The Art is an Anchor: Grounding Directives in Trauma Treatment

As a therapist I spend a lot of time finding and then utilizing safe places for my clients to rest in and catch their breath during trauma work. When we are approaching and then entering the memories, feelings, and sensations associated with trauma, it can quickly feel overwhelming if not outright terrifying. The experience of reliving the trauma to any degree can take us over for an unknown period of time, leaving us flooded and unable to function normally. This is why teaching and practicing grounding tools, also called self-regulation skills, is such an essential part of trauma resolution work.

The best grounding tools are body-centered in some way, because it is most often the body's response to recalling trauma that is so painful and overwhelming. Breath awareness, mindfulness of body sensations, and focusing one's attention on neutral zones in the body or the environment are essential grounding exercises. This post will be focusing on bringing art into grounding exercises, sometimes separate from body-centered grounding and sometimes in tandem with it or as an enhancing tool.

In resourcing work I spend a lot of time with the client in their imaginative world. Art therapy is essentially using imagination and creative processes for the purpose of healing, and it is important to focus the imagination on building internal structures and characters of resource and vibrancy. Many trauma survivors can imagine worst case scenarios and tragedies very well - in fact, they may spend a lot of time living in fear of their imaginations and what may be conjured up next. Part of the creative therapist's task is to help the client turn a former enemy into a friend by utilizing one's imagination for the purpose of hope and positivity. For more on imagination and its use in trauma work, read The Story Lives: Repetition of the Traumatic Experience.

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1. A Structure of Safety: It is important to envision what type of containment would feel helpful when the symptoms of trauma are active and flooding the client. More likely than not, the client may have no idea what could possibly contain their overwhelming thoughts, feelings, and body sensations when they are activated. It is during struggles like this where I utilize surplus reality, a concept developed by the founder of Psychodrama, J.L. Moreno. Surplus reality is an imaginative space where anything is possible, and we can create a new possibility around us through visualizing and then interacting with what we imagine. In the context of creating a structure of safety, the art therapist would introduce the idea of surplus reality, and then ask the client to visualize a structure, in the loosest possible use of that term (a room, box, tree house, geometric shape, set of armor, circle of light, jacket, tent, etc.) that would help the client feel safe while activated. After the visualization, the client will create a sculpture or image of this structure to more fully concretize and engage with said structure. The therapist can ask the client to place their art somewhere in their home that will cue them to envision and, hopefully, meditate on this structure regularly. Reminding the client that it takes repetition and time to strengthen such inner resources may be helpful. Entering that safe structure can also become a practice at the beginning of each session with the client as part of grounding before trauma processing.

2.  Neutral Place: Clients processing trauma need places in their minds and/or bodies to go to for refuge when the memories and thoughts associated with the trauma become overwhelming. Just like the therapy office is hopefully a neutral place to process trauma, having internal neutral spaces for the 167 hours of the week when the client isn't in therapy (and may still be processing trauma) is important. I often utilize the bilateral grounding exercise described below to help the client find their neutral place before translating that place into a visual cue.
a. Ask client to sit in their seat with back straight, feet flat on the floor.
b. Then ask client to place their right hand on their left arm (between the shoulder and elbow, outer bicep area) and their left hand on their right arm. It will look they are lightly hugging themselves.
c. Ask client to start tapping in an alternating pattern on their arms with their hands: model this and do this along with them.
d. Ask client to do this for a couple of minutes while imagining a place they have felt content or pleasantly neutral. Tell them to imagine they are in that place, noticing any sights, sounds, smells in that particular spot.
e. Track the client: if you can tell that they aren't accessing any space, ask them to open their eyes and brainstorm together a neutral place they have been to (while still tapping). It could be a waiting room at a doctor's office, a coffee shop they've been to once or many times, an area in the grocery store they find pleasant, etc.
When the client has done this exercise effectively you can move to art making, asking the client to represent that space on a small piece of paper, block of wood, or stone: something small that they can carry with them as a reminder for when they need it.

