The creative arts therapies are evidenced-based professions which include art therapy, dance-movement therapy, drama therapy and music therapy. This article demonstrates their unique role in the provision of therapeutic care to those with learning disabilities.
In Ireland all creative arts therapists are fully qualified at Master’s Degree level and are registered with the Irish Association of Creative Arts Therapists (IACAT). The creative arts therapies use the arts to explore feelings, images, sounds and thoughts to help clients understand their inner world and experiences.
‘The core elements to understand “intellectual disability” and individual functioning are: the person, the environments in which this person finds him or herself and the support given to this person’ (Global Initiative on Psychiatry 2007). The creative arts therapies can meet the individual where they are, acknowledge their strengths and resources and provide support and encouragement in the context of a therapeutic relationship.
The creative arts therapies provide new ways of exploring present and past life experiences, to enable the client to make positive changes in their lives. They are particularly beneficial for people with communication deficits or those who find ‘talking therapies’ difficult. Creative arts therapists often work with people with learning disabilities (including those with a severe or profound learning disability) in disability services, community care, education, mental health services and in private practice.
Due to issues surrounding expression and communication, a person’s behavioural problems or mental health issues may be intensified. Creative arts therapies can prove very effective for individuals with a learning disability. They work in a similar way to verbal psychotherapies, in that they are used to explore the client’s state of mind, and offer ways to communicate and process and express thoughts and feelings, whilst working towards solutions. Their advantage is that they can provide a non-verbal medium through which to work in a non-threatening way.
The creative arts therapies offer an alternative form of independent expression for those with multiple or severe learning disabilities. They are thought to be motivational, and may help increase learning whilst stimulating communication and interaction.
The client is at the centre of the creative arts therapies and the interconnected relationship between the therapist, the client and the art form is unique to these therapies. The building of rapport, leading to therapeutic alliance, is central with clients with learning disabilities. ‘It is important to be accepting and consistent to help the person feel safe and be able to build trust’ (Caprio-Orsini 1996, p. 13). It is only then that the individual can take risks and face challenges.
Art therapy is a form of psychotherapy and involves art making as part of the process of therapy. It is defined by the British Association of Art Therapy (BAAT) as ‘a form of psychotherapy that uses art media as its primary mode of communication’ (British Association of Art Therapy 2011). Drawing, painting and sculpting offer ways of expressing feelings, thoughts and memories that are often difficult to put into words. Being ‘good’ at art is not important. Simple marks can mean as much as a carefully worked picture. In a client’s words, ‘It is not that the artist is a special kind of person, it is that each person is a special kind of artist.’Art therapy within learning disabilities aims to help people express, contain, explore and reflect on their thoughts and feelings, so that they can more effectively resolve or manage their difficulties in creative and constructive ways. It aims to develop creative activities that help reduce impulsive behaviours and enhance interpersonal behaviours. Art therapy is also effective when working with sensory and motor deficits, the art therapist may choose specific tasks that help to expand motor skills, support self-esteem and increase independence.
The client and art therapist work together to explore and understand what the artwork may ‘say’. Sometimes the work doesn’t translate into words and just accepting it helps people become more accepting of themselves. The artwork is stored carefully and provides a ‘map’ of the client’s therapeutic journey. The therapist and the client’s artwork support the client in making sense of their feelings, understanding difficulties and in making choices.
Dance movement therapy
Dance movement therapy is rooted in the expressive nature of dance itself- Dance movement therapy involves a direct expression and experience of oneself through the body. It is a basic form of authentic communication, and as such it is an especially effective medium for therapy. Based in the belief that the body, the mind and the spirit are interconnected, The Association of Dance Movement Therapy UK defines the field as: ‘the psychotherapeutic use of movement and dance through which a person can engage creatively in a process to further their emotional, cognitive, physical and social integration’ (Association of Dance Movement Therapy 2003).
