What is art therapy after trauma and how does it make room for the unspeakable? Read about safety first, the work used in sessions and the evidence.
"I try to talk about it, but when I open my mouth nothing comes out." After a road accident, a sudden loss or a major disaster such as the 6 February 2023 earthquakes in Turkey, many people say this. What happened is vivid in the mind; it turns into dreams at night and sudden images during the day. But it does not turn into words. And sometimes, when it is put into words, it becomes overwhelming, as if it were happening all over again. Art therapy after trauma rests on the idea of adding another means of expression alongside words at this point: colour, shape, clay, collage. In this article we explain how creative methods can be used in psychological support after trauma, why safety comes before everything else, what kinds of work may feature in sessions, and what research says on the subject.
What Is Art Therapy After Trauma?
Psychological trauma is a condition that can develop after experiences that overwhelm a person's ability to cope, involving a threat to their life or integrity, or witnessing such an event. Not everyone experiences the same event in the same way; while some people recover over time, in others the symptoms can persist for a long time.
Art therapy is the use of materials such as drawing, paint, clay and collage within a therapeutic relationship for the purpose of psychological support. After trauma, this approach aims to help the person express what they have been through and the marks it has left without being limited to words, to make contact with their feelings from a safer distance and to rediscover their own strength.
Let us make an important distinction from the outset: creative methods are generally used not as a solution in their own right in the treatment of trauma, but as tools that support an evidence-based therapy process. For more information about the symptoms that can arise after trauma and the diagnostic process, see our article on post-traumatic stress disorder.
Why Is Trauma So Hard to Put into Words?
Many people who have experienced trauma struggle to talk about the event. There may be several reasons for this:
- Memories can be fragmented. Traumatic experiences may be remembered not as a whole with a clear beginning and end, like a story, but as disconnected fragments such as images, sounds, smells or bodily sensations.
- Talking about it can feel like reliving it. Starting to describe the event in words can bring the fear of that moment back to life in the person's body.
- Shame and guilt: Thoughts such as "Why didn't I run?" or "If only I had stayed at home that day" can make sharing what happened even harder.
- Not finding the right words: Some experiences are so unusual that the person cannot find the words to describe them.
- The reactions of others: Well-meaning but conversation-closing remarks such as "It's over now, forget it" or "There are people worse off than you" can lead the person to fall silent.
These difficulties are not a sign of weakness; they are a natural consequence of the way trauma can affect the human mind and body. Creative methods can be a bridge at this point. Instead of describing the event, the person can express the feeling they have carried inside since that moment with a colour, a shape or clay. This is a more indirect and controllable route than direct description.
Sometimes putting a feeling on paper feels a little lighter than carrying all of it inside us, because now we can also look at it from the outside.
Safety Comes First in Art Therapy After Trauma
The most fundamental principle when working with trauma is safety. Creative methods can open up powerful emotions; used at the wrong time or at the wrong pace, they can overwhelm a person. For this reason, the following principles are generally observed in work after trauma:
- Safety and stability first: In the first stage, the aim is not to process the event in detail but for the person to feel safe, to be able to carry on with daily life and to strengthen their skills for coping with intense emotions.
- The person sets the pace: Nobody is forced to draw the event they experienced. Direct instructions such as "Draw the earthquake" can be harmful for someone who is not ready.
- A sense of control: The person can stop at any moment, change materials or leave the work. This is an important experience in the face of the helplessness that trauma leaves behind.
- Interpretations are not imposed: The professional does not make comments such as "This red represents blood." The person decides the meaning.
- A safe ending: At the end of each piece of work, time is set aside for closing so that the person can calm down and return to daily life. Sometimes this is done with a soothing drawing or a breathing exercise.
- The work belongs to the person: The resulting work is kept, photographed or shared only with the person's explicit permission.
These principles show how carefully creative methods need to be used in trauma work. Art therapy after trauma is therefore a process that cannot be rushed. For some people the first weeks may be spent simply getting to know the materials, playing with colours and feeling comfortable in the room; and this too is a valuable part of the process. However simple the materials may look, the door they open can be a powerful one.
What Creative Work Can Be Used in Sessions?
The creative methods that can be used in work after trauma vary according to the stage of the process. The following is a general introduction, not a set of instructions.
Drawing a safe place
The person is asked to draw a real or imaginary place where they feel safe: a garden, a room, a seashore. This exercise can help create an "anchor" that can be returned to mentally in difficult moments. It is often used at the start of the process.
Symbols of resources and strength
The person may be asked to draw, or bring together in a collage, images symbolising the things, people or memories that give them strength. The aim is to make visible again the strengths that have slipped out of view after the trauma.
Body map
On the outline of a human figure, the person uses colours to show where in their body they feel particular emotions. When the connection with the body has weakened after trauma, or bodily sensations have become frightening, this can be a gentle starting point for noticing these sensations.
Clay work
Working with clay offers a tactile experience that keeps the hands busy. The person can make a shape, break it down and reshape it. For some people this process can be calming; however, it does not have the same effect for everyone.
