Author Q&A: Paula Howie

Posted on: March 10, 2020

In honor of the publication of Art Therapy with Military Populations, we spoke to author Paula Howie about the unique benefits of art therapy for soldiers and their families.

Your new book provides an overview of the theory, history, and latest trends in art therapy with servicemen and women and their families. What are the benefits of art therapy for servicemen and women who are struggling with service-related trauma or PTSD?

Trauma and PTSD can make the world a dangerous place, even after the person is no longer in harm’s way. As human beings, when our stress response is activated, it becomes hard to trust others, to ask for help, or to put the traumatic event in the past. The individual is changed and now inhabits an altered, more frightening universe. Trauma disrupts the person’s life story, activates the stress response system of fight/flight, and fragments memories. These memories, which may not have a conscious narrative, emerge when the person smells something similar, hears loud sounds, has other body sensations familiar to the trauma, has nightmares, or is led to experience the trauma as though it were happening in that moment. Art therapy is one approach to healing the symptoms of trauma. Art therapists encourage expression of feelings and concerns, treat the visual memories by ameliorating gaps in memory and address non-verbal activation of the fight/flight system. Because trauma interferes with daily functioning, job performance, and family relationships, art therapists’ goals include reducing the persistent over-activation of stress response system, integrating the fragments of memory for traumatic events from the emotional and stress response components of that memory, and changing the interpretation of normal everyday experiences as threats.

Even though this book is about working with the Military, it also addresses family members and others who have suffered trauma. Families are involved in art therapy treatment both as an integral part of a family focused intervention or as a resource for the veteran.Substance abuse disorders, which have a high co-occurrence with PTSD, are treated with art therapy interventions that focus upon the meaning the substance abuse has for the soldier. Military sexual abuse (MST) is reported to be as high as 1 in 4 females and 1 in 100 males and has become a high priority for prevention and treatment. Art therapy interventions have been successful in treating the aftermath of these devastating abuses.

How does art therapy compare to other therapies in treating trauma and PTSD?

Service members often return home with severe psychological or medical conditions that limit their ability to function, complicate their re-entry into the civilian workplace, and alter family relationships. Although PTSD has proved difficult to treat, there are viable interventions that have been researched and proven effective. The special value of art therapy is inherent in addressing the visual as well as the non-verbal and narrative parts of trauma.In observing the trauma memory using art interventions, the soldier is able to make concrete and observable images, which means these images have less power and become an integrated memory. Non-verbal stories are made whole and understandable to the conscious mind. Art therapy helps soothe the stress system, reduce anxiety and mood disorders, reduce behaviors that interfere with emotional and cognitive functioning, and help with externalizing, verbalizing, and resolving memories of traumatic events. This entails reactivating positive emotions such as self-worth and self-esteem. Currently, art therapists and researchers are attempting to quantify the value of art therapy in treating PTSD in each of these areas.

Art therapy can be used by anyone, even those who have not used visual art materials since childhood or have not had any formal art training. With relatively simple art materials and a trained art therapist, the service member is inspired to address debilitating symptoms, to have opportunities for expression and resolution of painful memories, and to enhance stress reduction through art based interventions and relaxation.

How can art therapy help families and caregivers of veterans and those in the military?

Military families relocate more often than civilian families and may move as often as 2-3 times a year. Every military family must provide their own stability and rely on the structure of the military for support. This extreme mobility can result in isolation and alienation from both civilian communities and the extended family. The military is made up of individuals from diverse cultural and ethnic backgrounds and has an authoritarian organization that often extends into the structure of the home. Service members and their families pride themselves on their strength and ability to successfully confront challenge. Asking for help may carry the stigma of weakness. Service members have reported concerns about appearing weak in front of their peers or commanders; commanders have reported concerns of appearing weak to their subordinates. These beliefs, which help make our military strong, can also place service members in a double bind when they do find themselves in need of support, especially when that support entails mental health services.

Families and caregivers can receive art therapy treatment alongside the veteran who is recovering. Family art therapy can become a helpful resource for the veteran depending upon their input and influence in the veteran’s life. They can help make sure the veteran is safe, can make sure the treatment team is alerted when their service member is in distress or suicidal, or can assist more directly in their treatment.If the family is in crisis, this can be assessed though art therapy evaluation sessions.

Military culture is not widely associated with art and creativity. How does that impact your work with this population?

The Military is similar in its organization to a family.It is focused on the continuation of the unit for the individual soldier’s protection, identity, and personal development. The Military is rules-based, yet within the structure it provides to its members, it is more open to creative approaches than one might think. Although the Military is not thought of a creative organization, individual soldiers, airmen, and sailors are often called upon to figure out creative solutions to problems and use their informed judgment to make decisions. Thus, the individuals in the military are often creative of necessity. By mobilizing this creativity in the service of treatment, art therapists became valued members of the treatment teams for inpatient, partial hospital, consultation/liaison, and outpatient settings.

Wars have been fought throughout the ages, making it important for those in the Military to study trauma and its effects. In fact, the first mention of psychological battlefield injuries occurred in the chronicles of the battle of Marathon by the Greek historian Herodotus, written in 440 bce. Due to art therapy’s effectiveness treating those suffering from trauma and PTSD, there has been a willingness to make it available in military settings. In fact, all the creative arts therapies, because of their non-verbal and symbolic basis, have proved helpful when working with Military members. Art therapy became a unique field after World War II partly due to its success addressing military and civilian trauma in the aftermath of major devastation and carnage.

How have you seen the field grow and change in your 40+ year career? Are there any emerging trends in treatment that you are particularly excited about?

The treatment of military members using art therapy approaches expanded over the time I worked at Walter Reed Georgia Avenue and continue to the present. Indeed, this book is a testament to this expansion; it is the first book dedicated to describing art therapy services in the military in the United States. The field of art therapy has changed immensely since I became an art therapist. When I first began, the American Art Therapy Association was relatively new. We now have an office with dedicated staff in the Washington, DC area, and art therapy training programs have increased across the country. Licensure is being sought in many states including the District of Columbia; and in some states art therapists are licensed as counselors, social workers, marriage and family therapists, and psychologists.

The most innovative trends in treatment are those art-based approaches, which focus upon helping the individual tell the entire trauma story without disassociating and without re-traumatization. This can be accomplished in several ways with art, through the use of graphic stories, drawings, paintings, masks, and sculptures. Also, using art therapy to work with personality parts (ego states), promoting a dialogue, and getting the parts to work together is an exciting new way to understand how trauma affects the persons’ world view. At times, service personnel feel those who were not present in the war zone could never understand what they went through or that they could spare their families agony by remaining silent. In telling the story through art, the service member is given the opportunity let family members know how military service altered his life. This can bring families closer together rather than pushing them further apart. As a country, we should not be surprised when the soldiers we send into harms way return with major psychological impairments, nighttime terrors, and reliving the horrors of the battle.

For further information about art therapy please contact the American Art Therapy Association:
4875 Eisenhower Ave. Suite 240, Alexandria, VA 22304
Phone: (703) 548-5860