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The making of mess in art therapy: Attachment,

trauma and the brain
Frances O'Brien
Version of record first published: 02 Jan 2008.

To cite this article: Frances O'Brien (2004): The making of mess in art therapy: Attachment, trauma and the brain,
Inscape: Formerly Inscape, 9:1, 2-13

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 THE MAKING OF MESS I N ART THERAPY
Attachment, trauma and the brain
by Frances O’Brien
Abstract
This article explores the hypothesis that artwork created during
art therapy may activate neurological structures of the brain
enabling non-verbal early experience to become known. Art
making is a right brain activity and early experience is
processed in the right brain. Art therapy can attempt to access
early emotional trauma which has caused damage to the right
hemisphere of the brain.
Mess is often present when working with children who have
had early experience of abuse or neglect. The article
investigates the meaning of this through a review of research
on attachment, trauma and the brain, and linking it with case
material. Early relational trauma is suggested as a possible
explanation. Mess may be a consequence of damaged neural
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lntroduction
I work as an art psychotherapist in a CAMflS team
offering long-term work to children, often from the
’looked after’ population, who have enduring
problems associated with early life experience of
neglect or abuse. When given the freedom to use the
materials, the room and myself to express their inner
world, these children can make an excessive mess,
whch feels chaotic. Finding a way of thinking about
mess became an important way for me to understand
it and to contain the uncertainty generated within the
session, which extended to the wider team. Mess
seems like a retreat from being with another person,
suggesting it might be a form of dissociation. Many
children with emotional difficulties produce well-
orgmised artwork in their art therapy sessions, but
where early infant relational trauma exists, especially
if in conjunction with sexual abuse, there is often
abundant mess and confusion. Children who can
make aesthetically pleasing drawings Seem unwilling
to resist the chaotic pouring, mixing and emptymg of
paint and clay in the art therapy room. Structure and
order disappear, lines or predetermined shapes are
seldom made, but organic pools of liquid flow over
surfaces (see Figure 1).
The child I call Bella is one of a number of children I
have worked with who have arrived in art therapy
traumatised by early abuse, having been abandoned
or neglected by their birth parents, and unable to talk
about what has happened. They are often excluded
from school, with foster or adoption placements in
danger of breaking down. They use the therapy room
and myself in similar ways. Using the session
intensely, they appear to relate but resist attempts to
relate to me as a person. Finding it impossible to
allow themselves to be in a relationship, they attempt
2 lnscape Volume Nine No. 1 2004
pathways resulting from early relational abuse with dissociation
used to repress the memory of abuse or neglect and to stop
thinking taking place.
Brain development in infants and young children is briefly
explained, including how interpersonal relationships with carers
and others are essential for this. Visual processes, the
importance of the gaze between infant and carer to establish a
feeling of wholeness, and good attachment are discussed,
emphasising the importance of regulation of affect by parents
and others, which leads to healthy development of the mind.
Key words: art therapy, attachment, brain, dissociation,
shame, trauma
to keep me silent in their areas of painful need.
To understand whether the mess in art therapy was
useful or whether it was a contraindication to
continuing, I needed to know what the meaning of
the mess might be. I was drawn into investigating
trauma, a complex subject discussed in the
neuroscience literature, but not yet widely considered
by art therapists. I have attempted to understand how
the brain develops during infancy and how relational
experience becomes part of that development. I
believe this augments understanding of what occurs
in the art room alongside the theory that normally
underpins art therapy. I also wanted to understand
how the brain deals with vision and imagination.I
developed three questions to look at these different
areas of the literature. Firstly:
How do children who have had experiences of
abuse, neglect and abandonment in their earliest
years, communicate and make sense of these
experiences through their use of the room, the
materials and myself?
It seems important for some children to have
repeated experiences of making mess; many art
therapists speak of it, describing it as a symbolic
communication (e.g. Sagar, 1990). At the Theoretical
Advances of Art Therapy Conference in 2000, Felicity
Aldridge gave a talk that included the subject of
mess, and animated discussion focusing on the
experience and meaning of it followed her
presentation. Trauma, caused by abuse, seemed a
common thread, and in discovering what constituted
trauma, and what resulted from chronic relational,
physical or sexual abuse, I found my second question:
What is the damage to the brain that OCCUIS when a
child is subject to early traumatic abuse and lack of
attachment?

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Trauma is defined as ‘any experience that causes the
child unbearable psychic pain or anxiety. For an
experience to be unbearable means that it
overwhelms the usual defensive measures’ (Kalsched,
1996, p. 1).Key texts by M o r e (1994,2003a, 2003b),
van der Kolk (1996), Trevarthen (1995) and Teicher
(2000) state that the development of the brain is
harmed in infants who experience relational trauma.
Allan S o r e (1994,2001a, 2001b, 2003a) describes
what happens to patients who have had insecure
attachment. Damage to neural pathways, the
hippocampus and corpus callosum inhibits the
exchange of information between hemispheres, and
prevents emotional experience being processed into
language. My third question emerged:
Is the right hemisphere of the brain, which is
imprinted with early life trauma, close to the part of
the brain that processes visual material in art? And
if it is, what are the implications for art
psychotherapy?
