Creative Expression Workshops in School: Prevention Programs for Immigrant and Refugee Children

Abstract

Introduction

Immigrant and refugee families underutilize mental health services and schools are in a good position to develop prevention programs to help children adapt to their new environment.

Method

The transcultural psychiatry team at the Montreal Children’s Hospital, in partnership with schools, has implemented creative expression workshops for kindergarten, elementary schools, and high school to help the children bridge the gap between past and present, culture of origin and host society.

Results

The workshops provide a safe space for expression, acknowledge and value diversity, allow the establishment of continuity, and facilitate the transformation of adversity.

Conclusion

Refugee and immigrant children’s needs should be addressed through intersectoral programs that target exclusion and support a sense of agency.

INTRODUCTION

A large number of immigrant and refugee families in Canada have experienced organized violence in their homeland and may still be in an unstable environment even after migration (Rousseau and Drapeau, 2004). Despite grappling with adversity, such families generally underutilize conventional mental health services, which are not always culturally sensitive. Schools are thus faced with the challenge of developing prevention and intervention programs to help new arrivals deal with their past experiences and adjust to new realities (Tolfree, 1996; Hodes, 2000). Artistic activities, as a mean of expression, have come to be considered a good way of helping immigrant children elaborate identity issues and construct meaning around the experience (Barudy, 1988; Golub, 1989; Lykes and Farina, 1992).

In this paper we will share the experience of a transcultural child psychiatry team’s work with multiethnic schools to develop and implement creative expression workshop programs for immigrant and refugee children. The workshops are built into the regular school day and have been designed to be transitional spaces that allow the children to build bridges between the past and the present, their culture of origin and the host society, home and school, and their internal and external worlds. All the programs were designed through a step-by-step process, implementing a series of pilot projects evaluated qualitatively before deciding about the final program components. After finalizing the development of the program, they were quantitatively evaluated with an experimental or quasi-experimental design.

We will first briefly describe the programs developed for different age groups – sand play, art and storytelling, and drama workshops – then present two vignettes to illustrate the effect of the workshops on children’s self-esteem and symptoms.

SAND PLAY FOR PRESCHOOLERS: REPRESENTING AND WORKING THROUGH THE TSUNAMI EXPERIENCE

The aim of the sand play program is to improve the social adjustment of children from immigrant and refugee families when they enter kindergarten by allowing them to represent the challenges of their bicultural world through play.

The technique was developed by Dora Kalff (1973) and has been used both in individual therapy and as a way to work preventively in schools (Wohl and Hightower, 2001; Van Dyk and Wiedis, 2001; Domenico, 1999). The children are given sand trays and are encouraged to create a world and a story with small figures representing nature, animals, people, and various objects (Lacroix, 1998).

In our qualitative assessment of the first pilot project for immigrant preschoolers, the children represented death and organized violence scenes in ways unexpected for this age group. This led the team to pay special attention to the reconstruction strategies used by the children. When the children were later given numerous figures representing their cultural and spiritual universes, they made massive use of these cultural signifiers in explaining adverse events and in proposing solutions.

This became particularly evident in January 2005, when the timing of the program coincided with the Asian tsunami disaster, which affected millions of people. The school was in a Montreal neighborhood with a large population from a number of South Asian communities, and more than 60% of the children in the program were of South Asian origin. Although the group leaders did not mention the tsunami, it was represented over and over in the sand tray by many children, who expressed their concerns for their country and family, their fear of repetition, but also their desire to help, repair and, above all, make sense of such a disaster. Again, religious signifiers were at the forefront of the attribution of meaning and of the imagined reconstruction processes. The sand play workshops were evaluated quantitatively in 2005, but the results are not yet available.

STORYTELLING AND DRAWING IN ELEMENTARY SCHOOL

The elementary school creative expression workshop program was the first one developed and assessed qualitatively by the team (Rousseau et. al., 2000, 2003) and quantitatively (Rousseau et. al. 2005a). It consists of 12 weekly sessions that are part of the regular school curriculum, run by an art therapist and a community worker in conjunction with the teacher. The program is composed of three types of activities that always combine verbal and nonverbal means of expression (drawing or painting a picture and telling a story), along with times for individual work and times when the children go back to their groups to listen or present their work.

