Art Therapy for Adults with Learning Disabilities
It’s my pleasure to share this thoughtful article from one of my students, Michelle Kurth. She wrote this essay as part of her coursework for the Art Therapy Diploma Course.
Robert GrayDirector and Senior Lecturer at CECAT
Registered Art Therapist and Psychologist
MA A. Th., AThR; B. Soc. Sc. (Psych.) (Hons.), MAPS.; BA. Theol. (Hons), MA Theol.
Art Therapy for Adults with Learning Disabilities
I have chosen to write my essay on art therapy and working with adults with learning disabilities as a result of witnessing many positive results and outcomes when this group of people has the opportunity to incorporate art making into their lives.
I started volunteering with a charity called ActionSpace in 2003. ActionSpace is a London-based organisation working with artists with learning disabilities. Facilitating artists in open studio groups in different venues across London, the sessions take place in art studios, public spaces and day centres. Each project, depending on funding can last from one year to the current longest-running group; twenty-five years. The groups are small, giving each client the right level of support, and the opportunity to work with materials and subject matter that interests them.
Mary McGraw, the founder of The Center for Therapy Through the Arts in Cleveland, Ohio notes that open group studio settings ‘Can empathises the uniqueness of each person’s creative process’. She goes on to say ‘Sessions focus on creative art experiences that encourage experimentation, learning new information, developing motor or cognitive skills, or enhancing creativity through art-making’. (Malchiodi p211 2007).
McGrew’s words resonate with me. They are very similar to ActionSpace’s mission statement and philosophy.
Working with this group of people, I was amazed not only at the high level of work produced but also the profound healing and huge boost to the participants confidence and overall wellbeing that the process of creating art promoted. I volunteered a day a week for several years; before becoming a paid artists facilitator for PMLD clients. (Profound And Multiple Learning Disabilities).
ActionSpace supports adults who are interested in art. I now understand that what they provide, and I facilitated was ‘Art as Therapy’. Clients were recommended by social workers, and support because of their interest in art. The client, where possible would choose for themselves, or be recommended to include art as part of their care package.
On several occasions I was introduced to a new client who had previously been working with an art therapist, and considered ready to work with a group in the studio environment. The art therapist would work alongside ActionSpace; supplying us with the client’s history, risk assesment and suggested pathways for the client to move forward.
This really was my only experience of art therapy. I met some brilliant art therapists in this process, and I looked into various courses, but none of them really appealed to me.
Years later I started to look deeper into the theory around art therapy. This was often in relation to a piece of art that one of the artists had created, or how they had acted in the process of producing a piece of work.
After moving to Australia in 2017, I began working on outreach art projects with people with learning disabilities. It was then that my interest in art therapy grew, and I realised that I wanted to dig deeper into this fascinating subject.
When I attended Rob Grey’s two day introduction course last year I was immediately drawn, not only to his way of teaching but to his philosophy around art therapy. Any preconceived ideas I had around art therapy were very quickly thrown out of the window.
Since enrolling on the certificate course, and learning more about art therapy, I realise that procedures advocated by ActionSpace are approaches practiced by some art therapists.
Some of the Challenges Faced in Working with People with Learning Disabilities
Recent Statistics from the NHS (UK 2022) stated People with learning disabilities have often been overlooked to receive art therapy: They were deemed unable to participate in the therapeutic process as they can often have limited communication.
As a visual therapy, often by passing words you would assume that this therapy is ideal for those with limited vocabulary. However for many people with learning disabilities it is their lack of vocabulary or understanding that be a challenge. They may find it difficult to articulate and may not understand what the therapist is asking them to do.
The therapist may also feel uncomfortable working with clients who are non-verbal, have limited vocabulary, and possibly behavioural issues if they have not had specific training or previous experience.
Since the late 1990’s more documentation and research has been made available on best practice for working people with learning disabilities (Bull 2012). This helps to promote a greater understanding of the challenges, and also procedures that need to be implemented by staff and therapists, and different ways of working to get the best outcomes.
Art therapists working with people with learning disabilities have often worked from the theory of psychological models of child development as well as being influenced by psychological models. Many of these clients will be at the pre-symbolic stage and not able to use art materials for the making of images through which feelings can be expressed and insights gained. (Case, Dalley, Reddick p205 2014).
Mencap (UK 2012) published ‘Treat Me Right’ is a document about providing better healthcare and services for people with a learning disability. The publication contains case studies and aims to educate and makes recommendations on how to better work with this group of people:
Staff and therapists should receive general disability awareness training so that they have the opportunity to examine their attitudes and values toward people with a learning disability. (Mencap 20l2)
There are also practical and logistical considerations when working with this group of people:
- Art therapy can be overlooked if the client is unable to choose this therapy for themselves. Unless recommended by a social worker, or support it may never even be considered as an appropriate therapy.
- There are also issues around consent and confidentiality. If the client is unable to give their consent their safety may be compromised because they are dependent on another person in terms of a confidentiality agreement.
