 Yesterday was our first arts-based workshop of the autumn season provided for a dynamic group of administrators, physicians, and clinicians at Elmhurst Hospital Center along with my esteemed colleague from the Whitney Museum of American Art. With an original screen print by abstract expressionist Helen Frankenthaler as our focal point, hospital employees embarked on a “close looking” exercise involving guided observation of the art work. This moment of mindfulness was followed by rich discussion around the materials used, background of the artist, and personal reflections about the piece.
Frankenthaler is quoted as saying, “There are no rules. Let the picture lead you where it must go.” Indeed, her intuitive, open approach to art-making provided a wonderful segue for the personal art-making experience to follow and inspired our use of fluid, wet media. Participants were invited to engage in an adapted open studio process approach to art therapy, including embodied breathing for grounding, free associative writing for creativity development, art-making with playful, non-traditional mixed media, personal self reflection, and group sharing for synthesis and community building. One participant shared how the liquid watercolor kept dancing around the page each time she shifted her position, resulting in imagery and a “final” product that was ever-changing. Although challenging to try to control the drops at first, she reflected on how this constant movement and evolution of her piece was actually a refreshing and exciting example of surrendering to not knowing what to expect as opposed to trying to control the outcome. It was a beautiful demonstration of art as therapy, requiring creative problem solving, frustration tolerance, self compassion, and reframing of perspective to come to this conclusion. These are certainly skills that can also be applied to daily life while managing stressors in a demanding hospital environment. We hope that the creative experience we provide and the artwork on display in the institution itself will serve as reminders of each individual’s own creative resilience. #artastherapy #artheals #caregiverburnout #healthehealer Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original photos courtesy of Elmhurst Hospital Center
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 Aside from back to school time for families and important holidays for many, September also marks NICU (Neonatal Intensive Care Unit) Awareness Month, established to acknowledge and educate the public around the unique challenges childbearing families face while navigating their baby’s time in and provide them with the support and resources they need. It also honors the professionals who work in these critical and demanding spaces.
The reason for admission and length of stay in a NICU varies widely, sometimes due medical complications after labor and delivery, recovery from surgery, or a need for monitoring concerns around pediatric digestive conditions or respiratory issues. Some birthing people have just experienced a traumatic birth when their babies are admitted to the NICU, adding yet another layer of vulnerability and stress to the typical challenges around establishing a milk supply for breastfeeding or creating a feeding routine with a newborn. Fear for the little one’s well-being, extreme helplessness around limited access to them, confusion around what one is “supposed” to be doing, anger toward the medical system, dashed hopes around having a “perfect” birth, and anxiety around what the future brings are common here, as well as deep concerns around bonding with the baby. Some medical settings, such as the Monroe Carell Jr. Children’s Hospital at Vanderbilt University, employ creative arts therapists to help ease this massive transition for both infants and families. NICU music therapy, for example, focuses on providing safe and effective evidence-based music interventions to promote neurodevelopmental stimulation, increase infant rest and regulation, and provide opportunities for caregiver bonding. Research has shown that creating and singing lullabies also promote overall family well-being by supporting maternal health, early child development, and the attachment between parent and child. #nicuawareness #perinatalmentalhealth #creativeartstherapy Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original photograph by Gabriel Tovar via Unsplash Doctors are now “prescribing” activities such as museum visits, nature walks, volunteering, book clubs, and expressive arts practices as a more holistic approach to wellness. In the UK and some parts of the US, “social prescribing” has become integrated into medical practices to combat isolation, loneliness, and somatic responses to stress. These symptoms are often exacerbated for those in helping/caregiving professions due to burnout syndrome and a kind of desensitization that can develop as a way to cope with chronic exposure to high levels of stress and demand. A recent Harvard Public Health newsletter quotes a London-based physician named Giurca who champions this model of care: “Instead of a health care model based entirely on pills and procedures, where doctors ask patients, ‘what is the matter with you,’ this concept makes a paradigm shift to asking ‘what matters to you.’” This person-centered approach is highlighted in the HHArt of Medicine program via NYC Health and Hospitals and the Whitney Museum of American Art, which fosters the emotional well-being of its staff to promote healing and wellness for patients, families, and caregivers. Since countless studies reflect how expressive arts engagement can improve mental