Poetry Therapy

The Therapeutic Use Of Poetry
Pilot Project Evaluation Report September 2011
Now you build them cathedrals in their sense of sound RAINER MARIA RILKE

From May to July 2011 a pilot project at Jack Tizard School assessing the impact of the therapeutic use of poetry for children who have a range of disabilities took place. Philip Wells, a performance poet and teacher, attended the school for one day a week over a ten-week period working with four individual children and four classroom groups. The aim of the project was to assess a therapeutic model developed over the past ten years by Philip Wells. Rebecca O'Connor, Consultant Music Therapist, facilitated the project by advising on the project methodology, supervising the clinical work and observing sessions.

Jack Tizard School and The Alice Fund jointly financed the project.

Introduction to the therapeutic use of poetry for children with severe and complex needs and disabilities

The poet and the child connect and communicate through dramatic language, creative wordplay and percussion. The poet juggles syllables, words, rhythms and timbres to reflect back elements of the children's behaviours, vocal sounds and emotions, creating imaginary stories and exciting dynamic journeys through which the children can experience different landscapes of feeling where they can express themselves freely and fearlessly.

This therapeutic approach is driven by the word, its music and its rhythms. At its heart is a belief in the power of the music of language and the language of music, and in the richness of listening and silence, the fertility of the fusion of its breath and its beat. It learns attunement from music therapy, and the child-centred listening to the choice of the child, the hidden voice of the child. It reflects the empathetic building of a musical conversation that is central to music therapy. It is acutely sensitive to the cues of communication sent out by the child. So it listens to the thousand kinds of silence and it reads signs, in the combination of the flicker of an eye and a deep sigh, in the changing rhythms and the patterns of a breath, in the most subtle of vocalisations combined with movements of fingers, head, eyebrows and mouth. It reads the lyrical turning of a head like a multitude bowing to a king. It understands body language in all its eloquence.

It is by nature spontaneous and improvisational, fusing aspects of clowning, theatre, storytelling and song with the spiritual knowledge of the bardic tradition. While this therapeutic approach revels in the ever-expanding playfulness and the natural abandon of the creative imagination, where it is acutely tuned in to atmosphere and presence, it is also firmly rooted in established teaching methods, in narrative themes and educational forms, in the psychology of transference and in theories axiomatic to music therapy relating to mother-child interaction.

While the therapeutic use of poetry is new, poetry has since ancient times been recognised as a powerful communicative medium and was originally known as "mother of the arts." It has unique qualities in recreating space through the dynamics and vibroacoustics of musical sound. Through these dynamics the child is able to connect at a profound pre-verbal intuitive level to the poet and to the "place beyond that is so close". It is an exciting new way of communicating across the language barrier with huge potential to increase pathways of connecting with disabled children in a multi-disciplinary therapeutic setting. In fifteen years as a professional performance poet working in a huge range of settings across education, health, entertainment and industry, Philip is able to testify to the amazing pre-verbal capacity of poetry to communicate meaning through sound alone.

Like poetry itself, the therapeutic use of poetry aims to give voice to the voiceless; to bring the hidden into the light; to begin to speak of impossible things; to articulate what cannot be put into words. It is a powerful release, when what is blocked and contained and dammed and trapped is suddenly unleashed in speech, in expression. In the most practical of ways, the therapeutic use of poetry can literally give a child a voice, a means of making choices at every stage of an ongoing narrative so that every reaction, every breath and silence and vocalisation, is picked up by the improvising poet and absorbed into the narrative in a continuous flow to create a meaningful dialogue in word and syllable, in sound and rhythm and song.

Project methodology:
In order to evaluate the impact of therapy intervention data was collated from three sources:

1. Questionnaires: At the end of the ten week course questionnaires were completed anonymously by all members of Jack Tizard staff who witnessed three or more sessions, 26 questionnaires in total (see Appendix One).

2. Video recordings of sessions: Video recordings were taken of session one and session seven of the individual children's sessions and of a variety of group sessions. The video footage was analysed by Philip and Rebecca to observe the children's interactive skills and responses to the therapeutic use of poetry.

