Let's Create - Case Study

LET'S CREATE CASE STUDY

A therapeutic art group for women, building confidence and self esteem through art and the sharing of food.

Let's Create is a therapeutic art group for women with a focus on building confidence and self-esteem through engagement with the creative process and the act of sharing food. The study seeks to explore how the combined acts of creativity and sharing food, when facilitated within a safe and holding environment, can have significant benefits on mental wellbeing and can lead to the development of peer to peer support networks.

Introduction Let's Create evolved from another art group, Play with your Food which was set up as part of the Create, WHALE Art's strand of Tasting Change, a multiagency partnership project set up to address issues of food insecurity in Wester Hailes.

Play with your Food was started in April 2018. The focus was on cooking, sharing a meal and engaging in an art activity using leftover or other food-related ingredients.

WHALE Arts Wester Hailes

The author took over the delivery of the group in May 2018. At this point, there were two members in the group, both women and both with significant mental health problems. They faced many challenges in relation to their physical and mental wellbeing, their financial circumstances and in relation to food insecurity.

After consulting the members it was decided to change the focus of the group, placing greater emphasis on creative activity and less on cooking while maintaining the element of sharing food. We also change the name of the group from Play with your Food, which the ladies found a bit childish to Let's Create, a name they came up with after a quick brainstorming session.

This study charts the development of the group and seeks to demonstrate how facilitating the creative process and coming together to share food within both a safe space and a holding environment, can bring significant benefits to the participant's mental health and wellbeing.

WHALE Arts Wester Hailes

The context Let's Create is based at WHALE Arts, a community-led arts charity and social enterprise which is firmly established as the cultural anchor organisation for Wester Hailes.

Let's Create was set up through Tasting Change, a multi-agency partnership project established to tackle issues of food insecurity in Wester Hailes.

WHALE Arts is a founding partner in the Tasting Change project along with Prospect Housing, The Health Agency, SCOREscotland, and CHAI.

Wester Hailes is an area facing many challenges relating to health, employment, access to services, crime and housing. It falls in the 6% most deprived areas on the SIMD.

The women who attend Let's Create all live in Wester Hailes. They all suffer from varying forms of mental ill health and many have other disabilities and physical problems as well.

Most have experienced significant trauma in their lives and the majority have been referred to the group by counsellors, therapists or other health professionals.

All the women who attend the group are on low incomes, many are on benefits, either ESA(Employment Support Allowance) and/or PIP (Personal Independence Payment) and most have been affected by issues of food insecurity.

Whale Arts, Wester Hailes When the group started there were only two women attending. there are now nine members most of whom attend on a weekly basis.

Wellbeing: Engaging in creative activity: The benefits for mental health & wellbeing

a ‘dynamic state, in which the individual is able to develop their potential, work

Much has been written about the benefits of engagement in the arts for mental health and

productively and creatively, build strong

wellbeing and In recent years the links between

and positive

the arts and wellbeing have been well

relationships with

established (Taylor 2018).Â

others, and contribute to their community. It is

Evidence for this can be seen in the rise of social

enhanced when an

prescribing, initiatives such as Arts on

individual is able to

Prescription and in the case of Let's Create, that many of the group members have been referred via GP's and other health care practitioners.

fulfil their personal and social goals and achieve a sense of purpose in society'

There are numerous articles and research papers Foresight Mental Capital and

expounding the benefits of engagement with the arts for wellbeing. Key findings from the Visual Arts, Mental Health and Wellbeing: Evidence Review (2018) by the What Works Centre for Wellbeing, provide evidence to support the belief that engaging with the visual arts can:

reduce reported levels of depression and anxiety. increase self-respect, self-worth and self-esteem. encourage and stimulate re-engagement with the wider, everyday social world. support in participants a potential renegotiation of identity through practice-based forms of making or doing.

Wellbeing Project: Final project report (2008)

In my own experience as an artist and group facilitator, engaging in creative activities within a group setting can have the additional benefits of helping individuals overcome insecurities, facilitating discussion and breaking down

"There is now a growing body of evidence demonstrating that

barriers. It is a powerful mechanism for building

participation in the

confidence, instilling a sense of achievement and

arts and access to a

strengthening resilience.

range of arts opportunities can

Katherine Taylor in her report 'Art Thou Well?

