Book Review: Healing Trauma with Guided Drawing, A Sensorimotor Art Therapy Approach to Bilateral Body Mapping

Categories: General Somatic Healing Methods, Healing Through Art

December 21, 2018

Healing Trauma with Guided Drawing, A Sensorimotor Art Therapy Approach to Bilateral Body Mapping, by Cornelia Elbrecht, is an in-depth instructional textbook for the somatic therapeutic approach Guided Drawing. Based on leading edge understandings about trauma healing and the body (sensorimotor psychotherapy, somatic experiencing, etc.), this book is a treasure trove of trauma healing knowledge, insights and clarifications. Guided Drawing effectively weaves together a number of different therapeutic processes creating a multifaceted and holistic trauma therapy. I would recommend this book for anyone interested in somatic therapies, expressive arts therapies and trauma healing modalities, tools and techniques.

Scribbling

When I was an undergraduate at Mills College, I interned as a Teacher’s Assistant in an art class at a local elementary school in Oakland. One day, I had the children do a scribbling exercise to loosen up before class. While scribbling, the children became wild, energetic, expressive and enthusiastic, a complete contrast to their previous self-conscious or restless and distracted states. When the children went back to the art teacher’s assignments, I was a little dismayed to see them all pull out their rulers and begin drawing straight lines. I had an intuitive sense that scribbling was something that could open up some part of the creative process that might lead somewhere important, but I didn’t know where.

Guided Drawing is Mainly a Somatic Therapy

Guided Drawing is, at its core, a somatic therapy – a somatic therapy that includes body awareness / tracking, somatic presence, organic movement, self-regulation, titration, insight / self-understanding, “active meditation” and expression (as in expressive arts therapies) that occur in a cyclical way.

The artistic expression aspect – the drawing part – of Guided Drawing is a reflection of motions, movements, feelings, and sensations arising from within the body rather than “art” as we generally think of it (as representative or symbolic). The process starts with “tracking” or deepening into the tapestry of body sensations, the same process that is done in Trauma Resiliency Model®, Somatic Experiencing and other somatic therapies, but then adds components that allow the tracked sensations to find motions, patterns, shapes, pressure, direction, etc. on paper. The motions of the hands reflect a careful, aware presence with the body sensations and the development of a partnership or alignment with the messages being communicated by the body.

You could say Guided Drawing is “scribbling,” but it’s actually a complex and comprehensive somatic therapeutic system that goes way beyond just scribbling or free-form self-expression.

There is also a component of mindfulness, or the potential to enter into altered states of consciousness during parts of the experience: “Guided Drawing is a mindfulness exercise. Hippius called it a form of “active meditation.” Page 9

“Guided Drawing can be perceived as purely body-focused or as an outlet for emotional charge, or as a medium to create images – whatever offers individuals access to their inner world. As clients progress, body sensations, emotions, and their mind and spirit begin to connect, forming an integrated narrative.” Page 31

Bringing Forth “How do I feel?”

4 Unique Characteristics

The process of Guided Drawing has some unique characteristics beyond other free-form type drawing exercises, characteristics that support depth, trust, safety, regulation, presence and discovery/insight. These characteristics are:

guidance that supports being in alignment with body sensations throughout the process,
the use of bilateral stimulation/expression,
the use of rhythm,
drawing with eyes closed or semi-closed.

Tracking in Safe Space. In a Guided Drawing session, time is spent in the beginning becoming aware of various sensations going on in the body while in a safe container. This sinking in time with the supportive guidance of the therapist is important because the body can feel very challenging and daunting – and “off-limits” – to trauma survivors. Staying connected to the body sensations while simultaneously feeling connected to another person who is fully present, mirroring, socially engaged and deeply supportive of the sinking in process is a big step for trauma survivors. It creates new neural pathways.

Bilateral. Using both hands to draw at once – engaging both sides of the body – is an approach that engages both hemispheres of the brain, accessing the whole brain and whole body and stimulating, “synchronicity between the two brain hemispheres, the intuitive and the rational.”

