Relationship Status: ‘It’s complicated!’: A drama therapist and an art therapist reflect on working in a multidisciplinary team
by Alisa Ray (Art Therapy) and Danieyella Rodin (Drama Therapy)
Hi there, I’m Alisa. Dani and I work at the same psychiatric recovery centre, and these are some reflections on being in a relationship with the multidisciplinary team (MDT) there.
The Blind Date
I worked as an art facilitator conducting groups at this facility for several years before the art therapy programme at the University of Johannesburg was launched in 2020. I attended some of the MDT meetings in 2012 when I was finding my feet in this environment. I stayed in my lane as an art facilitator conducting groups until February 2022 when my master’s studies enabled placement work at this facility with individuals.
The artwork here titled “Therapy Hand” was response art in relation to my first MDT meeting as a master’s art therapy student.
Reflecting on this artwork, I wrote:
Today I attended a multidisciplinary team meeting at my workplace. I was disturbed by the language that the young OT was using and the broad judgements she was making. It struck me that the OT and this team are in such a position of power to decide the fate of certain persons. I decided some time ago that I preferred not to attend these meetings regularly as I enjoy working with the group without having any preconceived ideas about individuals. I know this will change when I become an Art Therapist.
I chose a sturdy piece of yellow paper and thought that it was a good symbol for the client. The traced hand on the paper symbolises the help we extend to the people we work with. It can be a heavy authoritarian hand and can wield power in a destructive way, or it can be a gentle hand. I want my hand to be a gentle and colourful one that allows the client to be. Art is where the clients who cannot follow the rigid therapeutic outcomes of the programme find a home.
My 2022 reflective piece captures an aspect of what I hear many arts therapists describing in peer supervision spaces: many of us do not like labels to describe our clients. I think this is because as arts therapists we encourage a person’s self expression. We are witnesses to a person’s essence as expressed through art or drama or music. Our description of our clients can be profound in resonating with their unique life experiences, and a Diagnostic and Statistical Manual of Mental Disorders (DSM) label in contrast may feel reductive and judgemental.
The Whirlwind Romance
I continued to attend the MDT meetings as a registered art therapist and developed a good working relationship with members of the team. I became accustomed to the use of DSM labels and realised that these were not set in stone, and were merely a quick descriptive tool in summarizing a group of behaviours. I learnt not to let the labels interfere with my relating to the clients as an art therapist. My observations as an art therapist were also useful in confirming or challenging the given labels. Artwork can reveal continued delusional thinking or psychosis in its content and expression. Sometimes art can offer an initial glimpse of a depression lifting or a return to a manic state. I felt that my contributions were valued in this team and that I too had something to offer in the making of the tailor-made treatment plan of each client.
In turn I learnt about family dynamics and the complexities involved in being a social worker. I learnt that occupational therapists provide clients and their families with concrete answers derived from frequent assessments. The clinical psychologist helped me enormously with my individual work with clients in formulating realistic therapeutic outcomes. I felt that I could express my fierce love for my work in these meetings and express on behalf of the client something unique. I was there to remind the team that we were working with a unique individual and not a label. And in this, I still resonate with what I wrote as a student.
The Breakup
Sadly, I have not been able to continue to attend MDT meetings. Arts therapists, unlike other members of the team, are external facilitators and not staff members. This means that we are not remunerated for our time in these meetings. The general struggle of arts therapists in the South African environment is reflected in this setting. To stabilise my finances, I have taken other work in the times of these MDT meetings and for now, I have left Dani to represent arts therapists in this space.
The Rebound Relationship
Hi there, I’m Dani. As an in-training Drama Therapist dreaming into a future of working in the field, thoughts of working within a multidisciplinary team included images of collaboration and challenge: a weaving together of vibrant colours to form a beautiful tapestry in the interests of each client. However, after a year of working within a MDT, I realise that for an arts therapist, integrating into the team looks quite different.
It’s Not Me… It’s Actually You
As an emerging arts therapist, part of my professional growth is about developing my clinical voice, as well as the common language with which to reach colleagues from other disciplines. However this honing of skills emerges through the relationship between myself and the work environment. And thus, the institutional culture and structures impact this professional development.
What structural conditions contribute to keeping the arts therapists’ voice in the margins within these spaces?
In the honeymoon phase, I excitedly started showing up to multi-disciplinary team meetings fortnightly, on the days I would run my drama therapy group. Financially, it didn’t make sense for me to drive in on days when I was not being paid. I worked hard to keep up with new intakes, old clients and new diagnoses and other developments with clients. However, this proved challenging. At first I took this as a failing of mine. But over time, I’ve come to realise that the institution’s processes and schedule play a big role in my ability to be able to do that effectively. For instance, I realised after a few months that attending fortnightly meant that I missed out on discussions on a number of clients, since the MDT meetings happened weekly.
