Breaking The Silence - Art Therapy

BREAKING
THE
SILENCE
"Art and violence are directly oppositeeachotherin their effects."
Rollo May
My Questfor Beauty
BREAKING
THE
SILENCE
Art Therapy with Children
from Violent Homes
SecondEdition
Revised and Expanded
Cathy A. Malchiodi, M.A.,

A.T.R., LPAT, LPCC
Routledge
Taylor & Francis Group
New York London
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Malehiodi, Cathy A.
Breakingthe silence:art therapywith children from violent homesI by Cathy A. Malehiodi. - 2nd cd.
p. em.
Ineludesbibliographical referencesand index.
ISBN 0-87630-824-8
I. Abusedchildren-Mentalhealth. 2. Art therapy for children. 3. Brief psychotherapy.4. Family
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Contents
Foreword by Eliana Gil, Ph.D. vii

Acknowledgments xi
Introduction Xlll
CHAPTER ONE The Role of Art Therapy in the Assessment

and Treatmentof Children from Violent Homes:An Overview 1
DomesticViolence, Children, and Art Therapy: Some
PersonalObservations 1
Art Therapyand DomesticViolence: Contemporary
Perspectives 6
CHAPTER lWO Working with Children from Violent Homes 16

SomeBasic Considerations 17
SomeCommonalitiesAmongChildren Who PopulateShelters
for BatteredWomen 20
Inherent Frustrationsfor the TherapistWorking in Shelters
for BatteredWomenand Their Children 44
CHAPTER THREE Art Evaluationwith Children

from Violent Homes 50
Using Art Expressionwith Children in Crisis: A Brief
Overview 51
Intake: Initial Art Evaluation 52
Art Evaluation: What to Include 54
DevelopmentalLevelsin Children'sArt and Their Importance
in Evaluation 67
Organizingthe Written Evaluation 74
Key Areasin an Art Evaluation 75
Referral 90
Summary 90
v
vi CONTENTS
CHAPTER FOUR Art Interventionwith Children

SomeOverall Considerations 93
Initial Stageof Intervention 95
Middle Stageof Intervention 96
SomeSuggestions for SpecificGroup Art Interventions 122
Termination Phase 124
Summary 128
CHAPTER FIVE Child SexualAbuse 130

SomeDefinitions of SexualAbuse 131
Issuesin Treatmentofthe SexuallyAbusedChild 132
The Use ofArt Expressionas Assessment and Therapy
with SexuallyAbusedChildren 136
Art ExpressionsofSexuallyAbusedChildren: Complexities
and Commonalities 139
SomeFinal ThoughtsAbout the Art ExpressionsofSexually
AbusedChildren 163
Interviewing the SexuallyAbusedChild AboutArt
Expressions 164
Movingfrom Contentto Validation ofAllegation 166
SpecialQualificationsof the TherapistWho Works
with SexuallyAbusedChildren 168
CHAPTER SIX DevelopingArt TherapyProgramsfor Children

Qualificationsof the Art Therapist 172
Policies 173
ServiceDelivery: SomeSuggestions 175
Environment 178
Supplies 179
Play Items 184
SomeAdditional Advice 186
Display of Children'sArt Expressions 187
Epilogue 190
ResourceList 191
References 195
NameIndex 205
SubjectIndex 207
Foreword
Scotty had beeninterviewedby police on four different occasions.At four

yearsof age,he was unableto satisfy with clear,consistentanswers.He was
referredto me as a potential child sexual abusevictim, and I interviewed
him while a police officer watchedthrough a one-way mirror. Talk of his
father definitely producedagitation, but reasonswere unclear. He went
from one toy to another,obviously overstimulatedby play therapychoices.
I offered him a blank pieceof paperand a pencil and told him he could
draw anythinghe wanted.He drew an oblong shapeand then drew parallel
lines crossingover the shape.He looked up at me with a solemnlook on his
face. "Bad pee-pee,"he stated.I looked down at his picture and simply
repeated,"bad pee-pee.""Pee-peein jail," he added."Oh," I responded,
"the pee-pee'sin jail." "It's bad," he affirmed. "What did the pee-peedo
that'sbad?"I askedhim. "Pee-peehurt my bottom."This was the beginning
of Scotty'sdisclosure.
Children who are hurt are often put in the untenable positionof having
to communicateto strangerswho ask often complex and repetitive ques-
tions aboutwhat happenedto them. Sometimeschildren are young enough
that their languageskills make it difficult for them to make clear state-
ments;othertimes,childrenhavean arrayof emotionsassociatedwith hurt-
ful experiences.And yet often we are unableto protectchildren unlesswe
know what hashappenedto them and how they arereactingto thoseevents.
My experiencewith abusedand neglectedchildren has taught me that
they do indeedcommunicatenonverbally.They communicateboth through
active and passivebehavior-whatthey do and don't do, and they express
themselvesin a variety of ways. Children are almost always showing us
somethingabout how they feel or what they think, if we are able to see,
hear, and decodeovert and covert messages.Unfortunately, too often our
clinical attentionfocuseson verbal communication,and we sadly overlook
or minimize the vast information children provide in more familiar ways.
Thereare severaluniversalactivitiesfor children: Play and art are among
the most common.Clinicians recognizethe potentialvalue of play and art,
and in response,equip their offices with toys and art supplies.Mostly, clin-
vii
viii FOREWORD
icians view theseas obviouspropsfor "breakingthe ice" with children,but

more and more, there is recognitionthat play and art are critical tools that
facilitate both diagnosisand treatment.The level of training in thesemedia
will dictate the level at which clinicians are able to facilitate their client's
optimal use,yet many clinicians continueto ventureinto art work with lit-
tle preparationor training regardingits powerful impact and implications.
Cathy Ma1chiodi'sbook is a useful tool for both trained and untrained
professionalswho seekto assistchildren in crisis, particularly childrenwho
come from violent homesand who are currently living in homelessshel-
ters-apopulation only recently recognizedas one requiring specialized
services.She carefully presentsa contextualframework for the use of art
work with this population. Children in shelters are experiencing acute
stress:They are in unfamiliar surroundings,they are separatedfrom a pri-
mary parent, they have witnessedviolence, and they are experiencinga
range of emotionsfrom worry and concernabout their mother, to fear or
longing for their father. Sheltersare also environmentsin flux; peoplecome
and go in various stagesof crisis. Children in theseenvironmentsare often
difficult to comfort, and peer relationships may become difficult or
strained.Art work, Ms. Ma1chiodipointsout, may help children makeorder
out of chaosand may help children channelaggressiveenergyinto the cre-
ation or constructionof art products,which may then producefeelings of
accomplishmentand well-being.
Homelesssheltersare complex environments:In the midst of efforts to
transform crisis into opportunity, despair into hope, helpers busy them-
selveswith a variety of tasks: providing crisis interventionservices,coun-
seling, and assistingfamilies in the difficult tasksof stabilizing and creat-
ing safeenvironments.
Art work can be both a respite and an agitator. Done properly, art can
help children releaseandcontaina rangeof emotions.Doneimproperly, art
can overwhelmand agitatechildren. Ms. Ma1chiodi providesreaderswith
a deep understandingof the power of therapeuticart work, offering safe-
guardsand cautionsevery stepof the way.
The art work in the book brings children'svoices to the forefront. It is
one thing to imaginewhat it must be like for children whosefamilies expe-
rience domestic violence, it is another thing to see the graphic images
which give us an "inside look" at how children makesenseand give mean-
ing to theseexperiences.
This bookis especiallyaboutusing art work with childrenwho havebeen
hurt throughwitnessingdomesticviolence,but it also encompasses the use
of art expressionto help individuals with a rangeof crisesandtrauma,since
imagemaking allows for externalizationof both painful and terrifying feel-
ings, as well as hopeful ones and eventualtransformation.Ms. Ma1chiodi
describesher approachas art intervention,basedon a belief that the most
importanttaskwhen working with a child in crisis is to focus on stabilizing
FOREWORD ix
the child throughintervention,as well as assessingthe needfor further spe-

