Research ArticleGluing the pieces together: Female adolescents’ construction of meaning through digital metaphoric imagery in trauma therapy
Graphical abstract
Introduction
According to a Western worldview, psychological trauma is seen as a unique individual experience when a sudden or unexpected incident takes place that exposes the person to death or threatened death, and actual or threatened serious injury or sexual violation (Marzillier, 2014, Sanderson, 2013). Trauma is accompanied by the association of intense fear (Marzillier, 2014), horror, and helplessness (Sanderson, 2013) and it violates the person’s belief and expectations about the world and the self (Boehnlein, 2007; Cohen, Mannarino, & Deblinger, 2017; Sui and Padmanabhanunni, 2016, Van der Kolk, 2007). However, not everybody is affected in the same way: resilience (Alayarian, 2011, Harms, 2015, Konner, 2007); personality and coping strategies (Dass-Brailsford, 2007); religion (Boehnlein, 2007); developmental, family, communal, political and sociocultural contexts (Lemelson, Kirmayer, & Barad, 2007) also determine how the person copes with the trauma. Developmentally, adolescence may compound coping with trauma ‘when teenagers struggle to establish their identities’ (Dass-Brailsford, 2007, p. 182) as the transformation of adolescence is often already associated with a profound sense of disquiet (Gatta, Gallo, & Vianello, 2014). Although there are various types of trauma (Briere & Scott, 2015), child psychiatrist, Lenore Terr, distinguished single-incident trauma and complex trauma as main types in children (Courtois and Ford, 2013, Marzillier, 2014). This papers deals with complex trauma which is defined as repeated traumas within the caregiver system (Harms, 2015).
Trauma should not be reduced only to distressing emotional states; Joseph and Linley (2008) allude to post-trauma growth following adversity or positive changes after struggling with trauma (Kilmer & Gil-Rivas, 2010). The struggle after the trauma has a transformative quality (Lepore & Revenson, 2006). Although the scars of trauma are acknowledged, they do not devaluate the self-identity and they are not all-encompassing future determinants. The survivor’s life is not over; good things in future are possible (Briere and Scott, 2015, Harms, 2015; Kirmayer, Lemelson, & Barad, 2007; Meyerson, Grant, Carter, & Kilmer, 2011; Rousseau and Measham, 2007, Tedeschi and Calhoun, 1996). Trauma may thus be seen as a process that evokes both vulnerabilities and strengths (Padmanabhanunni and Edwards, 2016, Rousseau and Measham, 2007) as adaptive reactions to survive it.
Emotional, cognitive and behavioural reactions to trauma may affect normal interactions and daily routines as these reactions break through the normal defences and create a profound state of disorganisation in which meaning collapses (Marzillier, 2014). Contributing to the disorganisation, Avrahami (2006) and Edwards (2013) explain that trauma memories are not integrated with other memories through the usual process of associative connections and information processing. Instead, trauma memories are sorted as isolated fragments of sensory observations and emotional states of visual images (Van der Kolk, 2007). ‘They [trauma memories] consist of sensory impressions rather than thoughts … and are triggered by cues that are not semantically related to the trauma’ (Marzillier, 2014, pp. 48–49). The trauma memories that are without narrative organisation (Gantt & Tinnin, 2009) can be accessed through artwork. The latter provides a gateway to the sensory impressions of the trauma that the brain retains (Chilton, 2013) which can then be processed through a trauma narrative (Gantt, 2012).
The creation of a personal trauma narrative is necessary to translate and integrate the trauma memories into contextual aspects of the autobiographical memory (a memory about one’s life) to achieve coherence (Marzillier, 2014) and to establish more organised and meaningful cognitions. The process of recounting trauma seems to involve a progressive cognitive reorganisation and reintegration (Kirmayer et al., 2007). Art therapy acts as a safe vehicle for self-expression in the creation of the trauma narrative. It also helps individuals to construct meaning (Terr, 2009) and provides relief from overwhelming emotions or trauma (Appleton, 2001, Gantt, 2012, Malchiodi, 2012, Rousseau and Measham, 2007). Gatta et al. (2014) state that art therapy ‘weaves a web that joins body, mind and emotions’ (p. 1) to contain the chaos of the trauma within the borders of a concrete art product as part of the integration process and the regaining of control (Avrahami, 2006). According to Marzillier (2014), the narrative can allow positive feelings to emerge, ‘a sense of human dignity and virtue, of survival against all the odds’, thus facilitating hope for a good future (p. 265).
