Is Art Therapy An Effective Means in Treating Young Survivors of Sexual Abuse?

Sometimes we humans are challenged by such extreme events, that our capacities to cope with them come to a limit. In these moments we seek help in order to process these problems. Psychotherapy is a process that can be helpful in these cases (Wampold, 2006). Most forms of therapy however rely on premise that the victim can express themselves verbally, but not everyone is able to vocalize extreme experiences, which involve very strong emotions, that are best forgotten. A form of therapy that can circumvent this problem is art therapy. Contrary to most other forms of therapy, art therapy can use any type of visual art or any medium of art to communicate the victim's most inner feelings (Boston, 2005). Studies have repeatedly shown that art therapy is effective in treating different kinds of cognitive diseases (e.g. Alzheimer's disease) or psychological disorders (e.g. post-traumatic stress disorder, depression) (Kim et al., 2008; Bar-Sela et al., 2007). Hence it should not come as a surprise, that art therapy has been used in a variety of different settings and different demographics. One of these demographics are children. Compared to adults, children have the distinct advantage, that they have more difficulties in expressing their emotions and thoughts clearly. Often children have difficulties to put strong events into perspective and have hence problems processing the experience appropriately. Recognizing, and dealing with emotions is an important part of recovery in order to prevent the child's long-term health from being threatened (Murphy, 2001). Art therapy has the possibility to help the child process a certain event, since it does not rely as heavily on verbal communication. Unlike adults, children are less developed to use words for inner thinking, so to a large extent, the child will play in order to think things out" (Dalley, 1987). Studies have shown that art therapy is an effective way to treat children with different emotional problems, such as grief and loss (Rozum, 2012), epilepsy (Stafstrom, Havlena & Krezinski, 2012 ), domestic violence and se ual a!use ("alc#iodi, 2012)$ In this paper I would like to focus on the efficacy of art therapy on children who suffered from sexual abuse. I would like to discuss different processes and perspectives, how and why art therapy can help young children to process their experience with sexual abuse.

Art therapy in child abuse It is common for children who have undergone extreme cases of continual abuse to have complete dissociation from the body. This has been described as the victim "going numb" or to "float out" of the body in order to avoid the pain (Young, 1992). As Young put it: "Children who have been sexually abused have suffered a physical violation of their bodies in the breaching of the boundary between their insides and outsides. Such a physical challenge to the integrity of the body threatens the child, as a living organism, with annihilation. It thus constitutes severe trauma, leaving a lasting mark that is inscribed in and often on their bodies, and calling into question even the child's relation to living within a body Children suffering from sexual abuse deal with emotions of anger, anxiety, depression, a poor self-image, isolation, outbursts of hostility, and an awareness of sexuality inappropriate to their chronological age. Common symptoms include irritability, suicide attempts, and confusion about sexual boundaries. Longer-term effects can lead to self-destructive behavior, a tendency to re-victimization, and substance abuse in adulthood. Survivors of abuse may seek out relationships that reenact the abuse, either becoming perpetrators or continuing as victims. (Murphy, 2001) Young children of abuse have difficulty verbalizing their sexual experience through lack of vocabulary or fear of the consequences of talking. Art therapy can be seen to provide an outlet for children with trauma to experience and understand their emotions in a safe way. The setting is less intense than a verbal therapy relationship, and transference onto the materials as well as the therapist can take place. Children have the opportunity to use visual symbols and metaphors to describe what happened to them. The feelings that are expressed in the child's art that are representative of their trauma is the first step for the child to separate the self from their traumatic experience (Murphy, 2001). Techniques that can be used in art therapy to elicit this experience are sand play, puppets, anatomical dolls and therapeutic dolls, which all have to be proven to be effective in treating children survivors of sexual abuse (%o#nston, 1&&')$ Further even if children have the ability to express their experiences verbally, many do not

