Gender Issues in Art Therapy

A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN CHAPTER 8 A Discussion of the Use of Art Therapy with Women who are Pregnant or who have Recently Given Birth Susan Hogan Many pregnant women share a dread of personal obliteration ... [or] worry about the irreversible character of motherhood... {Matthews and Wexler 2000, p.xt) Introduction The poet Adrienne Rich managed to capture aspects of the experience of pregnancy, birth and first time motherhood in her groundbreaking and eloquent text Of Woman Born: Motherhood As Experience and Institution {1976). Rich manages to convey something of the tremendous emotional impact of motherhood: No one mentions the psychic crisis of bearing a first child, the excitation oflong-buried feelings about one's own mother, the sense of confused power and powerlessness, on being taken over on the one hand and of touching new physical and psychic potentialities on the other, a heightened sensibility which can be exhilarating, bewildering and exhausting. No one mentions the strangeness of attrac148 149 tion- which can be as single-minded and overwhelming as the early days of a love affair- to a being so tiny, so dependent, so folded-in to itself- who is, and yet is not, part of oneself. (Rich 19 7 6, p.3 6) It is a platitude to insist that nothing can possibly prepare us for the intensity and power of this .experience, but it is also true. Her work captures both beauty and tenderness but also her sense of claustrophobia, terror and rage; it is a very personal account. Invariably, she falls into the trap of generalising about women from her experience though the text has many insights and descriptive potency. A certain set of reactions to the experiences of pregnancy and childbirth are considered within normal limits and those which fall outside and are defined as aberrant can provoke a range of responses from suspicion and hostility to compulsory medical intervention. A woman who refuses to agree to a planned Caesarean section, thought necessary by her obstetrician, for example, faces the possibility of her obstetrician obtaining a court order forcing her to undergo the life-threatening procedure against her will._Women w (th a history of mental 'dis-ease' are particularly at risk of such interference. Furthermore, women who are not passively compliant can quickly be characterised as difficult or irresponsible. Even being too inquisitive about facilities and procedures can provoke highly defensive reactions, as I discovered myself when I was first pregnant. There is a burgeoning literature on pregnancy and birth. Anne Oakley's book From Here to Maternity (1981) was one of the first to explore the systematic way in which women's wishes and desires are violated as part of modern obstetric regimes. Anyone who has read Oakley's fascinating interviews with women about their pregnancy and birth experiences will have been chilled-to-the-bone by the recurrent reports made by women, regarding a range of medical interventions: 'I told them I didn't want it but they did it anyway'. Over and over these kinds of responses are made: 'I told him no, but ... ': a terrifying leitmotif running through many of the accounts. The reality of pregnancy and birth for many women can come as a tremendous shock. Another text employing interviews is The Woman in the Body: A Cultural Analysis of Reproduction by anthropologist Emily Martin (1987). However, this research was conducted in the USA and cannot, therefore, 150 GENDER ISSUES IN ART THERAPY A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN be regarded as reliable in providing information about British women's experience. Some of the accounts are as chilling as those provided by Oakley. Martin's emphasis is on the machinery of obstetrics and the way that this systematically undermines and denigrates women's bodily experiences and impulses. She notes that 'the content of the women's remarks, the substance of what she objects to, escape notice' (Martin 1987, p.125). This research was particularly interesting in its focus on women's acts of resistance in the context of highly regulated and standardised 'technocratic' hospital births. apt quotation of interview fragments) there is, as well as a deep condescension, an offensive negation of women's experience: 'At present there is no evidence that long labours .. .labours complicated by induction, or Caesarean sections have on their own been responsible for prolonged emotional upset' (Cobb 19~0, p.132). In other words, the woman who is deeply traumatised by her birth experience was neurotic in the first place1 Figes, unlike Cobb, does not question the veracity of the women's powerful testament. Cobb's book devotes only a very small section to the subject of women's emotions, concluding that women will be 'more liable to be upset' (Cobb 1980, p.52). Indeed the text appears to perpetuate the 3 idea that women become rather unhinged during pregnancy. This idea is perpetuated in all kinds of quarters; here is an example from the historian David Starkey writing on Catherine Parr (who in the sixteenth century remarried after the death of her husband Henry VIII): 'Maybe it was the effects of this pregnancy- her first at the age of thirty-six- which unbalanced her judgement' (Starkey 2001, pp.69-70). Here we have an example of age at conception and potential instability linked. As a woman who also experienced her first pregnancy at