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3.Hands and Feet: The extremities of the body, i.e. the hands and feet, are both areas of neutral sensation and the parts of our bodies that interact the most with the world. Most of us walk on our feet through the world and use tools with our hands (pens, mobile devices, door knobs, steering wheels, spatulas, spoons, etc.) to navigate and serve our varied purposes. People with trauma may or may not find their extremities places of neutral sensation. I have noticed that a certain amount of clients with deep intergenerational trauma have feet issues, while some torture survivors experienced a lot of damage to their feet or hands. Many clients with trauma, however, seem to have a neutral if not positive relationship to these parts of their bodies. When much of the body can feel off-limits to clients with trauma, the extremities can be an entry way into increased body awareness and self-care.

Doing art work that uses the hands and feet while focusing on mindfulness can be a powerful - and fun - way to increase body awareness via these "entry points." Below are some ideas of hand-feet directives to offer clients:

A. Casting Hands: using plaster gauze, work with the client to cast one or both hands in plaster. Cut the plaster gauze into small strips, dipping each piece one at a time in warm water and applying to the client's hand. Gently pat the wet strip until the open holes in the plaster are gone and each strip is integrated into the ones around them. After the casting is done and the piece feels cool and sturdy, the client can wiggle their fingers until the cast comes loose. Note: Only cast one side of the hand. You cannot extract a hand from a casting that wraps around the entire hand! After the cast dries (this takes a day+), the client can paint their cast in a way that feels beautiful, empowering or expressive of who they are. This same directive can be done with the feet.

B. Walking Painting: lay a large sheet of paper on the ground/floor (I usually do this outside), and provide paints like tempera in pans or flat tupperware containers. It's important to have a couple of bath towels and a pan of soapy water on hand for cleanup. Ask the client to 1.) walk their life path on the paper, or 2.) simply paint with their feet, tracking the sensations of the experience.

C. Finger Painting: This is something we have all done as children, and it can be either energizing and grounding or very triggering for clients with trauma. Check in with the client and know your client: if they lean towards being more disorganized in their trauma, or they have major sensory issues, this may be too unstructured of an exercise. If your client, however, enjoys doing work with their hands and leans towards being overly controlling and structured in their lives, this may work very well for them. Ask them to track the sensations and any thoughts, images, memories that are associated with the sensations.

4. Character of Strength: Clients with severe, complex trauma may have very few people in their lives who feel dependable and stable. It can be incredibly difficult to aspire to get better when you've rarely interacted with what better can look like. I find this is particularly true with clients under 30 and even more so with my teenaged clients. With this exercise you are asking your client to thoroughly imagine a strong and stable person and internalize that person.

Ask the client to think about a person they have known in their lives who seemed stable and supportive. It may be a teacher in high school, a friend's mom, or a neighbor they only knew for a year. Did this person help the client feel better about themselves and provide them with hope for their future? Did the client hope to someday be like them? If they answered yes to these questions, they may have found a character of strength for themselves.

Ask the client to make an art piece that reminds them of this person: it could be a portrait, a collage, or a sculpture that elicits a certain memory of that person. If their English teacher wore scarves, maybe they knit a scarf or glue a scrap of a scarf onto a canvas. If their great aunt who was really sweet to them gave them chocolate covered cherries, maybe they paint a small picture of a chocolate covered cherry. Spend time working on this piece, discussing how the client might integrate the person and the associated artwork into their life. When the piece is done, guide the client through visualizing the qualities of this character of strength and the ways in which the client may already embody some of these qualities. When they feel stuck ask them to imagine what their character of strength would do: in this way you are guiding the client to create a positive introject.





These directives have become regulars in my work with trauma survivors. I have seen clients click with their resources, really internalizing their own strengths and accessing safe places in the mind and body through the active engagement of art making. Therapy with trauma survivors must include active experience and practice of other ways of being, or the client will not be able to do and be differently. As an art therapist, I see infinite ways art can be used in the service of transformative doing and being: my best and most well-honed directives, however, feel almost like alchemy to me when I use them in session with the right client at the right time.