By Clare McCarthy ATR-BC, LCPC
 
Central to the trauma healing applications of dogs in the therapeutic context is their ability to create trust in environments and in relationships.  When a person sustains interpersonal trauma, it often contributes to lasting feelings of diminished safety in relationships with others and an ongoing sense of hyper-arousal and hyper-vigilance.  This makes seeking help and sustaining a helping relationship difficult due to the survivor feeling vulnerable and guarded against further trauma  (Barber, Connolly, Crits-Cristoph, Gladis, & Siqueland, 2009). While therapeutic social support and guided trauma reprocessing is critical in psychological trauma recovery, lasting apprehension and heightened sensitivity to perceived interpersonal threats may lead to increases in treatment avoidance and social isolation, with the unintended consequence of isolating the survivor and exacerbating their PTSD symptoms and associated physiological stress (Chandler, 2017).  While all clinical therapists may benefit from the inclusion of a therapy dog within their work, art therapists may find this to be a particularly natural fit with their practice due to their training in non-verbal anxiety reducing interventions, and their tendency to work with clients who may be struggling to overcome barriers to verbal communication due to traumatic experiences. 
The presence of a non-threatening animal within the therapeutic setting makes use of the biophilia hypothesis, which holds that humans have an innate need for deep and intimate association with animals, and an inclination to affiliate with life to achieve meaning and fulfillment (Kellert & Wilson, 1993).  The presence of a dog in the therapy space can help to instill a sense of calmness and reduce the client’s psychological and physiological stress (Shiloh, Sorek, & Terkel, 2003), counteracting the normal tendency to shut down or discontinue therapeutic work when triggered by external stimuli or internal experiences. Research evidence indicates that the amygdala (which plays a primary role in the processing of emotional reactions) prefers pictures of animals to landscapes or people, which may indicate that animals are wired to touch us in deep and basic ways, and can provide access to inner human emotional spaces, even those spaces that are profoundly defended (Mormann et. al, 2011).  Likewise, the presence of a supportive animal has been demonstrated to reduce state anxiety as measured by decreases in cortisol levels, blood pressure, and heart rate (Yount, Olmert, & Lee, 2012), and increases in oxytocin (Nagasawa, Kikusui, Onaka, & Ohta, 2008; Odendaal, 2000), a biomarker linked with secure bonding and attachment (Buchheim et al., 2009), social affiliation (Carter, 1998), trust (Theodoridou, Rowe, Penton-Voak, & Rogers, 2009), sharing emotions (Lane et al., 2012), reduction of the fear response (Huber, Veinante, & Stoop, 2005), management of anxiety (Heinrichs, Baumgartner, Kirschbaum, & Ehlert, 2003), and relaxed immobility without fear (Carter, 2017).  
 In addition, observing an animal interact within the therapeutic setting can help the client to non-verbally assess the safety of the therapeutic environment and the therapist, and can encourage the development of a trusting therapeutic relationship.  For example, if the animal appears to be feeling safe and comfortable, and demonstrates that they like and trust the therapist, it can indicate that the therapist is safe and reliable, and a person who can be trusted to keep others safe (Prothmann, Bienert, & Ettrich, 2006).
As the therapeutic relationship becomes established and the therapy progresses, the animal, the therapist, and the client form a living therapeutic triad that expands possibilities for interaction, projection, and expression within the space. Mirror neurons within the human brain respond to the movement and behavior of the animal, and assists the client in projecting their thoughts and emotions onto the animal (Keysers and Gazzola, 2014)—allowing the client to safely experience, express, and process aspects of their own memories and experiences that may have been masked or covered due to the traumatic effects of psychological splitting and dissociation from the real self (Parish-Plass & Pfeiffer, 2019). The warm and supportive energy of the animal can also create a further source of therapeutic unconditional positive regard that can alleviate feelings of overwhelming shame resulting from the unprocessed trauma, and boost client’s ability to see themselves as whole and worthy of love and affection in the present moment (Tedeschi, Jenkins, Parish-Plass, Olmert, & Yount, 2019).