Towards Creative Devolution of Mental Health’ (2018) eloquently describes how engaging with the arts can bring about positive change.

dramatically improve health outcomes and increase wellbeing"

National Alliance for Arts, Health and Wellbeing

"Importantly for healing processes, the arts can engage multiple senses at once. Unlike medications, the effects of cultural engagement target an underlying sense of well-being. In bypassing the need for specificity, they enable the mind and body

"I think we all understand each other now and we've become friends.

to tolerate and respond to stress, inequality,

walking in the door

and adversity."

can be a bit, thingmy, and then you realise

Of greater value perhaps, is the participants

everybody's here with

own perception of how engaging in creative

the same difficulty or

activities has effected change for them.

different difficulties or problems, once

"It gives me a purpose in life" (J)

you get to know

"It gives me a point to aim for" (EM)

somebody your more

"Keeping your mind active" (L)

confident to talk with

"Really good for depression" (C)

them"

"I've got more confidence" (S) C group member

Sharing food: The benefits for mental health & wellbeing

"Eating is often a social event that involves active training and embodiment of

There is a wealth of evidence supporting the fact

communicative norms

that the nutritional elements of our food directly

and commensality

impact on our physical health and the link

values"

between a healthy diet and a healthy body is now widely accepted. There is also a growing body of evidence exploring the impact of food on our

The cultural structuring of mealtime socialization Ochs & Shohet, 2006

mental health and wellbeing.

While the meal shared with the Let's Create group

"In these increasingly

was always healthy, usually a simple soup and

fraught times, when

bread, attention was not focused on the

community cohesion

nutritional value of the meal or the potential

is ever more

benefits of certain ingredients for health purposes. The most important factor was for the

important, making time for and joining in

meal to be nutritious, sustaining and shared.

communal meals is More important to us was the act of coming

perhaps the single

together to share food and whether this could

most important thing

have a further positive effect on group members

we can do – both for

mental health and wellbeing.

our own health and wellbeing and for

There is increasing evidence to suggest that

that of the wider

sharing meals can have significant impacts on peoples feelings of wellbeing, sense of contentedness, and sense of belonging within the community.

community.'"

Breaking Bread: the Functions of Social Eating R. I. M. Dunbar

Research conducted by Oxford University with data from a national survey by The Big Lunch identified three key beneficial aspects of communal eating, building wider community and inter-community relationships, making and reinforcing friendships and health benefits that arise from well-formed social relationships.

Looking more closely at the links between health and social relationships and with reference to a large body of research in this area They stressed the important role of friendships and noted the correlation between the size and quality of social networks and consequences for health, susceptibility to illness, wellbeing and happiness.

The act of sharing a meal within the context of Let's Create provided the group with a valuable opportunity to come together after the activity and reflect on the session. As well as reflecting,

"I do like the soup

we used the time to talk about other activities or

factor and theres

particular soups that the group would like to try.

something to do with us all eating together

We would push the tables together to making one big table that everyone could sit around. This physically brought the group together and with everyone sharing the same food this connected the group on another level.

which is really nice and then we get to all know each other again because we've worked in the class

I believe that sharing a meal was a hugely

and we talk about

valuable element of the group. Allowing time to

what we've done in

reflect, relax and share together. This gave

the class and its quite

opportunities for individuals to bond and develop

communal."

friendships and just as important to have a laugh together.

M group member

Setting the boundaries & establishing a safe space Taking over the delivery of an existing group had the advantage of being able to talk with the members about what aspects of the group they liked, what was working well and what aspects they would like to change.

It also gave the opportunity to discuss with the group what issues were most important to them and to set the boundaries.

There were two ladies in the group when I took over as facilitator and both talked openly about their struggles with mental and physical ill health.

They both expressed an interest in exploring a wider range of arts and craft activities and while they agreed that the sharing of food at the end of the session was important, they wanted to spend less time making food and more time making art.

One of the ladies has an eating disorder and was not comfortable eating in front of others. She was happy to take a portion home and understood the value of sharing a meal for the others.

