Abstract
While there has long been an extensive range of medical, pharmaceutical, psychological, physiological, spiritual and physical programs available to ADF personnel seeking health assistance, allied health practices—particularly creative arts interventions—are still relatively new in the wellbeing context.
The Australian Defence Force Arts for Recovery, Resilience, Teamwork and Skills Program (hereafter, ADF ARRTS) is an immersive, non-clinical residential program of creative engagement, funded and delivered by the ADF. It has been held biannually at the University of Canberra’s ACT campus since 2015, delving into the disciplines of creative writing, music and rhythm, and visual arts and, for a time, drama.
The Defence Science and Technology Group assessed early programs for any improvements in the psychological wellbeing and recovery of Australian military personnel with service-related injuries, finding that, compared to baseline levels, there were significant improvements in self-reported self-esteem, social functioning, physical functioning and general positive affect, and significant reductions in psychological distress, insomnia and post-traumatic levels. There was no significant change in negative affect levels.1
With very encouraging short-term results, as a people-focused program, it remained incumbent on qualitative research into the longer-term effectiveness of program attendance, and on how creative engagement modalities may act to offer improved outcomes for uniformed personnel and veterans.
The subsequent qualitative case study, reported here, clarifies the impacts, benefits, challenges and outputs of how engaging with creativity can shape identity and future directions for wounded, injured and ill personnel.
Introduction
The terms of reference for the recent Australian Royal Commission into Defence and Veteran Suicide laid scope for enquiry into multiple angles of Defence service. In the second of these terms, a subelement required the commissioners to query ‘the availability, accessibility, timeliness and quality of health, wellbeing and support services (including mental health support services) to the Defence member or veteran, and the effectiveness of such services’.2
Since 2015, 398 wounded, injured and ill personnel have completed the month-long ADF ARRTS exploration into artist educator mentored activities in a no uniform, no rank and no judgement environment, comprising 362 ADF and 36 Australian Capital Territory Emergency Services Agency, Australian Federal Police and recently transitioned Defence personnel.
The program follows an incremental path:
- Week one – Explore: Introduce concepts and methods
- Week two – Develop: Develop ideas and skills
- Week three – Consolidate: Consolidate development while adding refinement
- Week four – Celebrate: Finalise creative project production and present works
Each workday commences with a whole-of-program artistic skills and awareness broadening hour, followed principally by participants engaging with their chosen stream of creative writing, music and rhythm or visual arts.
Throughout the program, participants are encouraged to consider their ‘Week five and beyond’ strategy for creative engagement continuance and how that might fit into their timetables and home environments practically.
To underscore the non-judgemental approach of program delivery, an adapted academic teaching structure—removing grading—is utilised in mentoring participants via engaging and meaningful creative skills. This is congruent with the already uniformed ethos that training is for skills enhancement to achieve mission outcomes. Mentors draw on the premise that the volunteer participants know how to learn and are willing to be trained.
Materials and methods
The Directorate of Australian Army Health examined the training delivery of the pilot program. They reported that all participants agreed ADF ARRTS should remain as an option of active recovery for wounded, injured and ill Defence personnel, that many participants said they had tried numerous other forms of treatment and this is the first form of rehabilitation they feel has worked for them, and that it has given them a sense of belonging, hope that they can move forward and skills that can be utilised in future endeavours.3
To ascertain the viability of creative intervention investment, the long-term outcomes, if any, for injured or ill-serving and career-transitioning personnel required examination. Inclusive, voluntary qualitative research, as a case study of the ADF ARRTS program, focused on the six programs held over the first 3 years. Although not all remained contactable, from the ADF ARRTS programs of 2015 to 2017, there were theoretically 134 participants to draw upon, of which 15% (n=20) committed to the research, comprising personnel from all three ADF services. The research respondents’ span of services, ranks, age, length of service and gender were compared to the ADF ARRTS population demographics from all programs and the entire ADF population. With only minor variations across the board, the research group was representative of those wider groups.
The research project sought to ascertain whether creative arts programs lead to long-term outcomes for injured or ill-serving and career-transitioning personnel, and what aspects of program design influence outcomes.
A literature review was applied to creative arts programs,4-30 wellbeing,31-36 resilience37-38 and identity;10,38-43 none exclusive to the military. In examination of military-centric literature, among others, McGarry et al.,38 delve deep into military systems of how to unravel the complexities of differing approaches to imbuing or managing resilience in the training and healthcare of armed forces. Yet, it is in the non-military space that much of the applicable literature originates. For example, the studies by Kristen Ørjasæter and her colleagues9-11 identify the importance of creative arts interventions for identity in mental hospital patients and deliberate on why this may be the case. In the examinations of how to define wellbeing by the World Health Organization and others,31-33 there is much discussion and some agreement on what factors should be considered.
