ERASING THE TRAUMA: ARTS THERAPIES

Blair E. Hughes
Ivy Tech University
November 27, 2015

Erasing the Trauma: Arts Therapies

Abstract
Arts therapies includes art therapy, music therapy, and dance/movement therapy among
others. These therapies are beneficial in the healing of trauma in children. Diagnosing trauma is
one of the reasons helping children heal from trauma is difficult. Another reason is providers are
quick to diagnosis and treat the symptoms rather than the underlying factors of trauma.
Medication management is overly used despite the vast dangerous side effects proven to exist
with many medications used to treat the symptoms of trauma. If arts therapies were utilized in
addition to talk and behavior therapy, children would be more apt to heal from the trauma instead
of compensating through negative means.

Erasing the Trauma: Arts Therapies

Erasing the Trauma: Arts Therapies

Gabe, a 7-year-old diagnosed with Post-traumatic Stress Disorder (PTSD), AttentionDeficit Hyperactivity Disorder (ADHD), Oppositional Defiance Disorder (ODD), Reactive
Attachment Disorder (RAD) and Communicative Disorder, was arguing with a peer over a
soccer ball. Mrs. Smith and Mrs. Johnson intervened, and the students were taken to separate
locations. After being separated, Gabe continued to act aggressively towards staff members.
This resulted in staff members utilizing Crisis Prevention Institute (CPI) transportation to the K3 grade timeout room. Once Gabe was in the timeout room, he attempted to block the door from
closing with his foot. A staff member removed one boot from his foot while another staff
member attempted to remove the second boot. Gabe hit Mrs. Smith with a closed fist. Then,
staff members shut the door, and Gabe began to growl. He then removed the second boot, using
it to hit the window of the timeout room, causing the glass to splinter. Gabe punched the window
with a closed fist, effectively shattering it. Officer Jackhoff removed Gabe from the room, due to
the broken window. He transported Gabe to the timeout room in the 4-6 grade room. Gabe
continued to show aggression in the 4-6 grade timeout room, which did not have a window.
Officer Jackhoff placed Gabe in a restraint, effectively blocking his arms and legs, in an attempt
to keep himself and others safe while waiting for Sally. Sally, who is CPI trained, arrived and
relieved Officer Jackhoff, continuing the restraint. Mrs. Higgins arrived to monitor the restraint,
ensuring CPI procedures were followed and to ensure the safety of Gabe. The restraint was
maintained until 1:37pm, when Gabe stopped attempting to get out of the restraint and stopped
being verbally aggressive. Gabe then sat in the timeout room with the door open until 2pm, when
he came out and told Mrs. Higgins and Miss Jones he was ready. Gabe was unable to process
what triggered his episode. Later in the week, during an appointment with his therapist, Gabe

Erasing the Trauma: Arts Therapies

was asked to draw a picture of the event with the soccer ball. By utilizing art during therapy,
Gabe was able to disclose memories of a traumatic time in his life which had resurfaced during
the time he was with the peer. Gabe is just one of millions of children who suffer from PTSD.
According to a report by the National Association of State Mental Health Program Directors
(NASMHPD) and the National Technical Assistance Center for State Mental Health Planning
(NTAC), Every year, between 3.5 10 million children witness the abuse of their mother. Up to
half of these children are also abused themselves (2004, p. 72). The arts therapies, which
include art, music, and dance/movement therapies, started in the 1940s. Arts therapies are
integral in the treatment of children suffering from trauma, and should be utilized before
medication management is in place, and in addition to traditional therapies, such as talk and
behavioral therapies.
Assisting children, who suffer from trauma, to heal is difficult for many reasons. One of
these reasons is the misdiagnosis of trauma frequently occurring due to other psychiatric
disorders having similar and overlapping symptoms. Due to Diagnostic and Statistical Manual of
Mental Disorders Fourth Edition (DSM-IV) requirements, symptoms related to traumatic
exposure may be overlooked. Albert Einstein College of Medicine of Yeshiva University
conducted a study evaluating the effectiveness of the Child Behavior Checklist (CBCL) which
assesses PTSD in children. In this study twelve out of fifty-one children met the conditions for
PTSD according to the CBCL standards, whereas only two out of the fifty-one children were
considered to have PTSD by MSD-IV standards (Loeb, 2011, p.430). By using an interview
process, the hidden symptoms of PTSD, such as avoidance of situations, which are not easily
apparent can be discovered. Even after a child is diagnosed, a treatment plan needs to be
designed and implemented. Talk and behavior therapies are common choices, and many times

