Introduction

Context

 

The Russian invasion of Ukraine in February 2022 escalated the conflict begun in 2014 when Russia annexed Crimea. Numbers of Ukrainian refugees across Europe increased significantly (UNHCR, 2023a). To accommodate refugees the UK government established the Homes for Ukraine scheme whereby British families could sponsor Ukrainians, offering support and accommodation for six months on arrival in the UK.  People under the age of 18 arriving as part of this scheme were offered places in local schools to continue their education and promote social integration.

 

Those involuntarily displaced by war face challenges to their mental health and wellbeing (Papadopoulos, 2021). These challenges include not only the trauma of loss but also the uncertainties or dangers of travelling to a new country and the ongoing difficulties of settling within the host community (Gonsalves, 1992). There is insufficient research on trauma treatment specific to displaced adolescents (Genc, 2022). Nonetheless, it is known that, though not all will develop longer-term issues like PTSD and depression, young people are at greater risk of doing so, particularly after exposure to war (Worrall and Jerry, 2007; Hodes and Vostanis, 2019). Proactive psychological support is recommended at an early stage (Tyrer and Fazel, 2014; Meyer DeMott et al., 2017).

 

The school setting has the advantage of reaching those who might otherwise struggle to access support (Tyrer and Fazel, 2014; Beauregard, 2014). Schools hosting displaced children were advised by the UK Department for Education (2022) to offer therapeutic services. Aware that the Ukrainians were struggling to integrate, the wellbeing team referred them to the school counselling service, an independent service contracted by the local authority to provide therapeutic services throughout county schools (to retain anonymity neither the school nor counselling service are identified. All participants have been given pseudonyms).

 

The counselling team decided that, in view of their recent experiences and the language barrier,  art therapy would be appropriate (Akthar and Lovell, 2019). Art therapy has been shown to be effective in addressing trauma in young refugees (Ugurlu, Akca & Acarturk, 2016; Meyer DeMott et al., 2017; Bonz, Casa and Arslanbek, 2020). Coming largely from the east of the country, where Russian is often the first language, these Ukrainian students preferred Russian to Ukrainian. The counselling team therefore allocated a Russian speaker to co-facilitate the group with the art therapist. The goal of therapy was to enable the students to express and explore feelings about war and displacement.

Theoretical framework

 

Studies of refugee wellbeing highlight several key issues. One is the re-establishment of a sense of safety and belonging, feelings normally associated with ‘home’ (Lloyd, Press and Usiskin, 2018; Lloyd and Usiskin, 2020; Papadopoulos, 2021; Kalmanowitz, 2022). Another is the challenge of integrating past and present selves, life before and after dislocation, so as to find meaning and regain belief in a future over which one has some control (Emberley, 2005; Kalmanowitz, 2016; Akthar and Lovell, 2019).

 

In the presence of violence, the sense of home as a safe place may be lost even before an individual has left that home (Papadopoulos, 2021). Where family members remain behind in danger, the sense of safety is further eroded (Ehntholt and Yule, 2006). This is especially damaging for children and adolescents who are most vulnerable to the loss of attachment figures (Akthar and Lovell, 2019). Re-establishing a sense of safety was therefore a primary task of art therapy.

 

Uncertainty about the future is a major anxiety for displaced people and can cause reduced motivation, depression and hopelessness (Lloyd, Press and Usiskin, 2018). This period of transition can be ‘a liminal space in which the individual is no longer at home but does not yet feel at home in the new environment’ (Dieterich-Hartwell and Koch, 2017, p.2). In this case, there was uncertainty around when, or even whether, these adolescents would be able to return. They were also aware that the home they had left no longer existed; they would have to rebuild ‘home’ whether they stayed in the UK or not. Koch (Dieterich-Hartwell and Koch, 2017) suggests that the arts can offer a temporary ‘home’, acting as a safe space to contain powerful emotions and bridge the old self and the new. In this space there is the opportunity to reframe the story, to mourn loss and integrate past home with present home (Fitzpatrick, 2002). Papadopoulos (2021) describes this as the final stage in the resettlement process. As the art therapist lead, I drew on this thinking in devising activities to examine and reflect on uncomfortable feelings and relationships in a safe contained way.

 

The UK Trauma Council (Ferrari, 2022) advises that displaced young people benefit from work that promotes a sense of safety, helps with emotional regulation, promotes connection, hope and a sense of control. Displacement causes particular issues for those in the developmental stage of adolescence. The loss of the ‘safe base’ of home, family and culture makes it harder to develop independence (Kerpelman and Pittman, 2018). At the same time, the peer group towards which they would be moving may also be fractured. Their developing sense of identity is challenged with the loss of home culture and the need to integrate into the new host culture (Lemzoudi, 2007). The unfamiliar environment and language may cause increased dependency on adults at exactly the stage when young people are trying to develop their own competency and problem-solving skills independent of their attachment figures. This may diminish their sense of agency and control. Disruption to education in adolescence is more likely to have a prolonged adverse effect on the transition into adulthood and employment, causing anxiety about the future (Taylor and Sidhu, 2012).

