Book Review: Phil Jones,The Arts Therapies: A Revolution in Healthcare

Context

The reviewers of this book are five Arts Therapists working in a well-established NHS team whose work takes place across community adult mental health and adult learning disability services. A collaborative and cross-modal approach is practised with regular co-working within the team, as well as with other disciplines from the trust, and with external stakeholders. We were particularly interested to read and review this book and felt that it could relate closely to our day-to-day working practice and may speak to our experience of working within the arts therapies in a healthcare context. The reviewers’ voices represent each of the four arts therapy modalities (music, art, dance movement, and drama) and include the perspective of a newly qualified Therapist.

Hopes and expectations

Before reading, a common hope the reviewers had was that Jones would deliver a broad overview of the arts therapies and offer insight into the arts modalities outside of which one trained. This expectation was supported by the books preface and first chapter where Jones sets out an intention to deliver a ‘broad introduction to ideas and work’ (preface xvii) and to draw connections, exploring commonality and difference, between the disciplines. Influenced, perhaps, by both the books title and by our own work in an NHS Trust, the reviewers hoped for a comprehensive representation of the arts therapies in healthcare settings today. We were eager to uncover the ‘revolution’ in healthcare that Jones describes in his title and hoped that the book would explore contemporary challenges, research and innovation in the arts therapies in healthcare contexts around the world. Like us, Jones also determines his own hopes, or aims, for this book: one of which is to be a ‘first book’ for those not yet engaged and wishing to understand the arts therapies from outside of the field. Although our expectations were met, in part, by Jones’ book, an overall sense of unmet expectation was felt after reading.

Book content

Jones’ endeavour to represent all of the four arts therapy modalities in one book such as this one is no small challenge. While Jones does attempt to consider the whole range of modalities throughout his writing, this often does not feel particularly well balanced or equal. In Jones’ introductory chapters, for example, the dance movement psychotherapy chapter is significantly shorter than the others; such a sentiment is echoed in later chapters wherein the focus is rarely on this modality. Throughout the book, Jones also draws heavily from music therapy and art therapy case examples and research; this left us in want of more from both the dramatherapy and dance movement psychotherapy fields.

Putting aside any scrutiny of cross-modal balance, the reviewers considered the representation of each modality in Jones’ work. For art therapy, there is a general sense that Jones effectively explores the ongoing debate about directive and non-directive models while also helpfully considering a number of different cultural contexts and client groups. Conversely, when introducing dance movement psychotherapy, the chapter could benefit from some exploration of the use of props or music with consideration for the range of practitioners’ views on using these. Examples of what a dance movement psychotherapy session might look like would also be a welcome addition. In the introductory chapter to music therapy, Jones attempts to describe the modality himself rather than utilising the considerable amount of music therapy literature that is available to provide a more well-rounded definition. The reader may struggle to reach a clear understanding of what dance movement psychotherapy and music therapy are, where they are used, who they serve, or the processes and theories involved in their practice. There appears to be an imbalance in representation of different models of music therapy with perhaps a larger focus on Nordoff-Robbins than is illustrative of the profession as a whole. Finally, in his representation of dramatherapy, Jones offers a helpful overview of models and practices from the modality both in the United Kingdom and around the world. This includes two detailed and different accounts of the practice, which clearly offer a sense of what dramatherapy is, as well as the underlying processes in action within it.

The reviewers appreciated that Jones holds space throughout this book for both the commonality and difference in our work and across our modalities. This includes sustained and relevant discussion about whether the expressive form is a significant factor in the outcome of therapy. Within this, there is an admirable attempt to analyse the subtle differences between modalities wherein Jones explores what may be ‘foreground’ or ‘background’ within each modality. While this is an interesting way of viewing each modality, this occasionally leads to generalised statements that do not always feel representative of the reviewers’ experience. An example of this is in Jones’ statement that music therapy foregrounds non-verbal communication and backgrounds the use of the body (Chapter 11); this is a perspective which the reviewers believe to be inaccurate.

The reviewers do, however, appreciate Jones’ simple statement – representing all modalities – that the client does not need to be creative in every session and that merely the potential to be creative is there and is enough. This can sometimes be a point of contention in services where Therapists may have to advocate for the process over product, or even with clients who may feel an internal pressure to be creative and have an output within the session. Such statements, therefore, feel representative of our experience in the arts therapies and are refreshing to see so clearly stated in a book such as this one.

