(Above) Ice Dye Mandala (2016): I created ice dye mandalas for my expressive art project for Biological Basis of Behavior. This semester I studied trauma and its effect on the brain. I really feel like the ice dye process lends itself well to trauma therapy and this process is very symbolic. First of all, ice is hard, it is cold, it is frozen- but in the thawing of the ice, which involves a great deal of trust and very little control over the actual details, a beautiful result is obtained. Also, as the ice melts with the dye, it begins to pool beneath the garment. Some artists like to keep their piece elevated on a grate of some sort so the resulting dye water, which is a conglomeration of all of the colors will not touch the underside of the garment. However, I learned from another tie dye artist that this resulting liquid is known as “the muck”. She taught me that the secret to beautiful ice dye is to “never disturb the muck until you are ready to rinse”. She told me this would result in deeper depth of shade and more beautiful variation in color. And so I took this advice and the results are incredible. Where the muck touches the garment is almost always an interesting shade of brown, and while that seems like it might muddy the results, it doesn’t at all! The brown creates images and designs and DEPTH. And I really meditated on this and reflected on the metaphor of “the muck”. We are all sitting here in our own muck, the result of years of experiences, both good and bad. But we need to recognize that this muck is actually beautiful and gives us depth, and adds flavor and interest and character to us. And when we finally decide to “disturb the muck” and do the difficult inner work of rinsing it all out, the resulting mandala can be more beautiful than it ever would have been protected from all that LIFE! The resulting piece is a wonderful meditation tool and a visual reminder that sometimes our imperfections are an indispensable and exquisite part of who we are.
Expressive Arts: A Brain-Wise Response to Trauma
As a student of psychology, I have come to recognize the importance of understanding that the root cause of many psychological issues lies in past experiences, specifically traumatic ones. I have realized through discussion with other ethical practitioners, and from my 8 years of work in community mental health, that there is no more important topic I can study as a soon-to-be therapist. Research over the past several decades has shown us that, despite earlier beliefs in the rarity of trauma and adverse childhood experiences, trauma is much more common than previously believed. Most therapists will come in contact with individuals whose lives have been affected by trauma. Moreover, the effects of trauma can sometimes manifest in seemingly unrelated issues such as bouts of rage, insomnia, and physical illness and pain. It is only through understanding this, and learning to recognize and address these issues that therapists can truly provide trauma-informed care.
In earlier times, many psychiatrists did not link signs of mental distress to previous trauma. Freud and Breuer were perhaps the first to do so, and, as Judith Herman discusses in her book, Trauma and Recovery (1992), their thesis was not well received (p.14). Clinical inquiry into the link between trauma and mental health concerns was, for-the-most-part, ignored for several decades after that. The 1960’s and the second wave of feminism brought interest in domestic violence and its effect on women, but it wasn’t until the 1980’s, with the publication of the DSM-III and the advent of the diagnosis of PTSD that serious scientific inquiry began. In the decades since, much work has been done to attempt to decode and understand the brain, how trauma can affect the brain and its development, and what we can do about it. I have explored several resources written by pioneers in this field, and I have learned a great deal about this process. Continually, throughout this research, I keep coming back to a common theme. Some of the most effective treatments for individuals suffering from trauma involve the expressive arts. In this paper, I intend to lay out the effects of trauma, specifically on brain function and development, and how expressive arts practices can be used in a “brain-wise” way to help unite the hemispheres, and integrate the brain so individuals can heal and recover from trauma.
