I found this curious. Then I realized that there was something about
these particular stories that grabs both teller and listener. In both traditions
there are many spirit gods, some not quite anthropomorphized, others in
animal guise. There is a wonderful respect for nature. These are in high con-
trast to our own heritage that stresses the superiority of man over beast, sees
a singular god as being outside the world and mankind and favors the taming
of nature rather than the nurturing of it. A totally different civilization and
way of living are experienced when the informing myth presents nature as
‘fallen’ (as in the Garden of Eden story) or seen as a manifestation of divine
presence on earth.
It seems that in these trying times, for people who are struggling to recon-
cile lifestyle with spiritual concerns, storymaking and storytelling that
include some mythological material which points to the revelation of divinity
in nature may help individuals to find a path that puts them in accord with
their surroundings.
The goal of all mythologies is to instruct the members of a given society on
their role throughout life; to put people in accord with the nature of life,
death and the universe. The basic motivating factors that govern the behavior
of human beings have not changed since early times. The life crises of birth,
initiation, marriage, separation and death are the same ones that have been
faced by humanity since time immemorial and these are still the main motiv-
ational forces today in all societies, despite historic modifications and differing
social systems.1
Mythology helps individuals to identify not with particular isolated inci-
dents but with the universal images that transcend time and place them in
accord with all those who have gone before and all those who will follow.
These rites continue to elevate the ordinary individual to the status of war-
rior, bride, widow or priest. These roles (and the accompanying rituals such
as weddings and wakes) are manifestations of the archetypes of myth. By
participating in the ritual, we are participating in the myth.
Down through the ages the custodians of the traditional, instructive ma-
terial of myth and legend have been the storytellers. They have held positions
of great awe and reverence and were counted upon to remember the past and
reveal the future. They were often thought, as in the case of the shamanic
traditions found in many places in the world (including the American Indian
and Inuit in North America), to walk amongst the very gods and to have
power over life and death.2
In all cases, in primitive times, the storyteller was not an ordinary individual
and the stories were not told for entertainment but for instructional and
transformational purposes. Myths were definitely not created by ordinary
folk. Their stories refer to psychological insights governed by natural environ-
mental factors. The images of virgin births, great floods and resurrections are
138 Using the creative arts in therapy and healthcare

found in most mythological traditions and seem to be examples of what Jung

refers to as a collective unconscious. Keep in mind that these are symbolic
images and not to be taken as literal fact. To concretize the symbol is to lose
its message. Mythology is a picture language and its goal is to transcend
history and to let the mind open to the great mysteries of life and the
universe.
Mythic symbolism was disguised in many pieces of literature. T. S. Eliot’s
The Wasteland (a reworking of the Grail legends from the twelfth century),
Robert Browning’s Childe Roland to the Dark Tower Came (towers are found
in all mythic traditions, usually representing the central axis of the world) and
James Joyce’s Ulysses (a familiar mythic frame to express ‘modern’ and per-
sonal feelings) are all examples of archetypal images disguised as profane
literature. There are hundreds more pieces that could be categorized in this
vein. Even today, our novels and films abound with symbolic imagery – the
search for paradise, the ‘perfect’ man or woman, the hero’s quest, slaying the
monster and life after death.
We can see that mythology still plays a dominant role in our lives and
material that is rich in symbolism needs to be sought out and rediscovered.
The question is, why do we need to tell these stories when television and film
can do it for us?
First, a story told orally allows listeners to imagine the hero, the monster,
the tower, in their own way. The symbolic figures will be painted according to
the needs of the individual. How disappointed I remember feeling when the
filmed version of a beloved tale did not match my own imagined one.
Second, there is a personalized feeling one receives when listening to a real
person tell a story. There is a human connection, a thread sustained by eye
contact and motivated by the audience’s mood or reaction to the material.
Third, there can be audience participation. In the old days most of the
stories were known by heart and the crowd was encouraged to join in on key
phrases or on parts that were sung.
Fourth, many stories are meant to be shared orally and do not lend them-
selves well to the visual medium. I am thinking of those where gods are
represented or supernatural events occur. Sometimes the special effects of
film are so special that the symbolism is lost in favor of the effect.
Personally (as more and more people are channeled into sitting in front of
computer screens), I feel the need for the oral tradition becomes almost
imperative. Many of our children see more of teachers than they do of par-
ents, and new technology is making even this human contact less and less
possible.
Storytelling has fallen on hard times and it will take great effort to restore it
to its rightful place. When trying to resurrect the art, we must search for
material that will hold meaning for today’s audiences. The wonderful thing
about most mythic stories is that they distance listeners from themselves and
allow the symbols to work on the unconscious level. The listener identifies
 Storymaking and storytelling 139

with the hero or heroine and can learn vicariously from the triumph over
great obstacles and hardships that are experienced or the tragic ending that
some characters face.

Choosing stories
Choosing stories is one of the most challenging tasks facing a teller. This is
particularly true if the objective of the telling is work in special education,
rehabilitation or healthcare settings on personal development or self-healing.
I will endeavor to help identify some meaty material and its uses in the next
section.

Teaching stories
There exists in almost every tradition a body of instructional material known
as ‘teaching stories’. These have existed in both oral and written form for
thousands of years. Examples that the reader may already be familiar with
are Sufi, Zen and many Christian and Hasidic stories. These works are not to
be confused with parables or fables, which although instructional in nature
tend to be more openly didactic with moralistic principles and values. True
teaching stories do not preach. Their distinctive feature is that (although
appearing to be simply entertaining) their inner content stays with you long
after the story is done. Also, in some cases, the listener may not even be aware
of external significance at all, until an event in their lives parallels the story in
some way.
For this reason, using teaching stories tends to be a little like learning the
procedures for fire safety. We review what to do, and this information is
stored in order to be prepared in case a fire breaks out. However, fires do not
happen every day. The knowledge of fire safety stays dormant in the brain
until the need for it arises. The same applies to teaching stories. When some-
thing in life triggers its memory it gives insight into human behavior and
thought, and often points past the individual human act to a greater and
deeper truth. They may be thought of as a kind of pattern of human response.
We can hold them up against our own lives and get some sense of what fits
and what does not. Most teaching stories are very ‘lean’. They do not make
superfluous points or add unnecessary characters. They are pure protein for
the inner mind, no fat, no cholesterol.
It is not the goal of teaching stories to give rational explanations for
human behavior. There is also no right way of interpreting these stories, no
right answers. When working with a group, comments on the story should be
confined to personal interpretations only – there should not be any comment-
ing on other people’s comments. All individual reactions are valid for the
person who has them; all interpretations or feelings true. It is often interesting
to help participants in these sessions to look for patterns in their responses.
140 Using the creative arts in therapy and healthcare

For instance, similar reactions to similar characters or behavior in a number

of stories may point to the way in which the participant holds the world. The
more opposed the reaction is, the more certain we can be that we have struck
an important note.
It sounds as though teaching stories are extremely powerful tools. The job
then is to identify teaching stories from other kinds of material.

Finding the story

First, there are books that are labeled teaching stories. Good libraries and
bookstores can be helpful to find them.
Second, look for traditional material; this includes myths, legends and
folktales. Generally speaking, the older the tale, the richer the inner content.
If it were not so the tale would not have survived for so long. A good example
of the kind of material that works well on both outer and inner contents
is the trickster tales of various traditions. Coyote, for instance, in North
American Indian legends is a trickster character. He is portrayed as a power-
ful, godlike figure one moment and a sniveling coward the next. The same
kind of figure is also found in the Turkish stories of Nasreddin (there are
various spellings). He also appears at different times as both a wise man and a
fool or as a teacher or a student. Two other popular trickster characters are
Loki of the Norse mythology and Jack of the Appalachian mountains in the
United States. Perhaps in all of these characters we find the dualism within
ourselves and this is the reason why these stories have remained so popular.
Another source for teaching stories is folktales. Not all are as rich as some
of the above material. However, some stories do strike a chord. You can
identify such a story if it stays with you after a few readings. Again, look for
stories that do not preach but seem to speak of some inner truth.

Myths
Of course myths come under the heading of teaching stories as well. Some of
these stories can be quite gruesome (witness many of the Greek myths as an
example). However, in most cases there is a certain satisfaction in the fact that
the characters in myth who show distinctive character flaws (greed, vanity or
disobedience) receive what they deserve. These stories can spark great debate
over whether the punishment meted out was too severe or not. It is interesting
that in the Greek tradition, as well as in many stories from the Christian
faith, obedience is the main factor for punishment in the story. This is con-
trary to other traditions, such as Celtic, Norse and Germanic myths where
disobedience often helps the character to grow in wisdom or strength.
Think of stories where there is a door that must not be opened at all cost.
Yet the hero is placed in the position where the door must be opened in order
for the kingdom to be saved or the elixir to be retrieved from evil hands.
 Storymaking and storytelling 141

Telling a variety of myths from many traditions is a good way to find out with
what basic belief system we identify.

Legends
When speaking of legends, I am referring to stories that are usually based
on historical figures in specific time periods. These characters are larger than
life – the figures have been endowed with almost superhuman qualities and
are able to transcend ordinary human possibilities. Again they are essenti-
ally tutorial in nature and most often contain the same symbols as myths.
The Grail legends of Sir Gawain and the Green Knight, King Arthur and
Lancelot come to mind; also, tales of Robin Hood. It seems to matter little if
the ultimate conclusion of the story shows the hero gaining a kingdom, a
princess or some other reward. The final success is the culmination of a
spiritual quest in which the individual (Robin Hood, for instance) against
great odds (the Sheriff of Nottingham and his men) earns a sense of himself
in terms of self-integration, wisdom and spiritual realization (Robin becomes
a man and takes his rightful place as leader of his people).
All these sources are good ones for meaty stories. The reader is encouraged
to discover material from a variety of traditions and to choose from as wide a
selection of stories as possible. Once you begin reading you will find that even
some newspaper stories parallel the teaching stories you have been reading
and are also excellent to use. Sometimes the line between life and art is indeed
a very fine one.

Simple folk and fairy tales

Some of the same symbols contained in myths and legends can be found in
simple folk and fairy tales. These stories are told primarily for entertain-
ment and are not purposely designed to instruct the individual on matters of
living with the order of nature, society and the universe. Most of the tales end
happily and were the pastimes of simple folk whiling away the days and
nights long ago. Nevertheless, one can still discern mythological motifs within
them. An example would be a character venturing deep into the forest who
suddenly hears a voice or meets a ‘helper’ sometimes disguised as a bird or
animal who points the way out of the woods.
These stories are now primarily for children and can be looked upon as a
form of children’s mythology. Many of the tales are about initiation into
adulthood expressed by killing dragons, crossing dangerous thresholds or
getting past a place where one is stuck in childhood (Snow White is an
example of this – the little girl goes to sleep until the prince comes and
awakens her womanhood).
Since these tales are not looked upon as real events (Little Red Riding
Hood is not a ‘real’ girl for instance) the symbols inherent in the material are
142 Using the creative arts in therapy and healthcare

able to do their work and can leave important subliminal messages for the
psyche.
Many tales contain vestiges of primitive beliefs and customs. Supernatural
tales, tales of animal magic and those fairies, gnomes and giants were all once
contained in the myths of the past. There are timeless images that we recog-
nize: the young man going off to seek his fortune, the little girl pondering life
while tossing a golden ball, the mother waiting for news of a son called to
war, all these and more speak of the eternal cycle of life and of concerns that
swirl in the deep waters of human memory.
Readers will find their own favorites. One can recognize a good story for
telling when it calls to you repeatedly. These are the ones that need telling as,
if they call to you, you can be sure they will appeal to others as well.

Telling teaching stories

As a rule, teaching stories should be repeated as faithfully to the original as
possible. This is because the wording has been mulled over and perfected
countless times to maximize impact. Try to stay with the vocabulary that is
used and avoid improvising new situations or dialogue for the characters.
Another distinct difference between telling teaching stories and regular
stories is that teaching stories should be told with as little personal inflection,
emphasis or judgment on the part of the teller as possible. The teaching story
is told slowly so that the listeners are encouraged to work on personal insights
without relying on the teller for clues. This takes a little getting used to as
most of us want to make our tales lively and full of personality. This will
work against the material in this case.
A cautionary note about these particular stories is not to tell too many in
one session. They were originally designed to be told one at a time so that
there would be ample time for reflection. I would suggest using only one or
perhaps two in an hour session.

Home stories
As mentioned before, there are two types of story, ‘theirs’ (teaching stories)
and ‘ours’ (home stories). There are those carried in the myths, legends and
folktales of a given society and those that are familial – told to us by parents
and relatives. It is the latter ‘home stories’, a term coined by Barton,3 that we
will deal with here.
Home stories form a substantial body of largely unconscious material that
provides the framework for what we may recognize as personal identity.
These are made up of an interwoven set of stories, rituals, customs and rites
that shape our world view, often causing this view to be held uncritically, and
give a sense of meaning and direction to our lives. These informing myths, as
Sam Keen calls them, have the power to propel individuals forward with
 Storymaking and storytelling 143

confidence in their ability and a healthy perspective on their place in the

world or they can stifle feelings of self-worth and leave people feeling power-
less to change their fate. Home stories can give the illusion of ‘no choice’ for
what is simply a judgment call.
We begin to receive these messages as children. Our ideas on self-worth,
race, color and creed are all part of this body of knowledge. We learn whom
to recognize as the good guys (our family, our country, our church), who are
enemies (foreign leaders, politicians, big business), what is right (look before
crossing the street, eat everything on your plate, love your mother), what is
wrong (hitting, communism), who to fear (the boss, the law), and whom to
imitate (daddy or mom). This information is absorbed and stored away in our
unconscious and is called upon when important decisions need to be made.
Statements such as ‘That is the way it is’ or ‘You can’t change things’ or
‘Welcome to the real world’ are a reflection of such a perspective on the
world. So is ‘It’s not like it was in the good old days.’
Of course the truths of one family may not be shared by others. Dys-
functional families, for instance, often share an inherited view of reality that
would seem abnormal to most. This view is very difficult to overcome in the
face of other ‘normal’ situations since reality is always shaped more on an
unconscious level than a conscious one. The illusion of ‘that’s the way it is’ is
very strong and difficult to change.
As well as these family truths there are also the larger societal ones that
help to form a larger accepted view of the world. Ours, in the Western trad-
ition, assumes that values such as free enterprise, democracy and competition
are fundamentally right. This largely unconscious assumption promotes both
obedience and action without discrimination within this framework.
Thus status quo and time-worn ‘truths’ become sacred, almost holy. It can
be seen that, unless there is a radical forced change to lifestyle, such as a world
war or depression, society will stick to the proven path, even when change can
be shown to be needed. (A good example of this is the struggle to revamp the
educational system – a large segment of the population is still clinging to the
‘back to basics’ movement.) Marshall McLuhan refers to the phenomenon as
‘a walk into the future while looking through a rear view mirror’. This picture
is further complicated by the media of television and film.
People are bombarded psychologically by ideals. Fashion is dictated by
soap operas and rock stars, eating habits by commercials. Heroes may be
created and villains exposed. Sometimes, as in the case of dealings with
foreign countries, people may be convinced that foreign leaders are the
essence of evil one week and our trusted partner in the global village the
next. This picture, obviously, can be very muddy and confusing to people
struggling to find their identity and role in society.
Consider also the names of our main streets: everywhere we see examples
of famous historical conquerors, generals, politicians and statesmen. Our
informing myth of competition and hierarchy is very clear. There are very few
144 Using the creative arts in therapy and healthcare

poets, painters, musicians or storytellers on this list. One can understand

the disillusionment in many young people when it begins to dawn on them
that the great North American dream of fame, money and power is but an
illusion for most and they are left awash in a sea of media-induced wants and
needs.
It becomes increasingly clear as we reflect on the above, that stories (par-
ticularly those of childhood) need to be put into a kind of perspective in
order to be dealt with objectively. For as Bernie Warren suggests: ‘From
the day we are born our lives are enmeshed in story. The way we talk
about ourselves and the way that others talk about us creates the story of our
lives.’ James Hillman stresses the great significance of story awareness in
childhood:

To have had stories of any sort in childhood puts a person into a basic
recognition of, and familiarity with, the legitimate reality of story per se.
It is something given with life, with speech and communications, and not
something later that comes with learning and literature. Coming early in
life it is already a perspective on life. One integrates life as story because
one has stories in the back of the mind (unconscious) as containers for
organising events into meaningful experiences. The stories are means of
finding oneself in events that might not otherwise make psychological
sense at all.4

So childhood conceptions are brought forward into adulthood and operate

within our daily lives. I have been concerned, as an instructor of storytelling
and storymaking, with uncovering these lost or buried pieces of the puzzle. In
order to deal better with external struggles, it is often very helpful to under-
stand the internal ones. This can bring new meaning to the term ‘know
thyself ’.
The activities that I use to uncover lost stories are designed to shed light on
otherwise forgotten material and the new or rediscovered insights to be help-
ful, eye-opening and often produce a feeling of nostalgia, empowerment and
well-being.

Techniques for learning and sharing stories

We have previously discussed the telling of teaching stories, which has a
separate technique from most other material. The next section concentrates
on looking at the components of most other stories and gives some exercises
to help develop skills to tell them.
 Storymaking and storytelling 145

General characteristics of story

Shape
All stories (with the exception of some North American Indian myths which
have no real ending per se) have three basic sections: the beginning, the
middle and the end. Each has a specific function or goal.
The first section or ‘act’ establishes the setting for the story, introduces
the main character, outlines the situation that propels the main character
into action and sets up the outer motivation of the hero/heroine – what
is to be achieved by the end of the story. The second section builds the
obstacles, impasses or conflicts that the main character must overcome. It is
also the section where character development takes place. The last section
contains the highest moment or climax of the story. The ending should also
resolve whether or not the hero/heroine has met the objectives set out in
section one.
Roughly speaking, the first section takes up about one quarter of the story,
the middle section about half and the ending about one quarter. If you are
telling a ten-minute story, then two minutes would be spent on the objectives
of section one, six minutes on section two and two minutes on section three.
A visual image of this is shown below:

1 2 3
Establish Build tension and characters Resolve

Conflict
All stories have problems, conflicts or hurdles that the main character must
face. Each of these must be made to seem greater and more difficult than the
previous one. If the teller makes the first obstacle as overwhelming as the last,
most difficult hurdle, without any break in the tension, the other obstacles
become a land of anticlimax. The idea is to make each challenge a little more
insurmountable than the last so that the tension of whether or not the main
characters will reach their objective is maintained. This is represented in
Figure 9.1.

Figure 9.1 Storytelling techniques.

146 Using the creative arts in therapy and healthcare

Pacing
The momentum of the story must build steadily as the main character pro-
gresses towards the climax (usually the last most difficult obstacle of all). The
pace must accelerate. This is done in two ways.
First, the gaps between hurdles or conflicts must become shorter and
shorter. There is consequently less time for the listeners to ‘catch their breath’
(‘catching breath’ is very important and discussed later).
Second, there should be an increase in the speed of delivery and an increase
in the intensity of the voice. This is sometimes accompanied by a shortening
of sentences which gives the illusion that the story is going faster.
Now, in order to maximize the impact of the final climax it is absolutely
imperative that the listeners understand what is going on in the story. It is
disastrous to have to stop and explain how the hero/heroine got into the mess
in the first place. If this happens, it is usually because not enough attention
was given to section one. The accelerated pace will not be maintained if
explanations are necessary at a crucial moment so be sure to emphasize the
story set up and tell it slowly and carefully.

Creating highs and lows

A story told from beginning to end in a highly emotional tone will leave the
listener emotionally uninvolved. This is because there is only so much emo-
tional investment a person can give at a stretch. Highly emotional moments
must be balanced by ones with less emotional impact so that the audience has
a chance to take a breath. Failure to do this creates a situation of overstimula-
tion where the audience becomes desensitized and emotionally distanced
from the story. A plot where there is non-stop violence, for instance, becomes
monotonous, even boring, if there is no break in the action. Think of each
intense moment as needing a set-up, a punch and a breather. The idea is to
maximize each emotional segment and ensure the listener’s emotional
involvement. A roller coaster is a good image to remember here.

The finale
The climax of the story is that scene, usually found in the third section,
where the hero/heroine meets the greatest obstacle. It is the highest emotional
point of the story. It must be unambiguous to the listener. The hero/heroine
either succeeds in achieving the goal or does not. Many novice tellers
writing their own stories spend a great deal of time developing the storyline
up to the highest climactic moment but fail to provide a satisfactory ending
because the main motivation of the hero/heroine has been left unresolved.
The audience must know at the onset what the character visibly or physically
hopes to achieve or accomplish and this must be resolved satisfactorily and
 Storymaking and storytelling 147

decisively at the end. This does not mean that all endings must be happy ones,
it means that the audience needs to be clear as to whether the character met
the objectives put forth at the beginning of the story.

Credibility
All stories have a kind of rule structure that must be adhered to in order for
them to be believable or logical. Even stories of gods with superpowers have
limitations within their unique universe. The teller must make sure that the
world where their characters reside appears to have a plausible structure. A
character cannot be dead one minute and alive the next, as an example, unless
it is clearly spelled out that this is possible within the boundaries of the
character’s world.
Characters must talk and act within the limits of their powers and abilities
and situations must appear logical. There must be compelling reasons why
characters act as they do or the listener will disengage from the story or not
stay in emotional accord with the character. This is why it is critical to outline
the setting and the abilities of the characters early in the story. Remember,
even Superman has his weakness and this is what makes him an engaging and
sympathetic hero.

The story in pictures

I find it helpful to see the story as a series of snapshots. I make a set of
pictures in my mind that gives me the order of the scenes. Then it is quite easy
to flesh out the action around each picture. I also list words or phrases that I
associate with each picture or episode and create an outline for each story,
creating enough to jog the memory. The idea is to keep this outline short so
that remembering it does not become more of a chore than learning the story.
I most emphatically suggest that with the exception of teaching stories the
teller does not memorize the story. Memorizing can be disastrous since a
forgotten line or phrase can make the mind go completely blank leaving the
teller truly at a loss for words. The teller should also be free to add details to
the story, as previously shown. This is what makes storytelling such an
appealing form. The story is new each time the teller begins.
However, I do suggest that the first line be memorized (just to get the
teller started with confidence) and also the last line (many tellers find it dif-
ficult to end a story satisfactorily). In this way, the teller is able to bring both
personality, style and response to the audience, to bear on the body of
the tale.

Physicalizing the story

One interesting way of practicing a story is to work on it as though it were a
physical exercise. The objective of the following exercises, based on Laban’s5
148 Using the creative arts in therapy and healthcare

principles for understanding the quality and range of the body’s movement,
is to make the storyteller as fluent and flexible in the use of body and voice as
possible. Laban’s techniques, which involve looking at human movement
along the continuums of time, space, force and flow, are widely used for the
training of dancers and theatre students. Below are some adaptations of these
exercises to help tellers visualize the motion found within the story.

Time
All stories happen within a certain time frame. As an example, a story may
take place over the space of several hours, days or years. The story has a
specific entry point where we meet the hero/heroine and a specific destination
or ending point.
We want to maximize impact in certain sections (the hurdles or conflicts
referred to previously) as we go along, and we also want the plot to move at
an accelerated pace as the hero/heroine meets the final climax and proceeds to
the final moments of the story. Try the following exercises and keep in mind a
story you are presently working on.

1 Walk at a normal pace around the room. Notice that your heartbeat is
steady and regular. Your body should feel relaxed, unhurried. Increase
the pace slightly and notice the feeling even this slight step up in
momentum gives the body. Build up speed until you are moving as fast as
you can without running. Notice the tension in your arms and upper
body.
2 Now stop and start with quick, sudden bursts (it is a good idea to have
one participant use a drum beat to indicate the stopping and starting).
What sensation do you now feel in the body? What effect does this type
of pace have on your heartbeat?
3 Return to normal pace and then slowly decrease your movement until
you are going at the slowest possible pace without stopping. What kind
of feeling are you now experiencing?

Keeping these exercises in mind it can be seen that combinations of a sus-

tained or increased pace in your story possibly using intermittent pauses or
slowing down can dramatically affect the body’s involuntary response to it.
Try doing the same exercises vocalizing a nonsense syllable like ‘aah’ as
you move. As your pace increases let the volume of your voice become more
intense.
This kind of variation is what the storyteller is trying for within the story.
Remember that the teller’s body language, the signs that this is a stressful
moment, is ‘read’ by the audience and is as important as the words themselves.
As for when to use a sustained or increased pace refer back to the section on
the shape of a story.
 Storymaking and storytelling 149

Space
Another concept directly related to that of time is that of space. All stories
take up a certain amount of space. Some move along directly to the point
with a sparse amount of extraneous detail as though in a rather narrow band
and others tend to meander, picking up threads of other characters, using
detailed descriptions of settings or objects and sometimes recounting asides or
adjunct stories about the main characters that may add to our understanding
of their motives or actions.
In order to physicalize this try the following exercises. It is always up to the
teller which technique will be used. No matter which one is chosen, both need
to be well under control:

1 Pick a point in the room. Focus on it ignoring all other objects around
it. Go there directly without losing sight of your objective. Do not let
anything else catch your interest.
2 Now, try going across the room to a new point. This time, however, allow
your eyes to be caught by different objects or colors. Focus on this for a
little while, even moving towards the new focus before returning to your
objective. Take your time and don’t feel that you are being rushed.

Some stories, those with a moral, for instance, often have a very narrow focus
both in the meaning itself and the language used to propel the story. It is like
the first exercise which is very controlled and purposeful. Some other tales,
such as those from the Irish tradition, are the opposite. The story seems to
meander off the point now and then as we learn more about the ‘root to
Paddy’s problems’, for instance, or as details are added in order to keep the
story from advancing too quickly. Do not be fooled into thinking that the
meandering technique is an excuse just to improvise instead of planning
the story carefully. Just as you would have to map out the route you took in
the second exercise in order to repeat it, the storyteller too must carefully plan
all asides or added information. Any extraneous material must be designed to
add to the impact of the story. Both techniques take practice. Remember that
too much meandering can obscure the hero’s motivation and the point of the
story can become lost.

Force
Every story needs to be considered in terms of force. By this I mean the
impact of the story on the listener. Is it subtle and light, like the touch of a
feather, or blunt and heavy? Much of the control of this has to do with the
teller’s body language and use of voice. Is the teller conveying the tension in
the story by lightening their own voice and muscles or is the body and voice
in neutral? To get an idea of the difference try this:
150 Using the creative arts in therapy and healthcare

1 Tighten your muscles slowly to the slow beat of a drum. As the drummer
increases the pace, tighten more. When the drummer produces one final
loud beat, crumple to the floor allowing the tension to flow from your
body. This is how the set-up, punch and breather mentioned previously
works. The set-up includes an increase in tension in both body and voice.
The tension and intensity of voice rises to a peak or climax and then
decreases once the climactic moment is passed so that the listeners are
allowed to rest. Remember the roller coaster ride!
2 Move around the room now as if gravity were of no concern. Picture
yourself physically rising up on each step. Think of the air in your lungs
and arteries turning to helium. It rises up through the top of your head to
escape. If you give sound to this you will probably notice the sound is
centered in your head somewhere behind the eyes. There are stories where
a far-away feeling is needed either for characterization purposes or as a
way for the teller to speak in a detached manner. Visualizing this exercise
may be helpful while telling in order to recreate this feeling of lightness
both for yourself and the audience.
3 Explore strong, firm, slashing motions. Move around the room taking
great strides. Notice your body’s commitment to each stroke and the
abrupt end to each movement. Add sounds to the strokes. Try to see where
this technique might be used to enhance the movement of a story. How
could it be used in a fast-paced action story with lots of excitement, for
instance?

Flow
The last of the four areas to explore is that of flow. This element is very much
connected to the qualities of space and force and time. I like to think of flow
as the kind of control the teller exercises on the other aspects above. Consider
these two polar opposites.

1 Bound flow. Remember the exercise of crossing the room directly, with-
out distraction? Try this same exercise but imagine you are doing so
while balancing a tray of very expensive glasses filled with champagne.
Even though your ultimate focus remains the same and the time it
takes to cross is roughly equal, the control of the body is very dif-
ferent. Without the tray, it is quite relaxed as you cross, arms swinging
at your sides perhaps. As soon as the tray is added, tension is also
added.
2 Free flow. Contrast the first exercise with this. Try turning the body,
slowly at first, in a circling motion. Increase the speed until you feel the
impetus of the outward pull on the body. When the energy is at its peak,
allow the movement to run out until it is spent or is stopped by some-
thing else (such as the wall or if you spin downward the floor). In free
 Storymaking and storytelling 151

flow, the movement is not controlled as in bound flow. Try adding sound
to these two exercises.

The teller must decide which kind of story they are telling. Does it need the
teller to appear very controlled from beginning to end or would a seemingly
more improvised style (as though the story has a momentum of its own) be
better? I like to think of the first one as a kind of precision march and the
second as a dance. Generally, myths and many folktales require the first while
fantasy stories and humorous stories, especially with chase scenes, require the
second.
All four elements are important, particularly with novice tellers. Vocal-
izing the exercises is also very good, since many people are timid about using
the range of their own voices. Exercises help to break down these barriers in
an acceptable format where no one is being put on the spot.

Gesture
A further area that I would like to mention is the teller’s use of gestures. The
teller must bring to life all of the characters, the setting and plot and theme
for each story. Gestures must be used to enhance the story and should not
detract from it. Nervous groping at buttons, tapping of feet or pacing and
fidgeting while telling can draw so much attention that the actual story is lost.
Be aware of body language and the use of the hands. Let gestures arise
naturally from the story. Some tellers are more animated than others. This
should not be stifled but should be under control.
These are a few of the components that make for a successful storytelling
experience. These can be mastered by the reader and then shared with their
own groups of inexperienced tellers. The main caution is to go slowly and
enjoy the reactions that occur when a story is well told. Each success will
encourage the teller to risk longer and longer stories and with a little practice
a fairly extensive repertoire can be built up. Storytelling is an art but with a
little dedication it is accessible to everyone.

Bow bended, my story’s ended;

If you don’t like it, you may mend it.
(Old ending for fairy tale)

Techniques for sharing home stories

One of the great causes of difficulties for people today, I feel, is brought about
by our emphasis on becoming something other than what we already are. It
seems that we are never good enough, smart enough, rich enough, beautiful
enough or happy enough. There always is more that we must do or be in
order to attain personal fulfillment. Consequently, the value of our lives as
152 Using the creative arts in therapy and healthcare

they are, the experiences we have had, are often viewed as rather dull, or at
best not terribly significant. Countless times I have asked beginning story-
telling groups, particularly teenage and young adults, to share a little about
themselves only to receive the ‘my life is really dull’ or ‘nothing exciting has
ever happened to me’ or ‘I have nothing to tell’ response. This seems to me
to be extremely significant. How can one find meaning in one’s life if one
doesn’t see anything of significance or value in it?
One of the great importances of sharing home stories is to bring to light
the experiences that shape us and to give them significance and hence mean-
ing. Home stories also promote, as shown previously, a new understanding
of these stories as the foundation of a unique view of the world, our own
personal sense of reality.

Beginnings
When beginning with a group about to examine home stories, I try to estab-
lish a trust level and intimacy that will allow for more personal material to be
shared. I do this in two ways: first, by sharing one or two of my own personal
stories, usually in a lighthearted vein to show that even the leader is human;
second, by encouraging participants to share details about themselves that,
while very low key and non-threatening in detail bring about a personal
knowledge of each member. The following activity, popular with many
storytelling animators, is a good one to begin with.

I am
We all receive a name at birth and this is a great place to start telling home
stories. Perhaps we are called after Uncle Herbert, our mother’s favorite
brother, or the doctor who delivered us. Maybe our name means ‘strength’ or
‘steadfast’ or ‘one who loves horses’ in another language. It could be that a
middle name is a former last name of a grandmother or great-grandmother.
Finding out about and sharing information about names and family gives all
members of the group both something in common and something unique to
share with others
There is something very special about knowing personal details about some-
one. It seems that by sharing, a bond is established. Perhaps this is because we
only share information about ourselves with those who are meaningful to us
in some way. The following activities lay a foundation of acceptance and
belonging for later work:

1 To stimulate interest and to help those who have no access to such infor-
mation, bring in books of name definitions – both given and surnames.
Allow time for research and informal sharing. Later, let each person
relate what they learned or already know about their names to a partner.
 Storymaking and storytelling 153

This may be further increased to groups of four, each person telling

about their partner, rather than about themselves.
2 Individuals may also bring in a family heirloom or an object that holds
significance of some kind for their family. Again, these may be shared
with a partner or in small groups (no more than five).
3 A third activity is to try to find out a little about their family history – the
country of origin, for instance, or an anecdote about a grandparent.
(Remember that we are keeping it simple at this point, no need to write a
lengthy tale or make it perfect. We are only trying to build a sense of
sharing within the group.)

In all cases keep these little beginning story fragments short and confine the
sharing to one to four people. Whole-group sharing can be very intimidating
to first-time tellers, especially those who feel isolated or powerless in their
daily lives.
Now, there may be some members of the group who do not have (or cannot
share for some reason) any history of their names or family or find it difficult
to talk about themselves at all. Perhaps their background is so troubled that
they need to develop confidence to face it themselves. In these and all cases,
participants should not be pushed to share information if they are not ready
to do so. In these first activities it is sometimes enough for some just to look
up their name origins in the book and to share the information. The more
accepting the animator is of the individual’s freedom to choose what is to be
shared, the sooner these participants will feel safe enough to reveal more
details about themselves.

