Figure 2. Mason Durie’s Te Whare Tapa Wah – The Four Pillars of Well-being.

The context

The wharenui greets you as you drive into the car park of Te Ora Hou Northland, a Kaupapa Māori community centre for youth, based in Whangārei. The building provides tangible holding that represents the four pillars of well-being – wairua, hinengaro, tīnana and whānau (Sculley & Smith, 2023). Within this a group of mothers, and their teenage sons with special and complex needs, enter each week. As 4pm comes around and the vans pull in, the excitement from all involved is heard before seen. Shoes off at the door, wheels manoeuvred over the curb, smiles, shrieks, and palpable joy from the boys at seeing each other.

In this setting collaborating teenage boys are ‘making kin’, where ‘making kin’ is being in opposition to mainstream exclusionary relational practices (Bakan, 2021, p.25).

There is an adjoining room in the wharenui, entered through a doorway in-between, that leads to the wharekai. This is a different space. A place where, following tikanga, kai and nourishment are created. A place separate from the wharenui, yet joined by a single door, one space supporting the kaupapa of the other. The metaphor of nourishment underpins the invitation to the mothers, giving a small space for creative exploration and play, while their sons, through that door in-between, find and flourish in their own fun through music and dance. “There are no spaces like it where mums can freely be” (Jim Callaghan, personal communication, 26/2/2024).

The group participants congregate in the wharenui, and after greetings, settle into a welcome song followed by a transition song which is the cue for the mums and arts therapist to get up and move through the doorway in-between, crossing a threshold into the wharekai. Based on the origins of the word ‘threshold’, the idea of “crossing a threshold comes to us, then, with a history as a noisy enterprise evoking movement, change, and delineation; the separation of what matters from what does not”. (Kirst, 2023, p.1). The linking of theory-ing and storying, the linking of micro and macro worlds is present in this threshold.

The simple dual model of art-making in one space for the mothers, and music-making for their rangatahi in the other, actuates the holding metaphor of the wharenui/wharekai in a new and different way. It is a metaphor that keeps arising as the mothers share lived experiences, as friendships grow between the rangatahi, and as bonds emerge through a mode of community creative therapy that is co-created and self-determined by its members.

Pihama (2020) refers to whakawhānaungatanga or establishing meaningful connections between whānau members – typically kin – and their environments, as being the base of all flourishing relationships. She describes a context such as is experienced here as “kaupapa whānau” (p.6) since the relationships are based on a shared lived experience and purpose for gathering. Consistent with the nourishing capacity of acceptance and belonging and of whakawhānaungatanga, Skaife (2001) refers to Merleau-Ponty’s reasoning that we are constantly relating to our environments; that we both develop our sense of self and contribute to that of others reflexively through intersubjectivity.

The theory

Community arts therapy can be defined as:

...both an approach and a setting that is practiced in context and shaped by the culture of the people in the community, it centers creative practices for both individual and collective therapeutic benefits, and it continues to grow and evolve. (Nolan, 2023, p.3)

Furthermore, community arts therapy is strength-based, not relying on pathology for point of access, non-directive and co-regulatory in nature. By being held – metaphorically and literally – in places of connection and acceptance, it can “contribute to social change” (Nolan, 2023, p.7).

The connections formed are manifold and are intersectional and non-binary as participants engage as individuals and as groups, with materials, music, voice and other instruments. This contrasts with other social care practices based on binary thinking, where disability is attached to the child rather than reflecting societal attitudes and structures. Kielhofner (2005) posits that disability is a social construct, achieving negative status only when met with attitudinal or environmental limitations, and that transforming social conditions would enable impairment to be seen as value-neutral.

‘Queering music therapy’ (Metell, 2019) refers to a therapy process of disrupting established values of normalisation in favour of honouring uniqueness. When children with disabilities are put in contrast with classifications such as ‘healthy’, ‘normal’ and ‘fully participating’ (Van Hove et. al., 2009), this has a limiting impact on families. Services designed from the perspective of enabling families to parent from beneath the weight of raising a child seen as so differently abled, may contribute to the experience of engaging with those systems as stressful. The mums in the group in Whangārei have a specific concept of normalcy, defined by them, and which is often the basis of shared humour not accepted in other social settings, even familial ones. For the rangatahi and for the mums, the honouring of self-defining normalcy is important as it can support and enhance the body to return to homeostasis (Thom, 2010).

