Book review

Healing trauma in children with Clay Field therapy
By Cornelia Elbrecht

North Atlantic Books, 2021
ISBN: 9781623176716

Reviewed by Liz Antcliff

Healing trauma in children with Clay Field therapy is a much-awaited book. As I have read it, I have attempted to consider how it would be understood by students of art therapy, and therapists from the fields of counselling, psychology and psychotherapy, and to try to see through their lens what this book would hold. This 2021 publication centralises children and trauma healing. Reviews herald Cornelia Elbrecht as a leading voice in the field, with this recent book contributing a unique sensorimotor art therapy approach in working with children (see Malchoidi, Levine, Lanius, Lay, Franklin, Tucci, Rappaport and Chapman cited in their review of the book). For those trained in and working with modality, this provides a reference to working with children at the Clay Field.

I am reviewing this book as a Clay Field therapist and as a somatic art psychotherapist. I have worked with clients with the lived experience of trauma, and I am currently completing a PhD on the topic of haptic perception expressed in Clay Field therapy as a creative arts therapy approach.  

The book is divided into three sections. The first is the underpinning theoretical frames of reference in support of Clay Field therapy theory and its efficacy as trauma treatment with children. The second is the theory of Clay Field therapy as it relates to working with the developmental stages of children. The third is a series of case studies presented in support of the intervention of Clay Field therapy. This review is formatted around the three sections.

Section 1: Theoretical frames of reference

Elbrecht’s intention within the nine chapters that form the first section of this book are clearly referenced on page 57. From chapter one, in which the setting is introduced, to chapter nine, in which Elbrecht aligns Clay Field therapy within the art therapy theory of the Expressive Therapy Continuum (Hinz, 2009, 2019; Kagan & Lusebrink, 1978; Lusebrink, 2014), a theoretical scaffolding is presented to support the efficacy of Clay Field therapy as an art therapy intervention for children who experience trauma. Specifically, Elbrecht refers to Clay Field therapy as a sensorimotor art-therapy approach.

Chapters one, two and three create the background upon which complex theories are presented in the latter part of section one. Chapters four to eight weave a foundation of theories relating to the physiology and neuroscience of haptic perception and attachment theory, the relationship between the lived experience of trauma and the autonomic nervous system, and the application of these understandings through the Neurosequential Developmental Model (Perry, 2009). Elbrecht has drawn upon the work of leading researchers and theorist in these fields – notably, Grundwald (2008) and Linden (2015) on haptic perception and touch; Hughes (2011) and Tronick (2009) on attachment theory; Levine (1997, 2010, 2015), Porges ( 2011) and Van der Kolk (2014) on the autonomic nervous system, polyvagal theory and trauma theory; and Perry (2006, 2009) on the Neuorsquential Developmental Model – and also is supported by other notable clinicians/researchers such as Heller and La Pierre, Pat Ogden, Janina Fisher and Cathy Malchoidi.

Intertwining of these theories is a complex task. The theory of Clay Field therapy is rich in clinical efficacy but has limited foundation in empirical research. Therefore, the theoretical scaffold presented in the first section of this book is an attempt to provide the research background missing from Clay Field therapy theory. The book is formatted with Chicago referencing style, which makes a fluid reading; however, footnotes are used rather than in-text citations, creating a more arduous task to follow the evidence presented by the author.

Throughout the text, Elbrecht has simplified the concepts of elaborate theories, and supports this information with diagrams and images, as well as with vignettes illustrating the relationship of the theoretical concepts to Clay Field therapy. ‘lake full of chocolate milk’ on page 43 exemplifies the use of a vignette and images to elucidate the dual polarity of sensory awareness and motor impulse as expressions of perception. Chapter four has several diagrams and illustrations to support the presentation of the multiplexity within the concepts of neuroscience.

However, there are some new phrases and terminology used to contextualise the theoretical foundation of Clay Field therapy. It would have been useful if the author had explained and defined these, especially when used in new context. For example, the terms “anthropogenic” (p.27) and “anthropogenic drive” (p.33): the word ‘anthropogenic’ generally means “caused by human intervention” (Macquarie Dictionary, n.d.), e.g., the impact on global climate. Therefore the term ‘anthropogenic drive’ is confusing, as human drives are associated more with innate forces rather than interventions. Another example is the term “dyadic implicit resonance” (p.31): it seems that this term may relate to the concept of attunement. As attunement was discussed in the pages prior to use of the term ‘dyadic implicit resonance’, I am left wondering what value was added with the new terminology – is this different language to explain the same meaning?