The first activity is organized around myths, tales, or legends from different cultures. These stories are used to represent the tension and richness of multiplicity and to promote appreciation of nondominant traditions. They are chosen for their themes, which can be specifically associated with migration or the transformation induced by traumatic experiences. For example, the Japanese story about the origin of kites introduces a traditional strategy against nightmares. The stories become structuring metaphors that evoke both continuity, because they represent traditions that have withstood the vicissitudes of history, and flexibility, because they can be modified and played with by the children who, by illustrating and commenting on them, make them their own.

In the second activity, children are asked to tell the story of a character of their choice (human or not) who has been through a migration journey. They depict the past (life at home before migration), the trip itself, the arrival in the host country, and the future. The children draw a picture and then talk and write about the character’s story at each of these four points in the migration process (Rousseau and Heusch, 2000). Typically children borrow elements from the first activity to support their stories. This helps them to establish a time sequence.

During the last activity, the Memory Patchwork, the children bring in myths and tales from their families and communities, which thus represent their own identities more directly (Rousseau et. al., 1999; Rousseau et. al., 2003). The three most common types of stories are traditional tales from their homelands, historical accounts, and stories of family experiences. This activity creates or reinforces a dialogue between children and their parents about positive aspects of their past, and helps bridge the gap between home and school by symbolically bringing the family into the classroom.

The quantitative assessment of the workshops done using a quasi-experimental design suggests that the program activities are associated with a significant decrease in both internalizing and externalizing symptoms and with a significant increase in self-esteem (Rousseau et. al., 2005a). Focus groups revealed that the program improved teachers’ understanding of the children’s premigration and family experiences and changed their perception of their pupils’ emotional and behavioral difficulties.

DRAMA THERAPY WORKSHOPS FOR ADOLESCENT IMMIGRANTS AND REFUGEES

These workshops are based on Augusto Boal’s forum and Jonathan Fox’s playback theatre. Playback theatre is a type of improvisational theatre that aims to achieve personal and social transformation through sharing a theatre experience within a ritual space (Fox, 2000). The ultimate goal of our program is to facilitate the adjustment of newly arrived teens and help them work through their traumatic experiences in order to prevent behavioral and emotional difficulties that may be exacerbated by the migration and premigration context.

Within a safe and respectful atmosphere, a play director coordinates and contains the story reported by a youth as it unfolds, while actors and musicians gather the information in order to play the story back to the teller and the group. The stories can be transformed and replayed through alternative scenarios developed by the participants. The idea is to alter the situation to empower the storyteller and the others, either by changing the meaning, building a relationship, or creating an opening or dialogue with others that was missing from the original story. This part of the workshop becomes a collective effort, focusing on cocreating a story or situation where teens look for alternatives to their first reactions and strategies.

The qualitative evaluation of the drama therapy workshops shows that their ritual nature provides a safe environment for adolescents to express themselves. Witnessing the reenactment of their traumatic stories as well as their hopeful stories of resilience allows the teens to transform adversity directly, indirectly (by witnessing others), or metaphorically. The workshops empower them by emphasizing the strengths that stem from adversity and provide them with an opportunity, through the playback of their stories, to construct meaning and grieve some of the losses associated with migration and premigration experiences (Rousseau et. al., 2005b).

The quantitative assessment of the drama program compared newly arrived adolescents whose classes were randomly assigned to the experimental or control group. Our results suggest that although the program had no direct effect on the intensity of symptoms reported through the Strength and Difficulties Questionnaire (youth and teacher versions), it significantly reduced the impairment associated with these symptoms. The therapy was also associated with a marked improvement in academic performance, especially in mathematics (Rousseau et. al., submitted)

IMPACT OF THE WORKSHOPS: CLINICAL PERSPECTIVE

The stories told by Raj and Ron illustrate how the creative expression workshops can interact with different psychopathological presentations and be useful in a variety of ways when migration traumas and losses are involved.

Raj is an 11-year-old boy of South Asian origin who arrived in Canada one year ago with part of his family. His father remained behind in Africa as a political prisoner. Raj was very disruptive in class and had difficulty following instructions and classroom rules. He had a very short attention span and could not concentrate for more than 10 minutes. Easily frustrated, he often became aggressive towards his peers and was not part of the group.

