Trauma-Informed Art Therapy (T-IAT) and Trauma-Informed Expressive Arts Therapy
© 2010 Cathy Malchiodi, PhD, LPCC, LPAT, ATR-BC
from http://www.cathymalchiodi.com/art-therapy-books/trauma-informed-art-therapy/
Part One: Developmental Trauma
In order to provide trauma informed intervention, it is important to first understand
the complexities of chronic trauma across the lifespan. Many trauma specialists and
helping professionals encounter children and adolescents with a history of multiple
chronic traumatic events throughout their young lives. In the past, we have referred
to this as “complex trauma,” or Type II or even Type III trauma; in brief, trauma
specialists generally agree that youth who have experienced multiple traumatic
events involving abuse, violence, or abandonment react differently than those who
may have experienced an acute, single incident of trauma or loss.
The Complex Trauma Taskforce of the National Child Traumatic Stress Network (NCTSN) undertook a
significant step in identifying and resolving the problems associated with diagnosing complex trauma in
children. In 2005 Bessel van der Kolk and colleagues proposed “developmental trauma disorder” (DTD) to
more accurately describe children and youth who present a range of difficulties as a result of exposure to early,
chronic and severe trauma. These individuals may have experienced developmentally adverse trauma involving
abandonment, physical abuse or assault, sexual abuse or assault, emotional abuse, witnessing violence or death,
and/or coercion or betrayal. Understandably, these types of repeated events cause feelings of rage, fear, shame,
defeat, and withdrawal; they are reactions to years filled with adverse and inhumane treatment by parents,
family members, caregivers, or others who impact these children’s lives.
Youth with DTD often have problems with attachment and authority, are unable to
regulate their emotions and impulses, and can experience cognitive impairment and
attention deficits. Trauma experts concur that these individuals may benefit more so
from our efforts to help them recognize and regulate their trauma reactions rather
than pharmacological approaches that are used in desperation to control or medicate
behaviors such as attention deficit disorder, cognitive and behavioral problems, and
anti-social behaviors.
As we continue to learn more about complex, chronic trauma, just how should trauma specialists address DTD
and make appropriate interventions with these children and adolescents? Here are some simple
recommendations, based on my work with children from violent homes, abused children, and youth who
witness homicides:
1. Establish a sense of safety. This includes helping children establish both an internal sense of safety and
identification and support for safety within their homes, neighborhoods, and communities.
2. Regulate affect. Help children understand that what has happened is “not their fault,” and assist them in
learning methods to regulate and moderate arousal [limbic system] with the long-term goal of restoring
emotional equilibrium.
3. Reestablish attachment. Chronic, complex trauma disrupts basic trust because it is often caused by
dysfunctional or abusive interpersonal relationships; our goal as helping professionals is to help children
reestablish attachment with positive adult role models and to learn how to empathize and productively interact
with peers.
4. Enhance the brain’s executive functions. Serious and repetitive trauma impacts cognition, disrupting
cortical functioning; our goal is to help children effectively engage attention, comprehension, and problemsolving skills to allow for the experiences of mastery, self-esteem, and self-efficacy.
5. Reframe and integrate traumatic experiences. Chronic, complex developmental trauma cannot be erased
from memory; however, with our help children can learn to how to manage their reactions, enhance adaptive
coping skills, and cultivate present-oriented responses to current stresses. Our ultimate goal in intervention is to
help these youth transform, incorporate, resolve, repair, and construct meaningful lives, post-treatment.
Part Two: What is Trauma-Informed Practice
According to the Substance Abuse and Mental Health Services Administration (SAMHSA)
(2010), trauma informed interventions specifically address the consequences of trauma in
the individual and recognize the interrelation between trauma and symptoms of trauma. A
comprehensive view of neurological, biological, psychological and social effects of trauma
and violence ultimately informs intervention. Here is what SAMHSA specifically has to say
about trauma informed practice:
Trauma-informed programs and services represent the “new generation” of transformed
mental health and allied human services organizations and programs who serve people with
histories of violence and trauma.
