Scope note
The book does not present “pacing and grading” as an explicit, named clinical framework in the occupational-therapy sense. The word grading in the OT meaning of calibrated task complexity does not appear; pacing surfaces only briefly as a term. Instead, both ideas run through the volume under the language of “reasonable adjustments,” “adaptations,” “co-production,” and “working at the individual’s pace.” What follows draws together the principal passages.
1. Pacing
1.1 Pace as the central adjustment (Chapter 5, Power et al., “No Barriers Here”)
The book’s clearest statement on pacing comes from a co-produced advance-care-planning project with people with learning disabilities and/or autism:
“The main difference when working with people with learning disabilities and/or autism in a co-produced way is time. Everything must be done at an individual’s pace. There is always intention to work inclusively, it just never gets the time allocated to make sure this does happen in the most meaningful way.” (Ch. 5)
The chapter frames pacing as a structural and ethical question, not a within-session technique:
“When working in co-production with people with learning disabilities and/or autism reasonable adjustments must be considered to ensure equitable participation. These may include the way and format that information is shared and at a pace that is comfortable for the individual.” (Ch. 5)
The “No Barriers Here” model itself is paced architecture — three two-hour workshops over three weeks moving from identity to relationships to end-of-life wishes — designed to “offer space and time… to slow down and encourage exploration of views” (Ch. 5).
1.2 Pacing as the therapist’s discipline (Chapter 6, Schwartz, “A Story about Geoffrey”)
Schwartz’s case study of two years’ work with “Geoffrey” is the book’s most sustained meditation on therapeutic tempo. There is no programme; there is a stance.
“The process was slow. Weekly art therapy sessions with Geoffrey tested my patience frequently.” (Ch. 6)
“Geoffrey made progress at a glacial pace over a very long period of time. There were times when, stubbornly, Geoffrey refused to progress and would slip back into his old self… But the anchor would bring me back to the task at hand, and I’d return to my place of patient waiting.” (Ch. 6)
Pacing here means tolerating regression and absence of progress. Schwartz reframes the therapist’s role as “compassionate witness” (Schwartz, 2023a) — “to maintain the earth so that something might grow, retain a non-judgemental attitude and a welcoming space that Geoffrey could return to when ready” (Ch. 6).
1.3 Pacing as person-specific, not protocol-driven (Chapter 3, Brown, “Art Therapy, Power, and Change”)
In the trauma chapter:
“These stages are commonly observed, [but] it is accepted that not everyone reaches these stages at the same time and that the pacing of therapy looks different for different people. Trauma therapy requires a careful and intricate approach over a longer [period]…” (Ch. 3)
1.4 Temporal and environmental scaffolding
Pacing in the book extends beyond session tempo to the surrounding architecture of care:
- Chapter 9 (Drumm, Lizzy): session times moved to avoid weekly fire-alarm tests; agreement reached with on-site builders to halt loud work during appointments; therapy room reconfigured for wheelchair access (Ch. 9).
- Chapter 10 (Jayden, secure care): multi-year therapy with a young man in long-term segregation; recognition that bank-holiday seasons destabilised his mood led to proactive slowing and redirection of activity ahead of known trigger periods (Ch. 10).
- Chapter 16 (Hackett & Power) notes from a systematic review that, for adult LD work, “the duration of treatment was most likely to be 13 months… group work… most common length of therapy was six months, within a range of 2 to 15 months” (Power et al., 2023, cited Ch. 16) — situating pacing as a long-horizon practice.
2. Grading and adaptation
2.1 Reasonable adjustments and adaptive practice
The volume’s editors set out adaptation as a core competency:
“Work creatively and flexibly: implement adaptive ways of working that support the person to fully engage in the therapeutic intervention.” (Ch. 16)
“Therapists employ a range of adaptive techniques informed by trauma-informed approaches and with an awareness of the impact of wider socio-cultural movements.” (Ch. 1, Power & Hackett)
2.2 Grading the communication mode
Several chapters describe calibrating the mode of expression to the client’s communication ability:
- Chapter 9 (Lizzy): a client-co-designed “Red-Yellow-Green” traffic-light mood check-in used at the start of each session; adapted consent and mood assessments; a visual timeline to support self-advocacy after a life-changing accident (Ch. 9).
- Chapter 5: “Sometimes we can’t find the words to speak, the pictures we created together did the talking for us where talking was at its most sensitive time… A reasonable adjustment if we don’t feel like talking.” (co-author quoted, Ch. 5)
- Chapter 7 (Bragge & Fenner): the “interactive square,” a non-verbal scaffolded approach for autistic children to access art therapy.
2.3 Grading the emotional load
Chapter 13 (Frames of Identity, Down syndrome reminiscence work) is explicit that themes themselves can be graded:
“By thoughtfully choosing and adjusting the themes, we were able to encourage participants to open up about sensitive topics that they might have found overwhelming. This approach provided a safe space for individuals with Down syndrome and their carers to explore these topics, while containing strong emotions.” (Ch. 13)
2.4 Grading re-entry after disruption
Chapter 14 (Coming Out of the Coronavirus Pandemic) describes graded re-introduction of face-to-face therapy through “social stories” — easy-read written and pictorial statements explaining COVID protocols, including photographs of the therapists with and without face coverings “so that clients would not be alarmed if we looked different from usual” (Ch. 14).
2.5 A caution on under-grading
Several contributors push back against defaulting to “easy-read” formats. Chapter 5 notes that pictorial resources “are suitable for some people, [while] others may find it difficult to relate to images that are not about themselves.” Chapter 14 makes a parallel point — that standardised questionnaires may fail to elicit the voice of group members where a “more conversational style” succeeds. Adaptation is ongoing and individual, not a level set in advance.
3. Synthesis: principles drawn from the volume
- Time is the primary adjustment. Most “pacing” issues are insufficient time allocated, not incorrect tempo within a session (Ch. 5).
- Pace is set by the client, including the right to refuse, regress, or remain still (Ch. 6).
- Adapt the environment before the task — sensory, temporal, and access conditions shape what any grading can achieve (Ch. 9, Ch. 10).
- Grade by emotional load and communication mode, not only by motor or cognitive demand (Ch. 7, Ch. 9, Ch. 13).
- Co-design adaptations with the client. The “No Barriers Here” model is the book’s clearest example (Ch. 5).
- Hold “patient waiting” as an active stance, not a passive default (Ch. 6).
Chapter references
- Ch. 1 — Power, N. & Hackett, S. Disrupting Narratives: The Role of Diverse Voices in Co-Creating Change in Art Therapy.
- Ch. 3 — Justice: Art Therapy, Power, and Change.
- Ch. 5 — Power, N. et al. Doing Things Differently: Working Together to Talk More about Death and Dying — The No Barriers Here Approach.
- Ch. 6 — Schwartz. Self-Doubt and the Art of Listening: A Story about Geoffrey.
- Ch. 7 — Finding Connection through Group Art Therapy and “Being in a Book.”
- Ch. 9 — Advocacy and Art Therapy: “It helped me piece together what happened.”
- Ch. 10 — Finding Connection Using Attachment-Based Art Psychotherapy in Secure Care.
- Ch. 13 — Frames of Identity: Unveiling Life Stories of People with Down Syndrome through Art Therapy and Reminiscence.
- Ch. 14 — How Do We Hear the Voice Behind the Smile? Group Art Therapy Coming Out of a Coronavirus Pandemic Lockdown.
- Ch. 16 — Hackett, S. & Power, N. Bridging Practice and Research: Art Therapy with Children and Adults with Learning Disabilities.