This pilot programme offers brief and long-term art psychotherapy to support individuals with a diagnosis of type 1 diabetes. Subjects received individual and group therapy sessions, depending on their therapeutic needs, and explored themes of self-esteem and identity, as well as coping mechanisms. The preliminary results of this study show a significant reduction of Hba1c scores compared to the control group.
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The innovation was the introduction of an art psychotherapy programme to the paediatric and adolescent cohort. The programme consisted of 12 patients receiving either individual or group therapy sessions. Depending on the patient’s needs, a brief intervention was offered (1-6 sessions) or an intensive set of sessions (up to 20). The themes and directives of every session would address the issues of identity, control, self-esteem, coping mechanisms and expression of emotions in a safe and confidential manner. Although the emphasis was on diabetes management and care, the psychosocial aspect of living with the illness was the centre point of the work and yet no issue pertinent to the client was circumvented. The focus was to examine the established defence mechanisms, coping strategies and issues with self-esteem. The therapeutic relationship coupled with the art-making in the sessions could then provide opportunities of reparation and restoration of the patients’ sense of control and self -perception that in turn could provide increased self-management of their diabetes. The patients knew and agreed to the terms of therapy and were aware that it was a confidential service. Prior to this intervention, the paediatric cohort had no on-site psychological support available to them either as an inpatient or an outpatient. The team consisting of three consultant paediatricians, three DNS’s, one dietician and one trainee art psychotherapist developed and structured a referral system to this pilot service. This programme of art psychotherapy was the first of its kind to be delivered to the patients with type 1 diabetes within this medical setting. It provided group or one-to-one support, the patient attended the art therapist weekly and the progress of the sessions would be fed back to the MDT. The Hba1c scores were measured pre-and post-sessions and a significant improvement was seen in the cohort selected compared to a control (10) group that received no art therapy. The objective was to offer a service that would facilitate the improvement of both mental and physical health in a combined therapeutic programme.
The delivery of the art therapy sessions were offered weekly for the patients referred to the service. A number of sessions were decided based on the therapeutic needs of the client. The inclusion criterion for patients was the age range of between 10-17 years of age who presented with a poor diabetes management and Hba1c score. The sessions would range from 1 to 20 sessions over a period of weeks and months. The Hba1c would be measured and recorded to see any change pre- and post-sessions. The art therapist would work directively or non-directively depending on the client’s needs and presentation. The group therapy sessions took place weekly for eight weeks with adolescents. The themes and directives were focused on identity, diabetes management and normalisation of the illness.
Patients who participated in the art therapy programme significantly reduced their Hba1c scores compared to the control group that received no art therapy intervention. They complied and adhered more to their diabetes care and this was seen through their scores and attendance and engagement in the clinic. This was seen in their baseline Hba1c scores and post session Hba1c scores. The programme was offered as a brief therapy to the patients or if needed, a longer set of sessions would be offered. In terms of effectiveness, the Hba1c scores highlight that the brief therapy intervention produced better compliance and adherence with a short time frame (six weeks). The usual referral system and process into a community mental health team would have a lengthy waiting list time. The therapist in this setting was on site and could see a patient immediately if necessary and within a short time after the initial referral.
Sustainability and Spread
The programme offered to the individual and group can be reproduced and replicated to this demographic in a similar setting. It would be recommended similar to other psychological studies of its kind to run a parent support group alongside it. This would ensure that all parties involved felt supported and heard and would increase uptake, attendance and participation.
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