Atlas›Domain VIII · Creative & expressive arts therapies›Guide 036
Guide VIII-036

Sanatorium art therapy

Adrian Hill1938Midhurst, Sussex, England
A 46 · L 37 · M 1710 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Adrian Hill's sanatorium practice as described in Art Versus Illness: A Story of Art Therapy (London: George Allen & Unwin, 1945; 2nd edition 1948). Status: no readable text of Art Versus Illness or Painting Out Illness (1951) is publicly available (the Wellcome copy of the 1945 book is in closed stores; its record gives 100 pages, subject "Occupational Therapy"), and Hogan (2001) and Waller (1991) are used here only through pages that cite them, so the detail of Hill's own procedure is [uncertain]. What was verified: the 1946 British Journal of Nursing review of the book; Hill's 1938 start and the Red Cross picture scheme (Wikipedia and a biography citing Hogan and Waller); and Edward Adamson's Netherne work, from the Wellcome catalogue of his papers, a BAAT/Wellcome article and two Outside In essays. Still unverified: the exact year occupational therapy began at Midhurst, how much Hill actually taught, and the content of both books. The modern adaptations given here are marked [synthesis]. [source: BJN 1946 review; Wellcome catalogue records; Wikipedia "Adrian Hill", "Art therapy"; Les Ruches d'Art biography; Wellcome PP/ADA; O'Flynn & Trainor 2019]

This is a historical practice, not a current manualised therapy. Adrian Hill (1895–1977) was a painter and a former war artist, not a clinician. He was being treated for tuberculosis at the King Edward VII Sanatorium in Midhurst, Sussex, in 1938. While there he drew objects within reach of his bed and found that this helped his recovery. The review reports him as saying it helped "set the pendulum in motion again". When occupational therapy was introduced at the sanatorium, the resident occupational therapist asked him to give simple drawing and painting lessons. These went first to service casualties and then to civilian patients, especially those for whom other crafts held little appeal. The sources date this differently. Wikipedia and a biography that cites Hogan (2001) and Waller (1991) both give 1939, "a year later" than his own start. The contemporary 1946 review gives 1941. The secondary histories favour 1939; the date is [uncertain]. Hill is credited with coining the term "art therapy" in 1942. With the British Red Cross Society he also ran a picture library that lent reproductions of famous paintings to hospital wards, mainly in TB sanatoria at first, and provided talks about them. By 1950 the scheme reached nearly 200 hospitals, with a waiting list. The National Association for the Prevention of Tuberculosis and the Red Cross also funded artists to work in hospitals. [source: Wikipedia "Adrian Hill"; BJN 1946; Les Ruches d'Art biography citing Hogan 2001] The continuation: Edward Adamson at Netherne. Adamson was an artist who had served as a medical orderly in the war as a conscientious objector. After the war he worked with Hill on the Red Cross Picture Library and was among the first to take it into long-stay mental hospitals. In 1946 Netherne Hospital in Surrey employed him, part-time at first; he was the first artist employed in the NHS. He stayed until he retired in 1981, and the works made in his studios form the Adamson Collection, now at the Wellcome Collection. [source: Wellcome "Papers of Edward Adamson" PP/ADA; Wikipedia "Edward Adamson"]

Core idea of change (Hill's own account, as reported): making art occupies a long-term, bedbound patient in a way that counters lethargy, boredom and distress. Hill wrote that its value lay in "completely engrossing the mind (as well as the fingers)" and in "releasing the creative energy of the frequently inhibited patient". This let the patient "build up a strong defense against his misfortunes". [source: Hill 1945, quoted in Wikipedia "Art therapy" citing Hogan 2001 and Dannecker 2003] He held that looking at good pictures on the ward also helped recovery. He had a quasi-spiritual theory, which is his own and not established fact: when physical resistance is at its lowest, the "animal ego" goes quiet and a "spiritual essence" becomes creative, and this creativity tends to fade back into the "pictorial commonplace" as the patient recovers. [source: Wikipedia "Adrian Hill", summarising Hill 1945]

What survives today.

