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Arts health practitioners in focus: Arts Specialist Psychologists and Psychotherapists

Tuesday, August 7th, 2018

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 ChapmanI’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.

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.

Monia Brizzi: Performers sometimes have assumptions about the kind of person that they imagine they should be in order to be performers. These might include such narrow definitions as having to be ‘strong and powerful’, ‘technically perfect’, ‘never making mistakes, ‘always confident’, ‘bigger than life’, ‘a diva’, ‘eccentric’, ‘free and creative’. Non-performers might hold disparate biases such as that performers are somewhat mad, disregulated, histrionic, chaotic, irrational, or exotic, superior or even infallible. Working with a performance psychologist is an exploration of what makes you feel grounded in your experience. 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: What my clients consistently tell me is that they often struggle with practical difficulties in managing a busy and often unpredictable rehearsal, audition and performance schedule with family and personal life.

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.

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. Read more about the BAPAM Psychosocial Practitioners Peer Supervision Group.

PPL CEO Peter Leathem Appointed BAPAM Chairman

Tuesday, August 7th, 2018

Peter Leathem, Chief Executive Officer at PPL is the new Chairman here at BAPAM

Peter takes over from Richard Price, who retired in July after 12 years steering the charity as it grew into an integral service for the UK’s performing arts community. With unique expertise gained over 30 years delivering clinical services to performing arts professionals and students, and working collaboratively with health care practitioners and arts organisations throughout the UK, BAPAM is now at the forefront of setting standards in performance health and education.

Commenting on his appointment as BAPAM Chairman, Peter Leathem says: I have been involved with BAPAM for some time now and it is a hugely worthwhile cause that makes a real difference to people’s lives by providing specialist health advice to all sorts of performing artists – from musicians and singers to actors and dancers. 

I have found it very enjoyable and rewarding to dedicate time to helping the charity and being an active member of its leadership board. I am very proud to have now been elected Chairman and hope that I can help the organisation to achieve even greater impact in the future, drawing on my own experience as the Chief Executive Officer of PPL and also a Board Director of UK Music, the British Copyright Council and the international forum for performers’ collective management organisations, SCAPR. 

One of the fundamentals of PPL’s business is our dedication to supporting performers, not least to maximise their revenues.  BAPAM has many shared values with PPL in terms of looking after performing artists as an absolute priority – I am truly excited about the future as BAPAM Chairman.

Claire Cordeaux, BAPAM Director added: We are delighted that Peter is taking the role of Chair of BAPAM. As a medically-led organisation, we are uniquely placed to offer clinical expertise in the performing arts industry. In addition to PPL, we are pleased to count amongst our supporters Help Musicians UK, the Musicians’ Union, Equity, PRS, and the Grand Order of Water Rats. We want artists to enjoy successful, sustainable careers, and we look forward to working with Peter to build partnerships throughout the industry and make a significant impact on the health of musicians and all arts professionals.

The Accent Method Course

Thursday, June 28th, 2018

A 3-day course conducted by two of the leading names in vocal health will be taking place in Birmingham.

The course which is organised by the British Voice Association will be fairly practical with some time devoted to explaining the scientific rationale behind the technique. It is used widely in rehabilitation for voice disorders, but also used for training healthy voices and developing the dynamic range of performers.

The first two days of the course will take place on 12th and 13th July 2018 with a five month break followed by a final day in January 2019.

The technique is well researched and has a good evidence base and is designed to co-ordinate respiration, phonation, articulation and resonance to produce clear and well modulated speech.

Specialist speech and language therapist Sara Harris and singing teacher and voice coach Dinah Harris have been working together for many years, most notably at the multidisciplinary voice clinic in Lewisham Hospital.

BAPAM returns to Scotland!

Thursday, May 17th, 2018

We’re very pleased to announce that BAPAM is reintroducing its free medical assessment clinics to help performing artists based in Scotland. The clinic, which will take place at Scottish Opera’s Production Studios on Friday 8th June, will be held by Dr. Philippa Wheble BSc Hons (Pharmacology), MBChB, DRCOG, who is an NHS GP and a graduate of the MSc in Performing Arts Medicine at UCL. Pippa is herself a keen performing artist. She plays violin and viola and trained as a dancer.

For further details or to book your place, please contact BAPAM on 020 7404 8444.

