The potential space and relational aesthetics

The authors suggest that the value of the intervention described lies not in the artworks produced, but in the shared acts of drawing, looking and being seen. Collaborative sketchbooks, paired portraits and quiet rituals of mark-making all model what art theorist Nicolas Bourriaud (Reference Bourriaud2002) termed ‘relational aesthetics’, where meaning resides not in the object, but in the intersubjective encounter it enables.

Studies have shown that drawing activates neural pathways involved in affective integration and social cognition (Bolwerk Reference Bolwerk, Mack-Andrick and Lang2014). These neurobiological models, although useful, are only part of the picture. Blodgett et al (Reference Blodgett, Deighton and Lereya2022) found that group-based creative interventions in community mental healthcare significantly boosted well-being, especially when focused on shared meaning rather than outcome. What shifts in the space between clinician and mother, mother and child? What is remembered, what allowed?

Who holds the brush? The ethics of clinician participation

The authors write with care and attentiveness, but the ethics of participation deserve further attention. The case study suggests something radical in a psychiatrist picking up a pencil beside a mother. The gesture signals a shift: from authority to companionship, from clinical stance to shared presence. Such shifts are fragile. The clinician may still decide when the session ends, or what is safe to display. Even the act of choosing not to draw can carry meaning in in-patient wards, where participation in activities may be read as progress. No group is without dynamics. No invitation to create is entirely free from expectation. Who felt able to participate? Who declined? What was drawn but not understood? When clinicians and patients enter aesthetic space together, the roles bend but do not disappear.

There are important lessons from other aesthetic movements. For example, El Sistema, the Venezuelan music programme lauded for its social impact through orchestral music, has been both celebrated and critiqued. Critics, including former insiders, raised concerns about aesthetic coercion, hierarchical pedagogy and cultural imperialism. Tunstall (Reference Tunstall2019) and Baker (Reference Baker2014) argue that such programmes, although well-intentioned, can privilege Western forms at the expense of local or indigenous expression, reinforcing dominant narratives while obscuring discomfort, dissent or exclusion. These critiques remind us that even ‘beautiful’ projects require critical scrutiny: who is invited, what forms are validated and whose stories are erased in the process?

Beyond the perinatal ward: context and generalisability

For all that there is to admire in this case study, there are limitations. The group should be interpreted with caution. For example, Nichols (Reference Nichols2024) explored poetic arts practices with perinatal illicit-substance users, showing how aesthetic expression may unintentionally obscure discomfort or reinforce silence. Phillips & Trainum (Reference Phillips and Trainum2025) further suggest that silence during creative interventions may mask discomfort, and that the appearance of connection can sometimes preclude dissent.

Hafes & McGlynn describe a group that worked, and worked well, but have not described what made it possible. Was it the facilitation style, the ward rhythm, the particular interpersonal skills of participants? Interventions like this are often treated as replicable, yet arguably their potency lies in their specificity. Lifted from context, they may wither, or worse, distort.

In our medical training, psychiatrists are taught to ask what the active ingredient is in any treatment, and to weigh its potential benefits alongside its possible harms. We need to develop a comparable discipline for arts interventions. How much of a drawing group is needed? Over what time period? In which setting? What are the possible adverse effects? Who is most likely to benefit, and who might feel exposed, overlooked or even harmed? These are not questions designed to undermine a creative intervention, but to support its ethical development.

In common with many colleagues, I have seen arts-based projects that were deeply meaningful, rooted in community and culture. Conversely, tokenistic offerings land badly: uncontextualised, under-resourced and at times inadvertently re-traumatising. The scientist in me wonders whether, in such cases, it was not the wrong intervention, but perhaps an insufficient dose, delivered at the wrong time or to recipients who needed something different.

In their recent meta-analysis, Qian et al (Reference Qian, Zhang and Zhou2023) reviewed 21 randomised controlled trials involving more than 2800 women and found that arts-based interventions in perinatal mental healthcare were associated with significant reductions in perinatal depression and anxiety. The interventions varied widely in content, duration and delivery, but showed moderate effect sizes, particularly when participant-led and when delivered over multiple sessions. Danquah (Reference Danquah2023) emphasised that arts-based counselling in Ghana, although effective for identity exploration, required cultural adaptation to avoid dissonance. Howard & Khalifeh (Reference Howard and Khaliefh2020) evaluated an in-patient perinatal arts group in the UK, highlighting how timing, relational safety and contextual support are crucial for meaningful outcomes. These findings highlight the complexity of response. Context, modality, relational safety and timing all shape outcomes.

A new framework for evaluation

Hafes & McGlynn note that theirs is not an evidence-based intervention in the conventional sense. Relational and political meanings in arts-based interventions often evade standard clinical evaluation.

I suggest that to meaningfully evaluate such practices, the field now needs evaluative models that can hold both qualitative and quantitative insight, that capture not only mood shifts or diagnostic symptom change, but also shifts in agency, identity and meaning-making.

Fancourt et al (Reference Fancourt, Baxter and Bell2023) have recently argued for broader paradigms that include social, symbolic and aesthetic dimensions of health.