Art Therapy In The Female Veteran Population

“Women have greater odds of adverse mental health among deployed veterans,” (Hoglund and Schwartz, 2014, Lehavot et al. , 2012, Maiocco & Smith, 2016). In today’s society, a lot more women are joining the military. According to the Department of Veterans Affairs, there were 1. 6 million women veterans in 2014. Although more women are joining the military, there is still very little research on them. In Monson et al. (2012), they only looked at 6 female veterans out of 60 veterans. In case studies like Walker et al. (2016) and Jones et al. (2019), they only looked at male veterans. What’s even more alarming is that women are more likely to develop PTSD.

According to the Department of Veteran Affairs’ National Center for PTSD, 10% of women will develop PTSD compared to only 4% of males. The VA is an organization that caters to the needs of veterans, however there are gender disparities in care. A study by Fontana & Rosenheck (2006) looked at the overall comfort of female veterans in the VA system that predominately cares for men. The VA system created a program called the Women’s Stress Disorder Treatment Team (WSDTT) which focused on care, safety, and comfort of female veterans entering a VA (Fontana & Rosenheck, 2006). The research found that the women were more comfortable receiving these specialized programs if they had not been attending the VA before (Fontana & Rosenheck, 2006). Overall the VA has been proven to be a great organization in care. When looking at racial disparities in the VA, research suggests that the VA healthcare system has less racial disparities than other systems (Rosenheck and Fontana, 1994, Grubaugh et al. 2008). A pressing disparity in the veteran population is the lack of research for female veterans. Art therapy is another thing that has not been well researched in the veteran population (Lobban & Murphy, 2019). Art therapy utilizes different forms of art to help someone heal from a range of mental health disorders.

There are many mechanisms to why art therapy actually helps people. In Gabel & Robb (2017), they discuss the 5 therapeutic factors of art therapy. The biggest is symbolic expression, something that is discussed in a lot of research (Lobban & Murphy, 2019, Gabel & Robb, 2017). Symbolic expression is best defined as the use symbols, like colors or characters, to convey an experience (Gabel & Robb, 2017). Symbolic expression can be seen in many different pieces of art, not just therapeutic pieces. The other therapeutic factors of art therapy include: relational aesthetics, embodiment, pleasure, and ritual (Gabel & Robb, 2017). Embodiment is similar to symbolic expression in that, doing art helps people confront their trauma (Gabel & Robb, 2017). Art is fun. People generally enjoy creating something. Relational aesthetic means there in a nonverbal language that comes about in group settings, meaning the images depicted in art can tell someone’s story (Gabel & Robb, 2017). Gabel & Robb (2017) also discuss how art therapy can be delivered across all different models including: psychiatric, medical, wellness/prevention, rehabilitation, and to survivors of violence.

Art therapy is a very versatile form of therapy that can potentially help many people. Whether it’s in a group setting or one-on-one, art therapy has many benefits. The first being a sense of safety, which multiple studies and analyses have found (Brandão et al. 2019, Jones et al. , 2019, Walker et al. 2016). Safety is a very important thing. Feeling safe in an environment can mean that someone can be vulnerable, not always on guard. Someone is more comfortable opening up about experiences if they feel less judged. Another benefit is the relaxation that art therapy brings (Lobban & Murphy, 2019). When people feel more relaxed, they can also become more vulnerable leading to openness about trauma. Art therapy is a more holistic method of therapy. Drug therapy is commonly used in the psychotherapy world. Psychopharmacology can be beneficial for many people. However, medications tend to have unpleasant side effects (Brandão et al. 2019). These side effects may cause distress when re-experiencing traumas or cause general distress in daily life. Another important factor of art therapy can be community, something mentioned in a lot of research (Jones et al. , 2019, Lobban & Murphy, 2019, Gabel & Robb, 2017, Walker et al. , 2016). Communities are generally a large group of people who all share similar ideas and/or experiences.

In the case of art therapy for veterans, the community would be veterans who may have experienced similar trauma. Perry and Szalavitz (2017), discuss the importance of community in a book about children who have experienced trauma. In the book, it is stated that, “healing and recovery are impossible—even with the best medication and therapy in the world—without lasting, caring connections to others,” (Perry & Szalavitz, 2017, p. 260). This means that community is more important than any other form of treatment. Combining the benefits of community in group art therapy with the general benefits of art therapy, it could potentially be the most beneficial therapy for many different populations.

Intervention

Based on previous research, the intervention will then be conducted for the target populations. The entire population for the intervention will be female because of the gaps in veteran research. Ideally the intervention will be a racially diverse population. The age range for the sample will be above 18, the age where people can sign up for the military.

The women must be non-active members for this intervention. Although there are gaps in research on active duty members, this intervention is not addressing those specific gaps therefore only non-active members can participate. Any socioeconomic status is welcome to sign up for the intervention to ensure there are no further gaps in the intervention model. The women must exhibit some form of post-traumatic stress. Women suffering from PTSD or cPTSD are welcome to partake in the intervention as well. All women must go through a PTSD diagnostic checklist, a military duty checklist, and a trauma exposure checklist conducted by staff. To gain further knowledge on how the intervention effects certain traumas and symptoms, it’s important to have these checklists conducted. The intervention itself is targeting post-traumatic stress and the symptoms that are involved. The intervention is conducted as a group art class, nothing suggesting that the class is specifically therapeutic. The sessions will take place once a week for around 2 months, 8 total sessions. Each art class will be 1 hour in length. The sessions will happen on the same day every week, perhaps on a day that women interested can attend. This information can be collected through surveys.