the age of thirty-six I could not help but wince at this remark. Figes' book is a better attempt than that of Dana Breen (1989), for example, who uses transcript fragments in a crude manner as a peg from which to hang her object relations theory. The theory does not elucidate the women's experience. Similarly, Ruddick's attempts to define 'maternal thinking' in Representations of Motherhood (1994) represent the kind of reductive essentialism which is not helpful to a critical analysis. A text worthy of mention is Tess Cosslett's Women Writing Childbirth: Modern Discourses ofMotherhood (1994) which is highly entertaining but which falls into the trap of generalising about women's experience from analysis of only a small number of mainly literary descriptions of pregnancy and childbirth (and it is not clear which of the women authors cited have experienced birth and which have not, so the reader cannot distinguish between childless women's fantasies about childbirth and those written from experience). Her main point that women develop a more fluid sense of self-identity through the experience of pregnancy and childbirth is very interesting. Maternal processes challenge preconceived ideas about individuality. What all these accounts fail to do is to Another North American text is Motherhood and Representation: The Mother in Popular Culture and Melodrama (Kaplan 1992). This book is interesting insofar as it analyses visual 'texts' as well as written ones (mainly providing short analyses of popular films). However, despite its promising title, the book fails to extend the debate about women's changed sense of self-identity and sexuality through motherhood. The nature of Kaplan's material tends to perpetuate cliches about the subject and not all the debates can be seen as relevant to a British context. Recently, texts such as Kate Figes' Lift After Birth (1998), attempt to reveal the impact of pregnancy and birth on and for women. Based on a number of informal interviews, the emphasis of the book appears to be to reassure readers that they are not deviant in having certain feelings and reactions (such as the impulse to check that their baby is still breathingwhich women constantly act upon) and the book is useful in this respect, though lacking in a critical analysis of the theoretical material presented. A similar and earlier text is Cobb's Babyshock (1980), which aims to introduce the harsh realities of early parenthood, in particular, to those expecting children. It is based on the premise that 'women, before the birth of their first child, have little or no idea what to expect', so this is a 1 book to give them an idea (Cobb 1980, p.11 ). The book uses quotations from women from interviews,. which are interesting and often moving. However, in terms of narrative analysis, the women's veracity is sometimes undermined by the voice of medical authority; the women's experience is presented in the form of a quotation which is then contra2 dicted by the medical expert. Although the book is useful in pointing out that motherhood can be very stressful, and that caring for a baby can be very demanding (and this is achieved powerfully through the use of 151 154 GENDER ISSUES IN ART THERAPY A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN Caesarean section performed upon a competent pregnant woman (Re: S Adult: Refusal of medical treatment) was authorised 'in the vital interests of both mother and unborn child'. Interestingly, this was the same phrase used by my own obstetrician when we were discussing surgical interventions. She emphasised the shared need for intervention. Though the above case of non-consensual Caesarean section generated widespread condemnation, for ethical reasons as well as on grounds oflegal principle (Jane Mair in Elliston 1997), it is not surprising to find obstetricians thinking in terms of the linked interests of foetus (or 'unborn child') and 'mother' rather than in terms of the autonomy and well-being of the woman as uppermost (for often pragmatic reasons no doubt, but the attitude is arguably rather contrary in spirit to the current UK legal position). Tl1e above example of the non-consensual Caesarean section found in favour of medical intervention and 'against the autonomy of the pregnant woman' (Jane Mair in Elliston 1997). A third way of viewing the situation and the way the law in Britain currently views the situation (though this is frequently challenged) is that the woman and the foetus constitute two indivisibly linked entities(the plural is relevant here, as after the birth a prenatally damaged child has the opportunity to take separate legal action, except against the actions of her mother). Therefore, the foetus is perceived as an entity, a thing in some sense because it has the potential to acquire legal rights. However, UK law is somewhat fuzzy on this point. Whilst the foetus is in some sense an entity it is not, according to barrister Sarah Elliston, an 'other' in UK law. She explains: 'The fetus [sic] has been deemed to have no legal personality. The effect of this is that, since the fetus has not been legally accorded the status of a person, it has no legal rights or interests until it is born ... The fetus gains legal personality only when it has achieved an independent existence by being born' (Elliston 1997). So, in legal terms, the foetus is an entity because it will acquire rights but not a personality because personhood