We started by setting out a structure for the sessions. The space would be booked from 9.30am until 1.00pm every Tuesday. The session would officially start at 10.00, with the first half hour for preparing the food - a healthy soup. I would prepare the soup but members could arrive early to help if they wished.

The creative activity would take place between 10.00 and 12.00pm and the last hour was time for tidying up and sharing a meal together.

Having established the boundaries in terms of time and space, we moved on to explore other issues that were important to the group.

Both ladies had survived rape and forms of domestic violence or abuse. They were adamant that this group remain a group for women. While by chance there were only women in the group at this point, it had never been officially stated that this was a women-only group.

Establishing this as one of the boundaries and officially declaring Let's Create as women's group was hugely important to the ladies involved and the first step in creating a safe space.

That the group remain an adult group was also an important issue and that if anyone came late or missed the odd session this would not affect their place in the group.

Another issue discussed was the pressure to perform or engage with activities. It was decided that there would be a creative activity each week but that there was no obligation to take part. Members were welcome to come regardless of whether they engaged or not.

Establishing boundaries and the concepts of a safe space and holding environment is central to and much written about in the field of art therapy and other forms of psychotherapy (Case & Dalley 2014, Waller 2006, Waller, Gilroy, Dryden 1992, Herman 1992, Winnicott 1971, 1986).

It is important to note that this group is not an art therapy group but a therapeutic art group or a group using art as therapy. These types of group are distinctly different, with the main points of difference being as follows:

In an art group/therapeutic art group or group using art as therapy, The primary goal is creating a finished piece of art within a fun and/or learning environment.

Participants are often expected to make use of a particular set of skills that can be taught, practised, evaluated or judged aesthetically.

The facilitator, often an experienced artist may influence the creation of the artwork and often provides advice.

In an art therapy group, The primary goal is the intentional use of the arts for psychological change.

The artwork produced is not intended as a product in itself.

Creating an ugly piece of work or destroying artwork is seen as an important part of the process.

The work produced does not have to be aesthetically pleasing or even finished to be valuable.

While Let's Create is not an art therapy group, establishing a safe space and a holding environment was deemed important.

Considering the wider aims of the project particularly those relating to improving mental wellbeing and increasing social connectedness, it was felt that using engagement in the arts as a vehicle to improve mental wellbeing for a group struggling with mental ill health, was unlikely to be successful without the provision of such a space.

Development of the group The main focus of the Let's Create group was to engage participants in a range of creative activities. While the activities were primarily arts-based we took a very wide view of the term arts and the spectrum of activities explored was broad.Â

In the first few sessions, we stuck to simple activities such as making paper fans and flowers, working with paper mache and decorating ceramic bowls.

These type of activities, with the exception of the paper mache, not too messy, easy to control and more importantly, participants could see results quickly and produce objects they were pleased with.Â

That the participants gained a sense of satisfaction with their work was important at this early stage as it helped boost their confidence and overcome the belief, common among many adults who have not done art since school, that they were no good at art.

The paper mache was the exception, being both a messy activity and in our case one where the results were not aesthetically pleasing. However, the two ladies who took part in this session later rated it as a favourite, partly due to the laughter generated in the session and the memories brought up and shared while engaging in the activity.

"I had so much fun in that session bonding with J " (S)

"IÂ felt like a child back in nursery again, I loved it" (J)

As the weather got warmer we started working outside, making use of the garden at WHALE Arts and taking over a small plot to plant lettuces. A new lady joined the group and while this did affect the dynamic, as the original two members had formed a close bond by this stage, they were quick to welcome her and the group of two soon settled as a group of three.

WHALE Arts runs a summer programme for children and due to this, we were forced to work outside or off-site over the summer months.

This brought both challenges and benefits.

Anxieties arose with the change to the usual structure and routine. The ladies were concerned about losing the safety of their protected space,

where usually, no one but group members was allowed to enter while the group was in progress.

As far as possible we maintained the boundaries of the group, working mainly in the garden at WHALE Arts and going on a couple of trips. We cooked over a campfire in the garden, used some of the lettuces we'd grown in salads and explored various dying techniques including shibori and tie-dye.

