Cathy Malchiodi, PhD, LPCC, LPAT, ATR-BC, REAT holds a doctorate in psychology and is an expressive arts therapist specializing in the treatment of traumatic stress. For the last 3 decades, she has worked with traumatized children, adolescents, adults, and families, expanding the range of understanding of nonverbal, sensory-based concepts and methods. She is the executive director of the Trauma-Informed Practices and Expressive Arts Therapy Institute that has provided online and live training in expressive and somatosensory approaches to over 25,000 practitioners around the world.
Dr. Malchiodi is the 2022 Cecil and Eda Green Honors Chair on trauma and expressive arts and is an investigator in a 3.7-million-dollar, 5-year grant with the U.S. Department of Education, integrating expressive arts therapy into classrooms. Dr. Malchiodi is a popular presenter and workshop leader, she has given over 700 invited keynotes and workshops throughout the United States, Canada, Asia, Europe, the Middle East, and Australia. She has authored 20 books, including the bestselling Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process and Understanding Children's Drawings. Her publications have been translated into over 20 languages.
Many clinicians are familiar with the idea that the “body keeps the score” when referencing the effects of trauma (van der Kolk, 1994, 2014). Malchiodi (2020) explores the use of expressive arts modalities to treat the effects of trauma focusing on how the body and senses need to be activated and explored while also using traditional talk therapy. Expressive arts counseling combines the principles of counseling with the creative process to promote healing. The use of expressive modalities can be especially beneficial to those who may have trouble articulating, with words, their lived experiences. Research has shown the effectiveness of using expressive modalities in working with children and adults, individuals and groups, as well as in, couple and family counseling (Gladding, 2020; Malchiodi, 2020). Expressive arts counseling can utilize music, dance/movement, imagery, visual arts, writing/literature, drama, humor, play, animal-assisted therapy, horticulture, nature, and wilderness therapies (Gladding, 2020). Malchiodi emphasizes the importance of utilizing these expressive mediums while activating the senses (sight, sound, taste, hearing, and touch). Essentially, expressive arts counseling is accomplished by creating different art forms and utilizing the senses to explore the inner and outer worlds of the clients and their lived experiences (Dunphy et al., 2013). Family counseling is designed to include the entire family in the process. While talk therapy may be effective with older children and adults, children talk through play. Utilizing expressive arts within family counseling recognizes the importance of the developmental levels of all family members and allows for young children to be active participants in family counseling (Armstrong & Simpson, 2018). Dr. Malchiodi shares her experiences with utilizing expressive modalities in various types of counseling, her path to becoming an expert in this modality and her lessons learned along the way.
Pender Baum: I really appreciate you taking the time to talk with me today. I think it will be helpful for the readers of The Family Journal to hear more about what you are doing and the impact of your work, as well as, your research in the field of counseling, psychology, social work, and education. If we could start off with you sharing a bit about your journey to where you are now in your career.
Malchiodi: Well, that's a big question. It's too existential.
Pender Baum: What led you to this specialization in expressive arts and your trauma-focused background.
Malchiodi: Well, I started out in the arts before I got into mental health work. So, I started with studio art, visual art and performance, and a bit of music and drama. That was the foundation. But you know, I think, like some of my peers, I was not really satisfied with this kind of solitary thing as an artist. There are a lot of people that love that solitude. I just always thought to myself, that I want to be interactive somehow. I also recognized early on that art was helpful in other ways besides just making art and putting it on a wall, or making music, or whatever, just for the sake of making art.
Pender Baum: So early on in your career you began to see a shift in that you enjoyed the artistic component but also needed a way to be more actively involved with others.
Malchiodi: Yes, but I didn't know about any field that incorporated art in an interactive way so I became an art educator. I liked the interactive nature of being an art educator and I got involved in that early on. I was teaching and working with young children, school-age children, adolescents and those in private public schools. That experience was great but then I started to see that what was going on with me as an art educator in a classroom was different than what a math teacher or an English teacher was experiencing.
Pender Baum: Tell me about the differences you were seeing.
