Art therapy has experienced tremendous growth over the past two decades, not only advancing treatment options but also advancing into different populations and treatment settings. In particular, art therapists have been working with a very special and unique population — the military.
For over 15 years, post-9/11 military service members and veterans have been coming home after serving sometimes multiple tours to Iraq and Afghanistan. Many have sustained physical and psychological combat injuries and require extensive care. While medical advancements have made it possible to survive catastrophic injuries, the reality for those who do survive is that they may require extensive physical, hands-on care for many years to come. In addition to physical impacts, post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBIs) are prevalent in the Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn veteran populations, which poses tremendous daily challenges for the veteran and his or her entire family.
Stark cultures exist between the military and art therapy. The military — an institution and culture of rigid protocol, disciplined training, mission-focus; and art therapy — a profession based in creativity and the therapeutic relationship, within a fluid and flexible approach that offers myriad ways to openly express one’s feelings and thoughts. Yet many who serve in the military are finding art therapy to be their preferred method of treatment.
Why? It’s a simple answer to a not-so-simple and pervasive issue challenging many military members who return from war: trauma. These two contrasting worlds of military service and art therapy intersect because art therapy has the means to assist service members, veterans and their families in dealing with combat trauma.
The American Art Therapy Association explains Art therapy is an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship (AATA, 2017).
In 2016, the Defense and Veterans Brain Injury Center reported that 352,619 US military service members worldwide have been diagnosed with TBI, with 82.3% cases classified as mild. Research points to the connection between PTSD and TBIs in military service members. In fact, recent studies link TBIs sustained during deployment to significant predictors of the service member developing symptoms of PTSD (Walker et. al., 2017).
Combat veterans are seeking art therapy to assist with trauma resolution, integrate with their TBI treatment plan, and provide coping mechanisms for PTSD symptoms. These therapies have become an increasingly accepted form of complementary care for military veterans (Nanda, Gaydos, Hathron, & Watkins, 2010). Art therapy, facilitated by a professional art therapist, effectively supports personal and relational treatment goals as well as community concerns (AATA, 2017).
Over the past 20 years, the field of neuroscience has grown exponentially and has contributed to advancing art therapy to the forefront of trauma-focused treatment today. Significant to the use of art therapy in trauma work is understanding the neurobiology of trauma, the biological study of the effects of trauma on the nervous system.
Advances in medical technology, such as brain imaging, now allow physicians, therapists, and scientists to literally see and understand what art therapists have known all along: creating, such as art-making, can change neural pathways in the brain; and that potentially changes the way one thinks and feels.
Art Therapy is a profession that facilitates psychic integration through the creative process and within the context of the therapeutic relationship. Conscious and unconscious mental activity, mind-body connectedness, the use of mental and visual imagery, bi-lateral stimulation, and communication between the limbic system and cerebral cortex functioning underscore and illuminate the healing benefits of art therapy — none of which could take place without the flexibility of neuronal processes, otherwise known as neuroplasticity (King, 2016).
Creative arts therapists know through creating — whether through art, music, poetry, or drama — that traumatic memory can be readily accessed in a way that is far less threatening than traditional verbal therapies. Traumatic memories are often stored in images and other sensations rather than in words or through verbalization, and many art therapists have observed how making art helps in releasing traumatic memories that were previously inaccessible.
Recent developments in neuroscience have provided information about areas of the brain responsible for the verbal processing of traumatic events. Brain imaging illustrates that for many, when recounting a traumatic event, the Broca’s area (language) of the brain shuts down, and at the same time, the amygdala becomes aroused (Tripp, 2007). Right brain activation through art media and process allow for less reliance on the verbal languages area of the brain, which provides some substantiation for why nonverbal therapies like art therapy might be more effective when working with trauma (Klorer, 2005).
Art Therapy operates on multiple levels, addressing immediate symptoms and underlying conditions that cause symptoms to persist (Howie, 2016). The American Art Therapy Association identified four major contributions of art therapy to the treatment of PTSD (AATA, 2012).
1 – Reducing anxiety and mood disorders
2 – Reducing behaviors that interfere with emotional and cognitive functioning
3 – Externalizing, verbalizing, and resolving memories of traumatic events
4 – Reactivating positive emotions, self-worth, and self-esteem (American Art Therapy Association)
For many service members, being able to express memories, feelings and thoughts in a nonverbal way is a big relief. The artwork provides a safe way to depict and confront recurrent nightmares, flashbacks and traumatic memories. Art therapy practice encourages the healthy expression and integration of imprinted memories as they are brought to consciousness within the safety of the therapeutic relationship (Wadeson, 2010).
Art therapy was introduced into military treatment facilities years ago because it is an effective treatment for service men and women who have experienced the trauma of war. Today, art therapy has become a more widely accepted treatment for those experiencing trauma from their military service. Many are learning that to overcome combat trauma, art therapy is a critical part of their treatment plan.
American Art Therapy Association, Inc. (2013). Art therapy, posttraumatic stress disorder, and service members [Electronic Version]. Retrieved July 24, 2017 from www.arttherapy.org/upload/file/RMveteransPTSD.pdf.
American Art Therapy Association, Inc. (2017). Definition of profession [Electronic Version]. Retrieved July 24, 2017 from https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf
Howie, P. (2016). The Wiley Handbook of Art Therapy, First Edition. In D. Gussak & M. Rosal (Eds.), Art therapy with Trauma (pp. 375-386). Oxford, UK: John Wiley & Sons.
King, J. (2016). The Wiley Handbook of Art Therapy, First Edition. In D. Gussak & M. Rosal (Eds.), Art Therapy: A Brain-based Profession (pp. 77-89). Oxford, UK: John Wiley & Sons.
Klorer, P.G. (2005). Expressive therapy with severely maltreated children: Neuroscience contributions. Art Therapy: Journal of the American Art Therapy Association, 22 (4), 213-220.
Nanda, U., Gaydos, H. L. B., Hathron, K., & Watkins, N. (2010). Art and posttraumatic stress: A review of the empirical literature on the therapeutic implications of artwork with war veterans with posttraumatic stress disorder. Environment and Behavior, 42(3), 376-390. dio:10.1177/0013916510361874
Tanielian, Terri, Rajeev Ramchand, Michael P. Fisher, Carra S. Sims, Racine S. Harris and Margaret C. Harrell. Military Caregivers: Cornerstones of Support for Our Nation’s Wounded, Ill, and Injured Veterans. Santa Monica, CA: RAND Corporation, 2013.
Tripp, T. (2007). A short term therapy approach to processing trauma: Art therapy and bilateral stimulation. Art Therapy Journal of the American Art Therapy Association, 24 (4), 176-183.
van der Kolk, B. (2003). Post-traumatic stress disorder and the nature of trauma. In M. Solomon & D. Siegel (Eds.), Healing trauma: Attachment—mind, body, brain (pp.168-196). New York, NY: W.W. Norton.
Wadeson, H. (2010). Art psychotherapy (2nd ed.). Hoboken, NJ: John Wiley & Sons.
Walker, M.S., Kaimel, G. Gonzaga, A.M.L., Myers-Coffman, K.A., & DeGraba, T.J. (2017). Active-duty military service members’ visual representations of PTSD and TBI in masks, International Journal of Qualitative Studies on Health and Well-being, 12:1, 1267317.