Creative Arts Therapies in Disability Settings

Bill Ahessy writes on Creativity...

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  • Creative arts therapies are health professions which include art therapy, dance-movement therapy, dramatherapy and music therapy.
  • They can promote opportunities for social interaction and emotional expression and are especially valuable for people with difficulty communicating verbally.
  • Up to half of creative arts therapists work with children, young people and adults with intellectual disabilities.
  • Therapists still await statutory recognition by CORU and development of a grade within the Health Service Executive.

Humans have always possessed an innate creative capacity and a drive to express themselves. Whether that be through song, art, dance, storytelling, or innovation, we have communicated our experience through creative forms. From cave paintings and ancient myths to early social communication through dance and music our history is intertwined with creative expression.

Creative Arts Therapies

The creative arts therapies utilise this creative capacity and drive to allow people to express themselves authentically and support them in reaching their full potential. The collective term incorporates four evidenced-based health professions: Art therapy, Dance-Movement Therapy, Dramatherapy and Music therapy. Though distinct professions, each one utilises the creative and expressive process of arts engagement “to improve and enhance the psychological and social well-being of individuals of all ages and health conditions” (Shafir et al. 2020). At the centre lies the therapeutic relationship, which acts as a dynamic and vital force for growth and change. Creative arts therapists are inherently person-centred but also informed by a range of approaches including: psychodynamic, humanistic, cognitive, and developmental.

In Ireland, the majority of therapists use an integrative or holistic approach to meet the individual needs of clients. Furthermore therapists employ a range of creative methods to enhance their work. These include: mindfulness, drama, music, visual arts, movement, role play, sand tray work (Ahessy, 2020). Training usually involves a two-year masters programme in a chosen discipline which includes personal therapy and clinical placements in a variety of settings.

The creative arts therapies engage people in creative interventions to address clinical goals in various domains and improve overall well-being and functioning. Because of their adaptability, they can focus on motor, communication, psychosocial, cognitive and emotional goals. Creative arts therapies are resource-based and focus on what individual can do, promoting autonomy and agency. As with most health professions, a procedure of referral, assessment, treatment and evaluation shapes the clinical intervention. Therapists engage with the evidence base to inform their methodology and enhance their practice. Creative arts therapies are unique in their approach and the information gathered in a session can often provide a different picture to that observed in other settings. Drawing on this potential, creative arts therapists often work closely with members of multidisciplinary teams to help people with intellectual disabilities achieve goals set by allied health professionals, teachers and social care workers (Rickson & McFerran, 2007).

Working with People with Intellectual Disabilities

Creative arts therapists have worked with children, adolescents and adults with intellectual disabilities for decades (Alvin, 1965; Nordoff and Robbins, 1971; Jennings, 1978; Leventhal, 1980; Lowenfield, 1987; Chesner, 1995; Johnels, Johnels & Rådemark, 2016). Evidence demonstrates that creative arts therapies enhance the behavioural and psychological well-being and functioning of people with intellectual disabilities (Duffy & Fuller, 2000; Poquérusse et al. 2018; Schrade et al. 2011). Playing an instrument, engaging in role play, making an image, moving freely or a combination of creative mediums can afford an individual a different way of being. It can stimulate new behaviours, skills, expressions and emotions, which can then be transferred into everyday life (Hayes, 2016).

Arts-based interventions provide a rich platform for self-expression and invite people who are unable to express themselves verbally, to do so through a creative medium (Got & Cheng, 2008). This is especially valuable for people who have experienced trauma and are unable to process or express it due to cognitive or communication deficits. Because non-verbal and gestural communication precede language development, creative art therapies offer the possibility to establish pathways to communication at a pre-verbal level. For people who experience difficulties in making contact and interacting with others the creative arts therapies can act as a social glue, developing interpersonal skills and building relationships (Lister et al. 2009).

The multisensory nature of the creative arts therapies can promote sensory regulation as well as supporting psychomotor development (Koch et al. 2015). For children and adults with profound and multiple learning difficulties or complex needs, the creative arts therapies can work on a sensory level, connecting to the body and stimulating the senses. For Nordoff Robbins (1977), self-image is built by exploration and creativity (Meadows, 1997). For people with complex needs, the arts provide a blank canvas to make their mark thus reinforcing their sense of self. They can also foster meaningful interaction with others. Due to their flexibility and attuned improvisatory nature, creative arts therapies can be tailored to an individual’s responses in the moment, providing opportunities for nuanced expression and connection.

