2012 Lawrence Dena 1

THE WINSTON CHURCHILL MEMORIAL TRUST OF AUSTRALIA.

Fellowship Report. Dena Lawrence 2012 Fellow. To investigate the use of Art therapy for Post Traumatic stress Disorder in Hospitals, Clinics and Centers in USA and Israel

I understand that the Churchill Trust may publish this Report, either in hard copy or on the Internet or both, and consent to such publication. I indemnify the Churchill Trust against any loss, costs or damages it may suffer arising out of a claim or proceedings made against the Trust in respect of or arising out of the publication of any Report submitted to the Trust and which the Trust places on a website for access over the internet. I also warrant that my Final report is original and does not infringe the copyright of any person, or contain anything, which is, or the incorporation of which into the Final Report is actionable for defamation, a breach of any privacy law of obligation, breach of confidence, contempt of court, passing-off or contravention of any other private right or of any law. I include a statement/disclaimer in my report that “No endorsement intended or implied by the United States Government” for the visit or for the Churchill Trust.

Signed: Dena Lawrence

 

Dated:

1  

To investigate the use of Art therapy for Post Traumatic stress Disorder in Hospitals, Clinic and Centers in USA and Israel

Report by Dena Lawrence Art Psychotherapist Hollywood clinic Hollywood Private Hospital Contact details Email: [email protected] Phone: 0427466796 Address: Monash Avenue. Nedlands 8009

 

2  

Table of Contents Acknowledgments…………………………………………………

4

Introduction………………………………………………………

5

Executive Summary……………………………………………… Objective………………………………………………… Highlights………………………………………………… Findings Visits……………………………………………………………

6 6 6

USA: Warrior Resilience Center (WRC)……………………… Focusing-Oriented Expressive Arts Therapy Institute….. National Intrepid Center of Excellence (NICoE)………. Intensive Trauma Centre………………………………... Israel: Natal Israel Centre for Victims of Terror and War…………… Community Stress Prevention Centre (CSPC)………….

7 9 10 13

Conclusion and Recommendations…………………………….

19

Bibliography ……………………………………………………

21

Appendix………………………………………………………...

22

 

7

14 16

3  

Acknowledgements

 

•

I wish to acknowledge and say thanks to all the people who have supported me and encouraged me on this journey of investigation to USA and Israel of Art therapy and Post Traumatic stress disorder.

•

Thanks to the Churchill Trust for awarding me this most prestigious fellowship. The generous funding and support has allowed me to explore and bring back to Australia some rich and in depth knowledge and information of Art therapy and trauma in USA and Israel. I am most grateful of this most wonderful opportunity

•

Thanks to my Referees Karen Gullick - Director of Nursing at Hollywood Private Hospital and Doctor Jim Goodbourne consultant Psychiatrist at Hollywood Clinic, Hollywood Private Hospital.

•

The professionals I met during my fellowship who were without exception hospitable helpful and interested in learning about Australian practice and Art therapy in the field of trauma as I was in gaining knowledge from each of the centers I visited.

•

My work colleagues at Hollywood Clinic, supervisors and Mentors Dr Mike Woodall. Dr Winston Chui, Dr Sue Lutton. And Graeme Sparks.

•

To Mark Wouda for his endless support.

•

My family Mr. Ern Lawrence, Mrs. Agnes Lawrence, Norma and Chris Jeffery, Bevan Lawrence, Helen Walsh, Pauline and Tim White, Helen Lawrence and Leonie Rawlings

4  

Introduction. Background to Art therapy. My passion and interest of Art therapy has existed for the past 30 years. I Initially worked as a Mental Health Nurse at Hollywood private Hospital. I completed the Masters of Art therapy at Edith Cowan University and then created and developed the Art therapy program at the Hollywood Clinic. I facilitate Art therapy groups and also see individual clients who suffer from Trauma, anxiety, depression, addictions and Eating Disorders. Three years ago I created and developed a community based Art therapy project in Kashmir titled “Psychiatric Art therapy – A Path with Art ‘ created to provide Art therapy for those who suffer from trauma due the conflict that has existed in Kashmir over the past 60 years. Initially I was self-funded and later was supported Rotary and Hollywood Private Hospital. My experience and interest has shown me that Art Therapy is an effective healing method for those who suffer from trauma. The Art therapy process is a way to tell their story through Images – It gives people a voice. The process is often cathartic or meditative- it provides a way for participants to focus and is also an effective way to self soothe. Art therapy increases their insight awareness and creativity. I was keen to learn what others were doing who specialize in trauma and Art therapy. This led me to apply for a Churchill fellowship to investigate how countries such as USA and Israel work with Art therapy and Trauma.

