تفسیر: بررسی پارادایم اساسی در هنردرمانی خلاق تروما

“Although creative arts therapies may capture the imagination of the therapist, it is important to keep in mind that, as with many other therapies discussed in this volume, empirical evidence for their efficacy with PTSD and other, related symptoms is not available.” So conclude Edna Foa, Terence Keane, Matthew Friedman and Judith Cohen in the recently published second edition of Effective Treatments for PTSD (Guilford, 2009, p. 630). We are a field perpetually at the margin; not only are we placed there by the dominant forces holding sway at the center, but we place ourselves there, between art and health, in the liminal, transcendent, and transitional, spaces between body and mind, observation and action, containment and expression. In 1987, when the first Special Issue on the Creative Arts Therapies and Trauma was published, the center was held by psychoanalysis, dreamers spellbound by the unconscious, fantasy, and the unseen (Johnson, 1987). Many of us attempted to accommodate to this dominant force and defined our creative arts therapies work in terms of psychodynamic formulations, both out of sincere appreciation for the links between our work and psychoanalysis, as well as our interest in gaining favor with the reigning center. One sees the continued hold of this paradigm in this Special Issue in the articles by Buk and Haen and Weber, as well as traces of it in the articles by Harris and Sutton and De Backer. In 2009, however, we awake to find that a new paradigm has risen and taken over the center, sending the dreamers into enclaves within a few urban centers. The cognitive-behavioral paradigm is now the dominant paradigm in the mental health field, and with its partner, evidence-based treatment, it has pushed many approaches further into the periphery. (For example, recently the New York City Commission on 9/11 has eliminated creative arts therapies from the approved list of providers because there is not sufficient evidence for their efficacy.) Unlike the previous era, when creative arts therapists enthusiastically modeled their work on psychodynamic principles, creative arts therapists have been slow to adopt or integrate the principles of cognitive-behavioral treatment. This is demonstrated, for example, in that none of the articles in this issue relies on a cognitive-behavioral approach and only Harris makes mention of it. The question arises whether we should accommodate or not. Though leaders in the creative arts therapies have called for empirical research and cognitive-behavioral formats, frankly few if any have come. Does this mean that there is something antithetical between the CATs and CBT? Will we sacrifice our true nature out of our need for survival? Or do we hide in our offices until “the pendulum swings again?” In this article, I plan to address these questions, but first I would like to examine briefly the five articles in this issue and identify the underlying paradigms upon which the authors rely. Each of these fine articles demonstrates how the creative arts therapies can be helpful in the treatment of trauma-related conditions. Perhaps such an analysis will reveal trends that may help us answer the broader questions raised above.

“Although creative arts therapies may capture the imagination of the therapist, it is important to keep in mind that, as with many other therapies discussed in this volume, empirical evidence for their efficacy with PTSD and other, related symptoms is not available.” So conclude Edna Foa, Terence Keane, Matthew Friedman and Judith Cohen in the recently published second edition of Effective Treatments for PTSD (Guilford, 2009, p. 630). We are a field perpetually at the margin; not only are we placed there by the dominant forces holding sway at the center, but we place ourselves there, between art and health, in the liminal, transcendent, and transitional, spaces between body and mind, observation and action, containment and expression. In 1987, when the first Special Issue on the Creative Arts Therapies and Trauma was published, the center was held by psychoanalysis, dreamers spellbound by the unconscious, fantasy, and the unseen (Johnson, 1987). Many of us attempted to accommodate to this dominant force and defined our creative arts therapies work in terms of psychodynamic formulations, both out of sincere appreciation for the links between our work and psychoanalysis, as well as our interest in gaining favor with the reigning center. One sees the continued hold of this paradigm in this Special Issue in the articles by Buk and Haen and Weber, as well as traces of it in the articles by Harris and Sutton and De Backer. In 2009, however, we awake to find that a new paradigm has risen and taken over the center, sending the dreamers into enclaves within a few urban centers. The cognitive-behavioral paradigm is now the dominant paradigm in the mental health field, and with its partner, evidence-based treatment, it has pushed many approaches further into the periphery. (For example, recently the New York City Commission on 9/11 has eliminated creative arts therapies from the approved list of providers because there is not sufficient evidence for their efficacy.) Unlike the previous era, when creative arts therapists enthusiastically modeled their work on psychodynamic principles, creative arts therapists have been slow to adopt or integrate the principles of cognitive-behavioral treatment. This is demonstrated, for example, in that none of the articles in this issue relies on a cognitive-behavioral approach and only Harris makes mention of it. The question arises whether we should accommodate or not. Though leaders in the creative arts therapies have called for empirical research and cognitive-behavioral formats, frankly few if any have come. Does this mean that there is something antithetical between the CATs and CBT? Will we sacrifice our true nature out of our need for survival? Or do we hide in our offices until “the pendulum swings again?” In this article, I plan to address these questions, but first I would like to examine briefly the five articles in this issue and identify the underlying paradigms upon which the authors rely. Each of these fine articles demonstrates how the creative arts therapies can be helpful in the treatment of trauma-related conditions. Perhaps such an analysis will reveal trends that may help us answer the broader questions raised above.