Shoulder pain – free advice for musicians

Wednesday, May 2nd, 2018

Instrumental musicians often experience symptoms of pain, weakness, fatigue or tension around the shoulder area and there is no mystery to their origin. At this forthcoming free advice session, which is the first in a new series, performance therapist Nikki Rawlings and performing arts orthopaedic clinician Dr Hara Trouli, both of whom are BAPAM registered clinicians, will try and explain how these symptoms are developed, maintained with playing and what can be done to relieve them and eventually control or abolish them in the long term. The event is organised by PhysioEd Medical’s musicians clinic and is free of charge. You can register here info.belsize[at]physioedmedical.co.uk

The Music Commission: Opportunities and Barriers to Progressing in Music

Wednesday, May 2nd, 2018

The Music Commission, supported by ABRSM, has launched its first call for public evidence, with a survey containing a series of specific questions around progress in the development of a musical life. Taking part enables all voices to be heard, so if you are involved in music education – as a music leader, teacher, learner, or consumer – The Music Commission would like to hear from you!

Have you found abundant opportunities to develop your musical practice or have there been barriers to participation in musical life? What are your positive and negative experiences of learning and work environments, your peers in the arts community, teachers, employers, media, access to venues and rehearsal space,  housing, earning a living or supporting yourself through university? Perhaps you have you encountered health problems that have been a barrier to progress – there are significant physical and psychological demands placed on music students and professionals, which can be eased or exacerbated by social factors.

Please take the survey here.

The Music Commission is also asking organisations within the music sector to run focus groups, an initiative you can find out about here: Let’s Talk Music. The questions are modeled on the online survey.  How the discussions take place and in what context however, are entirely up to the organisation hosting them. The aim of the group is to discuss questions and then to put together a collaborative statement which draws on the thoughts, feelings and opinions of the group.  This can be submitted in writing, or using recordings, video content or images.

 

Grand Order of Water Rats pledges support for BAPAM

Wednesday, April 25th, 2018

We are pleased to announce that the Grand Order of Water Rats has become a major supporter of BAPAM with annual funding to help us grow our performing arts specialist health service.

The GoWR join our partner organisations, Help Musicians UK, The MU, Equity, PPL, and the PRS Members Benevolent Fund, in recognising and supporting the need to develop accessible, specialist and effective medical support for performing arts professionals and students overcoming career-related health problems.

Councillor Mike Martin said,  “The splendid work and dedication of BAPAM most definitely ticks the boxes of our basic remit… to assist fellow performers who are in need. We are delighted to support such a worthy organisation.”

Freeing the Dancers Voice, March 2018

Thursday, March 1st, 2018

Are you a dancer increasingly called upon to sing during performance? A singer increasingly called upon to dance? In London on Sunday 18th March the British Voice Association is running a multidisciplinary workshop, Freeing the Dancer’s Voice, in how to successfully face the challenges of combining talents in the same performance. It boasts a panel of esteemed therapists, tutors and other specialists, including specialist performance physiotherapist, Ed Blake, and osteopath and UCL Performing Arts Medicine MSc graduate, Tommi Sliiden.

Sunday 18th March 10:30am-5pm

Arts Educational School, Chiswick, London W4 1LY

For further details and to book your place contact administrator[at]britishvoiceassociation.org.uk or visit www.britishvoiceassociation.org.uk

BAPAM Director Appointed

Thursday, December 7th, 2017

We are delighted to welcome our new Director, Claire Cordeaux

Having started her career as a youth and community worker over 30 years ago, Claire Cordeaux has worked in the private and voluntary sectors, social care and the NHS, covering early years and children’s services, workforce development, health strategy, research and innovation at international, regional and local levels. In addition to a language degree, Claire holds a Masters in Research and Postgraduate Diplomas in Public Sector Management and Youth and Community work. Prior to her current role, Claire was Healthcare Director of SIMUL8 Corporation, working globally to improve healthcare using computer modelling and simulation. Claire is an active musician in a Celtic folk fusion band, and has supported a number of arts initiatives and festivals from youth music projects to running a boat stage to connect performers in coastal areas.  Now Director of the British Association for Performing Arts Medicine, Claire counts herself as very lucky to have a role which combines her two passions of health improvement and performing arts.

Injury Prevention at The Purcell School for Young Musicians

Thursday, June 8th, 2017

The Purcell School’s Specialist Physiotherapist, Sarah Upjohn, has had her pioneering work incorporated in the school’s new Playing-Related Musculoskeletal Injury Prevention Policy. While working at the school (and helping performers here at BAPAM), Sarah’s Doctoral work at the University of Cambridge has focused on preventing playing-related injuries in young musicians. Most of these problems, which musicians starting university and entering the profession frequently already suffer from, are preventable. The Purcell School’s strategy to identify risk factors and improve injury prevention awareness among pupils, staff, parents and all involved with the school, is exemplary in preparing young musicians for healthy and succesful careers.

Find out more and read the policy here.