Arts Health Practitioners in Focus: Arts Specialist Psychologists and Psychotherapists
In collaboration with key partners in the industry, BAPAM is developing a framework for best practice in mental health care and support in the performing arts. When we asked BAPAM-registered psychotherapists for their thoughts about working with arts clients, it was clear that this is a fascinating area to which they bring a great variety of unique experience and expertise, one that we’ll return to in future posts. These specialists help artists enjoy successful, sustainable careers in a psychologically tough business – the original gig economy. Here, they share insights into what it means to identify as a performer, what happens when something disrupts that identity, performance anxiety, working conditions, lifestyle, why they enjoy working with performers, and advice for maintaining psychological balance and good health.
BAPAM provides clinical assessments for artists with health issues which are impacting their performance. Find out how to make a free appointment at a BAPAM clinic.
We are currently seeking Clinical and Counselling Psychologists and Psychiatrists to assess clients in our clinics. If you are interested in finding out more about this please email Information Coordinator Dan Hayhurst via dan@bapam.org.uk.
If you are a healthcare professional interested in working with BAPAM as an independent practitioner registered on our Directory, find out more here.
Therapists’ Backgrounds
Carol Chapman: I’ve spent a lifetime amongst performers and have witnessed and experienced many of their difficulties and issues. When I decided to move from academic psychology to become a Counselling Psychologist and to work in performing arts I felt I had come home. I could bring together my own experiences learning music, many years of close contact with performer relatives, friends and colleagues, and add this to my therapeutic knowledge and skills to helping performers cope with their problems and fulfill themselves. Many problems have been well researched and workable solutions exist. Anything I can do to further the lives of artists ultimately benefits their art, and this also benefits all of us who are enriched by it as well.
Dare Mason: I have had vast experience with musicians and performers in my job as a record producer and recording engineer. If you have ever been in a studio, you will know that patience and sensitivity are essential requirements for a producer. People often feel anxious and vulnerable at the thought of entrusting their art to someone who is essentially a stranger. We quickly have to build an atmosphere of trust so we can all feel comfortable to express ourselves openly. The parallel with therapy couldn’t be more obvious!
Jane Oakland: I have been a performer all my life. I must have been in the profession for about 20 years, working and living in Holland, when I started to feel uncomfortable with my singing. It was a gradual process and something I tried to cover up until it was too much. Two decades ago in Holland there was no one to turn to, so my answer was to try and find out why this was happening to me. This started a 10 year journey of studying psychology for musicians, gaining counselling skills and conducting academic research. I was fortunate that I was able to keep working through this period and learned enough to start enjoying singing again, but by this time I had become aware of the lack of specialist resources that were available to performing artists who encountered problems. In 2010 I made the decision to return to the UK so I could work with performing artists in my own language and to give something back to the profession that had been my life for 35 years.
Alison Penfold: Before retraining and becoming a BACP Accredited Psychotherapist, under my stage name I worked for many years as a classical singer, both freelance and for a time for ENO. I regularly worked as a recitalist and in oratorios and was a soloist in Variety Theatre including for The Players Theatre and The Good old Days at The City Varieties Leeds. I now regularly support performers from many different genres, including instrumentalists, actors, singers and dancers. I also work with non-performing creative artists, including choreographers, writers and others in the world of film and theatre. I am a visiting lecturer at Trinity Laban Conservatoire where I present seminars on psychological aspects of performing and teaching to vocal studies students.
Monia Brizzi: Since starting out in psychology more than 20 years ago I have worked with a wide variety of issues that performers bring to me. During this time it has become increasingly clear to me that creativity is central to the process of attaining and maintaining health and well-being. This has led me to focus on the question of what constitutes integrated, actualised or peak experience and, from 2006, to work with artists and performers to help them achieve optimal performance. My clinical practice and research are primarily concerned with the psychology of performance and creativity.
Your performing self
AP: Many performers become entirely defined by their performing self. This can be immensely distressing when things aren’t going so well. I can support you to recognise that whilst your performing self is indeed important, it isn’t the only significant part of you. Discovering the parts that have been unintentionally minimised, can really help to build a stronger sense of self. When the need to be a perfect performer (in order to be worthwhile) is reduced, this can ultimately increase the ability to audition and perform freely, without fear of failure and shame.
