EXPRESSIVE THERAPIES IN TRUAMA, MENTAL ILLNESS AND SUBSTANCE USE RECOVERY
Expressive Therapies in Trauma, Mental Illness and Substance Use Recovery
Drama, Dance/ Movement, Play Therapies and Implications Toward Circus Arts Therapy
Kiendra Simpson
Department of Social Work SUNY Brockport
Masters Project Thesis
Dr. Pamela Viggiani
“Art is the meeting ground of the world inside and the world outside”- Elinor Ulman (Thompson, 2021).
Acknowledgments
I want to give thanks to some people who have helped me along the way. I want to thank my mom, brother, sisters, stepdad, and stepbrothers for pushing me to always do more for my education and for supporting me. My fiance for being my rock and always believing in me and supporting my career goals. I want to thank all of my professors and close colleagues from the past and current that kept pushing me toward my career goals. I want to do a big thanks to all circademics for doing the necessary work to make this thesis happen. Lastly, thank you to my circus family, Hooplah Troupe, and students I have made along the way. Without your input, this would have never happened. I am eternally grateful to all of you. You all keep me inspired and remind me that this work is important.
Abstract
This graduate thesis focuses on the use of expressive arts therapies with those who are in recovery from mental illness and substance use disorders as well as trauma survivors. The recovery model, person-centered care model, trauma-informed care model, harm reduction, and biopsychosocial model are further emphasized when utilizing expressive arts therapies. The following expressive arts therapies were included in the literature review of this thesis: drama, dance/ movement, and play therapies. The thesis ultimately aims to outline the concept of circus arts therapy being an integrated or intermodal expressive arts approach consisting of drama, dance/ movement, and play therapies. Circus arts interventions highlighted include clowning, flow arts and aerial arts. Social Circuses and non-for-profit circuses are highlighted as a community and at-risk youth intervention. The writer proposes more research on circus arts as an expressive therapy providing first-hand accounts of those who use circus arts as a self-identified therapeutic intervention.
Introduction
Traditional talk therapy has been used by mental health professionals since Dr. Sigmund Freud first coined psychotherapy. Psychotherapy has been shown to be very effective with those who utilize it, however, recent research has been expanding around other types of therapies alongside psychotherapy. The core competencies of social work practice are to demonstrate ethical and professional behavior, engage diversity and difference in practice, advance human rights and social, economic, and environmental justice, engage in practice-informed research and research-informed practice, engage in policy practice, engage with individuals, families, groups, organizations, and communities, assess individuals, families, groups, organizations, and communities, intervene with individuals, families, groups, organizations, and communities, and evaluate practice with individuals, families, groups, organizations, and communities (Council of Social Work Education, 2015). The core competencies show that utilizing therapeutic intervention with individuals is integral to social work. The therapy this thesis will be discussing is multiple modes of Expressive Arts Therapy. Expressive arts therapy can encompass all of the core competencies, this thesis will be highlighting these competencies periodically.
Expressive arts therapy was first pioneered by Shaun Mcniff, Paolo Knill, and Norma Canner in 1974. The definition of all expressive arts therapies are defined as a unique domain of psychotherapy and counseling, there are many kinds of these therapies. There is art, music, drama, dance/movement, poetry, play/ sand play, and an integrated arts approach (Malchiodi, 2007). There is some confusion about the difference between creative arts therapies and expressive therapies. The difference is that creative arts therapy is really drawing in on a person's creativity. From Buckwater’s podcast, Malchiodi says the word creativity can seem daunting to some (Buckwater & Malchiodi, 2021). Expressive arts therapies focus more on the creation of a piece of art rather than the outcome. Expressive arts further emphasize the act of expression may be of one's self, emotions, etc. To become a registered expressive arts therapist you need to have either a master's degree in expressive arts, a counseling-related master's degree, or a fine arts master's degree. The other way to become registered is with extensive experience in the field. Regardless, to become registered even with a master's degree listed before, you need to have extensive experience in the field as well as take courses to fulfill other requirements. To become a REAT (expressive arts therapist) you further get credentialed through the International Expressive Arts Therapy Association (IEATA). This thesis is concerned with only some of the expressive arts therapies listed above, they are drama, dance/movement, and play therapy thus, using an integrated expressive arts approach (circus arts) as a therapeutic intervention for those who are in recovery from mental illness, substance use, or trauma. Recovery is a term defined by the Substance Abuse and Mental Health Association as “a working definition” and is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (SAMHSA, 2012). They further have identified 10 guiding principles to recovery. These are hope, person-driven, many pathways, holistic, peer-support, relational, cultural, address trauma, strengths/ responsibility, and respect. The recovery model is something to keep in mind and utilize when using therapeutic interventions.
Person-Centered Care
Person-centered care was first coined by Carl Rogers in the 1950s. Tondra and colleagues (2014) explain there is no one definition of being person-centered. The subtitles of their module highlight the importance and important aspects of person-centered care. These include active participation and empowerment being vital, developing trusting, reciprocal and collaborative relationships are key, language matters and should reflect recovery values, all parties have full access to the same information, plans capitalize on the strengths and the values of lived experience, high expectations of recovery are the norm, natural community activities and relationships are emphasized, responsible risk-taking and growth are valued as part of recovery, the focus of care and planning is on personally valued life goals, cultural preferences, and values individualized care (Tondra et al., 2014). These concepts are all integral to utilizing any therapeutic process but will also be important to circus arts therapy. Person-centered care further is highlighted when using the recovery model.
