From Practice to Pedagogy: How Lessons Learned in the Field Helped Decolonize Creative Therapies Education (De la pratique à la pédagogie : comment les leçons apprises sur le terrain ont aidé à décoloniser l’enseignement aux thérapies créatives)

Abstract

Mental health outcomes for First Nations Australians continue to decline as government spending continues to support the biomedical model. This article speaks to a decolonized model of creative arts therapy practice that could have major implications for creative therapies education. It speaks to the inherent theoretical imperialism embedded in Western theories and therapeutic practices, and proposes a way forward in navigating a currently colonized education system, while keeping true to the course’s underlying principles of social justice, equity, and connection. Two of the authors of this paper were part of a government-funded remote healing service, one as Manager and Creative Arts Therapist, the other as an Aboriginal Healer/Elder and Artist. The third author is a linguist and educator who works extensively with Aboriginal students. This article tracks how incorporating First Nations practices such as Etuaptmunk and Dadirri, while simultaneously deconstructing Western practice, paradigms, and systems, can have a profound impact on both practice and pedagogy. We take the lessons learned from working with First Nations people and communities from across remote Australia and embed them into a cocreated Creative Arts Therapies course within an Australian regional university.

RÉSUMÉ

Les résultats en matière de santé mentale pour les Australiens des Premières Nations continuent de décliner alors que les dépenses gouvernementales continuent de soutenir le modèle biomédical. Cet article met de l’avant un modèle décolonisé de pratique de la thérapie par les arts créatifs qui pourrait avoir des implications majeures pour l’enseignement des thérapies créatives. Il aborde l’impérialisme théorique inhérent aux théories et pratiques thérapeutiques occidentales et propose une voie à suivre pour naviguer dans un système éducatif actuellement colonisé, tout en restant fidèle aux principes de justice sociale, d’équité et de connexion sous-jacents au cours. Deux des auteurs de cet article faisaient partie d’un service de guérison à distance financé par le gouvernement, l’un en tant que gestionnaire et thérapeute en arts créatifs, l’autre en tant que guérisseur/aîné autochtone et artiste. Le troisième auteur est un linguiste et un éducateur qui travaille beaucoup avec les étudiants autochtones. Cet article examine comment l’intégration de pratiques des Premières Nations telles que Etuaptmunk et Dadirri, tout en déconstruisant simultanément la pratique, les paradigmes et les systèmes occidentaux, peut avoir une incidence profonde sur la pratique et la pédagogie. Nous prenons les leçons apprises du travail avec les peuples et les communautés des Premières Nations à travers l’Australie éloignée et les intégrons dans le cours cocréé Thérapies en arts créatifs au sein d’une université régionale australienne.

Introduction

Connection: If we were to choose a word that in some way underpins this story, it would be connection. We have chosen to employ a narrative style as a testimony to connection, as it is through understanding the various discourses around connection and by truly listening to these stories that we can begin to understand the cultural context and what that means for creative therapy practices, which are embedded in Western knowledges. The authors have worked in creative therapies, child protection, and education, in both urban and remote settings in several states and territories across Australia, which has afforded insights into working in the crosscultural space, which is transferable across disciplines and contexts. The models of healing and pedagogical practice proposed in this article are the culmination of many years of research that have implications for Creative Arts Therapy Education.

Context is a central concept in this paper as we begin by unpacking the current state of the mental health system and the systemic issues that adversely impact our First Nations people in the Northern Territory of Australia. We speak to the disconnect with First Nations beliefs and contexts. We explore the formation of the Turn ‘em around Healing (TeaH) model and the use of First Nations concepts of Dadirri, Etuaptmunk, and the third space as ways to deconstruct and reconstruct our practice as a decolonizing devise. This journey and the lessons learned have informed our cocreation of a decolonized creative arts therapy course, which sits within a neoliberal entrenched higher education system, and we discuss some of the challenges this presents and make suggestions as to how other creative therapies practitioners and educators may integrate decolonized approaches in their work.

