Check out this paper I presented at The American Art Therapy Association’s 44th Annual Conference
Symbolizing Bodily Held Memory: The Role of Visual Expression in Healing Trauma
During the talk, I suggested a way to conceptualize and apply art therapy as a body-oriented complex trauma treatment. Informed by neurobiological and attachment theories, I showed how art–based visual symbolizations and sensory-motor actions performed in therapy reduce somatic dissociation and improve affect regulation, key goals in healing complex trauma. The following is a summary of the material covered in the talk, including a bibliography:
Complex trauma is a non-DSM diagnostic formulation developed over the past two decades by trauma experts (Herman, Terr, Van der Kolk, to name a few), who observed complex symptom presentations unique to clients who have experienced repeated, overwhelming, inescapable threat. It is now more narrowly defined as the psychopathological condition resulting from repeated exposures to traumatic events over a period of time, at a young age, within the caregiving system. Resultant symptoms span multiple domains of functioning, including: attachment, biology, cognition, dissociation / amnesia, affect regulation, behavioral control, and self-concept (Cook, Blaustein, Spinazzola, Van der Kolk, 2003).
According to experts, “talk therapy” alone is insufficient to treat trauma (Van der Kolk, Schore, Courtois, and Shapiro, to name a few.) Francine Shapiro (2002) asserts that because “sensate experiences form the engines of continuous traumatic reliving”, “talking and insight” alone hold little promise as treatment interventions (p. 7). One proof of this assertion comes from the neuroscientific discovery that traumatic memory is encoded in the right brain hemishpere as unconscious, sensory-motor perception, locking traumatic memories out of left brain mediated functions such as conscious, linear, autobiograhical memory and verbal recall (Van der Kolk and Fisler, 1995).
The most highly regarded trauma therapies today are body-oriented, among them, EMDR (Shapiro), Somatic Experiencing (Levine), and Sensorimotor Trauma Therapy (Ogden).
In regards to specific trauma treatment goals that may relate to the field of art therapy, Bessel Van der Kolk (2002) asserts that:
The task of [trauma] therapy is to both create a capacity to be mindful of the current experience and to create symbolic representations of past traumatic experiences with the goal of uncoupling physical sensations from trauma-based emotional responses … (p. 19).
By “symbolic”, Van der Kolk means new synaptic patterns in the brain, not visual art symbols. But could visual expression accomplish this task? Art therapist researchers assert that art expressions visually represent traumatic material such that the unsymbolized traumatic memory becomes symbolized and therefore ready for conscious processing (Klorer, 2005; Lusebrink, 2004; Pifalo, 2007). During conscious processing, art therapy, theoretically, provides a bridge between right- and left-brain hemisphere functions—between conscious mind and unconscious perceptual memory, integrating traumatic memory into the mainstream of symbolically encoded, conscious, autobiographical memory (Avrahami, 2006; Johnson, 1987a; Malchiodi, 2008).
Art therapy trauma treatment protocols have addressed the associated goal of “uncoupling physical sensations from trauma-based responses” to varying degrees of specificity (Chapman, Morabito, Ladakakos, & Schreier, 2001; Gantt & Tinnin, 2007; Talwar, 2007; Tripp, 2007).
The research presented specifically identified how accessing traumatic memory through somatically informed art therapy interventions may be causing this “uncoupling ” to occur. It also provided a conceptualization of how this “uncoupling” may be leading to the type of bi-cameral brain integration suggested to be occurring through art therapy by researchers in the field. Through presentation of case material and identification of specific interventions and clinical interpretations, the applications of these theoretical concepts were illuminated.
References
Avrahami, D. (2006). Visual art therapy’s unique contribution in the treatment of post-traumatic stress disorders. Journal of Trauma & Dissociation, 6(4), 5–38.