Trauma-Informed Care
SAMHSA tells readers that trauma-informed care includes four “R’s.” The first R is realization, this is about trauma and understanding how it can affect people and families. The second R is recognizing the signs of trauma. The third R is response; to how the organization would respond effectively to trauma. Lastly, the final R stands for resist retraumatization (2014). SAMHSA further tells readers that trauma-informed care has six key principles these are safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and cultural, historical, and gender issues (Substance Abuse and Mental Health Services Administration, 2014). Trauma-informed care is necessary for working or talking with anyone to avoid the potential of triggering a person. A huge name in modern research around trauma is Dr. van der Kolk and his focus on trauma and how it can be stored in the body. In his book, he states “trauma affects the entire human organism- body, mind, and brain. In PTSD the body continues to defend against a threat that belongs to the past. Healing from PTSD means being able to terminate this continued stress mobilization and restore the entire organism to safety” (van der Kolk, 2014). This is especially important to note for this thesis for the emphasis on physicality the thesis has. Drama therapy involves body language, dance/movement therapy involves a wide range of body motions, and commonly play therapies do as well.
Harm Reduction
The National Coalition of Harm Reduction says the harm reduction model incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Meeting clients where they are at is especially important to being a social worker and truly utilizing person-centered care. Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction (National Harm Reduction Coalition, 2020). Harm reduction is important to note as there are other models for those with substance use disorders, this model is best used with those who may not want to or can not be completely sober. All of these models are important for this thesis as using any therapeutic interventions regardless of the population with these models is important. Harm reduction models and services especially have a place in this thesis as the festival/ rave culture that circus arts are popular in.
Biopsychosocial Model
Lastly, the biopsychosocial model is of importance to this thesis as expressive arts and other therapies in general use this model. Geroge Engel first coined the model in 1977, he proposed that more than just a person's biology has to be considered for treatment in health care settings. The other aspects Engel considered should be psychological and social toward a person's care. This is especially important to note for social workers. When all of these factors get considered this makes up a person’s well-being. Kim & colleagues (2021) looked into the biopsychosocial model in art-making with a population of older adults. This research focused on visual arts, performance arts, media arts, and creative writing. What they found was that using person-centered care and the biopsychosocial model of analyzing the results of art engagement, helped to explain the populations that chose each art mode. “Overall, females, those with higher levels of education, those whose personalities were extraverted and open to new experience, those having a large social network, and a positive attitude toward the arts were more likely to engage in any type of art-making activity. With the exception of sex, these findings do not support our hypothesis that biological/physical characteristics (e.g., age, chronic health conditions, and physical function) would be associated with engagement in an art-making activity. Rather engagement in an art-making activity is influenced by various biopsychosocial factors in older adults. Our findings confirm some of the biopsychosocial characteristics from NEA publications (i.e., sex, education, personality traits, social network, and attitude). With respect to specific types of art-making activities, engagement in the visual arts was associated with female sex and higher levels of education, while engagement in the performing arts was associated with the personality trait of extraversion. Engagement in the media arts was associated with male sex, higher levels of education, and the personality trait of openness to experience, while creative writing was associated with higher levels of education and a personality of openness to experience. Not surprisingly, a positive attitude toward art-making was associated with engagement in any type of art-making” (Kim, et al., 2021). The results are interesting and may show some direction in which population will benefit from different expressive arts interventions using the biopsychosocial traits of a person.
Performance arts can fit into the biopsychosocial model as circus arts is an off branch of performance arts. As an example, the University of Rochester and the Eastman School of Music has a new initiative, the Eastman Performing Arts Medicine. With this, they utilize the biopsychosocial model with performance arts such as dance, music, and more. They further assist performers with a multitude of different things such as medical attention for performance-related injuries and issues, mental health, healing through art, and helping others heal through art. The program manager's name is Gaelen McCormick. As is seen, by the services that are offered, there is an emphasis on all of the components of the biopsychosocial model. Since circus arts is a form of performance arts, the research shows that extraversion is a trait someone may have that would benefit from this intervention. Another factor that should be touched on more in-depth for the purposes of the thesis is the social component of the biopsychosocial model.
The social portion of the biopsychosocial model is especially important for those in recovery from mental illness, substance use, and trauma survivors. Tong & colleagues (2021) examined the use of community and the biopsychosocial model with a population of those with serious and persistent mental illness. One of the main findings of Tong & colleagues' research identified “social support was moderate–strongly correlated with adaptive coping, self-efficacy, and social integration, indicating that better social support can lead to better coping skills, self-appraisal, and social interactions for persons with SMI” (Tong et al., 2021). The social aspect in terms of circus arts is also a very large subject. Community around circus arts is one of the most valued aspects to clients that utilize circus arts. Community gives those a sense of belonging, Spiegel and Parent interviewed participants in social circus programs in Quebec about their experiences with social circus. Almost all of the participants noted the relationships they made through circus and the community as being huge factors to bettering their well-being. “We come to circus to get something… we need a sense of belonging, we have an unmet need that we filled with drug use, theft, all kinds of stupid shit we did to boost us, but at the end of the day, it was always negative” (Spiegel & Parent, 2017). This quote speaks volumes to the positive social benefit of circus arts. The biopsychosocial model is valuable to circus arts as an expressive therapy and is shown to be very useful for the well-being of people. Utilizing the following models of care are especially important for expressive therapies.
Body Mind Connection
An important aspect to discuss inside of this thesis is the emphasis on humor, somatic and kinesthetic movement as a way of healing as well as the mind-body connection further identified in the biopsychosocial model. This further is proved by Dr. van der Kolk's work regarding trauma remaining in our bodies. In Dr. van der Kolk’s chapter losing your body losing yourself, Dr. van der Kolk tells readers about a patient named Sherry. He says as soon as Sherry came into his office he could tell by her body language and motion that she was “afraid to face the world.” Dr. van der Kolk said he could tell by how her shoulders were slumped and her chin was in her chest. This thesis correlates to this as Sherry’s physical body language is an indicator of her mental well-being. It further may show how she felt that she needed to be tense, preparing herself for the next trauma, and very close to herself. After talking with the doctor she disclosed immense psychological abuse from her mother as a child. She had a lack of relationships due to her own self-esteem her mother had broken down a long time before she had gone to therapy. Sherry further had scarring on her skin, she expressed that picking was something she could not control and Dr. van der Kolk endorsed this as a form of self-harm however, her suicidality was not a risk. Sherry may have used picking as a way to feel more in her body as she had been so disconnected from her physicality for years. Dr. van der Kolk further addressed how trauma survivors sometimes feel the sense of losing their bodies. Some of his patients told them they “could not feel whole parts of their bodies” (van der Kolk, 2014, p.91) For example, he would do an exercise for trauma survivors where they would guess what was in their own hands while blindfolded, it would be car keys, metal tabs from soda cans and more. A lot of trauma survivors were so disconnected from their bodies, that they couldn't make out what exactly was in their hands. Expressive arts therapies help clients to get back into their bodies and not just their minds.
