The Inclusion of Expressive Therapies to Promote Cultural Safety with First Nations People

I acknowledge the traditional owners of this Country and the Kaurna Land [AT1] on which I reside. I recognise Aboriginal people’s continuing connection to Land, Sea, Waterways, Sky and Culture. We pay our respects to Elders, past and present and emerging. I acknowledge that I benefit as a result of being a White Australian, and I stand in solidarity with the First Nations people.  Sovereignty was never ceded, and this always has and always will be Aboriginal Land.

Image Credit: L. Weill [1]

Often in my mind, I see the image of a little girl. She’s always doing different things and surrounded by different materials. In one image, she has a pile of books beside her as she flips through the pages of a paperback triple the size of her hands. In another, she has her head bent over a sketchbook at a desk. Another image shows that sketchbook replaced by a notebook covered in her messy scrawl. Her friends often wonder how she has so much creative energy in her. Her parents can’t wait to see her bestselling novel on bookshop shelves one day. But none of them know what internal struggle this girl is battling, and the only thing she knows how to do to make herself feel better, is to create. Years later, that little girl writes this post, not wanting people with their own battles to face them alone the way she did and knowing that creation can be a way to help with that.

Throughout history, Aboriginal and Torres Strait Islander people have connected with their community, their land and their ancestors through art. Whether it be through dance, traditional paintings, or through storytelling passed down by ancestors, these creative practices have acted as a tool for healing amongst the many First Nations communities across Australia. In more recent years, various counselling and psychotherapy services have begun working in conjunction with First Nations people to create a more culturally and socially aware counselling space that the community would feel comfortable approaching for support. Mental health, like most other systems in Australia, incorporates a Westernised lens to their counselling practices. Modalities like Cognitive-Behavioural Therapy (CBT) have often been criticised for their more structured approach that can, at times, be very confronting for clients, and research has been done to adapt it to fit some non-Western cultures [2]. Additionally, counselling has typically also been focused on the verbalisation of trauma - or ‘talk therapy’. But Expressive Therapies (ET) offer something a bit different and can incorporate cultural safety into a workplace that has rarely considered such elements.

Expressive Therapy, sometimes known as Creative Arts Therapy, uses various creative modalities to express one’s thoughts, experiences and emotions. It emphasises the non-verbal experience, and is known to bring out the unconscious elements of trauma that the client would’ve otherwise not known was there [3]. For First Nations people, many of whom experience intergenerational trauma, simply talking about the suffering they and their ancestors have experienced isn’t healing. Simply put, it’s retelling traumatic experiences that offer no opportunity to move towards a stage of healing. For many First Nations people, they might not be aware that their mental health is associated with intergenerational trauma. It has been suggested over the years that using art therapy modalities is a way to decolonise the therapeutic space and use an Indigenous perspective, rather than a Western one, to support First Nations clients in the therapy space [4]. Using modalities that are so intertwined within First Nations communities and allowing unconscious thoughts and feelings to be expressed through creativity not only creates a space for realisation, but also creates room for healing.

For thousands of years, ceremonial Aboriginal Dance has been part of their culture, with each tribe having specific movements signifying the country they resided on. Music is also another traditional and ceremonial part of their cultures. Tribes would play music at weddings, during Sorry Business, and for Dreamtime ceremonies, to name a few events. In many instances, music incorporates the sounds of the animals native to that tribe. Paintings have shown us the story of Aboriginal and Torres Strait Islander people for centuries. Each painting showcases the land and therefore the spirit of the people who live there. There are many painting styles that originated from First Nations people, such as Traditional Dot Painting, alongside the use of natural substances such as ochre that are used to create the paintings. Finally, the art of storytelling is an incredibly important pastime for First Nations people. The act of telling stories of their land and ancestors to the next generation is strengthening. Storytelling is the primary way that the history of First Nations people has been recorded and passed down [5], and it emphasises knowledge, history and community within their cultures [6]. Artistic expressions such as dancing, music, art and storytelling are used within a traditional Expressive Therapies session in a way that might differ somewhat from how Aboriginal and Torres Strait Islander people are used to. However, it also offers the opportunity to be adapted to client preferences and be inclusive of cultural practices.