Raj’s initial artwork was chaotic, disorganized, and messy. He seemed disturbed by his own work and would throw out most of it because it was “too messy.” Figure 1 illustrates this first phase of his work. It represents an expressionless face where the eyes are the main feature. He kept painting the eyes until holes were torn through the paper. The eyes look like they have seen a lot.

Figure 1.

Early printing by 11-year-old Raj.

Raj gradually formed an alliance with the art therapist. He looked for excuses to stay in the classroom and help out during the break. He began to be part of the group and participated in the activity more intensely. He enjoyed the storytelling, listened attentively and used the proposed metaphor to speak about his own experience, although always indirectly. When his peers were invited to tell their stories, he suggested that the group act them out. He engaged with his peers in this drama activity, laughing and enjoying himself. In the last few sessions, his artwork was playful and much less chaotic. He used collage material to structure his work (and perhaps himself), and made use of very delicate colors. His interactions with his peers were smoother and he reported a sense of belonging to the group.

Ron is a 12-year-old boy from South Asia. He arrived in Canada one year ago, alone, to be reunited with his father and younger sister, who were already in the host country. Back home, Ron’s father was involved in an opposition party and the family’s home was bombed while Ron’s mother was inside. In spite of his father’s efforts to save her, she died from her burns. Ron’s father then fled, leaving the children in a refugee camp. Ron’s father managed to have Ron’s younger sister sent to him a year later, but Ron remained alone in the camp for two more years before he was able to join them. The family never again spoke of this traumatic experience.

Ron’s teacher, who did not know his detailed background, considered him to be a very shy and inhibited boy. He was withdrawn and almost too polite and submissive. He displayed very low self-esteem, in spite of his reasonably good academic performance. At the beginning of the workshop he paired up with a disruptive peer and endorsed his partner’s opposition to the activities.

The workshop provided Ron with a safe space for the expression and validation of his trauma. In the third session, he was strong enough to speak openly about his experience. The class stood as a group witnessing his trauma, which was collectively contained with the help of the workshop organizers. Ron’s teacher had difficulty handling the situation and cried, and this made Ron feel a little guilty. His peers remained supportive. He gradually became one of the group and participated actively in group discussions.

Ron’s artwork is very elaborate. Heroes are usually alone and engaged in a quest (Figure 2), and houses are empty. In his comments, he raised a lot of questions related to spiritual matters such as God, heaven, and protection, exploring ideas about what happened to his mother, where she was, who she was with, and the emptiness he felt. By the end of the series of workshops, Ron was much more connected to his peers and teacher and this very resilient child had begun to grieve without falling apart.

Figure 2.

Typical picture by 12-year-old Ron.

Raj and Ron are similar in terms of their cultural origin, their traumatic stories, and the time spent in the host country. They differ in terms of their symptoms and in the way that they used the space for personal expression provided by the workshops. Raj expressed himself through metaphor and the dramatization of his peers’ experiences. Ron disclosed his personal story and used the healing environment to pursue his mourning process. Both reestablished links with their peers and with their teachers. In Ron’s case, the teacher also felt the need for support. The effect of disclosure on school staff who may not be familiar with traumatic stressors points to the need to support all participants in school intervention activities.

CONCLUSION

Creative expression workshops can be implemented successfully with different age groups, adapting the modes of expression to their varying developmental needs. Four aspects seem to play a key role in all the workshops: the construction of a safe space, the acknowledgement and appreciation of diversity, the establishment of continuity, and the transformation of adversity (Rousseau et. al., 2004).

They can be replicated in different school systems and adapted to class programs for immigrant and refugee children, as long as three central points are kept in mind. First, a verbal and nonverbal means of expression must always be paired, to offer the children more than one way of expressing themselves and to circumvent the inevitable language barrier. Second, the program should metaphorically represent cultural diversity to allow a give and take between mainstream and minority cultures. Third, it is essential to provide a secure place for working through issues, and this can be done by alternating opportunities for personal expression and small group discussions to foster empathy and solidarity. Finally, the experience of the creative workshops raised the importance of sensitizing the teachers to the children’s life experience and of supporting them in this process.