Context

The Northern Territory (NT) in Australia is vast (1.42 million km²) with some 76 remote communities and over 500 homelands (outstations). First Nations people comprise 32% of the NT population, which is the largest population of Australian First Nations people on the continent. Many First Nations people in the NT live in poverty with those living very remotely among the poorest (Australian Institute of Health and Welfare [AIHW], 2022). Challenges include overcrowded housing, overpriced fresh foods, an increased likelihood of being taken into foster care and/or have contact with the justice system, higher levels of chronic illnesses, high suicide rates, and a high prevalence of intergenerational and vicarious trauma (Carson et al., 2020). When we couple these factors with the scarcity of mental health services, especially those that are culturally appropriate, it is little wonder that health outcomes for our First Nations people continue to decline. The sheer logistics of providing services to remote communities, which demands many hours of travel, with some communities becoming inaccessible in the wet season, are compounded by factors such as unacknowledged intergenerational trauma, government legislation, policies and funding mechanisms, and adherence to the biomedical model which all sit comfortably within the Western neoliberal paradigm (Moss et al., 2022; Moss & Lee, 2019). These neoliberal systems purport a confining system of control that embeds Western ideologies over methods for support and care of the needs of Indigenous peoples. While government policies are now seen to be advocating for more community input for the provision of care for First Nations Australians, it is these Western constructs that remain in place, that continue to overshadow First Nations voices and take the dominant role in shaping change.

For example, the Australian Government spent AUD$11 billion on mental health services in 2019-2020 with $566 million spent on mental health prescription drugs while no funds were directed to traditional healing modalities or community-centered healing approaches. For decades, government funding has supported therapeutic interventions that fall within the biomedical model, even in the face of worsening outcomes and ever-higher rates of suicide (Australian Government & Department of Health, 2013; Moss & Lee, 2019). The biomedical model of mental health is a disease-based model, which some argue is a form of social control (Deacon, 2013; Fitz et al., 2022; Szasz, 1962). Gilroy (2011) highlights that the underlying assumption within this paradigm is that there is a linear relationship between the diagnosis, current research, treatment, and the person being diagnosed. The Australian healthcare system’s funding mechanisms rely on diagnosis and funds certain professionals directly to deliver these services. In Australia, the biomedical model is embraced by almost the entire healthcare sector, which works to subjugate First Nations people’s knowledge, values, and beliefs (Kowal, 2008; Murrup-Stewart et al., 2019). It is even more problematic for remotely based people who have mental health issues as their choices are limited to spasmodic and limited psychiatric and psychological services. The use of many of the common interventions such as Cognitive Behavioral Therapy (CBT) has been found not to work for many First Nations people particularly in dealing with intergenerational trauma. More recently, Kowatch et al. (2019) found that CBT required cultural adaptation to be effective. Where trauma is linked to colonial ideologies being thrust upon cultures, it is arguably counter-intuitive to place these models at the center of health support practices. Durán (1990, 2019) talks of intergenerational trauma as a “soul wound” that occurs due to the accumulative effect of deep losses across generations. First Nations Australians likewise have referred to it as an “ancestorial hurt” or “soul sickness”. Traditional Healers from Central Australia (Ngangkari) explained, “When a child becomes sick or sad, it is because their spirit has gone. If a child is hit or hurt, their spirit becomes misplaced and uncentred. They lose their sense of self” (Peters et al., 2010).

Children are born with the spirit that holds itself in culture, country, and language. Suicide occurs when their spirit is broken. The concept of the spirit is intrinsic to First Nations healing and well-being and must be incorporated into healing practices. The Healing Foundation (2014) identified important factors that should be incorporated into any healing program within the First Nations context. These factors include: a recognition of past trauma, service based on local culture and values that are underpinned by community empowerment, capacity building, and social justice, the involvement of Elders and spirituality as core to the model. To Marsh et al. (2016, p. 1), “strengthening cultural identity, incorporating traditional healing practices, encouraging community integration, and inviting political empowerment can enhance and improve mental health and substance use disorders in Aboriginal populations.”

