“Once we can easily engage the social system, we are free to mobilise without being in flight or fright… living more fully, experience more positive emotions, and engage in satisfying, spontaneous relationships”
– (Porges, 2011)
Childhood Trauma
A child removed from their parents or primary caregiver due to abuse and neglect will potentially suffer the effects of significant trauma and attachment issues for many years, resulting in developmentally adverse consequences (Van der Kolk, 2005). Trauma disrupts cognitive, neurological and psychological development in the child and negatively affects attachment to adult caregivers. Some children may also suffer effects of trauma after the death of a loved one, bereavement, survival from a serious accident, or experience a natural disaster (Malchiodi, 2014, p.3).
Research has highlighted the increasing number of adverse childhood experiences in individuals contributes to long-term significant health outcomes across the lifespan (Felitti, 2002). While some children have the inept ability to cope with highly stressful situations, others may not and require the help of specialist therapy to overcome and process the painful memories to release the trauma impacting brain development and healing. These children are at risk of developing serious symptoms that interferes with normal cognitive, emotional, physical, or social development (Malchiodi, 2014, p.3).
According to Terr (1990), trauma does not heal itself and burrows deep down within the psyche, limiting the child’s ability to regulate, defend him or herself and develop positive coping mechanisms (Terr, 1990). It is important for the therapist to form and develop a trusting, productive relationship with the child to help them safely revisit painful memories, make meaning from the experience and instil a sense of hope (Malchiodi, 2014, p.3).
Trauma Reaction and Responses
During hyperarousal children may experience intense psychological distress and physiological reactivity when exposed to an aspect relating to the traumatic event. This may lead to difficulties with concentration, difficulties falling or staying asleep, outbursts of anger, hypervigilance, and irritability (Van der Kolk, 2005). Children may also experience hypoarousal in the form of dissociation when exposed to situations that stimulate sensory memories.
Many children may avoid these intrusive thoughts, experience nightmares, be unable to recall elements of the event, detach from family and friends, persistently blame themselves and refrain from participating in events they previously found enjoyable. Additionally, relationships may become fractured with the forming of attachment disorders to primary caregivers (Malchiodi, 2014, p.5)
A Creative Approach to Therapy
The Australian, New Zealand and Asian Creative Arts Therapies Association (ANZACATA) is the peak professional association for creative arts and defines these therapies as, “a natural aspect of all cultures and human experience” (ANZACATA, 2021).
The principles of creative therapies are embedded in client-centredness, where the practitioner is led by the client who inherently knows the best and most appropriate healing approach for themselves, facilitated by the practitioner.
Other principles include a connection to the subconscious through multi sensory exploration using metaphor and creative expression. It is important practitioners describe creative material but do not interpret, for this is the transformative element clients seek to express themselves.
Creative therapies offer many benefits in assisting trauma-affected individuals. For children, it can often be difficult to express themselves through traditional talking therapy sessions, so the familiarity of engaging in a fun activity is a softer approach to developing a trusting therapeutic relationship. Children take pleasure in making, inventing, doing and creating; and use this natural ability to engage in imaginative play or creative endeavours. These creative activities help to develop individual self-worth and confidence through enhanced self -xpression (Malchiodi & Perry, 2014, p.20).
Brain Integration through Creative Therapies
As therapists, it is useful to know what is happening to the brain when clients engage in creative activities. According to research, creative therapies are successful in helping clients to become more expressive, communicative, and more aware of their thoughts and memories, invoking an invitation for change (Eaton et al, 2007). When clients experience increased awareness and are able to talk about traumatic events in a safe and calm environment, information flows simultaneously in multiple directions, involving many neural networks across the brain, nervous system and body.
Networks combine emotion, behaviour, sensation and conscious awareness into an integrated, functional and balanced whole. Both sides of the brain are involved in healing although the predominant flow of information in dialogue-based counselling is top down (cortical to subcortical) and left to right hemisphere. However, it should be noted that, due to the brain’s complex interconnectivity of systems, it is too simplistic to approach brain integration in this way (Cozolino, 2017, p 27- 31).
How do Creative Therapies fit with Neuroscience?
Neurobiological evidence and research support the integration of play and creative arts approaches into a neurosequential approach to psychotherapy with clients across the lifespan (Eaton et al, 2007). In children, therapies designed to connect the limbic and cortex regions will help to regulate early childhood experiences and meet developmental milestones. These include physical coordination, making friendships, sharing, learning to recognise and regulate emotions, enhance verbal and nonverbal communication, develop empathy, learning right from wrong, develop cognitive reasoning, and problem-solving capacity.
Utilising a range of sand, play, dressing up, storytelling, art, games with rules, imaginative play and bibliotherapy enhances limbic and cortical development, designed to compensate for interruptions in the child’s developing years (Prendiville & Howard, 2016, p. 28).