A further important body-mind connection essential to this type of work is humor. Humor is important to any performance art and shows large benefits for those who use it. Smiling has been shown to help release neuropeptides to fight stress. Dopamine, serotonin, and endorphins also are involved when smiling and laughing. There is even research suggesting that faking smiling may help boost your mood and happiness (SCL Health, 2019). Humor is not for everyone however, in terms of drama and play therapies this can be essential at times. McGee talks about the use of a playful mind in his book titled Humor as Survival Training for a Stressed-Out World: The 7 Humor Habits Program. In this, McGee emphasizes the use of channeling your inner child and finding your own playful side (2010). Further, comedy is a genre of drama that can not only benefit a potential audience but the people partaking in it.
Somatic work should also be recognized for this thesis. Dr. van der Kolk addressed yoga as a great healing tool in trauma in chapter 16 of his book. A further great resource for utilizing somatic exercises for clients is a workbook called The Somatic Therapy Workbook by Livia Shapiro. Livia Shapiro highlights on page 23 of her book the connections between somatic therapies and somatic practices and the arts. There is an overlap between two of these concepts that bring us interventions such as the Alexander Technique, Body-Mind Centering, Feldenkrais Method, and Yoga (Shapiro, 2020). She further addresses somatic psychotherapy with dance/ movement therapy interventions such as Body-Mind Psychotherapy, Dance/Movement Therapy, Eye Movement Desensitization Reprocessing therapy, Hakomi Method, Moving Cycle, Sensorimotor Psychotherapy, and Somatic Experiencing (Shaprio, 2020). Although this thesis will not be focusing on these therapies, they are important to note because of the mind-body connection this thesis will be focusing on.
Lastly, kinetic-based therapies are great to add to the mind-body connection. One kinetic therapy, in particular, will be addressed in this thesis. This kinetic therapy is called kinetic release therapy and is offered by Edan Harari. Kinetic release therapy is defined as “a combination of various potent healing systems and its purpose is to heal physical and psychosomatic pain and restore emotional balance” (Harari, n.d.). This therapy is not traditionally used however, it is worth noting as it is an upcoming field. Harari has had great success with clients while utilizing this therapy. These are all important in regard to the expressive arts therapies this thesis will be focusing on as drama, dance/movement, and play therapies all require the use of a client's body. Circus arts further encompasses all of these expressive therapies thus, making this integral to discuss in this thesis.
Expressive Therapies
Drama Therapy
Drama therapy is the systematic and intentional use of drama/ theater processes products and associations to achieve the therapeutic goals of symptom relief, emotional and physical integration, and personal growth. It allows a client to potentially tell their own story, achieve catharsis, extend the depth and breadth of inner experience, understand the meaning of images and strengthen the ability to observe personal roles while increasing flexibility between roles (Malchiodi, 2007; see also National Drama Therapy Association, 2004). Drama therapy has been shown to help those in mental illness recovery. One study that shows this was done by Torrissen and Stickley, the writers examined the relationship between participatory theater and mental health recovery. Torrissen and Stickley did this by interviewing four people utilizing mental health services at Teater Vildenvei. Teater Vildnvei is a semi-professional theater company open to mental health service users and their allies. They based interviews from CHIME, “a conceptual framework that consists of: (a) 13 characteristics of the recovery journey; (b) five recovery processes comprising: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (giving the acronym CHIME); and (c) recovery stage descriptions which mapped onto the transtheoretical model of change” (Leamy et al., 2011). Torrissen and Stickley found when using the CHIME framework their participants noted having more confidence about communicating with others and having a healthier self-image when engaging in drama therapy are Teater Vildenvei.
Drama therapy further has been associated with helping those with substance use
disorders. Newman presents readers with two case studies. Both case studies were people in group drama therapy treatment after being in active addiction, the case studies may only include a small sample however, there is still importance in the findings. Newman (2017) reported that “during active addiction, the addict intoxicates themselves to reach a sense of disconnection from overwhelming feelings and intrusive thoughts. Drama therapy offers a safe place where this re-connection can be explored and difficult emotions can be contained and held in a healthy manner. Through character roles, letter writing, sculpt-work, and imagination exercises, participants have unlocked repressed memories that created unhealthy core beliefs, they have empowered themselves in relation to their addiction and most importantly, they have been seen, accepted, and have experienced a healthy group identity” (Newman, 2017).
Drama therapy lastly, has been shown to help those with trauma heal. Jones provides a case example of a young boy named Abui. Abui was a refugee that had some issues with bullies when he went to his new school. This article only includes a one-person case study thus, making the sample small again, this is a limitation of the study. Like the article before this, there is still importance in the findings. Jones tells readers of the success he had with using drama therapy with Abui. Abui had put on a small play about his trauma to his classmates, Abui thought of this by himself. “Abui’s experience illustrates how the arts therapies are similar to the ‘awake dreaming’ I referred to above. Abui had not been able to express what happened to him. As discussed earlier, just as dreaming enables the expression of trauma through metaphors and symbols, the objects and improvisations of drama enabled Abui to find a language to safely express what happened to him. Just as dream allows images and expressions that are not possible in the waking world, so drama therapy creates a space and image form for Abui to test and touch areas that he cannot engage with outside the therapy space. As it involves enactment rather than description, drama therapy allows the potency of live emotional encounters with the images” 2015).