Cultural healing: Past experiences

In 2014, while the Mental Health Council of Australia recognized the urgency of reform, they also recognized that while the principles of community involvement are an accepted wisdom, it rarely happens in practice due to funding cycle requirements and key performance indicators as dictated by the funder (2014). It has been highlighted in several government reports from as early as 2004, that there is a severe lack of appropriate healing services for First Nations children who have experienced trauma, especially in remote areas (Northern Territory Government, 2007). It was out of these findings that the federal government funded a pilot to find a therapeutic model of practice that would work for these children. The service had four offices across the NT, with between 20-30 employees and was tasked with servicing over 90 remote communities as defined by the funders. The service was vigorously evaluated both internally and externally and the service received 10 years’ worth of funding, which was unusual as most funding is linked to the three-year electoral cycle. The child protection body under which the service sat, however, diverted these funds into other areas of child protection and chose to shut the service down. The lessons learned during this time had a profound impact on our future practice in supporting First Nations People.

Partnering with an Aboriginal Healer/Artist and Elder allowed for an unpacking of the theories and practices of Western-based Creative Arts Therapy within this new context. This highlighted the need to critically analyze the very foundation of Western therapeutic practice and its underlying assumptions. It speaks to the inherent theoretical imperialism within Western theories and education, which then get embedded into our “best practice” models. There have been calls in Creative Arts Therapies education to ‘unlearn’ internalized systemic racism within the education system (Comas-Díaz et al., 2019; Selvaraj, 2021), by making this ‘unlearning’ central to pedagogical practice (Selvaraj, 2021; Talwar, 2002). To do this, we needed to deconstruct and decolonize this concept of therapy, which would allow for new knowledge to emerge and future healing to occur. Even the language we used needed to be unpacked, as it too was imbued with power, so we used the language of healing rather than therapy as this proved more meaningful for the people we were working with. Basic therapeutic assumptions such as time, place, boundaries, diagnosis, and concepts of healing were all up for critical reflection as this new context highlighted new meanings and depth of understanding. The Turn ‘em around Healing (TeaH) model was developed from the research and evidence collected, which was extensive with quarterly reports to government tracking outcomes. Relationship and connection were vital with a key principle of the TeaH model being integrity built on trust, because for First Nations people, relationships underpin the success of any service (Price-Robertson & McDonald, 2011). Integrity, trust, and relationship provided the foundations for all levels of engagement (Moss & Lee, 2019). To arrive at a model that works and was transferable, what was demanded of us was to listen deeply to each other and the communities we were working with and embrace other ways of meeting their needs. The concept of deep listening or Dadirri, made famous by Dr Mirium-Rose Ungunmerr (2020) from the Daly River region in the NT, is central to being able to blend ideas and cocreate new knowledge.

Etuaptmumk: Two-eyed seeing

According to Thomas (2016), Marshall et al.’s (2015) concept of Two-Eyed Seeing (Etuaptmumk in Mi’kmaw) embraces “[l]earning to see from one eye with the strengths of Indigenous knowledges and ways of knowing, and from the other eye with the strengths of mainstream knowledges and ways of knowing, and to use both these eyes together, for the benefit of all.”

For this to occur, the power dynamics embedded in Western knowledges and systems needed to be acknowledged and critically analyzed and the very foundations of therapeutic practice in the West needed deep questioning. This demanded bravery and, for some Western practitioners we were supervising who were working in this context, this proved too challenging. It demanded a high level of questioning of their own theory bases and practices along with the realization that, contrary to what they have been led to believe in their studies, they are not the experts in this context.

An example of this is the concept of time. Western practice is heavily influenced by the concept of time. A usual therapy session can be typically between 40 minutes to 1 hour long and this is part of the boundaries set by the therapist within a fee-for-service system. A therapist will usually run their practice set to the clock. For First Nations people, particularly for those who live remotely, time can be viewed as an event and things get done in community time. This in of itself can cause a tension for the Western practitioner and assumptions can be made about the boundaries of “clients” and/or their level of engagement. The therapist will often choose the therapeutic space, which may not be a safe space for the participant. Boundaries and confidentiality also need to be considered differently in this new context. Traveling long distances and working closely together as a team on remote communities provided the opportunity for two-eyed seeing to occur as we embarked on the journey of both decolonizing and cocreating our healing practice. Gender protocols also needed to be considered. Having a team that comprised both male and female proved fortuitous in being able to provide a culturally appropriate service as decided upon by the community.