One of the major strands running throughout the book is the sustained consideration of matters of culture and diversity. Jones’ exploration of definitions in Chapters 2–7 is refreshingly international in its references to associations and different practices across the world. Indeed, throughout the entire book, the research and practice included has a global scope. It was felt that while this could risk overwhelming a reader who is new to the field, it could enable the more experienced reader to appreciate the breadth of practice and of the opportunity that exists within the arts therapies around the world. Jones also clearly depicts the profound impact of culture on key therapeutic processes, such as improvisation, and how the arts can be used to communicate differently in a variety of cultural settings.

The reviewers concurred that in Chapter 7, Jones offers a particularly relevant and insightful discussion relating to how one’s culture might shape one’s sense of the differentiation between the different disciplines within the arts therapies. His observation that not all cultures recognise the separation between art, dance, drama and music is a helpful and necessary contribution to the wider discussion of the inter-relatedness of the arts therapies which is a major theme of the book. This section, as well as other parts of the book, encourages a reflective attitude from the Arts Therapist with regard to the cultural context of self, client, the wider setting, and how these might impact upon practice and the therapeutic relationship. This encouragement to reflect felt particularly pertinent to the reviewers, as we are currently in a period where self-examination at a personal and institutional level is essential if we want to uncover and address systemic prejudices. While such careful consideration of culture and diversity was a real highlight of Jones’ book, some discussion was felt to be occasionally tangential. Perhaps there is space for a separate book examining the diverse practices within the arts therapies around the world, and the impact of cultural identity on the therapeutic process.

Much like his approach to culture, Jones includes and explores a vast array of relevant and interesting research examples throughout this book. While doing so, he astutely observes that the great diversity one encounters while exploring research in the arts therapies is not a reflection of ‘chaos within’ (p. 308) but rather a sign of the diversity of the experience which, in turn, requires a flexible approach to research and efficacy. Jones’ approach to research throughout this book is no different and he draws upon a wide variety of case examples to illustrate this. While occasionally an imbalance between modalities creeps into this aspect of his work, Jones largely draws from a wide pool of pre-existing research and literature while considering culture, methodology, and client group alongside the arts modalities.

Jones exemplifies behavioural or analytic framework methods of research juxtaposed with those using more of a relational approach. He cites a contemporary model of research using videos, photos, and apps which are bespoke to each participant. The inclusion of such contemporary research showcases the innovation at play within the fields of the arts and how these have informed arts therapies practice. At odds with such recent research are randomised control trials providing empirical evidence for music therapy and case studies which evidence the historical work of practising Arts Therapists. These inclusions seemed somewhat distant and dated in comparison and are not representative of recent innovations in arts therapies research. Jones also observes that research which fits more with a scientific approach, that which is typically closer to the medical model, is weightier than more the process driven ‘lived experience’ of the client. Jones also gives a clear description of the counter forces of ‘outcome research’ versus ‘process of change’ (p. 295); the research evidence that he has chosen to include shows that the arts therapies are capable of the latter but have more work to do to develop their approaches to the former.

Alongside different approaches to research, Jones also inspiringly notes that by engaging in creative dialogue with other disciplines, and by involving clients when answering questions of efficacy, the arts therapies can learn from one another how to move forward in this area. A poignant example of such work is given by Jones’ referencing of a collaborative project between Dance Movement Psychotherapist Matthias Moreno and Music Therapist Anthony Cardona. In this work, Moreno and Cardona identified the need for a ‘researching eye’. This idea, which relates to being more aware of the innovations in research within other disciplines and gaining sufficient knowledge of different research techniques, is inspiring and tangible for Arts Therapist readers of this work.

In fact, the need for the arts therapies to have a dialogic approach in healthcare contexts remains a central theme throughout the text. Jones clearly presents the potential strengths and difficulties of such an approach, considering history and current context. Arguably, this topic is essential reading for Arts Therapists working in such settings today. While there were some examples of research and practice operating positively within such ‘dialogue’, the reviewers felt that there could have been greater representation of experience such as theirs; whose day-to-day work with service users in an NHS context is marked by dialogical mutual understanding and respect. It may be that more examples of such practice would have added depth and colour to Jones’ description of the role of the arts therapies in healthcare settings and environments.

