When Words Aren’t Enough: Creative Expression for Nervous System Regulation, Meaning Making, and Healing in the Perinatal Timeframe

By Madison Petersen, LCSW, PMH-C

PTSD Awareness Month

“As both a clinician and an artist (with lived experience with both perinatal loss and a PMHD), I have seen how writing and visual art can give shape to emotions that often feel unspeakable and play a vital role in reclaiming your own voice, making meaning, and ultimately finding healing.”

It’s 2022, and I’m looking at myself in the mirror. I look tired, stretched thin, sad. It was a night of “team no sleep” as my son was in yet another sleep regression. As I searched for something familiar in myself, my two-and-a-half-year-old daughter tugged at my leg while my five-month-old cried for my attention elsewhere. Needs were asking to be met all around me. But what about my needs? Being able to even identify what they were felt far from attainable.

As a therapist in the middle of a struggle with perinatal mental health, it felt difficult to identify exactly what was happening with my own body and mind. I was struggling, but I was also at the beginning of a transformative journey. Now, as both a perinatal mental health certified therapist and a woman who lived through a perinatal mental health disorder, I have seen how writing and visual art can give shape to emotions that often feel unspeakable and play a vital role in reclaiming your own voice, making meaning, and ultimately finding healing.

What is perinatal trauma, and is it always PTSD?

Any person in the postpartum period knows what it feels like to feel a bit disconnected from who they are. With one out of every five women and one out of every 10 men experiencing difficulties with their mental health during pregnancy or postpartum, feeling unlike yourself is not exactly uncommon (Postpartum Support International, 2014). Even without clinically significant, diagnosable symptoms consistent with a perinatal mental health disorder, this time of your life is trying. Sleep deprivation, constant caregiving, physical healing, shifting family dynamics—it’s a lot! 

But there is a notable population that does experience this shift as traumatic. An estimated 9% of women experience PTSD following childbirth (Postpartum Support International, 2014). There can be many factors that contribute to experiencing PTSD in the perinatal timeframe, including but not limited to birth trauma, stillbirth and other perinatal loss, birth injury, large deviations in expectation of delivery, and rapid birth. It is important to remember, though, that trauma is not linked to a specific event, but to how the event is perceived by the individual’s nervous system. Westminster College (2021) describes trauma as “experiencing too much, too fast, too soon in such a way that one’s ability to cope is overwhelmed.” Put more simply, trauma is highly subjective. This leads me to believe that trauma in the perinatal space is likely under-recognized, which makes trauma-informed treatment a non-negotiable for all providers, especially mental health providers who work in the perinatal space.

When talk therapy falls short: limitations of talk therapy and the emergence of bottom-up approaches to trauma treatment.

I began experiencing symptoms of perinatal depression at around four months postpartum with my second child. My children were born almost exactly two years apart, both rapid births, and we moved homes only four months after my son was born. I was also navigating chronic pain later linked to undiagnosed endometriosis that greatly hindered my ability to cope with stress (too much, too fast, too soon). Even as a mental health professional, the signs of perinatal depression were difficult to recognize and felt equally as hard to navigate when it came to pursuing steps toward healing.

Understanding the nervous system and its involvement with trauma has been an important development in mental health, and as more people become aware of the nervous system’s role in experiencing trauma, more people are seeking ways to heal using somatic practices. Because we understand the nature of trauma is embodied—experienced by and stored in the body—we must reach for therapeutic modalities that are also embodied. I believe considering this somatic piece in therapy is vital in treating trauma in general, but is even more important with perinatal clients because pregnancy and postpartum are BODY-based experiences. The dramatic shifts that a body goes through during pregnancy and postpartum can be traumatic in more ways than just physical. But the physical drama of this time can be traumatic on its own. So, when trauma explicitly involves a person’s body—the experience of growing another human inside of the body, and that person leaving the body in expected or unexpected ways—we must consider healing through embodied practices.

Several evidence-based approaches fall under the umbrella of somatic therapy, including Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing (SE), Accelerated Resolution Therapy (ART), Trauma-Informed Yoga, Somatic Breathwork, Internal Family Systems, and others. However, as a social worker, I am always considering systemic barriers to accessing such therapies. These therapies can be expensive; they must be conducted by a licensed professional; they require therapeutic trust and rapport; and they can be time-consuming (which is maybe the greatest barrier during the postpartum time). All of these are limitations for the client. And there are limitations for providers too, as these therapies require advanced training, which is expensive and time-consuming. However, everyone has access to a pen and a piece of paper.

Expressive art as a bottom-up approach to healing.

As I grappled with my own unraveling mental health, I reached for my pen and journal, a familiar place for me to process my experiences. I had always been a writer, finding comfort in the physicality of pen to paper. I was also in talk therapy. I had incredible family and friends supporting me. And I turned toward my faith to find meaning and strength. But I still was struggling to feel like myself. The more I wrote in my journal, the more I longed for a more embodied way to express my feelings. I couldn’t stop thinking about making visual art.

Later that year, visual art became a road back to myself. Visual art offered me a safe place to release what I held bound in my chest. Making became a way to loosen what my body carried and what I feared might be “too ugly” if it were ever seen. I didn’t care if what I made looked “pretty” or good, I was more focused on how it FELT to create. Something inside of me unlocked as I allowed my body to guide expressive marks—to prioritize my felt experience rather than intellectualize or cognitively process through journaling or talk therapy like I always had. I didn’t realize it at the time, but I was accessing a bottom-up approach to healing.