Children under three years of age process experience
in the right hemisphere (Schore, 2001a). Drawing is a
right brain activity (Edwards, 1979).The right brain is
used for both functions (Gregory, 1995,1998;
Edwards, 1979; Latto, 1995; Mollon, 2001; Trevarthen,
1995;Carter, 2002). Mess and trauma might have a
link that offers some explanation about the chaotic
use of the art room and myself. Mess might be a
valuable tool for the art therapist tracing the
experience of abuse back to infant life and enabling
preverbal memory to be accessed. It s e e m to be
possible, through the messy products that children
make, that they may be reconnecting neural
pathways by activating nearby parts of the brain
Inscapt Volume Nine No. I 2004
THE MAKING OF MESS IN ART THERAPY
Figure 1. Structure and order disappear
and organic pools of paint flow over the
work surface.
through a visual process that retrieves emotional
experience. I began to hypothesise that the chaotic
use of materials might express the trauma caused by
chaotic relationships of abuse, neglect and fragle
attachments.
Bella and our environment
Bella was the fourth child of a mother who was
educationally, financially and socially deprived.
Although her mother was never able to be ’good
enough‘, Bella clung to the notion that she was
attached. I understood there were drug and alcohol
problems plus sexual and violent behaviour and that
Social Services had been involved from before Bella’s ‘
birth. Bella was in care because she had disclosed
sexual abuse by both parents; she was neglected and
emotionally abused from birth and was confused,
unhappy and scared, having lost everyone she knew.
When I started seeing her, Bella was in foster care
with a family who could not contain her fears and her
disturbed behaviour was escalating. The trauma of
previous abandonment was active in her; she had
little support and no idea what was ahead of her. She
was seven years old.
Bella did not use the therapy to understand, but
exposed her emotional experience in paint and
repeatedly evacuated it. She enacted and represented
her traumatic early life experience making ’dramas’
to enact her feelings, often playing the part of an
older girl I call Mandy, or Mum or teacher. I was cast
in the role of Bella herself, or Mandy’s mum and
occasionally Bella’s Mum. A boy I call Curt was in
Bella’s imagination, often called on to express Bella’s
sexual feelings and to show me how her own birth
3
 THE MAKING OF MESS IN ART THERAPY
parents had acted. This did not seem to be a
conscious re-enactment, but was jumbled fragments
of experience.
Activities swiftly changed and materials cascaded
throughout the room. The mess not only consisted of
watery paint that spread over table and floor,
together with plaster, clay and soggy paper, it was
also the fragments of drama, the angry outbursts and
the refusal to allow me to speak or look that was the
character of every session. Bella needed repeated
experiences of existing in a real relationship and not
only in the fragmented world of fantasy she had
come to inhabit, or perhaps had never left; but early
in therapy she was unable to find ways of relating.
Bella was frightened of me and wanted me dead, but
at the same time I was an object of desire for her and
she wanted me to love and care for her. I needed to
find way of understanding her material so that I
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could help her towards symbolisation.
Bella’s sessions
Bella was in trouble at home because she wet herself
and smeared her faeces on bedclothes and walls. Five
early sessions were concerned with uncertainty and
confusion about urine and excrement and in the end
with bleeding from the vagina. She emptied yellow or
orange paint into trays or the sink each time she
amved. Balls of plasticine were dropped into the
paint the first week, and in the second, Bella angrily
threw a ball at the paint, making a splash. Furiously
she shouted and threw the ball again at the liquid;
table, walls, chairs and floor were spattered in yellow
paint. In the next session the yellow mixture
appeared again. Her feelings found words as she told
me it was ’wee‘, crossly telling me to stop looking at
her as shame became conscious. Her feelings became
more sexualised and the quantity of watery paint
increased. She told me that Curt could undo the zip
in her jeans and put his hand inside her clothing. As
she spoke she picked up a large container of watery
paint, she turned and it tipped, emptylng onto the
floor Her sexualised play escalated, she kissed and
caressed the cupboard doors. In the next session she
again got out the yellow and orange paint and filled
several mugs; then emptied them into the sink,
thickly coating the bottom and sides; she took small
stirring twigs and threw them into the paint. This,
seemed like ’poo’ floating in the ‘wee’. She left them
there for the rest of her session, unlooked at but not
forgotten. She filled a box with glue and paint, while
telling me about sleeping with her boyfriend.
I think Bella was telling me through her process
about being abused. She was confused about what
comes from her body and her communication was
unclear. Her experience was stored as a non-verbal
stream of feeling. It felt as though she was oblivious
to my presence and that a re-enactment of her
4 Inscape Volume Nine No I 2004
dissociated experience was happening; parts of her
experience were presented separately, apparently
without knowledge of each other (Pynoos et al., 1996)
and there was no integration between herself as
abused child and her present child self (Davies and
Frawley, 1994). Her activities seemed random and
meaningless at the time and I was left worried and
uncertain, often feeling alienated and distant from
Bella and frightened that what she presented was still
occurring in the present. Shortly afterwards, she
needed to show me more of what had happened.
Bella as Mandy wanted to make drinks but was
womed that we were nearly out of her favourite
colours. She poured a large mug of orange paint and
shook and squeezed all the bottles, pouring all she
could manage into the sink, and then shut the
curtains. She wanted it to be night to be with Curt.
She kissed him,telling him he could stroke her leg.
She gently stroked herself, but became aware of me
and was angry; my gaze evoked shame and brought
unmanageable feelings to the surface. Kaufman (1993,
p. 64)speaks of the ’erasure of consciousness’
brought about by shame. Bella rushed out of the
room and I could hear her outside giggling and
saying ’Oh Curt, stop it’. She opened the door
repeatedly but would not reenter. After a while she
came in and decided to make a bed for herself and
Curt in the cupboard. She placed paper covers and a
pillow down, all the while talking to Curt as though I
was not there (see Figure 2). She took two ’drinks’
inside and lay down. The atmosphere was sleepy and
she closed her eyes. Every now and then she would
pretend to wake saying, ‘Oh Curt, stop, you’re heavy
on me’. When it was time to go she came out and I
noticed that she had put a spot of purple paint on her
skirt, her pants and a spot on the bed.