Given that arts therapists are often only paid to run a 1 or 2 hour long group, rather than to be there for a day or two a week, or employed as part-time or full-time staff, we are by nature on the margins of the multidisciplinary team. We encounter our colleagues and the clients less than other team-members do — there are fewer chance encounters unless we engineer them, which I do as often as possible.
It took me months to realise that as much as I tried to carve out a space and own it within the team and find my voice, there were structural forces deeply ingrained within the system making this more challenging. That I’d have to find a different way — embrace the margins?
Trying Out an Open Relationship
How I responded was to craft corridor meetings over WhatsApp, building connections and relationships with colleagues by reaching out directly. I engaged in conversations — testing out my voice and my clinical impressions and through this built rapport and trusting collegial relationships. This happened mostly over the phone and slowly stealing a few minutes here and there in person. Through developing my clinical voice and insights with trusted colleagues, I slowly began to gain more confidence to share it more widely, and more loudly.
Then, over the course of a few months, the staff body changed quite dramatically, with many old colleagues leaving and lots of new faces arriving. It felt like being back to square one. The schedule for MDT meetings changed suddenly to accommodate new (more permanent) members of staff making it impossible for me to attend at all, and so, the story begins again…
Self-Love: Acceptance and Knowing Your Worth
Perhaps it is about owning the edges and the margins: making the most of half-conversations and colleagues who seem open to engaging outside the boundaries of the meeting space. Perhaps it is being sure that when something needs to be expressed from the edges, you find a way of sharing it: either by whispering it to that team-member who will listen, or projecting your voice loud enough for all to hear.
It could also be that, as with a page, no matter what content gets created and erased and recreated in the centre, the margins are always there holding the frame. They serve as a container: holding everything that may be possible. From this perspective, it would behoove institutions to negotiate even a small remuneration for meeting attendance, so that we could contribute to the MDT regularly.
Dani, I am sorry you were ‘breadcrumbed’…
I read Dani’s experience of stepping into the MDT space. I read with frustration her account of being enticed into a relationship with the institution and not being offered stability. I know that I had felt the MDT team I was a part of valued the arts therapies. There was sadly no legacy I had managed to leave behind and no institutional changes initiated to embrace art therapists as core members of the MDT team. Dani will have to start all over again in bringing arts therapies to the attention of the new MDT team.
Could I have done more? The pressure to perform at work, advocate for the profession and make a living all seemed to me to be a recipe for burn-out. A step back is not all bad. It gives time to reflect and recover and analyse this complicated relationship.
Alisa, let me help you with the relationship ‘postmortem’…
As we reflect on this ‘It’s Complicated’ relationship status, I’m struck by this sense of having to reinvent the wheel over and over again.
However, it also occurs to me that just as we learn the language of the other disciplines in these shared spaces, our presence helps others learn our lexicon too. Perhaps the frame of advocacy makes this feel burdensome at times, but maybe by simply being in the room consistently our approaches become valued. This being said, our time does need to be honoured. If not, we may be forced to leave the room completely.
Finally, I recall how important it was to witness you, Alisa, as the art therapist engaging in the MDT meeting in the first few meetings I attended – how the language you used made my nervous system feel safe in an environment which sometimes felt (as you so eloquently described), detached and cold. Stepping into this world, seeing you hold that part of the puzzle in the room was important to me as an emerging Drama Therapist. It modelled what communication with these other professionals could look like. Having attended many of these meetings now, I too have grown accustomed to and learned from each team member. Everyone cares deeply for the wellbeing of these clients.
Our relationship goals
With all of this in mind, for the legacy of the arts therapies in these spaces, it feels even more important to be in the room – for each other, for the discipline, for the rest of the MDT.
The arts therapies want to shift away from ‘It’s Complicated’, and make this romance work. How can we shape this relationship so that no-one loses out?
ALISA RAY
Alisa Ray is an Art Therapist. She currently offers online art therapy sessions for adults (18+). She is well suited to offer support to family members coping with a loved one who has an addiction, psychiatric illness or dementia. She is also available for supporting those navigating the difficulties of life and its changes. She offers support for loss and grief, including the complicated and disenfranchised kinds.
DANIEYELLA RODIN
As a drama therapist Danieyella Rodin is gentle, embodied and playful. She works with adult and adolescent individual clients in her online private practice, at Waldorf Bryanston and runs a drama therapy group at a psychiatric step-down facility. Her private practice focuses on working with expats, grief, relationship challenges and identity.