Therapeutic Space Research Articles

Developing Magical Consciousness: A Theoretical and Practical Guide for the Expansion of Perception

Developing Magical Consciousness: A Theoretical and Practical Guide for the Expansion of Perception

Creating ‘art-alongside’ in Peer Art Therapy (PATh) groups: nurturing connection and trust, and responding to power dynamics

ABSTRACT Background: Creating ‘art-alongside’ in peer art therapy groups: connection, trust, and power dynamics. Practice Contexts: Online, private practice; peer-focused PATh group and PATh group with people within the LGBTQA + community. Face-to-face, non-government organisation; art therapy groups with people living with cancer. Approach: Peer art therapists enter therapeutic spaces alongside their own Lived Experience of mental-health challenges. In PATh, art therapists create art-alongside participants in group art therapy. Outcomes: Through creating art-alongside peer art therapists can demonstrate embodied understanding of and modelling of surviving mental ill-health experiences as well as deliver authentic empathy for participants with current struggles. Art-alongside can be a mutually-connecting, co-learning, beneficial practice for participants and therapist. Creating art-alongside in PATh groups can create safer spaces for participants and provide grounded therapist-as-peer role modelling. Conclusions: Creating art-alongside participants in PATh applies peer-work and art therapy understandings and skills. It dismantles therapist/participant power locations of traditional art therapy and can be a process of mutuality and connection for participants and therapist. Implications for Research: Co-produced research with participants and therapists on the experience of art-alongside in PATh groups and co-produced research across ‘companion art’, ‘reflection-art’ and art-alongside in PATh, evidencing the impact of therapist-articulated Lived Experience. In addition, research is needed into the inclusion of an art-alongside PATh model in art therapy training. Plain-language summary Peer Art Therapy (PATh) is the framework used for practitioners who are trained and experienced in both art therapy and mental health peer work. Peer work is the practice of using our own Lived Experiences to support someone also living with similar ones and being equals within our spaces. In our context we specifically mean ‘experiences of mental health issues’. It combines the theories, skills, tasks and practices of both fields to work alongside and responsively to clients. Peer art therapists – the authors included – share with clients, aspects of their own personal experiences of living with mental health challenges. In this article, we talk about the practical application of this approach and how peer art therapists create ‘art-alongside’ the participants in their groups. This practice can benefit both the participants and therapists and creates strong connected relationships where both are learning. Our article discusses the concepts and theories of this approach and the positive responses it creates, including: building safer spaces, peer/role modelling, increased empathy for and understanding and survival of complex mental health challenges. The authors use personal examples of art created alongside from our clinical settings – online peer-focussed peer art therapy group and peer art therapy group with LGBTIQA + clients and art therapy groups in a non-government organisation, with people living with cancer. Our work also dismantles the need for therapist as expert in the practice of art therapy. We recommend a number of areas for future research about the value of peer art therapists making art alongside clients - research that includes both clients and therapists.

Psychological Effects of Walking and Relaxed Sitting in Urban Greenspaces During Post-pandemic: A Case Study in Bogor City, Indonesia

The COVID-19 pandemic disrupted the world order from the beginning of 2020 to the end of 2022. The COVID-19 pandemic has had a significant impact on changes in healthy living practices, such as decreased physical exercise and increased stress, compromising psychological well-being. The psychological impacts of walking and relaxing in urban green spaces on IPB University students are investigated in this study. Bogor City Alun-Alun, Sempur Park, and Heulang Park were used for the experiment. Participants completed 15 minutes of walking and relaxed sitting before and after the experiment, and the psychological impacts were assessed using Profiles of Mood States (POMS), State-Trait Anxiety Inventory (STAI), and WHO Quality of Life (WHOQOL-BREF) before and after the experiment. The results indicate that physical activity improves psychological wellness. These findings give scientific evidence for the psychologically relaxing effects of walking and relaxed sitting, as well as recommendations to support the development and construction of therapeutic urban green spaces.