 

The counselling team suggested group therapy to reinforce these adolescents’ new peer group. Inclusion of UK students in the group was discussed, but my co-facilitator and I thought that exploring shared experience and recovering a voice were more important than, and possibly a necessary precursor to, integration (Bion, 1961; Block et al, 2018). The group also offered a chance to mirror the family, with co-facilitators potentially standing for parents in the transference (Yalom and Lesccz, 2005). Conscious of the cultural differences between facilitators and participants, we made efforts to be curious about their cultural experience, invite them to share cultural references and use the art materials in a way that felt meaningful to them (Emberley, 2005; Kapitan, 2015; Kuri, 2017; Gaywood, Bertram and Pascal, 2020; Hanania, 2020).

 

In thinking about interventions with this group I took a strengths-based approach, focusing on resilience and empowerment (Peltonen and Punamäki, 2010; Moore, 2017; Papadopoulos, 2021). The strengths-based approach is a collaborative process which looks to identify and strengthen the resources of the individual and their community without ignoring or minimising challenges (Moore, 2017; Block et al, 2018; Hayward, 2019; Berberian and Davis, 2020; Yuen et al, 2020). Resilience is defined as the ability to adapt positively to adversity (Bonnano, 2004; Masten, 2014) and is an innate process in humans (Masten, 2015). In predicting resilience, the number of risk factors and duration of exposure are balanced against the protective processes in place. Protective processes include self-esteem, a sense of competency, hope, personal insight, creativity, connection to family and community and positive relationships with others (Worrall and Jerry, 2007; Masten, 2015).  I offered creative and imaginative activities to promote a state of ‘flow’ in which the mind becomes totally immersed in a challenging activity to the exclusion of everything else: ‘when consciousness is harmoniously ordered, and they want to pursue whatever they are doing for its own sake.’ (Csíkszentmihályi, 1991. p.6). This state produces positive feelings of empowerment and control that can be particularly beneficial to displaced young people (Worrall and Jerry, 2007; Lee, 2013). Artmaking is also a form of play which, by activating the imagination, can form a bridge between the emotions felt in the body and the thinking mind (Kalmanowitz, 2016; Meyer DeMott et al, 2017; Kalaf and Plante, 2020).

Practice Description

 

Participants

The group consisted of eight Ukrainian girls aged 13 to 16 (no Ukrainian boys attended the school at that time). All had been relocated, with members of their families, to host families in the local area. They came from different parts of Ukraine and (with the exception of twins, Lilya and Larysa, and their cousin, Alina) had no relationship with each other before starting school.

 

When the group began, I was newly qualified with no previous experience of working as an art therapist with refugees or asylum seekers. However, I had worked with refugees in my previous role in community engagement and had some personal insight as the daughter of a Hungarian refugee. I had also worked in a school with adolescents as a trainee on placement. My co-facilitator was a qualified counsellor registered with the British Association of Counselling and Psychotherapy, originally from Lithuania, who had voluntarily relocated to the UK. She had significant experience working with adolescents in the school counselling service and was a competent Russian speaker.

 

 All members of the group gave written consent for the use of words, images and interactions from the sessions in this paper. Where feedback was given in Russian it has been translated into English by my co-facilitator. The students chose the words ‘refugee’ and ‘displaced person’ to describe themselves in their current situation and I have used these interchangeably throughout.

 

Therapeutic space within the school setting

Therapy took place in the school’s wellbeing suite, a quiet space separate from the rest of the school. We had use of the space once a week for the entire day. One of the effects of trauma is a loss of trust in the world as a safe and welcoming place (Akthar and Lovell, 2019). My co-facilitator and I worked to establish the therapy room as a physical and psychological ‘safe space’ (Kalmanowitz and Lloyd, 2005b) The main room was furnished with sofas, chairs and tables. Art materials were set out in a central working area and on a table in the corner. A second smaller room was also available for one-to-one discussions.

 

The size of the room necessitated dividing the participants into two groups. As friendships had already begun to form within year groups, we initially divided them according to age. Each group had an hour-long session at the same time each week. Outside these times the participants could use the space and art materials as they wished, while we remained present. The shared use of the rooms throughout the day meant that it quickly became a ‘safe haven’ where they could become absorbed in their work (Lloyd and Usiskin, 2022). Their ownership of the space had a positive effect on their sense of agency within the therapy sessions and on the therapeutic alliance.

 

Sessions began three weeks after the start of the school term, when members of the group had been in the UK for two to four months. They continued weekly with breaks for holidays. Attendance was consistent but all members missed sessions at times due to illness or absence for family visits. The activity described in this paper is the making of hanging mobiles, which took place in session 12, the first session after a two-week holiday. This was one of a number of directed activities devised in response to the evolving needs of the group. As context I will first summarise the work of the sessions leading up to this activity as the development of a strong therapeutic alliance and sense of safety in the group was an essential pre-requisite to the mobile-making activity.

 

Sessions 1-5: Building a sense of psychological safety

During the first five weeks of therapy we focused on establishing a sense of psychological safety, developing the therapeutic relationships and a sense of belonging and trust within the group (Yalom and Leszcz, 2005). Predominant issues brought were homesickness, fear for family remaining in Ukraine and uncertainty about the future. Loss of home also meant a loss of expected and planned-for futures. It was hard at this stage for them to imagine alternative futures. In the first three sessions we explored what safety looks and feels like and identified triggers and self-soothing strategies (Treisman, 2017). It was important to complete this work prior to the mobile-making activity in order to provide tools for managing any distressing feelings that might arise (Tripp, Potash and Brancheau, 2019). The group benefitted from noticing similar responses to shared experiences (Akthar and Lovell, 2019). Some more confident members modelled talking about their feelings which enabled less confident members to join in. Some remained unwilling to share verbally but made artwork that was validated by the shared gaze of the group (Isserow, 2008).