commences at birth! A fourth way of perceiving the process (and perhaps the most plausible way) is to view the situation in terms of a maternal-foetal unity. The idea of an interlinked identity (singular) is iconoclastic in terms of the emphasis in our culture on individuality and autonomy, and is therefore difficult to conceptualise. However, speaking personally, this is how I experienced my own pregnancy: with an awareness of something growing which I knew was not me, yet was at the same time me (in the radical physical changes to my body I perceived a sort of' otherness', the involuntary foetal movements were more rando!ll than t~e involuntary movements usually produced by my body's functions). However, at the same time the foetus did not feel and was not perceived by me as separate, much to my own surprise. The sense of being connected continues after the birth, but to a lesser extent, with baby's suckling causing the woman to experience little uterine contractions and bleeding. Even thinking about one's baby can cause one's breasts to flood with milk! If we accept the proposition, put forward by many social scientists, that bodily experiences are culturally mediated in the way that they are individually experienced, then the debates around these different ways of perceiving pregnancy and their attendant representations must influence 5 the way pregnant women conceptualise their experience. My emphasis here is on dominant modes of representation, especially those which might be helpful in elucidating the group members' experiences. New technologies and social practices associated with these, such as in-vitro fertilization (IVF), have created alternative ways of perceiving the body. Indeed, all technological advances can have an influence. Endoscopic technology, for example, allowed images of disembodied foetuses to be used for political purposes by anti-abortion groups- the embodied reality of maternal/ foetal unity explicitly denied by such imagery (Hogan 1997b, p.30). Kaplan (1992) discusses such imagery thus: Displacement of the mother and the world of her actual, material and complex body, is evident in the way photographic discourse renders inception and gestation in cosmic terms. The inside of the woman body is magnified tremendously until it looks like outer space, an Other World. The brightly coloured images of swirls and folds look like the images of earth's creation - conception on a grand scale: the foetus-as-miracle, as the wonder of 'man' [sic], far beyond the mundane scale of the simple, ordinary female body. The body is nowhere in sight, but is rather the repressed vessel for all this wonder. (Kaplan 1992, p.204) 155 156 GENDER ISSUES IN ART THERAPY A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN 157 Kaplan appears to be drawing on the idea of woman as essence, woman as nature in the above analysis. Regarding the topic of surrogacy, Germaine Greer {2000) has pointed out that the womb is often portrayed as an empty space: Descriptions of surrogacy often use expressions like 'wombs to let' or 'wombs for rent', as if the woman who agrees to act as a surrogate was running a kind of fleshy boarding house. Any society that can regard asking one woman to act as a surrogate mother, by allowing the fertilized ovum of another to be implanted in her uterus and gestation to continue there until the child is born and handed over, as both feasible and tolerable can attach little importance to the process or the mother's role in it. The woman who thinks that her own conceptus is a stranger taking over her body is supposed to be deep psychic trouble but, if preparing a womb to harbour the progeny of strangers is morally acceptable to us, we must have to some extent accepted the idea of the womb's being an impersonal container. If bodily proximity has anything whatsoever to do with intimacy, there can be no relationship closer than that of the woman to the child developing inside her own body ... (Greer 2000, p.S3) Figure 8.3 Figures 8.2 and 8.3 Images of pregnancy by members of the art therapy and support group, Derby, 1999 Theory and method Anthropologists such as Blaffer Hrdy (1999, p.S03) stress that geographical and social conditions are essential to the construction of attitudes and behaviours towards infants. Her large study on the subject points towards tremendous variation across cultures and explodes universalising ideas such as 'maternal instinct', which are deeply entrenched (Blaffer Hrdy 1999, p.308). Furthermore, her critique of attachment theory indicates that Bowlby was mistaken in his views regarding the undesirability of modern women engaging in paid work (Blaffer Hrdy 1999, p.494-504). He believed that women shouldn't engage in labour outside the home which caused them to be separated from their infants. Blaffer Hrdy's detailed analysis points to the possibility of viable attachments between infants and carers other than the mother ('allomothers'), giving examples of societies in which as many as fourteen allomothers (male and female) are involved in an infant's care in any one day (Blaffer Hrdy 1999, p.SOO). Attachment theorists have tended to posit the need for one carer, preferably the biological mother, for the psychological stability of the Figure 8.2 160 GENDER ISSUES IN ART THERAPY A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN The group was located at the University of Derby and operated on a self-referral basis. Advertising