Table 3

Differences in group processes and response to adverse events in Art Therapy and activity groups used in the trial

Aspect of structure or content

Activity Groups

Art Therapy groups

Late attendance

Remind client about starting times

Use clinical judgement when deciding how to explore reasons for late attendance/feelings about the group

Conflict with facilitator/therapist or other group members

Make efforts to help the patient calm themselves, try to refocus patient on group activities, and try to take steps to avoid escalation of the situation

Use clinical judgement to enquire about reasons for conflict and understand the behaviour in terms of their art work, group processes, and other factors in the patient's life

Annual leave/sick leave

MATISSE group supervisors should discuss this with individual group facilitators but we suggest that every attempt is made to avoid absence of facilitators during the first few weeks of the study. Once a group has become established short periods of leave should be managed by the co-facilitator

If the art therapist is unable to attend the group the group will be cancelled

Wherever possible the group will be notified in advance and space provided for members to process this

Handling psychological material

If participants raise psychological concerns these should be handled in a sensitive, client-centred manner by the facilitator. Diversionary methods may be used to help participants focus on group activities as a means of distracting themselves from their symptoms. Participants may also be encouraged to raise their concerns with their key worker

Art therapists should use their clinical judgement to decide how to help participants express themselves both verbally and through use of images. Experiences of distress may be considered in the context of factors occurring in their lives and the outside world, but may also be thought about in relation to group processes and their use of art materials. While therapists may sometimes suggest links between art work and the persons' mental state or history, therapy is generally focussed on the 'here and now'. Efforts to address the content and meaning of art work produced by a person who is acutely psychotic need to be handled with utmost sensitivity or avoided

Psychological concerns will not be explored in these groups and interpretations of participants' behaviours or comments must not be provided

Group facilitator leaves

Changes in group facilitator should be explained ahead of any change wherever possible

Opportunities for exploring participants' feelings about changes of facilitator should be made available

Crawford et al. BMC Psychiatry 2010 10:65   doi:10.1186/1471-244X-10-65