 

5  

Executive Summary Name: Dena Lawrence Position Art Therapist at Hollywood Private Hospital: Email: [email protected] Mobile: 0427466796 Address: Monash Avenue. Nedlands. Western Australia Fellowship objective To investigate the use of Art therapy for Post Traumatic stress Disorder in Hospitals, Clinic and Centers in USA and Israel. Fellowship highlights. 1. I visited “The Warrior and Resilience Centre” in Fort Bliss Texas and observed and participated with the Art therapist Danielle J. Braxton whilst working with soldiers afflicted with post-traumatic stress disorder still serving in the Army and others who moving back into the community. 2. I attended individual training with Laury Rappaport who created and taught me the technique of focus orientated Art therapy. FOAT is a clinical approach of Art therapy while working with clients who have a history of trauma. 3. I shadowed Art Therapist -Melissa S. Walker for one week working with soldiers with traumatic brain injury and PTSD at the National Intrepid Center of Excellence (NICoE) located on the campus of Naval Support Activity Bethesda. 4. I spent one week at the Intensive Trauma centre where I met with Linda Gantt a with a well known Art therapist, who has worked extensively with trauma using the graphic narrative. 5. I visited for four days NATAL – Israel Centre for Victims of Terror and War. Natal is a non-profit organization established in 1998 6. I met with Professor Mooli Lahad the founder and President of the “ Community Stress Prevention centre “ in the North of Israel - Kiryat Shmona, on Israel’s Lebanese border, established 33 years ago. Findings In Israel and USA – Art therapy is part of and integrated into a multidisciplinary approach in the treatment of trauma as a result war and terror. In USA and Israel the settings provided for those who suffer with trauma were patient friendly and extra care was given to create an environment, which was soothing and welcoming, and providing a sense of community. Treatments are tailor made and the focus was on the personal relationship as the healing agent. In the Military centers in the USA and Israel - mask making in all was an important and vital ingredient in the Art therapy sessions. The private Art therapists I visited focused on early childhood abuse – and worked with techniques that included the body awareness and focus as well as visualizations, mindfulness and creative writing to process the trauma. There was an emphasis on qualitative approaches rather than quantitative in providing evidence to the effectiveness of Art therapy. There still remains little research in the use of Art therapy other than the image being the evidence.

 

6  

I plan to disseminate this information through conferences, workshops discussion with Psychiatrists, Art therapist and allied health professionals and centre’s in Australia that provide treatment for trauma.

Visits Danielle J. Braxton MA, ATR-BC Clinical Art Therapist William Beaumont Army Medical Center Department of Behavioral Health Warrior Resilience Center (WRC) Fort Bliss, TX I visited the revolutionary treatment program, which provides hope for veterans who are suffering and afflicted with post-traumatic stress disorder. The program assists those who want to stay in the Army and also those who are moving back into the community. While confronting Post Traumatic Stress Disorder (PTSD), the program addresses the emotional and spiritual aspects as well. Clinical psychologist John E. Fortunato conceived a wholistic approach to treating PTSD at the Fort Bliss Restoration and Resilience centre. Fortunato was convinced traditional PTSD treatments were not adequate or comprehensive enough. He created a program that treated all aspects of PTSD and was interested in treating the whole soldier. The treatment program today remains almost identical to the one Fortunato had set up and is now followed on by Dr Vicki Thomas in 2006. The treatment program provides Psychotherapy as well as Art therapy and other nontraditional therapies Yoga, Reiki and massage therapy, Acupuncture, martial arts, biofeedback. The program was geared to address all aspects of the person. Soldiers who experience “hyper-arousal were treated with techniques massage and “Reiki” a Japanese stress reduction technique. Acupuncture is also provided proven to be extremely effective in treating anxiety; panic and tension induced physical pain. Physical exercise is very much part of the program and soldiers power walk and play water polo. Field trips during the program took soldiers out too hot spots, which are very crowded and noisy for some exposure work. They then taught ways to regulate their stress levels so that they can handle those same kinds of environments. To assist with concentration problems and memory the program offers a mix of Physical activity and calming techniques such as Toga, Tai chi and Qigong a Chinese self-healing method and biofeedback, which uses the mind to heal the body as well as Meditation. In a technique called rehearsal therapy to help soldiers deal with painful memories and experiences he/she tells the story over and over again until the have emptied the experience of it is emotional intensity. When soldiers core belief and values are shaken a Chaplain helps them to review and make sense and meaning for healing. Soldiers also attend the Art therapy groups to express their feelings and trauma. The Art therapy gives a voice to the unspeakable and allows the soldier to access their own creativity to assist them in navigating a way through trauma

 

7  

The program aims at looking at the whole soldier and treat all of him or her. Soldiers usually attend the program for 6 months. All the soldiers work to over come their combat stress and return to their units as well as return to the community. During my visit to the Center – I shadowed Art therapist Danielle Braxton and observed the process of her working with young Veterans who were currently serving in Iraq and Afghanistan. The Art therapist facilitated Art therapy groups 5 days a week. The program she created was based as a four-week module. At one time 3 streams of Soldiers where attending her program as well as all the other groups outlined above