choose to do so, because it is very uncomfortable to do so. That is why art therapy can also be applied in group settings, which tends to be the method of choice according to Klorer (2012). According to Killian and Brakarsh (2004), group therapy has the distinct advantage of individual therapy, that children do not need to get very emotionally intimate with an adult (in this case the therapist) very soon after their abuse experience. Children who experienced abuse, will experience an inherent distrust towards adults and might behave secretive and defensive towards them. A group offers the children to share their experiences with other children and let them realize that they are not alone in their experience. Studies have investigated the efficacy of art therapy in child abuse. Different approaches have been used, but overall art therapy seems to be an effective way in treating child abuse (Brown & Latimir, 2001; Meekums, 1999). A study by (retorius & (feifer (2010) investi)ated a )roup art t#erapy approac# on se ually a!used )irls$ *#eir pro)ram +as !ased on ,e istantial-#umanistic, .estalt, client-centered and a!use-focused principles/$ 0ontrary to t#e control )roup, t#e art t#erapy )roup si)nificantly improved on measures suc# as an iety and depression, +#ic# proves once a)ain t#e efficacy of art t#erapy$

I would like to delve deeper into the mechanics of art therapy when applied to child abuse. Although the term art therapy implies that art is being used to help children, it is not obvious in what way art is being used. To fully understand the effectiveness of art therapy, it is important to have a grasp of how art materials can be used to facilitate the recovery of a human being. This is why I chose to show a more applied aspect of art therapy. I chose to focus on the perspective of the art therapist Ann Gillespie. In her ten years' experience, Gillespie worked with children who had all been permanently separated from their parents due to multiple abuse and neglect, and who had endured a history of care orders, court cases, and many failed placements in institutional and foster homes. Another reason why I chose Ann Gillespie, is that unlike other therapists who have been known to use symbolic objects within their therapy sessions, Gillespie focuses on having as little pictorial or representative objects as possible in her method of conducting therapy sessions (sand play). I find this unconventional approach to be very interesting, since it shows the flexibility and range of art therapy. In the following section I will have better look at Ann

Gillespie's approach to art therapy and I will show how she uses materials such as sand and water to help children to address the their emotions.

Sand and water in art therapy with sexually abused children

For children who have experienced trauma of sexual abuse, it is important they are able to experiment freely and spontaneously in the protected space of an art therapy hour. The act of art making facilitates the differentiation of the self from the internalized bad objects/people and their ways. The tactile qualities of art materials allow for a reawakening of physical and emotional sensations that the child may otherwise deny (Murphy, 2001). The art the child creates is an object that comes from the self, yet gradually becomes separate. The child can take from it what she needs, and with the help of the therapist, leave the rest behind (Thomas in Murphy, 2001).

Through research, the inclusion of sand and water has become a recurring theme to use in art therapy sessions with children who have suffered from sexual abuse. Gillespie mentions that playing with sand and water is an activity children everywhere respond enthusiastically to. In an art therapy situation, this activity can evoke physical sensations and imaginative images of the child, turning ordinary play into an opportunity to explore complex body issues connecting to their sexual abuse in an unthreatening way (Gillespie, 1990). Gillespie observed unconscious connections being made through the tactile use of sand and water: For those who were abused before they had words, or those who had forgotten or been lied to about it, or those for whom the pain of it was unspeakable, it was important that they could play freely in this very bodily medium, only very gradually moving towards exploring fragments of their traumatic experience . It has been said that children are drawn to play with these two universal materials naturally, "almost it seems with a sense of coming home" (Balint, 1969). Gillespie mentions that along with fire and

air, sand and water are elemental primary substances of the earth, "archaic mother symbols," with whom powerful and primitive links are made and retained throughout life. Through the use of sand and water, children are able to seek out skin sensations that reactivate primitive responses, which allows

