Daniel Thomas looks at how music, art and dramatherapy are used to help pupils with SEN
There is a long tradition of using the arts therapies for children with SEN and strong successes have been highlighted in areas such as understanding non-verbal communication, gestures, mentalisation, sensorimotor issues, and regulating behaviour and emotions.
Music therapy, art therapy and dramatherapy (the arts therapies) are part of the allied health professions, a group of 14 professions which form the third largest workforce in the NHS and education settings. Due to their Masters level training, arts therapists are professionally autonomous practitioners, regulated by the Health and Care Professions Council (HCPC), which maintains standards of practice, ethics and disciplinary structures. Parents and teachers can, and should, check that the arts therapist working with them is registered with the HCPC.
Arts therapies and SEN
The arts therapies can be uniquely engaging for children, which often means that referral outcomes – such as better self regulation, improved balance or longer attention span – can be worked on more successfully than if the child was attending a physiotherapy or educational psychology session alone. Music therapy, for example, can bypass an individual’s cognitive appraisal to provide almost direct emotional processing (Chanda and Levitin, 2013), meaning that arts therapists can work on the source of the presenting issue, for example the unregulated fight or flight reaction in a child’s brain, without having to use words or give instructions that the child may not be able to understand or tolerate.
Within autism, therapists, parents and other caregivers have seen that music therapy can make a difference in improving children’s social skills, verbal and non-verbal communication (including imitation and turn-taking), emotional interaction and changes in behaviour (Reschke-Hernández, 2011). A recent Cochrane review – considered by many to be the gold standard for healthcare evidence – showed that music therapy significantly improves non-verbal communication skills in children with ASD, compared to control groups, where they participate in stimulating activities such as play or storytelling (Gold, Wigram and Elefant, 2006).
Children with autism often display difficulties with symbolic and creative “make believe” play (Hobson et al., 2009; Mastrangelo, 2009). Dramatherapy is uniquely suited to support a child with impaired “pretend-play” skills and imagination, and utilises the dramatic reality in order to achieve emotional awareness, providing appropriate emotional responses.
Within the wider cohort of pupils with SEN, dramatherapists create environments in which a child feels safe to express how they are feeling about events in their own lives through both verbal and non-verbal modes of self-expression. They use techniques such as mime, movement, play-acting, puppetry and improvisation, which allow children to distance themselves from the referral issue or perceived problem, in order to communicate more freely. The goal of dramatherapy can be to build self-confidence, creativity, social awareness and problem-solving skills.
Art therapy also has a robust evidence base supporting the work of therapists with children with SEN and autism. Neuroscience increasingly demonstrates the importance of the arts for both cognitive and emotional development (Malchiodi, 2012). Recent studies show how the creative process of art-making activates multiple areas of the brain (for example, Kaufman, 2013). Healthy brain functioning is correlated with the integration of different brain structures (Cozolino, 2002). By activating different brain regions, art therapy might provide a means of exercising the whole brain, supporting integration, brain plasticity and healthy brain functioning. This activation of neural plasticity can be used by the art therapist and their client to start to build and develop additional cognitive, emotional or motor skills functions, which may have been diminished by the impact of the child’s SEN.
Collaboration
Arts therapists can work in very collaborative and flexible ways, meaning that even if a child is working with a dramatherapist, different modalities (art and music therapy) and sensory materials can be used to explore dominant themes and to support intended outcomes. Even when movement is not explicitly part of the therapy, processes of painting, moulding, playing, gesturing and vocalising add physicality to the areas of emotion, cognition and symbolic representation pursued through the arts. The tactile nature of different materials or instruments and the kinaesthetic processes of creating and embodying artistic processes to further non-artistic goals, can provide important opportunities for sensory integration (Hass-Cohen, 2008).
Music therapy: Jon’s story
Jon was 12. He was at a special school that specialised in working with children with emotional and behavioural difficulties. There had been concerns raised by Jon’s primary school about the safety and stability of his home life and, at the point of starting music therapy, he had been placed in emergency foster care. There was a hope that he may return to his birth home but also a recognition by teachers and professionals that this may not be possible. His mum hoped for his return. Jon wanted to go home too, but he was also getting used to his new surroundings and a calmer atmosphere. He was described as not very academic and could not read.
Starting music therapy, Jon was very much in control. He told the music therapist what to play and when to stop, and presented himself as strong and tough. If the music therapist did something musically that Jon had not asked for, Jon might leave the room and stand outside the door, or take the instrument away and stop the music. This way of interacting lasted for several months, but increasingly the music therapist saw moments in most sessions where Jon was able to tolerate musical “mistakes” made deliberately by the therapist – for example, playing the drum in the rhythmic way Jon requested, but then dropping the beater onto the drum “accidentally” creating a “messy sound”, which Jon and the therapist started to laugh about. The music therapist felt that by adding in these small moments when the predictable became unpredictable and the musically fixed became messy or mutable, Jon’s capacity to manage change and start to tolerate conversations about change might increase.