My house
One of my favorite means of uncovering details of stories to do with the past
is based on an activity I discovered in a book called Telling Your Story by Sam
Keen and Anne Fox. This involves giving each person a very large piece of
squared paper and asking them to draw a floor plan (the inside) of the very
first house they clearly remember living in. It should include doors, windows,
closets and cupboards. They are encouraged to remember the kind of
furniture, wallpaper and floor coverings that were in this house, as well as
any other details that made the house special. Many people also include the
garden and garage if they were there as well. Here are some questions that
will stimulate memories while doing this activity:

1 What was your favorite room? Why?

2 Did you have a favorite hiding place?
3 What room if any was off limits?
4 What window gave the best view?
5 What room do you associate with family activities?
154 Using the creative arts in therapy and healthcare

6 Did you have a best friend? Where did you play?

Each person writes down snatches of ideas as they spring up right on the
paper after the floor plan is complete. This activity may take one session or
may be worked on over a series depending on the interest of the group. The
result is a rich supply of story fragments that may be shared in small groups
or with the group as a whole. Some of these may be developed into a longer
story for sharing as well.
I have seen participants become so absorbed in this ‘house collage’ that
they actually research pieces of wallpaper and textures of materials on sofas
and chairs and bring in samples to accompany their drawings. Others cut
facsimiles from old catalogues and paste them in place. No matter how it is
rendered, this activity always sparks a wealth of personal stories and it is
gratifying to watch as some hidden or obscure memory suddenly surfaces and
a group member eagerly shares an insight into the past.

Schooldays
Most of us have both good and bad memories of schooldays and these tend
to be quite vivid as they represent the first dealings with outside authority
figures, new exciting experiences, fears and frustrations and formal routine.
Much of who we turn out to be and how we view education in general stems
from this time.
Some of the attitudes of older participants can also be clearly related to
this period. ‘If it was good enough for me, it’s good enough for my child’, or
conversely ‘I hated school. I want my children to enjoy it.’ Some see it as a
kind of initiation that must be endured in order to reach adulthood: ‘I got the
strap lots of times when I was in school, but I survived it.’
I like to bring people back to their earliest recollections of school. With
some groups, I use the same technique as in the house activity, having them
create a map of their school, their route home, favorite game to play on the
way to and from school, etc. A floor plan of one particular schoolroom is
also an interesting place to begin, as is a physical description of a teacher who
stands out in their minds in some way (either because they were exceptionally
mean or exceptionally nice). Here are some questions to help focus the group:

1 Do you remember the first time you were in trouble at school?

2 Who was your favorite teacher?
3 Who was the meanest teacher?
4 Did you ever skip school in favor of another activity?
5 What games did you play during free time?
6 Who was your best friend?
7 Were you ever picked on by others? Did you ever pick on anyone else?
8 What rules do you remember from this time?
 Storymaking and storytelling 155

There is usually a great deal of discussion around this topic and these story
fragments are once again very rich in detail. Some people elect to write those
memories down in a kind of diary and these in turn often trigger other
remembrances as well (such as vacation times, after-school activities and field
trips).

Heroes and villains, friends and enemies

Many of those figures whom we consider to be heroic or villainous are a
consequence of a kind of societal consensus as we have seen. Still, it is often
quite revealing to go back and look at who was held up to us by our family as
either a pillar of society or as an example of evil. We may often gain insight
into our value system, beliefs and prejudices (either conscious or unconscious)
by examining our past:

1 Who did your parents hold as examples of good citizens?

2 Who did they discourage or forbid you to play with?
3 What causes or ideas were championed in your house?
4 Do you remember any incidents that involved prejudice of some kind?
5 What behavior was frowned upon (either by members of the family or by
neighbors, friends, etc.)?
6 Who was your hero/heroine?
7 What qualities did you admire in them?
8 Does this still hold true today?
9 Who was your best friend?
10 Who was your enemy? Why?

There are many topics under home stories that could be examined in the above
manner. These include religion, fantasies and dreams, fears (superstitions,
strange events, first public performance, first time away from home, etc.),
initiations (first dates, dares, forbidden places) and deaths (pets, relatives).
When dealing with home stories, it is not really important that they are told
the right way. The emphasis in fact is in the discovery process and on the
personal insight that comes from uncovering the hidden story. It will be less
inhibiting to both the teller and the listener if the structure for sharing the
tales remains loose and above all non-judgmental in format. The stories
should be allowed to flow freely for their own sake.
Sometimes tales of surprising clarity and quality are brought forth and,
of course, these are a welcome gift. But it is the spirit of the tales that binds
the group, leaving everyone with a sense of discovery and insight into the
complex forms of human nature and behavior.
156 Using the creative arts in therapy and healthcare

Stories just for fun

We have seen that stories have great power. They point to connections
between the past and the present and can inform us of our innermost feelings,
fears and hopes. But what about telling just for the fun of it? This is probably
the best reason of all to share stories! Here are some of the activities that
I have used in my own sessions for no other reason than to share them.

The tall tale

A tale is an exaggerated story that is intended to make the listener laugh. A
good way to give novice tellers the idea of how a tale might grow out of
proportion is as follows. Ask three volunteers to leave the room. Have the rest
of the group seated in a circle and tell the following little story:

Once there was a man who was not used to country living who came to
visit a cowboy way out west. One day he was out for a walk when he came
upon a snake pinned down by a boulder that had rolled off a cliff. He
released the rattler (for it was a rattlesnake) and won its eternal gratitude.
It followed him like a pet dog everywhere he went and even slept at the
foot of his bed at night.
One night, the man awoke with a start, feeling something was wrong.
The snake was missing from its accustomed place. The man went out to
the kitchen, feeling a draft from that direction. Sure enough, the window
was open and there was the snake with its body tightly wrapped around a
burglar, with its tail hanging out the window, rattling for help!

Ask one volunteer to come back into the room. Let someone who just heard
the story retell it. The first volunteer then retells it to the second volunteer
who has been brought back into the room and then the second repeats the
story to the third volunteer. The third volunteer tells the story a final time to
the group. It is interesting to notice:

• how different each version is from the last and whether details are altered
• the choice of words each teller uses
• whether the teller uses a dialect to embellish the story
• if the punchline stays the same in successive tellings.

Liar, Liar, Pants on Fire

This activity encourages the participants to really exaggerate the details of
their stories. The idea is to take a perfectly normal activity such as getting up
in the morning or eating lunch and to exaggerate it all out of proportion.
I usually ask the participant to recount either that morning’s activities,
 Storymaking and storytelling 157

something that has happened to them recently or something they saw happen-
ing to someone else. There is no particular order to the tellings. Each volun-
teer begins where the last person left off, trying to connect the story in some
way to the previous one.
For example, if the last tale was about a really bad start to the day, the
next teller could begin by saying, ‘Hah! you think that was a bad morning?
Listen to this’ and then tell the tale. In this way, the tellings become a kind of
collective, flowing from one story to the next.
The tellers should also be encouraged to have a reason for telling the story.
For instance, it might be to make the audience feel sorry for them or to make
them laugh or to make them believe they have superhuman qualities!

Superman, Wonder Woman

Ask the group to tell what attributes they associate with superheroes. Share
these informally in round-robin fashion. Each person should now imagine a
superhero of personal choice and ‘become’ that person. He or she may be in
disguise during the day as an ordinary individual, but at night or in times of
crisis turns into . . .
Give them one of the following situations to build the story around (they
could also make up their own if they wish):

1 There are thieves breaking into a bank in the middle of the night. Tell
how you foil their plans.
2 There is a damsel in distress. She is floating down a fast-flowing river on a
log. There is a waterfall around the next curve. Tell how you bring her to
safety.
3 There is a giant earthquake or volcano eruption and the government call
on you to stop it. Tell how you save the day.

I knew her when

Recite the following little poem:

There was a maid on Scrabble Hill

And if not dead she lives there still
She never drank, she never lied,
She never laughed, she never cried.

Ask participants in small groups of three or four to do the following

activities:

1 Write down what they know about the maid. These are facts they can
glean from the poem.
158 Using the creative arts in therapy and healthcare

2 Write down what questions they might have that are not answered in the
poem.
3 Write down who might know the answers to their questions (i.e. neigh-
bors, relatives, friends, etc.).
4 Now ask one person in each group to become the person they would
most like to question. Let the rest be reporters, historians, police officers
or someone else who might be interested in the maid. Let each group
have about five or six minutes to question their ‘witness’, then elect one
person to report their findings to the group.
5 Each group can then prepare a group telling of what they think is the real
story behind the poem of the maid. They should do this in a round-robin
fashion where each person tells a portion of the completed tale. These
tales are then shared with the whole group.

It is fun to work with existing dialogue, script or printed material and then to
find the hidden story lurking just underneath the surface. The same technique
works well with portions of novels. I try to take a section from a book that
leaves lots of questions unanswered. It can be right at the beginning of the
story or at the climax. There is no right or wrong of course. The participants
are free to tell the story based on the story fragment in their own way. It is
often interesting to go back and read the original book to see the author’s
version.

Postscript
Throughout this chapter on storymaking and storytelling I have tried to show
the great value, even the need, of sharing stories, both our own and those of
others. We live in interesting times where technological advancements and
artificial intelligence make it difficult sometimes to remember our humanity.
Through the reawakening of the inner mind, through storytelling, we partici-
pate in our common heritage and come to sense the fundamental mysteries of
being, in which we all share. The activation of our imaginative life, the life that
is inside, is one of the most challenging tasks open to us, both personally and
professionally. If our technology is an expression of our intelligence, then our
stories are an expression of our soul. The balance lies somewhere between.

Notes
1 M. Eliade, The Myth of the Eternal Return, Princeton, NJ: Princeton University
Press, 1974, p. 5.
2 M. Eliade, Images and Symbols, Princeton, NJ: Princeton University Press, 1991,
p. 26.
3 B. Barton, Tell Me Another, Markham, Ontario: Pembroke Publishers Ltd, 1986.
4 J. Hillman, ‘A note on story’, Parabola 4(4), 1989, 43.
5 R. Laban, Modern Educational Dance, London: MacDonald and Evans, 1975.
 Storymaking and storytelling 159

Further reading
Anderson, H.C. (1861) Danish Fairy Legends and Tales (trans. C. Peachey), London:
Henry G. Bohn.
Arkhurst, J.C. (1964) The Adventure of Spider: West African Folk Tales, Boston: Little
Brown.
Barton, B. (1986) Tell Me Another, Markham, Ontario: Pembroke.
Bettelheim, B. (1989) The Uses of Enchantment, New York: Random House.
Campbell, J. (1949) The Hero With a Thousand Faces, New York: Princeton University
Press.
Campbell, J. (1990) The Hero’s Journey, New York: Harper and Row.
Chase, R. (1943) The Jack Tales, Cambridge, MA: Houghton Mifflin.
Crimmens, P. (2006) Drama Therapy and Storymaking in Special Education, London:
Jessica Kingsley Publishers.
Curtis, N. (1907) The Indian’s Book: An Offering by the American Indians of Indian
Lore, Musical and Narrative to Form a Record of the Songs and Legends of Their
Race, New York: Harper and Brothers.
Eliade, M. (1974) The Myth of the Eternal Return, Princeton, NJ: Princeton University
Press.
—— (1991) Images and Symbols, Princeton, NJ: Princeton University Press.
Erdoes, R. and Ortiz, A. (1984) American Indian Myths and Legends, New York:
Pantheon.
Feldmann, S. (1965) The Storytelling Store: Myths and Tales of the American Indian,
New York: Dell.
Gersie, A. and King, N. (1990) Storymaking in Education and Therapy, London:
Jessica Kingsley Publishers.
Grimm, J. and Grimm, W. (1972) The Complete Grimm’s Fairy Tales, New York:
Pantheon.
Hamilton, E. (1942) Mythology, Boston: Little Brown.
Hillman, J. (1989) ‘A Note on Story’, Parabola, 4(4): 43.
Keen S. and Fox, A. (1989) Telling Your Story, Los Angeles: Tarcher.
Laban, R. (1975) Modern Educational Dance, London: MacDonald and Evans.
Opie, I. and Opie, P. (1974) The Classic Fairy Tales, Oxford: Oxford University Press.
Perrault, C. (1957) Fairy Tales of Charles Perrault (trans. G. Brereton), Harmonds-
worth: Penguin.
Ransome, A. (1968) Old Peter’s Russian Tales, London: Thomas Nelson.
Rasmussen, K. (1921) Eskimo Folk Tales (ed. and trans. W. Worster), London:
Glyldendal.
Rosen, B. (1988) And None of It Was Nonsense, Richmond Hill, Ontario: Scholastic
Tab.
Sawyer, R. (1970) The Way of the Storyteller, New York: Penguin.
Shah, I. (1979) World Tales, New York: Harcourt Brace Jovanovitch.
Shedlock, M.L. (1951) The Art of the Storyteller, New York: Dover.
Wilson, B.K. (1989) Scottish Folktales and Legends, New York: Oxford University
Press.
Zipes, J. (1983) Fairy Tales and the Art of Subversion, New York: Weldman.
Chapter 10

Creating community
Ensemble performance using masks,
puppets and theatre
Wende Welch

Anyone who has ever worked in the theatre will say that the experience is
anything but private. Creating theatre involves many people working together,
ultimately to communicate something to someone else. Theatre cannot exist
for and of itself; it is only complete when it is performed for an audience.
It depends on human interaction.
In this way, theatre can be seen as a microcosm of life itself. Just as we
weave in and out of the events, crises and victories that occur in our lives, so
too does the theatre artist. The agents of these events comprise the many
relationships we are constantly building, maintaining or destroying through-
out life’s journey. Though the relationships between characters in a play may
seem contrived, this should not lead us to believe that they are any less valid
than our real life relationships.
The appeal of the theatre lies in the desire to witness and experience the
mystery of human survival in extraordinary circumstances. The actors com-
mit to the playing of their parts for an audience who wants to see them
succeed. The pursuit of human achievement, reaching and perhaps surpass-
ing one’s potential, offers the participant and the spectator an opportunity
to unite and celebrate the joy of life. In this way, theatre demands a sense of
community for its success. It requires the joint effort of individuals coming
together to pursue a common goal.
The arts serve this purpose by enabling an individual – or group of indi-
viduals – to express themselves, to communicate their ideas through whatever
medium they choose. Providing the opportunity for this self-expression
places responsibility on the community to expose individuals to the various
forms of art. The chance for individuals to enrich their lives through artistic
endeavors not only stimulates personal growth but also builds confidence
through a sense of achievement. The result is a community that benefits from
such capable and functioning members.
Theatre is a medium that can be used to create an environment where
integration can occur.1 The collaborative nature of theatre lends itself to the
exploration of artistic expression as a collective. This is what many theatre
artists refer to as ensemble. Ensemble means together. The spirit of ensemble
 Creating community 161

implies an unselfish support for the others with whom one works in harmony.
The strength of a group is only as strong as its individuals. When integrating
persons with disabilities into a theatrical environment, I have found that
creating an ensemble proves both a necessity and a boon for all involved.2
Under such circumstances, the combined efforts and talents of the collective
ideally balance out to involve as well as serve the immediate needs of each
individual within the group.
Ensemble theatre can be used effectively in an integrated setting as an aid
to increased self-expression, and therefore self-awareness. In addition, imagine
how such exploration might affect the individual’s involvement in the greater
community in which they live.

Mask and puppetry

Masks and puppets can be any inanimate object brought to life through
human effort before an audience.3 They both belong to a family of theatre
animation that has existed for centuries in many different cultures. The dra-
matic function of mask and puppetry is not unlike any other performing art
form. Essentially, it strives for communication between performer and audi-
ence: the actor, musician, dancer, singer or puppeteer shares something with
the spectator, who in turn responds, thus reinforcing the will of the performer
to communicate. This creates a constant cycle of exchange that unites the
performer and audience. The success of a performance depends on the degree
to which both performer and audience are willing to accept and commit to
this interaction. The result is a shared human experience on many levels:
intellectually, physically, spiritually and emotionally.
However, where some performing art forms might achieve this experience
based on a subjective approach, mask and puppetry choose an objective
presentation to fulfill the same function. For example, an actor playing a
character in a play will elicit a different response from each audience member
simply because human beings see other human beings differently. Their
responses to the actor’s appearance, the sound of his or her voice, the way he
or she uses his or her body, and how he or she makes use of these to play the
character will naturally vary according to personal taste. However, a mask or
a puppet has one expression. It intends to capture the essence of an emotion
or character trait. The audience immediately distinguishes the good character
from the evil character. Mask and puppetry operate on less sophisticated
principles, thereby making the theatrical convention easier to accept. This is
directly responsible for the success of mask and puppetry with both children
and adults.
The art of mask and puppetry mirrors that of the theatre, but adds another
level. Discovering the reality of the inanimate object – the mask or the puppet
– goes beyond using only one’s body and voice to communicate with an
audience. The performer must develop a relationship with the mask or puppet
162 Using the creative arts in therapy and healthcare

to breathe life into it. This should not be mistaken for hiding behind the mask
or puppet, using it as a crutch, transferring the responsibility for any action
or thought on to the object itself. It is up to the performer to explore fully
the potential of the mask or puppet: what is it capable of doing, feeling and
saying? The answers to these questions lie in the ability of the performer to
objectify the emotion of the character. Only then will the mask or puppet speak
and delight its audience; when bond between actor and mask or puppeteer
and puppet is an organic one, and therefore imperceptible.
Theatre with mask and puppetry can aid in building a sense of ensemble in
an integrated setting. The first step involves learning to relate to an inanimate
object. For those with certain developmental disabilities, this may come easier
than having to relate to another human being. For others with severe physical
disabilities, such interaction may only be possible with the help of other mem-
bers of the group. Through playing, relationships begin to form as communi-
cation occurs between the individuals and the masks or puppets. Discovering
the character of the mask or puppet requires the individual to explore
imaginative ways of using their body and voice. This may lead to increased
self-awareness and the confidence to express oneself. In an integrated group
setting, participation fluctuates between doing, helping and observing. A
sense of ensemble grows as individuals begin to trust and support one
another. All of this work must ultimately serve the final step – the perform-
ance. Such a challenge rewards each individual with pride in their achieve-
ment. The discovery and realization of the individual’s contribution to the
whole has involved the group in reaffirming the need to create community.

Workshops
The following are suggested activities designed to warm up the individual’s
voice and body, in preparation for the creative work to follow. The warm-up
should be a group activity, as a sense of ensemble must be implemented from
the beginning. In an integrated group setting, all workshop activities may
require assigning individuals to assist those with a disability. In such cases,
the focus of the exercises becomes an investigation of how to help one
another to perform the given task together.

Voice 4
When warming up the voice, try to incorporate exercises that stimulate the
body as well as the mind. For our purposes in the theatre, and specifically
with mask and puppetry, emphasis should be placed on breath support,
amplification of sound using the various vocal resonators, and the articula-
tion of thoughts and feelings organically. The voice is inside the body. We
release it when we feel the need to express ourselves.
Breath support begins with an awareness of the body. Ideally, the skeleton
 Creating community 163

acts against gravity to support the body, relieving the muscles of that duty,
leaving them free for movement. When this occurs, the breathing musculature
responds freely, providing a more efficient support for the voice. Try rolling
up and down the spine. Roll the head, shoulders and arms; raising and releas-
ing arms, elbows and wrists – all with an increased awareness of the breath
moving freely in the body.
Allow those with limited physical capabilities to work within their own
range of movement. If they require assistance, encourage one or two other
members of the group to help guide that individual through the exercises by
gently moving the head, shoulders, arms and wrists for them. Working
together in this way should only be attempted with the consent of the indi-
vidual and if there is no risk of jeopardizing their physical condition. Avoid
rolling down the spine. Similar results can be arrived at by having someone
cradle the back of the individual’s head and jaw in their hands, while another
supports the upper arms. Gently lift the head and arms straight up, allowing
the spine to hang and the muscles around it to relax. Note increased awareness
and freedom of the breathing muscles.
Humming provides a gentle means for waking up the resonators in the
body, face and head. Feel the voice rumble, buzz or ping in various parts of
the body while collecting vibrations on the lips. Then open the mouth and
release the sound. Use vivid images that excite the mind and involve the voice
and body in play: animals, insects, vehicles, industrial noise, carnival sounds,
etc. Encourage interaction during these exercises.
Articulation implies clear speech. However ‘correct’ pronunciation won’t
move an audience without clear thought behind it. This point proves doubly
vital for mask and puppetry, where articulation governs the animation of the
mask or puppet. Effective communication through a mask or puppet requires
precise speech and movement. Developing a sense of rhythm can help achieve
this. Singing, preferably accompanied by some movement or dance, offers a
comprehensive warm-up and unites the group. Here, you may choose to divide
the group into smaller groups of twos, threes or fours, creating a less awkward
and crowded environment for the sake of integrating with those individuals
with a physical disability or those who have a visual disability. Singing in
rounds offers an ideal warm-up for an integrated group and could prove a less
threatening activity for those with developmental disabilities who need extra
encouragement.

Body
A gentle stretch should precede and follow any physical activity. Animating a
mask or a puppet for the first time may painfully awaken muscles one never
dreamed one had. Pay particular attention to the neck, shoulders, arms,
wrists, hands, fingers, waist, lower back and calves. Again, offer physical
assistance to those who ask for it, within their range of movement capability.
164 Using the creative arts in therapy and healthcare

The following simple playground game is a thorough actor’s warm-up in

disguise. It sharpens listening and memorization skills, stimulates the body to
respond to changing circumstances, builds concentration, hand–eye coordin-
ation and physical stamina – and is fun!

Water babies 5
For this a soft ball, approximately 10 cm in diameter, is required. In a circle,
each individual in the group calls out a number, beginning with one. This
number becomes theirs for the game and they will need to remember it, as
well as those of the others. (If you chose to use this game in an orientation
session, you may wish to substitute names for numbers.) To begin the game,
one individual stands in the centre of the circle, throws the ball straight up
into the air, and calls out a number (not their own). The individual whose
number was called must now catch the ball. If they catch it, they throw the
ball back into the air, calling out a new number. If they miss it, they must first
retrieve the ball and then call ‘freeze’. When someone has missed the ball, the
others in the group must flee to the perimeter of the defined play area before
that individual calls ‘freeze’.
Once ‘freeze’ is called, the others must stop and remain motionless. Fixed
to the very spot from which they called ‘freeze’, the caller must now throw the
ball at one of the ‘frozen’ others. If the ball touches someone, that someone is
given a ‘water baby’ and must begin the game again from the centre of the
circle; if the ball touches no one, the individual who called ‘freeze’ is given a
water baby and must begin the game again from the centre of the circle. Once
an individual has received three water babies, they are out of the game. Water
babies are also given to an individual who calls the number of someone who
is out of the game or who calls their own number.
Water babies can be adapted for an integrated group. Have those who have
a visual disability play the game hand in hand with a seeing individual, shar-
ing the ball tossing and catching responsibilities. Those with physical dis-
abilities may require an able-bodied partner – to aid in tossing and catching,
as well as moving around the circle. Using eye contact and calling the indi-
viduals’ names (instead of numbers) may succeed in involving those with
developmental and/or learning disabilities. The group dynamic becomes a
network of support, with everyone eager to coach any individual through the
game, as long as they need help.
The creative work now begins by building performance skills. The follow-
ing exercises incorporate mask or puppetry dramatically in an improvisa-
tional context. The group leader should come prepared with several masks
and puppets for use in the workshops. At this stage of the work, it is import-
ant to inspire the group with well-made, three-dimensional puppets that are
large, colorful and full of character.6
 Creating community 165

Journey through the body 7

The group begins by lying on their backs on the floor (those who use wheel-
chairs need not lie on the floor). With their eyes closed, encourage the group
to relax every muscle in the body (guide them though this). As they begin to
relax, remind them to pay attention to their breathing rhythms and placement
in the body. Then ask each individual to imagine their ideal mode of trans-
port. It can be anything from their past, present, future or fantasy life. Allow
them to learn everything they can about their chosen vehicle (ask questions
pertaining to size, age, color, interior/exterior, speed). At this point, inform
them that they are going on a journey through their body, using their vehicle.
However, their vehicle will only run on ‘breath’, so they must stay aware of
their breathing to make the journey. Ask the group to put themselves in their
vehicles and then either guide them through the journey or leave them to
make it in their own time (allow 10–20 minutes for this).
You may need to pair certain individuals with developmental disabilities
with a partner for the duration of the exercise. Avoid closing the eyes and
lying on the floor. The partner should keep the individual’s interest in the
exercise stimulated by constant questioning and sharing of information
about their vehicles and their journeys through the body. Making drawings or
using toy vehicles may prove necessary.
When everyone has completed their journey, ask for volunteers to share
their experience with the group. They must do this dramatically, using either
a mask or a puppet. This means relating to and through the mask or puppet
to engage the group in a storytelling experience. Focus initially on developing
the relationship between actor and mask or puppeteer and puppet. Once this
has solidified, then gradually encourage interaction between the mask or
puppet character and the group. Speech need not be the only form of com-
munication here. Other forms such as song, mime or dance may be used
effectively in conjunction with mask or puppetry. Remember, in an integrated
group there will always be those available to help individuals with a disability
to animate a puppet or to share the experience with them before the group if
this is necessary. This should be done dramatically, to support the individual
and to collaborate creatively in the telling of their story.

Blind drawing 8

PART 1

Scarves for blindfolds, large newsprint paper, charcoals and ‘wet ones’ towels
will be needed. Begin with the group comfortably seated at a table or on the
floor. Ask each individual to tie a scarf around their head, covering their eyes.
Do not insist on the blindfold. Those who aren’t ready to trust this concept
may either close their eyes or focus anywhere but on the paper in front of
166 Using the creative arts in therapy and healthcare

them. Then, hand each individual a sheet of newsprint paper and a piece of
charcoal. Next, give the group a word that will inspire them to draw whatever
they associate with that word. Stick to abstract words like love, anger, depth
or music, as they tend not to have a single representational picture. Once they
‘see’ a picture in their mind’s eye, they may begin to draw it. No peeking!
Once a drawing is complete, remove the blindfolds and share them. Before
doing any more drawing, hand out towels to clean the charcoal off hands,
fingers, arms, faces, etc.
Those with limited upper body mobility may require a partner to hold the
paper for them, support the arm and/or hand as they draw, or even to draw
for them. If the last is chosen, have the individual rest their hand on their
partner’s, moving with them as they draw.

PART 2

For this you will need 6 ft × 4 ft cotton drop(s),9 high-intensity flashlights,

sheets of thin cardboard, markers, Stanley knives, scissors, fishing wire,
garden wire, paperclips, rivets and scotch tape.
Divide the group into smaller groups. Have each of these small groups
review the drawings and choose one they all agree on. Then give the groups
some time to explore moving in a way that the picture suggests to them.
Introduce the concept of shadows by giving each individual a chance to move
between the cotton drop (held by two individuals) and the flashlight (held
by one individual). Taking what they’ve just learned from using their bodies
to make shadows, have each group build a shadow puppet capable of moving
in the same way. They will quickly understand what the cardboard, markers
and wire are all for and begin tracing and cutting away with great enthusiasm.
Allow ample time for this phase, for here the notion of ensemble is put to
the test. The groups are thrown into a situation where they must work
together, sharing ideas and coming to agreements every step of the way, to
produce the final product. They must also learn to integrate by delegating
roles and responsibilities based on the individuals’ capabilities. Be available to
answer questions and offer technical advice, but try to let the groups do any
problem-solving themselves. Finally, have each group present their shadow
puppet and give a demonstration of what it can do (relating back to the
original drawing).

Sock puppets
You will need socks with toes cut horizontally for the mouth; felt-covered
cardboard oval shapes for the inside of the mouth; needle and thread or glue
gun; assorted odds and ends for facial features; and hair – buttons, felt
shapes, yarn, etc.
Sock puppets offer a friendly incentive to communicate and interact with
 Creating community 167

others. They are easy to build and fun to animate. Most sock puppets have
mouths used for speaking, but they are also used for grabbing, tugging, lifting,
holding, throwing, catching, plucking and digging, among other things. They
can rejuvenate a group and bring focus back to the work at hand.
Sock puppets also provide an enjoyable means for developing articulation
and rhythm skills.10 Bring in tapes of popular music that the group can all
relate to (the Beatles are always a safe bet). Place a group of puppeteers
behind a makeshift storyboard11 and have the rest observe as audience. Watch
how the puppets’ lip sync the lyrics and dance to the music. Give everyone
a chance to perform and to observe.
Where the puppeteer positions their body in relation to the puppet
becomes an important consideration, especially when changing direction.
Working behind a storyboard makes everyone sensitive to the spatial rela-
tionship between bodies, especially when there are puppeteers who use wheel-
chairs. Encourage the group to adapt by learning to share space and making
room for everyone.

Neutral mask 12
Essentially, neutral mask technique attempts to wipe the slate clean, so that
the actor is left with a neutral base upon which to build a character. Neutral
mask is not an end in itself, it is a process. At a glance, the exercises them-
selves seem fairly straightforward. However, once the expressionless mask
covers the face, any extraneous, idiosyncratic movement becomes glaringly
apparent. The goal here is not to move like a robot. Rather it is to strip
movement down to the bare essentials necessary to complete a given task.
This requires that the individual think about each step they make, and its
intention. This moment-to-moment concentration on the present toward the
future is the actor’s thinking process, and must be developed for the sake of
ensemble performance.
The workshop leader should come prepared with at least two neutral
masks. It is much easier to make them than to buy them (the leather Sartori
neutral masks, made in Italy, would cause a pronounced deficit in most
budgets). The masks I use are an adaptation of the Sartori masks. I build up a
papier mâché form over a three-dimensional styrofoam mould covered with
petroleum jelly. I then reinforce the papier mâché foam with plaster of Paris
gauze strips and secure an elastic band at both sides (Figure 10.1).
There are several schools of thought surrounding the actual putting on of
the mask. Some recommend a period of contemplation, studying the mask
for an increased understanding of every layer of its character, before putting
it on. Others prefer to work with the mask on right from the start, allowing
the character to unfold as the body takes on the rhythm and energy of chosen
images. Once the mask is on, some insist on working in front of a mirror,
whereas others may rely on the impressions and comments of the instructor
168 Using the creative arts in therapy and healthcare

Figure 10.1 A neutral mask.

or director. Either way, it really comes down to a matter of personal prefer-

ence, based on training, experience and appropriateness for the group in
question.
Once the mask is put on, a visible (to the audience) and tangible (for the
actor) transformation occurs. Those who have worked with mask will often
speak of the ‘energy’ or ‘personality’ of the mask, which is no wonder as a lot
of imagination has already gone into the creation of the mask. Perhaps
several actors have already put on the mask, adding to its own personal
history with their creative energies. The mask is a powerful tool for communi-
cation and should, therefore, be handled with care and treated with respect.
You will undoubtedly encounter those in the group who either fear the
mask or won’t wear it. Never force the issue of the mask. Rather, encourage
those individuals actively to participate by observing others in the exercises
and giving constructive feedback afterwards. Watching others tackle the exer-
cises first may give some the courage they need to try the mask themselves.
Or, you may find it necessary to pair individuals in the exercises. The same
principles of neutral mask would apply. Only now there’s the added benefit
of two actors learning to communicate with and be aware of each other in
the work.
There may also be those in the group who haven’t full control of their
motor skills and for whom it may appear impossible to exercise any economy
of movement. Neutral mask is a mental and physical challenge for everyone,
 Creating community 169

regardless of disability. Part of integration involves learning to appreciate an

individual’s movement as a reflection of who they are. Why deny anyone the
right to express themselves or the chance to develop a keener understanding
of how their body can serve them creatively?
The first set of exercises allows the individual to discover their neutral base
through improvising in a given situation. Feedback on the exercises serves to
make the individual aware of what they may be consciously or unconsciously
communicating with their body. It may be clear in the mind of the individual
what they are doing or feeling, but are they making it clear enough for an
audience to understand?
The second set of exercises gives the individual the opportunity to begin
building on the neutral base they’ve achieved in the first exercises. Here, the
individual learns to tap into their physical resources by calling upon the body
to explore the different rhythms and energies suggested by certain images.
Participation must obviously be limited to the number of masks available.
More than four individuals at a time makes it difficult to watch what each one
is doing. The defined play area (stage) may only be used by those participat-
ing in an exercise. The rest of the group must observe the exercises from the
periphery (audience).

First exercises
Ask those participating to assume a comfortable resting position either by
lying on the floor or by totally relaxing in their wheelchair, on stage with the
masks on. In their own time, they are to do the following:

1 Get up, look at the horizon, then resume resting position.

2 Get up, look at the horizon, see an object (real or imaginary) before you,
take it, use the object, place it back where you found it, look at the
horizon, resume resting position.
3 Get up, look at the horizon, see your bus before you, move as quickly
as you can to try to catch your bus as it is pulling away, watch it drive
away, turn and move back to your original position, turn and look at the
horizon, resume resting position.