Trauma survivors and consumers in these programs and services are likely to have histories of physical and
sexual abuse and other types of trauma-inducing experiences, and this often leads to mental health and other
types of co-occurring disorders such as health problems, substance abuse problems, eating disorders,
HIV/AIDS issues, and contact with the criminal justice system. When a human service program takes the step to
become trauma-informed, every part of its organization, management, and service delivery system is assessed
and potentially modified to include a basic understanding of how trauma impacts the life of an individual
seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the
vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so
that these services and programs can be more supportive and avoid re-traumatization (Retrieved from SAMHSA
at http://mentalhealth.samhsa.gov/nctic/trauma.asp)
Part Three: Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy. Art therapy
and expressive arts therapy have a unique role as an intervention with traumatized individuals. In fact, the
International Society for Traumatic Stress Studies (ISTSS) (Foa et al, 2009) provides a comprehensive
summary of the role of the creative art therapies in the treatment of posttraumatic stress disorder (PTSD). The
ISTSS statement underscores the growing interest the relationship between the creative arts therapies and the
brain, including how the brain processes traumatic events and the possibilities for reparation through art, music,
movement, play, and drama interventions.
In my practice as an art therapist and mental health counselor, most children I have worked with over the years
have been chronically abused and neglected. As a result, these children generally have a variety of severe
trauma reactions (hyperarousal, avoidance, dissociation, and intrusive memories), learning and psychosocial
challenges, and attachment difficulties. In many cases, psychodynamic and cognitive behavioral strategies alone
cannot address the reactions of children whose cognitive, developmental, and interpersonal skills are
compromised by multiple traumatic experiences of sexual abuse, physical abuse, emotional abuse, domestic
violence, and neglect.
Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy
integrate neuroscience and neurodevelopment, somatic approaches, mindfulness
practices, and resilience enhancement, using art making as the core approach. In general,
a trauma informed approach must take into consideration the following:
Five Components of Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy
1. Uses a “neurosequential approach” via expressive arts therapies to stabilize the body’s responses.
2. Identifies of the body’s reactions to stressful events and memories through trauma-informed evaluation and
sensory-based activities using expressive arts.
3. Responds to the body’s reactions to traumatic events through somatic and sensory approaches to selfregulation.
4. Reinforces a sense of safety through reconnection with positive attachment and self-soothing.
5. Builds strengths by using the arts to normalize and enhance resilience (Malchiodi, 2008; 2011).
Because young survivors of trauma may also be without the means to place memories in historical context
through language, art therapy combined with neurobiological, somatic, and cognitive-behavioral approaches can
assist children in bridging sensory memories and narrative. Trauma informed art therapy is based on the idea
that art expression is helpful in reconnecting implicit (sensory) and explicit (declarative) memories of trauma
and in the treatment of PTSD (Malchiodi, 2003). In particular, it is an approach that assists children’s capacity
to self-regulate affect and modulate the body’s reactions to traumatic experiences in the earliest stages to set the
stage for eventual trauma integration and recovery.
References
Foa, E., Keane, T., Friedman, M., & Cohen, J. (2009). Effective treatment for PTSD: Practice guidelines from
the International Society for Trauma Stress Studies. New York: Guilford Press.
Malchiodi, C. (2003; 2012). Handbook of art therapy (1st & 2nd ed.). New York: Guilford Press.
Malchiodi, C. (2008). Creative interventions with traumatized children. New York: Guilford Press.
Malchiodi, C. (2011). Trauma informed art therapy with sexually abused children. In Paris Goodyear-Brown
(Ed.), Handbook of Child Sexual Abuse: Prevention, Assessment, and Treatment. New York: Wiley.
Substance Abuse and Mental Health Services Administration (2010). Trauma informed care. Retrieved
September 12, 2010 from http://mentalhealth.samhsa.gov/nctic/trauma.asp.
- See more at: http://www.cathymalchiodi.com/art-therapy-books/trauma-informed-arttherapy/#sthash.nUXcZwCk.dpuf
Psychology Today
Trauma-Informed Expressive Arts Therapy
Tapping the arts’ powers as trauma intervention
One of my first jobs as an art therapist and expressive arts therapist was with
children in shelters for survivors of domestic violence. That work set me on the
life-long path of developing and refining trauma-informed art-based (TraumaInformed Art Therapy®) and expressive arts therapies (Trauma-Informed
Expressive Arts Therapy®) approaches for the past two decades. I have been
fortunate to be able to apply these methods with children, adults, families and
communities that have experienced interpersonal violence, witness to homicide,
combat or war, natural disasters, terrorism, complicated grief, and medical
illness. For those who are unfamiliar with the term "expressive arts therapy," it is defined as the use of creative
arts (music, art, movement, and other artforms) as a form of therapy (Malchiodi, 2005). As I have written in
previous posts, the sensory-based qualities of art and expressive arts are key to helping individuals
communicate traumatic memories, repair and recover.