When engaged in art making or discussion surrounding traumatic reprocessing, animals can further serve as a source of security in the here and now, and provide grounding and sensory self-soothing in the case that the trauma memory becomes disorienting or intrusive in the form of flashbacks or overwhelming negative emotions (Greenbaum, 2005; Zilcha-Mano, Mikulincer, & Shauer, 2012).  During times of encountering negative emotions associated with traumatic memories, people seek social engagement to reduce anxiety. However, when the social world was or is perceived as the source of the threat, the neural system directs the body to mobilization (fight or flight) or dissociation to reduce anxiety (Porges, 2011).  The inclusion of a trusted animal in the space therefore allows the client to engage socially, and receive oxytocin boosting interaction, without being reliant on human interaction. This animal assisted intervention can then serve as a bridge to reconnecting with the human social world in the form of the therapist, without reinforcing unhelpful coping or short circuiting reprocessing.
Animals in the presence of a supportive art therapist offer clients a deep and primal path back into the primary processes that may have become inaccessible due to overwhelming negative experiences and consequent negative coping patterns.  The gifts dogs provide as adjunctive trauma therapists can only be fully accessed when the animal itself is psychologically thriving, and in a trusting and secure partnership with the handler which promotes the wellbeing, healthy boundaries, and mutual respect of all parties involved (Howie, 2015).
REFERENCES:
Barber, J., Connolly, M., Crits-Christoph, P., Gladis, L., & Siqueland, L. (2009). Alliance predicts patients’ outcome beyond in-treatment change in symptoms. Personality Disorders: Theory, Research, and Treatment, S(1), 80-89.
Buchheim, A., Heinrichs, M., George, C., Pokorny, D., Koops, E., Henningsen, P., et al. (2009) Oxytocin enhances the experience of attachment security. Psychoneuroendocrinology, 34, 1417-1422.
Carter, C. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779-818.
Carter, C.S. (2017). The role of oxytocin and vasopressin in attachment. Psychodynamic Psychiatry, 45, 499-518.
Chandler, C.K. (2017). Animal-assisted therapy in counseling, 3rd edition. New York, NY: Routledge
Greenbaum, S. (2005). Introduction to working with animal assisted crisis response animal handler teams. International Journal of Emergency Mental Health, 8(1), 49-63.
Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003) Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54(12), 1389-1398.
Howie, A.R. (2015). Teaming with your therapy dog: New directions in the human-animal bond. West Lafayette, IN: Purdue University Press
Huber, D., Veinante, P., & Stoop, R. (2005). Vasopressin and oxytocin excite distinct neuronal populations in the central amygdala. Science, 308(5719), 245-248.
Kellert, S.R., & Wilson, E.O. (Eds.). (1993). The biophilia hypothesis. Washington, DC: Island Press.
Keysers, C., & Gazzola, V. (2014). Hebbian learning and predictive mirror neurons for actions, sensations, and emotions. Philosophical Transactions of the Royal Society B: Biological Sciences, 369, 20130175.
Lane, A., Luminet, O., Rime, B., Gross, J., de Timary, P., & Mikolajczak, M. (2012). Oxytocin increases willingness to social share one’s emotions. International Journal of Psychology, 48, 676-681.
Mormann, F., Dubois, J., Kornblith, S., Milosavljevic, M., Cerf, M., Ison, M., et al. (2011). A category-specific response to animals in the right human amygdala. Nature Neuroscience, 14(10), 1247-1249.
Nagasawa, M., Kikusui, T., Onaka, T., & Ohta, M. (2008). Dog’s gaze at its owner increases owner’s urinary oxytocin during social interaction. Hormones and Behavior, 55, 434-441.
Odendaal, J. S. J. (2000). Animal-assisted therapy: Magic or medicine? Journal of Psychosomatic Research, 49, 275-280.
Parish-Plass, N., & Peiffer, J. (2019). Implication of animal-asisted psychotherapy for the treatment of developmental trauma through the lens of interpersonal neurobiology. In P. Tedeschi, & M. A. Jenkins (Eds.), Transforming trauma: Resilience and healing through our connections with animals. West Lafayette, IN: Purdue University Press.
Porges, S. (2011). The poloyvagal theory: Neurophysiological foundations of emotions, attachment, communication and self-regulation. New York: WW Norton and Co.
Prothmann, A., Bienert, M., & Ettrich, C. (2006). Dogs in child psychotherapy: Effects on state of mind. Anthrozoos, 19(3), 265-277.
Shiloh, S. Sorek, G., & Terkel, J. (2003). Reduction of state-anxiety by petting animals in a controlled laboratory experiment. Anxiety, Stress and Coping, 16, 387-395.
Tedeschi, Jenkins, Parish-Plass, Olmert, and Yount (2019). Treating human trauma with the help of animals: Trauma-informed intervention for child maltreatment and adult posttraumatic stress. In A. H. Fine (Ed.) Handbook on animal-assisted therapy: Foundations and guidelines for animal-assisted interventions, 5th edition (pp.363-378). San Diego, CA: Elsevier
Theodoridou, A., Rowe, A. C., Penton-Voak, I. S., & Rogers, P. J. (2009). Oxytocin and social perception: Oxytocin increases perceived facial trustworthiness and attractiveness. Hormones and Behavior, 56, 128-132.
Yont, R. A., Olmert, M. D., & Lee, M. R. (2012). Service dog training program for treatment of posttraumatic stress in service members. U.S. Army Medical Department Journal, 63-69.
Zilcha-Mano, S., Mikulincer, M., & Shaver, P. R. (2012) Pets as safe haves and secure bases: The moderating role of pet attachment orientations. Journal of Research in Persoanlity, 46, 571-580.
 