Malchiodi: I was really in close proximity to students, helping them to do different things with their art, but also hearing stories. They were telling me things that happened to them, or relationships that they were in or worried about. Then, I started to hear more powerful stories, too, and some of the stories I started seeing in their art. One that I remember quite a bit still, to this day, was a girl who we would now classify, if we were going to diagnose as a counselor, with bipolar disorder, and she was actually showing me that in her work. Sometimes the work was very depressed with colors, and she would talk about this. I'm not having a good day; I have really low energy. Then she would go into these very creative moments, which one might classify as manic, high energy or anxious, though I don’t really like those terms. I started to notice those kinds of situations.
Pender Baum: So, looking back now, you can see their lived experiences coming out in their artwork.
Malchiodi: Yes. It led me to start talking with the school psychologist. I said I'm hearing things here that I don't think any other educator is hearing. And she was very appreciative of that, and said, you probably are because of the relationship that you have. It's felt more personal with each student in the art class. And then you are getting this story from their artwork. So, that got me interested in what is this? This is a really interesting; I really enjoy this. And then, all of a sudden the synchrony happened. There was an art therapy graduate program that opened up in the area we were living in California. I didn't even know what it was but I said, I'm going to get a master's degree and I signed up for it.
Pender Baum: So, again you were recognizing what you were seeing come to life in your art students and knew that continuing your education, exploring this art therapy concept, we your next adventure.
Malchiodi: Yes. It started me down this path. I do not think it was anywhere near what I needed to learn. The programs back then were very simple and they didn't have much research yet. They didn’t know much about what this thing was called art therapy.
Pender Baum: You first had this career as an art educator and then went into the art therapy graduate program. What came next for you?
Malchiodi: After I graduated, my first job was in domestic violence, working at a domestic violence shelter. I feel that this population sort of chose me. When you graduate and are looking for a job, you just go for it. I knew nothing about domestic violence and we didn’t even talk about trauma in my graduate program. That was not on the menu back then.
Pender Baum: It's not been that long that trauma has really been a focus in the profession.
Malchiodi: Yes, and I started working with children, and eventually mothers at that shelter and learned that this is something that people need. The trauma pieces. But there was nothing written about it at that point. So, then I wanted to expand my knowledge and get into mental health counseling and get my licensure. Eventually, I wanted to get into psychology as well.
Pender Baum: So, your journey started with the arts and through that experience you noticed this opening into the lives of those you were working with. An opening into their world; their lived experiences. But that left you noticing that something was missing. You could see this connection between their lived experiences and their art but wanted to learn more about how to draw that out in a healing way.
Malchiodi: I think the pathway now is a little different. I started with the arts and moved into mental health but I think many now go into the mental health field and then search for more of the expressive arts training after that. Really to expand their scope of practice. So, I think there's a broader way to go about this now. But a lot of people in my generation started out in the arts.
Pender Baum: Well, in a way, it was kind of meant to be. And this is something that I've noticed with expressive mediums; that you just start to notice what's for you. I see this a lot with dance and music like you feel it in a different way than you might if doing only talk therapy. There's just this way of being that emerges.
Malchiodi: I think there's probably play therapists that feel like that, too. I mean the whole thing of being interactive in some way. They always want to be really active with the people they work with, which are often children. But they work with families, too.
Pender Baum: Yes. And I find a lot of clinicians who work with families may lack the training in doing so. Have you seen this in your experience and also any connection with trauma work?
Malchiodi: I think what's interesting in the trauma field is a lot of clinicians and researchers are talking about these active approaches, but not a lot of them are actually doing them. They often fall back into the talk therapy approach. Perhaps that is because it is what they are used to. If you are used to being a therapist that sits in a seat with the other person in front of you, then it can be hard to get up from your seat and try something new. You're using your foundation. It can be a big change from what the clinician has learned but for me, it wasn’t a change because I started with the interactive approach. It wasn’t out of the ordinary for me to pull on expressive mediums.
Pender Baum: So, in a way, it is encouraging clinicians who perhaps haven’t had experiences with expressive arts to get out of their comfort zones and explore/integrate expressive mediums with clients to bring out not only their story/experiences but also healing.
Malchiodi: Yes. I just don’t see how you can process trauma without getting out of the words for a while, and into some other way of expressing oneself whether through art, music, drama, or movement.
Pender Baum: I'm seeing that more and more. I think that there's something to that. I’m wondering if you can talk a little bit more about that in terms of processing trauma, and with getting away from traditional talk therapy and incorporation of expressive mediums.
