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Sex, relationships, consent and capacity: Can the arts therapies help?
An insight into how the arts therapies can help support vulnerable people when dealing with issues surrounding consent & capacity
Consent and capacity have become the topic of conversation following recent cases brought to the Supreme Court.. Daniel Thomas,
managing director at Chroma
explains how the arts therapies may be able be used to support vulnerable people when dealing with issues surrounding consent & capacity.
‘Capacity and consent’ has become the subject of debate since December 2021 following a Supreme Court case involving a client living with a brain injury, who wanted to access a sex worker. The ruling stated the client must be able to demonstrate the ability to understand, and be able to provide on-going consent and must have the capacity to do so.
This raised many questions as to the implications for the client, the sex worker, his care workers and case managers. Key questions to arise following the ruling were - can a care team be lawfully involved in facilitating contact with a sex worker for a vulnerable person; and does the client have the capacity to provide consent as well as the capacity for ongoing consent – understanding the needs of another person?
Dan Thomas THE ROLE OF THE ARTS THERAPIES IN DEMONSTRATING AN UNDERSTANDING OF CONSENT
Consent means giving permission to do something, and in these cases, refers to an agreement between participants to engage in sexual activity. Capacity is the ability to understand information and make decisions about one’s own life.
It can be difficult for traditional therapies to reveal such abilities in someone with impaired cognitive function, but the arts therapies may lend themselves well to creatively unlocking the capabilities of the brain.
Music Therapy (MT), Art Therapy (AT) and Dramatherapy (DT) are all capable of finding out and demonstrating if someone has the ability to make decisions and choices, and, to work with cognitive abilities e.g. holding information in mind, looking at issues around memory, organisational/ problem solving skills, and sense of self.
Dramatherapists, for instance, may implement role-play to help clients understand the feelings of others as well as how their actions may affect those around them. Role-play also provides a means to embody what it may feel like to start a relationship with someone.
Art Therapy can help a client to understand how the world may see them, and how they may see themselves, helping the client understand themselves. This can be in the context of their personal safety and their possible vulnerability in the world around relationships.
Music Therapy uses techniques such as song writing to help determine if someone has the cognitive abilities required to understand what consent and capacity entails. If a client can create, plan, execute a song, and then replicate the entire process the following session, it shows the ability to hold information in mind and supports the possibility that the client may be capable of giving and understanding ‘consent’, at least in the context of song-writing.
WHAT IS CONSENT AND CAPACITY IN TERMS OF SEX?
Capacity means the ability to understand information and make decisions about one’s own life. If one cannot show one understands and retains the information, one is said to ‘lack capacity’ and deemed unable to make decisions about one’s own treatment or relationships, for example.
As recent judgements show, it can be difficult to make clinical and care decisions in someone’s best interests in the context of the law, but consent in this context, refers to an agreement between participants to engage in sexual activity. In this situation, consent must be communicated clearly and freely and this should be verbal and affirmative, and on-going.
It can be challenging for case managers, care workers or clinicians to determine whether the individual they are supporting can give consent and understand their sexual partner must also give consent.
Findings gathered during arts therapies sessions can provide indications that individuals are able to make choices and decisions in therapy and therefore may be able to apply this to other areas of their lives. Creativity helps support clients in demonstrating whether they have the ability to provide consent.
THE IMPACT OF SUCH RULINGS
In cases such as these, creative arts therapists must prepare for the client’s high level of emotional need as well as from those who support them. When clients are deemed to not have capacity and are prevented from starting a relationship or using a sex worker - it is of course impactful, not only for the client, but for the network of people, whose role it is to enable that person to live with the best quality of life. The creativity of arts therapies lends itself to helping the client, and their network, think through the emotional impact of the ruling.
SCIENTIFIC EVIDENCE FOR THE ARTS THERAPIES EMOTIONAL AND FUNCTIONAL SUPPORT
Art Therapists may use clinical interventions such as clay as a means to support emotional expression and communication in a creative and non-threatening way. According to Elbrecht C & Antcliff L, (2014) “Neuroscientific research provides increasing evidence of the intimate relationship between physiological and psychological dimensions of human experience. Haptic perception allows non-verbal access to psychological and sensorimotor processes thwarted by trauma.”
Dramatherapists may implement clinical Interventions such as Embodiment, Projection, Role (EPR), which enables clients to start adding layers of meaning and expand their reflective capacities in a playful non-threatening way (Jennings, 1990).
Dramatherapy supports psychological adjustment and through stories, clients can access material not easily spoken about through language. Stories provide “distance” from the challenge or issue, which enables clients to work with the areas of their lives that are important to them, in a non-confrontational manner. And stories can help clients to understand the dynamics of difficult life events which helps them to come to terms with their experiences.
Music therapists use musical training to enhance brain plasticity. Evidence shows that musical training is associated with improved perceptual, motor and cognitive skills, including executive functions (Criscuolo et al 2019, Thaut, 2014, Galinska, 2015).
It also emerged as a useful framework for training-related plasticity in the human brain, which results in behavioural, structural, and functional changes on time scales ranging from days to years (Arkin et al, 2019. Herholz 2012, Vaquero et al, 2018).
In essence, Music Therapy, especially Neurologic Music Therapy techniques, can improve brain function and help clients demonstrate their capacity for understanding and providing consent.
HOW CAN THE ARTS THERAPIES HELP CLIENTS LIVING WITH COGNITIVE IMPAIRMENT IN TERMS OF RELATIONSHIPS?
Everybody craves intimacy. Those living with cognitive impairment are no different – they are still human beings with natural urges and feelings. To be told you are unable to fulfil those needs would be devastating. Creative arts therapists may offer an effective means to help case managers determine if their clients have the capacity for consent around aspects of creativity which could be transferred to other areas of their lives, and could help care staff have conversations about the impact of these judgements.
An arts therapist’s finding may not change the capacity assessment, but could assist the multidisciplinary team and the clinician performing the capacity assessment, as it provides them with evidence to see what the clients’ capable of. Arts therapists can also present information on behalf of the client, for example via melody which research suggests is a very useful “information-scaffold”. What sets the creative arts therapies apart from other therapies is that they are able to help a client improve cognitive function whilst engaging in a fun, creative activity. They provide a nonthreatening, safe environment for the client to process their thoughts and feelings, whilst gaining a better understanding of their situation. The Arts Therapies are able to highlight everyday abilities through creativity. Dramatherapists and art therapists can use their medium to help clients understand the sequence of setting up a date for instance; starting a conversation with someone, through role-play, or through creating art using a learned sequence. Both means have the ability to discover if the client has the capacity to learn and if they do, the use of Arts Therapies in this context gives hope to the clients who need it, in that intimacy may be a possibility for them in their future. ■
For more information about Chroma Neurologic Arts Therapies within neurorehabilitation settings, please contact Daniel Thomas, Chroma via daniel@wearechroma.com or 0330 440 1838 www.wearechroma.com
