Transforming Trauma: The Healing Power of Art Therapy for PTSD
What is Art Therapy
Art therapy is a form of psychotherapy that utilizes creative expression as a means of communication and exploration of emotions, thoughts, and experiences. The client and therapist work together using different materials and techniques to help the client gain insight into their feelings, improve self-awareness, develop coping skills, and facilitate personal growth and healing. Art therapy is often used to address a wide range of psychological, emotional, and behavioral issues and in this post specifically, we will be examining the healing power art therapy has in relation to trauma.
What is Trauma, Acute Stress Disorder, and PTSD
Trauma is defined as a deeply distressing or disturbing experience and can result in acute-stress disorder or PTSD. Acute stress reactions typically diminish within a few days to a month following the removal from a threatening situation. Acute stress reactions can include dazed states or disorientation, intrusion symptoms, negative mood, avoidance, and arousal symptoms. PTSD can develop as a short or long term reaction to a threatening situation. PTSD symptoms develop sometime after the trauma - anywhere from a few weeks to six months after the event. Symptoms can include flashbacks or intrusive memories of the traumatic event, nightmares, severe anxiety, and uncontrollable thoughts about the event. People with PTSD may also experience avoidance of reminders of the trauma, negative changes in mood or thinking, and increased arousal or reactivity.
As we move forward it is important to note that not everyone who experiences trauma goes on to develop PTSD. Everyone responds to trauma differently. The art therapy we describe below can be applied to trauma as a whole, including PTSD and acute stress disorder treatment.
The Role of Art Therapy in Trauma Treatment
Art therapy can play a significant role in the treatment of trauma by providing clients with a creative outlet to explore and express their emotions, memories, and experiences in a safe and supportive environment. Establishing safety and physiological homeostasis is the first step for trauma processing. As an art therapist, it is important to incorporate relational work into the work with clients so they can start to view therapy as a safe place to process difficult experiences and memories.
In my own sessions with clients when establishing safety, I like to work on breathing regulation, grounding, and present moment awareness along with managing dissociation, intrusive thoughts, and unwanted feelings. When starting art making, I like to ask the client to visualize or draw/create a safe space. I will guide them in a meditation that asks them to focus on their breath and recall a place, real or imaginary, that provides them with comfort and peace. I ask them to recall, vividly, all the details of this space including sensory elements, and then have them sit in this space. Afterwards we will participate in reflection and recall any feelings that have come up. I give the client time to recreate this space using art materials. This foundation is used throughout upcoming sessions as a place the client can go to find regulation as they access difficult memories and experiences.
Some other examples that can provide safety and grounding include directives such as creating a safety doll, a sensory box, and drawing a breath, to name a few. Safety is a priority, so it is important to continue to provide the client with tools to regulate their nervous system as they move along in their journey.
After safety has been established and the foundation has been set, the client can move forward with stage two which involves processing their experiences and creating a coherent trauma narrative. This stage is often called remembering and mourning and includes a detailed review of memories and bodily sensations. Creating art during this stage can help individuals process and make sense of their traumatic experiences. Details including the sights, sounds, smells and bodily sensations are explored. By externalizing these along with thoughts and memories through artistic expression, individuals can gain new perspectives, insights, and understanding of their trauma. I often like to ask my clients to create images that depict some parts of their trauma. The image does not have to be realistic but can be conveyed through lines, shapes, or colors, or any particular moment that sticks out to them. During this stage, it is also important to help the client build their self-esteem and self-compassion.
The third stage of trauma processing is devoted to reconnection with ordinary life, and is also known as the integration phase. Tasks shift from professing to engaging through meaning making and renewed interest in activities. Art making at this stage can include attention to archetypes, which provides a scaffolding or growth path for a client to expand to their fullest potential. Advocacy art might also be significant at this stage. Opportunities to share their work with others can facilitate a sense of belonging and connection with people who might have had similar experiences.
Overall, art therapy interventions can help with symptom reduction and processing. Creating art in relation to traumatic memories can not only allow for growth and self-actualization but can provide a client with a sense of control and mastery over their experience. The act of art making itself also has a calming and grounding effect on individuals with its repetitive and sensory nature. This makes art a safer way to process and re-experience traumatic events.