Dance Movement Therapy
Dance/ movement therapy is based on the assumption that body and mind are interrelated it is defined as the psychotherapeutic use of movement as a process that furthers the emotional, cognitive and physical integration of the individual (Malchiodi, 2007 see also; National Coalition of Arts Therapy, 2004b). Dance/ movement therapy research has been done in relation to mental health recovery. Kiepe, Stöckigt and Keil did a systematic review to evaluate the effect of dance/ movement therapy as a therapeutic intervention for adults with physical and mental illnesses. Kiepe Stöckigt and Keil found dance movement therapy had a “positive impact for patients with breast cancer, improving quality of life, shoulder range of motion and body images as well as for patients with depression, decreasing psychological distress and increasing neuro-hormones (plasma-serotonin concentration). Ballroom dances such as tango and waltz improved balance and coordination in patients with Parkinson’s disease and had cardiopulmonary benefits in patients with heart failure classes I and II” (2012).
Dance/ movement therapy has also been done with those with substance use disorders. Fisher tells readers of their own experiences with clients partaking in dance movement therapy. One of her clients, Anna, highlighted the benefits of dance movement therapy in her recovery. Anna stated dance/ movement therapy benefits for herself were “healthy escapism, getting out of the head and into the body, inducing altered mind state without the use of drugs, safely losing inhibitions, learning from within, self-expansion, accessing creative play and valuing freedom of expression” (Fisher, 2005). Lastly, Dance/ movement therapy has been shown to help those cope with trauma. Bernstein discusses empowerment-focused dance movement therapy for those in trauma recovery. Bernstein discusses the Kolkata Sanved dance movement therapy model. Kolkata Sanved is a “Dance Movement Therapy-for-Change model that is unique, as it is practiced in the developmental context. Named Sampoornata [meaning: fulfillment], Kolkata Sanved’s model was developed to heal and empower individuals from marginalized communities, including survivors of gender-based violence and at-risk children and youth” (Kolkata Sanved, n.d.). With the model, Bernstein found that “Kolkata Sanved Empowerment-Focused Dance/Movement Therapy provides an emotionally safe approach which utilizes the full potential of dance for developing inner strengths and professional skills” (Bernstein, 2019). Bernstein further highlights the different kinds of dance interventions and their implications. They highlight creative, improv, and group dance interventions.
Play Therapy
Play Therapy is the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development (Malchiodi, 2007; see also Boyd- Webb 1999; Ladreth, 1991). Play therapy has mostly been shown in the literature to be with an adolescent, the adult research is little however, there were still some. Play therapy has been shown to help those in mental illness recovery. In Schafer’s book Play Therapy with Adults, there is a chapter Hutchinson (2003) wrote regarding the use of play therapy with adults who have disassociative identity disorder, more specifically adults that may have children alters. Hutchinson argues play therapy is a powerful tool for adults traumatized as children to recover a sense of self and regain social and emotional development.
Although there was very little on the relationship between substance use disorder and play therapy as an intervention there was one. Rubin, Smith & Kirby (2007) provide a chapter around this relationship. The chapter says “In my personal experience in working with clients struggling with SUD, I have found that one of the more interesting, well-received, and effective ways of directing Narrative Therapy metaphors occurs via framing SUD as a comic book-style villain and framing recovery as a superhero. Many clients easily embrace this concept and they have expressed enjoyment in creating the metaphor. More precisely, it was helpful for them to visualize their SUD as a “bad guy.” Correspondingly, many participants found it difficult to create a hero” (Rubin, Smith & Kirby, 2007). There further were some articles regarding play therapy with adolescence with guardians that may have a substance use disorder. A great chapter about this is in a book called Integrating Play Techniques in Comprehensive School Counseling Programs by Curry et al. (2013).
Lastly, play therapy has been shown to help those cope with trauma.”Play therapy, although largely viewed as applicable to children and adolescents, can be an effective therapeutic medium for working with adults with complex trauma who experienced early childhood interpersonal trauma. Because interpersonal trauma in early childhood significantly alters neurobiological and developmental functioning” (Olson-Morrison, 2017).
Integrated Arts: Circus Arts
The Integrated Arts Approach will be used as a definition of Circus Arts Therapy. Circus arts therapies involve concepts and ideas from drama, dance/ movement, and play therapies. The integrated arts approach is defined as involving two or more expressive therapies to foster awareness, encourage emotional growth, and enhance relationships with others (Malchiodi, 2007; see also Knill, Barba & Fuchs, 1995). For circus arts, this includes clowning, flow arts, and aerial arts as a therapeutic intervention. There is very limited research on the broad categorization of circus arts as an expressive therapy. Meilman (2018) chose to write a thesis similar to the topics of this thesis. Meilman also proposes circus arts therapy as an expressive arts therapy. They further touch on social circuses, social circus is an emerging field that utilizes circus activities with the aim of social change. This is mostly done through youth and community development. However, social circus is not the only way to utilize circus in benefiting populations.
Clowning
One of the most well-known forms of circus arts is clowning. Clowning mixes drama, humor, play, and sometimes dance and movement. History of Circus tells readers the history of clowns, “The first known clowns date from the time of the Fifth dynasty of Egypt, around 2400 BC. Later civilizations also knew about clowns. Early clowns were also priests and their roles were almost indivisible. Clowns of ancient Greece were bald and wore padded clothes to appear larger. Ancient Roman clowns wore pointed hats and were the butts of the jokes. Italian commedia dell'arte of the 16th century introduced masked characters Arlecchino (Harlequin) and Pierrot (Pirouette)” (History of Circus, 2022). It is important to know the history that happened after this. Clowning and circus arts, in general, has a history mired in racism. Clowning actually was the origination of black face, something not many people know about. Two well-known black face clowns are Richard Ward “Dick” Pelham and George Nichols. Today, clown schools around America either highlight the atrocities that the art form of clowning has done in the past or do not address it at all, this thesis highlights this as clowning could be something that someone receiving services may know as being offensive and is further important to note as a circus educator. Today, the concept of clowning, as defined by The Clown School based in Los Angeles California says “we think of the clown as a natural part of your life, but one that has often been overlooked or pushed down, relegated to your dreams, where your love of authenticity and your attraction to both light and darkness continue to seek expression. We want your clown to burst out of you, to give license to your spontaneous, fearless, and playful self. We’re sure that your clown is creative and generous and always alive” (The Clown School, n.d.). This definition is important as it shows the therapeutic value there is to clowning. There is not just therapeutic value to the person clowning but also, to the person who may interact with a clown.