Theory to practice: Pleasure‐Arousal‐Dominance (PAD) theory for architectural color design

AbstractDesigners are often called upon to design therapeutic spaces that serve people who are in fragile emotional and/or physical states. While there is considerable guidance on designing for function in these spaces, the evidence‐based guidance on aesthetics is virtually non‐existent, especially when it comes to color. For a long time, the prevailing assumption in these studies, and among the public in general, has been that hues are the drivers of emotional content (e.g., red is exciting and blue is calming) and they have, for the most part, disregarded the distinct emotional connotations of light, dark, and muted versions of a hue. This oversight has led to unfortunate outcomes in the real world. The idea that blue is calming, for instance, has paved the way for brand new state‐of‐the‐art facilities featuring light blue walls that occupants may read as cold and unwelcoming. Designers need a rational, evidence‐based approach that helps them understand what many of them already know intuitively: spaces can be calm and inviting without being blue. After an overview of the design process, this article proposes that Pleasure‐Arousal‐Dominance (PAD) theory may aid designers to better understand that pale and dark (high and low value) colors convey opposites messages related to strength/power (dominance), and that vivid and muted colors (high and low chroma) convey opposite messages about energy/activity level (arousal). Finally, the author illustrates how this thought process might be applied in an architectural design practice.

The efficacy of art therapy on hope and resilience in youth within a secure care centre

ABSTRACT Background Art therapy is one rehabilitation treatment which enables youth in secure care to express unresolved conflicts, increase self-esteem, and gain insight to personal experiences in a creative and supportive therapeutic space. Aims This study investigated hope and resilience outcomes following art therapy for youth residing in a secure care centre located in Canada. Methods In this pre–post experimental design study, thirteen (N = 13) youth, ages 12–19, received 12 weekly individual art therapy sessions. Hope, resilience, and goals were measured using the Children’s Hope Scale (CHS), the Resilience Scale (RS-25), and the Bridge Drawing with Path (BDP) art-based assessment. Results Results indicated that the 12 weekly individual art therapy sessions enhanced hope and resilience in youth residing in secure care by 29% and 16%, respectively. Conclusions Secure care environments may benefit from incorporating art therapy as a rehabilitation treatment to improve youths’ levels of hope, resilience, self-determination, and future pathways. Implication for Future Research Future studies should utilise a group design with a control group to evaluate the effects of art therapy on youth residing in secure care environments. Plain-language summary Art therapy is one rehabilitation treatment which enables youth in secure care to express unsettled conflicts, increase self-esteem, and gain understanding of personal experiences in a creative and supportive therapeutic space. This study investigated the effectiveness of art therapy on the levels of hope and resilience in youth residing in a secure care centre located in Canada. In this pre–post experimental design, thirteen youth, ages 12–19, received 12 weekly individual art therapy sessions. Hope, resilience, and goals were measured using the Children’s Hope Scale (CHS), the Resilience Scale (RS-25), and the Bridge Drawing with Path (BDP) art-based assessment. Results showed that the 12 weekly art therapy sessions enhanced hope and resilience in youth residing in secure care by 29% and 16%, respectively. Secure care environments may benefit from including art therapy as a rehabilitation treatment to improve youths’ levels of hope, resilience, self-determination, and future pathways. Future studies should use a group design with a control group to measure the effects of art therapy on youth residing in secure care environments.

Chaplaincy Perspectives on the Role of Spirituality in Australian Health and Aged Care

The aim of this study was to explore Australian chaplains’ views of spirituality. Semi-structured online interviews were conducted with 16 participants. Participants relied heavily on metaphors and analogies to describe spirituality. Four inter-related themes were identified through reflexive thematic analysis: (1) The core of spirituality: spirituality as a source of meaning or belief which leads to connectedness with something greater than oneself; (2) A function of spirituality: spirituality empowers people to cope in a crisis, by providing motivation, hope and comfort; (3) The experience of spiritual crisis: admission to hospital or residential care can lead to existential struggle; and (4) The spiritual practice: of holding space between struggle and growth. Greater understanding of the theoretical basis of their work may allow chaplains to offer more in the therapeutic space.

Trainee clinical psychologists’ experiences of the therapeutic alliance while pregnant

SummaryThe present study examined trainee clinical psychologists’ experiences of the therapeutic alliance while pregnant.There is a dearth of literature that has explored trainee clinical psychologists’ lived experiences of the therapeutic alliance while pregnant. To address this gap in the literature, the present study explored trainee clinical psychologists’ experiences of the therapeutic alliance while pregnant. Using a qualitative design, 11 trainee clinical psychologists from clinical doctorate programmes in Ireland and the United Kingdom were invited to take part in a semi-structured interview about their experiences. From the analysis, three superordinate themes emerged: a) disclosure of the pregnancy; b) perception of the alliance and c) changes within the therapeutic interaction. The findings suggest that trainees may experience changes in their relationships with clients during their pregnancy. Recommendations from this study include the development of specific guidelines for responding to these relational changes that may emerge within the therapeutic space, in response to their pregnancy. Directions for future studies are discussed.