Types of Art Therapy for Trauma/PTSD
Instinctual trauma response
Instinctual trauma response was developed by Linda Gantt and Lou Tinnin to treat trauma reactions using art therapy. This approach has been used with individuals exposed to trauma related to combat, car accidents, medical traumas, natural disasters, childhood abuse, kidnapping, rape, captivity, and industrial accidents. The goal of this approach is to provide clients with exposure to traumatic memories through art and through dialogue when discussing the art. The client will engage in three stages to resolve trauma: narrative processing, resolving dissociation, and resolving victim mythology with the essential task being developing a trauma story in autobiographical fashion with a beginning, middle, and end. Art can be used in the first and last stage. In the first one it provides ways to create a coherent narrative and during the last it can be used to create safety and reinforce a sense of trust in oneself and the world by creating a sense of identity that feels solid.
Neurobiologically informed trauma art therapy
This process was introduced by Linda Chapman and offers ways to strengthen the parts of the brain that have been compromised by using mind and body. Chapman emphasizes safety and predictability during her art therapy sessions where each session follows a consistent pattern: creating motivation through introduction to the art activity, art making, exploration of art images, concluding with a clear ending and planning for the next session. She works with children and teens in four segments: self-phase, problem phase, transformation, phase, and integration phase. The self-phase focused on helping the client establish comfort with themselves, safety, and control over their behavior and the environment and attending to any physical needs. The art materials are highly structured items such as pencils, markers, crayons and are most likely familiar and predictable to the child and the activities are non-threatening and less skill based. In the problem phase the focus is on establishing emotional regulation and homeostasis. More fluid materials are introduced such as chalk, paint, and watercolors to elicit emotional expression. Activities will explore family and other relationships, and the therapist will pay attention to shame and secrets, and grief and loss. The transformation phase helps redefine the self and practices coping skills and new behaviors which should begin when PTSD symptoms have lessened. The art includes exploration of the self and autobiographical art. The client will create narratives and explore future goals through art making (bridges, road drawings, book making, etc) and many different materials can and should be offered. Integration works on separating the past from one’s present sense of self and sessions will shift towards the future. Art at this stage focuses on developing a wise inner voice (boundary bowls, inner nurturer, etc).
The Check Protocol
The check protocol was created by Hass-Cohen and is grounded in neurobiological theory. It facilitates rebalancing, a coherent trauma narrative, and an autobiographical coherence to the trauma narrative and includes five art interventions designed to promote coping, control, and mastery. The first art intervention is a creation of an autobiographical trauma timeline which promotes present-moment awareness and brings awareness to the passage of time since the trauma and emphasizes that it is in the past and different from the present moment. The second intervention is a drawing of the trauma with a verbal narration which exposes the client to the memories but allows them to remain in control of which moment or memory should be shared. This piece should be captured digitally for later use. The third intervention asks the client to alter the previous image by asking them about what they could change or keep about the previous drawing and the client then works through the alteration. The client is then asked to look at the differences between the two images with the goal of the discussion being to increase emotional awareness and inner sense of control. The fourth and fifth interventions ask the client to create a drawing of self-strength and an image of an optimistic future which are designed to promote resiliency. This protocol is designed to be repeated as many times as necessary and the client is then engaging in a predictable series of art interventions.
Art Therapy Trauma Protocol
This was designed by Savneed Talward and addresses somatic and nonverbal trauma memories. It emphasizes a neurobiological understanding of brain integration to address self-perceptions and underlying negative feelings. A clear memory of the trauma is not needed, but instead offers the client to attend to distressing vague memories or felt-sense. This protocol is played out in three phases and uses large 22” x 29” paper and tempera paints. The paper is positioned at a distance from the paint so the client can move back and forth from the paper to the paints. The emphasis on movement and proprioception is purposeful because it engages bilateral brain stimulation. In phase one the client is asked to suspend their thoughts and just paint moving back and forth between the table with the pain and the wall where the paper is hung. The client is then asked to pair a dominant emotion with the painting. Second, the client is asked to identify negative self-representations or cognitions followed by identifying desired, positive self representations and then asked to rate the belief on a scale of 1-7. They then paint on a new piece of paper with their non-dominant hand while concentrating on a traumatic memory while keeping in mind the negative cognitions. The third phase has the client continue painting, switching between both hands and using a new sheet of paper each time, until they no longer notice disturbing feelings when recalling the memory.
