Janice Lobban: Combat Stress
We are excited to bring you a Creative Insights interview with Janice Lobban, artist and senior art psychotherapist with Combat Stress (UK). Jan has spent nearly two decades working as an art therapy researcher and practitioner in military mental health with Combat Stress, who have provided support to veterans experiencing mental health challenges since the end of WWI. Within this long history of support the arts have been used consistently as a way for individuals to unlock and integrate their complex and often challenging emotional responses to their experiences of service. It is the work of researchers and practitioners such as Jan and her colleagues in the UK and internationally, which is both explaining and highlighting our contemporary need for expanded arts service provision in this arena.
Michelle Saleeba: It has been said that creative expression and arts engagement are fundamentally tied to our sense of vitality and wellbeing. Why do you think this is?
Janice Lobban: Art-making doesn’t come naturally to everyone. When working with veterans in the UK, coming to the session might be the first time participants have picked up a paint brush since school. They might have been told, or have the assumption that, they are no good at art. It can make people feel vulnerable and concerned about getting it wrong and feeling a failure. For some veterans, the bar is set at perfection and if that is not achieved it can be extremely frustrating for them. If veterans are able to overcome these barriers, some can find a powerful and liberating means of self-expression through art-making.
Regularly participants go on to develop their newly discovered artistic skills and interests, and report a greater sense of wellbeing. Indeed, there are an increasing number of research studies that link arts engagement with improved wellbeing. For instance, in the UK, UCL have been at the forefront of evidencing the psychosocial impact of arts and cultural participation on health and wellbeing.
MS: If there is intrinsic therapeutic benefit to engaging in creative pursuits, how is art in therapy, or art psychotherapy, different and why is it beneficial?
JL: This would seem related to objectives. In some contexts engaging in creative pursuits might be associated with, for example, discovering new skills or finding ways of distracting from problems and finding much needed relief. Art therapy objectives are often turned towards addressing specific problems, and artistic skills or interest are not necessary.
So, when working with traumatised veterans at Combat Stress, our objectives might include finding ways to articulate emotional/sensory memories that haven’t been stored in thoughts and words, and to create a narrative of the experience to enable processing. Or perhaps to work through the grief of loss. Art therapy can also provide a way of overcoming experiential avoidance, as the process can bypass censoring conscious thought. One hopes that the veterans find this beneficial. It is often a painful process where things can feel worse before they get better.
MS: Why art therapy? Describe your journey into and through this profession.
JL: I didn’t train to be an art therapist until I was 40. I had other art-related careers first. Whilst working as an art instructor in a neuro-rehabilitation hospital, it became clear to me that people recovering from sudden neurological trauma, for example, after road accidents or strokes, were using the art-making process to express their emotional distress. I wanted to understand more and to learn the necessary skills to assist this process.
Consequently, I trained as an art psychotherapist at Goldsmiths’ College, London.
I then worked as an art therapist in a number of different contexts, including with children in foster care; adults and children with head injuries; and with people with learning difficulties, searching for an area of work that would really capture my passion and interest. Then in 2001 I found it at the veterans’ charity Combat Stress.
MS: What drew you to work with veterans through Combat Stress?
JL: When I walked through the door into the treatment centre for my job interview at Combat Stress, it felt like entering an embodiment of history. Veterans from all conflicts of modern times were represented – from the Second World War up to the current day. I got a sense of tapping into something inextricably linked with the ordering of society: the warrior group, with its particular culture and ethos. The organisation was founded in 1919 in the aftermath of the First World War and has helped over 100,000 veterans since then. It felt a tremendous privilege to be there and subsequently to be told personal stories by so many veterans.
MS: Describe the art therapy programme offered at Combat Stress and how it is designed to benefit your clients.
JL: Art therapy is embedded into all our short-stay, inpatient programmes including the six-week intensive PTSD programme and the two-week anger management programme. Art therapy is usually provided in a group format but individual sessions are also available. We have evolved a particular way of working based on short-stay admissions; an awareness of military culture; and the neurological basis of PTSD. We take a trauma-informed, phasic approach to treatment. This means that a foundation of strategies for managing distressing feelings is laid before making in-roads into traumatic experiences. People need to feel safe before they open doors into dark places.
Group sessions are in two sections: a time of image-making in response to a theme is followed by a time of reflective discussion. In this way veterans are able to express their own thoughts and feelings in relation to the theme but also have the opportunity to explore different perceptions. Looking at the images together can assist meaning-making. Often veterans discover that they are not the only one who feels a certain way. This can help to reduce isolation and to feel connected again.
Image 1 in this blog was created in an art therapy session by a veteran who has kindly given me permission to include his work. It was created spontaneously in response to the previously unknown theme of ‘Moonlight’. Subsequently, its personal meaning was shared with the other group members and stimulated much discussion.
MS: Art therapy has a long history, and has undergone considerable evolution and development. Currently research into AT interventions is burgeoning. In your view how is the profession responding to new evidence, and in particular our increasing understanding of neuroscience?
JL: Indeed, many art therapists and their research collaborators are evaluating practice and working towards an evidence-base for art therapy. As previously mentioned, an awareness of the neurobiological basis of PTSD and its implications for the processing of trauma is part of the givens for art therapy in our context. Trauma is not stored in words but in our sensory-motor system in emotions, visual imagery and body sensations. Art therapy can help to express what is wordless, thereby helping veterans to create a narrative of their experiences. Once articulated, the material can be processed by conscious thought and stored in words and meaning.
MS: Research has shown the therapeutic relationship, between therapist and client, as paramount to positive outcomes. In art therapy there is a third element in the relationship, the artwork, how does this triad alter the therapeutic process?