3. Observations by Rebecca O'Connor, consultant music therapist: Rebecca acting as an 'engaged observer' observed sessions one and seven of the group and of the individual sessions taking detailed notes focussing specifically on the children's responses to Philip's words, vocal timbre, rhythm and pitch.

Poetry therapy evaluation:
Questionnaires: Questionnaires were structured so that both qualitative and quantitative data could be collated. The questionnaires included details regarding the impact of poetry on the children's communication and social skills including eye contact, listening skills, interactive skills and vocalisations.

The following is a summary of findings:
Quantitative findings:
• 100% of staff who completed the questionnaire stated that they felt the therapeutic use of poetry was beneficial to the children
• 100% of staff who completed the questionnaire stated that the children showed an improvement in listening skills over the course of ten sessions.
• 100% of staff who completed the questionnaire stated that the children showed an improvement in interactive skills over the course of ten sessions.
• 100% of staff who completed the questionnaire stated that they would recommend the therapeutic use of poetry to others
• 100% of staff who completed the questionnaire stated that the children showed an improvement in eye contact over the course of ten sessions
• 24/26 staff who completed the questionnaire stated that the children showed an improvement in vocalisations

Qualitative findings: Examples of staff comments: The benefits of the therapeutic use of poetry for children:
• 'It is a great form of intensive interaction'
• 'It contributes to the student's language and literacy skills'
• 'It helps the non-verbal students to communicate in their own way'
• 'It is amazing how much 'A' has understood and enjoyed'
• 'In the groups the students have bonded and social skills have been improved within the group'
• 'It enables the students to respond positively and creatively'
• 'Students are a lot happier, calmer and able to focus and sit through the 20 – 30 minute sessions'
• 'It values the individuals'
• 'The children are learning to be more spontaneous and lyrical with their speech'
• 'It is another way of accessing learning and developing the students awareness of themselves'

Would they recommend this therapeutic approach to others?
• 'I would recommend this therapeutic intervention to children in a mainstream school'
• 'I would recommend this to others because I believe it is a good way to release stress and unwind and be comfortable in yourself'
• 'Yes I feel that there are so many emotions that the children show that we would not normally see'
• 'Yes it is a great form of intensive interaction'
• 'I would recommend this therapy as I feel that there is an inherent need in children to communicate which this therapy has catered to'

Ways that the therapeutic use of poetry could be improved:
• It should be available to every child
• More group sessions
• The sessions could be run between different class groups
• Write down some of the poems that have been created with the children and put them in the achievement folders or send home to parents
• Discussion with the teachers beforehand so that communication skills that are being worked on in class can be incorporated in the sessions
• Longer sessions with a particular theme to see the progress over a period of sessions

Video recordings of sessions and Rebecca's observations:
Sessions one and seven were observed by Rebecca and recorded on video. The impact of poetry on the children's communication and social skills including eye contact, listening skills, interactive skills and vocalisations were observed and compared between session one and session seven. Analysis of video footage of sessions by Rebecca and Philip and analysis of Rebecca's detailed session process notes clearly indicated positive changes in all sessions particularly in the area of the children's listening skills, interactive skills and eye contact. These findings were consistent with those reflected in questionnaires completed by staff. Case studies The therapeutic use of poetry in group sessions Philip worked with four groups, each a valuable experience in different ways: Zebra class, Elephant class, Kangaroo class (all in the upper primary range, aged 7 to 11) and the 6th form. In Zebra Class Philip found a powerful and joyous way of accessing the curriculum with children with no language but a range of vocalisations. The sessions were always rigourously inclusive, dynamic and great fun, and proved the importance of mixing lyrical improvisation with a structured narrative storyline. With improvisation, all the children's vocalisations and expressions are woven into a common narrative wherever possible. The children eagerly anticipated the sessions because they knew that their choices and expressions would be listened to and honoured. J in particular consistently showed a determination to be heard, choosing a musical instrument to express herself in every session, despite profound difficulties in basic communication and movement.