The personal narrative, however, needs to be created without causing unnecessary trauma or pain to the client. The retelling of the personal narrative involves a controlled re-experiencing of the trauma experience in a caring, stable environment to help heal the emotional, psychological injury caused by the trauma (Briere and Scott, 2015, Van der Kolk, 2007). Using metaphor in art therapy renders the re-experiencing less threatening because of the metaphor’s anxiety-buffering value (Foley, 2015, Reich, 1998), although it still contains imaginal exposure (Johnson, 2009). It also provides ‘glue that links disparate aspects of human mental life, over time and across different contexts’ to help with the creation of a narrative that gives meaning to past and present experience (Bornstein & Becker-Matero, 2011, p. 172). Metaphor has the capacity to tap sensory experience (Reich, 1998), similar to artwork that also provides a gateway to the trauma’s sensory impressions. McGuinty, Armstrong and Carrière (2014) maintain that metaphors are the scaffolding process that is central to therapeutic change in narrative therapy.
The purpose of this paper is to zoom in through a metaphoric lens on the digital art of female adolescents residing in a house of safekeeping during trauma therapy. How did digital metaphoric imagery in trauma therapy facilitate the construction of meaning? We also briefly zoom the lens out to give a wide angle of the context in which these metaphors as creative art therapy (CAT) format were integrated into a cognitive-behavioural (CBT) trauma treatment. Although this paper exposes one of the three main directions to explore in trauma treatment, namely to ‘develop CBT-based approaches and formats for the CATs in trauma treatment’, as recommended by Johnson (2009, p. 119), the macro focus remains on digital art. However, the digital art does not contain the entire course of therapy. Digital art in this paper refers to artwork created on a computer as many art therapists currently incorporate digital media, which has become part of daily life, into therapy sessions (Alders, Beck, Allen, & Mosinski, 2011; Carlton, 2014, Orr, 2012). Eaton, Doherty and Widrick (2007) have already established that art therapy was used successfully in a variety of contexts as a treatment regimen for traumatised children and adolescents. However, we could not find any systematic enquiry into digital metaphoric imagery as trauma treatment in the ScienceDirect, Proquest and Taylor & Francis databases, hence providing the rationale for this research. We coined the term ‘digital art trauma therapy’ to consolidate the frameworks of CBT trauma treatment, art therapy, and technology.
Section snippets
Conceptualising metaphoric imagery in trauma therapy
The use of metaphor in therapy lies in the transfer of meaning from one domain to another. It can be thought of as referring to a way of looking at things (Legowski & Brownlee, 2001). It forms a bridge to the client’s inner world and the client can talk about the externalised concept in therapy. The metaphor functions by describing aspects, characteristics or situations indirectly to give them meaning which is often multi-layered (Moon, 2007). The therapist does not interpret the concept or
Design
The research is art-based to show the relationship of art to therapy (Carolan, 2001). The systematic use of actual art creations (McNiff, 2008) specifically aimed to address how ‘images [can] be used as a means of developing a relationship with aspects of self or other so that dialogue can develop and new meaning evolve’ (Carolan, 2001, p. 203).
The method is social constructionism that focuses on collective generation of meaning which implies some kind of interaction between the inquirer and
Initial client-generated metaphors
Participant 1 (grandmother’s abuse survivor) changed herself into a fish eagle (Fig. 2). She placed the image of the fish eagle in the centre of the artwork, coloured the background green and proceeded to use various colours to circle and decorate the picture. She also made shapes alongside the image. She made lines over the image and then used the smudging tool to blur parts of the image. While obscuring the image, she remarked that the fish eagle was struggling to fly. She stated that she
Discussion
The overall impression of Fig. 2, Fig. 3 is quite chaotic, and could also display the participants’ profound state of disorganisation (Marzillier, 2014). Although some of the artwork may have been experimentation with the software tools and techniques, the participants could have easily erased elements that they intended to depict in a different manner.
Conclusion
This paper showed how digital metaphoric imagery in trauma therapy facilitated the construction of meaning of four female adolescents residing in a house of safekeeping. Attaching meaning to trauma memories helped them to contain the disorganisation of the trauma in order to integrate their trauma narratives into contextual aspects of their autobiographical memories. The transformations of therapist-generated and client-generated metaphors enabled associative connections with other memories.