JL: Although we do work with veterans individually, it is the group work that forms the framework of our art therapy programmes. Group therapy adds a further dimension – the trust that is built between veterans. In the military context, people are used to looking out for each other and watching each other’s back. The sense of connectedness is an essential ingredient of art therapy groups at Combat Stress. Veterans describe how they can drop their mask and be honest within this trusted and familiar peer group.
Also, we have found that the art therapy images can become working documents that veterans can share with other people involved in their recovery if they so choose. This might be their family, psychologist or care worker. In this way, the work can become a valuable means of communicating feelings or experiences that are hard to convey in words.
MS: Often therapists have a defining professional experience that enhances or solidifies the why of their practice. Have you had any formative experiences, or lessons that have impacted on you professionally?
JL: I think the ability to adapt practice according to context is important and not to expect one size to fit all. When I first began working at Combat Stress I thought that encouraging self-expression would be helpful as had been the case in other settings I had worked in. In fact, art therapy can reach deeply very quickly and I soon discovered that it was better to apply the brakes with people who have been traumatised. Going into experiences too quickly is more likely to re-traumatise than to assist processing. Hence adopting the phasic approach for safe practice.
Along with that, I think having the openness to diversify and to look outside the profession for helpful theories and techniques. I have learned so much from other approaches to working with trauma. This has enabled the creation of a metaphorical toolbox to use as appropriate.
MS: Do you feel there are perceived barriers to participation in creative activities generally, and art therapy specifically? In your view is this more of an issue for some populations? How might these be overcome?
JL: Art is often viewed as ‘good’ or ‘bad’, so it’s not surprising that people are apprehensive about engaging. Even seasoned artists can feel vulnerable when exhibiting their work for fear of criticism. Consequently, it never ceases to impress me how veterans coming to our service are willing to ‘give art therapy a go’ when it might not have been on their personal radar at all before. The willingness to overcome anxiety in the hope that something useful might be gained. Seeing other veterans finding benefit in the process can be a great encouragement too.
MS: There is substantial research about the importance of social connectivity for health and wellbeing. Art therapy is often delivered as a group process. Does making art with others enhance social connection and a sense of belonging?
JL: This has certainly been my experience when working with veterans. Participants frequently see their own life reflected in the work of others – no longer feeling alone with their issues. There can be an uncanny similarity between creative responses which seems to key into the deep bonds formed during military service.
MS: Part of the art therapy process is helping clients realise the ways in which they are already resilient. How do you incorporate this process of assisting people to identify their existing strengths into your therapy practice/programmes?
JL: In the early stages of art therapy we would often focus on resource-building. This might entail identifying strengths and abilities such as resilience, determination, hope or the desire for change. Recognising this ‘hidden treasure’ is a good basis for deeper exploration of traumatic experiences.
MS: Most art therapists have their own art practice or creative outlet, which we don’t often hear about! Describe your art and what inspires you.
JL: I keep a visual journal which helps to vent and make sense of experiences, as well as providing material for developing more crafted pieces of work. I also very much enjoy going to art exhibitions, or re-visiting permanent collections. This provides lots of inspiration, as does walking in the countryside and enjoying nature at its best whatever the weather. More often than not, I’ll use pastels to capture my observations (Images 2 & 3) but I also enjoy using clay or mixed media for a more conceptual approach (Images 4 & 5).
MS: What strategies do you employ to help yourself when you feel creatively blocked? How might you encourage someone who is experiencing creative “stuckness”?
JL: Don’t set the bar too high. Striving for perfection can be so pressurising. Just doodling can help to make a start. If something interesting emerges, so be it. We set themes in art therapy groups at Combat Stress to help prompt a creative response. Occasionally I might use one of the themes myself as a personal barometer e.g. ‘inner landscape’ or ‘movement’.
MS: Are there any books that have particularly influenced you in relation to your development as an art therapist &/or artist? What is it about them that you most enjoy?
JL: I was inspired by book illustration from an early age. Initially by those in children’s books such as the marvellous drawings by John Tenniel for ‘Alice in Wonderland’ which brought the words to life. Later I went on to study exquisitely decorated medieval manuscripts like the Book of Kells and the Winchester Bible. The illustrations appealed to the senses and captured the spirit of the time.
Other favourite artists/illustrators include Arthur Rackham and Aubrey Beardsley. I enjoy the sumptuousness of the illustrations and mastery of line as well as how, working in tandem with the text, the viewer is then able to connect with the story on multiple levels.
MS: Do you have any exciting news, upcoming projects or publications relating to your work that you’d like to share?
JL: Yes indeed, at the moment we are exploring collaborative wellbeing projects with museums and galleries, thereby taking art therapy out of the treatment centre and into a non-medical setting. We will be running a programme for veterans with chronic depression and/or anxiety, exacerbated by social isolation and loneliness. Potentially, the project could have a wider impact on families/carers, and serve a preventative role.
I am also writing a book chapter with a veteran about our 14 year therapeutic alliance. It will be published later this year in a text by Jessica Kingsley Publishers.
Check out www.combatstress.org.uk for the latest news on our work with UK veterans.
MS: I was particularly interested to hear that Jan utilises visual journaling in her personal creative practice. We didn't get to explore the benefits of art journaling for this interview, but I can recommend it as an immensely beneficial activity for anyone wanting to get started with a creative outlet. The private container aspect of a visual journal can be extremely freeing for people who struggle with the idea of creative self expression having to be a finished piece of 'Art'. We will explore the benefits of art journaling in an upcoming Creative Insights, stay tuned.