CC: Being a performer means that it’s not just a job but a way of life and it impacts on every aspect of the person. And when you’re doing your job, playing, acting or singing you’re very much exposed and vulnerable, which is very different from any other kind of job. And that creates all sorts of problems, impacting on the way you see yourself, how you relate to your colleagues, friends and family. That helps to explain that a lot of people come through our door who have a sense of relief that they can finally get some help.
MB: Performers sometimes have narrow and restricting assumptions about the kind of person they imagine they should be in order to be performers. These might include definitions such as ‘strong’ and ‘confident’, ‘technically perfect’, ‘larger than life’, ‘diva’ and ‘eccentric’. Others might also hold biases of performers such as that they are ‘mad’, ‘histrionic’, ‘selfish’, ‘irrational’, ‘difficult’, ‘exotic’, ‘alien’ or ‘frivolous’ – these stereotypes can create a complicated social milieu for performers to navigate. Working with an arts specialist psychologist is a systematic and efficacious exploration of what makes you feel grounded. It transforms performer’s relationship to themselves, their world and their art. We look at your connection to issues such as stability, perfectionism, constraint, identity, anxiety and all the embodied feelings that come with them. It is a privilege for me to help people overcome problems and connect more fully to their capacities, aspirations and creative practice – both on stage and in their life.
JO: Setting unrealistically high personal goals and expectations can be a problem. Unhelpful perfectionist tendencies, negative thinking patterns and over investment in the musical self can also be evident. In terms of well -being, this can leave a musician emotionally vulnerable if they do not learn skills to separate self and performer. Developing outside activities is one way to create such boundaries. In addition, the expectations of music being a source of emotional self-expression can be put to the test in an orchestral or choral situation where you have very little autonomy over musical expression and interpretation. Musicians who have managed long careers have found ways to fulfil these needs outside of the workplace such as putting on solo recitals, playing in string quartets, even conducting amateur groups. My research looked at how a group of singers managed their sense of self when enforced career transition meant they could no longer work. Work was the main medium through which they were able to validate their status as singers. This form of self- validation is fragile because it is dependent on external elements outside the control of the singer. When this was taken away from them, several experienced physical illness and two were unable to physically sing. I found that within the professional singing identity several subsets of identity emerged, such as being a performer or being a musician. Using a theory of Post Traumatic Growth, the singers that ultimately managed this traumatic event were those who created a new life from the pieces of the old, finding other opportunities to be a performer or re-defining themselves as a ‘musician’. In some cases the meaning of singing changed through trauma: Singing means expression now; it was identity for years The research highlighted how identity should be a dynamic process, something we do rather than have and that flexibility in identity formation can help all performing artists manage the inevitable crises in a career.
Performance Anxiety
JO: Most performers come with issues surrounding performance anxiety, at least that is what they state, but performance anxiety can often be underpinned by other more complex issues such as general anxiety, workplace stress, balancing a career and a home life, or physical stress. Performers often feel they can work around other life stressors until it impacts on their performance.
Working conditions
DM: Musicians as an occupational group are at risk of experiencing anxiety and/or depression. The nature of the industry can often make existing conditions worse as well as presenting complex, new challenges.
CC: The industry can trigger issues in varying ways… It might be working flat out on a film. It might be interpersonal factors. Maybe your agent never gets you any work. You may have difficulty within your band or orchestra. Sometimes it’s things from the past that prevent people from getting on with their career and affect the way they see themselves. Helping people deal with wider career issues is very much a part of what I do, as well as helping people with anxiety, depression, anger and all those other emotions. Work-related medical problems can cause secondary psychological issues – voice, hearing, sight problems, overuse injuries, or any other kind of activity-limiting problem.
JO: The profession makes increasing demands. As with the general public, the impact of stress depends on the context and on how an individual interprets and manages that stress. Stress is good for us! The arousal that is at the heart of stress releases the hormone noradrenalin and helps us to focus and problem solve. However, the life of a musician in 21st century incorporates stressful situations that are often out of their control, such as heavy touring, busy physical and mental schedules, lack of understanding from management etc. Unhelpful coping mechanisms can be adopted. Physical injury can be the result of mental stress. In extreme cases burn-out can occur mid-career and the love of music can be lost. However, rather than blaming the profession itself, if musicians can learn to harness the energy generated by arousal (particularly at an early stage) they will be in a better place to manage the ‘uncontrollables’ and develop resilience and self -awareness.
