Client Populations Clinical Interventions

Therapies for First Nations Australians: Expressive, Somatic, and Trauma-sensitive

Clinicians working with Aboriginal peoples have noted that expressive therapies, somatic experiencing, and trauma-sensitive therapy may be helpful.

By Mental Health Academy 2024-02-09 05:27:28

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Clinicians working with Aboriginal peoples have noted that expressive therapies, somatic experiencing, and trauma-sensitive therapy may be helpful.

Related articles: Therapies for First Nations Australians: Post-modern; Therapies for First Nations Australians: Rogerian/Person-centred; Therapies for First Nations Australians: Positive Psychology.

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Introduction

Following on from interview research to examine how dominant-culture clinicians could better serve Aboriginal clients in counselling, we suggested which types of therapies may be more effective with Aboriginal populations and which employ concepts or assumptions that are incompatible with Aboriginal customs, beliefs, or cultural mores (See the Mental Health Academy course, Sitting with Aboriginal Clients: Appropriate Modalities).

In a previous article, we drew from that research to begin a series examining broad groups of therapies, first looking at post-modern therapies: narrative and solution-focused, whose understanding that “reality” is a subjective, socially-negotiated phenomenon is compatible with Aboriginal experiences of “truth” or “reality”. In today’s piece, we investigate the usefulness of expressive therapies, somatic experiencing, and trauma-sensitive therapy for First Nations Australians. First up, expressive therapies.

Expressive therapies: What are they and why use them with Aboriginal clients?

No English at home and trauma

Surveys showed that, in the Northern Territory, for example, 32.4% of people spoke a language other than English at home in 2021 (.idcommunity, 2022). The general notion of language diversity and a concomitantly lower role for English in the Territory, where many Aboriginal people live, was supported by one of the counsellor-informants in the research, who commented that there were at least 50 language groups in Alice Springs, with 10 more in adjacent areas.

Then there is the question of trauma. Given the effects of colonisation and oppression, some clients are unable to put into words how intergenerational and other trauma is affecting their lives. Still other clients are so traumatised as to be unable to even have sensation in all parts of their body. In such cases, therapists may be better off to work primarily with therapies that rely heavily on other than verbal exchange to attain therapeutic goals.

Definition

Expressive (arts) therapies are defined as the use of art, music, drama, dance/movement, bibliotherapy/poetry/creative writing, play, and sand play within the context of psychotherapy, counselling, rehabilitation, or medicine (Malchiodi, 2005). These therapies introduce action to psychotherapy; the action is rarely limited to a specific mode of expression. Two or more utilised together are called an “integrative” approach (Malchiodi, 2005). Because clients have different expressive styles (such as being visually dominant, more kinaesthetic, or more auditory), the therapist can more fully enhance each person’s capacity for effective, authentic communication if a variety of modes of expression is included in the therapeutic work.

Helpful characteristics

Malchiodi (2005) has outlined four characteristics she believes make the expressive therapies unique:

  1. Self-expression, which accelerates self-exploration, helping people practice more adaptive behaviours.
  2. Active participation, which energises clients, redirecting attention to verbal, tactile, and auditory channels.
  3. Imagination, which encourages experimentation with new ways of communicating and finding innovative solutions that lead to change, resolution, and healing.
  4. Mind-body connections, which lessen post-traumatic stress, induce calm and confidence, reduce symptoms of chronic illness, and mimic self-soothing.

Helpful results: More secure attachments and most conditions improved

Therapists increasingly recognise the value of expressive therapies in re-establishing and encouraging healthy (secure) attachments – seen to be crucial for brain development – through sensory experiences, interactions, movement, and hands-on activities. Dance, art, and play therapies in particular may be helpful in repairing and reshaping attachment through experiential and sensory means, partly because they can tap early relational states before words become dominant. This may help the brain to establish new, more adaptive patterns (Malchiodi, 2005).

While the expressive therapies are often used not on their own but as an adjunct to more traditional modalities, there are few conditions not improved through the use of them. There is wide agreement that some of the most prevalent mental health conditions – for example, anxiety and depression – are typically improved through all of these therapies. In general, claims are made that the therapies improve physical, mental, and emotional wellbeing, help people to understand themselves and their emotions, increase awareness of others, express their emotions, cope better with life’s challenges, relax and relieve stress (thereby improving sleep quality), and – often – manage conditions such as addictions and eating disorders (see also the Mental Health Academy course: Creative Therapies: An Introduction).

Caveats . . .

The expressive therapies sound like an ideal therapeutic solution for some Aboriginal clients, particularly those who are not able to express themselves well in English or those who have been abused or traumatised. What must we be aware of in using such therapies?