Give everyone in the group a chance to do an exercise before moving on to the

next one. Ask those participating to remove the masks once everyone on stage
has completed the exercise. At this point, encourage those observing to give
constructive comments based on what they saw.

Second exercises
Begin the same way as in the first exercises. Ask those participating to think
of an image. It could be anything representational that pops into their mind:
170 Using the creative arts in therapy and healthcare

the sun, a cloud, a flower, a raindrop, a brick, a tornado, a camp fire, etc.
Once they all have an image, give them time to think about what it might feel
like to be the sun or a flower. Whatever feelings come, instruct them to fill the
body with those feelings. This provides the impetus for movement. As they
begin to explore the movement, they will naturally fall into a set rhythm.
Once they have a established a rhythm, ask them to begin moving around the
stage. If anyone loses their rhythm, chances are they’ve lost their concentra-
tion and should return to their resting position to rekindle their original
impression of the image.
Steer them away from a tendency to fall into clichés. It is not important
that they look like a flower; it is far more useful as an actor to understand
how it feels to be that flower, and to communicate that fact to an audience.
Likewise, discourage them from playing the mask at this point in the work.
The neutral mask intentionally takes focus away from the face, forcing the
actor to communicate with the body.
The next step involves removing the neutral mask to allow words to come
organically from the character emerging from the movement. This step can be
made more accessible with the use of animal imagery. Repeat the above exer-
cise, only now ask each individual to think of an animal. Stick to familiar
land mammals, birds and reptiles. Fish and water mammals pose a problem
because they exist only in water.
Once they begin to move, they immediately take on the nature of their
chosen animal, for example, the kitten plays with yarn, the dog lifts his leg,
the squirrel collects nuts, the snake slithers through the grass, etc. Being able
to relate to the animal’s reality makes it easier for most people to begin
interacting with the other ‘animals’ on stage. Encourage them to find a reason
to meet. If a particular couple or threesome appears to have tapped a poten-
tially dramatic relationship, coach them from the floor on to their feet. Ask
the actors to ‘hold’ and have several observers go on stage and remove the
masks. It is important here for the actor to drop the notion of animals and
move on to applying the animal’s qualities and energy to the development of
a human character.
The actors should continue developing the relationship as they move. The
circumstances for the relationship mixed with the animals’ energies give the
actors the reason to speak. Begin with sound that is released as an extension of
the movement, and therefore rooted in the body. Gradually, move to words and
watch an improvised scene unfold before your very eyes! Later, commedia dell’-
arte masks may be added to objectify and exaggerate the character’s qualities.

The process
Now the work becomes more focused. We have been building skills for a
purpose: to introduce each individual to the craft of mask and puppetry so
that they may now use these skills to explore the art. At the same time, they’ve
 Creating community 171

learned to adapt those skills to suit the needs of an integrated setting. Further
exploration will now unite the group by taking them on a journey that begins
with rehearsals, continues through the building of masks, puppets, costumes,
sets, etc. and culminates with the actual performance. The process cannot,
and should not, be avoided. The process enables the ensemble to grow and
mature. The foundation for trust in an integrated group requires a shared
commitment covering time and experience. With trust comes confidence in
oneself and in others. This must be in place in order for each individual to
make the transition from rehearsal to performance.
The decision to rehearse, build and present theatrical performance using
mask and puppetry begs one primary consideration. Masks and puppets
must begin as an integral part of the concept for the performance. First,
masks and puppets are not props. They are the characters of the play, and
in some cases even become actors themselves, playing beside their human
counterparts. Second, the relationship between mask and actor or puppet
and puppeteer must be given the chance to develop. Any inconsistency here
would guarantee a superficial performance.13 This can be prevented if the
group becomes comfortable working with masks and puppets (those built for
the performance or cardboard mock-ups) from day one. Animation with
masks and puppets demands sensitivity and practice. Introducing them as an
afterthought would disrupt the harmony of the performance and demon-
strates a lack of respect for the art form.

Rehearsals
The following suggestions offer two approaches to building material for a
collective performance. I recommend building material over a script for several
reasons. In an integrated setting, adhering to a specific text and blocking it
(that is setting the actors’ stage movements and ‘business’) might prove too
sophisticated a proposition for some groups. The material to be performed
must remain flexible enough to accommodate the unpredictable behavior of
certain individuals in the group with developmental disabilities. If the words
and accompanying movement originate from them, the concept of interacting
as characters by allowing words and movement to serve the characters’ inten-
tion in the action of the performance becomes a less foreign proposition. Also,
building material for a performance calls for the active participation of the
ensemble at all times. Using a script may persuade some to separate themselves
from the ensemble and concentrate only on what they’ve been given. There-
fore, allow the ideas for the performance to stem from group involvement.14

Storytelling
Assorted masks and puppets, or cardboard mock-ups will be required.
I developed my own approach to storytelling while working with Das
172 Using the creative arts in therapy and healthcare

Puppenspiel Puppet Theatre on their adaptation of Jumping Mouse. I’ve

since used it for gathering material for collective creations and street theatre
performances.
Divide the group into subgroups of three to four individuals. Give each
subgroup a structure from which to build their story. This structure is arrived
at by plugging in each one of the variables in the box to complete the equation.

Method Media Situation Conflict

Narrator, Mask Who, What
Brechtian, + and/or + Where and + Obstacle
or Realism Puppets When

Under the Method heading I’ve listed three choices. Narrator implies that one
character is to tell the story, while the others act it out. The Brechtian method
allows for all the characters to switch between narrating and acting out the
story. Lastly, Realism simply requires the characters to act out the story with
no narration.
An example of this approach was used to create a street theatre perform-
ance I directed with an integrated cast. They chose: (Brechtian) + (Mask) +
(Mouse, running away from home, to the circus, in the early morning) +
(must help his new friend, a Lioness, escape the inhumane conditions and
abuse she has suffered at the hands of the ringmaster). From this scenario, the
group worked together to flesh out the story, adding other circus characters,
improvising sound effects and music and using their bodies as the actual
circus tent. The group saw to it that everyone had a part to play, and when
they weren’t directly involved in the storytelling, individuals would provide
the soundscape or become part of the set.
In this particular group, there was an individual with a developmental
disability who often grew restless and would wander away from the rehearsal.
The group eventually solved this problem by bringing the entire rehearsal to
them, thereby refusing to allow the work to be interrupted and reminding the
individual of their importance and responsibility to the group. Throughout
the rehearsal period, the group used neutral and character mask exercises to
harmonize the energy and movement of the animals with the masks.

Theme-based performance
This approach follows a more loosely structured formula. The effect
resembles that of a collage: an assemblage of separate scenes that share a
common theme. With such compositions, the continuity or throughline
becomes the theme itself, and not the chronology of any one story. Theme
pieces also lend themselves to an eclectic blend of performing arts, taking full
advantage of the spectacle aspect of theatre.
 Creating community 173

I collaborated on a street theatre performance with an integrated cast,

using a carnival theme. The size of the group (over 20 people) permitted us
to give each person performance as well as production responsibilities. The
following illustrates the breakdown of these responsibilities.

Performance areas
• Punch and Judy scene
• King and Queen of the carnival
• Commedia dell’arte scene
• Clowns
• Sideshow acts
• Maypole dance
• Kazoo marching band

Production areas
• Finding and building
– masks and puppets
– sets, props and costumes
– musical instruments
• Painting
– scenery
– masks
– puppets
• Make-up workshops.

Under such circumstances, I’ve found that the success of the rehearsal process
rests with the ability of the director or instructor ‘to provide an atmosphere in
which creation can take place’.15 This can be done in any number of ways,
from ensuring a clean and clutter-free rehearsal space to rotating activities to
keep the work fresh and interest alive. During this part of the process, every
effort must be made to encourage the individual to believe in their ability to
contribute in a useful way to the project. The more familiarity breeds a sense
of ensemble, the more the individual will feel comfortable with sharing their
ideas and cultivating them in a creative way.

Building masks and puppets

There is much to consider before sitting down to build a mask or puppet:

1 How many masks or puppets are needed? Could some characters be

174 Using the creative arts in therapy and healthcare

played with a mask instead of a puppet, or vice versa? How many actors
and/or puppeteers are required to animate them all? Is it possible for
them to play more than one role?
2 Who are the mask or puppet characters? Which of their personality traits
should I emphasize? How do I want the audience to feel about each
character?
3 How is the mask to be used? Must the actor speak or not? Must the mask
change expression or shape?
4 What must the puppet do? Speak? Handle and use objects? Fly or swim?
Eat? Come apart? Breathe fire?
5 Where is the performance to be performed? Indoors (with or without
lighting) or outdoors? In an intimate setting or a larger venue?
6 What size should the masks or puppets be? Do they fit the scale of the set
or storyboard? Do they fit the scale of the venue?
7 What is the required lifespan of the masks or puppets? Will they be used
once or twice or over a period of weeks, months or years? Will they be
transported from place to place frequently?
8 How much can be spent on materials? Is there a cheaper way to achieve
the same desired effect? Can found household objects be cleverly used?

Masks
Suggested materials are: cardboard, markers, Stanley knives, scissors, fabric
scraps, trimmings, carpenter’s glue, contact cement, 12-inch balloons, pieces
of foam core, various styrofoam shapes, cheesecloth, paperbags cut into
strips, multicolored construction paper cut into strips, plaster of Paris strips,
petroleum jelly, acrylic or tempera paints, small to medium paint brushes,
elastic strings and bands.

Masquerade, half-masks
This type of mask was built for the maypole dance sequence in the carnival
street theatre performance mentioned earlier. The outline for the mask is
drawn with markers on a piece of thin cardboard. Use scissors or a Stanley
knife to cut out the face, eye holes and any other details drawn. Poke holes at
either end of the mask. Thread the elastic string through holes, knot and
staple into place. Apply glue to the front and back of the mask. Stretch fabric
over the mask and add trimming.
For a more three-dimensional look, sculpt foam core pieces in the shape of
eyebrows, cheeks and noses. Attach the foam pieces to the face of the mask
with contact cement. Measure out the elastic band and attach both ends to
the back side of the mask with contact cement. Allow to dry before stretch-
ing cheesecloth over front and back of the mask. Using a brush, cover the
entire mask with a mixture of carpenter’s glue and water. Be sure to keep the
 Creating community 175

desired shape of the mask. Allow to dry before painting with acrylic or tempera
paints (Figure 10.2).

Character, full masks

Here, I would recommend building the mask on a mould. Ready-made plastic
masks make suitable moulds and can be found at the larger theatrical supply
or craft stores. You might also check Chinese souvenir shops. A simpler way
would be to use an inflated balloon. Blow the balloon up to the approximate
size of the individual’s head and tie a knot at the end. With a marker, draw on
the balloon where the eye, nose and mouth holes will be as well as the peri-
meter of the mask. Treat the inside of the marked area with petroleum jelly. Dip
the paperbag strips in a mixture of carpenter’s glue and water and arrange
them within the marked area on the balloon. Remember not to cover the eye,
nose and mouth holes. Allow to dry before adding the next layer.
Once the second layer has dried, you may want to build up facial features.
This can be done by sculpting and arranging pieces of styrofoam on the
mask. Set the pieces in place with carpenter’s glue and secure them by adding
a layer of wet plaster of Paris strips over the entire mask. For a more colorful
alternative, cover the mask with several layers of construction paper strips
(solid or multicolored) dipped in the same glue and water mixture as before.
Once dry, gently lift the mask off the balloon. You may find it easier to pop
the balloon. Acrylic or tempera paints can be used on the plaster of Paris

Figure 10.2 Half masks.

176 Using the creative arts in therapy and healthcare

masks. Attach an elastic string or band as described above, substituting

plaster of Paris strips for the cheesecloth.
You can expedite the process by using the individual’s face as a mould.
This method takes about an hour, during which the individual must sit or lie
still and not move a muscle on their face. Some individuals may not wish to
place themselves in what they perceive to be such a vulnerable or terrifying
position. However, those who wish to try could donate their masks as moulds
for the others to use. Have the individual sit or lie down in a comfortable
position. Ask them to tie their hair back from their face and to remove any
jewelry. They should either wear an old shirt or wrap an old towel around
their neck and shoulders. Spread a thin layer of petroleum jelly over their
entire face. Then, apply a single layer of wet plaster of paris strips directly on
to their face. Do not cover the eyes, nostrils or mouth. If need be, these areas
can be covered with a second layer once the mask is removed from the face.
Allow to dry and harden before lifting the mask off the face. I’ve found this
experience most enjoyable and relaxing, particularly if the entire group is
involved all at once and there is music playing in the background. You may
then choose to add more layers, build up the facial features, add paint or
simply leave the mask as is.

Puppets
Suggested materials: head: styrofoam balls (4–6 inches in diameter), large
cardboard boxes, foam core sheets (1 inch thick), toilet paper and paper towel
tubes, various styrofoam shapes, carpenter’s glue, straight pins, paperbags
and multicolored construction paper cut into strips, cheesecloth, yarn or
burlap threads, trimming, acrylic or tempera paints, small, medium and large
brushes; body, arms and legs: an assortment of colorful and contrasting
medium to heavyweight fabrics, cotton muslin, stuffing, wire coat hangers,
wood dowelling, pliers.

Hand puppets
This type of puppet was used for the Punch and Judy scene in the carnival
street theatre performance mentioned earlier. The head and neck of the pup-
pet consist of a toilet roll tube and a styrofoam ball. Treat one end of the tube
with carpenter’s glue, then insert it into the styrofoam ball. From here, follow
the same basic procedure as with the masks. Sculpt facial features out of the
styrofoam shapes and arrange them on the face of the puppet. You may wish
to trace the features on to the face first before gluing them on and pinning
them in place. Then, use the papier mâché technique described above to add
several layers of either the paperbag or construction paper strips to the entire
head and neck of the puppet. For such small work, you will need to use
smaller pieces of the paper. Allow for drying time between layers. Once dry,
 Creating community 177

the puppet’s face, head and neck may be painted. You may wish to attach
other trimmings for the eyes, mouth, nose or ears (especially if the hand
puppet is an animal). Arrange yarn or burlap threads and glue on to the head
for hair.
While one individual or group builds the head, another could build the
body of the puppet. Building the body of a hand puppet takes no time at all if
you have access to either a sewing machine or a glue gun. A simple smock-like
pattern can be traced or cut out and pinned on to double-width fabric (shoul-
ders at the fold). Make sure the length of the smock will cover both the hand
that is animating the puppet and most of the forearm. Stitch or glue (right
sides together) two side seams, from the underside of the arms down to the
base of the smock. Little mitt-like hands can be traced, cut out of cotton
muslin, and sewn or glued together in the same manner. Stitch or glue the
open wrists of the mitts to the open armholes of the smock (again, right sides
together). Now, turn the whole thing right side out. Glue the open neck of
the smock to the tube neck of the puppet. Pin, stitch or glue on extra trim for
collars, hats, vests, aprons, jewelry, etc.

Rod puppets
Follow the same procedure as used for hand puppets but with a few adjust-
ments. Primarily, this kind of puppet is animated with rods and not with the
hand and fingers. Therefore, you will want to make some sort of adjustment
to the head and neck area as well as to the body. Try gluing and inserting a
piece of coat hanger or thin dowelling into the top or back of the puppet’s
head. Bend a hook into the coat hanger or add a wooden knob to the dowel-
ling to improve the grip. This kind of adjustment enables the puppeteer to
animate the puppet in front of them and on the floor. If you wish to play the
puppet overhead, behind a storyboard, use a paper towel tube instead of
a toilet paper tube for the puppet’s neck. The longer tube now becomes the
rod for head animation.
The body of a rod puppet is usually more detailed than that of the hand
puppet. So, adapt the smock pattern to include arms, hands, legs and feet.
When tracing or cutting the pattern, keep the arms and legs wide and long.
Make the body out of cotton muslin. Stitch or glue right sides together,
leaving the neck open. Turn right side out and stuff the body with light-
weight, synthetic stuffing. I recommend stitching joints for wrists, elbows,
shoulders, hips, knees and ankles as you stuff the body. Glue the body to the
neck of the puppet. If your puppet has the paper towel tube for a rod, make a
slit in the fabric, from lower to middle back, to slip the tube through. Scout
the thrift stores, jumble or garage sales for baby and children’s clothes to
dress your puppet in. Later, you may wish to add two more rods at the wrists
or at the elbows, especially if you are animating the puppet overhead.
178 Using the creative arts in therapy and healthcare

Larger than life sized rod puppets

These were used for the King and Queen puppets in the carnival street theatre
performance mentioned earlier. The heads were cut out of the sides of large
cardboard boxes. A layer of thin foam core was glued to the front and back
of the cardboard. The foam scraps were sculpted to form facial features.
Cheesecloth was then stretched over the head and brushed with the glue and
water mixture. Multicolored papier mâché substituted for the actual painting
of the faces. Burlap threads served for the hair and beard; Mylar scraps and
fancy trim were combined to make the crowns.
The bodies of the King and Queen puppets were basically two crosses,
composed of 2 inch × ½ inch slats (shoulders) with a hole drilled through the
middle to accommodate long, 1-inch thick dowelling (body). Cardboard tub-
ing had been inserted into the puppets’ heads in order to secure them on top
of the dowelling. The cotton muslin hands were pinned to two large, heavy
pieces of fabric draped over the shoulders as regal robes. Rods were inserted
into the hands to aid in animating the arms.
Adapting the process for an integrated setting involves making mask and
puppetry accessible to everyone. A strong sense of ensemble, therefore, is
necessary to achieve this goal. This support system must ideally meet the
needs of every individual in the group. For some, it is a sense of achievement.
For others it is knowing that they’ve helped one another to achieve some-
thing. It could be as simple as animating a rod puppet with three puppeteers
instead of one, or building a mask and constantly asking for input or sugges-
tions. Time restraints and safety considerations may require that many of the
materials be prepared in advance. For some individuals, mixing and matching
the finished pieces may prove a more accessible introduction to mask and
puppet building.

Performance
Who is the group performing for and why? Again, it comes down to com-
munication. The added element of a private or public audience allows the
group to take the process one step further. That is to say, the time has come to
share the story with someone new. By focusing on the process and not the
product, the group maintains a clear perspective on the work. Process brings
us back to ensemble and the notion of working together to produce some-
thing. With an integrated cast, ensemble performance becomes a balancing
act. It seeks to even out the scales by reducing any disparity in talent or
ability.
In the carnival street theatre performance, Judy was played by a puppeteer
with a visual disability. Her way of adapting to the experience was to set
markers along the inside of the storyboard that she could feel with her left
hand, while the right hand animated the puppet. This way, she knew exactly
 Creating community 179

where to make her entrances and exits. The puppeteer who played Punch
helped to make puppetry accessible to her by staying in constant physical
contact with her and the puppet.
In this regard, it becomes apparent why we bother with mask and puppetry
in an integrated setting. Some individuals require the added reinforcement
of character that masks and puppets provide.16 Mask, puppetry and theatre
combine to bridge, visually and orally, any communication gap between
performer and audience.
The benefits from such a performance reach everyone involved. The experi-
ence yields an enormous sense of pride in the performers. It also promotes
public awareness. Sharing the work with and for others may eventually suc-
ceed in conquering social stigmas surrounding disabilities in general, in favor
of a healthier and more productive sense of community.

Notes
1 I use the term integration to describe ‘the full, active and equal participation and
acceptance of persons with disabilities into the society in which they live. A key to
implementing this idea is to provide persons with disabilities the most “normal”
environment possible in all areas of social life, which includes, in addition to
education, employment, housing and medical care, the ability to participate in
social, cultural and leisure activities’, quoted in R. Richard, ‘A descriptive analysis
of two approaches to the use of drama with persons with a disability’, unpublished
MA thesis, Concordia University, Montreal, 1992.
2 I use the term disability or disabilities to refer to ‘a condition which makes the
completion of a task or tasks more difficult. This condition may be sensory,
intellectual or physical in nature’, quoted in B. Warren ‘Integration through the
theatre arts: responses to theatrical performance integrating persons with a dis-
ability’, unpublished paper, 1991.
3 I must acknowledge Bil Baird, renowned American puppet master, for this
definition.
4 The concepts and exercises presented here stem from my own voice training. I have
chosen to adapt and simplify them for the purposes of this chapter. They are
discussed in greater detail in K. Linklater, Freeing the Natural Voice, New York:
Drama Book Publishers, 1978.
5 This game was introduced to me by Dean Gilmour, a Toronto-based theatre artist
and clown, to whom I am also indebted for my knowledge of neutral mask, clown
and commedia dell’arte. I’ve adapted his Le Coq-based mask exercises to suit the
needs of this chapter.
6 C. Astell-Burt, Puppetry for Mentally Handicapped People, London: Souvenir
Press, 1981, p. 44.
7 I first did this exercise as a part of my actor voice training with David Smukler at
York University. I have since adapted it for my work with mask and puppetry.
8 Enid Kaplan, an artist and a dear friend, shared this exercise with me as a tech-
nique for tapping into and trusting one’s creative resources. I’ve chosen to take the
exercise one step further, by including the actual building of puppets.
9 I use the term cotton drop (known also in the theatre as a scrim or cyclorama) to
refer to any size, white or natural cotton fabric, stretched taut, on to which light
and images are projected. In the case of shadow puppetry, the image (puppet) is
180 Using the creative arts in therapy and healthcare

animated flush against the stretched cotton drop, with the light source (here, the
flashlight) defining the image from approximately 30 to 60 cm away (recom-
mended for a 6 ft × 4 ft drop). The puppeteer(s) should position themselves
outside the beam of light; otherwise they will destroy the illusion (with their own
shadow) for the audience, viewing the image from the opposite side of the cotton
drop.
10 This is actually ‘muppeteering’ technique, and the exercises were those taught
to me by muppeteer Gordon Robertson.
11 A storyboard provides a proscenium style playing area for marionettes, hand and
rod puppets. The puppeteers are masked from the audience’s view, animating the
puppets from behind the storyboard. The puppets play to the audience from inside
a picture frame stage (proscenium). In the case of the marionette, the puppeteers
animate the puppets from above the stage; with the hand and rod puppets, the
puppeteers animate them overhead. The colorfully striped booths used for Punch
and Judy shows illustrate a classic example of a storyboard. A makeshift story-
board, therefore, can be any structure used to mask the puppeteers from the
audience, to focus attention on the puppet(s). It could be as simple as a table
turned on its side, or a cardboard refrigerator box with a picture frame window cut
out. The cotton drop described in Note 9 may also serve as a makeshift
storyboard.
12 See Note 5.
13 C. Astell-Burt, Puppetry for Mentally Handicapped People, London: Souvenir
Press, 1981, p. 46.
14 C. Astell-Burt, Puppetry for Mentally Handicapped People, London: Souvenir
Press, 1981, p. 103.
15 L. Appel, Mask Characterisation: An Acting Process, Carbondale and Edwards-
ville: Southern Illinois University Press, 1982, p. 7.
16 C. Astell-Burt, Puppetry for Mentally Handicapped People, London: Souvenir
Press, 1981, p. 109.
Chapter 11

Arts for children in hospitals

Helping to put the ‘art’ back
in medicine
Judy Rollins

Hospitalization has long been recognized as a stressful experience for every-

one, but research indicates that it is especially difficult for children. With
proper support, however, children can survive and even grow from the hos-
pital experience. In recent years we have come to recognize that the arts can
play a signifiacnt role in that support1.

What hospitalization is like for children

A dominating feature of childhood is children’s sense of powerlessness and
lack of control over what happens to them.2 Possibly nowhere is this more
evident than when children are hospitalized. This sense of powerlessness,
added to their illness and limited understanding, increases their vulner-
ability.3 Children are not simply smaller versions of adults; they are con-
stantly growing and changing. Thus, not only do they experience illness and
hospitalization differently than do adults, but they also experience it differ-
ently from one year – or even one day – to the next.4

Stressors of hospitalization
Many stressors are inherent in hospitalization. Upon admission, children are
required to submit their small bodies to adult control and restriction. They
are rarely permitted to refuse or even delay treatments, medications, and
procedures. In the passive role of patient, they are poked and prodded, con-
stant recipients of ‘things’ being done to them, things they may not fully
understand, which leaves them feeling powerless and confused. Coupled with
limited opportunities to make meaningful choices, emotions often are intense
and confusing.5

The hospital environment

Hospitals seethe with the unfamiliar. Children hear strange sounds, and
also very loud ones, especially in intensive care settings. For the baby in an
182 Using the creative arts in therapy and healthcare

incubator, even the popping of an envelope when opening rubber gloves can
be as loud as a pneumatic drill.6 High levels of noise can result in disengage-
ment from the environment; extreme noise may further promote a sense of
helplessness and powerlessness. However, sounds do not need to be loud to be
troublesome. For example, hearing a child crying softly in another room can
be frightening for other children. They may wonder why the child is crying,
what the child did to cause this to happen, and ‘Are they going to do the same
thing to me?’
Children are faced with many strange sights when hospitalized. From cords
or wires on walls that look like monsters at night, anything can be scary if
you do not know what it is. They see many strangers, usually over 50 in their
first 24 hours of hospitalization. The observation below describes a common
hospital scene:

The wards are reached through a very long corridor on to which spill
visitors, staff, relatives, doctors discussing patients, and patients. There
are doors to toilets, more corridors, A&E [Accident and Emergency],
wards, shops and operating theatres. Some of the doors have signs which
say ‘Emergency theatres’ and there are people standing around in their
theatre greens, very old and ill looking people on trolleys, and people
who look like your next door neighbor walking around in their slippers
and nightwear. It certainly is a slice of life, some of which will never have
been seen before, particularly by young children.7

We often underestimate the effects of the sense of smell, which reaches more
directly into our memory and emotions than any of the other senses. Medi-
cinal smells can produce anxiety, and unpleasant odors can increase heart
rate and respiration. Illness and medication may alter the sense of taste, which
is related to smell, so food, if the child is able to eat, may taste bad, or simply
be different from that served at home. Further, treatment may require nasty-
tasting medicines or preparation mixtures for procedures.
Finally, touch is an important consideration. Although some touches the
child receives when hospitalized may be comforting, others may be painful or
even confusing, for example, when children are poked in areas they have been
told to never let strangers touch.

Dignity
In recent years, discussions about the dignity of the child in the hospital are
becoming more common in the healthcare literature. However, a clear defi-
nition of dignity is lacking: ‘Dignity is a slippery concept, most easily under-
stood when it has been lost.’8 Although no consensus exists regarding the age
at which people believe that dignity becomes an issue with children, research
confirms that privacy and dignity are not always respected on children’s
wards,9 which, for certain children could be the most difficult stressor of all.
 Arts for children in hospitals 183

Children’s reactions to hospitalization

Although the age of the child is the best predictor, the ways in which children
respond to hospitalization also depend on the child’s previous experience
with illness, separation, and hospitalization; innate or acquired coping skills;
seriousness of the diagnosis; and available support systems.10 Common reac-
tions include separation anxiety, sadness, apathy or withdrawal, fears of the
dark or health personnel, hyperactivity, aggression, sleep disturbances, and
regression. A typical regression is the potty-trained child having ‘accidents’.
Children who lose control over a previously mastered skill may feel shame
and decreased self-esteem.11 Behavioral regression frequently continues after
hospitalization. Children may not reach their pre-hospital level of develop-
ment until well after discharge.
Negative outcomes from hospitalization may last as many as ten years or
more, especially for young children who undergo multiple, intrusive pro-
cedures, experience lengthy hospitalizations, and have parents who are highly
anxious or who cope ineffectively with stress. An increasing incidence of post-
traumatic stress disorder (PTSD) has been noted in children following life-
threatening illnesses or injuries and life-endangering medical procedures.12

The arts as tools for coping with hospitalization

Adults who are hospitalized encounter many of the same issues that children
face. The difference, however, is that adults typically have the cognitive ability
to understand and make sense of their surroundings, and have some skills to
cope with their experiences. Children, particularly young ones, usually need
some help sorting out the situation. They may feel powerless and yet lack
the courage or the words to express their feelings. This is where the arts come
in: ‘Art can be a way of asking questions, seeking information, provoking
thought, communicating, and offering something about the world as perceived
by humans.’13
Before reviewing some of the ways in which participating in the arts can
help children to cope with hospitalization and illness, a distinction must be
made between the therapeutic use of the arts and the expressive (e.g. art,
music, dance, poetry, drama) therapies:

In the first instance, artists and other caring adults facilitate children’s
engagement in expressive activities that may be therapeutic. For exam-
ple, children may communicate verbally or nonverbally their thoughts,
feelings, and concerns through or while engaging in these expressive
activities. Expressive therapies, however, are conducted by expressive
therapists who receive special training to interpret and prescribe specific
expressive activities. A certification or licensing process is involved. Indi-
viduals without these credentials can do meaningful work with children,
184 Using the creative arts in therapy and healthcare

but they must be aware of their limitations and not cross the boundary
into territory for which they are unprepared.14

This discussion focuses on the therapeutic use of the arts for children
where the artist is facilitator of the arts experience.15 Participating in the
arts with professional artists can help children deal with several realities of
hospitalization:

1 Pain and discomfort: children can develop new coping strategies and dis-
tance and distract themselves.
2 Limited opportunities to make decisions: children can make choices and
be independent.
3 Passive roles: children can be the active ones, the ones in charge.
4 Emotions: children can communicate both pleasant and unpleasant feel-
ings, safely let go, and relive and master traumatic experiences.
5 Physical limitations: children can draw on their remaining abilities,
imagine what they may be unable to do physically, and direct others to
achieve their creative decisions.
6 Unfamiliar environment: children can do something ‘normal’ and familiar,
share experiences with others, and experience the joy of childhood.
7 Opportunities for learning and growth: children can demonstrate under-
standing of their condition and treatment, experience closure through a
completed project, and develop potential for a lifelong interest in the arts
and creative expression.16

Using the arts therapeutically, artists should avoid initiating conversation

about the child’s illness, yet be able to listen and to talk about it if the child
introduces the topic. This policy provides children with the choice of using the
arts to escape their illness and situation for a time. The expressive therapist
may have a different goal and thus a different approach.
With the arts, there is no one right way to express something. This reality
promotes success and all of the good feelings that go along with it. In the space
of a moment or two, the arts can transform a child from victim to victor.

Choices, choices, choices

Perhaps the arts most significant contribution to helping children cope with
hospitalization is its intrinsic capacity to provide many opportunities for
making choices. The core of the creative process is one of problem solving
and decision making. In painting, for example, a child can choose what to
paint, what brush or other tool to use, the width and length of lines, colors,
etc., and when the painting is finished.
Children unable to physically engage in an activity still may be able to make
creative decisions, which the artist can carry out under the child’s direction.
One rainy afternoon, for example, an eight-year-old boy and I completed a
 Arts for children in hospitals 185

painting together. Only one day post-op, the child had one hand tethered to
an IV pole, and generally was very weak. He selected the subject for the
painting; the paint colors; the width, length, and other qualities of brush
strokes; and decided when the painting was finished. My hands were simply
his tools; the piece that emerged was truly ‘his’ in every important way.
Artists who work in hospitals usually quickly discover that for a number
of reasons children may choose not to participate in an arts experience.
However, by simply offering a creative experience to a child, the artist has
given the child an incredible gift: to how many people in the hospital can a
child say ‘No’ and have that ‘No’ honored? This opportunity may be the first
and only one that the child has had that day.

The campfire effect

A child’s creative product (e.g. painting, song, dance, story) is often a ‘literal’
or direct expression of the child’s experience. However, at other times the
product may serve as a starting point for unrepresented content that the child
wants to communicate. This phenomenon – which I like to call the campfire
effect – is the result of an activity or experience that provides a focal point
shared by the individuals involved that serves to increase conversation in both
quantity and intensity.17 Much like sitting around a campfire with friends,
while sitting around the drawing, painting, poem, story, or other creative
piece, children will sometimes take this opportunity to share whatever is on
their minds – their treatments, medications, worries, hopes, dreams, fears. The
transfer of focus from the child to the product seems to relax the child by
relieving the pressure of being the object of direct communication.

Research findings
A small but growing body of research supports that physiological processes
may take place through contact with the arts. Studies indicate a relationship
between arts experiences and the release of endorphins – the body’s own pain
reliever, relaxant, and mood enhancer.18 Researchers report significant
increases in salivary immunoglobulin A (IgA), an antibody that provides
defence against various infections,19, 20 and oxygen saturation levels, an indi-
cator of respiratory regularity directly affected by the individual’s behavioral
state and degree of pain.21
Technology sometimes makes this visible for the artist. For example, chil-
dren at our hospital are frequently attached to equipment to monitor oxygen
saturation levels. How exciting to step into a room when a musician is strum-
ming the guitar and singing softly, and watch this level slowly rise on the
child’s monitor. Even when the child is unconscious, the music seems to filter
through, and the results are there for all to see just how powerful the arts
can be.
186 Using the creative arts in therapy and healthcare

Preparing artists to work with children in hospital

Most paediatric program directors agree that although artists may be able
to work effectively with adults without preparation, working with children
demands more. We use the following formal selection, training, and super-
visory process to help to quell the concerns of hospital staff, parents, and
even the artist themselves.