The researcher—also the ADF ARRTS Artistic Director—had previously deployed to Bougainville to produce, direct and perform entertainment shows for the Peace Monitoring Group. The trust in the Defence mission built through the provision of entertainment by the military musicians, who wore the same uniform as the Peace Monitors, was appreciable. Targeted engagement with the locals built on this trust, as children overcame suspicion to willingly join in the fun, with that effect then flowing to their parents as they eventually joined in. Similar effects were experienced on deployments in Timor Leste and the Solomon Islands where, in addition to concerts, cultural exchanges were arranged with local artists to create two-way engagement. A legacy effect is the realisation that sharing creativity, rather than simply delivering it, has a multiplying effect with direct and positive impacts.
The decision to employ the single case study of previous ADF ARRTS program cohorts evolved for several reasons. First was the ability to survey participants of programs at differing intervals since program participation would indicate trends in program outcome longevity. Second, conducting in-depth interviews encourages rich data that are more likely to provide direct yet diverse advice towards the research question’s understanding of what design aspects have influenced outcomes. Third, the authenticity of the data presented would make compelling evidence to satisfy the key questions.
Within the case study, Stake’s responsive evaluation model was employed. Responsive evaluation is a general perspective in the search for quality and the representation of quality in a program,44 and being responsive requires orientation to the experience of personally being there, feeling the activity, the tension, and knowing the people and their values. With a preference towards privileging the voices of ARRTS participants, responsive evaluation fits with both that positioning and a constructivist worldview. The constructivist researcher seeks to understand the inner world of a person through that person’s understanding of that world. Constructivism is closely linked to interpretivism, with the constructivist-interpretivist approach well suited to exploring the research questions.
With a personal conviction of the power of arts to heal born of deployment experiences and later involvement in mentoring on ARRTS, a need to ensure self-reflexiveness was a key researcher commitment. The research design was geared as far as possible to prevent biases, and the lived experience of former program participants is privileged as a core value central to the research. Acknowledging that all research is value-laden with beliefs and views, the relationship already formed between the researcher and participants on ARRTS is considered beneficial for both parties. As Balfour notes in his important recent work on arts and mental health of returning military personnel, the tendency for individuals experiencing mental health issues is to withdraw, and thus creating an environment of trust and participation is ‘one of the very large challenges’ in this type of research.26
Data gathering was in two tranches; initially offered to participants as written or audio survey responses to open-ended questions on the impacts, benefits, challenges and outputs of program participation. All respondents chose to respond in written form. The follow-up survey was completed face-to-face in the locales of all participants, Australia-wide, in a setting of their choice. These interviewees were asked to expand on the initial survey responses and were recorded for professional transcription.
The subsequent analysis of data applied Clarke and Braun’s version of thematic analysis, emphasising ‘an organic approach to coding and theme development’ and ‘the active role of the researcher in these processes’.46 This complements the principle that the research methodology for this project should closely reflect the approach taken in the delivery of the program being researched and acknowledges the value of the interactive face-to-face interviews. As the research responses informed the shape of the themes and subthemes, some appeared in multiple enquiry fields. These cross-cutting outcomes were reported to represent their original intent to maintain response authenticity. For example, throughout the data analysis, the subtheme of ‘Confidence’ continually emerged as pertinent under ‘Impacts’ as a natural outcome of participant comfort and through skills growth under the described ‘Benefits’. In ‘Challenges’, confidence factored in the themes of identity and trust, and was also referenced by respondents in influencing their reports of ‘Outputs’.
Outcomes
On the questions of impacts, benefits, challenges and outputs of program participation, researched personnel expressed feeling capable and rewarded, and being able to identify as performance musicians or artists was common. Respondents gained enjoyment from their creativity while on the program and through sustained, longer-term benefits, with most (85%; n=17) continuing or revisiting creative engagement at times of their choosing in the three to five years since program attendance. Those who were not actively continuing with creative engagement post-program reported that the enjoyment from their ADF ARRTS experiences made them content that they could turn to artistic pursuits at any time, should they feel the need. This lingering sense of positivity has provided optimism in everyday life long past the residential phase, reinforcing the value of the ‘Week five and beyond’ approach.
The following topical descriptors outline themes and subthemes revealed, with examples of participant responses to illustrate.
