The impact and importance of creative arts as part of a holistic approach to treating what Dame Cicely Saunders described as Total Pain, was high on the agenda as delegates were treated to inspiring presentations full of real-life case studies demonstrating the effectiveness of several different approaches.
There were several recurring and strong themes for delegates to latch on to and to take back to their workplace, including the importance of creating a safe place for people to express themselves, even if that can take many different forms, the need to focus on what matters most to people rather than what the matter is with them, using creative arts to make a connection with people, the power of the metaphor and, last but not least, ensuring that as a professional working in palliative care you’re equipped to deal with the inevitable ‘tsunami of pain and suffering’ that comes with the job.
Mandy Bruce, Psychological and Spiritual Care team lead at St Christopher’s, opened the conference spelling out its intention; to give people a better understanding of the various ways of using creativity in palliative care to honour the patient experience.
She said that by understanding and treating, in the widest possible sense, people’s physical, psychological, spiritual and social pain, a multidisciplinary team can provide the right support at the right time.
“It’s human nature to resist pain and to try and push it away. We’re not trying to fix it but help them to turn towards it and create a space in which they can face it,” added Mandy.
“Creative therapies provide a safe and secure therapeutic space to explore what works, warts and all. We reach into pain and suffering in a way beyond words.”
Mandy and her colleague music therapist Sean Kenny shared four case studies illustrating the effectiveness of giving people a chance to experience what it means to be mortal. These included a A retired military man, bashful about his creative capabilities, who made an armadillo out of clay with a thick outer shell and a crumbling interior, an apt metaphor for how he felt. There was also a middle-aged man struggling with unresolved grief following his mother’s death and challenged by his own terminal diagnosis was helped to process his grief and pain and come to terms with own impending death through music, singing songs he sang with his mother and then recording a CD for each of his children.
Picking up on the theme of the safe and secure space, Art psychotherapist Deborah Kelly described the success of Groups in Nature, a weekly group she set up in the woods in Sussex.
Nature, Deborah said, provides a supportive and creative space for people. Just being in nature helps our mental and physical wellbeing and we’re hard-wired to love open spaces. And by witnessing the changing of the seasons we can reflect on the cycle of life and come to terms with the fact that we’re part of something much bigger than ourselves. People reported that it gave them a sense of belonging, relieved loneliness and helped them to understand where they would like to be cared for and to die.
Linsey Clark, Dance Movement Psychotherapist who works at Weston Hospice Care in Weston-Super-Mare, talked about a very different but equally secure, safe place for people to come together and express themselves – in a closed room in the hospice. In her talk: When the door is shut, we shut everything out, she shared the work she does introducing patients from the hospice to dance.
Everyone in the room has something significant in common, they can take comfort from it but don’t need to say it. Being together in a room with the door shut provides a further security – allowing them, Linsey says, to feel no limitations, to push boundaries, readying themselves for the unknown. She added that while she can’t change’s people’s outcomes or take their pain away, she can help change their experience of that pain.
Drama therapist Peter Darby-Knight highlighted the power of stories in the palliative care setting, in his talk, Once upon a time. With every example of the impact stories can have on people, he came back to the same powerful point – connection. Whether it’s the 4,000-year-old tale of Beauty and the Beast or the cowboy films featuring stoic, granite-jawed heroes like John Wayne and Clint Eastwood that his father so admired, we all find our own connection in stories.
Peter illustrated this with the story of a teenage boy struggling to come to terms with his mother’s terminal diagnosis and who was very reluctant to engage with him. They made a connection over a shared love of Star Wars and soon the boy had written a script full of emotion and grief, expressing his feeling in a way he most likely wouldn’t have without that connection with the story.
Sculptor Lisa Snook focused on connections too. She works with both bronze and clay and says that sculpture is something we feel, that connects to the body as we push and pull the clay. For her, she says, contact with the clay is like a form of meditation aided by the 17,000 touch receptors in our hands.
When clients come to her, Lisa says, they’re often stuck, but touching the clay can help them change that, to make sense of the world.
Find a safe, secure place is as important for professionals working in palliative care as it is for the people they work with, stressed Michael Kearney, who recently retired after more than 40 years working as a doctor in palliative care, starting out at St Christopher’s in the late 1970s.
Most of Michael’s presentation, delivered via video link from his home in California, was aimed at the health and social professionals in the room and designed to provide them with some tools to cope with the pandemic of burnout to which everyone is vulnerable, he said.
Deep security provides people with the resilience to stave off burnout’s three main symptoms; overwhelming exhaustion, depersonalisation and low personal accomplishment.
Take away that sense of deep security and, Michael said, we find a lot of unhappy people walking around with protected hearts, cut off from creativity.
Michael did offer some pathways back to security and that all-important resilience – all based around different models of self-care to help you live better with the tsunami of pain and suffering you come across. He used the metaphor of water to describe three ways of coping – traditional self-care which is like holding your breath under water and then come up for air. The second type is self-awareness self-care which is like breathing underwater. While the third approach, which came to Michael on a walk in his favourite Californian woods, involves letting the water, or experience, flow through you.