The Arts in Psychotherapy 40 (2013) 250–256

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The Arts in Psychotherapy

The art-gallery as a resource for recovery for people who have

experienced psychosis
Susannah Colbert, PhD a,b , Anne Cooke, MSc b , Paul M. Camic, PhD b,∗ ,
Neil Springham, MA c
a
Oxleas Foundation NHS Trust, London, United Kingdom
b
Department of Applied Psychology, Salomons Campus, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom
c
Art Therapy Department, Oxleas Foundation NHS Trust, London, United Kingdom

a r t i c l e i n f o a b s t r a c t

Keywords: Dominant personal and community narratives of psychosis can often be experienced as oppressive and
Psychosis stigmatising. An important aspect of recovery may be overcoming this internalised, self-depreciating
Recovery story. This intervention sought to understand whether an art gallery-based group facilitated modifica-
Art gallery
tion of the dominant narrative of psychosis in the participants’ personal narratives, promoted recovery,
Art museum
wellbeing, and a subjective sense of social inclusion. The narratives of mental health and gallery staff
Social context narrative analysis
were included to investigate the modification of the dominant narrative in their personal narratives.
People with an experience of psychosis participated in a gallery-based group where they reflected on
paintings related to their life experiences. Participant interviews at the conclusion of the group were
subjected to literary and social context narrative analysis. The findings suggested that some individuals
used art-related concepts to modify the dominant narrative within their personal narrative. A commu-
nity narrative regarding a different staff–client relationship, characterised by validation, commonality,
friendship and genuineness, emerged within the group. The intervention was depicted as promoting
recovery and wellbeing, mainly through achievement, and described as more successfully addressing
bonding social capital than bridging social capital. Art gallery-based interventions show some promise
to provide a safe haven where people with a psychosis can engage in a recovery-oriented approach to
mental health care, where a different staff–client relationship could occur, away from the demands and
possible stigma of mental health services.
© 2013 Elsevier Inc. All rights reserved.

Introduction narratives are stories repeatedly told in socializing institutions

Telling stories may be one of the most powerful ways that
individuals construct and express meaning (Dent-Brown & Wang,
2006; Mishler, 1986). But the stories in society about psychosis
may be oppressive and stigmatizing (Read, Haslam, Sayce & Davies,
2006). These narratives are often incorporated into the life stories
of people who experience psychosis, resulting in a spoiled or taboo
identity (May, 2004). Recovery may involve reclaiming authorship
of one’s experiences away from this stigmatizing narrative and
developing an alternative understanding of what it may mean to
be a person who experiences psychosis (Thornhill, Clare & May,
2004).
Rappaport (2000) proposed a three-tier model of narrative that
spans individual, group and societal levels of analysis. Dominant
∗ Corresponding author. Tel.: +44 (0) 1892 507 773.
E-mail address: paul.camic@canterbury.ac.uk (P.M. Camic).
(e.g. schools, media), which influence the beliefs and identities of
most of the population living or working in that place. According
to Rappaport, those with the power in any given society main-
tain dominant narratives about marginalized groups. Community
narratives are a shared story amongst a smaller group of people
that tell group-members important information about themselves.
Personal narratives are individuals’ accounts of their own life expe-
riences and represent their identity.
Dominant narratives of mental illness can be oppressive, iso-
lating, create dependency and despondency for those diagnosed
with mental illness (Rappaport, 2000). The dominant narrative
about people who experience psychosis often centres around dan-
gerousness and unpredictability, being out of control and unable
to function (Read et al., 2006). Society’s dominant narratives
are sometimes drawn upon to find meaning in personal expe-
riences (Rappaport, 2000). Indeed, the impetus to account for
personal experiences may be so powerful, people even appropri-
ate stigmatizing dominant narratives into their personal narratives

0197-4556/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.aip.2013.03.003
 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256
(Casey & Long, 2003). Women with a diagnosis of schizophrenia
reported that their diagnosis contributed to their feeling isolated,
rejected by family and community, incompetent and ashamed
(Rice, 2006).