health outcomes, The Arts in Medicine department utilizes visual, literary and performing arts programming throughout the Health + Hospitals system. Yesterday’s Art-Centered Practice workshop invited hospital staff members from various departments to engage in mindful observation of a mural installation on the first floor by abstract painter Helen Frankenthaler, followed by an open studio process approach to art-making and reflective writing as a form of self care. One participant shared how she had neck pain at the beginning of the session, and has been struggling with a number of personal health issues. While experimenting with the wet media inspired by the mural downstairs, she realized that it only took one stroke of a paint stick to fill her entire page with color if she also added water. The resulting image was bursting with warmth, and evoked feelings of “wholeness” for her. By the end of the session, her neck pain was gone. Her creative process had reminded her of her own personal resourcefulness and resilience, which she felt on a physical and emotional level. Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Workshop Photos courtesy of Titus Rawle  Healing is not linear. Or always visible. But we can still trust it’s happening. This is especially true when we are living in an Age of Anxiety, when public health and environmental variables compound everyday stressors and push our cortisol levels to new heights. In the northeast US, last week’s smokey skies and corresponding lockdown likely triggered some lingering pandemic PTSD, especially for frontline workers or pandemic parents who were finally starting to exhale after years of white knuckling through public health alerts. Ecological anxiety rooted in concern about climate change is well warranted, but it is also easy to get swept up into cognitive distortions around a projected dystopian future for our children when it looks like we’re living on planet Mars. Whether we’d like to admit it or not, we are highly sensitive beings, heavily influenced by both our internal and external worlds. So, how do we take a deep breath, relax, and trust everything will be ok when the air we breathe is not necessarily safe anymore? When we need to dig deep and turn inward for strength, our own imaginations are rich terrain to cultivate grounding, mindful practices. When my mind starts to dwell in dark caves of fear or unknowns, I like to transport myself into calming, sensory scenes with ocean waves lapping against the shore, water trickling over smooth stones in a clear, cool stream, or leaves lazily dancing in a breeze. I find solace in the way nature’s cycles silently and steadily carry on with the passing of time. Indeed, after two days of hazy skies here in NYC, the winds dutifully cleared out the smog, allowing the summer sun to peek through again. But those dark days offered an eerie reminder of pressing ecological issues we can no longer ignore, as well as our own vulnerability as humans. It takes a certain level of trust, in oneself and the world at large, to learn to take comfort in the transience of all things, the constant movement of time, the fact that everything eventually passes. A similar outlook leads to better outcomes in therapy, too. Managing expectations around what growth will look or FEEL like in therapy is so important when one is really in the nitty gritty of the work. We all want the magic formula to instantly feel better and the gratification or public recognition of our measurable progress. But in reality, engaging in an ongoing therapeutic relationship is a highly individualized, private process. Often only the therapist and clients bear witness to positive personal change–regardless of how big or small– with hopes that this will translate outside of session. It can feel different session to session, sometimes like “two steps forward, one step back,” or a “”progression/regression” scenario, where there may be a personal breakthrough one week, followed by exacerbated symptoms or an increase in triggers the next. Yet this is still healing. Regardless of whether one is engaged in ongoing therapy due to physiological, spiritual, sexual, psychosocial, or emotional concerns, the journey is a hard, but noble one. We all need to remember to breathe as we continue to navigate this ever-changing world–together and on our own. Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original Photo by Patrick Ryan via Unsplash   Although the status of the nation-wide public health emergency due to the COVID pandemic was recently downgraded, a physical and mental health crisis in this country remains. Post-pandemic staff shortages in medical institutions around the US speak to the growing gap in care, in large part because employees no longer feel safe–financially, physically, or emotionally–in these high-risk, frontline, demanding positions. In response, the Whitney Museum of American Art has recently partnered with NYC Health and Hospitals agency in offering Art in Medicine workshops for all public hospital employees inspired by artwork on loan from the museum’s collection. The hope is that by developing an “art-centered practice” infused with mindful art observation and creation, employees can develop self care and stress management skills that will help combat burnout syndrome on the job. Yesterday, inspired by the warmer weather, shifting landscape of the pandemic, and a piece of mixed media art by artist Howardena Pindell, participants were asked to creatively explore the theme of “layering.” They were provided with a range of collage and drawing supplies to engage in an Open Studio Process method of creative