The trips were a huge success and a real confidence boost for the group who used materials collected at the beach to work on in future sessions.

Having no choice but to face some of their fears gave opportunities for reality checking. Most agreed, that the perceived fear of working in a less contained environment with the possibility of others/strangers coming in and disrupting the group, was much worse than the reality they experienced while working outside over the summer.

Despite this, the group were relieved to get back to their usual space and routine when the summer programme at WHALE Arts was finished.

New members joined after the summer and the group grew from three members to nine in the space of two months. This dramatically altered the dynamic and holding the group became challenging at points. Conflicts arose as some

members vying for more attention or a sense of

"In groups, as well,

power in the group struggled to find their place

you will observe that

within the larger group. One of the new members who had come with her support worker

members will align themselves with

and did not interact much with the other ladies, left after a few sessions.

allies according to shared values and

Two of the remaining members found it difficult

what is in their best

to tolerate each other and after an argument

interest. Different

during one session, the group split into two

group members find

distinct subgroups. This resulted in the three

ways to stick

newest members, sitting at a table on one side

together."

of the room and the rest of the group all squeezed around one table at the other end.

Learning group leadership: an experiential approach Jeffrey A. Kottler, Matt Englar-

The room was usually arranged with four

Carlson

individual tables set out in a large square. Two of the members always sat at the same table

"Generally speaking,

and the others tended to move around making use of the other tables as it suited the particular activity they were working on.

people will often recreate the same patterns and behaviour

After two sessions with this arrangement, one of

in a group that have

the newer members said that she felt like they

been established as

were being segregated. In the next session, I

templates from their

rearranged the tables making a row of three

early years. This means

tables with just enough space to pass between

that people will create

them.

a social microcosm, an extended reality of

The members spread themselves out across the three tables with the gaps between them giving

what they are used to in their outside world."

enough separation for those who found it hard to be near each other but also a sense of

Learning group leadership: an

cohesion allowing those who felt segregated to

experiential approach

feel part of the group again.

Jeffrey A. Kottler, Matt EnglarCarlson

Shifting the furniture and reaffirming the boundaries of the group went some way to diffuse the situation. Understanding that in groups people often subconsciously recreate the dynamics of their earliest or family group, and recognising that most of the group members had had challenging early lives, we were able to talk about this collectively.

This led to one members understanding and sharing that another member had triggered a highly emotional response when the other's behaviour reminded her of her mother. The other member recognised her own behaviour patterns and tendency to become aggressive whenever she felt challenged. The two ladies resolved their issues and for a time, a sense of harmony and togetherness pervaded the group.

After the Christmas break, one more lady joined the group. Again this posed challenges to the group dynamic and similar tensions and power play arose. This time the group settled more quickly and before long the new lady was accepted and made friend with many of the other group members.

TThe coming together, sharing food and reflection time at the end of each session played a big part in helping to diffuse any tensions that had arisen during the creative activity. Each week at this point there was a distinct change in the atmosphere of the group. After the hive of activity and rush to clear everything up there was a sense of calm when everyone sat down together to eat.Â

The ladies left at different times and not everyone ate, some took portions to eat later but sat with the group to talk, sometimes people left after the activity and most weeks they took food away with them. There was always a core of at least four who stayed to help tidy up after the meal and sometimes everyone stayed until the end.

We engaged in a wide range of creative activities including painting, various forms of printmaking, bookbinding, origami and mosaics.

We tried other craft-based activities such as soap making, candle making and using natural materials to make face packs and hand creams and we occasionally invited guest artists to deliver specific sessions.

The different activities and range of materials necessitated different ways of working. Some members preferred the more contained activities such as origami and bookbinding where there were a distinct set of steps to follow and a clear idea of what the end product would look like.

Others preferred a more fluid way of working and favoured printmaking or painting. Those who preferred the less controlled activities tended to be more confident in their own creative process, less bothered about the aesthetics of the work they produced and took more enjoyment from the process than the end result.

Some members really struggled with this way of working and needed support and direction but fortunately, the group members were very helpful

and supportive of each other. They would often team up, with someone who was good a drawing helping others create designs or someone who had worked out a certain origami fold showing the others how to do it.