MB: Clients frequently consult me because they struggle with practical difficulties in managing a busy and unpredictable rehearsal, audition and performance schedule with family and personal life. We usually try to escape uncertainty yet the performing arts world is permeated with it. Uncertainty is generally seen as negative, it is tempting to try to escape it but what gets overlooked is that it is also the ground of creativity, of novel change and transformation. Since it is a given, a professional hazard of this dynamical industry, it is important to harness the affirmative powers of uncertainty and establish an effective stance toward it. Working conditions in the performing arts can trigger identity tensions for performers where on and off stage sense of self is in conflict or unbalance. This often leads performers to experience themselves and their world in a profoundly divided manner – where they find themselves simultaneously wanting and not wanting the same things and it can be very unsettling and confusing. If performers completely identify with roles that are given to them by others in their performing life, they can end up with a sense of blankness about their own agency. They might not feel entirely connected to their various roles nor feel that they are self-chosen, or there might be a sense of emptiness to themselves where they no longer really know how and who to be once their performing roles are over. They can struggle with maintaining the steadiness of things and with feeling substantial or grounded. Performers often consult me because they feel stuck at extreme poles with little room in between – either trapped or lost, perfect or a ‘failure’, always in control or totally out of control. The work we do together has a lot to do with mapping this in-between space of vitality and potentiality. It is challenging but also truly exhilarating for people to give themselves the opportunity to self-create in this way, often for the first time in their life. Ultimately my work assists performers in achieving a balancing act in between the various aspects and contrasts of their performing and every day world. I help them to find the right combination where they are not so overly identified with their performing self to be unable to differentiate themselves from it or maintain any sense of agency outside of it (otherwise it will put too much pressure and swamp them), but also not too distant that they end up struggling to connect to it, to their art and audience.
CC: You have to develop resilience and the ability to bounce back and deal with rejection, because rejection is in the mix very early on. And I think teachers have a responsibility here to be real with their students to prepare them and to develop that mental health awareness in themselves. I see actors who are pushed over the edge in training and sometimes there are no staff at hand to recognise they’ve gone beyond what is reasonable and need support and help. You wouldn’t dream of pushing an athlete way beyond what’s optimal for them.
Talking about mental health in the industry
JO: The stigma that is still attached to any mental health condition in the performing arts means that many musicians are reluctant to seek help early enough and will play through pain and anxiety which only adds to an unhelpful attitude towards stress.
CC: Performers are often afraid of revealing when they are struggling, but when they open up they find that they share the same problems. It is gradually changing and we at BAPAM are doing what we can to drive that change by helping to educate teachers and trainers as well as working with industry leaders to try and change and encourage more of an open attitude.
Lifestyle
AP: The lifestyle of a performer can present unhelpful opportunities which might increase vulnerability to addictive behaviour. I can support you to understand these triggers and to seek and maintain recovery.
DM: Alcoholism and drug dependency are unfortunately common problems in the music industry. How do you calm your nerves before going on stage, and when you come off, how do you unwind? How do you fill the potentially tedious hours or days or weeks between performances? Alcohol and drugs can become a coping mechanism that can turn into a dependency. Since 2016 I have been counselling clients from Addaction, a substance misuse agency, and this has become an area of expertise for me.
Early Life Experiences AP: Trauma in childhood, whether from physical, sexual or emotional abuse can be triggered repeatedly by the stress of auditioning and performing. I can support you to explore how difficult early life experience might be impacting life now, sometimes causing debilitating self-doubt. Many of us have unintentionally internalised an unhelpful and punitive narrative, which we believe to be indelible.
Deciding to See a Therapist
DM: Seeing a psychotherapist is a courageous step. It usually means things are so bad that you have to admit to yourself you need help – and that can be difficult. But you are not alone. All of us suffer mental health issues of some sort, sometime. Entering therapy can be daunting but, as I found out for myself, it can be a fascinating and joyful journey towards finding your true self, a sense of purpose and inner resources of strength, love and compassion.
Practice Methodology
DM: I do most of my work via Skype (unless you happen to live near Penzance!) We would begin with an introductory assessment session. This is a chance for you to present the problems or issues you would like to work on. I would be interested in how you had dealt with these issues in the past and how severe they are at present. Then I will explain the way that I work. Most of the time I will be listening but I will also ask questions, suggest techniques or even challenge you.