Expressive arts therapy is the purposeful application of art, music, dance/movement, dramatic enactment, creative writing, or imaginative play. These are largely non-verbal ways of self-expression. More importantly, they are action-oriented and tap implicit, embodied experiences of trauma that can defy expression through verbal therapy or logic. (Malchiodi 2020). The externalized, sensory focus associated with expressive art becomes a key ingredient to addressing the all-too-common internalized shame associated with perinatal mental health disorders and trauma. Emphasizing a process over product way of creating removes pressure and creates space for clients to connect with their experience and their art in a new way. Often, it is in the process of making that you can even recognize the weight (or texture, or color, or shape, or magnitude) of what you had previously been carrying. Giving shape or imagery to experiences can be an approachable way to begin speaking about things that felt too difficult before.

Why expressive art for expecting and postpartum mothers?

During my own healing, I prioritized time every day to create. Sometimes it was 15 minutes with my journal, sometimes it was a few hours to draw or paint after bedtime. It felt like something that was protected as “mine.” It was easily accessible. It was cost-effective. It was meaningful. Then, something else started happening. I started sharing my art, and it became a connection point for me with others.

Based on current evidence-based and emerging brain-body practices, there are eight key reasons for including expressive arts in trauma intervention: (1) letting the senses tell the story; (2) self-soothing mind and body; (3) engaging the body; (4) enhancing nonverbal communication; (5) recovering self-efficacy; (6) rescripting the trauma story; (7) making meaning; and (8) restoring aliveness. (PsycInfo Database Record (c) 2025 APA, all rights reserved). In my work with perinatal clients, I typically see themes of identity tension either due to trauma or loss, or just the general shift that entering parenthood brings. Outside of the reasons I have already stated in this article, like nervous system support, I almost always recommend expressive art as a companion to therapy for people in the perinatal timeframe for a few reasons:

1. It’s fun, and it’s free. Pregnancy and postpartum are expensive and often mundane. There is freedom that comes when we stop consuming and start creating. It can bring in delight and remind us that the present moment can hold magic.
2. It helps you slow down and get clear. During pregnancy and postpartum, you may be rushing to meet needs constantly. Making art offers you a chance to slow down to the pace of your own thoughts and get really clear about what is going on inside of you.
3. Art doesn’t require words. Art helps you work things out without talking. You can give your “mom brain” a break and make something that feels good instead.
4. Art reveals to us how we are doing…really. Art offers you space to be honest about how you are doing without fear of how someone will respond. You can feel first and interpret later.
5. Art matters so much and doesn’t matter at all. As a person in the perinatal phase of life, you are expanding and changing. And this matters so much that it can feel terrifying or paralyzing, leading us to feel stuck. Add caring deeply for a baby and potential trauma to the mix, and risk-taking of any kind can feel too threatening to your nervous system. Art gives us a chance to explore again in a safe/non threatening way. When we try something new, take risks, and allow ourselves to not be “good” at something, it is good practice for parenthood and the many changes that come along with it. So, art deeply matters. Your expression matters. Getting it out matters. Somehow, art has this power to lead us back to our own ability to take risks in our lives. But also, art doesn’t matter. That thing you made that you hate…go ahead and throw it away. There is no major consequence for making art.
6. Art opens the door to connection. If you allow your art to be a form of meaning-making, it can turn into a reclamation of your voice and provide a way to connect with others and share your story. For example (shared with permission), I had a client who experienced a stillbirth. She worked with me in therapy and used expressive art alongside her therapy sessions consistently for about a year to process her feelings and articulate her experience. She now uses art making to connect with other parents who have experienced perinatal loss, sending them a handmade card for their child’s birthday. This act connects her to a broader community while allowing for ongoing meaning-making as she grieves and grows.
7. Art is healing. You are deserving of healing. Period. 

Where do you start?

The most important reason I recommend making art to my clients is that art is something they can do without me. The entire purpose of therapy is to have a witness to work alongside you until you feel confident in your own abilities. I think that art is a beautiful way to encourage or rebuild self-trust and self-confidence. Ultimately, I believe that expressive art can play a big role in empowering people to reclaim or reorient their identity after major life shifts, like having a baby. If I introduce you to art making to support your mental health and then you use it as a supportive tool for the rest of your life, I think I did my job. Something about teaching a man to fish…or something.

If you are interested in more information related to expressive art and therapy, I recommend looking into the International Expressive Arts Therapy Association, Neuroarts Research Center, and The Birth Project.

If you are reading this article and you want to start making art to process your own experience, YAY, mission accomplished! My tips for how to start:

1. Try expressive writing. Set a timer and write, stream of consciousness, for 5-10 minutes (I like to aim for a full page of writing). No judgment, no editing, just write it out!
2. Start a visual journal. For one week, experiment with depicting your emotional landscape through color/shape/texture alone. I like to do this in a journal with a taped off 4×4 square on every page. I also like to name the piece a simple word or phrase to capture the essence of what I am attempting to depict. I also like using blind contour drawings as a simple abstract exercise to mark the moment, break free from perfectionistic thinking, and slow down to a mindful pace.
3. Just play. Get a coloring book and do it with your children. Scribble on a paper. Experiment with collage. Get out the play dough!
4. If you are in Oklahoma, reach out to me! I am not a registered art therapist, but as a therapist who is also an expressive artist, I often integrate expressive art into my therapy modalities. You can find me at www.madisonpetersenllc.com or on Instagram @madison.petersenllc.

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Citations

Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process. The Guilford Press.

Postpartum Support International. (2014). Perinatal mood and anxiety disorders fact sheet. https://www.postpartum.net/wp-content/uploads/2014/11/PSI-PMD-FACT-SHEET-2015.pdf

Westminster College. (2021). Impacts of trauma. https://www.westminster.edu/campus/services/title-ix/pdf/impacts-of-trauma-ac.pdf

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