 

The second issue that arose early in therapy was that of belonging. Cultural and language barriers made it hard for the Ukrainians to make friends with their British peers. They experienced bullying and exclusion in the school community and struggled with the unfamiliar education system. In sessions they were able to express their anger, for example making images of the bullies, defacing them, and finally flushing the pieces of paper down the toilet. The group was able to share and validate their feelings of frustration, rejection and sadness.

 

 

Sessions 6-11: Longing and belonging

On return from the holiday there was a shift of focus. They were beginning to develop friendships and engage in some normal adolescent behaviours. Those who had visited family In Ukraine or Poland reported a difficulty in feeling connected there, as if they had begun to put down new roots in their host country and felt more distant from their lives in Ukraine. They expressed some discomfort and guilt about this. It was also at this point that several participants stopped following Ukrainian online school. For some this represented a positive investment in their lives in the UK, but for others it was an expression of hopelessness and an inability to imagine a future either in the UK or in Ukraine. When invited to situate themselves on a line with Ukraine at one end and the UK at the other, some remained closely attached to Ukraine, but others had shifted much closer to the UK. Longing for the past was now in tension with a need to belong in the present. The mobile-making activity was intended to explore the complexity of holding such conflicting feelings.

 

 

Session 12: Making hanging mobiles

The idea for this activity arose from discussion within the group. Each individual brought specific issues, but the underlying theme was the discomfort of existing in a liminal space of transition in which they no longer felt rooted in Ukraine nor yet belonged in the UK.  They asked for a directed activity to explore these feelings, which may have reflected a need for containment while they navigated potentially destabilizing emotions.

 

The metaphor of the hanging mobile suggested itself as a way to explore non-verbally how competing or contradictory feelings might be held together, opposites connected, and some balance found which could allow both to exist even if no resolution was possible. Mobiles have been used effectively by Spier (2010) to address challenges of school transition with adolescents and in family therapy by O’Brien and Loudon (1985).

 

A variety of materials was provided including found objects (seashells, driftwood, stones), coloured beads, small organza bags, variously-coloured balls of yarn, raffia, string, fabric, wire and barbecue skewers (with the pointed tips removed). Paper, card, markers, pencils and pens, scissors and tape were also available.

 

I showed the group a mobile I had made, sharing what each of the objects represented for me and my observations on the process of making and balancing them. I suggested they make their mobiles taking the following steps:

 

1. Think of the main issues in your life and pair them e.g. Ukraine and UK, school and home, things you enjoy and things that weigh you down
2. Choose or make objects to represent them
3. Attach each pair to opposite ends of a skewer
4. Attach the skewers to each other using string or yarn and adjust so that the mobile balances

 

Participants were free to explore the materials and select items that resonated with them. My mobile was hung in the room for reference and I and my co-facilitator were available to help if needed.

 

Ruslana first constructed an object from wire and twine to represent things she struggled with.  She reflected that these things took a lot of time and energy in her life and felt complicated. To balance this, she filled an organza bag with colourful beads and an orange feather symbolising her interests and passions. She said this was easy and enjoyable to construct.  At the next level she attached small wooden figures, blue representing her father, red and green tied together for her mother and younger sibling. At the bottom level she chose a stone with a hole to represent her relationships in school in the UK, which felt like a weight dragging her down. For her friendships in Ukraine she chose a large shell with a hole in the side because her relationships with her Ukrainian friends were beautiful but not perfect. She also associated the shell with home, safety and belonging.

In balancing the mobile, Ruslana noticed that she had to slide the centre of balance closer to the stone and away from the shell. She reflected on how distant she feels from Ukrainian friends and how hard she must work on new relationships in the UK. She also noticed that the weight of these objects had the effect of grounding and stabilising the entire structure. I wondered with her whether this reflected the centrality of friends in her life currently. At the top level she had to move the centre of balance much closer to the bag of beads and observed that to feel happy she needed to focus on her passions, hopes and dreams through enjoyable activities.  Reflecting on her family situation, she noticed how distant she felt from her father in Ukraine but acknowledged there had always been emotional distance between them. She also noticed how hard it is for the family to be separated, which led to discussion of her guilt at expressing negative feelings when her mother was also struggling.

 

Klara similarly used beads and a feather for things that keep her positive: her hobbies and interests. A heavy shell bound with yarn symbolised things that drag her down. She noticed that to balance the mobile she had to add more pleasurable activities. Two bundles of wool represented her mother in the UK and her father in Ukraine. A small wooden figure attached to the latter was an important friend, who had remained in Ukraine. Klara noticed how hard it was to balance the mobile and how easily it became destabilized, which she felt mirrored the volatility of her own moods.

