Introduction

In this article, I offer an account of the ways I invited poetic and creative contributions from other faculty members within the School of Creative Arts Therapies (SoCAT) at Whitecliffe in Aotearoa New Zealand, and then explored, as the sole author, the ways in which the word ‘clinical’ has agency in our professional context.[1] The word concept of ‘clinical’ has a number of connotations (such as precision, objectivity, detachment, starkness, and institution) that often sit at odds with what we do in our profession of creative arts therapy (CAT). It also has connotations that hold and align with what we endeavour to be (such as rigorous, credible, trustworthy and well-researched in our practice).  

Post-qualitative research, which this article aligns with, poses radical questions about the hierarchy of agencies, shifting agency from being something that only humans possess to something that can potentially be attributable to human beings and nonhuman material things and forces, which exist in an entangled relationality (Murris & Zhao, 2022). This notion, coming from the thinking of Karen Barad (2007), a feminist physicist and new materialist/posthuman thinker on quantum field theory, conceptualises beings as indeterminate and dispersed across different spaces and times. In this article, I argue that the concept of ‘clinical’ exerts an agentic ‘force’ that ripples through different spaces and temporalities in the CAT profession, materially and discursively. Nonhuman things and forces (such as clinical) actively shape and constrain the bodies they encounter, including the humans who never fully possess or control them (Jackson & Mazzei, 2012). This piece aims to bring attention to some of the agentic ripples and force of ‘clinical’ and how it moves through our teaching and practising experiences as CATs with different points of contact.

As the instigator of this research, I invited my colleagues to think-with and create-with me, through poetic ethnography. My colleagues were not research participants but my sympoietic creative partners, in the sense that Haraway (2016) means of relational creativity and “making-with” (p.58). The explorations were begun by, held by, and brought to fruition by me, but my colleagues’ words, ideas, and images offered depth to the explorations in ways I could not have otherwise found. Researchers and writers are never truly ‘alone’, from a new-materialist perspective, nor is the research ever truly finished. To think myself out of certain shapes (shapes that have been informed by the spaces and worlds I have lived and am living through in my ‘clinical’ practice), I was curious to invite others and to consider the ways in which their words and creative responses move with mine, into something more. In writing this article, my colleagues’ words are akin to living in the same relational space as Barad. Their voices have as much weight and agency as guiding theories and help me think-with the idea of ‘clinical’ in ways that stretch my own. While they are not formally my co-authors in this paper, they are undoubtedly my inspirators and co-conspirators.

To begin this paper, I offer a brief global and local history that traces the ways ‘clinical’ came to be a force within our profession. Following this, a small creative study aims to diffract and elucidate responses to the word ‘clinical’ from the experiences of SoCAT faculty members. I then map these responses through art and poetry. The research process broadly draws from arts-based methods and contemporary forms of poetic ethnography (Maynard & Cahnmann-Taylor, 2010), specifically, the method of found poetry.

This piece considers the connotations, lineage, agentic ripples, and meanings of ‘clinical’ in our professional world by meandering through different musings. Barad’s (2013) theories of diffraction inform this method as a “coming together of opposite qualities within, not as a flattening out or erasure of difference, but as a relation of difference within” (p.175). This article does not provide an answer to these musings. Instead, the diffraction demonstrates the ongoing complexity of this word concept in our living worlds. Each poem is accompanied by a drypoint etching, which I created by collaging together the different artistic responses from each colleague. Like the poems, these etchings are creations both ‘made’ and ‘found’.

In this study, I asked SoCAT faculty members the following questions: In what ways do we experience and inherit the word ‘clinical’ in our practice, teaching, and research? In what ways do we experience the agentic force of ‘clinical’? What meanings does ‘clinical’ have in the programme, in practice, and as professionals? How may we trouble assumed definitions and meaning of the word moving forward? Through asking these questions, I welcomed the troubles (Haraway, 2016) and reached for Barad (2008), who reminded me that “language matters, discourse matters, and culture matters” (p.801, my emphasis added). Barad also reminded me that we do not obtain knowledge by standing outside the world; we know because ‘we’ are of the world, we are the world, making/inheriting/changing/becoming/breaking/redefining/living ‘clinical’.

