A recent Center for Disease Control [CDC] study reviewed the effectiveness of art therapy
and play therapy in trauma
intervention with children. According to the authors, neither has been proven to work for children with posttraumatic stress
disorder. But are these therapies effective
-that's the real question.
Because I have used art and play therapies in trauma intervention with children, adults, and families for more than two decades, a recently published study examining these and other interventions caught my interest. In brief, the CDC team concludes that out of seven therapies [play therapy, art therapy, drug intervention, psychological debriefing, cognitive-behavioral therapy, and two others] examined, only cognitive-behavioral therapy [CBT] was effective [see original study from the American Journal of Preventative Medicine at http://www.ncbi.nlm.nih.gov/pubmed/18692745]. Not an earthshaking conclusion, since most of the currently accepted evidence-based protocols for trauma intervention use CBT as the core approach.
Of course, professionals in art therapy and play therapy have been more than a little irritated by the release of this study. As an art therapist, yes, I admit I felt a little twinge of infuriation, too. As a researcher and proponent of outcome studies in these fields, I must also say that art and play therapists need to be more proactive about demonstrating efficacy for their methods.
However, the CDC team did miss a number of important aspects in their analysis. Surprisingly, they overlooked both the presence of art and play therapies within the very CBT interventions they cited - even when CBT is the identified intervention, it is often delivered within an art or play activity with an intended therapeutic goal. In fact, many art therapists and play therapists use methods such as CBT, and stress reduction, mindfulness, and narrative therapy, too, to enhance the methods they use in treatment. But more disappointing to me as a trauma worker, in an effort to make comparisons the CDC team lost sight of the very essence of what art and play therapies actually offer children who are traumatized.
The conclusions of CDC study bring about more questions than answers on many fronts. For example, the authors inaccurately define art therapy's role in trauma intervention with children, based on the examination of single journal article that proposed trauma is stored in memory as an image. Yes, trauma memories can be stored as images, but it does not necessarily follow that art brings forth traumatic memories as images alone. Art - and play for that matter-are experiences that include images, movement, sound, taste, smell, and other sensations.
As I have noted in previous posts, art also provides a more universal purpose in trauma work. While some proponents of art therapy believe that processing actual trauma memories via drawing or other creative activities helps to resolve trauma symptoms over time, it is more than the image itself that helps in reparation. We store much of what we experience during trauma as implicit memory, a sensory memory of the event. When most people, including children, draw a memory related to trauma, they generally do not draw an accurate
or photographic image of the trauma event. What they really draw, paint, or create, [or in the case of play therapy, enact] are sensory memories of the trauma. Sometimes these creations involve a narrative of the trauma, but more often they convey the "feeling" [implicit memory] of the events experienced. Getting out the sensory memories of trauma is where the real action is [along with a skilled professional who facilitates the experience]; it's not in making an accurate image of the trauma narrative.
I hope someday we'll read a CDC study explaining exactly how art and play therapies effect change in children who have been traumatized. As trauma expert Bruce Perry notes, art and play have decades of proven efficacy simply by their use within all cultures throughout history. Even so, we may not find that these sensory methods alone consistently repair trauma reactions in all children via standard research methods. But the creative process, whether making drawings or engaging in play, offers something else we ought to be measuring in child clients. Art and play therapies help to move individuals from a state of victimization to one of empowerment; that may be where the measurable effect resides and where the proof will be ultimately found.
**And I also look forward to seeing some of you at the 39th Annual Conference of the American Art Therapy Association next week in Cleveland, Ohio, from November 19th-23, 2008!
© 2008 Cathy Malchiodi