What is art therapy?

LiAnn is an art therapist and counsellor At Living Well. She has 14 years’ experience and has lived in many countries.

What is Art Therapy?

Have you ever wondered what art therapy is or how it can be used? It's a question I get asked almost every time someone finds out that I trained to be an art therapist! Here's a brief explanation: 

“The focus is not on making beautiful art”

In a nutshell, art therapy incorporates art making or guided drawing into the therapy room. However, the focus is not on making beautiful art - in fact it can be really messy and look like nothing at all! Rather, the focus is on developing a deeper experiential awareness of one's own sensory perceptions by being present in the moment. Using the art making process therapeutically can communicate and express externally what's going on internally in a way that feels safe while at the same time creating new, positive experiences & neural pathways in the brain.

“Art therapy is one of the more effective trauma treatment methods (Dr. B. Van Der Kolk), helping the nervous system soothe, calm and regulate.”

As a ‘bottom-up’ approach, art therapy is one of the more effective trauma treatment methods (Dr. B. Van Der Kolk), helping the nervous system soothe, calm and regulate.  In addition, art therapy and the expressive arts more easily supports and restores healthy attachment through the areas of synchrony, attunement, grounding and engagement (Dr. C. Malchiodi).

In an art therapy session, you can expect a mixture of bottom-up (using movements and the senses) and top-down approaches (using thoughts, symbols and metaphors). This connects and integrates thinking and feeling and is especially important at the end of each session to help clients make meaning and gain insights of new perspectives that may come from their initial movements, marks and impulses.

5 Things I Learned By Going To Therapy

Simon Thomas works as a copywriter for a Christian charity in England, where he lives with his cat and several thousand books.

“ I’m writing the sort of article I wish I’d been able to read back then.”

There were about 15 years between deciding I should get therapy and actually booking my first session. The idea wasn’t in my mind the whole time, but it would often come to the surface in conversations – “Yes,” I’d laugh, “I should probably do something about that!” – knowing that I almost certainly wouldn’t nudge myself to do it that day, that week or even that year. So I’m writing the sort of article I wish I’d been able to read back then. The therapy I needed was very specific: phobia therapy. But I hope there are useful points of comparison, whatever sort of therapy or counselling you are considering.

I am arachnophobic – meaning I have a fear of spiders – which started when I was a pre-teen and got worse and worse over time. (Sidenote, in case you share this phobia: I will use the word ‘spider’, but there are no pictures or videos of spiders in this article. I don’t describe any encounters with them.) It’s a common fear, and a lot of people don’t like the creatures, but it was an increasingly debilitating part of my life. Fast forward to 2021 and it was getting out of hand. I couldn’t say the word ‘spider’; I was having panic attacks at the thought of them; I had regular nightmares about them.

But how did I go about getting phobia therapy? I couldn’t google ‘arachnophobia therapy’, because of the likelihood the search results would include pictures of spiders. I relied – not for the last time in this process – on the kindness of a friend, who told me about a service I could be referred to. There was a bit of a waiting period, and then my therapy started. Here are five things I learned along the way.

1.        I could set the pace

One of the reasons I’d resisted taking the plunge to phobia therapy was that I’d only heard of the most full-immersion version. I knew I didn’t want to go straight in the deep end, or be forced to encounter the scariest spiders. But my therapy was totally at my own pace.

The therapist – let’s call him R – was very intuitive in our conversations. I could say the word ‘arachnophobia’ but I couldn’t say ‘spider’ and, let me tell you, it’s not easy to explain which word you’re unwilling to say! But R picked it up on my hesitance immediately, and matched my use of ‘creatures’ instead of ‘spiders’ without questioning it. Throughout the whole process, he was keen to emphasise that I didn’t need to do anything I was too reluctant to do, and it was also fine if progress wasn’t totally linear. That is to say, if a session started and I was finding things harder than the previous session, that was all part of the overall arc of progress. There was no condemnation.