Global history

The earth’s crust drifts, wanders, and collides, as do human cultures, languages, and ideas (Clark, 2004). At the inception of our CAT profession, a collision of ontologies between arts and science occurred. In Indigenous cultures, arts and science are not considered opposing but entangled. CAT ontologies move well with these ways of thinking and being; however, for the scope of this piece, I am considering the Northern Hemisphere Western paradigms that this profession was birthed from: in the United States of America by Margaret Naumburg, the United Kingdom by Adrian Hill, and, to some extent, parts of Europe with the anthroposophical movement (Kaplan, 2000). In these spaces, in the early 20th century, a collision occurred in healthcare when the arts were invited to have direct contact with medicine and science. The collision birthed a form of practice called (creative) art(s) (psycho)therapy – the brackets denote the different professional titles this fractured into.

Historically and globally speaking, the origins of CAT are diverse and multiple. On one side, some clinical practitioners recognised that creativity is an inherent part of the human experience and that healing/healthcare/treatment/progress/wellbeing could not happen through talking or medicating alone (Hogan, 2001). In these spaces, there was both a leaning towards ‘clinical’ and a recognition that art-making could be brought in to complement these ways of practising in creative ways. The arts were considered useful in spaces where pharmaceuticals, psychotherapy, or other medicalised practices left gaps in treatment, as they offered non-invasive approaches that respected the patient’s autonomy (Pitman, 2016). The arts moved in and demonstrated that creativity and medicine are not in opposition but can be harmonised. However, if I am talking about the spaces in which this occurred, medicine was there first, and the arts had to find spaces to exist within already-established paradigms and practices. The arts often hybridised, learnt the language of medicine and science, adopted some practices and flavours of these spaces, and a ‘clinification’ occurred (Allen, 1995). ‘Clinification’ has proven useful for the profession in some areas. These spaces have allowed door-opening and translation processes between our ontologies and other, more homogenised science-based practices.

On the other side of the argument, there existed arts therapists who were, and continue to be, very vocal about not embracing anything associated with ‘clinical’ (Kapitan, 2008; Kramer, 2000; Moon, 2016). Many of these practitioners lean more towards ‘open studio’ forms of practice in which artmaking, rather than the therapeutic relationship, is viewed as the focus of the therapeutic work. In an open studio, the emphasis is on the artistic creation directing the healing, and the facilitator provides the venue and conditions for this process but does not lead it (Allen, 1995). Many CAT training programmes now lean toward a hybridised version of these two stories, recognising the place of each in the diverse realms in which CATs may come to practice.

Local history

These overly simplified global origin stories tendril deep into time and space in the CAT world, “threaded through one another in a nonlinear enfolding of spacetimemattering” (Barad, 2013, p.18). These stories tendril to meet us now, in Aotearoa. The dominant healthcare model of Aotearoa, a Western Euro/anthropocentric society, is still firmly grasped by medical/clinical/gold-standard/quantitative/evidence-based concepts. And, yet, CATs exist in the healthcare space, too, and we practise from very different ontologies. This is the ethical space we sit in, and the space in which the training programme was established.

Since its inception in 2000 as the Master of Arts in Arts Therapy (MA AT), the programme at Whitecliffe has undergone many iterations. The original two-year master’s programme consisted of taught papers and a research project. A significant shift occurred in 2007 when the programme added an optional ‘clinical’ year. Students with the MA AT degree could complete this additional year by applying their theoretical practice and research in placement settings under supervision around Aotearoa. Through this year, they could accrue the required hours to register as professional members with the professional body and were awarded an MA AT (Cinical) degree.

In 2015, the programme went through a further shift in which the first year was structured as an introductory course to CAT, a postgraduate diploma (PGDipAT). The subsequent two years became the master’s programme, where research and clinical practice were taught concurrently. Students gained experience, accrued hours in placement, and undertook a research project simultaneously. Those who completed the master’s programme received the MA AT (clinical) degree. In 2021, the programme underwent further core curriculum changes to adopt the professional title of ‘CAT’, as per ANZACATA’s shift towards this, changing the qualification to the current iteration, which is an MA CAT (Clinical). This contextual and historical information provides a snapshot of how ‘clinical’ has been mobilised, adopted, adapted, and used through the iterations of the programmes at Whitecliffe to distinguish it as a course that trains those who want to enter into clinical spaces in Aotearoa.