Having described a small part of Bella’s art therapy, I
go on to present a review of the literature, which I
have divided into several sections to help me
understand what I experienced in the art room and to
steer a course through familiar and unfamiliar
territory. It is through this that I keep my questions in
focus, of how materials are used, what damage is
done to the child and, importantly, how visual
material is processed in the brain.
Mess and chaos
Experience among British art therapists suggests that
when working with abused children there is an
abundance of mess. Art therapists have written about
this,using words such as pouring, mixing, dripping,
swamping, spilling and smearing to describe it. These
words illustrate sensation-based experiences, which
suggests to me that using art materials may be
sensual rather than cognitive. Materials, used as
bodily substances or dirt, conveying feelings of being
messed up inside, or as attempts to find boundaries

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or to distinguish between good and bad feelings, are
described (Sagar, 1990; Douglass, 2001; Drucker, 2001;
Gil lespie, 2001; Levens, 1989; Thomas, 1998; Aldridge,
1998; Brown and Latimir, 2001; Murphy, 2001;
Bissonet, 2001; Aldridge and Hastilow, 2001;
hibridge, 2001).
That confusion and pain suffered is symbolically
represented in the materials clearly resonates with
many art therapists’ experience, but I frequently
experienced mess that I believed contained no
symbolic element. There appears to be an implicit
memory of the abuse, stored in the body that
becomes enacted rather than described. I would like
to consider whether the sensuous qualities of the
materials might access somatic memory of emotional
experience. Art therapy accesses chaotic feelings,
perhaps unconsciously expressing feelings of
invasion and loss of boundaries. 1understand it as a
pre-symbolic internal representation of the abusive
experience projected into the materials and the
therapist.
Mess, by which I mean the use of materials, drama
anti non-relating to keep thought at bay, creates a
sense of fragmentation and alienation which I began
to think might be a dissociative process. Although
dis5ociation is noted in art therapy literature, it is not
described. Forgetting or repression of experience is
described, suggesting dissociation as a way of coping.
Killick (1999, Mann (1997) and Levens (1989)
desaibe projective identification as a defensive
mechanism, this seems to include elements of
dissociation. Importantly, Mann (1997) challenges the
view that painting is mainly creative saying it may
function defensively,coming from a preverbal,
primitive state.
InscGpe Volume Nine No. I 2004
THE MAKING OF MESS IN ART THERAPY
Figure 2. The ‘bed’ Bella
made in a cupboard for
Curt and herself.
Dissociation as survival strategy
Schore (2001a, 2001b, 2003a) describes dissociation,
saying processing of external and internal stimuli is
stopped when individuals are overwhelmed by
traumatic experience, including relational trauma. He
explains that normal infants respond to stress with
intense startle, crying and screaming with high levels
of hormone released into the brain. The (m)otheris
able to regulate feelings with face-to-face looking,
rocking in arms and soothing, but if no regulation is
available, the highly aroused state cannot continue;
the infant will quieten, become immobile, avoid
contact, become compliant and restrict output. This
becomes a familiar sequence: hyperarousal followed
by dissociation, accompanied by a rise in pain-
numbing endorphins and high homone levels. This
psychic deadening defence is eventually entered into
for long periods, with little reason. Its function is to
numb the pain and chaos of the body. Repeated
experiences of insensitive attachment or of abuse
cause such distress in infants that they learn to stop
feeling. The child can never find a coping strategy
when their parent is the abuser, as they need to seek
proximity and avoidance at the same time. Fear
cannot be modified and emotion cannot be
symbolised by thought and language. Input from
external stimuli becomes unbearable, which prevents
emotional learning, reduces development and makes
attachment and understanding impossible.
When a child’s physical integrity or autonomy is
compromised their attentions will be directed
towards fantasy or fear of the psychic or physical
harm. They may become dissociated to protect
themselves from threat or to distance themselves
from what is happening, and may present parts of
5
 THE MAKING OF MESS IN ART THERAPY
their experiences in different guises, identified by
Pynoos et al. (1996) as ’fearful’, ‘aggressive‘ or
’intervening’. Children have little knowledge of
themselves as whole individuals and need holding
together in order to have a sense of self and other.
Alvarez (1992) cautions that abuse experience needs
to be absorbed in tiny pieces as children may have a
fragmented sense of self and be unaware of their
whole experience (Alvarez, 1992; Drucker, 2001).
Mess may be a dissociated response to anxiety,
preventing verbal thought. In stressful situations, this
way of relating to self and others may influence the
way in which art materials seem to become both a
defence as well as a route to somatic memory. I
understand mess and chaos during the session to be
sensory, possibly accessing and expressing the chaos
of early life.
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Brain damage through early life abuse
Schore (2003a),Carter (2000,2002) and Pally (2000)
explain how brain circuits grow; interrelationship
plays an essential role, activating neurons, which
strenhaen pathways and cluster circuits together.
Research is improving our understanding of how
traumatic stress affects children and there is
increasing awareness that a greater incidence of
violence within the family occurs than previously
believed (Pynoos et al., 1996).Exposure to extreme
violence may intrude on children’s developmental
processes, affecting memory, cognition, learning,
personality and moral development (Alvarez, 1992;
Pynoos et al., 1996).Serious and long-term psychiatric
damage, with risk not only in the present but
persisting into adulthood occurs, causing damage to
future health and vulnerability to stress throughout
life (Felitti, 1998; Pynoos et al., 1996).When
emotionally stimulated, traumatised children lose the
capacity to make sense of their feelings, or to use
them as a guide in assessing situations. Instead they
go from stimulus to response, unable to use the
thought process in between. This results in
aggression or numbing of feelings and becomes a
pattern of behaviour, utilised frequently for major or
minor reasons (Schore, 2001a; van der Kolk, 1996).