for the group was primarily through a research department of the local maternity hospital and via the local newspaper. All participants were informed that the group was part of an ongoing research project, that all artwork produced in the sessions would be photographed and that all sessions were to be tape-recorded. Two of the women were not pregnant but had already given birth (both of these participants had suffered from depression after their babies were born). The majority of women in the group were educated to degree level (three women did not hold a first degree, though there seemed not to be any disparity between the women's ability to communicate in the group based on educational attainment). One participant, apart from the facilitator, held a post-graduate qualification. All of the women were white 7 and most were local to Derbyshire or the North of England. Advertising described the group as an art therapy and support group which would provide individuals with the opportunity to explore their feelings about their experience of pregnancy, birth and motherhood in a confidential closed group. The group was 'user led', insofar as the subjects raised were chosen entirely by the group members. I regulated the time to make sure that everyone had an opportunity to speak if they wished, whilst making it clear that they were under no obligation to do so. Although I was curious about many topics I limited my questions to those which facilitated the subjects already raised by the women themselves. tional support, it may be surprising to learn that the 'intervention group babies required less intensive and neonatal care and had better health in the early weeks . .. ' The research findings illustrated that the group of women who received additional support had fewer very low birth-weight babies, antenatal hospital admissions, induced labours and obstetric interventions in deliveries (Oakley eta!. 1996, p.8). A follow-up survey one year later confirmed that these children continued to enjoy better health. 'The psychosocial health of intervention [group] mothers was better, they felt more positive about motherhood and less anxious about their babies [than those in the control group]' (Oakley eta!. 1996, p.8-9). After seven years there were significant differences evident between the two groups of women with regards to the health and development of the children as well as the well-being of the women (Oakley et a!. 1996, p. 7). Given these research findings it is somewhat surprising to discover that a serious longitudinal study of the implications of offering an art therapy and support group to pregnant women has yet to be undertaken in the UK. Many women attend prenatal or 'parent craft' classes provided by their local authorities. However, these groups tend to be practical in their focus and do not usually provide scope for the expression of emotions, especially powerful emotions; the tone and ambience is of hopeful cheerfulness and anxieties expressed (in my experience) brushed aside or deflected. Rather, these groups provide basic information on obstetric procedures to a more or less sophisticated degree (in my experience very crudely). Sometimes, they are entirely lacking in critical analysis and debate or they may simply provide information readily available in popular books. In the antenatal group I attended interventions tended to be described as though they had no connection to one another. What was not made clear was the way that one intervention can lead to further linked interventions. The full implications of agreeing to a particular obstetric procedure were therefore not made sufficiently apparent. A detailed critique of such provision is not the focus of this chapter, though it was the limitations of this service which led me to decide to run a mixed art therapy group for pregnant women and women who had recently given birth, to enable them to explore their feelings about their experiences. An exploration of feelings took place during the making of Why offer art therapy? Women who receive support during their pregnancies experience significantly better health outcomes than those not offered this support (Cohen and Syme 1985; Oakley 1992). These gains include physical health as well as emotional well-being. In a research project involving 509 women, Oakley eta!. (1996) provided additional support to pregnant women in a series of meetings with the emphasis on the provision of a 'listening ear' . (The women who received this additional support are referred to as the 'intervention group'.) Whilst it may not be surprising that 'the physical and psychosocial health' of the intervention group mothers was better than that of the control group of women who did not receive the addi- 161 162 GENDER ISSUES IN ART THERAPY A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN artworks (through the manipulation of the materials and the pictorial surface), during formal discussion and analysis of the images after their completion which took place as a group (with the maker of the image speaking about their work and then inviting comment from others if they wished), as well as well as informally during the coffee break. Although the focus of the group was on giving emotional support and the opportunity for self-reflection, group members did also exchange practical information about birthing and child care. Although, as stated, a critique of these services was not my