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International Journal of Art Therapy: Learning Disability Special Edition

19 June 2017

This important special edition on art therapy with people who have learning disabilities includes a case study, two opinion pieces, a project report and national practice-based guidelines...



The work reported in the Learning Disability Special Edition takes place within a wider context of policy change and transforming care for people with learning disabilities that has been a focus for the NHS in recent years. This work reflects a snapshot of the thinking, theory building, innovation and development of a clinical consensus for art therapists working in the UK.

Central features of the work written about in this edition are the images made by people with learning disabilities in art therapy; however, the front cover image is a painting by an art therapist of his client. Take a look at this picture. The man stands in front of a whiteboard and holds in his hand an outline of a shopping basket. The whiteboard was used by Kevin O’Farrell at the start of art therapy to help the man identify what he thought he needed. The man wanted his old life back, before two traumatic events that had happened to him. In the art therapy sessions that followed, the man continued to make images of himself on the whiteboard and repeated this session after session. Because his pictures had to be wiped from the board each week, the therapist started thinking about making a portrait of the man so that he could take it away. This became a collaborative process, with the painting being made by the therapist and the man giving guidance about what he wanted in the picture. An example of this collaboration in the picture is the deliberately unfinished shopping basket that the man is holding. The man initially wanted items painted in it to symbolise his desire to become more independent, but then he decided he would leave it empty because he thought that what he needed in the future might change. Kevin O’Farrell’s image is important for us to consider as it encapsulates four themes emerging from the work of art therapists included in this special edition.

Firstly, themes of supporting people with learning disabilities to make sense of their past and the sometimes extremely difficult events they have lived through that have brought them to need art therapy. Siobhan Burns and Roseanne O’Shea provide an in-depth case study of a woman with a history of abuse by a member of her family and demonstrate, with the addition of retrospectively collected data and reports from support staff, a positive change over time.

Secondly, working collaboratively in a way that jointly enables the person to have a stronger voice and say what they need in their present situation. Art therapy can be an empowering encounter with the potential for a rehabilitation of self-image and self-efficacy. Simon Marshall explores the challenges of articulating and describing the subtleties of change that can take place in therapy ‘in the moment’ and often in non-verbal ways. These moments can be extremely important for some individuals with learning disabilities and they cannot be captured through standard methods like post-therapy questionnaires. Kevin O’Farrell discusses art therapy approaches that include giving feedback and using art therapy to empower self-identity.

Thirdly, there is space for innovation, potential and new possibilities. Therapists work flexibly to connect with their clients in a way that allows them to make best use of the learning about themselves and others that takes place. The images we make can teach us a lot about ourselves, especially if we are limited in our ability to speak or find the right words at the time. I am delighted that Penny Hallas and Lydia Cleaves are extending the palette of traditional materials available for art therapists to work with. They report on a project using digital and gesture-based technology across the spectrum of arts engagement and art therapy. This work extends the therapeutic reach of art-based therapies and gives potential for these approaches to become increasingly accessible to a wider range of people, including those with profound and multiple learning disabilities.

Fourthly, we must consider the wider context that our clients live in. In a changing health and social care landscape, art therapists are developing holistic ways of working with children and adults who have learning disabilities. This special edition includes the ‘UK Art Therapy practice-based guidelines for children and adults with learning disabilities’, which it has been my pleasure to develop with colleagues Liz Ashby, Karen Parker, Sandra Goody, Nicki Power and the Art Therapy and Learning Disability Special Interest Group in the British Association of Art Therapists.

Acknowledgements: I would like to thank all of the authors for their contributions and the editorial board for their support for this important special edition on art therapy with people who have learning disabilities.

