Art: its healing and transformative potential

Tonya Alexandri – January, 2014

 Creating art to heal

 Through the creation of art a bridge is created between the survivor and the trauma itself, and then through sharing one’s artwork a bridge is created between the survivor and others

 Art has always been very important for me whether that involved creating it or looking at and interacting with others’ art. In childhood art provided me with a parallel safe reality within the unsafe walls of my home and life, and drawing and other art activities, both at home and at school, gave me a lot of pleasure and pride as a child. Inevitably, my journey towards healing and recovery during adulthood, with its many setbacks and difficulties, has been facilitated greatly by the creation of art and has been inextricably linked to my ‘reclaiming’ my wounded creativity. Creating art has proved a safe context to process feelings and meanings and has simultaneously provided a less threatening way to communicate feelings and experiences that were too painful to put into words. It has further helped me integrate traumatic events and make links across experiences and time, accept and understand how past events have influenced my later life experience, choices and decisions. Also, apart from art’s potential to help us address and contain difficult feelings like anger, fear and resentment, art can assert our individualism and increase self-esteem and sense of empowerment, which is very important for survivors since growing up with abusive caretakers involves becoming the site of their unacceptable impulses, feelings and attitudes. Sanford (2006) writes that ‘it is tough for survivors to rest easy and be secure in their sense of inherent worth and that they suffer from low self-esteem, which begins in the family of origin and is the result of ‘projected deficiency’ because abusive parents rely heavily on the psychological defense of projection’. Hagood (2000) supports that ‘involving survivors in the art process in itself tends to improve self-esteem’. Anderson and Brooke also suggest that art creation and expression can boost self-esteem (1995; 1997, cited in Hennig).

Furthermore, art making for its own sake can be very therapeutic and liberating and humanistic approaches to art therapy, suggest that ‘the process of art making is also an opportunity for self-actualization and it has a transformative quality’ (Malchiodi, 2007). Alice Miller (1923–2010), a psychologist, researcher and advocate against child abuse, as well as the author of 13 books, translated into thirty languages, tells us in the introduction of her book Pictures of a Childhood (a collection of watercolour paintings) that “five years after I began painting spontaneously, I started writing books. This never would have been possible without the inner liberation painting has given me. The more freedom I got playing with colours, the more I had to question what I had learned twenty years ago’http://www.alice-miller.com/gallery/ A striking example concerning art’s restorative power is the change that it brought about in Jimmy Boyle’s life, a former gangster and convict in Scotland, who discovered clay and his talent by chance and today is a highly successful sculptor (Brown, 2002). Art therapist, Joyce Laing, who became well known for her work at the Barlinnie Special Unit, a progressive prison that was organized on therapeutic community lines, worked with Jimmy Boyle in prison, helping him transform into a talented sculptor (Wood, 2011). While in the Special Unit Boyle had the chance to exhibit his work and study for an Open University degree.

Apart from my first hand experience, I have been able to further understand and appreciate the healing and empowering potential of art making in others. For instance, while working with a severely disabled and traumatized individual I was able to witness how art gradually broadened her life experience and increased her self confidence and capacity to reflect on her condition. Art making became a means for her to communicate her situation and the feelings she could not verbalize and provided her with an experience of normalcy. Art creation also reduced her boredom levels, uplifted her mood and helped improve her hand dexterity. She seemed to rise above her serious physical limitations and disability when she engaged in art making. Processing and discussing recurring themes and topics also brought about deeper insight of painful experiences. Due to her difficulties and special needs we also engaged in more directive activities, which could be considered co-creations, in the sense that I assisted her in expressing what she needed to express (Edith Kramer, http://edithkramer.com/, believed that the therapist should assist the client create what he/she needed to create and that. the art product was as important as the process and she.referred to the therapist’s assistance as the artist’s ‘third hand’). I found that this exchange and corporation facilitated communication and allowed the processing of material, without the individual becoming overwhelmed by the burden of difficult emotions. Some of the more directive activities involved the creation of drawings inspired by children’s stories and books. Providing different happier endings helped us tap into difficult emotions and concerns and allowed the discussion of positive emotions like love and hope and issues like justice, cruelty, etc. Providing titles to her pictures and then binding her artwork to create little books facilitated her sharing her artwork with others. Feeling that her drawings were appreciated resulted in boosting her self esteem and sense of worth, which additionally, gave her immense satisfaction and triggered discussions concerning her need to relate to others. Laing writes that ‘art offers a medium which can give both communication with others and confrontation with the self’ (1974, cited in Dalley, 1984). Laub and Podell write that trauma destroys the inner sense of the ‘other’, that is an inner sense of connection with others, and creative arts expression can re-establish that sense of connection (1995, cited in Hennig) and Johnson suggests that ‘public display or performance of creative arts products can help reconnect survivors to society, as well as, providing a sense of empowerment’ (1987, cited in Hennig).

