Trauma Treatment through Art Therapy (TT-AT): a ‘women and trauma’ group in Tanzania

Abstract

ABSTRACT Background In low–middle income countries the number of patients suffering from PTSD (from adult onset trauma) and from complex-PTSD (who have suffered from childhood emotional, physical and sexual abuse, deprivation and domestic violence) is high, but there is a shortage of clinical psychologists. The International Society for Traumatic Stress Studies (ISTSS) has recommended the development of innovative interventions. Context At Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania, a number of mental health professionals have been trained in providing Art Therapy as an ‘additional skill’ within their respective professions. In the Department of Psychiatry we have developed a protocol for a short-term Trauma Treatment with Art Therapy (TT-AT). Approach Our intervention is focused on the six patients’ needs outlined by ISTSS in the following areas: Emotion Regulation; Relationships; Self-Identity; Gradual Exposure to Trauma; Integration of Trauma; Personal Resources. We have developed six Art Therapy workshops aimed to address each one of these needs. The approach is supportive and non-interpretative. Outcomes The intervention was developed at Muhimbili National Hospital with a ‘Women’s Group’ of four patients, who had experienced different types of trauma. All patients attended regularly and reported improvements to their trauma symptoms. Conclusion This short-term art therapy intervention was useful with this population, and may be applicable to patients who suffer from a broad range of traumatic experience. Implication for research The protocol is described in detail, and can easily be replicated for clinical purposes and research. Plain-language summary There is a need for innovative interventions in the field of trauma, especially when the trauma was experienced during childhood (loss, abuse, deprivation and domestic violence). The task force of the International Society for Traumatic Stress Studies have encouraged the development of innovative interventions, recommending that new interventions are focused on patients’ needs rather than on trauma exposure, and should include emotional strengthening interventions. Six psychological needs were outlined by the International Society for Traumatic Stress Studies in the following areas: emotion regulation; relationships; self-identity/self-esteem; gradual exposure to the trauma; integration of the trauma in one’s life; and personal resources. At Muhimbili University of Health and Allied Sciences, in Dar es Salaam, Tanzania, we developed a Group Art Therapy intervention protocol, which was based on six art therapy workshops, plus time for free art making. The intervention was carried out with a group of four female patients who had all experienced different types of trauma, and began with three strengthening workshops: Filling the body outline, to facilitate the safe expression of emotions; A memory of a positive relationship in childhood, to remember positive relationships; and The fantasy of a tree growing in the desert, to cultivate feelings of hope. The next two workshops were focused on a gradual exposure to the trauma, these included: The fantasy of a traumatised child; and The life-line, to integrate positive and negative memories. The final workshop was devoted to strengthening the awareness of personal resources. The four patients all attended regularly and reported improvements to their trauma symptoms at the end of the intervention.