Malchiodi: Some of the benefits that I’ve seen most in working with the military and their families. I started out working with the children, and then ended up working with the families, and also the military personnel themselves, active military and veterans. But more recently, over the last few years, because of being involved in some grants of the United States, I’ve worked more with teachers in the education field and public schools. I was assigned first to work with the teachers and help them to learn some of this, to put it into practice in the classroom. Well, what quickly happened in the first year of doing that? The teachers were getting such a benefit from the activities themselves and they were benefiting their students by bringing these different ways of working with them into the classroom. The students were learning new skills but the teachers were saying this kept me from quitting their job. The teachers responded that they had been under a lot of emotional distress by things happening in the classroom, trying to keep up with the workload and then the pandemic hit and it was all too much.
Pender Baum: Yes. I think many of us can relate to the impact of the pandemic on our mental health.
Malchiodi: Yes. And it led me to think, what is it that helped them change? What was it that I was teaching them that had such an impact? My goal was to teach them skills they could use with their students but they were finding such value in them personally. I wanted the teachers to be able to use these expressive methods because they are the first line of intervention. They see the kids every day that may or may not ever go into counseling. I started to think, what is it that really helped them change and or feel this way, and respond this way and say this has changed me somehow for the better.
Pender Baum: What answers did you come up with?
Malchiodi: I found that people have to get up and move. We have to move our body in whatever means it can. The more we can move and add movement to the experience the more impactful it can be.
Pender Baum: I’m so sorry for the interruption from my daughter.
Malchiodi: No that's perfect because what Maddie just showed us here with that image, her drawing, those images are what generate language. We have over 25 years of studies now, that show that it doesn’t matter what you draw. But that there is a personal story attached to the drawing, the dance, the music, the art. The story starts to emerge from engaging in the activity. We now know, that the drawing and looking at that image stimulates language 2–3 times more than just talking alone.
Those are two things that I think the whole trauma field is kind of missing. They introduce movement or making sounds or any number of other expressive means but they don't take it through all the senses. So, you've got movement. You've got sound. You've got image making, and you’ve got storytelling from that. And that's what I think I'm finding with the teachers, because that's what I always do with them. I always start with some simple movement. It's not like getting them dancing, but it's moving in some way, even making a sound with that, whatever comes to mind, and then creating a Doodle of that.
So, one of the things I do a lot which we're doing over and over again now, because the students really enjoy in the classroom is just practicing different sighs. Because the sigh is a relief kind of thing physiologically and we do it all day long. And the students are doing that with the teacher. But see what's important there is. They're doing it WITH the teacher. Doing it together with the students, not just assigning them something in the classroom but making sounds together, moving together, getting silly together. Simply engaging together is therapeutic. And then making the pictures and showing them to each other. And talking about that. It's really that whole continuum of the senses. And that's what's restorative.
Pender Baum: So, your work has transcended beyond training clinicians and working with clients but also showing how expressive activities can be incorporated into the classrooms by teachers to have an impact on development as well.
Malchiodi: Yes. So, it's really simple. Obviously, teachers are not generally trained in mental health, but they picked up on all this stuff right away, and we're able to bring it into the classroom and put it in the curriculum, and have these 15-min sections each week, maybe two or three times a week. The students engage in these activities, but equally important is that the teachers engage with them. The arts can help us coregulate with each other. So, I think that that's the really key thing. We don’t need to just give somebody something to do. But it's that connection point which goes back to our principles of counseling. I mean, that's why I have counselors learn to do these expressive activities with clients. It's that cocreation together, mirroring each other, and responding to each other that is most impactful.
Pender Baum: Yeah, really it reminds me of what I always hear people say is the most important part of the therapeutic process; the therapeutic relationship that you have and being in that room together. And wow! What a powerful experience to go in with these teachers with the goal of helping them to bring these things into their classrooms with their students, and through the process of teaching them and them engaging in it that they also felt that it was healing for them.
Malchiodi: Yes. Opening up the therapeutic value in it themselves, really sounded like it had saved some of their careers.
Pender Baum: Have there been other ways you have found for your teachers or even families to find that therapeutic value in themselves?