  • The term "art therapy" and the British profession it seeded. BAAT was founded in 1964. Hill was later its president, and Adamson was instrumental in founding it and was briefly its first chair. The profession moved towards psychoanalytic and psychodynamic "art psychotherapy". Hill disagreed with that turn, and Adamson later withdrew from it. [source: Wikipedia "Adrian Hill"; Wellcome PP/ADA; Barham, Outside In]
  • Hospital picture-loan and arts-in-health programmes. The best known today, Paintings in Hospitals, was founded separately in 1959; its own history does not cite Hill. [source: Wikipedia "Adrian Hill"; Paintings in Hospitals "Our story"]
  • The Adamson Collection of Netherne patients' work. The Wellcome catalogue gives about 5,500 works and Wikipedia about 6,000. Most of it was deposited at the Wellcome Library by 2013. [source: Wellcome PP/ADA; Wikipedia "Adrian Hill"]
  • Bedside and ward art activity in medical, rehabilitation and palliative settings [synthesis].

Professional frame: No regulated profession of "sanatorium art therapy" exists. In the UK, "art therapist" and "art psychotherapist" are protected titles. They require an HCPC-approved master's degree (two years full-time or three years part-time) and HCPC registration, and using the title without registration is a criminal offence under the Health Professions Order 2001. A psychotherapist who is not HCPC-registered may offer drawing or picture-viewing as an adjunct within their own competence but must not call it art therapy. [source: BAAT "How to become an art therapist"; BAAT "'Art therapist' as protected title"] Elsewhere the national credentials apply, for example AATA/ATCB in the USA.

2. Framework

No phases, session counts or progression criteria were found in any source opened [uncertain]. The book's chapters "The Personal Approach" and "The Psychological Problem" are named in the 1946 review, but their content is not drawn on. What follows is (A) the historical course reconstructed from the sources and (B) an adapted structure for a psychotherapist today, which is [synthesis].

A. Historical course at Midhurst (reconstructed) [source: BJN 1946; Wikipedia "Adrian Hill"]

  • Setting: a tuberculosis sanatorium. Patients were bedbound or ambulant ("up" patients). Art was offered under the new occupational therapy department.
  • Entry: referral through the occupational therapist. Art was offered especially to patients who did not take to other crafts. The review mentions no formal selection beyond this.
  • Format: simple drawing and painting lessons for a mixed group, from complete beginners to professional artists, drawn from many occupations. Bedside work followed Hill's own start of drawing objects near the bed.
  • Parallel strand: weekly lectures on old masters and modern painters. Prints were shown and then hung so that bed patients and up patients could both study them. Pictures were changed often.
  • Duration: open-ended for the length of the sanatorium stay. The sources give no number of sessions [uncertain].
  • End point: none was defined. Hill observed that creativity tended to fade as patients recovered.

B. Adapted structure for today [synthesis]

  1. Medical and practical check (session 1). Goals: learn the patient's energy, breathlessness, positioning, infection-control rules, hand function and prognosis; agree the aim (occupation, morale, expression) and say plainly that this is not a medical treatment. Move on when the patient consents and the care team has no objection.
  2. Absorption phase (roughly weekly 20–45-minute bedside or small-group sessions, length set by fatigue). Goal: sustained, engrossing making, such as drawing near objects or simple painting. Move on when the patient can begin a piece unaided, or asks to work between sessions.
  3. Expression and viewing phase. Goals: freer self-expression, chosen subjects and looking at pictures together. Keep it open-ended through the admission.
  4. Transition or discharge. Goals: plan ongoing creative activity, such as community art or social prescribing, and anticipate the waning of creative drive that Hill reported on recovery. If psychological distress emerges, refer to an HCPC art psychotherapist or continue it in your own psychotherapy.

3. Guiding principles

Sourced items are tagged. Their practical translations are [synthesis] unless stated.

