The TT-AT trauma protocol piloted in different international settings: Zambia, UK, Italy

ABSTRACT

Background

Art therapists have worked with traumatised individuals from the very beginning. Nevertheless, the effectiveness of art therapy in the treatment of Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) is not yet evidence-based. Studies suggest innovative treatments should describe clearly both the intervention, in order to facilitate replication, and the treatment targets, in order to facilitate assessment and research.

Context

In the ‘Trauma Treatment through Art Therapy’ (TT-AT) protocol, the intervention is described clearly, and the treatment targets are the six client symptom clusters listed by the International Society for Traumatic Stress Studies (ISTSS): (1) emotion regulation; (2) relationships with others; (3) relationship with self; (4) awareness of trauma; (5) distancing; (6) resources. The intervention consists of six sessions, one for each symptom and related need.

Approach

The TT-AT protocol – that was developed and piloted in Tanzania – is now being applied in three other countries (Zambia, the UK and Italy).

Outcomes

The group participants in the three countries followed the six themes easily. Some shared the history of traumas, even though verbal sharing was optional, and sometimes for the first time hidden traumas of the past. After the intervention they described being able to leave the past in the past, feeling stronger in the present, and more hopeful about their future.

Conclusions and implications for research

The TT-AT protocol can be replicated easily and it has clear treatment targets. This makes it suitable for use in research.

Plain-language summary

This article reports on the implementation of an innovative trauma treatment intervention (the TT-AT protocol) in three countries: Zambia, the UK and Italy.

The format is group art therapy and all the participants are women with a history of traumatic experience presenting with a variety of PTSD and C-PTSD symptoms. The six art therapy workshops addressed the six symptoms listed by the International Society of Traumatic Stress Studies (ISTSS). The groups are: (a) a group of six medical students in Zambia; (b) a group of five in a community mental well-being project in the UK; (c) a group of four private practice clients in Italy.

The article illustrates the art therapy process in each group. The participants moved through three stages, from the initial strengthening phase to the stage of becoming more aware of their trauma, to the final stage of trusting their own resources.

Feedback shows improvements in dealing with their past and in coping with present life challenges. This report suggests that the protocol is suitable to be applied to diverse countries and cultures.

KEYWORDS:

• Trauma protocol
• art therapy
• global
• international
• symptoms
• women

Acknowledgements

We thank psychotherapist Elena Arimondo for referring some of her clients to art therapy, and for administering the pre and post ITQ to them; Dr Richard Kunda, PhD, MSc, BSc, Dean of Health Sciences, Levy Mwanawasa Medical University, Lusaka, for enabling the delivery of the protocol in Zambia; and Nadia Mirghani, art therapy student, for co-facilitating the UK group.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding details

The authors received no funding for this work.

Confidentiality and consent

All participants have given their consent to publish their artwork, words and clinical content.

Additional information

Notes on contributors

Joanna Pearce

Joanna Pearce trained as an art therapist in Sheffield and later received an MA in advanced art psychotherapy at Goldsmiths. She worked for NHS Lothian for over 20 years in adult learning disabilities (forensic and mental health). As part of Zambia Therapeutic Art she has developed and delivered training to health and social care professionals and trainees since 2014.

Lillian Njobo

Lillian Njobo, MSC, PGDIP, BA, is a lecturer at Levy Mwanawasa Medical University, School of Health Sciences. She teaches psychology and counselling to health professionals and undergraduate students. Her practice includes work with children, adolescents and adults with various psychological problems. She is trained in the TT-AT protocol, TF-CBT (implemented with sexually abused children) and the Common Elements Treatment Approach (CETA), and as a practitioner and trainer in therapeutic art.

Emma Mills

Emma Mills is an artist and art psychotherapist who has worked since 2006 in NHS CAMHS teams, women’s domestic violence refuges and adult community mental health projects. She lectures for the domestic violence MA at Goldsmiths College and has developed and delivered training to education and social care professionals in Botswana since 2008.

Alessandra Agnese

Alessandra Agnese is an artist (Fine Arts Academy, Italy) and art therapist (ATI, Italy), recognised as an art psychotherapist by Goldsmith College, London. She has worked mainly with traumatic patients, for more than ten years in medical art therapy, with children and adolescents in paediatrics and child neuropsychiatry and with adults in oncology, hematology and bone marrow transplant; also with teenagers with physical and learning difficulties and with women in prison (UK). She teaches in art therapy training schools (APE, ATI) and has presented her work at several international conferences. She is an APIArT board member (Italian Association of Professional Art Therapists).

Paola Luzzatto

Paola Luzzatto, PhD, trained in London as an art-psychotherapist and worked at Tooting Psychiatric Hospital and St Thomas Hospital. In New York she directed the Art Therapy Service for cancer patients at MSKCC and developed the Creative Journey (AATA Clinical Award). In 2011 she started the European Network of Art Therapy, which became the European Federation (EFAT). She worked for five years in the Department of Psychiatry at Muhimbili University, Tanzania, where she developed the TT-AT protocol. She has written articles and an art therapy textbook. She is a full member of BAAT, AATA, EFAT, and teaches at ATI, Bologna, Italy.