Central to the recovery model is a person’s ability to find his or
her own voice and challenge or modify the oppressive dominant
narrative (Thornhill et al., 2004). The women who participated in
Rice’s study described a need to find meaning in their lives and to
tell their stories in order to recover. The genesis of recovery can
be through talking to others, especially other service-users (Brown
and Kandirikirira, 2007). For some, hearing others’ stories of suffer-
ing and survival in the mental health system may be the beginning
of transforming despair into hope (Ridgeway, 2001). Further-
more, through this storytelling, an alternative community narrative
regarding psychosis may emerge. Individuals may then have the
opportunity to draw upon the community narrative in their per-
sonal narrative (Mankowsi & Rappaport, 2000). Well-developed
community narratives offer a challenge to the stigmatizing domi-
nant narrative in shaping personal stories (Rappaport, 2000).
Community-based projects may be a particularly powerful
approach to address personal narratives. Art galleries and muse-
ums, unlike hospitals and clinics, tend to be non-stigmatizing
environments and they are most often publically accessible sites
available in many locations throughout the world, making them
ideal locations for public health interventions including health
education, health promotion and illness prevention (Camic &
Chatterjee, 2013). They have recently been used for non-clinical
community interventions for people with dementia (e.g. Eeckelaar,
Camic & Springham, 2012; Rosenberg, 2009), for family caregivers
of people with enduring mental health problems (e.g. Roberts,
Camic & Springham, 2011), and to increase social inclusion (e.g.
Coffee, 2008; O’Neill, 2010). The healing possibilities of hand-
ling museum and heritage objects have also been examined (e.g.
Chatterjee, Vreeland & Noble, 2009) within the larger context of
the museum and art gallery as place for health and wellbeing
(Chatterjee & Noble, 2013).
In addition, museums and galleries have been cited as emerging
locations for art therapists to expand their practices to include new
possibilities for engagement with clients and community groups
(Treadon, Rosai, & Thompson Wylder, 2006; Peacock, 2012). Salom
(2011) has proposed four metaphorical roles museums can play
with a range of different groups; these roles include museum as
co-leader, museum as group, museum as self, and museum as envi-
ronment.
Arts-oriented interventions can help to facilitate working
through a personal journey, as the art encourages different perspec-
tives on the difficulties people experience (Sixsmith & Kagan, 2005).
Developing a creative identity and engaging in creative activity
can have positive benefits for wellbeing and provide meaning or
purpose to life (Brown and Kandirikirira, 2007). There is a broad lit-
erature on the contribution of the arts to healthcare (Camic, 2008).
For example, in a general hospital setting, art displays were found
to ease stress levels and improve patients’ mood (Staricoff, Duncan,
Wright, Loppert & Scott, 2001). Narrative approaches to research
have been adopted as a useful and appropriate method of gain-
ing in-depth stories regarding the significance of art to the person
(Stacey & Stickley, 2010).
The present study
The study aimed to provide an opportunity for individuals with
a diagnosis of psychosis to explore the meaning of their life experi-
ences through reflecting upon paintings in a public art-gallery along
with National Health Service (NHS) mental health staff and gallery
staff. The study sought to explore whether an art gallery-based
project would enable participants to modify the dominant narrative
251
regarding psychosis within their personal narratives; contribute to
the recovery process by enhancing wellbeing and social inclusion
and; facilitate a new community narrative regarding psychosis.
Theoretical framework
The underlying epistemology of the study was social construc-
tionism. This post-modern epistemology states that people form
constructions of reality, which are derived from, and embedded
within, individual, historical, political and social contexts (Gergen,
1997). Thus, multiple understandings of reality, or of a particu-
lar phenomenon, are available at any one time (Willig, 2001). The
status of ‘psychosis’ and ‘mental illness’ are contested in the lit-
erature, with some authors arguing that psychosis/schizophrenia
represent social constructions, rather than an illness that exists
within individuals (e.g. Boyle, 2004). Narrative analysis under-
taken from a social constructionist perspective focuses upon ‘lived
experience’, including the construction of the self and of one’s
experiences through language and embodied experience (Crossley,
2000). Within this methodology, the dominant narrative regarding
psychosis can be investigated alongside alternative understandings
from the perspective of those who had experienced it. Additionally,
this approach could embrace multiple understandings of recovery,
wellbeing and social inclusion, without imposing a realist perspec-
tive that recovery is a state that exists within an individual.
