This article is reprinted from TLC's Journal, TRAUMA AND LOSS: Research and Interventions, Volume 1, Number 1, 2001
Cathy A. Malchiodi, ATR, LPAT, LPCC, is the Director, Institute for the Arts & Health and advisory board member, The National Institute for Trauma & Loss in Children, author of numerous books including,Understanding Children’s Drawings (1998) and The Art Therapy Sourcebook (1998), and published over 50 articles and chapters on the use of art intervention with children. Cathy has given more than 140 invited keynotes and presentations throughout the US and the world and is the editor of Trauma & Loss: Research & Interventions.
Abstract: This article provides a basic overview of how therapists and counselors can use drawing as intervention with children who have experienced trauma or loss. Topics covered include: drawing as a mode of communication for children; why drawings facilitate verbal reports; how drawing helps the process of recovery from trauma; drawing tasks useful in trauma debriefing and resolution, and overall considerations for professionals using drawings in clinical work. An appendix on drawing materials is provided for those therapists and counselors who do not have experience with art as intervention with children.
Introduction
Drawing is a natural mode of communication that children rarely resist and that offers a way to express feelings and thoughts in a manner that is less threatening than strictly verbal means. For the child who has experienced trauma or loss, it helps to externalize emotions and events too painful to speak out loud and is one of the only means of conveying the complexities of painful experiences, repressed memories, or unspoken fears, anxieties, or guilt. Drawings expediently bring issues relevant to treatment to the surface, thus accelerating the helping professional’s ability to intervene and assist troubled children. A drawing can provide information on developmental, emotional, and cognitive functioning, hasten expression of hidden traumas, and convey ambiguous or contradictory feelings and perceptions. With the advent of brief forms of intervention and the increasing pressure to complete treatment in a limited number of sessions, drawing helps children to quickly communicate concerns and problems, thus enhancing the efficiency of therapist-child interaction.
Offering children the opportunity to communicate through drawing is a strategy that can easily be a part of every therapist’s repertoire. Although other modalities can help children express themselves, drawing is certainly one of the most economical. Drawings are particularly useful in trauma debriefing where sensory-based methods have been identified as helpful in disclosure and crisis resolution (Malchiodi, 1997; Pynoos & Eth, 1985; Steele, 1997).
This article proposes that therapists and counselors consider using drawing with children who are recovering from traumatic events or loss. Topics include a brief overview of drawings as intervention; why drawings facilitate verbal reports; why drawing is helpful in recovery from trauma; drawing tasks useful in trauma debriefing and resolution; and overall considerations for professionals using drawings in clinical work. An appendix on drawing materials is provided for those therapists and counselors who do not have experience with art as intervention with children.
Drawings: A Picture is Worth a Thousand Words
For more than a century psychologists, educators, and others have tried to determine whether or not children’s drawings reveal their thoughts, feelings, and psychological well-being. To some extent, a drawing is “worth a thousand words” and does reflect the child who created it. Drawings are useful in understanding and evaluating a child’s development (Gardner, 1980; Golomb, 1990; Kellogg, 1969; Lowenfeld & Brittain, 1987) (Figures 1, 2, 3, & 4), and the universal stages of children’s artistic expression are a basis for using drawing in intervention (Malchiodi, 2001a; 2001b). Children’s drawings have been used as projective measures of personality (Buck, 1966; Hammer, 1967; Koppitz, 1968; Oster & Montgomery, 1996), but have proven to be less reliable in this regard than first thought. Specific drawing tasks have also been developed and applied to the evaluation of cognitive abilities in children (Silver, 1996; 2001).
rawings as Intervention
While drawings may say a great deal about the child who creates them, what is more important are the therapeutic benefits that the process of drawing provides. In recent decades drawing has become a recognized modality in therapy with children (Malchiodi, 1990; 1997; 1998; 1999; Rubin, 1984) and has been used in the treatment of children who have been physically or sexually abused or exposed to domestic violence (Malchiodi, 1990; 1997; Riley & Malchiodi, 1994; Webb, 1991); have emotional disorders (Kramer, 1993); or have medical conditions (Malchiodi, 1999). Pediatrician Donald Winnicott (1971) noted that children’s art could be used as means of communication between therapist and child and believed that his young patients wanted to be active participants in their treatment. Winnicott recognized the value of drawing in helping children express their problems and world-views. His work affirmed that drawings can be a catalyst for increased interaction and interchange, thus expanding the effectiveness and depth of the relationship between clinician and child.