Nina chose a feather for her mother, who kept her ‘under her wing’. Opposite she hung a wire circlewrapped in green wool for her grandfather, whom she had last seen in Ukraine inthe spring when everything was green. A piece of driftwood represented her‘little hobbies’ and a small wooden figure was an important friend in Ukrainewith whom she had experienced a lot. She felt this friend was always with her,even though they were now physically distant. She noticed how hard it was tobalance everything as the stone, representing school and her current life, keptdragging everything down. She was pleased to be able to counterbalance it with alarge shell symbolizing her hobbies.

Nadiya completed this activity slowly and carefully. She used string to create a star representing her passion for dancing. A shell stuffed with shiny cloth and a bead symbolised her family. She chose two corks to represent her friends, balancing it with a pair of feathers, standing for an important person who had recently come into her life in the UK. She spent time balancing the mobile, noticing how the large feather dominated.

Yeva and Alina both struggled to construct their mobiles. Yeva balanced a collection of coloured feathers, representing life in Ukraine before the war, with a fragment of dried sea sponge, bound with tape to represent life since the war. To signify school life, which dragged everything down, she chose a stone which she tied with string but found too heavy to attach. She could not find anything to counterbalance it and therefore couldn’t finish the mobile.

Alina chose a piece of driftwood to represent her life and balanced it with blue paper symbolising her free time. She wrapped leaf ribbon around the other skewers and said this was her family but gave up on attempts to balance it or add any more items. She was dismissive of her work and chose not to reflect on it. I felt this was connected to her low self-esteem and her sense that she had no agency in her own life.

 

Larysa and Lilya came late to this session and so had less time to complete the activity. Larysa used a selection of colourful beads to create symbols for spring and summer. She said that weather and the seasons were important to her but did not reflect further. Lilya spent longer constructing her mobile and struggled to balance it. She drew a face on a fragment of cuttlefish to represent her family. Against this she balanced a scrap of plastic netting for school, below which she hung a green plastic bead. She threaded wooden beads onto a length of green wool with knotted loops to represent her memories of the past. She did not try to balance this with anything else, instead it hung down as a single string with the ball of twine on the end. Making the visual representation seemed enough for her as she chose not to reflect on the meaning of these items or their relationship with each other.

Service user feedback

 

Participants completed a standard self-report measure, YP-Core (Clinical Outcomes in Routine Evaluation for Young People), translated into Russian, at regular intervals (Twigg et al., 2010). In order to offer an outcome measure more tailored to this group, I devised a visual measure, “Feelings’ Cups” (Figure 6), which was used simultaneously as a trauma-informed approach focusing on issues commonly faced by refugees. This drew on the Outcomes Star (Triangle, 2020) and on guidelines for using outcome measures with adolescents and refugees (BACP, 2016; NCTSN, 2019; Demkowicz et al., 2020). When the measure was repeated, participants were invited to reflect on any changes.

In the session following the mobile-making, Ruslana noticed that she had less motivation and believed it was because she no longer had any hope of making a good life in the UK as she felt it was impossible to belong in UK friendship groups where she continued to be excluded. Nina was pleased to see that her “Feelings’ Cups” contained more safety and hope and less fear. There was still some anxiety and sadness, which she attributed partly to her relationship with her mother, now even more difficult under the stress of displacement.  Nadiya was glad to see a decrease in negative feelings and an increase in positive feelings. She felt the improvement was due to developing friendships, better communication with people and finding opportunities to smile and laugh. Her YP-Core score had reduced significantly indicating an improvement in wellbeing.

 

Yeva's “Feelings’ Cups” showed hope and motivation completely empty now. Happiness and safety contained slightly less, anger remained the same, but sadness, anxiety and fear contained slightly more. Yeva told us that she felt unable to see any future other than returning to Ukraine and was aware that her education had all but stopped as she was no longer following Ukrainian online school and the language barrier prevented her from accessing British education. She felt distressed and hopeless about her future.

 

The group was asked for feedback, either written or verbal, on the mobile-making activity. Ruslana, Klara, Nina and Nadiya liked the structure of the guided activity and found it ‘helpful and interesting’ to think in this way about things they were struggling with. The group discussed how it was easier to balance the mobiles if somebody helped and noticed that the mobiles were fragile and constantly changing. They were able to draw parallels with their current life situations. Some objects interfered with others as they swung around and some needed to be tied on especially tightly. Nina ‘loved’ the mobile-making activity, finding it ‘healing’ and was pleased with her mobile. Klara said the mobile-making was ‘useful and interesting’.  She enjoyed sharing her thoughts and feelings in the group and found artmaking ‘relaxing’. Nadiya found the activity very satisfying and was pleased with the result.

 

Yeva did not dislike the activity but said that she had found it difficult to think what to make and had struggled to create the mobile. Alina disliked the activity and her finished mobile. She found it difficult and did not know what to make or think about. I wondered if her response to the activity reflected her negative self-image and low self-esteem, evidenced elsewhere in her approach to artmaking. Her “Feelings’ Cups” indicated increased sadness and anger, with hope, happiness and motivation remaining low.

 

Larysa and Lilya disliked the mobile-making activity and were unhappy with what they made. Lilya found it difficult to reflect and felt others had made better mobiles. Larysa felt that hers was unfinished but she did not know what to add. I acknowledged that they had less time and had not been given the same introduction to the activity as the rest of the group. They had also missed sessions while visiting family abroad. I wondered whether on their return it had been difficult to settle again. I felt that they did not have the same level of trust with us or sense of belonging in the group. I noticed they were often marginalised by the others: they tended to sit apart, talked only with each other and were always the last to select materials. I wondered whether, as twins, there was some interdependency in their relationship which kept them apart from the group (Dilalla, 2006).

