تحقیق در مورد هنر درمانی با افراد مبتلا به زوال عقل مرتبط با ایدز

The Human Immunodeficiency Virus (HIV) and the resulting condition known as Acquired Immunodeficiency Syndrome (AIDS) have brought together areas of experience which we in the western world consider to be taboo: death, sex, sexuality, disability and contagion. The dementia resulting from the activity of HIV upon the brain perhaps represents a final taboo—a loss of the sense of oneself. AIDS dementia is not an inevitable consequence of HIV infection. It occurs in about a quarter of all those who are HIV positive, but it is probably the most feared of all the conditions related to HIV. I worked as an art therapist for 9.5 years in a hospice that cared specifically for people with HIV and AIDS. This was a new field of practice for art therapy and one which I found challenging in a number of ways (Wood, 1990 and Wood, 1998). However what I found most challenging was working with the patients who had HIV brain impairment or AIDS dementia who formed a small part of my caseload. This report describes an exploration of my practice with these patients. The exploration took the form of research, using qualitative analysis techniques that included case notes made by me after our sessions. The aim of the exploration was to make sense of these clinical encounters by arriving at a set of propositions about the nature of art therapy practice in this area. This report begins with a survey of the literature on art therapy with people suffering from a variety of dementias, thus providing a context within which to understand the present study. The next section provides a detailed description of the methodology used and is followed by a section detailing the findings of the research. These findings are then discussed and propositions are made about the nature of the art therapy relationship with people who have AIDS dementia. Some areas are also suggested as worthy of further research.

The particular difficulties experienced by people with AIDS dementia means that social interactions are awkward and opportunities for self-expression are limited. Likewise, there are difficulties for carers, both lay and professional, such as feelings of profound helplessness and sadness in the face of the patient’s physical, social and cognitive losses. These feelings are also compounded by the fact that, until recently when the use of new drugs has introduced an element of reversibility (Lodge, Tanner, & McKeogh, 1998; Ward, 1998), death usually came within 6 months of a diagnosis of AIDS dementia. My contact with such patients over a 7-year period left me with a confusing picture of what I had offered and what art therapy could provide and became the subject for this study. In contrast to much of the art therapy literature on working with people who have dementia it was the brief relationship between myself as therapist, the patient and the art materials—described here as the therapeutic encounter—that was the focus of my research. What has emerged is the hypothesis that establishing a connection between patient and therapist was the thrust of the therapeutic encounters, and that creating conditions which maximise this connection was an essential part of my practice. Much of my early confusion about the use and value of art therapy for this patient group was clarified in the process of this study, and it enabled me to recognise the confusion as a response to the very challenging needs of these patients. Firstly, the research shows that I needed to be flexible and able to adapt my boundaries to accommodate patients’ particular difficulties. Secondly, that I had to recognise and deal with my own anxiety when faced with patients who did not appear to be able or willing to use the art materials, and finally that investing emotional energy in relationships which are quickly disrupted by illness and death does take its toll. My research shows that the familiarity of the location and the therapist to the patient are important factors to consider when embarking upon work with this patient group. It also highlights how the variabilities of the patient’s health influence the clinical work and have an impact upon the therapist. The research has also raised questions about the role and function of the art therapist’s note taking. This is an area that would benefit from more research and one which could provide interesting insights into how therapists understand and construct their encounters with patients. I had hoped, from this research, to propose some principles for art therapy practice with people who have AIDS dementia. What I have found is that beyond being prepared to take a flexible and patient focused approach to the work, there is very little difference in the principles of practice with this and other patient groups. The main difference lies in the time frame, which is extremely fragile with patients who are terminally ill. A resistance within the therapist to engage with the patient is perhaps the most important principle to recognise, for once the therapeutic encounter begins the therapist must mobilise her thinking and skill as she would for any patient. In developing the concept of connection I have found it helpful in understanding my work with other types of patients, such as nursery children. It may well be that this concept is descriptive of other areas of art therapy practice beyond HIV/AIDS dementia. In conclusion, I have argued that a sense of isolation within both the patient and the therapist can be a motivating force towards a therapeutic encounter. I have proposed that the idea of a connection between the therapist and patient in therapy is a profound experience that goes beyond language, and should be considered as the substance and goal of the therapeutic encounter. I have also drawn attention to the impact upon the therapist of working with people who have a terminal illness.