The Treatment to Children PTSD with Art Therapy

Abstract:

There are many children in the US who suffer from PTSD symptoms, such as depression and insecure attachments. Also, have effects on their behavior due to possible changes to the frontal lobe. These children have the ability, however, to free themselves of the pain, by receiving help from a therapist. Art therapy is found to help children who have undergone some level of PTSD, by exploring their feelings and through the catharsis of art.

A sad truth is that in the United States “an estimated 4 to 10% of children have experienced maltreatment, such as neglect, abuse, and sexual violence (Leenarts, Diehle, Doreleijers, Jansma, & Lindauer, 2012) and approximately 15 million children are affected by domestic violence each year (McDonald, Jouriles, RamisettyMikler, Caetano, & Green, 2006). After being exposed to traumatic events, many children exhibit harmful behavior toward themselves or others. Because of this harmful behavior, 50,000 children end up in residential treatment, (Vaughn, 2005) and nearly 4 million children in the U.S. are diagnosed with mental health disorders (Thompson & Trice-Black, 2012). Not only is it concerning that many children are exposed to trauma, but also the likelihood exists for children diagnosed with PTSD to experience life-long negative consequences.” (Puent). So long as these people, these children come forward though, there is still hope. There are ways that we can help these people get over the trauma that their past experiences left them feeling, such as through art therapy, which is found to be helpful, particularly for children.

Children experience helplessness for they feel, and are truly unable, to change their environment; and they don't understand that this situation can be temporary. Eventually, they will get the keys to their freedom. Executive functioning is not fully in place in children or adolescents, so they can’t grasp the concept that there is an end in sight. Now, as older individuals, if we have a teacher, for example, that causes us misery, we have an inner locus of control and we can figure out a way to get out of it. (Klapper).

“Trauma is an event that is life-threatening or psychologically devastating to the point where a person’s capacities to cope are overwhelmed” (Gilgun, 2010, p. 3)”. (Puent). This response leads to the state of the Sympathetic nervous system which causes a person to disregard non-immediate needs, such as feelings of hunger, undergo an adrenaline rush, and yield feelings of intense fear; fight or flight. “Being traumatized by an event happens when there is no escape or self-defense possible (Herman, 2015).” (Puent).

There are three types of trauma: firsthand, second hand, and complex. All types can affect any individual without regard to age, sex, or race. Firsthand trauma is something experienced by the individual himself; it affects one physical state as they perceive danger and it overwhelms a person and their system and causes one to feel emotions such as fear. Examples of first-hand traumas would be abuse, natural disaster, or exposure to violent crimes. Second-hand trauma is trauma taken in situationally, by learning of another’s traumatic event. An example would be hearing of another person's experience during the Holocaust. Another way that someone may be exposed to second-hand trauma is if they are experiencing the death or injury of a loved one, and the death or injury was caused by something unexpected or violent. Complex trauma is a person's prolonged experience of trauma that affects them, in a real way, as an individual. Because child neglect or abuse can happen frequently over time, various forms of child neglect or abuse can be examples of complex trauma (Fusco & Cahalane, 2013). (Puent).

The person who witnessed the traumatic event will “experience intrusive symptoms such as distressing memories, upsetting dreams, dissociative reactions, avoidance of things related to the traumatic event, negative moods and thoughts related to the event, and strong reactivity to things associated with the event” these are symptoms which are exhibited in people suffering from PTSD. (American Psychiatric Association, 2013).” (Puent).

The individual will often think about the event that has transpired and may repeat “behaviors and reenact the traumatic event because the trauma survivor feels compelled to re-create the moment of terror in order to conquer the feelings that resulted from the traumatic event” (Puent). This is an interesting point, and a sad truth; the client seems to need to come to terms with an event by gaining a level control over the event, at least in their mind. It is unhealthy, however, for the individual to do this. This process of resurfacing and delving into past emotions and experience is something that can be beneficial, though, likely, in a therapy session, for example in play therapy, where the client can release these emotions and the therapist can help the client to work through and understand these emotions with them.

Trauma is also experienced in the mid-brain and lower brain making reason and logic not easily accessible through talk therapy or cognitive therapies (Kuban, 2015). Damage is done to the neuroendocrine system when children don't have a secure attachment to caregiver due to abuse or neglect. Child abuse or neglect has a repercussion upon the limbic system, the developing brain, which includes the amygdala, the hippocampus, the cerebral cortex, and the corpus callosum. “The limbic system controls emotions and survival drives such as fight, flight, or freeze responses.” (Puent). Without a properly functioning limbic system, people can act on impulse. 'Harm to the hippocampus causes difficulty in understanding special contexts and recalling memories or events and is related to dissociative states, anxiety and panic disorders' (Coates, 2010). (Puent). Children, thereby have the potential to hurt others, for through the trauma they experienced the way they act is effected. “Brain development is affected by early life stress, with the potential to cause neurobiological changes that affect the individual for the rest of his or her life (Coates, 2010).” (Puent). This effects serotonin levels, as well, which impact moods. Low production of serotonin makes a person vulnerable to depression and aggression. There is hope, however, that restoration can be done through intervention and neural plasticity, which is especially prevalent in children. (Puent). Additionally, to highlight the point about secure attachment, it is vital to help the child to be able to create secure attachments, despite not being able to create one with a parent or caregiver, so that they can develop bonds and attachments for the future.