Although there is a lot of issues with women participating in the VA system, the art group will take place at the VA. Hopefully the WSDTT will be able to promote the intervention in the community of women attending the VA. The art class will be facilitated by a trauma-informed professional who works at the VA. This professional will be a women to create a sense of safety for the participants. The classes will involve arts like drawing, painting, and sculptures which are called manual work (Brandão et al. 2019). Participants will have very little supervision in what they create. The facilitators main job is to be there in case someone is overwhelmed emotionally, helping them in any way they need. The reason for this is that the veterans will be able to create what they want or what subconsciously comes out. Some participants may have artwork that depicts deeper meaning and others may not. They have the freedom to create what they want, and what they need to heal. Every 2 weeks, 4 times total, participants will self-report symptoms, improvements in symptoms, overall impressions of the class, and overall impressions of the facilitator. This will help track whether symptoms are increasing, decreasing, or staying the same.

The overall impressions will give information on what is working and what is not. The facilitator will not have access to this information until after the intervention is over, making sure there is consistency between the sessions. After the sessions are over, all self-reports will be collected and examined to see if the intervention helped improve symptoms and if the women enjoyed the group. There will be a 1 month, 6 month, and year check-up for all participants. These check-ups would be the same self-report checklists received during the intervention. If the intervention works, there would be a significant decrease in symptoms across the participants. This decrease would continue long after the intervention is over.

Discussion

The intervention designed, a women’s art therapy group held at a VA, will most likely show promising results.

Although every case is vastly different from the next, it is believed that the intervention should reduce post-traumatic stress and associated symptoms. In a case study done by Walker et al. (2016), they followed a veteran on his journey through art therapy. He found that symptoms decreased and he already felt better after just 1 session (Walker et al. , 2016). Another case study following 3 veterans, showed similar results to the first. In Jones et al. (2019), Matt, Jay, and Dane all found art therapy to be incredibly healing. Each man was able to heal from their own unique traumas, even seeing symptom relief after the first session (Jones et al. , 2019). The intervention should help veterans realize their experiences don’t separate them from others. This is done through the aspect of community, taken care of by the group setting.

Art therapy helps create connections with other members, showing that their traumatic experiences are normal (Lobban & Murphy, 2019). Veterans are able to relieve their traumatic experiences through nonverbal means, which can sometimes be less traumatic for certain people (Lobban & Murphy, 2019). The intervention has benefits for all different populations, not just women. This intervention is specifically designed for women because there is a lack of research for women experiencing trauma. This intervention has been shown to work for people with depression (Brandão et al. 2019, Lobban & Murphy, 2019), traumatic brain injuries (Jones et al. , 2019, Walker et al. , 2016), and people with PTSD (Jones et al. , 2019, Lobban & Murphy, 2019, Walker et al. , 2016). Women veterans also want to feel a sense of community. The military is a very tight knit community that often feels distant from other members of society (Maiocco & Smith, 2016, Demers, 2011). Women veterans probably feel even most distant because there is lack of programs offered to these women (Fontana & Rosenheck, 2006). This intervention should help many women veterans find healing, community, and purpose after experiencing the traumatic life of being in the military. There are many potential limitations to the intervention that must be taken into account.

Although the intervention encompasses all branches of the military, different branches may have different effects during the intervention. Another limitation is the active versus non-active duty member. The intervention is designed to be used for post-traumatic stress, meaning that pre-trauma populations and peri-traumatic stress might not have similar results. Another limitation is the kind of art. Perhaps arts like theater and music should be integrated into the program. The intervention is only happening at a VA hospital, leaving other veterans organizations out of the research.

Finally, the last limitation to consider is the stigma around treatment. It took, on average, 11 years for veterans to seek help (Lobban & Murphy, 2019, Murphy et al. , 2016). Something to consider about the intervention is whether people will actually attend. There is quite a gap in research for women and for art therapy. Through this intervention, the population will have a women-specific therapy program. However, art therapy can work for a number of populations. Art therapy has been shown to have very beneficial effects. It is a holistic approach to therapy. It could be very cost-efficient, saving people large amounts of money they’d be spending on other forms of therapy. Art can also be cost-efficient because anyone can engage in art in their own homes.

Although more research is needed, art has the potential to benefit people with ongoing trauma. Art creates an escape into a world full of symbolic expression, all while experiencing a fun creative hobby (Gabel & Robb, 2017). The veteran population is increasing and so are the women. Research needs to be done to study how to help women veterans with PTSD. This intervention can be used for women who have experienced all types of trauma too. War and deployment can cause many different types of trauma, meaning this intervention can be applied in different women populations. Although there isn’t much research pre-trauma with art therapy, it could be a helpful tool while undergoing trauma. Art therapy may be able to lower stress and symptoms that could lead to PTSD. The best option is for people to seek treatment sooner, so research can be done on whether art therapy stops the development of PTSD. Overall this intervention provides research for both women and art therapy, giving women a method that can work for them.

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