Hammerschlag (2016) tells readers “clown therapy is just another manifestation of solution-focused psychotherapy, resilience-based therapy, positive psychology, existential psychotherapy, and logotherapy that happens in brief encounters. The focus of those solution-based approaches always is on helping people identify their strengths rather than focusing on the problems. It's about asking the question: "What do you want, and what's keeping you from getting it?" It's active and involves listening to people talk about their dreams and imagining that they have the answers within to solve their problems. They all focus on people's strengths and getting them to think about what they want to change” (Hammerschlag, 2016). Hammerschlag also noted that one of the clowns expressed their experience with being a therapeutic outlet for someone. A woman had approached him in his red nose and told him a secret she had never told anyone. The clown said people are more trusting of you when you put on a red nose which was interesting.
Flow Arts
Flow arts is another circus arts medium this thesis will discuss. Most of the art this thesis will discuss is founded by BIPOC cultures. Now, these props are also associated with hippie and rave culture. Hippie culture is something that started in the 1960s however, is actually still very active today. Mulari (2021) tells readers of a flow art community in Finland and how the community relates to basic hippie culture themes and resistance. Mulari tells readers that not everyone in the flow community identifies with the word hippie however, some others do. The flow community is aware that they are labeled like this. Mulari further highlights the aspects of the flow community that mirror hippie culture such as peer learning as resistance, hugging as resistance, and spatial resistance in the city. Rave culture is something predominantly new, Huston tells readers how some may call rave events as spiritual experiences.”The rave is my church. It is a ritual to perform. I hold it sacred to my perpetuality ... we in the rave are a congregation--it is up to us to help each other, to help people reach heaven .... After every rave, I walk out having seen my soul and its place in eternity” (Huston, 2016). Rave culture is important to note for this as it is a somewhat meeting ground for flow artists. Rave culture is further beneficial to discuss because of the opportunity to provide therapeutic, crisis and life-saving services at these meetings. As most people correlate raves and festivals with drug use, there inevitably will be drug use at these events. However, there are now organizations that help provide harm reduction and crisis services at events like these. One of the most well-known organizations is DanceSafe. DanceSafe “is a 501(c)(3) public health organization promoting health and safety within the nightlife and electronic music community. Founded in the San Francisco Bay Area in 1998 by Emanuel Sferios, DanceSafe quickly grew into a national organization with chapters in cities across North America” (About Us, n.d.). DanceSafe further has two fundamental operating procedures they are harm reduction and peer support. A local organization that the writer just recently got involved with is PHREE TEMple. PHREE TEMple has similar goals as DanceSafe and involves volunteers going to various festivals to supply harm reduction and crisis intervention services (What We Do, n.d.). The most common drugs used at festivals are psychedelics such as Marijuana, LSD, MDMA, Psilocybin Mushrooms, Ketamine, and more. When working with those who may be in a psychedelic induced crisis rather than other drugs, there is some difference in how a provider would work with them. Right now, psychedelic-assisted therapies are becoming more normalized and accepted, psychedelics have huge opportunities for various uses however, these drugs should still be administered and used when it is legal and in a controlled environment. Raves and festivals are very overwhelming environments and easily can result in a psychedelic crisis. The Zendo Psychedelic Harm Reduction Training Manual tells readers the four main principles for psychedelic harm reduction is creating a safe space, sitting not guiding, talking through not down, and lastly, difficult is not the same as bad (Zendo Project, 2017). The conversation around rave and festival culture and flow arts at this point, would not be complete without mentioning the use of drugs in these settings.
Flow arts props include hula hoops, juggling, poi, fans, diablo, staffs and more. Flow arts also include acrobatics. The words flow arts can be something attributed to flow theory. Flow theory was first introduced by Csikszentmihalyi in 1975. Csikszentmihalyi proposed that flow is a state in which people are so involved in an activity that nothing else seems to matter (1975). The flow props above usually are coupled with dance and movement, play and sometimes drama. Flow arts is an integral part of circus arts as well as the rave/ festival community.
Focusing on specific props, the writer's favorite is the hula hoop, the writer has been training with their hula hoop for almost five years and has been performing for two years. There is seldom information on the hula hoop as a therapeutic intervention however, again with the emergence of circus arts academia there is some. Shannon & Patricia (2017) tells readers that hula hoop dance originated from Native Americans. There is no clear history of when it originated or how. There are three theories the first is some believe it was from the creator and that it was something for man to pass on as a gift. The second theory is southwest Native Americans believed that cliff-dwelling ancestors created it to give children better dexterity. The third and final theory comes from Anishinaabe culture told a tale of Pukawiss, he was born into their tribe and was different from other boys. Instead of hunting or running like most of the boys would, he would observe nature. His father was angered by this and disowned him. This did not stop the boy from watching the animals and he began to hoop dance to emulate the animals' movements. Later this was used as storytelling (2017). The writer found a thesis around the biopsychosocial and spiritual effects of hoop dance. Harrington shows readers that hula hoop dancing consists of various therapeutic methods such as dance and movement therapy, exercise therapy, mindfulness and meditation, mindfulness, and movement. Further other, non-therapeutic, benefits discussed are community healing and personal transformation, self-expression and discovery, spiritualness, and more (2014).
Another flow prop with some beneficial research is poi. Cain tells readers the history of poi spinning originated with the Maori people of New Zealand. “It is not known when poi dancing was created by the Maori, but it pre-dates their first contact with Europeans in the early 1800s and likely goes back to as far as 1500 A.D” (Cain, 2019). Sirs & Meek tells readers that ““poi” refers to any singular or plural set of tethered weights that may be held in the hands and spun around the body” (Sirs & Meek, 2021). Sirs & Meek highlight that poi may be beneficial to help clients with self-regulation, expression, and body awareness.
