دستیابی به حافظه پس از سانحه از طریق ساخت هنر: پروتکل ترومای هنر درمانی (ATTP)

“We use our minds not to discover facts but to hide them.” Antonio Damasio “Art makes the invisible visible.” Paul Klee In this article I propose an art therapy trauma protocol (ATTP) designed to address the non-verbal core of traumatic memory. Trauma theorists [van der Kolk, B.A. (2003). Frontiers in trauma treatment. Presented at the R. Cassidy Seminars, St. Louis, MO 2004; Steele, W. & Raider, M. (2001). Structured Sensory Intervention for Traumatized Children, Adolescents and Parents-Strategies to Alleviate Trauma. New York: The Edwin Mellen Press] have endorsed alternative treatment methods such as eye movement desensitization reprocessing (EMDR), body-based psychotherapy, and expressive arts therapy as an alternative to verbal psychotherapy. Following an overview of the role of memory and emotions in trauma and theories of art making and brain function, I describe a protocol that has had success in integrating the cognitive, emotional and physiological levels of trauma drawing on EMDR, McNamee's bilateral art and Michelle Cassou's method of painting. A one-session example serves to illustrate its use.

In this article I propose an art therapy trauma protocol designed to address the non-verbal core of traumatic memory. Recent developments in neurobiology have shown that memory is an active and constructive process, and that “the mind constantly re-assembles old impressions and attaches them to new information” (van der Kolk, 2002, p. 2). Most memory researchers “deny that the mind is capable of precisely reproducing the imprints of prior experience,” (p. 2) including precisely recalling memories of smells, images or sensations. Individuals diagnosed with post-traumatic stress disorder (PTSD), however, report exact sensations, memories and emotions related to the trauma, and sometimes do so months or even years later. Individuals with PTSD symptoms experience a lack of control, as if they were involuntarily reliving the trauma, even when they may be aware of the disproportionate nature of their reactions. One of the primary challenges for the psychotherapeutic process is regulating the sensory imprints associated with trauma. In recent years, advances in neurobiology and psychotherapy have informed the practice of art therapy, which has increasingly been utilized when verbal psychotherapy has failed to help clients. Numerous therapists have reported the benefits of creative arts therapies in their settings (Appleton, 2001 and Chapman et al., 2001; Brett & Ostroff, 1985; Howard, 1990; Klorer, 2000; Meekums, 1999 and Rankin and Taucher, 2003; Yates & Pawley, 1987, among others), although few controlled studies have been published. Researchers in the field of art therapy have begun to pay attention to neurobiology and its relationship to art making and its implications for art therapists (Chapman et al., 2001, Klorer, 2005, Lusebrink, 2004 and McNamee, 2004). Chapman et al. (2001) published a study with pediatric trauma patients. They reported that although the clinical trial did not indicate significant differences in the reduction of PTSD, there was evidence that children receiving art therapy did show reduction in acute stress symptoms. A recent study, however, conducted at Thomas Jefferson University, Philadelphia, provides data on improvement of the quality of life (Monti et al., 2005), and emphasizes the connection between the body–mind and creativity, illustrating the efficacy of art therapy. In trauma treatment it is not the verbal account of the event that is important, but the non-verbal memory of the fragmented sensory and emotional elements of the traumatic experience (van der Kolk, 2003). Art therapy has long been recognized as a method that constitutes a primary process (Kramer, 1958, Levick, 1975, Naumburg, 1966 and Rubin, 1984; Ulman and Dachinger, 1975) that taps into the non-verbal realm of imagery (Cohen & Riley, 2000). Successful art therapy can serve to integrate right and left brain functions that, in turn, help integrate experiences (McNamee, 2003, McNamee, 2004 and McNamee, 2005), especially on a non-verbal level. In the first part of this article I define “trauma,” and review current research into how it acts to subvert, or is a subversion of, normal brain functions that integrate experience and memory. In the second, I survey current thinking on the subject of art making and creativity and how they may involve specific areas and functions of the brain; this is a topic for which considerably more research is needed, so mine is necessarily only an overview of an emerging field. In the third part I describe the art therapy trauma protocol (ATTP), give a one-session example, and relate the technique to the issues raised in parts one and two.

The ATTP described grew out of my clinical practice. Although no research study has been undertaken, clients report positive results in processing speechless traumatic memories. This article has focused exclusively on processing somatic memory. Addressing the full spectrum of trauma treatment lies outside the scope of the paper. During the therapeutic sessions the therapist must carefully evaluate the client's readiness to confront a specific event or somatic memory. Considerable time must be spent getting the client ready through emotional and cognitive processing and by creating an awareness of the somatic memory on the affective and emotional level. The type of processing described gives the client tools to create sensory awareness, which promotes affect and emotional regulation. The process of creating the image helps the client to observe his/her thoughts and actions while becoming aware of the sensorimotor experience, promoting propriception. The walking back and forth allows for activation between left and right brain process. In creating the image, left brain processes, of deciding between colors, brushes, and sequential decisions using analytical thinking, alternate with right brain processes, activating the spatial, visual motor, emotions, and sensory regions. During this process, the mediating limbic structures, the hippocampus and amygdala, are creating a sequence of events and assigning the events their emotional significance. The bilateral stimulation through art making, engages the integrating and planning functions of the prefrontal cortex as the memory is assigned a narrative of beginning, middle and an end by the hippocampus, using left brain functions. The ATTP is a method that has an integrative approach offering a positive adaptive functioning model, but successfully using this method depends on each individual's internal self representation. Omaha (2004) emphasizes the importance of the therapeutic relationship in strengthening internal representation of the individual. I concur with him that restructuring early developmental milestones to increase ego strength and internal representations is imperative before processing the trauma blocks.