Simon Hackett, Guest Editor



Feedback feeds self-identity: using art therapy to empower self-identity in adults living with a learning disability

Kevin O'Farrell

Although there has been little systematic research on the subject of feedback, this article attempts to explore the concept, use and function within art therapy and its potential in the learning disability population to create and reawaken self-identity. The author uses case material to illustrate how self-identity may be enhanced through amplification of the image, use of ‘third hand’ approaches and therapist engagement and feedback. The article is written in the form of a road map to identify key areas of research. Reflections on art therapy, resilience and implications for practice are discussed at the end. Pseudonyms, with consent, have been agreed for all client names except one person who wanted to use his first name. In an unorthodox manner, the author starts this article by exploring his own experiences of feedback and his knowledge of the learning disability setting to make up for a lack of research on this topic.

‘I like your new coat’: The emergence of secure base and sense of self and other through an art psychotherapy relationship
Siobhan Burns & Roseanne O’Shea

Art therapists working with learning disabled clients are used to adapting an art therapy model to work in a way meaningful to the individual. The attuned response to working with past trauma may often be a more interactive responsive style depending on the ability of the client to process cognitive material. This article illustrates in detail an example of an art therapy intervention which demonstrates a flexible, collaborative approach as well as presenting retrospectively gathered evidence of the outcomes of the work. It highlights the ability of an art therapy relationship to enable positive changes in a client whose distressed behaviour could not be managed by behavioural strategies or use of psycho-active medication alone.


On measuring the subtleties of change: a reflection on small-scale evaluation in arts therapies work with adults with learning disabilities
Simon Marshall

Arts therapists within the field of learning disabilities have long struggled to record the subtle and often silent changes that take place for their vulnerable clients in the course of treatment. In this article, I reflect on outcome evaluation and the challenge of maintaining curiosity with clients whose emotional intelligence can appear hidden, and where a parallel process of worthlessness can pervade the work of arts therapists. I briefly outline possible forms of inquiry, and describe the conversations within the arts therapies team that I am part of that led to the development of carer focus groups to capture a perception of change in clients resulting from treatment across modality for clients of all ability. I note how this approach enables collaboration with health workers and colleagues as witnesses, and the place of broad, collaborative conversations as evidence.


‘It’s not all fun’: Introducing digital technology to meet the emotional and mental health needs of adults with learning disabilities
Penny Hallas & Lydia Cleaves

A project that began with an aspiration to introduce digital technologies into an arts therapies service turned into arts therapies taking a lead on these being introduced across all professions and services in a National Health Service (NHS) Learning Disabilities Service. This article can only give limited details of the project as a whole; rather, consideration is given to the benefits of digital technologies to adults with a learning disability, with particular focus on gesture-based technologies. Project design and methodology are described, followed by brief accounts of gesture-based technology (GBT) used across the spectrum of arts engagement and art therapy. Data from qualitative outcome measures inform discussion of the impact of and potential for gesture-based technology in arts therapies practice. In conclusion, we recommend areas for further investigation, and perhaps encourage others to overcome systemic barriers to introducing digital innovation.


UK art therapy practice-based guidelines for children and adults with learning disabilities
Simon S. Hackett, Liz Ashby, Karen Parker, Sandra Goody & Nicki Power

Art therapy is a form of psychotherapy that uses art media as its primary mode of communication. Having skill and experience in art is not a pre-requirement for people to benefit from art therapy. Making art work can offer the opportunity for expression and communication within a psychological therapy for people who find it difficult to express their thoughts and feelings verbally, and it is an accessible approach for children and adults with learning disabilities. An estimated 20% of art therapists working in the UK have some involvement with children or adults who have learning disabilities. These clinical practice guidelines were devised within the UK by the British Association of Art Therapists. A guideline development group was formed by the Learning Disability Special Interest Group and a national consultation was carried out among its membership. Ten overarching guideline recommendations for clinical practice were identified, namely ‘working relationships’, ‘communication’, ‘support networks’, ‘managing risk and vulnerability’, ‘establishing therapy agreements’, ‘assessment, formulation, and therapeutic goals’, ‘working creatively and flexibly’, ‘working psychotherapeutically’, ‘monitoring progress’ and ‘professional responsibilities and self-care’. The published art therapy practice-based guidelines for children and adults with learning disabilities are an example of a clinical consensus on current best practice in the UK.


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