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Why Art Therapy

rage artwork happiness artwork
By Terry Pifalo, M.Ed, MPS-CAT, ART
Art Therapist, Lowcountry Children's Center

Artwork provided by children being treated at Lowcountry Children's Center, Charleston South Carolina

The experience of being sexually abused is a non-verbal experience. Art therapy is, at least initially, a non-verbal approach to the treatment of this type of trauma. Anyone who has experienced psychological trauma may have difficulty expressing their experience directly or effectively in words. Indeed, children are often unable to verbalize their thoughts and feelings surrounding sexual abuse. Most children do not possess the adult vocabulary to describe the sexual acts that they were pressured, coerced, or forced to participate in with the offender. They simply do not have the words. Art therapy is an intervention that provides the opportunity for nonverbal expression and communication.

Art is a non-threatening way to visually communicate anything that is too painful to put into words. Often victims of sexual abuse have been lied to, threatened, or misled with words by their abusers or other adults whom they trusted. Words have become misleading and mistrusted and strictly verbal approaches to therapy may meet with more resistance. This is one of the major reasons that many therapists have found that art therapy is actually preferable to verbal therapy in many cases (Richards & Sealover, 1991; Waller, 1992).

Another benefit of art therapy is that sexual abuse victims may have been threatened by their abusers �not to tell,� so drawing their secrets may be less frightening than �telling� them in words. The art therapy group creates a safe place for children who no longer trust words or for those who tend to hide behind them. Since most people are used to communicating in words and not images, our grasp of non-verbal communication is less sophisticated than spoken languages; therefore, we have fewer established defense patterns (Waller, 1993).

In addition, children and adolescents are more easily engaged through drawing pictures either directly or indirectly related to the traumatic event than through talking about the event (Powell & Faherty, 1990). It is the personal observation of this author that during the art therapy sessions, group members were frequently visibly quite relieved that they were going to �do stuff,� and not just sit and talk about �it.�

The use of art therapy in the particular population of sexually abused children adds information that may not be accessible by any other means. As far back as 1973, Margaret Naumberg noted that art therapy offered a specialized nonverbal symbolic imagery for expressing unconscious, repressed emotions (Naumberg, 1973). Stember (1980), the first registered art therapist to access rape trauma syndrome in children through their drawings, found that the inner turmoil and conflict of many sexually abused children responded directly to art therapy. Sember noted, �Since the trauma of sexual abuse is primarily psychological, art work can provide a vehicle for bringing even deeply repressed trauma to the surface where it can be balanced by the outer world� (Stember, 1980, p. 61).

An example of the power of expression through art, in contrast to verbalization, occurred in a drawing done by a seven-year-old girl identified as #SkLG7. This child had been almost nonverbal during the early sessions. Her images, however, �spoke� volumes. In a spontaneous drawing of what she identified as �her house,� a bed is partially scribbled out at the lower right-hand corner of the drawing (See drawing on the following sheet). This object was so obviously out of place, drawn outside of the house, that she pointed it out herself to the group leader, saying: �This is where it happened.� Up until she had made this drawing, she had never disclosed [or perhaps did not remember] where she had been raped by a 13-year-old friend of her brother�s. She did not appear to be conscious of what she was drawing as she drew it, but the memory surfaced spontaneously during the process of her creating the image.

In early research examining the use of art therapy with sexually abused children, Kelley noted that drawing pictures of the event may provide information concerning the actual incident and allow repressed feelings to resurface where they can be addressed effectively (Kelley, 1984). Although the child in this study received no directive to draw what had happened to her, she did so spontaneously; most probably the information emerged at a time when she was ready to process it.

Like the girl whose drawing appears on the following page, many children are often able to express graphically what they are unable to express verbally. Indeed, engagement with the art form appears to simultaneously facilitate the following: an unearthing of unconscious material, including memories, images, and feelings; the production of an image or feelings which can be then faced as acknowledged reality and a way of �speaking� that is reality. Psychiatrist Allwyn J. Levine told a New Jersey court that art in its various modalities of representation can provide a direct line to the unconscious (Levick, Safran, & Levine, 1990). The use of art therapy provides a visual dialogue to communicate the information that arises from the unconscious and its resulting emotional affects without relying on words.

Due to the dissociation of the memories of traumatic experiences and the resulting disruption of the victim�s ability to translate feeling states into words�a state referred to as alexithymia�gaining access to traumatic events is exceedingly difficult. According to research, this difficulty may be due not only to psychological defenses, but also to the neurological processes responsible for the actual coding of such events (Johnson, 1987).