Trauma is incredibly common in our society. In his book, The Body Keeps the Score (2015), Bessel Van Der Kolk describes his pioneering work in the field of trauma research. He discusses how his early work revealed to him how little this subject had been studied, and he brings up several times how his medical training had emphasized the relative rarity of traumatic experiences and childhood abuse. What he makes clear throughout the book, however, is that this information was patently false, and that trauma, particularly stemming from childhood abuse and neglect, is far, far more prevalent than previously believed. Van Der Kolk examines the Adverse Childhood Experience Study (The ACE study), and how it was a real turning point in the medical community. The ACE study began in 1995 but has continued to the present day with follow-up of participants. The study demonstrated a number of notable findings. First, Adverse Childhood Experiences are extremely common, even among the middle-class, educated, and steadily employed population that largely made up the sample. The study measured ACEs with a score of 1 for each “yes” answer on a survey with a possible ACE score ranging between 0-10. According to Van Der Kolk (2015), “Of the two-thirds of respondents who reported an adverse experience, 87 percent scored two or more. One in six of all respondents had an ACE score of four or higher” (p. 461). In addition to being very common, adverse childhood experiences tend to occur in clusters. People with histories of trauma are more likely to experience other traumas throughout their lives, Van Der Kolk summarizes these findings succinctly:
“Felitti and his team had found that adverse experiences are interrelated, even though they’re usually studied separately. People typically don’t grow up in a household where one brother is in prison but everything else is fine. They don’t live in families where their mother is regularly beaten but life is otherwise hunky-dory. Incidents of abuse are never stand-alone events. And for each additional adverse experience reported, the toll in later damage increases.” (p. 462)
So this study has made it clear that many, many people in our society have been through difficulties in their childhood experiences. It also demonstrates that those who experience one trauma are likely to experience more traumas. If these were not telling enough however, the longitudinal nature of the ACE study demonstrated what is perhaps the most important aspect of these findings – people who have experienced trauma are more likely to have disruptions in healthy brain development. This impairment often leads to further traumatization and difficulty in adulthood, which often leads the individual to engage in unhealthy behaviors. These behaviors manifest in many different ways in different people, but can include drug abuse, under or overindulgent eating and drinking, risky sexual behavior, a tendency towards abusive relationships, social isolation and withdrawal, etc. These behaviors then lead directly to problems in relationships with others, as well as a decline in physical health. Finally, researchers have shown with this study that the culmination of this cycle, known as the “ACE Pyramid”, often leads to an early death. Van Der Kolk really summarizes this study down to its key points and drives home the fact that the medical community cannot continue to ignore past trauma while calling themselves healers. We must look at the whole person and the sum of their experiences if we are to stop this cycle and help ourselves and others to lead healthy and happy lives.
We also need to take into account the fact that these risky behaviors that are adopted by many traumatized people are not simply ways of acting out. These behaviors are reinforced because they have served as coping mechanisms and have helped people to survive. If we ignore the importance of that, and only treat the symptom, we will fail. Van Der Kolk describes how Felitti, the main researcher on the ACE study, was perplexed by a patient he was treating in an obesity trial. This woman had lost a significant amount of weight and seemed to be doing really well, but in short order, she fell off the bandwagon and gained back even more weight than she had lost. Felitti could not figure out why, and he saw this cycle repeat in several of his overweight patients. Years later, after findings of the ACE study had come out, Felitti came to recognize that for many of his female patients who had experienced sexual violence, being overweight served as a protective mechanism that made them feel safe from harm, as they were no longer perceived as sexual objects by those who might abuse them. Van Der Kolk also draws parallels between this and men who seek to keep their bodies large, either through fat or muscle, as they feel being larger will make them more intimidating and less likely to be victimized (p.468). While this is almost certainly not a conscious process for these individuals, changing their behavior will be very difficult without first addressing the purpose these coping mechanisms have had in their survival.
Survival is an important aspect of understanding trauma. In his amazing book, Waking the Tiger (1997), Peter Levine discusses the primordial roots of how our brains react to and cope with trauma,
“The involuntary and instinctual portions of the human brain and nervous system are virtually identical to those of other mammals and even reptiles. Our brain, often called the triune brain, consists of three integral systems. The three parts are commonly known as the reptilian brain (instinctual), the mammalian or limbic brain (emotional), and the human brain or neo-cortex (rational). Since the parts of the brain that are activated by a perceived life-threatening situation are the parts we share with animals, much can be learned by studying how certain animals, like the impala, avoid traumatization. To take this one step further, I believe that the key to healing traumatic symptoms in humans lies in our being able to mirror the fluid adaptation of wild animals as they shake out and pass through the immobility response and become fully mobile and functional again.” (p. 25)
