PTSD and communication
Overview
See also: Communication
with rape victims
Some therapists who
work with trauma patients are working on "integrating both verbal
and nonverbal therapy with a client with severe anxiety and depression."
(McNamee, 2004) The reason for this
is the way the brain works. The right brain works with images and the
left brain works with logic and words. PTSD victims temporarily loose
functioning (essentially) in the left side of the brain. The creative,
image oriented side has to take over those functions. That makes logic
more difficult. This is due to the passage between the two sides (corpus
callosum) being damaged by PTSD. (Villarreal, G. et.al., 2004) , (Seritan,
2005). There is also new evidence that PTSD patients actually store traumatic
memories in image form in a different part of the brain than normal memories.
(Turner,
2004)
Online resources
PTSD
and Relationships
http://psychcentral.com/library/ptsd_relationships.htm
"Trauma survivors
with PTSD often experience problems in their intimate and family relationships
or close friendships. PTSD involves symptoms that interfere with trust,
emotional closeness, communication, responsible assertiveness, and effective
problem solving"
Journal articles
Norman, Judith. (2000).
CONSTRUCTIVE NARRATIVE IN ARRESTING THE IMPACT OF POST-TRAUMATIC STRESS
DISORDER. By: Clinical Social Work Journal. 28 (3). p303-319, 17p. link
Abstract
Research and clinical
practice in social work have historically recognized a strengths perspective.
More recently, the role of a constructivist perspective has been discussed
in social work education and practice. Narrative construction for the
stress disordered client reflects both perspectives. Social workers can
listen for and, with clients, identify strengths, survivorship, and resilience
as the stories of trauma and victimization are told. Attending to the
language of strength and survivorship can actually yield realistic treatment
goals. A model of collaborative conceptualization of the problem and target
goals is presented with the intended focus of this paper being to encourage
the telling and adaptive retelling of the story of trauma. The author
shares examples of language and communication given by clients in the
adaptive description of traumatic experiences which form the foundation
of ongoing healing.
Does writing reduce
posttraumatic stress disorder symptoms? Deters, Pamela B.; Range, Lillian
M.; Violence and Victims, Vol 18(5), Oct 2003. pp. 569-580. link
Abstract
To see if writing
about their trauma lessened PTSD and related symptoms, 57 undergraduates,
previously screened for traumatic experiences, wrote for 15 minutes on
4 days across 2 weeks about either their trauma or a trivial topic. They
reported PTSD, impact, suicide ideas, dissociation, and depression pre-,
post-, and at 6-week follow-up testing. Trauma and trivial writers were
not different. Surprisingly, at follow-up everyone reported less severe
PTSD symptoms, impact, and dissociation, and fewer health visits, but
about the same suicidal ideation and depression. On PTSD symptoms and
impact, the pattern of improvement was different: Those writing about
trauma got worse at posttesting, but improved to better than their initial
state by follow-up. Those writing about a trivial topic got better by
posttesting, and held that position at follow-up. In this project, writing
seemed to reduce PTSD symptoms regardless of whether it concerned the
trauma or what they ate for lunch. (PsycINFO Database Record (c) 2005
APA, all rights reserved)(journal abstract)
Felmingham, Kim L.;
Bryant, Richard A.; Gordon, . (2003). Evian Processing angry and neutral
faces in post-traumatic stress disorder: An event-related potentials study.
Neuroreport: For Rapid Communication of Neuroscience Research. 14(5).
pp. 777-780. link
Abstract
Examined evoked response
potentials (ERPs) to angry and neutral faces in 15 individuals with post-traumatic
stress disorder (PTSD; mean age 35.8 yrs) and 15 age and sex-matched controls
(mean age 26.2 yrs) over temporal (T5,T6) and occipital (O1,O2) regions.
20 faces with an angry expression were alternated with 20 faces with a
neutral emotional expression. There were significantly larger early negative
(N110) and late negative (N650) ERP components in controls to the angry
compared to the neutral faces. The PTSD group did not display ERP differences
between angry and neutral faces, and the amplitude of their negative waveforms
were reduced relative to controls. It is concluded that these findings
may reflect adaptive, rapid responding to potential threat in the controls,
and a reduced capacity to discriminate between non-threat and generalized
threat stimuli in PTSD.
Lange, Alfred; Schoutrop,
Mirjam; Schrieken, Bart; (2002). Interapy: A model for therapeutic writing
through the Internet. In: The writing cure: How expressive writing promotes
health and emotional well-being. Lepore, Stephen J.; Smyth, Joshua M.;
Washington, DC, US: American Psychological Association, 2002. pp. 215-238.
link
Abstract
(from the chapter)
This chapter provides a detailed discussion of an ongoing program of research,
the Amsterdam Writing Project, which includes clinical trials of expressive
writing interventions and a novel Internet-based approach ("Interapy")
for delivering mental health services that was born out of these trials.