The right hemisphere of the brain is dominant in the
first years of life for processing, expression and
regulation of emotional information and for the
infant’s developing ability to understand social
interaction (Schore, 1994).Damage to the right
hemisphere occurs through early trauma; this is
associated with difficulties in both the perception and
communication of affect, creating problems in
establishing love relationships which involve
recognition of the other as a whole person (Mollon,
2001). Van der Kolk (1996) found that when
previously traumatised patients were exposed to re-
experiencing their trauma in imagination there was
6 Inscape Volume Nine No. I 2004
heightened activity only in the right hemisphere, the
area most involved in emotional arousal. This is the
part of the limbic system associated with the
amygdala and central to the experience of anxiety.
Activation of these structures was accompanied by
heightened activity in the right visual cortex. The part
of the left hemisphere called the Broca’s area,
responsible for making experience known as
language, was ’turned off‘; this can be seen in the
frozen watchfulness often observed in traumatised
children as well as emotion enacted as behaviour or
pain rather than speech (van der Kolk, 1996).
Pynoos et al. (1996) and Teicher (2000) state that the
fullrange of post-traumatic stress disorder (PTSD)
symptoms will be experienced by abused children.
Aldridge and Hastilow (2001) add that repeated
sexual abuse will cause symptoms of PTSD. Teicher
(2000, p. 50) reports ’startling connections between
abuse of all kinds and both permanent debilitating
changes in the brain and psychiatric problems . . .
[which include] MSD’. Attention deficit hyperactivity
disorder (ADHD) is often present with PTSD in
traumatised children (van der Kolk, 1996), with
attention and stimulus discrimination difficulties.
The years of language acquisition between age two
and ten are vulnerable to the effects of early
maltreatment. Normal development enables children
to organise a story into a continuous narrative that
has a beginning, middle and end, but chaotic
narrative construction results from trauma
experience, affecting reading, writing and
communication skills. Early childhood trauma causes
permahent alteration to the development of the left
hippocampus, resulting in problems with processing
memory and dissociative symptoms that persist into
adulthood (Teicher, 2000). The job of the
hippocampus is to organise informa tion from the
amygdala and integrate it with previously existing
information (van der Kolk, 1996). The hippocampus
and corpus callosum are damaged by cortisol
released in response to stress and psychological
abuse, they remain underdeveloped with
communication and transmission of memory
between the two hemispheres reduced (Teicher, 2000;
Schore, 1994).
Children interviewed in research described by van
der Kolk (1996), five years after disclosing abuse,
were unable to think or remember clearly. They re-
enacted the event behaviourally with sexually
provocative play, or somatically by feeling pain or
illness. Children varied in their ability to recall their
experience verbally, many remembering only
fragmented traces of incidents, while some drew
representations of part of their abuse. None were
aware that the symptoms they had might have any
connection with the previous abuse.
Face recognition and the sound of the mother’s voice

have such an important function for the infant that
the brain has developed specific areas within the
right hemisphere to process these. Recognition of the
mother’s face is considered pivotal to good
attachment. Schore (1994, p. 188)believes that
without it relational trauma results: it ’allows the
brain to regulate and maintain a regular pattern of
dormation flow within itself’. The ’interactive
smiling and looking between faces’ (Wright, 1991, p.
355) is needed for the infant to have a tolerable
experience of separation.
Good attachment
G o d attachment is essential between the infant and
their primary caregiver. Without it the infant’s sense
of self is lost and changes to the brain occur.
The brain is born prematurely, with development
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continuing during childhood and into young
adulthood (Pally, 2000). The genetically timed
emergence of brain circuits during infancy means it is
esptrially important for the infant to experience
relationship as the development and structure of the
brain and how the mind becomes organised is
dependent on interpersonal relationships (Schore,
2003a; Pally, 2000). Good attachment has a profound
effect on the healthy development of the brain, and
ultimately on the personality and future health of the
child. Bowlby (1979) knew that distress in infants
colours their future relationships, and Schore (1994)
explains that what happens between the child and
their sigruficant other is stored as a pattern for future
experience. These patterns will determine the coutse
of future relationships.
Early interactions of mother and baby show that from
the Garliest moments of life, infants look intently and
with concentration at the mother, becoming
emotionally involved, cooing and gesturing
(Trevarthen, 1995,2001).Soon after birth they imitate
their mother’s movements and facial gestures
(Trevarthen, 1995; Gregory, 1998) and at two months
seek interaction with friendly humans. ’They are
extremely sensitive to the quality of vocalization,
holding, moving and facial expression of pleasure or
indifference in a person giving care’ (Trevarthen,
1995, p. 163), communication with face, body and
limbs is important (Pally, 2OOO; Schore, 1994). Parents
and others give meaning to the infant by leading and
responding to play and constant communication of
verbal and non-verbal interactions gives structure
and pattern to the world. ‘The infant experiences
intense states of excitement that are modulated by
mother’s responsiveness’ (Pally, 2000, p. 10);touch or
physical holding are important (Kaufman, 1993);
young children who are not handled or rocked have
reduced production of thyroid hormones resulting in
high levels of stress hormones in the brain, giving an
increased feeling of fear and a heightened adrenaline
lnscnpe Volume Nine No. I 2004
THE MAKING OF MESS I N ART THERAPY
response (Teicher, 2000). Relationship is essential to
human maturation; if the parent is unable to create a
’genuine and mutual relationship’ (Kaufman, 1993, p.
a), the child will be insecure and will feel unwanted.