Levine gives a basic overview of the brain and its reaction to trauma, and he speaks at length about our innate tendency to fight, flee, or freeze when faced with overwhelming fear. Levine talks specifically about the immobility response, which is not discussed as frequently in our society as “fight or flight”. When a person is overwhelmed by terror, and is unable to either fight or flee, the final choice is to freeze. Levine draws parallels to wild animals here. He talks about how in predator/prey situations in the wild, the prey will often freeze when they can no longer escape and are unable to fight. This freezing actually does have benefits, in that sometimes the predator will lose interest thinking the prey is already dead. If this fails, and the poor creature still succumbs to the predator, the freeze response has another benefit in that it is in this state that dissociation occurs. Dissociation is a complex response to overwhelming fear that I will not attempt to explore in depth in this paper, but in a basic sense, the ability to dissociate is actually a coping ability of the brain that can help to remove the individual’s consciousness from the overwhelming situation, even if they are unable to physically remove their bodies. People speak of dissociated states frequently when discussing traumatic situations, describing themselves as witnessing the event from above or somewhere outside of their bodies. Additionally, many people lose sense of their memories when dissociated; it is almost as if their consciousness is in a suspended state or somewhere outside of themselves. Levine says that this occurs with wild animals as well, and that it is a built in function of the reptilian brain, which is automatic and not consciously controlled. Levine goes on to discuss how the reptilian brain is wired to deal with these states. Going back to the predator/prey situation, if the frozen animal does not get eaten, they will eventually emerge from their state of immobility and return to their lives. Wild animals do not carry psychological after-effects of trauma the way that humans do. Levine (2015) states,
“Most modern cultures tend to judge this instinctive surrender in the face of overwhelming threat as a weakness tantamount to cowardice. However, underneath this judgment lies a deep human fear of immobility. We avoid it because it is a state very similar to death. This avoidance is understandable, but we pay dearly for it. The physiological evidence clearly shows that the ability to go into and come out of this natural response is the key to avoiding the debilitating effects of trauma. It is a gift to us from the wild.” (p.25)
Throughout the book, Levine comes back to the immobility response and our need to resolve the pent up tension stored in our bodies from traumatic experiences. He describes how animals that are panicked when they become immobilized, will often emerge from that immobility in a panicked state as well. When an organism is in a state of terror, there are many physical symptoms. Our heart rate increases, our body temperature rises, we begin to sweat, our breathing becomes erratic, some people feel sick in their stomach, others dizzy and confused, the way we physically manifest these symptoms is not the same for everyone. But the feeling of arousal and activation of adrenaline is what gives us the power to fight or flee, and while frozen, that process does not stop. It is almost as if someone just hit pause for a period of time, and upon resumption of activity, the organism remains in a heightened state of fear and arousal. Levine compares the state of the immobility response to be similar to hitting the gas and break in a car simultaneously. The body wants to fight or run, but the mind recognizes it cannot. In animals, the reptilian brain activates the immobility response, the animal remains frozen until the danger has passed, and in reawakening from this state, the animal is able to “discharge” this pent up explosion of energy, release it from their body, and move on with their life. In wild animals, this is automatic. It requires no therapy, no reflection, not even conscious thought. Levine states that most animals will go through a physical sort of trembling and shaking that serves to dissipate the energy before resuming normal activity. Unfortunately for us humans, this unconscious process becomes interrupted by our brains, specifically our neo-cortex, or rational brain, which attempts to process and deal with the trauma on a conscious level, and interferes with the automatic reptilian brain’s attempt to shake off and discharge the trauma. Levine talks about how the reptilian brain continuously attempts to complete its instinctual process and deal with the trauma, but its attempts are suppressed and thwarted by the higher mental processes. When we begin to have anxiety and panic attacks and our bodies shake and tremble, we go see psychiatrists who prescribe powerful tranquilizers that prevent our bodies from moving and discharging trauma. When we feel primal urges within us to cry, scream, or somehow release this pain, we stop ourselves…maybe because we cannot consciously connect the desire to scream out to the past trauma, we fear where this urge comes from and we do not allow it to play itself out. What we must realize though, is that these “symptoms” are often signs that the mind is trying to work it out, but the unconscious nature of the process makes it unpredictable and difficult to control, and as a result, traumatized people often end up retraumatizing themselves, rather than finding release and catharsis. Levine discusses how he has worked with previously traumatized individuals to help them reach this level of release in therapy through a process he calls “renegotiation”.