Methods
Intervention
The intervention took place during usual opening hours at Dul-
wich Picture Gallery in London, Britain’s oldest public art gallery,
which is well known for its longstanding community outreach pro-
grammes. Participants were invited to four weekly sessions each
lasting 2.5 h. The first 75 min was facilitated by the museum edu-
cator and spent in the gallery. The educator began by describing
the story depicted in the painting while also helping participants to
understand the meaning of the painting through their own personal
interpretations. Background information was given about the his-
torical period when the painting was created and the circumstances
surrounding its creation. Some information about the artistic tech-
niques was also described, for example the composition of the art
work. It should be emphasized this component was designed as
an interactive discussion where people were invited to comment
and share their responses to the painting and not an art history
lecture. At the end of the art viewing component participants had
the opportunity to sketch in the gallery for about 20 min. They
frequently sketched the works that had been described by the edu-
cator, however they could also choose to sketch other works in
the gallery. The museum educator was also available to answer
questions regarding any other painting.
At the end of the art viewing and drawing components in the
gallery, participants adjourned to the gallery’s studio where they
were then invited to create an art-work with the support and
encouragement of the museum educator and the art therapist, who
facilitated this part of the intervention. Basic art materials includ-
ing sketch pads, watercolors, pastels and pencils were available.
The final 30 min involved discussing the artworks, facilitated by
the art therapist. Each participant shared the subject of their work
and their inspiration behind creating the work. The other partic-
ipants were then invited to comment on the work and give their
responses to it. Two groups ran, the first with four participants and
the second with three participants.
252 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256
Participants
Six men and six women, in their late twenties to early sixties,
participated. Eleven participants were white British, and one was
of Middle Eastern heritage. Five men and two women were clients,
the two gallery-staff (educator and coordinator) and art therapist
were women while both a man and a woman composed the NHS
staff who accompanied the clients (occupational therapist (OT) and
occupational therapist technician (OT-tech)). Although it is unusual
in research for staff narratives to be included along with client nar-
ratives, in order to give a broader perspective on the influence of
the project, and to investigate the modification of the dominant
narrative regarding psychosis within personal narratives, staff nar-
ratives were felt to be important aspects of the project. Gallery-staff
attended all the sessions; NHS staff attended the sessions attended
by the participant they were accompanying.
The client-participants were recruited through a complex needs
service (including both inpatients and outpatients) in a mental
health NHS trust. Five inclusion criteria were used: experience of
psychosis, interest in art, fluency in English, ability to reflect on their
experiences and tolerate participation in the project. An assessment
of suitability was made by the first author and the art therapist. Four
client-participants had a diagnosis of schizophrenia, one of bipolar
disorder, one of schizoaffective disorder, and one of both bipo-
lar and schizoaffective disorder (diagnoses had been made by the
service). Six were taking medication and four had either completed,
or attempted, higher education qualifications. Four attended all ses-
sions, one attended three sessions and two attended two sessions.
The project was approved by a local NHS research ethics committee.
Design and methodology
Consistent with the use of narrative analysis in the social sci-
ences, whole interviews were taken to represent the participants’
narratives (Reissman, 2003). The first stage of the analysis consisted
of literary narrative analysis (Murray, 2003) to give the analy-
sis global, local and thematic coherence (Reissman, 1993). Global
coherence refers to the goals and beliefs the person hopes to con-
vey in their story, local refers to the use of linguistic devices in
the portrayal of the narrative and thematic refers to the repeti-
tion of themes throughout a narrative. The following areas were
identified:
• The genre of the narratives: the type of story the participant was
telling.
• The core narrative: a summary of each story in a few words.
• The narrative tone: the participant’s manner of telling the story
and researcher’s subjective response.
• Positioning: what the narrator was hoping to achieve through
telling the story and how they did this.