cific interventions.Shediscussesthe relative merits of "openingup" client
woundsin a settingthat is short-term,and during a time fraught with inher-
ent emotionaldemandson children. Shedelineatesuseful as well as poten-
tially dangerousinterventions;intrusiveversusnonintrusiveart tasks;selec-
tion and suggestionof differing mediaand tasksvis a vis the type and stage
of assessmentor treatment;and provides criteria for designing effective
interventionsfor injured children with a rangeof emotionaland behavioral
dysregulation.
This book was a godsendbackin 1989.Now, with its expandedliterature
review, thoughtful insights born of additional experience,and state-of-the-
art references,this book servesas a compelling and informative guide for
thoseof us working with injured and displacedchildren in crisis. The use
of art with this populationis not only helpful, it may be a preferredtreat-
ment methodsince it clearly does not rely on languageskills, which may
not be developed,and it allows children a pleasurableand constructiveway
to communicate,externalize,andprocesstheir undisclosedpain, fears,wor-
ries, and triumphs.
Eliana Gil, Ph.D.

Director, StarbrightTraining Institute
Rockville, Maryland
To my husband,David Barker,
and my parents,Grace and JamesMalchiodi
Acrul0wledgmel1ts
When I wrote the first edition of Breaking the Silencein the summerof
1989,I had no idea that it would be so well receivedas to warranta second
edition. Thank you to Natalie Gilman, former editor at BrunnerlMazel,
whoseforesight and editorial assistancemadethe first edition of Breaking
the Silencepossible.
Thank you to all my friends andcolleaguesin the field of art therapywho
have supportedand encouragedmy clinical work and writing. In particular
I want to thank Shirley Riley, for her support,wisdom, and laughter;Carol
ThayerCox andLori Vance,for their generosityof spirit both as friends and
professionalcolleagues;Cay Drachnik,for writing the forewordto the first
edition of this book and for her continuedsupportof my work; and Eliana
Gil, internationallyrecognizedfor her work with traumatizedchildren, for
writing a foreword to this secondedition. A big thank you also goesto my
husband,David Barker, for his supportand for helping me to find my voice
as an authorby introducingme to the computer.
Lastly, revising this book remindedme of all the remarkableopportuni-
ties that I have hadto witnessthe healingpowerof art in my work with chil-
dren from violent homes.Therefore,I want to acknowledgethe many chil-
dren who have sharedwhat are often painful stories through their art and
whose experiencesunderscorethe important messageof this book. Their
images and words served as both an inspiration and foundation for the
developmentof this text and allowed me to realize the exceptionalrole art
plays in the expressionand ameliorationof trauma.
xi
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Introduction
When reviewing the literature of other researchersand clinicians, I came

acrossa shortdiscussionaboutthe theory of pragmatismas a trend in child
therapy.In this discussion,Schaefer(1988) definespragmatismas "a com-
mitment to be guided by what works in practice" (p. 4). He goes on to
observethat this commitmentoverridesadherenceto a particulartheoreti-
cal orientation,and he advocatesthe use of reliable researchfindings and
clinical experiencesratherthan personallyappealingtheories.He notesthis
pragmaticapproachutilizes "practical consequences of a therapeuticinter-
vention as a standardfor evaluatingits usefulness"(p. 4).
Theseconceptshold a great deal of appealfor me becausemy experi-
enceswith working with children in crisis have requiredboth practicality
and flexibility that do not seemto fit neatly into anyoneperson'stheory of
therapeuticintervention.Therefore,I havetried to be guidedby pragmatism
throughoutthe writing of this book. Professionalswho work with children
from violent homeswant some specific and efficacioussuggestionsabout
what to do for thesetroubled children. However, there has beenvery little
literatureavailableto help them understandthesechildren, let alonedesign
effective interventionsfor them.
Over the last decade,I have had an increasingnumberof requestsfrom
clinicians for practical information and advice on how to implement art
therapyprogrammingwith children from violent homes.Thesecommuni-
cations often come from social service agencies,both private and state
operated,sheltersfrom domesticviolence, safe houses,and YWCAs with
programmingfor batteredwomen and their children. Other requestscome
from mental health professionalsand studentswho have an interestin how
art expressioncan be specifically used therapeuticallyand diagnostically
with childrenwho are abusedor subjectedto violencein their homes.There
are also many questionsaboutcurrentfindings concerningreliable assess-
ment and evaluativetechniqueswith the emphasison graphic indicatorsof
abusein any form.
In light of theserequests,I particularly hope the information presented
will be helpful to the professionalor studentwho is looking for clarity and
xiii
xiv INTRODUCfION
understandingof how art therapy may be applied to work with thesechil-

dren. Although this book is written from the perspectiveof an art therapist,
it is also intendedas a guidefor fellow practitionerswho work with victims
of domestic violence and child abuse.Social workers, protective service
personnel,play therapists,counselors,and psychologistsoften want to
enhancetheir understandingof the use of art therapy with children from
violent homes. Additionally, administratorsand program directors who
want to initiate or contract for art therapy servicesmay need to increase
their understandingof the scopeof art therapyservicesand how they can
be bestdelivered.
In an effort to addressthesepracticalquestionsand issues,this book has
threepurposes.
The first purposeis to discusspossiblecommonalitiesin the art expres-
sionsof this child population.It is hopedthat suchinformation will help pro-
fessionalsunderstandwhat thesechildren are communicating,what expres-
sive commonalitiesexist in this child population,and the importanceof the
use of art in the assessmentof children from violent homes.When dis-
cussingtheseobservations,every effort has beenmadeto identify and dif-
ferentiatewhich visual commonalitiesare speculationor personalobserva-
tion and which are basedin empirical research.It is important that the pro-
fessionalor studentreadingany text that discussesthe contentof drawings
be informed in this way so that the information presentedwill be appropri-
ately applied inclinical practice.
For reasonsof confidentiality, case materialsupportingeachdrawing in
this book is presentedin its briefestform, consistingof a short description
of the child and the major presentingproblems.In somecases,information
has been alteredto further protect the child's identity. Although the draw-
ings havebeenreleasedfor the purposeof educationalpublication,length-
ier or more revealingdescriptionsof the childrens'casescould threatenthe
confidentiality of thesechild clients.
The second purposeis discussionof art intervention strategiesand
their implementationwithin crisis-orientedwork with children from vio-
lent homes.The major focus of this discussionis on the therapist'srole
in the assessmentand treatmentof children in sheltersfrom domestic
violence.The environment,facility, or agencyin which art therapyis uti-
lized must also be taken into consideration.Therefore,conceptsof inter-
vention as well as the professionalconcernsof the therapist working
with children from violent homesare both addressed;theseprofessional
concerns include ethical issues relating to domestic violence and the
practice of art therapy,working with the courts, integration of art inter-
vention within the shelteror safe housestructure,and team versusindi-
vidual approachesto treatment.Dimensionsof art interventionwith chil-
dren from violent homesthat may be frustrating or problematicare also
identified and discussed.
INTRODUCTION xv
The final purposeis to identify programstrategiesfor implementationof

