This narrative report provides an overview of the development and progress of the clinic from the perspectives of the clinical team, clients and organisational partners. September 2010 to August 2011 has seen remarkable developments and growth in Ragamuffin’s pioneering Arts Therapy work in Cambodia:
The door is opened!
The Ragamuffin Project recruited and employed a team of six Arts Therapists. For the first time in Cambodia Cambodians are providing effective and culturally sensitive therapeutic care for traumatised and vulnerable children and young people through Creative Arts Therapy. In the past 12 months the therapy team have provided 262 individual client therapy sessions and over 760 children and young people have attended group therapy sessions. Our team of young and dynamic Cambodian Arts Therapists are pioneers in the use of Arts Therapy in the transformation of suffering into hope for the future.
A word from members of the Therapy Team…
Sophea Kuy – Ragamuffin Arts Therapist 2011
“Working as a therapist with the children is like the morning mist that gives the freshness to the grass and flowers as the new day dawns. Through the sorrow and pain, beauty is found as together we create and grow. As I watch them heal, I too am being healed. Arts Therapy helps those who are suffering to find a find space to breath and begin to discover a new way for their life and to see the world anew. As an Arts Therapist I believe that art helps the clients to face the most difficult challenges they have in life and find relief and hope.
In Cambodia many people from young children to the elderly faced the war and have also been abused. Culture and tradition means there are few opportunities for them to speak out the deep feelings and painful stories they hold inside. Cambodians are suffering and this clinic is one of the few places that provides a great help to them. I believe the clinic does not only benefit the children but also their families too, the children lead the way and they are our country’s hope for a different future.” (Sophea Kuy 2011)
Chatti Phal – Ragamuffin Arts Therapist 2011.
“As a Khmer-American, I did not realize the immense need for psychological services in Cambodia until I came here. As a foreigner, we are so removed from the problems of a different nation that sometimes it becomes invisible to us. We see stories on television, but we don’t fully understand the impact it has on a society. Being an Arts Therapist in Cambodia has been eye opening. There is a lot of injustice happening: forced evictions, prostitution and sexual slavery, children are made to go out on the street to work in order to support their families, there is so much domestic violence, and everyone is impacted by generational trauma. These are all children that we see in the Ragamuffin Arts Therapy Clinic. Arts Therapy helps the children to self-regulate, to recognize and assess their inner resources, to start to learn the different ways in which one can explore and express themselves. I also believe that the work that Ragamuffin is doing is setting the standards for professional mental healthcare in Cambodia. Our therapists are all trained in Arts Therapy, we understanding the therapist professional code of conduct. We have strengthened our Child Protection Policy and Protocol with our team and our partners, so that all children who come to Ragamuffin will feel safe and protected from harm” (Chatti Phal 2011).
Complex, multiple needs...
Ragamuffin’s Arts Therapy Clinic for children and young people continues to grow and develop. In partnership with six organisations, Ragamuffin’s Arts Therapists are working with children and young people with diverse needs and who are often from complex and extremely difficult socio/economic backgrounds for example:
The following is an extract from a report by one of Ragamuffin’s Arts Therapists:
Creative Arts Therapy work by Serey Samchet (Ragamuffin Arts Therapist 2011)
During the past 6 months I have been working with clients in both individual and group therapy. These include clients referred by the French/Cambodian Red Cross who are infected by HIV, and referrals from Enfants et Developpmment who work to improve life opportunities and psychosocial support for vulnerable children and their families. During the therapy sessions, I have used different arts forms as the tools to allow the clients to assess and express their feelings and problems.
Throughout my journey as an Arts Therapist, all clients have reported the benefits of receiving the therapy and how Arts Therapy has given them the healing space to explore their creativity, competencies, strengths, values, safety and trust and find calmness in difficult circumstances, and so begin to find change, light, hope and their capacity for empathy and love. The therapy journey has become the inspirational space for them to discover themselves and so find the courage to move on in life. The series of changes and transformation emerges with the flow of creativity and the therapeutic relationship during each session.
I have a client who is 14 years old, and he is HIV infected. He is under medication (ARV) second line. He is an orphan. He used to be burnt and physically abused by his father. Tragically the whole family died in a fire and he was the only person who survived and witnessed everything during the incident. He became withdrawn, and unable to engage or communicate with anyone after this event. During the first therapy sessions, he was so quiet and said very few words to me, there were often long pauses of silence and it was difficult for him to stay for the whole session. I felt his silence was communicating so much, I too became still and patient, it was important for me to wait until he was ready and felt safe enough to begin to open up. By the third session, he drew some pictures silently and I witnessed how his pictures reflected the deep stories he was holding inside him.