Growing Well: Providing Secure Attachment and Reconnection to Physis Through Eco-TA and Farming

This article explores how farm-based ecotherapy using a transactional analysis approach addresses the links between structural oppression and the symptoms of poor mental health that arise from alienation and isolation. It uses a case study of the development of Growing Well, a cooperative that supports people with poor mental health, to examine the value of using transactional analysis theories in the development of an outdoor therapeutic space on a farm. It explores how a cultivated outdoor space can offer a secure attachment experience that helps people with mental health problems to regulate themselves. The article explores the connections between ecotherapy and eco-TA and examines the nature of homonomy and physis.

Using a workbook to support cognitive behavioural therapy with young people: a survey of psychological practitioners

Abstract Practitioners have mixed views about the value of cognitive behavioural therapy (CBT) manuals, with some preferring to work based on professional judgement. The workbook represents a compromise, providing guidance and resources without prescribing standardised procedures. Workbooks have not previously been widely addressed in the CBT literature. This exploratory study analysed how practitioners use a CBT workbook (Think Good – Feel Good, TGFG) to support therapeutic work with young people (YP). Practitioners (n=238) completed an online survey about how TGFG is used and how it supports CBT. A convergent mixed-methods design was pursued. Qualitative and quantitative data were analysed using content analysis, descriptive statistics, and chi-squared tests before themes were defined to summarise the dataset. When deciding whether to use TGFG, practitioners consider a YP’s presenting difficulty, level of understanding, motivation, and availability of systemic support. Practitioners use TGFG inside and outside the therapeutic space to plan sessions, revise CBT concepts, and complete worksheets (particularly those with a cognitive focus). Practitioners use TGFG flexibly and pragmatically (combining it with other therapeutic approaches), and they adapt resources to suit a YP’s understanding and interests. TGFG appears to be a widely used resource for practitioners across the range of experience. Key learning aims (1) To expand upon the concept of the workbook as a therapeutic adjunct within the CBT literature. (2) To explore how a popular CBT workbook is useful to practitioners, how it is typically used, and the breadth of usage. (3) To consider whether and how workbooks are used flexibly by practitioners. (4) To encourage practitioners across the range of experience to reflect on how workbooks support planning and delivery of therapeutic interventions.

Integrating Art Therapy With Feminism for Self-Advocacy Through Storycloth: Case Study

This case study integrated feminist theory and social action approaches through the use of a storycloth (fiber arts-based intervention). The feminist approach of being transparent and egalitarian focused on addressing social, cultural, and political issues that are not always covered in the therapeutic setting but may be an underlying cause of distress and mental health issues. The case follows 35 art therapy sessions between a white art therapist in training and a LGBTQIA African American woman, who had a history of trauma. As an outcome, the client experienced a therapeutic space to tell her story and enabled her to self-advocate within art therapy sessions which translated to new understanding within her day-to-day life.

The therapeutic relationship at the heart of nursing care: Aparticipatory action research in acute mental health units.

To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse-patient therapeutic relationship. Participatory Action Research. Ninety-six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

Reversing the Panopticon: On Narrative Therapy and Its Place in the Treatment of Eating Disorders

With eating disorder treatment options gaining traction in Australia due to increased government funding for dietician and counselling sessions, psychotherapists and psychologists /are called to position themselves as an authoritative force within the therapeutic space. The current paper rejects this notion and uses personal and professional reflection on eating disorder treatment to suggest narrative therapy as a primary treatment option for eating disorders. Narrative therapy upholds collaboration between client and counsellor, rather than the clinician exalting an expert position. Its principles allow the client to centre themselves as the author of, and protagonist within, their life. Further, narrative therapy offers a dismantling of dominant discourse that may sustain limiting descriptions of the client and thereby discount the complexity and intersectionality of an individual’s life and identity. Through the narrative therapy tool of therapeutic letter writing, the author—a psychotherapist herself—tracks her experience of, and recovery from, anorexia and bulimia as a process of reversing the panopticon that is often sustained by the contemporary health care sphere.