Art therapy program Week 1 Activity 1. “ How does that make you feel? - A Power point presentation of different artworks and images.” During the first activity the Art therapist presented to the group a variety of paintings and images on power point downloaded from the internet. Each image showed an intense emotion. The Art Therapist then asked the participants after reflecting on the image to describe the feeling that arose and was activated whilst looking at the image. This process gave the soldiers a first chance in this session to try and identify different feelings states. Activity 2. Create a collage of their index trauma – The instructions were to do a body tracing and then create a visual representation of PTSD. The body tracing would include a representation of any of the symptoms suffered. They could choose their preferred Art materials including collage to illustrate their trauma or other associated feelings. Activity 3. Trash and treasure. Participants were invited to create an image of the behaviors beliefs and attitudes in their lives that no longer served them well and represented as trash. Followed by another image of those aspects and relations that they treasure and would like to increase in their lives. Week 2 Activity 1. Create an image of anger. Instructions were given to represent a feeling that was generated from watching the power point presentation. They were then encouraged to express those feelings using watercolors or paint. Activity 2. Create an image of what is the other side of Anger – After completing the Anger image/negative image - Participants were instructed to create an image that depicted the opposite to that feeling. This place could be perhaps be a place that was peaceful or relaxing or doing something that they enjoyed Activity 3. Create a Hand of Cards Participants were asked to create a pack of cards. On each card a drawing, painting or writing was created to depict the most negative and positive feelings or attributes. A discussion was generated about the cards as being what they had been dealt with in life.

 

8  

Week 3. Activity 1. “What does that look like”? The Art therapist displayed various famous art pieces on the board. Participants were then asked, “What does that look like” and were given the instructions to create a visual representation of what the images evoked within through drawing painting or using clay. Activity 2. How does that make you feel? The objective was to get to know how certain images evoke particular feelings. The next instruction was to create a painting of what feelings were evoked when viewing that particular image image. Activity 3. Masks – Inside Shadow and outside persona - A metaphor or representation of different parts of the self. The Art therapist gave an explanation to the soldiers about masks as a metaphor and of their symbolic meaning. They were encouraged to use a variety of art materials to decorate a mask - the inside representing their inner shadow and then on the outside the outer persona and social mask. On completing the mask the participants were given a questionnaire in order to identify the function of these aspects and then to discover the nature. Week 4. My Therapeutic journey: Pat, Present and Future. Instructions were –To use a visual Art journal to depict your journey including each phase below 1. The past – the self before starting therapy. 2. The present – image of where you are now after completion of the program. 3. The future – what will look like? 3 months, 6 months. I year and 2 years from now. How do you see yourself moving forwards

Laury Rappaport. Focusing-Oriented Expressive Arts Therapy Institute. Santa Rosa. California In Santa Rosa I visited and spent 4 days with a Private Art therapist Laury Rappaport. Laury pioneered, created and developed Focusing-Oriented Art Therapy (FOAT) and Focusing-Oriented Expressive Arts Therapy (FOET)—based on 30 years of clinical work. Focusing-Orientated Art therapy is a methodological and theoretical approach that integrates Gendlins (1981,1996) focusing method and principles of focusedorientated therapy with art therapy “Focusing is the process of listening to your body in a gentle, accepting way and hearing the messages that your inner self is sending you. It’s a process of honoring the wisdom that you have inside of you, becoming aware of the subtle level of knowing that speaks to you through your body.” (Cornell, 1996, p.3) Focusing, created by Eugene Gendlin, is a mind/body method of listening in a gentle, compassionate way to the wisdom of the body. Focusing can be used for emotional wellness and intelligence, decision-making, writing, creative expression, and relationship building. Through Focusing, one deepens a relationship with the authentic self, cultivates self-acceptance, and strengthens relationships through

 

9  

increased presence and understanding. Focusing can be used a tool for self-care, integrated into psychotherapy, and done with others through a Focusing Partnership or group. Through Focusing, access to imagery occurs through the bodily felt sense of an issue, situation, or experience. Focusing adds an aspect of mindfulness to the art therapy process. Experiences of self-compassion, self-care, inner trust, and authenticity are heightened through Focusing-Oriented Art Therapy. Through the Arts therapies the client Focuses on a particular issue or experience as a ‘felt sense.’ coming from within the body. They are then asked to create a symbol, or word, phrase, image, gesture, or sound that matches or acts like a handle for the inner felt sense. The client waits for the symbol or handle to come from the body. There is no right way-word, phrase, image, gesture, or sound. Once the symbol comes it is easily transferred to expressive art modalities as follows: Word or phrase——————————–poem or writing Image——————————————–visual art Gesture——————————————movement or dance Sound——————————————–music or sound exploration To summarize, the felt sense symbolization or handle is the doorway to expression through various expressive arts modalities.