art interventionswithin shelterprogramsfor children from violent homes.
"Programstrategy"is a broadterm coveringboth the integrationof art ther-
apy servicesinto domesticviolenceprogramsand the establishmentof such
services.For many years, I have been fortunate to have been allowed to
developand evolve programming;as an adminstratorI was able to design
combined approacheswith other therapists, include other expressive
modality therapists(suchas dramaandmovement),anddevelopnew meth-
ods of service delivery. This information is included in the final chapter,
"DevelopingArt TherapyProgramsfor Children from Violent Homes," to
illustrate ways to initiate and developsuchprogramming.
Thereare many therapistspracticingin isolatedsituationsin sheltersand
domestic violence programs throughout the United States and Canada.
Theseprofessionalsare looking for ways to programand adaptart therapy
for thesespecialchildren who are seenin situtationsthat may differ from
medicalor psychiatricmilieus. These"pioneers"arecreativelyadaptingart
modalitiesto suit the requirementsof short-term,crisis-orientedagencies,
becomingpart of treatmentteamsand providing valuableassessment data
on the traumatizedchildren they see.It is extremelyexciting for me to see
this happening,knowing from my own perspectivethe value of art therapy
in clinical and community work with children from violent homes.I hope
that in someway what is said here may validate their efforts.
This book is not meantas a profoundstatementor testamentto the pow-
ers of art therapywith children; other authorshave addressedthat topic in
many fine volumes,someof which are listed in the resourcesectionof this
book. Art therapy is not a panacea,but rather a vital, growing field with
many impressive accomplishments and great promise for further growth.
Art therapyhasbecomean importantmodality in the field of mental health,
particularly psychiatry,counseling,and rehabilitation.There is still a sig-
nificant need,however, forart therapyservicesand expertisewith children
who are in crisis or in traumabecauseof the effectsof family violence.Art
therapyis compatiblewith social services,crisis work, and child protective
services,providing the primary servicesof evaluation,treatment,and refer-
ral, and it is easily adaptableto use in crisis situationsinvolving children
from violent homes.Most important,perhaps,the art productionsof these
children may yield neededinformation to the skilled therapist,information
that may not be readily availablethrough verbal meansand that can bene-
fit a child in needof interventionand understanding.
It must be cautioned,however,that art when usedfor therapyor evalua-
tion is not a simplistic tool and does require serious training to be fully
understood.As art therapistJudith Rubin (1984b)pointsout, "Art is a pow-
erful tool-onewhich, like a surgeon's,must be usedwith careand skill if
it is to penetratesafely beneaththe surface" (p. 299). In the handsof the
inexperienced,thoughwell-meaning,clinician, it can evenbe dangerous;a
XVI INTRODUCTION
seeminglybenign art task can elicit powerful feelings and sensationsin a

child that can be harmful. Interpretationof art expressionwithout under-
standingof developmentallevels inherentto children'sexpression,cogni-
tive factors, media potentialities,and contemporaryresearchin diagnostic
indicators can be even more dangerous.The scopeof this book cannot
cover all these aspectsof the field of art therapy; others have compiled
many years of experiences,observations,and study on thesebasic topics
and the readerunfamiliar with basic theory of art therapyis encouragedto
refer to them for additional information.
In many ways, this book is about using art as an interventionfor all chil-
dren who are in crisis. It presentsa model and informationfor working with
traumatizedchildren in short-termsettingswhere intervention and assess-
ment must be swift. Children who are in crisis for any reasonreactin sim-
ilar ways. Therefore,the information presentedmay be adaptableto chil-
dren in relatedsettingssuch as family supportcenters,crisis day care, and
. counselingprogramsin the public schools.In my work with children who
havebeenhospitalizedbecauseof chronic physicalillnessor surgery,I have-
seen many correlationsand parallels with the assessmentand treatment
methodologypresentedhere.
In closing, I want to say rather unpragmaticallythat I have found great
personalsatisfactionin knowing that art expressionhasbeenthe key factor
in successfulinterventionwith children from violent homes.Becauseof my
strong ties to both visual arts and therapeuticwork, I have deep feelings
about the power of art expressionin effecting changeand encouraging
growth in both the individual and in society. Family violence continuesto
be problematicto our contemporaryculture and is one of the greatestchal-
lenges to the helping professionsin the coming years. If, as Rollo May
(1985) says, "Art and violence are directly opposite each other in their
effects" (p. 215), then art expressionmay have tremendousimplicationsin
the ameliorationof aggressionin our families andin society.It is this intrin-
sic characteristicof art that convincesme that art therapyhasa uniqueplace
in the treatmentof children from violent homes.
CHAPTER ONE
The Role of Art Therapyin the

Assessmentand Treatmentof
Children from Violent Homes:
An Overview
DomesticViolence, Children, andArt Therapy: Some

PersonalObservations
During recentyears,the areaof domesticviolence hasreceiveda consider-

able amountof attentionfrom the government,mentalhealthprofessionals,
medicine,and the public. Child abuse,a componentof family violence,has
had the longest tradition of study and research(Finkelhor, 1979), going
back to Henry Kempe's identification of the "batteredchild syndrome"
(Kempe, Silverman, Steele, Droegemueller,& Silver, 1962). It was not
until the mid-1970s, however, that domestic violence becamea growing
issue amongmental health professionalsand only in recentyears that the
problem of abuseand violence amongfamily membershas emergedas a
major focus of both interventionand research.
It is now known that violence in the home is a frequent occurrence
(American PsychologicalAssociation,1994). At least 2 million American
womena yearare batteredby their partners;in addition,violencecan occur
in samesexrelationships,althoughit is morecommonfor womento be bat-
teredby men. It is alsoestimatedthat approximately10 million children in
the United Statesareexposedto wife abuseeachyear(Straus,1991).These
children a!"e known to be at increasedrisk for abuseto themselvesfrom
their parentsor guardiansas well as emotional,cognitive, and behavioral
problemsthroughouttheir lives. However,despitea growing understanding
1
2 BREAKING THE SILENCE
of domesticviolenceand its effectson children,the impactof domesticvio-