The last flow prop this thesis will highlight is juggling whether it is with balls, clubs, fire, knives or even eggs. Juggling Magic tells readers “juggling has a long and colorful history that goes back to almost 2000 B.C. Most historians think that juggling began in Egypt. Also, evidence of ancient forms of juggling can be found anywhere from the Pacific Islands to the Aztec Empire of Mexico” (2022). Nakahara and colleagues looked at juggling as an intervention for anxiety with seventeen females. The study found that juggling for six months lowered scores on the state anxiety, trait anxiety subscales of STAI and tension-anxiety, score of POMS were significantly lower in the juggling group than in the non-juggling group as well as Depression, anger-hostility scores of POMS were improved more than non-jugglers (2007).
Aerial Arts
Aerial Arts entails the use of apparatuses like trapezes, silks, aerial hoops, rope climbing, pole, and more to suspend a person into the air. With apparatuses, you can also do flips and drops that may shock a crowd. The oldest forms of aerial arts are rope climbing (taken from Mallakhamb which originated in India in 1135, this is also where the aerial pole was taken from) and flying trapeze. Barrett tells readers that the flying trapeze was the first aerial performance ever and was introduced in 1859 by Jules Leotard. The aerial hoop or Lyra was also used back during these times as well but, there were not many (2020). Kosma and colleagues did a study on undergraduate students who were beginners to aerial arts. It was shown that the practice of aerial arts ultimately decreased depression and stress scale answers (2021). Aerial is a very difficult sport and requires a lot of strength at times making the aerial community not as inclusive as others. Very seldom do bodies that do not fit the petite mold accepted or celebrated which is very harmful. The writer connected with an amazing award-winning aerial and burlesque performer, Ginger Snaps, that highlights the discrepancies between traditional euro- traditional performer bodies and bodies that may not fit that mold. She further advocates for the inclusion and teaching of plus-sized bodies in circus arts and performance in general. The writer took a workshop with Ginger Snaps and she supplied great variations and ways to make plus-sized bodies feel more welcome, supported, and determined in circus arts spaces. Another important note is highlighting not only the size of traditional euro-traditional performers but race as well. Aerial is dominated by euro-based dancers as well. Very seldom will you see black, indigenous, or people of color doing aerial. Aerial Physique acknowledges this in a blog post stating that aerial has become whitewashed (2020). One example of this is the focus on pointed toes during aerial arts, this is well known to be a traditional aspect of European dance. However, flexed feet actually are traditional in African dance thus, aerial arts emphasize forms of dance and motion that are from white-skinned individuals. Aerial Physique then interviewed many different black artists to let their voices be heard.
Lastly, it is important to note, circus arts involve more disciplines than just clowning, flow arts, and aerial arts. For this thesis, these are the only disciplines the writer knows enough about to discuss. Other disciplines may include martial arts, acrobatics, etc.
Circus Arts as an Intervention Applications
Social Circus
One application of circus arts as a social worker is the concept of social circus. “Social Circus refers to the use of circus arts as a medium for social justice and individual wellness and uplifts the role of art and culture as powerful agents for change. Social Circus practitioners support participants as creative change-makers through the collective development of self-esteem, solidarity, and trust” (American Circus Educators, n.d.). There are many social circuses all across the world. A lot are not-for-profit companies that focus on youth however, adults are welcome to join most of the time. The most well-known social circus is Cirque Du Monde, which was founded by a partnership between Cirque Du Soleil and Jeunesse Du Monde. Cirque Du Monde has some evidence backing this initiative. The mission of Cirque Du Monde as told by Fournier & colleagues is to “foster the personal and social development of at-risk children and youth” (Fournier, 2014). Although like many other social circuses, there is an emphasis on the youth population, more specifically, the at-risk youth population, Cirque Du Monde helps to propose a circus as an intervention tool in the world of social justice. Cirque Du Monde has eighty communities around the world. Some social circuses, since they are non-for-profit, have financial aid available for those who can not afford the high costs associated with circus training. However, it is important to note that just because a circus is non-for-profit does not mean they identify as a social circus. Some academics point out the fault in some social circus initiatives. Rogden & Alterowitz talks about Bessone research in 2017 saying “she (Bessone) underscores these definitions of social circus as “reinforcing reductionist views of ‘the other’ and unequal power relations” (Rogden & Alterowitz, 2021). Another viewpoint discussed is indicating it as a neoliberal viewpoint and further suggesting the colonization aspect this brings to other countries that the United States is known for. As social workers know, there are many different cultures, and most of them we are not familiar with enough to speak on. When someone from America goes to another country to teach the other country America's way, especially if they believe this is the only correct way, this can be seen as problematic and pushing colonialism as well as potentially whitewashing. America’s viewpoint on anything may not be the same for example as those living in Africa, one of the places where Cirque Du Monde is located. This further pushes America’s culture on people that did not ask for it. It is further important to discuss how some of Cirque Du Soleil's shows have been discussed to be harmful to some communities. Kessner, a non-binary circus artist, discusses how Zumanity, a Cirque Du Soleil show that was meant to be a more “deviant” show, portrayed a gay men's act. There is contention around Cirque Du Soleli and if this was harmful. Zumanity had first come out in 2003, gay marriage was not legal thus potentially making the act “a product of its time.” However, it is worth noting that Cirque Du Soleli does partake in advocacy now for gay rights, the show as being harmful still needs to be addressed.