  • Engross mind and fingers. [source: Hill 1945 via Wikipedia "Art therapy"] Choose tasks absorbing enough to fill time and attention, not merely to decorate it.
  • Release inhibited creative energy. [same source] Assume most patients can make something, and lower the barrier to starting.
  • Build morale against misfortune. [same source] The aim is resilience during long illness, not insight or a cure.
  • A personal approach to the lethargic patient. [source: BJN 1946, naming Hill's chapter] Engage each patient individually, especially apathetic ones, before expecting group work.
  • Open to every level of skill. [source: BJN 1946] Beginners and trained artists can share a session, so pitch help to each person.
  • Self-expression as the goal. [source: BJN 1946] Encourage the patient's own subjects and style rather than correct copying (the degree of technical teaching Hill used is [uncertain]).
  • Looking at art is therapeutic too. [source: Wikipedia "Adrian Hill"; BJN 1946] Bring good images into the room and talk about them, not only making.
  • One picture at a time, changed slowly. [source: BJN 1946 reviewer citing Nightingale's Notes on Nursing; not confirmed as Hill's wording] Rotate a single image rather than cluttering the bedside.
  • Psychological repair matters as much as physical repair. [source: Wikipedia "Adrian Hill", on Hill's view of war damage to "minds, bodies and hopes"] Address morale alongside medical care.
  • Hill's "spiritual essence" theory is his own belief, not fact. [source: as above] Expect creative output to vary with illness and recovery, without promising any mechanism.
  • No interpretation from the therapist. This comes from Adamson's later Netherne lineage, not Hill. Adamson called interpretation "the therapist's own projections". [source: Wikipedia "Edward Adamson"] Listen to the patient's account of the work and do not read meaning into it.
  • Do not read artwork as evidence of recovery or of a disorder. [source: Wellcome "Ron Hampshire" article, on Adamson's contested reading of a patient's stylistic progress] Treat changes in style as the patient's to explain, never as diagnostic data.
  • An adjunct within medical care. [synthesis] Art never replaces medical treatment. Coordinate with the ward team.

4. Intervention inventory

The sources name the activities but give almost no step-by-step procedure. Each entry therefore separates History (what the sources report) from Steps today, which are [synthesis] for a non-art-therapist psychotherapist working with medically ill, long-stay or bedbound clients. Materials and physical safety for all items [synthesis]:

  • Use non-toxic, water-based media: pencils, charcoal, soft pastels with a fixative used away from the patient, and watercolour.
  • Avoid solvents and turpentine near breathless or respiratory patients, aerosols, and craft knives where self-harm risk or poor hand control exists.
  • Follow ward infection-control rules: single-patient packs or wipeable kits, no shared water pots between infectious patients, and clean surfaces and boards.
  • Use a bed table or lap board and check position and fatigue.
  • Get nursing clearance before hanging anything on walls.

4.1 Bedside drawing of near objects

  • History: Hill's own starting point. As a TB patient he drew objects within reach of his bed and felt this restarted a sense of time moving. [source: BJN 1946; Wikipedia "Adrian Hill"]
  • Purpose / when: a first, low-demand activity for a bedbound, bored or apathetic patient with limited energy.
  • Steps today: (1) Check energy and positioning, and set up a lap board. (2) Offer a soft pencil and small paper. (3) Ask the patient to choose one object in view, such as a cup, a flower or a hand. (4) Suggest looking more than drawing, and say there is no right result. (5) Stop before fatigue sets in, usually 10–20 minutes at first. (6) Leave materials if the patient wants to continue alone. (7) Next time, look at the drawing together and ask only what the patient wants to say about it.
  • Example language (illustrative): "Pick one thing you can see from the bed, anything, and just follow its edges with the pencil. It doesn't need to look right."
  • Watch for: breathlessness or fatigue; frustration about skill (see 5.2). It is working if the patient loses track of time, starts unprompted between visits, or reports the day passing differently. [synthesis, based on Hill's "engrossing" aim]

