In broken English, a 13 year boy asked if he could draw me a picture. I sat with him as he sketched a superhero figure he had seen on TV. He was amazingly talented and drew with great detail and passion. When he was finished he smiled, gave the picture to me and proudly said “For you. Welcome!” It was my first day volunteering at Casa Hogar Los Angelitos (CHLA) in Manzanillo, Mexico. The orphanage has over 50 children and is registered as a Mexican civil association. During the spring of 2011 I was able to spend an extended period of time at CHLA as part of a university sabbatical. I asked to volunteer at CHLA because of their outstanding reputation for working with “difficult to place” children in Mexico. Most of the kids come from toxic environments that include domestic violence, homelessness, physical and sexual abuse, prostitution, sexual assault, neglect and abandonment. During my professional career as a social worker I have been privileged to visit many orphanages around the world. Most of them provide for the basic survival needs of children, giving them minimal healthcare, clothing, food and shelter. The kids survive but few thrive. They often repeat the patterns and lifestyles of the poor and abusive homes they grew up in. Because of the lack of resources, few orphanages effectively address the complex needs of traumatized children. CHLA came highly recommended as a place where I could observe a “success story” and learn how they do it.
I started my sabbatical experience at CHLA with the following questions: Why is CHLA so effective with “difficult to place” children given their limited resources? Why are CHLA children more likely to remain in school and go to college? Why are their rates of teen pregnancies, drug use, gang involvement, and criminality so low? I discovered many reasons for their success while I was there. They have dedicated staff, passionate volunteers, visionary leadership and a holistic approach to child development. A surprising finding, and maybe the strongest reason for the success of CHLA, is the extensive use of expressive arts in the daily lives of the children there. The founder of CHLA, Nancy Nystrom, instinctually began using expressive arts at the orphanage when it started over 15 years ago. Children receive instruction in music and have regular access to instruments. They can train and participate in a highly skilled and prestigious troupe of dancers that perform traditional Mexican dances in local, national and international performances. The kids have access to donated art supplies and regularly draw and paint. Many of the children participate in creative writing, journaling and poetry. Expressive arts are integrated into each stage of the child’s development. Through a wide variety of programs, CHLA facilitates emotional and creative expression, heals psychological wounds, and accelerates developmental growth through its use of the arts. I have never seen an orphanage embrace the arts as fervently.
Art is an important and universal facet of human expression and is as old as human civilization. “The use of art for healing and mastery is at least as old as the drawings on the walls of caves” (Aron-Rubin, 2005, p. 6). Expressive arts include activities such as dance, drawing, drama, creative writing, painting, poetry, music, sculpture, and photography. Professions such as art therapy, music therapy and movement therapy require graduate-level training and special professional certifications in the United States. The therapeutic use of expressive arts by non-credentialed professionals and paraprofessionals in orphanages is different in that it simply focuses on the inherent therapeutic value of children participating in creative endeavors. Both approaches encourage creative expression but the context, facilitation and purposes are very different. Most orphanages would welcome the opportunity to have expressive art therapists but the lack of funding and the availability of these specialized professionals in developing countries usually limit their use. Instead, orphanages such as CHLA use expressive arts as a way to supplement the care that children receive. Most of these activities are facilitated by volunteers, clinical staff or child care workers.
Creative arts allow children the opportunity for self-awareness and growth through self-expression. This has been shown to reduce stress and accelerate psychological and physical healing. For many children and adults imprisoned in German concentration camps in World War II, drawings and paintings were used to cope with the horrors they saw each day. Prisoners had to carefully hide their work as many were killed when their art was found (Orstein, 2006). They traded food for painting supplies, and used garbage, old boxes and newspapers to paint on. Paint was made from coal soaked in water, watered down rust and vegetable dyes. “They responded to an imperative psychological demand to put on paper what they saw and what they felt” (p. 395-396). Painting and poetry were a way for them to survive and cope.
I began to use expressive arts as a young counselor in the 1980s out of pure desperation. I worked with adolescents who struggled with mental health and substance abuse problems. Traditional “talk therapies” did not seem to work very well. I started reflecting on my own adolescence and the activities that helped me cope with stress and family problems. Activities such as music, sports, poetry and outdoor adventure provided an outlet to express myself and help me manage stress and adolescent angst. Much to the dismay of many of my coworkers, who tightly subscribed to traditional approaches, I started incorporating expressive arts into my counseling sessions. As my successful outcomes with adolescents grew, so did the agency’s support of my methods. I was allowed to hire licensed and certified art therapists, music therapists, dance therapists, outdoor adventure therapists and exercise physiologists in our residential treatment programs. These programs supplemented traditional individual, group, and family interventions. The organization found that successful treatment outcomes were higher for adolescents that participated in expressive therapies than those who did not.