Throughout the book, Levine honors and pays homage to the amazingly rich power of the imagination. His form of therapy focuses on engaging the individual to understand their experiences in this context, to recognize the ways they have remained stuck in the immobility response, and to “thaw” out and unfreeze the person by renegotiating the way they perceive the traumatic experiences in their inner mental framework. He discusses one prominent case where a client of his was able to relive a traumatic childhood event where he was attacked by dogs and felt his father was ashamed of him. He worked with the client first to prime his imagination with feelings of power by visualizing a successful hunting expedition. After going through this guided imagery, the client began reimagining the dog attack, and envisioned himself fighting off the dogs successfully and escaping, and then seeing pride in his father’s face. This “renegotiation” of the event helped the client reorient his memory and sense of self in relation to the trauma, and release himself from the fear and immobility he had carried since it happened. By imagining himself as a successful hunter and feeling a primal sense of power as predator, rather than prey, he was able see himself in an empowered sense, and went into his traumatic memory prepared to fight and flee, rather than freeze in the face of danger. Levine does an excellent job describing this work and making it tangible in a therapeutic sense, and his book is extremely poetic, inspiring, and humbly written. His work appealed to my intuitive sense of helping and healing, and I resonated with him in a way that felt like truth to me. But what Levine was able to do for me in that sensing and emotional sense, Bonnie Badenoch’s book, Being a Brain-Wise Therapist (2008), took a step further by clearly and beautifully describing the scientific rationale behind why what Levine does, works!
Badenoch has worked extensively with Daniel Siegel, whose book, The Developing Mind (1999) and audio recording, The Neurobiology of We (2008), I had read and listened to last semester. I will be honest and state that even though Siegel is gifted at describing difficult neurobiology concepts in a simple and understandable way, I still felt overwhelmed by the magnitude of information he presented, and felt that I needed to explore his work in much more depth to fully digest it. Badenoch did an amazing job discussing these concepts in a way that further reinforced them for me, and helped me to understand Siegel’s work so much more. What I love about Badenoch is that she is a therapist first and foremost. She has worked extensively with people who have been traumatized, and she has a practical and tangible taste of the reality of clinical work, and ways to take these difficult concepts and put them to real use in our field. She talks in her book about how describing neurobiology to her clients has helped her to reach many people on a level that would not be possible otherwise, “We have found that sharing the idea of neuroplasticity with your patients gives hope. Creating your own simple way of helping your patients feel their brain’s ongoing capacity for change may be a valuable resource” (Badenoch, 2008, p. 12).
When people understand the mechanism behind their behavior, they feel more in control of it. For example, if a person comes to understand that their tendency to choose poor romantic partners is not some doomed aspect of their personality outside of their control, but rather a pattern of behavior reinforced by neural pathways made strong by a history of childhood abuse, than new neural pathways can be formed through directed attention and brain-wise practice that can in-turn, lead to new patterns of behavior, better decision making, and a greater sense of self-worth. Understanding this process has many benefits for a client. They can have the realization that these choices have been outside of their conscious control and are not their fault. They can also feel empowered to realize that there are clear actions they can take to redirect the course of their lives. This is the true power of therapy. It is not about providing a person with answers, as many people misperceive it to be, rather, it is about empowering people with the tools they need to find the answers in themselves.
In working through this book, I also listened to a podcast interview with Bonnie Badenoch where she talked about writing the book and struggling with deciding whether to refer to the people in her cases as “patients”, “clients” or something else. She stated that she would have preferred “courageous people” as she really felt it was more fitting for what people working through trauma are. Trauma is incredibly pervasive, and the brain’s ability to bury these experiences as a coping mechanism is amazing. Many people go through their lives with traumatic experiences lurking beneath the surface and causing all kinds of chaos and disorder in their lives that they refuse to acknowledge and are unable to cope with. No one can fault these individuals, because the process of digging up long covered bones is excruciating, painful, and fraught with uncertainty. People who make the conscious choice to come to therapy and do this work are unbelievably brave and worthy of our respect. I really appreciate how much Badenoch recognizes this and stays true to her respect and admiration of her clients throughout the book. Badenoch talks in depth about the process of “integration” and the many ways we can become better integrated to live more fulfilling lives. She discusses the difference between the brain and the mind and emphasizes that the two are certainly not one and the same. Through conscious and directed attention, we have the ability to change our brains, thus, the mind influences the brain but is not the brain. She also discusses how neural pathways can be created between negative memories and positive experiences through the therapeutic relationship.