Further, in the chapter ‘Sensorimotor cortex’, Elbrecht writes, “the stress responses arising from the autonomic nervous system instantly impact on the somatosensory and motor cortices in the peripheral nervous system” (p.106) (my italics). Then again, at the end of the same paragraph: “Understanding the somatosensory and motor cortices in the peripheral nervous system has much to do with a trauma informed therapeutic approach”. The somatosensory cortices are part of the brain structures and are not part of the peripheral nervous system. The peripheral nervous system consists of nerves and ganglia outside of the brain (Hass-Cohen & Carr, 2008). Perhaps Elbrecht is intending to state that there is an influence upon the peripheral nervous system from within the somatosensory and motor cortices. This information on somatosensory cortex on page 106 is seemingly confusing. However, on page 109 there is a correct description of the peripheral nervous system, with a supporting diagram given on page 110. Further, Elbrecht does not support these statements about the somatosensory cortices and the peripheral nervous system with references. For a reader new to the language of the brain and the human nervous system, reading this would add confusion. For students of arts therapy keen to learn about this approach, caution is needed, and research and verification of the material presented in this book is encouraged.

Section 2: Theory of the Clay Field®

Section two in the book presents the theory of Clay Field therapy. Elbrecht has been a client, then a student and a colleague of Deuser, the founder of Clay Field therapy. Both Elbrecht and Deuser have been deeply embedded in the formation of the theory and its development for 50 years now. Heinz Deuser lives and works in Germany, and writes in German. Elbrecht has not only translated his theory of Clay Field therapy, but she has also interpreted it to make sense out of this work within a contemporary therapeutic context. Without a doubt this is a unique contribution not only to creative arts therapy discourse, but also to education and the arts.

This section is titled ‘Haptic developmental building blocks’. Written with an age-specific developmental focus, the application of the theory of Clay Field therapy with children is explained. Concepts of skin sense, balance and depth sense form the basis of learning the language of Clay Field theory. The term ‘perception’ is expanded in meaning, beyond a cognitive process to a whole-of-being, embodied phenomenon innate to human experience. There are many images supporting the explanation of the Clay Field theory. This enables the reader to gain a perspective on how children present at the Clay Field.

Within the book, reference is made to work at the Clay Field and to Clay Field therapy. The former phrase is the literal interpretation of the German title of this intervention – Arbeit am Tonfeld – and the latter is a term created for the English-speaking therapeutic world. Elbrecht seems to use the terms interchangeably.

Section 3: Practice of Clay Field therapy

Part three of the book is titled ‘Case examples’. While throughout the entire text there are vignettes offering clinical applications amplifying the theory in practice, this last section explores the intervention of Clay Field therapy in a variety of settings. Each of the chapters in this section [A9] is authored by a different practitioner; four from Australia and one from Germany. The settings include school, private practice and psychiatric services. They are noted as case examples and therefore no critique of the actual work is presented.

Phillippa Rose is a schoolteacher working with younger children from pre-school to early adolescence. In her chapter she also shares some of the pragmatics of the setting and of working with clay, and how she documents the sessions with the children. This information is helpful to those who are beginning their practice. Both Chris Storm and Monica Finch are Australian-based arts therapists. Their presentations follow one client over several sessions. Katharina Krama and Ina Schott are based in Germany and share in their chapter several cases, to illustrate how Clay Field therapy and the “haptic process allows children to experientially redefine their own resources for emotion and mental well-being” (p.348). The final case example is titled ‘Developmental trauma in the psychiatric hospital setting’. While a significant proportion of the theory presented in this book has a particular focus on children and developmental trauma, this last example is of an adult and is incongruous with the intent and focus of the book being healing trauma in children. Developmental trauma is manifest in adults (Van der Kolk, 2014), and the inclusion of this case in this book can be understood from this perspective; however, it seems more suited to a discussion on the impact of trauma in adult life than being aligned with developmental stages in childhood.

