The 6-year-old knew deep inside that the things her father and big brother had been doing to her were wrong. But she couldn't bring herself to talk about them.
For one thing, the words "sexual abuse" and "incest" weren't in her vocabulary. For another, the people who'd assaulted her were people she had been taught to obey and had learned to fear.It took crayons and paper and a friendly face to allow her to communicate her trauma.
The child was asked to do a series of drawings of her family.
"One day, all of a sudden, her father and brother turned up pictured with red eyes, sharp teeth and fingernails dripping blood," recalled Diana Partain, an art therapy intern working with the girl at the Evansville, Ind., Psychiatric Children's Center.
In discussing the picture with the girl, a team of therapists was then able to get her to talk about what had happened and how she felt about it, and to help her deal with her emotions.
The girl's case offers a demonstration of the communicative powers of art and its effectiveness within a relatively new form of therapy.
Art therapy belongs to a group of expressive therapies that includes music, dance and psychodramatics, and is steadily gaining acceptance in treatment of mental and emotional problems.
Through it, people unable to articulate feelings and emotions often find they can express things of which they weren't even conscious, said Larry Barnfield, a registered art therapist and director of the University of Evansville's undergraduate art therapy program.
It's not always as dramatic as in the case of the 6-year-old.
A 7-year-old at a shelter for victims of spousal and child abuse expressed his own, more confused feelings about his father when asked to draw his family and home.
The boy grouped himself, his mother and his siblings on one side of the page, in front of their house. The figure representing his father stood near the car, on the opposite side of the page.
What the boy found difficult to express verbally became painfully clear on paper.
"He wanted his father on the paper, but he couldn't be as close as he used to be," recalled Ms. Partain.
Other children have revealed loneliness, alienation and lack of self-esteem in pictures, either by setting themselves apart from other family members, picturing themselves home alone all the time or depicting themselves in obviously smaller dimensions than others in their families and peer groups, said Partain.
"Primarily, children cannot express themselves verbally, but art is second nature to them. Whatever they see, whatever they feel, they'll express it in art," she said.
Art therapy is more than a window into people's feelings, says Barnfield. It also provides a good developmental assessment tool with children and with mentally retarded adults, and it helps people develop physical, conceptual and social skills, he said.
Art as therapy has slowly emerged as a treatment method during the past 20 years, said Barnfield. During that time, about 30 colleges and universities have established undergraduate degree programs in the discipline, and more than 30 have created graduate programs.
Today, the technique is well-established on the East and West coasts, and it is gaining acceptance in major Midwestern cities. About 1,300 art therapists are now registered with the American Art Therapy Association.
One of the major challenges to further development is getting more clinicians to try art therapy, Barnfield said, debunking the concept by some that art therapy is more akin to making ash trays or weaving baskets.
What the art therapist is looking for are patterns that often emerge in the works, using those as a beginning point for discussions.