2.        Just being there was a triumph

“(The therapist) was a partner in this brave step of confronting something I wanted to change in my life.”

After so many years leading up to therapy, the biggest step of all was the first step. I was so proud of myself for starting the work of therapy, and it is one of the hardest things I’ve ever done. I prayed a lot before it started and I cried pretty much non-stop through the first two sessions – partly because it was emotionally quite overwhelming to have made the decision to get help, and partly because of R. He treated my phobia seriously. Even having someone recognise that I was struggling meant an awful lot. He didn’t think I was weak or silly for needing therapy – he was a partner in this brave step of confronting something I wanted to change in my life.

3.        I could set my limits

My form of counselling was exposure therapy. That meant I made an exposure hierarchy – a list of things I wanted to be able to do, starting with the easiest one and then working my way up in increments to the hardest one. It made the whole process manageable. I wasn’t going 0 to 100 overnight.

The first thing on my list was saying the word ‘spider’ – though at this point, of course, I just wrote ‘sp’ on my list. At the top of the list was watching a video of a tarantula. Crucially, I got to choose the end point. There are scarier things I could put on the list, but I knew I’d never need to hold a tarantula or go to the exotic spider enclosure of a zoo. The list ended where I wanted it to, in discussion with R. Making the list was quite scary, but it wasn’t hard to determine. Every phobic will tell you that this hierarchy already exists in our minds, even if we haven’t written it out.

Over the course of weeks and months, I’d repeat each step – staying in it for several seconds, teaching my body that I didn’t need to flinch and escape – until I was half as scared as I was initially. I didn’t need to be totally unafraid – I just needed to see sufficient change. Some weeks I took a step back on the exposure hierarchy. Other steps flew by. But the important thing was that I was still in control. R was there to encourage or prompt me, but I would never have to do anything I wasn’t ready for.

4.        People were much more supportive than I expected

R wasn’t the only person whose kindness made such a difference during my therapy. I enlisted various friends to help alongside, particularly my brother, Colin. For instance, when I got to the stage of looking at a picture of a spider, I knew I couldn’t turn to google – a page full of image search results would be far, far too hard. So Colin would investigate pictures for me, and even bought an encyclopaedia of spiders for me – sending it to a friend’s house, so I wouldn’t have to open a parcel unawares. That friend sat with me when I got the book, describing the pictures I’d see before I saw them, so I could prepare myself. My small group prayed for me throughout the whole process. I couldn’t have done this therapy as successfully without the care of friends and family, and I couldn’t have that care without being vulnerable to them.

“After all, only people who are afraid need to have courage.”

One thing that surprised me was how few people in my life were aware that I was struggling with arachnophobia. Looking back, it shouldn’t have surprised me – after all, I hadn’t told them! There were good reasons why I hadn’t said much about my phobia to most of my friends –people often unthinkingly respond with stories of horrible encounters they’ve had with spiders – but friends can’t support me if they don’t know I need help. People who don’t have phobias can never really understand the grip it has on your life, but they can still offer support, encouragement, sympathy and cheering on.

Several months into my phobia therapy, I wrote a Facebook post about it. Again, I felt nervous. What if people thought it was funny to reply with spider pictures and gifs? I knew I’d got to the point where I’d cope with a picture or two, but it was still a risk. Well, I underestimated my friends. People wrote such lovely and encouraging comments, and it meant a lot to have my courage recognised. Because, after all, only people who are afraid need to have courage.

“When you compare my experiences to other people’s, it might seem a small thing. I didn’t have post-traumatic stress disorder, or the legacies of sexual abuse, or even generalised anxiety. But I had something in my life that was slowly gnawing away at my ability to be contented and feel safe.”

5.        Therapy changed my life

I am still arachnophobic - but now I can manage it. The point of therapy wasn’t to make me a different person or to totally remove something I find difficult – it was to make me able to clean the kitchen, watch a film, or buy groceries without being constantly fearful. I no longer have panic attacks thinking about spiders. I have dreamed about spiders once since therapy ended – but, in the dream, I put my exposure therapy lessons into practice!

