Painting a path to well-being: art therapy helps children of war mend the wounds

Painting a path to well-being: art therapy helps children of war mend the wounds

Abigail Pugh

Mohammad *, 12, is the oldest in a group of refugee children that I visited at a Toronto-area reception centre for recently arrived refugees. Mohammad has taken a long time over his painting of a pink-roofed house with a large tree beside it. He has covered the tree with plentiful red fruits, and tells the art therapist that it’s a very old tree, but strong. “Do you miss this tree?” she asks Mohammad. “Yes,” he replies. Then comes a wave of intricate details: there are four families in the house, and the trees outside provide enough fruit for all of them–with plenty left to share with other families. “It sounds like Eden!” I say. The therapist interprets this comment, and Mohammad acknowledges it with a proud smile. He misses his home; his memories are all he has left of the house, the trees and their fruit.

Violence. Loss. Forced exile from home and culture. Hunger, cold and disease. An unfamiliar language and society. Experiencing any one of these events would be enough to cause significant emotional suffering and possible long-term psychological effects for anyone. Refugee children from war-torn countries have often faced them all.

A 1999 study conducted by the Center for Crisis Psychology in Norway found that among 58 Kosovar refugee children living in Macedonia, 52 per cent were grieving a family member; 72 per cent had had their home seriously damaged; 30 per cent had been personally threatened with death or serious injury; and 48 per cent had strongly believed that they would die of hunger or thirst.

A study published in a 1997 issue of Pediatrics looked at 364 internally displaced Bosnian children. It found that 94 per cent met the established criteria for post-traumatic stress disorder (PTSD), including sadness, anxiety, guilt feelings, risk-taking and eating disturbances. More than half reported that they believed they would never be happy. Another study in a 1999 issue of the Association for Child Psychology and Psychiatry Journal revealed that of 239 Palestinian children who had experienced war trauma, more than 72 per cent had mild post-traumatic stress symptoms, and 41 per cent had moderate-to-severe PTSD.

Clearly, war takes an enormous toll on its youngest bystanders. Many children end up fleeing their homeland, arriving in a strange country with little more than their memories.

Supporting such children and helping them work through their experiences once they are physically safe in Canada is a complex challenge. Language and cultural barriers make talk therapy difficult, and children don’t necessarily have the vocabulary yet to talk about thoughts, issues and feelings. Refugee children face harsh present-day realities in addition to their harsher memories, as they struggle to adapt to new surroundings and reconfigured families. Asking them to recount their traumatic experiences directly may feel threatening and simply cause more distress by over-stimulating already burdened minds.

Art therapy is a less threatening way of helping these vulnerable children deal with their feelings. It is an expressive technique for healing, whose tenets and techniques are very simple. Clients are given access to painting, drawing or sculpture materials and create forms or images at will. They are then given the opportunity to discuss the work with the art therapist, who asks questions and encourages the process of communicating feelings–often fear, sadness and anger–in a safe environment. A study published in a 1998 issue of the Journal of Experimental Psychology: Applied found that children’s ability to verbalize actually increases when the act of talking is accompanied by the act of drawing, as Robin Feldman, an art therapist based in Victoria, British Columbia, observes: “Art transcends language barriers and cultures and speaks a language everybody understands.”

Helene Burt, a Toronto-area art therapist, says that “non-verbal expression is a door to unconscious material, and the process itself is inherently healing.” She believes the technique is useful for helping those afflicted by war: “War trauma is not a thinking, language-based experience,” says Burt. “It is experienced through images and not easily encoded into language. Working with art enables children to have mastery over those images, which are witnessed and contained.”

Bobbi Stoll, a Los Angeles–based art therapist who has worked on two projects with children in Bosnia-Herzegovena, describes the process: “The child is involved cognitively, affectively and kinesthetically–awakened and mobilized. The child might start with a big smile, and then suddenly start crying because the drawing has been a trigger for suppressed thoughts and experiences.”

Maryam, 10, sits very quietly, bent over her work with little display of emotion. She paints rapidly, and seems confident and familiar with the paints and paper. Because she is a girl, she has received no schooling in her home country. A large house appears on the paper, and the art therapist gently asks, “Where are the people? “Inside the house,” answers Maryam in her own language. “How do they feel?” asks the therapist. “They want to travel,” replies Maryam. Later in the session, she paints a pale, crying face. “Why is she crying?” asks the therapist. “Because her daughter has gone on a trip,” says Maryam quietly.

Afsaneh Shafai is a Toronto-based art therapist, who runs a weekly group with refugee children. The group takes place at a reception centre for recently arrived refugees run by COSTI, a non-profit agency funded by the federal and provincial governments and private donations. Her clients are “convention refugees,’ which means that their cases have been processed by the United Nations before they reach Canada, and they have been sponsored by the Canadian government to start new lives here. Most of the children in Shafai’s group lived in a third country on their way to Canada. Some have been in limbo for months or even years.

Shafai describes the experiences of many of the children in her group: “They have witnessed war or killings and have seen corpses. They have seen houses on fire, shootings, friends dying in front of them. They have lost parents or grandparents. Their houses have been bombed.” She is passionate about the benefits of art therapy for these vulnerable children: “Art is a catalyst for sharing feelings,” she says. “The group is a non-threatening environment, where it’s very natural for the children to dig into the paints.”