Van Der Kolk discussed in his book how people coming out of experiences of trauma can easily be re-traumatized every time they remember the event. He showed through his research that memories of trauma cause all of the same brain neurons to fire as if the person was actually experiencing the trauma again in the present moment. He also demonstrated that this traumatic experience is held in the body as well. When memories of trauma are brought up in the mind, the body reacts by reactivating the fight, flight, freeze response and heart rate increases, breathing becomes erratic, and adrenaline is released. This can be terrifying for a person and leaves them in a state of constant fear. Van Der Kolk discussed how most people are able to return to their baseline of relaxation after a potential threat passes, but for people who have been exposed to trauma, especially repeated trauma (and as the ACE study showed us, that is most traumatized people), their baseline is actually constantly elevated. Their heart rate is always a little faster, their breathing always a bit shallower, and their nervous system is always aroused, ready to pounce at the slightest threat. Of course, this is learned behavior. This is reinforced through years of repeated traumas, Levine would recognize it as the lingering energy yet to be discharged, it is reasonable to be ready to respond when life has taught you nothing is safe and danger lurks around every corner. And this is perhaps also why people with histories of trauma are quicker to anger and tend to act out in anger in seemingly inappropriate ways. It’s easy to lose your temper with so much adrenaline constantly pumping through your body. It’s also hard to sleep, or study, or concentrate, or parent your children. Obviously the effects of trauma are many and they are pervasive to every aspect of a person’s life. As therapists, we are up against all of this, but we have the power of our minds, the plasticity of our brains, and the knowledge of interpersonal neurobiology to guide us in surmounting these obstacles and achieving integration and release.
Establishing safety in a therapeutic space is one of the first most tantamount facts. We can do this by creating a welcoming and warm environment, and by treating our clients with respect and compassion, allowing them room to proceed at their own pace and never prying or pushing people to discuss things they are not ready to discuss. Levine talks about the importance of this in Waking the Tiger (1997). He encourages people to listen to their inner voices and to never go beyond what they are comfortable with,
“Don’t force yourself to do more than you can handle. If you feel tired, take a nap or go to bed early. Part of the grace of the nervous system is that it is constantly self-regulating. What you can’t process today will be available to be processed some other time when you are stronger, more resourceful, and better able to do it.” (p.64)
It is very important to respect this, and to help our clients learn to recognize signs in their body that signify comfort, dissociation, energetic release, etc. I do not believe it is ever of benefit to push someone to discuss something when they do not feel safe. Conversely, if we are able to successfully establish safety, and provide a comfortable space for our clients to discuss difficult subjects, we are working in the right direction. Literally. This is what Badenoch refers to as a right brain to right brain connection. When we can establish this and our clients feel safe, they can then go into their left brain, where logic and memories are housed, and remember past trauma, while still connected to that safe space in their right brain that we have established together, and that we as therapists can help to anchor them to. The association between remembering the difficult memory, while at the same time feeling safe and connected right-brain to right-brain with their therapist, creates a new neural pathway in the person’s mind, making the difficult memory a little less overwhelming because of this new association,
“The very process of directing attention toward a particular memory adds, at a minimum, the energy and information of the present moment to that memory. This process is one way that our comforting presence actually may alter our patients’ painful past experiences. If we are able to stay in connection with one another, the feeling of comfort – often communicated through the sound of our voice, the position of our body, the look on our face as it reflects our inner experience of compassion – will initiate new neural firings that will now become associated with, and ameliorate, the suffering contained in the neural nets of frightening and repeated childhood events.” (Badenoch, 2008, p.9)
The more times we do this, the stronger this pathway becomes. This is one of many ways we can work towards integration in therapeutic practice. Van Der Kolk also discusses this process in his book, where he is actually summarizing some of Levine’s ideas about ways to establish safety in the body. (I found it very interesting while reading several of these books this semester. Van Der Kolk, Levine, and Herman all reference each other several times in their works. It is clearly a small community out there of “experts” in this field, and given the prevalence of trauma in our society, this is surprising.) Van Der Kolk (2015) talks about the idea of establishing areas of safety in our somatic experience of the body,
We start by establishing inner “islands of safety” within the body. “This means helping patients identify parts of the body, postures, or movements where they can ground themselves whenever they feel stuck, terrified, or enraged. These parts usually lie outside the reach of the vagus nerve, which carries the messages of panic to the chest, abdomen, and throat, and they can serve as allies in integrating the trauma.” (p. 767)
By returning to these “islands of safety” when feeling overwhelmed, clients can feel anchored in their own bodies and build neural pathways of safety on their own, both inside and outside the therapeutic space.