Finally, Lane claims that the creative process causes specific areas of the brain to release endorphins and other neurotransmitters that affect brain cells and the cells of the immune system, relieving pain and triggering the immune system to function more effectively. This occurs because ‘endorphins are like opiates, creating an experience of expansion, connection and relaxation…., in conjunction with these physiological changes, art can regularly change people’s attitudes, emotional states and perception of pain’ (Lane, 2005, cited in Phelps, 2012).

Creating a language: symbols, patterns, themes and metaphors

As already discussed elsewhere on this site, one aspect of trauma is the loss of language that accompanies overwhelming traumatic experiences and the shutdown of the language areas of the brain, which allow us to provide some order to our reality and to place events in the right space and time context. Also, language is not always adequate when processing very painful or early experiences so images can become forms of non-verbal communication and art can complement verbal processing and can allow us to make sense of experiences without words (Malchiodi, 2007). The painter Georgia O’Keeffe said that she found she could say things with colour and shapes that she couldn’t say any other way. Moreover, art is multilayered, dense and economic compared to verbal language and expression and drawings can be precise reflections and depictions of events, difficult feelings and bodily sensations, but they can also represent our new meaning making of our experiences. Art also provides us with a sense of control and allows us to distance ourselves from traumatic memories and overwhelming feelings. Since traumatic memories are stored in implicit memory, as a kind of sensory, body based form of memory that is not the same as conscious, narrative memory and which ‘is often expressed in the symptomatology of PTSD, such as, nightmares, flashbacks, startle responses and dissociative symptoms’ (Rothschild, 2000), art expression can provide ‘a certain amount of distance and control and thus provide a sense of containment for clients’ (Johnson, 1987; Lev-Weisel, 1998, cited in Hennig). For instance, at some point I started using images from previous work in my more recent artworks understanding gradually that this did not only facilitate the expression of recurring themes, but also that using these image-symbols provided me with a sense of containment, distance and control over difficult material and emotions because ‘the act of symbolization shapes raw emotions and provides what Judith Glass calls ‘aesthetic distance’, which she defines as ‘the point at which the client can have access to his [her] feelings and also maintain an observer stance’ (cited in Carey, 2006). Moreover, the art product can become a safe container that can hold the emotion or the memory, allowing us the possibility to return later and re-process, further explore and create a more coherent narrative. Malchiodi (2007) suggests that artistic self-expression can also be used as ‘a container for feelings and perceptions that may deepen into greater self-understanding or may be transformed, resulting in emotional reparation, resolution of conflicts, and a sense of well-being’. Through the artistic process we gain a sense of control, which allows us to distance our self from the traumatic memory or difficult feeling and which in turn allows feelings and sensations to become objects open to scrutiny and further processing. Langer suggests that ‘the primary function of art is to objectify feelings so that we can contemplate and understand’ (1957, cited in Brooke, 2000).