Over the next year, Jon became more able to loosen his control over the sessions and, as a result, his capacity to learn through play increased. Jon started to be interested in a more joint way of working, creating landscapes or dens to explore and lyrics to sing together. Jon and the music therapist started to write down words and sentences to put into the songs they created. Teachers noticed that in the classroom Jon’s behaviour had changed. He was happier to work alongside other children and more able to cope in classroom settings. His reading ability improved, as did his self confidence. Jon didn’t return home, but through music therapy he started to explore the different relationships in his world that were important to him. He did this musically, with songs and in words.
Dramatherapy: Jenny’s story
At the age of ten, Jenny was referred to dramatherapy to help with her behaviour at home, which was especially concerning for her mum as she kept seeing Jenny destroying her toys and clothes.
Jenny had been adopted as a two-year-old and had been a “good child” up until the age of nine, when these issues had started to arise. Most parents would be concerned if their child was breaking toys and ruining clothes, as were Jenny’s mum and dad, but they were also trying to re-focus her on positive activities and things Jenny liked. They told the dramatherapist they were at the end of their tether and didn’t know what to do. They also hoped that Jenny would start to have more age-appropriate interests and move away from the dolls and teddies she always hung on to.
In the initial sessions, the dramatherapy involved lots of conversations between the teddies and toys and objects the dramatherapist brought each week. Jenny liked to put the big ones and the smaller ones in different parts of the room. Sometimes one of the teddies “crashed himself” across the room into the other ones and made a big mess of them. Normally, the teddy that flew through the air was a green one; it had a monster-quality about it. Jenny and the dramatherapist started to wonder about what it might say, and what it wanted, especially as it flew through the air. Jenny said the green teddy was like an explosion and no-one knew that it was about to fly.
The sense of the green teddy being difficult to contain and predict started to link to the forthcoming change of schools that Jenny and her class were preparing for. Jenny said she didn’t really know why she had to leave her primary school and she didn’t want to go. The dramatherapist started to liaise with Jenny’s parents about how Jenny’s destructive play at home may have been a way for her to try to understand how she felt about moving schools, and perhaps her sustained interest in toys that were normally for children much younger than herself might have been about trying to stay young enough to remain at primary school. As these things were discussed with her parents, and were allowed to be explored and played with in the dramatherapy sessions, Jenny seemed more relaxed at home. Mum and dad started to understand that her behaviour was trying to communicate something she didn’t have words for. Jenny kept going to dramatherapy for the next year and into her first term in her new school. When she had settled into the new routine, everyone thought that the sessions should come to an end. Jenny kept the green teddy at home to help remind her of the sessions.
Art therapy: Rachel’s story
Rachel was referred to art therapy because of a brain injury that left her feeling scared and frustrated. It also left her with a very different sense of herself post-accident, compared to who she thought she was before it. Rachel had run out of her house and had been hit by a car. As a 15-year-old, issues of identity, fitting in to peer and social groups and starting to stand on her own two feet were important. The accident had set this all back; she found herself more reliant on her parents again and without the confidence to go out with her friends.
Art therapy had been proposed as a way to support Rachel to work through some of her thoughts and feelings about the injury. This type of therapy was chosen because she was interested in drawings, magazines and the visual side of things. Rachel also knew that it was more than just an art class, but she felt that the art therapist might also be able to show her pictures or images, or create clay objects with her that expressed things which she didn’t feel able to say. Showing Rachel the range of art materials they could use was a good first start and made her feel at ease. She started by drawing on a piece of paper, putting objects and shapes on each side of the page, but nothing in the middle. These types of pictures and drawings continued for some weeks before the art therapist said, “The drawings seem always apart, with a gap in the middle of the paper. I wonder if there is anything that connects them?”
Over the next few months, Rachel and her art therapist started to think together about the blank space between the drawn-on sides of the paper. Rachel attempted to link the sides with thin lines or splashes of colour, but this was difficult for her. Talking more about the accident, Rachel was able to tell the art therapist that she felt somewhat to blame, as she had run out of her house in a temper and straight into the road, but that the driver who hit her was also going too fast to stop. It was very hard to work out whose fault the accident was and Rachel oscillated between feelings of guilt and responsibility on one side, and anger and helplessness on the other. Together, Rachel and her art therapist started to see that her drawings with the blank space in the middle of the page represented this dichotomy; the work was now about trying to bring these conflicting feelings together in a way that allowed Rachel to integrate and accept the different feelings she had about her accident.
Author: Daniel Thomas
Daniel Thomas
Daniel Thomas is Joint MD at Chroma, which provides arts therapies services across the health, education and social care sectors: wearechroma.com
