Report by Kavita Pillai, Arts based therapist, Bapu Trust
Pinnari lives in a low income community of Pune, where there are no services for mental health. Bapu Trust provides comprehensive mental health care using mainly psychosocial interventions (individual and groups) and a wide range of alternatives. Bapu Trust also provides general health care inclusive of psychiatry.
This is a case study report of a 19 year old girl who experienced repeated rape and sexual abuse since she was 9 which continued through her adolescence. She married the man who raped her due to family pressures and is currently living together with him and a 6 month old baby.
Pinnari was referred by a fieldworker to Bapu Trust organization for individual counseling in February 2012, for frequent anger out bursts, fights in the family and neighborhood, wandering for long periods, very low functionality, high sexual needs and multiple suicidal attempts. She was at a very high risk of developing a severe mental illness or being institutionalized or being on the streets: wandering and homeless.
She was in individual counseling for a period of 7 to 8 months….although some work was done with her through individual counseling it was observed that beyond a certain point she was not being able to move in therapy; it was very difficult to engage with her through talk, she had many pre occupations with sex and her body, it was becoming more and more difficult to ‘talk’ to her. The traditional counsellorAt this point of time we felt the need to bring in some other techniques which was different from talk, to be able to engage with her and progress. Consequently, she was referred to the Arts Based Therapy (ABT) program of the organization.
When I saw her for the first time, she felt like someone who had many of the so called symptoms of a Severe Mental Disorder but not such that could fit into a category/ a diagnosis and I had my own anxieties of being able to work with her.
It is known that early childhood trauma can have long term devastating effects on the person who has experienced it, particularly where sexual violence is involved. This is exactly what we saw in her. Initially, we did a couple of mandala drawings and painting sessions with her so that we could understand where she is right now.
An assessment of the paintings revealed that she had a broken sense of her body. Her ‘self’ was completely fragmented, as if broken into parts… she was occupying only some parts of her body, there was no integration between what she is feeling, experiencing, thinking, sensing and doing. She had escalated energy levels (particularly sexual energy), there was a huge need for attention, for affection; she had tremendous anger and aggression issues, and love hate feelings towards others particularly her husband.
ABT interventions started with her within this context. The initial sessions focused on providing a vent to her anger using projective techniques. We gave her a space to ventilate her feelings towards her perpetrators through mediums of story and dramatizations. In these sessions we placed the ‘monsters’ of her life right in front of her, in a safe and non-threatening way. She was encouraged to express what all she felt towards these monsters, in the session: right from anger, hatred, guilt, love, attachment …. slowly we inched from expression to assertion. Our stories changed from how she felt to what she could have done, we started exploring different ways to end the story.
Over a period of time, the sessions helped her to understand herself, understand the concept of safe boundaries, to setting limits and protecting herself from abuse. She was in a way, ready to move on to another level.
Throughout the therapy period, we gave Pinnari the liberty to choose what she wanted to work with and when: we went with her pace, addressed issues based on her priority list, changed direction to another level of intervention on her cues and used an integrated manner of working with her and her family.
Even after the first rounds of sessions, on anger, we observed that she continued to talk a lot, and talk continuously; she was hardly listening and often went back to talking about body’s need / desire for sexual gratification. She was very uncomfortable with touch and hardly made any eye contact. She was still occupying only some of her self: far from integration and wholeness.
Over the next few sessions the focus shifted to giving her a sense of her body… what does it mean to occupy that space within her, what are different ways in which she experienced her body: at the physical level, at the level of thoughts, feelings, emotions, and senses….. what does it mean for her “to be at home?” These sessions were done using many embodiment and chakra healing techniques …. Over a period of time it was noticed that her conversations had shifted. Her ‘sex talk’ had drastically reduced, she was speaking in terms of the different roles she played in life, she was speaking of things that she liked to do: as if the broken boundaries were slowly merging. She was indicating a sense of direction.
Behind your thoughts and feelings, my brother, stands a mighty commander, an unknown sage – he is called Self. He lives in your body, he is your body.
People perceive and conceptualize most experiences bodily. Embodiment is the process of uniting the imaginary separation between body and mind. It is the process within psychophysical therapy that generates ‘presence’. Specific body techniques are employed to enable the person to generate energy: the individual no longer lends his body to an exclusively mental process but makes the mind appear through the body, thus granting the body agency.
In Hindu and tantric/yogic traditions and other belief systems chakras are energy points or knots in the subtle body. They are located at the physical counterparts of the major plexuses of arteries, veins and nerves. Chakras are part of the subtle body, not the physical body, and as such are the meeting points of the subtle (non-physical) energy channels, called nadiis. Nadiis are channels in the subtle body through which the life force (prana), or vital energy moves. Various scriptural texts and teachings present a different number of chakras. There are many chakras in the subtle human body according to the tantric texts, but there are 7 chakras that are considered to be the most important ones.
Different chakras stand for different areas of the body, and can disfunction in different ways. Feelings, thoughts, traumas, and even illnesses of the body can lodge in the chakras, impeding healthy energy flow. Chakra healing methods are designed to establish connection with the chakras, heal illness, emotional blockages, restore disturbed energies and balance out /harmonize intra and inter chakra energies
In the last round of sessions, we moved onto working precisely on this: on the other issues in her life, her purpose of life…. her motivations and aspirations, other people in her life- their stories, where in life her story and theirs met; what she would like to do, where she would like to go from here. We received constant guidance and mentoring, by our director, to think out of the box and come up with creative and effective strategies for Pinnari. Apart from working with her at an individual level, our team especially the fieldworkers and the then psychologist were simultaneously intervening with her maternal and marital family and specifically with her husband.
We had to ensure their support in understanding where she came from, to ensure that they make positive contributions in her life, to form a safety net around her incase of future slips, to build a sound sturdy network around her for her and themselves to brace serious falls. All this happened over a period of 7 months in Arts based Therapy.
Eventually she decided to move on, we respected her decision and the case was closed.
Pinnari case status: Resolved and Closed
|Arts-Based Therapyʼ (ABT):
Arts-Based Therapy is a term that was coined by WCCL Foundation in 2001, to represent the use of multiple art forms (music, drama, visual arts) and their combinations in therapy.
ABT in BAPU Trust:
ABT is used either as an adjunctive/augmentative therapy, to complement the work of other healers from different psychological and counseling disciplines or as an independent intervention for attaining specific mental health objectives. Simply put, ABT interventions involve the deliberate use of art making to address an individual’s psychological or emotional needs.
When an individual engages with ABT he/she gets drawn into both: the creation of art and the discovery of its meaning. When integrated within the models of counseling/psychotherapy, ABT provides individuals many opportunities to move into ones inner world in a safe and supported manner. The process itself is designed such that the person can process difficult emotional issues; develop insights on inner experiences and support personal healing.
Clients in ABT are more compliant, the recovery process as well as healing being more sustainable. Once exposed to arts based therapies, the individual can practice ones preferred healing methods independent of a professional, while engaging with regular healing practices fosters personal and spiritual healing over a long term.
BAPU Trust uses ABT interventions for clients who may be perceived as being ‘difficult’, who are not comfortable with ‘talk therapy’ or for those who may be suffering from severe mental disorders. These therapies are used either individually or in a group setting, in a clients’ house or in community spaces.
The creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness, achieve insight, reduce hallucinations and other disturbing symptoms associated with mental illness.