Walter Reed National Military Medical Center. Washington Art Therapy Programming at the National Intrepid Center of Excellence (NICoE) Melissa S. Walker, MA, ATR Creative Arts Therapist/Healing Art Program Coordinator Walter Reed National Military Medical Center is the Nation’s Medical Center serving military beneficiaries in the Washington, D.C. area as well as those from across the country. Walter Reed Bethesda is the largest joint military medical center in the U.S. It is one of the first destinations in the continental United States providing tertiary care for the wounded, ill and injured from global conflicts. It is a tertiary care destination providing services in over 100 clinics and specialties. Walter Reed National Military Medical Center (WRNMMC) was established on November 10, 2011, as a result of the Base Realignment and Closure Act, which integrated the National Naval Medical Center and Walter Reed Army Medical Center on the grounds of the former NNMC campus in Bethesda, Maryland. The Medical Center combines the history and commitment to excellence of both the Navy and Army medicine icons. WRNMMC combines 170 years of providing outstanding compassionate care to war heroes and presidents alike. I visited the National Intrepid Center of Excellence (NICoE), located on the campus of the Walter Reed National Military Medical Center in Bethesda, Maryland and shadowed the Art therapist. National Intrepid Center of Excellence (NICoE is a state of the art facility designed for the treatment and research of traumatic brain injury (TBI) and underlying psychological health conditions in active duty military service members. The NICoE mission is to advance world class traumatic brain injury

 

10  

treatments and psychological health, research and education. The NICoE Vision is to be an Instrument of hope, healing, discovery and learning. The patients referred have typically not responded to conventional treatment and have complex physical and psychological issues during an intensive four-week program; they are treated with a combination of traditional medicine and alternative therapies, including acupuncture, recreational therapy, art therapy and writing The treatment program at NICoE is facilitated by a multi disciplinary team including but not limited to – psychiatry, neuropsychology, neurology/ sleep, family therapy (social work), art therapy, music therapy, speech and language pathology. Recreation therapy (yoga and Tai Chi), physical therapy, and complimentary therapies and alternative medicine are also included Art therapy program at NICoE. The Art therapy program is integral to the day patient program offered at the NICoE center helping people heal and find their way back to wellness. Opened since 2010 this brand new facility is pioneering a holistic approach to treating and researching combat related TBI and underlying psychological health concerns Melissa Walker the program’s art therapist facilitates the art therapy program, which consists of group art therapy sessions as well as individual art therapy sessions. The sessions are mandatory and part of the treatment program. The group program is designed to promote group cohesion, a sense of community among service members, increased socialization as well as empathy for and understanding of others and the self. The art therapy also plays an important role in planning and assessing the patients. While still maintaining patient privacy, artwork is taken and shown at team meetings as well as uploaded on to the integrated notes along with the participants, mood, cognitive abilities, psychological changes and symbolism within the artwork. Melissa spoke about the benefits that the service men and women gained from attending the art therapy - greater insight and development of hope for the future. The experience of art therapy inspired some people to take up art in their own time. Others took their finished product to other health professionals to continue the process of understanding. The most outstanding feature of the art therapy program at NICoE was the depiction of warrior identities via mask making, which were exhibited outside and inside the Naval Support Activity Bethesda. The masks allowed military members to visualize and externalize conflicting identities of who they were and who they have become “The service members going through the programe at NICoE are in transitional phases and are attempting to recover their new identities” Melissa states. The Group Art therapy session are based on a 4-week cycle. Week 1 - In the first week the participants are invited to depict their “warrior identities” through mask making. Prior to the mask making they are engaged in a guided imagery exercise to calm the senses and to assist the participants in focusing

 

11  

on the self. The masks making provided the participants a way to explore and become aware and reflect on who they were and who they have become and who they will become. Melissa states that service members are often able to communicate thoughts and feelings with each other that they would normally otherwise feel uncomfortable sharing. Week 2 - The focus is on expressive and creative writing. Service members are invited to participate and write about something that is important to them. If they enjoy this session and find it useful – they are then given the chance to attend a creative writing workshop, held once weekly after-care hours and facilitated by professional writers who are also combat veterans. The aim is to assist and inspire the servicemen to tell their stories and to experiment with new writing outlets. In these workshops they explored poetry, fiction, nonfiction sharing the work within the group. These groups provided another means for people to express their feelings and create a sense of community, increase self esteem and develop coping skills. Week 3 - all service members begin individual art therapy sessions to determine appropriate projects based on goals and needs. Service members may then be seen for the follow-up sessions depending on how much they need in art therapy. These sessions allow for the service members to process their artwork deeply as well as converse openly with the therapists regarding their artworks symbolism. Week 4 of the program the participants create a montage painting reflecting their NICoE Experiences and how the program has affected them. They are invited to reflect on the past and then look at their goals for the future. Music therapy is also offered as part of the programme at NICoE. In the past, a musician volunteer offered music lessons and service members were able to engage with learning and playing guitar, piano and or drumming. Currently a registered music therapist has been employed to facilitate group therapy sessions during which participants are invited to express their feelings through percussion instruments. They are given time to listen and hear their own heart beat. They are then invited to choose an instrument from a range of drums, flutes and carious percussion instruments from all different quarters of the world and to then start to making a sound in rhythm with their own heart beat. After some time people then started to improvise above the steady beat of the heart. The music therapist also works individually with the service members. A research protocol is being developed to investigate the efficacy of therapeutic writing for patients dealing with traumatic brain injury. While I was at the center I attended a meeting with other creative arts therapists and artists in residence and the medical centre that involved facilitation of the arts within the main hospital. I also gave a presentation of my work on Art therapy and trauma in Australia and Kashmir.

