Confusion and containment: Art therapy with an adolescent hospitalised with paediatric neuropsychiatric Systemic Lupus Erythematosus

Abstract

There is a dearth of information regarding art therapy with people diagnosed with neuropsychiatric Systemic Lupus Erythematosus (npSLE). Art therapy was an individual component of a broader consultation-liaison treatment intervention of a female adolescent who had ongoing and severe symptoms of refractory npSLE, including confusion, agitation, flat affect, echolalia, psychosis, and Parkinsonian features. She also displayed limited non-verbal and verbal communication, with her presentation differing from week to week and often fluctuating during each art therapy session. Due to the symptom manifestations of npSLE it was necessary for me to help her engage with art therapy. Each session provided freedom for expression in a safe containing space, which assisted her to manage some difficult feelings and for themes to emerge. The article reflects on some of the engagement strategies I adopted, as well as examples of containment and recurring themes. In summary, art therapy assisted to provide a space where engagement and containment were enabled, themes emerged, and a meaningful therapeutic relationship developed.

Keywords:

• Medical art therapy
• Lupus
• engagement strategies
• containment
• themes
• confusion

Acknowledgements

I would like to thank ‘Wendy’ and her parents for providing their consent to write an article and to include the artworks. I would also like to acknowledge and thank treating physicians Dr Davinder Singh-Grewal MBBS, FRACP, MMedSci and Dr Damien McKay MBBS, BAppSc(Physiotherapy), MSpMed, DipPaed. for providing the information on npSLE and Wendy's medical case history for this article. Thank you as well to treating psychiatrist Dr Kasia Kozlowska FRANZCP for her support of art therapy and for providing feedback for this article. Also, thank you to the interdisciplinary staff involved in Wendy's care, as well as my supervision group for their support. I would also like to thank photographer Paul de Sensi for reproducing Wendy's artworks (with the exception of Figures 1, 5, & 10).

Notes

1. In the computer game ‘Half-Life™’, a physicist graduate is trapped and must find, and fight, his way out of a secret underground research facility. He mostly battles the enemies alone, but is occasionally assisted by other characters.