lence on children is still not well understood.Professionalswho work with
troubled families continueto look for ways to treat domesticviolence and
child abuse,understandits effects,and preventits recurrence.
To complicatematters,children from violent homescome from diverse
backgroundsand bring unique experiencesto treatment.They may have
been physically abused,neglected,sexually abused,and/or witnessesto
violence to other family members.Moreover, althoughviolence within the
family structure may be defined as any interaction that involves a use of
physical force againstanotherfamily member,it can also include psycho-
logical maltreatment and emotionally cruel child-rearing practices.
Additionally, children who live in violent homes may have experienced
other typesof family dysfunctionincluding alcoholismor chemicaldepen-
dencyand mentalillness. Lastly, family dysfunctionmay be acuteor chron-
ic; violencemay haveoccurredover many yearsor may havebeentriggered
by a recentstressto the family system.
Children are often the victims of violence in the home becausefamily
violence often involves an abuseof power in which a more powerful indi-
vidual takes advantageof a less powerful one. Finkelhor (1979) observes
that abusetendsto gravitatetoward the relationshipsthat offer the greatest
powerdifferential. This is acutelytrue in situationsof incestor sexualabuse
in which an older personmay dominatea youngerone; in family violence,
a mothermay abusea young child or a husbandmay beathis wife.
From a cultural perspective,children may be exposedto violence not
only in the home but also in society. Gil (1979) believesthat family vio-
lence is a result of societalviolence and thus cannotbe viewed in isolation
from society. He describes"structural violence" as conditionsthat exist in
societythat limit developmentand obstructhumanpotential.Structuralvio-
lence might include poverty, discrimination, and unemployment;these,in
turn, may also causethe eruptionof personalviolence in the homein reac-
tion to the stressand frustration societyhas helpedcreate.Jaffe, Wolfe,and
Wilson (1990) also note that rock videos, violent sports figures, popular
movies, and television may also contribute to an increasein societal vio-
lenceand havean impact on violent behaviorin children,particularly those
who have beenexposedto violence in their homes.
Sinceevery child comeswith a different set of dynamics,social factors,
and coping mechanisms,every child perceivesfamily violence in a differ-
ent way, even though the circumstancesof trauma may be similar. Many
children will maintain incredible allegianceto their abusers,despite the
horror of their experiences;othersmay react with ambivalence,simultane-
ously angry at and protectiveof the abusingparent.For thesereasonsalone,
assessingand making appropriatetreatmentavailableto children from vio-
lent families is complicatedat best.
To make senseof the diverseexperiencesof thesechildren, I looked for
a themein their experiencesthat could help me to designtherapeuticinter-
ROLE OF ART THERAPY IN ASSESSMENTAND TREATMENT 3
ventionsthrough art experiencesand understandwhat thesechildren were

sayingthroughtheir expressions.When looking for a way to structurewhat
I wantedto accomplishwith thesechildren,I found that crisis was the com-
mon denominator within the varied constellation of characteristics.
Whetherthe child is in crisis becauseof violencein the home,to his moth-
er, or to himself or herself, or in crisis simply becauseof having to leave
familiar surroundings,a factor disturbing the equilibrium of the family
brought the mother and her children to seek refuge and support. It was
aroundthis themeof crisis then that I developedtheoriesof how to practice
art therapyin a shelterenvironmentwith children from violent homes.
More than fifteen yearsago when I first startedto work with the children
of battered women, I was profoundly struck by another commonality
amongthesechildren: a visual metaphorof monsters(Malchiodi, 1982) in
their art expressions.Often the metaphorwas literally representedby the
depictionof a monsterof somesort (Figure 1-1). Othertimes the "monster"
(Figure 1-2) was veiled in less literal, but equally powerful expressionsof
pain, anger,fear, or loneliness.Theseare the invisible monstersthat gnaw
Figure I-I. Monsterdrawing by a six-year-oldboy

at a batteredwomen'sshelter(pencil, 8'1z" x 11").
Figure 1-2. Drawing by a seven-year-oldboy at a battered

women'sshelter(felt marker, 8'/Z" x II").
away at the inner self, creaturesthat destroyself-esteemand leave in their

wake anxiety and pain. For children from violent homes,the monsterscan
be an abusiveparent,neglect,incest,and severeemotionaltrauma.
When I beganto work with thesechildren and their "monsters,"I also
sensedthere were some other commonalitiesin their visual communica-
tions. I beganto realize that the complexity of eachchild's situation con-
tributed to the form and content of hislher expressions.Situations could
include not only emotionaltraumabut also physical or sexual abuse,psy-
chological maltreatment,chronic stress,and neglect. Family interactional
systemsmight presentaddictions,seriousmental illness, or even involve-
ment in cults and bizarre life-style practices.
Historically, visual art has beenused to make senseof crisis, pain, and
psychic upheaval. Human suffering has inspired some our greatestart.
Anyone who has viewed Picasso'spowerful painting of the effects of war
on the Spanishtown of Guernicais awareof the power visual imagery has
in depictingtrauma,violence,and actsof aggression.With referenceto this
work of art, Rollo May observesthat "art is an antidotefor violence" (1985,
p. 215). He seesart expressionas giving one a feeling of transcendence that
might otherwisebecomenegativeoutcomessuchas drug addiction,suicide,
and, on a societalscale,possiblywarfare.May notesthe preventive aspects
of art expression,attributing to it the capacityto neutralizeviolenceby tak-
ing the "venom" out of it. For thesereasons,art therapy,a treatmentmodal-

ity that utilizes art expressionas its core, has a uniquerole in the ameliora-
tion of violence and its effects.The very natureof image making makesit
a powerful means of illicting and dissociating painful and frightening
imagesfrom the self.
There is precedentfor the useof art expressionin helping individuals to
expresscrisis and traumathroughimagery(Golub, 1985; Greenberg& van
der Kolk, 1987). Aside from the therapeuticbenefit of nonverbalcommu-
nication of thoughtsand feelings, one of the most impressiveaspectsof the
art processis its potential to achieveor restorepsychologicalequilibrium.
This use of the art processas interventionis not mysteriousor particularly
novel; it may havebeenoneof the reasonsthat humankinddevelopedart in
the first place-toalleviateor containfeelings of trauma,fear, anxiety, and
psychologicalthreatsto the self and the community(Johnson,1987).
Like many art therapists,I haveoften utilized art to understandand make
senseof trauma in my own life. Art expressionhas been the key to my
understandingof personalloss,crisis, and emotionalupheavalwhen words
could not adequatelyexpressor contain meaning.However, the value of
the art expressionfor me underthesecircumstanceshas not only involved
the resultant images but also my immersion in the creative process.In
essence,it has helpedme to break through feelings to which I have been
clinging and make new discoveriesabout myself (Malchiodi & Cattaneo,
1988).As aptly describedby May (1985),"In all creativity, we destroyand
rebuild the world, and at the sametime we inevitably rebuild and reform
ourselves"(p. 144).
Miller (1986), authorof contemporarystudieson child abuse,notes the
connectionsbetweenchildhood trauma,such as abuse,and creativeactivi-
ty. She observesfrom her own experienceswith visual expressionthat
repressedfeelings resulting from early childhood trauma take form in the
works of artists and poets.For children who havebeenabusedor havewit-
nessedviolence in their homes and are often silent in their suffering, art
expressioncan be a way for what is secretor confusingto becometangible.
Miller also speaksstrongly to the value of processin working through
feelings through art as sheexploredthe experiencesof her childhood:
The repressedfeelings of my childhood-thefear, despair,and

utter loneliness---emerged in my pictures, and at first I was all
alone with the task of working thesefeelings through.For at that
point I didn't know any painterswith whom I would have been
able to sharemy new found knowledgeof childhood, nor did I
have any colleaguesto whom I could have explainedwhat was
happeningto me when I painted. I didn't want to be given psy-
choanalytic interpretations, didn't want to hear explanations
offeredin termsof Jungiansymbols.I wantedonly to let the child
in me speakand paint long enoughfor me to understandher lan-

guage.(p. 7)
For a traumatizedchild, art expressionmay focus on the effects of vio-

lence as well as the situationalfactors causingdysfunction.Throughthe art
product, the child doesnot necessarilyfocus on only one aspectof family
violencebut ratheron a whole constellationof feelings and experiences.Art
products,becauseof their nature,can simultaneouslyencompassthe many
complex, contradictory, and confusing feelings the child from a violent
home may have.For a child, art can be anythingthe child wantsor needsit
to be. It can be cruel, horrifying, and destructivebecausein art expression
there are no restrictionsand such imagery is acceptable.
Art Therapy and Domestic Violence:

Contemporary Perspectives
My experienceas an art therapistwith children from violent homes has

come largely from direct involvement with children at batteredwomen's
shelterprograms.I was askedto provide interventionbecausethe shelter
staff often found solely verbal methodsof interview and treatmentunpro-
ductive and frustrating to thesechildren in crisis. Becausethesechildren
would not or could not verbalizetheir experiences,it was thought thatmore
expressivemethodsof therapy could help them to relate the psychic and
physical traumaof domesticviolence.
However, in 1980, when I first startedto work as an art therapistin a
domesticviolenceshelterfor womenandtheir children,therewere few role
models availableto guide my work within such a facility. It was not until
many yearslater that I cameacrossthe work of ClaraJo Stemberwho per-
formed a similar function while employedby the ConnecticutSexualAbuse
TreatmentTeam in the 1970s.Stember,an art therapist,wrote a landmark
article (publishedin 1980) that outlined her approachto art therapy with
sexually abusedchildren and their families. Most important, she strongly
supportedthe integrationof art therapyinto such a treatmentprogramwith
the art therapistserving as an important teammemberin both therapyand
diagnosis.Unfortunately,Stemberdied in 1978,but sheleft the field of art
therapya rich legacy of her clinical applicationsto abusedchildren.
Instinctively, the public has long recognized and acknowledgedthe
power of art expressionsof children from violent homes.For example,on
the cover of the May 14, 1984 Newsweek(Watson, Lubenow,Greenberg,
King, & Jenkin, 1984),a specialfeatureon sexualabuseis illustratedby the
drawing of a child sexually victimized by her grandfather(Figure 1-3). The
drawing is an extremely dramatic exampleof how the pain of a molested
child can be depictedthrough a visual art modality. It succinctly and effec-
Newsweek
Sexual Abuse
However,
However,
However,
However,
However,
However,
However,
Figure 1-3. Cover of Newsweekmagazinefeaturing specialissueon child sexual

abuse.
tively portraysthe complexfeelings of anger,anxiety, and frustration asso-

ciated with the traumaof sexual abuse.It does not take vast quantitiesof
clinical knowledgeto comprehendthis child's responseto her experiences,
but not all art expressionsby childrenwho are subjectedto abuseare so eas-
ily deciphered.However,the powerof visual expressionwith suchchildren
is undeniable.
Art therapists,psychiatrists,psychologists,social workers, and other
mental health professionalshave becomeincreasingly intrigued with the
possibilitiesthat art expressionhasfor children from violent homesin both
assessment and treatment.Becauseof the creativeand dynamic nature of
art expression,there is a great attraction to utilizing it in the treatmentof

the effects of domesticviolence and child abuse.However, therecontinues
to be relatively little written on this vital and important topic. Many clini-
cians are not well versedin the practice and discipline of art therapy and
have groped with the use of art therapy in treatmentof this child popula-
tion. Most are interestedin art expressionsolely for diagnostic purposes,
and thus the distinctionbetweendiagnosticart techniquesusedwith abused
children and the practiceof art therapyhasbecomeconfused.This is espe-
cially evidentin sexualabuseanddomesticviolenceconferencesand train-
ing symposiawhere social workers, legal experts,and other professionals
mistakenlydescribeany useof art with children as art therapy.
The literatureoften indicatesa misunderstandingand lack of depthcon-
cerning the use of art therapy in such situations.For example,Blick and
Porter (1988) have discussedthe use of what they term "arts therapy,"
which apparentlyrefers, at least in part, to the field of art therapy.One of
their primary rationalesfor utilizing such a therapeuticmodality in treat-
ment is vaguely labeled as "fun." Granted,art expressioncan be pleasur-
able, but such rationaledetractsfrom the unique possibilities the modality
has to offer this populationand placesthe goalsof art therapyin the realm
of recreationand diversion. When the theoreticaland clinical applications
of art modalities are not clearly understood,they are often relegatedto a
subordinatestatusof leisure-related,adjunctive-typetherapy.
Conerly (1986) advocatesthe use of art materialswith sexually abused
children but notesthat possibilitiesfor using them are limited becausethey
can be messyand are difficult to transportif itinerant. Clinicians who may
not have had substantialformal training or experiencewith art therapy
methodologiesare often uncomfortablewith artistic media and dismiss
their potentialsbecausethey do not know about them. They are generally
unaware of the variety of possibilities that different art media have in
accessingimagesand in enhancingthe therapeuticsession.
The professionalwho is unfamiliar with the theory and applicationof art
therapymay seeit as a tool for the child from a violent hometo expresshid-
den feelings and releasehostilities through cartharsis.Thus, it may be
viewed as a neutral outlet for the expressionof repressedanger (Kramer,
1971).Although this use may provide a temporaryremedyfor overwhelm-
ing emotions,there are deeper,more substantialusesof art therapy.
Within the fields of art therapy,creativearts therapies,and playtherapy,
there has been greaterand more seriousprogressin defining the scopeof
practice with children from violent homes. These disciplines have long
beenawareof art therapy'sspecialrole in accessingimagesand memories
of trauma, particularly with children. Clara 10 Stember(1978, 1980) was
cognizantof thesepossibilities and was in the forefront of the application
of art therapyspecifically to abusedchildren. Since her initial work in this
area,many art therapists;dance,drama,and music therapists;and play ther-
apistshaveexploredand expandedthe useof art making with children who