Virtual wobble spaces: A pilot study of the outcomes of online therapeutic spaces on practitioner well-being and social work practice

Abstract Stress, emotional exhaustion and job dissatisfaction have been prevailing issues in social work for decades, with recent research by BASW demonstrating poor psychological outcomes for social workers, amidst inadequate levels of staff retention and high burn out rates. The Covid-19 pandemic added to these existing stresses, with social workers experiencing multiple losses, including bereavements and changes to working practices. As a response to the pandemic, many hospitals and health care settings established bespoke wobble spaces, dedicated to enhancing staff well-being. However, despite the reported success of these wobble spaces, results from a literature review show that they have not been established within social work. The pilot study discussed in this article explored and evaluated the impacts of a virtual wobble space provided for social workers over three months at fortnightly intervals. The research design was purposefully creative and aimed at focussing on positivity and fun as a counter to much of the existing literature on stress and burnout in social work. The study is limited by a small sample size but nevertheless the unanimously positive findings and wider interest, suggest there may be a broader role for wobble space provision in social work.

Irony in Psychoanalysis

Psychoanalysis promotes psychological growth by nurturing patients’ creativity and cognitive, interpersonal, and affective competence. Cultivating ironic sensibility in the analytic relationship can give rise to a therapeutic play space in which the patient’s new ways of thinking, feeling, and relating are respected and supported. In particular, irony can facilitate the patient’s growing ability to link, acknowledge, and explore previously unsymbolized, dissociated affective states. By courting irony, the analyst can assist the patient in tolerating the anxiety and shame that emerge while working through traumatic material. This article discusses both the benefits and pitfalls of irony in the analytic process.

When I Cry Into My Icosahedral Mermaid Womb, The Sea Cradles Me: Creating Imaginary Water Worlds For Suicidal Depression and Healing Through Multisensory Environments

Imagine a future where technology is liquid, where the human senses are entirely wet, foggy, mushy, and gooey. Where everything and everywhere is liquefied and watery. Where humans evolve into pluviophile (love of rain) and hydrophile species. Imagine what state our depressed and suicidal bodies would react to and sustain in this hyper-watery world. This thesis set out to reimagine and recreate my personal experiences with depression, anxiety, and suicidal behaviours through a wet, watery, emotional, and hyper-futuristic narrative. The project aimed to design and create a series of immersive multi-sensory environments that provide therapeutic and healing spaces for mental health and well-being. Thus I have been informed by my personal story through imaginary water worlds and speculative fiction writing as a method of inquiry. These immersive multi-sensory works explore various emerging creative technologies to help realise my thesis project, such as using sound, interactive installation, digital, and extended reality (XR) technologies. I have used my own body, bodily experience, and personal feelings as a storytelling tool and primary material for my master's project. Water plays a significant role in my creative research and practice. Also, it hugely influences my writing, providing therapeutic and healing qualities. The approach to my research has drawn from methodological perspectives, including autophenomenography, first-person narrative, sensory ethnography, and speculative fiction through creative practice. I am using 'water' as a metaphorical guideline for methodological approaches to tie together as one, connecting these bodies of watery perspectives into an oceanic methodology. The significance of the research is the engagement and immersion of the multi-sensory environments through creating imaginary water worlds that offer a space for others to swim, dive, and acknowledge these critical issues relating to mental health by sharing personal stories and connections to their own experiences.

MODL-29. IN SILICO MODELING TO PREDICT ONCOGENICITY AND POTENTIAL TARGETABILITY OF NOVEL FGFR VARIANTS IN PEDIATRIC LOW GRADE GLIOMA

Abstract Pediatric Low grade gliomas (pLGGs) are largely driven by alterations in the RAS-MAPK pathway. The third most commonly mutated gene in pLGGs is the FGFR1 gene, having alterations including fusions, duplications or missense mutations. Accurate identification of these alterations has become increasingly important as FGFR inhibitors enter the therapeutic space. Here we describe a case of a pLGG patient with an FGFR1 W289_insW290 found through NGS in the tumor at diagnosis, and progression, without additional alterations. This extracellular, third-Ig domain mutation has not been reported. Transcriptional and proteomic profiling of the tumor showed low MAPK and high PIK-AKT pathway activation when compared to other gliomas. Literature review identified disorders of bone formation with similar mutations in the homologous FGFR2 gene. One such mutation, FGFR2 W290G favors inter-receptor disulfide bond formation over the normal intra-receptor disulfide bond. To determine if this insertion is a possible driver mutation in our pLGG case, Alphafold2 protein simulation software was used to make in silico models; quality metrics from both Alphafold2 and VADAR1.8 were used. Structure simulations of the FGFR1 insertion mutant (pLDDT = 81.8) and the mutant FGFR2 W290G (pLDDT = 83.4), were generated and compared to a protein data base, experimentally determined structure of wildtype FGFR1. When monomers of all three structures were aligned using PyMol, the root mean square deviations were < 1.5 indicating the structures are correct or the same. Based on these results we concluded that, like the known FGFR2 mutation, this insertion is predicted to cause hyperactivity by inducing prolonged dimerization due to an aberrant inter-receptor disulfide bond but any structural or functional differences only occur when receptors are dimerized. We are currently generating isogenic cell line models to test this hypothesis and treat these cell lines with inhibitors to determine which treatments might work best for our patient.

Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents.

The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.

Spaces of Refuge: The Clinical Practice of Félix Guattari and Institutional Psychotherapy

Guattari’s prescient final text, Chaosmosis, argues that the conditions of Capital responsible for the current social-psychic-ecological crisis of migration demand modes of analysis capable of grasping their complexity, ones grounded in the ethico-aesthetic. It is a text that draws directly from the therapeutic practice that he, Tosquelles, Oury, and others in the Institutional Psychotherapy (IP) movement developed in their clinics. This work entailed the inclusion of aesthetic practices that work to deterritorialise the institution, shifting from carceral sites and creating therapeutic spaces of care and refuge. This article explores the centrality of an ethico-aesthetic approach to the understanding of therapeutic space within the sites and clinical practice of Institutional Psychotherapy. Looking especially at daily life and the inclusion of aesthetic practice, it examines the particular notion of asylum that emerged in these sites that so informed the clinical and critical work of Guattari and Deleuze, and draws connections to the current global crisis of migration in the necessity of such sites to the forced segregation between those deemed mad and sane.

Implementasi Konsep Therapeutic Space pada Strategi Desain Pusat Rehabilitasi Penderita Depresi

<p><em><span lang="EN-US">The therapeutic space approach is an architectural concept that emphasizes the interaction of psychological and physiological elements in order to improve the well-being of patients through utilizing the functions of the built environment. It is necessary to further research into the connection between depression and the concept of therapeutic space is required.</span></em><span lang="EN-US"> </span><em><span lang="EN-US">Therefore, this research identified the needs of people suffering from depression related to therapeutic space. Method used analysis content of three theories and comparative content of them. The of therapeutic space theories are compared consist of Chrysikou, Jordan, and Liddicoat. The results of the comparison of the three theories are modified as the guidelines theory suitable for considering in designing of therapeutic space in the rehabilitation center for depression disorder by integrated harmony with nature.</span></em></p>

Burden of infectious diseases in prison settings and services offered

Abstract Introduction The WHO Prison Health Framework was developed to assess prison health system performance and support Member States (MS) in improving their prison health systems. Moreover, it shall enhance MS capacity to evaluate: the impact of changes in governance models, progress in service provision and improvements of the health status of people in prison (PiP). Methods The framework informed the 2021 data collection round of the Health In Prisons European Database Survey. Invitations were sent to all 53 MS of the WHO European Region. Those MS nominating a focal point and providing valid answers were included in the analysis. Results Answers were obtained from 36 MS, representing a total of 613,497 PiP. Access to immunization was very good across all MS, with the highest for COVID-19 (90% of MS provide it in all prisons). Vaccination against HBV was only available in all prisons of 25 MS. Access in all prisons to HIV post and PrEP were reported, respectively, by 78% and 58% of MS. Screening for diseases at entrance was common for HIV, HCV and HBV. In all prisons of 35 MS soap was provided for free, while needles & syringes and lubricants were only provided free of charge, respectively, in 3 and 4 MS. 5 MS did not have therapeutic spaces to tackle drug problems in any prison, in 73% of those having, accessibility was restricted to some prisons. HIV prevalence ranged from 0-16% and treatment was accessible to 55-100% of those diagnosed. Prevalence of HCV ranged from 0-34%, with access to treatment ranging from 0-91%. The most common format of health records in European prisons was paper based (44%). Conclusions Prison-based data collection systems resulted in limited capacity for extraction so that some countries were unable to provide any data on disease prevalence or treatments offered. Given the scarcity of data on this topic obtained from real-world and not from ad-hoc studies, this snapshot provides an important contribution to public health.