Another very important way we can work towards integration in our practice is through the use of expressive arts practices. In his work studying the effects trauma, Van Der Kolk used a newly introduced technology known as the PET scan to examine the brains of patients he was treating. He had his patients undergo the scan while listening to pre-recorded tapes of themselves, first of themselves discussing a normal everyday routine or place they felt safe, to establish a baseline, and then a second recording of themselves describing a traumatic event. Van Der Kolk states, “We deliberately tried to collect just isolated fragments of their experience—particular images, sounds, and feelings—rather than the entire story, because that is how trauma is experienced” (p.145). One thing that stood out to me in this section was as Van Der Kolk discussed proposing this experiment to his patients. They all knew this would be an incredibly difficult experience. A PET scan is certainly not a non-invasive procedure. Additionally, the process of recording and then listening to the tape in the scanner would be intensely difficult. When proposing this idea to his patients, Van Der Kolk states, “To my surprise, all eight agreed, many of them expressing their hope that what we learned from their suffering could help other people” (p.145). That really stood out to me, because it shows the strength of these individuals. The idea that their suffering could help lead to answers that may help diminish or curb others’ suffering was the driving force between deciding to put themselves in a great deal of personal pain. In participating in this research, they were able to give some meaning to their painful experiences in the context of their lives, and that in itself is therapeutic.
Getting back to the research, when reliving traumatic experiences in the scanner, all of the participants brains showed increased activity in the amygdala, where the fight or flight response is activated. Once the brain activates this area, the body follows suit with the increases in adrenaline, heart rate, breathing, etc. Though the study participants rationally knew that they were safe in the scanner, this did not stop their animal brains from firing off neurons signaling to their body that they were in imminent danger. This shows that people suffering the after-effects of trauma often relive memories of trauma as if the event is currently happening. Another finding really made it clear to me why expressive arts are so beneficial in treatment of trauma. Van Der Kolk states,
“Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. Broca’s area is one of the speech centers of the brain, which is often affected in stroke patients when the blood supply to that region is cut off. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words.” (p. 153)
Talking about trauma is difficult. There are many reasons for this, ranging from a person being threatened and therefore conditioned to keep quiet about what has occurred, a desire to forget about the pain, society’s unwillingness to accept that horrible things routinely happen and believe survivors, and myriad other reasons. But this research demonstrates that difficulty discussing past trauma is also biologically driven. Remembering traumatic memories leaves people speechless on the level of their brain function, and expecting them to put a coherent narrative together into words, without dissociating or becoming re-traumatized is unrealistic and downright cruel. I see parallels between this and Badenoch’s work on right/left hemisphere integration. Our experiences of feelings and emotions are seated in the right hemisphere of our brains, while much of our speech, memory, and organization of past events is seated in the left hemisphere. People suffering from unresolved trauma have a difficult time integrating the hemispheres to be able to put together a coherent narrative of their life experience or describe their feelings and emotions. Other research demonstrates this deficiency as well,
“Schiffer, Teicher, and Papanicolaou’s 1995 study of hemispheric activity of the brain in subjects with a history of trauma showed significant left-dominant asymmetry during neutral memories, which shifted markedly to the right when patients thought about an unpleasant memory. The implications of this research are that traumatic memories may be stored in the right cerebral hemisphere, which would make verbal declarative memory of the trauma more difficult.” (Schiffer et al. 1995, as cited in Carey, 2006, p.126)
It has now been clearly scientifically demonstrated that talking about trauma is no simple process for survivors. Expressive arts practices have been in use even before these findings had been scientifically proven and they have remained in practice because they work. Now, we have a greater understanding of some of the mechanisms of how they work, and this research will hopefully lead to wider use of expressive arts in the treatment of trauma. Arts practices are mostly rooted in the right hemisphere, where feelings and emotions also lie. This creative side of our brain is able to express itself in ways that words never could. In an excellent compilation work, Expressive and Creative Arts Methods for Trauma Survivors (Carey, 2008), a great rationale is given for why expressive arts methods are so helpful in this type of therapy,
“Staying with silence and respecting it as an understandable outcome of prolonged trauma can be difficult for many therapists because they operate under the principle that talking about the trauma is one of the goals of therapy. If one makes a small word change in this goal, it can become more achievable, as seen in the following example.
Goal: The clients will begin to talk about the trauma.
Goal: The clients will begin to express feelings about the trauma.