 

12  

Intensive Trauma Centre Out patient Treatment for Post Traumatic stress Disorder and Dissociation. Morgan Town. West Virginia Linda Gantt, PhD, ATR-BC My next visit was to the Intensive Trauma centre where I met with Linda Gantt a well know Art therapist who has worked extensively with trauma. Linda established with husband and Psychiatrist Dr Louis W. Tinnin, MD - The intensive trauma centre. While I was in the centre I attended an Accelerated Trauma course of 4 days.

The Intensive Trauma therapy is a freestanding outpatient clinic in Morgantown, Western Virginia, devoted to treatment, research, and training in the field of traumarelated problems. The treatment program for post-traumatic conditions consists of techniques and processes deigned to create a healing narrative. The team is a multi disciplinary team involved in working with the client to address trauma issues. The intensive Trauma therapy, Inc provides outpatient treatment, training for therapist, and consultation for the entire spectrum of trauma-related disorders. The centre treats children and adults who have post-traumatic stress disorder, Dissociative identity disorder DID or any of the following problems – • Motor vehicle accidents. • Domestic violence • Physical abuse of assault • Sexual abuse or rape • Severe neglect and abandonment • Captivity and torture • Combat • Natural disasters • Industry and mining accidents • Invasive and medical tests such as heart catheterization. • Dental and medical procedures (including early childhood operation, catastrophic illnesses, or prolonged bed and home confinement. The training consists of two areas 1. The sequential processing of trauma. This process is done by processing the earliest trauma and then in chronological order to the most current. The first trauma to process is a preverbal trauma that happened in the first 3 years of life. Education was also given on the Instinctual trauma response. Startle, Thwarted Intention (fight or flight). Freeze, Altered states of consciousness, Body sensations, Automatic Obedience. 2. Trauma is processed through verbal (verbal narrative) or nonverbal (graphic narrative) or a combination of both verbal and nonverbal. The Instinctual Trauma response is used as a template and then using a visualization technique to activate the hidden observer in the individual while retelling the trauma story.

 

13  

3. Externalized Dialogue to Repair Dissociation. The dialogue is externalized by speaking aloud (video) or written. The participants (present self and past self) take turn to dialogue with each other. The goal is to recruit the dissociated self into the present life of the person. The Graphic narrative. The goal of the narrative trauma processing is to eliminate intrusive and arousal symptoms and diminish numbing symptoms. This is accomplished by processing traumatic memories so as to achieve narrative closure. The objective is to integrate all of the dissociative images into a graphic narrative that depicts the entire traumatic experience as a historical event. The patient reviews the pictured event, puts into works and avows it as a personal history. This transforms the images from unfinished (seemingly present) experience to past history. Once narrative closure and verbal coding is achieved the images are no longer dissociated. After the completion of the Trauma course I gave a presentation of my work and the structure of the Art therapy groups in the Clinic that I work.

Natal Israel Centre for Victims of Terror and War. Saar Uzeily – Clinical Psychologist I spent 4 days at Natal and spoke to several members of the team. Unfortunately the Art therapist was not available in the time – Although I spoke with other members of the team of the Art therapy process Natal is a non-profit organization established in 1998 by Judith Yovel Recanti and the late Dr Yossi Hada. NATAL provides a multidisciplinary approach to the treatment of trauma as a result of war and terror in Israel. Natal has undertaken the mission to treat trauma victims and set them on a path to recovery, restore them to a productive and happy life. The centre is designed for a warm and welcoming place focusing on the personal relationship as the healing agent. It is a multi disciplinary treatment centre for victims of terror and war related trauma. IT is also a training centre for professionals and atrisk populations and educational resource centre Since 1948 the state of Israel has endured a series of wars, countless terror attacks, intifadas and constant bombardments of rockets and over southern communities. This has created an atmosphere of anxiety amongst many civilians trying to live a normal life, within an abnormal reality . Thousand of people suffer symptoms of trauma. Natal’s research show the 70% of children in southern Israel are suffering from on symptom of trauma Natal offers Multi disciplinary approach to the treatment and prevention of Trauma. The centre offers tailor made treatment including Hotline and Children’s hotline. Clinical services, testimonial centre, Social Therapeutic club,. The focus is to build Community Resilience through prevention, intervention and strengthening Resilience in conflict areas. The centre also trains other health professional. The Centre also looks at raising awareness of and breaking the taboo associated with PTSD,