Much evidence suggests that humans have two forms of memory encoding. One is a primitive, visually-based memory that records an event as a whole in its exact detail. The second form of memory is based on coding experience according to a hierarchical system of constituent parts, so that each memory is really a reconstruction derived from common elements (Penfield & Perot, 1982). Other researchers also observe that there are significant differences between the mechanisms that humans use to process verbal and visual material. Gregory Bateson (1973) wrote that iconic communication serves functions totally different from those of language and, indeed, performs functions which verbal language is unsuited to perform.

In the population of sexually abused children and adolescents, the use of art therapy is important in the different types of memory encoding processes. Research suggests that it is likely that at times of overwhelming stimulation and terror in the moments of trauma like that of childhood sexual abuse, the more highly developed cognitive system is temporarily bypassed. The traumatic event is recorded in �photographic form,� as a global record, unintegrated conceptually with other memories through normal associative links. For these reasons, the memory is not available to be processed, worked through, and continually transformed, as are other aspects of one�s memories.

Aside from the highly visual aspects of these traumatic memories, they also have strong sensorimotor qualities. Schimik (1975) has noted that unconscious mental representations may, in fact, be events that are recorded in sensorimotor form with strong visual and kinesthetic qualities. Reliance, then, on a verbal or discursive form of thought or communication is actually counterproductive to the process of accessing these particular types of traumatic memories.

Art therapy, on the other hand, is uniquely suited to gain access to traumatic images and memories. Because the encoding of traumatic memories may be via a �photographic� visual process as previously mentioned, a visual media such as art therapy may offer the means by which this information may come into consciousness. In fact, reports of clinical and research efforts in the special areas of child abuse have often used drawings to obtain information (Greenberg & van der Kolk, 1987).

It is important to note that art therapy is not only useful for obtaining information, but it also plays a critical role in processing that information. Psychic trauma occurs when an influx of external stimuli breaks the stimulus barrier of the psyche (Freud, 1955). The psychic trauma of childhood sexual abuse can be described as follows. There is no possibility of preventing the mental apparatus from being flooded with large amounts of stimulus. Another problem arises instead�the problem of mastering the amounts of stimuli that have broken in and binding them, in the psychical sense, so that they can be disposed of (Miller & Boe, 1990).

Bateson, G. (1973). Steps to an ecology of mind. London: Paludin.
Freud, S. (1955). Beyond the pleasure principle. In the standard edition of the Complete Works of Sigmund Freud. (Vol. XVII). London: Hogarth.
Greenburg, M., & van der Kolk, B. (1987). Retrieval and integration of traumatic memories with the painting cure. Psychological Trauma. Washington, D.C.: American Psychiatric Press.
Johnson, D. (1987). The role of the creative arts therapies in the diagnosis and treatment of psychological trauma. The Arts in Psychotherapy, 14, 7-13.
Kelley, S. J. (1984). "The use of art therapy with the sexually abused child". Journal of Psychosocial Nursing and Mental Health Services, 22,, (12), 12-18.
Levick, M., Safran, D., & Levine, A. (1990). "Art therapists as expert witnesses: A judge delivers a precedent-setting decision". Arts in Psychotherapy, 17, 49-53.
Miller, C., & Boe, J. (1960) "Tears into diamonds: Transformation of child psychic trauma through sandplay and storytelling". The Arts in Psychotherapy, 17, 247-259.
Penfield, W., & Perot, P. (1963). "The brain�s record of auditory and visual experience". Brain, 86, 595-696.
Powell, L. & Faherty, S. (1990). "Treating sexually abused latency age girls". The Arts in Psychotherapy, 17, 35-17.
Waller, C.S. (1992). "Art therapy with adult female incest survivors". Art therapy: Journal of the American Art Therapy Association,9. (3), 135-138.
Waller, D. (1993). Group interactive art therapy: Its use in training and treatment. London: Tavistock/Routledge.
Schimek, J. (1975). "A critical re-examination of Freud�s concept of unconscious mental representation". International Review of Psychoanalysis, 2, 171-187.

Stember, C. & Halpert, M. (1980). "Art therapy: A new use in the diagnosis and treatment of sexually abused children". (DHHS Publication No. 59-63). Washington, D.C.: US Government Printing Office.

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