Therefore, as mentioned above, the artwork can become a container that can hold material, which ‘one can return to and use as a resource for putting experience into words and creating metaphors’ (Brooke, 2007), that can play an important role in therapy. Survivors, for instance, may often describe the shame and loneliness they felt as a child as ‘a heavy rock in their heart’ or health patients may often use metaphors to describe their physical pain. Also, when creating visual art one can create visual metaphors or transform a ‘verbal’ metaphor into a visual metaphor. Many of the images in my drawings are metaphors, which have facilitated the processing of difficult material and emotions and the externalization of experience. However, they often also depict realities, since ‘metaphors are not abstractions only but can be quite concrete’ (Cox and Theilgaard, 1988, cited in Malchiodi, 2007). More specifically, in my artwork I have used metaphors to express loss, grief, pain, and anger and have for example drawn a face with sewn or sealed lips to represent silence and fear of breaking the silence. Images of different forms of encapsulation like containers, jars, balloons or fish bowls also seem to appear frequently in my work and journals, and it has only been through the artistic process, the reproduction and re-processing of these images that I was able to eventually diffuse the fear these images seemed to be strongly connected to and to allow deeper processing of information and experience to take place. It was as if I had broken enveloping structures and could at last breathe freely – as if through deeper understanding and processing I could virtually tear down walls and inhale enough oxygen. There are many approaches to the therapeutic use of metaphors and studies have been conducted to explore the use of metaphors in art making and in their role in therapy and healing. For instance, a qualitative collective case study, using questionnaires, art tasks and open-ended responsive and validation interviews, was conducted by Rachel Braun to investigate how the use of metaphor in art making can help people with chronic pain express the experience of acceptance and change. The results of this study suggested that the use of metaphor in art making can help people who experience chronic pain express the concepts of acceptance and change. Metaphors further provided them with a safe distance with which to face a challenging situation, allowed metaphoric objectification of a situation, allowing for assessment, clarity and wise decision-making. It further provided a way for patients to reflect on the influence of past experiences on present and future situations (Braun, 2009). It is also suggested that ‘the greatest value of metaphor lies in the treatment where trauma has occurred. In such cases working through the problem directly can be too anxiety-provoking or complex. Metaphors frequently deactivate the defenses without heightening the anxiety by allowing patients to defocus on the issue itself and focus on the metaphoric domain’ (Van der Hart, Witztum & Friedman, 1988)

Additionally, through art one is also able to discover symbols, a pattern of recurring themes and  other forms of expression that reflect our inner landscapes because art allows one’s thoughts, feelings, memories and perceptions to become visible and tangible. Changes in patterns and themes may reflect the changes that take place in our inner life and landscape and the deeper insight and self-awareness we might gain while processing the past or current issues, but may reflect events, positive changes or setbacks that inevitably take place in the present, as well. As already mentioned, my artwork seems to be part of a long ongoing art journal, which somewhat changes and evolves over time reflecting the change in circumstances, the setbacks, but also an increasing clarity and ability to make associations across time as I move through life and as my past experience interacts with the present and the ‘here and now’ of the art process itself. In the pages of this diary I have often drawn the child isolated, with its head bowed or with missing limbs and huge eyes staring inwards into some dark reality of its own, trying to capture my childhood feelings of pain and utter helplessness. I have drawn huge eyes staring out in fear or faces without a mouth depicting fear, secrecy and silence and my inability to tell. Animals, birds, insects and flowers are also recurring themes, which in some instances depict physical sensations and emotions. Also, in earlier pieces trees and hearts are a reoccurring theme in many of my drawings. Research findings and observations of survivors’ art reveal similar recurring themes and images. People use lines, shapes and different colours to express and represent their emotions and some have been associated with art created by sexually abused survivors, like triangles and hearts, for instance, (Sidun and Rosenthal, 1987; Cohen and Phelps, 1985; Spring, 1993, cited in Brooke, 1997). It has also been observed that both adult and children survivors draw dead trees with no leaves, tree trunks separated from the top or slanted trees (cited in Brooke, 1997). According to Malchiodi sexually abused girls use heart images in their work and Jones observed that survivors draw encapsulated hearts (1990; 1989, cited in Brookes, 1997). Kaufman and Whol reported that heart images perhaps reflected feelings of being exposed and vulnerable (1992, cited in Brookes, 1997). A study conducted by Rachel Lev-Wiesel analyzed common traits drawn by both women and men survivors of sexual abuse and found for instance, that they drew figures or images of themselves with shaded, hollowed or missing eyes and often limbs were omitted, cut-off or detached. Spring observed that in adult incest survivors’ work wedges and eyes appeared repeatedly in their drawings (1985, cited in Hagood, 2000).