Artist selection
Preparation begins with the recruitment and selection of artists. Although
each step of the preparation process is important, if appropriate artists have
not been selected, no amount of training or supervision can make up the
difference. We consider the following qualities essential:

1 Genuine interest in children, a caring attitude, and sensitivity to cultural

and ethnic values.
2 Knowledge and experience in a chosen art form.
3 Respect for the child’s creative process and products.
4 Appreciation and respect for the power of the arts and an understanding
of personal limitations.
5 Flexibility.
6 Sense of humor.
7 Ability to collaborate with others.
8 No health condition that could result in harm to the children or to the
artist.22

Training
The content and extent of training depend upon the role the artist will
assume. Substantive training is needed for artists working as integral mem-
bers of the healthcare team. Some topics that are frequently included in
training are:

• what hospitalization is like for children and their families

• children’s psychosocial and developmental needs and ways in which the
arts can support them
• communicating with children and families
• relationships with children and families
• safety considerations
• infection control
• confidentiality
• cultural issues
• death and dying
 Arts for children in hospitals 187

• stimulating creativity
• adapting arts experiences for children who are hospitalized.23

Most paediatric hospitals prefer artists who will interact with the children,
even one-time performers who primarily see their role as entertainers. Other
important considerations regarding entertainment include:

1 Is it appropriate for the developmental age of the children?

2 Could it cause confusion or misconceptions about anything that might
happen in the hospital?
3 Might it engender fears or fantasies about being harmed in any way?
4 Does it contain religious themes or content that might trouble some
families?
5 Does it avoid any suggestion of violence (including the use of weapons)
or death?
6 Does it avoid the use of masks or costumes that might frighten young
children?
7 Does it invite children’s participation in appropriate and non-competitive
ways? 24

Internship
A clinical internship provides an opportunity for artists to (a) practice their
art in the paediatric setting under supervision, and (b) evaluate whether or
not this is the kind of work they want to do. We begin the clinical experience
by having new artists shadow experienced artists-in-residence for a time or
two, and then we schedule three internship sessions for new artists to apply
their work in the setting under supervision. The program coordinator role
models appropriate interactions and offers the artist interns tips on ways
to adapt their art forms to the children’s healthcare setting. After conduct-
ing the three sessions, we together assess the readiness to end the internship
period.

Ongoing education and support

Although artists usually feel fairly confident at the completion of the intern-
ship, most tell us that it typically takes about six months to really feel com-
fortable in the paediatric setting. After the internship period, artists find it
helpful to have formal and informal mechanisms in place to provide ongoing
opportunities for problem solving, continued learning, mutual support, and
growth. We hold regular staff meetings, usually over a potluck dinner, to
provide this support and for artists to hear what others are doing, discuss
upcoming plans and arrange to work together on certain special events, share
information and resources, and to simply enjoy each others company.
188 Using the creative arts in therapy and healthcare

Practical activities
Recent research indicates that people who are hospitalized are more likely to
engage in arts activities that offer new or interesting experiences.25 In plan-
ning arts activities, it is fun to try something that children would not expect to
do in a hospital. For example, one morning I gathered fresh snow in wash-
basins for children to make snow sculptures, which they then painted. We
took photos to capture the memory before the snow melted.
On the other hand, an important concept in helping children cope with
hospitalization is ‘normalizing’ the environment with attention to what is
familiar, not unique. This concept drives strategies such as encouraging chil-
dren to wear their own rather than hospital clothing; to maintain sleep, meal,
and other routines as much as possible; to continue schoolwork, etc. Arts
activities can follow this approach by focusing on what the child likes to do,
incorporating seasonal and holiday themes, ‘softening’ medical equipment
and personalizing the child’s room with art, and facilitating a group project
to provide a sense of community with other patients, family members, staff,
and friends.
Safety is an important practical consideration. Certain art supplies or
techniques, for example, can be harmful for children. However, in many cases
substitutions can be used to eliminate the risk.26 Yet, after eliminating obvi-
ous hazards for any child, the next consideration must always be ‘Is this a safe
activity for this particular child?’ For example, certain activities, such as
printmaking with fruits and vegetables – seemingly quite innocent – can be
devastating for a child with a compromised immune system. When in doubt,
artists should always ask.
Other factors to consider concerning the child include:

• the child’s age

• reason for hospitalization
• anticipated hospital stay
• condition, illness, or injury and level of understanding about it
• physical effects and limitations
• interests
• present mood
• activity restrictions
• recent or upcoming experiences – good or bad
• cognitive disabilities.

A child able to join a group art activity, for example, will likely enjoy the
additional element of socialization.
 Arts for children in hospitals 189

Visual arts
Visual arts activities are popular with children in hospitals. Often only simple
materials are required and children can set the pace, working for a time and
then putting things aside when tired. On the other hand, materials can be
sophisticated. Artists now can bring laptop computers, digital cameras and
PhotoShop to incorporate technology into children’s art.
See Table 11.1 for a sampling of visual arts activities that are popular with
children in hospitals. Many visual arts activities can be extended easily to
group projects for establishing a sense of community among children. By
helping children symbolically become part of something bigger, such activities
help to relieve the isolation they often feel when confined to a hospital room.

Table 11.1 Sampling of visual arts activities

Marbling – floating colours on a liquid, creating designs, and capturing the resultant
image in a contact print. Use as background for drawing, greeting cards, covering for
boxes, cut into strips and woven, or cut or torn as material for an individual or group
collage.
Materials Instructions
• Can of white foamy shaving cream 1 Squirt shaving cream into the tray.
• Liquid watercolour paint 2 Dribble paint on shaving cream and
• Styrofoam packing trays create design with tongue depressor.
• Tongue depressors 3 Press paper lightly on shaving cream,
• Paper (with some ‘tooth’) lift and scrape off excess with tongue
• Paper towels depressor.
4 Wipe paper with paper towels and
set aside to dry.
Leaf and berry prints* – pounding natural materials to create a design on cloth.
Good for children dealing with anger post procedure or on a particularly bad day. For a
community project, designate a section of a large cloth for each child and hang as a ward
mural or use as a tablecloth for a special celebration.
Materials Instructions
• Cloth, cotton or muslin (old hospital 1 Have child create a design with
sheets work well) berries and leaves (vein side down)
• Freshly picked green leaves on waxed paper.
• Berries 2 Cover with cloth and have child
• Waxed paper pound on the cloth with the rock
• A smooth rock that fits into child’s hand until satisfied with the stains that
• Vinegar and water solution (1 tbsp appear.
vinegar to 1 cup of water) 3 Dip cloth in vinegar solution to set
• Washbasin or other container stains, wring out, and hang to dry.
4 Attach to cardstock and frame, or to
a dowel or branch for wall hanging.
Sand candles* – creating candles in a moist sand mold. A recording of the sound of the
ocean or some beach music can accompany the activity. An electric skillet on a cart can
be taken room to room and plugged in occasionally to keep the wax liquid.
(Continued overleaf )
190 Using the creative arts in therapy and healthcare

Table 11.1 Continued

Materials Instructions
• Electric skillet 1 Put wax in the coffee cans and the
• Empty coffee cans cans in electric skillet that contains a
• Candle or canning wax, beeswax rather few inches of water, and heat over
than petroleum-based because of the low to medium heat until the wax is
fumes melted.
• Crayons to add colour 2 Have child select crayon colour and
• Long-handled spoon peel off paper. Add to wax; stir
• Small white birthday candles occasionally until melted.
• Sand pail or washbasin containing new 3 Moisten sand with water until it
sand (intended for sandboxes) holds a shape, and ask child to make
• Water a simple negative shape in the sand.
• Oven mitts 4 Move mold from child’s reach and
• Newspaper pour in wax. When wax somewhat
solid, insert birthday candle until
only wick is showing, at site child
selects.
5 When wax completely cool, help
child remove candle from sand over
newspaper.
Marble painting* – painting with paint-covered marbles. Babies and toddlers love to
tilt or shake the container and watch the colours appear. Older children can move the
container with more intent.
Materials Instructions
• Small bowls 1 Pour colours child selects in the
• Tempera paints bowls and add a marble or two in
• Spoons each to coat with paint.
• Flat container with clear lid 2 Put paper in the container, scoop a
• Paper cut to fit the bottom of container paint-laden marble with spoon, and
• Scissors place marble on the paper.
• Newspaper 3 Apply lid and ask child to tilt or
shake the container, making trails of
paint on the paper.
4 Remove marble and add others until
child is satisfied with the results.
5 Place painting on newspaper to dry.

* Adapted from Rollins, J. Arts Activities for Children at Bedside, Washington, DC: WVSA Arts Connec-
tion, 2004.

Music
Of all the art forms used in hospitals, music seems to have the broadest reach.
Music can be used with all ages of individuals under almost any circum-
stances. Because hearing is still present when an individual is comatose, even
the child who is unconscious or dying is believed to benefit from hearing
 Arts for children in hospitals 191

music. Certain music is used to engage children, while other types are intended
to help the dying child ‘let go’ peacefully.
Musicians can offer new and interesting experiences that engage children
by bringing in an array of musical instruments from other cultures, demon-
strating their use, and helping children play them. Favorites in our program to
accompany our guitarist are kalimbas, xylodrums, and shekeres.
Singing requires very little, simply the desire ‘to give some small voice to
the everyday joy of the soul’.27 Children and their families may have favorite
songs, or the musician can introduce them to new ones. It is also fun to sing
certain songs (e.g. ‘Are You Sleeping’, ‘Down by the Station’, ‘White Coral
Bells’, ‘Three Blind Mice’) that, when sung or hummed at the same time,
sound beautiful together.28

Dance
A dancer trained in the postmodern tradition will best be able to actively
engage hospitalized children in dance. Postmodern dance hails the use of
everyday movement as valid performance art, and claims that any movement
is dance and any person can be a dancer, with or without training. Movement
can happen with children standing, sitting, or lying down. Depending on the
child’s physical condition, dances can be made with movements ranging from
eye blinks and nose wiggles to full-bodied jumping and falling, and every-
thing in between. Dancing offers many choices, including the choice of music
to accompany the activity.
Children enjoy ‘movement conversations’.29 Face to face with the child, the
dancer and the child begin with some body parts touching (fingertips touch-
ing, elbows or feet together). The dancer moves for three to five seconds and
becomes completely still and frozen, and then the child makes a movement
and freezes. Once the basic physical conversation is established, the dancer
begins to change the speed and the dynamic of the movement, and perhaps
initiate longer movement sentences.
Another favorite is mirroring (see Figure 11.1). This activity allows the
dancer to explore a child’s range of motion and to support the child’s choices
physically and verbally. Positioned face to face with the child, the dancer will
do what the child does for a while and then the child will do what the dancer
does. At times they will work together to make the same motion.
Gathering a group of children together or even drawing in family members
or staff at a child’s bedside, the dancer can facilitate a group dance. One at
a time, each individual makes a movement, which everyone follows. The
movement is added to those made before to create a series of movements, a
unique and beautiful community dance.
192 Using the creative arts in therapy and healthcare

Figure 11.1 Mirroring allows the dancer to support the child’s choices physically and
verbally.

Storytelling
A well-chosen story allows children to deal indirectly with and discuss if they
wish their difficult fears and realities. Some children simply enjoy stories as a
fantasy escape. Storytellers frequently dress in costume or use props to fur-
ther this element of fantasy. Story structure – with a beginning, a middle and
an end – can provide a much-needed sense of predictability and closure for
children who are ill. Classic stories, such as ‘The Three Little Pigs’ offer this
same predictability. Hearing a familiar story when attempting to cope with an
unpredictable illness gives children a sense of comfort and safety.
The storyteller can encourage children’s participation by telling stories
with chants, songs, rhythm, music, repetitious actions, and vocalizations.
Through role play, children become powerful people in control of their des-
tiny. Storytelling gives children ‘a chance to play, to create, to imagine, to have
sustained human contact, to have choice, to speak, to ask for what they want,
to express themselves, to have the time enough to say what is really on their
minds, to ask questions, to get the story they really need’.30 Excellent tips for
finding, learning, and telling stories can be found online.31
 Arts for children in hospitals 193

Creative writing
Writing is about discovery and children are often surprised by the insights
that emerge as they write. Although paper and pencil are all that is needed,
many hospitals now have laptop computers for children’s use. In our program
we like to give children large hard-cover sketchbooks to use as journals; the
absence of lines encourages drawing as well.
Children can write about illness or non-illness related topics, and often
need help getting started. Suggested topics could include what they see in
their room or from their window, people, animals, something in their room
that they don’t understand, etc. A ‘Top Ten list’ – top ten things that make
the child laugh, top ten most satisfying experiences, top ten petty annoyances,
etc. – also is a popular way to begin.32
Many children enjoy poetry because its nature allows them to express
themselves in metaphor. Various types of poems – rhyming couplet, quatrain,
limerick, chiquan, haiku, shape poems, free form – can be explored. Poets
frequently use props to get children started, such as blowing bubbles and
asking children what they think of when they see bubbles. Children may enjoy
writing music and lyrics as well.

Drama
Children love to dress in costume and be someone else for a time. As a
princess, superhero, or other favorite character, a child’s experience can be
transformative and empowering. Children can act out favorite stories or
make up their own, and perform for their families, friends, and staff. A
number of children’s hospitals now have performing areas for children to act
out their roles. Role playing can provide insight for and about a child, and
also be an excellent learning tool.
Puppets provide safe, vicarious outlets for impulses, fears, and fantasies, and
can be used to educate and to entertain. Children tend to feel unthreatened
when speaking for the puppet and assert themselves more than if they were
speaking for themselves. Puppets can be made from simple materials, such as
socks, paperbags, or even simply a piece of gauze draped over the hand and
secured with a rubber band. Colored markers can be used to add features.
Clowns can bring joy and laughter to children, but must be carefully selected
and trained. Regarding make-up, most hospital clowns wear little more than
red noses to avoid frightening children. As with other artists, hospital clowns
focus on engaging the child in the experience (e.g. teaching the child a magic
trick), and even have their own code of ethics.33
194 Using the creative arts in therapy and healthcare

Celebrating children’s creativity

A goal of the arts in hospitals is to create good memories to counter the less
pleasant ones that children experience. Celebrating their artistic achievements
can foster this goal. Consider the following ways to let children know that
their achievements are valued:

1 Avoid contests as competition detracts from the spirit of the arts.

2 Frame or mat their paintings or drawings.
3 Create simple anthologies of their poetry or stories.
4 Tape their songs.
5 Take pictures and videos.
6 Display their art throughout the hospital and the community, at places
such as libraries, museums, or shopping centres.

The future
Increasing numbers of individuals and organizations around the world (e.g.
Society for the Arts in Healthcare in the United States, National Network for
the Arts in Health in the United Kingdom) share the vision that some day all
hospitals will acknowledge and support the arts as an integral component of
healthcare. The arts provide an opportunity for children to achieve tremen-
dous growth while experiencing one of the greatest challenges of their lifetime.
Let us hope that this day arrives without delay.

Notes
1 J. Rollins, ‘The Arts in Health-Care Settings,’ Meeting Children’s Psychosocial
Needs Across the Health-Care Continuum, eds. J. Rollins et al. (Austin, Texas:
ProEd, 2005).
2 G. Lansdown, ‘Children’s Rights,’ in B. Mayall (ed.) Children’s Childhoods
Observed and Experienced, London: Falmer Press, 1994.
3 G. Bricher, ‘Children in the Hospital: Issues of Power and Vulnerability’, Pediatric
Nursing 26, 2000, 277–282.
4 J. Rollins and C. Mahan, From Artist to Artist-in-Residence: Preparing Artists to
Work in Pediatric Healthcare Settings, Washington, DC: Rollins and Associates,
1996.
5 J. Rollins and C. Mahan, From Artist to Artist-in-Residence: Preparing Artists to
Work in Pediatric Healthcare Settings, Washington, DC: Rollins and Associates,
1996, p. 121.
6 G. Grumet, ‘Pandemonium in the Modern Hospital’, New England Journal of
Medicine 328, 1993, 433–437.
7 P. Reed et al., ‘Promoting the Dignity of the Child in Hospital’, Nursing Ethics 10,
2003, 62–73.
8 P. Reed et al., ‘Promoting the Dignity of the Child in Hospital’, Nursing Ethics 10,
2003, 62–73, p. 67.
9 G. Rylance, ‘Privacy, Dignity and Confidentiality: Interview Study with Struc-
tured Questionnaire’, British Medical Journal 318, 1999, 301.
10 Hockenberry, M. et al., Wong’s Nursing Care of Infants and Children, Saint Louis,
MD: Mosby, 2003.
 Arts for children in hospitals 195

11 D. Popovich, ‘Preserving Dignity in the Young Hospitalized Child’, Nursing Forum

38, 2003, 12–17.
12 American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, Washington, DC: American Psychiatric Association, 1994.
13 S. Baumann, ‘Art as a path of inquiry’, Nursing Science Quarterly 12, 1999, 107.
14 J. Rollins and C. Mahan, From Artist to Artist-in-Residence: Preparing Artists to
Work in Pediatric Healthcare Settings, Washington, DC, Rollins and Associates,
1996, p. 121.
15 J. Rollins and L. L. Riccio, ART is the heART: An Arts-in-Healthcare Program for
Children and Families in Home and Hospice Care, Washington, DC, WVSA Arts
Connection, p. 48.
16 J. Rollins, ‘Art: Helping Children Meet the Challenges of Hospitalisation’, Inter-
ACTA 3, 1995, 36–41.
17 J. Rollins, ‘Tell me about it: Drawing as a Communication Tool for Children with
Cancer’, Journal of Pediatric Oncology Nursing 22, 2005, 203–221.
18 A. Goldstein, ‘Thrills in response to music and other stimuli’, Physiological
Psychology 8, 1980, 126–129.
19 R. Lambert and N. Lambert, ‘The Effects of Humor on Secretory Immuno-
globulin A levels in School-Aged Children’, Pediatric Nursing 21, 1995, 16–19.
20 D. Lane, ‘The Effect of a Single Music Therapy Session on Hospitalized Children
as Measured by Salivary Immunoglobin A, Speech Pause Time, and a Patient
Opinion Likert Scale’, Doctoral Dissertation, Case Western Reserve University,
1990.
21 S. Collins and K. Kuck, ‘Music Therapy in the Neonatal Intensive Care Unit’,
Neonatal Network 9, 1991, 23–26.
22 J. Rollins and C. Mahan, From Artist to Artist-in-Residence: Preparing Artists to
Work in Pediatric Healthcare Settings, Washington, DC: Rollins and Associates,
1996, pp. 1–2.
23 J. Rollins and C. Mahan, From Artist to Artist-in-Residence: Preparing Artists to
Work in Pediatric Healthcare Settings, Washington, DC: Rollins and Associates,
1996, p. 10.
24 Johnson, B., Jeppson, E. and Redburn, L. Caring for Children and Families: Guide-
lines for Hospitals, Bethesda, MA: Association for the Care of Children’s Health,
1992, pp. 245–246.
25 S. Stoner and S. Sahni, ‘How do we Know we make a Difference?’, presentation,
Society for the Arts in Healthcare Annual Conference, Chicago, Illinois, 29 April
2006.
26 M. Rossol, The Artist’s Complete Health and Safety Guide, New York: Lyons
Press, 2001, 366–369.
27 M. Leunig, The Prayer Tree, Pymble, HarperCollins, 1991.
28 For an extensive list of songs that go together, see Judy Rollins, Arts Activities for
Children at Bedside, Washington, DC: WVSA Arts Connection, 2004, p. 69.
29 K. Marty, quoted in J. Rollins, Arts Activities for Children at Bedside, Washington,
DC: WVSA Arts Connection, 2004, p. 75.
30 S. Gordon, quoted in J. Rollins, Arts Activities for Children at Bedside, Washington,
DC: WVSA Arts Connection, 2004, p. 57.
31 A. Fraenkel, ‘Storytelling tips’, SacredVoices Online 11 September 2001, 14 May
2006 (http://sacredvoices.com/docs/tips.htm).
32 S. Dion, Write Now: Maintaining a Creative Spirit While Homebound and Ill,
Teaneck, NJ: Puffin Foundation, 2000.
33 See British Medical Journal website (http://bmjjournals.com/cgi/content/full/319/
7212/792/a/DC1).
Chapter 12

Friends’ Arts in Healthcare

Programs at the University
of Alberta Hospital
Fostering a healing environment
Susan Pointe and Shirley Serviss

The harpist is in today, I notice as I walk into the hospital main atrium. My
feet slow to the melodic notes that float past the patients in wheelchairs
waiting to be ushered up to Dialysis. I glance up to admire the many colourful
patient window paintings that dot the 55 windows from the first to fifth floor.
As I near the Art Gallery, I see a patient looking in the floor to ceiling
windows at the art as he adjusts his IV pole. I catch his attention and say,
‘Come on in.’ In the gallery, a young couple is asking a volunteer about the
artists currently exhibiting. Three visitors, outpatients or visiting family
members of patients are relaxing, waiting, and lost in their thoughts. A
little boy of five and his mom are mining through the art materials seeking
a choice project to complete. As I take my seat at my desk, my colleague
grins and says, ‘We received another letter.’ Knowing what she means. I
read:

I would like to express my appreciation to you in relation to your musi-

cian . . . When I was doing an invasive procedure on a young man with
Down’s syndrome and Al was in the unit playing his guitar and singing,
I asked Al if he could stay for a few minutes at this patient’s bedside to
serve as a diversion to the patient while I was performing the procedure.
Al stayed and played for as long as I required him to, and made the
procedure go extremely smoothly with no requirements for sedating medi-
cations. This form of therapy is extremely beneficial both for patients and
families, and staff members alike.
(Advanced Nurse Practitioner, Cardiac Surgery1)

At Capital Health’s University of Alberta Hospital (UAH) this is business as

usual. The arts have become an integral part of hospital life. Unlike any other
hospital in Canada today, the UAH hosts a purpose-built art gallery, an art
collection of over 1200 artworks, and an Artists On the Wards program
where five permanent part-time staff artists work one on one at the bedside
with adult acute care patients. This chapter will explore how these services
and programs began and how they continue to flourish.
 Friends’ Arts in Healthcare Programs 197

University of Alberta Hospital Art Collection and

McMullen Art Gallery

The foundation of the Arts in Healthcare Programs

In 1986, the University of Alberta Hospital finally received its much needed
expansion into the newly named Walter C. Mackenzie [WMC] Healthsciences
Centre. With over 800 beds, the centre houses the University of Alberta
Hospital, the Mazankowski Heart Institute and the Stollery Children’s
Hospital. It is a national centre of excellence in transplantation, critical care,
neuroscience, medicine, renal, emergency and trauma care. The centre has
become one of Canada’s leading clinical, research and teaching hospital
complexes, treating more than 700,000 patients annually from across western
and northern Canada.
As the centre was being developed, William McMullen, a University
Hospital board member and a group of influential art collectors and artists
called for the development of an art collection and a gallery into the hospital
plans. The University of Alberta Hospital Board supported the development
of a collection under a provincial program encouraging the purchase of
artwork with a percentage of provincial capital dollars, and amassed over 750
original artworks to be permanently displayed in the new hospital.
Named for its founder, the 1000 square foot McMullen Art Gallery opened
its doors in 1986. Fronted by floor-to-ceiling windows, the gallery is located
next to a main hospital entrance, well situated to foster awareness in a large
hospital complex.

Friends of University of Alberta Hospitals

This integration of an art collection and gallery into the WMC Centre plans
could not have happened without the support of another key player, the
Friends of the University Hospitals. In 1986, the hospital looked to the Friends
to financially support permanent professional staff to direct the gallery and
assist in growing the collection. Being a non-profit organization with a mis-
sion to enhance patient comfort, the Friends viewed the gallery and collection
as an innovative patient-comfort service fitting well within their mandate.
The Friends responded, by establishing annual operating funds for the
gallery and employing a full-time arts professional with experience in pub-
lic programming and collection management.2 The Friends also set up a
volunteer program, where volunteers (known as gallery guides) would cover
weekly three to four hour shifts to provide security for the gallery, and act as
educational resources for the visitors.
Under the Friends’ direction, the gallery’s mandate expanded to serve as
more than an art gallery; to serve as a patient-comfort-zone that encourages
patient well-being by providing an environment that celebrates hope,
198 Using the creative arts in therapy and healthcare

compassion, beauty, creativity and life. Obtaining patient feedback is very

important to the Friends, and therefore we have a visitor comment card that
poses the question ‘Have we made an impression on you?’ Some of our
patients wrote:

Thank you for providing such a healing place in my traumatic time. After
being poked and prodded, I come here to calm down before I leave the
hospital to face the rest of life . . . I know now, for me, it will be a part of
my healing.

I truly find this one of God’s quiet places in the hospital! Thank you so
much.
This is a wonderful healing and nourishing space. It is indeed comforting,
health inducing, beautiful, hopeful, and affirming . . . Thank-you.3

And other patients’ family members wrote:

It [the gallery] is a place of peace and renewal for me. I first discovered
the gallery when my son lay deathly ill upstairs. It was a place of refuge
and sanctuary.

Thank you for a bit of peace for my sick child. He still deserves to see
beautiful things even if he can’t go outside.
Coming here with my son has been a reprieve from all the madness and
stress from cancer! We relax and enjoy it here! Thank you for having a
little piece of heaven here on earth!4

Under the Friends’ direction, the gallery exhibition programming has matured
and the art collection has grown. Today, the gallery receives 17,000 patients,
family members, staff and public visitors per year.5 Each year, we select five
exhibitions out of approximately 35 submissions. We seek exhibitions that are
sensitive in content to the needs of hospital patients and their families –
exhibitions that promote emotional, physical, and spiritual well-being, and a
diversity of ethnic backgrounds, cultures and heritage. We also endeavor to
give a broad range of community groups, curators, artists, heritage and art
organizations an opportunity to create exhibitions celebrating diverse aspects
of art and culture. In our submissions, we also look for exhibit proposals that
outline resources to assist our first-time gallery visitors such as extended
labels, artists’ statements and visitor feedback opportunities, and provide
hands-on or sensory exploration opportunities for visitors. The collection has
grown to now hold 1200 pieces of artwork. It is installed in priority in patient
and family rooms, waiting areas, public pedways, atriums and staff conference
rooms, and offices.
 Friends’ Arts in Healthcare Programs 199

Today, the Friends support two full-time and five part-time staff to manage
the collection, operate the gallery, and the Artists On the Wards program.
The hiring of the Art Advisor, in 1986, was key in the development of the
Artists On the Wards. Unlike most hospitals in Canada, the Friends financed
a full-time arts and collection professional for the hospital whose sole man-
date was to advise the hospital in gallery management, art collecting and to
potentially grow arts programming to meet the needs of patients.

Taking the arts to the bedside

The Friends Artists On the Wards Program

For 12 years the Friends received considerable acclaim for their support and
management of the gallery and art collection. However, in 1998, despite
strong attendance in the gallery from patients, family members and staff, the
Friends acknowledged their dissatisfaction with not being able to reach all
acute care patients.
In October 1999, the Friends agreed to fund a pilot project in which three
visual artists would be hired to work with patients for a period of four
months. The aim was to introduce patients to professional practicing artists,
lead patients in talking about art, watching an artist create for them, and
creating art themselves. The ultimate goal was that the artist would bring
the patient to an interest and comfort level where they would continue to
learn about art and ultimately create (draw, paint, sculpt) on their own.
After training on each unit with the nursing supervisors, each artist would
work eight hours per week in the pulmonary, cardiology, cardio-thoracic, and
the eating disorders units in the University Hospital. The visual artists began
by visiting with the patients, and introducing the program. Then, if encour-
aged by the patient, the artist would guide the patient in painting, drawing or
sculpting images or messages of their choice. If patients were physically
unable to create, the artist would create for them.
The most popular bedside activities became those where the patient would
create a small part of what would become a larger installation in the hospital.
Known as the Ceiling Tile Project and the Tile Wall Project, these installa-
tions are made up of ceiling tiles and ceramic wall tiles on which patients
or family members paint images or messages of their choice. Not only did
these projects provide a creative outlet, but they also enriched patient visits.
Painting tiles together created a new relationship between a patient and his
estranged daughter and enhanced the quality of the visits between an oil-rig
worker and his elderly mother as they enjoyed working on a project together.
Each tile stands as a powerful testament of the individuals who passed
through the hospital. Some tiles act as an important memorial for the family
who lost a loved one. The tiles are raw with messages of hope and courage,
and have a powerful effect on the viewer.
200 Using the creative arts in therapy and healthcare

Within the four-month period we constructed patient feedback and staff

evaluation forms which were filled out. Verbal and written feedback from
nursing and medical staff was immediate and overwhelmingly positive:

Patients . . . are under a great deal of stress, very anxious about their
lives. The interaction with the artists seems to give them a sense of con-
trol, purpose and accomplishment that brings balance back to many of
them. Clearly, physical healing is only one aspect of well-being and I
think [this] program plays a significant role in the psychological healing
associated with disease.
(Dr. Dale Lein6)

In her nursing evaluation of the program, Carrie Briones also noticed

beneficial effects:

The times that we have observed the artist with the patients, the mood of
the patients seems to be brighter . . . The patients have something to do
and this may lessen the amount of depression . . . [They] also seem more
motivated and determined to get involved in returning to daily activities.7

Other nursing staff members wrote:

The artists have helped patients not only take their mind off their illness
but often to express their feelings when they have been unable to do so. It
gives a purpose to days and months and a sense of accomplishment to
see what they have created. As a staff member I feel it has brought color,
and joy to a very serious atmosphere and I enjoy visiting different units to
see the works in progress. It has made the UAH a fun place to work. I
commend the artists for their work and the Friends of University Hos-
pitals for funding such a worthwhile project. Keep up the good work!8

Hospitals/medical personnel concentrate on the body, the medical, the

illness. [The artist] provides an opportunity to concentrate on the spirit-
ual, the emotional the holistic. [The artist’s] open non-judgmental
approach is a real gift. Sometimes they [patients] participate in the art-
work and other times just enjoy watching her create. Provides a ‘mental
break’ from other hospital activities . . . Any activity that can improve
emotional and/or spiritual well-being can ultimately help to improve
physical well-being.9

Patient feedback was equally positive:

Thank-you so much for the art supplies. I spent many hours playing and
found that it was great for venting my frustrations. Some of my work
 Friends’ Arts in Healthcare Programs 201

showed a lot of emotion with its vivid colors! This is a great program.
Please keep the program going.10

I want to express a very heartfelt thank you to Nancy Corrigan. Her

timing on stopping into my room to ask if I’d like to contribute to the
‘look in your eye’ mural could not have been more perfect. I spent a few
hours creating in which I forgot where I was. I had a wonderful time.11

The Friends were delighted with the success of the pilot, the demand for
artists in other units, the annual matching grant support coming from the
Alberta Foundation for the Arts and a one-time grant by the Canadian
Millennium Partnership Program. The Friends chose to match the incoming
grants and committed to ongoing support of five part-time artists. Today we
employ three visual artists, one poet/writer and one musician, each working
15 hours per week, servicing 34 nursing units throughout the hospital. These
units include the Fire Fighters Burn Centre, the Emergency Ward, Medical
Outpatients and Intensive Care as well as Cardiology, Dialysis, Gastroenter-
ology, Hematology, Neurology, Plastics, Psychiatry, Pulmonary, Transplants,
Trauma, Urology, and a number of surgical units.12
Five part-time artists cannot service 500 adult inpatient beds. However, due
to the support of Volunteer Services, we recruit approximately 24 volunteer
artists annually who assist our work. They range from art students to profes-
sional artists and bring a diversity of personalities, ages, and abilities to the
program. The volunteer artists are trained and supervised by the staff artists,
and they commit to three to four hours a week for a minimum of six months.

Is this program art therapy?

Art therapy is a psychotherapy specialization formally integrated into a diag-
nosis and treatment model. Generally, art therapists are clinical practitioners
who use art as a tool to diagnose, analyze and interpret a patients’ psycho-
logical profile. The art therapist uses art to uncover a patient’s inner con-
flict or psychological processes, then assists in addressing the grief, anger,
emotional or psychological illness that is present.13
The Artists-On-the-Wards program provides patients with the opportunity
to work with a practicing artist, journal, write poetry, sing, song write, make
art and not be in any kind of therapy. The patients have access to the artists
and arts for mere pleasure, and yet the connecting and creating can be, in
some cases, powerful in altering the physical, emotional or mental states of
the patient. Shirley Serviss, our resident poet, writes:

I started to write poems for patients to reflect back to them the stories
they shared with me about their lives and who they really were, not the
disease or illness they happened to have. A man, partially paralyzed by
202 Using the creative arts in therapy and healthcare

a stroke, became once again the commanding officer of a radar unit

stationed in the desert in the war as he told me his stories. When the
nursing attendant came in to feed him his meal, she could hardly believe
the transformation. He was no longer a miserable old man complaining
about being uncomfortable; he was smiling.
Another time, I was referred to a patient who had had both his legs
amputated and was understandably despondent. I shared some poems
with him that spoke to his despair and search for meaning. When the
clinical supervisor came in to ask if he was willing to try physiotherapy,
he told her: ‘I would have said no, but now I’m going to say yes.’14

The artists guide the patients to focus on joyful experiences, accomplish-

ments, the future, or simply being well in the moment. From this place, the
making of art becomes thoughtful, soothing and almost meditative. Also,
these experiences can assist patients in regaining identity and individuality –
making their mark in the hospital, broadcasting in the hospital I exist and I
am here. And what the patients produce often provides them a level of joy if
not pride. The realization of one’s ability in any form of art is empowering.
Therefore the artists also act as teachers or facilitators in bringing patients to
a level of comfort in an area where they may continue to learn and create on
their own ultimately contributing to their future wellness.

