Trauma Informed Art Therapy

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) (2010), trauma informed interventions specifically address the consequences of trauma in the individual and recognize the interrelation between trauma and symptoms of trauma. A comprehensive view of neurological, biological, psychological and social effects of trauma and violence ultimately informs intervention. Here is what SAMHSA specifically has to say about trauma informed practice:

Trauma-informed programs and services represent the “new generation” of transformed mental health and allied human services organizations and programs who serve people with histories of violence and trauma.

Trauma survivors and consumers in these programs and services are likely to have histories of physical and sexual abuse and other types of trauma-inducing experiences, and this often leads to mental health and other types of co-occurring disorders such as health problems, substance abuse problems, eating disorders, HIV/AIDS issues, and contact with the criminal justice system. When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma impacts the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization (Retrieved from SAMHSA at http://mentalhealth.samhsa.gov/nctic/trauma.asp)

In truth, I could be writing about trauma informed play therapy, bibliotherapy, narrative therapy, or any number of approaches that can be applied to trauma intervention. But I am talking about art therapy today because it is a central framework in my practice with traumatized individuals. It also is a particularly effective approach for trauma informed care with all individuals, especially children, because it is sensory, hands-on, and experiential in nature. As physician and neurodevelopment pioneer Bruce Perry has noted, it also can be a normalizing experience for children, one which children in all cultures recognize.

Art therapy, like other creative and expressive arts therapies, has a unique role as an intervention with traumatized children. In fact, the International Society for Traumatic Stress Studies (ISTSS) (Foa et al, 2009) provides a comprehensive summary of the role of the creative art therapies, including art therapy, in the treatment of posttraumatic stress disorder (PTSD). The ISTSS statement underscores the growing interest the relationship between the creative arts therapies and the brain, including how the brain processes traumatic events and the possibilities for reparation through art, music, movement, play, and drama interventions.

In my practice as an art therapist and mental health counselor, most children I have worked with over the years have been chronically abused and neglected. As a result, these children generally have a variety of severe trauma reactions (hyperarousal, avoidance, dissociation, and intrusive memories), learning and psychosocial challenges, and attachment difficulties. In many cases, psychodynamic and cognitive behavioral strategies alone cannot address the reactions of children whose cognitive, developmental, and interpersonal skills are compromised by multiple traumatic experiences of sexual abuse, physical abuse, emotional abuse, domestic violence, and neglect.

Trauma informed art therapy integrates neurodevelopmental knowledge and the sensory qualities of art making in trauma intervention (Malchiodi, in press).  In general, a trauma informed approach must take into consideration, but is not limited to, the following 1) how the mind and body respond to traumatic events; 2) recognition that symptoms are adaptive coping strategies rather than pathology; 3) emphasis on cultural sensitivity and empowerment; and 4) helping to move individuals from being not only survivors, but ultimately to becoming “thrivers” through skill building, support networks, and resilience enhancement (Malchiodi, in press).

Because young survivors of trauma may also be without the means to place memories in historical context through language, art therapy combined with neurobiological, somatic, and cognitive-behavioral approaches can assist children in bridging sensory memories and narrative. Trauma informed art therapy is based on the idea that art expression is helpful in reconnecting implicit (sensory) and explicit (declarative) memories of trauma and in the treatment of PTSD (Malchiodi, 2003). In particular, it is an approach that assists children’s capacity to self-regulate affect and modulate the body’s reactions to traumatic experiences in the earliest stages to set the stage for eventual trauma integration and recovery.

Trauma informed care not only involves how we practice, but also relationships between our clients and therapists, parents, family members, caregivers, case workers, teachers, and others; it is important to assessment and evaluation and the environments in which we see children and families, too. Dr. William Steele and I are currently working on providing more detailed information on trauma informed approaches to work with children and adolescents. And in future posts, I’ll be sharing some practical strategies on how to infuse trauma informed art and play interventions into our work as trauma specialists.

Be well,

Cathy Malchiodi, PhD, LPAT, LPCC

Be sure to check the TLC website for many resources, online learning opportunities, and future symposia that will help you to develop a trauma informed approach to work with children and families.

References

Foa, E., Keane, T., Friedman, M., & Cohen, J. (2009). Effective treatment for PTSD: Practice guidelines from the International Society for Trauma Stress Studies. New York: Guilford Press.

Malchiodi, C. (2003). Handbook of art therapy. New York: Guilford Press.

Malchiodi, C. (2008). Creative interventions with traumatized children. New York: Guilford Press.

Malchiodi, C. (in press). Trauma informed art therapy with sexually abused children. In Paris Goodyear-Brown (Ed.), Handbook of Child Sexual Abuse: Prevention, Assessment, and Treatment. New York: Wiley.

Substance Abuse and Mental Health Services Administration (2010). Trauma informed care. Retrieved September 12, 2010 from http://mentalhealth.samhsa.gov/nctic/trauma.asp.

Steele, W. & Rader, M. (2002). Structured sensory intervention for traumatized children, adolescents and parents: Strategies to alleviate trauma (SITCAP). Lewiston, NY: Edwin Mellon Press.

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