In the first goal above, the therapist has decided the mode of expression that is most valued, whereas in the second, the client determines this. This is one of the most important differences between expressive arts therapy and traditional verbal therapy, and it is why expressive therapy can be so effective in trauma work, since it bypasses the need for verbalization.” (p. 127)
As Van Der Kolk and others have demonstrated, survivors often cannot verbalize trauma, as their brains shut down the language centers when reliving difficult memories. Expressive arts therefore give them a medium by which to transmute and dissipate some of their pent up energy, and begin to process what has happened. Some expressive arts practices that encompass body work such as dance and drama therapy also work towards brain integration because movement requires the hemispheres to work together. In time, exercising different parts of the brain can help an individual to develop new neural pathways between the hemispheres, and it may become easier to put experiences into words. The point is that talking is not the only way to work out and resolve trauma, and in some cases it may not be necessary at all. All individuals are different, and therapy should be catered to the needs of the individual at their own pace and in the way that resonates most closely with them. There are no set rules that a person must retell and verbally relive every aspect of their past trauma in order to heal. Establishing trust and safety is much more important, and the brain will begin to work itself out. As Badenoch states eloquently in her book, “Instead of leaning into language and interpretation with our patients, brain wisdom encourages us to first immerse ourselves in the wordless experience of being together” ( p.5).
Another expressive art technique that I learned about in my research this semester is the concept of aesthetic distance. This concept is about being able to experience an artistic expression or representation of something, while sheltering the vulnerable aspects of ourselves away from it. By observing the feeling or emotion at a distance, through art or through some representational person or object, we are able to process it in a way that avoids re-traumatization. In Carey (2008), this concept is discussed by a therapist who works with female victims of rape. The therapist discusses how one client struggled with feelings of inadequacy, guilt, shame, and worthlessness. These feelings magnified when she was experiencing anxiety. The therapist asked the client to choose an object from within the therapeutic space to represent these feelings of inadequacy, therefore externalizing them outside of her inner reality. The client chose a black scarf and came to rely on that scarf frequently in therapy, as she would pick it up whenever the inadequate feelings would arise. Later, the client was telling the therapist of an experience where she had been at school and became overwhelmed by anxiety, compelling her to want to leave. She thought of the black scarf and wrote the words “black scarf” on a piece of paper to represent the object. This gave her the strength she needed to remain at school, “By concretizing the ‘bad’ messages via an object, she was able to place the ‘badness’ outside herself so that she was not the badness” (Carey, 2008, p. 62). Externalizing and visualizing inner states outside of us is incredibly empowering.
While I was reading Van Der Kolk’s book, The Body Keeps the Score (2015), I was so excited when I came to chapter 20, “Finding Your Voice, Communal Rhythms and Theater”. In this chapter, Van Der Kolk discusses Paul Griffin, and his work with The Possibilities Project. I personally knew Paul Griffin from my own experience with therapeutic theater in my teen years. In the late 1990’s, Paul started a non-profit in Washington D.C. known as City at Peace. The group gathered teenagers between the ages of 13 and 19 years old from the D.C. region. They brought together teens from all different ethnic, racial, and socioeconomic backgrounds to build a community and create a theatrical performance. I got to participate in a full season and cast when I was 15. The experiences I had in this group are indescribable. I formed connections with people I never would have had the pleasure to know otherwise. For a full 10 months we worked together as a group 2 afternoons a week at the University of D.C. We did team building exercises and racial confrontation exercises designed to examine our own inner biases and fears. We all, every single one of us, shared our “life story” with the entire group. We laughed together, cried together, and felt overwhelmed by each other’s experiences. And after all of that, we worked together to write and perform a musical performance based on our lives at major theaters around Washington D.C.
The show my cast put on was called “Laugh It Off”. We came up with the name together because so many of us had experienced indescribable pain and trauma, and in attempting to express it, had been told to “buck up” and “laugh it off”. Obviously, this is terrible advice, and our show demonstrated that to crowds 1,000+ people. My experiences in City at Peace helped me to grow immensely and become a more compassionate and integrated adult. I now understand the biological mechanisms of why, but even without knowing that, I can honestly say I do not think I would have survived my teens if not for the grace of this program. Paul left to move to New York half way through my cast year. Everyone was heartbroken to see him go, but he started City at Peace there too, which later evolved into The Possibilities Project. Don’t worry, he left us in good hands. Our director, Sandra Halloway, was one of the strongest, toughest, and yet gentlest human beings I have ever known, and she took us to amazing heights. I can personally attest to the power of drama therapy.