Balbemie (1999) and Pynoos et al. (1996) describe the
insecure attachment pattern that can result when a
child is subject to erratic or rejecting behaviou from
their carer, ‘a small child can only find the answer to
rejection or ill-treatment in fantasy, iden-g with
the very person who poses the threat in an effort to
acquire closeness through sameness’ (Balbemie, 1999,
p. 216).
Early social interaction is important in building a
psychological and biological capacity to manage
stress in later life (van der KO&, 1996).Adults with a
history of severe neglect in childhood have a poor
prognosis if retraumatised as adults, compared to
those who have had good attachment bonds (van der
KO&, 1996).Davies and Frawley (1994, p. 46) suggest
that poor attachment is the ‘earliest and possibly the
most damaging psychological trauma’. Early neglect
is now recognised as extremely damaging, impairing
brain development in limbic structures (Schore,
2003a); Teicher (2000) suggests neglect is a greater
stressor in boys than other forms of abuse, although
girls are most affected by sexual abuse.
I have focused on the face-to-face looking between
mother and infant, and the infant’s active
participation in creating that attachment. This has an
essential role in normal development leading to the
child understanding themselves as whole and
contained individuals. Relational abuse, neglect or
sexual abuse releases stress hormones that damage
the developing brain, affectinglanguage acquisition
and reasoning skills and the use of logic to make
sense of experience.
As an art therapist working with very distressed
children I am particularly concerned with how visual
material is used and wonder which parts of the brain
deal with this part of human experience.
Understanding how important good attachment is
may uncover the importance of visual stimuli which
might be enacted in art therapy.
The right side of the brain and art making
The right hemisphere of the brain generates and
stores images in art making and imagination. This is
important developmentally, happening from earliest
infancy.
Modem scanning techniques tell us that the same
regions of the brain are active for seeing and for
imagining (Gregory, 1998).Whether making or
imagining an image, the same part of the brain is
activated (Gregory, 1995).Gregory (1998) suggests
that cognition has a physiological base because
7
 THE MAKING OF MESS I N ART THERAPY
whether actually seeing an object or imagining the
same object, dreaming, waking or hearing the object,
the same parts of the brain are activated as though
the action was taking place. Latto (1995) suggests that
art comes from a physiological source rather than an
emotional or experiential one; he explains, ’form is
effective because it relates to the properties of the
human visual system’ (p. 67), suggesting that what
artists paint and how succeeds because they exploit
those systems. He suggests we are moved by forms,
not because of their representational power, but
because they reveal the distinctive features of our
brains. We have evolved specialised mechanisms for
visual processing of the human body; the human
brain contains cells in the right temporal lobe
responding to the human hand, face, body posture
and movement, he concludes ’art defines our
humanity by portraying the brain’s representation of
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the world’ (Latto, 1995, p. 91).
Trevarthen (1995, p. 157) writes that art is a ’record of
emotton in the experience of making and in the
imaglnation of its creator’, and that within it are the
perceptions, movements, emotions, thoughts and
memories that occupy the artist as he or she works.
S o r e reminds us that ’Seventy years ago, in the Ego
and the Id, Freud speculated . . . thinking in pictures
. . . approximates more closely to unconscious
processes than does thinking in words’ (Schore, 1994,
p. 447; see Freud, 1961, p. 21).
Mollon (2001, p. 197) too reminds us that the ’right
hemisphere can be equated with Freud’s unconscious
mind and is particularly concerned with processing
emobonal mformation’. Wright (1991)reminds us
that the mother’s face is the child’s first ‘emotional
mirror’, saying that it is through her reflection that
the ckdd is able to know their own emotions; if the
mother is not responsive, continues Wright, the child
will develop a similarly rigid defence against their
own emotions. Matthews (1999, p. 17), in researching
normal development of children’s drawings, writes
‘the basis for the expression of emotion and
representation of objects and events form within an
interpersonal arena between caregiver and infant’.
The mother-mfant relationship and its implications
for the later development of creativity and artistic
outcome are important (Trevarthen, 1995).The
infant’s maturing right hemisphere is
psychobiologically attuned to the output of the
mother’s right hemisphere, with the right hemisphere
participating directly in perceptual processes and
being involved in direct, visual forms of relationships
with the outside world (Schore, 1994).It is this visual
processing into the right hemisphere that gives the
infant the visual emotional information to enable
recognition of mother’s face as well as her facial
affective expression (Schore, 2001a); this is crucial to
8 Inscape Volume Nine No. I 2004
later emotional, social and intellectual life
(Trevarthen, 1995).
Edwards (1979) explains that the right hemisphere is
Concerned with creativity. She suggests that drawing
is a right brain activity and that if we could free the
right hemisphere of our brain (which stores,
processes and thinks imaginatively and creatively)
from the left hemisphere (which is language
dominated and in adults holds sway over the more
hidden right hemisphere) we would not only be able
to draw but to ’unstick . . . artistic development’
(Edwards, 1979, p. 64).Visual representation has been
thought of as the important marker in children’s
drawings, but body actions express emotion in
infants’ art, and their drawings are sensitive to
fluctuations in their own feelings. The marks we may
interpret as meaningless scribble are representative of
a different form of reality (Matthews, 1999).The right
side of the brain is important in understanding
metaphor and in dreaming (Edwards, 1979);
experience, emotion, trauma and relationship reside
in the right hemisphere and are processed there
before having words attached to become memory
(Edwards, 1979; Schore, 2001a).
