Portraiture as Therapy – Dr Paul Farrand, Medical Psychologist

Conventionally, art therapy combines the disparate discipline of art and psychotherapy in treating patients with a range of psychological problems.  Whilst disagreement still exists as to its theoretical assumptions, the practical emphasis is usually placed upon the art therapist in facilitating the production of art by the patient.  The main aim of this process is to promote catharsis within the patient, that is, to allow the patient to release emotions which otherwise may prove difficult for the patient to discuss.

Using portraiture as a form of art therapy, however, is both unique and innovative.  Rather than the emphasis being placed upon the patients producing their own artwork the production of the portraiture was left entirely to the artist, Mark Gilbert.  Irrespective of this, a research study devised to examine the nature of any psychological benefits arising from the project produced results which were surprising.   The research study used a semi-structured interview in which patients’ responses were taped and transcribed so that they could be coded and later analysed by computer.  Questions were derived from previous research which identified the particular types of psychological problems experienced by patients  who have had surgery on their faces, whether for facial cancer, as a result of assault or accident or to improve the function of certain regions of the face, particularly the jaw.

Overall the results of the study reveal that the project has brought numerous and often very idiosyncratic benefits which varied according to the patients’ personal characteristics and the nature of the surgery.  Several benefits to patients arise from viewing their portraits together with other painted images of their surgery a better understanding of what they have been through is achieved.  This often helps reinforce the true extent of the surgery they have undergone, and sometimes surprises them when they discover precisely what had to be done.  Interestingly, knowing the true extent of the surgery has enabled some to adopt a “fighting spirit” towards the future, which can be harnessed to deal with further cancer surgery, or just the everyday problems life throws at us all.  Encouragingly, this state of mind has tended to produce a better prognosis in patients diagnosed with certain forms of cancer.

Looking at the actual portrait itself also enables patients – predominantly those who have had surgery to correct facial function which has also dramatically improved facial appearance – to adjust psychologically to their new appearance.   Often patients with facial disfigurement have difficulties reconciling differences they believe to exist between their appearance and their personality.  Seeing their post operative portraits however has provided these patients with an image of themselves which matches the image of the person they have always believed themselves to be.  Interestingly, the view was often expressed that standard photographs did not serve the same function.  Whilst these captured the physical characteristics of the patient they did not capture the patients personality.

Common to many patients are the ways in which photographs of the portraits are used as “tools” to facilitate better coping strategies.  For example, one patient carries a wallet containing photographs of his portraits.  In the event of people staring at him in public the wallet is produced to engage them in conversation about his surgery and resultant appearance.  This method of coping known as “intellectualisation”, allows this patient to take on the role of an expert regarding his own surgery thus enabling him to talk about his surgery whilst remaining more detached.  In a similar manner another patient uses a photograph of his immediate post-operative portrait to deliberately facilitate discussion with family and friends about the violent assault he had experienced, a topic of conversation that would otherwise be deliberately avoided.

A further benefit from the portraiture is similar to that derived for a therapeutic counselling relationship which has by necessity to be based on mutual trust.  The portrait sittings appear to have been instrumental in establishing precisely this kind of relationship between patient and artist.  Patients reported how easily they were able to talk to Mark, initially about everyday things but during later sittings also about issues related to their surgery or the effects of their disfigurement.  Whilst Mark was obviously not involved in counselling the patients, as a result of the portrait sittings he was able to offer time as a “safe” space in which to discuss their concerns and experiences.

Finally, a benefit unanimously expressed was related to the exhibition of the portraits.  The patients expressed a strong desire to have their portraits exhibited to help educate the public about the nature of facial disfigurement.  Research has consistently shown that we are all guilty of making a series of assumptions based on facial appearance.  Generally the more attractive someone is believed to be the more positive the characteristics associated with them.  Conversely, the less attractive or disfigured are associated with negative attributes.  By exhibiting the portraits the patients hope that those who view them will begin to see the person beyond the appearance.  It is hoped that this will begin to challenge the negative associated with facial disfigurement and reduce discrimination that many facial patients believe exists.

Irrespective of the benefits, the use of portrait painting as a means to help patients with psychological problems is likely to be limited.  As an intervention it would prove far too time-consuming for the patients and expensive to be of widespread clinical benefit.  However in an age where science is seen as offering the best and only way through which to treat patients, the widespread benefits derived from the portraiture suggest that along with scientific advances, art, in its many guises, can also make a significant contribution.

March 2004- Info about Saving Faces