When working with children impacted by trauma, it is important for therapists to determine if the client shows signs of being hyperaroused or hypoaroused in choosing an appropriate up-regulating or down-regulating therapeutic approach.
Effective therapy work with children is enhanced by including active involvement by the primary caregiver (Prendiville & Howard, 2016, p.36). The use of active methods in therapy will build bridges between the left and right hemispheres of the brain and implicit and explicit memories (Perry, 2006).
Furthermore, creativity has been described as a protective catalyst for memory reconsolidation, as it transforms the past negative experience into something new, providing a sense of control, and distance from the event. It has been proven to assist clients with autobiographical memory through the practice of reflection, creation, touch, space, emotions, and meaning-making; ultimately helping the client to deal with long–term stress and trauma issues (Hass-Cohen & Clyde-Findlay, 2015).
Triume Brain Model
The Triune Brain Model helps us to identify which areas of the brain are affected by trauma and how therapists can help clients to rebuild functioning and development.
According to neuroscientist Paul Maclean, the brain has three distinct sections identified as the reptilian brain, the mammalian brain, and the rational brain.
The reptilian brain is the oldest part of the brain which includes the brainstem and cerebellum. Its function is to coordinate basic regulation, reflexes, level of arousal, cardiovascular functions and motor, emotional and cognitive functions.
The mammalian brain includes the limbic (emotional) system and drives urges, needs and feelings.
The rational brain is the youngest part of the brain and includes the neocortex and is responsible for thinking, planning and problem solving. It also provides for self-awareness, imagination and creativity, and empathy (Howard & Prendiville, 2017, p 13).
The right hemisphere is associated more closely with the body, emotional aspects of experience and visual-spatial processing and is dominant in the early years of life. It is sensory based and creative and relies on the somatic, embodied aspects of experience rather than verbal language. The left hemisphere takes the lead in language processing, linear thinking, and pro-social functioning. (Cozolino, 2017, pp 27 – 31; Howard & Prendiville, 2017, p.7.)
Brain Changes in response to Trauma
The treatment of trauma can be some of the most complex work therapists face. However, recent scientific advances in brain study have assisted therapists to understand what happens in the brain of someone who has experienced trauma. According to Van der Kolk (2021) there are three major ways the brain changes in response to trauma.
The first change in the brain occurs in the primitive brainstem (reptilian brain) with the perception of enhanced danger. This threat perception changes to a fear-driven brain. The second response relates to the thalamus, which is the brain’s filtering system becoming compromised, making it difficult to concentrate, focus and engage in ordinary situations (mammalian brain).
The final change relates to the self-sensing system within the rational brain as it challenges self-perception, triggering a defence response, and making the individual feel bad about themselves, manifesting as heartache and significant sadness. This often results in self-soothing malpractice such as alcohol and drug misuse to minimise negative feelings; inadvertently diminishing connections with others and responses to pleasure, sensuality, and excitement (Van der Kolk, 2021 NICABM).
For more information about how you can include creative therapies as part of your psychotherapy practice, visit https://anzacata.org/
References
ANZACATA (2021). About Creative Arts Therapies. https://www.anzacata.org./About-CAT
Cozolino, L. (2017). The Neuroscience of Psychotherapy. Healing the Social Brain. W.W Norton and Company.
Eaton, L.G., Doherty, K.L., & Widrick, R. L. (2007). A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. The Arts in Psychotherapy, v.34(3), 256-262.
Felitti, V. J. (2002). The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal, Winter; 6(1): 44–47.
Hass-Cohen, N & Clyde-Findlay, J. (2015). Art Therapy and the Neuroscience of Relationships, Creativity and Resiliency: Skills and Practices (First Ed), W. W. Norton & Company.
Malchiodi, C. A. (2014). Neurobiology, Creative Interventions, and Childhood Trauma, p. 3. In C. A. Malchiodi & B. D. Perry (2014), Creative Interventions with Traumatized Children (2nd Ed). Guilford Publications.
Malchiodi, C. A. (2014). Neurobiology, Creative Interventions, and Childhood Trauma, p. 5. In C. A. Malchiodi & B. D. Perry (2014), Creative Interventions with Traumatized Children (2nd Ed). Guilford Publications.
Perry, B. D. (2006). The neurosequential model of therapeutics. Applying principles of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (ed.) Working with Traumatized Youth in Child Welfare, p. 27-52. Guildford Press.
Porges, S. W. (2011). The Polyvagel Theory: neurophysiological foundations of emotions, attachment, communication, self-regulation. Norton.
Prendiville, E., & Howard, J (2016). Creative Psychotherapy : Applying the Principles of Neurobiology to Play and Expressive Arts-Based Practice. Taylor & Francis.
Terr (1990) Creative Interventions and Childhood Trauma, p.3 In C. A. Malchiodi (2008), Creative Interventions with Traumatized Children (2nd Ed). Guilford Publications.
Van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annuals, 35:401–408