Expressive arts psychotherapist Dr. Rachel Hoare keeps a box of miniature symbols in her therapy room; religious tokens, a skeleton: “Some things that are quite disturbing,’ she states. ‘I’m always collecting wherever I go.” Dr. Hoare discusses one of her clients in particular, a young male. Having made very little progress after five or six sessions, on his way out one day, he picked a miniature coffin out of the box. “He said ‘You see that? That’s how I felt when I was leaving [my hometown]. I thought that’s how I was gonna end up.’”
This is expressive arts psychotherapy. It aims to help people process their trauma through means beyond just talking about it. “There is no typical session,” Hoare explains. Her approach is to meet an individual and see what suits them. Talking about traumatic experiences, in many cases, can be retraumatising. “But they do need to process the trauma and get it out somehow,” says Hoare. “There’s been huge amounts of research in this area about how drawing it, painting it, using music, using expressive writing … can help with trauma. So that’s the way I work. What I’m trying to do is [pull things from their] unconscious into consciousness.” For her work in this field she was awarded this year’s Registrar’s Civic Engagement Award. Doctor Hoare runs Trinity’s elective Displacement: Exploring the Human Experience of Forced Migration. The elective explores forced migration through a lived experience lens and is available across all schools.
“Hoare works with Tusla’s Separated Child Seeking Asylum unit, conducting therapy with minors who have arrived into the country unaccompanied.”
Hoare works with Tusla’s Separated Child Seeking Asylum unit, conducting therapy with minors who have arrived into the country unaccompanied. They have been picked up at ports or the airport and entered into the asylum process, housed in either foster care or residential units depending on whether they are under or over twelve years of age. Trends in their countries of origin fluctuate, but Hoare identifies current displacement “hotspots” as Syria, Iraq, Afghanistan and some East African countries. The causes of their displacements are varied – conflict, identifying with a marginalised group, gender-based violence – and so too, are their respective treatments.
For example, another item in Hoare’s therapy room is a football. Hoare explains that nobody is going to reveal anything to her unless they have established a trusting relationship, and kicking a ball to each other can be an effective way of doing this. She describes another common process of hers as “working through the football metaphor”. “A lot of [my clients] come from cultures which are more collective, so they’re used to working as a team, as it were, in terms of extended family… We might explore that through different footballers, or through different positions in the team… Most of them do support Premiership teams, so we might focus on a specific person in that team who I know has experienced hardship and look at ways of coping and resilience [through them] … They’re interested in that, so that’s another way of connecting.”
“Many think they are insane because they do not understand that what they are experiencing is Post-Traumatic Stress Disorder, an utterly normal response to the atrocities they have witnessed.”
However, there are a lot of barriers to successful connection in Hoare’s therapy sessions. Often, language is one, and while she has found some interpreters with whom she works well, others are not so effective. This depends on whether they are “trauma-informed”, or how open-minded they are about her process. Another such barrier is stigma. Many of her clients have not heard of therapy or equate it with insanity. Many think they are insane because they do not understand that what they are experiencing is Post-Traumatic Stress Disorder, an utterly normal response to the atrocities they have witnessed. Hoare must often spend her first couple of sessions with a youth explaining and normalising the situation.
Hoare is also aware that the idea of expressive arts therapy can be intimidating to less artistic clients. She tells me of a “genogram”, a family tree-type diagram, she can construct with some such clients, to help them represent and process their situation. The clients place themselves in the centre. Significant figures in the client’s life can be represented by stick figures, or shapes; different relationships (supportive, abusive) by different coloured lines. “A lot of these young people, they may not even know if their family is alive or not… They may have left the country, lost their phone … Sometimes it could take them a year to be back in contact with their families.” In these cases, genograms can highlight the support network that the young person has in Ireland, helping them feel less isolated.
“Perhaps the most abstract testimony Hoare shares with me is that of a young boy who remarked that the lamp she had on in the corner of her room resembled the sunlight on the fields when he was fleeing his country.”
Perhaps the most abstract testimony Hoare shares with me is that of a young boy who remarked that the lamp she had on in the corner of her room resembled the sunlight on the fields when he was fleeing his country. Expressive arts psychotherapy encompasses everything, from sensory experiences like this one, to drawing a picture in the sand tray she has in her office, to saying, “Pick a symbol to represent your feelings at that time.” There’s no “one-size fits all”, Hoare asserts. It is as diverse and complex as human experience itself.
When asked what the future looks like for most of her clients, Hoare explains their main aim “is to try and get an education”. After being assessed by the City of Dublin Education and Training Board (CDETB), they will take classes in English, mathematics and a Life Skills cultural component. When their teachers feel they are ready, some will progress on to mainstream school to sit the Leaving Certificate, Leaving Certificate Applied or attend Youthreach, and some will progress further into third level education. “For some of them that will be getting some kind of apprenticeship or skill, but many of them would love to go to college because they haven’t had that opportunity where they’ve come from.” Once they have received asylum, family reunification is also on the cards for many. However, as Hoare points out, this can be a difficult time, with children becoming responsible for navigating and interpreting the world for their parents, and conflict frequently emerges.
“Hoare acknowledges that getting involved in activism to end direct provision is a good way to get involved, but views day to day acts of compassion with strangers as important too.”
While the spotlight on the problem of forced displacement has somewhat faded in recent years, it is still one that needs to be addressed. Hoare acknowledges that getting involved in activism to end Direct Provision is a good way to get involved, but views day to day acts of compassion with strangers as important too. “These young people have been through unimaginable things, but actually what they’re thinking about is the same as any kind of seventeen, eighteen-year-old in Ireland… They want to get a good job, get a girlfriend, get married at some point, settle down… Whether it’s the cleaner in college, or whoever it [is around you that appears isolated], just take time to have a little chat… just to see them.”
