What is Forensic Art Psychotherapy?

In my private psychotherapy practice, clients are often curious about my part time work as a forensic Art Psychotherapist. Forensic psychotherapy is very different to private psychotherapy. I thought would attempt to demystify my role within NHS forensic services, to some extent, by writing a short article about what my role in this setting involves.

Forensic Art Psychotherapy is a specialized therapeutic approach that combines forensic psychology with art therapy. It is aimed at working with individuals involved in the criminal justice system, including offenders, victims, or witnesses. Many of the roots of Art psychotherapy lie in psychoanalysis. Psychoanalysis involves the study of symbols, early development, and human experience. These aspects can intertwine with metaphors and imagery that speak to our deepest emotional and psychological experiences. Due to the high degree of trauma present in the forensic setting, awareness of how the human unconscious can symbolise itself and create metaphor both via artistic expression and via social interactions, becomes vitally important. This is because individuals in a forensic setting may have difficulty articulating their thoughts and emotions verbally due to complex psychological barriers. Therefore, complicated unconscious dynamics may develop and this can go on to impact the relationships between staff and patients. Forensic Art Psychotherapy, then, is not just about working with patients, it is about working with the dynamics of the institution by bringing awareness and consciousness to what is being expressed unconsciously.   

 I work within medium secure forensic services and I use art-making as well as verbal talk therapy as mediums for communication and expression. Direct communication from a patient can become intolerable due to the high degree of emotional pain an individual might be in. Therefore, psychological defences such as avoidance, denial and projection can become extremely pronounced and complex. Creative expression and awareness of relational dynamics can mitigate these defences to an extent and allow the safe communication of painful psychological material. As an Art Psychotherapist, I am trained to sensitively and carefully work with the symbolised and metaphorical content which, over time, can lower defences and allow disturbing thoughts, feelings and reactions to be processed. This processing is a form of containment, it reduces risk and can impact a forensic setting on many levels.  

My role as an Art Psychotherapist in medium secure serves multiple purposes:

1. Assessment: Art Psychotherapy can help in assessing the mental state, emotional health, and potential risk factors of individuals, as the artwork produced and therapeutic relationship may reveal unconscious thoughts or experiences relevant to a patient’s behaviour and criminal background. This information can then be sensitively fed back to multidisciplinary teams which are usually comprised of psychologists, psychiatrists, occupational therapists and nurses.

2. Therapy: Art Psychotherapy provides a safe and non-verbal outlet for individuals to express painful and overwhelming feelings which can be crucial to the rehabilitation process.

3. Reflective Practice: Having trained from a psychodynamic lens, I have extensive experience in holding and facilitating groups. This enables me to facilitate staff reflective practice groups in which staff members (nurses, occupational therapists, health care assistants and other members of the multidisciplinary team) can reflect on unconscious dynamics that might be present in their teams and on the wards in which they work.

4. Staff training: In the NHS, I regularly provide training in trauma informed care. This helps staff to understand how the background of service users can influence behaviour on the ward. I also provide training in relational security to help staff to better understand therapeutic boundaries.

5. Staff support: In mental health services, staff can encounter disturbing experiences which can lead to vicarious traumatization. This is when a patient’s own trauma can overwhelm a member of staff. For this reason, we have a staff trauma service in which I mainly use a combination of talk therapy and EMDR.

Forensic Art Psychotherapists often work in prisons, psychiatric hospitals, or rehabilitation centres, and they collaborate with legal professionals, psychologists, psychiatrists and social workers to support the therapeutic and rehabilitative needs of their clients. It is a varied role which orbits around the operationalisation of psychodynamic and psychoanalytic theory alongside creativity. It is complex and demanding work but it is always fascinating and fulfilling. Although it is very different to working in private practice, forensic work provides excellent opportunity for personal growth and development as a psychotherapist. My hopes are that this growth feeds into my skills as a therapist and enhances the service I provide in the very different domain of private practice.