Consequently, community arts therapy may be viewed as subversive, as fitting with social activist practice with its exploration of parameters of power sharing (Nolan, 2023). Social meanings of lived experience of disability are products of community attitudes (Kielhofner, 2005) and disrupting these meanings is possible in the community creative arts therapy setting.

Mauri Tui Tuia Creative Therapies

Situated within the liminal space of duality, unpinned by a bicultural holding of the whenua where the sessions take place, ‘knitting’, ‘crochet’, ‘threading’ and ‘embroidering’ repeatedly emerge as metaphors for connection from the mothers’ group. This imagery resonates with the kupu and kaupapa of Mauri Tui Tuia, a creative therapy company that houses music, dance movement and arts therapy and strives toward community co-creation.

McConnell (2023, p.71) states “The name Mauri Tui Tuia was gifted by a kaiārahi (Māori advisor)”. ‘Mauri’ refers to a “life principle, life force, vital essence... [as well as] the ecosystem or social group in which this essence is located” (Ministry of Education, 2009). ‘Tui Tuia’ comes from an ancient waiata, ‘Te Tangi A Te Matui’, symbolising the call of the matui bird, evoking a sense of unity, oneness, and collaboration” (New Zealand Folk Song, 2024).

The interweaving and collaboration that is central to Mauri Tui Tuia’s practice can draw our attention to the ancient knowledge we all carry in our bodies of song, movement, and symbol as a means of connecting and healing (McConnell, 2023). This model of creative therapy practice seeks to honour the wisdom, voice, and embodied expression of each group member. There is a parallel with the bicultural and cross-cultural co-creation that underpins the kaupapa. “When systemic oppression forces communities to prioritise coping strategies, a toxic environment is created which is not conducive to recognising and affirming everyone’s specific needs and differences” (Lechene, 2024, p.3). Decolonising frameworks can be viewed as a tool to combat ableism (Cyrus, 2017; Lechene, 2024; Shaw et al., 2022) and are an important consideration when seeking genuine co-creation. For the creative therapist, humility, reflection, and compassion are forefront to avoid the development of a tokenistic culture of collaboration. Bolger (2018) speaks of the therapist’s role to embody and offer a collaborative intent from which a mutual, shared process may emerge.

Literature review

There is little literature describing dual models of art-making and music-(or movement) making therapies (Green, 2011). Nevertheless, co-working across the creative therapies is noted for expanding the skills of therapists (Hanvey, 2019). Co-therapy models enable an active partnership between creative therapists and contribute to the prevention of burnout, while expanding opportunities for the exchange of ideas between therapists and reducing the incidence of professional loneliness (Roller & Nelson, 1991). Sustainability and therapist capacity is enhanced through the dual model approach, traditional or otherwise. This approach is also noted to focus on expanding group participants’ strengths and potential, ways of relating to self, and to others, and their physical experiences (Carr, 2021).

Creative therapies have a role to play in the emotional processing of caregivers, although it is challenging to offer group therapy to this population due to the demands of the caregiver role (Phillips, 2024). There is a gap in the literature with regard to offering simultaneous therapies to caregivers and care recipients. One such study (not undertaken by creative therapists) described a simultaneous programme for mums and children with high and complex needs. In this study, researchers recognised that high caregiver stress was experienced by mothers, and co-designed with the mothers a salsa dance programme that was held while their children were receiving therapy, and which resulted in significantly reduced stress levels for the mothers (Sanchez, 2020).

Participating in creative therapies groups increases one’s sense of belonging (Hanvey, 2019), and the group process is a modality for change including bridging social constructs (Wittig, 2012). Musicking in a social setting promotes communitas and this is especially important for expanding the psychosocial worlds of teens with high and complex needs; worlds that are seldom explored in the literature on this population (Roginsky, 2021). Frizell writes extensively of the presence of disabled people problematising ideas of self, of inclusion, of normalcy and even of being human in a society that seeks to ‘other’ diversity. She calls for inter- and intra-subjectivity in a post-humanist era that disrupts colonising binaries imposed upon same or different bodies and where greater differences are viewed as greater potentials for kinship and all humanity (Frizell, 2021).

In summary, there is evidence to support dual models for group creative therapy as being beneficial for the therapists and the participants – in this particular case, caregivers and adolescents with high and complex need and inclusion of these populations also has potential to benefit across society. The evident gap in the literature supports future implementation and research of the dual group creative therapy model.

