Simon: I did a fine art degree and really enjoyed that. I then went on to do things that a lot of people do, which is to go to Camp America to help run a sort of summer camp. I found myself working a lot with kids and with people with disabilities, and I found that I quite enjoyed that.

After my degree, I was sort of wondering what to do, and I became a support worker for people with learning disabilities. Then, I asked myself how do I combine this bit of my life where I like working with people and the bit of my life where I really love doing creative stuff? And this thing called art therapy came to my attention. I trained at Sheffield University and I’ve worked as an art therapist ever since.

Sarah: I noticed that you went to Coventry University. I did my undergraduate degree there as well and I graduated in 2000. I was a mature student and one of the reasons I am now interested in learning disabilities was because I am neurodivergent and struggled terribly at school. I had a diagnosis of dyslexia in the 1970s when it was treated like a disability and, obviously, disability is a very broad spectrum, and dyslexia is regarded more as a learning difficulty now.

I got so much from your research, particularly the 2017 guidelines around working with adults with learning disabilities and your work around an interpersonal art psychotherapy approach, which really supported my practice, especially going into placement. I got a lot from learning about social care, and the need to have context, valuing individualisation and uniqueness. That was very powerful and really helped me along the way.

Simon: I think what’s driven me was the opportunity to develop an approach, a therapy for people with learning disabilities and more broadly for people with, what was then called ‘developmental disability’, but now neurodivergence is used as a big umbrella term.

What traditionally has happened is, firstly, people with learning disabilities were often excluded from research. The assumption was that someone with a learning disability couldn’t give informed consent to participate in research, so historically we didn’t do research with them.

Secondly, when research was done on mental health interventions for people, if they were seen to be useful, they were then adapted and transferred to people with learning disabilities.

What I’ve been really interested in is: how do we start to design a therapy and to deliver therapies that are for people with learning disabilities and meet their needs? Working from a kind of person-centered approach, thinking about what’s going to work for that person, rather than adapting something that exists elsewhere in the world.

Simon: SCHEMA stands for Secure Care Hospital Evaluation of Interpersonal Art Psychotherapy. It’s a randomised control trial that’s happening nationally at the moment, across eight secure care hospital sites in Scotland and England.

It’s using something called interpersonal art psychotherapy, which I’ve been developing for a number of years and doing research on. It’s a 12 to 15 session individual art therapy approach and we look at interpersonal themes running through that therapy. It’s been designed for people with learning disabilities or for people who maybe struggle with communication, or people facing learning challenges. Unfortunately, what we find is this population is a little bit over-represented in the criminal justice system and in secure care, so that’s one of the reasons why we want to focus on that group.

We’ve had lots of involvement from people with learning disabilities. For example, they’re commenting on our manual where we have manualised treatment and we ask therapists to work in a particular way. People with learning disabilities have advised us on the things that are helpful in the manual. For example, we add in something that I call ‘augmentation’ but is essentially where the therapist is allowed to write stuff down in the therapy session, maybe draw a diagram, and check with the person in the room that they’re being understood and that they’re understanding that person.

The other aspect was the design of the research. Randomised control trials are really complex. We want to compare a group that doesn’t have the intervention (the art therapy) with a group that does. When we took this to people with learning disabilities and said, “this is how we’re thinking of doing the trial”, they actually said, “well, we think everybody in the study should have an opportunity to have art psychotherapy at some point”. So, we included that. After people have completed their final assessments, if they’ve been on the waiting list, they get an opportunity to have art psychotherapy.

We have advisory groups for people with learning disabilities. In those advisory groups, they use a jargon buzzer. If we’re talking about stuff and we use some jargon and somebody presses the button, we explain things and use more simple terms. This has been a really great tool we’ve adopted when we’re doing our involvement work around people having a say in research.

Simon: We’ve done different studies and smaller scale studies around music therapy and drama therapy as well. The SCHEMA trial is just art therapy.

Everything’s at a slightly different stage. The SCHEMA trial is now a randomised control trial but other things we’ve been doing are at a smaller and more local level, just to try them out. What we’re often trying to do at those stages is to think about whether what we’re asking people to do is acceptable. Is the intervention approach something that people will come back to? Are they finding it helpful? We’re asking questions around the assessment measures, finding out whether they’re appropriate ones that we would use. We’re trying to work out all of those things at different stages as we develop our interventions.

Simon: Yeah, we’re working with a theatre company called the Lawnmowers, which is a company set up and run by and for people with learning disabilities, and they’ve worked with us really, really, closely on designing this study.