With the Kangaroo Class there was more vocal ability and they developed an awareness of the order and shape of a story emerging from the initially chaotic joyful expression and fearless play. All their attempts at music-making and expression were profoundly valued and amplified, and this they found consistently satisfying.

The 6th form created many poems as a group through Philip working as a facilitator, and this worked to accentuate a powerful community spirit in which turn-taking, mutual appreciation, friendship and respect were of profound importance. Particular focus was on their names and what they were able to do and liked to do, and what special individual sounds and rhythms they were able to make.

In all the classes the staff were very successful at making learning work by creating a welcoming, giving atmosphere where joy and laughter and spontaneous risk-taking with ideas and vocalisations went hand in hand with the serious educational purpose of each session.

Case study: Elephant Class
The Elephant Class is a primary class of complex and varying behavioural and educational needs which showed over the ten-week formal period of sessions the principal strengths of the group approach to this therapy. In a very challenging class with challenging behaviour and a huge contrast in characters from the violently noisy to the painfully shy, from the profoundly autistic to the wildly attention-seeking, the therapeutic use of poetry sessions allowed an atmosphere of constructive concentration and measured calm to take hold.

Essentially sessions over the ten weeks took on a fairly consistent shape, typically taking a challenging classroom situation into a structured and consistent storytelling event in which each of the children would take on a role in a lyrical story where whatever they did would be creatively woven into the growing shared group narrative. This growing pattern would be repeated again and again throughout a session so the children could feel a narrative poem building, and they would feel themselves and their friends as part of it, as essential characters in a unique shared story.

For example, in one session the sometimes aggressive Timothy was pleased to see Philip, and waved his arms in the air, which was translated as "Hooray." This resulted in the sung line, "When we listen to Timothy, he says hooray!". This was repeated in a strong rhythm using the drum, so the staff could join in, and all the children could clap along in a shared percussive event. Then it was Suzanna's turn, and she started to move in rhythm to the drum's beat, so the sung line was added, "When we listen to Suzanna, she starts to sway." Suddenly, a narrative formula is found where each child in the class is included in a spontaneous way to a structured lyrical narrative where each child has equal status and ownership. In this simple way poetry can bring a transformative musical structure into an atmosphere that seems impossibly disparate, with children all pulling in their own directions and making irreconcilably different demands. Soon the atmosphere veers dramatically towards order and unity, led by the consistent drumbeat, which serves as the metrical backbone for the emerging narrative poem. It is as if the wilder elements of the tribe were all being drawn into the unifying warmth of the fireside, in a gathering of irresistible communal calm. And so the extreme repetitive screams of Lily became after a few hundred drumbeats a beautifully hypnotic silence, where Lily crouched up on her chair, gazing in wonder at the open book balanced perfectly in her open hand.

The narratives were varied, from hilltop picnics eating clouds to jungle playgrounds sliding down dinosaur necks, but they invariably involved being very individual (but essentially equal) members of a group, with perhaps varying skills and signature sounds. So in one session the roles were Suzanna as a flapping butterfly, Timothy as a roaring lion, Maya as a bouncing kangaroo, Mansour as a soaring eagle, Ahwad as a stamping elephant and Lily as a snapping crocodile.

This turn-taking principle is critically important with a child-centred approach, where every contribution, good or bad, is creatively valued. So Maya began one session protesting violently, but her protest was taken on board as a starting point, and so the whole session began with her being given, in the context of a lyrical story, a special underwater space. Once she had been given this space and it was sung into an ongoing narrative, all the other children had logically to also have a role in this underwater world, as part of this central turn-taking principle. Given the violence of the outburst with which Maya began the session, logic might suggest that she would continue to complain, but she was suddenly and remarkably calm. She had been listened to, and that is what she really wanted, to have her contribution accepted. All the other children were given roles in the world she had instigated, without a single word of protest from her. By the end of the poem the children were all polishing the ocean clean, with joyful and harmonious enthusiasm! The creative communal effort subsumes the chaos of competing individual voices in favour of the coherence and connectedness of the collective class voice. The children seem to feel emotionally connected to one another through the emerging creative narrative that they've joyfully contributed to and creatively invested in.