Erasing the Trauma: Arts Therapies

medication management is added to the treatment plan as well. These therapies are ineffective
since the child is unable to voice the symptoms he or she is experiencing.
The Brocas area of the brain is responsible for speech. Studies have shown this area has
decreased activities even during re-creation of traumatic events (van der Kolk, 2014, p. 40-43).
Therefore, it makes sense that children, who normally have trouble expressing themselves, have
a hard time verbalizing the thoughts and feelings connected to their traumatic experiences. Arts
therapies can assist with understanding even when words fail.
Oxford University Press defines art therapy as, a form of psychotherapy involving the
encouragement of free self-expression through painting, drawing, or modeling, used as a
remedial activity or an aid to diagnosis (2015). The unstructured forms of evaluation are most
usually presented in which the client is asked to respond in the most unhindered method possible.
In contrast there are also structured art evaluations. Stella Stepney, author of Art Therapy with
Students at Risk, describes the structured versions as consistent procedures such as drawings,
construction, visual constructs or objects that elicit specific data when presented to individuals
(2010, p.112). Stepney also explains that most structured art evaluations use the following:
standardized materials, clearly specified instructions for each drawing, and guidelines for any
post-drawing interrogation (PDI) (2010, p.113). Having the child discuss the creation, including
an explanation of what his or her creation represents, is a crucial element of art therapy.
Music has been used for centuries for health aspects and in healing. Music has recently
been taken further and is now a form of therapy. Association for Indiana Music Therapy, Inc.
states, Music therapy is an allied health profession which has been an organized profession in
the United States for approximately 60 years (n.d.). Music therapy is defined by Immaculata
University as a process that involves helping clients, children and adults who have therapeutic

Erasing the Trauma: Arts Therapies

needs, to develop skills, adapt their behavior, and overcome obstacles in their lives (2015).
Providing the client with experiences such as singing, playing instruments, writing songs, and
listening to and talking about music provides the client with the chance to meet his or her
specific goals by utilizing the relationship between the child, the therapist, and the music
(Immaculata.edu, 2015).
Based on the empirically supported premise that the body, mind and spirit are
interconnected, the American Dance Therapy Association defines dance/movement therapy as
the psychotherapeutic use of movement to further the emotional, cognitive, physical and social
integration of the individual (2015). President Carters Commission on Mental Health in 1977
even included dance/movement therapy (ADTA, 2015). If something is influencing a persons
body it is also believed to have an effect on the persons mind due to the correlation between a
persons mind and body. According to Malchiodi and Crenshaw, dance/movement therapy uses
mirroring, attunement, and empathic reflection, as well as connectional props such as scarves,
balls, stretch fabric, and even music (2014). Even though these therapies have been established
for decades, insurance companies, especially government funded insurance programs such as
Medicaid, are less likely to pay for these expenses than they are to pay for traditional therapies
and medication management.
Analysts believe that with tight budgets, state legislatures are reluctant to pass laws that
cost money or are perceived to cost money to implement (Deppe, 2013). In 2011, many
states cut costs by reimbursement rates being decreased. Indiana was one of these states,
reducing the rate to providers by 5% (Deppe, 2015). Music therapy licensure proposals were
considered in several states in 2012. Due to the broad scope of practice included in those bills

Erasing the Trauma: Arts Therapies

including assessment and treatment of communication disorders ASHA1 opposed these

proposals (Deppe, 2015). Medicaid services are a struggle to find for even the most traditional
services, much less for arts therapies. However, Indiana Medicaid offers three programs to cover
arts therapies. These programs are the developmental disability waiver, autism waiver, and
support services waiver (American Music Therapy Association, n.d.). Community and national
grant programs, Medicare, and self-pay are other options for paying for these services. According
to American Music Therapy Association (AMTA), private insurance success has occurred on a
case-by-case basis when the therapist implements steps within the reimbursement process and
receives pre-approval for music therapy services (n.d.). Although insurances prefer to pay for
traditional therapies and medication management, there are significant risks involved with
medicating traumatized individuals, especially children.
During a hearing concerning the increase of psychotropic medications in children who
are in foster care, Dr. Phil McGraw spoke on the matter, You do not treat a social circumstance
with a drug. You have to fix the underlying problem, and you have to do a differential diagnosis
(Griffin, 2014). Medications are useful with PTSD survivors by allowing the person to shut
down inappropriate alarm reactions (von der Kolk, 2014, p. 3). Medication should not be
viewed as a fix-all, cure-all, nor should it be used to control a childs behavior. Instead,
Medication should be used to enhance the childs abilities (Lawlis, 2004, p. 77). Dr. Frank
Lawlis also points out that, Only 50% of children with ADD can be helped through drug
therapy (2004, p. 71). Specific risks involved with medication management depend greatly on
the type of medication prescribed. The most common risks for prescription stimulants are
difficulty sleeping, stares or day dreams, lack of interest in activities, decreased appetite,
1 ASHA is the acronym for American Speech-Language-Hearing Association