Implications for Research

 

Feedback suggests that mobile-making can be helpful as a means of examining challenges inherent in the refugee situation. For those able to balance their mobiles, it had the potential to promote a sense of agency and control. Finding ways to balance the different objects offered a concrete way to explore holding and balancing the conflicting feelings of a transitional space, leading to greater self-awareness and insight.

 

While they engaged in this activity, there was an energy in the room that was not always present during other sessions, indicating a deeper level of engagement and creativity. Mobile-making is a complex process involving several steps; it can be hard to find balance. Those who succeeded became immersed in their efforts, possibly experiencing ‘flow’,  and gained a sense of mastery through their achievement. Finding the appropriate level of challenge in an activity is an important element in its success (Lee, 2013) and may help participants to connect the activity to the complex challenges in their lives.

 

The competency, personal insight and creativity experienced by some in the mobile-making are all key elements in resilience. There is a need for more research to explore and evidence how art therapy can promote resilience in displaced young people (Kalmanowitz, 2016; Ugurlu, Akca & Acarturk, 2016; Kalaf and Plante, 2020; Annous, Al-Hroub and El Zein, 2022) especially as numbers of displaced persons continue to increase worldwide (UNHCR, 2023b).

 

I had not anticipated that some participants would choose not to balance their mobiles. I saw this as an expression of overwhelm and hopelessness that highlighted their current situation and level of adaptation. These participants struggled to explore creatively, perhaps due to less capacity for this at that time (Kalmanowitz and Lloyd, 2005b). With less trust in the therapeutic relationship, they may have been unready to face the difficult feelings that might arise (Kälin and Murphy, 2005). Homesickness was also a factor in their unwillingness to integrate past and present (Isfahani, 2008). Mobile-making enabled them to express the weight of these feelings and their lack of motivation, hope or agency.

 

They could not balance their mobiles, just as they could not effect change in their lives. This was the first step towards a stronger therapeutic alliance, as we accepted and respected their unfinished and un-balanced mobiles, ‘holding’ them both literally and metaphorically. The role of artmaking in exploring the relationship between hopelessness, motivation and agency is an area for further investigation (Atlas, 2009; Kalmanowitz, 2016; Kalmanowitz and Lloyd, 2016; Procter et al., 2018).

 

In offering this activity in the future it will be important to ensure it takes place in a safe space and within the containment of a strong therapeutic relationship, as there is the potential to highlight the imbalance and fragility of a participant’s situation. It will also be necessary to provide appropriate support to explore the experience with participants who struggle.

 

The development of the “Feelings’ Cups” measure with these service users demonstrates how ‘the partnership of therapist and client has great value for fostering innovation within art psychotherapy’ (Coles and Winter, 2022, p.58). The information it provided regarding levels of motivation and hope was particularly helpful for the mobile-making activity and appreciated by participants. It would be valuable to use the measure in other circumstances to assess its usefulness.

Conclusion

 

This paper examined an intervention with Ukrainian refugees in a school setting, focusing on the activity of making hanging mobiles. Some participants gained insight and a sense of agency and mastery through the mobile-making. Others felt less agency but used the mobiles to share feelings of hopelessness. The mobile-making activity offers a means of examining the difficult feelings arising in a period of transition. There is potential for its use with dislocated populations and others in a position of uncertainty and change.

Acknowledgements

Thanks to the young people who agreed to share their experiences. Thanks to my co-facilitator Lolita Leistromate and to Helen Jury for support in preparing the manuscript for publication.

References

Akthar, Z and Lovell, A. (2019). ‘Art therapy with refugee children: a qualitative study explored through the lens of art therapists and their experiences’, International Journal of Art Therapy, 24(3), pp. 139-148. DOI: 10.1080/17454832.2018.1533571 (Accessed: 8 January 2023).

 

Annous N., Al-Hroub A. and El Zein F. (2022). ‘A systematic review of empirical evidence on art therapy with traumatized refugee children and youth’, Frontiers in Psychology, 13. DOI: 10.3389/fpsyg.2022.811515 (Accessed: 12 April 2023).

 

Atlas, M. (2009). ‘Experiencing displacement: Using art therapy to address xenophobia in South Africa’. Development , 52, pp. 531–536. https://doi.org/10.1057/dev.2009.74 (Accessed 14 January 2023).

Beauregard, C. (2014). ‘Effects of classroom-based creative expression programs on children’s wellbeing’, Arts in Psychotherapy, 41, pp.269–277. DOI: 10.1016/j.aip.2014.04.003 (Accessed: 11 January 2023).

 

Berberian, M. and Davis, B., eds. (2020). Art therapy practices for resilient youth: A strengths-based approach to at-promise children and adolescents. Routledge: Abingdon.

Bion, W. (1961). Experiences in groups and other papers. London: Tavistock Publications.