Care should be taken when employing a given therapy with severely traumatised individuals. In music therapy, it is essential to ensure that the client likes the type of music utilised, and that hearing is protected, just as care must be taken with any cardiovascular, joint, or muscle issues in dance therapy. In drama therapy/psychodrama, all the typical group concerns (such as fostering a safe environment, dealing with confidentiality, and the right to say no) are important. In bibliotherapy, care must be taken to provide high-quality materials for any reading, and to ensure that client-participants can manage the written materials (particularly in terms of language issues).

. . . And reassurance

With respect to particular aspects of the Aboriginal culture or world view, there are some reassuring aspects. One is that expressive therapists do not generally interpret artistic productions of clients, at least in the sense that psychoanalytic therapists do. Rather, clients are encouraged to find their own meaning and interpretation with any artwork. Popular Aboriginal themes related to spirituality, relationship to land, Dreaming stories, and works showing essential connectedness can be depicted in abundance, leading to healing without a sense of counsellor response generating a feeling of being “one down” in the client. Respecting the Aboriginal tendency to communicate indirectly, the expressive therapies can allow for free expression unconstrained by excessive questions or obligation to put experience into (rational, logical) words.

Assuming a qualified therapist in a nonjudgmental role, the expressive therapies have the potential to impact clients in ways that traditional, strictly verbal, therapies do not. Therapists using these therapies give clients the opportunity to participate actively in their own treatment and empower them to use their imagination in novel and adaptive ways. So, bottom line for use of expressive therapies with Aboriginal clients? “Go for it!” But, as one informant warned, be mindful that Aboriginal clients tend to be quite shy and may take longer to engage in artistic expression of any kind.

Somatic experiencing (SE) and Trauma-sensitive therapy

We consider together these two similarly-based therapies, which a psychologist-informant stated were helpful to her highly traumatised clients, with a brief explanation first for each.

Somatic experiencing: What it is

SE is a holistic therapy that studies the relationship between the mind and the body in regard to the psychological past, attempting to re-establish the natural flow between the two. Touted as one of the best ways to help those suffering from psychological traumas recover and live a normal life, it draws from many different disciplines to address the physiology of trauma. That is, it focuses on the physiological responses that occur when someone experiences or remembers an overwhelming traumatic event in their body, rather than focusing only through the thoughts or emotions connected to it. The theory behind somatic therapy is that trauma symptoms are the effects of instability of the autonomic nervous system, which was disrupted by past traumas.

According to somatic psychologists, our bodies hold on to past traumas, which are reflected in our body language, posture, and also expressions. In some cases, past traumas may manifest physical symptoms like pain, digestive issues, hormonal imbalances, sexual dysfunction and immune system dysfunction, medical issues, depression, anxiety, and addiction (San-Laurent and Bird, 2015; Khan, 2016).

The developer of the therapy, Dr Peter Levine, noticed that animals in the wild do not hold onto trauma. Rather, they follow through the full sequence of response to danger. They notice it, react to it – expending enormous amounts of energy to fuel the escape – and then recover from the threat, discharging the excess energy through trembling, shaking, or running. This allows the animal to re-set the nervous system, putting it into readiness for the next challenge.

Human beings, conversely, interrupt the cycle of response, causing the energy to get stuck in our bodies. We then fail to move easily between the different states of noticing, reacting, and re-setting, and the charge stuck in our systems is likely to be triggered in future when we come across people, events, or things that remind us of the earlier, never-completed cycle of experience. Somatic experiencing helps to restore the nervous system’s normal cycling between alertness and rest (San-Laurent and Bird, 2015).

The need for SE

We know that anything we experience as threatening to our survival or wellbeing – from war, accidents, rape or other attack, or natural disasters – may generate PTSD, negatively impacting our everyday interactions and activities. Even without a complete breakdown, we may experience a decreased ability to feel satisfaction or pleasure if we have had too much, too soon, or too fast for our nervous system to deal with. In the immediate term, when faced with survival threats, our self-protective responses kick in automatically from primal, “old” parts of the brain. We may try to flee, or if we can’t, we may attempt to fight. If neither of those is going to work, we may freeze, “playing dead” and hoping the danger will pass us by without noticing us. With the “freeze” response, our system also shuts down somewhat, so that if the danger doesn’t pass, we won’t feel the pain or suffering that’s coming.

All of this happens automatically, but when we have PTSD-like symptoms months or even years later, they indicate that the energy generated to deal with the original threat got “stuck” in the body, with the “shut-down” parts never fully coming back on board. The need is to resolve the symptoms. Somatic experiencing proposes that, by noticing what is happening and allowing those natural self-protective impulses to be felt, our body can sense more fully the capacity to protect itself. We can genuinely experience the actual reality of the danger being over, and finally settle, bringing the cycle of dealing with threat to completion (San-Laurent and Bird, 2015).

How it Works

The main goal of somatic therapy is thus to recognise and release physical tension that may remain in the body after a traumatic event. In session, the patient typically tracks his or her experience of sensations throughout the body. Sessions may include awareness of bodily sensations, dance, breathing techniques, voice work, physical exercise, movement, and healing touch (Khan, 2016).