Working on mosaics was one activity where everyone in the group was able to participate without difficulty. It appealed to those who preferred a more controlled way of working, they tended to produce mosaics with clear patterns or symmetry. Those who worked more fluidly and spontaneously created more abstract pieces and experimented with colouring or texturising the grout. Â

Making mosaics can be a great activity for groups or individuals suffering from mental ill health. The act of taking broken, fragmented or disparate pieces and bringing them together to make something whole can act as a metaphor for the broken or damaged bits of the self which can be brought together, reintegrated and made whole again.

Ending of the group Tasting Change was set up as an 18-month project, and while efforts were made to secure future funding these were not successful. In the run-up to Christmas, a level of anxiety permeated the group due to the uncertainty of whether the project would continue. We returned in January with the knowledge that Let's Create and the wider Tasting Change project would end in April 2019.Â

WHALE Arts was keen to amalgamate Let's Create into their adult programme but as yet had no funding in place. That meant that the group would be put on hold and potentially re-started when funding was secured.

This knowledge was painful and hard for the group to accept. Each individual had invested so much, most had made valuable friendships and many had come to rely on the group as a vital part of their support network.

The stark reality that the group was going to end and the fear of losing all they had built up together, caused anxiety levels to rise. Many of the old tensions and power plays started to resurface as the group struggled to accept the situation. Acceptance did not come easy and for weeks the group continued to propose a range of fundraising schemes to try and keep it going.

Perhaps the biggest difficulty was the notion that the group would stop but potentially be restarted at an unknown point in the future. This meant that while we were working towards an ending, it was not a clear cut ending and this served only to maintain a sense of uncertainty and unease.

One thing that was certain, was the fact that if and when the group restarted, I would not be the facilitator. I would continue to work at WHALE Arts but in a different role, which would not allow me to continue running the group. This brought other issues to the surface particularly the fear of change and a reluctance by some members to rejoin the group if, in the future, it was run by someone else.

So many unknowns made it difficult to work with the group towards a positive ending, an ending which if achieved, would go some way to ensuring the significant progress made by individuals and the group as a whole, would not be undone by the temporary dissolution of the group.

After negotiating with the CEO of WHALE Arts we agreed to book a room for the group, for one hour every Tuesday, so the ladies could come in and meet for a coffee if they wished. I would come for half an hour to check in with them and in doing so, maintain the sense of group cohesion while they wait

for the group to re-start. Once funding is secured, I would co-deliver the first few sessions with the new facilitator, as a sort of hand over period, giving time for the group and the new facilitator to adjust to each other.

This had a positive impact on the group's morale and with this came acceptance of the ending of the group. The energy in the group shifted with everyone determined to make the last few sessions great. We went on a trip to the Scottish Parliament, had another outdoor session where we cooked over a campfire and did more tie-dye and shibori, we made hand cream and face packs with herbs collected from the garden and planned a party for the very last week.

Conclusion and final reflections The members of Let's Create, all women from

"I felt nervous, I

Wester Hailes and all struggling with mental ill health, reflected on their time in the group; from how they felt coming to their first session, how they feel they have changed and what they value most about the group.Â

didn't know where to sit, what we were going to do."

EM group member

Most of them recalled feeling nervous, anxious and unsure when the came to the group for the first time.

Talking about how they have changed as a result of their involvement in the group, they all reported that they have more confidence. Many commented on the friendships that they have made and the sense of belonging to a community.

"I suffer anxiety, I don't think I would've have come if it wasn't

One lady noted that before joining this group she

for my friend

suffered such severe anxiety and agoraphobia that couldn't go any where on her own. Now and as a result of coming to this group, she walks here by herself every week and feels confident to

coming with me, to come with someone you feel

go by herself to other groups and locations around Wester Hailes.

more encouraged and I thoroughly

Another member who always got a lift from a

enjoyed it, it got

friend in the group, recalled at time she'd received a text saying her friend might not be able to come. This had brought tears to her eyes as she felt unable to come without her friend.

me out."

C group member

This same lady has since had the confidence to walk to the session herself on the occasions when her friend was unable to pick her up.