Block, A., Aizenman, L, Saad, A., Harrison, S., Sloan, A., Vecchio, S. and Wilson, V. (2018). ‘Peer support groups: Evaluating a culturally grounded, strengths-based approach for work with refugees’, Advances in Social Work, 18 (3), pp.930-948, DOI: 10.18060/21634 (Accessed 15 January 2023).

 

Bonanno, G. (2004). ‘Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?’ American Psychological Association, 59(1), pp.20-28. DOI:10.1037/0003-066X.59.1.20 (Accessed: 17 January 2023).

Bonz, A., Casa, S. & Arslanbek, A. (2020). ‘Conflict and displacement: Finding the space for creativity’ in Art therapy practices for resilient youth: A strengths-based approach to at-promise children and adolescents, Berberian, M. and Davis, B., (eds.). Routledge: Abingdon, pp.337-358.

 

British Association for Counselling and Psychotherapy (BACP) (2016). Children and Young People Practice Research Network (CYP PRN): A toolkit for collecting routine outcome measures. Available at: https://www.bacp.co.uk/media/2355/bacp-cyp-prn-toolkit-for-collecting-routine-outcome-measures.pdf  (Accessed: 12 September 2022).

 

Coles, A. and Winter N. (2022). ‘Curiosity, creativity and innovation in art psychotherapy’, in Jury, H. and Coles, A. (eds) (2022). Art psychotherapy and innovation: New territories, techniques and technologies. London and Philadelphia: Jessica Kingsley,

pp.43-60.

Csíkszentmihályi, M. (1991). Flow: The psychology of optimal experience. New York, NY: Harper Perennial.

Demkowicz, O., Ashworth, E., Mansfield, R. et al. (2020). ‘Children and young people’s experiences of completing mental health and wellbeing measures for research: learning from two school-based pilot projects’. Child and Adolescent Psychiatry and Mental Health 14, 35. DOI: 10.1186/s13034-020-00341-7 (Accessed: 12 September 2022).

Dieterich-Hartwell, R. and Koch, S. (2017). ‘Creative arts therapies as temporary home for refugees: Insights from literature and practice’, Behavioral Sciences, 7(4), 69. DOI: 10.3390/bs7040069 (Accessed 23 January 2023).

Ehntholt, K. and Yule, W. (2006). ‘Assessment and treatment of refugee children and adolescents who have experienced war-related trauma’, Journal of Child Psychology and Psychiatry, 47(12), pp.1197-1210. DOI: 10.1111/j.1469-7610.2006.01638.x (Accessed: 23 April 2023).

Dilalla, L. (2006). ‘Social development of twins’, Twin Research and Human Genetics, 9(1), pp.95-102. DOI: 10.1375/183242706776402876 (Accessed: 27 August 2023).

Emberley, A. (2005). ‘Responding to the crisis of relocation’, Canadian Art Therapy Association Journal, 18(1), pp. 10-19. DOI: 10.1080/08322473.2005.11432267. (Accessed: 15 January 2023).

 

Ferrari, B. (2022) ‘Creating the environment for recovery for displaced children, young people and families’ [Webinar], UK Trauma Council. Available at: https://uktraumacouncil.org/research_practice/refugee-asylum-seeking-resources (Accessed: 11 October 2022).

 

Fitzpatrick, F. (2002). ‘A search for home: The role of art therapy in understanding the experiences of Bosnian refugees in western Australia’, Art Therapy, 19(4), pp. 151-158. DOI: 10.1080/07421656.2002.10129680 (Accessed: 14 January 2023).

 

Gaywood, D., Bertram, T. and Pascal, C. (2020) ‘Involving refugee children in research: Emerging ethical and positioning issues’, European Early Childhood Education Research Journal, 28(1), pp.149-162, DOI: 10.1080/1350293X.2020.1707369 (Accessed: 11 January 2023).

 

Genc, E. (2022). ‘The effectiveness of trauma treatment approaches in refugee children and adolescents: A systematic review’, Children and Youth Services Review, 141. DOI:10.1016/j.childyouth.2022.106602 (Accessed: 7 January 2023).

 

Gonsalves, C. (1992). ‘Psychological stages of the refugee process: A model for therapeutic interventions’. Professional Psychology: Research and Practice, 23(5), pp. 382-389. DOI:10.1037/0735-7028.23.5.382 (Accessed: 14 January 2023).

Hanania, A. (2020). ‘Embroidery (Tatriz) and Syrian refugees: Exploring loss and hope through storytelling’, Canadian Journal of Art Therapy, 33(2), pp. 62-69. DOI: 10.1080/26907240.2020.1844416 (Accessed: 16 January 2023).

Hayward, M. (2019). ‘Chapter 1: Stop labeling me as traumatised or as mentally unwell – I am a resilient survivor: A discussion of the pathologising effects of trauma labelling for former refugees in contrast to a strengths-based settlement programme model’ in Educational Policies and Practices of English-Speaking Refugee Resettlement Countries, Jody McBrien (ed.).  Brill: Leiden. pp.17–41. DOI: https://doi.org/10.1163/9789004401891_001 (Accessed: 14 January 2023).

 

Hodes, M. and Vostanis, P. (2018). ‘Practitioner Review: Mental health problems of refugee children and adolescents and their management’, The Journal of Child Psychology and Psychiatry, 60(7), pp. 716-731 DOI: 10.1111/jcpp.13002 (Accessed: 19 January 2023).