References (65)
Digital culture and art therapy
The Arts in Psychotherapy
(2014)- et al.
A review of research and methods used to establish art therapy as an effective treatment method for traumatized children
The Arts in Psychotherapy
(2007) - et al.
Support for a neurobiological view of trauma with implications for art therapy
The Arts in Psychotherapy
(2009) - et al.
Art therapy groups for adolescents with personality disorders
The Arts in Psychotherapy
(2014) Commentary: Examining underlying paradigms in the creative arts therapies of trauma
The Arts in Psychotherapy
(2009)- et al.
Posttraumatic growth among children and adolescents: A systemic review
Clinical Psychology Review
(2011) Technology use in art therapy practice: 2004 and 2011 comparison
The Arts in Psychotherapy
(2012)Trauma, torture, and dissociation: A psychoanalytic view
(2011)- et al.
Technology in art therapy: Ethical challenges
Art Therapy: Journal of the American Art Therapy Association
(2011) Avenues of hope: Art therapy and the resolution of trauma
Art Therapy: Journal of the American Art Therapy Association
(2001)
ArtRage [Computer software]
Visual art therapy’s unique contribution in the treatment of post-traumatic stress disorders
Journal of Trauma & Dissociation
Early withdrawal from mental health treatment: Implications for psychotherapy practice
Psychotherapy: Theory, Research, Practice, Training
Metaphoria: Metaphor and guided metaphor for psychotherapy and healing
Religion and spirituality after trauma
Reconnecting psychoanalysis to mainstream psychology: Metaphor as glue
Psychoanalytic Inquiry
Following the metaphor: Bereavement care implications
Bereavement Care
Complex trauma in adolescence and young adulthood
Principles of trauma therapy: A guide to symptoms, evaluation, and treatment
Social constructionism
Models and paradigms of art therapy research
Art Therapy
Art therapy and flow: A review of the literature and applications
Art Therapy: Journal of the American Art Therapy Association
Treating trauma and traumatic grief in children and adolescents
The art and craft of psychoanalytic practice: A discussion of Orange’s Speaking the unspeakable: ‘The implicit,’ traumatic living memory, and the dialogue of metaphors
International Journal of Psychoanalytic Self Psychology
Treatment of complex trauma: A sequenced, relationship-based approach
Complex trauma, complex reactions: Assessment and treatment
Psychotherapy: Theory, Research, Practice, Training
Research design: Qualitative, quantitative, and mixed methods approaches
The foundations of social research: Meaning and perspective in the research process
A practical approach to trauma: Empowering interventions
Use of technology and software applications for therapeutic collage making
International Journal of Art Therapy: Formerly Inscape
We need to talk about epistemology: Orientations, meaning, and interpretation within music therapy research
Journal of Music Therapy
Responsive integrative treatment of clients with PTSD and trauma-related disorders: An expanded evidence-based model
Journal of Psychology in Africa
Cited by (12)
The development of the discourse of people with psychic injuries: From the unspeakable to the metaphor
2023, Annales Medico-PsychologiquesExploring the effectiveness of the Tree of Life in promoting the therapeutic growth or refugee women living with HIV
2019, Arts in PsychotherapyCitation Excerpt :The respectful approach created a safe space (Van Westrhenen et al., 2017) for the participants to open up and share their experiences. The combination of creating through artistic means and having a safe space to share their experience (Gantt & Tinnin, 2009) helped participants to self-soothe (Naff, 2014) and supported their post-traumatic growth, including through developing new meanings and hopes about their life (Kruger & Swanepoel, 2017). All except one participant had tremendous difficulty with roots.
Connecting identities through drawing: Relationships between identities in images drawn by immigrant students
2017, Arts in PsychotherapyCitation Excerpt :Since Tao’s Chinese identity seemed to be intact and robust, perhaps the boy did not need to rely on school as much as his peers in order to integrate his different identities into a meaningful whole. Still, even if Tao had a strong cultural identity of origin, the act of drawing seemed to have supported the boy in expressing elements of his culture of origin and in showcasing them in a positive way, while also helping him to express ambivalence towards both his Chinese and Canadian identities (Huss, 2009; Kruger & Swanepoel, 2017). One limitation of this study lies in the interpretative framework of the research.
Trauma-informed care in the creative arts therapies
2017, Arts in PsychotherapyA critical literature review: deconstructing narratives of trauma in art therapy with young people
2024, International Journal of Art Therapy: Inscape