After describing this approach to using structured writing assignments
in clinical practice, the authors describe experiments that evaluate the
outcome of writing assignments for posttraumatic stress disorder (PTSD)
patients and the role of habituation vs cognitive reappraisal in the process
of overcoming trauma and grief. One study permitted the authors to investigate
the importance of social sharing. The third part of the study describes
how the authors translated the face-to-face protocol into an interactive
format for writing therapy through the Internet.
Brown, Elissa J.;
Heimberg, Richard G. (2001). Effects of writing about rape: Evaluating
Pennebaker's paradigm with a severe trauma. ; Journal of Traumatic Stress.
14(4). pp. 781-790. link
Abstract
Examined the effect
of disclosing to others an attempted or completed rape, using Pennebaker's
disclosure paradigm. 85 undergraduate women who acknowledged attempted
or completed rape wrote about their experience and read their narratives.
In a 2 × 2 design, the value of writing only factual information
versus factual plus emotional information, and reading to oneself versus
reading aloud to another woman was examined. Before and 1-mo after the
task, symptoms of dysphoria, social anxiety, and posttraumatic stress
disorder were assessed. Greater detail and a moderate level of personalization
in the description of the trauma were associated with decreased symptoms
of dysphoria and social anxiety. Neither the nature of the writing task
nor the presence of another woman predicted degree of symptom reduction.
Mallay, Jane Neily,
StressArt Services, Sarnia.(2002). Art therapy, an effective outreach
intervention with traumatized children with suspected acquired brain injury.
Arts in Psychotherapy. 29(3) link
Abstract
Discusses the use
of art therapy in treating children with posttraumatic stress disorder
(PTSD), and present a case study. PTSD is a relatively new diagnosis for
children, with responses including depression, anxiety, fearfulness, sleep-eating
disturbances, and cognitions of self-blame and feeling damaged. Goals
of therapy with PTSD children include reestablishing boundaries, feelings
of safety, control, and body integrity, working on emotion ranges, removing
self-blame, and putting the event and system involvement in context. Art
psychotherapy is appropriate in these cases, with its capabilities to
assist with expression and provide verbal support in a psychotherapeutic
style. The case of a male (aged 10 yrs) who experienced trauma related
to being hit by an automobile shows the value of art psychotherapy in
cases of pediatric PTSD.
Fass, Margot L.; Brown,
Daniel. (1990). Writing assignments and hypnosis in the treatment of traumatic
memories. van der Hart, Onno; Boon, Suzette; van Everdingen, Ghisaine
B.; In: Creative mastery in hypnosis and hypnoanalysis: A Festschrift
for Erika Fromm. Hillsdale, NJ, England: Lawrence Erlbaum Associates,
Inc, pp. 231-253. link
Abstract
(from the book) interested
in extending our understanding methods [hypnoanalytic methods] for use
with PTSD [post-traumatic stress disorder] patients makes a distinction
between nonhypnotic techniques, specific writing assignments, and the
kind of hypnotic techniques described by Brown and Fromm (1986) in "Hypnotherapy
and Hypnoanalysis" for use with PTSD patients discusses various ways
clinicians can structure therapeutic writing assignments to help the patient
translate traumatic memories into a personal narrative also reviews a
variety of hypnoanalytic methods that can be used with such patients includes
a valuable discussion about criteria for deciding when to use either writing
assignments or hypnotherapy techniques with traumatized patients / writing
assignments are useful for patients who have some degree of awareness
of their trauma history and can see a connection between their past experience
and present symptoms
Communication and
rape victims
Using both sides of the brain:
Experiences that integrate art and talk therapy through scribble drawings.
McNamee, Carole M.; Art Therapy, Vol 21(3), 2004. pp. 136-142. link
Neuroscience researchers identify
a cerebral cortex with two functioning hemispheres: a left hemisphere
associated with language and speech and a. right hemisphere associated
with visual-motor activities. Additionally, neuroscientists argue that
contemporary lifestyles favor the verbal, logical left brain and often
ignore the truths that present in the right brain. Psychotherapy techniques
range in their use of left-brain verbal discourse and right-brain nonverbal
discourse. In a case study, the author describes experiences integrating
both verbal and nonverbal therapy with a client with severe anxiety and
depression. Nonverbal therapy involved annotated scribble drawings. Images
in the drawings became the stimuli for verbal discourse with the client.