have beenexposedto violence.
Naitove (1982), an art therapist,extendedStember'sconcepts,further sup-
porting the useof art therapyin treatmentandassessment of children whoare
physically or sexually abused.Naitove goesbeyondthe use of visual art in
therapy, discussingthe modalities of drama, poetry, movement,music, and
sound.She identifies thesetherapiesas providing swift and dynamic access
to importantinformation andrehabilitation.Shealso supportsthe conceptsof
Stember'sapproach,giving additional acknowledgementof Stember'ssuc-
cessfulefforts to definethe role of art therapyin the treatmentof sexualabuse
and increasingits respectamongotherprofessionals.
Severalyears prior to Stember'sand Naitove'swork with sexual abuse,
Howard andJacob(1969) recognizedart therapyas having a useful purpose
in work with abusedchildren and saw it as key to unlocking thesechildren's
emotional responsesto their experiences.In casesof sexual abuse,they
statedthat children havelittle difficulty in expressingthe traumathey have
experiencedthrough art modalities. They observedthat art therapy helps
children to relieve their tensionand anxiety and assistedthe flow of verbal
therapy.
In the realm of medical art therapy,Levinson (1986) discussesthe iden-
tification of child abuse andneglectin a bum centerutilizing both art and
play therapy.APT (Art and Play Therapy) is employedas both an assess-
ment and treatmentmodality in this setting. Levinson observesrecurring
themesin burnedchildren's art and play productsindicative of abuse.In
particular,shecites themesof hurting and sadism,which alert the therapist
to the possibility of abuse andcan corroboratesuspectedabuse.Levinson
also seesart expressionas a way to defuseoverwhelmingfeelings and a
way to assist the child in coping with feelings that may include physical
injury or ambivalenceabout an abusivefamily member.Other profession-
als havefound art in combinationwith play therapyto be particularly help-
ful not only in medical milieus (Webb, 1991) but also with domestic vio-
lence and sexual abuse cases (Doyle & Stoop, 1991; Harper, 1991;
Homeyer, 1995; Strand, 1991; White & Allers, 1994).
Edith Kramer (1971), a noted art therapist who worked with children
from dysfunctionalfamilies, has contributedsignificant theoreticalmateri-
al on art therapy that has application to children from violent homes.
Speakingfrom a psychodynamicpoint of view, Kramer has not only exam-
ined what children are saying through their art expressionsbut has also
explored their processesof art making. Her work with art therapy and
aggressionis of particularinterestto professionalswho work with children
from violent homesbecauseit toucheson many issuessalientto the treat-
ment of this population.
Kramer makesa strong casefor using the art processas a neutralizing
agentfor aggressionand violence:
As the child learnsto love art, the activity can becomea sanctu-
ary wherein feelings and perceptionsotherwisedrownedin con-
stant hostilities can be experiencedfor the first time. (p. 171)
Thus, Kramer observesthe art processas providing a respite from psy-

chic upheaval, an activity associatedwith positive feelings rather than
strife. Art making can also be utilized by the child to makeorder out of the
chaos associatedwith aggressivefeelings. In her theory of sublimation
through art expression,Kramer observesthat art making may channel
chaotic, aggressiveenergy into more constructive,acceptableactions; in
fact, she feels part of this energy, which goes into the making of art, is
derivedfrom neutralizedaggression.
Although art cannot remove the root causesof dysfunction or directly
changea family situationfor the child, Kramer seesit has having a signif-
icant effect by servingas a model for ego functioning. The art activity is a
forum for expressionof feelings and ideas and for experimentationwith
changes.It may even becomea metaphorfor the overwhelmingstimuli in
the child's life, giving the therapistan insight into the child's experiences,
ego strength, and methods of coping. All of these areas are integral to
understandingand treating a child from a violent or dysfunctionalhome.
Relatedto the subjectof aggressionand art, Uhlin (1972) conductedcon-
siderablestudy of the relationshipof art expressionto the violence-prone
personalityof juvenile offenders.He observedthat the violence-proneindi-
vidual often comes from a family where there are improper interpersonal
relationshipsand a lack of nuturance;such a situationcan createhostility,
resentmentand dysfunction-breedinggrounds for abuse to erupt. He
believed family therapy, involving the art process,could be a means of
enhancingcommunicationand improving interactionalpatterns.Uhlin also
advocatedthe useof art therapyas a preventativemeasureto deal with vio-
lence-pronetendenciesin adolescents.In the preventativesense,art expres-
sion may revealthe inner dynamicsof violent individuals,thus enablingthe
therapistto more fully addresssuchaspectsin treatment.
Few authorsdirectly discussthe role of art expressionin crisis resolution.
Landgarten(1981) statesthat the "art therapistbrings a unique dimensionto
crisis intervention,for the art task servesas a simple meansto aid the indi-
vidual in productively ventilating crisis-relatedaffects of anger, gUilt, and
loss" (p. 136). Shefinds art therapymost useful in the preventionof repres-
sion andthe provisionof a tangibleexpressionthat the therapistandthe client
can explore. Crisis interventionwith art therapy may take place in a single
session,offering the child client a "psychologicallyprophylactic"experience.
Although Landgartendiscussescrisis in relation to the experienceof hospi-
talization, exposure to a police shoot-out, and an earthquake,what she
observesabout art therapyand crisis eventsmay be applicablein work with
children who haveexperiencedthe crisis of violencein their homes.
Webb (1991) makesa strongcasefor play therapycombinedwith art mak-

ing in work with children in crisis, noting that thesemodalities provide an
appealingguise for child psychotherapy.She observesthat play therapy in
crisis work can aid in evaluation and diagnostics,establisha relationship
between the therapist and child, and help the child to expresscrisis and
relieve tension. She emphasizesthe necessityof posttraumaticplay for the
child in crisis, recognizingthat it is not only developmentallyappropriatebut
can alsoassistin abreactionandreleaseof painful memoriesandexperiences.
Contemporaryexpressivetherapists,such as music therapists,dance
therapists,poetry therapists,and drama therapists,have recently focused
attention on the use of various modalities with victims of child abuse
(Bowman & Halfacre, 1994; Goodill, 1987; MacKay, Gold, & Gold, 1987;
Mazza,Magaz,& Scaturro,1987). Othersare examiningand implementing
treatmentthrough art forms with populationswho have been traumatized
by many types of violence, such as rape, war, terrorism, and natural disas-
ters (Abbenante,1982; Golub, 1985; Herl, 1992; Roje, 1995;Webb, 1991).
Johnson(1987), a dramatherapist,observesthat arts therapiesmay be the
treatmentof choice when treating clients who have beensubjectedto psy-
chologicaltraumarelatedto violence.He notesthat art therapyhasa unique
role in the early stagesof treatmentin accessingtraumaticmemories;indi-
viduals who have experiencedtraumamay encodesuch imagesvia a pho-
tographic process,and visual modalities may offer a way to bring such
imagesto consciousness. Johnsonhypothesizesthat by bringing memories
out through art expression,a healthy distancing between the self and
painful contentsoccurs.
Mental healthprofessionalshave capitalizedon thesebeneficial charac-
teristics of art expression.PsychiatristsPynoosand Eth (1986a;Arroyo &
Eth, 1995) havedevelopedan interview protocol for use with children they
define as having"psychic trauma."SuchpopUlationsinclude thosechildren
who are subjectedto abuseor domestic violence, so their procedureis
applicableto children from violent homes.The initial part of their protocol
includes engagingthe child in drawing and having the child tell a story
aboutone of his or her pictures.It doesnot appearthat theseclinicians are
utilizing the drawing task solely for assessmentpurposesbut more as a
vehicle for eliciting verbal response.However, Pynoosand Eth do observe
that the contentof the traumatic event often surfacesin the drawing. It is
this information that can help the therapistunderstandthe child's current
coping skills in dealing with the trauma.
The secondphaseof their interview procedurefocuses on the child's
view of the traumatizingevent, with emphasison emotions,perceptions,
and pasttraumas.They again mention that they utilize drawing and "play-
acting" to help explorethe child's views and feelings.
Othershave studied creativeexpressionin traumatizedchildren from a
variety of perspectives.Newman(1976), in a study of children exposedto
natural disaster,found that there was an increasein the creativeactivity of