They also have a group called ‘Researchability’, so they’re now research experts and they comment on national research for people with learning disabilities and more general research around including people with learning disabilities. They help think about how people with learning disabilities should be involved in research. For example, what should be on the consent form or what should be on the information sheet.

They’ve worked with me on another study where they’ve collected the data and completed interviews and focus groups as well. And when we’ve got our final results from the study they’re going to put that into a presentation for us, which they’re brilliant at doing, especially at conferences where it’s really interactive and engaging stuff.

Sarah: That just fills me with joy! I know it’s work, and I know that there are outcome measures and serious content to the intention and development of art psychotherapy practice, but it sounds fun and accessible. Including everyone, versus the perceived traditional version of what an expert might be in this situation, seems really imaginative and brilliant.

Simon: Thanks. I could say a bit about that from an art therapist perspective. I’m a researcher and I don’t just do art therapy research. For example, I’ve been doing some work around housing for people with learning disabilities to give you a broader context. We’ve been using some theories and one of them is this idea of epistemic injustice, where we look at injustice in systems. We’ve been thinking about things like knowledge inequality, where some people’s knowledge is valued over other people’s knowledge, and then people can be disempowered.

I’ve been working with a group of people with learning disabilities on this and they’ve been making sense of complex theories around epistemic injustice, housing instability, knowledge and inequality. But the way that they’ve done that is by using creative methods. I’m really comfortable with creative methods, so it’s been a really accessible approach that can involve everybody in a research program.

I think it’s not just about developing an art therapy intervention that’s appropriate and helpful for people who have learning disabilities, or broadly, people who are neurodivergent, but it’s really about how do we involve people in commenting on and influencing the research? There was a really important piece of work and a statement: ‘nothing about us without us’, which came out of some really important work around involvement, particularly in research, but also in treatment.

I think that we, as art therapists, have got a toolbox where we can look at processes creatively and engage people in a meaningful way that allows them to comment and influence decision-making.

I guess there’s lots of ways of doing art therapy, there’s lots of contexts and there’s lots of client groups that we can work with. I think that collaborative approach is really central when we’re working with people and when we’re co-developing the work.

It also depends what context you’re in. I’m in a health research context, where I work in a commissioned mental health service. That means that the reason we’re often working as art therapists, particularly in the NHS, is that there’s some indication, or there’s an expectation, that there’s an evidence base for our approach.

Now that’s difficult for us as art therapists because we haven’t traditionally done lots of research in the same way that other health professionals have done research. We’ve been learning about that over the years and I’ve been really getting to grips with it. How do we do outcome evaluation studies? How did we develop interventions? How do we conduct research that meets internationally recognised standards for evidence-based practice and research?

Those are really difficult things and we have got a little bit better at that, but we need to get even better. We need to do even better, get our standards higher and understand how to do the work that really benefits patients and also demonstrates that we’re not doing any harm through what we’re doing as well, so we get really useful outcomes for it.

What I would say is, having got to grips with these kind of approaches in healthcare research, I think we’ve got some alternatives now. We’re starting to learn ways that fit a bit more closely with some of the practice we’d really like to do and we’re working it out.

Simon: Yeah, absolutely. I think we’ve got some really useful and helpful traditional approaches. I think now there’s much more of an opportunity – and I see this work and supervise some of this work through PhD students and postdoc students – that there’s a way that we can target the needs of particular groups.

My work has been with people with learning disabilities, but it could be children in schools of a particular age, or work around children who’ve got long term physical health conditions, or adults with particular mental health needs. We can use our art therapy practice, but with a little bit more sophistication in terms of targeting needs and working more collaboratively with clients. I think that’s the next step for us.

Sarah: I’ve found that art therapy has been very adaptive, having worked firstly in the placement for adults with learning disability and now I’m in a primary school with a different team, not a psychological team. Having to describe to new teams about how art therapy might work or explain the value of art therapy in that context, in terms of early intervention and the potential long term good, feels useful.

Simon: I think that’s a really valuable piece of work. We know that talking therapies and verbal psychotherapies work, don’t we? There is an evidence base for many of them. What I would say is that they’re not always accessible to perhaps children and young people, some people with learning disabilities, perhaps people with more long term severe mental illness.

I think that’s something we really should be pushing to take forward now to demonstrate that we can make therapies really accessible. We provide really accessible therapies for many people that might not be able to access other approaches.

New course! Learning disabilities: co-producing effective art therapy

Actors and artists from the Lawnmowers Independent Theatre Company will be teaching on our new course. The course, developed using coproduction with people with learning disabilities, draws together clinical experience and research evidence to support arts therapists and trainees to develop their skills and confidence when working with this client group.

Find out more