Other client responses to the annotated scribble drawings are described.
Use of drawing technique to encourage
verbalization in adult survivor of sexual abuse. Lev-Wiesel, Rachel; Arts
in Psychotherapy, Vol 25(4), 1998. pp. 257-262. link
Demonstrates the effectiveness
of drawings (art therapy) in encouraging an adult survivor of childhood
sexual abuse to speak about the past traumatic experiences. This ability
to speak up not only breaks the conspiracy of family members to keep the
secret, but also enables the victim to deal with negative feelings toward
himself/herself and his/her parents. The drawing technique is illustrated
in 4 therapeutic sessions (out of 24) with an adult female who was sexually
abused by her father in childhood.
Holistic Assessment of rape victims. By: Mayer, Rick A.; Ottens, Allen
J.. Guidance & Counseling, Mar94, Vol. 9 Issue 4, p24, 4p
This article describes a method
for the holistic assessment of rape victims. This method consists of assessing
the effect the rape has on the victims'affective, cognitive and behavioural
functioning. By assessing the severity of the trauma in these areas counsellors
are able to develop appropriate treatment strategies.
"The TAF permits counsellors to assess clients' level of impairment
with respect to affective, cognitive and behavioural reactions to a crisis.
Space is provided on the TAF for counsellors to make notation of any significant
clinical findings. Affective categories are: (a) anger/hostility (may
be present as agitation or a desire for possible retaliation); (b) fear/anxiety
(may be present as sense of disorientation or jittery tension); and (c)
sadness/melancholy (may be present as emotional and/or physical exhaustion
accompanied by a sense of hopelessness). Counsellors are asked to identify
clients' affective reaction to the crisis event using these categories
and also assess the level of impairment. Should more than one affect be
present, counsellors must judge which affect is primary, secondary and
tertiary."
Art speaks in healing survivors
of war: The use of art therapy in treating trauma survivors. Baker, Barbara
Ann; Journal of Aggression, Maltreatment & Trauma, Vol 12(1-2), 2006.
pp. 183-198.
Mental health clinics can use creative
art therapies as a means of reaching out to war refugees in their communities
who may not respond to traditional talk therapy. In this case, the use
of quilting and other artwork was utilized by the staff at Chicago Health
Outreach to assist displaced Bosnians to cope with their war-related trauma
and integration into their new environment in the United States. It can
be difficult to reach refugee populations within a community whose culture
and language are different from the majority, but finding other means
of communicating can make a real difference for these individuals as they
find safety and understanding by working on and sharing special creative
projects.
The healing art: The integration
of art therapy into the modern psychoanalytic approach. Sharon, Ruth Velikorsky;
Dissertation Abstracts International: Section B: The Sciences and Engineering,
Vol 65(7-B), 2005. pp. 3724.
In this study I want to illustrate
how the production of drawings and written associations of a patient in
the psychoanalytic framework can be a springboard for progressive verbalization
and communication. It is helpful because it can facilitate the expression
of pre-verbal and non-verbal material. Experiences of the patient, before
the age of language acquisition, fall into this category. I will do this
using a case study approach, by presenting the case of Rachel, a preoedipal
patient whom I treated through the use of art in the psychoanalytic framework.
Her case will be presented, and the repetitive material which signalled
the presence of the resistance and the unconscious material in her art
work and written associations to it will be summarized and explored. I
will discuss the presence of the transference, countertransference, and
resistance in our therapeutic relationship-as present in her work, her
actions, and her behavior as treatment progressed. My purpose in doing
that is to explore the ways in which the use of art effected those elements.
I also hope to open this field for more research in this area.
A descriptive study: Selection and use of art mediums by sexually abused
adults: Implications in counseling and art psychotherapy. Clukey, Frances
Harlow; Dissertation Abstracts International: Section B: The Sciences
and Engineering, Vol 64(4-B), 2003. pp. 1679.