Mess making, visual experience and emotion
The establishment of a connection between vision and
emotion is of central importance, and in returning to
Bella’s therapy I now hope to show that the visual
and sensory experiences of paint, water and clay may
be linked with damaging early relational experience.
By showing how Bella expressed her emotional world
in therapy I speculate that the visual, tactile and
emotional qualities of materials enabled Bella to
access her earliest memories and to process them so
that eventually they could be thought about.
As an art therapist I suggest that witnessing the use
of materials gives evidence of what has happened.
Through this,alongside observing body language
and hearing what is said or not said, words can
slowly be given. Bella enacted and represented her
traumatic early life experience, not using the therapy
to understand, but exposing her emotional experience
in paint and repeatedly evacuating it by means of
projective identification. Greenwood (2000) writes of
terror experienced through the process of her adult
patient making art and Killick (2000) describes states
of unintegration in adult patients in whch the
containing object has failed catastrophically; both
writers describe states seen in adult patients, but
equally present in children and undoubtedly having
developed from childhood experience.
Bella’s therapy
Bella’s mood was angry when she arrived for her
second session; she started mixing paint to make

~-
chocolate ’drinks’. She told me she was ’kissing in
bed’ with Curt. While speaking she painted a heart;
talking and smoothing it with thick pinkish paint; she
told me she wanted to have sex with Curt. She
poured large amounts of paint into mugs, asking me
if I wanted a drink. As she offered it (I was in the role
of ljella), she snatched it away: ’Well you can’t have
onr’. Several times she emptied the paint down the
sink, refilling the containers, she poured everythmg
into a large rectangular tray, overfilling it and
emptying it, she refilled it to the brim, wanting it to
be beautiful.
Bella expressed through her behaviour the memory
stored in her body (van der Kolk, 1996; Pynoos et al.,
1996).If 1 attempted to say anything she shouted
’Mmd your business, shut your gob’, unable to
tolerate any words being put to her confused feelings.
Traumatised children are unable to verbalise their
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experience (van der Kolk, 1996):the behavioural
memory of the sexual abuse that had been persistent
was expressed in Bella’s sexual enactments. Her
father had called her ’Princess’and had bought her
sweets and presents. Her memory had feelings of
being special as well as of pain, and her representing
took the form of love, expressed sexually towards the
empty space of the room. She had been exploited and
had no way of relating to people. She blocked out any
memory of her abuse, distancing herself from the
reality of both experience and possible participation
(P)noos et al., 1996).
There was no possibility for the contents of Bella’s
emotional memory to be thought about or processed
into language. There appeared to be no connection
between emotional and cognitive thinking and she
had no words for the feelings she had. Connections
between emotional memory and development of
language had been halted (Schore, 1994; van der
Kolk, 1996; Teicher, 2000). Bella had no narrative
available, and no memory to construct one. Had we
been able to look at that point, we might have
gli mpsed evidence of underdevelopment of the
~ ~ J ~ P O C C I I I I ~and
U S connecting pathways.
Psvchometic testing done before her referral to art
th&apy showed delayed development and mild
learning difficulty. This diagnosis seemed incorrect
later as there was no evidence of learning difficulty
after four years of art therapy. Learning may have
been blocked by emotional distress (Pynoos et al.,
19‘46).
BeDa was often abusive and aggressive when playing
Mandy. She told me to be Bella, then tyrannised and
punished Bella, telling her ‘Shut up and sit on that
chair, you shut your mouth and stop looking, you’re
just jealous.’ Her aggressive role was identifiable as
bullying rage directed at the frightened, hated and
isolated Bella, confused but having to keep quiet and
not tell her story. In this role Bella showed me parts
lnrcnpe Volume Nine No. I 2004
THE MAKING OF MESS IN ART THERAPY
of herself, identdymg with the abuser and, as
described by Pynoos et al. (1996) and Balbernie
(1999), showing the aggressive desire to punish and
retaliate, as well as the frightened child in need of
protection, rarely seen but often placed into me by
asking me to be herself.
Sometimes the fearful part of Bella was more in focus.
This first appeared in session six. Bella spent a long
time making ‘cake and ice cream’. She spread paint
over a box and filled it with water adding many
containers filled with paint mixture. She was Mandy
and I was Mum and not allowed to speak. As she
mixed and poured paint I became anxious about the
quantity she was using. Quickly she became anxious
about being ill. In her ’game’ she told me she was at
the doctor‘s, he told her she was on drugs and
prescribed medicine which she would not take,
saying he was trymg to poison her and was bad. It
seemed we were communicating: her anxiety became
palpable in me, and she felt this and used it to tell me
that she had been invaded in her body with
something that would harm her. Schore (2001b)
describes bodily based communications where the
therapist matches the rhythms of the patient in a
similar way to maternal non-verbal holding and Bion
describes ‘maternal holding’ in which the patient
gains a sense of self through feeling understood and
contained (Hinshelwood, 1989).Within Bella’s
therapy the conversation between the unconscious
mind and body of both therapist and patient was in
tune (Schore, 2001b) and perhaps the therapist was
able to ’tune into’ the split-off and unknown early
needs and anxieties of the patient (Sidoli, 2000, p. 55),
with the communication between the right
hemispheres of the therapist and child becoming
active in therapy (Wore, 2001b).