Most of the children at CHLA have histories of trauma and several display symptoms of post traumatic stress disorder (PTSD). For some, attachment bonds with primary caregivers were absent, disrupted or severed at an early age. This destroyed the trust and security essential for healthy emotional growth and relational intimacy. Early relationships provide the emotional, neurological and social foundations for our ability to love (Perry, 2009). During my stay at CHLA, I heard heartbreaking stories of domestic violence, physical torture, sexual abuse and assault, drug addiction, prostitution, extreme neglect and abandonment. Past traumatic events are difficult for children to talk about. They have not yet learned the words to describe the internal sensations, memories, images and snapshots. Painful emotions and horrific experiences are frequently repressed by the children as a basic survival mechanism (van der Kolk, 2002). Children with histories of trauma experience multiple losses and carry the toxic memories from their past. They have a higher risk of experiencing mental health problems as adults. The dissociative behavior and post traumatic stress experienced as a result of abuse and neglect negatively impacts a child’s ability live a healthy, satisfying life. Alice Miller (1984) wrote
The truth about our childhood is stored up in our body and although we can repress it, we can never alter it. Our intellect can be deceived, our feelings manipulated, our perceptions confused, and our body tricked with medication. But someday the body will present its bill, for it is as incorruptible as a child who, still whole in spirit, will accept no compromises or excuses, and it will not stop tormenting us until we stop evading the truth. (p. 315)
Expressive arts have long been used with children to promote psychological health and social support. They offer children “a way to express their feelings, perceptions, thoughts, and memories in ways that words cannot” (Malchiodi, 2005, p. 9). Studies indicate that expressive arts assist in healing from childhood trauma and aid in overall mental health “by providing opportunities to share experiences in an empathic environment through symbolically expressing emotions in a concrete way” (Smilen, 2009, p. 381). The staff and volunteers at CHLA engaged and positively reinforced children in the creative process by providing a safe space for them to express themselves. Because most children enjoy drawing, painting, singing, and dancing, art is a simple way for children to learn multiple forms of expressions. Children are allowed to express themselves without judgment or criticism. They are given the ability to choose from a variety of creative activities which increases their sense of internal control and willingness to participate.
Supportive peers can also be of great asset in the creative process. Many expressive art activities at CHLA are done in small groups. This cultivates social interaction, mutual support, peer modeling and empathy development (Cumming & Visser, 2009). Completing a work of art or finishing a performance in the presence of supportive peers and adults can raise a child’s confidence and self-worth. By creating and sharing in a safe and supportive group, children are able to break their sense of isolation and shame. They discover symbols, labels, and other forms of expression that accurately reflect their own inner landscapes. Bhagwan (2009) wrote “individuals do not exist as isolated, discrete or separate entities, but as interconnected beings whose growth, well-being and transformation are shaped by dynamic and fluid relationships between friends, family, the global community and a Higher Spirit within the Universe” (p. 226). I frequently observed older children teaching younger children how to dance, how to play the guitar and how to paint. I would hear comments from kids sharing drawings and poetry with their peers such as “This one looks really sad” or “This one sounds angry”. They would ask each other questions about their art, give encouragement and comfort one other if the process brought up past issues or difficult emotions. Adult facilitators carefully monitored this process and also offered affirmation and validation.
Expressive arts assist in the healing process by altering a child’s physiology. When children engage in expressive arts it alerts the parasympathetic system in their brain (Lane, 2005). Their breathing slows down, their blood pressure lowers and the body becomes more relaxed. This helps to reduce the physiological hyper-arousal, or “fight or flight” response, associated with stress. Creative expression modifies our biochemistry and improves our physical well-being. When children participate in the arts it actually changes their bodies.
The creative process causes specific areas of the brain to release endorphins and other neurotransmitters that affect brain cells and the cells of the immune system, relieving pain and triggering the immune system to function more efficiently. Endorphins are like opiates, creating an experience of expansion, connection, and relaxation. In conjunction with these physiologic changes, art can regularly change people’s attitudes, emotional states, and perception of pain. (p. 122)
Neurophysiologists have shown that “art, meditation, and healing all come from the same source in the body; they are all associated with similar brainwave patterns and mind-body changes” (p. 123). A child’s age and stage of development “has a profound impact on how an educational, care-giving, or therapeutic experience will influence the brain” (Perry, 2009, p. 243). Children who are traumatized when they are very young will respond and cope differently than children who are traumatized as adolescents.
Because of the way the brain develops, from the bottom up and from the inside out, different areas of the brain are impacted during trauma depending on the age of the child. The younger a child is during the trauma, the more necessary it is to stimulate specific neuro- pathways that promote healthy brain development (Perry, 2009). Certain neuro-pathways in the brain are developed and others underdeveloped depending in the experiences of the child.