4.2 Simple drawing and painting lessons

  • History: given at the occupational therapist's request to patients for whom other crafts held little appeal, first service casualties and then civilians. [source: BJN 1946; Wikipedia "Adrian Hill"] The sources say only that Hill was "invited to teach drawing and painting" and that he shared his skills and experience with other patients. [source: Wikipedia "Adrian Hill"; Les Ruches d'Art biography] Hill also wrote practical instruction books on watercolour and drawing (for example On the Mastery of Watercolour Painting, 1939), but none of the sources says he used them on the ward. How much technical instruction he gave, and whether patients copied from models or prints, is still [uncertain]: this would be answered by Art Versus Illness and Painting Out Illness, neither of which could be opened.
  • Purpose / when: to build enough skill and confidence that making becomes absorbing rather than discouraging, for patients who want "to learn to draw".
  • Steps today: (1) Ask what the patient would like to be able to do. (2) Teach one simple thing per session, such as light and shade on one object, a watercolour wash or a mixed colour, demonstrating on your own sheet and never on theirs. (3) Let them try it on a subject they choose. (4) Praise effort and looking, not the result. (5) Keep the next step small. Only teach within your own art competence. If you are not an artist, say so, and learn alongside the patient or bring in a hospital arts practitioner.
  • Example language (illustrative): "Want to try one trick today? Darker on the side away from the window, that's all."
  • Watch for: lessons turning into performance or judgement; the patient deferring to you for every mark. It is working when the patient sets their own next step.

4.3 The personal approach to the lethargic patient

  • History: Hill's chapters "The Personal Approach" and "The Psychological Problem" describe how to encourage lethargic patients to take up art as self-expression. Many discovered talents they had not known of. [source: BJN 1946] The specific methods in those chapters are not drawn on [uncertain].
  • Purpose / when: engaging the apathetic, withdrawn or low-mood long-stay patient who declines activity.
  • Steps today: (1) Visit individually and briefly, without pressure. (2) Show materials or a picture rather than describing art therapy. (3) Offer a tiny, optional task, or offer to draw something the patient mentions (see 4.9). (4) Accept a "no" and return another day. (5) If low mood is marked, assess for depression and risk using standard practice. Art does not replace that assessment.
  • Example language (illustrative): "I've left a pad and pencil here. No pressure. If you're bored later, it's yours."
  • Watch for: apathy that is a sign of medical deterioration or depression; feelings of obligation. It is working when the patient picks up the materials on their own.

4.4 Mixed-ability group session

  • History: Hill's classes mixed complete beginners with professional artists from many occupations. [source: BJN 1946]
  • Purpose / when: for ambulant or semi-ambulant patients, where social contact on the ward is itself a goal.
  • Steps today: (1) Set ground rules: no comparing, no comments on others' work unless invited, and confidentiality. (2) Offer a shared starting point, such as a still life or a print, with freedom to depart from it. (3) Circulate and pitch help to each person. (4) Close with an optional show-and-tell where only the maker speaks first.
  • Example language (illustrative): "Everyone starts from the same jug, and where you take it is up to you."
  • Watch for: skilled members intimidating beginners; infection-control limits on grouping. It is working when members return voluntarily and talk to each other about the work.

4.5 Art-appreciation talk with prints

  • History: weekly lectures on old masters and modern painters, with prints shown and then hung so that bed patients and up patients could study them. Speakers, including Hill and later Adamson, gave talks on Red Cross reproductions, mostly in TB sanatoria at first. [source: BJN 1946; Wikipedia "Adrian Hill"; Paintings in Hospitals "41 art therapy's pioneering history"]
  • Purpose / when: for patients too unwell, or unwilling, to make art. It offers engagement through looking and conversation.
  • Steps today: (1) Choose two or three reproductions, on screen or printed. (2) Give a short context (who, when, what to notice). (3) Invite looking before talking. (4) Ask open questions about what the patient sees and likes. (5) Keep it brief and leave a print if wanted.
  • Example language (illustrative): "Take a minute with this one. What's the first thing your eye goes to?"
  • Watch for: lecturing at the patient; images whose content may distress, such as illness, death or war, for this particular person. It is working when the patient asks for more, or chooses the next image.

4.6 Hanging and rotating pictures on the ward (picture lending)

  • History: with the British Red Cross, Hill set up a scheme that lent reproductions of famous paintings to hospital wards, reaching nearly 200 hospitals with a waiting list by 1950. Prints were changed often. He had to overcome administrative and medical objections to hanging pictures on walls. [source: Wikipedia "Adrian Hill"; BJN 1946]
  • Purpose / when: to improve a monotonous care environment for long-stay patients.
  • Steps today: (1) Get ward or estates and infection-control approval, since frames must be wipeable and securely fixed. (2) Let the patient choose from a small selection. (3) Hang the picture within the patient's line of sight from the bed. (4) Agree when to rotate it. (5) Or refer the service to an institutional loan scheme (4.10).
  • Example language (illustrative): "Which of these would you most like to wake up to this week?"
  • Watch for: imposing your own taste; images becoming triggers. It is working when the patient comments on the picture or asks for a change.