 
 
 
 
 

By Dr. Mary Andrus DAT, ATR-BC, LCPC, LPC
​I had the pleasure of talking at length with Jimmy Morris of PsychSessions.com about the complexity of art therapy the profession, specifics of what art therapists do, who they treat, their training and education and how they become licensed. If you are curious about trying out art therapy or considering entering the profession of art therapy this might be a great place to start to learn a bit more about it! 
You can download the session from itunes here. Enjoy!

by Tricia Morales ​ATR, LCPC

​An individual I worked with in art therapy asked me to help her create new meaning for a pair of jeans she used as inspiration for continued restriction and diminished life in her eating disorder. Together we worked to create new meaning through art therapy by turning this life limiting pair of jeans into a symbol of hope for recovery in the creation of a dream catcher. The dream catcher was formed by cutting up the jeans into strips, dying them different colors, and weaving them around the outside of the dream catcher hoop. This jean covered hoop contained the repetitive soothing motion of woven yarn to create the web to catch her dreams for recovery from her eating disorder. The remaining strips of jeans were used to hang from the bottom of the hoop. The final addition of a loop of yarn at the top provided the completion of this dream catcher to be hung in a space of her choosing as a reminder of the possibilities in recovery – finding a new way to relate to her body via the process of physically creating this art piece.

Millions of men and women suffer from eating disorders at some point in their lifetime. These disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, or OSFED – other specified feeding or eating disorder according to the DSM-5. (http://www.nationaleatingdisorders.org/get-facts-eating-disorders)

If you are struggling with an eating disorder or have a loved one that is, art therapy at ATSC could be a necessary starting place, change in treatment approach, or addition to current treatment. The story above highlights the trust built in relationship between the patient and art therapist to find new meaning for a pair of jeans and her body image that continued to hold her prisoner in her eating disorder. The following is an overview of common underlying feelings, co-morbid diagnoses, and additional treatment used for the healing process of art therapy with women and men that suffer from eating disorders.

Brief Eating Disorder Definition
Quickly I would like to provide you a brief definition of a few eating disorders most commonly seen, anorexia (process of starving oneself at times to death), bulimia (bingeing and purging through the use of vomiting, over-exercise, laxative use, diuretics, starvation, etc.), binge-eating disorder (consumption of large quantities of food), and a combination of the above mentioned disorders.

Common Underlying Feelings and Co-morbid Diagnoses
As the eating disorder progresses it often leads to increased isolation. Shame experienced about the use of eating disorder behaviors leads to increased disconnection from self and others. Food has likely become the most intimate relationship in your life assisting with avoidance of emotions. Others in your life may not understand leading you to experience more despair. Prolonged social isolation intensifies experiences of depression, anxiety, self-harm, suicidal ideation and other related disorders. Through art therapy you can begin to form a trusting, non-judgmental relationship with the art therapist and art supplies to increase feelings of connection and practice expression of underlying feelings of shame, loneliness, sadness, anxiety, pride, guilt, or anger. 

One of the most significant steps is working to admit that your relationship to food is unhealthy. The role you have given food in your life is self-created for coping with pain. This pain you have hidden under your relationship to food is what can be explored through art therapy for healing. This pain may stem from childhood – not feeling like you are enough or past verbal, physical, emotional, or sexual abuse. PTSD is a common co-morbid diagnosis for those suffering from an eating disorder.

Art provides a safe way to explore the hurt or loss you have witnessed or experienced that you may not be able to put into words. Through art you can practice being kind to your inner child. This can be accomplished using collage, painting, drawing, sculpture, weaving, or other media. Taking the images of past hurt you are experiencing in your mind and placing them on paper, canvas, or another surface of choosing can help you find a new way to relate to the image via writing or dialogue. This work provides new understanding about self, your relationship to eating, past trauma, sexuality, challenging emotions, and your body.