Rhythm. During the Guided Drawing process, the client creates rhythmical motions and repeated shapes, shifting into other rhythms as the feeling arises. The rhythms the hands make shift and change to get closer to a more accurate expression of the internal reality being experienced. Spending time with repeated motions and rhythms supports exploration, curiosity and discovery of the internal reality.

Rhythm is something that is soothing and comforting to the body. Rhythm is also used in EMDR, drumming, music therapy, and it is native to our human physiology (heartbeat, circadian rhythm, etc.). Rhythm is already an internal structure in the body. Rhythm is regulating for the nervous system.

“Both the emerging shapes and their rhythmic repetition have the purpose of building trust and inner structure.”

Creating the same form or shape repeatedly in relation to one sensation or area of sensations also extends the period of time spent exploring what the specific sensation is about, what kind of motions reflect the sensation, what it feels like, what its characteristics are. So, rhythm supports titration, which is the process of slowing down and taking only really small bits at a time.

As a trauma survivor, because of my tendency to want to avoid challenging feelings within me (which is a trauma symptom), I can rush through things. Focusing on one sensation for a long time slows the process down and helps create more space and time around it. At first it may feel uncomfortable but ultimately, going really slowly makes it way more tolerable and also brings up insights and information that would otherwise not have time to come to the surface. Titration creates safety by removing overwhelm for a little while.

“So much resentment and pain is held in the body, often for decades. We ‘can’t move on,’ we are ‘stuck.’ Rhythmic repetition can track the patterns of contraction and holding on tight. With loving awareness and an attitude of gentleness and kindness, which has to be role modeled by the therapist, our instinct, our intuition, our life force will find a way out. Be this into less pain, into forgiveness, or until the rhythm of life can find a new pulse.” Page 17

Also, there are moments the therapist will make suggestions to try a specific rhythm to obtain certain therapeutic results. The rhythmic nature is essential because of the fact that the difficult pattern was repeated numerous times so the healthy pattern needs to be repeated enough times to build a new neural pathway that will overcome the old one.

“Rather than repeating and thus emphasizing a destructive internalized behavioral pattern, it might be beneficial if the therapist offers a new option to life. In her pilot study on sensorimotor interventions with children who have experienced complex trauma, Lauren Hansen emphasizes that such interventions must be repetitive in order to compensate for the incorrect development of the neural pathways; only repetitive stimulation is capable of redirecting neural development.” Page 34

…only repetitive stimulation is capable of redirecting neural development.”

The exploration of rhythmic motions also helps one learn, over time, what it feels like for their movements to be directed by something other than the mind/cognition – by a more primal, nonverbal part of themselves. This slowly links together and repairs internal pathways that may have been broken since early childhood.

Discovering one’s own shapes and rhythms also supports feelings of it being OK to express what is one’s own uniqueness, building internal feelings that it’s possible to say something that is all one’s own and remain safe.

Inward focus. Keeping the eyes closed, half closed or with a blurred / unfocused gaze supports learning how to focus inwards and not get distracted by visual stimuli. After the internal focus is learned then the eyes can be opened. “The closed eyes have the purpose of discouraging a visual focus of making art, getting it right, and looking beautiful. ” (If someone is triggered by having eyes closed or has some other issue, the eyes can be open.)

What the word “Guided” Refers to in Guided Drawing

“Guided Drawing does not mean guided by directions and instructions from the therapist but rather guided by an inner force that is clearly present, even though hard to pinpoint.” Page15

“Once clients have become comfortable in taking their sensory prompts seriously, inner guidance has set in; and once this stage is achieved in the therapeutic process, the therapist takes on the role of the supporting midwife. The therapist will assist with the process of birthing, but only the client is the one who can give birth, when the conditions are right and ready for the arrival of something new. As therapists we cannot provoke changes in clients, if they have not organically evolved inside them.” Page 16

The Role of Traditional Art Therapy

Traditional art therapy can be used to help clients become comfortable and to build their inner resources.