4.7 One picture at a time, changed slowly

  • History: the 1946 reviewer links Hill's practice to Florence Nightingale's Notes on Nursing (1860), which advises showing one picture at a time and changing it slowly so that patients enjoy the variety. [source: BJN 1946] Whether Hill himself framed it this way is [uncertain].
  • Purpose / when: fatigued, sensorially sensitive or confused patients, for whom many images overstimulate.
  • Steps today: a single image at the bedside, rotated at an agreed interval, with the patient deciding when to change it.
  • Example language (illustrative): "Shall we keep this one up a few more days, or swap it?"
  • Watch for: agitation in delirium or dementia; it is working if the patient anticipates and chooses the changes.

4.8 Showing patients' work

  • History: Art Versus Illness was illustrated with work by Hill's patient-students. [source: BJN 1946] Adamson chose patients' drawings and paintings for group exhibitions from 1947, and in 1956 selected about 500 works for a Netherne Gallery that ran until 1981. [source: Wellcome "Ron Hampshire" article; Outside In, "The evolution and influence of the Adamson Collection"]
  • Purpose / when: recognition and mastery for patients who want their work seen.
  • Steps today: (1) Get explicit written consent for each work. (2) Let the patient choose anonymity or a name. (3) Exclude any identifying medical details. (4) Respect the right to withdraw a work at any time. (5) Never display without consent, and handle work by children under safeguarding and parental-consent rules.
  • Example language (illustrative): "Would you like this up in the day room? Totally your call, and you can take it down any time."
  • Watch for: pressure to perform; exposure of personal content. It is working if the patient feels pride without anxiety.

4.9 Conversational starting and open studio (Adamson's successor variant)

  • History: this is a successor to Hill's work rather than Hill's own method. Dr Eric Cunningham Dax, the medical superintendent, recruited Adamson to Netherne in 1946 to test two things: whether patients' art could aid diagnosis, and whether making art was therapeutic. From 1946 to about 1950–51 Adamson ran a psychiatric research art studio. He held regular sessions, passed the work to psychiatrists and discussed some of it on ward rounds. [source: O'Flynn & Trainor 2019 (BAAT); Wellcome PP/ADA; Barham, Outside In] He was not a passive facilitator. He started conversations and drew what patients talked about to draw them into making. [source: O'Flynn & Trainor 2019] After Dax left in 1951, Adamson made the studios less clinical and put the therapeutic side ahead of diagnosis. He later supervised several open-access studios where, as one account puts it, people "created without direction or interference", and he kept and dated almost everything made there. The earliest works were made with whatever was to hand (spent matches, hospital pencils, scraps of paper), so cheap, simple materials were the norm. [source: O'Flynn & Trainor 2019; Wellcome PP/ADA; Outside In, "The evolution and influence of the Adamson Collection"] He saw himself as an artist facilitating art-making rather than as a therapist, and he publicly rejected psychological interpretation of the works. He also resisted placing art therapy under occupational therapy. [source: Barham, Outside In; Wellcome PP/ADA; Wikipedia "Edward Adamson"] His unpublished notebooks, however, record his own interpretations alongside patients' insights, so the sources differ on how far he interpreted in private [uncertain]. "Minimal technical help" comes from Wikipedia and secondary accounts only [uncertain].
  • Purpose / when: patients who cannot start on their own, and long-stay settings where a regular open space is possible.
  • Steps today: (1) Keep a regular time and a space where materials are freely available. (2) Chat, and if the patient mentions something, offer to sketch it, then hand the pencil over. (3) Stay present without directing or commenting. (4) Listen if the patient talks about the work, without interpreting. (5) Agree with the patient, in writing, who keeps the work and whether it may be stored or shown [synthesis]. Netherne patients were told the hospital would keep their work, which today raises consent and ownership questions. [source for Netherne practice: Barham, Outside In]
  • Example language (illustrative): "You mentioned your allotment. Shall I start a rough shape of the shed and you fix it?"
  • Watch for: Adamson's own warning that an astute patient may "catch on" to what the instructor wants and keep supplying it. [source: O'Flynn & Trainor 2019] It is working when the patient's own subjects and style emerge.