In sessions we used art, objects and played musical instruments. He never talked or told me directly of what happened to him but we interacted with each other through the language of these creative mediums. He repeatedly created battle scenes where he acted out a war between soldiers and monsters. It was violent and aggressive. Over time he began to discover how he could express his deep rage safely through the Arts. In the torn paper (see image left) he started to share the story of the torn paper mess that he made. Through the torn paper he began to express his torn life and all the fear and suffering within his heart, body and soul. This was such a breakthrough for him – he was brave and honest. In each session that followed, he was on the journey of self-discovery to find the courage to fight with all the discrimination he had experienced from family, friends and his community and so begin to discover his true identity and self worth.
Each session has become the remarkable moment of helping him to restore his inner resources, creativity, self-identity, confidence and resilience. We were together in a sacred connection through the Arts.
Over the course of the therapy he started to take the lead and create very different play experiences and through this he began to tell me about his hope for the future. He began to discover that he had dreams, a talent and a realistic vision to learn to be a chef and cook delicious food. His joy has spread from the inside out and other people have started to recognise the changes in him.
Feedback from our partner organisation:
“I am so surprised to see a lot of remarkable changes in his behaviour, communication, and self-care. He was totally withdrawn and now he initiates play with other children in the orphanage, and can verbally communicate with other people both at school, and in the community. He can tell me and other people what he needs, especially; he can take medicine (ARV) regularly by himself without any need for me to remind or do this for him. It is a truly remarkable change!.“
(Support Staff French/Cambodian Red Cross 2011)
The therapy has been an ongoing process to help bring positive transformation to the client ‘s life.
“I have noticed a lot of positive changes in him, he has became cheerful and socialize with other children in the centre. And he is looked completely different from the past.”
(Feedbacks from one of the housemothers in the orphanage)
Arts Therapy has become the oxygen for some clients to move on in life. As another of my client’s reflected saying:
“My heart has already died but no one knew of what going on inside me, but whenever I come to Ragamuffin, I have found the new breath and oxygen to live for the next day”
And from clients...
Arts Therapy and the therapist can become the only safe place and survival space for the clients to find their courage to live through their distress and challenges as another client describes:
“ At Ragamuffin, I can see what really happens to me, my life is so complex and nothing can change it, but to be here helps me to look at other possibilities and find a new hope to live alongside with the complexity of my life. I am so thankful – I know so many more children need to come here to have what I have found. ”
My reflections as therapist
"Overall, throughout the first year of Arts Therapy work, it has been a fruitful, creative and beneficial journey for all my vulnerable clients. The positive transformation of the clients has inspired me and given me so much energy to keep on my therapeutic journey by using the arts. Arts Therapy has shown to be the medicine to heal people’s soul, to bring the positive transformation and to be the bridge for people to walk across to another side of their life. It has helped them to discover the truth and to look for a new hope, and courage beyond fear. I strongly believe in Arts Therapy and my work. I can see how Arts Therapy has naturally helped my clients to find healing and to discover their inner resources by its gentle and powerful process. The more I work in this field, the more I feel that Arts Therapy is one of the most powerful and safest tools for trauma therapy in Cambodia". (Serey Samchet 2011)
Healing home...healing hearts...
Ragamuffin House is a unique sanctuary for Creative Arts Therapy, Training and Supervision. The environment is one of peace, safety, healing and playfulness. An outdoor meditation garden brings the inspiration and comfort of nature to support all who come for Arts Therapy.
“ A house surrounded by the nature, waterfall, flowers and sunshine - it makes me feel protected and I want this environment at work and in my life because I feel safe here and it’s the same feeling for the children coming here too!” (Organisation Partner Support Staff 2011)
Hand in hand...
The clinical team also work closely with the partner organisations. This includes provincial work in Kompong Cham and Kompong Som. Such work has enabled the development of psychosocial programmes of care within organisations in remoter provinces where there are fewer services.
