“How can we help a nonverbal youth express their emotions?”
I provide clinical support at a group home for youth who have experienced trauma, and this question was asked by one of the support workers during a meeting. It struck me then, as it has before, how much we rely on verbal communication in therapy. My immediate answer was to suggest drawing activities, and I determined to learn more nonverbal strategies to share with the workers.
This led me to Cathy Malchiodi’s book, Trauma and Expressive Arts Therapy. I am not an arts therapist, although I dabble in creating art. Still, there is valuable information in this book for any counsellor who wishes to expand their practice beyond talk therapy. The book ties research and practice together with clear explanations and clinical examples. Here are six insights I learned about arts-based healing:
Arts-based healing practices are more than just painting and drawing.
The four categories of arts-based healing practices are movement, sound, storytelling, and silence. Some of the practices listed in Malchiodi’s four-part model are:
- Movement – dance, yoga, bilateral movement, play, cultural practices
- Sound – singing, drumming, playing instruments, humming, listening
- Storytelling – drama, visual arts, role play, creative writing, ceremonies
- Silence – meditation, mindfulness, yoga, witnessing arts
I had not thought of practices such as yoga or singing as arts, but these are expressive activities. This greatly expands the repertoire of nonverbal strategies we might use.
The language area of the brain is impacted in many cases of post-traumatic stress.
This was particularly relevant for the question asked by the youth support worker. Individuals who have experienced trauma may be physically unable to talk about it. Using words can be overwhelming, reactivate trauma reactions, or bring about powerful feelings of shame or guilt. This is even more the case for children. By asking them to talk about their experiences or feelings, we may add to their psychological distress. Instead, arts-based activities can assist individuals to “speak” about feelings and experiences that are literally unspeakable.
Expressive arts practices promote whole-brain reparation and integration.
Unlike verbal therapy which relies mostly on left-brain function, engaging in any arts-based activity uses many parts of the brain. Malchiodi cites several studies that show the relationship between making art and certain brain regions. Having been a nurse for many years, I found this particularly fascinating. The research underscores that art is not just something nice or fun to do but has measurable healing impacts on the brain and body.
Unlike verbal therapy which relies mostly on left-brain function, engaging in any arts-based activity uses many parts of the brain.
Arts can facilitate a bottom-up approach to healing.
As with talk therapy, cognitive therapy is popular. However, this requires cognitive functioning at the “top” level of the brain, which may be inaccessible for those who have experienced trauma.
The Expressive Therapies Continuum described in Malchiodi’s book provides a framework for linking arts interventions to particular areas of the brain, promoting healing from the bottom-up. That is, intervention begins with attention to functions of the brainstem, and progresses to the midbrain, limbic system, and cortex. Sensory soothing and experiences of connection are the foundation.
Arts-based therapy interventions should be applied with intention and care.
Arts-based interventions are not without risk. For example, the body scan or body outline is a commonly used strategy. But for persons struggling with hyperactivation or dissociation, this can be challenging, even terrifying. Safety must be the first consideration, so it is important to identify the person’s window of tolerance for emotions or body awareness. Self-regulation, grounding, and anchoring are essential foundations to any expressive actions. Slow pacing and strategies for containment are needed.
Understanding this, my guidance to the youth workers is to focus on safety and supporting the youth in self-regulation skills.
Self-regulation, grounding, and anchoring are essential foundations to any expressive actions.
It is the expression, not the interpretation, that is important in healing.
My first response to the question that sparked my exploration of arts-based healing was to suggest drawing. What I hadn’t thought about was that often we feel that we need to interpret the meaning of drawings, but Malchiodi points out that interpretation is not the goal. Instead, healing occurs in the act of drawing itself. For instance, bilateral drawing, making marks or gestures with both hands, is useful as a grounding technique. The marks themselves are less important than the bilateral movement.
I have a greater appreciation for the skills and knowledge of expressive arts therapists after reading Malchiodi’s book. The solid research foundation and many examples make it interesting and have sparked a number of ideas for how I can improve my use of nonverbal therapies. There is so much more in the book than these few points, so I would encourage any practitioner working with trauma to read it. As for me, I’m getting out my paints right now!
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