Dance movement therapy can be a powerful tool for stress management and the prevention of physical and mental health problems. Dance movement therapists integrate the dancer’s special knowledge of the body, movement and expression with the skills of psychotherapy, counselling and rehabilitation to help individuals with a wide array of treatment needs. Social, emotional, cognitive and physical difficulties can be addressed through dance movement therapy in group and individual sessions in many different types of settings, for example: hospitals, rehabilitation, schools and social care settings.
Drama therapy is an action therapy that is effective when the use of words is difficult. Many different methods are used to help build assertiveness and self-esteem and the drama therapist will offer the client the opportunity to experiment with different ways of thinking, feeling and behaving. Drama therapy methods can include social drama, movement, dream work, role playing and improvisation. They can help to build new coping strategies for problem solving and emotional difficulties.
In a client’s words, ‘The drama I’ve done … has allowed me to move on from the place I was … and the change has been incredible.’
In a drama therapy session all that is required is that the client is willing to share their personal story, their inner drama. No acting or performance skills are necessary; the emphasis is on participation not performance. Drama therapy can include non-verbal techniques and can be practised through group or individual work. Reflection is an important part of the process. The playful and active approach of drama therapy makes for a very suitable intervention for adults and children with learning disabilities and autism.
Drama therapists work in inpatient and outpatient mental health settings, educational or school/after school settings, community centres, group homes, multicultural centres, private practice, early intervention programmes, home-health agencies, hospices, rehabilitative facilities, hospitals and wellness centres.
Music therapy is an effective intervention to more standard forms of counselling and psychotherapy for people with emotional, communication, psychological, physical and social difficulties. It is an adaptable therapy and is able to embrace many different approaches, including cognitive behavioural therapy (CBT), psychodynamic therapy and person-centred therapy.
In a music therapy session the client is encouraged to experiment with sound, choosing from a wide selection of percussion and melodic instruments and the voice. The client is introduced to the instruments at their own pace. Each individual expresses themselves through sound and develops a musical relationship with the therapist. There are no right or wrong notes in music therapy and no prior musical experience is necessary. The therapist improvises with the client in a way that supports, encourages and contains the client’s music. The structure of music and the therapeutic relationship that forms provides a safe framework in which the client can explore feelings, thoughts and ways of relating to themselves, others and past or present issues.
‘The music helped me to reach things….that I hadn’t been able to talk about…it was a way in for me…. and I could feel through this.’
Music therapy can focus on specific issues such as communication, cognition, attention span, self-awareness. It also encourages emotional self-expression, which can provide a meaningful outlet for those with a learning disability. Each session may include a large or small component of talking, depending on their abilities and what feels right for the client at the time.
How can the creative art therapies be helpful for people with learning difficulties?
Some people with learning disabilities have limited verbal communication. The creative arts therapies offer an alternative means of self-expression. Often people with learning disabilities find it difficult to cope with change. It might be that a significant life event, such as the loss of a loved one or the transition from family home to residential care, has been difficult to cope with. The creative arts therapies allow a safe environment to explore these feelings and assist the client in adjusting through improved coping mechanisms.
The interactive aspect of creative arts therapy group sessions develops insight, allowing clients to understand themselves and others better through the shared experience of art, dance movement, drama and music therapy.
The creative arts therapies have an important role in working with clients who have learning disabilities, across the spectrum. In Ireland the creative arts therapies have established themselves in disability organisations, schools, day-care centres, hospitals, mental health and social care settings. They provide therapeutic support, interdisciplinary work, research and advocacy within the field of learning disabilities. The creative arts therapies offer a unique and transformative insight into those living with learning difficulties. For the individual they can provide avenues for communication, opportunities for development and growth. For families and carers they can offer a window into the lived experience of those with a learning disability and they provide therapeutic support that focuses on the strengths of the individual.
A common characteristic among people with learning disabilities is uneven areas of ability, ‘a weakness within a sea of strengths’. There often appears to be a gap between the individual’s potential and actual achievement. This is why sometimes learning disabilities are referred to as ‘hidden disabilities’: (American Music Therapy Association). The creative arts therapies can focus on an individual’s strengths and resources and afford opportunities for growth and achievement and a means to reach their full potential.