As the 10th anniversary of the events of September 11th approaches, like many mental health professionals I am revisiting what I experienced and in particular, what lessons I learned about psychological trauma. In the weeks and months after the terrorist attacks I provided art therapy and mental health counseling to numerous individuals who were directly and indirectly affected by events in New York City and Washington, DC. I also had the unique opportunity to talk to hundreds of children throughout the US about their impressions of what happened and to ask them to tell me through drawings about the events they witnessed either firsthand or on television.
Art therapy reached a new level of public recognition in the days just after 9/11. Just about every major newspaper and print magazine featured stories about how art therapy was used as psychological intervention with children who lost a parent in the attacks, particularly those associated with the World Trade Center. Hillary Clinton, then US Senator for NY, entered a statement in the Congressional Record shortly after 9/11 citing that "since September 11, many of us have witnessed its enormous benefits in helping both children and adults alike express their emotions in a very personal, touching way." As I look back on that time period, I am reminded of just how much has been learned about trauma intervention with children in particular. Here is some of what psychologists, counselors, and creative arts therapists have learned, post 9/11:
Repeated exposure to traumatic events impacts the content of children's art. As I have noted in previous posts, "when trauma happens, children draw." After 9/11, children were drawing images about the attacks, whether at home, in clinics, in community agencies or at school; some of their art expressions were spontaneously created while others were at the request of concerned therapists, teachers and parents. Their drawings conveyed remarkably similar stories about 9/11
and mostly one singular and iconic image: planes flying toward or into the World Trade Center. A smaller percentage of children included a second incident associated with the attacks in New York City-- the depiction of people falling out of the Twin Towers. These children usually reported that they had viewed television footage of this particular event. While commonsense tells us that children draw what they see, the repeated widespread exposure via media to images of the destruction of the Twin Towers taught mental health professionals a lot about how children translate what they experience into art. Specifically, we learned just how children use drawing to express repeatedly televised images that are traumatic, frightening and confusing.
The content of children's drawings, paintings and play activities, post-9/11, also offered a context for new understanding of posttraumatic stress reactions in children. While no large scale art therapy studies were conducted, collective clinical and anecdotal observations about the content of children's drawings post-9/11 and after other disasters such as Hurricane Katrina provided some valuable insights. For example, children who were more susceptible to long-term trauma reactions such as PTSD were less likely to include images of helping adults such as first responders in their drawings of traumatic events than those children who were more resilience. In brief, art expressions may give us clues to which children have a positive outlook and hope in the future in contrast to those who believe help will never come.
Art expression stimulates narrative. Studies during the past decade underscore that art is not just a "right brain" activity, but actually a "whole brain" activity that stimulates storytelling. In fact, research with children indicates that drawing while talking about an emotionally laden event can actually stimulate two to three times as much narrative than just talking alone. This finding is having wide-reaching impact on current treatment of a variety of stress responses, including PTSD in returning military and interest in developing graphic narrative approaches for Veterans as therapy and self-help.
Art expression is a form of re-exposure to sensory memories. In my interviews with children post-9/11, it became evident that drawing images or impressions of traumatic events re-exposes individuals to some of the same sensory (visual, auditory, kinesthetic and tactile) memories of that event. For some this is an opportunity to make meaning of an emotionally laden or upsetting experience. For others-- particularly those with unresolved trauma reactions-- it may trigger avoidance, intrusive memories or anxiety, requiring strategic and sensitive intervention on the part of the therapist. Increased understanding of creative arts therapies and play therapy as forms of exposure therapy after 9/11 are contributing to contemporary best practices with not only traumatized children, but combat military in the form of sensory interventions as wide-ranging as virtual reality programs to art-based programs for the treatment of PTSD and related conditions in Veterans hospitals.
Art theorist and perceptual psychologist Rudolph Arnheim once noted, "Art serves as a helper in times of trouble." The events of September 11th, 2001 increased our knowledge of how art serves as a helper in times of profound crises. More importantly, 9/11 ironically resulted in greater recognition of art therapy's potential to illuminate our understanding of posttraumatic stress and why the healing arts are important and effective approaches to trauma intervention for individuals of all ages.
Cathy Malchiodi, PhD, LPAT, LPCC
©2011 Cathy Malchiodi
Malchiodi. C. (2008). Creative interventions with traumatized children. New York: Guilford Press.
International Society for Traumatic Stress Studies (2011). Guidelines 16 and 17 (Creative art therapies). Retrieved at http://www.istss.org/TreatmentGuidelines/3337.htm.