Malchiodi: Yes. That makes me think of the opportunities to use treasures. Something special to the teacher or the family member that they either brought with them or have in their office. It's like, okay, you know, what? What is it about the object that you resonate with? What about the texture stands out? Really using the senses with the exploration of the object. Through the exploration of the object with the senses, the story that emerges from it; those experiences just highlight some really important points or places for the storytelling to come to life. This can be used to explore strengths but also the traumas they have experienced. So, you just start with these simple things. But it all rests in that relationship. It really does. I think that is why everybody who does any kind of counseling or psychotherapy needs to include some of the sensory stuff because it makes it. It amplifies it. It expands it.
Pender Baum: And it can be grounding for them, too, especially as you process through the traumas.
Malchiodi: And you know we can talk and do a lot of good with each other through talking. Words are certainly the way we communicate, but this other thing gives it a whole different level. The idea of I'm feeling it in the body, and the joy of that, or the curiosity or the mastery. Sometimes, you know, watching each other, master something. The playfulness that comes about. So, all those things are really important. I think that we just think, well, we're having a good conversation with somebody, but we can extend it in a lot of different ways. Just through some very simple expressive means.
Pender Baum: Of course. And for a lot of clients, I find that being able to externalize that way, whether it's with one of the senses, or drawing something, or writing a poem, or a letter, or whatever it might be is almost easier than saying the words themselves. Being able to kind of put it there and almost process through it in a way, without even verbally having to talk about the specifics of what's happening.
Malchiodi: Yes, that's exactly what it is. But sometimes it feels a little bit safer. I think one of the things about the arts you just articulated is that using the arts can help process through or explore the traumas in a safe way before or even sometimes without talking about it. When I think back to when I started with the domestic violence work, there were a lot of women who did not want to ever talk about what happened, but they made pictures of it or they wrote things that kept the secret but got out the feelings.
Pender Baum: Yes. It sounds like a way of honoring their individual experiences.
Malchiodi: And I think we talk a lot in mental health about honoring diversity and the intersection all these things through lived experiences because everybody's lived experience is different. Just the art itself. Just a drawing itself is, I think, a lived experience, and you don't necessarily have to put words to it. When you've been violated somehow you may not want to talk about it, but the lived experience is captured in the expressive medium. It is one way for people to get it out and safe. They may not be able yet to talk about their experiences because of their emotions or their own sense of safety, but they can put something out/get something out without having to use words.
Pender Baum: Yes. It makes me think about working with children and how play is their language but at some point, we shift away from that.
Malchiodi: Children have lived experiences they cannot always articulate in words. They don't have the words yet. They're learning. They're growing up and learning language. So, how do we honor their lived experiences? They come about it through all the creative expression.
Pender Baum: Shifting gears a little, I think one of the challenges that we see at least that I've experienced in counseling programs, is that a lot of state licensure boards are using Council for Accreditation of Counseling and Related Educational Programs as sort of the standard for being able to be license counselors now. Not all states endorse it but many do, and there's so many standards that I feel like as educators sometimes we get stuck in making sure that we're meeting those standards and not thinking outside the box. And so, I find my program is really pushing to make sure that we still have the expressive activities class or at minimum embed these mediums within other courses. We have a child and adolescent class which is heavily focused in expressive mediums. But I'm pulling it into other courses as well, like my trauma and crisis course. But I do feel like, though, there is very much a challenge in meeting the standards that we have to meet because there are so many to cover in such a limited time that they're in the program while also finding ways to bring that creativity in. It's important to remember that there is research to support the use of creativity in the work we do with clients.
Malchiodi: I think we're really at a place where we're starting to understand why counselors should be including this in their work and getting the best information and research, because the research is just snowballing, showing the connections between the senses and trauma. For example, how do you use expressive work to support mindfulness practice. All the things in play therapy that we need to know for children and their families. All that's expanding with understanding neuroscience and counseling. So yeah, I just kind of want to put that out there that Drs. Samuel Gladding and Thelma Duffy, who both passed away recently, really helped to move creativity in counseling forward for a long time, and I hope the field of counseling won't let that go away. People resonate with the American Counseling Association (ACA) division of Creativity in Counseling and that was in large part due to those two leaders in the counseling profession.