 

14  

I spoke with Saar Uzeily A clinical psychologist and Clinical Director of the NATAL Unit. In discussion with him he told me of Natal’s expert inter disciplinary Clinical unit providing tailor-made one to one therapy to men and woman and children who suffer from trauma symptoms as a result of terror and war. The overall vision of the Clinical unit is that the patients receive more than one form of treatment. For example a patient may receive a combination of individual psychotherapy, sessions with a psychiatrist, art therapy, safe – touch therapy and also be a member of the Social Therapeutic Club. One of the most common experiences amongst sufferers of PTSD is the loss of the ‘inner home’. This experience is both physical and emotional. In order to feel whole and in harmony with oneself, it is important to feel the connection between the body and the soul as a whole. Social Therapeutic Club NATAL”S therapeutic club enables the most traumatized victims of terror and war (who are often socially recluse) to participate in meaningful social and therapeutic interventions. Housed in NATALs Multidisciplinary centre in Tel Aviv, the club encompasses an entire floor of the building with a computer room, two art studios and a communal kitchen in which members cook meals and eat together. Within the clubhouse there are 7 group activities over the course of 5 days: Creativity workshops, leather workshops, movement, cooking, ceramics, painting and music. Other activities include trips, museum trips, watching theatre performances, celebration of holidays and birthdays. Professionals in that specific field of interest teach each class. The club is an essential lifeline in the outside world and helps them regain a sense of normality and community. The club also hosts a group for the Ministry of Social Security Natals Testimonial centre provides trauma victims with a therapeutic platform for documenting their experiences. The patients shares his/her personal story in the presence of a mental health professional, who helps them guide them through a process while recording their retelling of their experience with a film camera. Community outreach. The professionals of the NATALs community Outreach Unit go into the field and meet the people in their day-to-day environment. Their activities are carried out in The population and groups that are exposed to trauma or that have a high chance of such exposure. The team uses a systemic model developed by NATAL which include: interventions at the individual, family, community and society level, primary prevention (assistance before trauma develops), secondary prevention (assistance in a situation where there are difficulties already) and tertiary (assistance to symptomatic population). The working principles of the model emphasise empowerment and strengthening natural resilience, strengthening coping abilities and growth in crisis situations, and integrating body and mind. Interventions are applied via treatment, professional workshop, training team, team building and group facilitation, building emergency team and community resilience Establishment of the Hot Line The NATAL Hot Line was inspired by the concept of Judith Lewis Herman (Trauma and Recovery, 1983), a clinical psychologist who works with victims of violence. She claims that traumatic experiences affect the individual’s sense of security, cause them

 

15  

to relive the traumatic event repetitively and creates problems in rebuilding the connection between the victim and their community. She claims that trauma tears families, friendships and community relationships apart. From this theory it is possible to understand why trauma victims suffer from isolation. In addition to isolation, other researchers found that the quality of life of trauma victims becomes progressively more limited when the traumatic event reappears repeatedly. This recurrence prevents them from connecting to and renewing their strengths. The victims are not only very isolated but also suffer from a dilution of their strength and resources. Therefore, the people calling the Hot Line need something and someone who will help them begin to move forward. Due to trust issues there is a need for a transitional stage before a person is capable of coming for treatment. The Hot Line can serve as an intermediary between the stage where individuals finds it difficult to begin treatment and clinical treatment itself. This is a process, since the issue of trust is one that takes time to develop. The caller needs to believe in the ability of the caregiver to help them. One of the goals of NATAL is to serve as a safe environment where people feel as though they came to the right place to receive support. The first person who answers the telephone is neither a secretary nor a voicemail box but rather a person who is trained to give answers. The Hot Line can be seen as the gateway to NATAL, which ensures that the caller will remain within the NATAL framework as long necessary. Art Therapy sessions at NATAL. Art therapy is integral to the treatment regime at NATAL. Groups and Individual sessions are offered. Art therapy group is held for the spouses of those who suffer PTSD. The sessions provide a safe place, a place to process memories, longing and fantasy and restore a sense of community. In the Art therapy space they may gain a sense of permission as part of the freedom of creativity. Also at NATAL focus was placed on mask and face making to explore inner shadow and future self

