How Should Students Be Prepared for the Replacement?
As stated above, the discourse with the students and preparing them for the replacement must take into account their age, their difficulties, their ability to accept a change and express themselves. In any case, since the replacement can bring up issues of connection, trust, abandonment and change, it is important to make preparations for the replacement. This preparation should include discussing the therapist’s departure on maternity leave and an explanation of what can be expected when the substitute arrives. It should also include information about the duration of the replacement, when the therapist going on leave is planning to return and whether there will be a change in the modality and the form of therapy (for example, transitioning from individual therapy to group therapy). In the discourse with
The Role of A rt Therapy Substitutes 221 the clients, it is important to invite them to express their feelings about the replacement. Certain clients may oppose replacement, and some of the survey respondents argued that it is important to find out what the clients want and allow them to refuse. It is important to legitimize the emotions that may arise but also to emphasize the importance of the replacement and the opportunities that it provides for a new relationship, the wonderful possibility of meeting another therapist, and another creative mode of treatment, an opportunity to see things from a new perspective and to create change. Many participants in the study suggested having a joint meeting between the student and the therapists going on leave and the substitute. Similar recommendations were suggested by clinicians, who saw the pretherapy sessions with the therapist going on leave and the substitute as an opportunity to prepare the clients for the transition (Chairamonte, 1986; Gibb, 2004; McCarty et al., 1986; Sarnat, 1991). This type of meeting can convey the mutual confidence of the therapists in each other to the student, together with the feeling that he or she is being contained and protected by them together. It can help clients accept the change. At this type of meeting, the therapeutic goals and the changing setting can be defined together. Even towards the end of the replacement period, it is important to have another meeting between the outgoing and the incoming therapists, for purposes of sequencing and continuity, and a redefinition of the goals and the setting.
How Should the Parents Be Prepared for the Replacement?
It is advisable to meet with the parents in advance to discuss what will take place when the therapist leaves and for how long, as well as informing them who is going to replace her. It is important for the parents to hear about the replacement from the therapist going on leave, and not from the student, since parents may feel anxious about the expected change. If possible, it is important for the parents to be partners in the thinking process about the replacement for their child, the expected benefits and the possible costs, in a way that will enable them to take part in the decision of whether and how the replacement will unfold. It is also a good time for the parents to look back to see what their child and themselves have accomplished so far, and to think about what they would like to do in the future. The purpose of the discussion is not only knowledge, but also to obtain parental consent, and even invite them to take part in the process, as this alliance will also be passed on to their child. It is worth engaging the parents in a discussion of ways they can support the process, and how they can mediate the transition. It can reduce the parents’ anxiety and help them get used to the change and mediate the transition to their child. If possible, the therapist going on leave should introduce the substitute to the parents. This provides an opportunity to discuss the way the substitute will work with their child, define goalstogether, and examine the setting and its suitability for the student. The parents should be informed about the new therapy plan, and if therapy will take place in a new modality that they are unfamiliar with, it should be explained as well. The parents need to hear about how they can get in touch with the substitute so that they feel they have someone to talk to, despite the fact that the therapist is going on leave. In the conversation, the transition and the separation from the departing therapist should be connected to the contents from the student’s therapeutic process.
What Important Principles Should the Substitute Implement During the Replacement Period?
The replacement period may involve reactions by the clients to the departure of the therapist. Therefore, during the replacement period there should be a place for expressing emotions such as jealousy, abandonment and perhaps detachment that can arise. The substitute can help elaborate the meaningful relationship with the former therapist by connecting between what took place, what is being experienced and the future. At the practical level, in the interviews the therapists described the ways in which they contained the passage of time for the clients. For example, some therapists made a train with carriages that symbolized the passing weeks. In addition to suggesting to the substitutes to create a continuum and continuity by referring to the regular therapist’s goals and interventions, the survey participants also recommended having a clear perception that the therapy in the replacement is not the same as the previous one, but rather a new, complementary, time-limited treatment.
As stated above, many participants in the broader study stated that the replacement, whose therapeutic intervention is limited in time, should be based on the principles of short-term treatment, focused on pre-defined goals, the issue of separation or in establishing a relationship. Sometimes the treatment will be pre-defined as maintenance care alone. At times, it is possible to maintain focused group therapy on subjects such as strengthening social skills or another structured purpose. The participants argued that it is important that the substitute be given an opportunity for the new relationship to evolve, discuss the opportunity for something new and get other points of view.
Finally, it is important that the substitutes have a commitment to get supervision and make sure that they have someone in school to consult with in case of need. It is advisable to have intense supervision especially in cases of therapists who are new to the educational system. In addition, the substitute should take part in a supervision group. It is crucial for the substitute to be assisted when he or she begins in the educational system, the new school, planning his/her therapeutic goals and when deciding on the choice of interventions. The supervision should also include technical and
The Role of A rt Therapy Substitutes 223 institutional integration to help in thinking about developing therapeutic programs and what is right or wrong in this framework. Some argued that there is no difference between a substitute and other arts therapists, but the majority noted that there is a need for a unique approach, and providing more assistance than usual for the substitutes.
The decision on an appropriate model to work with depends on the professional perceptions of the people involved. It is dependent on the substitute’s training and his/her familiarity with treatment methods. It is of course related to the needs of the clients and the system’s perception of these needs. Many survey respondents said that sometimes when the art therapist is going on maternity leave, the role of the substitute can be maintenance and emotional support until the therapist returns. Many suggested that continuation of individual therapy during brief periods of substitution may increase the feeling of abandonment, and in some situations, it is preferable for some of the clients to be offered group therapy instead. Many participants conceptualized the replacement period as a time-limited therapy and suggested that thinking about the replacement period as a short-term treatment and about appropriate objectives and interventions is the most appropriate when coping with the challenges involved in replacement. There were many proposals for working in a structured model (some of these models are described in other chapters in this book) that can include the class as a group, open studio, Group Theater, musical composition and psychoeducational projects. Some suggested that the replacement period can be a time to experience a focused therapy technique, such as Cognitive Behavioral methods, Mindfulness or more targeted goals such as improving social skills, development of playfulness or increased emotional regulation, depending on the substitute’s specialization and training.