Impacts
Regarding the first question—What would you identify as the most significant impact on your life as a result of participation in the ADF Arts for Recovery, Resilience, Teamwork and Skills Program?—dialogue from respondents centred around comparisons of treatment options, the realisation that others are also hurting, the fun of creative engagement, and the exploration of alternative lifestyle options. Note that ‘impact’ can be twofold for some: the responses can record memories of the program’s impact at the time or impact in the longer term, with some reporting on both. Four broad themes were observed from the surveys and interviews, revealing trends across 10 subthemes:
Comfort – Confidence, Acceptance
Environment – Personalisation, Respite, Location, No rank and no uniform
Opportunity – Rekindled interests, Something New
Effect – Expression, Legacy
The reported impacts of creative engagement have created positive options among the unknowns of a post-Defence future and have also provided important clarity for participants, whether remaining in uniform or career transitioning, exampled in this participant quote: ‘Participating in the ADF ARRTS program helped me reengage my right brain. This reconnection to creativity has helped me process difficult emotional memories and led to greater success in psychotherapy. Aside from the neuro-cognitive benefits of the program, it gave me the confidence to take risks. This led to me travelling overseas solo and becoming a yoga teacher. As a result, I’m now running an organisation that provides strategies for trauma management and stress relief. I’d say the program has had a significant impact on my life and the lives of others.’
Benefits
To the second question—What were the benefits for you from your creative engagement during the ADF Arts for Recovery, Resilience, Teamwork and Skills Program?—responses focused on the gaining and honing of enjoyable skills, how connecting with mentors and others was beneficial, and finding the time to reflect on life, assess support and value the sharing between new-found friends. As anticipated, there were some similarities with responses to the earlier question on ‘impact’—although ‘impact’ is not necessarily positive, unlike the implication of ‘benefit’. Three distinct themes were presented, with eight subthemes revealed:
Skills – Confidence, Possibilities, Enjoyment
Influences – Mentoring, Connection
Introspection – Reflection, Support, Sharing
Seventy per cent of respondents (n=14) specified that the program had impacted positively through using skills, citing enhanced confidence, the exploration of possibilities—the notion, the doing and the influence—and the enjoyment derived from their creative engagement.
It is also strongly reported that the pause for reflection afforded through time away from participants’ usual workplace and/or home environments has catalysed revelations on a myriad of life, health and career situations, with these dimensions providing the confidence to make significant life changes. Respondents reported that the atmosphere for considered introspection in creating storied works, coupled with support from staff and mentors, benefited interactions with participants’ families and workplaces and out into the communities in which they live. In the words of one participant: ‘Doing the ARRTS program gave me the confidence to try more things outside, like I could perform music now and I could study, and it’s really helped me through that rather than just go to work, form up, drive a LAV [armoured vehicle] and then go home. It was the free exchanging of ideas that really resonated with me.’
Challenges
With the third question—What were the challenges for you from your creative engagement during the ADF Arts for Recovery, Resilience, Teamwork and Skills Program?—and noting that not all challenges are negative, three key themes were observed, reporting trends across nine subthemes:
Personality – Clashes, Limits, Freeness, Departure
Identity – Dilution of responsibilities, Self-focus, Bare emotions
Trust – Confidence, Doubt
Focusing on self and feeling that ADF ARRTS was an excellent opportunity, while developing an understanding of the needs and situations of others created an environment where empathy could be nurtured. Experiencing judgemental thoughts of fellow participants regarding whether they had experienced similar war exposures or even combat was cause for reflection on how to learn and grow egalitarian principles.
Being in creative group situations, with an increasing realisation that a sense of humour can dissipate over time through military service and why that might be the case, was challenging, and the raw emotions elicited through creative activities generated reflections on life and career situations. Although challenging at times, this caused introspection with positive outcomes for some, while it gave rise to anger for others.
Engaging with a process about self, not Defence outputs, was highlighted as a foreign notion. As one participant contemplating the program’s parameters of avoiding military ‘learned responses’ reports: ‘This will be one of the difficulties for the program; we, both officers and soldiers, come through a factory, to think inside the square, to do what you’re told to do instinctively, whereas the ARRTS is working against that and saying, look, just draw that line wherever you want it to go. I think that’s a bit problematic when you’ve got, I don’t know, is it 30-odd people doing the course? And their crutch has been often, I would imagine, the Army or the service—“This is the way you do it”.’
Outputs
To the final question—If you’ve engaged in creative activities since attendance at the ADF Arts for Recovery, Resilience, Teamwork and Skills Program perhaps you’d like to share what it is you’ve done?—dialogue from respondents informed four observed themes:
Inspiration and expression
Storytelling routes
Professional channels
Consolidation and collaboration
With the style of question changing from the topic enquiry of the previous three to one of a more practical response to physical creations, the four themes listed above are consolidated areas of reference flowing from the responses and are not subthemed.