Erasing the Trauma: Arts Therapies

increased irritability, body complaints (such as stomachaches, headaches, or dizziness), increased

anxiety, and increased blood pressure or heart rate. According to Kennedy, Terdal, and Fusetti,
authors of The Hyper-active Child Book, 1 child in 100 develop tics (1993, p. 57). Xanax,
Ativan, and valium are benzodiazepines, used to treat anxiety. Brain scans have shown
diminished activity with the use of these medications. In addition to prescription medications,
natural substances also carry side effects. For example, St. Johns Wort, which is used to mildly
treat depression, can cause sensitivity to sun exposure and even decreases the effectiveness of
other medications, even birth control. If medication is chosen as treatment, with or without other
forms of therapies, it should never be viewed as a long-term option. Dr. Phil McGraw also
broaches the question, Is the treatment of choice to begin drug therapy or is the treatment of
choice to begin some type of evidence based psychological therapy and I think the former has
many more side effects than the latter and therefore is much more dangerous (Griffin, 2014).
Not only are the arts therapies less dangerous, they offer many more advantages to the
child. By using art therapy, a child is able to access and externalize the sensations, memories,
and visual images that have been shaped by trauma (Kuban, 2015, p. 19). Children from all over
the world can benefit from art therapy. [Art therapy] permits children of diverse cultures to
express what we have come to know as the common, universal, subjective experiences of trauma
despite language and cultural differences (Steele & Kuban, 2013, p.73). With art, children are
more able to explain the different parts of their experiences. This in turn allows the child to learn
more about and improve their own story. Art therapy also actively involves children in their
own healing process, which in turn supports their inner resilience to bounce back from other
challenges (Steele & Kuban, 2013, p. 72). Art as a therapy can be used to help a child
reestablish his or her views on life and his or her place in the world by managing the traumatic

Erasing the Trauma: Arts Therapies

memories and by regulating the emotional and physical reactions caused by those memories.
Images a youth draws stimulate verbal discussion, giving us a window into the young persons
unique private logic (Kuban, 2015, p. 20). By discussing the creation, which is integral in art
therapy, the therapist is allowed to see the world through the eyes of the child: how the child sees
him- or herself and others, the environment the child is accustomed, and the meaning the child
has given to the experiences he or she has been through (Steele & Kuban, 2013, p. 68).
The advantages to art therapy are shared advantages of music therapy as well. Young
people with attachment trauma present in music therapy with a wide range of issues that are
challenging to both clients and therapists (Malchiodi & Chrenshaw, 2014, p. 69). Some of these
issues include hyper-vigilance, hyper-arousal, exaggerated startle response at the slightest
trigger, disorganized or agitated behavior, withdrawal, a hardened or hard-to-reach demeanor,
and emotional tuning out (Malchiodi & Crenshaw, 2014, p. 69). Music therapy is great not
only for Reactive Attachment Disorder (RAD) and Attention-Deficit Hyperactivity Disorder
(ADHD) children, but also the traumatized child. Music is a wonderful source for stimulation.
According to Dr. Daniel G. Amen, author of Making a Good Brain Great, Researchers have
also found that music lowers blood pressure in certain situations and increases oxygen
consumption by the heart (2005, p. 165). In a study by Rosalie Rebollo Pratt, 19 children,
diagnosed with ADD, showed brain waves which slowed to the exact rhythm to the underlying
beat of Mozarts music (Amen, 2005, p. 164). Listening to Mozart also improves a childs focus
level, mood control, impulsivity, and even social skills. Art and music are not the only therapies
that show a significant advantage if utilized in RAD, ADHD, and trauma children;
dance/movement therapy shows great promise, particularly for RAD children.

Erasing the Trauma: Arts Therapies

10

Dance/movement therapy does have a unique set of processes for promoting the
emergence of bodily experience within the therapeutic movement relationship (Malchiodi &
Crenshaw, 2014, p. 87). Malchiodi and Crenshaw also describe the positives of dance/movement
therapy in the statement, The development of kinesthetically attuned interactions will support a
client in establishing emotional regulation and healthy attachment relationship(s) (2014, p. 87).
Once the relationship with the therapist has been established, the child is able to feel secure and
the new experience is able to be used as a building block for new behaviors with others outside
of the therapy environment. Many of the advantages of the arts therapies are advantages of not
just one specific category, but many of the arts therapies as well.
The basis for each of these forms of therapy also share commonalities, such as music
being involved in not only music therapy, but also art and dance/movement therapies. These
therapies also share common goals in helping the child overcome traumatic experiences and
become productive in his or her own way. Medication management has its uses, but too often is
thought of as a means to fix a child. The strong possibility of negative side effects need to be
taken into account before medicating a child and ignoring the other options available to help
bring the childs positive assets to the forefront. Talk and behavior therapies do not adequately
help a traumatized child overcome the symptoms they are facing, especially due to the fact
trauma causes speech portions of the brain to decrease in activity. Medication hides the
underlying issues until a later date in life, when the child, who is then an adult, would have to
work through the issues regardless. Utilizing arts therapies in addition to talk and behavior
therapy is key to uncovering these underlying issues in a child, allowing him or her to heal the
trauma, and learn how to see him- or herself in society.