Moreover, while working with sexually-abused and chemically-dependent women, Spring found that they drew disembodied faces, bottles of water and flowers. She also noted that the higher the level of posttraumatic stress the greater the frequency of eyes and wedges (1985, cited in Brooke, 1997). Hagood (2000) has observed the presence of phalluses created realistically or in some sort of abstract form both in child and adult survivors’ art. Research and work that focuses on assessment has also found particular types of drawing content that reoccurs in the artwork of survivors of childhood trauma. Actually, the omission of body parts in the artwork of sexual survivors is widely supported (Kelley, 1984; Sidun & Rosenthal, 1987; Malchiodi, 1990; Burgess & Hartman, 1993, etc, cited in Brooke, 1997). Sexually abused individuals may not represent the lower part of the body (Sadowski & Loesch, 1993, cited in Brooke, 1997) and the lack of a mouth, which was observed in the art of children and adolescents, may relate to the secrecy surrounding abuse, (Briggs & Lehmann, 1985; Sidun & Rosenthal, 1987, cited in Brooke, 1997). The girl figure in one of artist survivor Jane Orleman’s paintings with the title Symptoms of Child Abuse, has sealed lips, a missing arm, a circular dark area on her abdomen and ‘loss of mobility’ written next to her left leg. On the other hand, circular mouths may be related to the silent scream (Spring, 1993, cited in Brooke, 1997). In addition to, armless figures and the omission of body parts, Chase found that children survivors of sexual abuse drew long necks, clothing omitted and presence of phallic-like objects (1987, cited in Brookes, 1997). Chase also found that incest survivors significantly drew encapsulated figures (1987, cited in Brooke, 1997). In a study conducted by Kelley half of the children survivors drew tiny self-portraits, possibly revealing low self esteem; 30% omitted the hands, which may reveal helplessness and 20% drew figures with questionable gender identity (1984, cited in Brooke, 1997). Finally, for ritual abuse survivors’ art creations may often be direct representations of unbearable realities and experiences they have survived or the recording and visual presentation of natural coping mechanisms to overwhelming events, like dissociation. For instance, Lynn a survivor of torture writes that her paintings ‘visually describe the process of dissociation, which is the outcome of an adaptive, creative response to horrible experiences. It is not an illness. It is a condition that should carry no shame or stigma’ http://lynnsart.net  or http://ritualabuse.us/smart-conference/conf06/did-system-function-in-survivors  Becky Frye supports that the separation from and amnesia about various experiences originally helped the child survive ongoing trauma and abuse; however this once functional coping mechanism causes at least as many problems in adult living as it originally avoided in the past and art making can actually be a safe way for clients with DID to ‘tell’ their memories’, to  increase their insight, to deal with their stress constructively and to create a positive identity (1991).

The inside and the world outside

‘The power of image to uncover memories and unconscious material is always to be respected’ (Hagood, 2000)

Through art one can regress to earlier stages to access traumatic memories and buried material in a less threatening way and link unconscious and conscious dimensions. Drawing and engaging in creative work proves an effective means in allowing unconscious and deeply buried elements to emerge because it helps access the well of the unconscious and brings repressed traumatic events and memories to the surface by removing strongly built barriers and walls of denial, fear and self-censorship. Practically, it means connecting with those parts of the self that hold the traumatic incidents. It is as if painful experiences, internal conflicts and feelings, swimming around in dark waters, are allowed through art making to flow from the unconscious to the surface. Spontaneous, non-directive art making facilitates this process and allows one to create links, both consciously and unconsciously, across experiences and time, and this in turn, can allow spontaneous grouping of experiences to be achieved, which can further increase insight.  Hagood (2000) also writes that ‘the art process helps to uncover buried memories’ και η Rubin notes that Freud recognized that peoples’ ‘most important communications were descriptions of visual images’ (1987, cited in Gil, 2006). Art expression assists us in understanding our inner world and further offers us the possibility of trying out solutions and changes which may lead to solutions, changes and restoration. The artist and art therapist, Edith Kramer, who worked extensively with children in the USA, suggests that ‘art brings unconscious material closer to the surface’ and ‘provides an area of symbolic experience wherein changes may be tried out’ (Ulman et al., 1977, cited in Gil, 2006). Additionally, as already mentioned, art creates a bridge of communication between our conscious and unconscious experience, which can increase our insight because it allows conscious awareness and processing of events and memories that were held in the unconscious or some other level of awareness. Martin Fischer, who was instrumental in founding the Canadian Art Therapy Association, claimed that ‘we should listen to our conscious mind and we should listen to our unconscious mind. And it is only when we combine the two, simultaneously, that true learning and growth takes place’.