With children, there are other variables, in comparison with adults. Let’s say a child went through a loss but they are outside playing with friends, so objectively they may seem “fine”. We need other ways than to get to see what's really going on. Art therapy, for example, is a tool to get into their world. Or play therapy, is another way, and can be very telling, if, for example, if the child will choose to lock the father doll in the attic. (Klapper).

“Young children may not be developmentally capable of completing typical talk therapy or written activities that are commonly used with adults, such as self-report questionnaires, activities that involve reading, or activities that require advanced thinking and advanced verbal skills” (Yorgin et al., 2004). (Puent). It is easier for children to put their thoughts, hopes, and feelings into drawing them into words. “Projective drawings are thought to provide information about a person’s personality, fears, wishes, strengths and motivations (Kaufman & Wohl, 1992).” (Puent). A specified type of drawing that is used to assess how the client views familial relationships is called the kinetic family drawing. Look how each individual is represented if they are incorporated, and how they are incorporated. Chapman (1999) stated, “The art media, as the facilitator of expression, allows for the creation of symbols and metaphors which become a psychological mechanism for change.” (Puent).

Art Therapy is a good method of communication between client and therapist. Additionally, the art serves as a metaphor, so to speak, and relays the client’s inner thoughts and feelings, that are often unconscious. Art, in it of itself, is therapeutic and is therefore helpful in treating PTSD, and other issues. The Art Therapy Association well defines the role of art therapy:

“Art Therapy is a mental health profession in which clients, facilitated by the art therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self- awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem. A goal in Art Therapy is to improve or restore a client’s functioning and his or her sense of personal wellbeing. Art Therapy practice requires knowledge of visual art (drawing, painting, sculpture, and other art forms) and the creative process, as well as of human development, psychological, and counseling theories and techniques.” ('American Art Therapy Association,' 2013, para. 3).

A “traumatic event and the resulting PTSD symptoms that children experience tend to disrupt their psychological and emotional development” (Puent). It is then as though a person is developmental younger than their true age, and the therapist must work with the patient at their level. Need to build a relationship, a secure attachment kind of relationship, with the caregiver and to teach the child self-regulation. 'To avoid re-traumatization, it’s important to find positive ways to integrate trauma memories into the trauma survivor’s life. Art Therapy is one researched approach that meets these needs” (Puent).

As an Art Therapist, there are a few general points to keep in mind. One is that there must be a variety of media accessible to the client, paint, for example, which is more fluid and pencil which is restricted, and note which media the client uses and how they do so, in accordance with their age. There is also structured and unstructured in the way the art is presented. Does the client have a point to their creation, does it tell a story, is there any main aspects or images in the foreground? Talk to their client about their work and their feelings. “Narrating or sharing one’s own story about a traumatic event, in drawings, can be one of the most effective ways to treat trauma (Knoverek et al., 2013)” (Puent). For the child to have a chance to share the progression of their story, in a visual way, to move past the dark memories and into the present. “In families where there has been violence or abuse, art can help to alter worldviews of the family and provide a way for family members to cope with the loss and grief that is associated with that violence.” (Puent).

There are three possible ways in which someone may deal with trauma. One may strike out against others, which is a fight response. On the other side, one may utilize a flight response, in which the person may distance his or her self from any situation which presents conflict or is seemingly threatening. A third response would be for the individual to disregard the event which is happening or happened and to act as if nothing is going on. “While these reactions may be momentarily helpful in protecting the psyche, there are negative repercussions that affect one’s ability to function both interpersonally and intrapersonally when unresolved trauma persists (Badenoch, 2018; Siegel, 2010a).” (Perryman, Blisard, and Moss).

As a therapist, the role is to continue to give the client the opportunity to be heard and helped. “For some clients, processing an activity verbally may be sufficient for resolution. For others, writing about their reaction to the activity and then sharing it with the counselor may offer added benefits in clarifying their stories.” (Perryman, Bisard, and Moss). Others need more time to process, so doing work at home, such as drawings, which engage the right hemisphere of the brain, can be helpful. (Perryman, Bisard, and Moss).

There are two practically opposing opinions on how parents can affect, or not affect, their child's PTSD. Scheeringa, M. S., Myers, L., Putnam, F. W., & Zeanah, C. H. say, “it is generally believed that the parent-child relationship is of central importance for normal social and emotional development (Crockenberg and Leerkes 2000; Zeanah et al. 1997a).” “Among the constructs of social-emotional development, emotion regulation has been considered the keystone development in the early years of life,” and the sensitivity that the parent, particularly maternally, makes a difference, especially in the long run, in child psychopathology.

In a limited study spoken about by Furuta, M., Sandall, J., Cooper, D., & Blick, D., it was found that the parent does not seem to have much effect on the way the trauma effects the child. While studies do show that there 30% heritable predisposition to trauma, it is not significant enough to be very impactful. Neither does the parenting style, sensitivity, or lack of sensitivity seem to affect the severity of the trauma. In fact, they found that parents can become distressed because the child is distressed, and not the other way around. The best way to combat trauma is to deal with the trauma itself. In comparison to the DSM-IV, the DSM-5 includes two new subtypes of PTSD. (1) In reference to preschool age children, who manifest symptoms differently than older children and adults. Their symptoms are thereby different and are more rooted behaviorally. (2) “dissociative subtype of PTSD that includes symptoms of depersonalization and derealization (APA 2013).” (Choi, Graham-Bermann). One may repress memories because of trauma or remove themselves from the event.