What exactly do they do at the bedside?

Since the program’s inception, the artists have spent over 15,000 hours on the
wards and have visited over 50,000 patients. They work mostly one on one,
seeing between one and three or more patients per hour.15 It is very important
to the Friends that the artists make patient comfort a priority. Therefore,
rather than trying to serve a high volume of patients, the artist ensures that
each patient receives a quality visit (Figure 12.1).

Music
Our staff musician, Al Brant, plays music for the patients on his guitar. He will
sing his own songs for patients, or ones they request. He also composes songs
with and for the patients. More and more frequently, Al is requested by family
members to play for patients as they are being disconnected from life support.
In support of Al’s work, we host volunteer musicians who play a portable
keyboard, a harp, the lute, guitar and Native American flutes for patients.
Other volunteers simply sing at the bedside in response to patient requests –
everything from country and western favorites to operatic pieces in other
languages. Al Brant writes:

Music is a wonderful tool for breaking barriers. Whenever I enter a room

 Friends’ Arts in Healthcare Programs 203

Figure 12.1 For those patients unable to create, the artists will paint to request on
windows, sculpt creations to patients’ specifications or draw portraits. One of
our Visual Artists in Residence, Cornelia Osztovits.

the first thing I do is introduce myself and the program, let them know it
is a free service. I usually start by asking what type of music they like;
most times they will encourage me to play whatever I want. I usually pick
a song that might bring up a good memory of home or just an uplifting
song. I find that music can take a person away from their present situ-
ation for those few moments; you can see the patients daydream. Often,
after the song is done, a conversation will ensue about thoughts that were
triggered from the song.
If a patient is willing, I will get into the process of writing a song with
them. I usually start this by pulling things out of conversations that
occur, for instance if a patient is missing their home I might suggest for
them to think about fond memories or funny moments that have hap-
pened. I find that most times a song does not get finished but the process
is usually a good experience.

A couple of stories:

There was a patient I had played for in Cardiology ICU over a period of
several months with no response. Quite often, in this job, you can play for
a person one day and the next day they are gone and you usually never
know what has happened to them. But one day I was walking past the
204 Using the creative arts in therapy and healthcare

elevators and this patient looked at me and said, ‘I can see clearly now.’ I
looked at him a little strangely and he said it again. Then he said, ‘You
played that song for me while I was recovering from a heart transplant.’
That song gave him hope. He then said, ‘Thank you’ and got on the
elevator.
There was another patient whom I had been visiting who is a pianist.
We would exchange songs, or she would sing a song while I played my
guitar, then I would sing while she played guitar. This patient was in for a
transplant and while in surgery ended up having a global stoke. The
family asked if I would keep visiting her in ICU even though she was
non-responsive. This patient did come back and after about three
months, when she was out of ICU and in her own room, I would come
up with our portable piano and place it in front of her. She started out
with single notes and by the time she left for home she was trying to sing
again. I recently received an e-mail from this patient; she said her piano
playing is 80 per cent, her voice is coming back and she is starting to
write songs.16

Poetry and writing

Our writer, Shirley Serviss, often begins by reading poetry to patients – her
own poetry and that of other poets whose work is uplifting. Many patients
have at least one poem from long ago still memorized, and are always
delighted to recite – even while sitting in the Emergency.
Many of the poems our writers have written for patients have become
treasured keepsakes, and have been read at funerals. Other poems have simply
been used for patients and family members to articulate what they want to say
to each other. Shirley writes:

At my invitation, a patient waiting for a heart transplant composed a

touching poetic tribute to his wife. He went on to write a poem about his
hopes for a new heart, and a poem bargaining with God for more time
with his family. His daughter expressed her appreciation that her father
had been encouraged to write. She had learned things about his thoughts
and feelings through his poetry that she hadn’t known because they
weren’t a family who could speak about these things. I encouraged her to
write a poem for her father, which she did. Although this patient did not
live, his daughter spoke of how poetry became a way for her family to say
what was necessary at the time. Today, this family hosts an annual golf
tournament in their Father’s memory and they donate the monies raised
to the Friends Artists On the Wards.

Although engaging patients to write poetry can be challenging, having poetry

contests with deadlines has proved to be very inspiring for many patients and
 Friends’ Arts in Healthcare Programs 205

staff. The Friends have held four contests to date. To celebrate the winners of
the contest, we host a reading in the gallery, where patients, their families and
staff attend and read their poems in front of an audience. Whether or not
they are winners, the contests encourage patients to put their feelings and
experiences into words. Here are two examples:

Bedridden Haiku
All alone in bed
IV line in hand and neck
Uselessness fills me.

Limerick
A young man from the land of the bailer
Ended up with Acute Renal Failure
He’d grow up real fast
Innocence in the past
His new life he would now have to tailor.

In 2001, the Friends published a number of the patients’ poems in a collec-

tion entitled Read Two Poems and Call Me in the Morning, which is still for
sale in the gift shop. Since then, contest winners and honorable mentions have
been framed and installed along a very busy pedway, known as the Poet’s
Walk. Woven along the wall, in between each piece, is a poem about writing
poetry.
Projects where patients only have to contribute a few words are always
successful. In one such project, Shirley outlined a tree on the wall of Medical
Outpatients and invited people to write something they wanted to invite into
their lives on a cut-out bird and perch it in the tree. They were asked to write
something they wanted to release on a leaf and attach it to the wall so it was
falling. Many patients confided in Shirley that it was helpful to name their
hopes and fears and comforting to see they were shared by others.
Sometimes Shirley involves patients in writing a ‘group poem’ on a unit
whiteboard. After gathering images from the patients in the unit, she com-
poses a poem on the spot to write on the board. The writers also hand out
‘Thoughts for the Day’ and ‘Poetic Medicine’ – long, skinny poems rolled up
and placed in prescription bottles – to patients, visitors and even doctors
when a little poetic inspiration is in order. They give patients blank jour-
nals and autobiography duo-tangs containing questions to evoke positive
memories with space for the patient to respond.
The writers have also installed a permanent writing desk in the patient
library with an open journal where patients, visitors and staff are encouraged
to record their experiences. The stories that are written there are very poign-
ant and readers respond to each other with words of encouragement. One
206 Using the creative arts in therapy and healthcare

woman returned to the library to write in the journal a year after her sister’s
death in hospital. Another woman wrote:

I sit here at a desk in the patient library. I’m not a patient but my son is
. . . He goes in for heart surgery later today. Small at just over two pounds
and almost four months pre-term. I’m scared . . . Even as the car slid off
the road, all that was to be thought about was the small makings of the
little person in my belly. . . . All that day, through the labor and the tests, I
was told over and over again that he might not make it . . . This journal
has helped me see that none of you quit and you still have hope.17

Visual art
Not surprisingly, the visual artists are the most noticeable on the units. One
of our visual artists, Cornelia Osztovits, writes:

As I wheel my brightly colorful cart on my path to my units, I flash

smiles wherever I stroll and inform those I meet of our unique program
and free workshops. I ride the freight elevator beside nurses, doctors,
maintenance workers and patients with all kinds of medical transport
equipment and testing mechanisms. My art cart stimulates curious and
creative conversation and eases the silence amongst strangers. Smiles are
contagious.18

For those patients who are physically unable to create, the artists will paint on
windows, sculpt creations of the patients’ specifications or draw portraits.
One of our visual artists, Nancy Corrigan, writes:

Once I drew a portrait of a lady who just was in the Burns Isolation area
for a long time. Her face was disfigured and she was not in great spirits. I
said to her I am going to give you a makeover. At first, she was not sure
about having her portrait done but a humorous session of giving her pink
cheeks, perfect skin and hair in whatever style she so desired, changed her
mood and she kept that portrait on the wall until she was discharged.19

Nancy has received notes, letters, postcards and verbal feedback about how
much the portraits mean to patients and family members. A nursing staff
from another city hospital contacted Nancy to tell her that one of our
patients had brought her portrait from the University Hospital to the Grey
Nuns Hospital and insisted that it be put up in her room. The nurse said,
‘You never know Nancy – the things your program can do.’20 This feedback
has taught us never to underestimate the power of creating for patients who
cannot create for themselves. After completing a large waiting-room window
painting, Nancy writes:
 Friends’ Arts in Healthcare Programs 207

Today was a rare day. For the first time a patient wished to paint on the
window. As she painted, a medical intern came over, selected a brush and
began painting as well. Behind us gathering was a small crowd to watch
us – another intern, nursing staff, other visitors. They were laughing,
talking, just being a part of the joy of creating.21

The visual artists also involve the patients in drawing, doodling, dream
catchers, painting, sculpture, origami, beading, bookmaking, mandalas,
mobiles, collage or specific projects such as tile painting, postcards, or gel
transfers. The range of projects is limited only by the imaginations of the
artists and patients, the cost of materials or their suitability for use in a
hospital setting. The artists have found ways to work with patients who are
visually impaired or who have limited movement, but must always be sensi-
tive to which materials can be used in particular units. For example, no
organic material can be brought into the Hematology unit.
Not surprisingly, the most popular bedside projects are those where the
patients create a small piece of a larger project that is permanently installed
in the hospital. Nancy has led a simple project where patients and staff
trace their hands. Then they imbue these hands with color, images and
words. Nancy then proceeds to amass these hands in a large collage for the
unit.

Figure 12.2 Over 100 handprints and messages written by patients line this installation.
208 Using the creative arts in therapy and healthcare

Our transplant nursing staff were inspired by the Hands Murals and initi-
ated a wonderful project which they asked the artists to carry out. All recipi-
ents of a transplant are invited to make an imprint of their hand on a clear
transparency. Beside their handprint they are invited to write whatever
message they would like. The handprints and messages are laminated and
hang from a permanently installed rod next to one of the nursing stations in
the unit. Messages range from expressions of delight over new-found freedom
to heartfelt thanks to donor families. One of our kidney recipients wrote:
‘Now I can eat watermelon! I’m going to enjoy summer one slice at a time.’22
Another patient wrote:

The sacrifice of the donor’s family is what I marvel at most – that they
would be willing to give of their loved one so that someone else could
have a better quality of life. I think of that person and their family often
and believe there’s going to be a part of that person within me forever.23

Hiring artists

Strength comes in facilitation skills, specialty and

professionalism
The most difficult challenge in administering this type of program is
finding the right fit of artist for the hospital and for the bedside. After seven
years’ experience, there are four qualities that we feel are strong indicators
if an artist is going to be successful in the program. These qualities are
superior facilitation skills, demonstrated empathy and sensitivity towards
others, formal training or equivalent in an artistic discipline, and a current
professional practice.
Excellent facilitation skills are seminal in engaging adult patients. We
believe that the superior facilitation skill of our chosen team of artists has
been vital in the success of our program. Most often these skills come from
artists who have had a variety of teaching and/or coaching experiences.
Unfortunately, many Canadians have had a consistent lack of good art edu-
cation in the school system. As a result some patients are very wary of the
arts. Add on to that the fact that adults are much more self-critical and
inhibited than children, particularly if previous art experiences were negative.
Adult patients often refer to their lack of skill. The artists must be experi-
enced with this initial reaction and able to turn it very quickly into one of
comfort, curiosity and confidence. Excellent facilitation skills and years of
experience enable artists to handle these situations. Shirley Serviss writes:

Many people don’t feel they are educated enough to understand poetry.
An elderly woman I offered to read poetry to expressed discomfort. She
thought her daughter would probably get more out of it because she was
 Friends’ Arts in Healthcare Programs 209

a teacher. I chose to read her a poem of mine about women’s history

being written in rows of washing hung to dry in the sun and canning
lined up on cold-room shelves. As I read, she sat up in bed with excite-
ment and stopped me. ‘That’s my life,’ she said. ‘You’re writing about my
life!’ Afterwards she told me I’d left out blueberry picking and raking
hay. So I wrote her a poem of her own to value her life’s experience.24

Demonstrated empathy and sensitivity towards others is vital in interacting

with patients and families who are dealing with a health emergency, a recent
diagnosis, a long-term illness, or an impending death or who simply may not
feel up to engaging with the artist that particular day. The artist may be the
first contact a patient has after receiving distressing news on a medical condi-
tion and must be able to respond appropriately when the patient writes on a
piece of paper: ‘I will never speak again. I just found out.’ Artists must also
recognize any situation or set of emotions that should be referred directly to
the nursing clinical supervisor. Participation in creative activities by patients
and family members can release emotions. Tears from patients are not
uncommon while listening to a song or favorite poem or trying to find the
words to express what an organ transplant means to them. Our artists have a
support system in place beginning with the clinical supervisor on every unit
we serve. We also provide the artists with ongoing training by nursing staff
and opportunities to debrief at a biweekly ‘Artists Rounds’.
Formal training or experience in an artistic discipline is also important to
the credibility of our program. If we tell patients and staff they are going
to meet an artist, then we are committed to introduce them to a trained
professionally practicing artist whose work is of a relatively recognizable
caliber. An understandable example is with musicians. Musicians who work
at the bedside with a diversity of patients must not only be able play their
instrument well, but must also have an extensive repertoire of music. An
added bonus for patients is when they encounter a musician who will write a
song with or for them.
The same is true for visual artists and writers. Patients and staff recognize
lack of skill and they do let us know when they see it. It is through years of
training and experience that the visual artists and writers acquire the host
of ideas for bedside projects that are mature and engaging enough for adult
inpatients. It takes extreme talent to work with such a range of people in
often difficult situations and to generate projects that will culminate in a
larger installation in the hospital.
Employing artists that are professionally practicing, at least part time, is
also critical to the success and credibility of our program. Not only does it
ensure that the artists will have a combination of training, experience and
talent, but it also means that they are embedded in the arts community.
We have found that professionally practicing artists are able to bring a variety
of opportunities to the program that others may not. These opportunities
210 Using the creative arts in therapy and healthcare

include connections with other artists, guilds, arts organizations and asso-
ciations, and granting agents. These contacts are vitally important when
recruiting volunteer artists, initiating new projects, seeking out funding part-
ners and establishing relationships with healthcare professionals within the
hospital. For example, when the Friends applied for the first time for an
Alberta Foundation for the Arts Grant, we believe that it was the competitive
salary and the credentials of the artists in our employ that convinced the
grant peer jury members to award us the sum we were seeking. This respect
garnered for our program rests on the artists we hire.

The effect we have

Can artists at the bedside assist in reducing patients’ pain perception, anxiety,
fear or depression? Can artists at the bedside assist reducing the use of pain
relief medication and sedatives? After seven years of managing the Friends
Artists On the Wards Program at the Walter C. Mackenzie Health Centre, we
believe artists at the bedside can reduce the perception of pain and alleviate
boredom, loneliness and anxiety, thereby reducing the use of pain medication,
sedatives, and antidepressant medication. We believe that artists at the bed-
side enhance patients’ healing, therefore assisting in the reduction of patients’
length of stay.
More and more studies are being released in the UK and US supporting
the positive physical and emotional effects of creative activities on patients.25
What we at the University Hospital have are many stories, letters, emails, and
comments from staff, patients and family members, and strong encourage-
ment to continue. Today, physicians, nurses, psychiatrists, social workers,
chaplains, physiotherapists and occupational therapists stop the artists in the
halls to refer patients to the program. While the artists are very careful not to
get in the way of treatment and care of patients, they find that their work is
also respected. Shirley Serviss writes:

One day, a doctor came into the room as I was working with a patient.
‘I’ll be out of your way in just a moment,’ I said. ‘Stay,’ the physician
responded. ‘I’ll just be a moment. What you’re doing is important.’

As Bernie Warren has stated, all of these ‘stories’ are grains of sand. And,
in looking at all of the grains of sand we eventually see a beach: a view of
something larger that is forming – the realization that invoking creativity
responds to individuals’ need for self-expression.26 All of us, who are creative,
albeit in carpentry, cooking, sewing, or painting know the profound pleasure,
the transcendence, and the power of creating. Creative expression is soothing,
meditative, and can reduce the perception of pain, alleviate boredom, loneli-
ness and anxiety. Guided by highly skilled artists in facilitation, the act of
making art provides patients opportunities to recapture the joy and respite
 Friends’ Arts in Healthcare Programs 211

that comes from losing oneself in an act of creation, watching a piece of visual
art emerge, or experiencing live music or words. Through art, poetry and
music we witness the will of the spirit to thrive in the direst of circumstances.

Acknowledgements
We would like to thank the Friends Board of Directors for the support, guid-
ance and trust as we grew the arts in healthcare programs; to the Administra-
tion Team of the University Hospital, thank you for your encouragement;
and to the Shands Arts in Medicine Program for your leadership and inspir-
ation. Particular thanks go to the artists whose journaling made this chapter
possible: Al Brant, Nancy Corrigan, Cornelia Osztovits and Shirley Serviss,
and to all of the volunteer artists, thank you, your skills are crucial to the
success and growth of our programs; and to Michelle Casavant who has
worked with us from day one; Diana M. Young who helps us in every way
every day; and to Geri Watson who believes in this work.

Notes
1 Kimberly Scherr, letter to Patti Lemieux, Director of Patient Relations, 13 October
2003.
2 Funds to support all of the Friends services and programs are raised through a
large and well-designed hospital gift shop which benefits from a highly populated
and central location in the University of Alberta campus. In addition, the Friends
provide operational funding for the Hospital Volunteer Department (managing
over 900 volunteers) in addition to large annual financial gifts to the hospital for
patient comfort.
3 Feedback recorded from gallery comment cards collected from 1999–2006.
4 Feedback recorded from gallery comment cards collected from 1999–2006.
5 The Gallery is open from 10 am to 8 pm, Monday to Friday, and 1 pm to 8 pm on
Saturdays and Sundays. Admission is free.
6 D. Lein, letter to the Friends, 15 June 2000.
7 C. Brione, staff evaluation, 8 September 2000.
8 J. Tabak, letter to the Chief Operating Officer of University Hospital, 5 March
2001.
9 L. Sanderson, staff evaluation, 11 May 2000.
10 Anonymous, letter to the artist, 10 December 2001.
11 Signed by patient, letter to Nancy Corrigan, undated.
12 Despite the obvious pairing of children and the arts, the Friends consciously chose
at this point not to grow the program into the Stollery Children’s Hospital for two
reasons. One, the positive response from the adult units was overwhelming and the
demand from new adult units was increasing. Two, the Children’s Hospital had a
Child Life Department with eight full- and part-time staff who focused on the
leisure and recreation of children which did on occasion include the arts. The
adult units had no such programs.
13 M. Samuels et al. Creative Healing: How to Heal Yourself by Tapping Your Hidden
Creativity, San Francisco: HarperCollins, 1998, p. 13. For more information on art
therapy contact the American or Canadian Art Therapy Associations or visit
www.arttherapy.org.
212 Using the creative arts in therapy and healthcare

14 Shirley Serviss, Artists On the Ward Journal, 2005. Shirley A. Serviss is a pub-
lished poet, freelance writer, editor and creative writing instructor. Her most
recent poetry collection, Hitchhiking in the Hospital (Inkling Press, 2005) is based
on her experience as an Artist on the Wards for The Friends of the University of
Alberta Hospitals.
15 With the exception, two of our artists see psychiatric groups of between three and
15 patients, once per week.
16 Al Brant, Artists On the Ward Journal, 2006.
17 Friends Library Journal, undated.
18 Cornelia Osztovits, Artists on the Ward Journal, 4 April 2006.
19 Nancy Corrigan, Artists on the Ward Journal, 12 April 2006.
20 Susan Scott, personal communication with Nancy Corrigan, May 2005.
21 Nancy Corrigan, Artists on the Ward Journal, 29 September 2004.
22 Anonymous, Hands of Hope, undated.
23 Anonymous, Hands of Hope, undated.
24 Shirley Serviss, 2005.
25 N. Nainis, ‘Relieving symptoms in cancer: innovative use of art therapy’, Journal
of Pain and Symptom Management, February 2006, 162–169; R. L. Staricoff, A
Study of the Effects of Visual and Performing Arts in Healthcare, London: Chelsea
Westminster Hospital, 2004, report; S. Walsh, Art at the Bedside with Family
Caregivers of Cancer Patients: A Pilot Study, Miami: School of Nursing, Barry
University, 2003, report; Creative Centre, Final Report: Satisfaction and Outcomes
Assessment, Hospital Artists In Residence Program, New York: Creative Centre,
2002, report; G. Cohen, Creativity and Aging Study: The Impact of Professionally
Conducted Cultural Programs on Older Adults, Washington, DC: National Endow-
ment for the Arts, 2004, report. For other studies and research visit the Society for
the Arts in Healthcare Website (www.thesah.org).
26 Bernie Warren, personal communication, 2005.
Chapter 13

Healing laughter
The role and benefits of clown-doctors
working in hospitals and healthcare 1
Bernie Warren 2

Setting the scene

Clowns have worked in hospital settings at least since the time of Hippocrates.
Doctors of that era believed that mood influenced healing and Hippocrates’
own hospital on the island of Kos supported constant troupes of players and
clowns in the quadrangle. In Turkey, several centuries ago, the dervishes who
were responsible for the well-being of patients first fed the body and then
used their performance skills to feed the soul. At the end of the nineteenth
century, The Fratellini Brothers (a famous clown trio) began the current
practice of clowns (both amateur and professional) making occasional visits
to hospitals, particularly pediatric hospitals.
However, the presence of professional clowns working on hospital wards as
part of a healthcare team is a relatively new phenomenon. In 1986, Karen
Ridd in Winnipeg and Michael Christensen in New York, separately and
unbeknownst to each other, began working with children in large urban pedi-
atric hospitals. Since that time, clown-doctors have fast established a niche for
themselves within the healthcare field as this new and exciting artistic practice
stirred the imagination and started to take hold in more than a dozen coun-
tries around the world.3 While each program is unique, all value and place a
high priority on professionalism, regular training, and maintaining the highest
standards possible.
Moreover, the work is not static. While the initial work was focused on
children, more recently clowning has moved outside the pediatric unit and
beyond the hospital with palpable benefits to patients, families and staff
and the community.
In 2001, professional clowns started to work with seniors in hospitals and
in that same year Hearts&Minds began their Elderflowers project with
dementia patients in nursing homes and seniors’ centers in Scotland (Killick
2003). This initiative, and others like it in Europe and Canada, acted as a
catalyst for change as clowns started to deliver service to healthcare facilities
outside of large urban centers, not only to children but across the lifespan.
More recently Cliniclowns in the Netherlands developed web clowning.
214 Using the creative arts in therapy and healthcare

Patients and other interested parties can surf over to the Cliniclowns website
(http://www.cliniclowns.nl) and view the clowns in action. In this way, they
can help more children than they could ever see personally, particularly as the
trend is to keep sick people in the hospitals for shorter and shorter durations.

Six months after its launch, the fascinating world of clowns is visited by
more than 200 children a week. They meet their clown via webcam, chat
and e-mail. They also meet with other children. The children are just as
enthusiastic as the clowns. The nature of contact is different, certainly,
but of the same quality as meeting in the flesh.
(Van Troostwijk)4

Before we begin: a few words about clown-doctors

Currently there are several models of practice for clowns who work in hun-
dreds of hospitals and healthcare settings in countries. Professional clowns
whose focus is on healthcare not just entertainment are called many things
(hospital clown, therapeutic clown, clini-clown or simply clown). The focus
of this chapter is on the work of Fools for Health’s clown-doctors. However,
much of what is described may equally be applied to the work of others.
Clown-doctors are specially trained professional artists who work in a
hospital. In the same way that ice dancers may be considered a blend of ice
skaters and dancers, clown-doctors are a blend of artist and healthcare worker.
They work in pairs, wear a red nose, use a minimal amount of make-up, wear
a white lab coat and are usually referred to as doctor (e.g. Dr Haven’t-A-Clue).
Clown-doctors work with patients, their families and the healthcare team to
promote wellness and to improve quality of life through the use of music,
improvisational play and humor.
Their work requires them to bring together training in music, movement,
theatre and other areas (e.g. magic, puppetry) with additional training, orien-
tation and sensitivity to issues related to illness and disease and then, in
character, not only improvise but also interact with their audience, not on a
theatre stage but in a public space where healthcare is delivered.
Clown-doctors are not simply entertainers. Rather, they are accepted as
valuable members of the multidisciplinary healthcare team and acknowledged
as integral components of the healthcare delivery process.

The development of Fools for Health

Developing clown-doctor programs outside a large city is not without its
problems. The experience of developing Fools for Health has something to
say to others interested in living in smaller communities or in rural areas who
wish to develop similar programs. In April 1999, after 15 years of research on
humor in healthcare and an earlier failed attempt to bring clowns to Windsor
 Healing laughter 215

hospitals,5 I was invited to present at the First World Symposium on Culture,

Health and the Arts held in Manchester, England. While there, I met Caroline
Simonds (Dr Giraffe) and learned about the work of the clown-doctors of Le
Rire Médecin. For the next two years, as part of research on a book about
their work,6 I made many trips to France to take notes and to shadow clown-
doctors in the hospitals. The days of observation were often followed by long
discussions on how and what Caroline and Le Rire Médecin do and why they
are successful. In May 2000 I had my first conversations about developing a
clown-doctor program in Windsor. In November that same year the work on
Fools for Health began in earnest.
Windsor is a border town, an urban automotive centre that sits in the
shadow of the much larger city of Detroit, which although technically in
another country is only about a 15-minute car ride away on a good day. In
addition, it has one of the most ethnically and linguistically diverse popu-
lations in the country. In many ways it is different to any other city in Canada
or anywhere else that I know about.
The Windsor and Essex area health region covers the city of Windsor, in
which about 230,000 people live, and Essex County, which is predominantly
a rural farming area and home to about another 180,000 people. At the time
I was looking to develop our first program, all clown-doctor programs
focused on children. Most often these services were delivered in large special-
ized pediatric units or hospitals. However, in 2000–1 while Windsor did have
a 60-bed pediatric facility,7 the provincial government was knee deep in
healthcare reorganization.8 As a result, I was told that a pediatric program
was unviable at the time. Looking back, I see this as one of those ‘think of the
solution, not the problem’9 moments, one of many in the six years since Fools
for Health began. In many ways, Fools epitomizes the notion that ‘necessity is
the mother of invention’. To remain viable and provide stimulating employ-
ment, Fools for Health has had to look at developing new frontiers.
From the start, Fools for Health was unusual. Besides being the first
Canadian clown-doctor initiative, its first program, launched in July 2001,
was delivered on the adult inpatient rehabilitation unit at the Western Campus
of Windsor Regional Hospital. Since then, clown-doctors have worked regu-
lar shifts in various local hospitals on oncology, palliative care, complex con-
tinuing care, intensive care unit, medical, surgical and pediatric units. They
have also worked occasional shifts in emergency, outpatient clinics and even
operating rooms.
In 2002, Fools for Health started to offer programs in nursing homes. In
2003, the first familial clown program was launched and in 2004 clown-
doctor and familial clown programs started to be delivered in smaller, more
rural settings throughout Windsor and Essex County. One result was the
development of a model for service that targets the whole hospital rather
than a single ward or unit. Currently, Fools for Health delivers clown-doctor
programs at five hospitals and familial clown programs at five local area
216 Using the creative arts in therapy and healthcare

nursing homes/long-term care facilities not only in Windsor and Essex but
also Chatham-Kent Health regions.

Personnel and training

Developing a clown-doctor program in this area is a much different prop-
osition to developing one in a large urban centre such as Paris (Le Rire
Médecin) or New York (Big Apple Circus Clown-Care unit), or Sydney
(The Humour Foundation). While we have a university with excellent per-
forming arts programs10 and a thriving arts community, we do not have the
resources or job opportunities for graduates available in larger centers. Few
professional performers choose to move to Windsor to seek a career and
upon graduation most local graduates usually move to Toronto, Los Angeles
or New York to seek fame and fortune. To keep someone in a smaller centre
like Windsor, a program needs to provide stimulating satisfying full-time
employment.
Fools for Health was one of the first clown-doctor companies to work
across the lifespan, and even today works with adults and seniors as much
as if not more than with children. This variety certainly provides more work
opportunities and a variety of experiences. However, while each population
has its own joys and challenges, this work necessitates that the clown-doctors
be enthusiastic, empathetic, good with all ages, non-judgmental, and multi-
talented as a performer. It is difficult enough to learn to work with one
population, but the Windsor clowns have the harder task of learning to work
with all the populations, and to be able to switch from one population to
another, sometimes on the same day.
The work in Windsor requires a great deal of training. In the first four
years, I trained 30 different clowns to work in hospitals using several different
models of training. In part this was because of the factors cited above and
in part due to lack of adequate funding. In the last couple of years things
have stabilized. Funding has been more secure and I have worked with the
University of Windsor to develop the first English language university-based
training for students wishing to work as clowns in a healthcare setting. The
training to work with Fools has several phases:

• First, there is an audition and interview to assess the individual’s level of

performance skills, their physical and mental health and their aptitude/
potential for the work.
• Once selected there is extensive training in clown, improvisation, char-
acter development, musical repertoire and an orientation to work in
healthcare that covers medical and psychosocial factors and the culture
of healthcare facilities.
• Each clown-doctor develops their own character through a series of train-
ing games and exercises that enable them to come up with a characteristic
 Healing laughter 217

voice, walk and personal traits and then create a costume and name to
complement these characteristics.
• Before ever working in the hospitals, clown-doctors get a taste of the
intensity of the work through observation and shadowing senior clowns.
This observation and shadowing is at first done out of character, then
later in clown.
• Regular round-table meetings and in-service training sessions are con-
ducted with the clowns to improve and maintain their skills. The meet-
ings allow other clowns to find out what is happening on the floor,
share stories about what has been happening with the patients, and air
concerns.
• The in-service training is run by both the company and guest speakers/
workshop leaders and covers performance skills (clown, song, music) and
medical/psychosocial aspects of the work such as dealing with death, or
working with those with dementia.

A typical day
Each day the team follows the same pattern. After arriving and signing in
they go, out of clown, to get the daily census and to receive notes from and
ask relevant questions of the healthcare contact for the unit, usually an
experienced nurse, charge nurse, or in Leamington a chaplain who initially
trained as a nurse.
The pair proceed to the ‘clown office’ to change into their clown-doctor
characters. The process takes about 30–45 minutes. During the process of
transformation the partners talk a little about the mood of the ward, the
types of problems present that day and possible strategies for working with
each patient. Then they warm-up vocally and physically and finally get into
character and leave the room.
Once in character they will spend from two to six hours as a clown-doctor
at the hospital. At the end of the day the partners change back into street
clothes and make detailed notes about the day’s work. They then spend time
debriefing with their healthcare contact about the events of the shift sharing
any especially important events and observations.

Working across the lifespan

From the start, Fools for Health was unique. They began their work with a
two-month pilot project at an inpatient rehab ward rather than the well-
established route of clowning on a pediatric ward. Since then, the wide
variety of settings that they have worked in means that they have interacted
with patients ranging in age from newborns to centenarians.
The development of recent work in small rural hospitals has often involved
the clown-doctors having to clown to all age ranges within a single day. Each
218 Using the creative arts in therapy and healthcare

population has its own joys and challenges. Thus, the clown-doctors have to
be multitalented. It is challenging enough to learn to work with one popula-
tion, but Fools for Health clown-doctors have the harder task of learning to
work with all populations, and being able to switch from one population to
another.
When working with children, the main concern is finding time to visit every
child on the ward, while still providing extra attention to those who need it
most. Although this is difficult, when they succeed, they are incredibly bene-
ficial not only for the patients but also for the staff. A pediatric oncology
nurse shared the following anecdote:

We have one Oncology little girl who gets her chemo every week, and
she’s got a port . . . I was having a lot of problems with her, I wanted her
to lay down, and she wanted to be sitting up . . . I couldn’t feel the port
effectively, I needed her to lay down so that I could push down on it, and
she just was not going to do it, she was just being really cantankerous . . .
the clown-doctors came, and within about two minutes, she was laying
down and I accessed her port. And, then, we had appointments with
them – they would come back . . . on Wednesdays – that’s her day to
come for chemo, so . . . make a point of [them] coming down to be
with her.

When working with adults, one of the biggest challenges for the clown-
doctors is to overcome the ‘clowns are for kids’ mindset. Many adults believe
that clowns have nothing to offer adults, as they are meant to entertain
children only. The clown-doctors have to show the adults that clowns are for
everyone. The benefits when the adults realize this are wonderful, as reported
by one clown-doctor: ‘The husband of the woman on Oncology told us that
last time we were in, his wife was complaining about pain but after we left, the
pain was gone.’