More specifically, ‘spontaneous art making provides access to the unconscious in a fashion similar to that of free-association’ (Malchiodi, 2007). Naumberg claims that thoughts and feelings are spontaneously recorded in the artwork as they surface from the unconscious without being censored, edited or criticized (2001, cited in Smith, 2005). In my artwork I have mostly recorded images automatically as they surfaced, but I have worked on emotions and particular memories or dream material that I was preoccupied with, as well, and many of my drawings include glimpses of the present because current daily experiences and concerns have inevitably entered my work even though I was mostly focused on past experiences either repressed or held in conscious awareness. Betensky describes art therapy as utilizing a ’hand-eye-thought-feeling’ energy, and as integrating one’s inner and outer world through mind and body (1973, cited in Smith, 2005) and Elinor Ulman claims that ‘art is the meeting ground of the world inside and the world outside’ (cited in Malchiodi, 2007). Art making has the potential to allow one to learn more about the self and the world, and moreover, to integrate this knowledge. Ulman writes ‘in the complete creative process, inner and outer realities are fused into a new identity (cited in Brookes, 2000).

Emotions and art

It is well known that even when survivors remember their trauma in more detail, they often have difficulty being aware of, defining and expressing the feelings connected to the trauma because avoidance and numbing responses are inherently woven with traumatisation. Furthermore, in dysfunctional families and environments expression of emotions and discussion of the abuse are stifled and not encouraged; however, in order to heal, the trauma needs to be processed on both a cognitive, bodily, as well as, an emotional level, which means that, to some extent, survivors need to experience the difficult feelings connected to the traumatic events and this causes fear because as a species we fear and tend to avoid suffering, losing control and being overwhelmed. But by not acknowledging and avoiding to process difficult feelings, we remain numb and half alive. So we need to tolerate the duration and the intensity of these feelings and hang on and grit our teeth and feel, and once we have confronted our feelings and fear of them we will not need to displace them on those around us or to become self-destructive by turning our anger inwards. Emotions could be viewed as energy in action, which always needs some kind of outlet or else if we suppress or dissociate them they will manifest in our physical symptoms or they will be represented in our actions and behaviours. Being able to feel is vital ‘for if we do not feel we become numb or callous, and a vital part of us dies’(Thornton, cited in  Bass and Thornton, 1991). However, once we come into contact with our repressed or dissociated unwanted difficult feelings, like anger and rage, we need to find ways to deal with them in healthy and creative ways. Journaling and art can become tools to contain, release or sublimate very difficult feelings. It is widely supported that creating art assists emotional release and it can facilitate discharge of very intense and difficult feelings, which is referred to as catharsis, which then allows the healing process to begin. The process of creating art can aid us in transcending trauma through releasing powerful emotions and making new meaning of our traumatic experience and often the images in our artwork are imbued with our meaning making of our experiences and emotions. Becky Frye writes that survivors ‘can change the way they look at the past by releasing their pent up emotions through the imagination and fantasy’ (1991). Art therapy and art expression can complement other therapeutic modalities or can be used as an initial approach to identify and express unbearable experiences. Art therapy has been used successfully in the treatment of PTSD because the sensory qualities of art provide us with a means to tap into our emotions more easily than using words alone and it allows trauma survivors to communicate their inner pain non-verbally and less directly (Malchiodi, 2007).. Johnson further suggests that art expression can help survivors who suffer from alexithymia, which is a trauma related condition that involves the inability to express feelings in words, to explore their feelings and memories (1987, cited in Hennig, 2012).