Professor Mooli Lahad Community Stress Prevention Center (CSPC) I met with Professor Mooli Lahad the founder and President of the Community Stress centre in the North of Israel. The town of Kiryat Shmona, is on Israel’s Lebanese border and was established 33 years ago. This centre is the oldest centre in the world that deals with civilians coping with Trauma since 1980 and one of the first to develop models and tools for assessment and development of Resilience. Professor Lahad of the Drama therapy MA studies at the local college Tai Hai and the founder of the Bibliotherapy in Haifa University in the late 80’s. He has worked and published a lot on the use of Arts therapies or expressive art therapies in crisis. He has focused on how to use it as a preventive/resiliency development tools and how to use it post disasters. He developed the Integrative Model of Coping and Resiliency 'BASIC PH'’ and the 'SEE FAR CBT' psycho trauma treatment protocol, adopted by other practitioners worldwide. This centres on people's natural coping mechanisms, of which he has identified six types. The method aims to help people suffering from anxiety disorders

 

16  

or traumatized individuals to reduce their symptoms either completely or to a manageable level to enable them to regain a sense of control of their lives. Lahad has practised his methods in the immediate aftermath of disasters such as the 1999 earthquake in Turkey, the United States dealing with the aftermath of the September 11 attacks, in New York and New Jersey and in Sri Lanka following the 2004 tsunami. This has included both dealing with individual cases and providing 'cascade' training of professionals known as 'train the trainers' or 'helping the helpers' who then go on to train others, to quickly build a large force of counsellors a concept he calls 'building islands of resiliency'. Other services they provide include: • Psycho trauma treatment and clinical services • Worldwide disaster management consultation • Pre and post disaster training • Cross-cultural work • Multidisciplinary Resilience Research Centre The Community Stress Prevention Centre (CSPC) provides over 190,000 hours of training and more than 25,000 hours of direct treatment for patients with psycho traumatic symptoms, and trained over 300 local authorities in Israel and abroad in the treatment. Consultation and research CSPC provides disaster management consultation and preparedness activities through "real-time" intervention and post-incident recovery and treatment for all society partners: Ministries, first responders, health, welfare, uniform bodies, commercial and NGOs. CSPC has a long history of developing programs, manuals, standing operational procedures (SOPs) in conjunction with a variety of clients, local authorities and community services as well as with the Ministries and operational bodies. CSPC's provided crisis intervention, resiliency and rehabilitation programs and consultation worldwide. They have been involved in training crisis management and intervention and mental health training for both professionals and paraprofessionals, along with a wide range of community resiliency activities, in Europe, Turkey, the Middle East and Asia Cross-cultural work They are involved in cross-cultural work with a variety of communities and faiths in Israel and world-wide, spread over 30 years, the work has included immigrants groups from the former USSR and Ethiopia, ultra-orthodox Jews, Moslems, Christian Bedouins and Druze communities. CSPC has been the leader of a consortium of experts who designed five community resiliency centres in the south of Israel since 2007. We have the knowledge and experience to revise and adjust it to the specific local characteristics. Research Centre CSPC serves as the Tel Hai College Research Center for Social Sciences and Humanities. Its research team, led by Professor Lahad, has published articles and books dealing with the psychosocial aspects of disaster and crisis management,

 

17  

developed the coping model of BASIC Ph and the treatment method of SEE FAR CBT and has conducted several academic and professional seminars and workshops in Israel as well as Europe. Between 2007 and 2009, CSPC conducted a large project, funded by the NATO Science for Peace program, for psychosocial professionals from Eastern Europe, the Caucasus and Central Asia in order to train and empower them to deal with disaster situations and to jointly build, virtual resiliency centres for their respective countries via the internet. “SEE FAR CBT is a suggested new protocol for the treatment of anxiety disorders and post-traumatic stress disorder (PTSD) using creative form of treatment based on empowerment through fantastic reality. The model emphasizes the role of fantastic reality and the use of imaginal re-narration of the traumatic event with the use of cards as a means of externalization or distancing. The treatment protocol incorporates methods of somatic memory reduction as well as CBT elements.

 