This research was designed to explore
what happens in the process of therapy when clients, having persisting
symptoms of sexual abuse and having disclosed that abuse, have access
to a wide variety of art materials to select and use in treatment. A blend
of qualitative and quantitative research in design, the study is an initial
step towards a greater understanding of the potentially transformative
experience of art making and the role of art mediums in the practice of
therapy. Treatment for abuse is a long, complex and arduous process. Persistent
aspects of abusive experience remain deeply buried within the body and
cause periodic, cyclical, somatic and psychological problems in an individual's
life. Clients often feel words are too immediate and too explicit to describe
the experience and the resulting emotional response generated by sexual
abuse. Created within the context of what psychiatrist Winnicott (1971)
described as the "good enough" therapeutic relationship, artwork
may be viewed as more concrete and symbolic, or less immediately explicit
and therefore safer than verbal communications. Sensory-based therapies
such as art therapy are, therefore, particularly useful in accessing traumatic
memories and transforming the experience to a less damaging state. For
this study, the author set up private practice to work as therapist with
eight individuals for eight fifty-five minute sessions in a traditional
art therapy studio. Each session was documented on videotape. Artwork
was photographed. Videotapes, artwork, intake histories and the researcher/therapist's
notes were analyzed. Brief case studies were developed. Data were considered
by frequencies and ordinal comparisons for immerging patterns. The data
described art mediums as accessing cognitive, symbolic, emotional, perceptual,
kinesthetic and sensory levels of understanding. A spiral model facilitated
understanding the process. The potential to pace the process of therapy
by direction and selection of more or less mediated, fluid and controllable
art mediums was shown to exist. Through the spatial and kinesthetic processes
of art making in art therapy, the individual controls recollection, comprehension,
integration and resolution of trauma. Art mediums are central in art therapy
as they safely provide the means of expression and reflection to transform
trauma in the bodymind.
Three art assessments: The Silver Drawing Test of cognition and emotion;
draw a story: Screening for depression; and stimulus drawings and techniques.
Silver, Rawley; New York, NY, US: Brunner-Routledge, 2002. xxiv, 315 pp.
(from the jacket) Art can be an
invaluable means of communication. It can bypass language and hearing
impairment and become a means of communicating thoughts or feelings too
difficult to express with words. This book uses three original art assessments
that use stimulus drawings to elicit response drawings that provide access
to a patient's emotions and attitudes toward themselves and others while
testing for the ability to solve problems and convey ideas. Each assessment
includes studies of reliability, validity, and normative data, drawing
on international research in the field and on the author's own body of
work spanning more than forty years. Stimulus drawings are provided as
well as drawing from imagination tasks, and rating scales to assess emotional
and cognitive content.
Arts as language: Access to thoughts
and feelings through stimulus drawings. Silver, Rawley; New York, NY,
US: Brunner-Routledge, 2001. xix, 187 pp.
(from the cover) Discusses the
use of the visual medium as a linguistic parallel to verbal or written
communication. While recognizing that language expands and facilitates
thought, the author illustrates the existence of high-level thinking in
its absence and demonstrates the usefulness of drawing as an expressional
tool for patients who are unable, or unwilling, to express themselves
through the conventional use of language. Covering areas such as cognition,
creativity, and emotion, this book provides the reader with an introduction
to and explanation of stimulus drawing assessment. In this approach, drawings
serve as the principal channel for the exchange of ideas. Stimulus drawings
are provided to the patient to evoke a response drawing. These response
drawings allow patients to sketch their fantasies, thus allowing some
sort of gratification. The drawings may also serve as a means of acceptably
expressing feelings the patient deems inappropriate, such as fear or anger.
Reviews of qualitative and quantitative studies follow the introduction.
By reviewing studies of children, adolescents, and adults suffering form
various impairments and injuries, the author shows the broad applicability
of stimulus drawing assessments.
Mandala artwork by clients with
DID: Clinical observations based on two theoretical models. Cox, Carol
Thayer; Cohen, Barry M.; Art Therapy, Vol 17(3), 2000. pp. 195-201.
The authors have explored the compositional
patterns and thematic imagery in mandala drawings by a large group of
patients diagnosed with multiple personality/dissociative identity disorder
(MPD/DID). In approaching this work, they used both the Ten Category Model
(G. M. Cohen & C. T. Cox, 1995) and the Great Round of Mandala theory
(J. Kellogg, 1978, 1997) looking for parallels between the two systems
of analysis to help therapists better understand the nonverbal communications
of their clients. Although not a formal research study, the observations
based on the synthesis of these two unrelated models are nonetheless consistent
with the assessment and treatment literature on DID.
Art psychotherapy groups: Between pictures and words. Skaife, Sally; Huet,
Val; Florence, KY, US: Taylor & Frances/Routledge, 1998. x, 209 pp.
(from the cover) Presenting an
account of the challenges encountered in art psychotherapy practice, this
book explores new theoretical material arising from the merging of art
and group psychotherapy. The contributors present in-depth discussion
of case studies with client groups such as children, forensic patients,
patients on acute psychiatric wards, the cognitively impaired elderly,
institutionalized patients moving into the community, and drug and alcohol
abusers. A common theme which emerges from the book is that the physical
use of art materials and the space of the art room offer a possibility
for communication of feelings which is not possible in purely verbal groups.
