Neurodevelopmental Art Therapy (NDAT) for Developmental and Relational Trauma in Children and Adolescents

Neurodevelopmental Art Therapy (NDAT) is psychodynamic, attachment-focused treatment of relational trauma. It is now accepted in neuroscientific and lay circles that the body-based results of trauma are stored in the right hemisphere of the brain (Siegel, van der Kolk).  Art therapy, along with the other right brain-activating creative arts therapies (music, dance / movement, drama, drumming, poetry therapy), as well as with play therapy and sandtray therapy, utilize the brain’s integrative capacity.   

It is now accepted in neuroscientific and lay circles that the body-based results of trauma are stored in the right hemisphere of the brain (Siegel, van der Kolk).  Art therapy, along with the other right brain-activating creative arts therapies (music, dance/movement, drama, drumming, poetry therapy), as well as with play therapy and sandtray therapy, utilize the brain’s integrative capacity.   

Activation of the right hemisphere offers access to the stored physical and emotional traumatic memories, internal sensations, feelings, and thoughts that can then be expressed in visual form.  Initially, kinesthetic and sensory experiences activate the right hemisphere of the brain, which are then followed by the limbic system, and cognitive and prefrontal structures.

The Neurodevelopmental Art Therapy (NDAT) model for the treatment of developmental and relational trauma is grounded in current neuroscience, and includes interpersonal neurobiology and attachment theory.  An art therapist using the NDAT model can revisit earlier critical periods of right brain development in order to repair early sensory motor delays and attachment deficits.  Spontaneous right brain dynamics are played out within the container of the therapeutic alliance.  The emotional right brain is dominant in all forms of psychotherapy, but this is especially true in child psychotherapy that is centered in the creation and perception of right lateralized visual-emotional self-images.   The NDAT model underscores the importance of not only interactively regulating the client’s traumatic arousal, but also provides an opportunity for the child to newly experience sensory motor experiences that were lacking in early development.  The therapeutic alliance between therapist and client can promote a right-brain mind-body attachment system that was not fully developed in the early relationship with the primary caregiver.  As NDAT focuses on the affective power of images in treatment, it not only reduces trauma symptoms, but also allows for an expansion of previously blocked right brain social-emotional development.

 

The NDAT model of neuroscience-based treatment was developed by Linda Chapman, MA, ATR-BC, whose research considered the extensive writings of Dr. Daniel Siegel on the impact of trauma on brain development and subsequent functioning.  Her influences also include Dr. Bruce Perry who writes about the neurobiology of violence, and Dr. Allan Shore, whose research discusses how effective PTSD treatment of complex, relational trauma is now focused on the right hemisphere, the primacy of affect, the importance of relationships at critical times in development, and ways to dynamically apply these concepts in psychotherapy. In the opening pages of his 2012 book, The Science of the Art of Psychotherapy, Dr. Schore writes of a paradigm shift occurring across all sciences, from conscious, explicit left-brain discourse to the unconscious, nonverbal, body-based expression of the right hemisphere.  Examples of early models of mind-body therapy for PTSD include somatic therapy, sensory motor and EMDR. 

As a mental health provider with more than twelve years of working with children and teens, I am concerned about the lack of government and other resources for the development of psychological assessments and the prescribing of medication before less-invasive treatments are utilized to control symptoms. I am concerned about the number of young children who are asked to learn academic skills that are beyond their developmental level, their information-processing capacity, and their cognitive ability. I am concerned about the number of children who are exposed to domestic violence, video game violence, film violence, television violence, and the transgressions of those who bully them in their schools and communities. I am concerned about the severity of the cases that cause therapists to feel inadequate when traditional methods of therapy prove ineffective for their clients.

  • NDAT utilizes the integrative capacity of the brain - cortical cooperation - and applies neurobiology in the clinical setting.

 

  • A paradigm shift is occurring across all sciences from conscious, explicit, analytical, verbal and rational left brain to the unconscious, integrative non-verbal, body-based emotional processes of the right brain.

 

  • All are central to a deeper understanding of the fundamental mechanisms that drive development, psycho-pathogenesis, and psychotherapy.

 

  • The concrete image on the paper allows the client to objectify the images, creating distance and allowing her to speak about an external event rather than an internal one.  Objectification of images also eliminates the flooding of disturbing images and sensations.  The drawing format itself is effective. The paper acts as a container of that trauma.