CC: A lot of the people I see are functioning very well. They’re not debilitated but psychologically they are compromised to some degree. They may be depressed or be lacking in confidence, frustrated, sad or angry which is preventing them from being the person, actor, musician or dancer that they can be. My work is facilitating and enhancing performance as much as remedying problems. What I do covers a wide range of aspects and it’s what I call a bio-psycho-social process. I’m interested in not only the symptoms but how the problems developed and what pre-disposed them. Were there factors in their past like bad teaching or technique, or being bullied? There may be precipitating factors or there may be something that happened like a big change, a loss or an injury that caused the problem immediately. Then I look at the perpetuating factors that might keep it going, for example avoidance and getting stage fright, and limiting the exposure which you give yourself in order to avoid fear. And finally the protective factors, things in your character or your skill set or environment that make things easier for you. The assessment is very specific and individualistic, I call what I do a formulation and it’s different from a diagnosis – it’s very individual. This is especially important in the work I do as I can create an open and trusting therapeutic relationship with clients. The therapeutic approach I use depends on the problem, the person and their environment.
JO: Research tends to show that the relationship between client and therapist is, certainly of equal importance, if not more important than the model itself. My first aim is to gain the trust of a client and find out more about their lifestyle, general characteristics, their current workload and very importantly, are they in a place where they can take a proactive role in their recovery etc. My own experience of the profession is particularly helpful at this stage where developing trust is aided by ‘speaking the same language’. When I have gained as full a picture as possible of their life histories and concerns, I then decide if I personally have the necessary skills to intervene or if I should refer on. Because performing artists generally need to keep working through problems or return to work a soon as possible, I tend to start with a top down model, usually based on CBT combined with integrative counselling to address the issues that they feel are likely to give them some effective coping mechanisms to continue working. In some cases, an understanding of anxiety management and specialist mental skill training is all that is needed to manage performance ‘nerves’. However, if anxiety is more deep rooted, then I discuss more long term CBT work with a client but I use this in combination with other psychological theories such as identity, motivation and performance enhancement skills.
MB: I use a CBT treatment approach and am also trained in existential psychology. Performance, creativity and art are central to existential psychology because it views perception and consciousness as primary creative acts that give form and unity to the different dimensions of experience. Existential psychology is concerned with questions about the interplay of mind-body, thoughts-emotions, self-other, meaning and meaninglessness, how to structure chaos and what gives substance and vitality to life. It addresses themes such as uncertainty, vulnerability, behavioural, emotional and body disturbances, stress, anxiety, perfectionism, self-criticism, time, values, purpose, commitment, identity, relationships and transformation. Existential psychology is discovery-oriented rather than prescriptive, so it is a very effective clinical tool for work oriented at facilitating a richer awareness, connectedness and creativity, for balancing and reconciling different and often contrasting aspects and tensions. It enables me to work with psychosocial difficulties and distress as relational and normative life issues and signposts to solutions rather than pathologies, thus enabling my practice to challenge the stigma and prejudice that, unfortunately, still interferes with getting help in the performing arts industry. Existential therapy equips you to find out what possibilities for being and for doing are realistically achievable for you beyond familiar roles and identities. In this therapy you can make sense of the pros and cons of the particular ways you process your experience, how you re-structure it and what changes to make.
What is different about working with performers?
CC: Performers are a joy to work with because they’re used to looking in to themselves and know themselves and their body quite well. They’re often highly disciplined and are used to working hard. A lot of them seek therapy as a last resort. Many people have tried non-specialists who don’t know what it’s like in the performing arts and finding someone who really does understand also helps. As they’re working they’re putting themselves on the line which can itself create heightened emotions and a lot of self-critical thoughts and beliefs. Many of the people I see experience perfectionism. This can be a positive thing as it encourages them to do better but it is correspondingly negative if they end up beating themselves up all the time. A lot of performers are idiosyncratic and unusual. I get on well with unusual people as it’s a challenge; some therapists can find them awkward and difficult.
