S2 E11: Dr. Cathy Malchiodi on Healing the Mind With Imagination
After experiencing trauma, it can be challenging to start talking about what happened. But one way to overcome that is to find other ways to express yourself. So as an art therapist, how does Dr. Cathy Malchiodi use color, sound, and movement to help people tell their stories and start to heal?
Cathy Malchiodi: Hi, I’m Dr Cathy Malchiodi, I’m a psychologist and expressive arts therapist who works with trauma.
David Condos: Dr. Malchiodi, thank you so much for being with us at the US Journal Training Conference in Scottsdale, Arizona.
Cathy: Well, thank you.
David: Let’s start with your story, your background. The journey you took to being interested in art, in your case and doing what you’re doing today.
Cathy: I actually started out as a visual artist as an undergraduate and even before that, I think as a child, I realized that the arts were really helpful to me in other ways, in recovering from loss and trauma as a child. I think I was lucky that my family encouraged me in that direction just intuitively knowing that that was helpful for me.
David: Did you realize that at the time that it was helpful?
Cathy: I did in some ways realize by the time I was an adolescent, that it really helped untangle my emotions. My first encounter was losing a very close family member, grandmother and that was the first death I ever experienced. My father intuitively gave me a paintbrush and old paint from the house and let me paint in the basement on a wall.
I remember that so vividly about what was happening in that moment and being allowed to do that but I also knew it was not just the painting itself, it was the fact that I got to move with the paintbrush across a canvas, being that cellar wall. From there, I always move towards the arts, so not just visual art, but also music, theater, movement in particular.
When I went to art school and became an artist, visual artist, I still felt the need to really take that further and really started to think, “Well, I could teach so I can interact with people that way.” At that time, fortunately for me, it was kind of a synchronicity. There were programs opening up called art therapy graduate degrees at the master’s level so I thought immediately without even knowing what that was, I knew that was what I wanted to do.
Then from there, it just continued to snowball. My first work was with trauma, with children who were abused, children who had witnessed domestic violence. Then I continued in the mental health area. Keeping my own art alive as a piece of what I do for myself, but realizing that this was a really important piece for those children and actually for those adults that I saw in those facilities.
David: As you were having that realization, what was it that made you see the connection for how art could have this profound impact on trauma?
Cathy: I guess the earliest experience and not having training in trauma because it was not standard at that time, even in mental health. There was also a message given to us even working in the first facilities that I worked at with children, that maybe we didn’t really want to talk about what happened to them, because maybe it would be best if they just forgot. That was actually the statement that was made back decades ago.
David: We just leave it under the rug, don’t stir it up.
Cathy: Yes, don’t stir it up. One of the things I also saw too, they did not want to talk. I knew they had stories that were really painful so immediately, I started to see that in the art, and they’re using puppets, using all kinds of different art-based expressions that they were expressing things about what happened to them. It was really obvious that there was something that needed to be expressed, but to express it through talk was not comfortable.
Fast forward now, and with the work of people like Bessel van der Kolk, I also studied with an early trauma specialist Nolan Ortaire, they knew that there was a reason the brain said don’t talk. You can’t talk. This is too powerful. It’s too overwhelming.
You can’t express it through language and Bessel, in studies that he’d done with other researchers found that to be true that there was a part of the brain, a language part of the brain called Broca’s area, that actually shut down when you tried to get people to talk about very, very traumatic events. All this kind of like, “Wow, what I’m presenting to them as an alternative way of communicating probably has a really important place in this work.”
David: Yes, so this is something that you’ve seen in other people. You said it is something that you felt yourself? Could you describe how did it make you feel to be able to get it out, to be able to use this expressive arts as you say?
Cathy: Well, that’s a good question because we’re just finding out there’s a lot of levels to this. One level is if you find an art form that is relaxing and calming to you, it’s self-regulating. To just have that piece is a pretty important piece when you can turn to something that you can do with your hands or with your body or with your voice that starts to lower that anxiety, that starts to moderate that anger, starts to maybe even increase your feeling of aliveness and take down that depression.
There’s that level but there’s other levels through it too. There’s the level of being able to put something out, a message, an experience in a way without words so that it can be witnessed, and I work right now with active military and veterans.
This is a really important piece for them, to be able to get those things out that have happened to them in combat, or some of the struggles they’ve had about being in the military, and express that in a way that you and I can witness them, and we can actually start to understand their story. That’s another powerful level to it as well.
David: Yes, it’s like our bodies and our minds are crying out to communicate this, to have actually someone else about this.
Cathy: Yes, exactly.