Art expression, particularly drawing, seems to be well suited as an intervention with children who are traumatized or abused because it may be easier to use visual communication than to talk about painful feelings and experiences (Malchiodi, 1997; Steele, Ginns-Gruenberg, & Lemerand, 1995). Drawing mobilizes the expression of sensory memories, and recent attention to neurobiological factors in the treatment of trauma (Siegel, 1999; van der Kolk, 1987) has enhanced understanding of why drawing can be particularly helpful in debriefing, disclosure, and resolution of trauma. Because the core of traumatic experiences is physiological, the expression and processing of the sensory memories of trauma are essential to successful intervention and resolution.
Drawing is an activity that taps a variety of senses--tactile, visual, kinesthetic--in ways that verbal processing alone does not. It is possible that drawing stimulates neurological processes that, in conjunction with trauma-specific questions and debriefing techniques, may be specifically helpful in resolution of stress reactions, intrusive thoughts, and other posttraumatic effects. Drawing and art expression provide “self-soothing” experiences, ones that are used by traumatized children to reduce stress and ameliorate posttraumatic stress reactions (Malchiodi, 1990; 1997), and the rhythmic actions involved in drawing and coloring are reminiscent of the movements used in trauma interventions such as Eye Movement Desensitization and Reprocessing (EMDR) (Schapiro & Forrest, 1997).
Facilitating Verbal Reports
Drawing is particularly useful in trauma intervention because it both facilitates children’s ability to verbalize their experiences and encourages the expression of emotionally-laden events more successfully than talking alone. Gross and Haynes (1998) conducted a series of studies to explore how and if drawing facilitated verbal reports in children, supporting the premise that drawing does indeed appear to enhance children’s communication of feelings and perceptions. In their initial investigation they compared two groups of children: one group who talked about experiences while they drew and a second who were simply asked to tell about their experiences. Children who were given the opportunity to draw while talking about their experiences did report more information than the children who were merely asked to talk. A second experiment was conducted to examine children who were interviewed with both procedures; it also revealed that children do report more when asked to draw.
These researchers hypothesized that there may be several reasons why drawings are helpful adjuncts to increasing children’s verbal reports:
- Drawing may reduce anxiety and help the child to feel more comfortable with the interviewer or therapist;Drawing may increase memory retrieval;
- Drawing may help children organize their narratives;
- Drawing may help in prompting children to tell more than they would during a solely verbal interview (Gross & Haynes, 1998).
In the field of art therapy, drawings have been traditionally used with children in numerous ways to encourage verbal expression. For example, Gabriels (1999) used a specific series of drawing directives to help children with asthma relate their experiences with breathing difficulties and to identify environmental triggers of symptoms. Barton (1999) developed a drawing protocol using simple body outlines to assess pain severity with children with arthritis. In legal contexts, Cohen-Liebman (1994; 2001) has observed that drawings are useful in obtaining information on abuse and neglect from children and in forensic interviews with child clients for court cases involving maltreatment or child custody.
Specific Drawing Tasks for Trauma Debriefing and Intervention
There are several drawing tasks that seem to be particularly helpful in situations where the helping professional encounters a child who has witnessed a traumatic event such as an accident, domestic or neighborhood violence, or has experienced traumatic loss such as the death of a family member, friend, or classmate, or even the loss of a parent through divorce or separation. In applying the drawing tasks described below, it is important to accept that children who have been traumatized do need and want to relate the terror of their experiences. For many years it was believed that children should not be asked to talk about these traumatic memories for fear of re-traumatization. However, it is now known that it is important to the recovery process to provide children with ways to express their apprehension and worries and to provide sensory experiences that mobilize the expression of these feelings in a structured manner.
Several drawing tasks are particularly useful, including:
- Drawing “What Happened”. When an individual experiences a trauma, drawing “what happened” is essential. Pynoos and Eth (1985) found that in order to successfully resolve and master a traumatic event, children must have the opportunity to recount the experience in detail. They proposed a structured interview along with drawing to facilitate this process. While it is a difficult task to recreate an image on paper of the traumatic event, most children find a degree of relief in finally being asked to describe what happened
