USING ART IN TRAUMA RECOVERY WITH CHILDREN

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____________________________________________________ About Art Therapy Art therapy can be beneFcial to people of all ages, but it is especially useful for children. Art is a natural form of communication for children because it is easier for them to express themselves visually rather than verbally. This is particularly true for children who have experienced a traumatic event, such as Hurricane Katrina or other natural or man-made disasters.

Art therapists are mental health professionals speciFcally trained to use art with individuals of all ages who are emotionally stressed or traumatized. Members of the American Art Therapy Association hope that this information will give those working with traumatized children and their families a greater understanding of how art therapy can be used to support trauma recov- ery. ___________________________________________________________________________________ Art therapy is an established mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well being of individuals of all ages.

It is used with children, adolescents, adults, older adults, groups, and families to assess and treat the following: anxiety, depression, and other mental and emotional problems and disor- ders; mental illness; substance abuse and other addictions; family and relationship issues; abuse and domestic violence; social and ... more. less.

emotional difF- culties related to disability and illness; trauma and loss, physi- cal, cognitive, and neurological problems; and psychosocial difFculties re- lated to medical illness. Art ther- apy programs are found in a number of settings including hospi- tals, clinics, public and community agencies, wellness centers, educational institutions, busi- nesses, and private practices. Art therapists are professionals dedicated to the belief that the creative process involved in art making is healing and life enhancing. For chil- dren, the opportunity to draw, paint, and con- struct with an art therapist can help them to communicate difFcult issues, reduce stress, and reconcile feelings. Understanding Children 9s Trauma Reac- tions Children who experience catastrophic disasters and events show a wide range of trauma reac- tions. Some children have worries and bad memories that gradually disappear over time with emotional support of caregivers and com- munities. Other children may experience more long-term problems, stress reactions, and post- traumatic stress disorder (PTSD). Emotional reac- tions -- fear, depression, withdrawal, or anger and physical complaints or symptoms with no medi- cal basis -- can occur immediately or appear weeks and months after the traumatic event. Wor- ries and concern can interfere with a child 9s abil- ity to pay attention and concentrate and cause difFculty in school. Loss of trust in others and fears of the tragedy happening again are common responses in many children and adolescents who have experienced a traumatic event. USING ART IN TRAUMA RECOVERY WITH CHILDREN From the American Art Therapy Association 1202 Allanson Road, Mundelein, IL 60060-3808 1-888-290-0878 www.arttherapy.org Some children are more vulnerable to the effects of traumatic experiences for reasons that we still do not completely understand. For example, chil- dren who have experienced previous traumas or who already have a mental health disorder may be more susceptible than others to problems fol- lowing traumatic events. Also, children who wit- nessed or directly experienced the disaster are believed to be more at risk than others who are less directly affected. But even second-hand expo- sure to a disaster (through media reports or hear- ing vivid stories about the event) can be traumatic for some children. A child whose caregiver is hav- ing a hard time coping with the disaster will also likely face more challenges. In all cases, children who have experienced a catastrophic disaster, such as the recent hurricane, need support from others to avoid long-term emotional problems. Working with Emotionally Traumatized Children 1) Be supportive and compassionate in talking with children to help them feel safe. Children who have been displaced from their homes by a disaster, have been separated from family mem- bers, or who have lost loved ones are particularly vulnerable. Help children share in maintaining their feelings of safety by asking them about their speciFc needs for comfort and self-care. Help them develop a personal csafety plan d-- informa- tion about where to go and whom to contact to feel more secure. 2) Discuss what is being done and what will be done to help in the future. In the case of a disaster such as the hurricane, reinforce that while no one can predict the future, it is not likely that another hurricane will happen again. 3) Encourage children to express their feelings and listen without judgment. Allow children to cry, be sad, or be angry. Do not force expression of the traumatic event, but let children know that it is normal to feel upset, angry, or afraid when something bad happens. 4) Provide structure and routine whenever possi- ble while being Gexible to children 9s needs. Let children make some decisions about routines and other aspects of daily life to the extent that it is possible. 5) Realize that children who have lost a parent, sibling, relative, teacher, friend, or pet will need additional support and for a long period of time. Be aware that memories and feelings about these losses are recurrent and can be triggered by eve- ryday images and reminders of the person or the hurricane, other events, holidays, or anniversa- ries. 6) Offer meaningful creative activities to encour- age children to express their feelings and become active participants in their own process of recov- ery (see next section). 7) Be open to ongoing discussions. New questions and feelings develop over time. Look for oppor- tunities to bring up issues and create an open en- vironment that encourages children to talk about their concerns at any time. 8) Be sure to manage your own feelings about the disaster or traumatic event. Take time to under- stand your own feelings and prepare yourself emotionally before you attempt to reassure or work with children. 