18  

Conclusions and Recommendations. This fellowship and trip to USA and Israel has given me the opportunity to explore and investigate the different treatment options in centres that focus on Art therapy and PTSD. All of the centres have a wholistic multi dimensional and Multi disciplinary approach in the treatment of Trauma. The centres include traditional therapies Psychology, Cognitive behavioural therapy and Psycho education as well as Art therapy, Biofeedback, Music therapy, Movement as Tai Chi and Yoga, body therapies as massage Reiki, Acupuncture as well as exposure work. At each centre that dealt with combat related trauma the Art therapy was integrated and included into the programs. Art therapy was included and offered as group therapy and on a one to one basis if required by the client. In the trauma centers that I visited there was an emphasis on creating a warm and welcoming environment and milieu. Consideration, thought and care was taken in creating a physical environment that was peaceful and conducive to healing and relaxation A multi disciplinary team of therapists delivered the treatment regime in all the centres. The groups and individual sessions were tailor made to suit the client. The four combat related trauma centres I visited held the Art therapies in high regard and respected with enthusiasm this approach in dealing with Trauma. Through the Arts therapies a voice was given to the unspeakable. The Art therapist in each of the centres would regularly present to multidisciplinary team meetings Art therapy images and also upload the paintings and images into the integrated notes to share information. Whilst attending the program and centres I explored different models and perspectives and I learnt a number of new techniques and styles of Art therapy. The techniques were Focus Oriented Art therapy, graphic narrative and SEE FAR CBT. Each of these techniques were a combination of Somatic experiencing (body memory) imagery and Art creations, fantasy, relaxation and Cognitive behaviour therapy. What was common in all these approaches was that they all used play, playfulness and the creative process as part of the healing process. The creation of a safe place and cultivating the observer self to process trauma was also included, along with exposure work, Psycho Education and relaxation techniques. Specific techniques and approaches of masking making were used in all the centres as a way to explore and express self-image, identity and trauma. The mask making allowed a way that was concrete, kinaesthetic, tangible and transformative. I recommend that at Hollywood Clinic and other centres that treat Post Traumatic Stress disorder apply a similar model of treating the whole person and take into account that for healing and resiliency therapy and treatment could be aimed at  

19  

including, belief and values, affect (emotional), social, imagination cognitive and physiological aspects. These represent an integrative and multifaceted approach and suggest that each person has a personal combination of those elements, which form his/her unique coping style Despair, haunting nightmares and a rift in on e belief system is at the root Post traumatic stress disorder. In all centres encouragement, help, support and hope is achieved though a multi dimensional approach. The Churchill fellowship has allowed me to develop my skills, understanding and knowledge to integrate in to my Art therapy work at Hollywood Hospital I have gained value and knowledge from the Churchill Fellowship that will enhance the quality of care I deliver to the patients I work with at Hollywood Hospital. The exploration has been valuable in augmenting my existing skills. With this new knowledge I can also teach others in the field of Art therapy by disseminating the information learnt.

 

20  

Bibliography Anne Weiser Cornell, Phd. (1996). The Power of Focusing: A Practical Guide to Emotional Self-Healing. Oakland: New Harbinger. Johnson Read,D., Lahad,M. Gray, A (2009) Creative therapies for Adults. E. Foa, T.M., M.J. Freedman, J.A. Cohen (eds.) Effective treatments for PTSD, Practice Guidelines. (pp 479-490)NY: THE Guilford Press. Judith Herman MD: (1997). Trauma and Recovery. The aftermath of violence – from domestic abuse to Political Terror. Basic Books. New York. Laury Rappaport. (2009). Focused – Orientated Art therapy. Jessica Kingsley UK Louis Tinnin & Linda Ganntt. (2013). The Institutional Trauma Response. Dual – Brain Dynamics. A guide for Trauma Therapy. Morgan Town USA Mooli Lahad, Miri Shacham, Ofra Ayalon : (2013). The "BASIC Ph" Model of Coping and Resiliency: Theory, Research and Cross-Cultural Application. Jessica Kingsley Publishers. London Mooli Lahad: (2010). Protocol for treatment of Post Traumatic Stress Disorder: SEE FAR CBT. The authors and IOS Press. Istanbul. Lahad, M. (2000) Creative Supervision. Jessica Kingsley Publishers. London. Lahad,M Farhi, M. Leykin, D. Kaplansky, N. (2010). Preliminary study of a new integrative approach in treating Post Traumatic Stress Disorder: SEE FAR CBT. The Arts in Psychotherapy, 37, 391-399. Peter A. Levine. (1997). Walking the Tiger: Healing Trauma. North Atlantic Books. Berkeley California. Peter A Levine: (2008) Healing Trauma. Sounds True. Canada.

 

21  

Appendix Case study A patient named Danny (pseudonym), 40 years old, married with 2 children, was recommended to try art therapy treatment after receiving 10 months of traditional therapy that was not progressing for him. Danny was hurt when a suicide bomber exploded himself next to his car at a red traffic light. Two of his passengers were killed and Danny suffered from severe injuries as a result of the blast. He was diagnosed as suffering from combined psychological and organic symptoms of PTSD as well as problems with memory, hearing, tinnitus – dizziness, flashbacks, insomnia and depression. In the first therapy session Danny said, “the noise in my head is like radio static…” in the first phases of the therapy we decided that he would try to visualize through painting what this noise “looks” like in his head It is important to note that Danny wasn’t painting before and he didn’t know that he had the talent for that. To his surprise, while he was painting he felt relaxed and the noise in his head lessened. The work caused him great pleasure and quiet. After several years of treatment, the therapist recommended Danny to study the art of painting in the framework of the national insurance, and indeed, Danny actually finished four years of studying.

 

22  

 

23  

 

24  

 

25