Listening to the child can mean having seemingly flexible external boundaries (much more easily achieved in a creative context than a purely educational one) and this can make all the difference. For example, on one occasion Lily would not come to the storytelling "corner" established by precedent in the corner of the room. In an improvisational, playful context, this "problem" becomes the central creative idea that leads to the solution. As Marshall McLuhan say, "You cannot not communicate". And so Lily becomes the stray deer or the faraway city or the lost jewel, and Philip goes out towards her to make sure that whatever her stance she is creatively involved in the communal narrative, even if her creative stance is that today she does not want to be part of the community. This radical inclusivity makes the child feel profoundly valued in their expression, and contributes to the child feeling wanted and needed and not being isolated and cast aside by the group. The child's voice is welcome, whatever it wants to say.

Within this inclusivity, individuals made real progress. Timothy's eye contact was much brighter and enthusiastic by the end of term; Lily would let Philip read whole stories to her in rapt concentration; Suzanna, having been intimidated initially by Philip, began to smile broadly and regularly and on one occasion tapped Philip's chest rhythmically to the class rhythm and danced with him as part of the story.

The overall positive effect was in no small measure due to the excellent staff, who joined in enthusiastically and always put the children first. They were very slow to judge, but very quick to smile and engage with whatever concept was dreamed up, always happy to be part of the wild new creative journey.

One-to-one sessions
Four students were chosen by Jack Tizard staff as being particularly suitable for therapeutic intervention using poetry. All four were of very varied character, but all had actively showed an appetite for listening and an affinity to rhythm and music. Choices were based on which children would most benefit from the intervention.

Tali is a young boy of primary age with no spoken language and severe cognitive and educational limitations who showed a particular liking for dynamic and theatrical play with nonsense syllables, which was utterly unique, and he showed a delightful and exuberant joy in extremes of sound. His listening skills in particular intensified over the sessions and his intense stillnesses at times were completely charged with an intense presence.

Ryal is another unique young man, of secondary age, with complex physical and educational needs, whose vocalisations were extremely creative and expressive and very close to real language. He had an exuberant idiolect that was a poetry all of his own. His listening intensity and eye contact intensified dramatically over time, and peaked with the performance of dramatically performed poems which he seemed to understand in his own instinctive way to a remarkable degree. For example, listening to Robert Frost's "Stopping By Woods On A Snowy Evening", Ali seemed to know precisely when the poem finished (despite several dramatic pauses previously on my part), and let out a huge sigh at the end of the poem as if to praise the emotional force and integrity of the poem.

Tarin has profound physical limitations and no language but is a very sensitive listener of pre-primary age, acutely aware of emotional dynamics and though slow to warm to a strange new voice, over time he really came out of his shell and began to engage in powerful eye contact with a broad smile, as well as becoming much more mobile, especially when craning and moving his neck. His listening ability intensified dramatically and he showed an amazing intuitive understanding of language way beyond his years.

Case study: Muri
Muri is a young man of fifteen who is restricted to a wheelchair and who has no language, with limited voluntary movements and severe learning difficulties but who is able to vocalise, and can shake your hand when he really concentrates. He was very upset when he first heard Philip declaiming to the beat of the drum, which concerned everyone except the teacher and Philip who both felt it was simply a natural outpouring of personal grief and sadness and needed to be explored further. It became clear over time that he had simply needed someone to acknowledge and accept his sadness and grief, because his mood brightened consistently during the ten weeks and he showed a great liking for being in a one-to-one session where he was literally the centre of attention. Muri seemed to experience a remarkable transformation during the last sessions of the ten week therapy which is difficult to quantify or source, but which did ultimately clearly manifest itself in an increase in physical co-ordination, increased vocalisation, an increase in concentrated listening and in the steady intensification of eye contact.