In the second stage of the analysis, social context narrative anal-
ysis (Murray, 2003) was employed to explore the presence of the
dominant ‘psychosis’ narrative in personal narratives, to estab-
lish to what extent the dominant narrative was modified and an
alternative community narrative developed, as a result of the inter-
vention. The narratives were read for the influence of the project
upon recovery, wellbeing and social inclusion.
Social inclusion was read through the lens of a complemen-
tary concept from the literature on social capital. This literature
distinguishes between two forms of social capital: “bonding” and
“bridging” (Putnam, 2000). The bonding form is defined as the cre-
ation of supportive links between people in a group, whereas the
bridging form means to bring diverse groups together. Viewing
bridging social capital in the light of social inclusion requires linking
a group into the wider community (Bates & Davies, 2004).
Additionally, the manner in which different aspects of the art-
project were represented in the narratives was identified in order
to explore mediating outcomes.
Interview schedule
The research interview commenced with the question (adapted
from Thornhill et al., 2004) “As you know, the conversation we
are about to have is part of a research study to try to understand
whether the art-project was useful in helping you to think about the
experiences that led you to be in contact with the complex needs
service. Perhaps you could begin by telling me something about
yourself and what has brought you to the point of sitting here talk-
ing to me about the art-project?” In order to facilitate the sharing
of life stories, the question “and then what happened?” was used
(Reissman, 1993). A list of interview topic areas included: visiting
the gallery, being in a group, reflecting on the paintings, art-making,
ideas around mental health problems, recovery, wellbeing, social
inclusion1 .
Procedure
Following the gallery sessions, the first author met with each
participant for the narrative interview. Interviews lasted between
35 and 90 min, and were digitally recorded and transcribed. People
and place names were made anonymous.
In terms of validity and quality assurance, an audit and respon-
dent validation were performed (Elliott, Fischer & Rennie, 1999).
A sample of the analysis and summaries were checked by the
second and third authors to ensure the analysis followed the prin-
ciples of narrative analysis. Consistency was established through
the multiple researchers adhering to the principles of narrative
analysis and checking the analysis was based upon the transcripts,
rather than any individual’s preconceptions or assumptions. Coher-
ence may be established by the findings fitting together to form
a data-based narrative of the research. To promote coherence, it
was highlighted where the findings overlapped, for example in the
depictions of wellbeing and recovery. The second and third authors
then checked the coherence of the analysis. Following the analysis,
the first author met with each participant to share the transcript
and a summary of the analysis, to obtain their feedback on its
validity.
Results
Literary narrative analysis
The literary analysis revealed that familiar genres of stories
were identified in the participants’ narratives, (e.g. epic, tragedy)
(Table 1). The genres of ‘enlightenment’ and ‘cacophonous’ were
drawn from previous research on narratives within psychosis
(Lysaker & Lysaker, 2002; Thornhill et al., 2004). The tone and posi-
tioning within the narratives were particular to each participant.
Dominant narrative of psychosis
The analysis revealed that aspects of the dominant narrative
were present in all except one of the participants’ narratives. Vio-
lence, being in trouble with the police, and acting inappropriately
in public all appeared in the narratives, for example: “I can’t help
these violent thoughts”. Psychosis was depicted as defining the self:
“The problem and you are the one, are the same thing”. This meant
1
A list of specific interview questions is available from the first author.
 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256 253

Table 1
Results of the literary narrative analysis.

Participant Genre Core narrative Tone Positioning

Afsanaa Epic “It’s always darkest Independent Establishing the validity of her story
just before the dawn”
Brian Cacophonous A tale of divine Struggling to remain Portraying himself as a tough man and a good
retribution with the conversation guy
Clive Tragedy “Someone broke my Haltingly Co-constructed with the researcher
heart”
Kevin Unresolved “I . . . felt like I was Contradictory Resolving a conflict regarding being a
with the Dutch master successful man in society’s eyes
at the top”
Olivia Journey “Glass head” Moved from closed to Defining her own experiences
open
Roger Enlightenment “All arts and things like Monotone Communicatinghis enjoyment of the project
art, when you gain an
insight in to it, it’s an
achievement”
Simon Cacophonous “Butterfly mind” Unfocussed A coherent position was not developed
OT Interdependent “The same with me” Reflective Communicating the similarities between
herself and her client
OT-tech Expert “They felt comfortable Gentle A professional with expertise
with me being a part of
that”
Guide Journey “Opening doors” Performing Sharing her insights into the project
Coordinator Reawakening “Opened my eyes” Magisterial Contrasted her experience of this project with
others in order to benefit the research
a
Pseudonyms are used.