MB: Because performance entails an opening up of consciousness beyond ordinary mind/body, self/world and cognitive/practical divisions, working with performers requires addressing the physical, psychological and relational contexts of life with a focus on broadening perspective, meaning and purpose. Art can be seen as a supreme form of language capable of expressing fundamental yet elusive and often preverbal dimensions of experience pertaining to the further reaches of being. This is no easy endeavour, no wonder so many performers seek help. The primary material for performers, their embodied emotions, and how they attune to, suppress or evade them, will largely determine the qualitative tone of both their experience and of their art. Simply put, dismissing their felt experience can come at an even higher price for performers than other people that come to see me because for performers feelings are the energy source of their art. Gaps, knots and disconnections in these primal relations can be problematic but, fortunately, this is also where psychology can be most effective, and the work can be incredibly rewarding! Essentially, how we focus on something changes it. I work with perception as the most basic creative act, prerequisite to overcoming a passive stance and realising a creative vision. Choosing what performers pay attention to and how they do so is an act of freedom, and the key to developing the habits necessary for achieving a more productive career and flourishing life.
Working with singers and voice users
JO: We express every aspect of our emotional lives through our voice. That voice grows and changes with us, so it is not surprising that our emotional state can impact on the voice. Leaving aside the obvious consequences of overuse, many singers experience vocal impairment with no physical explanation. One explanation of this is what is commonly known as conversion reaction or psychogenic voice loss where a traumatic experience or post-traumatic experience can leave a person feeling out of control and metaphorically ‘without a voice’ in the situation. Knowledge in this area is very much on going, there is some evidence to show that the suppression of emotion to certain life situations is related to laryngeal muscular tension, just as the physical symptoms of arousal (as in performance anxiety) initiate muscular tensions which result in shallow breathing. Because the voice is an embodied instrument, any physical or psychological impairment can initiate further wellbeing issues. Ideally treatment should be carried out by a multi-disciplinary team.
Advice for performers
CC: Plan to have a work-life balance. I spend a lot of time on very practical things like time management and stress management. Prepare for a career which can be uncertain and where people that you work with can be difficult and unreasonable. Learn to be resilient and to bounce back from rejection.
JO: Develop techniques to ‘switch off’ when you enter your home and ensure that you engage in activities that are non-work related. Without being overly health-conscious, consider your lifestyle and coping mechanisms – are they helpful? If you find you are not managing stress or anxiety seek help sooner rather than later. You can find lots more useful advice in our free BAPAM Health Resources.
BAPAM Psychosocial Practitioners Peer Supervision Group
CC: We are a growing group of therapists using evidence based treatment methods. It’s very good for us to talk about performers’ issues that we face because they are different to other client groups we treat. There are special things that come up to do with lifestyle and career, with being a musician, actor or a dancer. And it’s very nice to have a forum in which to share expertise, help each other, make suggestions and encourage research.
JO: We set up the peer supervision group because, although general supervision forms a part of our work, we felt there was a need to supplement this to incorporate the work we do that is specific to the performing arts. I believe the peer group is unique in this area and will hopefully add another layer of professionalism to the work we do and set standards for the future of psychosocial interventions in the performing arts. We come from a variety of different backgrounds and approaches which is already broadening my personal perspective and insights into the work I do as well as confirming that my own approaches and experiences are helpful to others. It means you are not working in isolation.
MB: Our peer supervision group is a dedicated arena to discuss key issues arising within the performing arts industry, share specialist expertise on best practice and advance the conversation between the performing arts and psychology. It is invaluable to consult with highly knowledgeable and experienced colleagues to investigate the possibilities and challenges of practicing at the interface of psychology and the arts. We are all committed to the necessity of art to society, to our humanity and being – and therefore to supporting artists in being the best they can be. We emphasise a shared social reality of performing art psychology to challenge the default individualisation and privatisation of experience which are at the root of the problem of prejudice and stigma in the performing arts world. We aim to demystify this area by focusing on the human as well as on medical side of health and well-being. Psychology can support and humanise art, but reciprocally art can also help humanise and bring psychology forward. This fruitful partnership is not recognised enough both in contemporary psychology and in the arts. For founding pioneers of scientific psychology William James and John Dewey art was not domain specific, relegated to the stage or gallery. For them what is most significant about art wasn’t only its capacity to civilise man or educate nature, or even its ability to tap into and express otherwise difficult to access ineffable meanings, but something even more fundamental: The fact that before all this art is first and foremost the capability to bring forth, the basic creative relation binding together subject and object – the primary foundation of each act of lived experience and perception, the basic engendering character of beings. All these are crucial issues in psychology and, clearly, there is much that art can offer to inform and enrich psychological practice. In the group we consider these questions and collaborate to find always better ways to let them inform the work that we do.
Read more about the BAPAM Psychosocial Practitioners Peer Supervision Group.