Working with Partner Organisations enables us to develop joined up services and strengthen the capacity of each organisation’s psychological services. Training, the development of policies and protocols for safeguarding children, and providing programmes of individual and group Creative Arts Therapy all serve to meet children in their need and deepen an understanding of the emotional and psychological needs of children for the staff team. This helps create a response to children that is sensitive,and aware. To this end Ragamuffin Therapists also provide a specialist service that works alongside social workers, caregivers and medical staff.
Capacity building with partenr organisations:
Ragamuffin are also building the capacity of 8 key staff from the partnerships through our Foundation and Advanced Training Courses in the Healing Arts. This will build the capacity of the organisations to provide Arts Therapy whilst also increasing continuity of the care for young people.
“The clinic team come to MT every 2 weeks to work on difficult individual cases and group work with many children. The team offers great supervision and has helped our staff to learn how to reflect more and use art forms to express themselves and help their clients to discuss issues that may be hard to talk about with more traditional counselling. We have used what we have learnt for so many children and use regular art therapy with 150 youth in prisions every 2 weeks, and to 20+adult clients in our alcohol support group. We also use Art Therapy in our staff peer support groups as well as for group work with our youth groups: Happy Bird and Red Rose groups. We have worked in close partnership with Ragamuffin for over 6 years and they have consistently supported us on many levels, training individual staff on the foundation and advanced Healing Arts Therapy courses, and offering tailor made group training for our social workers and counsellors. They have a good understanding of the setting we work in and the training / lessons are well planned to meet the needs of our staff. Our relationship is positive and long term”. (Maggie Eno MTP Director 2011)
Clinical supervision and care for staff teams.
Capacity building and de-briefing for staff is critical for those working on the frontline of care in ensuring they are themselves resourced and sustained in their roles of caring for vulnerable or traumatised children and young people:
Giving space and a chance for someone to share their feeling with others is like giving them light to find the way out from a very dark room. The therapeutic training creates empathy, support and care to the staff. It is like the water that helps people to live everyday (Phea – Ragamuffin Arts Therapist 2011).
“ I did not know it helps this much when you can share your story or your feeling with someone you feel you can trust until I tried it. It helps a lot and I feel fresh in my mind after that, especially they listen with care and empathy. I feel this will help me to understand the children more”.
(Organisational Partner staff 2011)
Responding to Emergencies - Koh Pich Bridge Stampede
During this time Cambodia suffered another tragedy. On November 22, 2010, during Cambodia’s most celebrated Water Festival, a stampede on Koh Pich Bridge in Phnom Penh killed 347 people and injured over 700. Working alongside organisations involved in frontline care, Ragamuffin has been providing Arts Therapy sessions for survivors and de-briefing for organisations whose staff responded to the emergency.
After such a shocking and unexpected event, many were deeply distressed. In particular, children and adolescents are struggling and needed support. Such an immediate response helped ameliorate what might otherwise result in more deeply set psychological reactions to this trauma. Giving vulnerable young people the opportunity to address their psychological and social needs has been crucial to their longer–term well being. Shock and grief can be extremely debilitating when the impact of a traumatic experience is not recognised and understood and meaningful, sensitive and professional help is not available. The clinic staff, together with our partners, have all played a significant role in this process. Ragamuffin’s Arts Therapy Clinic has now developed a policy and protocol for responding to emergencies in Cambodia and will work together with the National Disaster Management Committee and our Clinic Partners in the provision of any programmes of response in the future.
Concluding thoughts - Rachel Hiskins - Arts Therapist 2011
The positive thing about the clinic is that the clients have a space to be and explore their lives through creativity in a safe and therapeutic environment. The client's would never have the opportunity to be able to work with the Art Therapy team and their skills if the clinic was not funded. Art Therapy is so important for clients that find it hard to express their emotions and feelings through words, thus working in Cambodia serves to be a stupendous match. I have found my client to be enthusiastic and passionate about visiting Ragamuffin every time. Coming to Ragamuffin is where she can explore her self without judgement in a beautiful and safe environment. As a therapist I feel that in each moment spent at Ragamuffin I am enriched with more knowledge and skills.
I recommend that this clinic be funded so Ragamuffin can expand and develop and that the clients are able to access such a great service. Its important to remember that Art therapy like other helping professions, do not have a quick fix. Art therapy is marvellous, as it can trigger empowerment and allow the unconscious to speak. Through our lives, we become detached at times, so when we speaking through the image, the client is able to transcend and speak from their true inner self. (Rachel Hiskins 2011)
Thank you for your continued support...for believing and giving hope...
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