When you compare my experiences to other people’s, it might seem a small thing. I didn’t have post-traumatic stress disorder, or the legacies of sexual abuse, or even generalised anxiety (though they did ask me that a lot, to make sure!) But I had something in my life that was slowly gnawing away at my ability to be contented and feel safe. Therapy changed that. I am so grateful to R, to my friends and family, and to God. I’m grateful to 2021-Simon who made one of the most courageous decisions of his life and sought help.

“Asking for help might be scary, but I promise it’s worth the leap.”

If you are wondering whether or not to have counselling – please imagine what it would be like to live more freely than you do now. Whatever is hurting you can be improved. It might not go away completely, but you can be helped to manage better. Asking for help might be scary, but I promise it’s worth the leap. You can do it.

Ready to try counselling? Click here

Eight ways to prevent burn out in your team

As a counselling organisation working with charity workers, teachers and missionaries in Cambodia, we often see clients who are experiencing burn out. People sometimes think that burn out is only caused by having too much work to do but there are other causes too. The good news is that if you are in a leadership role in an organisation, there are things you can do to make your team less vulnerable to burn out.  And the fact that you’ve chosen to read this article probably means you’re already the sort of leader who is good at looking after your team.

“The fact that you’ve chosen to read this article probably means you’re already the sort of leader who is good at looking after your team. ”

One: Help your team to see the difference their making. Let the team know the results of their hard labour. For example, if your organisation is a school, help your team know the difference that education makes to the lives of Cambodians by showing how the lack of education has hurt the country in the past. Share stories of past or present pupils which show the difference your school is making. Find some research about the difference that maths skills make to quality of life and share it with the maths department. Find a teaching assistant who has brightened a student’s day and tell her about it. Notice how the school has improved in the last ten years, work out who contributed what to make this happen and let them know. If you’re in a mission organisation, a charity, a church or something else, think of the equivalent for your organisation.

Two: Give creative thank-yous People burn out when they feel underappreciated. If someone has gone above and beyond, write them a thank you card. When someone reaches their fifth, tenth or even twentieth anniversary of working for you, take the time to find out about the different things they’ve done and celebrate them with a gift and a meal. Think outside the box (but inside of what’s culturally appropriate for that person!) and find ways to show you appreciate them.

Three: Know your organisation’s values and hire people that match. A lesser known cause of burn out is when an employee has different values to the organisation they work for. Do you know what your organisation’s values are? Do you have a clear idea of how they look in practice or are they a set of vague ideals hidden in a word document somewhere in a maze of files? When you hire new staff, what could you do to help find people whose values line up with your organisation’s?

Four: Create a sense of community and enable your staff to find other areas of community too. A common cause of burn out is a lack of community and this is a particular challenge for people living in a different country to most of their old friends and relatives. Having work social events may not feel like a productive use of time but preventing burn out in this way could significantly reduce staff turnover.

And make sure work isn’t preventing your team from accessing other communities. Does their schedule allow them to see friends and family? Can they get to church regularly if they want to? If they live in a part of Cambodia with very few expats, what opportunities are there for them to visit parts of the country where they can connect with other people from a similar culture to them? Do they have good enough WiFi to connect with people back home and enough annual leave to be able to visit home every few years? While integrating into the local culture is important for many roles, it may not give everyone the sense of community needed to prevent burn-out, especially when the language and culture are still new to them.

“If we want our team to keep their work within their working hours, we need to do the same”

Five: Give people choices. A common cause of burn out is a lack of choice or control. There was once some research done in an old people’s home. The residents on one floor of the home were given a lot of choices: how to spend their time, what to eat for dinner, what film to watch in a trip to the cinema. The residents of the other floor had all of these things decided for them. The difference in results was so impactful that the residents who had been given more choices actually lived longer (even though the residents who didn’t get given a choice were having their decisions made by people who had their best interests at heart). Of course, this doesn’t mean you’re going to move your entire office to a rural village of Cambodia at a week’s notice just because one new member of your team wants to. But it is healthy to consider whether staff could have a little more choice and autonomy in their work or ministries.