 Children and art 

 Art has also proven especially useful and effective in working with particular populations like traumatized children, who often cannot put their trauma into words and do not have the vocabulary to express their emotions or experiences. Actually, there is quite a lot of literature concerning art therapy with children, which according to Roger Arguile ‘reflects that aspect of art therapy which grew out of the ‘child art’ movement of the late nineteenth and early twentieth centuries’(cited in Waller and Gilroy, 1992). He notes that ‘as a result of that movement children’s drawings and paintings began to be taken seriously and to be seen as vital to their development and psychotherapists working with children tended to have art or play materials to hand, finding that the art process offered the child a non-verbal, symbolic language through which to tell their story (Pickford 1967, Lowenfeld 1971, Winnicott 1971, and many others, cited in Waller and Gilroy, 1992). Edwards has further noted that drawing exists as a parallel to verbal language and is the simplest of all non-verbal languages. It further does not have the restrictions of linguistic development in order to convey feelings and thoughts (1986, cited in Brooke, 2000). Moreover, children and adolescents may often be reticent to express and discuss difficult feelings, and therefore, the indirect symbolic aspect of art and art therapy may be more suitable and effective than talk-therapy alone with children. Additionally, art and play are ‘familiar, user friendly, pleasurable activities for children and they can engage easily with these techniques’ (Gil, 2006). Strauss (1999) writes that ‘younger children distance themselves from negative feelings and older children tend to project negative feelings onto others while they deny their own’ and that ‘it is relatively rare for a pre-adolescent child to be willing to participate in a discussion of negative feelings’. Mallay claims that when children have no means of processing trauma, they psychologically register and store traumatic memories in the brain, which leads to anxiety, fearfulness and other trauma related symptoms; however, art can provide a means to work with children and help them process their traumatic events through creative activities (Mallay, 2002, cited in Chilcote, 2007). Art creation can increase children’s ability to deal with overwhelming emotions and talk about unspeakable painful past experiences and very difficult current realities. Volgi-Phelps used art therapy with children and found that ‘through art, the child learnt to mange emotions, promote self-concept, and learn socially acceptable ways for expressing feelings (1985, cited in Brooke, 1997). Malchiodi also suggests that the use of drawing with traumatized children enables them to express emotions and verbalize experiences more effectively than using words alone (2001, cited in Chilcote, 2007) and Coulson et al support that drawing ‘assists children, in giving voice to their traumatic experiences’ (1994, cited in Brooke, 1997).

A four week art therapy intervention was implemented at a local school for 113 children aged 5 to 13 in Sri Lanka by Rebecca Chilcote, after the tsunami in Sri Lanka, to help children process their experience and loss because children survivors of natural disasters ‘may display problems, such as, clinginess, separation anxiety, aggression, behavioural problems, decreased concentration and somatic symptoms’ (Roje, 1995, cited in Chilcote, 2007). Art therapy proved an effective, psychologically beneficial and culturally applicable intervention for children affected by the tsunami in Sri Lanka. Through simple art tasks the children shared trauma and pain they had not been able to verbalize and they were able to regain emotional control (Chilcote, 2007). In addition, Chilcote (2007) claims that the group setting provided witness to a collective grief, allowing the children to voice their trauma with other survivors. A pilot study was conducted in New York by Francie Lyshak et al (2007) to examine the efficacy of an adjunctive trauma-focused art therapy (TF-ART) intervention in reducing chronic child PTSD symptoms. They found that although both treatment groups improved, the adolescents that received TF-ART experienced substantially more PTSD symptom reduction. Another pilot study conducted by Corder and her colleagues using art therapy in conjunction with play therapy over five months with a group of girl survivors of sexual abuse found that the children reported fewer sleep disturbances, demonstrated more compliant behaviour and became more verbally assertive (1990, cited in Brooke, 1997). Morgan and Johnson also reported reduced frequency and severity of nightmares after art therapy interventions (1995, cited in Hennig).