 

Isfahani, S. (2008). ‘Art therapy with a young refugee woman – survivor of war,’ International Journal of Art Therapy, 13( 2), pp.79-87. DOI: 10.1080/17454830802503453 (Accessed: 9 January 2023).

Isserow, J. (2008). ‘Looking together: Joint attention in art therapy’. International Journal of Art Therapy, 13(1), pp. 34–42. DOI:10.1080/17454830802002894 (Accessed: 18 February 2020).

Jury, H. and Coles, A. eds. (2022). Art psychotherapy and innovation: New territories, techniques and technologies. London and Philadelphia: Jessica Kingsley.

Kalaf, L. and Plante, P. (2020). ‘Restoring lost resources for young refugees: An integrative review of the resilience-building potential of expressive therapies’, Canadian Journal of Art Therapy, 33(1), pp. 5-16. DOI: 10.1080/08322473.2019.1684182 (Accessed: 14 January 2023).

Kälin, A. and Murphy, J. (2005). ‘The moment in and out of time: Reflections on context and timing in art therapy interventions in Kosovo’ in Art therapy and political violence: with art, without illusion,

Kalmanowitz, D. and Lloyd, B. (eds.), Routledge: Hove, pp. 60-75.

Kalmanowitz, D. (2016). ‘Inhabited studio: Art therapy and mindfulness, resilience, adversity and refugees’. International Journal of Art Therapy, 21(2), pp. 75–84. DOI:10.1080/ 17454832.2016.1170053 (Accessed: 19 March 2021).

 

Kalmanowitz, D. (2022). ‘Reinforcing a home in the mind: An art therapy and mindfulness-oriented approach to working with refugees, trauma and resilience’ in Jury, H. and Coles, A. (eds) (2022). Art psychotherapy and innovation: New territories, techniques and technologies. London and Philadelphia: Jessica Kingsley, pp.165-186.

 

Kalmanowitz, D. and Lloyd, B. (2016). ‘Art therapy at the border: Holding the line of the kite’, Journal of Applied Arts and Health, 7 (2), pp. 143-158. DOI: https://doi.org/10.1386/jaah.7.2.143_1 (Accessed: 17 January 2023.)

 

Kalmanowitz, D. and Lloyd, B. eds. (2005a). Art therapy and political violence: with art, without illusion. Routledge: Hove.

 

Kalmanowitz, D. and Lloyd, B. (2005b). ‘Inside the portable studio: Art therapy in the former Yugoslavia 1994-2002’ in Art therapy and political violence: with art, without illusion. Kalmanowitz, D. and Lloyd, B. eds. Routledge: Hove, pp106-125.

Kapitan, L. (2015). ‘Social action in practice: Shifting the ethnocentric lens in cross-cultural art therapy encounters’. Art Therapy, 32, pp.104-111. DOI:10.1080/07421656.2015.1060403 (Accessed: 20 March 2022).

Kerpelman, J. and Pittman J. (2018). ‘Erikson and the relational context of identity: Strengthening connections with attachment theory’, Identity, 18(4), pp. 306-314. DOI: 10.1080/15283488.2018.1523726 (Accessed: 10 December 2022).

Kuri, E. (2017). ‘Toward an ethical application of intersectionality in art therapy’. Art Therapy, 34, pp. 118-122. DOI:10.1080/07421656.2017.1358023 (Accessed: 19 December 2022).

 

Lee S. (2013). ‘“Flow” in art therapy: Empowering immigrant children with adjustment difficulties’, Art Therapy, 30(2), pp. 56-63. DOI: 10.1080/07421656.2013.786978 (Accessed: 27 October 2022).

 

Lemzoudi, Y. (2007). ‘Migration: Acculturation process, cultural identity development, and art therapy imagery of adolescent migrants’, Canadian Art Therapy Association Journal, 20(2), pp. 2-21. DOI: 10.1080/08322473.2007.11434770 (Accessed: 15 January 2023).

Lloyd, B and Usiskin, M. (2022). ‘The community table: Developing art therapy studios on, in-between, and across borders’ in Contemporary Practice in Studio Art Therapy, Brown, C. and Omand, H. (eds.). Routledge: Abingdon pp. 101-116.

 

Lloyd, B. and Usiskin, M. (2020). ‘Reimagining an emergency space: practice innovation within a frontline art therapy project on the France-UK border at Calais’, International Journal of Art Therapy, 25(3), pp.132-142, DOI: 10.1080/17454832.2020.1786417 (Accessed: 12 December 2022).

Lloyd, B, Press, N. and Usiskin, M. (2018). ‘The Calais winds took our plans away: Art therapy as shelter’, Journal of Applied Arts and Health, 9(2), pp.171-184. DOI: https://doi.org/10.1386/jaah.9.2.171_1 (Accessed: 14 December 2022).

 

Masten, A. (2014). ‘Global perspectives on resilience in children and youth’. Child Development, 85(1), pp. 6–20. DOI: 10.1111/cdev.12205 (Accessed 25 July 2022).

 

Masten, A. (2015). Ordinary magic: Resilience in development. New York: Guilford Publications.