Soraya is only two and a half, which is slightly too young for the session. But when she sees the other children and the paints, her enthusiasm is infectious, so the therapist welcomes her to the table. Soraya doesn’t need any direction, diving eagerly into the paint and then painting with the coloured water in the paintbrush jar. In her short life, she has experienced upheaval and change, and has witnessed the sights and sounds of war; yet while she paints, she is just a happy, excited little girl, absorbed in her play.

Stoll agrees with Shafai that a trusting environment is key, observing that the uniqueness of art therapy lies in its gentle, non-coercive approach: “Art is an easy way to make that first contact” she says. “It breaks the ice like nothing else can. If you ask kids questions, they feel interrogated. But if you throw out expressive materials, they’ll begin to tell a story through symbols.”

Emad is four years old, and has just arrived in Canada from a country that has seen decades of war and civil unrest. He paints several complex, intertwined shapes that cover the paper. When asked to explain what the shapes represent, he says they are three smiling faces. The therapist points to another shape at the corner of the paper, and Emad starts to describe a special game from his home country. Not fully understanding what Emad is referring to, the therapist patiently asks him some more questions, showing interest in his memory and attempting to uncover what he is conveying in his work.

Art therapists work from the assumption that every mark made on paper or clay is significant, whether what is conveyed is a literal image from memory or a playful mixture of fact and fantasy. Older children often create literal images from memory, of weapons or fires, for example, while younger children usually work more metaphorically. Stoll likes to wait and see whether an image appears repeatedly in a child’s work before she tries to attach a symbolic meaning to it: “If I see a tree appearing repeatedly over time and it begins to change, I will ask a question about the changes–about what each tree stands for. Or I’ll get two different trees in dialogue with each other.” This ability to examine the child’s self-expression as it develops over time is another important benefit of art therapy. The technique allows therapist and client to look back at work from previous sessions to assess progress and see positive change.

Stoll says that it is very important that the therapist consistently trust the artwork that comes through. “Children haven’t developed such a solid defensive structure, so their images are authentic representations of what they are feeling or thinking.”

Robin Feldman facilitates a peer-support program for refugee children, sponsored by the Victoria Immigrant and Refugee Centre in Victoria, British Columbia. She says that compounding the trauma refugee children have often experienced is the fact that it is not always through their own choice that they have come to Canada. She describes how well-meaning adults often wish to hear about how happy the children are to have come to Canada, when the reality is that they are homesick and confused. “They face internal pressure to become part of the new culture, and they don’t know what to do with their feelings, of longing, for example.” Art therapy provides a safe, trustworthy environment in which to express these complicated emotions.

Intergenerational conflict is another issue the children may face. “Sometimes parents want to retain contact with their culture, and the kids want to assimilate,” says Feldman. “Caregivers may experience a loss of authority because the child assumes the leading role within the family.” Again, art therapy is a subtle, yet powerful tool for allowing the children to access and explore their feelings.

The COSTI children are still in limbo. The reception centre is only able to offer them shelter for three weeks, after which time the children, with their families or caregivers, must find a more permanent home and face a challenging future. Some refugee children, therefore, only benefit from a single art therapy session. But Shafai believes that much can be achieved in a short time. She believes in the power of her work: “With these children, you see the hope. You see the healing happening.”

Art around the world for children of war

Several organizations bring art and other expressive therapies to children affected by the violence and deprivations of war:

War Child is a network of independent organizations responsible for several initiatives in war-torn countries. Recent art therapy projects have taken place at War Child’s “Little Star” rehabilitation centre in Chechnya; in Eritrea, where children are taught “to play again”; in Sierra Leone, where former child soldiers are rehabilitated; and in Kosovo, where “creative therapy buses” bring healing to thousands of traumatized children and adolescents. War Child has offices in Canada, France, the Netherlands, the United Kingdom and the United States.

In part through its Psychosocial Programme for Traumatized Children, the United Nations Children’s Emergency Fund (UNICEF) brings art and other expressive therapies to children in such war-torn countries as Bosnia, Serbia and Palestine, and to areas that have experienced natural disasters, such as Turkey.

The Canadian Centre for Victims of Torture is a Toronto-based non-profit organization that offers counselling and support, including art therapy, for individuals and families that have experienced torture,

The ArtReach Foundation, based in Atlanta, Georgia, organizes, develops and provides resources for programs that offer creative problem-solving and expressive art activities for children who have been emotionally traumatized.

Practising art therapy

Art therapists use various approaches, depending on their academic background, client base and therapeutic orientation. Art therapy is not limited to a single psychological model or school of thought, but practitioners may use a variety of approaches, including psychodynamic, cognitive behavioural or humanistic approaches.

For a complete list of art therapy training programs in North America, visit

Art therapy associations in Canada include:

Association des art-therapeutes du Quebec tel.: (514)990-5415, e-mail:

British Columbia Art Therapy Association tel.: (604) 878-6393, e-mail:

Ontario Art Therapy Association e-mail:

* All names in the vignettes are fictional. These vignettes describe events from the COSTI-run group.

COPYRIGHT 2003 Centre for Addiction and Mental Health

COPYRIGHT 2007 Gale Group