There isn’t much research exploring the efficacy of Expressive Therapies in working with First Nations communities in Australia. The small amount of research that does exist emphasises how creating art related to one’s culture is healing [7], however it’s a long process due to the countless instances of trauma the community has faced [8]. One researcher, Binh Truong [9], highlighted that Expressive Therapies is the best therapeutic modality to use when working with clients who have experienced Racial Trauma. She states that “the creative arts connect the implicit and explicit memory of the traumatic experiences in the brain to provide a less threatening way to retell the incidents” (p. 24). (You can learn more about Racial Trauma and how to support clients here on Jack Castine-Price's Infographic). Truong goes on to highlight how the framework used within Expressive Therapies creates “neural pathways between traumatic events' physical, emotional, and cognitive components” (p. 4), and that the open-ended creative process promotes a healthy power balance that is especially important with marginalised communities who have faced trauma from their oppressors that abuse such power. Malchiodi highlights the sensory-based experience that Expressive Therapies promotes. She goes on to say:

“By relying on sensory-based, image-based expression the arts have something unique to offer. Nonverbal approaches are also significant in that they provide particularly useful treatment for clients for whom verbal language is inaccessible… (and) these sensory/image-based communications may be potentially useful for those who have experienced trauma” (p. 187).

Aboriginal and Torres Strait Islander communities have experienced numerous traumatic occurrences throughout their lives as a result of colonisation, the Stolen Generation, systems like Child Protection, and instances such as suicide. Expressive Therapies can be an outlet for them to heal from their trauma without needing to verbalise it to their therapist. Art making crosses language barriers, and the cross-cultural implications of conducting a session with a First Nations client using creative arts can form a strong therapeutic rapport to help aid in their healing process. However, art for First Nations people differs from how Western people view art, which is “more individualistic and often emphasizes the aesthetic appeal of artwork” [11]. The most important aspect to remember in this instance, is that what works therapeutically for one client won’t work for another. How art is used in that client’s culture needs to be considered [11], as well as what the individual themself prefers. That is that will affect the therapeutic relationship and the subsequent outcomes of therapy.

Creativity helped me through the various struggles I faced throughout my life, but it’s not a new concept. As counselling in Australia has adopted a Western mental health model, the way of healing for our First Nations people has been overlooked. It’s important that as up and coming practitioners, we consider all modalities of trauma-informed healing that vary from traditional talk therapy, and work collaboratively with the First Nations community to incorporate their preferred therapeutic methods into the counselling space.

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[1] Weill, L. (2016). Australian indigenous art: A spontaneous art therapy. [Video]. YouTube. https://www.youtube.com/watch?v=ESVo7tlLOMg 

[2] Rathod, S., & Kingdon, D. (2009). Cognitive behaviour therapy across cultures. Psychiatry, 8(9), 370-371. https://doi.org/10.1016/j.mppsy.2009.06.011 

[3] Malchiodi, C. A. (2005). Expressive Therapies. The Guilford Press.

[4] McKenna, T. & Woods, D. B. (2012). Using psychotherapeutic arts to decolonise counselling for Indigenous peoples. Asia Pacific Journal of Counselling and Psychotherapy, 3(1), 29-40. http://dx.doi.org/10.1080/21507686.2011.631145

[5] Watarrka Foundation (n.d.) Indigenous stories with Indigenous people.  https://www.watarrkafoundation.org.au/blog/indigenous-stories-with-indigenous-voices

[6] Jenkins, S. (2013). Counselling and storytelling How did we get here? Psychotherapy and Politics International, 11(2), 140-151.  http://doi.org/10.1002/ppi.1297

[7] Archibald, L., & Dewar, J. (2010). Creative arts, culture, and healing: Building an evidence base. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 8(3), 1-25. http://www.pimatisiwin.com/uploads/jan_2011/01ArchibaldDewar.pdf

[8] Hergass, S. (2019). A model of art therapy for Aboriginal children within the preschool (Doctoral dissertation, Australian Catholic University). https://acuresearchbank.acu.edu.au/download/e7e602dc73627159d94640dfc79b893cebdc6db80fc5ea5f19c5c1e876c9324e/3574627/Hergass_2019_A_model_of_art_therapy_for.pdf

[9] Truong, B. (2023). Unpacking racial trauma and reclaiming a sense of self with the Expressive Therapies continuum: A literature review. Expressive Therapies Capstone Theses. 695. https://digitalcommons.lesley.edu/expressive_theses/695

[10] Green, A. R. (2018). Visual Expressive Arts therapy with children: Fostering multicultural competency. Emerging Perspectives: Interdisciplinary Graduate Research in Education and Psychology, 2(1), 1–13. https://journalhosting.ucalgary.ca/index.php/ep/article/view/42139