Pender Baum: I do think there's still a lot of interest in it. And, I think, when I think about the conferences that I've been to recently, ACA and the IAMFC conferences even our state conference, there is very much an interest in creativity in counseling. The key is ensuring that counselors are intentionally integrating expressive mediums in counseling and not just using gimmicky activities with no base of research to back it.
Malchiodi: Yes. We don't want it to be a set of activities. You need to know how it integrates with the practice of counseling. It's hard because it can just turn into a bunch of well, here's a good activity.
Pender Baum: Yes. Absolutely, we have the data to back up the use of and importance of expressive mediums in counseling. It also makes me think of the buy-in for it too. Not just from the counselor but the client. For example, I can barely draw a stick figure, but I can see the value in using say drawing in generating self-expression and the generation of the personal experience or story. What experiences or advice do you have in terms of perhaps the buy in for clients when you're trying to explore the expressive mediums with them and help them to see how it can be therapeutic and cathartic in their work?
Malchiodi: Oh, what I've been lucky with, and it wasn't always the case with the military was that after they started to see how well it worked with their children and their children invited them in, they actually just rolled with it. The children invited them in to see what they were doing. Early on, I worked with large groups of military children and their parents and a lot of the military parents were tough audiences to get the buy-in from initially. But many were shocked to see that their child thought or felt what they were experiencing. You know the level of worry.
The military personnel started to hear and see how helpful the expressive mediums were for their kids and then started to self-refer. They would say I've heard that you do things in kind of a different way. I’m not sure if this is going to work for me. But I've heard from some of my buddies, that this really is helpful, so I'm willing to give it a try.
It is common for there to be a lot of resistance. What I always say is we're going to spend some time figuring out what you're comfortable with doing. It can be a lot of different kinds of things. And I always say, you're an art space researcher in this with me. You're going to help me understand through whatever you choose to express through. But, they need to understand the why. So, I try to gently and sensitively bring that forward. For example, I try to help them understand how this is going to be helpful in different ways beyond words because words can just take us so far.
Pender Baum: So, really helping the family to see that they can have some control in the process and that it is about cocreating and the client(s) really helping us to understand them.
Malchiodi: One of the things that's really important for the military population, I found, was to keep them moving. I might say, you were trained to be strong, to be active, to use your body in some way. Let's see if we can go back to the ways that are enjoyable for you, but also help us learn about what's been going on, what feels good in your body, what doesn't feel good right now. Some of them have anger management problems. Some of them have posttraumatic stress. Some may have traumatic brain injury. There's a real frustration with those things going on. So, it's how you frame it.
But the movement doesn’t have to be physically taxing. Maybe they can’t move their body in the way they did before. You could use music. You could use gentle movements or even other sensations. It's about finding the entry point for each client.
Pender Baum: Yes, finding what they connect with. Like you said, not everybody is going to connect with drawing. But what other senses or creative mechanisms might they be connected to? And emphasizing your point about it being a process that you're going through with them and that they're really teaching you about their lived experience. We have covered a lot of ground. I have just one more question that I like to ask everybody that I interview because I think it's such an important focus. I wonder about your thoughts in terms of these expressive mediums and self-care.
Malchiodi: Well for me it's pretty easy. I don't know if it's that easy for everyone. But you know, once you get involved in expressive kinds of things you're going to find something you resonate with. Of course, I resonate with a lot with making visual art. So, I always kind of go back to that. So, sometimes I have to think out of the box here around that self-care. What is it that takes us out of that place; that disruptive or stressful place. How do we shake that off? How do we also experience in our own bodies in a joyful, re-sensitizing way?
Pender Baum: I feel like you're right. I mean especially for those of us who work with trauma. It's heavy and it's hard to take on every day. But when you’re actively engaging in the things that you're having your client do, it has that therapeutic release for you at the same. Any final thoughts that you'd like to share with our readers, which primarily are those working with couples and families.
Malchiodi: Well, I think you know we didn't talk much about it but you have so many options when working with couples and families. So, shake that up a little bit. Maybe they just converse on a piece of paper nonverbally. And with families using expressive mediums can equalize all the members.
Pender Baum: Thank you. It's quite the honor to be able to sit down with you this morning and learn more from you.
Malchiodi: You're welcome.