that client-participants felt they were not regarded as part of the
mainstream population and there existed a “them and us divide”,
with individuals with psychosis being on “a different planet” and a
“pariah”. Psychosis was regarded as incomprehensible: “they said
that it’s psychosis because they couldn’t make head nor tail of what I
was saying”. The views that people with mental illness are unfit to
work, and are dependent on medication, also appeared “absolutely
100% relying on my medication”.
Modifications to the dominant narrative
The dominant narrative appears to have been modified in every
personal narrative. For one participant, the idea that mental illness
is permanent was modified through the idea of recovery: “if you go
through a bad patch it doesn’t mean necessarily all your life is going
to be coloured black from then on. You can recover, you can get bet-
ter”. The dominant narrative was modified in two narratives by the
idea that individuals with psychosis were primarily vulnerable and
not able to contribute or participate because of that vulnerability:
“we’re just vulnerable people”.
Several participants drew upon narratives around art to subvert
the dominant narrative. One participant drew upon the narrative of
madness being linked with creativity, and felt the project reinforced
this alternative narrative “it reinforced my ideas of, in a positive way,
of people with mental health problems that can be creative”. Another
participant represented herself as an artist, defining her recovery
in terms of her artistic productivity which was supported by the
intervention: “I judge it by how many pictures I can get painted in a
week”.
In the painting ‘Samson and Delilah’ by Anthony Van Dyck, one
participant saw“terrible states of mind” greater than those he had
experienced, which helped him accept that different states of mind
could be part of human experience, rather than segregated as ill-
ness. Similarly, another participant viewing this painting modified
the dominant narrative by beginning to value personhood as impor-
tant and more valuable than a diagnosis (when talking about a
client): “I mean I don’t know what her diagnosis is and I don’t really
need to know, erm, I just see her as a person and she’s an amazing
person. We all saw me as a person and saw her as a person”.
In the narratives of the staff-participants, the commonality of
being human was drawn upon to reject the “them and us divide”.
The commonality of “everybody’s had their ups and downs” was
employed as a metaphor to counteract the incomprehensibility of
psychosis.
Alternative community narrative
An alternative community narrative regarding psychosis did not
emerge from the personal narratives, perhaps because psychosis in
itself featured very rarely in the conversations during the inter-
vention. However, a community narrative regarding a different
type of relationship between the staff and clients, characterised by
validation, empathy, friendship, ‘joining in’, commonality and gen-
uineness, appeared in the several of the client and staff participants’
narratives.
Validation
Prior to the project, two client-participants expected that they
would be patronised or belittled. One participant told a story of
when he had been very rudely put in his place by a previous member
of staff. He commented on the impact of this on his self-esteem and
made a direct comparison with the gallery-project where different
relationships occurred: “sometimes you can feel like you’re treated
as less, and comparing that to the group. . . we weren’t treated as less
. . .we were treated like people. Everybody’s got a story and no matter
how bizarre or sort of frightening the story is, it’s still an individual
story”.
Empathy
One participant explained how a particular painting revealed
the importance of the different staff–client relationship. She
described the painting ‘The Guardian Angel’ by Marcantonio
Franceschini: “it was an image of an angel holding the hand of
this/Little child and just falling into a ditch almost, but pointing
upwards”. When the educator explained that this was a guardian
angel, she made the symbolic connection to the human touch of
the educator, her empathy, and how meaningful that was for her:
254 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256
“it really dawned on me that how much human touch can make a dif-
ference, you know, just even within words. . . it’s that understanding,
that empathy”.