David: Another phrase that you use related to the presentation that you gave was how expressive arts can have this cultivation of the imagination element to it. That’s interesting because that word imagination is not something that I hear a lot in this context, talking about healthcare, mental health, why is that important?
Cathy: Well, I think when you look at the continuum of recovery, so there’s all this process going on, like I just mentioned about being able to be self-regulated. The pieces about maybe being able to express the trauma narrative. You’ve expressed that maybe in some way, but you have had that narrative in your life, it’s often taking away your ability to play, feel alive in your body, because it’s scary, it’s painful.
The thing that I always work towards and when people are ready to hear this idea, I say, “What we really want to work towards is imagining a new narrative, the old one’s not really ever going to go away, and you will still have that experience that you’ve had, but now you’d be living in a new narrative that you’ve created,” and that’s what I think, that’s the real crux of this whole approach with expressive arts therapy is getting to the imagination.
Now, I should say one more thing, it’s very hard sometimes in the beginning if trauma survivors are listening to this, imagination sometimes is blocked because when you go to imagination, a lot of things stir up that can be very painful too that are related to imagination.
To work with the therapists over time and develop that self-regulation through the arts, develop that sense of safety, those are all the foundations that have to take place in order to start to very slowly approach that imagination and develop this sense of aliveness through that imagination to replace that old narrative.
Creating art, in some sense, says that we’re looking towards the future, there’s a different future out there, and then that’s what imagination is about is imagining something new. If we’re stuck in that old story, there is hope that we can get out of that and we all have this imaginative, a capacity. Everybody has it to some extent.
The other thing I think I should bring up too is people think like, “Okay, wants me to be creative in these sessions.” I very rarely use that word. I say we might get to that, you might enjoy using that word, but I say everybody is expressive somehow, I say even if you just make one mark on paper, you’ve expressed something and it may not necessarily be creative, but you’re starting that process of imagination because you’ve taken that first step.
David: I like the imagination piece that you just said was how it’s imagining hope. It’s imagining a different future that’s better and different than what you’ve experienced thus far. Does that help unlock that when they go to talk to a therapist and when they go to do other parts of treatment?
Cathy: Yes, I think so. It’s different for everybody. There’s some commonalities. People have had complex stories in their life. They’re pretty horrifying stories. I’ve found that I can start to imagine and fantasize these different things, different endings to it. If you keep doing it, it starts to stick. Our brains are very malleable that way. Our brain can believe something imaginative as much as it can believe something that’s right there in reality.
I think with the arts, so you have these pleasurable experiences that are action oriented that start to support that kind of thing. These can be very simple because sometimes they think, well, if a practitioner is listening to this or thinking do I have to be very artistic.
You can get people started through gesture, through just that mark-making, though you saying, “Okay, you have a worry today, can you show me in colors, shapes and lines what that is on this piece of paper? What color is it? Is it blue? Is it red? Is it green? Is it a lot of different colors?” Those are the simple ways to develop that language of imagination.
David: That’s what I was going to say because I imagine approaching the idea of making art is intimidating for a lot of people who don’t experience. How do you help them overcome that skepticism?
Cathy: Just a little bit right there when I said use gesture. Just show me through a gesture what you’re feeling right now. You’re feeling clenched inside. Are you feeling in your gut some pain? I’m showing you right now in a gesture what that is. It can be as simple as that.
Say we have to help people develop that language. It’s just like learning a language except they’ve never done art before and never really done any drawing. How do we start? Just with line, with shape. What’s really helpful, too, is I see a lot of people in groups and group work is really helpful for trauma survivors through the arts because they see what other people are doing.
I’m always like, oh, it’s okay to look over at somebody else’s. Hey, try that out because it resonated with you. Try that color. Try what they did with the gesture, because that’s the other thing that happens in trauma, there are some people that they have a hard time coming up with the ideas, the talk, the expression, but they can gather it from other people who are essentially in the same boat with them.
They’re all bringing something to the table. It’s painful. They start to get that from each other. There’s a lot of dynamic expression that goes on within a group.
David: Here at the conference, you were speaking to a lot of people who are doing this work out on the front lines with addiction and mental health. What are some tips you gave them? What’s your message for them of how they can integrate this in what they’re doing, take this back to their work, the expressive art.
Cathy: There’s a lot of simple techniques because a lot of people work in an office. They don’t have a big arts studio. I’ve oftentimes just worked in an office where I have to create the studio environment, create spaces for things to happen. To use just felt markers and oil pastels, regular sized copy paper.
