Cambodian Women’s Crisis Center: a mid-week reflection

We are now halfway through our trip, with five days of work at Cambodian Women’s Crisis Center behind us, and only two more to go. The work days have been physically and emotionally exhausting, and I admit I am challenged to synthesize my thoughts. Organizing a written reflection for public consumption is difficult when the experience is still so fresh, especially when my instinct is to focus on giving myself the care I need to replentish my energy for the coming day. But this is an important piece in the training, navigating the transitions between the several roles we play as professionals: being empathically attuned and available to clients, turning inward for self-care rituals at the end of the day, accessing the logical academic brain. So today after work I did my best to create a compressed version of the wind-down ritual. Pre-supervision chocolate soymilk, post-supervision shower to wash the humidity and sad stories down the drain, excellent barbeque chicken and peanut sauce from the stand across the street, a half hour of practicing ukulele on the balcony until the ants started biting, and now, sigh, the laptop.

Before I describe the past week, I would like to acknowledge our team’s debt to the two groups of NCAS-I students who came before us. It is because of their efforts that we are able to reap the benefits of this fruitful relationship with CWCC, and because of the strong bonds they formed last year, the staff and clients at CWCC anticipated our arrival and were prepared to engage with the materials and processes with open mind and heart.

CWCC’s mission is to provide  comprehensive one stop  service to victims of domestic violence, labor trafficking, and sex trafficking. The NGO provides a safe shelter for women and their children, legal services, counseling services, and occupational training. They also hold anger management trainings for perpetrators of domestic violence, citing that to help the women is not enough;  if the cycle of violence is to be disrupted, men must have access to services as well.  I found that to be quite culturally progressive, and applaud the scope of CWCC’s vision. Our work with the NGO is broken up into several parts. In the morning we work with the staff, doing trainings in Art therapy, Trauma-specific therapy, and Art based self care for mental health workers. In the afternoons, we work with clients in the relatively cool and breezy counseling room, which has been transformed into a vibrant, chaotic open studio. Each NCAS-I student has prepared an art intervention to present to the group, and several art making stations are set up at tables around the room. Because CWCC also provides services to so many young children, we students take turns running activities outside to keep the little guys entertained so that their mothers can focus on art making. Lastly, we are conducting individual art based assessments with clients in a separate counseling room. After being debriefed on a client’s history, we decide one of three assessments, and conduct a 50 minute individual session under the supportive gaze of a NCAS-I supervisor, a CWCC therapist, and our translator. This is not only an important learning tool for us students, but a source of unique insight for staff in terms of new possibilities for the direction of therapy.

Staff training is an integral aspect of our work here. We are only working with CWCC for ten days, our visit is a blip on the radar. We are not here long enough to establish the trust necessary for the work of trauma therapy. In fact, it would be unethical to attempt to go into such deep territory with a client under these time limitations. Our work here is to help staff access important tools that can empower them to be more fully present to their clients, to endure the weight of their work, and to not suffer overwhelm and burnout. I will share a story from Friday, when a few of our team members introduced a Yoga based activity. Our superstar translator, Panchena, explained the directive in Khmer,  “When we work with clients, we feel it in our bodies and we carry it with us. When we don’t work on that energy, it becomes trapped, and can hurt us.” Participants were lead in a twenty minute Yoga routine, and were asked to create two drawings; one to represent how they felt before yoga, and one to represent how they felt afterward. One staff member depicted a figure whose chest was full of blue dots. In the second drawing, the figure was surrounded by blue dots, with only a few remaining inside his silhuette. When asked to describe the difference between the two drawings, he responded, “Before, I was very anxious inside. Now, that worry is outside of me. There are some worries that I will always have with me, but those are just a part of me.”  This was a simple but profound example of how a combination of somatic experience and art making can be used to both inform and alleviate vicarious traumatization.

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In Transpersonal Psychology, there is the idea that the client directs the content of the therapy, while the therapist holds the context. That is to say, the therapist provides a safe container of walls and a roof, and the client fills the house with life. For the past two years, we have been learning the foundations and practical applications of Art Therapy. We come with an understanding of which art materials bring about certain emotional and physiological responses. We understand how image can serve as a metaphor for things which cannot be spoken, and how as images change, the internal experience can be transformed. We consider developmental trauma and Post-traumatic stress disorder. We also consider how socioeconomic status, the intergenerational trauma which exists in this Cambodian culture, and gender inequality might effect the way a client relates to the therapist and art materials. We consider the mission of CWCC, and what circumstances may have brought clients there. All of these elements factor into the context that we hold as student therapists.