My interest was re-piqued in this area by reading Van Der Kolk, and in discussing this with my friend Sarvi, who I met at Goddard, I discovered she is the director of a non-profit theater project that is working with survivors of trauma to develop performances and workshops based on their experiences. They happened to be performing in Boston on October 7th, so I decided to drive to Boston and attend. They put on a moving and poignant show, The Survivor’s Circus: Breaking through the Fog. Each character in the show was a fictional creation, but with characteristics shared by cast members of their personal experiences. The characters each experience their own feelings of power vs. powerlessness and become disoriented by their personal “fog”. Eventually, through speaking out and seeking support, one character is able to see through her fog and remove an obstacle from her path. The symbolism of the show was deep and resonated with many in attendance, as evidenced by the lively discussion afterwards. Following the show, cast members participated in a workshop facilitated by Sarvi that demonstrated the process and rationale of much of the symbolism in the show.
We began with group building theater exercise activities. I recognized some of these from my City at Peace days, including “Pass the Face”. These activities got everyone laughing and loosened up. Next, we were each compelled to reach into our imagination and find our own inner character. We were asked to work with a partner to develop our characters further by asking questions of each other about our character’s name, appearance, personality traits, fears, etc. Then we came back together as a group and a few volunteers shared their character. After sharing their character with the group, volunteers were invited to identify their character’s “fog”, i.e. what is holding them back from achieving their goals. Additional volunteers were asked to come forth to represent the fog. These volunteers held up a barrier of some sort and repeated back to the character words that they identified as being representative of their fog such as “you’re not good enough” or “you can’t do it”. The person sharing the character was then asked to symbolically break through the fog by pressing past the barrier, thereby stopping the voices of doubt. This symbolic activity was clearly cathartic for the volunteers brave enough to share. We had time to act this out twice, and both times a real sense of powerful medicine was felt by the entire circle.
I feel this demonstration was a perfect example of aesthetic distance. By creating this character that was not us, we were able to experience the character’s weakness and vulnerabilities (i.e. our own conscious or unconscious fears) as happening outside of us and not to us. This distancing makes the experience less painful as it is less likely to trigger the danger switch in our brains activating the fight or flight response. By holding these anxious feelings at a distance, we can do real work on them in the imaginative space, that can translate to healing in our actual tangible world. It was beautiful to experience this in action and I am grateful I made the journey to see the play and participate in the workshop. My interest in therapeutic work using theater has been greatly rekindled this semester. As I stated, I used to participate in a lot of theater and it was immensely useful for me in coping with difficulties in my life at that time. After my work this semester, I feel compelled to learn more about how to use those experiences and my knowledge of theater in my practice to help people gain confidence and work out inner conflict through this amazing medium.
As we experience the events that make up our lives, we begin to store traces of these experiences in our minds and our bodies. Research into neurobiology in recent years has demonstrated that these experiences are also stored in our brains through the reinforcement of neural nets. What happens to us in our lives effects us on every level, from body, to mind, to spirit. The work of several pioneers in the field of trauma research in the past few decades has finally given us some answers as to why traumatic experiences lead to the sometimes puzzling behaviors that they do. We are finally realizing the connection between our experiences and our physical and mental health, and discovering new ways to help people heal from difficult experiences to live more fulfilling lives. We, as a society, still have a long way to go. We need to recognize the prevalence of trauma, specifically childhood trauma, and work to reduce it. We also need to come together to support survivors, listen to their stories, believe them, and facilitate healing. As therapists, we are gifted with incredible opportunities to help, and I am inspired by the work that has been done by Herman, Van Der Kolk, Levine, Siegel, Badenoch, and many others. I am hopeful that we can continue to build upon this body of research in the coming years. I feel my research into trauma and its effects is far from over. I have only been able to scratch the surface this semester, and yet, this information has left me with a greater understanding of how I can help, and also a realization of how many times in the past I may have misinterpreted someone’s behavior because I didn’t know how to recognize the effects of trauma. I am especially inspired by expressive arts interventions and have clearly seen the power of these tools in transmuting dark and overwhelming energy into healing and empowerment. I would like to end with this quote from Peter Levine (1997), who elegantly stated with such uplifting hope,
“The journey back to health and vitality is anything but immediate. Any step, however small, is significant and noteworthy. Unlike so many of the other journeys we undertake in the course of our growth and development, this journey has a finish—a resolution that leaves us richer and fuller for having accomplished it.” (p.110)
Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York: W.W. Norton &.
Carey, L. J. (2006). Expressive and creative arts methods for trauma survivors. London: Jessica Kingsley.
Herman, J. L. (2015). Trauma and recovery: The aftermath of violence, from domestic abuse to political terror (1st ed.). Basic Books.
Levine, P. A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books.
Van Der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma (1st ed.). Penguin books.
By Robyn Heydari