Research

Overview
Fools for Health is unique in other ways. The organization began as a collabo-
ration between Windsor Regional Hospital and the University of Windsor.
From the beginning, Fools for Health kept records of its work in order to
track its successes as well as determining areas of possible improvement.
It remains committed to systematic, rigorous and continuous research11 on
factors that influence the efficacy of, and limits to, the role and benefits of
clowns working in the healthcare system and effects of the work on the
clown-doctors and familial clowns themselves.12 In general the research we
have conducted over the last several years suggests the following:
 Healing laughter 219

• Smiles and laughter have the capability to cross all barriers (age, gender,
language, illness, pain).
• No two patients/residents, healthcare team members or units are the
same.
• Patients/residents, nurses and doctors are part of the community in
which they live, and they’re all interconnected. Moreover, each hospital is
a focal point of the community, especially in a small rural community.
• Clown-doctors, like ‘mail carriers’ in a small village, interact with all
members of the ‘village’, spreading smiles and creating community in
each room, ward and throughout the hospital.
• Each facility (hospital, nursing home) should be considered a unique
‘living organism’ and each clown-doctor program needs to be designed to
try to meet the unique properties of that facility.

More specifically our research has already shown that clown-doctors help to:

• ‘reset the clock’ (i.e. reframe perceptions of time) for patients and staff –
especially valuable in emergency waiting rooms and for patients waiting
for surgery
• take the minds of patients and families off illness
• brighten the mood of nurses, doctors and other healthcare staff
• reduce anxiety in young children awaiting surgery
• act as a distraction during minor bedside procedures (e.g. inserting an
intravenous drip, or a Ventolin treatment)
• extend the range of motion for stroke and aphasia patients
• encourage patients with a tracheotomy or aphasia to speak
• reduce the use of pain and antidepressant medication
• reduce the overall length of stay in the hospital
• increase staff morale
• reduce staff absenteeism
• increase satisfaction with rehabilitation programs.

In reflecting upon the work in the hospitals, the clown-doctors came to

understand that beyond the individual benefits they brought to the people
they saw, their work helped to improve the overall environment of the hospital
in a number of ways. Talks with healthcare staff working at these locations
further substantiated these beliefs (Figure 13.1).

Clown-doctors help to humanize the healthcare experience

Clown-doctors often work hand in hand with pastoral care, helping to
humanize hospitals stays. As one hospital chaplain observed, ‘Clown-doctors
provide moments of respite from pain, depression and boredom.’ They do
not forget a patient’s illness but always try to focus on those parts of the
220 Using the creative arts in therapy and healthcare

Figure 13.1 ‘You’ll never know, really know what your visits have meant to me . . . I will
never forget when you came to visit me as I was going for my surgery and how
you said that OR meant Over the Rainbow. It helped me a lot and I even think I
was saying that in recovery after . . . am I over the rainbow!’

individual that are healthy. They help remind family members and the health-
care team that a patient is not simply their illness. They spread smiles and
laughter wherever they go and make being in a hospital or nursing home a
more pleasant experience for everyone. As one hospital CEO once put it:
‘I don’t need statistics to see the good you do in this hospital. Everywhere
you go, you bring sunshine, not just to the pediatric unit but to the hospital as
a whole.’

Clown-doctors help to improve healthcare delivery

Patients and visitors are often more relaxed and comfortable with the clown-
doctors than other staff and open up to them more. The clown-doctors
record what they observe and what is told to them, and report this valuable
information to the healthcare team. This information is used to improve a
patient’s treatment.
Our research has noted the problems that the staff and clown-doctors have
in communicating with patients from other cultures so we developed training
workshops on how to reach out to patients from other cultures. These involve
learning songs and phrases in the main languages used in each healthcare
 Healing laughter 221

facility that help the clowns communicate with patients in the patient’s own
language.
Clown-doctors work with physiotherapists, occupational therapists and
speech therapists to help with a patient’s rehabilitation. As the manager of a
rehabilitation unit notes:

Patients have commented that the clown-doctors made them work harder
in therapy . . . and also that they allow them to have a bit of normalcy to
their lives, for a few moments. When clown-doctors are near, smiles are
everywhere. There is an infusion of endorphins into the air. Staff sing
with them, react with them and if needed are quiet with them.

Clown-doctors make hospitals more accessible and user friendly

They create a sense of community in a room, a ward and throughout the
hospital (Figure 13.2). There is a ripple effect to the work of the clown-
doctors. As one patient put it, ‘They bring sunshine and laughter. They put
a smile on your face and it lasts the rest of the day and when you think of
them {the clowns} it {the smile} comes back. They leave good feelings
behind.’
Those who come into contact with the clown-doctors experience an uplift-
ing of their mood which may then carry over to others they meet during their
day. When patients or family leave the hospital this sense of community

Figure 13.2 Oncology: ‘Boy, you’ve got to carry that weight!’

222 Using the creative arts in therapy and healthcare

continues on with them into the community at large. Student nurses, who
train in many facilities throughout our region, often comment about seeing
clown-doctors in other facilities and how much the patients, families, and
staff look forward to their visits.

Clown-doctors benefit the hospital as an institution and

community partner
Over the past few years clown-doctors have on several occasions been
involved in the process of hospital accreditations. Accreditors have cited the
clown-doctors as:

• one of the major reasons a rehabilitation program was given an ‘excel-

lent’ rating
• an example of ‘best practice’ recommending other ‘hospitals provide this
service for their adult patients as well as pediatrics’.

Moreover, the physician recruiter for the Windsor/Essex community, a much

under-serviced area, reports that the presence of clown-doctors in local area
hospitals has helped in the process of physician recruitment.
In a little over five years, clown-doctors have become accepted as valuable
members of the multidisciplinary healthcare team and are acknowledged as
integral components of the healthcare delivery process. In this short time
clown-doctor programs have helped to reduce healthcare costs through
decreased use of medications, shorter hospital stays for patients and less
stress on and fewer sick days taken by hospital staff. As one hospitalist put it,
‘The presence of clown-doctors improves the attitudes of the staff both to the
patients and to each other and inspires confidence in hospitals and in the
patient’s healthcare.’
Chatham-Kent Health Alliance’s Annual Report 2005–06 states that clown-
doctors ‘reduce stress and anxiety and improve clinical outcomes’. They have
helped to improve the quality of life for countless patients, residents, visitors
and staff. Healthcare workers, families, patients, and even members of the
community who have never seen clown-doctors and familial-clowns at work,
have come to see the value of humor in healthcare.

Other developments

Familial clowns
The familial clown program was begun in 2003. During the previous year we
had worked extensively with seniors on a complex continuing care ward. The
clowns found that their interactions were positive, from the point of view of
both the patients and the clowns. The decision was made to pursue more
 Healing laughter 223

opportunities to work with seniors, particularly with dementia patients. Fools

for Health expanded their work to local seniors’ homes. There they found that
the persona of a doctor had to be discarded. Unlike in the hospitals, in this
environment doctors are not a typical fixture, and their presence was alarming
rather than expected. Familial clowns are like clown-doctors except that they:

• do not wear white coats or carry stethoscopes

• use relatively little ‘medical shticks’
• ‘age’ their characters
• are not called Dr, rather they are called by a single name, e.g. ‘Buddy’ or
‘Sweetie’.

These changes were inspired in part by the Hearts&Minds’ Elderflowers

program.
As many nursing home and long-term care facility residents experience
cognitive difficulties (such as dementia, Alzheimer’s disease), familial clowns
employ laughter, music, storytelling and ‘reminiscence’ techniques to stimu-
late memory and improve cognitive functioning. Familial clowns aim to
increase the quality of life for seniors by engaging them in activities that help
rejuvenate creative, expressive and communication skills and that help resi-
dents connect the past to the present and be present in the here and now. They
ask stimulating questions, motivating the resident to engage in a conversa-
tion. They encourage the resident to take the lead in the interaction, telling
the clowns what to do or sing; returning the power to people who have very
little control over their lives. This engagement is especially important for
residents who do not receive many visitors.
Since the beginning of the program, Fools for Health has put familial
clowns in six different assisted living homes across the Essex County region.
Within these six settings, the familial clowns have interacted with seniors, as
well as their visitors and the staff. Familial clowns’ work has shown that they
help seniors to:

• connect to their immediate surroundings

• recognize family members
• remember the past
• improve cognitive functioning and communication skills.

In addition, they help to increase the quality of life for seniors, their families,
and the healthcare staff who work with them.

Junior clown-doctor program

In addition to its impact on healthcare facilities, Fools for Health’s work
extends into the community. In 2004 we created, in partnership with the
224 Using the creative arts in therapy and healthcare

Hospice of Windsor and Essex County, a ‘junior clown-doctor’ program

designed to alleviate emotional stress for the siblings and children of cancer
patients.
The premise behind the junior clown-doctor program is to provide children
whose relatives are battling with life-threatening illnesses with the skills and
self-esteem to become clowns in their own right. They are taught the benefits
of using humor in the face of serious illness, and how to incorporate that
humor into their daily life. The initiative:

• helps to build self-esteem in the children

• gives the junior clown-doctors a ‘tool’ (humor) to deal with their own
feelings of stress and depression
• allows them to feel like they are doing something for their ill relative
• helps to expose and hopefully foster a love of the arts in the child.

Modified versions of the training used with professional clown-doctors are

adapted for work with younger participants. They are shown how to find a
voice, find a costume, find a walk and a name, and taught how to work in
pairs. They are given pointers on developing a clown character. Once the
training is complete, their families are invited in for a special performance.
The newly minted junior clown-doctors give an improvisational performance
in pairs.

Clown-doctor clinics
Often the most salient way of explaining our work is to have people experi-
ence it for themselves. In 2003, in part as a result of a collaboration with
Dr Christine Thrasher on a health promotion she organized for the Faculty
of Nursing,13 Fools for Health began developing health promotion programs
that deliver ‘clown-doctor clinics’ at local elementary schools, health fairs
and other community events. Clown-doctors are sent to these various events
around the region where they:

• perform more, and in a ‘larger’ style, than they would at the bedside
• choose an audience member or two to be their ‘patients’
• perform some of the more popular medical shtick with the ‘patient’
• describe (or have another staffer describe) the work of the clown-doctors.

All those who attend these events can see for themselves how the clown-
doctors can help to make them feel happier and bring joy. As another
way of spreading the word about the work of the clown-doctors and the
benefits of humor in healthcare, this initiative is concerned with health
promotion.
 Healing laughter 225

Developing and delivering clown programs in hospitals

and healthcare
The success of Fools for Health has shown that even in smaller, less arts-
oriented centers clown-doctors can survive and flourish. Organizations
simply have to be creative and ‘think outside the box’. Those who are con-
templating the development of such a program in their own locations would
do well to consider the following advice:

1 Learn from others’ successes and mistakes.

• Do your homework, read any relevant journals/articles, visit the
websites of the numerous clown-doctor companies around the
world, and if possible, talk to them.
2 Choosing a site can be tricky and may take a lot more time than you
anticipate.
• You may have to meet with several people and make many ‘pitches’
of your idea before you connect with the right contact who can open
doors for you.
• Prior to delivery of the program, make sure to meet with senior
management.
3 Give a general presentation on the value of the work, backed up with any
research data or anecdotes from other reliable sources.
• Do not make extravagant claims you won’t be able to back up later.
4 Design a program that you feel meets the needs of the hospital culture
and the unit on which you work which you can deliver.
5 Remember that no two situations are the same.
• Each hospital, ward/unit and healthcare team has its own unique
challenges and ways of doing things.
• Each patient, visitor, doctor and nurse is unique and may respond
differently to the clown-doctor’s interactions.
• Each clown-doctor is unique, with his or her own strengths and
weaknesses.
6 Ensure that you can adequately fund each project.
• Ideally secure at least partial funding from the host site as this
financial commitment usually transmits to support for the program,
especially during the often bumpy initial phase of the program
delivery.
7 It is often a tall order to find just the right person, but choosing the right
people is crucial to the success of the work.
226 Using the creative arts in therapy and healthcare

• If you live in a large city with a thriving performing arts community,

there are many ways to find and interview potential clown-doctors.
In smaller communities you may have to be creative.
• Placing interview/audition notices with job banks, local theatre
groups, universities, colleges, and even high schools with performing
arts programs or social services organizations may produce just the
person you are looking for.
8 As a word of caution, do not be blinded by technical skill; simply being a
good singer or accomplished stage actor does not necessarily make the
person a good clown-doctor.
• Look for qualities in a person that make them a good person first
and a good clown-doctor second. When it comes to clowning in
healthcare facilities, maturity and life experience often outweigh
talent.
• Look for someone who is a ‘good enough’ performer, but one who
is positive, empathetic, good with people, a good listener, a giving
improviser, willing to learn new songs, approaches and ideas, and is
generous to others.
9 Having chosen the right people, make sure you provide appropriate
preliminary and in-service training.
• Enlist the services of your site contact to provide the appropriate
orientation to new facilities and local healthcare professionals (doc-
tors, nurse practitioners, nurse clinical educators, hospital chaplains)
to provide guidance and training on particular healthcare problems.
10 Visit the facility at least a week before the first day of program delivery.
• Spend time walking around the facility.
• Talk to and get to know any and all staff who will be involved with
your program. If possible, meet again with senior management and
the hospital board.
• Insinuate yourself and the clown-doctors into the healthcare team as
much as possible; arrange to attend rounds and interdisciplinary
team meetings and have lunch in the staff lunch room.
• Determine who would be your best contact and secure them as your
‘point person’. Formalize a ‘check in/check out’ time.
11 During program delivery, be sure to listen with ‘all antennas up’: that is
pay attention to sights, sounds and general ‘energy’ of each moment.
• Working as a pair really helps. What one partner misses the other
usually picks up which helps to avoid most major problems.
12 Share information with the healthcare staff as you may be in a position
 Healing laughter 227

to notice important information about the patient that the staff didn’t
see.
13 Most importantly, keep good notes and try to learn from your mistakes.

Conclusion
In order to thrive, clown-doctor companies need to be flexible and creative.
Thankfully, this is part of a clown-doctors’ nature. In this chapter, I have
outlined how Fools for Health have expanded their work beyond the pediatric
ward, where most hospital clowns are found, and beyond the typical notion
of clown-doctors to include familial clowns and junior clown-doctor trainers.
In the next two chapters Magdalena Shamberger and Peter Spitzer present
how they have expanded upon their traditional clown-doctor work.

Notes
1 This chapter is based in part on research conducted as part of an SSHRCC grant
‘What is the Value of a Smile’. The grant is jointly held by Dr Warren and Dr Peter
Twohig of St. Mary’s University, Halifax.
2 I wish to thank my research associate, Nicole Gervais, who wrote sections of the
original drafts of this text and without whom this piece would not have been
finished and my research assistant, Candace Hind, who helped by reading the final
draft and making many useful suggestions about its improvement.
3 There are many hospital clowning programs around the world and some of these
are Theodora Foundation (Europe, South Africa, Hong Kong and Belorussia), Le
Rire Médecin (France), Die Clown Doktoren (Germany), Payasospital (Spain),
Soccorso Clown (Italy), CliniClowns (Europe), Doctors of Joy (Brazil), Fools for
Health (Canada), Zdravotni Klaun (Czech Republic) and Humour Foundation
(Australia).
4 T.D. von Troostwijk, ‘The hospital clown: a cross-boundary character’, in
B. Warren (ed.) Suffering the Slings and Arrows of Outrageous Fortune: Inter-
national Perspectives on Stress, Laughter and Depression, Amsterdam, New York:
Rodopi, 2006.
5 In 1992 I wrote several grants for ‘Prospero’s Fools’ (an Integrative Theatre
company) to develop a pilot clowns in hospitals program. Unfortunately adequate
funding was not available and the idea was shelved.
6 Le Rire Médecin published by Albin Michel in 2001 and later in English as The
Clown Doctor Chronicles by Rodopi in 2004.
7 The unit provided first line medical and surgical care not only for all the usual
suspects of childhood (i.e. upper respiratory and gastrointestinal illnesses, acci-
dental injuries, diabetes, etc.), but also for more problematic conditions (e.g.
childhood cancers, cystic fibrosis, rare ‘syndromes’/diseases). If after an initial
diagnosis children needed more specialized care, they were stabilized and then
moved to larger centers in London and Toronto and occasionally Detroit.
8 At the time there was one hospital in Leamington and four hospitals in Windsor.
The Windsor hospitals were reorganized into two hospital corporations, each
with two sites. Duplication of services was phased out as were emergency depart-
ments at two hospital sites. Pediatrics was assigned to move from one hospital
corporation to another, although this move eventually took five years.
228 Using the creative arts in therapy and healthcare

9 Zedd, in T. Goodkind, Wizard’s First Rule, London: Gollancz, 1995.

10 My day job is as a Professor in The School of Dramatic Art.
11 Currently two research projects are under way, ‘What is the Value of a Smile?
An Investigation of the Impact of Clown-doctors on the Lives of Patients, their
Families and the Healthcare Team in Windsor Hospitals’, funded by SSHRC, and
‘Down Memory Lane: Work with Seniors’, on the work of familial clowns, funded
by Ontario Trillium Foundation.
12 N. Gervais, B. Warren and P. Twohig (2006) ‘ “Nothing seems funny anymore”:
studying burnout in clown-doctors’, in B. Warren (ed.) Suffering the Slings and
Arrows of Outrageous Fortune: International Perspectives on Stress, Laughter and
Depression’, Amsterdam, New York: Rodopi, 2006.
13 Currently Nursing Professor Christine Thrasher and I are developing a course to
train ‘standardized patients’ for clinical programs in nursing and medicine.
Chapter 14

Songlines
Developing innovative arts
programmes for use with children who
are visually impaired or brain injured
Magdalena Schamberger

Background
Hearts&Minds is an arts-in-health organisation based in Edinburgh,
Scotland. The aim of the organisation is to promote the quality of life for
people in hospital and hospice care using clowning and the performing arts.
Hearts&Minds currently runs two programmes: the Clowndoctors pro-
gramme for children in hospital and hospice care (launched in 1999); the
Elderflowers programme for elderly people with dementia (launched in 2001).
Both aim to contribute to the physical, mental and emotional well-being
of participants and use clowning and the performing arts (including music,
puppetry, dancing, etc.) as a starting point for communication with the
participants and as an outlet for their creativity.
The artistic style of Hearts&Minds’ work has its roots in the European
theatre clowning of Jaques Lecoq, Philippe Gaulier and Pierre Byland. We
use the red nose, ‘the smallest mask’ in the world, to aid the performer to
connect to his or her own curiosity, playfulness, openness and naïveté. This
can enable the creation of profound linkages with the participants beyond the
spoken word.
The context of our work initially was highly visual and often non-verbal.
From the outset this proved to be a particular strength and led to a further
development of the Clowndoctors programme, called the ‘Special Branch’.
The Clowndoctors ‘Special Branch’ was developed specifically for children
with multiple special needs, fully dependent children and children with ter-
minal illnesses in residential care. With contributions from physiotherapists
as well as speech and language therapists, this development created a new set
of tools elaborating on existing successful Clowndoctor interactions. It also
highlighted a different set of challenges when working with children who were
partially sighted, blind or had acquired brain injuries – who, due to physical
restrictions, could not fully appreciate these activities.
230 Using the creative arts in therapy and healthcare

The beginning of Songlines

The idea was born to create a new project which would be tailored for such
children and benefit those who could not participate in visual stimulation or
for whom this stimulation could be overpowering and/or even painful. Within
this new development the idea was still to follow the basic principles of the
Hearts&Minds Clowndoctors programme, which are:

1 Using a person-centred approach.

2 Using clowning and the performing arts as a starting point.
3 Delivering activities in Clowndoctors character (with a red nose, no
make-up and a yellow doctors coat), and as a duo. Two Clowndoctors
interact with individual children with the aim being to facilitate the child’s
responses.
4 Providing individual visits: rather than providing ward or group enter-
tainment – individual children are referred to the Clowndoctors by
healthcare staff for a specific reason.
5 Using a referral system: in advance of their visits, Clowndoctors receive
basic information on the children (name, age, illness, special needs,
communication needs, special interests) and when appropriate more
detailed information on their emotional state and family situation, etc.
The Clowndoctors are therefore able to make an informed decision on a
planned approach. A written record is then produced which contains
both the plans for each individual session at the beginning of the day as
well as the outcome of each interaction at the end of the day.
6 Gathering feedback: feedback from healthcare staff and Clowndoctors
practitioners is gathered through a strategic programme review process
twice a year, while feedback from participants is gathered on a more
informal basis.
7 Undertaking evaluation and monitoring: end-of-day summary sheets with
relevant non-confidential information are forwarded to the Hearts-
&Minds offices after each Clowndoctors visit. This information is used
to provide statistical information and provides a mechanism for quality
control. The Artistic Director makes onsite supervision visits at each of
the units at least twice a year.

From the idea to the project proposal

When forming the idea it was essential to clarify the exact context for the
Songlines project and to set the following parameters:

• deciding who exactly the project should benefit

• identifying the challenges of working with this particular client group
• describing the expected benefits
 Songlines 231

• potential challenges within the interactions and areas of need for our
Clowndoctors (e.g. information, training, assessment tools)
• potential content of research phase and development
• considering timing of research, development and training
• considering potential training contributors, potential training content
and expected outcomes.

Decisions on context and content were made after discussion with our team
of existing Clowndoctors practitioners as well as healthcare staff. This was
followed up by onsite artistic observations of regular Clowndoctors visits with
the potential target client group and conversations with organisations such as
Sense Scotland and the Child Brain Injury Trust (CBIT).

From the non-verbal to the non-visual

We embarked on this exploration from the highly visual and non-verbal to
the non-visual. The plan was to develop and deliver interactive music, sound
and storytelling activities for children who are visually impaired or brain
injured. I decided to give the project the name of Songlines and the choice of
title seemed to inspire the content of activities.
The Songlines project takes its inspiration from Aboriginal tradition,
which describes songlines (or Yiri in the Walpiri language) as tracks across
the landscape created by mythical Aboriginal ancestors when they rose out of
the dark Earth and travelled, creating mountains, valleys, waterholes – all the
physical features of the land. As the ancestors underwent various adventures,
the laws for living, and hunting skills were established. Ceremonial songs,
which pass on these stories, are described as ‘songlines’.
From its inception Songlines aimed to create music, sound and individual
story maps for, and with, each participating child – a ‘map’ representing paths
or landmarks of each child’s physical, creative and emotional environment.
Hearts&Minds aimed to promote these musical and vocal ‘areas of success’
for participating children, opening up channels of non-verbal creative expres-
sion and humour through sounds, voice, rhythm, fragments of words and
letters rather than elaborate speech.

Project: timing, research and development

We started our research in August 2003 with financial support from the
Scottish Arts Council (SAC). This was followed by a period of development
(September to mid-November 2003), and then training (mid-November to
January 2004) culminating in the delivery of the activities from February
2004 onwards.
I started by gathering useful information from relevant organisations such
as Sense Scotland, the Child Brain Injury Trust (CBIT) and Royal National
232 Using the creative arts in therapy and healthcare

Institute for the Blind (RNIB) and participated in a conference organised by

Sense that was inspirational and gave a valuable insight into the world of
potential participants.
I made onsite visits in several of our regular hospitals and residential
houses for children with multiple special needs and watched Clowndoctors
interactions with children who could potentially benefit from our Songlines
project. I observed and noted details of those activities that worked, as well
as the shortcomings and challenges of some of the interactions. Furthermore,
I attended a day at the Royal Blind School as I was interested in seeing and
hearing a participant’s sound world outside their regular Clowndoctors visit
and away from their residential setting.

Trainers and training contributions

Very early on it was clear to me that as well as creating brand new approaches,
techniques and routines, we would be able to build on existing routines and
materials. Three trainers were chosen to contribute to the Songlines project. I
met with each of them, clarifying the aims and objectives of the project as
well as outlining their training briefs.
Drawing on the expertise and practical experiences of the Hearts&Minds
Clowndoctors programme and focusing on some time-tested Clowndoctors
principles, the three trainers helped us ‘translate’ our highly visual activities
into a non-visual context. They were James Robertson, a music therapist,
Naheed Cruickshank, a professional musician and music educationalist, and
Pete Vilk, a professional musician and Clowndoctors practitioner at the time.
All three trainers were asked to contribute to the creation of a training pro-
gramme for Clowndoctors Songlines and were provided with the following
training briefs.

James Robertson
• Provide an insight into the basics of Nordoff-Robbins Music Therapy1 –
theory, strategies, approaches, instruments, teaching material, training
plan.
• Share experiences from a music therapy setting: playful approaches and
strategies.
• Help contextualise music therapy approach for the Clowndoctors work.
• Explore the use of musical instruments and voice: improve Clown-
doctors’ confidence to improvise (individual, group and duo).

Naheed Cruickshank
• Explore the use of voice: training, repertoire, confidence to improvise.
• Create a bank of Songlines repertoire (music and rhymes).
 Songlines 233

• Explore the use of graphic notation, including basics of Kodály system.2

• Share experiences from educational settings: (as above) playful approaches
and strategies.

Pete Vilk
• Explore the use of voice and musical instruments (practitioner’s own,
new instruments and self built instruments).
• Help adapt the existing Clowndoctor’s artistic themes/repertoire and find
new strategies/musical approaches.
• Research the needs of target groups.
• Assist in the creation of sound scenarios and events.
• Explore the use of sound signifiers and sound symbols.
• Assist in the purchase of instruments and their use. These instruments
would later make up the content of the Songlines case.
• Explore storytelling using musical instruments and sounds.
• Contextualise graphic notation, scoring and recording.
• Help contextualise all material created in sessions with other trainers.

In addition, Pete and James were asked to help evaluate the project.

Training content and training sessions with

Hearts&Minds practitioners
The aims of the training sessions for the practitioners were as follows:

• To prepare the ground for the Clowndoctors for this additional focus on
music and voice and to establish a basic musical vocabulary.
• To discuss the use of potential instruments (bought and made).
• To discuss and plan the actual making of instruments.
• To explore musically different themes and stories.
• To design multisensory Clowndoctors coats to be worn as part of the
costume and explore the use of suitable multisensory props. This included
the idea of creating wristbands for the practitioners bearing their
Clowndoctors names in Braille.
• To research the existing ‘sound world’ of participating children and to
discover starting points in regards to music and sound in order to develop
sound scenarios as well as sound conflicts.
• To explore the possibility of sound recording of the interaction and to
make an attempt to create a notation of creative symbols to provide
written/drawn record of the interactions between the Clowndoctors and
the child.

In the practical training, James led the exploratory sessions. He focused on

234 Using the creative arts in therapy and healthcare

improvisation – and on simplicity, space and selflessness. Naheed’s work

helped build the Clowndoctors’ confidence in using music and voice and on
creating a bank of Songlines songs and rhymes. Pete, due to his experience
working as a Clowndoctor, was a practical collaborator who helped translate
the activities into concepts that his fellow Clowndoctors could understand
and use. The other Clowndoctors also contributed their practical experience
of working with the target children in a residential setting.

Philosophy and approach

The Hearts&Minds practitioners’ approach to the Songlines interactions are
informed by the Clowndoctors’ approach to visiting children in general and
are as follows:

• Using different rhythms for each Clowndoctor (steps, sounds and move-
ment) to make it easy to distinguish between individual characters and
to make them easily recognisable, even if a child is unable to see. This
enables games such as siding with one or the other Clowndoctor, losing
and looking for a Clowndoctor, etc.
• Using clear and strong rhythms within their musical approaches to provide
simple and clear suggestions for starting points and games. Establishing
rules enables the freedom of playful interaction.
• Being aware of the importance of a strong/confident entrance. The Clown-
doctors often play music when approaching from afar to announce their
arrival in the hallway and create anticipation for their visit. However, once
they enter a child’s room/space they use a strong clear entrance – so the
child knows it is their turn. This also helps to distinguish chosen sounds
from other background noise such as televisions, music players, etc. and
provides a clear starting point for the interactions/play.
• Taking a moment of silence to tune in with the child at any particular time
at a given location. This includes reading their needs and exploring their
likes/dislikes, etc. – rather than just filling the air with ‘busy’ sounds.
• Using the child as a starting point to create Songlines. The sounds and/or
rhythm of movement/voice of a child, even a fully dependent one, who
is unable to verbally communicate, can create a starting point for a
musical exploration of their world. The surrounding environment can
influence the sound scenario – using the sound of drawers, water taps,
light switches, etc.
• Allowing silences throughout the visit. Silence is an essential marker
before changing any activity. In theatrical clowning, silence allows for
the arrival of ‘the flop’ – the moment of failure when nothing happens
and the clown shows his or her humanity through their failure – and
has the generosity to share this failure with the audience. This gives
the audience, even an audience of one, time to observe, understand
 Songlines 235

and react to the failure (often through laughter). The same applies here.
• Playing with distances and spaces to change the perceived environment.
• Remembering the importance of simplicity, space and selflessness. In
clowning, the simplest suggestions (simple – as in not complicated) are
the strongest and best. They are the easiest to pick up and develop.
• Allowing for physical and musical space gives the participants time to join
in and respond. The interactions are about facilitating the individual
child’s needs rather than for the Clowndoctors to show off their skills
(e.g. playing the flute):
Dr Superdoc and Dr Pavlova were visiting a child who suffers from
mild seizure activity. From previous visits the Clowndoctors knew
that the child loved physical and oral slapstick, such as falling over or
making the sound of falling.
The child was genuinely enjoying his visit, laughing during the
visit in between the mild seizures (lasting no more than 30 seconds).
Every time a seizure arrived the Clowndoctors would stop and wait
until it had passed and then continued with their visit.

• Using simple language. Both verbal and musical vocabulary should be

simple allowing for it to be repeated and developed at a later stage or
further session. Comic timing and play are generally created by setting up
an expectation (i.e. a rhythm) and later ‘destroying’ it by changing it.
These ‘ruptures’ often cause laughter (Figure 14.1).
• Taking risks. Dr Superdoc and one of his colleagues were visiting an
eight-year-old boy Adam3 at a children’s hospice. Adam has multiple
special needs and can’t see very well. He is generally very passive. Initially
the Clowndoctors were very careful, initiating interaction by playing gen-
tle music during a series of visits. As there appeared to be no great
response they took the risk of a very different avenue. They started a visit
by stamping their feet loudly accompanied by the use of a kazoo. In this
way they discovered that the child seems to love loud rhythmic music and
responds very well to this. Another approach would be to start gently and
increase the volume. The boy is now starting to physically move along
with the music, he smiles and his eyes light up.
• Linking different visits with sounds. When there is more than one partici-
pant in the same room, the Clowndoctors often link these visits with
particular sounds/instruments. Rather than stopping and starting they
use these sounds to ‘balance’/connect the group while giving individual
attention.
• Leaving with sounds after ending the visit. Just as it is beneficial to
approach a child playing music to announce yourself, we realised that
children seem to find it soothing if the departure is also still accompanied
with sounds/music.
236 Using the creative arts in therapy and healthcare

Figure 14.1 A musical rupture.

• When in doubt, listen. When the plans you have made don’t work, then
stop, wait and listen. Rather than overpowering a room or an entire visit
with sounds and ideas, start with the child from ‘nothing’ and let a new
idea arrive.
• 2:1 sessions vs. group sessions. In general most of our Clowndoctors and
Songlines sessions are 2:1 (two Clowndoctors will visit one referred child).
However, sometimes children and young people can find the amount of
attention disconcerting. They find it easier to participate when the focus
is not directly on them. With children that have multiple special needs
and/or are fully dependent, these preferences might be harder to read:
Dr Molotoff and Dr Pavlova found it hard to achieve any reaction
from Susan, a 16-year-old fully dependent girl in one of the residen-
tial units we visit. The only means of communication for her is eye
movement during very close up eye contact.
During one of their Clowndoctors visits they came across Susan in
the living room with another couple of residents. Being unsure how
to develop activities with the teenager, the two Clowndoctors decided
to treat the visit as a group session. They started creating a sound
world for another child, when Susan, to their great surprise, joined in
by vocalising along with the sounds and becoming part of the sound
world being created. The Clowndoctors incorporated her contribu-
tion and also managed to link it to a third resident child.
 Songlines 237

During a further visit the Clowndoctors wanted to give Susan

individual attention but had to realise that she prefers participating
as part of a group.

Songlines referrals
The stages and techniques used by the Clowndoctors in working with an
individual child include:

1 Create a Songlines record card for each participant with the help of
healthcare staff. This becomes the children’s ‘passport’ to their Songlines
journeys.
2 Receive Songlines referral with updated information from staff.
• The Songlines referral card (which we adapted from the Clown-
doctors referral system and which was also influenced by patients’
cards which the healthcare units already used) and referral sheet
(end-of-day summary) provided the basis and a record of all
activities we provide.
• It contains basic information such as name, age, ability level, likes
and dislikes and communication needs.
• In addition we use photographs of the children and add additional
information such as effect of medication, abilities, disabilities, range
of vision, range of hearing, range of physicality, preferred physical
position, signs for approval, signs for disapproval, signs of relax-
ation, signs of discomfort.
• Following several visits with an individual child we would then create
and record a Songlines sound control: preferred musical instruments
and style; signs for yes, no, stop, go, again, more, less, louder, quieter,
faster, slower.
3 Prepare and plan Songlines activities.
Dr McFlea and Dr Molotoff were going to see Jason, a boy with
multiple special needs and very limited vision. Jason spends most of
his time in a wheelchair in his room or the living room. The Clown-
doctors made a plan to take him on a journey through the corridors
of the residential home using sounds.
4 Initiate interaction with child, with the help of musical triggers. They initi-
ated contact and suggested the idea of a journey by using a tri-tone
whistle as the starting point to a train adventure.
5 Listen and translate – enabling participation and facilitating exchange,
enabling a creative and emotional outlet for participant: the Clown-
doctors played with distances. They responded to and explored sounds
Jason was vocalising himself.
238 Using the creative arts in therapy and healthcare

6 Share own musical experiences with the child: in addition to the journey
sounds and Jason’s vocalising, Dr McFlea and Dr Molotoff also used
their musical abilities to increase the musicality of the ‘adventure’.
In this case, they added some jazz elements to the tri-tone whistle
and incorporated instruments (tambourine and harmonica) into the
story.
7 Reflect and report – working to build a long-term relationship with
the child, enabling success for participants. At the end of the day the
Clowndoctor practitioners produce a written record on the activity and
outcome of the session:
Songlines storyline (a ‘train journey’); activities and games (leading
and following; playing tag, hide and seek with sounds).
Positive response (Jason was alert and vocalised). Negative
response (Jason started shaking his head when the train journey took
him into the bathroom).
Significant developments (Jason made direct eye contact for the
first time during a visit – when anticipating train sound; he held eye
contact for several seconds).
Successful sounds and instruments (Jason responded particularly
well to the tri-tone whistle in combination with the harmonica).
8 Creating a written Songline for each individual child as a part of the refer-
ral system to create an artistic and playful ‘world’ for the child. At the
end of the day, in addition to the written record, the Clowndoctors would
attempt to create a drawing of a musical/sound score/storyboard of the
journey – so it could be re-created and built on at a later stage. This proved
to be the most difficult part of our explorations and mostly we had to rely
on written description instead.