Trauma-sensitive therapy (also called “trauma-sensitive yoga”)

What it is and what it aims to do

First used as an adjunctive treatment within a clinical context, trauma-sensitive yoga helps clients regain comfort in their bodies, counteract rumination, and improve self-regulation. The objective of trauma-sensitive therapy is not to go into emotions or evoke trauma memories, but to help clients heighten their body awareness—to notice what is happening inside their bodies—and thereby learn to release tension, reduce and control fear and arousal, and tolerate sensation, thereby gaining a feeling of safety inside their bodies. It may work via pathways of interoception, which are underactive in traumatised people. For those clients who are not ready to talk about their trauma, trauma-sensitive therapy can bypass talk and go right to the body (Jackson, 2014).

How it works

Trauma-sensitive therapists emphasise the dynamics and mechanics of the breath, with the goal of restoring and calming. This helps individuals experience the present moment, regulate affect, change their relationship with their body, and assist with centring and grounding. There is the realisation integrated into the treatment that relationships can create conditions for trauma. To that end, its practitioners work to imbue the client with a sense of empowerment, preceding cues with an invitation rather than a command: that is, saying “If you like, lift your foot up” rather than merely, “Lift your foot up”; clients thus come to feel empowered rather than that they are being told what to do with their body.

This modality is best used with people who experience treatment-persistent PTSD or complex trauma. It is especially useful with interpersonal trauma: traumas perpetrated by people on other people and taking place within relationships (including incest survivors and victims of domestic violence and/or child abuse and neglect). A reduction in dissociation, abreaction, anxiety, impaired memory, hypervigilance, emotional numbness, and joint and muscle pain are all symptoms of trauma which can be alleviated through trauma-sensitive therapy. It can help such clients become more flexible, on multiple levels of being (Jackson, 2014).

Somatic experiencing and trauma-sensitive therapy for Aboriginal clients

Our informants said they believed their Aboriginal clients had been subject to childhood trauma, intergenerational trauma and that resulting from Stolen Generations displacement, and trauma from colonisation. NITV, Australia’s Indigenous channel, reported in February of 2018 on a recent report by the Australian Institute of Health and Welfare, which stated that Indigenous women were 32 times as likely as non-Indigenous women to be hospitalised for family violence; for Indigenous men, the figure was 23 times, with Indigenous children being seven times as likely to be victims of child abuse and neglect as non-Indigenous children. The NITV article noted that Indigenous Australians have increased risk factors, such a social stressors, poor housing and overcrowding, financial difficulties, and unemployment. Moreover, it stated, the removal of land and cultural dispossession over 230 years, along with systemic racism and a history of colonisation has resulted in social, economic, physical, psychological, and emotional problems for First Australians (Thorpe, 2018).

Even trauma from a single source takes much time to work through; multiple trauma is hugely more complex. Most clinicians are more familiar with “talk therapies” than SE or trauma-sensitive therapy. Yet, we rejoice that therapies exist which do not rely on excessive verbal skill. The psychologist-informant using these two therapies told us that she often needed to use them first, alone, for a fairly lengthy period, until trust in her could be built and also some healing could happen for the client. The “shame job” aspect of Aboriginal cultures in general might mean that such clients could take a lot longer to feel safe enough with the counsellor to engage in the techniques. In fact, Aboriginal clients as a whole might feel safer in a group, or if other family members joined in, to help overcome the shyness/shame . Once trust was built, use of somatic experiencing and trauma-sensitive techniques could be paired with other, more verbally-oriented therapies.

Therapists need to be trained in these modalities in order to use them, but – along with the expressive therapies – they stand as ways of meeting clients where they are at when the therapy begins: in need of connecting with themselves, their environment, and other people on a basic physical and emotional level while the therapeutic alliance grows slowly. At least, these modalities consider the history of trauma that many Aboriginal clients bring into the therapy room.

For more training on somatic approaches to counselling, refer to these Mental Health Academy courses: Drawing upon the Body’s Intelligence: An Introduction to Sensorimotor Psychotherapy, The Role of the Body in Couple Therapy, and When Talk Therapy is Not Enough.

Key takeaways

  • Expressive (arts) therapies, which introduce action to psychotherapy, help clients who are traumatised or whose primary language is not English engage self-expression, active participation, and mind/body connection to accelerate healing with less verbal exchange.
  • Somatic experiencing helps to restore the traumatised person’s nervous system to normal cycling between alertness and rest, removing “stuck” responses to threat and resetting the system.
  • Trauma-sensitive therapy uses the dynamics and mechanics of breathwork to help individuals experience the present moment, regulate affect, change their relationship with their body, and assist with centring and grounding as trauma symptoms reduce.

References

Mental Health Academy courses:

Other references:

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