Providing treatment for a child who has experienced trauma means treating both the child and her family. After a traumatic experience, families have different ways of coping; Often there is chaos. Chaos in the environment makes it very difficult for a young child to feel safe to be a child. Trauma also can make it difficult for family members to emotionally connect with each other.
What happens to the child?
In my occupational therapy practice, I regularly provide therapy services to the adult victims of car accidents. Recently, I have provided expressive art therapy for a ten-year-old child who was with her mother when she was involved in a motor vehicle collision. From age 3, my client grew up in a family that is broken by trauma.
This client is not the direct victim of the car accident; nonetheless, the effects of the accident left a large impression on her childhood and continues to do so today. As service providers, we must not forget that trauma affects the victim’s spouse, child, and family members.
When I first met my client, she was very sad. She was unexpressive and emotionally withdrawn. During our first meeting, she looked down, sat still and didn’t make eye contact. She couldn’t speak about her feelings and was only able to express that nothing seemed important to her. She did not volunteer a lot of information, making it difficult to assess in therapy sessions how she was doing physically and emotionally. She had no voice. After a lot of questions from me and with long pauses of silence on her part, she would occasionally talk about nightmares. She did not, however, want to elaborate – she was shut down.
So how does a therapist approach this situation?
Judith Herman has explained in her book Trauma and Recovery, that in trauma-informed art therapy we must establish safety first. Initial sessions must emphasize the development of trust and safety and focus on teaching self-regulation skills.
What are self-regulation skills?
Self-regulation is the ability to calm oneself down when upset and cheer oneself up when feeling down. In this case, my client had very few self-regulation skills. She was always very sad but not able to express her feelings. Or she would be frustrated and angry and physically lash out at her siblings instead of telling them to stop or asking her parents for help. For a child to be able to recover from trauma, she must be comfortable with self-disclosure. She must feel emotionally secure in order to be able to learn new skills.
Our rehabilitation team worked on supporting her abilities to learn self-care and self-regulation through identifying situations that create worry or anxiety (marks at school, not being prepared, nightmares), how her body reacts to stress (cold feet, upset tummy) and strategies for reducing stress when uncomfortable feelings arise (breathing, talking to an adult).
Peter Levine and Maggie Kline, in their book Trauma-Proofing Your Kids, say: “A child must experience the following in order to feel safe and to be able to self-regulate:
- My body is safe
- My feelings are safe
- My thoughts, words, and ideas are safe
- Things I make are safe.
During Art therapy sessions, we worked on safety and self-regulation through art. I asked my client about how she felt when we first met and started therapy, and what skills have changed. I asked her about how she felt at the start of therapy and how she feels now. The purpose of reflecting on past difficult times or feeling is to help the client recognize how much she has grown and the new skills she possesses. Recognizing copying skills and personal growth helps build confidence. I asked my client to write down these reflections in her journal. Then she can read them out loud to her parents to help the family form new emotional bonds.
Expressive Art Therapy
We also began to make a “Happy Mosaic Board” to create symbols of what makes her happy. She said that dancing, music, colours, sparkly things and friends made her happy. She included the symbol of a music note at the centre of her board, surrounding it with sparkly things and colours! She started her board by laying down the foundational tiles.
In Creative Interventions with Traumatized Children, Cathy Malchiodi explains that step two of trauma-informed art therapy (after establishing safety and trust) involves telling the trauma story. Children are encouraged to talk about how the trauma affected them. The overall goal is to help children heal the trauma of violent events and to begin to regain their abilities to experience and enjoy life even though bad things have happened.
When we were completing the mosaic board, I asked the client again about the changes she has been able to make in her life since I’ve met her. She has learned skills from her social work counseling sessions, like patience– learning how to wait. She has also learned to control her anger through breathing exercises and to moderate sadness by first crying and then doing something that makes her happy.
She also learned, with occupational therapy, daily living skill such as :
- budgeting to make sure she has enough money to purchase small items from the dollar store;
- scheduling her appointments by writing it down on her calendar;
- researching topics and finding books at the library; and
- using a computer and iPad.
She also experienced interactions with adults role model who listens and respects her wishes. The reflection exercise helped her to feel good about herself and to recognize her abilities. I then asked her about the nightmares again. At this point, she was ready to open up. She said that had nightmares almost 4-5 times a week before therapy, but now it is significantly less at about once a week. Without Trauma-informed Expressive Art Therapy, it would be very difficult for her to share this trauma.
Telling the trauma story doesn’t have to be long or complicated, but the child needs to feel safe enough to tell it. She feels safe about who she is and that:
- Her body is safe
- Her feelings are safe
- Her thoughts, words, and ideas are safe
- The things that she makes are safe
Right now, my client is happier. She is in an environment that is more safe and loving. She felt like she has the freedom to be who she is. Here is her finished “Happy Board.” It is colourful, full of sparkles, creativity, and full of life. I asked her to name her board. She called is “Dream of life.”
The outcome measure from the client’s initial assessment shows that a year ago she felt like she had very little abilities to do her daily activities. She also had very little satisfaction in the things she did indicating signs of childhood sadness and depression. I reassessed her and was pleasantly surprised that most of her scores have improved.
Judith Herman explains that step three in trauma-informed art therapy involves restoring the connection between traumatized individuals and their communities. My client needed to restore connections with important people in her life: her family.
I helped the client to take the lead by encouraging her to share accomplishments and achievements with her parents by sharing her journal writing and reflections. The client felt real accomplishment through working on and finishing a piece of art. Her parents were pleasantly surprised at her creation and framed her artwork in the living room. They were proud of her and finally recognize their little girl.
Trauma-informed art therapy assists in recovery from exposure to trauma. It reduces stress-related symptoms and enhances resilience to future crisis. I believe that the client’s “dream of life” is the beginning of the development of her abilities and capacities. These skills and abilities were buried when I first met my clients; Now they are expressed through therapy, care, and art!