1. Non-Verbal Communication

During the sessions, words and rhythms were used by the poet in direct response to Muri's unique sounds, breathing patterns, movements and facial expressions. He would often jiggle his shoulders enthusiastically after a pause to show his desire for the rhythm to continue. Smiling broadly when he felt he had been understood, he soon realised that his own rhythms dictated the pace and shape of the session as a whole. He was especially responsive to the vibration and feeling of the tambour as he moved his own hands in rhythm, initially tentatively, then gathering in confidence and speed. He enjoyed the sound of the tambourine on top of the drum, and enjoying moving between the tambourine and the drum to experience the different qualities of the sounds. The more he enjoyed the sound, the more his whole body - shoulders, knees, hands, feet - moved to the momentum of the rhythm. He made his feelings very clear in the intensity of his eye contact: at times he would move his whole head forward to engage in a particularly strong positive response.

2. Vocal Sounds

Muri's vocal range developed over the course of the ten weeks. Initially he was quietly engaged but lacking confidence and very quiet, only sounding through the tapping of his hands on his chair. Later on he developed a short good-humoured moan which in turn developed into a lilting singsong he used along with the rhythmical bobbing of his hands and feet. With the variety of sonic and imaginative journeys Muri went on, the intensity and range of vocal activity began to expand, particularly when articulating his pride and excitement to Lucy, his carer.

3. Listening Skills

Muri's levels of concentrated listening and focused interaction increased steadily, until by session Eight he was able to concentrate on interactions for the whole of the half-hour session, as opposed to earlier sessions where he might focus for five or six minutes maximum. He was clearly aware that the lyrical, musical story was an ongoing, meaningful dialogue that was very much dependent on his emotional and intellectual input. Muri was able to express ideas and feelings far beyond the obvious limitations of his language. By the end of the ten-week period, his carer commented on how much brighter and more animated and interested in others he was all around the school.

4. Physical Goals

Even though Muri's physical goals were not seen as part of his individual learning focus and were not flagged up initially as educational aims, it was in his developing physicality that he was most impressive and surprising. His enthusiastic rocking became more and more controlled to the extent that he would playfully stop - suddenly at times - to see how quickly Philip could react, which elicited waves of laughter from Lucy and Philip. Effectively he was actively initiating a creative interaction and changing the narrative of a session, and by implication the narrative of his personality and his life. Once he realised that he was the fulcrum and the drive for all the music and all the words (his name was often used in the narrative to remind him that these words and stories ultimately related to him) he seemed to take off, and every part of his body that he could move, he did move, from his neck to his shoulders to his knees to his feet and to his hands. In his final session Muri was deliberately tapping new parts of his arms with his hands, as if simply enjoying the variety of ways he had learned to tap out a rhythm. This was amazingly tangible physical progress, and showed just how much the energy of the rhythms we had explored had become an intrinsic part of his growing personality. It was reflected in his persistent determination to shake my hand before and after every session.

The Power of a Consistent Witness
Crucial to Muri's progress was the constant presence of his carer Lucy, who always assisted Philip open-mindedly and enthusiastically, joining in with beats as requested and improvising with Muri's name and nonsense syllables when asked. The result was that the journey over the ten sessions was a powerful shared journey all had invested in, with real emotional and intellectual energy, and our sessions took on a momentum and communicative force all of their own as if a seed was growing into a tree. As a result all three present learned something new, that the sum is greater than the parts, especially in terms of creative improvisation. Philip and Lucy were constantly surprised by the integrity, power and appropriateness of the sounds and words and ideas being created together. And these shared thoughts, and this shared journey, Lucy carried with her through the days between sessions so that all that had been discovered was never lost. Indeed it was built on and valued from week to week until by the tenth session there was a towering creative structure, a lyrical story with an integrity and a power and a purpose all of its own. Muri seemed to understand completely that none of this would have happened if it hadn't been for his own creative expressive input. He was constantly reminded, in the form of the music of his own name, that this was a story in song that had been created by him, and was for him. It was all the more valuable to him because it was being witnessed by Lucy, his carer, who knew and understood him so well.

