The art of healing : traumatic stress and creative therapy in South Africa

Traumatic stress and specifically child trauma is a ubiquitous problem, and in South Africa rates of abuse and trauma exposure are one of the highest worldwide. Considering these high figures, there is actually limited expertise available that can help us understand and effectively treat the long-term consequences of these experiences of posttraumatic stress in children. Moreover, previous studies are primarily based in a high-income context; in low and middle-income countries studies are even more scarce. This dissertation described the psychological impact of traumatic events in South Africa, analysed current barriers in mental health care through the experiences of social workers, and evaluated the potential suitability and effectiveness of a creative arts in psychotherapy intervention that was developed, implemented and evaluated in the South African context. The overall aim was to contribute to an improvement in mental health care offered to children after trauma, specifically in a context characterized by high levels of abuse, violence, crime and poverty. Results demonstrated that high levels of traumatic exposure in the South African society do indeed place the population at risk for developing posttraumatic stress disorder and other negative mental health consequences. There are several barriers to providing proper mental health care, pointing to a need for better support and training for the health care professionals and stronger collaboration within the communities between relevant stakeholders and clients to make treatments work. At the same time, opportunities were pointed out such as high levels of resilience, transdisciplinary collaboration, and using strategies that are embedded in indigenous systems such as creative arts therapy. The current knowledge-base of creative arts therapy is very limited compared to more regular approaches to treating posttraumatic disorders such as CBT and EMDR. Yet, unique advantages of creative arts therapy are that it is non-threatening, allowing for desensitization whilst restoring dignity, accommodating possible language barriers and incorporates indigenous knowledge. The potential effects of a creative arts therapy treatment (CAP) were demonstrated in a non-randomized controlled trial, comparing creative arts therapy with a low-level supportive programme without treatment. The children participating in the programme reported less posttraumatic stress symptoms after attending therapy, compared to a low-level supportive programme. Despite major challenges of implementing and evaluating this intervention in a context with ongoing violence, lack of resources and language barriers, the potential of using creative arts therapy within communities as treatment for child trauma was demonstrated. The positive findings laid a first foundation for similar work that can be followed-up and improved in future, and hopefully inspire much more work in this area