children to experience a range of tactile experiences with no expectations or demands, and hence reawakening dulled senses. This process is thought to gradually lead to sensations that might trigger memories of abuse stored in body tissues (Gillespie, 1990). There is also and ease with using sand and water, enabling creative activity. Playing with sand and water also offers a release from the expectations of skill, meaning, or art making. This way, the children do not have to feel threatened by anything that will in their eyes reinforce their lifelong failure (Gillespie in Murphy, 2001). By touching and manipulating forms into sand, children are able to relax, without the need of having a clear goal. "It offers a child the chance to experiment with the structure of their own world or objects in a fluid and completely individual way, free from the predetermined forms, meanings or expectations of other materials," mentions Gillespie. Without having a product-oriented approach, children have the opportunity to respond to their internal world, playing out memories, fantasies and conflicts from within. Both materials have in themselves very symbolic meanings. Sand enables the children to scratch designs into its surface, dig down into it, build castles and other forms, or bury things underneath. It can be soft, warm and powdery, damp and firm, or sometimes hard, cold and heavy. Offering both visual and tactile qualities, it is a recommended medium for the projection of images, dreams, fantasies and feelings. The indestructibility of the sand is an important property in this work. If the child attacks the sand, the substance does not become destroyed. This may provide reassurance about the child's fantasised powers of destruction and its effects. (Gillespie in Murphy, 2001)

In one case Gillespie speaks of, an eight-year-old girl gave up her struggle to construct a

cardboard house, and decided to travel over to the sand tray. She first spread her fingers into the sand, and instantly became free from her frustrations that were involved with the cutting, fixing, and gluing of the cardboard. She spread the sand out saying, It's a desert. Then, dreamily she pushed the sand into a heap with her arms outstretched in front of her. She buried her hands into the mound, staring at it the way one may see pictures in clouds. Then she scooped up the sand, gently kissing it. The case with the eight-year-old girl is an example of the relaxation using sand in therapy offers, taking the patient away from the need to try hard. Gillespie observes that the girl responded to her sensations of the sand gently. She treats the substance as she might treat a loved body, bringing it up to her face and lips. The second material, water, is often the first play substance children experience as infants. Children are able to create imaginative rivers; lakes, seas or oceans. Water can be also combined with sand to create swamps as well as other soggy areas. Water can be added in various quantities. Sometimes just enough water for the sand to become moldable, and sometimes a lot of water is used to create rivers and canals. When using too much water, or not enough, there are still limitations regarding the control of the child's formations, which is helpful for the child to accept and creatively adapt to change. The initial excitement and gleeful addition of more and more water for its own sake easily turns to destructiveness, and while this can be useful in releasing anger, it could also cause the child to be dangerously overwhelmed in chaos and excitement (Gillespie in Murphy, 2001). Gillespie believes that the water dissolving the sand can be symbolic of dissolving boundaries of held feeling. She uses the example of a ten-year-old girl named Nadia, the youngest child in a family of five. Nadia had been abandoned by her mother at age five, and later cared for and abused by her father. Nadia and her therapist work together in the sand tray, building bridges and tunnels by Nadia's instruction. Nadia mentions building a tunnel wide enough for the trucks to get through, and carefully clears away messy sand from both entrances. Then she says, Now we are going to put it in and you will feel it, referring to the water she decides to fill the tunnel with. After witnessing these sexual

implications that Nadia demonstrates above, Gillespie observes the covering over of evidence and the magic of making 'it' disappear (Gillespie in Murphy, 2001). Under Nadia's instruction, both she and the therapist continue adding more and more water, eventually dissolving the sand into a sloppy muck. Gillespie analyzes that the dirty mucky sand connects to what many abused children feel, fills their insides. Later, Nadia's progress was noted through her care of cleaning up the muck at the end of the session. She would try to repair the damage that had been done to her imaginary forms, making efforts to take care of the abused (sand) body (Gillespie in Murphy, 2001). ConclusionA major benefit of art therapy is the opportunity to express feelings and thoughts, without actually verbalizing them. It is important to notice that art therapy does not necessarily have to involve pictorial representations. Ann Gillespie's water and sand approach is a good example to show, that even very simple materials can facilitate a child's recovery process. Contrary to other therapy forms, art therapy can access very different communication channels and therefore also different associations and feelings. And this is a big advantage for children, since their age can limit them to express their thoughts and feelings in words. This is where I see the biggest strength of art therapy in children who suffered from sexual abuse: they finally have a channel to express themselves freely. Therefore it should not come as a surprise that many professional see art therapy as a successful alternative to conventional psychotherapy for this population group (Bissonnet, 2001; Murphy, 2001).

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