The Transformation Is in the Expressive Arts Relationship

A relational moment can be both reparative and life-saving.

Posted Nov 21, 2018

The Transformation is in the Expressive Arts Relationship

 © 2012 C. Malchiodi, Ph.D.
"Times They Are A' Changing" from an altered journal by C. Malchiodi.
Source: © 2012 C. Malchiodi, Ph.D.

The transformation and reparation of trauma through relationship is not a singular event; it involves multiple moments that support the unfolding of trust, safety, and co-regulation. Psychotherapy is one such corrective experience, because it includes a consistently empathetic relationship with another individual who can respond empathetically to anger, fear, and mistrust from the traumatized person. Verbal therapy contains valuable and effective relational qualities, such as well-chosen prosody, gesture and eye contact. Expressive arts therapy, however, adds something uniquely important to work with traumatized individuals, by naturally bringing in implicit sensory and body-based elements to psychotherapeutic dynamics that are not always available through even the most skilled verbal exchanges. In some cases, introducing expressive arts may be the only possible entry point to developing and restoring connection to others for those activated by personal narrative or unable to talk about any details even remotely related to their experiences. This is particularly true for individuals who have endured developmental, relational, and interpersonal trauma.

A Life-Saving Memory of Relationship 

One client in particular taught me much of what I know today about the psychotherapeutic relationship formed through expressive arts therapy. I first encountered Christa with her mother Joelle and brother Joey at a residential shelter program. During the two occasions she resided at a residential shelter with her mother and brother Joey, I truly believed I had failed miserably to help Christa in any meaningful way, because of her lack of responsiveness to my many attempts to establish trust and communication. The impact of developmental trauma did not resolve with her subsequent stay at an inpatient psychiatric unit for intensive treatment of multiple challenges. Christa's experiences of interpersonal violence and assault continued into her adolescence, with prostitution instigated by her mother Joelle, despite Child Protective Services workers’ attempts to remove Christa and her brother from the home. At age 15 years, Christa finally decided to run away from home to escape more sexual assault and prostitution. Her dissociative disorder and depression became so overpowering that by age 16 she contemplated suicide. But she consciously decided not to take her life when she remembered what she later called a “life-saving memory” of time spent at the shelter with her brother Joey in our art and play therapy sessions. That memory really did save her life; because of it, she managed to get herself to a university neuropsychiatric hospital and present herself for inpatient treatment by reporting her symptoms and intentions to end her life to the hospital staff.

Once Christa became a psychiatric patient on the hospital’s adolescent unit, she insisted that the social service workers assigned to her case contact “Dr. Cathy” to let me know that she remembered to “get help” if she felt in danger from others or herself at any time in the future. At first, the social workers were at a loss for who this person might be until Christa added, “You might know her. She is the one with the really funny last name. She was my art therapist when I was younger. We stayed at big shelter for mothers and children in the city.” At that point it was easy for the social workers to guess that it was me, given my unusual last name, art therapist identity, and previous work with domestic violence.

Of course, I was extremely curious and concerned about her condition, but also greatly relieved that she was safe from further assault and prostitution. The social workers who were handling her case agreed to meet with me, and Christa gave them permission to share her status and more detailed information about her current treatment. But what I was most intrigued about was what really brought Christa to arrive at the doorstep of the neuropsychiatric hospital, which I knew was not an easy journey due to the location.

What she put into a short written note to me I have kept to this day, because what Christa said convinced me that how we relate to individuals, both through words and nonverbal cues, always matters, even when they don't acknowledge in the moment that we are indeed making an impact on them. She wrote: “I know Dr. Cathy really cared about my brother (Joey) and me. She let me sit right next to her while she read stories to Joey and did not mind if I held her hand or laid my head on her shoulder sometimes. She always had time to play and draw with my brother. I couldn’t draw at the time, and I couldn’t talk much. She really wanted me to have fun when she and Joey played games and danced to music. But she was patient and let me just sit and watch Joey draw and play. I always knew that she loved both of us, and I want her to know that.” She included an image that she said that only I would understand; it was a small collage about “what I need” she had struggled to make during one of our sessions. I remembered that in addition to the basic needs depicted (food and a house), Christa searched through many photos for an image of a face; while she could not say anything about the face she chose, I always felt she was trying to communicate her internal emotional pain that was impossible to speak out loud. It was obviously an important art expression for her, so much so that she managed to keep the collage in her possession for the several years after her last stay at the shelter program.

Reading that last sentence of Christa’s statement pretty much brought me to tears; seeing the collage image once again brought back many memories of what she and Joey endured and survived. The fact that Christa also chose to communicate with me through that image affirmed that even during the times when she was too overwhelmed or dissociative to draw or create, she did feel that there was value in relating to me through art. Most of all, I was stunned that so many simple interactions I had initiated to establish a relationship were recalled by Christa, despite a lack of any identifiable responses from her when she was previously at the shelter in sessions with me. Her message, image, and ability to seek out help convinced me that we never really know how meaningful our psychotherapeutic interactions may be, and that we can build meaningful relationships even with the most severely impacted individuals. The fact that she used the word “love” let me know that she not only remembered, but she also felt something quite powerful within our relationship. Fortunately, she had been able to retain that feeling over the course of not only sexual assaults, but also her own struggles to stay alive. 

Children are not the only individuals who have taught me the importance of relational moments during expressive arts; over the years, many adults have come forward with similar memories that not only recall the psychotherapeutic relationship, but the sensory, implicit qualities that expressive arts added to the experience. Christa’s story reminds me that one of the most powerful and life-changing feelings one can have is to know that both one’s presence and absence mean something to someone. Relational work, at its best, is reflected in both the individual’s belief that the therapist values the person not only in the session, but also long after the therapy has ended. In this case, I was fortunate to receive the gift of being valued for the help I tried to offer during treatment, as well as being remembered long after therapy had concluded.