Milieu therapy is another important aspect of our work and learning here. This refers to the more informal interactions that take place with and amongst clients in public group space. Clients are often at their most relaxed and natural, and tremendous interpersonal and intrapersonal shifts can unfold here, particularly with the nonverbal medium of art at their disposal.  While it often the picture of meditative absorbsion, at times the studio is a flurry of glitter and tissue paper, brandished brushes and peals of laughter. This calls to question, where is the line between therapy and playing? When we are having fun and getting to know each other over a language divide and a table full of clay, it looks very different from a traditional clinical practicum. Is this valid clinical practicum work? To address this, we carefully consider the way we construct these interactions in the context of transpersonal psychology. We are playing with children, yes, but we are viewing these interactions through the lens of developmental psychology and attachment theory. I keep a sketchbook dictionary, adding pencil drawings and asking clients for the Khmer translation. I repeat incorrectly several times amidst hysterical laughter, my American tongue unable to maneuver the nasal subtleties  and near-silent consonants of the language. I piece together crude sentences such as,  “Red is nice, I like cat” with great pride, and hold up a snakeskin triumphantly and declare “Bwoh!” The clients double over in laughter, as I have mispronounced and said the word for “stomach”. In our first two days of work, CWCC’s clinical team was away on retreat, and our primary objective was to build rapport with the clients, set ground rules for the studio, and help clients become more comfortable using the materials. I have introduced this collaborative vocabulary sketchbook as a personal intervention for creating connection, which will facilitate a greater degree of trust and communication for the coming week. It began quite spontaneously, I was sitting on the floor with a group of children, and an 8 year old boy handed me a stack of the mandala pages he’d colored. After marveling over his attention to detail and color choices, I picked a blank page and drew a star. On his page, he drew a star. I drew a monkey, and with a furrowed brow he copied my lines. for a half hour, we say and drew dozens of animals, mirroring each other’s movements, until we ran out  of paper. Already knowing the word for “cat”, I pointed at my drawing and said, “Ch-mah”. “Chmah!” he nodded in approval. I pointed at the drawing of an elephant and asked, “A nee how ay? (How do you say?)”
Boy:   “Dom brey”
Me:   “Bom dry?”
Boy:   “Dom Brey!”
Me:   “Bom Prayb??”
Boy:   (sigh) “DOM….. BREY!!!”
Me:   “Dom brey???”
Boy:   “Bah”   ***

This interaction snowballed into a frenzied dance of pointing, drawing, gesturing, and repeating. We were joined by a few other children, but the boy was clearly the leader of this game. There was an urgency to the exchange, the sense that everything hung on our ability to meet somewhere in the middle of the verbal chasm. It was giddy, breathless, and fun. The creation of this book became an important therapeutic tool for me. It allows for a shift in the power dynamic, letting the client  be the teacher and I the student. I am modeling behavior by entering an uncomfortable process and recovering again and again from small failures. And with each drawing recognized and word correctly pronounced, we celebrate a small victory. It bonds us, we have struggled together over a small hurtle and succeeded. We are establishing an element of teamwork and interdependence. We are engaging the client’s sense of autonomy and agency, that their input and effort are essential and invaluable. Through this book, I am communicating a desire to enter the client’s world, to connect and understand. The boy later said to our translator, Panchena, “I feel happy. When I draw a dog, she says dog, and she understands.”

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Does drawing pictures of objects and enlisting clients as translators count as Art Therapy? When viewed from a Relational or Feminist perspective, I believe it does. As therapists, one of the greatest gifts we can offer clients is our presence, our relationship. We communicate that they are seen, heard, recognized, and appreciated. Only in the context of trust, safety, and relationship can true healing begin.

*** It was later confirmed that the correct pronunciation is “Dom Rye” , and that when I was chasing children around the yard waving my arm like a trunk and making trumpeting noises, yelling “Jom riep sour, khnom chmouh Don Brey! ( Pleasure to make your aquaintence,I am elephant) ” it was very confusing for everyone.

 

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