Trauma focused CBT art therapy

I was recently reading Pifalo, T. (2007). Jogging the cogs: Trauma-focused art therapy and CBT with sexually abused children, Art Therapy:Journal of the American Art Therapy Association, 24(4), 170-75; the author articulates the benefits of a visual approach to therapy rather well.

Pifalo writes: « Because of the visual nature of traumatic memories, an image-based therapy may offer the most efficient means of accessing, processing, and integrating these split-off fragments that otherwise may continue to result in flashbacks and nightmares » (p.171). He explains that survivors of trauma especially children, are often without the symbolic and linguistic representations necessary to articulate and place the trauma in historical context, suggesting that a strictly verbal approach may be ineffective. He sees art therapy as an alternative mode of expression that provides a bridge between feelings and words.

It has been my repeated experience that we harbor a store of pre-conscious knowingness that appears readily in the form of images and shapes. Experience is stored in a variety of ways. Confusing emotions or strong sensations can and often do bypass cognitive awareness. They reappear in a variety of disguises. When we ask clients to connect to and draw a feeling or sensation, or  model it out of clay, we are asking them to give shape to the formless, to make visible was is not clear. There are three direct benefits from this process:

1. The making of something creative facilitates the release of energy through bodily action and movement (Luseblink, 1990). Anxious children benefit readily.

2. An image of a problem is a problem once removed; providing a needed distance to look at and begin to make sense of a problem.

3. Giving form to the amorphous nature of a feeling, sensation, vague memory gives shape to something that is difficult to grasp and provides a base from which to develop and expand from. As we explore and creatively ‘play’ with images, the client is helped in beginning to construct a sense making narrative.

Trauma focused CBT therapy goals include : rapport building, anxiety management, affective identification and processing, psychoeducation, development of coping skills, construction of the trauma narrative and identification and reduction of future risk (Deblinger & Heflin, 1996).

Art therapy facilitates CBT benefits:

1. Art therapy environments are child friendly; art materials often reassure children

2. Playfulness helps a child to stay emotionally receptive. Play should never be seen as minimizing the serious work being done. In fact it often makes it possible in an otherwise unreachable child.

3. A child is more receptive when he is relaxed and comfortable. One approach is to engage in parallel art play with the child. « Parallel activity allows the therapist to impart information in a non-threatening way at a slower pace that the child does not experience any pressure to respond or to feel undue scrutiny because the primary activity appears to be the play » (p.172).

Some of the creative activities that may be engaged in are:

1. Timelines and road maps; to reconstruct the trauma narrative, see the gaps.

2. Rewriting the story (in a more empowered role). Use drawing or comic strips or creative writing.

3. Letter writing to the abuser(s) (not sent).

4. Drawing or constructing a detailed safe place.

5. « Strings of strengths » are strung beads to represent supportive people and personal strengths. They act as transitional objects and tangible reminders when worn on a wrist or attached to a backpack. I have use ‘message beads’ where a positive message is written and rolled into bead shapes.

Pifalo who has conducted a number of research studies on trauma, using CBT and art therapy concludes the following:

The visual nature of traumatic memory, the concrete graphic approach of art therapy, and the underlying structure of the cognitive behavioral approach create a powerful, efficient treatment model within which to achieve the goals of trauma focused therapy (p.175).

Classé dans , , , , .

Catégorisé dans Thérapie.

Publié le 30 oct 2008

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