- Accessibility to the art sessions: If the client’s support system doesn’t understand the benefits of art therapy, sessions may be missed due to the client not being able to get to the venue. The client’s support may not see art therapy as important enough to make the logistics work.
The artists I have worked within a studio setting required support to get there each week. One of the biggest challenges was the logistics of actually getting the artist to the venue. It was more challenging if their support did not understand the positive role that art played in the person’s life. Artists who would have benefitted greatly from the opportunity to attend additional art sessions, have solo shows and projects missed out through lack of understanding by those in a supportive role.
Relational Aesthetics is a term created by curator Nicolas Bourriaud in the 1990s to describe the tendency to make art based on, or inspired by, human relations and their social context. On learning more about this, particularly in Catherine Hyland-Moon’s chapter in Judith Aaron Rubin’s book ‘Approaches to Art Therapy’ I have come to understand that when we worked with participants in different settings at ActionSpace, we were working with Relational Aesthetics. Hyland-Moon writes about creating an open studio group in a Men’s homeless shelter. She explains that at first moving art materials around and setting up seemed like a task that had to be done. However it became obvious as time went on the benefits of building these aesthetics in the environment, and how it created patterns of connection. Hyland-Moon goes on to talk about that her presence in the shelter:
Setting up a collective space for art making and conversation was also about creating patterns of conversation. All these small acts countered the experiences of alienation and economic apartheid’. She adds ‘You may not think of these small acts of resistance and change as art therapy but I see their relational value and think about how I might involve others I work with in more meaningful relationally enhancing ways. (Hyland-Moon in Rubin, 2016)
I can similarities between Hyland-Moon’s experiences at the men’s shelter and my facilitating ‘Art as Therapy’ in day centres.
At the start of any project, we would work with social workers regarding suitable clients to join the group. For the clients with high support needs this meant that a group was six participants at most. Myself, assistants and trained support workers could therefore assist each client to fully benefit from each session.
Small day centres had around twelve clients, and in the recreational spaces we used it was difficult to not include everyone. Clients outside of the group become part of the session. Whether this was helping to set up, making tea, or observing group activities. It became quite evident that our visits to the day centres were also beneficial to those who were not participating directly in art. It was a regular occurrence that some clients then asked if they could join the group.
‘Peperfield’ was in a small council-run day centre in a multi-culturally diverse, mixed-income area in Central London. When the group launched in 2012; our initial clients were six, part-verbal and non-verbal adults. The adults had fairly high support needs, which was why the group was small. It became apparent after our first session that in the large communal area where the sessions were held, the remaining clients were very interested in our presence, and activities.
The remaining clients were all non-verbal with very high support needs. However, their obvious interest in us being there instigated a new way of working for us: inclusion for everyone. Unable to make their own art we decided to alter the environment for the remaining clients. We changed the space within the space. The whole day centre could then join in with our sessions on some level if they chose to. Using lights, coloured cellophane, fabric, music and art created by other participants we would transform a section of the main room each week; packing it away at the end until the next session.
It became evident that even those who were thought of as ‘not being able to join in, could. With observation and awareness, we could work out the client’s favourite colours, shapes, and sounds. We created simple activities that they could join in with. The sessions became inclusive for all, and more than ever, the relationships became just as important as the art making’.
If I had to sum it up I would say that relational aesthetics informs every aspect of my work with clients because the relationship is central to the art making process (Hyland-Moon, in Rubin p62 2012)
The art studio or open space becomes a fully supported place where the artists can safely explore, let go and feel safe. In the beginning, they may be involved in ‘Free Play’; unstructured play which is creative and improvised. Indeed for much of the time working with adults with learning disabilities there was a lot of free play, improvisation and flexibility, and absolute awareness of the artist too, where they were emotionally in each session. This could differ very much from week to week. Author of ‘Free Play’ (Steve Nachmanovitch 1991) talks about the importance of becoming absorbed in art making and ‘disappearing’. For many of the artists I worked with, having the time to let go, create, and ‘disappear’ while in a safe, nurtured environment was an important part of the art-making process.
Some of the artists I have worked with created art which directly expressed part of their life; interests, relationships, environment or situations which brought them happiness or distress. Simple conversations stimulated by a problem could sometimes open the way for the artist to find a new direction with their work. After learning about Mind Mapping. (Grey p76 2019) I realise that a variation on this process was something that I had used when working with artists who were able to vocalise their some of thoughts and feelings within the framework of recurring and current issues.
Patrick, an artist with a limited vocabulary joined one of my studio groups. Patrick loved his iPad, headphones, and making collages from printed images. However, he became lost in his own world and would not communicate with those around him. It was agreed that we would try other materials for Patrick to explore, keeping the iPad away from the studio. Patrick started creating collages with tactile materials. He was engaged but it felt like he was never fully absorbed with these activities.