Elbrecht also introduces the ‘Art Therapy Star’ as an assessment tool, stating that the model was developed by a faculty member of the Institute of Sensorimotor Art Therapy (p.294). There are several concerns with this claim. The star was first known as the ‘outcome star’ and was developed in the United Kingdom in 2003 by Triangle, a community-service organisation (well before the Institute of Sensorimotor Art Therapy was established). Together with global collaborators, Triangle have developed several applications of the star assessment tool (Mackeith, 2011). It would be more accurate and ethical to identify that the outcome star has been adapted for this application within Clay Field therapy.

Further comments

Accompanying the text are several series of images of children at the Clay Field, which focus on the children’s hands as they present within a Clay Field session. Included throughout the chapters are diagrams and tables that support the theories being referenced. This is particularly helpful in the first section of the book, which presents multiple theoretical frames in support of Clay Field theory and therapy.

Cornelia Elbrecht is an Australian arts therapist, so it is surprising to note use of American language throughout the text – words such as ‘mom’ rather than ‘mum’ or ‘mother’ and reference to the volume of clay being given in pounds rather than kilograms. This may seem like a moot point given that the publisher is American; however, as there continues to be a lively discourse on the impact of ‘Americanising’ the Australian English language (Guild, 2004; Korhonen, 2020) I find it sad that the Australian voice within the arts therapy profession has been diminished with the use of expressions associated with the US. Perhaps this reflects the market that Elbrecht and the publisher hope to reach.

Conclusion

Section one provides the underpinning framework for the following two sections of the book, building a complexity of references in support of Clay Field therapy theory. The second part of the book presents the theory of Clay Field Therapy as it relates to the developmental stages throughout childhood. The final and third section is a series of cases written and presented by Clay Field therapists predominantly from Australia. This publication has received positive reviews from notable researchers and authors on trauma, art therapy and cognitive neuroscience. It is surprising that some of the assumptions and unreferenced statements have not been challenged. While this book makes a significant contribution to the field of creative arts therapy, I also urge readers to hold a curiosity and a criticality, and to measure their understandings of this material through both clinical practice and knowledge . After all, this book is breaking new grounds and presenting new material.

Author disclosure

On a personal note, as a reviewer of this book I acknowledge that in the past I have worked with Cornelia Elbrecht and the Institute of Sensorimotor Art Therapy. I no longer hold an association with the Institute of Sensorimotor Art Therapy. Apart from this review I have had no input into the text or editing of this book at any stage of its formation.

References

Guild, A. (2004) The Americanisation of Australian culture. https://www.ironbarkresources.com/articles/guild2004americanisation.htm

Hass-Cohen, N., & Carr, R. (2008). Art therapy and clinical neuroscience. Jessica Kingsley.

Hinz, L. D. (2009). Expressive therapies continuum: A framework for using art in therapy. Routledge.

Hinz, L. D. (2019). Expressive therapies continuum: A framework for using art in therapy (2nd ed.). Routledge. https://doi.org/10.4324/9780429299339

Kagan, S. L., & Lusebrink, V. (1978). The expressive therapies continuum. Art Psychotherapy, 5, 171–180.

Korhonen, M. (2020). American influences on Australian English. In L. Willoughby & H. Manns (Eds.), Australian English reimagined (pp.193-209). Routledge.

Lusebrink, V. (2014). Art Therapy and the neural basis of imagery: Another possible view. Journal of the American Art Therapy Association, 31(2), 87–90.

Mackeith, J. (2011). The development of the Outcomes Star: A participatory approach to assessment and outcome measurement. Housing, Care and Support, 14(3), 98–106. https://doi.org/10.1108/14608791111199778

Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children: The neurosequential model of therapieutics. In N. Webb (Ed.), Working with tramuatized youth in child welfare (pp. 27–52). The Guilford Press.

Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the Neurosequential Model of therapeutics. Journal of Loss and Trauma, 14, 240–255.

Macquarie Dictionary. (n.d.). Anthropogenic. In Macquarie Dictionary. Retrieved February 22, 2022.

Van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. Penguin Group.