"It's like a wee family. Everyone has their things

When speaking about what they most value about the group, most ladies cited the

wrong with them and here everyone

friendships they have made and the sense of community that has developed between them.

relates to things like that, that's

"Quality of life is improved, greatly,

what the groups,

because we have these problems at

for its a place you

home and we have a certain

feel comfy."

confidence in each other that we can

C group member

communicate with each other and that kind of trust, or something like that and these things are swimming

"It's here, Let's

about your head and we can give

Create, that we

voice to them, then we can diminish

really love, its here

them a bit, then we go back home again and continue from where we

that we really love coming to. We

left off." (M)

come to the meal This same lady has since had the confidence to

on the Friday but

walk to the session herself on the occasions

its still not the same

when her friend was unable to pick her up.

community feel as this group, here

When speaking about what they most value about the group, most ladies cited the

we're just used to

friendships they have made and the sense of

everybody, we're

community that has developed between them.

comfortable here.Â

C group member

Being a part of Let's Create has clearly had a positive impact on everyone involved, however, the journey has not been smooth. As individuals, each has struggled with their own internal issues, relating to their mental health and the challenges faced in life outside the group. Collectively, they've faced interpersonal conflicts and experienced many challenges related to the ever-shifting group dynamics.

Despite this, each individual has reported degrees of positive change, in relation to their levels of confidence and self-esteem, their re-engagement with the wider social world and their overall sense of wellbeing.

The group as a whole has gone through many transformations from being, in the early stages, quite a close-knit unit, to becoming fractured, fragmented and wrought with tension as it expanded to accommodate more members.

Then overcoming these troubles and in a sense reforming, to become a caring and supportive community in its own right.

As separate, unconnected acts, engaging in creative activity and sharing a meal with a group, can both bring significant benefits for individuals' mental health and wellbeing. When combined and delivered together the potential for positive change can be greatly enhanced.

The success of Let's Create lies not just in the combination of these two acts but also by creating the right environment, a holding environment, a safe space with clearly defined boundaries where participants feel able to bring their issues, safe in the knowledge that they will be listened to, understood and will not be judged.

This type of group has proved invaluable for improving wellbeing in a group of women who all suffer from mental ill health and significant change has been achieved in a relatively short space of time. It is questionable whether this change will be sustained if the group does not continue and the support networks built up, start to dwindle away.

Recent Policy changes have led to a rise in the prescription of social interventions for individuals with mental health problems, many delivered by charities and other third sector organisations. In the current economic climate as they scrabble for ever decreasing pots of funding their ability to deliver these interventions is also diminished.Â

Long term, sustainable change requires sustainable investment in longerterm projects, without which, short term gains will remain just that, shortterm.

References A systematic review of the subjective wellbeing outcomes of engaging with visual arts for adults (“working-age”, 15-64 years) with diagnosed mental health conditions, Professor Alan Tomlinson. (2018)

Creative Health: The Arts for Health andWellbeing, All-Party Parliamentary Group on Arts, Health and Wellbeing Inquiry Report. (2017)

How Art Changes Your Brain: Differential Effects of Visual Art Production and Cognitive Art Evaluation on Functional Brain Connectivity Anne Bolwerk, Jessica Mack-Andrick, Frieder R. Lang, Arnd Dörfler, Christian Maihöfner. (2014)

Food, mental health and wellbeing, Scottish development centre for mental health https://www.communityfoodandhealth.org.uk/wp-content/uploads/2012/02/CFHS-SDCfood-and-mental-health-bulletin.pdf

Mental Health Strategy for Scotland: 2012-2015, https://www2.gov.scot/resource/0039/00398762.pdf

Social eating connects communities http://www.ox.ac.uk/news/2017-03-16-social-eating-connects-communities#

The Arts and Mental Health: Creativity and Inclusion, Hester Parr.

The cultural structuring of mealtime socialization, Elinor Ochs Merav Shohet, (2006) https://doi.org/10.1002/cd.154

The Handbook of Art Therapy, Caroline Case, Tessa Dalley. (11 Jun 2014)

What can arts and culture do for health inequalities?” Developing a Culture Strategy for Scotland, Voluntary Health Scotland. (2017)