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Museum prescriptions and art therapy approaches at the Montreal Museum of Fine Arts: interview with Stephen Legari

We are glad to host an interview with Stephen Legari, art therapist at the Montreal Museum of Fine Arts (Canada) and member of our international Faculty

Q. We have started one year ago to follow accross the ocean the activities of your Museum, including the medical prescription research. Would you like to comment on preliminary information that you could have of this disruptive and innovative project?

SL. What I have to share is anecdotal as it is our partnering doctors who are tracking the actual data. We have now finished our pilot year of partnership with the Association of Francophone Doctors of Canada (Association des médecins francophones du Canada). What they have shared with us so far is that nearly 400 prescriptions were filled. One doctor noted that 100% of her patients requested a re-fill, that is to return to the museum. The majority of the feeback was that the patients enjoyed making their own decisions about what to do at the museum and when. The doctors will be launching a focused study in the coming year to evaluate the program closely with a sample of doctors and patients being followed through the process. There has also been an increased demand from doctors in the association to have access to the prescription.

Q. Is this medical prescription of museum therapy becoming a viral process (Toronto, The British Museum in London)?

SL. The museum prescription has gained a lot of attention in both Canada and internationally. While it is impossible to say what influence it is having directly on other museums to embark on their own prescription initiatives, it is exciting to see this kind of partnership being explored between the medical and museum communities. The Royal Ontario Museum in Toronto, Canada has its own model of prescription and there are a number of museums in Europe and the United States who have contacted us for information on how such a prescription came about. Within the province of Quebec, we are actively seeking to spread the model province-wide so that a greater number of doctors will be able to prescribe museum visits for their patients to their local museums. We will share the latest news in this initiative as it develops.

Q. Beside the medical prescription, which other innovative Art and Wellbeing projects have started  or are in plan to start in the Museum?

SL. This year we have collaborated with the Dallas Museum of Art and the Palais des beaux-arts de Lille to develop a guideline for museums to become increasingly accessible to those who are on the autism spectrum or are neurologically a-typical. We have just completed the therapy component of a study looking at the benefits of museum art therapy for adults who have suffered a stroke and are experiencing symptoms of low self esteem, depression, or isolation. We have recently launched a new studio in our museum dedicated to teenagers and young adults called the Atelier 15-20. We are hoping to develop an art therapy project for those that have been through the criminal justice system. And we will continue to offer programs to those living with illness such as cancer, Alzheimer’s and Parkinson, those living with serious mental health issues, and  those affected by trauma and loss.

Q. How narrative medicine is going to help you in conducting your activities as an artherapist? Do you see and do you get benefits of integrating both practices?

SL. Narrative medicine offers a very compelling model for at least three kinds of activities. One, every project we do at the museum must somehow be connected to the museum’s collections. These encounters with art may last several minutes or more than an hour. How we ask questions and what we learn about our participants’ lives is very important. I see narrative medicine as a potential tool to refine the way we ask questions about art and then later connecting those discussions to therapeutic work. Two, as a research tool. We nearly always use a qualitative component in our research questionnaires. Narrative medicine can help us better refine our questions that may yield more cohesive data. Three, as an educational tool. We are working more and more with health care professionals. As I witnessed while working alongside Maria Giulia Marini and her colleagues at ISTUD, narrative medicine opens up a whole new territory for teaching compassionate communication for health care workers.

Q. The WHO Europe has recently issued the report Evidence of Art Therapies and Health and Wellbeing: Launch of first WHO report on the evidence base for arts and health interventions. What do you think about this achievement? How would you comment on this document? Many pages are dedicated to music therapy, museum therapy and art therapy are not fully expanded. Why in your thoughts?

SL. This important document is a bigger subject that a few lines of comment can pay tribute to. For many professionals who have been tirelessly working in the arts and health for years and decades it is an overdue validation of what they have known, researched, promoted and taught. The creative art therapies of music, art, drama, and dance may be separate practices but they collectively represent truly holistic disciplines in the arts and health. Music therapy has enjoyed a lot of good research given its affliation with neuroscience. It is an extraordiary modality. Art therapy and museotherapy may yet enjoy a similar status with more RCTs which we know are costly and hard to control for given the diversity of art expressions that can emerge in a single session. I find two of the themes in the findings particularly encouraging:

 … The arts hold promise in tackling difficult or complex problems for which there are not currently adequate solutions. Additionally, this review identified how the arts can provide a holistic lens to view conditions that are often treated primarily as physical; this approach fits with current trends in health towards giving parity of esteem to mental health and also towards situating health problems within their social and community context (p. 52-53).

This theme could easily warrant an entire disseration but needless to say it points to the holding capacity of art to contain very complex and often unnamble problems while illuminating new roads to recovery. A third theme was that the evidence base did not just show efficacy of arts interventions but also showed economic benefits, with some arts interventions showing equivalent or greater cost–effectiveness to possible health interventions (p. 53).

This assertion is echoed in the International Coucil of Museums and their collaborative document with the Organization for Economic Co-operation and Deveopment Guide for Local Governments, Communities and Museums. Wherein ours, and other museums are cited for their contributions to supporting those dealing with mental and physical health problems.

Q. Would you like to give us suggestions about how to enjoy Museum visits in any possible place? On Christmas Holidays we might have more free time for us!

SL. Walk through a local or museum gallery slowly alone or with a trusted companion. Stop, observe, listen, sense. Try to connect with what you find beautiful. Go see a concert, a choral perhaps. Make some time to move your body or get out some art and craft materials and let yourself express without the need to make something specific. Even better, make art with the children in your family. They are experts and can guide you when you feel stuck. Supporting local artists also feels very good.

Q. What would you like to tell to the carers (physicians, nurses, other health care providers) about the fact that the people need art to diminish stress and to achieve a better wellbeing?

SL. I believe that they either already know this and just don’t have the time or resources to fully utilize it or they have not been given the time or permission to connect with the arts for their own health and I would encourage them to discover that for themselves.

Q. What would you like to say to the museum directors, and to the staff involved in a Museum, to foster the promotion of an Alive Museum, Full of vitality which can become a dramatic therapeutic resource?

SL. I would like to say that there are very likely elements already alive in their museums that can be nourished or discovered. They are often hiding in a school group, a specialized visit, or even in the solitary contemplations of the museum visitor. There are so many examples world wide that I have learned from. We can afford to dream bigger. Museums don’t stop being museums just because they can also provide space for respite and care. They can also call me if they would like to exchange more on the subject.

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Epidemiologist and counselor – 30 years of professional life in health care. Classic humanistic background, including the study of Latin and ancient Greek, followed by scientific academic studies, chemistry and pharmacology. First years of career, in private international environment. I worked in medical research, moved to health care organization, getting academic specialization in Epidemiology. Later, in consultancy and health care education. Counselor with transactional analysis orientation. Currently, director of Innovation in Health Care Area of Fondazione ISTUD, an independent not for profit Italian Business School with an humanistic approach acknowledged by the Italian Ministry of Researech.. Active member of the board of Italian Society of Narrative Medicine, tenured professor of Narrative Medicine at Hunimed, Milan, and in 2016, referee for World Health Organization for “Narrative Method in Public Health.” Writer of the book; “Narrative medicine: Bridging the gap between Evidence Based care and Medical Humanities,” edited with Springer and of international publications on narrative medicine in scientific journals. Last book “The Languages of care in narrative medicine: words, space and sounds in the healthcare ecosystem”. Lecturer in different international contexts from Academy to Public and Private Foundations.

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