Before, now and after
At later stages of the process, when the person is ready, they can work on three separate sheets showing their life before the event, now, and as they hope it will be in the future. This exercise can help them see that the trauma is a part of their life, not the whole of it.
Group drawing activities after a disaster
After major disasters, drawing activities with children and adults are often organised in tent cities, schools or community centres. These activities can help people come together, establish a routine and relax, even if only briefly. However, they should not be confused with therapy. A volunteer asking children in a large group to "draw the earthquake" can be overwhelming for a child who is not ready. In such settings, a safer approach is to favour free drawing, play and safe themes, not to interpret children's drawings, and to refer children who are struggling to a professional.
None of this work is a test. No conclusions about what a person has been through, or about a diagnosis, can be drawn from the resulting pictures.
What Does Research Say About Art Therapy After Trauma?
An honest picture is needed here. A review published in 2018, which examined 27 quantitative studies from 2000 to 2017, reported that art therapy has been used in a range of areas including trauma and that the results are promising, but that the studies remain methodologically limited. A 2015 health technology assessment examining art therapy in adults with non-psychotic mental health problems also found positive changes in 10 of the 15 randomised controlled trials, but noted that the quality of the studies was generally low.
Common limitations of studies in this area are: small samples, the impossibility of blinding because participants know which group they are in, short follow-up periods and measurements relying largely on self-report.
These findings show the following: creative methods can be a useful aid in support after trauma; however, they should not replace psychotherapy approaches that are supported by research on trauma. Approaches such as trauma-focused cognitive behavioural therapy or EMDR are methods frequently used in this area. Creative work can be considered within this framework and, where necessary, together with an assessment by a psychiatrist.
On Your Own at Home: What Can You Try, and What Should You Avoid?
After a difficult experience, drawing, painting or working with clay can do some people good. Such pursuits are not therapy; but they can help you calm down and make space for yourself in daily life.
Things you can try:
- Free painting or pattern drawing with soothing colours
- Drawing a place, a memory or an object that makes you feel good
- Repetitive activities that keep your hands busy: knitting, clay, simple crafts
- After finishing, taking a few deep breaths and noticing five things around you
Things to be careful about:
- Do not push yourself to draw or write about the event you experienced in detail on your own. If you are not ready, this can cause intense distress.
- If palpitations, shortness of breath, a feeling of detachment or a sense of reliving the event arise while you are working, stop; plant your feet on the ground, look around you and get in touch with someone you trust.
- Be cautious about online content promising to "heal trauma by drawing".
If you want to support someone close to you who has experienced trauma, you can choose to be there for them rather than pushing them to draw or talk about anything. Quietly painting something together, going for a walk or simply saying "I'm here if you want to talk" is often more valuable than detailed questions.
Let's say someone who still cannot sleep at night a year after the earthquake has started colouring on a friend's suggestion. Colouring may ease the restless hours before falling asleep a little. But if the nightmares, moments of intense fear and difficulties in daily life continue, this may be a sign that it is time to speak to a professional.
When to Seek Professional Support, and How Is It Approached in Therapy?
In the first weeks after a traumatic event, struggling, having sleep problems or thinking about the event often can be expected reactions. However, it is important to speak to a mental health professional in the following situations:
- Recurrent, involuntary memories and nightmares even though weeks have passed since the event
- Constantly avoiding places, people or conversations that remind you of the event
- Being constantly on edge, startling easily, sleeplessness
- Emotional numbness, a feeling of being cut off from life
- Marked difficulties at work, at school or in relationships
- An increase in alcohol or substance use
If you are having thoughts of harming yourself or ending your life, do not wait; in an emergency, call 112 (emergency services). The other signs do not in themselves amount to a diagnosis; but they deserve to be assessed.
In individual therapy, trauma work proceeds at the person's own pace, with attention to their safety and stability. Within structured, research-supported approaches such as cognitive behavioural therapy (CBT), creative tools such as drawing a feeling or making a picture of a safe place can be used at points where conversation gets stuck. We describe the general framework of art-based work separately in our article what is art therapy. Where necessary, an assessment by a psychiatrist also becomes part of the process.
Frequently Asked Questions
Do I have to draw my trauma?
No. In creative work after trauma, nobody is forced to draw the event they experienced. The process often begins with supportive exercises such as a safe place or sources of strength. Working directly with the event comes up only when the person is ready and within a safe framework.
Does drawing heal trauma?
Drawing can help make room for feelings after trauma and help you calm down. However, although research is promising, most of it is small and limited; creative methods are regarded not as a treatment in their own right but as tools that support an evidence-based therapy process.
Is creative work after trauma also used with children?
Yes, tools such as drawing, play and the sand tray are often used when working with children, because children frequently express their feelings through play and drawing. However, no conclusion that a child has experienced trauma can be drawn from their drawing; assessment is always carried out as a whole.
What if I feel as though I'm reliving the event while drawing?
This is a reaction that can occur after trauma, and it signals that you need to stop. Planting your feet on the ground, naming the objects around you and breathing slowly can help you return to the present. If such reactions happen often, it is important to speak to a professional.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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