Sitting in the third space

The third space acts as a tool for navigating the tussle between First Nations and Western paradigms in a respectful way. The third space originally coined by BhaBha is a postcolonial space where there are “unequal forces of cultural representation” (BhaBha, 2004, p. 245). It is radical, unstable, and fluid. For Carnes (2014), the third space is defined as the space in-between Western and First Nations paradigms. This third space aligns with the belief that the dominant Western paradigm is only one version of reality. It demands that the supposition of “truth” be continually questioned for understanding and embedding First Nations worldviews.

It is in this uncomfortable space in-between that students and practitioners are asked to question, “What does this mean for me and how I practice?” One needs to be brave in order to sit in this space as the process involves a level of truth-telling. State of Reconciliation Report (2016) link truth-telling to social justice, reconciliation, and healing. They go on to state that truth-telling requires “political will, joint leadership, trust building, accountability, transparency, and investment of resources” (2016, p. 15). In the context of Creative Arts Therapies education, the third space provides an opportunity for identifying systemic and personal biases and assumptions while questioning what this means for them in practice. Atkinson (2012) refers to the Five Rs—respect, rights, responsibility, reciprocity, and relatedness—as the underpinning of a First Nations critical pedagogy that is not just about what is taught, but rather how that translates into actions in how one conducts oneself in all aspects of life. This kind of education experience can be transformative in that the individual grows by building on existing knowledges with new and emerging knowledges and does not revert to old ways of knowing (Atkinson, 2012).

In the context of pedagogical applications of the third space to teaching and learning, we adopted key principles. We invite students into the third space when we deconstruct Western concepts. The third space provides a safe and new space for alternative questioning of their own practices and biases allowing students to discover what new knowledge means for their practice. In the third space, students become more aware of their colonial thinking and are supported to explore other views and concepts where a clear separation of existing knowledge can be identified. This is achieved through guided classroom learning activities and taught as a practical skill to students to use in their communities and workplaces to help manage, deconstruct, and build in new knowledge in an empowering way.

Neoliberalism

The neoliberal paradigm, which is founded upon the assumption that market forces provide the best way to organize human life, has had a profound impact on all aspects of our lives. For First Nations people living in remote Australia, like colonialism before it, neoliberalism and its individualistic philosophy runs contrary to the collectivism found on communities (Garond, 2014). Wolfe (2006) argues that both paradigms are geared toward access to land and resources (Strakosch, 2015). Native Title is an example, in that it has divided communities, as the system is set up to confer land ownership to individuals and families, which Harvey (2007) argues has provided access to land and resources for governments and multinationals. The managerialism that supports neoliberalism has created administrative-heavy organizations along with a rise in audits, performance reviews, strategic plans, and continual restructures (Hill, 2021; Watts, 2021). Creative Arts Therapy courses sit within universities across Australia; hence neoliberalism and managerialism has impacted these courses. Managerialism finds its validity by aligning itself with the language of “quality assurance” in education. These cumbersome systems have worked to standardize courses. Any new course needs approval from several levels of bureaucracy, which are centrally controlled by the Australian Qualifications Framework (AQF). The learning outcomes, wording, and assessments must comply to be approved. It could be argued that this level of regulation creates uniformity and leaves little room for innovation, other pedagogical practices, or cultural approaches, as many institutions see cultural practices and healing as lacking in a strong Western evidence base.

The Graduate Certificate in Creative Therapies course this article speaks to complies with the AQF and includes four units: principles and practices, working with children, working with diverse groups, and trauma. These four units can then be scaffolded into the Graduate Diploma course, which has more of a focus on assessments and research. To be approved by the AQF, course and unit outcomes must comply in language and form as dictated by the framework; that is, English is the dominant language of instruction. With that said, in our course, we privilege the power of using language to share and tell stories as a way of navigating the Western dominance and utilizing the third space.