Bella arrived for her sessions in a highly aroused
state. As soon as we entered the room for session
seven Bella told me that she was Mandy, and I was
playing the part of Mum.She asked Curt if he
wanted a drink and made several for him and
imaginary friends; she then disappeared behind the
cupboard doors ‘doing something’ with Curt that
involved kissing sounds and whispers. Periodically
she leant out and addressed me as Bella, ’Bella, stop
staring, you’re always looking you are, you’re just
jealous.’ She stepped out from the cupboard and
looked at me with a seductive smile asking if I knew
what she was doing. Bella’s concern was evoked that
I was angry and going to tell her off. I was both the
aggressive Mum and the bullied Bella in her mind.
She made mixtures of ice cream and milkshakes
while talking to Curt on the phone, holding one arm
across her waist, and curving her body seductively
and rhythmically as she spoke. It is hard to watch a
small child behaving in a sexually alluring way.
Anxiety is evoked in the therapist that the abuse is
9
 THE MAKING OF MESS IN ART THERAPY
being continued in therapy, so I asked her if she
would hke to paint. She hastily made a painting
using the paints she had made as drinks, emptying
some onto paper. Glue was spread over the paper,
and hssue paper stuck into it. She poured paint
around the tissue, and attempted to roll it down to
contain the paint she wanted to have hidden inside.
As she lifted the painting the wet paint ran down,
pourmg out. There was little feeling of making an
image. It had a quality of disposal (Schaverien, 1987),
of attempting to hide the paint inside the fragde
tearing s h of tissue. It was made in response to my
suggestion that she paint, but her need was to get rid
of feeling rather than to understand it, and in my
difficulty in witnessing her experience I had
attempted to push her towards something more
palatable. Bella was still seven years old, but her
sexual behaviour had been established at an early age
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as a distorted form of attachment. It was held as a
beha\ioural memory that she enacted frequently.
Bella wanted to continue pouring, filling, emptymg
and making dinner. She filled buckets with a
dissolving packaging material adding water and
paint making it thick and bubbly. She repeated this
several times, emptymg and filling more mixtures,
talking about being in love with Curt. She a n p l y
told me she was old enough, but Bella was not. She
wankd to stay out all night with him,but was
concerned I would be cross. She repeated that Curt
loved her because she had a beautiful body and
described her desire for intimate touching with him.
Throughout she made more dinner, making mixtures
darker, with thick paint in the bottom, several
coloucs, orange, yellow, and white with black always
added. After a while she went and faced the wall,
kissing the space between, and asking if I could hear.
What did she want me to hear? How could Bella tell
me ht.r story? She had no way of making sense of it.
Both her father and mother had sexually abused her.
Her mother had, in addition, been unable to attune to
her infant needs. The face-to-face gazing, described
by Wiore (2001a, 2001b) and Trevarthen (1995)as
essential for building future relationships, had been
interrupted by furious outbursts from her mother,
who had been unable to find a way to hannonise
their emotional rhythms. The continued,
unmanageable fear was a repeated pattern when in
stressful situations. The hyperarousal learned in
infanc*ywas often present with materials used to both
anaesthetise her and express her somatic experience.
Bella was unable to hold her thoughts herself; the
thinlung function was mine for a long time. The early
part of therapy was characterised by 'primitive
anxiety' and she seemed unable to symbolise (Killick,
1997).Bella was telling her story in very concrete
ways (Thomas, 1998), and it was always difficult for
me to distinguish between concrete and 'as if'
10
communications (Killick, 1993,2000).
I attempted to find ways of talking with J3ella about
how I experienced the relationship and the
transferencebut found that this was usually an area
that was completely rejected and refused. The painful
past was not to be thought about and if I attempted to
make links between what happened in sessions and
what had happened in the past there was an increase
in chaotic fragmentation, or an outburst of abuse
directed at me. Creative activity is sometimes a
frightening experience as it can be difficult for the
child to differentiate between the actual abuse and
trying to think about it (Thomas, 1998).
The pouring out of 'drinks' was a visual cue that
seemed to tap into the same part of the brain that
stored her non-verbal memories, but they remained
non-verbal, perhaps unable to be transferred through
the underdeveloped corpus callosum between her
emotional right brain and the hippocampus to make
language and meaning (Schore, 2001a; van der Kolk,
1996).Her feelings were accessed but the part of her
brain responsible for making language appeared
inaccessible. There was no beginning, middle and end
to her story; no narrative ability existed. Her
performance had an unending quality, it seemed
timeless and trapped, to be continuously enacted;
unable to become a coherent whole.
Returning to the three questions I posed at the
beginning of this article, my first was to wonder how
children like Bella use the room, materials and myself
to communicate and make sense of their experience. I
began to think of the question slightly differently in
that my interest became why do I and other art
therapists allow such mess to continue and does it
heal past damage. The careful gathering and storage
of her fragmented artwork and the importance of
normal boundaries of time, place and day must be
stressed. For many months Bella found leaving at the
end of sessions almost impossible, but gradually the
rhythm of closely held boundaries helped her to
establish a space to remember week by week. Bella
used the space to reenact somatic and behavioural
memories; she experienced thinking as frightening,
frequently splitting the hurting and tender part of
herself into me, then behaving abusively. It seemed
she needed to feel powerful and would punish Bella
in me. Bella was able to experience the very strong
emotions of love and hate in therapy and find that
these emotions would not ultimately annihilate her.
She projected her murderous feelings, and discovered
that she was still loveable. Killick (2000, p. 100),
writing of adults, states 'without a space inside the
self in which experiences can be held and potentially
digested, the experience of emotion threatens the
sense of self with annihilation'.