One Monday morning, Patrick arrived at the session very upset. He tried to vocalise what he wanted to say but we couldn’t fully understand him. He became frustrated. He suddenly picked up a pen and started writing on the table: ‘Respite, pillow, shout, angry, slam door’.
No one had any idea that Patrick could write or spell. After some time putting together the written words and Patrick trying to explain, we were able to piece together his story:
Patrick had come to the session from respite. He had removed a pillow from another client’s bed because someone had taken his pillow. He said told off and shouted at. This had made him angry and he had slammed his door.
Writing these words down became a way for Patrick to release his frustration, and it introduced a new direction into his art making that he loved. From then on Patrick chose to create artworks completely around his life experiences, whether they were places he lived as a child, to events that had happened that day. Patrick was not only able to express himself through his art, his art making became an outlet for him to release his frustrations and worries. We developed a process in which Patrick could engage more with those who supported him. We decided that whoever worked with Patrick would write the words that Patrick dictated into a notebook. This not only initiated a conversation between Patrick and the support, but it also became a reference for Patrick’s artworks.
Patrick produced many books and later created a sound installation where he read out the words from his books. This became part of a major exhibition piece alongside his hanging artworks.
Art, Colour & Non-verbal Communication
Art therapy involves nonverbal communication through artistic expression, the emphasis is less on traditional talk therapy and more on using the art process to uncover and develop meaning. (Cass, Tessa Dalley, Dean Reddick. 2023). Not only does their art help non-verbal artists to communicate their feelings and emotions, but the colours they choose can also help to create a dialogue for them: They can communicate with colour through their art.
Colour is a form of non-verbal communication. It is not a static energy and its meaning can change from one day to the next with any individual – it all depends on what energy they are expressing at that point in time. (P Simpson, p22 2021).
Philippa was a non-verbal artist. On joining the group we were informed that Philippa was a painter. It soon became evident that Philippa used her painting process, and especially colour as a way of expressing her emotions, and a way of communicating. At the start of each session Philippa would pick up the paints that she wanted to work with. After lunch, we would re-introduce the paints in case Philippa wanted to change or add anything to her colour pallette. If Philippa was in a bad mood when arriving at the session then she would start her session with black. As her mood lifted, so did the colours she worked with. Red was her favourite colour. Along with orange and yellow, these were her happy colours. Blues and greens were used when she was mellow and calm, and pink was her excited colour. By watching Philippa and the colours she used we were able to understand even subtle differences in her disposition.
Although colour may express our thoughts, perceptions and physical sensations, we most associate colour with emotion. (Malchiodi p156, 2007)
‘A Dialogue With Colour’ was a three-month residency and exhibition Philippa and I participated in together. The project focused on us working collaboratively as artists; Philippa as a painter and me as a weaver and textile artist. Colour became a big part of our collaboration and an important communication tool.
We created the bulk of the work in twelve full-day sessions. At the start of the morning and afternoon sessions, I laid out ten different coloured yarns for us to choose from; with the idea that we chose the colour, we felt reflected our current mood or emotion. These were colours that Philippa often worked with, and the process was similar to the way we offered her colour choices in the studio. I documented these, and wove the chosen colours into two strips; one for each of us. They became a record of our emotions during those sessions, and the woven piece part of our final exhibition.
Working with this group of adults is now second nature to me. Looking back I remember how I often felt uncomfortable, and sometimes completely at a loss of what to do next. Over time, and with experience and support it became easier.
I remember in the early days walking into the office feeling like I had failed. I was told ‘Relax into it. It’s not about you, or what you think you need to achieve in a session. Let things unfold naturally, and be flexible. Flexibility is important, and having the trust to allow things to go in a direction that you hadn’t necessarily planned. The outcome is often ten times better than you could ever think of.
I think awareness is even more important. It doesn’t matter how many different art activities you can provide, or how good you are at art: If you’re not fully aware of the person you’re working with, and are not fully present, you will miss the subtle things. Without awareness, I don’t believe you can fully support them.
There can be challenges working with this group of people, but I think the benefits far out way them. The art-making process can be the foundation to enhance their wellbeing beyond measure, It can create a positive ripple effect in their lives. As I move forward with my studies I am excited to research further into ‘Art in Therapy’ for people with Learning Disabilities.
Cathy A. Malchiodi. (2007 ). The Art Therapy Sourcebook. McGraw Hill
Judith A. Rubin. (2016). Approaches to Art Therapy. Theory and Technique. Routledge
Caroline Cass, Tessa Dalley, Dean Reddick. (2023). The Handbook of Art Therapy. Routledge
Robert P Grey. (2019). Art Therapy and Psychology. Routledge
Stephanie Bull, Keven Farrell (2012) ‘Don’t Guess my Happiness’
Personalisation and a new landscape for learning disability services. Routledge.
P Simpson. (2021). The Colour Code. Profile Books
Mencap (2012) ‘Treat Me Right’. Mencap Publication
NHS. Health and care of People with Learning Disabilities, experimental statistics 2021-2022. NHS Digital
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