Methodology

The collaborative process in action underpinned the co-creation of a dual practice model. Initially this programme was a pilot, following an informal consultative conversation between the music therapist and a parent support group. The seed of a concept for a sustaining, connecting, and creative forum for parents and/or caregivers, as well as for their rangatahi, was sown.

Auto-ethnographical theory underpinned this process as therapists noted links between what was occurring in their practice and with their thinking and aesthetics, with concepts and ideas; such links between theory and story appear as reciprocal, ever-evolving and bridge-creating (Holman Jones, 2016). A second underpinning theory is from Huss who describes her theory of “embodied, socially embedded, relational aesthetics” (Gardner, 2019, p.28) in which any art-making is inseparable from the social context in which it is created. She refers to art as being a bridge between the micro (ie. clinical theory) and the macro (ie. social systems, politics) and reflects that creative therapies can do the hard work of holding both of these levels at once (Gardner, 2019). Huss refers to this as “creative place-making” (Gardner, 2019, p.31) and notes the shift in roles when at times therapists may experience enriching learning from their clients. A Māori method of teaching and learning, tuakana/teina highlights this same knowing, that development may happen in both an upwards or an across-ways movement over a poutama (Te Whāiti et al., 1997). That is, kuia/kaumātua may learn from the knowledge of rangatahi as well as rangatahi learning from kuia/kaumātua.

This group – mums, rangatahi, therapists – has co-created a unique relationship embodying tuakana/teina, of nourishing, flourishing, theory-ing, storying, and place-making, whereby the bridge may be seen as the doorway in-between.

Consent

Adult participants, upon joining the group, are offered the opportunity to discuss with the facilitating therapists what may be involved, any potential conflicts of interest, and the reporting and recording processes planned for the group. Once satisfied, they are invited to sign a written ‘consent to participate’ form, on behalf of themselves as well as their rangatahi.

Process: The rangatahi

Some walk in, some wheel in, some say hello, some sound and gesture. This is a diverse group of young men coming together through the music and movement experience. The music and dance therapy aims to provide spaces for shared pleasure through mutual music making, for enhancing culture, and as an avenue for self-expression, and connection (Metell, 2019). The rangatahi are conceptualised as co-creators within the group and therefore as having expertise. The idea is that the families themselves can set the goals; that having a good time, connecting with other families, and learning more about how to use music together are valid goals (Cohen, 2023, Vaisvaser, 2019).

A theme that emerges from these whānau is the limited opportunities for friendship and social connection for their young people, especially once they are out of the schooling system. Creative movement and music offer another dimension in which to develop socialisation, to learn via mirroring and to contribute to group cohesion. Kinaesthetic empathy, attunement rhythm and mirroring provide a movement and sounding dialogue in which a safe and trusting therapeutic relationship can develop (Halprin, 2002). The use of gesture as metaphor develops a system of symbolism, allowing a different way to represent images, objects or concepts that are of significance to each person in the group (Van Hove et al., 2009).

The sessions start with the whānau together, with a welcome song where each rangatahi is named and witnessed. A transition song allows the mothers to move through to the other room to begin their own creating. Supporting these transitions allows an extension of social capacity for the rangatahi. Familiar group rituals develop, involving playfulness, joint action, and mutual joy, laying the platform for the expansion of peer relationships.

According to Schmais (1985), for leaving to be a positive experience, individuals need to acknowledge each other, what they have learned and how this learning can be carried outside the group. Each session is finished with a similar ritual, the mothers re-joining the rangatahi for a goodbye song. This is intentional scaffolding around transitions toward social participation and expanding a tolerance for change in the teens.

Social participation is a core element of music and movement within the group environment. The use of props and rhythmic tools (such as lycra, Octabands, and scarves) have been a supporting method of group holding as well as enhancing access to social participation and joint play. When props are utilised with such diversity of physicality within the group, the place of shared rhythm emerges frequently. Rhythm notably calms and connects the group, organising and focusing attention and inclusion to support relational experiences (Geist & Geist, 2018). Trevarthen & Malloch (2017) speak to theories of caregiver – infant interaction that recognises early rhythms form part of our human ability to state-shift towards equilibrium and self-soothing. Singing, playing, and moving simultaneously – i.e. engaging in synchronistic activity – are powerful ways to develop a sense of connection, foster solidarity, and create a sense of ‘harmony’ (Rickson et al., 2018). Anticipated and repeated movement sequences are used to encourage a sense of ownership (Thom, 2010). Vocal slides expand both expressive vocal range while also using anticipation as a tool for focus, mastery and joy. Movement and music, whether structured or improvised, provide a channel through which relationships can be formed or repaired, often decreasing isolation. A young person connecting with others facilitates their ability to engage in social problem-solving (Devereaux, 2012).