intention, the women in the group were fairly forthright in their criticisms of parent-craft classes and support services so I shall present their views on the subject. One of the feedback sheets stated, 'I felt that we were playing in parent-craft classes, and I really didn't learn much at all. I certainly did not learn anything about myself'. There was spontaneous reflection on the group experience in the final session. One woman said that she had found the sessions reassuring: 'It's nice to come and be reassured that you are, that everything that's happened to you is, normal and that you are not going mad and [knowing that] other people are experiencing the same [things]. It's been really good for that'. Of the midwives and health professionals, she said, 'They're all too busy and they're kind of rushing you as well. .. I felt they don't want you there ... ' Another woman said, 'You feel like you have to impress your midwife, you know, make her feel good by saying there aren't any problems or worries. But yet in your head, like you have these questions that you think if I get the chance I'm going to ask about that. Yet when it comes to it she's so happy and bouncy that everything [is] going OK and she can put little ticks all over her boxes that you sort of think- I don't want to spoil it for her'. Another group member reflected on how reassured she felt to hear that other women also found being with a new baby 'really hard'. Some of the group members complained about insensitive GPs or childless midwives. The group was highly valued because 'It's the insight - it's the support that comes with the insight ... other people might support you but they don't really know what it's like.' Another woman said of the group experience, 'It's the real support that you don't actually get from anywhere else really, I think you expect it but you don't get it, even if you're asking for it '. Being able to express difficult feelings was considered a benefit of attending the group, providing 'a real supportit's like- on Monday I can go and sound off- because it won 't sound like I'm whingeing too much . .. ' Another group member said that she found the group useful in giving her a perspective on things. After the group she was able to go and talk to her husband about her feelings. It is clear from these reactions that the women found the group very helpful. Oakley's (1996) research suggests that extra support for pregnant women can have long-term benefits, including health gains which should not be overlooked with regard to cost analysis of such provision. I63 The facilitator speaks As a new mother I wanted to share my experience with the group without this being intrusive or distracting me from my primary role as facilitator. I decided not to paint but to make one disclosure about my experience per session, if it felt appropriate to do so. My aim was twofold: I wished to make it clear to the group that I did not regard myself as a 'sussed' and totally successful or model mother there to impart wisdom about how it should be done. Rather, I wanted to give permission for the expression of a range offeelings from euphoria to despair. Whilst I adore my daughter, I was willing to admit that some aspects of early mothering were appalling! I also decided to give group members a copy of an article I'd written which explored my reactions to having given birth (Hogan 1997a). I didn't want to be a tabula rasa but preferred to be seen as someone up-front about their own issues and agenda. My second reason for deciding to speak in the group was because I wished to get feedback from participants about whether or not they found this helpful (this group being part of an ongoing research project). Whilst many readers will regard this as quite straightforward, others will be aware that such disclosures from the therapist are regarded as slightly taboo in some therapy circles. The well known psychotherapist Irvin Yalom summarized the reasons why: 164 GENDER ISSUES IN ART THERAPY The patients are here for their therapy, not mine. Time is valuable in a group .. .and is not well spent listening to the therapist's problems. Patients need to have faith that their therapists face and resolve their personal problems. But, Yalom points out 'these are indeed rationalisations. The real issue was wantofcourage.' (Yalom 1989, p.164). 8 He went on to reveal that: I have erred consistently on the side of too little rather than too much self-disclosure; but whenever I have shared a great deal of myself, patients have invariably profited from knowing that I, like them, must struggle with the problems of being human. (Yalom 1989, p.164) Like Yalom, I am aware that I have a basic commitment to minimising the dichotomy between sick patient and expert healer. As a feminist working with women I feel that such an approach is absolutely essential. 