Footnote: The Poetry Factor

Poetry is best at speaking of what lies above and beyond and through words because it arises from the awesome integrity of the imagination, which is an instrument not of the mind but of the heart, and the weaver of the two. Through poetry children are able to fly above their disabilities into a world of absolute freedom where the imagination is stimulated to such an extent as to inspire new kinds of physical movement. The deeper you go, the more powerful and transformative the images. So there was a transference of astonishing lucidity when improvising with Muri, a young man who has no language and yet is utterly conscious and hungry to communicate. He connects with the poet in the many ways we've already discussed but - uniquely in poetry - he also communicates through psychological transference in the form of images. So over ten weeks essentially the poet communicated in the music of images, exploring for example in improvised song the echoes of sad subterranean caves, walking through endless tunnels to soprano chinks of light, looking through primeval forests for hidden thundering doors, flying above seas, swishing on flying fish wings, transported in silence over mountains, from where Muri surveyed new worlds like a king. And on the last day his voice began to open and we took away his hand from his face so he could be truly heard, and the sound gushed from his mouth like a bubbling spring, silver-white bubbling from the dark depths of the underworld into the glittering brightness of a morning in Eden. Lucy and Philip felt and expressed that Muri's experience of poetry had been profoundly positive and praises him as a genuine "poetry star".

Summary and conclusion
The results of this pilot project are consistently positive. The feedback from the school staff members clearly indicate that they feel children who have attended sessions have benefited particularly in the area of listening skills, interactive skills and communication. The results of the video analysis and observations by Rebecca were overwhelmingly positive in support of this therapeutic model.

"The sessions have been very well received by the students. Their interaction and communication skills are developed within the sessions and the curriculum is also accessed in a fun, creative way"

Quote from the Jack Tizard School 'Celebrating our achievements' booklet.

Thank you for considering this report.

May we also express our deepest thanks to Hugo Gerrard, Lorna Waring, Mark Drackley and Joanna Omar from The Alice Fund and also to Sarah Melman and Cathy Welsh at Jack Tizard School, and to all the staff involved in the project, for their inspiring and unswerving help in making this pilot project so successful.

Philip Wells MA (Dist) Poet

Rebecca O'Connor MA SRAth(M) RGN Consultant Music Therapist

Note: All children's names have been changed in the interests of confidentiality

Appendix 1 Questionnaire POETRY THERAPY PILOT PROJECT 2011 QUESTIONNAIRE Poetry Therapy is a brand new therapy being trialled at Jack Tizard School. In order to evaluate and assess the Poetry Therapy treatment, we would be very grateful if you could complete the questionnaire below. Your responses will be completely confidential and can be anonymous. How many sessions of music therapy have you witnessed? ___

Over the course of Poetry Therapy sessions, would you say that______________________________________has shown any improvement in the following? (Please circle as appropriate):

Eye Contact YES NO
Vocalisation YES NO
Listening Skills YES NO Interaction Skills YES NO

Overall, would you say that Poetry Therapy was beneficial for ________________? In what ways? And if not, why do you think this might be? Would you recommend Poetry Therapy to others? If so, why? And if not, why not? In what ways do you think Poetry Therapy could improve? Thank you very much for taking the time to complete this questionnaire. Your views are absolutely vital and are much appreciated. Please return your completed questionnaire to Philip Wells. If you don't want to take part, please tick here________

Appendix 2 Costings & Contact Details

Cost Per Ten Week Unit

One day a week with 8 sessions of 30 minutes' duration (Mix of group & one-to-one sessions is flexible. At Jack Tizard there were 4 group sessions and 4 one-to-one sessions every Thursday for ten weeks)

Poet's daily charge: £250

Total cost £250 x 10 = £2,500

Contact details Philip Wells info@firepoet.com

Rebecca O'Connor beckysoconnor@gmail.com