Four Years Later: Clara Revisited

TOPIC. The use of art therapy to treat posttraumatic response. PURPOSE. To demonstrate through the use of a case presentation ways in which art therapy can be used to facilitate healing from post-traumatic response. SOURCE. The author's own clinical work. CONCLUSIONS. The healing process for individuals experiencing post-traumatic response does not end with the formal termination of therapy. It may need to be supplemented with support and follow-up, short-term therapy episodes. Healing can be facilitated by art therapy, which provides a useful medium for identifying and exploring changes in self-concept, behaviors, and feelings. Key words: Art therapy, healing, posttraumatic response Childhood abuse and the accompanying consequences for adults who experience it have become a major problem in our society (Briere, 1992). "By extrapolating from prevalence figures for individual types of abuse, it can be conservatively estimated that at least one-third to one-half of all women will experience some type of abuse in their lifetime" (Bohn & Holz, 1996, p. 442). In a study of 1,040 consecutive admissions to a tertiary care military medical center, Brown and Anderson (1991) reported a prevalence rate of 18% for childhood physical or sexual abuse. The study included both males and females. Jacobson and Herald (1990) reported that 54% of the females and 26% of the males of the 100 psychiatric inpatients in their study had experienced some form of childhood sexual abuse. In a national telephone survey of 2,626 American men and women 18 years of age or older, sexual abuse was reported by 27% of the women and 16% of the men (Finkelhor, Hotaling, Lewis, & Smith, 1990). This article is based on a case presentation narrative that appeared in Perspectives in Psychiatric Care 6 years ago (Glaister, 1994). Clara's story reflects the relationship of child abuse to post-traumatic symptoms later in life. Art therapy was used to facilitate the healing process, which she experienced as helpful. Clara's story illustrates the ongoing nature of healing and the benefit of short-term, supportive interventions. Her drawings were used throughout all therapeutic episodes and provided a medium for identifying and exploring changes in self-concept, behaviors, and feelings. Clara was 37 years old when she first entered therapy and 44 when she returned to therapy. Clara chose to use her real name to emphasize ownership of herself and her work. Post-Traumatic Response People with histories of childhood abuse often experience post-traumatic symptoms and problems (Carlson, Furby, Armstrong, & Shlaes, 1997; Harvey, 1996; Rowan, Foy, Rodriguez, & Ryan, 1994). "Trauma permanently changes one's personal construction of reality, particularly after trauma is inflicted by another human being" (Root, 1992, p. 229). Three basic assumptions that change as a result of trauma are (1) believing in personal safety and security, (2) perceiving the world as meaningful and comprehensible, and (3) viewing oneself in a positive way (Janoff-Bulman & Frieze, 1983). Elements that distinguish traumatic from nontraumatic events include (1) the inability of the individual to control events, (2) the perception of the event as having a highly negative valence, and (3) the suddenness or abruptness in the occurrence of the event (Carlson et al.). As a result of trauma, individuals often feel vulnerable. Many try to make sense of the event they have experienced. They decide whether or not the world is safe and whether what they did or didn't do led to their situation. Depending on conclusions derived from this exploration, individuals determine how to view themselves. They evaluate the event as positive or negative and decide whether they deserve negative consequences. After the trauma, individuals either integrate the new data into their present assumptions, or revise their assumptions so they can again view the world as being nonthreatening. …