The creative arts therapies can increase awareness of emotions and enhance the capacity for emotional expression (Ho et al. 2020). They can contribute positively to self-development and in turn build confidence and self-esteem (Stickley, Crosbie & Hui, 2012). Furthermore, they can foster empathy and a space in which to share common experiences. For people adjusting to a disability they can promote coping and resilience as well as providing opportunities for “escapism, creativity, spontaneity and enjoyment” (Hackett & Bourne, 2014, p. 1).

Creative Arts Therapy Practice in Ireland

Creative arts therapists in Ireland have a long history of working with people with additional needs including intellectual disabilities. A recent national survey (Ahessy, 2020), highlighted that more than half of self-employed creative arts therapists worked with children with additional needs and over one third worked with adolescents and adults. Many contracted creative arts therapists work in the intellectual disability sector, however permanent posts were more difficult to come by and most worked in a self-employed capacity offering sessional services. Almost half (48%) of creative arts therapists in Ireland work in mainstream and special education and It was identified as a key area for advocacy and development. Although a few contracted posts were reported, most therapists provided freelance services. In the United Kingdom, creative arts therapists experience significant positive opportunities, because schools have more freedom to commission therapeutic input. In Ireland there are less opportunities due to the lack of formal avenues for contracting and because creative arts therapies are not appropriately integrated into the services and systems. This can act as a barrier to the development of services in schools, residential and day service and other intellectual disability settings. Sometimes pilot or short-term funding is available; however, students and service users can be negatively impacted when this funding is discontinued. The lack of formal avenues for funding posts is often the deal breaker for many schools and organisations in establishing sustainable creative arts therapy services. In some cases in adult residential services, this results in clients funding their own therapeutic input.

In Ireland there yet exists no supportive systems of personal budgets for people with disabilities enabling them to procure therapeutic inputs to meet their expressed needs (Carter Anand, 2012). HSE consultation with people with disabilities has revealed dissatisfaction with the amount of choice, control and independence they experience in relation to services and a desire for more “flexible supports to suits individual needs” (HSE, 2009, p. 3). There is a commitment from the Irish  government for people with disabilities to have greater control over the provision of support and care services they receive and in 2018 a task force was set up to examine personal budgets for people with disabilities (Department of Health, 2018). In many countries including the United Kingdom, the Netherlands, Australia and Canada such schemes exist (Carter-Anand, 2012). The National Disability Insurance Scheme [NDIS] in Australia enables people to access NDIS-registered creative arts therapists to help achieve their goals (Cameron, 2017; Bibb et al. 2018). In Ireland, personal budgets could provide individuals with more choice and control over the services and supports they receive and make creative arts therapies more accessible to all.

Conclusion

Creative arts therapies are innately person-centred, resource focused and support the National Disability Inclusion Strategy in striving to help people achieve and maintain “the best possible physical, mental and emotional well-being” (Department of Justice and Equality, 2020).  While creative arts therapists have been working in Ireland for decades, they await statutory recognition with CORU and a designated grading within the Health Service Executive. These milestones will ensure that clients are protected and that the therapists providing services are qualified to do so. Formal recognition will make it easier for health and disability service providers to establish creative arts therapy posts and promote a deeper understanding of their clinical role, and unique contribution to multidisciplinary team working. When validated and more clearly understood, the professions will flourish, increasing access for people who benefit from engagement with these therapies and for those who need them the most. Although creative arts therapies face many challenges, practitioners are determined and hopeful for the future. There are currently 380 professional members of the Irish Association for Creative Arts Therapists (IACAT) and this year the President Michael D. Higgins became its sole patron, which has invigorated the community and endorsed the creative arts therapy professions.

For more information on the creative arts therapies visit www.iacat.ie and www.iacat.ie/professional-journal-polyphony

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Bill Ahessy is a senior music therapist and clinical supervisor in Dublin with over 15 years experience working with children and adults with additional needs, mental health needs and adults with aged related conditions. Bill is based at St. Josephs School for Children with Visual Impairment and ChildVision in Drumcondra and in St. John of God School in Islandbridge, Dublin.

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