Non- For- Profit Circuses
One thing important to not confuse is the difference between a social circus and a non-for-profit circus. The writer talked with the owner of “Circus Culture”, Amy Cohen. Amy has been a circus artist for twenty-five years and has been teaching circus arts for twenty years. Amy prides herself in her teaching style and places emphasis on theory, practice, creativity, and play for her students. She further states she really emphasizes meeting students where they are at. Circus Culture is a non-for-profit circus here in Upstate New York, Ithaca more specifically. Circus Culture further offers classes and financial aid for students who may need it to participate in their programming. Through connecting with Amy, the writer had gathered a lot of information about Circus Culture and Amy’s experience working in the field. Circus Culture's mission statement can be found right on its webpage. Their mission statement says “our mission is to provide circus education and opportunities for all in Ithaca, N.Y. We invite individuals and groups from the Ithaca area to engage with circus as an art form and life tool through classes, workshops, performances, parties, camps, and more. We believe in dedicated play, creative physicality, and inclusive community”(Circus Culture, n.d.). When the writer asked more about the organization's policies around financial aid Amy said “We never turn anyone away due to lack of funds, no questions asked. We work to build a relationship where our community feels comfortable asking for what they need and we always follow through. We ask participants to self-assess what percentage of the "list price" works for their budget and fill in the rest with our financial aid fund. We also subsidize private lessons, support transportation, plan schedules around public transit, and other aspects of working to bridge the gaps that may make it challenging for someone to participate. This is an ongoing quest. We provide classes for students of all ages and experience levels. We focus on individuals and groups who are interested in diving deep into circus and aim to continue supporting them as their interests grow and change. Due to our location, we have a mixture of circusers from urban and rural environments in upstate NY” (A.Cohen, personal communication, April 15, 2022). The last important thing Amy wanted to be known is that she does not consider Circus Culture a social circus but rather a community circus. The difference should be addressed here in academia. Amy told the writer “In my role at the American Youth Circus Organization for 10 years I spent many years witnessing various efforts to codify what Social Circus is. I think that like many things (and academia taught me this well!) it's really important to define your terms and work within those definitions for clarity, honesty, and understanding of one's limitations which ultimately leads to a more expansive possibility. I feel this way about social circus especially. It's a very polarizing term- some people want to use it (finding it celebratory, something to be proud of, something that gets funding in an honest way), some people don't want to use it (feeling it puts down the artists/youth involved as less than, feels like it tokenizes participants), everyone has different opinions about what it means…I choose to identify what we do as a community circus because I find it holds space for the most possibility and authenticity as things grow and change. I have a very grassroots approach - who we serve, when, why, how, where - it will all grow and change with community input over time” (A. Cohen, personal communication, April 16, 2022). Amy supplied very valuable information toward defining both social and community circus and the difference between these.
Healing Through Circus Arts Presentation
All of the following information was taken from a presentation done by Simpson, the author of this thesis. Since there is little research about circus arts as a therapeutic intervention, the writer decided to provide a space for those who have used circus arts as a healing tool to share their own stories through circus acts. The acts ranged from experiences of trauma, recovery from substances, recovery from mental illness, LGBTQIA+, grief, psychedelic-assisted therapy, hope-driven performances, and more. The acts further highlighted how the circus had helped the performers heal from these experiences through creating their acts or training in general. To participate, act creators had to write blurbs to tell the audience what their performance was about. The writer had provided a questionnaire to those that created acts as well as the audience. Both questionnaires included a disclaimer at the top stating the responses would be anonymous as well as the potential for their answers to be included in this thesis as well as saying their answers would only be looked at by the writer. For the privacy of those involved the writer has provided pseudonyms.
Methods
The questionnaires for the act creators included questions about making their acts. The questionnaires included these questions: How long have you been doing your art (dance, aerial, pole, ground etc.)?, What is your main mode of art and how did you start?, When did you realize your art helped you in a therapeutic aspect?, What did your act present?, What is the best part about your art? (ex: community, expressing yourself), Was this act difficult to create or were there any barriers you found yourself having to work through for your act?, Do you think your art was more drama, dance/movement or play based? (could be a mix of all), Do you currently have a mental illness or substance use diagnosis?, Do you currently utilize therapeutic services?, Do you find your art to be therapeutic?, How did the creation of your act make you feel? Before, during and after, and Did you notice any specific bodily sensations during the creation and/or execution of this piece? Lastly, the writer included a comments section about anything else the act creators may want to share. The audience questionnaires were all multiple choice. The questions asked were: Do you currently or have in the past attended mental health or substance use services?, Are you a mental health or substance use provider?, and What act stuck out or spoke the most to you? As well as a comments section.
Blurbs
As was mentioned above, act creators had the opportunity to write a blurb to share with the audience about their act. Some endorsed using this as a therapeutic intervention itself, one performer, Samantha, writes about her experiences all throughout her life and how her art now is the one thing that helped to build her self-esteem. After going through traumatic experiences her whole life she notes were the reasons for her poor self-esteem. She writes “circus was the first time I really felt like I could be physically good at something. Circus taught me to stop looking at my legs and look at what my body could do. I enjoy learning new things. It helps my self-esteem.” Another participant, Carol, who has struggled with a co-occurring disorder for years wrote “ circus arts has provided an incredible avenue to healing for me. It has boosted my self-esteem and confidence to be able to express myself through movement and dance when I could not find words and watch myself achieve goals as I blossomed through my art. When my mental health improves, I have an easier time getting and staying sober, which is why practicing circus arts is so integral to my sobriety. It has also been incredibly healing to be in a supportive community where I bond with others over our shared art, instead of the facade of bonding with others over drugs.” She further writes “ I've found there is a direct relationship between the time I spend immersing myself in my art and my community and my ability to stay sober and fight my depressive tendencies.” Another performer, Cindy, writes of the hardships she has been experiencing for the past 3 years including multiple losses and her battle with mental illness “ I started cross-training in Aerial Arts and it has by far been the best medicine for my mental health. It has been the only factor I seem to have control, discipline, structure, purpose, and fun. Aerial arts keeps me grounded, and focused, restoring my sense of security and creativity.”