‘Joining in’
Initially, the OT was concerned that there may be a counterpro-
ductive divide between the staff and clients: “it felt very much sort
of staff and clients, I‘m kind of thinking “oh no, I don’t want. . . this isn’t
going to work””. She then described a change in dynamics that arose
from staff and clients being involved in the project together: “we
(staff and clients) were all going to go down to the gallery and join
in on that bit, I think that changed the dynamics”. The OT-tech felt
a prerequisite for ‘joining in’ would be a comfortable staff–client
relationship: “it really depends on what the clients felt comfortable
with”.
Commonality and genuineness
Being aware of the potential ‘them and us’ divide, the coordina-
tor felt that being “alongside” the participants was important. She
appeared insightful as to the ‘them and us’ divide that can occur in
health settings and why this might be necessary “partly for protec-
tion I suppose from the workers that there is a ‘them and us”’. However,
a different type of relationship could occur in the gallery. This dif-
ferent relationship was one where “we weren’t separate, we’re all
human beings together”.
Another common factor for staff-participants was the cautious
development of interest: “it became quite clear that we were all
genuinely sort of interested”. This genuineness seems to represent
the staff bringing their personhood into the project, not just their
professionalism: “And not only professionalism you say you adopt a
persona, it wasn’t like that, its, you’re all genuine people and you’re
involved in this area and, yeah it came across”.
Recovery and wellbeing
The project was depicted as a further step in a recovery journey
for clients: “it was a definite positive step” and “one more step in a big
long journey”. Ten participants felt that the project had contributed
to their wellbeing. The processes that were depicted as enhancing
recovery and wellbeing were: achievement, the physical process of
art-making and distraction.
One participant was ambivalent about whether the project
enhanced his wellbeing: “if it was something that’s good for
me I couldn’t decide at the time”. This accords with his deci-
sion to drop-out after two sessions. Interestingly, neither of the
client-participants who withdrew, nor the staff-participant who
accompanied them, gave full account, in their narratives, of why
this occurred.
Achievement
Participating in the project was depicted as an achievement. As
participating in the arts was new for some participants, the sense
of achievement was even greater: “I‘ve been there and conquered a
little bit”. The high social value of art may have increased the sense
of achievement, e.g. in doing something ‘normal’ despite expe-
riencing psychosis: “normal things can still be entertaining”. This
highlights the value of accessing the gallery, which is ‘normal’, out-
side the realm of mental health services. Three participants had
visited another gallery in the few weeks between the end of the
project and interview. This was regarded as another achievement
and seen in terms of recovery. The narratives revealed that that all
participants continued to engage in art-related activities following
the project.
Achievement was derived from learning about art, “I enjoyed
the education side of it”, therefore the educator’s role in educating
was crucial: “when you achieve something it’s always a. . . boon for
your self esteem. And not only self esteem, she’s given us, let’s just
say the critical apparatus to look at these paintings”.
Both the NHS staff-participants and one client-participant
described art as being failure-free, which was regarded as impor-
tant for achievement and wellbeing: “challenging but not in a way
that you could fail”. As art viewing has few rules, it provides more
freedom: “you don’t have to follow different rules to make something
that’s accepted by everybody”.
Distraction
Another prominent theme linking the project to recovery was
distraction from distressing thoughts: “you don’t have to consis-
tently and constantly be consumed with your own inner world,
you can be distracted nicely, don’t have to be a bad reflection all the
time”. One client-participant described concentrating on the art as
reducing auditory hallucinations: “I suppose they’re always there
and in periods where I‘m concentrating intensely. . . I can drown
them out”. The coordinator described this distraction arising from
deep engagement with the art-making process: “losing yourself in
it”.
Social inclusion
The importance of social inclusion was highlighted by the coor-
dinator: “It’s quite a big thing for people who have such problems,
and still have such problems, to come to a completely strange and
alien environment”. However, one participant revealed an ambiva-
lence regarding being included: “I don’t want social inclusion to
invade my privacy”.
Bonding
Several participants described the bonding aspect of social cap-
ital: “It’s a time to make new friends isn’t it?”. Engaging with art was
seen as a vehicle for promoting this: “I suppose it was a bit of a
bonding process for the group to all be looking at the same thing and
listening to each other’s answers”.
