Zooming the Sensory-based Relational Art Therapy Approach (S-BRATA)

When I was approached by Sasha to work with her sons using the Sensory-Based Relational Art Therapy Approach (Durrani, 2020), I was completely thrown out of my comfort zone.

Not only were Sasha and I separated by multiple time zones until then I had not considered the possibility of ‘S-BRATA  online’. S-BRATA is a framework that originated from my doctoral research on impaired attachment and Sensory Integration Dysfunction (SID) in children with autism. It positions the art therapist as an attachment figure and targets both attachment and SID concurrently in children on the spectrum. The approach aims to ameliorate impaired attachment by lowering anxiety caused by SID which is implicated in attachment disruption in children with ASD. Underpinning the S-BRATA is an extremely sensitive, attuned reciprocity between child and therapist, involving nuanced layers of explicit and implicit interactions mediated through art materials and art-making. Hence, telehealth does not present as a viable option or at least that is what I believed until recently.

Sasha’s boys Ali (12-years-old) and Ahad (9-years-old) are on the spectrum. They are non-verbal and have significant communication and behavioural challenges. Sasha had read my publications on ASD (Durrani 2014; 2018; 2019; 2020) and was intrigued by what she thought was a “different way of working with children on the spectrum”. Sasha’s immense dedication towards her boys had made her leave her country of origin as a single mother to provide them with the best opportunities to achieve their potential. Her eagerness to try something out of the box that resonated with her overall approach to raising her kids convinced me to attempt ‘S-BRATA online’ with her. Another significant factor that influenced my decision was that Sasha was enrolled in an undergraduate art therapy program which meant that she was familiar with the inherent qualities of art materials and the power of relational artmaking. I felt a sense of community with her that further instilled in me the confidence for the undertaking.

Let the sessions begin

We decided to hold sessions once a week. Since I was not there in person, I would guide and train Sasha through directives and close observation of her interaction with the boys. As such I would be facilitating dyad therapy remotely. A few things had to be put in place before sessions could begin. I recommended a list of art materials that Sasha had to prepare such as paints in squeeze bottles, brushes, coloured sand,  shaving foam and a large plastic sheet to cover the living room floor where the sessions would be held. Also, Sasha had to figure out the optimal placement of the camera that would allow me a good view of the boys and their artmaking on Zoom. 

Goals

My goal for Ali is to facilitate communication through art which is a form of expression he enjoys and is motivated to use. Ali’s artwork can become a conduit for his feelings which he struggles to express verbally. Joint artmaking between Ali and Sasha can mimic a conversation where a verbal exchange is not necessary. 

Ahad needs are different from Ali’s. He appears to be more anxious and his receptive and expressive language is significantly more limited than his brother. My goal for Ahad is to induce regulation through art materials in order to lower his anxiety and to give meaning to his marks. 

For both Ali and Ahad, Sasha is the attachment figure that in my book Sensory-Based Relational Art Therapy Approach. Supporting Psycho-Emotional Needs in Children with Autism (Durrani 2020) is a role that I emulated as an art therapist.

Sneak peek into a session

Ali

I had Sasha laminate some photos of Ali taken at the trampoline park that he enjoyed visiting. The plan was to ask Ali to choose a photo and to create an association between his brush/hand strokes and the image of him jumping (action) and enjoying (feeling). After pointing to a photo, Ali picked up red paint and poured it on the paper using his hands to spread it out. Sasha prompted Ali to add more colours related to the moment the image represented, emphasizing the action and the emotion. My role was to observe and guide Sasha’s interactions and responses to Ali’s behaviour. For instance (a) when Sasha should step in to facilitate Ali’s process (b) when she should hold back interaction (c) when to use exaggerated affect (d) body positioning and so on. Ali created the artworks (Figures 1&2) requiring frequent verbal prompts and encouragement. This session was remarkable because in the previous ones he imitated Sasha’s artmaking whereas in this one he created the artworks independently.

  Figure 1 

     

                                                                        Figure 2     

After Ali’s artmaking, I reflected with Sasha on his process and her interaction with him. I recalled how Ali struggled with lack of structure and was always looking to either imitate or be directed to do something as was the norm in school and otherwise. Moreover, I observed that Sasha had the tendency to scaffold him or step in to help if he was not responding as per the expectations. However, the flexible structure of the S-BRATA that emphasizes meeting the child at their level and following their lead seemed to have struck a note with Ali.