4.10 Referral into hospital picture-loan and arts-in-health programmes (current survival)

  • History and today: Paintings in Hospitals, founded in 1959 by the almoner Sheridan Russell, lends artworks to health and community care sites across England, Wales and Northern Ireland. It holds a collection of more than 3,000 works and runs art walks, artist projects and creative activities. It merged with CW+ in July 2025, and a Government Art Collection partnership loans works to NHS hospitals. Its history does not cite Hill. [source: Paintings in Hospitals "Our story"]
  • Purpose / when: when a service, not just one client, would benefit from art in the environment or creative activity.
  • Steps today: (1) Raise it with the service lead. (2) The service applies to borrow through the charity's website (for the new programme, enquiries go to CW+). (3) Combine it with your individual work, such as choosing and discussing works (4.5 to 4.7).
  • Example language (illustrative, to a team): "There's a national scheme that lends original art to wards. Could we apply for the day unit?"
  • Watch for: confusing an arts-in-health activity with therapy. It is working when the environment changes and patients use it.

5. Handling problems

Only three problems are documented in the sources: patient lethargy, institutional objections and patients producing what the instructor wants. All the responses below are [synthesis] unless they are tagged otherwise.

5.1 Lethargy, apathy and declining (stuck or non-adherent clients)

  • Source basis: Hill treated lethargy as "the psychological problem" and answered it with a personal approach. [source: BJN 1946, chapter titles only]
  • Keep invitations small, optional and repeated, as in 4.3.
  • Switch from making to looking (4.5 to 4.7) when making is refused.
  • Before assuming the apathy is psychological, check with the medical team for deterioration, medication effects, pain or delirium.
  • Screen for depression and suicidality using standard risk assessment, and escalate through local pathways.

5.2 "I can't draw" and fear of judgement (resistance)

  • Name that beginners and professional artists worked side by side in Hill's classes. [source: BJN 1946]
  • Offer tasks with no "correct" outcome, such as tracing edges, a colour wash or a mark-making warm-up.
  • Never correct the patient's sheet.
  • Praise looking rather than the product.
  • Illustrative: "Nobody's grading this. I'm more interested in whether the time went quicker."

5.3 Fatigue, breathlessness and physical limits (overwhelm, physical)

  • Keep sessions short and stop at the first sign of fatigue.
  • Adapt the equipment:
    • thick-grip pencils for weak grip
    • pre-wet paper so less effort is needed
    • a fixed board for one-handed use
    • work in the patient's preferred position
  • Avoid dusty media and fumes with respiratory patients.
  • Coordinate timing with nursing care, rest periods and treatments.

5.4 Infection control and the medical setting

  • TB sanatoria were infectious settings. Today's equivalents include respiratory, oncology, transplant and isolation wards.
  • Follow the ward's rules: single-patient kits, wipeable boards, and no materials passed between patients.
  • Get nursing sign-off before any wall display.
  • Hill himself met administrative and medical objections to pictures on walls and overcame them. [source: BJN 1946; how he did so is not described]
  • Answer objections with concrete safety plans: secure, wipeable frames and agreed placement.

5.5 Emotional overwhelm and distressing content

  • Hill's aims were absorption and morale, not uncovering, but long illness can bring up grief, fear of death or trauma imagery in the work.
  • Respond with containment:
    • slow the pace
    • let the patient decide whether to talk about it
    • offer grounding, such as returning to drawing an object in view
    • close the session gently
  • If sustained expressive or psychotherapeutic work is indicated, either do it within your own psychotherapy competence or refer to an HCPC-registered art psychotherapist.
  • Do not use "art therapy" as a title unless registered. [source for title rule: BAAT protected-title article]

5.6 Reading too much into the art

  • Hill's theory that creativity rises when physical resistance is low and fades on recovery is his own belief. [source: Wikipedia "Adrian Hill"]
  • Adamson's reading of one patient's stylistic changes as recovery was later questioned. [source: Wellcome "Ron Hampshire" article; O'Flynn & Trainor 2019]
  • Netherne's research studio (1946 to about 1951) was set up to test whether patients' art could aid psychiatric diagnosis, and the work was passed to psychiatrists. [source: O'Flynn & Trainor 2019; Wellcome PP/ADA] Adamson himself moved away from this after 1951. No validated diagnostic use comes from this lineage [uncertain; no validity data found].
  • Never treat changes in style or content as evidence of improvement, deterioration, abuse or disorder.
  • Ask the patient what the work means to them.