Six: Make support available and make it normal. Provide your team with opportunities to share their struggles with you, with each other and with outside people. Research shows that people are much more likely to make the most of these opportunities when they are built in as a normal thing that everyone does, rather than something you have to sign up for. 

Seven: Model healthy habits. My sister was once being shown around the office on her first day of a new job and her boss said to her “You should always make sure you take a proper lunch break away from your desk. Although I can’t remember the last time I did that!” My sister said the message she took from this was “don’t really have a proper lunch break even though I’m saying you should. That’s not how we do things.” If we want our team to keep their work within their working hours, we need to do the same. If we want our team to access counselling when they need it, we need to do that too.

“ If you don’t want your team to burn-out, don’t reward people for setting off on the road towards burn out.”

Eight: Don’t praise over work. It’s great to reward people for going the extra mile or doing a healthy amount of hard work, but if we publicly praise people for working an unhealthy number of hours, we’re encouraging others to do the same. If you don’t want your team to burn-out, don’t reward people for setting off on the road towards burn out. Instead, let them know how much you appreciate their work but also encourage them to slow down, ask how you can help make their workload more manageable and praise them when they take steps to restore their work-life balance. 

If you’d like us to lead a seminar with your team about how they can protect themselves from burn-out, get in touch.

What have we missed? Let us know in the comments.

FIVE THINGS A TCK WANTS PARENTS AND OTHERS TO KNOW

Image by Passport and Plates

My name is Rachel, and I finally know the meaning of “home.” A third-culture kid (TCK) is a child who was raised in a culture outside of their parents’ passport country. Our parents and other adults in our lives play a vital role in supporting our unique upbringing and identity. TCKs spend a significant portion of our formative years outside our parents' home culture. We navigate a complex world that is unfamiliar to those around us. Here are five things I believe everyone should keep in mind when around TCKs.  

1. Take Time to Learn about the TCKs’ Experience

“When we leave, we take a bit of every culture we are part of with us.  ”

Being a TCK, we quickly learn to say goodbye, whether it’s us or others leaving. It is hard to explain where we are from or where our home is when we haven’t been to our passport country in a while.  I was fortunate not to relocate to multiple different countries while growing up. I was born in Canada, my father’s birthplace, but moved to Cambodia, my mother’s birthplace, when I was a year old and have lived here ever since. Yes, that was easy to explain, but when someone asks me, “where are you from?” I always go blank. My family returns to Canada every three years for the summer, and it’s always the same. We go to different churches, sometimes more than one, every Sunday. We visit supporters and friends during the week. Everyone always asks the same question or makes a similar comment: Are you glad to be home? Do you remember me? Did you miss your home country? Which country do you prefer? And the list goes on. Some of the most difficult questions TCKs have to answer are these. Although I know they ask with good intentions and genuinely want to know, it's hard to answer.  

I have a group of friends who all live in different countries, but we meet once a year, and during this time, we talk about our lives. One of our favourite topics is airports. Since we are all TCKs, we’ve travelled so much that we consider airports “one of our homes." We can laugh and joke around because we understand each other. It’s hard to relate to someone who doesn’t understand this life—to never have the ability to be fully something because we are exposed to so many cultures growing up. When we leave, we take a bit of every culture we are part of with us.  

2. Acknowledge Transition Difficulties 

“A benefit of being a TCK is that we adapt faster to change than most, but that doesn’t mean we don’t feel emotions when someone or something important leaves our lives.”

