Clinical Meeting: Underneath the smile

In this month’s clinical meeting we were pleased to have a presentation by Jane Caven. Jane is part of our team of art therapists and has been working in the area of learning disabilities for several years. She came to talk to us about a chapter she wrote in a recent book (Art Therapy and Learning Disabilities: “Don’t guess my happiness”, 2012). In addition to Jane’s talk, art therapist Dave Rogers provided some input about working with clients who have learning disabilities and who are accessing art therapy by using personalisation budgets.

During the first part of the meeting, Jane asked the group to think about a person we know who has learning disabilities and make an image while keeping him/her in mind. The artwork evoked some powerful recollections for the participants, from childhood memories to current clients. Much like this image of a closed but brightly coloured bag, it is not always clear what emotions are underneath the cheerful, “lovely” presentation which is expected of many people with learning disabilities in our society.

Jane discussed her work setting in an inner city community team. She talked about theories in psychotherapy and art therapy about learning disabilities, as well as common issues and approaches. Following this, Dave provided the group with his thoughts about personalisation budgets, a relatively new way of giving service users more control over the way they access a range of services and therapies. He raised the following points:

- How personal are personalisation budgets? Since clients who have learning disabilities may require assistance with handling their finances, the money rarely goes directly from client to therapist but is handled by staff or family members instead.
- How are decisions around personalised services made? We could accept the view that every service accessed by clients has been specifically selected by them, but it is likely that staff and family also had input in making those selection.
- How can the art therapist know they have not been chosen to “assist” service users in using up funds, rather than for genuine need or desire to attend? At points, money provided for personalisation budgets has to be used up.
- Perhaps the biggest ethical dilemma for the private practitioner involves the decision to end therapy: in the current financial climate, it could be tempting to continue to work indefinitely with clients who come with a guaranteed source of income. For this reason, all therapists who work with personalisation budgets have to remain reflexive and review their clients regularly, to ensure that art therapy is only provided when it is useful.

The last part of the meeting involved a presentation by Jane about her case study. In her chapter, Having a Learning disability: the question of what to say and when to say it, she wrote about the use of popular culture in her work with clients who have learning disabilities. In particular, she considered the way certain characters from films and TV (for example, King Kong) can surface in the artwork as a way for clients to identify with anti-heroes and those who are different from the “norm”. She pointed out that, while it is clearly important to discuss the personal meaning of their learning disabilities with clients, it is not always easy to know how to bring this up. Through the case study Jane demonstrated that by being sensitive to the client’s experiences and providing containment and a safe space, this issue can come up in the images and through discussions about popular culture. It can then be addressed in the sessions when the client feels ready; instead of a therapist-led conversation, this would allow the client to have control over the way this sensitive subject is handled.

Jane Caven’s writing:

Jane’s blog entry on the London Art Therapy Centre’s website
Caven. J. 2012. ‘The question of what to say and how to say it’ in Bull, S and O’Farrell. Art Therapy and Learning Disabilities: ‘Don’t guess my happiness’. Routledge, London and New York