case one: Woman, late 20’s, Rape
Art therapy is truly spectacular in its ability to treat almost any diagnosis and—it works. It works especially well in treating sexual abuse and rape, traumatic events that most patients have difficulty talking about.
Art Therapy works in three basic ways.
The first way that it works is that the patient will draw a picture or make a piece of art that accurately represents the traumatic event and will then talk about it.
The second way that art therapy works is that the patient will draw a picture or make a piece of art representing the event but talk about it only in metaphor. Eventually, when the patient is ready, the metaphor will be broken and used as a springboard for verbal therapy where the event will be talked about for real.
The third way that art therapy works is in its purest form. This is when the artmaking process is pure sublimation, the cornerstone of art therapy theory and practice. Sublimation is a very unconscious process. It involves taking the memory of a traumatic event and sublimating it by engaging in a higher, creative activity. This case is a good example of sublimation.
This woman, in her late 20’s, was carjacked, and raped and sodomized for hours in a brutal and horrifying way. She got herself to an emergency room, bleeding profusely. She was referred to me from a rape crisis team that I used to work on. The team helped her through her emergency room exam and knew enough about the level of trauma that they were witnessing that she would benefit from art therapy combined with verbal psychotherapy.
My work with this woman started slowly and gently. She was deeply traumatized. Often we just sat together quietly on the couch with soft music playing. She liked my office. She would make herself a hot cup of tea in the waiting room and come in and help herself to a soft throw blanket for her lap. Eventually she started asking about the art therapy. She was a very creative person and was intrigued by the abundance and variety of art materials in the studio area across the room. When I talked to her about art therapy, she said that she could never risk trying it; even if she intentionally tried to make something that had nothing to do with the rape, she was afraid that it would come out that way anyway.
I told her that I thought she didn’t seem ready to try any artmaking yet, and that that was okay. That there would be time. So we kept sitting, and talking, or sometimes not talking, or sometimes she would just cry and cry and cry. And I would sit with her. I noticed, though, that she kept gazing across the room at those art materials in the studio area.
One day, she came in and announced “I want to make something” and headed straight for the art table. I followed, surprised (but always ready) and gave her an orientation to the studio. I asked her if she wanted music and put on a moving, inspirational piece for her. I lit a candle. I took a seat next to her, but slightly off to the side to give her space. I waited.
She dove into the materials with a fierce hunger, a mission. She did not talk, or sit. She mixed paint and tested different glues and dug through the collage box and came up with a handful of feathers, which she fingered gingerly for a moment, then set aside. She squeezed red paint onto one hand and black onto the other and started furiously painting with her fingers. She set that piece aside. She washed her hands and finally sat and quietly and serenely began to create the sculpture that you see here. A calm settled over the room, and over her in a way I had never seen before.
When she was done, just before it was time to go, I asked her how she felt. She said that she felt better than she had felt in a long time, “energized and relaxed at the same time.” She said she felt like she could go home and put on a little makeup and go out to dinner with her boyfriend. When I asked if she liked her piece, or if it had any special meaning, she said she loved it, but didn’t think it really meant anything. I nodded in approval and promised to keep it in a special place after it was dry. She left with a smile and a grateful thank you.
In this case, the artmaking worked because it felt good, and because the patient was able to sublimate a piece of the traumatic event through a higher, creative activity. A piece of her was set free. But there is more. The unconscious mind is a powerful thing. Any seasoned art therapist who has looked at thousands of pieces of art will tell you that this sculpture looks like the female genital and anal areas, open and bleeding. The patient did not, of course, notice this, and there would have been no reason to have pointed it out. On an unconscious level, it was a powerful first step in working through trauma that was not only too horrifying to talk about, but, at that stage, too horrifying to be conscious.

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