writing, artmaking, and self-reflection on their personal exploration of metaphorical layers they wish to examine, keep or shed. The hospital employees in attendance represented various departments within the institution, together creating their own mosaic of different personal experiences and approaches. As they played with, experimented, and engaged in the tactile properties of the materials, self compassion, creative problem solving, and positive perspective-making were emphasized. One participant remarked that she wished she had clear tape so that she could layer her tissue paper pieces in a specific pattern, and a colleague playfully reminded her to “get creative” in finding another way to create the same effect with the materials at hand. Another participant created a vibrant tissue paper flower that blossomed off the page out of the “concrete” below, with each petal representing a layer of herself she wanted to preserve and honor. Next, a volunteer shared that she first wrote all about how much responsibility she has and the crushing weight of these burdens. She then began making art and exploring the materials at hand, having “no idea what she was doing.” In the end, she realized that she was “playing” in her artwork through her swirling lines and pops of color, which is what she needed most. Their experiences represent a kind of parallel process that can happen when creating intuitively and having one’s inner experience mirror the outside world. Pediatrician and psychoanalyst D.W. Winnicott writes, “It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self.” It was a true joy to witness others in their creative processes of discovery yesterday. Post and Photograph by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C  Happy Maternal Mental Health month! Early records by Hippocrates from around 500 BC mention birthing women suffering from “agitation” and “delirium” in the perinatal period. Later medical documentation from the 14th century called it “madness” which evolved into “melancholy” and “hysteria” in the 16th century. Hundreds of years later, the field of perinatal mental health was born, finally adopting a feminist, person-centered, evidenced-based clinical lens to address what is now called perinatal mood and anxiety disorders (PMADs).
Art therapy is an integrative mental health profession around since the 1940’s, (though humans have of course been using art as therapy since our cave painting days.) It incorporates trauma-informed, sensorimotor-based practices that can be extremely effective in supporting birthing people in coping with challenges along their family building journeys. The powerful intersection of these fields is only recently being written about, with this groundbreaking text "Art Therapy and Childbearing Issues" edited by Nora Swan-Foster at the top of the list. Grateful for the fellow unicorns, movers, and shakers who are paving the way in developing innovative, compassionate, and creative maternal mental health care. It’s about time! #perinatalarttherapy #pioneerwomen #maternalmentalhealthmatters Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C  Today is World Maternal Mental Health Day, first established in 2014 to draw awareness to the many socio-emotional challenges perinatal families face. 1 in 5 birthing people and 1 in 10 partners worldwide experience a perinatal mood or anxiety disorder (PMAD) during pregnancy or postpartum, and yet only 25% of those struggling receive treatment.
There are a kaleidoscope of reasons why new parents don’t seek out help and end up suffering in silence, including stigma around mental health issues and lack of education, awareness, and routine screenings to assess maternal mental health risk factors. There are also more nuanced reasons perinatal people often don’t disclose the extent of their suffering to loved ones or professionals. Author, therapist, and perinatal mental health pioneer Karen Kleiman MSW, LCSW highlights the “ambiguity” factor during this massive life stage transition: “because moods and other internal experiences are expected to fluctuate following childbirth, women sometimes decide it is best to brave any discomfort and hope it goes away by itself.” Often birthing people end up “white knuckling” it through this period on their own as a result, despite the fact that “research literature consistently demonstrates that communities with strong social support provide shelter and yield lower rates of postpartum depression.” Shame around being judged as an “unfit, ungrateful, or bad” caregiver also heavily influences how much is shared, if any. And yet, especially with anxious, obsessive, or depressive thinking, the critical inner voice only gets louder when extreme distress is avoided, denied, or repressed. Kleiman reminds us, “Depressive thinking can inhibit attempts to deal appropriately with scary thoughts by distorting or exaggerating the possible outcomes of disclosing.” Fears that they are alone in their experience, will be labeled as “crazy,” or become institutionalized or separated from their baby against their are powerful shame-based rationales for avoiding treatment. Above all, deeply embedded societal messages around motherhood being “the happiest time in a woman’s life” create an environment of toxic positivity where any presence of negative thoughts or feelings becomes taboo or forbidden. Only when the full spectrum of experience around this vulnerable life stage is accepted and shared freely will those struggling feel safe enough to seek help when they need it most. Let’s start today. #maternalMHmatters Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Excerpts