9 Issues arising: an overview We learn, often through painful self-discipline and self cauterization, those qualities which are supposed to be 'innate' in us: patience, self-sacrifice, the willingness to repeat endlessly the small, routine chores of socializing a human being. We are also, often to our amazement, flooded with feelings both oflove and violence in tenser and fiercer than any we had ever known. (Rich 197 6, p.3 7) The reactions of women to their pregnancy and birth experiences are exceedingly complex and the art therapy group gave scope for a multi-levelled exploration of emotions and reactions. The women were able to give each other support and compare and contrast experiences. The use of art materials gave opportunity for the exploration of emotional states and bodily experiences which could not otherwise be articulated. Sometimes the images produced were a springboard for a group discussion; other times the focus was on unravelling meanings. For some women the images were more about emotional release. Empathy was apparent between group members through motifs appearing in images or styles of expression creating echoes between works. The A DISCUSSION OF THE USE OF ART THERAPY WITH WOMEN 165 structure of the group and the fact that I tape-recorded the group discussion at the end also had an impact on the dynamics of the group. The complexity of the total experience is hard to convey but the group offered a tremendous freedom from formal restraints which the participants appreciated. Certainly, fear and the fear of being judged harshly was a dominant issue of women in relation to their interaction with other services. The fact that the art therapy service was discrete (separate from their other antenatal care) and confidential had a liberating impact allowing participants to explore their experience in a profound manner. Another pronounced feature of the group was the expression of humour. Perhaps it was generated out a sense of relief (as well as potentially embarrassing subject matter) but I have seldom experienced a group which was so funny and in which laughter played such a large part. Although the group was serious it was very enjoyable. A number of subjects arose quite strongly in the group. A dominant and recurring subject was that of autonomy and the feeling of being manipulated (physically and psychologically). This was linked to perceived coercive threats {professionals having the power to impose unwanted interventions or actually remove the baby). This had an inhibiting effect on the women's openness to the professionals with whom they dealt, and all the women in the group were aware of this to some degree. Linked to feelings around control were feelings towards the baby which were not expressed, these included emotional disengagement or violent impulses. The desire to acknowledge feelings of despair or self-doubt was made harder by discourses about 'maternal insight' or the 'naturalness' of the mothering role. Guilt featured quite strongly. However, group members gained comfort and reassurance from finding out from their peers that they didn't find that it all came naturally. All of the women were aware of an unprecedented amount of interference in their lives, either from relatives or the medical professions or both. All of the women were experiencing profound changes. These were different for the two groups of women involved. The pregnant women were concerned with bodily changes, changing roles and relationships, and preparations for the impending birth (including dealing with the fear of death). The women who had already given birth were more concerned with their feelings towards their children and adjusting to a new life (not -166 GENDER ISSUES IN ART THERAPY Figure 8.4 Jerry Hall and GabrielJagger by Anne Leibovitz {1999} © Anne Leibovitz / Contact Press Im ages Idealised andfantasy images ofmotherhood continue to abound. This is aparticularly interesting example by Anne Leibovitz. exclusively though as they also had strong feeling about their birth experiences). Adjustment was hard as their new lives were not what they had anticipated. It is one thing to know intellectually, for example, that infants cry, but quite another to be in the actual situation of trudging up A DISC USS IO N OF THE USE O F ART T H ERAPY WITH WOMEN 167 and down at four o'clock in the morning with a screaming baby. Aspects of tedium and repetition were acknowledged by group members. Another theme was that of relationships. Problems already existing before the pregnancy between family members tended to become exacerbated. Parents and in-laws, their expectations and interference, caused the women and new mothers some stress in a variety of ways. Lack of support from husbands and/ or the feeling that the experience could not be fully shared or properly understood by spouses caused women to feel alienated from their partners in a number of ways. Some women resented their husband's ability to forget about the pregnancy, though denial also featured, with more than one woman in the group finding it hard to believe that she was really pregnant. Other minor themes and issues which arose in the group, unexplored by this piece of writing, will now be noted in brief. Although the women in the group expressed fears about the possibility of having a mentally or physically handicapped baby, it emerged that three of them had declined to take blood and other tests designed to check for abnormalities. This decision had precipitated feelings of guilt and resulted in pressure to have the tests from healthcare professionals and others. Refusing such screening may be very difficult, especially when tests are presented as both routine and rational. There appeared to be a consensus among the women that they would have liked a designated midwife whom they could get to know well and who would attend their birth. Several of the women complained about rota systems which resulted in their never knowing who they'd be dealing with for antenatal check ups (or who would be