Ahad

Ahad who was seated at the table began drawing the shape of a snake from his favourite Erik Carl book. Sasha stepped in to help him. When she had completed the outline,  Ahad attempted to colour the snake. His body language conveyed a sense of restlessness. It is possible that the lack of structure in the session made him uncomfortable. Sasha shared that Ahad liked to do things fast so maybe he was struggling with the pace of the session where I was trying to keep his attention sustained for longer in an activity. Therefore, I decided to follow Ahad’s lead and move from drawing one animal to another at the pace he desired. After he had coloured the snake Ahad indicated that he wanted to draw a bear. When Sasha moved forward to help him this time I stopped her. Ahad scribbled a shape with a brown coloured pencil and I named it ‘bear’.  In order to hold his attention, I quickly asked him what the bear wanted to eat and he indicated ‘bat’.  Then Ahad scribbled with a green pencil next to the bear representing the bat (Figure 3)

I discussed with Sasha how in future sessions an activity could be developed using Ahad’s interest in animals and building a narrative around them. So for the following session, Sasha and Ahad created a landscape with papier mache animals  (Figure 4) that sustained Ahad’s attention for significantly longer than the previous session.

 Figure 3

Figure 4

According to Sasha:

“I love the fact that in the sessions, it is possible to work with each boy independently, according to their ability and they both are attracted to each other's sessions; they are interested in what will happen after they start. I was so happy when Ali painted his happy jumps and was able afterwards to make up a sentence describing his activity (similar to what we work on with the SLP) and then write it on the writing lines ( in a similar manner to what we do with the OT). For Ahad,  after I told the SLP about what you did she asked him what he wanted and he chose the bat, then she gave him the marker to draw the bat ( in the past she would draw it for him). Next, she asked him “what do you want the bat to eat” and he chose lollipops. She loved the idea of building on his choice instead of repeating descriptions of which animals he wants or sees. What I wanted to say is that your approach combined with the input from SLP and OT and me (the mom) was able to have a positive impact on the boys and me. On the other hand, your approach is teaching their SLPs and OTs to follow the boys' lead in a creative way that they didn't use before, like building on their choices, instead of repeating the same activity. For me, this will have great benefits for the boys. This all shows me how powerful your approach would be if it is incorporated in the IEP ( Individualized Educational Plan ) which is done at the beginning of the school year or if it is included in the boys' activities regularly”.

Future possibilities

So it seems that all is not lost with telehealth. In fact, had Zoom not been a forced trend in these times, perhaps Sasha and I would not have entertained the thought of trying out S-BRATA online. 

There is great value in training caregivers and teachers of children with autism in approaches like the S-BRATA, as it departs from the traditional focus on modifying behaviours and skill-building. It emphasizes the emotional, sensing, feeling child who can be in danger of getting lost in the flurry of conventional approaches. Also, S-BRATA is not limited to the use of art therapists only and can be used as a guiding framework by all therapists using creative, multi-sensory, multi-modal approaches.

References

Durrani, H. (2020). Sensory-Based Relational Art Therapy Approach (S-BRATA): Supporting Psycho-Emotional Needs in Children with Autism. New York: Routledge.

Durrani, H. (2020). Sensory-Based Relational Art Therapy Approach (S-BRATA): A Framework for Art Therapy With Children With ASD, Art Therapy, DOI: 10.1080/07421656.2020.1718054

Durrani, H. (2019). Art Therapy’s Scope to Address Impaired Attachment in Children With ASD and Comorbid SID, Art Therapy, DOI: 10.1080/07421656.2019.1677063 

Durrani, H. (2018). A Case for Art Therapy as a Treatment for Autism Spectrum Disorder. Art Therapy: Journal of the American Art Therapy Association, 0 (0), 1-4.

Durrani, H. (2014). Facilitating Attachment in Children with Autism Through Art Therapy: A Case Study. Journal of Psychotherapy Integration, 24 ( 2 ), 99-108.