What Does Art Therapy Do for Traumatized Patients?
Trauma is Nonverbal
Oftentimes, traumatic memories are stored nonverbally because of the neurological activations during and after the trauma which makes trauma primarily a nonverbal phenomenon because it is sometimes unable to be integrated into the ego. Trauma survivors often have a hard time creating a consistent timeline and recalling certain memories of aspects of the trauma. It can however sometimes be accessed through recollections of sensory, affective, visual, olfactory, auditory, and kinesthetic elements making it not surprising that art therapy, a nonverbal means of expression, can be so helpful with processing and managing trauma.
Art Externalizes the Experience
Art externalizes traumatic experiences because it is both an internal and external process. When participating in art therapy you can access your internal feelings, thoughts, and experiences and turn it into art work. Art can also make this feel safer because the client can convey their memories and feelings though the use of symbols and metaphors. The client and therapist can then spend time processing the art work and its meaning and how it felt to remember the trauma through the artwork.
Creating Art Boosts Positive Emotions
Creating artwork can also boost positive emotions. Art making and art therapy can activate the brain’s reward system which then releases feel-good chemicals. This can increase self-esteem, mindfulness, improve resilience, and reduce stress which are all affected if someone has or is experiencing trauma and/or PTSD. Reactivating the positive thoughts and working through emotions helps clients with self-compassion which therefore reduces shame and self-judgment.
Art Therapy Improves Social Relationships
When processing trauma through art therapy many theories help the client work through integration and connection with themselves and the community therefore improving social relationships. Through art making clients can establish and examine support systems, identity community resources, and even connect with others through group art making and workshops.
Combining Art Therapy with Other Treatments
Exposure therapies such as cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR), offer evidence-based treatment to address PTSD and trauma. These are important to consider alongside art therapy if the client is showing PTSD symptoms after sharing and processing their memories. It may be important to collaborate with other therapists who have training in these techniques if you do not.
CPT is a type of cognitive behavioral therapy that teaches clients how to identify and change negative thoughts about trauma. It helps clients understand how their thinking has been impacted by trauma and how to challenge and modify beliefs. PE therapy is a type of psychotherapy that helps people process traumatic experiences and involves two main procedures: imaginal and in vivo exposures. Imaginal exposure is repeatedly recounting the traumatic memory and in vivo exposure is directly facing a feared object, situation, or activity in real life. EMDR is a therapy that involves eight phases and allows the brain to resume its natural healing process and it utilizes rhythmic left-right (bilateral) stimulation.
How to Benefit From Art Therapy
Anyone can benefit from art therapy, not just artists. Art therapy is all about the process of art making, utilizing different materials to evoke different responses, and the examination of the art materials.
How to Find the Right Art Therapist
Finding the right art therapist is important when healing from trauma and PTSD. It is important to look for someone who is trauma-informed. This therapist should also be trained in art therapy and art therapy theories and should possess an ATR-P, ATR, or ATR-BC. Art therapy trauma processing should not be done with a therapist who does not have training in art therapy because a certain process of the art making could be triggering. The art therapist will also have knowledge about what materials might be best and how they could evoke different responses. It is also important that you are able to build the correct rapport with the therapist because this will help establish safety and trust within the therapeutic relationship. Before signing up with a therapist it is within the client’s right to have a phone consultation with the client to find out more about their approach and therapeutic style.
Conclusion: The Power of Art Therapy
Art therapy is transformative in trauma recovery. Through creative expression, individuals can navigate each stage of trauma recovery in a unique way and access parts of themselves that might not otherwise have a voice. Art making can be a powerful driver in helping clients find empowerment, acceptance, and catharsis while also fostering connection and community, nurturing solidarity and collective resilience.
Reference: Backos, A. (2021). Post-Traumatic Stress Disorder and Art Therapy. Jessica Kingsley Publishers.
