Alison McClymont Pscyhotherapy - Hong Kong
Arts Therapies and Post Traumatic Stress Disorder (PTSD)

Arts Therapies and Post Traumatic Stress Disorder (PTSD)

One of the subjects I am most passionate about in the work I do is the healing power of creativity and imagination. I believe, and my clinical experience confirms this, that the human imagination has the power to invent truly beautiful and wonderful new coping mechanisms and strategies to overcome the most terrible of traumas. The very act of expressing yourself through a creative medium such as art, drama or music can provide amazing benefits to an otherwise traumatised or troubled psyche. The human mind is a magical thing and it never ceases to amaze me what it can create and overcome.

Post Traumatic Stress Disorder (PTSD) is generally defined as a condition that negatively affects the emotional, physical and cognitive state of a person following an incidence of trauma. The diagnostic criteria for PTSD is listed in the DSM V, with a new addition now, including PTSD with dissociative symptoms.

The vast majority of my clinical experience has been trauma based work, and it is an area of treatment that I think is often neglected or mis-diagnosed by practitioners. I have seen many, many people come through the door with labels of personality disorders, mood disorders, poor memory functioning, poor attention span, you name it, when in fact, they are trauma survivors.

Whilst I am not claiming there is not the potential for co-morbidity with trauma survivors (ie there may well be the presence of bipolar disorder AND PTSD), unfair and incorrect “labelling” does occur, and frequently.

A traumatic event can shake the very core of your being and produce reactions and “symptoms” in an otherwise healthy person that they may never have had. This is exacerbated if the trauma occurred over a long and sustained period of time (such as in cases of child or domestic abuse). These “reactions” can come in the form of insomnia, mood swings,memory “blanks”, psychosis and dissociation. As an example, it is not difficult to see how a sexual assault survivor who presents for treatment with volatile interpersonal relationships, extreme moods, and distorted self image can be diagnosed with borderline personality disorder, when in fact their body and mind is harbouring the reactions of the trauma of being assaulted.

An experienced clinician should be able to differentiate between the symptoms of an un-processed trauma and a pathological disorder, and should be more than capable of managing any symptoms accordingly. However, whole situation becomes more complicated when we consider the idea that trauma may cause personality disorders, there is often a connection made between childhood trauma and borderline personality disorder for example.So should we treat the symptoms of the disorder alone, when it becomes present? I would argue no, I would argue that by treating the trauma,you are treating the “disorder”.

Using the example of the sexual assault survivor, by treating the feelings of shame, and low self worth surrounding the assault, you are helping the client to create healthier cognitions of themselves, and their body. In an ideal world, trauma therapy should help the client to embrace their body as precious, and something to be loved, which in turns assists them with developing and maintaining, healthier interpersonal relationships. This is an extremely simplified view of a very complex process, but I hope it goes some way to make the point that by treating trauma, you are greatly assisting the general wellbeing of any client.

So why art therapies? If we return to the connection between body and trauma, here is where the magic of arts therapies really comes in to its own. Arts therapies, particularly dance and drama therapies, focus on the connection of mind and body, not simply the mind, as some schools of psychology do. There is a wealth of research now positing the importance of this connection when treating trauma, such as Laurence Heller and Aline Pierre’s work on the Neuroaffective Relational Model, or Peter Levine’s Somatic Experiencing. Arts therapies are particularly skilled at repairing damaged, or poorly functioning, mind-body connections. By working with the “vessel” of all the negative emotions and thoughts a client has about themselves, and offering them the space to “re-encounter” this vessel as a strong, creative, beautiful thing that is capable of dancing, playing, running, laughing and feeling, you are in essence “giving back” the client their own body, as something to cherish.

As any trauma clinician will tell you the process of helping a survivor “love” their body again, is a long and winding road and it is not something that happens over night. But by inviting the body in to the therapy space as the medium of expression, you are encouraging the client to not only acknowledge its presence, but to begin to explore the emotions this mind-body relationship generates.

Complex trauma expert, Christiane Sanderson, writes that safe trauma therapy should incorporate some idea of “distance” in to the work, so as not to overwhelm, or re-traumatise the client through re-telling. Arts therapies work almost entirely in a “distanced” metaphor, and for this reason can be among the safest ways to work with trauma.  As they use a communication medium almost entirely entrenched in the metaphor or the “as if”, they provide a  “container” for even the most difficult of stories. This “containing metaphor” (be it a story, a poem, or a picture) can then be used as a therapeutic tool to explore the themes and images of the client’s story, without working directly with material a client might find overwhelming or traumatising.

In order for trauma therapy to be truly effective, there must be an established therapeutic relationship based on trust and mutual respect in order to generate growth, regardless of the method of therapy used. Arts therapies come from the humanist school or “person-centred” school of psychology, and as a result seek to ground all of their work, in this relationship. If this relationship is established, then through the use of safe “containing” metaphors and the  gentle introduction to mind and body connection, truly regenerative and magical processes can occur.


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