Erasing the Trauma: Arts Therapies

11

References
Amen, D.G. (2005). Making a Good Brain Great. New York: New York: Harmony Books.
American Dance Therapy Association. (2015). ADTA.org. About Dance/Movement Therapy.
Retrieved Nov. 23, 2015, from http://www.adta.org/about-dmt
American Music Therapy Association. (n.d.). FAQs. Retrieved Oct. 29, 2015, from
http://www.musictherapy.org/faq/#51.
Association for Indiana Music Therapy, Inc. (n.d.). About Us. Retrieved Oct. 24, 2015, from
http://indianamusictherapists.com/about-us/
Bauer, M. (Feb. 17, 2015). Expressive Art Therapy for Children. Livestrong.com. Retrieved
Oct. 22, 2015, from http://www.livestrong.com/article/209497-expressive-art-therapy-forchildren/.
Deppe, J. (2013). State Laws Bring Practice Changes: SLPs and Audiologists Around the Nation
May Feel Effects of New Laws and Regulations on Licensure, Medicaid, Hearing Aids,
Telepractice, and the Like. ASHA Leader, volume (19), p. 19. Retrieved Oct. 22, 2015,
from http://go.galegroup.com/ps/retrieve.do?sort=DASORT&docType=Article&tabID=T003...
Griffin Discusses Overmedication of Foster Care Youth with Dr. Phil McGraw and Dr. Michael
Naylor. (May 30, 2014). State News Services. Retrieved Oct. 29, 2015, from
http://ic.galegroup.com/ic/bic1/NewsDetailsPage/NewsDetailsWindow?

Erasing the Trauma: Arts Therapies

12

failOverType=&query=&prodld=BIC1&windowstate=normal&contentModules=displayquery=&mode=view&displayGroupName=News&limiter=&search_within_results=&p...
Hodas, G.R. (2006). Responding to Childhood Trauma: The Promise and Practice of Trauma
Informed Care. Pennsylvania Office of Mental Health and Substance Abuse.
Immaculata University. (2015). Immaculata.edu. Defining Music Therapy. Retrieved Nov. 23,
2015, from
http://www.immaculata.edu/academics/departments/graduate_music_therapy/define
Kennedy, P., Terdal, L. & Fusetti, L. (1993). The Hyper-active Child Book. New York, New
York: St. Martins Press.
Kuban, C. (2015). Healing Trauma through Art. Reclaiming Children and Youth, Vol. 24
(issue 2), pg. 18-20. Retrieved Oct. 22, 2015, from
https://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=6fd8ca35=ddcc-4d5193b5-33e78011f5d1%40sessionmgr4005&hid=4113.
Lawlis, F. (2004). The ADD Answer: How to Help Your Child Now. New York, New York:
Viking.
Loeb, J., Stettler, E.M., Gavila, T. Stein, A., and Chinitz, S. (2011). The Child Behavior
Checklist PTSD scale: Screening for PTSD in Young Children with High Exposure to
Trauma. Journal of Traumatic Stress, volume 24, pg. 430-434.
Malchiodi, C. & Crenshaw, D. (2014). Creative Arts & Play Therapy for Attachment Problems.

Erasing the Trauma: Arts Therapies

13

New York: New York: Guilford Press.

National Association of State Mental Health Program Directors (NASMHPD) and National
Technical Assistance Center for State Mental Health Planning (NTAC) (2004): The
damaging consequences of violence and trauma: Facts, discussion points, and
recommendations for the behavioral health system. Washington, D.C.: U.S. Department
of Health and Human Services (HHS).
Oxford University Press. (2015). Oxforddictionaries.com. Art Therapy. Retrieved Nov. 23, 2015,
from http://www.oxforddictionaries.com/us/definition/american_english/art-therapy
Steele, W. & Kuban, C. (2013). Working with Grieving and Traumatized Children &
Adolescents. Hobooken: New Jersey: John Wiley & Sons, Inc.
Stepney, S. (2010). Art Therapy with Students at Risk. Springfield, Illinois: Charles C. Thomas,
Publisher, LTD.
von der Kolk, B.A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing
of Trauma. New York, New York: Viking.