Lessons learned

In creating a Creative Arts Therapies program within a higher education institution, many challenges were faced to create a program that privileged First Nations knowledges, healing, and improving practice in communities. Privileging or putting First Nations knowledge at the forefront speaks to the inherent pedagogical bias in the education system by demonstrating a flip in, and critique of, the existing power structures in the system. Tamburro (2013) identifies that in social work, decolonization of practice and pedagogy is positioned as something to be attained to work better with First Nations people; an add-on rather than an interrogation of current practices, which is indicative of systemic racism embedded across disciplines including in other Creative Arts Therapies courses. It leaves little room for the empowerment of First Nations people, nor does it provide a space for privileging their knowledge. We contend that this is a characteristic of higher education in Australia and the systems that recreate the dominant paradigm. For Wallace and Pease (2011), the cloak of sensitivity is attained by “allowing” First Nations people and knowledges a place while still retaining the power of controlling where and when it is allocated. Education for many First Nations people is grounded in relationships and connection to country, which benefits family and community. While neoliberalism advocates for education to be viewed as a transaction, in our courses, for these learners it is an experiential journey built on relationship. For Shalley et al. (2019), until academia realizes that that there is more than one episteme and ontology, First Nation voices will not be heard.

To do this, we embedded part of the TeaH model into our course design. Part of the TeaH model was to offer a range of learning activities for different groups in the communities we were visiting. These ranged from workshops on Fetal Alcohol Spectrum Disorder and vicarious and intergenerational trauma, to puppetry and creative workshops. These activities were held by requests from the community. Lessons learned from cocreating these activities with communities provided evidence base for cocreating a decolonized model of education transferable across disciplines. They also provided practice knowledge directly relevant to healing work within the cross-cultural context. What became evident was the need for professional development for remote workers, particularly around vicarious and intergenerational trauma within their community context. Upskilling of community members and professionals so that healing can occur from within communities needs to be considered, because the current model of ‘fly in, fly out’ mental health services lacks efficacy. Being ‘on country’ can be healing in of itself for First Nations people and the option of bringing people in from community for treatment in a hospital-based mental health facility can prove problematic for this reason (Trudgen, 2000). We structure lessons around these workshop and creative teaching approaches (puppetry), not only as a pedagogical approach to modeling ways to work using creative therapies but as a cultural device for navigating the third space as part of their learning journey.

The ability of First Nations Australians in the NT for entry and retention into higher education is impacted by the fact that for many English is a third or fourth language, coupled with previous negative experiences with the education system, different cultural learning styles, and unreliable access to the internet and technology. These systemic factors needed to be considered in the development of this new pedagogical model. Counter to the neoliberal learning paradigm of student as consumer and teacher as service provider, the embodied experiential dynamic of First Nations people’s learning demands connection and relationship that considers power dynamics and works at flattening the hierarchical structure within higher education. To the Lowitja Institute (2020), power needs to be removed to encourage new voices and knowledge to come to the fore. Critical thinking is crucial and needs to be embedded in the model and, as Giroux and Giroux (2006) highlight, the conditions need to be provided that create a culture of questioning and a safe space to engage in critical dialogue. To Morley and Stenhouse (2021), critical analysis is crucial to identify one’s own assumptions and to make oppressive practices explicit. To make the course accessible to First Nations people, we provided a pathway into the course. In Australia, you usually need an undergraduate degree before enrolling into a postgraduate course, but we allowed First Nations people into the course without an undergraduate degree. Applications through this pathway are passed on to the course coordinator for approval and many of these students request connecting by phone or Zoom with the coordinator before enrolling. This pathway was a clear way of acknowledging First Nations knowledges.

Implications for pedagogy

To ensure stakeholder relevance, we started off by bringing together First Nations organizations, Creative Arts Therapies educators, First Nations Elders and practitioners, and people from health and education to form a course advisory group. This group was tasked with helping to direct course curriculum and pedagogy to align with industry relevance. Our experience working on communities highlighted the need for flexibility, so this needs to be considered within the context of higher education. While it is vitally important to provide knowledge around trauma in any healing program, student safety also needs to be considered because of the triggering nature of the content for students who have been victims of trauma.

