Expressive Art Therapies Torture1-2011
Expressive Art Therapies Torture1-2011
Expressive Art Therapies Torture1-2011
*)
Restorative Resources Training & Consulting
LLC & Trauma Resources International
USA
amber@ecentral.com
T O R T U R E Vol um e 2 1 , N u m be r 1 , 20 1 1
T O R T U R E Vol um e 2 1 , N um be r 1 , 20 1 1
40
Creative Arts Therapies including art therapy, sandtray therapy and psychodrama are
described in Scott6 from a psychodynamic
clinical orientation. Case studies are used
to illustrate the therapeutic process and
outcomes. While these case studies describe
work with survivors of trauma (vs. trauma
secondary to torture) the traumas experienced by the clients include early childhood
abuse and sexual abuse, and a house fire.
Given the small body of writing that exists
specific to expressive arts and somatic therapies with survivors of torture, any anecdotal,
outcome or clinical trial research on these
modalities with survivors of trauma may be
useful when determining a course of treatment for torture survivors.
Another article7 focuses on the use of
art therapy to document childrens memory
of war and violence, and post-conflict situations. Art is described as a powerful medium
for young survivors who may not have words
to describe what they have been through and
their ideas and hopes for the future. Art is
a direct portal to the symbolic realm, and as
such may be a useful medium to access both
traumatic and resource-based memories
in children, and in adolescents and adults
with earlier trauma exposure. The language
of childhood is the imaginal realm, and art
allows safety and containment when accessing memories underlying the traumatic
response. Greenberg et al.8 describes the use
of painting with a client who has been assessed using standardized neurological and
psychiatric tests. The article does not include
data on client improvement, other than to
state that the use of drawing and painting
benefits the clients recovery.
The limited references to art therapy
should not minimize its use with this population. Art therapy is used world-wide with
survivors of torture in many contexts and
cultural settings. The lack of clinical outcome research and reliance on anecdotal
information and case studies limits this modality to an emerging practice. Hopefully,
future research will earn art therapy its place
as a promising practice in clinical work with
survivors of torture. See Table 1.
41
Type of Practice
Introduction
1
n/a
Porges SW. Music therapy & trauma: insights from the Polyvagal theory. In:
Stewart K, editor. Symposium on Music Therapy & Trauma: Bridging Theory
and Clinical Practice. New York: Satchnote Press; 2008.
Promising
Terr LC. Too scared to cry: psychic trauma in childhood. New York: Basic
Books; 1990.
n/a
van der Kolk B, Greenberg M, Boyd H, Krystal J. Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of posttraumatic stress. Biol Psychiat 1985;20(3):314-25.
n/a
van der Kolk B. The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiat 1994;1(5):253-65.
Promising
Greenberg M, van der Kolk BA. Retrieval and integration of traumatic memories with the painting cure. In: van der Kolk, BA, editor. Psychological
Trauma. Virginia: American Psychiatric Publishing, Inc.; 1987. p. 191-215.
Emerging
Janzen RK, Janzen JM. Ayiwewe: war-traumatized children draw their memories. Can J Afr Stud 1999;33(2-3):593-609.
Emerging
Emerging
Dance/Movement Therapy
9
Promising
10
Promising
11
Emerging
12
Emerging
13
Emerging
14
Gray AEL. Dancing in our blood: dance movement therapy with street children
and victims of organized crime in Haiti. In: Jackson N, Shapiro-Lim T, editors.
Dance, human rights and social justice: dignity in motion. Maryland: Scarecrow Press; 2008. p. 222-36.
Emerging
15
Gray AEL. Dance movement therapy with a child survivor: a case study.
Dialogues. 2001;6(1):8-12.
Emerging
16
Emerging
17
Gray AEL. The body as voice: somatic psychology and dance/movement therapy with survivors of war and torture. Connections 2001;3(2):2-4.
Emerging
T O R T U R E Vo lu m e 21 , N um b er 1, 2 0 11
42
Article
Type of Practice
18
Gray AEL. The body remembers: Dance movement therapy with an adult survivor of torture. J Dance Ther 2001;23(1):29-43.
Emerging
19
Emerging
20
Promising
21
Singer AJ. Interactions between movement and dance, visual images, etno
and physical environments: psychosocial work with war-affected refugees and
internally displaced children and adults. In: Jackson N, Shapiro-Phim T, editors. Dance, human rights, and social justice: dignity in motion. Maryland: The
Scarecrow Press, Inc.;2008. p. 237-52.