A further strength of this book was Jones’ ability to clearly present and explore much of the complex theory at play within, and around, the arts therapies. Jones effortlessly identifies the range of schools of thought which underpin the arts therapies and consistently connects them to the emergence and practice of each modality. A clear example of this is in Chapter 15, where Jones considers that rather than being rooted in pre-existing psychotherapeutic theory, such as psychoanalysis, the arts therapies may be considered within a unique theoretical framework of their own. While noting that they have evolved in close dialogue with other models of therapeutic practice, Jones argues that the arts therapies have also made their own unique, and valuable, discoveries about the therapeutic relationship and the potential for client transformation, healing, or change.

In Chapter 14, Jones clearly presents his own theory to draw connections between the different modalities explored throughout this book. Attempting ‘to summarise what makes the arts therapies so innovative and effective’ (p. 215), Jones defines ‘the eight core processes’. These core processes are, for Jones, the key catalysts for change and transformation in the arts therapies. Jones utilises a number of case studies, covering all modalities, to identify and illustrate each process. This encourages the reader to feel both connected, and yet distinct from, other modalities and creates an interesting theoretical perspective. While this theory is engaging, it is refreshing that Jones also notes the importance of not entirely homogenising and deconstructing the arts therapy process in this way. When concluding this chapter, he notes that ‘dividing up the arts therapies in this way is an artificial construction around something that, in practice, is not separated into such categories’ (p. 235). Such a reflection is a relief to those who may feel stifled by such deconstructing processes. Although Jones does not outline the leading or headline theories of each modality, as one might expect in a ‘first book’, his focus on theory for the arts therapies as a whole is clear and engaging and is an overall strength of this book.

Editing

The editing and construction of this book leads to some issues with clarity. Although Jones clearly depicts the five key ‘parts’ of his book, which are outlined at the start of this review, he does not reflect such clarity in his chapter-specific titles. While the use of metaphor and quotation in such titles offers creative intrigue (e.g. Chapter 9 – ‘Everything is Ripe’), the reader may struggle to ascertain the contents of the chapter from the title alone.

Similarly, and despite his hopes for this to be a ‘first book’ for readers wishing to know more about the arts therapies, the accessibility of this book is occasionally lacking. While in some areas Jones explores complex ideas and theories with clarity, much of his language is otherwise dense and cerebral. The sections where Jones utilises the voice and expertise of others in the field are usually engaging, interesting and clear.

The reviewers came across a number of editing errors dotted throughout the book, including spelling, punctuation, notes to the editor, and out-of-date organisation names. This could undermine the reader’s confidence in the content of the book and, in the case of novice readers, provide an incorrect overview of the professions.

Conclusion

At the close of reading, the reviewers considered that the strengths of this book include detailed analysis of the arts therapies, which are carefully framed in different cultural contexts and which are insightful to the reader and encourage self-reflection. Equally, Jones’ inclusion, and explanation, of complex theory was strong and allowed the reviewer to gain a clear sense of the modalities outside of which they are trained. The reviewers wonder if a book edited by Jones, comprising of the leading voices from all arts modalities, would have better suited a task such as this one. While many aspects of Jones’ book are useful and interesting, a lack of clarity around scope and audience occasionally prevail.

It is felt that this book reaches beyond being a handbook for a curious novice and risks overwhelming readers who are not already involved with our field. In part, this is due to its expansive breadth in relation to scope and practice. For instance, a clearer definition of the scope of ‘healthcare’ referred to in the title may have narrowed the book’s focus, bringing more contextually nuanced depth and discussion. With that considered, the reviewers conclude that this book is likely to be more useful for experienced clinicians. They would be able to approach the detailed aspects of the book with their own specific knowledge and educated curiosity. They may also be more able to offer a critical stance if there are parts of the book they feel do not represent their own experience in this vast and varied field.

Reading and reviewing this book, has, overall, been an interesting and thought-provoking process for the reviewing group. Many elements of Jones’ writing prompted a dialogue between the group and encouraged us to discuss our practice together; something which we hope the book could do for other teams or groups of clinicians. The book encouraged us to consider such things as ‘what is the distinctiveness of each of our modalities?’, ‘What do we routinely borrow from one another?’, and ‘What does one lose in terms of identity or expertise when we integrate our art forms?’ A key aspect of Jones’ argument, which the team mused and appreciated was his clear and relatable point that ‘the broad aims and directions of therapy, along with its general outcomes, are largely common to all the arts therapies [but] it is in the language and the interactions within the therapy itself that the differences [between modalities] fully emerge’ (p. 65). Such a statement feels representative of all our experiences in our fields and is, seemingly, not considered elsewhere in the literature.