This allows clients with severe mental health problems, and groups who
would not normally be considered for purely verbal group therapy, to benefit
from a psychodynamic group process.
The book is intended to be a resource for practising and trainee art therapists,
and all professionals working psychodynamically with clients who have
severe mental health problems.
Therapeutic presence: Bridging expression and form. Robbins, Arthur; Philadelphia,
PA, US: Jessica Kingsley Publishers, Ltd., 1998. 280 pp.
(from the cover) In the therapeutic
workplace, the interaction between patient and therapist is built upon
cognitive, affective and expressive experiences. The contributors to this
book explore this interaction, examining the concept of therapeutic presence,
and the therapist's ability to maintain it. The theory integrates a creative
framework that synthesizes traditional and non-traditional approaches
to treatment, and will be of use to all mental health professionals.
The author suggests that, since therapeutic presence calls for an openness
and awareness of the intersubjective space between therapist and patient,
therapists who become receptive to the subtle cues of sensory perceptual
communication, as well as to the playful mirroring and meditative interaction,
will achieve more successful and meaningful interactions with patients.
Therapeutic presence requires a sensitivity to the temporal characteristics
of the therapeutic frame, and an experience of energy that may open, shut
down, or disrupt the field of therapeutic contact.
This stance can be applied to therapeutic modalities ranging from psychoanalysis
to creative arts therapy, in work with both short term and long term populations.
The author suggests that the full use of the therapist's creative energies
may provide the only solution to overwhelming therapeutic situations.
Books
Malchiodi, C. (1997).
Breaking
The Silence: Art Therapy With Children From Violent Homes. NY: Brunner
Routledge.
Mary Beth Williams,
Soili Poijula. (2002). The PTSD Workbook: Simple, Effective Techniques
for Overcoming Traumatic Stress Symptoms. Oakland, Ca., New Harbinger
Publications.
Bibliographies
CORK
Bibliography: Post-Traumatic Stress Disorder (PTSD)
http://www.projectcork.org/bibliographies/data/Bibliography_PTSD.html
Healing,
Therapy, and Psychology
http://www.ra-info.org/library/books/by-topic/therapy.shtml
Resources to research
this subject:
Journals
and articles
Search
the NCJRS Abstracts Database
Google
scholar or Findarticles
Finding
books at the library
Online
Libraries on sexual assault
Encyclopedias
and Dictionaries
Training manuals
Search terms: *Art
Therapy; *Drawing; *Oral Communication; *Psychotherapeutic Techniques,
*Art Therapy; *Explicit Memory; *Life Experiences; *Psychotherapy; *Sexual
Abuse; Art; Counseling; Emotional Responses; Symptoms, *Art; *Art Therapy;
*Drawing; *Measurement; *Psychological Assessment; Attitudes; Cognitive
Processes; Communication; Emotions; Problem Solving; Projective Personality
Measures; Projective Techniques; Screening Tests, disclosing
to others in writing; factual information; emotional information; undergraduate
women; rape victims; symptoms of dysphoria; PTSD; social anxiety, constructivist
perspective, narrative construction, PTSD, strengths perspective, PTSD
symptoms; posttraumatic stress disorder symptoms; traumatic experiences;
writing, Emotional Trauma; *Posttraumatic Stress Disorder; *Psychotherapeutic
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services, family art therapy, physically abused boy, art therapy room,
art interventions, shelter setting, shelter environment, graphic indicators,
art expressions, shelter life, art therapy sessions, child clients, psychological
maltreatment, person drawing, felt markers, shelter programs, art therapists,
art tasks, person series
Related links: Victim
blame, Memory
and ptsd, Panic
attacks, Body memories,
Sleeping
problems, Dyslexia
and PTSD
References:
American Psychiatric
Association. (1994). Diagnostic and statistical manual of mental disorders,
fourth edition. Washington, DC: American Psychiatric Association.
Clukey, Frances Harlow. (2003).
A descriptive study: Selection and use of art mediums by sexually abused
adults: Implications in counseling and art psychotherapy. ; Dissertation
Abstracts International: Section B: The Sciences and Engineering, 64(4-B),
2003. pp. 1679.
Villarreal, G. et.al., (2004).
Reduced area of the corpus callosum in posttraumatic stress disorder.
Psychiatry Research: Neuroimaging Section, 131(3), 227-235. Link
McNamee, Carole M. (2004). Using
both sides of the brain: Experiences that integrate art and talk therapy
through scribble drawings. Art Therapy. 21(3), 2004. pp. 136-142. link |