The title ‘clinical’ was initially applied to distinguish between graduates of the original MA AT degree and those who had completed the placement requirement to become registered practitioners on the basis of the award of the MA AT (Clinical). It has stuck with the MA CAT programme through its many iterations because it is an important word that upholds the credibility and robustness of the programme, and many graduates use it as part of their post-nominals or professional titles. However, is Whitecliffe producing ‘clinicians’ or practitioners capable of working in clinical spaces? What is the difference, and in what ways might it matter?

The current faculty of the SoCATs all went through the Whitecliffe programme at different points over the past 20 years. We have experienced the programme’s evolution as both students and faculty members, and have our own relationship with the word ‘clinical’. In the next section, I explore how the word ‘clinical’ matters, in a philosophical and theoretical sense, for this project and the profession.

Theory and philosophy

Serendipitously, while Karen Barad is indeed a scientist and a physicist, they are also an artist, as they do things with language in a lyrical way that enriches our sense of the emergent and intra-active character of material reality. Barad plays with words and invents their own. You do not need to be a quantum physicist to read Barad, but must possess an ability to read poetry and their words through metaphor. Barad paints such vivid word pictures with their concepts of entanglements, intra-actions, diffractions, cutting-together-apart, spacetimemattering, and hauntings that reading them, as an artist, is sumptuous. Barad is, therefore, the theorist I lean into in this work when considering the places where arts and science meet.

Barad writes about quantum physics and how things come to ‘matter’ through co-directional relationality. They write about how ‘agency’ is not an attribute of something or someone; rather, it is the process of cause and effect in enactment (Barad, 2007). According to Barad, agency is understood as being attributable to a complex network of human and nonhuman agents, including those that exceed the traditional notion of the ‘individual’ (Jackson & Mazzei, 2012). In the context of this work, this means that the concept of ‘clinical’, a historically loaded, weighty word, is an agentic matter, enacting upon, through, with, and because of humans in a more-than-human world. Agency, meaning enactment, is what occurs in between, in the co-creating of worlds. ‘Clinical’ is agentic in the ways it moves through our teaching/researching/practising/living experiences as CATs. It is a force that elicits different experiences and has many points of contact, individually and collectively.

CATs have inherited this word concept, and Barad (2012) invites us to consider not just how words or discourse function but how they materialise. Language is central to our construction of reality. In other words, we know the world and our place in it, often through the language we enter into, with ‘clinical’ being a particularly weighty discourse. We are both constructed and constrained by language, and, through discursive practices, we define what counts as meaningful statements (Jackson & Mazzei, 2012). So, to invoke a Deleuzian (1990/1995) concept, it is not a question of “what does language mean, but how does it work?” (p.9). How does ‘clinical’ work? Such questioning shifts my thinking from how discourses produce particular subjectivities, to how these subjectivities can be understood as a set of linkages and connections with other things and bodies (Barad, 2010). My, our, understandings and experiences of ‘clinical’ are full of subjectivities, yet, out there in the world, it often feels that ‘clinical’ has a kind of objective shape.

In this work, I consider how, in our individual and collective experiences of the phenomena of ‘clinical’, we are experiencing not only our own lived reality but also the realities of those who have come before. We are an assemblage of our memories and the memories that we have inherited. Alchemy happens when stories and memories meet from different times, spaces, and places, and find ways to coexist and be transformed through and with each other. The stories and experiences of ‘clinical’ that are lively and mattering in the CAT world matter for us and the students we support as they also inherit and experience them. The spaces our students will ultimately work in as professionals, and the clients and colleagues they meet within these spaces, are implicated in these assemblages of how we come to know, lean towards, or away from, the mattering of ‘clinical’.

Barad’s theories support me in considering how experiences continue to live in our bodies, minds, memories, and words, how they live in the spaces between us, and how past experiences continue to impact educational and practice spaces, politics, pedagogies, power dynamics, and language in a constant looping of time. As Haraway (2016) puts it, it matters what stories we tell to tell other stories with, it matters what ideas think ideas. What stories and ideas about ‘clinical’ are thinking our ideas and stories of CAT? This is the question beating at the heart of this piece.