adapted from from Kleiman (2010) Dropping the Baby and Other Scary Thoughts. Original Photograph by Kelly Sikkema via Unsplash The World Health Organization just released a new report that coincides with National Infertility Awareness Week. Almost 18% of the global adult population–which averages to 1 in 6 individuals worldwide–are impacted by infertility in their lifetime, regardless of biological sex, socioeconomic status, or location. Generally speaking, infertility is defined as being unable to conceive after one year (or longer) of unprotected sex. Some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex, since fertility in females is known to decline steadily with age. While infertility affects males and females at nearly equal rates, it is often associated with a women’s health issue, which can be both isolating and frustrating. Dr Tedros Adhanom Ghebreyesus, Director-General at WHO reflects, “The report reveals an important truth: infertility does not discriminate. The sheer proportion of people affected show the need to widen access to fertility care and ensure this issue is no longer sidelined in health research and policy, so that safe, effective, and affordable ways to attain parenthood are available for those who seek it.” “Subfertility” generally describes any form of reduced fertility with prolonged time of unwanted non-conception, in other words–taking longer to conceive than hoped or planned for–which is an incredibly common, yet still taboo, scenario for those on their family building journeys. Struggling with infertility is also a risk factor toward developing a perinatal mood and anxiety disorder (PMAD) later on, due to emotional distress and social stigma that it can carry, along with the financial burden of high out of pocket costs of assisted reproductive technology like in-vitro fertilization (IVF). Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO states, "Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and all too often, a medical poverty trap for those affected.“Better policies and public financing can significantly improve access to treatment and protect poorer households from falling into poverty as a result.” Clearly, there is an urgent need to increase both awareness and access to affordable, high-quality fertility care for those who seek it. Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original photo by Everton Vila via Unsplash   Today I had the incredible opportunity of facilitating an arts-based wellness workshop for the Education department at the Whitney Museum of American Art. As we creatively explored the behavioral, physical, and professional hazards of chronic stress, themes of playfulness, nature, and connection to others emerged during the writing and art-making components. Pablo Picasso said it best: “Art washes from the soul the dust of everyday life.”
The use of art as therapy has countless benefits for one's overall well-being. Creating “art for art’s sake” is an exercise of self-care that can cultivate self-compassion and aid in healing. Art making in a safe space can provide a non-threatening way to access feelings that may otherwise be too overwhelming to name through language alone. The organizing, containing, and stress-reducing effects of art making can alleviate free-floating anxiety and build self-esteem through helping one to develop a sense of mastery over the successful completion of an art project that is within one’s control. Feelings of self-worth are also cultivated through challenging oneself to learn new and take healthy creative risks. Feelings of hopelessness and depression are countered with opportunities to “produce” something of personal value. Creative problem solving is encouraged through artmaking and the use of unfamiliar art media, as well as reframing perspective when observing the art product, which helps foster a more positive outlook; this is a key component of creative resilience. In a group context, the relational component of having another person witness a creative process or product can reduce feelings of isolation, foster connection, and help one feel seen and validated. From a humanistic perspective, a new social identity as “Artist” can be fostered as opposed to more fixed roles which alleviates the effect of role fatigue that is so common when experiencing burnout syndrome. #artastherapy #wellnessworkshop #burnoutprevention #stress #artheals #creativeresilience Post and artwork by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C  It’s not easy to practice what we preach. As a working mama of 2 supporting other caregivers for a living, it’s hard to find the time/energy/motivation/space/art supplies/etc etc etc to engage in any kind of regular art-making practice like I used to. Today I was inspired to create a response piece after a perinatal art therapy session to help me process the complexities of the case. I grabbed a piece of cardboard left over from a package, cheap paint pens I had previously forgotten about, popped on my headphones and let myself go for 15 minutes. That’s all I needed. This is what emerged.
My clinical training as an art therapist frequently involved creative processing to integrate and explore complex case material, and I’m grateful that this technique remains so intuitive and accessible whenever I need it. Just like my breath, my art practice is always there for me whenever I need fresh energy, a release, or grounding. #processoverproduct #arttherapylife #momtrepreneur #selfcare #mindfulart #nurturingthenurturer Post and artwork by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C |
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