For the OT, the different staff–client relationship also served to
enhance bonding: “I mean our group because it was very inclusive
and we were all equal, that’s makes it quite good”. However, she did
not feel the project addressed the bridging aspect: “we can take
people along and they can be included, but how much are they actually
included?”
Bridging
In contrast, other participants described the bridging aspect:
“when you go to a gallery there are lots of other people who are
there so you’re almost included, this feeling, this sense of being
included”. For one participant, the project served to make the
gallery more accessible: “I’ll definitely go back to Dulwich”. The OT-
tech described the project as allowing the participants to access a
new environment: “an environment that maybe a lot of them would
never. . . go”.
Discussion
The narrative analysis suggested that the art gallery group
appeared to help modify the dominant narrative regarding psy-
chosis within personal stories. There is also initial evidence to
 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256
indicate it also helped to promote recovery, social inclusion, and
enhanced wellbeing.
Art as a modification to the dominant narrative
Concepts from the field of art provided an alternative to the
dominant narrative regarding psychosis for some participants. One
participant drew upon the states of mind represented in a paint-
ing. The narrative of madness being linked with creativity was
employed, as was representing one’s identity as an artist in terms of
recovery. This resonates with other first person accounts of recov-
ery, where creative work was regarded as serving as a basis for
a new identity (Brown and Kandirikirira, 2007). The alternative
narratives provided by the engagement in art world challenged
the hegemony of the stigmatising, dominant narrative in the par-
ticipants’ personal narratives and offered an alternative, socially
valued identity.
Community narratives
The different relationship between the staff and clients that
was described in the project provided an alternative to the domi-
nant narrative, and appeared to emerge as a community narrative
between the participants. This community narrative supported the
emergence of a sense of personhood over patienthood or profess-
ionalism, which served to bridge the ‘them and us’ divide. In the
project, and within the gallery, the participants were no longer the
stigmatized other, the ‘them’. Rather, participants were all the ‘us’
together. This brought them into the socially valued community of
gallery-goers and art-makers. Within the recovery literature, there
is an argument that patienthood can become an all-pervading iden-
tity, one that negates other aspects of identity (e.g. Ridgeway, 2001).
It appeared that this project offered an exception to the ubiquity of
the patienthood identity.
Several factors (validation, empathy, friendship, joining in, com-
monality, genuineness) appeared to be crucial in developing the
different relationship in the group. These factors may have con-
tributed to the lack of an alternative community narrative about
psychosis. As we all genuinely ‘joined in’, the conversation focused
upon what we could all contribute to (e.g. being human, being
interested in art), rather than psychotic experiences. Our all being
new to the project and not knowing what to expect enhanced the
commonality between the staff and clients.
In mental health settings, describing a staff–client relationship
as friendship would raise anxiety, as the professional role prohibits
this type of informal relationship. This is regarded as necessary to
prevent the client being open to the abuse of such a relationship,
but may also serve to protect the staff. This resonates with Menzies
Lyth’s work on containing the anxiety evoked by taking an inti-
mate, caring role with individuals in distress (Menzies Lyth, 1988).
From the analysis, it can be seen that a safe space was created in the
gallery, where a different relationship occurred. This was described
as beneficial for both staff and clients, contributing to wellbeing
and social inclusion. ‘Real’ relationships, including friendships, with
staff have been identified within the recovery literature as pro-
moting healing (e.g. Blaska, 1995). Additionally, enhancing staff
wellbeing may aid retention and reduce burn-out.
Recovery and wellbeing
The depictions of recovery and wellbeing had many similarities;
for example, both were seen as enhanced through achievement.
This is consistent with idea that recovery may be more akin to well-
being, than the traditional view of recovery as merely a reduction
in symptoms (Anthony, 1993). As wellbeing was depicted similarly
255
in both the staff and client’s narratives, this suggests that a recov-
ery narrative may not be as distinct from other personal narratives
as would be suggested by the ‘them and us’ divide in the dominant
narrative of psychosis.