Chapman, L., Morabito, D., Ladakakos, C., & Schreier, H. (2001). The effectiveness of art therapy interventions in reducing post traumatic stress disorder (PTSD) symptoms in pediatric trauma patients. Art Therapy: Journal of the American Art Therapy Association, 18(2), 100–104.
Cook, A., Blaustein, M., Spinazzola, J., & Van der Kolk, B. (Eds.). (2003). Complex Trauma in Children and Adolescents: White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Child Traumatic Stress Network. Retrieved from http://www.nctsnet.org/nccts/nav.do?pid=typ_ct
Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment. Psychological Trauma: Theory, Research, Practice, and Policy, (1), 86–100. doi:10.1037/1942-9681.S.1.86
Gantt, L., & Tinnin, L. W. (2007). Intensive trauma therapy of PTSD and dissociation: An outcome study. Arts in Psychotherapy, 34(1), 69–80.
Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. doi:10.1002/jts.2490050305
Johnson, D. R. (1987a). The role of the creative arts therapies in the diagnosis and treatment of psychological trauma. The Arts in Psychotherapy, 14(1), 7–13. doi:10.1016/0197-4556(87)90030-X
Johnson, D. R. (1987b). The role of the creative arts therapies in the diagnosis and treatment of psychological trauma. The Arts in Psychotherapy, 14(1), 7–13. doi:10.1016/0197-4556(87)90030-X
Klorer, P. G. (2005). Expressive therapy with severely maltreated children: Neuroscience contributions. Art Therapy, 22(4), 213–220.
Levine, P. A. (1997). Waking the Tiger : Healing Trauma : The Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books.
Lusebrink, V. (2004). Art therapy and the brain: An attempt to understand the underlying processes of art expression in therapy. Art Therapy: Journal of the American Art Therapy Association, 21(3), 125–135.
Malchiodi, C. A. (2008). Creative Interventions with Traumatized Children. New York, NY US: Guilford Press. Retrieved from http://0-search.ebscohost.com.linus.lmu.edu/login.aspx?direct=true&db=psyh&AN=2008-02507-000&loginpage=Login.asp&site=ehost-live&scope=site
Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children: The neurosequential model of therapeutics. In Working with Traumatized Youth in Chld Welfare. Guilford Press.
Perry, B. D. (2009). Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of Loss & Trauma, 14(4), 240–255. doi:Article
Pifalo, T. (2007). Jogging the cogs: Trauma-focused art therapy and cognitive behavioral therapy with sexually abused children. Art Therapy, 24(4), 170–175.
Schore, A. N. (2003). Affect Dysregulation & Disorders of the Self (1st ed.). New York: Norton.
Shapiro, F. (Ed.). (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism (1st ed.). Washington, D.C: American Psychological Association.
Shapiro, F. (2004). EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma (Updated ed.). New York: Basic Books.
Siegel, D. J., & ebrary, Inc. (1999). The Developing Mind Toward a Neurobiology of Interpersonal Experience. New York: Guilford Press.
Talwar, S. (2007). Accessing traumatic memory through art making: An art therapy trauma protocol (ATTP). ARTS IN PSYCHOTHERAPY, 34(1), 22–35.
Terr, L. C. (1991). Childhood Traumas: An Outline and Overview. The American Journal of Psychiatry, 148(1), 10.
Tripp, T. (2007). A short term therapy approach to processing trauma: Art therapy and bilateral stimulation. Art Therapy: Journal of the American Art Therapy Association, 24(4), 176–183.
Van der Kolk, B. A. (2002a). Posttraumatic therapy in the age of neuroscience. Psychoanalytic Dialogues, 12(3), 381.
Van der Kolk, B. A. (2002b). Beyond the talking cure: Somatic experience and subcortical imprints in the treatment of trauma. In F. Shapiro (Ed.), EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. (pp. 57–83). American Psychological Association. Retrieved from http://0-search.ebscohost.com.linus.lmu.edu/login.aspx?direct=true&db=pzh&AN=2004-14136-003&site=ehost-live&scope=site