Songlines’ artistic repertoire

Exercises and improvisations

In training, we identified various aspects of the patient’s sound world that
the Clowndoctors could work with to enhance their sensory experience. As
most of our Clowndoctors are not trained musicians, we were trying to explore
the use of creative notation to find a way of creating a record or visual score
of what was going on musically during the Songlines session. We wanted to
be able to pass on the information, repeat it or build on it during future visits
(most of the children we see in Songlines are visited over a period of several
years on a weekly basis).
We only succeeded to a small degree as the creativity of the process left too
much room for individual interpretation. This made it hard to create universal
rules. However, I would recommend attempting the exercises as they were a
 Songlines 239

lot of fun and of great help in developing a musical relationship within the
partnerships.

Connotations of various musical instruments

Very early on, we embarked on an exploration of different instruments,
noting connotations and possibilities of sounds. These possibilities are out-
lined in the chart found in the Appendix to this chapter.

Sound signifiers
Personal musical signatures were created for all Clowndoctors and/or children
using a particular musical instrument to distinguish between the different
Clowndoctors. We created simple and clear phrases for: yes/no; confusion;
hello/goodbye for each of the Clowndoctors with their sound signifiers. These
would always be used in the same way. It is not important what the actual
sound is, only that it is consistent, clear and can be repeated.
Dr McFlea used her tambourine and would use the following musical
vocabulary:

• to indicate a yes, she would slap on the tambourine once

• to indicate a no she would scrape the skin of the drum
• when confused, Dr McFlea would hesitate (long pause) before scratching
the drum skin
• to say hello she would shake the tambourine as it rises and flick the skin
with two fingers at top
• to say goodbye she would reverse the above downwards and also reverse
the order.

Dr Superdoc always used his song whistle in the following ways:

• to indicate a yes he would use the stick for a quick curl up

• to indicate a no he would mouth the word ‘uh-uh’ (no)
• when confused, Dr Superdoc would use several quick phrases on his song
whistle
• to say hello he would use the whistle going from high to low
• to say goodbye he would reverse from low to high.

Ceremonial songs
By using the preferences of individual participants, such as favourite words,
the child’s name or the name of a pet or special interests, etc. and combining
them with the child’s favourite musical style, the Clowndoctors would create
a ‘ceremonial’ song for each individual child, which could be recorded and
240 Using the creative arts in therapy and healthcare

repeated. This could become their ‘special song’ and a starting point to each
visit. One girl insisted that every Clowndoctors visit would start with her name
being sung in an operatic style of music also incorporating the names of all
other people present in her room. This would give her the security of knowing
exactly who was around and she could relax and join in with other activities.

Sound symbols
The Clowndoctors use sound symbols as rituals signifying the beginning and
end of each of the sessions. This can be as simple as:

• using the same musical instrument such as a gong or cymbals for each of
the children
• using the child’s preferred instrument to provide a ‘frame’ for the visit
• using the Clowndoctors sound signifiers
• using a hello and goodbye song
• using a ceremonial song
• using a special rhythm of knocking at the door.

Sound events
Created by other ‘users’ of the same or adjoining space – the Clowndoctors
would react and respond to the sounds of the actual physical environment of
the room or the building: water; gargling water; monitors; doors; keys; win-
dows opening/closing; cleaning windows; curtains being drawn; doorbells;
ringtones; phone conversations; footsteps; chairs; radio players; bed wheels;
intercom; washing machines; etc.

Everyday sounds

Mapping the room

Use is made of the actual sound environment by creating a sound map of the
individual rooms of participants and their contents, for example: washing
basin; bin; stereo; television; cupboards with drawers; cupboards with sliding
doors; beds; windows; soap dispenser; door opening and closing; clocks; crisp
packets; sounds on shoes; tapshoes; squeaky shoes, etc.

Sound-making qualities
Some of these sound discoveries were planned, some incidental. During one
visit Dr Spritely took several instruments out of the Songlines case, some of
which were protected with bubble wrap. While unpacking the instruments,
one boy responded particularly strongly to the sound of the bubble wrap.
 Songlines 241

Therefore Dr Spritely explored using the sound of the plastic and also misused
it by playing the bubble wrap as if it was cymbals – which led to additional
slapstick.

Soundscapes
The Clowndoctors would often embark on musical journeys using the sounds
of the child’s actual environment. They would create sound maps of these
musical ‘landmarks’ in the child’s environment. In addition, they would use
these sounds to create different moods and atmospheres, therefore changing
the actual environment: for example, letting the source and choice of sounds
turn the child’s room into a kitchen, a playground, or a storm:

Dr Molotoff and Dr Sprout would create an age-appropriate soundscape

with Mary (16) using the sounds of objects in the room (such as CD
player, glasses, water, window), including the acoustics of the adjoining
bathroom (echo, steps).
One theme, ‘A Night on the Town’, was an attempt to take the girl out
of the hospital environment. It included: meeting with some girlfriends;
walking to a club and standing in line to get in; inside a club (music,
conversations, too loud, etc.); going back out for a breath of fresh air;
returning inside; walking back home and returning to her room.

Sound scenarios
Using musical instruments and voices, the Clowndoctors would take the
children on imaginary journeys such as to the bottom of the sea, the circus, to
the moon, on top of a mountain, to the farm:

Dr Spritely and Dr McFlea visited Sarah (7), a fully dependent girl at

Rachel House. Sarah is blind, but her hearing is unimpaired. The Clown-
doctors decided to create the sound scenario of a farmyard and farm
animals using a variety of instruments and voices.
The animals were introduced by their different sounds and moved
around the room. They were also told off by the Clowndoctors for eating
the plants. Different materials were used to let Sarah touch the animals.
She loved the cow in particular, which kept knocking into her chair. Her
mother and carer were present and soon became involved in the play.
Sarah’s mother was laughing and playing along as various animals too.
The visit concluded with a variation on the song ‘Old McDonald’
using the girl’s name. Finally, the animals were put on a bus and sent
back to the farm for their dinner.

Both soundscapes and sound scenarios offer opportunities to accompany,

242 Using the creative arts in therapy and healthcare

mirror, or contrast the movements, sounds and rhythms of the child. This
allows the practitioners to support, lead or follow the suggestions of the
participant.

Sound slapstick
Sound slapstick includes: musical accidents; counterpoints; contrasting
rhythms and ruptures – setting up a rhythm/pattern/song and then breaking/
interrupting/changing it; starting a song together slapstick – too early, too
late, too fast, too slow, etc.
In comic timing a very simple exercise is to set up a movement a couple of
times and then make a mistake the third time. The same applies to musical
clowning. Set up a musical pattern, play it correctly twice and then make a
mistake the third time. Play a melody well and then make a mistake. Make
a mistake thrice and then play the melody well, making a new mistake at a
different time than expected. Experiment with using strange/surprising sounds
that arrive spontaneously.

Dr Superdoc had regular visits with Holly, a fully dependent eight-year-

old girl. Holly responded particularly well to odd sounds – which she
found very funny. Dr Superdoc would play a beautiful tune on his song
whistle. One of his colleagues would interrupt the song with a vibra
slap. This rupture would make Holly laugh every time. At times the
anticipation of the rupture would be enough.

In our experience, sound slapstick (as well as visual slapstick) works par-
ticularly well with fully dependent children, those with multiple special needs
and those who are generally very ill (such as children on oncology or neurol-
ogy wards). These children, because of the nature of their illness, often spend
a lot of their time in isolation cubicles and the silence and ‘carefulness’ of these
environments tend to remain with them. The children seem to particularly
enjoy when this silence is broken (Figure 14.2).

Sound narratives
These are stories and conversations between musical instruments and/or
singing voices of distinctly different sound qualities such as:

• replacing verbal communication: i.e. using a harmonica and a drum

instead of words to converse, to lose and find each other, have an
argument, resolve it with a happy harmonious ending
• playing the child’s body parts (different body parts touched make
different sounds, accompanied by second Clowndoctor)
• playing the child’s environment (scratching of chair, tent, etc.)
 Songlines 243

Figure 14.2 A non-verbal conversation.

• interpreting movement of child with sound

• telling an existing story with musical accompaniment.

Sound dynamics
Explore different sound dynamics and their connotations, for example: pop,
stop, clutter, silence, surprise, rhythm, discord, harmony; create communica-
tion tools such as yes/no, stop/go, louder/softer, slower/faster, for each child.

Body sounds
These sounds may be: yawning, coughing, sneezing, breathing, smacking lips,
eating, drinking, gargling, kissing, smelling, body percussion.

Musical instruments
As a starting point I would generally recommend the use of acoustical rhythm
instruments combined with a range of whistles, mouth organs, vibra slap, and
might use them as follows:

• to play a song
• to tell a story
• as accompaniment within a story being told
244 Using the creative arts in therapy and healthcare

• for songs and instrumental pieces

• making rhythmical improvisations with instruments and voice using the
rhythms and sounds of a child as a starting point
• Hide and Seek with Instruments: hide from sounds
• follow the sound: look for the other Clowndoctor or Clowndoctor sound
• instruments – qualities of sounds, preferences and aversions.

Home-made instruments
Suggestions for home-made instruments might include: water bottles; sound
of water going from one vessel to the next; ping pong balls; kitchen instru-
ments; salad spinners; thimbles; graters; thunder sheets; tray of sand; balls
(graduation – different tones); elastic bands; sound tubes, etc.

Different styles of music

There is an endless range of music styles to choose from: opera; reggae; jazz;
swing; rap; barber shop; crooning; etc. Different musical styles and parodies
may be used. For example, to provide age-appropriate activities for teenagers
we would explore rapping their names, interests, etc.

Voice
Use of the voice might involve:

• storytelling
• foreign languages; accents; laughing; talking; describing; using animal
noises; words:
Two Clowndoctors were working with Brian, a young boy with com-
plex special needs, in respite care. Brian was quite unresponsive. The
Clowndoctors experimented with a range of different things, none of
which was successful. They persisted and by chance Dr Superdoc
started using the word ‘Ouch’. Brian responded very strongly in a
positive way. He appeared to like the sound quality. Dr Spritely
joined into an improvisation of ‘pain sounds’, which turned into a
pain song and a very successful visit.

• silences – silence speaks loudly too.

Singing
Singing might involve:
 Songlines 245

• operatic singing, rapping, film theme songs (e.g. Blues Brothers, Mission
Impossible, James Bond)
• misusing songs (i.e. insert different lyrics to well-known songs, getting
lyrics wrong)
• lullabies
• using song repertoire – ‘Moses supposes’ change Moses to child’s name
• sing child’s name in different styles
• can’t stop singing – keep holding notes for too long.

Bank of ideas for storytelling and soundscape visits

Touch and sound

For their work with Songlines, the Clowndoctors use multisensory coats.
These are standard yellow Clowndoctors coats covered with Velcro patches to
which can be attached a selection of tactile objects (e.g. carpet patches, shells,
sponge) and fabric that can create a tent between two Clowndoctors and a
child. In addition, each Clowndoctor will have Braille name bracelets. Other
materials and props, such as tubes filled with a selection of different grains
(e.g. rice, couscous, lentils, peas, etc.), coloured card, foil, crepe paper, acetate,
card, ribbon, mini-fan, smelly bubbles, sticky balls, magic wands, will help to
make the visit multisensory and to link touch with sound. Use of the tactile
objects might involve:

• feeling materials such as stone, velvet, vinyl, suede, shells, leaves, bubble
wrap, fluffy material, sandpaper
• feel these, which one feels like the sound
• place them in hand of child or use in tactile play (e.g. stone and Tibetan
bowl)
• play the sound of an instrument (e.g. child ‘creates/conducts’ music by
having different materials in tactile play).

Very small babies who are fully dependent and children with acquired brain
injuries seem to enjoy gentle and beautiful music and singing. These gentle
sounds can be combined with touch in the rhythm of the music: for example,
touch their hand/arm with an object such as a soft toy, so they can feel the
rhythm of the music in addition to hearing it. These objects can become little
beings/small animals dancing on their hands and arms.

Words
In our experience using naïve verbal narrative (‘Wow!’ ‘Oh!’ ‘Good!’ ‘Yes!’)
works better than description as the children get plenty of descriptive narrative
246 Using the creative arts in therapy and healthcare

from other sources. Obviously the Clowndoctors will be the best judge of this
in each individual case.

Stories and journeys

The quality of a sound can give a visual feel and/or describe a motion. It can
also indicate whether objects and/or people are stationary or moving as well
as the quality of movement (quick, slow, ponderous, flowing, etc.). Words and
stories/journeys can be woven together, but also allow room for silence.

Patients controlling Clowndoctors with sound

• Magic wand as sound control by child.
Dr Foot-Twanger and Dr Soundsgood were visiting 12-year-old
Martin on a Neurology ward in a participating paediatric hospital.
At the time, due to an acquired brain injury, Martin had no speech
and no movement aside from being able to wiggle one of his thumbs.
The Clowndoctors decided to take the entire Songlines instrument
case into the boy’s cubicle. Martin’s thumb became his ‘magic
wand’ with which he was able to conduct the Big Band consisting of
Dr Foot-Twanger, Dr Soundsgood, parents, grandparents, visiting
friends, staff members, etc.
Martin thoroughly enjoyed the control given to him and became
very animated during and after these repeated visits.

• ‘Sleepdoctors’ with musical instruments: a control game where one of the

Clowndoctors would not be able to stop himself or herself from falling
asleep and whereby a child with limited movement could use an instru-
ment to wake him or her up.
• Child directing Clowndoctors with sounds; movements, etc. – natural
movements become musical instruments.

Play each other’s movements

The set-up for this exercise is as follows. Two Clowndoctors work together at
a time and all other practitioners keep their eyes shut to listen to the music/
sounds created. One at a time, the pair musically accompany each other’s
movement:

• Play the movement/dance of the other Clowndoctor: sound – silence –

reaction – silence; the physical movement/gesture creates the sound.
• Play the movement of the child in hospital: the Clowndoctors play the
movement of eyes, hands, feet and other parts of body.
 Songlines 247

• Place a wand in the child’s hand and move it for them/with them so the
child can conduct the second Clowndoctor playing.

Assessment games
• Identify which part of the child’s body and what degree of their
movement they are using to consciously control the clown’s sounds.
• Eye movement: even though a child may be blind or partially sighted,
tracking is still common when alert and engaged in a visit.
• In the case of involuntary seizures, we can still treat these as signals and
give them some significance. Giving control to something that is essen-
tially out of their control can be empowering in some cases.
• Clowndoctor changes the dynamic variable as a rupture (e.g. child may
only have one signal, stop/go, so change it to loud/quiet).

Conclusion
I believe that some of the successes of the Songlines project are as follows:

• Our practitioners have found additional ways of communication with

participants through the use of music and sound.
• We have gained experience in the use of a range of musical instruments
(contained in the Songlines instrument case).
• We have created a repertoire of songs and rhymes to be used.
• We have created a common musical vocabulary to be used in our
Clowndoctors partnerships.
• We have found means of clowning and expressing humour through the
use of music and sounds.
• We have explored multisensory coats and Braille name bands as part of
our interactions (the portable tent proved highly impractical).
• We explored creative notation, which is the only point that did not find its
way into the delivery of the programme.
• We have successfully translated existing visual Clowndoctors activities
such as physical/visual slapstick (e.g. falling off chairs) into sound
slapstick.

Although the Songlines project has had a limited lifespan and was officially
concluded in 2005, the experiences and explorations we made have had lasting
impact in the ongoing delivery of our Clowndoctors and Elderflowers pro-
grammes. It has not only given us further tools to communicate with children
who are visually impaired, blind or have acquired brain injuries, but has also
taught us to have the patience to wait even longer for responses. It taught us
never to expect any responses at all and nevertheless continue exploring, trying
and listening. It has taught us to keep taking risks. If responses do happen we
248 Using the creative arts in therapy and healthcare

have learned to notice what triggered them so we can use this in future. Most
importantly, beyond any disability is always the ability and whatever it may
look like the child is in there.

Acknowledgements
A special thanks to Ian Cameron (Dr Superdoc), Fiona Colliss (Dr Spritely),
Clark Crystal (Dr Foot-Twanger), Zoë Darbyshire (Dr McFlea), Virginia
Gillard (Dr Pavlova), Maria Oller (Dr Molotoff ), Pete Vilk (Dr Soundsgood)
and Elizabeth van Zwet (Dr Sprout). These Clowndoctors contributed to
the development of the Songlines project and continue to deliver Songlines
activities within the Hearts&Minds Clowndoctors programme.

Appendix
Vibra slap Fun accident; earthquakes; rattlesnakes; woodpecker; a
marker; wake up (when played side on creates a muted earthy
sound).
Elephant bells Create little melodies; solitude; serene, gentle vibration.
Swirl xylophone Wheels; wagon; motion; time passing; sand in hourglass; rain;
dripping; underwater; little people, walking; arriving; good alongside
storytelling.
Hand chimes Strong/deep physical resonance in vibrations; establishing a sound
world; warm, cuddly, comforting; bells; markers for storytelling;
conversation one to one (third person drops in as a comic rupture
or to expand harmony).
Vibratone Outer space; question mark; submarine; valleys; echoes; distance;
chasing the quirky sound.
Sound tubes Wind; mountain top; ghostly; play like a didgeridoo; talk through them.
Frog drum Ship creaks; alien; doors opening; small curious creature; insects;
frog conversations between the two; too intense close up.
Nightingale Birds of the Amazon; cover hole for bubbles sound; cover hole and
whistle gently release whilst sucking in air creates subtle sound.
Goongroos Tied to ankles for entrances; Rudolph/Christmas; huskies in the
snow; circus; soothing close up.
Ocean drum Sea; water; waves; holiday at the beach; big dynamic range;
raindrops increasing to a storm; little drummer boy.
Tibetan bowls Falling asleep; arrival of a character; dreaming; calm; serene; strong/
deep physical vibration in the space; healing; intense warm sound
close up; call for lunch; slapstick ‘it’s beautiful here’ then rupture
with a silly sound.
Hand fan Flight of the bumble bee; fly; mosquito; landing; the wind (watch out
for hair!).
Tri-tone whistle Train; steam engine; boat; departure or arrival in story; singing/
blowing jazzy phrases through it; clip the sound to make it
vocal.
 Songlines 249

Electronic Happy birthday; nursery rhymes, ruptures well with the electronic
keyboard laughter bag.
Anticipation Create anticipation with lovely melody, then break it. Countdown,
and using silence then forget or play unexpected sound.

Notes
1 Nordoff-Robbins Music Therapy evolved from the pioneering use of music as ther-
apy developed by the late composer Dr Paul Nordoff and special educator Dr Clive
Robbins. Robbins says: ‘Music is the most basic way to reach handicapped children.
It is the one thing that transcends all human emotion and feeling. Though there is
so much these children can’t do, what we want to know is what they can do.’
2 Zoltán Kodály (1882–1967) was a music educationalist, born in Hungary. Kodály’s
approach to music education is based on teaching, learning and understanding
music through the experience of singing, giving direct access to the world of music
without the technical problems involved with the use of an instrument. The Kodály
approach to music education is child centred and taught in a logical, sequential
manner. There is no ‘method’ – more a series of guidelines. Tools used according to
Kodály guidelines are relative solfa, rhythm names and handsigns.
3 All names of participating children were changed.

Websites
www.britishkodalyacademy.org
www.clowndoctors.org.uk
www.heartsminds.org.uk
www.nordoffrobbins.org
Chapter 15

LaughterBoss
Introducing a new position in aged care
Peter Spitzer

It is the job of the LaughterBoss, via open-heart surgery, to touch the soul
and give it room to smile and laugh.

Introduction
LaughterBoss originates from the philosophy that laughter is the best medi-
cine. The positive power of humor is well known and bringing humor and
laughter into aged care assists staff to more creatively meet quality of life and
psychosocial care issues of residents. The LaughterBoss is also well placed to
help reduce staff stress and improve staff morale.
The LaughterBoss is the modern-day equivalent of the court jester. They
bring together the art and the medicine. Ideal candidates for training are staff
members who have intimate knowledge of residents, families and staff as well
as a thorough understanding of the environment and culture of the facility.
Training to become a LaughterBoss does not make the applicant a profes-
sional performer. They remain a healthcare professional who has developed
creative skills in introducing humor and laughter into their facility. This
chapter explores how to train and introduce a LaughterBoss into aged care.

Clowning and evidence-based medicine

Gelotology is the study of humor and its effect on the human body.1, 2, 3, 4, 5 The
Association for Applied and Therapeutic Humor (AATH), founded in 1988,
defines therapeutic humor as ‘any intervention that promotes health and
wellness by stimulating a playful discovery, expression, or appreciation of the
absurdity or incongruity of life’s situations’.6
Clowning has a long history of being an art form that invites play, inter-
action and, above all, laughter. Many studies on the effect and benefit of
humor and laughter have been published.
Laughter affects the mind and the body. There are many reasons why
laughter makes us feel good and a recent study has found that humor and
 LaughterBoss 251

laughter triggered the brain’s reward centres.7 Other studies show respiratory
and cardiovascular effects. Laughter stimulates respiration, relaxes arteries
and improves blood flow as well as oxygen saturation of peripheral blood.
After a transient rise there is a drop in blood pressure. Positive effects on
hypertension and diabetes have been noted. A relaxation response is experi-
enced after laughter. Laughter has been researched in the field of psycho-
neuroimmunology and studies have shown a drop in serum (cortisol) stress
hormone and enhancement of immune system functioning. Laughter reduces
pain. Laughter is also studied in the field of positive psychology and positive
effects on performance, mood, optimism, anxiety and depression have been
observed. Laughter enhances communication and is positively associated
with emotional stability.
There are many published studies on the impact and place of
humor and laughter in aged care and a small number is referenced
here.8, 9, 10, 11, 12, 13, 14, 15, 16, 17

Aged care issues and depression

Not that long ago, life expectancy was in the 40 to 50 range. Now, it is
common to be caring for people who are in their eighties and nineties. This
group suffers from a multitude of losses such as loss of physical and mental
ability, loss of power, loss of friends, loss of control in their lives and loss of
independence.
Depression is common at this late stage of life and brings with it significant
morbidity, which when left untreated is associated with higher health service
utilisation.18 Depression is a major public health problem. It is common
for depressed older adults in residential care not to receive optimal help
as depression is often under-recognised by health professionals and other
carers.
A crucial issue in health promotion intervention is to increase participation
in both mental and physical activity. Common health education messages
include: depression is not an inevitable part of ageing; depression is not a
spiritual or personal weakness and non-pharmacological treatments can be
effective when used alone.19 Multifaceted interventions have been recom-
mended due to complexity of depression in residential care as well as the
potential for synergy between different elements of possible interventions.20
However, cost of funding is a common factor in introducing intervention
programs.
With an increase in the aging population, the aged care health sector is
under growing pressure. Staff stress, lowered morale, burn-out, staff turnover
and absenteeism are recurring problems. In summary, implementing effective
depression interventions can positively affect quality of life and reduce phys-
ical and psychological morbidity and consequent patient transfers to higher
levels of supportive care.21
252 Using the creative arts in therapy and healthcare

Background to the LaughterBoss concept

In Australia, the Humour Foundation charity is the only national organiza-
tion delivering hospital clowning to children and adults through its Clown
Doctor program.22, 23 This includes episodic visits to aged care facilities.
Whilst we see and feel the impact of Clown Doctor visits, we are not able
to make regular visits, which limits the impact and connection with everyone
in the facility. The commonest complaint is ‘Why don’t you come more
often?’ This signals an inadequately met need. With the inability to meet
increasing demand for Clown Doctors to visit aged care facilities, the author
developed the LaughterBoss concept under the LaughterWorks arm of the
Humour Foundation. LaughterWorks provides education and runs seminars
for healthcare providers in using humor in patient/carer relationships. In
this initiative, we would teach a staff member humor intervention skills to
deliver, on a regular and opportunistic basis, the positive power of humor
and laughter.
The LaughterBoss model was presented at the First National Conference
on Depression in Aged Care: ‘Challenging Depression In Aged Care’ at the
University of New South Wales, Sydney, Australia in June 2003.24

Who and what is the LaughterBoss?

The court jester (or fool) was a particular type of clown associated with the
Middle Ages. In those days they were thought of as special cases that God
had touched with a childlike madness. They wore bright, motley-patterned
costumes and floppy cloth hats with three points, each having a jingle bell at
the end. They also carried a mock sceptre. Medieval medicine considered
health to be largely governed by four humors (sanguine, melancholia, chol-
eric and phlegmatic). Imbalance of the humors produced distinctive emo-
tional states and the court jester was specifically employed by the court to
help rebalance the humors. For example, the court jester would be summoned
to lift the monarch out of an angry or melancholic mood:

Above all he used humor, whether in the form of wit, puns, riddles,
doggerel verse, songs, capering antics or nonsensical babble, and jesters
were usually also musical or poetic or acrobatic, and sometimes all
three.25

The tradition of court jesters lasted about 400 years and they worked in the
royal courts of Europe, the Middle East and Asia.
The LaughterBoss is a modern-day equivalent of the court jester. The main
role of the LaughterBoss is to bring play, humor and laughter into the facil-
ity. This role originates from the philosophy that laughter is the best medicine.
The healing power of humor is well documented.26, 27, 28 Sharing a smile and a
 LaughterBoss 253

laugh reduces anxiety, positively impacts on the immune system, improves

circulation, modulates the mesolimbic reward centre,29 reduces depression
and creates an atmosphere of positivity and warmth.
While the main focus of the LaughterBoss is on the residents, a positive
impact on staff, visitors and general community has been reported. The
LaughterBoss can reduce staff stress and improve morale as well as assist
staff to better meet quality of life and psychosocial needs of residents. This is
done through assisting communication, increased support, giving residents
cognitive control, providing positive diversion and generally increasing the
‘smileage’ factor.
Ideal candidates for LaughterBoss training are facility staff members who
have an intimate knowledge of the people (residents, staff and families) and
a thorough understanding of the environment and culture of the facility.
The LaughterBoss position is added on to the ‘day job’ of the staff member.
This not only reduces costs but also addresses and enhances recommended
multifaceted interventions.
After training, the LaughterBoss is a new identity in the facility. They
should be easily recognisable and available to do their work at a moment’s
notice as the need arises. They also lead the way in introducing themes,
special days and events. Training does not make the applicant a professional
performer. They remain a healthcare professional who has developed creative
skills in introducing humor and laughter into their facility.
Given that training involves play, improvisation, engagement, humor and
laughter, the ideal trainer would have performance background with teaching
experience including the ability to deliver scientific data. Performers who
also do hospital clowning have the benefit of working in the healthcare sys-
tem as well as having the backing of their organization. This adds to depth
of experience as well as professional credibility. Trainers do not have to be
medical practitioners in order to deliver LaughterBoss training.
Feedback about quality and appropriateness of training given by our per-
formers who are also hospital clowns has been enthusiastic and very positive.

LaughterBoss training
The initial training is a full-day experiential program.

Selection
Applicants usually self-select and are motivated to attend training. They must
have the acknowledgement and support of senior staff and management.
Applicants have included CEOs, directors of nursing, nursing staff, diver-
sional therapists, occupational therapists, recreational therapists and the
clergy. Often, training grants cover the cost of training.
Group size is limited to 20–30 people and training is held on a weekday,
254 Using the creative arts in therapy and healthcare

typically from 8:30 am to 4:30 pm. Commonly, one person takes on the
role of liaison and administration assistant and this person also arranges
refreshments as well as audiovisual needs.
Advertising is usually via in-house, local newsletters, aged care journals,
within the allied health specialty groups and word of mouth.

Location
The space must be large enough to seat 30 people comfortably. Chairs are
often positioned in a semi-circle at the periphery. There must be space to hold
exercises. Lightweight chairs are used as some exercises are performed seated
in groups of two and three. Natural light and fresh air are preferred. Noise
and laughter levels can rise and this is factored in. Loose and comfortable
clothing is recommended.

Course materials and teaching aids

Each trainee receives a resource pack. It contains information on the
Humour Foundation Clown Doctor program which opens discussion on
introducing new models into the healthcare setting. There is a paper on the
LaughterBoss written by the author. There is a summary of the therapeutic
effects of laughter; review of laughing at vs. laughing with someone; humor
resources; a list of creative ideas; taking steps towards an optimistic state of
mind and a paper on the health benefits of optimism; a nursing journal paper
on the ‘Use of Humour in Patient Care’; a paper on ‘The Therapeutic Power
of Humor’ and an academic and therapeutic reference list on humor and
gerontology.
Humor resources and creative ideas give busy healthcare professionals a
practical summary of what material is available, how it can be used as an
intervention and where it can be sourced. This includes reading materials and
(local) internet access.
The scientific material and video clips are delivered using PowerPoint/
laptop computer/data projector. Usually a whiteboard is available. One or
two tables are used to hold reference books and materials as well as a variety
of props. One source for scientific material as evidence is our own site,
(www.humourfoundation.com.au: select Resources then Humor References
followed by Therapeutic Humor and Physiological response). See also Notes
at the end of this chapter for further references.
Providing a summary that includes both the psychological and physical
benefits of laughter helps to support with scientific evidence and to under-
pin the validity of LaughterBoss. The author typically presents information
on psychoneuroimmunology, stress hormone reduction, immune system
benefits, circulation benefits, and information on reduced depression, positive
cardiovascular benefits and the effects on the mesolimbic reward centres.
 LaughterBoss 255

Questionnaires
Three questionnaires are used. These are valuable in assessing the program
and can form stepping stones to future research. The first questionnaire is
filled prior to training. The second questionnaire is filled in at the end of the
training day. The third questionnaire is filled in at the half-day follow-up
workshops which are held every few months.

Training content
Training brings a number of elements together by:

• introducing the science behind the ‘laughter is the best medicine’ quote
• exploring the ‘art of medicine’ and how to introduce humor and play
• stimulating creativity and developing new skills
• networking between like-minded healthcare professionals.

Training is delivered over four sessions in the day. Session 1 includes: pre-
training questionnaire; introduction to the LaughterBoss concept and intro-
duction to each participant; group activities to have some fun and play with
each other; introduction to the Humour Foundation Clown Doctor program;
the science and psychoneuroimmunology underpinning laughter and humor;
video clips and stories from the coalface.
Video clips, when available, give visual cues to laughter/play interactions.
Photos are also used and give similar cues. Both open the door to delivering
stories from the coalface. Stories are a very important way of translating the
theoretical to the transformational reality.
Session 2 includes: group play; developing a new view of the aged care
space; introduction to the play basket, the humor noticeboard and resource
material; brainstorming in groups of three on creative ways to humor oneself,
residents and staff.
Group play includes a number of exercises that stimulate play. This
is valuable experientially to balance the intellectual activities. Group plays
show the value of brief interventions and are a good way of linking the
participants. Group plays are introduced in all the sessions. There are many
appropriate group plays available. A good resource is Playfair by Matt
Weinstein and Joel Goodman.
The play basket is in itself a play resource. A strategically placed basket can
have a variety of colorful props such as scarves, wigs, hats, lightweight balls,
etc., ready to be used at a moment’s notice. Local businesses and community
groups can connect with the facility by donating equipment.
The humor noticeboard is also strategically placed. It invites humor.
Residents, families and staff can add jokes/humor articles/photos. The
LaughterBoss maintains and supervises this space.
256 Using the creative arts in therapy and healthcare

Resource material can be donated or made by the local community.

