Connecting with the image: how art psychotherapy can help to re-establish a sense of epistemic trust.

Abstract

The International Centre for Arts Psychotherapies Training (ICAPT) was established by CNWL NHS Foundation Trust in London in November 2011. The centre was set up to further research and advance clinical practice within NHS mental health settings. At the la unch of the research arm of ICAPT in July 2012, Professor Peter Fonagy spoke on the subject of the future of research in arts psychotherapies. This paper is a response to Professor Peter Fonagy’s presentation (The ICAPT 2012) on the potential arts psychoth erapies have to enhance the development of the therapeutic relationship. During the presentation Fonagy suggested to a group of arts psychotherapists that: ”˜the future of research is trying to understand what you guys do that actually helps re - establish in our patient a sense of epistemic trust, a sense that human knowledge and human communication, as communicated by fellow human beings can be trusted, can be relied on ... ’ A recording of this presentation is followed by a discussion section in which two art p sychotherapists explore and expand upon the ideas presented by Fonagy. They explore his question about what the processes of making and reflecting on images in a therapeutic context can add to the development of ”˜epistemic trust’ within the therapeutic rel ationship. It is suggested that creative arts have the potential to enhance the development of epistemic trust within the therapeutic relationship by offering opportunities for contingency and joint engagement. Individual, group and dyadic art psychotherap y allow for the creation of an external object which is congruent with the maker's internal world. The art making process and the art object itself can create an additional channel of communication which helps the art psychotherapist to understand the client’s inner world. This greater understanding can support the psychotherapist’s capacity to respond in an attuned way to the client. The authors explore the idea that joint engagement in art making can lead to opportunities for enhanced mentalizing and that with sufficient research and theoretical underpinning, this type of model could help to define clinical practice for arts psychotherapies in mental health.

Key Words: Fonagy; mentalization; contingent communication; mechanisms of change; joint engagement.