“Guided Drawing requires mindfulness, sensory awareness, and trust; the body focus does not initially suit everybody. Many of my clients begin with traditional art therapy exercises where they create images of biographical or symbolic events: they assemble collages or sculpt figures. This is more in line with their expectations of a session, and it is often necessary to build resources. Once they have gained trust in the setting, in the therapeutic dyad, and in their inner process, we may continue with Guided Drawing.” page xxi

Guided Drawing Directly Addresses where Trauma Lives – in the Body.

Since trauma lives in the body, the Guided Drawing process supports direct access to where the trauma lives.

“Art therapy is … still primarily focused on image-making and the cognitive processing of such creations. These prefrontal cortex therapies, however, do not address the brain stem, where trauma is held. The top-down modalities have their place, but they are not capable to lastingly settle the involuntary fear responses triggered in the autonomic nervous system.” Page 16

“Guided Drawing does not so much address the story — the conscious memory of an event — but has its focus firmly on the implicit body sensations. Implicit memories arise as a collage of sensations, emotions, and behaviors. They are primarily organized around the emotions and action patterns we have learned in early childhood; they usually appear and disappear far outside the bounds of our conscious awareness. Through tracing these implicit body sensations with crayons on paper, it is possible to address physical discomforts, emotional distress, and pain — and then transform them.”

Through tracing these implicit body sensations with crayons on paper, it is possible to address physical discomforts, emotional distress, and pain — and then transform them.”

“Most art therapy activities have their emphasis on the image-making process. When working with complex trauma, however, it is crucial to address the underlying sensorimotor issues in order to reach the developmental needs of clients’ early childhood. All approaches that allow for rhythmic, bilateral, body-focused action patterns, such as bilateral drawing, but also drumming and dancing, martial arts, and bodywork, are able to repair and reorganize implicit memory in the brainstem. ” Page 44

The top-down modalities have their place, but they are not capable to lastingly settle the involuntary fear responses triggered in the autonomic nervous system.”

A Mix of Top-down and Bottom-up Therapies

“Guided drawing sessions are a mixture of top-down and bottom-up approaches.” p. 51

The bottom-up approach, starting from body sensations, is the main, most crucial part:

“Heller and LaPierre view the mindful bottom-up experience of the body as the foundation of the healing process. The more we are in touch with our body, the greater our capacity for self-regulation is. LaPierre is clear that we can only influence higher functions such a speech, language, and socioemotional communication if the lower neural networks are intact and regulated. ‘Patterned, repetitive somatosensory activities’ are necessary, if a poorly organized brain stem needs a reset.” page 51

‘Patterned, repetitive somatosensory activities’ are necessary, if a poorly organized brain stem needs a reset.”

But then at the end of the session, there is some time spent on the top-down approach (mental analysis, language) – the client has mental insights and understandings of what the experience means in relation to their history and overall healing process, and puts it into words:

“The bottom-up approach is initially kinesthetic, mostly nonverbal, and dominated by motor impulses. Than we move “up” in the body toward sensing, toward sensory awareness. A session will oscillate between drawn motor impulses and sensing the effect they have on the inside. However, toward the end of the session, cognitive integration is crucial. Even if words do not express the full story, it is important to formulate some of what happened, and thus tie the sensorimotor events to the conscious thought pattern.”

…it is important to formulate some of what happened, and thus tie the sensorimotor events to the conscious thought pattern.”

Shifting from Presence with the Problem areas to Presence with the Resources in the Body

Shifting from asking “How do I feel?” to asking “What do I need?” — In my own trauma recovery journey, I’ve spent a lot of time tracking. I think that I am pretty much always in a state of overwhelm, so mainly I’m just trying to self-regulate to get through the day. I haven’t yet shifted from a place of tracking sensation to then ask my body, “Now what do you need to do to make it right? What could heal you?” But I do know that this second step exists, the purpose of which is to give the stuck motion a chance to express itself. Give the desire to fight a chance to express aggression in a healthy way, give the desire to flee the chance to express running, the desire to push away a chance to push, etc. Or to give them the things they needed at the time – soothing, care, comfort, listening. And I know this can be a step that “transforms them.”