The art materials became a visceral reminder of
Inscape Volume Nine No. 1 2004

experience, enabling unprocessed memories to be
brought to life. Sexual memories were explicitly
enacted and painful to witness, precipitating strong
feelings of anxiety in the therapist. The ongoing need
for the child to evacuate feeling instead of attaching
symbol to it can feel quite persecutory, and it is
tempting to find symbol where there is none (Killick,
2000, p. 101). The course of therapy was slow, with
'mmy tiny integrations taking place' (Alvarez, 1992,
p. 153).
M j second question was to wonder which parts of
the brain are damaged by early abuse in children.
Neural connections continue to grow and strengthen
throughout childhood; relational abuse weakens this
development. Bella was unable to 'integrate
sensations and perceptions related to the trauma into
explicit memories' (van der Kolk, 1996, p. 291). She
constantly became aroused by sensation and
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appeared to communicate, but in reality proper
communication was not occurring because it seemed
her intention was to repress; she had no
consciousness of her communication. She appeared to
be II~.relationship but her role-play often had the
feeling of dissociated parts of herself being used as
separate identities. I thought she was using the
materials to dissociate from her memories but
realised that the opposite was also happening; she
used the somatic qualities of paint and clay to access
her non-verbal emotional memory. Understanding
that she was not deliberately withholding her
memories or refusing to talk, but literally had no way
of telling also contained some of my anxiety about
the continuing distress and her difficulty in accepting
any interpretation, as well as my difficulty in
explaining to colleagues that mess had a function.
MJ third question turns out to be the most important.
In wanting to understand where art processes are
generated and if this is the same area that holds the
early emotional experience, I wanted to see if there
are physiological Connections between visual and
emotional experience that would help to explain the
phenomenon of mess. That we both understand and
make art in response to the way in which the brain is
stnictured, suggested to me that children whose
earliest life had been chaotic may use art materials to
reflect this.In exploring my notes, I found that Bella
frequently used the experience of pouring paint to
express her inner world. I understand Bella's search
for meaning started with what appeared to be a
chaotic and random use of materials as a way of
accessing memories that also had no coherent
stnicture.
The optic nerves, responsible for our ability to see,
pass through the hemispheres and are increased by
fibres from the brain, enabling meaning to be given to
what is seen (Gregory, 1998).It is through thisthat
infants experience and construct meaning from early
Insciipc Volume Nine No. I 2004
THE MAKING OF MESS IN ART THERAPY
social interaction. Research findings that imagining
trauma activates the patient's right hemisphere and
right visual cortex (van der Kolk, 1996) reminded me
that Gregory (1995) found that whether seeing or
imagining a scene the same parts of the right visual
cortex is activated. The activation of the right visual
cortex and right hemisphere through the sensual use
of paint might provoke imagining in a somatic or
behavioural way, connecting with the earlier
emotional experience. This may, with time, enable the
original trauma to be represented as a thought. In
thinking more clearly about the purpose of mess and
the way in which it precipitated a particular form of
behaviour, I understand it as responsible for, rather
than a result of, the behavioural memory that
followed.
Conclusion
Paint pouring, smearing and spilling have been
essential ingredients in Bella's therapy and have been
an important part of accessing the emotional trauma
of her early life. The mess produced 'affect', slowly
understood and regulated by the therapist. The brain
develops during pregnancy, and for some months
after birth continues to be informed by the genetic
code, but during the period of infancy and childhood
development it is dependent on relationship, the
neural connections being strengthened by infants'
interactions with the environment (Pally, 2000). When
infancy is characterised by relational trauma with
poor attachment and neglect, toxins produced by
stress harm the brain. The infants' need of attachment
is so important that a large proportion of the cerebral
cortex is dedicated to vision, and the face-to-face gaze
of infant and mother is essential for development.
The art process is dependent on the right side of the
brain but this is also the part of the brain wherein
early experience resides. The evidence appears to
suggest that there might be connections between
early brain damage through neglect and abuse, and
the symptom of excessive mess made by children
who have been abused. It would seem that the mess
itself fulfilsan important role in enabling emotional
knowledge to be observed. The very messy products
of abused children might come about because they
are tapping directly into an underdeveloped
neurological structure where connections were not
made. That emotion has not been regulated by the
face-to-face interaction so essential in the earliest
years of life would seem to have serious
consequences.
Killick and Greenwood (1995, p. 106) remind us that
Bion believed 'it is by the introjection of the ability to
contain and transform projected material that we
learn to "think" '. Pally (2000) speculates that as
imagining or verbalising an event activates and
strengthens neural connections, and as new
11
 THE MAKING OF MESS IN ART THERAPY
connections can continue to grow into adulthood,
analysis may be able to change long-held emotional
responses. I imagine the art therapy process has a
similar function and that mess both accesses and
responds to a chaotic and fragmented early life.
T would also add that understanding this connection
might alleviate some of the very difficult projections
and tensions that are present in the work, allowing a
safer holding until the child is able to be conscious of
their own experience. There were periods when I felt
unable to understand or interpret the content of
Bella's sessions. I experienced the internal states that
Bella experienced, and often felt afraid that it was in
the present rather than in the past. I now feel more
confident that when working with children who have
had similar early life difficulties, that change can
come about through bearing to witness and later to
interpret what is seen in therapy, so that gradually
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physical states can become thoughts.
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Biographical note
Frances OBrien is a state registered art psychotherapist
having qualified at Sheffield University. She works in a
Midlands CAMHS team with a special interest in working
with children and young people whose early life experience
may have been coloured by abandonment, neglect and
abuse. She is curious to explore how these experiences affect
their use of art psychotherapy. This was her area of research
when completing her MA in Art Psychotherapy at
Goldsmiths College. Frances also works with adults who
have experienced abuse in their early life.
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