Mindfulness Practice in Art Therapy
An important part of art therapy is the use of mindful practice. By actively focusing on art making you are practicing mindfulness participate, which can lead to slowed heart rate, breathing, and potential feelings of relaxation. Mindful art helps give your mind a rest from obsessive thoughts about food (Another common co-morbid diagnosis is OCD). This can be a practice you continue outside the art therapy sessions by starting an art journal or altered book. This book can be a place for you when feeling emotionally dysregulated or uncertain to let go of perfection and allow yourself to freely create inside the safe pages of your book. Through creating you are allowing yourself the necessary connection to your emotions leading to increased experiences of positive feelings of accomplishment, connection, and joy. You may not have allowed yourself to experience these emotions due to feeling unworthy. This space for new understanding may help you clarify an approach you want to take in an important relationship or depict the internal conflict you are experiencing as you work towards recovery from your eating disorder.

Important Additional Services
Eating disorders are complex and often require a combination of treatment providers including a therapist, family therapist, dietician, MD, and psychiatrist. With physical complications to the body present within this disorder it is recommended to seek assistance from medical professionals. They can assist with the potential for re-nourishing the body and mind by managing after effects of purging/restricting/overeating/other physically challenging behaviors.

Art therapy at ATSC can provide a place to begin exploring the needs for treatment and work you are willing to do in recapturing your mind and body for a valued life. Together you and I will work on determining a starting point for treatment that you feel is most relevant to assisting you with healing in your life.
Does any of the information in this blog resonate with your life experience?
Do you have a desire to heal from your eating disorder and other treatment is not working?
Have you tried art therapy for treatment of your eating disorder?
It is time to take charge of your life, begin/continue the process of letting go of your eating disorder, connect and create new meaning via art making at ATSC!

 Author- Joan Erenberg, LCPC, BC-DMT, RYT
​The American Dance Therapy Association (ADTA) defines dance/movement therapy as the “psychotherapeutic use of movement to further the emotional, cognitive, physical and social integration of the individual”. This is based on the “empirically supported premise that the body, mind and spirit are interconnected.” Dance/movement therapy falls under the category of the creative art therapies and is conducive to both individuals and groups across a wide array of psychotherapeutic needs. The practice of dance/movement therapy aligns with the the mission of Art Therapy Studio Chicago (ATSC), “to connect through creativity’ and to “facilitate healing, insight and awareness.” 

A question that I’m often asked about dance/movement therapy is "why can’t I just dance in my living room, or at a nightclub, or in a dance class, or at the gym?  Why should I seek out a clinical psychotherapist whose specialty is dance/movement therapy?"

As with any other creative arts therapy, dance/movement therapy can provide a springboard for self-expression, emotional release, increased insight, and interpersonal connection when words get stuck, or are over-edited by the inner-critic. Body- centered therapies are a particularly effective resource for stress management, based on the premise that stress, anxiety and challenging emotions are stored in the body and need somatic release. Dance/movement therapy can provide a safe container to address body-image issues or to find more comfort in one’s one skin. Many people who experience dance/movement therapy for the first time report an increased awareness of body sensation which can help to illuminate deeper, subconscious material. As in other psychotherapeutic modalities, the therapeutic relationship can provide the foundation upon which healing can occur.

Dance/movement therapy resonates and can be integrated with almost any psychotherapeutic approach, from traditional talk therapies to other expressive art therapies. Body-based trauma therapies such as Sensorimotor Psychotherapy and Somatic Experiencing have informed the treatment of trauma, based on the premise that trauma has an overwhelming impact on the nervous system and needs to be addressed somatically before emotional processing is possible.

Cutting edge research over the past decade provides evidence that movement and body-centered therapies can re-pattern neural pathways and promote neuro-plasticity, providing greater potential for growth, healing and overall wellness. Mindfulness can be cultivated through dance/movement therapy and is key in promoting neural integration.

Dance/movement therapy can provide a fertile ground for group therapy, with a wide array of populations, including individuals dealing with depression and anxiety, eating disorders, gender identify issues and chronic mental illness. People with dementia and other cognitive disorders can also benefit from the opportunities for non-verbal communication and creative self- expression. Dance/movement therapy groups can also facilitate interpersonal connection for people of differing cultural backgrounds and provide opportunities to learn how dance and movement is utilized across cultures to support the healing process.

ATSC will be providing dance/movement therapy based groups in the near future, so make sure to stay tuned.