In a Guided Drawing session there can be this moment that the body shifts and then starts to focus on what it needs as resources.

“…you may move from the question of How do I feel? to inquiring into What do I need? What movement do you need in order to resolve this tension? What could help to ease the pain? Do you need soothing, circular, massaging motions or straight, sharp, even forceful lines to release pressure? Do you need to push something or someone away? Or do you need containment to be held?”

I suspect that enough of this second, resource finding step of What do I need? would indeed begin to transform some of this extreme anxiety I suffer from.

…you may move from the question of How do I feel? to inquiring into What do I need? “

Empowering

“What clients experience in its immediacy is that they can do something to help themselves, and that their actions have a tangible impact on their felt sense… The approach counteracts clients’ sense of helplessness, which often triggers hopelessness as a consequence. Passive suffering is turned into active responses that are in alignment with deeply felt inner needs. In this way, clients can move from survival to gradually feeling alive.”

“Once we have discovered, explored, and practiced these body-based learning steps, they become sensorimotor achievements that are remembered, similar to learning how to swim or ride a bike. They become lasting procedural memories that are able to transform even early childhood developmental setbacks and my: they assist in finding an active response to traumatic experiences. Such steps are able to restore empowering action.” Page 16

Passive suffering is turned into active responses that are in alignment with deeply felt inner needs.

I think that Guided Drawing would be empowering by:

Providing Safety – a Safe Space – to feel.
Helping to get what is internal, outside on paper.
Moving what has been stuck and still.
Viewing a reflection of what is internal, outside, looking back at you in a visual form, giving it a kind of tangible presence and validity.
Slowing down enough. Titration. The gift of ample space and time.
Having insights, putting things together, making sense and meaning out of things.
Asking the body for resources and realizing it has them or knows where to get them.
Experiencing the support, therapeutic suggestions and interventions of the trained therapist.
Experiencing new, healthy rhythms, patterns, sensations and neural pathways.

“The process is not unlike any other therapeutic encounter, except that an important part of the procedure becomes and remains visible. Especially with subtle changes, or issues one finds unbelievable, unacceptable, or unspeakable, this visibility can be helpful, as the drawings “prove” and document the event. They reflect the journey; they can inspire and provide enormous support.” Page 35

Three Stages of Preverbal Sensorimotor Development

Elbrecht observed and identified three core stages of preverbal sensorimotor development in children: 1. Sense skin; 2. Balance; 3. Depth sensibility

“The three core stages of early childhood development shape our implicit memory in the brainstem and in the limbic system.” Page 43

The Guided Drawing therapist observes where an adult may have become stuck and supports the healthy movements towards completion and integration within these three realms of development.

“If this sensorimotor base – developed through skin sense, balance, and depth sensibility – remains incomplete, it makes for a fragile base for all further development. In that case, clients lack the vitality of an embodied self…” Page 43

Conclusion

I appreciate Guided Drawing’s multidisciplinary approach; I think that this integration of somatic, movement, drawing, rhythm, bilateral stimulation, top and bottom down approaches, mindfulness, and all the various therapeutic interventions in the Guided Drawing therapist’s toolkit, creates a rich and comprehensive approach to trauma healing. Healing Trauma with Guided Drawing, A Sensorimotor Art Therapy Approach to Bilateral Body Mapping by Cornelia Elbrecht is a valuable addition to our developing understanding of all the various mechanisms at work within the human system – body, mind and emotions – in the complex journey of trauma healing and recovery.

There is much more in this 300-page book than I have touched on in this article. For example, the book includes 100 images and anecdotes from client sessions that serve as helpful examples for how to apply Guided Drawing with clients. Elbrecht also gives numerous examples of shapes and structures that therapists can use to guide clients in their healing.

About the Author

Author Cornelia Elbrecht is the founder and director of the Institute for Sensorimotor Art Therapy in Apollo Bay, Australia.