This can be a slow process. I think a therapist who wants to start to bring this in has to also engage in that and really perform that themselves and experience it. That’s, I think happens in these workshops, especially at these conferences. People start to get that feeling of like, I can do this. I can be improvisational. Now they can take that to the client work. You have to have your own playful spirit as well and your enthusiasm.
David: You have to be bringing that yourself.
Cathy: Yes, you have to bring it because you are going to carry a lot of energy for people who are quite depressed, in a lot of pain that’s preoccupying them. How do we get them out of that for even if it’s just the moment for that 90-minute session or that half-hour session, how do we get them out of that?
Once they have that one experience, there’s something to build on there. People do remember, too. There’s clients and they’ll contact me, they were 30 years ago. Gives away how long I’ve been around.[laughter]
David: It meant a lot to them.
Cathy: Yes, it meant a lot to them. If I ask them what it was that they remember, it was always the sensory thing that we did. I worked with disaster relief as well. It’s really interesting. I’ll come in there, we’ll have a lot of profound talks that would be after like a tornado or something like this, because I live in the Midwest. If I see them months or even a year later and say, what do you remember? Oh, I remember we did that big drawing and you played music. I can’t remember what the music was, but we all played together.
David: Engages all the senses?
Cathy: Yes, engaging all that. They remember that piece. It becomes very embodied. The talk is not remembered as well as the experience. What they felt becomes the most important thing.
David: We’ve talked about some ways to integrate this in with other mental health programs, trauma programs, addiction programs but it’s not everywhere yet. It’s still on that process. What would you say to somebody who maybe is in this work and they’re not doing it? They’re like, “Oh, that’s just another thing I have to add.” What do you say to them? To say that, “No, this is important. It can be really vital.”
Cathy: The one thing I was just thinking is I trained with Francine Shapiro in EMDR, way back when Francine Shapiro was alive and just teaching eye movement. I went back last year and got training again because there’s a lot of improvement and there’s a lot more research. We’re all at this place of like, “Oh, which thing do I pick from the menu?”
In doing so, when I went through the class, I had excellent instructor, I said to myself, wow, I’m really seeing a connection here between my expressive arts work and how I can integrate it with this EMDR in a much better way. That’s the nice thing about expressive arts. You can take any philosophy or approach that we’re already using and infuse it with it.
If people are doing cognitive behavioral therapy, you can make that value added by adding the expressive arts. Even if they come and take a very simple workshop, I think people, if they have an orientation that they really work from, they start to see the connection. They can put that together with it.
David: For someone listening who wants to dive in even deeper on learning about this topic, what’s one or two books, resources that you’d point them to?
Cathy: Well, the next book will be the one, it’s Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process.
David: That’s going to be your forthcoming book?
Cathy: Yes, and I very rarely pitch books, but I really tried to put this book together so that people with a variety of orientations that are working with trauma in particular will be able to look and say, wow, yes. Now I know how to use these things from a variety of art forms, movement or music or sound or visual art.
The other one I always recommend because a lot of therapists feel most comfortable starting with the art piece, so with the felt markers and paper and oil pastels or something, really collage, so just magazine pictures and those kinds of things is The Art Therapy Sourcebook. That’s been around for a while. The reason I suggest that one is for clients, they can use that too. It has a lot of exercises in it that the therapist can say, “Oh, maybe you should do this between sessions.”
David: To leave listeners with one last thing, what’s a favorite piece of advice? Something that’s meant a lot to you, something that you want to leave listeners with.
Cathy: Wow. That’s always a hard one. Well, I think the thing that I’ve learned over the last 10 years, this is about the time period I’ve worked with the military, it’s the fact that we need an integrated approach. Don’t be afraid of that. Infuse art, but infuse movement, because I think that’s the core right there.
Actually, that would be my basic recommendation to really think about the principles that Peter Levine has presented. Bessel van der Kolk talked about this. Pat Ogden, who does work with sensory-motor. We have people coming in with trauma and a lot of times, the worst thing that can happen that really triggers or reinforces the post-traumatic stress is being frozen in that trauma.
Getting people to move in some way is a really important thing. They can move on paper drawing, but to get them up and move in any which way is a really important thing that starts to get them feeling like they’re empowered and that they’re active in their own treatment. That’s one thing I just constantly say to people and keep it in my own life. I dance every day.
David: You’re practicing what you preach.
Dr. Cathy Malchiodi is a psychologist, art therapist, educator and author based in Louisville, Kentucky. Learn more about her work, including her new book called Trauma and Expressive Arts Therapy at cathymalchiodi.com.