Methods

Process

This small project aimed to gather an understanding of the word ‘clinical’ from the experiences of SoCAT faculty members through written and artistic responses, as informed by art as research through poetic inquiry. The responses interrogated and troubled the word and considered its connotations, lineage, agency, and meanings in our CAT world. The colleagues who contributed to this project all have their relationships with the agentic force of ‘clinical’ through their diverse practices outside of working for SoCAT. These are the contexts we bring into this project, and the frameworks and experiences from which we teach. While disparate experiences rub up against each other, they also provide clarity, rich conversation, and consideration of what this means for the MA CAT programme and the ways we teach and collectively understand ‘clinical’ as a word that matters. Questions were prompted that invited each contributor to consider how we experience both the word and the inheritance of the word in our practice, teaching, and research. I also invited consideration into the ways we experience the agentic force of ‘clinical’ and what meanings it holds for us. Lastly, we considered how we may trouble assumed definitions and meanings of the word, moving forward. I invited creative contributions in the form of images and written words with these prompts, which everyone shared collectively with each other in a growing email thread.

Poetic inquiry

Upon receiving the words from each colleague, I teased apart the texts and engaged in a sense-making process, reconfiguring the individual texts as collective poems. The poems consider how the words from each colleague, including mine, met one another. The poetic words were offered to the group for reading and edification. The overarching methodology of poetic inquiry was utilised in this process. Poetic inquiry is helpful for critical research into entangled social issues that ride dialectics between aesthetic and epistemic concerns (Faulkner, 2017). Specifically, found poetry (Prendergast, 2006) considers how words or phrases in different written pieces hold particular resonance or ‘glow’ (MacLure, 2013). I was guided by methodologies of sensing the ‘data’ as I read the words of others, locating the glowing pieces through the inner wisdom of the body (Rappaport, 2014; Wolff, 1972). Found poetry (Prendergast, 2006), or literature-voiced research poetry (Leavy, 2009), is a way to explore and distil written sources by creating poems from reassembled texts. There is no template or prescribed approach for creating found poetry. However, the general idea is to take words, phrases, or whole passages from other sources and rework them using poetic conventions such as changing spacing and/or lines (which consequently changes the meaning) or by altering the text by additions and/or deletions (Fitzpatrick & Fitzpatrick, 2021). The process of analysis and representation happens concurrently in this way of working.

As I worked through the poems, I resonated with Fitzpatrick and Fitzpatrick’s (2021) noticings that poetry can be political and pedagogical. I was encouraged and challenged by Leggo (2008, p.169), who invites us to consider that perhaps the important question is not “Is this a good poem?”, but “What is a poem good for?” The following poems tell political stories of struggles against power, disparity, and misunderstandings. Poems push feelings to the forefront by capturing heightened moments of social reality (Leavy, 2009). The purpose of poetry is not to close things down by defining them. Instead, poetry invites us to listen, dwell, stop, see, and open up (Leggo, 2008). Indeed, research methods should be selected because they fit well with the objectives and help answer the questions. Poetry helps us tell this story.

Through sense-making, six poems emerged that circumnavigate the materiality, (bracketed) inheritance, being and un-being, doing, and troubling of the word ‘clinical’. A similar process was followed with each colleague’s image, in which the individual images were teased apart into fragments and then reconfigured in collage form. I made an etching based on each collage and added it to be a visual ‘voice’ for each poem in the final form seen in this article. 

Drypoint etching

Drypoint etching is a print-making technique, an ancient one that was historically done on sheets of metal – copper, zinc, or aluminium – but now tends to be done on Plexiglass. It is a technique for mark-making. A very fine, needle-like tool is used to scratch into the surface, creating channels that the ink runs into. Then, when pressure is applied from the printing press, the ink transfers to the paper, forming an image. There is a relationality between the idea of ‘making a mark’ in etching and this idea of ‘clinical’, which has, in tangible, sensory, and ontological ways, ‘etched’ itself into our collective memories, identities, and practices. It has left a mark upon us, and equally, in co-directionality, we have continued to scratch into and leave marks of ourselves on the practice of ‘clinical’ in our different ways.

Etching is about leaving an impression through time. Currie (2011), an anthropologist, speaks about how objects that retain traces of making are expressions of their maker’s activity and decision-making processes. This is cartography in action. Like the feeling of ‘clinical’ and all of the white-coat, sanitised, medicalised associations it brings up, etching is a precision-based art form, and the needle-like tool used could almost be a medical instrument in itself. However, as an art form in relationship with CAT, there is a kinship with Paul Klee’s (1953) notion of ‘taking a line for a walk’ and Winnicott’s (1971) ‘squiggle game’. Walking, mapping, scratching lines, marking, charting, wayfaring, mark-making, way-finding – these are the ideas in kinship with etching.

Findings

I am calling the following collection of assemblage poems The agency of (clinical).