in attendance at the birth). Two of the women who had had Caesarean sections bemoaned the lack of opportunity to rest after the operation. They were aware that women who have Caesareans are given less chance to rest than other operative cases. Another subject that arose was the idea of motherhood as a fresh start or a new beginning (and connected with this, for some group members, were feelings of ambivalence about past behaviours). In this context, women expressed positive feelings about pregnancy and being with their 168 A DISCU SSION OF T HE USE OF ART THERAPY WIT H WOMEN GENDER ISSUES IN ART THERAPY newborn babies along with feelings of great excitement and elation. This included the expression of positive feelings about partners and husbands. Facilitating and participating: some thoughts At the group's invitation I did make one artwork. I painted a picture of myself breast-feeding. However, I struggled with the piece. I had wanted the quality of the paint to be very watery, creating an image like a reflection on a pond. Whilst painting it I became aware of the fact that I wanted to depict my baby both inside and outside of my body simultaneously. I imagined her suckling one breast whilst stroking the other with her little hand. But I was not able to achieve a satisfactory result with the materials and I spent the session working and reworking the image - struggling with the boundaries. The finished artwork, unresolved though it was, embodied my experience of merger and separateness. The act of painting brought to awareness and illustrated my feelings of conflict and ambivalence about these processes- my emotional struggle. Indeed, my inability to resolve the image pictorially was highly revealing. I had not experienced through conversation the full force of these conflicting emotions. Participating in the group reminded me of the power and poignancy of the art therapy process which yields the possibility for the articulation of powerful embodied feelings and responses which cannot necessarily be experienced or evoked through a verbal exchange alone. The total experience of the art therapy group cannot be conveyed though an examination of transcript fragments alone since the process of making the artworks, the feeling stimulated by this physical engagement, and the women's responses to finished art works were all integral to the total experience. I hope the above example will convince those unacquainted with art therapy of its unique value. larly depressed after their pregnancies (and regarded themselves as postnatally depressed) both had had Caesareans and neithe~ had been the first to hold their baby after the birth. Both women had Issues around needing more personal 'space' . Given that lack of 'space', or a feeling of having lost a sense of personal space, was a prominent theme, the pictorial space provided by the use of art therapy is relevant. Themes ofloss of self and personhood, a disrupted sense of selfbood, translate, as we have seen, into images. The pictorial space afforded an opportunity for the reconstruction of a lost self- indeed, more a 'creation' or tentative discovery of a new sense of being than a 'reconstruction ' of a lost self- as the changes wr~ught by motherhood are irrevocable and very real. A vital process of readJustment was aided by the art therapy. It is also interesting to observe that all of the women in the group had some difficulty in relating to healthcare professionals. This came as a surprise to me despite my familiarity with much relevant liter~ture. I ~as anticipating that only a proportion of the group would expenence difficulties. The feedback forms that the women completed after the close of the group indicate that the pregnant women regarded t~e. group as very useful as a preparation for motherhood and as provtdmg a level and . . quality of support which was not available elsewhere. To conclude, these are complex topics and it is hard to do JUStice to them in such a short piece of writing, however, I hope that this chapter has been of interest to those concerned with women's issues in general as well as serving to give art therapists and counsellors an idea of the kinds of topics they might be dealing with when offering support to pregnant women and new mothers. Furthermore, I am ever hopeful that the medical profession will recognise the importance and long-term value of providing emotional support for women as part of antenatal care. Conclusion In this chapter I have summarised the main issues which arose in the group. It would be bad research to generalise about women's experience from such a small amount of data. Indeed, I wanted the women's testimony (free of my speculations and analysis) to speak for itself. However, it is interesting to note that the two women who felt particu- I69 Endnotes 1 2 My italics. See Cobb 1980, pp.135-136 for an example of this. 3 See Cobb 1980, pp.54-55 for an example. 170 4 Zadoroznyi asserts that women's changed sense of self was a consistent feature of her interviewees' accounts. However, her focus is on the management of subsequent births and she notes that many women make decisions about the management of subsequent births and develop more definite ideas about how they would like them to be. However, in terms of the sorts of decisions made there is no analysis. Furthermore, it is not clear how birth differs from other major life events such as buying a house for the second time, for example, when one has learned from previous experience, having developed more definite ideas about what is required. 