 

  • In trauma situations, the brain is primarily processing information visually. The most common recall of traumatic imagery is in visual form.  NDAT helps clients remember, express, and integrate traumatic episodes.

 

  • Emotions are expressed and released through art media.  Incoming stimuli such as intrusive images, sensations or memories become better organized as the person becomes more aware of affect.
     

  • Art can bypass left-brain activity and use other regions of the brain where traumatic memories are stored.  The affective power of images does more than reduce trauma symptoms, it also allows for an expansion of previously blocked right brain social-emotional development.

 

  • The kinesthetic aspect of scribbling with art media activates the lower structures of the right brain and stimulates the formulation of imagery. The bilateral stimulation and eye movements appear to unify the hemispheres as a part of the neural restructuring process.  Most treatment sessions include mindfulness work and some form of nonverbal expression.

 

  • A focus on the right hemisphere of the brain can help to bring about healing.  By engaging in kinesthetic activity of art making, play and other creative work, sensory nonverbal pathways are activated along with the left-hemisphere verbal neural pathways, utilizing the integrative capacity of the brain.

 

  • NDAT is different from short-term, acute trauma treatment. Relational trauma and repeated exposure to child abuse and neglect are not single, one-time events.  To address sustained issues of grief and loss, maladjustment and inability to relate to others in a positive manner, a sense of trust has to be established. 

 

When the significant developmental task of attachment with a primary caregiver is missing or inadequate, the development of a child’s concept of mind/body/self is compromised. The child does not have the ability to develop the sensory and motor systems that normally occur through interaction with others and the environment, foundations for learning and behavior. Once the lower structures of the neural system are integrated, they will inform the higher structures.

 

The corpus callosum - the band of tissue that connects the hemispheres of the brain -  is smaller in abused children than in nonabused children. The child cannot access the higher structures of the brain for thinking, planning, judgment, consequences, wisdom, compassion, or empathy.

 

The prefrontal cortex includes wisdom, judgment, compassion, moral development, prosocial attitudes/behaviors, social decision making/pragmatic knowledge of life, emotional homeostasis, reflection/self-understanding, value relativism/tolerance, and acknowledgment of and dealing effectively with uncertainty. The prefrontal cortex is what makes us human, and is not completely developed until age 25 at the earliest.

Trauma Spectrum

 

Acute:        medical, natural disasters, human made disasters
Chronic:     repeated, anticipated, persistent exposure.  High incidence of PTSD, complex trauma,
developmental and relational: massive misattunement from caregivers causes extreme stress,
hyper or hypo arousal, altered neurochemical system

Sensorimotor delays - both sides of brain not operating in sync - left brain involves logical, linear thinking; right brain is body-based, seat of emotions.  Due to massive misattunement in early development, parental abuse, etc.

Lower Brain:     involuntary: breathing, heartbeat
Mid Brain:         limbic structure, seat of the emotions, and where PTSD resides
Higher Brain:   neocortex, prefrontal cortex makes us human; thinking, planning, judgment,
                           consequences, wisdom, compassion, empathy.  
                           Not completely developed until age 25.

NDAT and the brain’s integrative capacity:   

  • The brain encodes information visually

  • The most common recall of traumatic material is in visual form

  • Traumatic material is stored in the right hemisphere (RH)

  • Bilateral activity (drawing, painting) activates the RH


The technique I use with my clients is based on the neurobiology of attachment, on development, and on early experiences that the child may have missed from an abusive, or drug-induced parent.   Much of what I do in using art therapy is to go back and re-work those neural systems and re-do things that were deficits in early development.

Structured media, such as pencils, markers, collage is more controllable. Fluid media, such as acrylic paint, watercolors, finger paint, clay with water, is less controllable, and potentially more regressive

NDAT uses the scientific, or medical model of therapy, more so than transpersonal, solution-focused, and cognitive behavioral models   The NDAT model tries to address and reduce specific symptoms.  Children who are socially withdrawn, inattentive, have cognitive underachievement, depression, or have anger control problems in childhood and adolescence.  There may be higher incidences of panic disorder, substance abuse, suicidal preoccupation, shame, guilt, self-blame.  These children and adolescents are more likely to be abusive parents themselves. Symptoms of sensorimotor delays look like ADHD, ASD, etc.

The Bilateral Scribble (PDF)
The Bilateral Scribble is a fun and engaging warm-up, a kinesthetic experience that stimulates the formation of imagery, and activates both hemispheres.