Transitions between countries and cultures can be particularly challenging; Moving to a new environment and adjusting to different cultural norms and expectations can be disorienting and stressful for TCKs. Parents need to support their children emotionally, acknowledge their feelings, and assist them in adjusting to these changes. Whether we’re homesick, confused, or have a sense of loss, it's important to acknowledge TCKs’ emotions. TCKs get to the point where saying goodbye becomes natural. It comes so naturally that we hesitate to get to know new people because we know someone will end up leaving. As we enter a country we’re not familiar with, we start to miss the little things—food, smell, culture, behaviours, etc. A benefit of being a TCK is that we adapt faster to change than most, but that doesn’t mean we don’t feel emotions when someone or something important leaves our lives. Some transition difficulties when relocating are learning new languages, adjusting to new social norms and customs, and navigating unfamiliar schools. TCKs have to re-adjust and repeatedly cope with the emotional impact of leaving places or people behind. I study at an international school, and my classmates come from all over. Every year, someone always leaves and someone new comes. Although everyone has experienced loss, I believe that TCKs are more affected by it because of how often we deal with it. It is important for parents and the other adults in our lives to acknowledge that transition is difficult, especially for someone who travels a lot. 

“One of my biggest ‘homes’ is my family, because I know I can go back to them.”

3. Maintain Traditions and Holidays 

It's important to maintain family traditions or have something that stays constant. To stay connected to their cultural heritage, my parents made sure we celebrated both Canadian and Cambodian traditions. We also created new traditions. I always look forward to traditions and holidays like Canadian Thanksgiving or Khmer New Year. I know that even if everything is changing, these traditions and holidays stay consistent. While adapting to new environments, TCKs often crave the familiarity of family traditions. Parents should try to preserve these meaningful traditions and holidays because they help with comfort and stability, staying in touch with both cultures, deepening connections to our family, and even feeling like these traditions are a safe space – a place to go back to.  

One of the biggest issues for TCKs is “Where is home?” When I was a kid, I always thought it was the place I live now or the place I was born. Both answers are correct; however, it never settled right for me. I feel as if I need to have a correct answer. But the truth is, it’s a broad question. Home can be the country or city where they were born, the place where their family currently lives, or even where they spent their childhood. To a TCK, home may not be a single, fixed location but rather a combination of places, people, and memories. One of my biggest “homes' is my family, because I know I can go back to them. My family is a constant thing, and I think it is important to maintain traditions so that TCKs know that they can always go back to their families. No matter how big the change.  

4. Don't Set Unrealistic Expectations 

“There is a constant need to meet the standards of every culture we are a part of.”

TCKs can feel under pressure to maintain a particular reputation or image. Parents setting expectations for their children can have a bad effect on their development growth and cause them to exhibit a false side of themselves. I think there are so many expectations that TCKs must uphold. There are so many assumptions and stereotypes surrounding TCKs. One of the expectations I think TCKs must deal with is having to act like someone they’re not. When I go back to Canada, I feel as if I must act Canadian or act like a “perfect missionary kid." I’m supposed to answer a bunch of questions and present myself in a certain way. When it comes to TCKs, I believe that people sometimes forget that for us, life is simply life—not the “TCK” life.  

If I’m being honest, there are some days when I feel like I’m living a double life. There are times when I feel I need to adopt different personas or aspects of my identity depending on the group of people or the cultural setting in which I find myself. Being selective or hiding parts of you to avoid misunderstandings or to feel like you belong. TCKs are expected to uphold a perfect image. There is a constant need to meet the standards of every culture we are a part of. We need to adapt and perform different roles quickly. It can feel inauthentic like we are not being fully ourselves. It can lead to uneasiness and a struggle with identity and belonging. Having to navigate these cultural and TCK expectations can be an ongoing challenge.  

5. Provide a Sense of Belonging. 

A TCK has benefits like travelling, meeting new people, learning new things, and trying new foods. However, there are negative aspects like not knowing where to call home, difficulty in forming deep relationships, feeling misunderstood, lack of closure, and my biggest one, not feeling like you belong anywhere. Not feeling like I belong is a huge one for me because I'm both Canadian and Cambodian. It’s challenging because, in Cambodia, I know that I’m not fully Cambodian. I don’t look, act, or speak as fluently as other Cambodians. In Canada, it's vice versa. TCKs have a relationship with every culture they can be part of, but we aren’t able to identify with different nationalities fully. It leads to a sense of loneliness and can lead to not knowing who they are. I know that you are never going to find someone who understands you 100%, but some people understand to a point. I think it’s important to know that TCKs struggle with this, so being there for them, even if they act a little differently, is important. Regardless of race, nationality, where we live, or our story, we are all the same in the identity of Christ. 