Promising
Drama Therapy
22
Schinin G. "Far away, so close" psychosocial and theatre activities with Serbian refugees. Drama Rev 2004;48(3):32-49.
Emerging
Music Therapy
23
Jones C, Baker F, Day T. From healing rituals to music therapy: bridging the
cultural divide between therapist and young Sudanese refugees. Art Psychother 2004;31:89-100.
Emerging
Sandtray Therapy
24
Toscani F. Sandrama: psychodramatic sandtray with a trauma survivor. Art Psychother 1998;25(1):21-9.
Emerging
Johnson DR, Lahad M, Gray A. Creative therapies for adults. In: Foa E, Keane
T, Friedman M, Cohen J, editors. Effective treatments for PTSD: practice
guidelines from the International Society for Traumatic Stress Studies. 2nd ed.
New York: The Guilford Press; 2009. p. 479-90.
Promising
Concluding Considerations
T O R T U R E Vol um e 2 1 , N um be r 1 , 20 1 1
26
Foa EB, Keane TM, Friedman MJ, Cohen JA. Effective treatments for PTSD:
Practice guidelines from the international society for traumatic stress studies.
2nd ed. New York: The Guilford Press; 2009.
Dance/Movement Therapy
n/a
roots of all human language, communication, and experience, and therefore may be
particularly suited to work with survivors of
torture who have literally experienced the
unspeakable directly to their bodies. Dance
may be considered the creative or expressive
aspect of movement, and for many cultures
where the creative process is included in
ritual, healing and daily life, DMT may be
more appropriate than conventional talk
43
T O R T U R E Vo lu m e 21 , N um b er 1, 2 0 11
therapy. The non-verbal and pre-verbal nature of trauma also supports the use of this
modality.
Callaghan9,10 has written extensively on
the use of movement therapy, a term she
chooses to acknowledge the predominance
of movement over dance in her work. Using case material, the author describes the
application of this modality to work with
survivors whose bodies are affected through
pain, internal tension and conflict, shame
and guilt. For those whose bodies have been
deconstructed, movement may be more palatable, than dance, which requires a measure
of safety or cultural congruence with expression. A primary message of the case studies,
group and individual, is that mind and body
exist on a continuum so all injury secondary
to torture affects the body.
Gray11-15 and Harris16,17 expand the application of DMT to acknowledge the roots
of this form in ritual and traditional practices in Africa and Haiti. Harris17 includes
references to pre-and post- intervention
symptom (i.e. anxiety, depression, elevated
arousal, intrusive recollection, aggression)
assessment based on self-report, with positive outcomes in discharging aggression and
restoring interpersonal connection. While
the majority of the writing on dance/movement therapy with survivors of torture and
related traumas relies on case studies, the
cross-cultural adaptability of these expressive
arts therapies is particularly highlighted in
all the works reviewed. Gray describes the
cultural considerations of using DMT on
a continuum from individual to group and
community illustrating the broad application
of this form. Her articles describe DMT in
not only clinical settings, but in community
settings such as massacre sites and on the
very streets where street children who are
also survivors of violence and human rights
abuse reside. The adaptability of DMT to
44
T O R T U R E Vol um e 2 1 , N um be r 1 , 20 1 1
Drama Therapy
45
Concluding Considerations
T O R T U R E Vo lu m e 21 , N um b er 1, 2 0 11
erans and their families. This work is a useful reference for how ritual and ceremony,
familiar healing mechanisms in so many
cultures, can be adapted to deal with issues
such as separation from loved ones, exposure to violence and atrocity, and intense
emotions evoked by traumatic reminders
and memories. Rituals hold a potent place
in many cultures and assist individuals,
families, groups and communities to move
through lifes varied events, from the most
painful to the most joyful. Since the literature on ritual is limited to case material, as
an expressive arts therapy it can be considered an emerging practice. It bears noting that
as an ancient practice occurring regularly in
many of the home-countries of survivors of
torture, it might merit delineation as an evidenced based practice outside the strictness
of scientific paradigms.