9) Be sensitive to cultural differences among chil- dren who have experienced traumatic events or losses. For some children, expression of emotion or art making may not be acceptable or comfort- able. 10) Help children and families feel connected to peers and adults who can provide support and decrease isolation. Be aware of local resources to help children and families obtain additional help if it is needed. American Art Therapy Association, Inc. 2 Art and Trauma Recovery in Children In the aftermath of the events of September 11 th , 2001, and the recent tsunami disaster in Southeast Asia, art expression has proven to be a very im- portant part of the recovery process for children who have survived these traumatic events. Art offers a way for children to express their feelings, thoughts, and memories in ways that words cannot. With guidance and support, it can help trauma- tized children to make sense of their experi- ences, commu- nicate grief and loss, and be- come active participants in their own proc- ess of healing, beginning the process of see- ing themselves as csurvivors d rather than as cvic- tims. d For professionals using art activities with chil- dren, the experience of interacting with children who have experienced traumatic events may be a new one for you. The following guidelines may also be helpful in beginning your use of creative expression: 1) First, encourage children to express whatever they would like to express in their art. Some chil- dren also like to express themselves in other ways, such as in songs, stories, play, drama, or writing. Following a trauma it is important for children to be given choices. Because culture in- Guences self-expression, some children may feel more comfortable with one way of expressing over another. 2) Keep in mind that a child 9s age, ability, person- ality, interest, and skill inGuence their creations. The focus should be on the experience and proc- ess rather than the product. 3) Provide a safe and structured environment for creative expression to take place. Be empathetic, listen, encourage storytelling about art produced, and accept whatever is communicated about art created. Refrain from trying to interpret art and simply accept and encourage participation and self-expression. Engaging in a dialogue by simply asking a child to describe the elements in a pic- ture can be helpful and supportive. 4) Use art activities to promote self-reliance and problem solving in children. Provide opportuni- ties for experimentation with art materials, learn- ing new art skills, and making decisions about what to draw, paint, or make during an art ses- sion. 5) Be aware that children may use art expression in a variety of ways after experiencing a traumatic event. Some children will repeat images of the event in their drawings, paintings, or play activi- ties; others may resist memories of the actual event, preferring to use art activities to soothe and reduce stress. If trauma stories are expressed, remain calm, lis- ten, and respond without judgment or interpre- tation. It is particularly important for you to normalize any feelings expressed by letting children know that what they are experiencing is being experienced by many other children, too. 6) SigniFcant and personal feelings may be shared in the art making. It is important that children feel calm and in control at the end of an activity. Mak- American Art Therapy Association, Inc. 3 ing time to clean up or having a closing activity can be reassuring. About Art Activities & Materials Professionals who have not used art activities with children who have experienced trauma often wonder where to start. Using art in trauma recov- ery with children involves both non-structured and structured activities. Non-structured activi- ties are those that encourage children to create from their imagination 4in other words, to draw, paint, model, or build anything they would like. Many children already have ideas about what they would like to make in art and if they do, al- low them to experiment freely with materials in safe and structured environment and enjoy the soothing and rewarding experience of creative expression. Try not to be tempted to draw or paint for them, but be attentive and supportive and provide help if the child does not know how to use a material, brush, or tool. Other children, especially those who may be shy or withdrawn, may need a structured activity or theme to stimulate their participation and imagi- nation. For example, you might ask the child to draw a picture of a cworry. d Many children who have been traumatized have worries and fears since the tragedy happened. Making a picture of the worry or showing how big, what color, or what shape a worry is helps children to begin to identify fears and gives us a tangible image of what worries children Fnd difFcult to tell about with words. Use this as an opportunity to help the child Fnds ways to express feelings through art-- ask the child to show you through color, lines, shapes, or Fgures cwhat your worry looks like. d cSafety d is another common issue that can be turned into a structured activity for art making. Help children to create a painting or drawing of a real or imaginary csafe place, d where one can go in one 9s imagination when one is afraid or upset. Wherever possible, it is helpful to have the fol- lowing materials for creative expression: Materials for drawing -- pencils, colored pencils, oil pastels/Craypas, felt pens, and paper. Draw- ing materials help children to express and tell sto- ries and experiences because they allow for con- trol and detail. Materials for painting -- watercolor sets and tem- pera paints, and watercolor or card stock. Paint- ing helps children express stories and experi- ences, but also encourages expression of feelings through color and brushstroke. Materials for collage -- pre-cut magazine images, construction paper, tissue paper, string, yarn, glit- ter glue, and white glue. Collage is easy to con- trol, provides structure, and stimulates the imagi- nation. Materials for modeling -- Model Magic, Play- Doh, plasticine, and water-based clay. Modeling with clay provides the opportunity to work in three dimensions and to rework and reconstruct. Remember 4 not all children are familiar with art ma- terials. Be sure to show them what each material can do. For example, teach children basic skills about how to hold a brush, how to mix paint, and how to apply it to a surface. Be sure to create a structured environment for creativity that is safe and supports children 9s freedom to express them- selves through art. To locate an art therapist, please contact the American Art Therapy Association, Inc. at arttherapy@covad.net , visit our web site at www.arttherapy.org , or contact us at: American Art Therapy Association, Inc. 1202 Allanson Road Mundelein, IL 60060 1-888-290-0878 This monograph is based on information in Heal- ing Arts for Tsunami Survivors: Using Art Activities to Support Trauma Recovery in Children , a joint pub- lication of the International Children 9s Art Foun- dation ( www.icaf.org ) and the American Art Therapy Association, Inc., January 2005. American Art Therapy Association, Inc. 4

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