 

Meyer DeMott, M., Jakobsen, M., Wentzel-Larsen, T. and Heir, T. (2017). ‘A controlled early group intervention study for unaccompanied minors: Can expressive arts alleviate symptoms of trauma and enhance life satisfaction?’, Scandinavian Journal of Psychology, 58(6), pp. 510-518. DOI:10.1111/sjop.12395 (Accessed: 20 September 2022).

 

Moore, T. (2017). ‘Strengths-based narrative storytelling as therapeutic intervention for refugees in Greece’, World Federation of Occupational Therapists Bulletin, 73(1), pp.45-51, DOI: 10.1080/14473828.2017.1298557 (Accessed: 12 January 2023).

 

O'Brien, A. and Loudon, P. (1985), ‘Redressing the balance—involving children in family therapy.’, Journal of Family Therapy, 7 (2), pp.81-88. DOI: 10.1046/j..1985.00668.x (Accessed 31 July 2023).

 

Papadopoulos, R. (2021). ‘The approach of synergic therapeutic complexity with involuntarily dislocated people’, Systemic Thinking and Psychotherapy, 18. Available at: https://repository.essex.ac.uk/31750/ (Accessed: 4 January 2023).

 

Peltonen, K. and Punamäki, R. (2010). ‘Preventive interventions among children exposed to trauma of armed conflict: A literature review. Aggressive Behavior, 36, pp.95-116. DOI: 10.1002/ab.20334. (Accessed: 15 January 2023).

 

Procter, N., Kenny, M., Eaton, H. and Grech, C. (2018), ‘Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration’. International Journal of Mental Health Nursing, 27, pp.448-454. DOI: 10.1111/inm.12325 (Accessed: 28 October 2022).

Spier, E. (2010), ‘Group art therapy with eighth-grade students transitioning to high school’, Art Therapy: Journal of the American Art Therapy Association, 27(2) pp. 75-83. Available at: https://files.eric.ed.gov/fulltext/EJ901199.pdf (Accessed 31 July 2023).

Taylor, S. and Sidhu, R. (2012). ‘Supporting refugee students in schools: What constitutes inclusive education?’, International Journal of Inclusive Education, 16(1), pp. 39-56. DOI: 10.1080/13603110903560085 (Accessed: 16 January 2023).

 

The National Child Traumatic Stress Network (NCTSN) (2019). Refugee and Immigrant Core Stressors Toolkit (2nd ed.) Available at: https://www.nctsn.org/resources/refugee-services-core-stressor-assessment-tool (Accessed: 10 September 2022).

 

Treisman, K. (2017). A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma. London: Jessica Kingsley.

 

Triangle (2020). Outcomes Star: Guidance: How to…use the star in a trauma-informed approach. Available at: https://www.outcomesstar.org.uk/wp-content/uploads/HOW-TO-use-the-Star-in-a-trauma-informed-approach-012.pdf (Accessed: 10 September 2022).

Tripp, S., Potash, J. and Brancheau, D. (2019). ‘Safe place collage protocol: Art making for managing traumatic stress’, Journal of Trauma and Dissociation, 20 (5), pp.511-525. DOI: 10.1080/15299732.2019.1597813 (Accessed 20 April 2023).

Twigg, E., Barkham, M., Bewick, B., Mulhern, B., Connell, J., & Cooper, M. (2010). ‘The Young Person’s CORE: Development of a brief outcome measure for young people’,  Counselling and Psychotherapy Research: Linking Research with Practice, 9, pp.160 – 168. DOI: 10.1080/14733140902979722. (Accessed 31 July 2023).

;p0

Tyrer R. and Fazel M. (2014). ‘School and community-based interventions for refugee and asylum seeking children: A systematic review’. PLoS ONE 9(2): e89359. DOI:10.1371/journal.pone.0089359 (Accessed: 14 January 2023).

 

Ugurlu, N., Akca, L. and Acarturk, C. (2016). ‘An art therapy intervention for symptoms of post-traumatic stress, depression and anxiety among Syrian refugee children’, Vulnerable Children and Youth Studies, 11(2), pp. 89-102. DOI: 10.1080/17450128.2016.1181288 (Accessed 19 January 2023).

 

UK Department for Education (2022). Resources to help children and young people arriving from Ukraine. Available at: https://www.gov.uk/government/publications/helping-ukrainian-students-in-schools/resources-to-help-support-children-and-young-people-arriving-from-ukraine. (Accessed: 17 January 2023).

 

United Nations High Commissioner for Refugees (UNHCR) (2023a) https://data.unhcr.org/en/situations/ukraine (Accessed: 20 January 2023).

 

UNHCR (2023b), Refugee Data Finder. Available at: https://www.unhcr.org/refugee-statistics/. (Accessed: 23 April 2023).

 

Worrall, L. & Jerry, P. (2007). ‘Resiliency and its relationship to art therapy’, Canadian Art Therapy Association Journal, 20(2), pp.35-53, DOI: 10.1080/08322473.2007.11434772 (Accessed: 9 December 2023).

 

Yalom, I. and Leszcz, M (2005). The theory and practice of group psychotherapy. 5^th edn. New York: Basic Books.

 

Yuen, E. et al. (2020) ‘Accentuate the Positive: Strengths-Based Therapy for Adolescents.’ Adolescent psychiatry,10 (3), pp.166-171. DOI:10.2174/2210676610666200225105529 (Accessed 4 January 2023).