Act Creators Questionnaires
Performers apart of the presentation were aged 14- 40s. The time they have been training ranged from 5 months to 30 years. The modes of art mostly included aerial arts routines but there were also object manipulation, dance, singing, and clowning. The following was what the acts were based around based on responses from performers: reconnecting to themselves, confidence, creativity, coping with loss, facing fears, trauma, domestic violence, psychedelic-assisted therapy, overcoming anxiety, body image, the journey of religious deconstruction, focus, strength, the stigma of being LGBTQIA+; the stigma of pole dancing and reclaiming identity regardless of trauma. The following were answers provided by performers based on when they found that the art form of circus arts helped them therapeutically: after a toxic break-up, 6 months after starting, sophomore year of college after realizing it was a good distraction from harmful thoughts, immediately, when I realized I could teach kids the same art, when dealing with a loss and since returning from physical injury. Some important quotes to pull from this are “gave me an outlet when my mind did not”, “Aerial completely helped me turn my life around. When I discovered aerial, I began to socialize with people again. I also had a reason to stay free of drugs and alcohol. I never really had a hobby that I cared about until aerial, so it was freeing to find something to look forward to when I get out of work”, “I realized art was therapeutic when I was in college. I noticed that dance was not only my “escape” but made me in a better mood because that was my way of working out. Additionally, it was a way to express myself through movement.” When performers were asked what was the best part of circus arts almost every performer stated the community aspect as well as the opportunity for self-expression. Other things said were releasing emotions, entertaining people, the meaning behind routines, having a skill they’re good at, staying fit, feeling graceful, and strong, knowing they have ownership over their body, overcoming challenges, and loving teaching. Some performers had disclosed their mental health diagnoses, some performers had similar diagnoses. These were the diagnoses: depression, generalized anxiety disorder, social anxiety, borderline personality disorder, bipolar disorder, post-traumatic stress disorder, and undisclosed substance use disorder. The most common diagnoses among performers were generalized anxiety disorder however, some performers did not have a diagnosis. Some performers utilized mental health services, some utilized substance use services and some did not utilize any of those services. When asked if they thought of their art as a therapeutic aspect for them almost every performer except for two said yes. The two that did not say yes, said sometimes.
Audience Questionnaires and Observations
The audience questionnaires only had multiple-choice options, the first question was “Do you currently or have in the past attended mental health or substance use services?, the option to answer this was A. Yes in the past I attended mental health services, B. Yes in the past I attended substance use services, C. Yes in the past I attended both, D. Yes right now I attend mental health services, E. Yes right now I attend substance use services, F. Yes right now I attend both, G. Yes in the past and right now I attend (fill in the blank), H. No. Lastly, the questionnaire asked “If you answered yes, has this presentation made you think about your current services? Has the presentation inspired you?” Most audience members answered A, D, and H. There was a wide variety of those that had been involved are involved, or have never been involved in mental health care. For those that had answered yes, most respondents had said they were inspired as well as calling the presentation powerful and beautiful. The second question was “Are you a mental health or substance use provider?” The choices to answer were A. Yes I am both, B. Yes I am a mental health provider, C. Yes I am a substance use provider & D. No I am not. There was also the question in the event they were a provider “If you answered yes, has this presentation had you considered other ways of engaging and intervening with people you support?” Most respondents answered D however, there was one mental health provider and one provider who specializes in co-occurring disorders. One provider elaborated and said the presentation reiterated the need for somatic and movement work with clients.
Limitations and Implications
The presentation was not Institutional Review Board approved so, the data can not be the basis of anything and can be nullified. In the future, the writer would like to seek out Institutional Review Board approval so future research can be used amongst other academics as well as potentially be published. There are not many studies around this concept of circus arts as an expressive therapy thus, making this a somewhat pilot study for the possibilities of studying this phenomenon, since this pilot study is not Institutional Review Board approved there is still an opportunity to create a pilot study of this phenomenon. One that may include more strict guidelines for performers and facilitators.
More limitations could include the questionnaire, as it was not looked over by an IRB thus some questions were very vague and answered in various ways. Another is because this was not formal research so there weren't medical professionals to supply diagnoses of those who participated. A person could be potentially fabricating not having a diagnosis or having a certain diagnosis, this is not to say the person filling the questionnaire should not be trusted there is just no way to confirm or deny this.
As the thesis wanted to have a discussion around trauma as well, this could have been highlighted better in the questionnaires to performers. This was something someone actually asked about on their audience questionnaire. This is notable for the future. The thesis further could have looked more into the arts and activism. Lastly, the writer has only been training circus arts for a short period of time as compared to a lot of circademic researchers and educators.
The implications this research aims to suggest is the utilization of not only expressive arts therapies in therapeutic settings but also the coining of circus arts therapy. A further implication is toward policy, the policies in most mental health clinics do not emphasize expressive arts therapies. This thesis wants to push for more policy regarding these types of therapies.
Discussion
Circus arts can be utilized and best described as an expressive arts therapy, more specifically an integrated arts approach. Any therapeutic intervention used is important to be based on the recovery model, person-centered care, and trauma-informed care. Harm reduction further has space in discussion around circus arts as a therapeutic intervention. Circus arts therapy further can be best described as a therapeutic intervention utilizing the biopsychosocial model with a further emphasis on the body-mind connection as well as community building. General knowledge around humor, somatic and kinetic therapies with those in recovery, and trauma survivors can also be beneficial in utilizing circus arts therapies with those in recovery and trauma survivors. The integrated arts approach toward circus arts therapy consists of utilizing components from drama, dance/movement, and play therapies. Circus arts can be further made up of clowning, flow arts, and aerial arts. Circus further has potential for more than just therapeutic intervention for helping people including social circus and non-for-profit circuses. It is important to note the harm that has come from the circus, especially when working with communities that the circus community may have tokenized or discriminated against in the past. With changing times more circus schools and organizations are addressing this however, it is very important to note as a social worker potentially working in circus. When Rochester-based circus artists partook in a presentation around their healing and how circus arts contributed, almost all noted a positive outcome from the use of this art form. Lastly, more research needs to be facilitated on the basis of making circus arts a concrete therapeutic intervention. As well as circus arts in general. As times change so do the ways in which we treat people in recovery and trauma survivors, it is time to start helping those in recovery recover the way they want and may need. Circus arts may be able to help those in recovery and trauma survivors however, we need more research to help prove this, this thesis is a step in showing the potential benefits for those who need a different kind of therapy, not just traditional talk therapy.
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