According to McConnell et al. (2023), the music therapist uses the “forces, experiences, processes, and structures of the music” (Ansdell, 1995, p.5) to develop or strengthen the resources their participants bring. Creativity is the means of process (Halprin, 2002). There is a belief that all people have the innate ability to be creative and that the creative process is transformative and healing. This is seen in mirrored facial gesture, spontaneous reciprocity, and the emergence of small “moments of meeting” (Vaisvaser, 2019, p.6).

Emerging from this group is a unique body of understanding and relational cohesion from the participants, that has become meaningful and specific to them. The doorway in-between creates a safety net, with the rangatahi’s families close by, yet separate. The door acts as soundproofing, and there is a glass panel to look through from either side. This is their peer group, their own authentic friendships, outside of the definition of their disability. A space has been created to be simply young men, meeting together through the language of music, sound, gesture, and rhythm.

Process: The mums

The mothers in this group have spoken about the time when they realised their beautiful babies would develop according to their own make-up, in ways that would not be considered achieving typical developmental milestones. For them, this common entry point to the liminal state of ‘not quite fitting’ into society is felt repeatedly over time. Turner (1969) describes this liminal position as one in which a person “…passes through a cultural realm that has few or none of the attributes of the past or coming state” (p.359). A social bond has ceased to be with the birth of this precious child.

In response to the ‘not quite fitting’ into society, the state of communitas is sought by the mothers. Communitas is a supportive and subversive parallel reality for parents raising children with special needs. Parents observe that even those systems (health, disability support, education) established to serve their families are difficult to access and it is noted that positive or even value-neutral social experiences for this population are scarce (Metell, 2019).

The process of sympoiesis arrives into the liminal space when we offer creative therapy participants the opportunity to form their own order from chaos (Green, 2021). Making kin seeks to extend empathy and care across gender, race, and biological boundaries and it is activated through sympoiesis and tentacular thinking, thriving in flux, in chaos, and in the liminal state (Bakan, 2021).

In this space, communitas evolved somewhat rapidly when the arts therapist facilitator became aware, through their open sharing, that these mums’ lives are so completely determined by the needs of their teens. For example, there are routines of tube-feeding, bathing with the use of a commode, nappy changing and monitoring for seizures on a 24-hour basis, as well as negotiating complicated funding support systems. Freedom and creative play are rare for these women. Being here at the group reminds you of “who you are outside of the kids” (parent participant, personal communication, 26 February 2024). Yarn-bombing a tree, including creating a sensory play area underneath in a public park, is just one example of freedom and creative play the mums are considering.

Exercising their agency to create or not became a central element to the group milieu, and a joke formed about who was actually leading the group. Participants acknowledged such open power sharing as welcome yet rare in the organisations with which they regularly engaged. The therapist is a companion companioning, on a seat at the table, in the presence of, in co-creation with, the mums (Franklin, 2017).

Sympoiesis in action is felt as it nurtures participants towards communitas, by being with each other in acceptance (Green, 2021). Co-creation located within co-regulation offers mums expressing grief, learnings, and joy, an honouring of unique and similar experience. “This group lets us feel normal briefly” (parent participant, personal communication, 26 February 2024).

Discussion

When the mums intentionally move through the doorway in-between into a creative, nourishing realm they choose, that for the next 45 minutes, they matter. When sometimes rangatahi move through to connect with their mums, then connection matters more in that moment than music-making with friends. The Hero’s Journey provides an illustration of the Threshold as an act of such commitment to travel, to a special place, often requiring the facing of fears, challenges and meeting new allies (Voytilla, 1999). In this group scenario, there is fear involved for all participants when trusting their family members and themselves to the care of others, and when facing potential newness in social, sensory, creative and physical domains. In the first few sessions, the mums were not able to imagine the reason they were attending was for themselves, articulating their motivation as the music session for their sons, so stepping through the doorway was indeed stepping into a special place requiring courage and commitment.