somechildren following their experiences.This was interpretedto be a way
of trying to alleviate anxiety and attemptingto make senseof the trauma.
Terr (1981, 1990) went on to more formally observethe posttraumaticcre-
ative activity of children. She discussesart expressionas a componentof
play, emphasizingsimilarities in both theseactivities of children who are
psychically traumatized.Terr's subject sampling included children who
were witnessesto violence, kidnapped,or held hostage-agroup that had
experiencedsignificant personaltrauma. She found that the drawings of
thesepsychicallytraumatizedchildren sharecharacteristicsof posttraumat-
ic play-similaritiessuch as repetitiveness,stereotyping,and failure of the
activity to relieve anxiety. If children from violent homescan be definedas
a population that has experiencedsignificant trauma in their lives, then
thesecorrelationsmay be applicablein understandingthem and designing
appropriate,effective interventions.
Many clinicians have focused on the diagnostic indicators of sexual
abusein the drawingsof child victims (Cohen& Phelps,1985; Drachnik,
1994; Faller, 1988; Goodwin, 1982; Hagood, 1994; Kelley, 1984;
Ma1chiodi, 1994; Riordan & Verdel, 1991; Sidun & Chase,1987; Sidun &
Rosenthal, 1987; Spring, 1985; Uhlin, 1972; Yates, Beutler, & Crago,
1985).They hypothesizethat the drawingsof sexuallyabusedchildren will
differ significantly from those of nonabusedchildren, perhapseven from
those of children who are emotionally disturbed.Increasingemphasison
such researchhas resultedfrom the needto identify sexualabusein those
children who do not disclosetheir trauma.Art expressionmay be a way to
detect sexual abuse before it can be verbalized. Others (Burgess &
Hartman,1993; Goodwin, 1982) seeit as particularly helpful when assess-
ing young children who do not haveabstractingskills, a knowledgeof time
and sequence,and verbal information necessaryto substantiateabuse.
In the area of child physical abuse,Culbertsonand Revel (1987) con-
ducteda study that utilized the DAP (Draw-A-PersonTest); as a result of
their study, a list was compiled of graphic indicators thatare significantly
associatedwith physical abuse.Their study was basedin part on that of
Blain, Bergener,Lewis, and Goldstein(1981) who developeda list of indi-
cators found in the House-Tree-PersonTests of children who were physi-
cally abused.Theseresearchersconcludedthat certain specific indicators
may reasonablyhelp a clinician discriminateabusein children; they pro-
posea six-item testfor useby professionalsin attemptingto identify abused
children.
The author, Ma1chiodi (1987), conducteda study designedto compare
two drawing tasks, the Draw-A-Person (DAP) and the Life-Size-Body
Drawing (LSBD), and their usewith children from violent homes(but who
were not abused),with children physically abused,and with children who
were sexuallyabused.The purposewas to determinewhich task might elic-
it more information to the therapistin a short amountof time so that a refer-
ral could be made.Observationson child interestand investmentin the task

as well as verbal responsesconcerningthe productwere evaluatedin order
to assessthe value in treatmentof suchan art process.Preliminaryfindings
indicatedthat becauseof the natureof the LSBD task, it may be useful in
eliciting disclosurein sexuallyabusedchildren.
Wohl and Kaufman (1985) concludethat seriousemotionaldisturbances
were consistently expressedin House-Tree-Person(HTP) and Kinetic
Family Drawings (KFD) drawings by children who have lived with vio-
lenceor havebeenabused.They cite observingsuchfeelings as depression,
powerlessness, fearfulness,lack of trust, anger,and anxiety to be presentin
the drawings.Sexualand physicalabuseare also revealed.Family drawings
depicteda disconnectedfamily systemthat lacked nuturing qualities and
was unableto meet the child's needs.
Wohl and Kaufman'scriteria for analyzingthe drawingscomesfrom the
diagnostic criteria of Buck (1981), Hammer (1967), Iolles (1971), and
otherauthorities,as well as their own clinical impressions.It must be noted
that researchon the diagnosticcriteria of projective drawing tasks has not
undergoneextensiverevision and is not consideredcontemporarydata by
many clinicians; other professionalsquestion the validity of such data.
Current societal trends and the multicultural influence, among other fac-
tors, if taken into consideration,may have provided some very different
diagnosticcriteria. Someof the indicatorsmentionedmay not apply to all
child populations, unless the author has made a specific correlation to
developmental levels of art expression commonly found in children.
Therefore, therapistswho read studiesbasedon projective researchmay
havetheir own interpretationsother than the onesprovidedbecauseof their
own training and observationalskills in understandingthe art expressions.
An important point Wohl and Kaufman make in their work is that
through the use of projective drawings, the clinician is able to uncover
information about the child's cognitive and emotionaldevelopmentthat is
usually unobtainableduring the early phasesof treatment.This concurs
with other authors'impressionsthat art expressionis an extremelyhelpful
tool in understandingthe child from a violent home,offering a viable non-
verbal methodof relating information.
Overall, the generalfocus of mostcurrentresearchseemsto lean more in
the direction of what the art expressionsare saying rather than developing
rationalesand proceduresfor administeringart tasksto elicit changeor to
amelioratecrises. Professionalsseemto be most interestedin establishing
diagnostic criteria to determine existance of abuse, particularly sexual
abuse.This interestmay dominatethe field for severalreasons.The field of
art therapyis in the processof trying to prove itself through hard scientific
data and is compelledto prove the worth of the field through empirical
research.Identifying commonalitiesin typology of art expressionsof spe-
cific populationsis one route to theseends.Although establishingdiagnos-
tic criteria is not really art therapy (it is assessment,not therapy), it is
important and beneficial to the field in order to clearly define the possible
meaningsof visual expression.
A secondreasonfor the currentfocus on the meaningof art expressions
may be that suchdiagnosticinformation could be particularly importantto
children who needswift intervention.Visual signsthat alert the therapistto
the existenceof child abusemay help that child obtain necessaryprotection
and interventionto preventfurther trauma.Courts of law are interestedin
alternateforms of testimony for such children in court and have utilized
such art expressionas admissableevidence,along with documentationby
art therapists(Cohen-Liebman,1994; Levick, Safran,& Levine, 1990).
However,an important aspectstill neglectedby the literature is the actual
implementationof art therapymethodologyin settingswhere children from
violent homesare treated.Specific mentionof how to integratethis modality
in therapeuticwork with childrenwho cometo batteredwomen'sshelterpro-
gramswith their mothersis particularly scarce.Sincesuchshelterprograms
with significant child popUlationsexist in every major metropolitanareaof
the United Statesin the form of residences,safehouses,and crisis carecen-
ters, it seemsof vital importancethat such programmingbe developedand
evaluated.However,this role of art therapyin the treatmentof children from
violent homesis more difficult to define becauseof the inherent nature of
shelterprogramsand the complexitiesof this child population.
Someadaptationof the theoreticalconstructsof how art therapyis to be
practicedwhen working with thesechildren is necessaryand has madethe
developmentof methodologyproblematic and difficult to conceptualize.
The short-term,intervention-orientedenvironmentof a domesticviolence
shelterdemandsa different focus than other types of psychiatrictreatment
settingswhere art therapyis traditionally practiced.Theseconditionsforce
someredefinition about how art therapy should be implemented.Because
of the inherent conditions of shelter settings, the therapeuticuse of art
expressioncan be moreclearly definedas art intervention.This is basedon
the belief that the most importanttask when working with a child in crisis
is intervention. Such a focus includes stabilizing the child through inter-
vention and assessingthe need for further specific intervention,two con-
ceptscentral to the philosophyof crisis work.
Many theoriesthat form the basisof the field of art therapyimply a long-
term relationshipwith the client for the purposeof achievinginsight. It is a
highly unlikely scenario that any therapist would be able to take such
approacheswith children in crisis and in short-termsettingssuchas domes-
tic violence shelters.And in the current health care climate, with cutbacks
and a tighter economyfor healthcarein general,short-termfocus is becom-
ing more and more prevalentin all mentalhealth arenas,particularly in the
areaof social servicesand community work.
Additionally, some traditional art therapy approachesthat are basedin
psychotherapymay be inappropriateandperhapsmay evenbe hazardousin
such a setting. The generalphilosophy of crisis intervention is to get the
client stabilizedand back on his or her feet. Other types of approachesthat