5 For example, see the work of Butler 1990 and 1993 ; Cornwall and Lindisfarne 1994; Deutscher 1997; Ramet 1996. 6 7 One interesting example given is of a women fasting during Ramadan whilst pregnant. She wanted some vitamin pills and the translator, instead of translating her request, reminded her that under Islamic law pregnant women are exempted from fasting during pregnancy. Secondly, the translator suggested that she should not make the request for fear of being viewed as an 'uncultured fundamentalist' . One participant was from Scotland and another two from London . Two of the women could be clearly defined as 'house wives'; however, the majority of women in the group would not have felt comfortable with that definition. 8 My italics. 9 Training institutions and the art therapy profession in general seem to lack confidence in the therapist's ability to distinguish between a helpful and an exploitative level of disclosure (and perhaps this illustrates a fundamental lack of confidence in the quality of our practitioners). 10 My italics for emphasis (this phrase is liable to be misread) . 11 A DISCUSSION O F T H E USE OF ART T H ERAPY WITH WOMEN GENDER ISSUES IN ART TH ERAPY Italics added for emphasis. Acknowledgements First thanks are due to all the women who participated in the group. I am very grateful to the sociologist Dr Martin O 'Brien and anthropologist Professor Mary Douglas who were kind enough to read an early draft of this paper and give me constructive criticism. Thanks also to psychologist Dr Sarah Bennett and medical sociologist Professor Ursula Sharma who were generous enough to share some work in progress with me which I cite here. More thanks are due to barrister Sarah Elliston whose terrific 171 conference paper, along with our subsequent correspondence, stimulated my initial interest in this subject. A show of gratitude is due to Linda Whieldon, of the University of Derby, for the institutional support which enabled this project and to Teresa Barnard for her astute editorial suggestions. This is a brief discussion paper; for full details of the themes that arose in the group please see The International Arts Therapies journal (ISSN: 14762900) Volume 1, December 2001-December 200 2. Bibliography Blaffer Hrdy, S. ( 1999) Mother Nature: A History ofMothers, Infants, and Natural Selection. New York: Pantheon Books. Bourdieu, P. (1992} Language and Symbolic Power. Cambridge: Polity Press. Boyle, M. 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Oakley, A., Hickey, D. and Rajan, L. (1996} 'Social support in pregnancy: Does it have long term effects?' journal ofReproductive Psychology 14, 7-22 . 9 Re-Visions on Group Art Therapy with Women who have Experienced Domestic and Sexual Violence Oakley, A. (1992} Social Support and Motherhood. Oxford: Basil Blackwell. Oakley, A. (1981) From Here to Maternity. Harmondsworth: Penguin. Nancy Slater Patel, T. , Sharma, U. (2000} Birthing Mothers, Social Scientists and Subjective Experience of Childbirth. Working Paper provided by authors. Rich, A. (1976} OfWomenBorn:MotherhoodAsExperienceandlnstitution. London: Virago. Rose, N. (1980} Governing the Soul: The Shaping of the Private Self London : Routledge. Ruddick, S. (1994} 'Thinking Mother/Conceiving Birth.' In D. Bassin, M. Honey and M. Kaplan (eds) Representations ofMotherhood. New Haven: Yale University Press. Russell, D. ( 199 5} Women, Madness and Medicine. Cambridge: Polity Press. Sedgwick, E.K. ( 1990} Epistemology of the Closet. Berkeley: University of California Press. Seymour, J. (199 5} Fetal Welfare and the Law. Australian Medical Association. Seymour, J. (2000} Childbirth and the Law. Oxford: Oxford University Press. Simkin, P.T. (1992} 'Just Another Day In A Woman's Life?' Birth 19, 2, 64- 81. Smart, C. (ed) (1992} Regulating Womanhood: Historical Essays on Marriage, Motherhood and Sexuality. London: Routledge. Starkey, D. (200 1) Elizabeth. London: Vintage. Turner, B.S. {1992} Regulating Bodies: Essays in Medical Sociology. London: Routledge. Yalom, I. (1989) Love's Executioner and Other Tales of Psychotherapy. London: Penguin Books. Zadoroznyi, M. (1999} 'Social class, social selves and social control in childbirth.' Sociology ofHealth and Illness 21, 3, 267- 289. Introduction Since the late 1970s, when interventions for battered women were first developed in Western countries, group art therapy has been employed in women's refuges and other supportive services. In the 1980s, as the prevalence of sexual violence against women and children gained more public attention (Courtois 1988; Russell 1986; Slater 1998), group art therapy was used in sexual assault programmes and clinical practices (Anderson 1995; Brooke 1995; Meekums 2000) . . Until recently, domestic violence and sexual assault have been viewed as separate research and intervention issues. As the late 1980s approached, there was more awareness of the connections between incest, rape and the physical and emotional abuse of women (Breckenridge 1999; Clark and Foy 2000; Herman 1992, 1995; Slater 1998; Spring 1985). During the 1990s, increasing attempts were made to address the support services and treatment needs for women who had experienced multiple abuse (Brown 1997; Davis et al. 2001; Herman 1992, 1995; Roth eta!. 1997; Slater and Minton 1998). In art therapy, 173