This is a significant problem in the conventional mental health approach to maltreated children; many of their problems are related to disorganized or poorly regulated networks (e.g., the monoamines) originating lower in the brain. Yet, our clinical interventions often provide experiences that primarily target the innervated cortical or limbic (i.e., cognitive and relational interactions) regions in the brain and not the innervating source of the dysregulation (lower stress-response networks). Even when targeting the appropriate systems in the brain, we rarely provide the repetitions necessary to modify organized neural networks; 1 hour of therapy a week is insufficient to alter the accumulated impact of years of chaos, threat, loss, and humiliation. Inadequate „„targeting?? of our therapeutic activities to brain areas that are not the source of the symptoms and insufficient „„repetitions?? combine to make conventional mental health services for maltreated children ineffective. (p. 244)
Experiences of trauma are often kept in one’s memory as sensations, symbols and mental images which can be difficult to access in traditional “talk” therapy or informal conversation. These memories are situated in the primitive sections of the brain and may not be part of their conscious awareness. Expressive arts help children manage experiences that are too difficult or painful to assimilate. In his research on child trauma, Perry (2009) found that activities such as dance, massage, music, yoga, drumming and other similar interventions provide the patterned and repetitive neural input to alter the lower stress-response networks of the brain and help children better cope with the symptoms related to their trauma. This could explain one the many benefits children at CHLA receive from participating in the dance troupe. They practice their traditional Mexican dances many times per week. Their performance shoes have taps on them that make a percussive sound when they dance. While they rehearsed, I often closed my eyes and listened to the rhythms being created. The children emphasized specific beats and memorized the dance by the rhythmic sounds being created.
A child?s spiritual awareness and development can be improved by the use of expressive arts. In 2004, Broadbent found that the use of dance deepens “children’s spiritual awareness and provides a context for the development of a kinesthetic intelligence, which allows children to embody and give expression to abstract concepts and ideas” (as cited in Bhagwan, 2009, p. 229). A study by Mountain (2007) reported that creative arts “engage children in learning that is intimately related to spiritual development, involving self-understanding, understanding relationships, wider environmental connectedness, and connection with the divine” (as cited in Coholic, Lougheed & Lebreton, 2009, p. 31). The arts engage the senses in a way that transcends the ordinary and mundane aspects of life. As children connect to their poems, songs, dances or paintings, they become more aware of their thoughts, emotions and core beliefs. This assists in self-discovery and self-understanding and helps them find meaning. The children at CHLA use the creative process to communicate their joy and pain to God. One teen told me “I feel God’s strength and beauty in me when I dance.” For her, dancing was a way to move beyond her heartache and connect with her strengths and competencies. I attended several worship services held at CHLA each Sunday. These are completely voluntary and I was amazed how many children willingly attended. I observed them singing, dancing and using their creative artist talents to connect with God.
During my sabbatical I observed children at CHLA make great strides in their development and healing by participating in expressive arts. They beamed with pride and confidence after a dance or musical performance. Paintings and drawings were used to communicate a wide range of emotions and experiences. It was as if the arts were a normal and regular means of expression for the children there. The use of the creative process in each child’s life was planned, organized and well facilitated. The results were impressive and inspiring. Their dedicated staff and volunteers have been able to reach and engage hundreds of maltreated children through the natural restoration and rejuvenation that occurs when we dance, sing, paint, write and draw. While generalizations from a single case are certainly limited, the intention of this paper is to qualitatively add to the ongoing inquiry into the therapeutic use of art in orphanages throughout the world. Given the limited access to psychological resources in such settings, child care workers must be strategic in their methods and strategies. Expressive arts are a relatively inexpensive and an effective method to engage child who have experienced trauma. It is surprising that more orphanages have not incorporated them into their program.
Casa Hogar Los Angelitos uses expressive arts in a way that is fun, therapeutic and inspirational. Creativity and imagination serve as a catalyst in the children’s emotional, social, physical and spiritual growth. Further trainings must be provided for child care staff and volunteers on ways to use expressive arts without practicing beyond their level of competence. Experts in art therapy, music therapy and movement therapy could create inexpensive and safe activities to use with some guidance on how to facilitate the process. Further research is needed in the use of the arts in orphanages throughout the world as there are many variables involved in determining what makes an orphanage successful in working with “difficult to place” children. If these talented kids are to thrive and blossom to their full potential, we must be open to all innovative, inexpensive and evidenced-based approaches that help kids heal from trauma.
References
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Coholic, D., Lougheed, S., & Lebreton, J. (2009). The helpfulness of holistic arts-based group work with children living in foster care. Social Work with Groups: A Journal of Community and Clinical Practice, 32(1-2), 29-46.
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Don Phelps, Ph.D., L.C.S.W.
Dr. Phelps received his Ph.D. in social work in 1997 from the University of Illinois. He also studied at the George Williams College-School of Social Work at Aurora University where he completed his Master of Social Work degree in 1990, focusing on youth and family therapy. He is a doctoral level licensed clinical social worker. Dr. Phelps is currently an associate professor in the School of Social Work at Aurora University near Chicago. Over the last 25 years he has worked as a youth and family therapist, clinical director, chief operating officer and chief executive officer. He completed a university sabbatical in Manzanillo, Mexico during Spring semester 2011.