require more time may be unrealistic, not only due to lack of long-term
arrangementbut also becausethe therapist may open up some psychic
woundsthat will not be dealt with adequatelybeforethe client is out of the
program.This does not mean that such emotionalproblemsshould be left
untouched,but opening them up and asking the child client to deal with
them in the midst of crisis may be too much for the unstabilizedclient to
handle.The focus of interventionmustbe in synchwith critical client needs
to reduceconfusion,helplessness, and psychic pain.
Theseconcerns,intrinsic to work with childrenfrom violent homesin cri-
sis-orientedfacilities, fonn parametersfor art therapyinterventionand pro-
gramming strategiesthat are difficult, but not impossible to define. The
problematicnatureof such definitions may, in part, addressreasonsfor the
lack of availableliteratureon viable interventionalmethodologyand specif-
ic programming.However,from the personalexperiencesand the collective
researchof otherclinicians,it is certainthat art therapyhasan importantrole
in the evaluationand treatmentof children from violent homes.
Onefinal observationaboutthe role of art therapyin the treatmentof chil-
dren from violent homesrelatesto the aspectof prevention.Salant(1980),
an art therapist who worked at the National Child ResearchCenter in
Washington,D.C., saw the value of art therapyas a preventiveagent.Salant
believedthat providing art therapyto healthychildren could preventserious
emotionalproblemsresultingfrom life crises.Additionally, sherealizedthat
by interveningin and treatinga child's symptomologyat an early stage,one
could preventfuture dysfunctionalbehaviorpatternsfrom developing.
Art therapy,althoughit hasbeenprimarily utilized in the psychiatriccare
of children, also has a significant place in community-based,prevention-
orientedfacilities suchas shelterprogramswherelarge numbersof children
are also seen.Theseagenciesprovide frontline serviceswhose goal is to
preventfurther violencein the homefrom occurring.The useof art expres-
sion as a possiblepreventativeagentwith children from violent homeshas
not beenadequatelyaddressedby researchersand is certainly worth further
investigationand research.
This integrationof art therapy into the community for purposesof pre-
vention is not a novel concept; several decadesago, Kramer (1971)
observedthat one of the most importantneedsfor art therapymay be out-
side the traditional psychiatric facility. She felt that art therapy had a pre-
ventativerole and could be of value to thosewho lived within the commu-
nity but were endangeredor at risk for emotional upheavalin their lives.
Kramer observedthat art therapy could becomepart of programmingat
neighborhoodfacilities, halfway houses,and schools-places that often see
children before more serious pathology or dysfunction occurs. This pre-
ventativephilosophycould be extendedto the contemporaryphenomenon
of safe housesand sheltersfor domesticviolence and is worthy of further
investigation.
References
Table of Contents
Name Index
Subject Index 190 191 195 205 207

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Breaking The Silence - Art Therapy

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BREAKING

Cathy A. Malchiodi, M.A.,

Routledge is an imprint of the

Publishedin 1997 by Publishedin Great Britain by

© 1997 by Taylor & FrancisGroup, LLC

InternationalStandardBook Number-I0: 0-87630-824-8(Hardcover)

Visit the Taylor & FrancisWeb site at

Foreword by Eliana Gil, Ph.D. vii

CHAPTER ONE The Role of Art Therapy in the Assessment

CHAPTER lWO Working with Children from Violent Homes 16

CHAPTER THREE Art Evaluationwith Children

CHAPTER FOUR Art Interventionwith Children

CHAPTER FIVE Child SexualAbuse 130

CHAPTER SIX DevelopingArt TherapyProgramsfor Children

Scotty had beeninterviewedby police on four different occasions.At four

icians view theseas obviouspropsfor "breakingthe ice" with children,but

the child throughintervention,as well as assessingthe needfor further spe-

Eliana Gil, Ph.D.

When reviewing the literature of other researchersand clinicians, I came

understandingof how art therapy may be applied to work with thesechil-

The final purposeis to identify programstrategiesfor implementationof

seeminglybenign art task can elicit powerful feelings and sensationsin a

The Role of Art Therapyin the

DomesticViolence, Children, andArt Therapy: Some

During recentyears,the areaof domesticviolence hasreceiveda consider-

of domesticviolenceand its effectson children,the impactof domesticvio-

ventionsthrough art experiencesand understandwhat thesechildren were

Figure I-I. Monsterdrawing by a six-year-oldboy

Figure 1-2. Drawing by a seven-year-oldboy at a battered

away at the inner self, creaturesthat destroyself-esteemand leave in their

ing the "venom" out of it. For thesereasons,art therapy,a treatmentmodal-

The repressedfeelings of my childhood-thefear, despair,and

in me speakand paint long enoughfor me to understandher lan-

For a traumatizedchild, art expressionmay focus on the effects of vio-

Art Therapy and Domestic Violence:

My experienceas an art therapistwith children from violent homes has

Figure 1-3. Cover of Newsweekmagazinefeaturing specialissueon child sexual

tively portraysthe complexfeelings of anger,anxiety, and frustration asso-

art expression,there is a great attraction to utilizing it in the treatmentof

apistshaveexploredand expandedthe useof art making with children who

Thus, Kramer observesthe art processas providing a respite from psy-

Webb (1991) makesa strongcasefor play therapycombinedwith art mak-

natural disaster,found that there was an increasein the creativeactivity of

ral could be made.Observationson child interestand investmentin the task

client stabilizedand back on his or her feet. Other types of approachesthat

Subject Index 190 191 195 205 207

Abbenante,J. (1982). Art therapywith victims of rape.In A. DiMaria, E. S.

DiLeo, J. H. (1973). Children's drawings as diagnostic aids. New York:

Gil, E. (1994). Play in family therapy. New York: Guilford.

Lourie, I., & Stephano, L. (978). On defining emotional abuse.

May, R (1985). My questfor beauty.Dallas, TX: Saybrook.

Pynoos,R., & Eth, S. (1986a).Witness to violence: The child interview.

Silvern, L., Karyl, 1., & Landis, T. (1995). Individual psychotherapyfor

Winner, E. (1982). Inventedworlds: Thepsychologyo/thearts. Cambridge,

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