T O R T U R E Vol u m e 2 1 , N um be r 1, 2 0 11
46
practices and approaches. Therapies that acknowledge the body at the center of human
experience and the age-old importance of the
creative process in human expression, communication and civilization are an important
component of comprehensive treatment.
Neuroscience offers insight into why the
expressive arts therapies may allow unique
access to trauma and resource-related content
that may not be accessible through language.
Research in this area may best elucidate the
strengths of these therapies.
On a cautionary note, the power that
is inherent in the creative process indicates
discretion and careful consideration in how
and when these modalities are used, by
whom and with whom. It is recommended
those who are appropriately trained and credentialed in the therapeutic practice of the
expressive arts, or those working as artists,
work closely with other experienced clinicians, community leaders or healers in cross
cultural contexts to ensure that safety. Containment and processing of painful traumatic
histories need to be titrated and respectful of
personal and cultural boundaries. At minimum, the expressive arts therapies offered
as adjunct (or primary) therapies with more
mainstream therapies ensures that the
therapeutic process is inclusive of the whole
person. As a category of clinical modalities and practices, all of the expressive arts
therapies might best be described as emerging clinical practice that offer tremendous
promise.
Learning Points
access to trauma and resource-related content that might not be accessible through
language. Research in this area may best elucidate the strengths of these therapies.
The power inherent in the creative process indicates discretion and careful consideration in how and when these modalities
are used, by whom and with whom. It is
recommended to work with those who are
appropriately trained and credentialed in the
therapeutic practice of expressive arts.
Highly recommended readings
Dokter D, editor. Art therapists, refugees and migrants: Reaching across borders. London, Jessica
Kingsley Publishers, 1998.
Goodman R, Chapman L, Gantt L. Creative arts
therapies for children. In: Foa E, Keane T, Friedman M, Cohen J, editors. Effective treatments
for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. 2nd
ed. New York: The Guilford Press, 2009.
Johnson DR, Lahad M, Gray A. Creative therapies for adults. In: Foa E, Keane T, Friedman M,
Cohen J, editors. Effective treatments for PTSD:
practice guidelines from the International Society
for Traumatic Stress Studies. 2nd ed. New York:
The Guilford Press, 2009.
Porges SW. Music therapy & trauma: insights
from the Polyvagal theory. In: Stewart K, editor. Symposium on Music Therapy & Trauma:
Bridging Theory and Clinical Practice. New York:
Satchnote Press, 2008.
References
1. Porges SW. Music therapy & trauma: insights
from the polyvagal theory. In: Stewart K, ed.
Symposium on music therapy & trauma: bridging
theory and clinical practice. New York: Satchnote
Press, 2008.
2. van der Kolk B, Greenberg M, Boyd H et al.
Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of posttraumatic stress. Biol Psychiatry 1985;20:314-25.
3. van der Kolk B. The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiatry 1994;1:253-65.
4. Terr LC. Too scared to cry: psychic trauma in
childhood. New York: Basic Books, 1990.
5. Herman J. Trauma and recovery: the aftermath of
violence from domestic abuse to political terror.
New York: Basic Books, 1997.
47
20.
21.
22.
23.
24.
25.
In: Jackson N, Shapiro-Phim T, eds. Dance, human rights and social justice: dignity in motion.
Maryland: The Scarecrow Press, Inc., 2008:23752.
Berliner P, Mikkelsen EN, Bovbjerg A et al. Psychotherapy treatment of torture survivors. Int J
Psychosoc Rehabil 2004;8:85-96.
Schinin G. "Far away, so close" psychosocial
and theatre activities with Serbian refugees.
Drama Rev 2004;48(3):32-49.
Jones C, Baker F, Day T. From healing rituals
to music therapy: bridging the cultural divide
between therapist and young Sudanese refugees.
Art Psychother 2004;31:89-100.
Toscani F. Sandrama: psychodramatic sandtray
with a trauma survivor. Art Psychother
1998;25:21-9.
Johnson DR, Feldman SC, Lubin H et al. The
therapeutic use of ritual and ceremony in the
treatment of post-traumatic stress disorder. J
Trauma Stress 1995;8:283-97.
Foa EB, Keane TM, Friedman MJ et al. Effective
treatments for PTSD: practice guidelines from
the international society for traumatic stress studies. 2nd ed. New York: The Guilford Press, 2009.
T O R T U R E Vol um e 2 1 , N u m be r 1 , 20 1 1