Through our interactions with the course advisory group, we decided to incorporate the eight Aboriginal ways of learning: “The eight ways belong to a place, not a person or organisation. They came from country in Western New South Wales. Baakindji, Ngiyampaa, Yuwaalaraay, Gamilaraay, Wiradjuri, Wangkumarra and other nations own the knowledges this framework came down from” (Yunkaporta, 2021). This pedagogical approach is not linear and includes focus areas such as deconstruction/reconstruction, community and land links, story-sharing, the nonverbal, learning maps, symbols, and images. Critical thinking and deconstructing the underlying assumptions and power base of the theories and systems we use, that then inform practice, fit well with the eight ways.

To combat the language barriers for First Nations people in some ways, there are no set texts that are placed central to learning. The learning platform includes a variety of weekly interactive activities that allowed students to interact and discuss their learning. The platform is as visual as possible and there are weekly live “yarn ups” on Zoom. Rather than beginning from a base of Western practice and adding on First Nations knowledge, we start from the base of deconstructing the dominant systems and practices and bring in First Nations and other cultural knowledges and voices. Partnership and connection are demonstrated throughout the codesign of the entire curriculum and the ongoing teaching with First Nations People. Gair et al. (2015) contend that professionals need to relinquish their self-proclaimed expertise when it comes to First Nations people, and instead learn from them. In our experience, by providing ways for this to occur within the course, leadership opportunities were available for students.

The course is now in its second year with both First Nations and non-First Nations students enrolled across Australia. What the students are asked to do through the deconstruction process is to look deeply into their own practice and long-held assumptions. They are then asked to consider alternative healing paradigms and First Nations practices, including Dadirri. This kind of education can be transformative in that in this space in-between or third space, students are asked: What does this mean for your practice? What are the barriers to incorporating other cultural world views? The assessments are also flexible in that students are asked to take what they have learned and produce a resource for their context in each unit. On successful completion of the course, the students will have the beginnings of a useful portfolio of resources for their practice context. Given that we have students from a wide range of disciplines, such as from health, the arts, community services, and education, this provided for meaningful assessments that they could apply in the real world as well as being able to learn from each other. This gave the students some creative freedom in terms of how they presented their work, it was aligned with the eight-ways approach, and provided a practical vehicle for changing practice on the ground.

Challenges to practice

There are a number of challenges that continue to arise due to the innovative and unique nature of the course within the context of higher education in Australia. The pedagogical approach itself does not sit well in a system that demands evermore efficiency, ever higher student numbers with allocated marking hours cut to a bare minimum per student. This often means that the extra hours of marking to provide good feedback is taken on by teaching staff as extra work out of hours. However, designing assessment with flexibility in how the individual student contextualizes and presents work can allow for multiple tasks to be combined into single multifaceted creative and healing pieces of work.

When creating a new course, a college or faculty can decide to include established units from other courses to cost-cut. This can become problematic when the unit has a different pedagogical approach and requires standardized written assessment. Using reasonable adjustment measures to establish flexibility in the assessment and method of presentation provides a more support-focused model for bringing together pedagogically opposed units.

Similarly, the embedded pastoral care factored into the teaching and learning ensures students’ emotional and spiritual well-being is prioritized alongside their learning. Pastoral care refers to the tailored emotional and spiritual care of the students through individual support of the teaching staff and can range from counseling conversations to external referrals for additional support or modifying assessment to support the mental and spiritual well-being of the students, relevant to the content being covered. We understand and acknowledge that many topics can trigger emotional and spiritual trauma for many students and this needs to be supported in the learning. The level of pastoral care required to support students particularly when viewing triggering material, while largely unacknowledged, can also become problematic if careful provisions are not made for these students. This is particularly the case in materials about trauma and trauma stories.

Conclusion

Overall, creating a decolonized model of Creative Arts Therapy practice is providing new innovations for the delivery of Creative Therapies education for First Nations People. It provides a way forward in navigating a currently colonized education system, while keeping true to the course’s underlying principles of social justice, equity, and connection, which are underpinned by harvesting a deep connection to cultural safety. Course participants have provided consistent, overwhelmingly positive feedback, with many students reporting the learning and pedagogical approach as being transformative on both a personal and professional level. Further research into the transferability of this approach across disciplines needs to occur, but for this to happen truth-telling needs to occur at a systemic and discipline level. We hope that creative therapies can be the leaders of this transformation.