5.7 Patients producing what you seem to want (pseudo-compliance)

  • Source basis: Adamson warned that an astute patient may work out what the instructor wants and keep supplying it. [source: Wellcome article]
  • Stay neutral about subject matter and avoid repeated praise of one theme.
  • Vary the starting points.
  • Ask openly: "Is this what you want to make, or what you think I'd like?" (illustrative)

5.8 Ruptures and dependence

  • Ruptures can come from comparison in a group, a careless comment on the work, or displaying work without consent. Repair them by acknowledging the error directly and returning control to the patient: withdraw the work, change the arrangement, or pause.
  • Long-stay patients may become attached to the visiting practitioner. Plan endings and discharge early (Framework phase 4) and link them to ongoing community art or social prescribing.

5.9 Loss of creative drive on recovery

  • Source basis: Hill observed creativity fading back to the "pictorial commonplace" as patients recovered. [source: Wikipedia "Adrian Hill"]
  • Normalise this ahead of time.
  • Reframe a reduced need for the activity as a sign of recovery rather than a failure.
  • Offer optional continued routes, such as classes or community arts.

5.10 Deaths and deterioration on the ward

  • This is not addressed in the sources.
  • Long-stay settings mean other patients deteriorate or die. Acknowledge losses in groups.
  • Allow work to be made for or about lost peers if the patient wishes.
  • Agree in advance what happens to a patient's artwork if they die: return it to the family or keep it, as the patient chooses.

5.11 Children and young people

  • This is not addressed in the sources.
  • Obtain parent or carer consent and the child's assent.
  • Follow local safeguarding and mandatory-reporting duties if a disclosure arises during art-making. Report what the child says or does, never an interpretation of the image.
  • Use age-appropriate materials and supervision, with no sharp tools or toxic media.
  • Get guardian consent before any display.

5.12 Boundary between arts activity and therapy

  • Hill's work sat inside occupational therapy and later fed into a regulated profession.
  • A practitioner adapting it today should be clear whether they are offering:
    • diversional or arts-in-health activity, open to anyone
    • adjunctive art use within their own psychotherapy
    • art therapy proper (HCPC-registered only)
  • State this in consent and in records. [source for registration: BAAT pages]

Sources

Pages consulted:

Books and papers cited (known via the pages above):

  • Hill, A. (1945). Art Versus Illness: A Story of Art Therapy. London: George Allen & Unwin (2nd edition 1948).
  • Winnicott, D. W. (c. 1949). Review of Art Versus Illness by Adrian Hill (2nd ed.). Reprinted in The Collected Works of D. W. Winnicott, vol. 3 (Oxford University Press, 2016). The Wellcome item catalogued as "Art Versus Illness, British Journal of Medical Psychology, 1949" in Winnicott's papers is probably this review rather than a separate paper by Hill [uncertain].
  • Hill, A. (1951). Painting Out Illness. London: Williams & Norgate [publisher uncertain].
  • Hogan, S. (2001). Healing Arts: The History of Art Therapy. London: Jessica Kingsley.
  • Waller, D. (1991). Becoming a Profession: The History of Art Therapy in Britain, 1940–82. London: Routledge.
  • Adamson, E., & Timlin, J. (1984). Art as Healing. London: Coventure.
  • Hogan, S. (2000). British art therapy pioneer Edward Adamson: a non-interventionist approach. History of Psychiatry, 11, 259–71.
  • O'Flynn, D. (2011). Art as Healing: Edward Adamson. Raw Vision, 72, 46–53.
  • Nightingale, F. (1860). Notes on Nursing (as cited in the BJN 1946 review).
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