Trauma-Informed Art Therapy ©
Article by: Cathy Malchiodi
Cathy Malchiodi has contributed tremendously to the field of art therapy. In preparation for our training this weekend on Art Therapy and Healing Trauma BATC would like to re-post her article on Trauma-Informed Art Therapy. Cathy has written several books and articles on this topic, and travels all over the world teaching it’s principles.
Thank you Cathy for this informative piece and all your tireless work in bringing art therapy to the forefront in treating and healing trauma.
Trauma-Informed Art Therapy (T-IAT) and Trauma-Informed Expressive Arts Therapy© 2010 Cathy Malchiodi, PhD, LPCC, LPAT, ATR-BC
Malchiodi, C. (2015, July 13). Trauma-Informed Art Therapy (TI-AT) and Trauma-Informed Expressive Arts Therapy. Retrieved on (July 13, 2015) from http://www.cathymalchiodi.com/Trauma Informed Art Therapy.html.
Also see “Trauma-Informed Expressive Arts Therapy” on Psychology Today at http://www.psychologytoday.com/blog/the-healing-arts/201203/trauma-informed-expressive-arts-therapy. How to cite this reference: Malchiodi, C. (March 6, 2012). Trauma-informed expressive arts therapy. New York: Sussex Publications/ Psychology Today.
Part One: Developmental Trauma
In order to provide trauma informed intervention, it is important to first understand the complexities of chronic trauma across the lifespan. Many trauma specialists and helping professionals encounter children and adolescents with a history of multiple chronic traumatic events throughout their young lives. In the past, we have referred to this as “complex trauma,” or Type II or even Type III trauma; in brief, trauma specialists generally agree that youth who have experienced multiple traumatic events involving abuse, violence, or abandonment react differently than those who may have experienced an acute, single incident of trauma or loss.
The Complex Trauma Taskforce of the National Child Traumatic Stress Network (NCTSN) undertook a significant step in identifying and resolving the problems associated with diagnosing complex trauma in children. In 2005 Bessel van der Kolk and colleagues proposed “developmental trauma disorder” (DTD) to more accurately describe children and youth who present a range of difficulties as a result of exposure to early, chronic and severe trauma. These individuals may have experienced developmentally adverse trauma involving abandonment, physical abuse or assault, sexual abuse or assault, emotional abuse, witnessing violence or death, and/or coercion or betrayal. Understandably, these types of repeated events cause feelings of rage, fear, shame, defeat, and withdrawal; they are reactions to years filled with adverse and inhumane treatment by parents, family members, caregivers, or others who impact these children’s lives.
Youth with DTD often have problems with attachment and authority, are unable to regulate their emotions and impulses, and can experience cognitive impairment and attention deficits. Trauma experts concur that these individuals may benefit more so from our efforts to help them recognize and regulate their trauma reactions rather than pharmacological approaches that are used in desperation to control or medicate behaviors such as attention deficit disorder, cognitive and behavioral problems, and anti-social behaviors.
As we continue to learn more about complex, chronic trauma, just how should trauma specialists address DTD and make appropriate interventions with these children and adolescents? Here are some simple recommendations, based on my work with children from violent homes, abused children, and youth who witness homicides:
1. Establish a sense of safety. This includes helping children establish both an internal sense of safety and identification and support for safety within their homes, neighborhoods, and communities.
2. Regulate affect. Help children understand that what has happened is “not their fault,” and assist them in learning methods to regulate and moderate arousal [limbic system] with the long-term goal of restoring emotional equilibrium.
3. Reestablish attachment. Chronic, complex trauma disrupts basic trust because it is often caused by dysfunctional or abusive interpersonal relationships; our goal as helping professionals is to help children reestablish attachment with positive adult role models and to learn how to empathize and productively interact with peers.
4. Enhance the brain’s executive functions. Serious and repetitive trauma impacts cognition, disrupting cortical functioning; our goal is to help children effectively engage attention, comprehension, and problem-solving skills to allow for the experiences of mastery, self-esteem, and self-efficacy.
5. Reframe and integrate traumatic experiences. Chronic, complex developmental trauma cannot be erased from memory; however, with our help children can learn to how to manage their reactions, enhance adaptive coping skills, and cultivate present-oriented responses to current stresses. Our ultimate goal in intervention is to help these youth transform, incorporate, resolve, repair, and construct meaningful lives, post-treatment.
Part Two: What is Trauma-Informed Practice
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)
Part Three: Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy. Art therapy and expressive arts therapy have a unique role as an intervention with traumatized individuals. 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 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 and Trauma-Informed Expressive Arts Therapy integrate neuroscience and neurodevelopment, somatic approaches, mindfulness practices, and resilience enhancement, using art making as the core approach. In general, a trauma informed approach must take into consideration the following:
Five Components of Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy
1. Uses a “neurosequential approach” via expressive arts therapies to stabilize the body’s responses.
2. Identifies of the body’s reactions to stressful events and memories through trauma-informed evaluation and sensory-based activities using expressive arts.
3. Responds to the body’s reactions to traumatic events through somatic and sensory approaches to self-regulation.
4. Reinforces a sense of safety through reconnection with positive attachment and self-soothing.
5. Builds strengths by using the arts to normalize and enhance resilience (Malchiodi, 2008; 2011).
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.
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; 2012). Handbook of art therapy (1st & 2nd ed.). New York: Guilford Press.
Malchiodi, C. (2008). Creative interventions with traumatized children. New York: Guilford Press.
Malchiodi, C. (2011). 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.
– See more at: http://www.cathymalchiodi.com/art-therapy-books/trauma-informed-art-therapy/#sthash.gBrQieBc.dpuf