As exemplified above, there are so many answers to the question, what is dance/movement therapy? Hopefully some questions have been answered and curiosity peeked. I would also like to briefly share my own story of how I discovered dance/movement therapy, and how it has impacted my life journey. As an adolescent, my family moved from a diverse urban Chicago neighborhood to a homogenous suburb, in the middle of my sophomore year. This uprooting triggered a long period of depression, but I was fortunate to have parents who believed in psychotherapy which in turn, led to my work with a dance/movement therapist. Through this work, I was able to find a voice to express and release challenging emotions, tap into my creativity as a source of healing, find new and enriching relationships, as well as repair the ones that were suffering. I was also able to form a new, healthier relationship with my body, which had become a source of distress and low self-esteem. Many years later, in my practice as a dance/movement therapist, I have witnessed both profound growth and change in clients, as well as an increased sense of well-being and enhanced creativity.

Here are some questions you might ask yourself when pondering whether you would like to explore the possibility of working with a dance/movement therapist.

Do I feel comfortable with and in my body?
Does my body image create a barrier/obstacle to my psychological and emotional well-being?
Am I able to resource my body when experiencing stress and anxiety? 
Do I suffer from stress-related somatic discomfort and pain?
Do I want to find new more effective ways to express and regulate my emotions?
Does my body feel numb and detached, or more like a burden than a source of well-being?
Do I want to find more balance in my life. Do I feel a connection between my mind, body and spirit?
Do I want to find new ways to tap into and cultivate my creativity and find my voice through expressive movement?
Do I feel seen and heard by others. Do I want to feel more connected to others?
Do I want to investigate ways of unlocking trauma, both the experience of life threatening trauma and/or emotional trauma experienced while moving through the developmental stages of life?
For more information visit www.adta.org American Dance Therapy Association ADTA website to learn more about dance/movement therapy.

Recently Mary Andrus, Founder was interviewed by Dana Mack,  a Columbia College writing student. Click here to read her blog post. 

Author-Mary Andrus ATR-BC,LCPC
Founder, Art Therapy Studio Chicago Ltd

​Not too long ago we lived in an era when there was a home phone, some people had an answering machine and very few people had home computers. If someone needed to get ahold of you right away, you might have a pager. In that instance you would have to try to find a pay phone and some change so you could call them back.  You would actually schedule your evenings around when television shows aired, rather than having your DVR set to record it while you are out. You would listen to music on cassette tapes in our cars which were equipped with storage space for cassettes in the center console. Driving in the car was a time for reflection, road trips consisted of a time to connect, daydream or let our minds wander. Waiting at the doctors office was a time when you might pull out a crossword puzzle or pick up a random magazine. It was a time when we knew what it meant to be patient. Our brains were able to pause and rest from external stimuli. We were able to take time to journal, to reflect and truly be with ourselves and in relationship with others. We took the time to get to know the clerk at the post office, the cashier at the grocery store or the bus driver on our daily commute.
 
Today we are living in a time when we are glued to our digital media devices. We are expected to answer emails and texts immediately and we spend most of our day in front of screens. Many of us have become addicted to checking facebook, posting the latest video, blog, article or fascinating thing to get more likes and entertain those in our social circle. We get a rush of adrenaline and feel good about being recognized as important. We are shifting to living in this virtual bubble and disconnecting from the reality right in front of ourselves, (our children, intimate relationships, jobs… etc…)
 
Don’t get me wrong, for some, having this technology has helped us to feel more connected, but it also is very isolating. There are superficial demands placed on the image that we put out into the world and many become consumed with the living in this virtual world.
 
What happens when we make art?

1. We disconnect from the screen, we tune into ourselves, we tune into the people and things that are important to us and we create something that makes us fulfilled.
2. We relax our hyper-aroused limbic system.
3. We create something that makes us feel competent.
4. We reflect on who we are as human beings.
5. We see ourselves and others differently.
6. We relax, we begin to accept ourselves and find our true authentic selves, one who can sit with the unknown, one who can transform pain, one who can take effective action and feel good about ourselves.
7. We can find solace in the art, we can feel comforted by the art materials, we can have control over aspects of our lives that we feel powerless over.
8. We tap into how we feel, we can express ourselves without having to develop the words to describe our inner experience.
9. We learn to be patient.
10. Art makes us feel alive.

 
Art therapy can support you to reconnect with yourself and others. Think about ways you can bring creativity and imagination back into your day to day life. Take a walk, notice things around you that are interesting or beautiful. Take a few minutes to doodle in your notebook during a meeting, set a date with a friend to make a collage, allow yourself to play, give yourself permission to explore a new material. Go to the art store and wander. Join us for our next Meditative Open Studio on May 6th. Make art.