Physician and neurosequential development pioneer Bruce Perry has noted that arts therapies can be a
normalizing experience for children, one which children in all cultures recognize (in Malchiodi, 2008).
Expressive arts therapy has a unique role as an intervention with traumatized children. In fact, the International
Society for Traumatic Stress Studies (ISTSS) (Foa et al, 2009) provides a comprehensive summary of the role
of the creative art therapies in the treatment of posttraumatic stress disorder (PTSD). The ISTSS statement
underscores the growing interest the relationship between the creative arts therapies and the brain, including
how the brain processes traumatic events and the possibilities for reparation through expressive arts therapies-art, music, movement, play, and drama interventions.
Trauma-informed expressive arts therapy includes many concepts unique to the practice of expressive therapy
(such as the Expressive Therapies Continuum which I will talk about it another post), but in brief it integrates
neurodevelopmental knowledge and the sensory qualities of the arts in trauma intervention (Malchiodi, 2012).
In general, this approach takes into consideration, but is not limited to, the following 1) how the mind and body
respond to traumatic events; 2) recognition that symptoms are adaptive coping strategies rather than pathology;
3) emphasis on cultural sensitivity and empowerment; and 4) helping to move individuals from being not only
survivors, but ultimately to becoming "thrivers" through skill building, support networks, and resilience
enhancement (Malchiodi, 2011).
Because survivors of trauma may also be without the means to place memories in historical context through
language, expressive arts therapy combined with neurobiological, somatic, and cognitive-behavioral approaches
can assist individuals in bridging sensory memories and narrative. Trauma-informed expressive arts therapy is
based on the idea that art expression is helpful in reconnecting implicit (sensory) and explicit (declarative)
memories of trauma and in the treatment of PTSD (Malchiodi, 2012). In particular, it is an approach that assists
the individual's capacity to self-regulate affect and modulate the body's reactions to traumatic experiences in the
earliest stages to set the stage for eventual trauma integration and recovery.
Five Components of Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy®
1. Uses a "neurosequential approach" via expressive arts therapies to stabilize the body's responses.
2. Identifies of the body's reactions to stressful events and memories through trauma-informed evaluation and
sensory-based activities using expressive arts.
3. Responds to the body's reactions to traumatic events through somatic and sensory approaches to selfregulation.
4. Reinforces a sense of safety through reconnection with positive attachment and self-soothing.
5. Builds strengths by using the arts to normalize and enhance resilience.
And that's a brief overview! For more information, you can also visit the Trauma-Informed Practices and
Expressive Arts Institute [http://www.trauma-informedpractice.com (link is external)]and check out the
resources below.
© 2012 Cathy Malchiodi
References
Foa, E., Keane, T., Friedman, M., & Cohen, J. (2009). Effective treatment for PTSD: Practice guidelines from
the International Society for Trauma Stress Studies. New York: Guilford Press.
Malchiodi, C. (2005). Expressive therapies. New York: Guilford Press.
Malchiodi, C. (2012). Art therapy and the brain. In C. Malchiodi (ed.), Handbook of Art Therapy. New York:
Guilford Press.
Malchiodi, C. (2008). Creative interventions with traumatized children. New York: Guilford Press.
Malchiodi, C. (2011). Trauma informed art therapy with sexually abused children. In Paris Goodyear-Brown
(Ed.), Handbook of Child Sexual Abuse: Prevention, Assessment, and Treatment. New York: Wiley.
Substance Abuse and Mental Health Services Administration (2010). Trauma informed care. Retrieved
September 12, 2010 from http://mentalhealth.samhsa.gov/nctic/trauma.asp (link is external).
Malchiodi, C. (2015, July 24). Trauma-Informed Art Therapy (TI-AT) and Trauma-Informed Expressive Arts Therapy. Retrieved on (July 24, 2015) from
http://www.cathymalchiodi.com/Trauma-Informed-Art-Therapy.html.- See more at: http://www.cathymalchiodi.com/art-therapy-books/traumainformed-art-therapy/#sthash.suP1zIvT.dpuf