This includes materials for the play basket as well as items such as puppets,
balloons, etc.
The brainstorming exercise is a way of including others in creative
thought and expression. This is a safe and non-judgemental exercise in lateral
thinking.
A selection of books on humor is on display throughout the day.
Session 3 includes: more group play; using props as communication tools;
using polaroid and photography; examples of brief humor interventions;
humor during entry and exit; introducing love heart tennis as an example of
fun play that can incorporate residents, staff and family. In this play six
people (or more) participate. Equipment needed is chairs, one red heart bal-
loon (the ball), four soft fly swatters (the rackets) and a roll of toilet paper
(the net). Two people sit facing each other holding the rolled out toilet paper.
Two players sit side by side on each side of the net facing the players on the
other side. The aim is to get the love heart balloon over the net to the other
side. Scoring is strictly ad hoc. This play is quickly set up and very rapidly
changes the mood of the environment (see Figure 15.1).
A variety of props can be used to induce play, laughter and enhanced
communication. These are on display and the ‘schtick’ is shown. Colourful,
close-up magic or puppets often work well. Participants can experiment and
play with the props during breaks in the training. Polaroids/photography add
a dimension to play and leave a positive visual reminder of the activity/play.
Given the busyness of the day, brief improvisations/interventions make a

Figure 15.1 Love heart tennis – score: love all

 LaughterBoss 257

difference, make sense and are achievable during a busy shift. These are
shown and discussed. For instance, it may be possible for the resident to team
up with the LaughterBoss to play a ‘trick’ on the family.
Entry and exit to the facility, the staff room, the dining room and the
resident’s living space are areas where the LaughterBoss can trip over them-
selves literally – a way of acknowledging human frailty even in the staff.
This is theatre ‘on the go’; this is brief intervention; this invites reaction and
comment; this is play.
Session 4 includes: group play; planning and introducing themes; explor-
ing fun musical opportunities; aligning play to the resident’s history; explor-
ing the possibilities of the humor/play cart and the potential to connect
with the broader community; different ways of being funny on excursions;
dealing with dementia; question and answer segment and post-training
questionnaire.
Themes for the day, the week, the month and a variety of special occasions
are explored. For instance, how does the LaughterBoss make Funny Fridays
happen? Ways of engaging residents, their families and staff are discussed.
One facility put together a ‘Funny Day Out’ where residents had the oppor-
tunity to dress funny on a bus outing. This was also great for photo opportun-
ity. Photo opportunities can easily find their way to the residential or
local newspaper. The message is that residential facilities are a part of the
community.
A variety of musical/fun opportunities is explored. There is a variety of
ways of forming an ‘instant band’.
Taking the time to listen to the resident’s history gives the opportunity to
introduce appropriate play. The resident will give the cues.
Like the humor basket and the humor noticeboard, the humor cart is
another opportunity of introducing play. The medication trolley brings
medicine. The humor trolley brings play. This can have props as in the humor
basket as well as things like polaroids, puppets, magic, balloons, etc. These
can be sourced from the local community, schools and businesses – again
linking the facility with the broader community.
Throughout the four sessions participants experience the Massage Train.
This massage activity connects the group in a quick, enjoyable and light-
hearted way. In essence, the group forms a close circle facing the centre.
Everyone turns to the left and massages the upper back of the person in
front. After a couple of moments everyone turns in the opposite direction
and again massages the upper back of the person in front. This activity can
include residents and may be used during staff handover/shift change (see
Figure 15.2).
Each participant receives a colourful completion of training, the Laughter-
Boss certificate. Often a graduation photograph is taken.
258 Using the creative arts in therapy and healthcare

Figure 15.2 Rub my back and I rub your back

Follow-up workshops
These workshops are recommended every three to six months. Senior Clown
Doctors experienced in teaching lead them. They introduce their artistic
professionalism in taking the LaughterBoss role forward. The workshops last
half a day and include fun play, introducing new performance elements and
review and feedback of LaughterBoss activity. They finish off with the
questionnaire.
The training day and follow-up workshops also give an oppor-
tunity to meet healthcare professionals from other facilities and to establish
LaughterBoss networks.

Evaluating the LaughterBoss training

Broadly based evaluation using a series of questionnaires takes place during
initial training and at the follow-up workshops. A fairly typical training is
reviewed here. Twenty-six people took part in this initial training. They
came from 14 different organizations that included government community
health services, nursing homes, hospitals, carers and artist-in-community.
Participants held 15 different positions. The majority were registered nurses.
Activities officers, nursing aides, a social worker, speech pathologist, physio-
therapist, artist, diversional therapist, an adult day care manager and a
nursing unit manager also attended.
Reasons for attending included: to improve the atmosphere at work; to
introduce humor to reduce work stress; curiosity; to expand knowledge and
skills; to develop one’s own humor skills; to increase skills working with
dementia and have more fun and laughs with residents. Fifteen out of the
26 participants had no prior performance training.
Some thoughts on what the LaughterBoss could bring to the workplace
included: improved patient care; a more enjoyable workplace; reduced staff
stress; improved communication; permission to encourage laughter; certifica-
tion and validation of this new position; improved staff morale and team
building. Eighty per cent had the support of their organization to attend
training, while 8 per cent were organization independent.
 LaughterBoss 259

One hundred per cent agreed that training met expectations: 96 per cent
felt training gave sufficient skills to begin LaughterBoss work; 88 per cent felt
training gave enough confidence to begin LaughterBoss work; 100 per cent
had fun.
Thirteen (50 per cent) attended the follow-up workshop three months later.
Management had totally accepted LaughterBoss in 70 per cent of cases and
partially accepted in 30 per cent. Thirty-one per cent of other staff totally
accepted LaughterBoss with 69 per cent giving partial acceptance. Some felt
it was too time consuming and interfered with normal routine.
Of residents 54 per cent totally accepted LaughterBoss, with 46 per cent
giving partial acceptance. Comments included: always have to gauge whom
you can use it on; have to choose the right time; humor creates an instant
bond when meeting someone with dementia. Of families/carers 85 per cent
partially or totally accepted the LaughterBoss role. Comments included:
families need explanation on the role of the LaughterBoss; good feedback
from volunteers; it is now okay to laugh in here.
Comments on the wish list to maintain creativity and develop skills
included: have regular LaughterBoss meetings; LaughterBoss position for a
month – shared amongst all staff; time to fit creativity into a very lousy job;
attending magic and juggling courses.
Engaging residents with dementia in humorous interactions varied with the
level of dementia. Those with mild dementia engaged 69 per cent often/most
of the time. This was at 31 per cent for moderate dementia and 23 per cent for
advanced dementia. Of those working with people with dementia 46 per cent
felt improved level of confidence since introduction of the LaughterBoss.
Finally, some general comments included: love watching the pleasure on
their faces, even those not directly involved; I’m committed to getting a
laugh every day; proves that humor can be a positive therapy for people with
dementia.

Conclusion
The creative challenge is in becoming comfortable with and learning to
appropriately shift between health professional and LaughterBoss role. The
positive benefits of humor and laughter in the aged care setting have been
acknowledged. The ‘art of medicine’ as practiced by the LaughterBoss in
the new millennium is alive, well and needed in the aged care sector. Laughter-
Boss training is a step on the way to allowing the court jester to emerge.

Notes
1 L. S. Berk, S.A. Tan, W.F. Fry, B.J. Napier, J.W. Lee, R.W. Hubbard, J.E. Lewis
and W.C. Eby, ‘Neuroendocrine and stress hormone changes during mirthful
laughter’, American Journal of the Medical Sciences 298(6), 1989, 390–396.
260 Using the creative arts in therapy and healthcare

2 K.M. Dillon, B. Minchoff and K.H. Baker, ‘Positive emotional states and
enhancement of the immune system’, International Journal of Psychiatry 15(1),
1985–6, 13–18.
3 W.F. Fry, ‘The biology of humor’, HUMOR: International Journal of Humor
Research 7(2), 1994, 111–126.
4 W.F. Fry and W.A. Salameh, Handbook of Humor and Psychotherapy: Advances in
the Clinical Use of Humor, Sarasota, FL: Professional Resource Exchange, 1987.
5 M. Gelkopf and S. Kreitler, ‘Is humor only fun, an alternative cure or magic? The
cognitive therapeutic potential of humor’, Journal of Cognitive Psychotherapy: An
International Quarterly 10(4), 1996, 235–254.
6 The Association for Applied and Therapeutic Humor (www.aath.org).
7 D. Mobbs, M.D. Greicius, E. Abdel-Azim, V. Menon and A. Reiss, ‘Humor modu-
lates the mesolimbic reward centers’, Neuron 40, 2003, 1041–1048.
8 A.L. Barrick, R.L. Hutchinson and L.H. Deckers, ‘Humor, aggression and aging’,
Gerontologist 30(5), 1990, 675–678.
9 R.A. Dean, ‘Humor and laughter in palliative care’, Journal of Palliative Care
13(1), 1997, 34–39.
10 K. Fox, ‘Laugh it off: the effect of humor on the well-being of the older adult’,
Journal of Gerontological Nursing 16(12), 1990, 11–16.
11 W.F. Fry, ‘Humor, physiology and the ageing process’, in L. Nahemow and K. A.
McClusky-Fawcett (eds) Humor and Ageing, Orlando, FL: Academic Press, 1986,
pp. 81–98.
12 J.R. Hulse, ‘Humor: a nursing intervention for the elderly’, Geriatric Nursing
15(2), 1994, 88–90.
13 F.A. McGuire and R.K. Boyd, ‘The role of humor in enhancing the quality of
later life’, in J. R. Kelly (ed.) Activity and Aging: Staying Involved in Later Life,
Newbury Park, CA, Sage: 1993, pp. 164–173.
14 F.A. McGuire, R.K. Boyd and A. James, ‘Therapeutic humor with the elderly’,
Activities, Adaptations and Aging 17(1), 1992, 1–96.
15 J. Richmond, ‘The lifesaving function of humor with the depressed and suicidal
elderly’, The Gerontologist 35(2), 1995, 271–273.
16 J.J. Simon, ‘Humor and the older adult: implications for nursing’, Journal of
Advanced Nursing Practice 13, 1988, 441–446.
17 H. Williams, ‘Humor and healing: therapeutic effects in geriatrics’, Gerontion 1(3),
1986, 14–17.
18 R. Llewellyn-Jones, ‘New approaches for late life depression in aged care’,
Challenging Depression in Aged Care Conference, Sydney, Australia, 2003.
19 I. Hickie, ‘Depression in older persons: challenging community attitudes and pro-
viding appropriate treatments’, Challenging Depression in Aged Care Conference,
Sydney, Australia, 2003.
20 R. Llewellyn-Jones, ‘New approaches for late life depression in aged care’,
Challenging Depression in Aged Care Conference, Sydney, Australia, 2003.
21 R. Llewellyn-Jones, ‘New approaches for late life depression in aged care’,
Challenging Depression in Aged Care Conference, Sydney, Australia, 2003.
22 The Humour Foundation (www.humourfoundation.com.au).
23 P. Spitzer, ‘The clown doctors’, Australian Family Physician 30(1), 2001, 12–16.
24 Hammond Care Group (www.hammond.com.au/dsdc/
conferences.php?conference=2003).
25 B.K. Otto, Fools Are Everywhere. The Court Jester Around The World, Chicago:
University of Chicago Press, 2001.
26 W.F. Fry, ‘The biology of humor’, HUMOR: International Journal of Humor
Research 7(2), 1994, 111–126.
 LaughterBoss 261

27 H. Williams, ‘Humor and healing: therapeutic effects in geriatrics’, Gerontion 1(3),

1986, 14–17.
28 Hammond Care Group (www.hammond.com.au/dsdc/conferences. php?
conference=2003).
29 D. Mobbs, M.D. Greicius, E. Abdel-Azim, V. Menon and A. Reiss, ‘Humor
modulates the mesolimbic reward centers’, Neuron 40, 2003, 1041–1048.
Appendix

Resources

Training
At this time of writing there is an abundance of formalized programs avail-
able for people who wish to train to be a professional ‘art(s) therapist’.
While programs that prepare artists to work in hospitals and healthcare
settings do exist, these tend to be less formalized than those that train
art(s) therapists. As training requirements are different in every country
and because programs tend to spring up and/or close regularly I have resisted
making a list of every university and college that currently offers a training
program. Rather what follows is a partial list of contacts for English-
language based organisations committed to Using the Creative Arts in Therapy
and Healthcare. Many are national organizations that oversee training and/or
regulate professional accreditation in that country. Also most of these sites
have links to others.

Artists in hospitals/healthcare
Arts for Health
http://www.mmu.ac.uk/artsforhealth/
Australian Network for Arts + Health
www.anah.org.au
National Network for the Arts in Health
http://www.nnah.co.uk/index.html
Society for the Arts in Healthcare
http://thesah.org

Creative/expressive arts therapies

International Expressive Arts Therapy Association (IEATA)
www.ieata.org
 Appendix 263

Irish Association of Creative Arts Therapies

http://www.iacat.ie
National Coalition of Creative Arts Therapies Associations (USA)
http://www.ncata.com/

Art therapy
American Art Therapy Association
http://www.arttherapy.org
Australian and New Zealand Art Therapy Association
http://www.anzata.org/mambo/
British Association of Art Therapists
http://www.baat.org/
Canadian Art Therapy Association
http://www.catainfo.ca/

Dance therapy
American Dance Therapy Association
www.adta.org
Association for Dance Movement Therapy (UK)
www.admt.org.uk
Dance-Movement Therapy Association of Australia (DTAA)
www.dtaa.org

Drama therapy
British Association for Dramatherapists (BADTh)
www.badth.org.uk
National Association for Drama Therapy
www.nadt.org
Sesame Institute for Drama and Movement Therapy
www.sesame-institute.org/

Music therapy
American Music Therapy Association
www.musictherapy.org
264 Appendix

British Society for Music Therapy

www.bsmt.org
Canadian Association for Music Therapy
www.musictherapy.ca

Play therapy
British Association of Play Therapists
www.bapt.uk.com
Canadian Association for Child and Play Therapy
www.cacpt.com
United Kingdom Society for Play and Creative Art Therapy
www.playtherapy.org

Poetry therapy
National Federation for Biblio/Poetry Therapy
www.nfbpt.com
Name index

Amies, Bert 118, 132 Fratellini Brothers 213

Appel, L. 180n15 Fulkerson, Mary 86, 87, 87n5
Association for Applied and Therapeutic
Humor (AATH) 250, 260n6 Gaulier, Philippe 229
Astell-Burt, C. 179n6, 180n13, 180n14, Georgetown University Medical Centre
180n16 Gervais, Nicole 24, 25, 26, 27, 227n2,
Awa Kenzo 21 228n12
Gettings, Fred 43, 63, 63n1
Baird, Bil 179n3 Gilmour, Dean 175n5
Bartenieff 87n1, 87 Gordon, D. 87, 88, 133, 180n10,
Barton, B. 142, 158n3, 159 195n29
Big Apple Circus Clown-Care Unit 216 Gump, P.V. 41n6
Brant, A. 202, 211, 212n16
Briones, C. 200 Hardwick, Tim 1
Brownings, Robert 138 Hearts&Minds 213, 223, 229–234, 248
Burket-Smith, K. 41n3, 41 Hillman, James 144, 159, 159n4
Byland, Pierre 229 Hippocrates 213
Hoffman, Malvina 63n2
Campbell, Joseph 159 Hu, George Ling 97
Casavant, M. 211 The Humour Foundation 216, 252, 254,
Chace, Marian 77 255, 260n22
Chatham-Kent Health Alliance 222
Child Brain Injury Trust (CBIT) 231 James, William 135
Christensen 213 Johnstone, K. 133n1, 134
Cliniclowns 213, 214, 227n3 Joyce, James 138
Corrigan, N. 201, 206, 211, 211n11, Jung, Carl 138
212n19, 212n21
Crickmay, C. 87n5, 88 Kaplan, Enid 179n8
Cruickshank, Naheed 232 Kazan 22
Keen, Sam 142, 153, 159
Die Clown Doktoren 227n3 Kodaly system 233, 249n2
Dundes, A. 41n2, 41n6
Laban, Rudolf 66, 94, 147, 148, 159,
Eliot, T.S. 138 159n5
Lecog, Jacques
Fools for Health 5, 214–219, 223–227, Le Rire Médecin 215, 216, 227 n3, 227n6
227n3 Lein, Dr. D. 200, 211n6
Fox, Anne 153, 159, 260n10 Linklater, K. 179n4
266 Name index

Mazankowski Heart Institute 197 Shedlock, Marie 159

McLuhan, Marshall 143 Simonds, Caroline 215
McMullen, W. 197 Social Sciences and Humanities Research
Messenger, J.C. 41n2 Council (SSHRC)
Moss, L. 7n2 Spitzer, Peter 6, 227, 250, 260n23
Stanislavski, K. 123
Neill, Cheryl 5, 41n9, 135 Steinbeck, John
Newhouse, Jane 79, 96 Stollery Children’s Hospital 197,
Nordoff Robbins Music Therapy 232, 211n12
249n1 Sutton-Smith, B. 41n6
North, M. 87n1 Suzuki, Daisetsu 19

Opie, I. and Opie, P. 35, 41n5, 31n7, 42, Taylor, John 29

159 Theodora Foundation
O’Suillebahn, S. 41n8, 42 Thomson, C. 227n3
Osztovits, Cornelia 203, 206, 211, To, Hua 26, 30n5
212 n18 Tufnell, M. 96, 97n5, 98
Twohig, Peter 227n1, 228n12
Picasso, P. 55, 56 University of Alberta Hospital
University of New South Wales
Richard, R. 179 n1 University of Windsor 216, 219
Ridd, Karen 213
Robertson, Gordon 180n10 Van Troostwijk 214, 227n4 Tom Doude
Robertson, James 232 Vilk, Pete
Royal Blind School
Royal National Institute for the Blind Walter C. Mackenzie Health Centre 196,
(RNIB) 210
Warren, Bernie 1, 7, 8, 19, 64, 84, 115,
St. Mary’s University 227n1 134, 144, 179n2, 210, 212n26, 213,
Sense Scotland 231 227n1, 227n4, 228n12
Serviss, S. 196, 201, 204, 209–211, Watson, Geri 88, 211
212n14, 212n24 Windsor Regional Hospital 215, 218
Shamberger, Magdelena 6, 227
Shands Arts in Medicine Program 211 Young, Diana M 211
Subject index

Accountability 9 contract 9–17; between group and leader

across the lifespan 213, 216–17 126; conditions of 9, 13; goals 9, 17;
aggression, channeling 38 problems of 9–17; room 14–17
anxiety 33, 182, 183, 210, 219, 222, 251, co-operation, promoting 34, 103
253 court jester 250–2, 259
art, access to 2, 201; artifacts 31; emotion creative alertness 81, 84
and 1, 123, 249n1; in gallery 199; creative detective 10
healing 3, 6, 19–23, 73, 83, 135, 200, creative expression 3, 6, 50, 210,
210, 213–227, 252; for health 3–4, 231
20–1; as human exchange 61 creative moment 20
professional artists 4, 52, 184, 214; creative potential 2, 43, 48, 115
self-expression and 50, 161; as therapy creative therapy, definition 3; enjoyment
3, 10 ; therapy 3–4, 10–11, 31–3, 36 of 10, 31; goals of 11; patience,
Artists on the Wards 196, 199, 201, 204, importance of 11; preparation and
210 planning 11
Arts for Health 3–4 creative writing 193
Art of medicine 255, 259 creativity 43–63, 259; music and 49;
atmosphere, creation of 36, 49–50, 59–60, culture 31, 198, 220
69, 173, 200, 241, 253, 259
Dance-in-Education
body awareness 36, 67, 71 dance/movement 64–8; balance 73–4, 80,
Braille 233, 245, 247 84; body awareness 71–2; cerebral
Burns 206 palsy and 65; clothing 66; creative
alertness 67, 81, 84; Dance in/dance
cardiac (cardiology, cardio-thoracic) 199, out 78; Electric Puppet 71–2; emotion
201, 203 and; as “emotion in motion” 71;
Ceiling Tile Project 199 equipment 66, 75; Follow My Dance I
cerebral palsy, dance and 58, 65 69–71, 77; Follow My Dance II 80;
clini-clown 214 Follow My Dance III 81; gesture 85,
clown-doctor 5–6, 213–27 94; group awareness 75; I Am Me
clown-doctor clinics 224 68–9; jump 68, 75, 85; Magic Aura 72;
collective unconscious 138 movement analysis 84–5; name games
communication, mask and puppetry and 117–20; Ninja 73–74; Parachute 75–6;
162 practical activities 66; Reed in the
community 160–79, 188–9, 221–6 Wind 76–7; repetition 87n3, 127; Rob’s
complex continuing care 215, 222 Little Finger Game 68; sensory
concentration, developing 21, 36, 39, 83, awareness, developing 83; spotlighting
93, 164 70, 118, 120; Stick in the Mud 34–5;
268 Subject index

warm-up 19, 67, 71; see also dancing; equipment; art materials see visual arts
movement equipment; assessing need for 14–5;
dancing 77–83; environment 160–1; dance/movement 66, 75 ; drama 117,
Essences 81–83; feather dances 79; 120, 123; mask and puppetry 165–6;
self-directed dance; sharing 83; presession check 15; sink 15
see also dance/movement;
movement familial clown 215–6, 222–4
dementia 257–9 fantasy, visual arts in; see also guided
depression 251–4 fantasy
diagnostic tool 10 Five Animal Frolics 26–9, 30n5
dialysis 196, 201 Folklore 31–41; context and function
dignity 182 31–4; fairy tales 141; folktales 140–2;
doctor (physician) 219 games see games; history of 39–40;
drama 115–33; auditory skills 121; Inuit of North America 33; Norse
blocking 126–7; the censor 129; mythology 140; see also mythology;
character 133n2; characters, creating storytelling
128–32; communication 128–9; folksongs 33, 101, 109
contract between leader and group;
definition; director, role of 168, 173; games, cumulative games 38–9;
Dracula 119–20; dramatic process development of spatial awareness 35;
116–17; equipment 117, 120, 123; Do the Opposite 38; Irish wake games
facilitator, role of 202; guided fantasy 37; London 35–6; memory games
127–8; as human interaction 115; I’m 38–9, 94; Muk 37; name games
Sorry I Must Be Leaving 130–2; 117–20; Pig in the Sty 38; Stick in the
improvisation 130–2; Keeper of the Mud 34; Sun and Frost 35; traditional
Keys 121–2; Liar’s Tag 130; The Magic 34–9; warm-up 38
Box 123–4; Magic Clay 125–6; Magic gelotology 250
Newspaper 124–5; Male or Female? goals 9, 14, 17; dance/movement 66
122–3; Mr/ Ms Engine 118–119; name group, abilities of members 67; age of
games 15, 117–18; pattern 126–7; members 11–12; cohesion 36, 77;
Playing the crowd 129; practical composition of 111; co-operation 34,
activities 117; repetition 126–7; ritual 103; decision-making and 15;
and 40–1; role 133n2; role-flexibility establishing trust 59–60, 76, 122, 171;
116–17, 128–9, 132n1; sex roles and expectations and 3; gaining confidence
stereotyping 122; spontaneity 115, of 43, 75, 84, 143, 160, 162; goals 9;
126; spotlighting 118, 120; storytelling leader, contract with 13, 15; mood 15,
and 128; Tarzan 120; Tennis-Elbow- 107; needs of members 13–14, 16, 66,
Foot Game 126; To Be Continued 76, 78, 120, 161, 178, 233; numbers in
129–30; the wall 129; Who Owned the 164; response of 66, 70, 120, 123, 127,
Bag? 131–2 139; ritual and 40, 118; sharing
dreams 135 information with 15, 152; trust
exercises 152, 162, 58–60; see also
Eastern martial arts 19–29 leader; sessions
eating disorders 199 guided fantasy 127–8; active participants
Elderflowers 213, 223, 229 128; directive 127; environment and
Emergency 204, 209, 219 128; leader and 127; non-directive128;
emotion, art and 44, 54, 56–7, 62; dance passive participants 128; traditional
and 64–6, 71–2, 76–8, 83–4 narrative, using 39
environment 11, 181; creating 160, guided imagery 22
179n1, 196–7; dancing and 81, 82;
guided fantasy and 128; importance of health 3, 20–1, 198, 250–1; healthcare 1,
11; see also room 135, 197, 213–14
 Subject index 269

home stories 151–2; beginnings 152; 178–9; performer and 161–2, 179;
friends and enemies 155; heroes and process 170–1; putting on the mask
villains 155; I am 152; My House 153; 167; Realism 172; rehearsals 171;
School days 154; sharing, techniques relating to inanimate objects 165; rod
for 144 puppets 177–8; Sartori masks 167;
hospital 181–94 singing 163; sock puppets 166–7;
hospital clown 193, 214, 227, 252–3 storytelling 171–2; theme-based
hospitalist 222 performance 172–3; voice, warming up
humor 224, 250–9; in dance 68; in drama 162–3; Water babies 164; workshops
151; effect of 224, 250 162
massage train 257
individual, developing trust 13; health of medical 3, 20, 23, 200, 209, 216–17
3–6; needs of 9–12, 15–17, 50; medical treasures 22
self-esteem 43; self-expression 44; motor control, assisting 33, 36, 53–4;
self-help 31; self-image 43 development of
Intensive Care (ICU) 181, 201, 215 movement, and body awareness 53–4;
International Year of the Disabled communication and 65; music and
Person 1 113; and spatial awareness 35; see also
Internet 31, 254 dance/movement; dancing
Internist 187 music 89–113; articulated intervals
108–12; ball of string 103; “big-bang”
Jr clown-doctor program 223–4 111; blocks of sound 107–8; body
exercise 97; chords 107;
language, common grammar 113 communication and 92; court dances
Laughterboss 250–9 106; duplet pulses 92; Eastern 101; the
Leader 8–18; and assistants 14–18; elements 90, 101–2, 110–12; events,
contract see contract; flexibility of improvising to cover 95; expression
approach 15; goals 14, 17; group, and 101–2; football chant 105; free
contract with 126; guided fantasy and sounds 106; gestures and 151; greeting
127; material, knowledge of 32, 43; the group 93; grounding 112; group
objectives 57; patience, importance of formations 92; grunting 108; humming
50–1; responsibilities of 13; role- 97–8; imagination and 90; inner
flexibility 132n1; written records, resources, finding 91; interlude in
importance of 17, 50; see also group; session 100–2; jazz 101, 238; lateral
sessions dimension of sound 101–3; length of
Learning through dance 1, programme, agreeing 90–1; major and
minor 107; melismatic intervals 101;
mask and puppetry, blind drawing 165–6; memory, reflecting on session 112;
body warm up 67; breath support microtonal intervals 102; minor third
162–3; Brechtian method 172; building 108–9; minors 109; musical form 90,
171, 173–8; character masks 175–6; 101m 113; name chorus 112; noise
commedia dell’arte 170, 179n5; 101–2, 111; octave 109; opposites 110;
communication and 161–3, 168, 178–9; organum 109; percussive and sustained
creating 170–8; discovering character songs 110; piano quintet 110;
162; equipment; full masks 175–6; plainsong 107; practical activities
function of 161; half-masks 174; hand 91–3; process of production 101;
puppets 176–7; humming 163; reflection on session 112; rhythm 103;
Journey through the body 165; larger- ritual and 90; rocking to 95–7; sense of
than-life sized rod puppets 178; form 90; session as journey or story 90;
masquerade masks 174; materials for social competence and 91; society,
masks 174; materials for puppets 176; sense of belonging to 94, 101; songs
neutral mask 167–9; performance see songs; sound images 111; sound-
270 Subject index

play 103; sounds structured and free referrals 237

and silent 106; space, time and form, Rehab 2, 4, 64–5, 135, 139, 219, 221–2
playing with 90; star points 103; star Ritual 31–41 68–9, 115, 118, 240 ;
radials 104; stepping-stones 104–5; artificially imposed 40; creative
stereophonic sound 111; structured therapy and 40–1; mythology and 137;
rhythms 101, 107; subdivision 106; predictability of 40
support music 108; swaying to 95; role-flexibility 116–17, 129, 132–3n1,
tactile objects 110; tennis 103; textures role-theorists 115
110; thumb fifths 109; the dance roles, context of 115–16; function of 91,
chorus 104; triplet pulses 92; tune 102, 117; interactions 116; stereotyping 38,
107; unstructured rhythms 101; use of 122
in session 91; vertical dimension of room 14–15, 17, 22; requirements 14–15;
sound 102; visual arts, use of in 113; security of 197; see also environment
vowels 111; within the interval 109; see
also songs self-esteem 2, 43, 50, 224
mythology 136–8; archetypes 137; goal self-expression 50–1, 64, 81, 83, 160–1,
of 137; as picture language 138; 210; theatre and 161
psychological insights 137; ritual and self-help 31
137; symbolic images 135, 138; self-image 2, 64, 117,
teaching stories139–40; universal seniors’ centers 6, 213, 223
images 137; see also folklore; sessions, continuity and scheduling of 13;
storytelling 135–8 ending 16; equipment required 14–15;
evaluating 17; goals 9, 14, 17; as
name games 15, 117–20 journey or story 90; planning 11–15;
naming songs 83–4, planning next 17–18; preliminary
neurology 201, 242, 246 questions 11–12; pre-session planning
nurse (nurse practitioner) 4, 196, 206, 13–14; questions during 15; questions
218, 219, 225, 226 following 17; running 11; structuring
nursing homes 213, 215–16 11, 14, 16; warm-up 15, 19; see also
group; leader; room
occupational therapists 4, 210, 221, 253 silence 21–2, 90, 97, 110–12, 234, 242,
oncology 215, 218 244, 249
Outpatients 196, 201, 205, smile 19, 29, 68, 206, 219–21, 250, 252–3
social worker 4, 59, 210, 258
Pediatric (pediatrics, pediatric oncology) society 2, 32, 37, 39, 51, 90–1, 101, 113,
222, 227n8 117, 121, 141–2 ; culture and 2;
Palliative care 215 development of, arts and 2, 51;
Participate 3, 53, 158 folklore 32, 39, 141–2; health of 91;
Physiotherapists 210, 221, 229 industrialized 121; sense of belonging,
Post-traumatic stress disorder 183 music and 90, 101, 113; traditional
Program 5–6, 9, 44, 193, 196–211, 39
213–19, 222–7, 227n3, 229–32, 247–8, songs, action songs 97; Body blues 98;
252–5, 262 body exercise 97; breath 99–100;
Psychiatry 201 familiar, repetition of 95; folksong 109;
Psychoneuroimmunology 251, 254, 255 football chant 105–6; grunting 108;
puppetry see mask and puppetry humming 97; as journey 113; melisma
109; naming songs 83–4; Oh What a
Qi 20 Beautiful Morning 95; ornamented
Qigong 20–3, 28–9 folksongs 109; percussive and
sustained songs 110; plainsong 107;
recreational therapists (diversional Rockets 99; rocking to 95–7; sentence
therapists) 253 repetition 100; silent song 97; swaying
 Subject index 271

to 95; Tarzan song 98–9; tile-dance 160; ensemble 160–1; as microcosm of

chorus 104; Toe song 98; see also life 160
music therapeutic clown 214
Songlines 229–48 Three healing breaths 23
speech therapists 221 Tile Wall Project 199
spotlighting, in dance/movement 69–70, Transplants 197, 201, 204, 208–9
77; in drama 117–18, 120 Trauma 184,
storytellers 137, 192 trust developing 13–14, 32, 51
storytelling 192; audience trust exercises group 59; partner 58
participation138; beginning of story
136–9; bound flow 150; characters, unconscious 135–6, 138, 142–4; collective
creating 128–9; choosing stories 139; 138
conflict in stories 145; creating highs
and lows 146; credibility 147; drama visual arts 43–63, 189–90; art history
and 132, 193; fairy tales 141–2; the books, use of 51; collage 57–8;
finale 146; finding stories 140; flow equipment see visual arts equipment;
150–1; folklore 31–4; folktales 140, group “trust” exercises 59; honest
142, 151; force 149–50; free flow 150; expression, encouragement of 52;
general characteristics of stories initial experience 53; as inner discovery
145–55; gesture 151; group 129; home 48; kits, use of 44; materials see visual
stories see home stories; I knew her arts equipment; mixed media work
when 157–8; learning and sharing 47–8, 57; music and drawing game
stories 144–55; legends 141; Liar, liar, 60–1; music, use of 49; negative space
pants on fire 156–7; masks and 45, 49; painting 46–7; patience,
puppetry and 165; metaphor 39–40; importance of 50–1; positive space 45;
myths and mythology see mythology; practical activities 44; storage and
as oral tradition 138; pacing 146; transport of works 49; suggested
physicalizing the story 147–8; shape of fantasy 61; written records,
stories 145; space 149; spiritual importance of 50; visual arts
concerns 137; stories in pictures 147; equipment, acrylic paint 47; brushes
Super Man, Wonder Woman 157; 47; chalk; charcoal 45; conte 45–6;
symbolic images 135, 138; tall tale erasers 49; graphite pencils 45; inks 47;
156–7; teaching stories 139–40; introduction of 43; kits 44; liquid soap
technology and 158; time 148; bottles 48; oil paints 46; oil pastels 55;
traditional narratives 39; truth 139–40, paint 46; paper, size of 48; paper,
143; universal images 137; see also supplies of 49; pastels 54; pencil 45;
folklore; home stories 142–4; selection of; Velcro 48; watercolours
mythology 137–8 46–8, 56–7
stressors 181 volunteer 10, 50, 133n4, 197, 201
surgeon 8
surgery (surgical) 219 web clowning 213
Wei Wu Wei 19–20
Taoism 19 workplace 3, 258
Theatre 160–2; collaborative nature of written records, importance of 17, 50