Respondents reported on the results of their creative engagement and provided insight into the wide variety of artistic practice outputs since their ADF ARRTS attendance. Three have joined music-enabling organisations to further their skills and enjoy camaraderie, and two have been involved on stage in theatre productions. Two have become involved as extras for TV and film, and two more have been involved in group activities involving creating objects. One has utilised performing publicly to benefit both him and the recipients, with another five choosing to share their music online. Two have held exhibitions of their artworks at galleries, while another is prolific online with drawings.
Describing their experience on stage, a participant was emphatic: ‘Being involved in the drama production allowed me to explore the emotions of experiences in Afghanistan through a monologue. It was a form of exposure therapy in a supported creative environment. Having participated in exposure therapy in a clinical setting [hospital PTSD program], I found that doing it in a drama group or on stage was far more beneficial.’
Discussion
Understanding any long-term outcomes for injured or ill-serving personnel is necessary to refine the delivery of ADF ARRTS, and to inform potential application to other contexts where non-clinical arts exposure may be useful. Moreover, new knowledge on any legacy impacts could provide important insights into the worth of creative immersions for ADF and emergency services leadership, including pre-deployment training for military personnel, training for first responders, arts for veterans or arts for post-natural disaster healing.
Of those who had career transitioned since attending (n=14), 12 (85.7%) were still involved with creative engagement activities, and for those remaining in service (n=6), five (83.3%) were still creating. That personnel remaining in service are continuing creative engagement at a similar rate to those who have departed is valuable new data, and a strong indication of the breadth of program success.
This research project provided a free-flowing, rich tapestry of reflections. Candour was exhibited regarding the effects of uniformed service on work and life decisions, with the guidance-based teaching method proving highly effective in providing participants with meaningful creative skills. This style reflects and builds on the participants’ prior knowledge that training is for skills enhancement while introducing the concept that not everything in life must be viewed in pass or fail terms.
It is instructive that responses inevitably trended towards the key topic of identity: the search for identity, the loss of identity, the compromise of identity, re-finding identity or realising, for the first time, that human behaviour naturally contains more than one identity per person. For example, a challenge faced by some participants centred on the nuances of the no-rank program environment and how best to deal with minor changes in verbally addressing other personnel. Behind that was the larger issue of what to do in a setting where the identity of rank had been removed. For some, the idea of not being a rank was confronting, providing cause to begin deciding who or what their real identity might be. For many, this transpired to the realisation that they have multiple identities, and are allowed to do so. This multiparticipant epiphany, likely more than any other result, has created a highly significant indicator of creative arts program success, validating an attendee’s faith in themselves for taking the first step to engage. It has allowed participants to conceptualise life after uniformed service, a sometimes-unimagined eventuality for all, very differently.
Limitations
Research was limited to including the first six program cohorts to meet the project goal of ascertaining the longer view of outcomes. This period (2015 to 2017) was closer to the withdrawal of the main body of Australian troops from Afghanistan than later programs. It may have hosted a higher number of veterans with war service. While the cause of an ARRTS participant’s injury or illness is not a factor of program eligibility or completion, conversations among long-term ARRTS program staff indicate that the earlier programs brought with them more anger and aggressive behaviours. Whether this is related to the Afghanistan War timeline has not been tested.
In this research, respondents have not been queried on the subjective topics of life/work/family challenges that may have been catalysts in seeking ARRTS program attendance for respite or pause from those settings. Similarly, information on the type of uniformed service rendered—combat, combat support or non-combat—has not been sought, with no assumptions drawn on a hierarchy of injury, as is appropriate for a study of a non-judgemental program.
Future directions
The research has shown that access to artist-educator-led, non-clinical creative engagement in a vocation born of conformity and uniformity can provide a safe opportunity to explore individualism. With high rates of creative continuum for injured or ill-serving and career-transitioning personnel, it is now appropriate to broaden that brief to a broader ADF population. A new research project: ‘Purposeful downtime on deployment: a study of the impacts, benefits, challenges and outputs of creative engagement by ADF personnel on deployment’, is now under way.
Conclusion
Reflecting upon creative engagement experiences and enunciating them from very personal perspectives is far removed from the ‘learned responses’ of the military environment. The creation of circumstances where individuals are drawing on more than one identity, and possibly several, in formulating their responses saw new schemas emerging, initiating shifts in cognitive direction and creating opportunities for change.
While the dominant discourse on identity in the military environment is team-focused, with a strategic emphasis on being ‘fit’—‘to fight, to work, for life’,37 it is apparent from this research that personnel involved in creative engagement are capable of forming new, individual identities and embracing new options: ones that can focus on self-esteem, self-efficacy and self-expressivity, when steering new paths through recovery to return to work or career transition.
Please specify the URL of your file