Although the project was represented as promoting recov-
ery (e.g. a positive step), the narrative analysis did not suggest
that the project had a direct impact upon recovery. Although
there were no depictions of the project as a ‘turning point’ in
a recovery journey (Brown and Kandirikirira, 2007), a longer
intervention period may have the potential to demonstrate such
impact.
The project was also regarded as promoting recovery through
distraction from distressing symptoms. May (2004) described one
way of working towards recovery as performing activities that
serve to reduce preoccupation with one’s inner world. The phys-
icality of art-making was described as distracting and soothing,
and contributed to wellbeing independently of reflecting upon art.
There is a literature describing the importance of self-soothing with
mental health difficulties (e.g. Linehan, 1993), including psychosis
(Gumley, 2007).
Social capital/inclusion
The importance of a sense of social inclusion for this group was
commented upon: “It’s quite a big thing for people who have such
problems, and still have such problems, to come to a completely
strange alien environment”. The narratives tentatively depicted the
project as more successfully addressing bonding social capital than
bridging. Engaging with art was seen as a vehicle for promoting
this: “art is very good for erm social interaction”, as was looking
at the paintings together: “I suppose it was a a bit of a bonding
process for the group to all be looking at the same thing and listen-
ing to each other’s answers”. The community narrative regarding
the different staff–client relationship depicted bonding social cap-
ital through the development of friendship and empathy in the
group.
There was, however, some indication that the project also pro-
moted bridging social capital. Some of the participants felt more
able to access other galleries and hence the socially valued nar-
ratives around gallery-goers. Indeed, four participants described
visiting other galleries since the project.
Limitations
Qualitative research aims to address specificity rather than gen-
eralizability (Elliott et al., 1999). There may be specific factors in
this project that should be borne in mind by those hoping to repli-
cate this work. Several of participants involved in the project were
well-educated. This is not necessarily typical of individuals with
psychosis, as the onset of psychosis can be disruptive of education.
It may be that the results from this project are specific to these
individuals with a high level of education. For example, achieve-
ment was regarded as an important outcome. It can be speculated
that individuals with higher educational attainment place a greater
value than others on achievement. Additionally, an inclusion crite-
rion was an interest in art; it may be that only clients with a higher
level of education felt confident enough to participate. It would be
useful to investigate whether the findings would be similar with a
group with lower educational attainment or without a pre-existing
interest in art.
Two participants withdrew from the project prior to comple-
tion. Neither gave a full account of this in their narratives. Indeed,
one participant was ambivalent regarding whether the project
enhanced his wellbeing.
256 S. Colbert et al. / The Arts in Psychotherapy 40 (2013) 250–256
Clinical and research implications
The most noteworthy of the findings appeared to be the alter-
native personal narratives provided by participation in the arts and
the different staff–client relationship engendered in the project.
The validation, empathy, friendship, commonality and genuineness
inherent in this relationship may serve to undermine the stigma
associated with a diagnosis of psychosis, for example isolation,
rejection and shame (Rice, 2006). As overcoming stigma may be
harder than recovering from psychosis (May, 2004), the different
relationship may be a powerful way to promote recovery and well-
being.
Mental health professionals and particularly art therapists,
applied psychologists and occupational therapists, may wish to
organize groups based around shared interests, where this different
staff–client relationship could flourish, for example music, writing
or discussion groups. Art also provides opportunities to address
personal narratives directly and art-galleries are very often open
to partnership working. For example, bookmaking involves creat-
ing pictorial life stories and could be used as a vehicle for sharing
personal narratives. An exhibition of bookmaking would elevate
the status of the participant to ‘artist’ and provide an opportunity
to contribute to society and others experiencing psychosis, fur-
ther enhancing wellbeing. Venues with a high social value could
be employed, such as galleries or studios. Future research endeav-
ors could address whether other such groups would be successful
in facilitating this different relationship.
Conflict of interest
None.
Acknowledgements
The authors would like to thank the staff of the Dulwich Pic-
ture Gallery, London for their generous support and assistance in
hosting this research and for their active participation as research
partners. In particular, we want to acknowledge the help of Gillian
Wolf, CBE, Director of Education and Michelle Weiner, Community
Engagement Manager.
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