Together and apart: using Plasticine as a sensory therapeutic intervention for a service user diagnosed with severe learning disabilities

ABSTRACT Background The prevalence of mental illness among people diagnosed with severe learning disabilities is well documented, however limitations in verbal, cognitive, emotional and social skills are often used as reasons to withhold referrals for psychotherapeutic interventions within this client group. Context This paper describes the one-year art-therapy informed psychotherapeutic work carried out with Ioanna, a 61-year-old lady with a dual-diagnosis that took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. Approach Within the case-vignette the use of Plasticine as a therapeutic medium is presented. Concepts from psychodynamic and object-relations theory are also used as a framework for understanding the course of this therapeutic intervention. Outcomes The contribution of sensory materials appeared valuable in this psychotherapeutic intervention with an apparently ‘untreatable’ institutionalised service user, helping to build a trusting psychotherapeutic relationship, and enable Ioanna to regulate some of her challenging behaviours. Conclusions The use of Plasticine and play, and the development of a ‘together and apart’ game within a psychotherapeutic intervention, appeared to modify Ioanna's challenging behaviour, and improve her ability to relate and communicate with the therapist and her carers. Implications for research Research into the use of Plasticine as part of an art therapy programme for people with severe learning difficulties, would provide a useful addition to the knowledge in this area. A review of the current psychiatric services in Greece and of what constitutes ‘clinical progress’ also seems necessary. Plain-language summary This paper describes the one-year art-therapy informed psychotherapeutic work I undertook with Ioanna, a 61-year-old lady with a diagnosis of severe learning disabilities and mental illness. This took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. At this time, I was also undergoing my art therapy training. The practice description in this paper describes the contribution of Plasticine as a sensory, therapeutic medium. Theories related to the relationship that a baby or child develops with its primary care giver are used as a framework for understanding the course of this therapeutic intervention. The relationship between learning disabilities and mental illness is well documented in clinical literature, however people with dual diagnosis or severe learning disabilities are often overlooked where referrals for psychotherapy are concerned, as it is believed that they cannot take part due to a perceived lack of communication skills. This paper describes how the use of Plasticine and playing a ‘together and apart' game appeared to contribute to Ioanna’s development of a trusting therapeutic relationship, the modification of challenging behaviour, and improved communication through the medium of Plasticine and play. Research into the use of Plasticine and the ‘together and apart game' with this client group is recommended. It is also important to rethink and reflect on the provision of psychotherapeutic services within the current psychiatric services in Greece for this client group, and consider what constitutes clinical ‘progress' from the client’s perspective.