To Summarise

My friend reminded me that every TCK has a different and unique story and that no one can capture how every single TCK feels. I won’t be able to relate to every TCK, but I think it’s important to acknowledge all five of these points: TCKs’ experience, transition difficulties, traditions, unrealistic expectations, and sense of belonging. Because it is something that TCKs go through every day. I think parents and others should try to understand to make their lives and their children’s lives a whole lot easier. Remember for a TCK, it is just life, and we simply want to live it being the truest version of ourselves. We have different definitions of homes and different stories, but we are just kids who want to live life. 

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THREE WAYS TO TAKE CARE OF YOUR MENTAL HEALTH WHEN LIVING OVERSEAS

1) Be honest with yourself about the hard stuff 

Some people think that the key happiness is to be positive all the time. I can’t stately this strongly enough: this isn’t true! When we do this, the negative stuff just keeps piling up behind the damn of our own denial, and eventually that’s going to burst. Whether that damn bursting looks like shouting at your spouse, getting sick, feeling cynical or giving up on something important, that damn will burst if you don’t let the negative out. So, let’s admit the negative stuff to ourselves. I’ll start. Here are the things I find hard about my life in Cambodia: the noise, the fact that I’ve tried so hard to learn Khmer and feel I’ve not got anywhere, how itchy the mosquito bites are, that my niece won’t remember me when I next go back home, how expensive cheese is. That’s a start. How about you? What’s on your list? Let yourself name it and feel the feelings that go with it. Breaking that damn will allow the negative and positive feelings to flow more freely.  

2) Celebrate the good stuff 

In some ways this is the opposite to the point above but in another way it’s the same. It’s being honest with ourselves about both the good and the bad and not fixating on one and denying the other. A friend of mine once said to try to see Cambodia as the “land of milk and honey”. Now, every week I write a list of things I like that Cambodia has that my home country doesn’t. For me, it includes things like being able to swim outdoors without being too cold, tuk tuks, landlords allowing pets, not getting hey fever and the fact that the international community is full of people like me who don’t have a spouse or kids. Your list might be quite different. What would it include?  

3) Rest and rest well

Whether I check my Bible or my psychology textbook, they both agree that rest is important. We are like a phone and our battery will run out if we don’t charge it. Some things we do use up more battery than they did back home. Navigating different traffic systems, language, ways of doing things and even different weather takes up energy. While I was writing this article there was a power cut which disrupted my day. Even though these things aren’t big traumatic events (and we may experience those too!), each of these little things uses up a part of my mental battery. So our batteries needs charging more often. We need more rest.  

I used to have a bad phone charger that charged my phone super slowly. And I think sometimes, I’ve tried some bad types of rest. Things like scrolling through social media or watching endless Nextflix that did very little to boost my energy levels. But when I go swimming or do something creative, I get a new boost of energy. The best types of rest for you might be different. If you’re not sure what boosts your energy most, rate your mood out of five before and after doing restful activities, and see which ones have lifted your mood the most.

And of course, to make time for rest, you’re going to have to say no to things.  And if everything that takes up your time is important, then the solution is both simple and difficult: you’re going to have to say no to something important.

So, in summary, here’s some practical steps you can take to help your mental health: 

1. Write a list of what’s difficult in Cambodia (or wherever you are) 

2. Write a list of what you love about life in Cambodia that you can’t do back home 

3. Try some different restful activities and rate your mood before and after to see which ones charge your mental battery most 

4. Challenge yourself to say no to at least one thing per week 

Want to find more ways to invest in your mental health while living overseas? A counsellor can help you with that.