Tracing the arc of healing

The opening chapter of the book provides an accessible overview of neuroscience, outlining how chronic stress and trauma imprints upon the brain and nervous system. In this section, Knash effectively argues for the necessity of bottom-up interventions – approaches that engage the body and sensory experiences before delving into cognitive processing. This idea aligns with Ogden et al. (2006), who highlight the importance of attending to the body in trauma recovery. By focusing on emotional regulation before symbolic meaning-making, Knash mirrors van der Kolk’s (2014) assertion that trauma is fundamentally stored within the body, necessitating non-verbal therapeutic approaches for effective healing.

Knash further develops this idea by exploring specific art therapy techniques that are structured around developmental sequencing. She emphasises sensory engagement – using rhythmic, tactile, and non-verbal interventions – as the primary entry point for clients whose trauma precedes language. This approach allows clients to build emotional regulation through embodied experiences before engaging in higher-level cognitive processes. Knash builds on Schore’s (2012) research on affect regulation and the neurobiological underpinning of emotional processing reinforces the importance of addressing the body’s physiological response to trauma, laying a foundation for deeper cognitive and emotional work.

Throughout the book, Knash continues to explore the integration of neural networks within the context of art therapy. As clients progress, the therapeutic interventions shift towards a focus on cognitive reorganisation and narrative integration. The book includes several case studies that illustrate how art therapy techniques, both directive and non-directive, facilitate emotional processing and the integration of fragmented self-experiences. These case studies provide clear examples of how art therapy interventions support affect regulation, personal growth, and the development of emotional fluency, making this approach highly relevant for practitioners working with complex trauma presentations.

The interpersonal landscape of healing

A key strength of Knash’s work lies in its emphasis on the relational aspects of trauma recovery. She explores the therapeutic alliance as a critical site of co-regulation and repair, demonstrating how attunement and embodied presence within the art therapy process can create a safe space for healing. By incorporating attachment-based frameworks, Knash underscores the importance of relational dynamics in art therapy, where mirroring, pacing, and containment play vital roles in fostering safety and trust (Kapitan, 2017; Schouten et al., 2015). The therapist’s ability to remain present and responsive to the client’s needs is presented as a cornerstone of trauma recovery.

Knash also discusses how, as clients move through the art therapy process, their engagement with symbolic and cognitive dimensions of art becomes more prominent. This transition, however, is approached cautiously – Knash warns against rushing into symbolic meaning-making before the client has had the opportunity to build a foundation of emotional regulation and safety. This caution is consistent with van der Kolk’s (2014) notion that trauma recovery requires patience and careful pacing, and symbolic engagement must be earned rather than forced.

Theory, practice, and clinical evaluation

Art Therapy as Cumulative Trauma Repair thoughtfully bridges the divide between neuroscience and therapeutic art-based practice. By integrating Perry’s NMT (Perry & Szalavitz, 2017) with Hinz’s (2020) ETC, Knash presents a developmentally sensitive, evidence-informed model for working with cumulative trauma. This dual framework offers a clear rationale for the use of bottom-up, sensory-informed interventions in art therapy and affirms the role of creativity in fostering co-regulation, emotional processing, and narrative integration (Ogden & Minton, 2000; van der Kolk, 2014).

A key strength of the book lies in its ability to translate complex theory into accessible, real-world clinical practice. Knash’s detailed case studies bring her neurobiological model to life, providing compelling examples of how art therapy can assist clients in progressing from dysregulation to integration. She foregrounds the importance of therapist attunement and presence, drawing on affect regulation theory and the therapeutic alliance as central mechanisms for healing (Kapitan, 2017; Schore, 2012). The book also acknowledges the emotional toll of trauma work, encouraging therapist self-reflection and care, particularly within high-intensity settings where burnout and vicarious trauma are common (Figley, 2002).

However, the text could benefit from deeper exploration in two key areas. First, although Knash acknowledges sociocultural influences on trauma, the discussion of cultural responsiveness and systemic considerations remains limited. A more robust engagement with issues such as race, gender identity, collective trauma, and systemic oppression would enhance its applicability for diverse populations (Kapitan, 2017; Talwar, 2019). Second, while the case studies are rich in clinical insight, the inclusion of structured and replicable tools – such as adaptable session plans, protocols, or therapeutic activity guides – would be particularly valuable for clinicians, supervisors, and educators seeking to operationalise Knash’s approach in practice or training contexts.

Despite these areas for further development, the book offers an innovative and meaningful contribution to contemporary trauma-informed care. Its integration of neurobiological theory, developmental sequencing, and expressive modalities highlights the unique capacity of art therapy to work across verbal and non-verbal domains, particularly with clients for whom language may be inaccessible due to the nature or timing of their trauma.

Conclusion

Art Therapy as Cumulative Trauma Repair stands as a valuable and timely contribution to trauma-informed practice within the creative arts therapies. By thoughtfully integrating neurobiological theory with creative, embodied methods, Knash presents a nuanced and practical framework for addressing the complex impacts of cumulative trauma. Her clear articulation of developmental and relational processes, supported by illustrative case studies, ensures the book’s relevance for clinicians, educators, and students alike. While there is room for further development in areas such as cultural responsiveness and the inclusion of more structured, easily replicable interventions, these gaps do not undermine the overall strength of the work. Instead, they signal directions for future scholarship and clinical innovation. Ultimately, Knash offers an engaging and grounded vision of healing, one that honours the role of creativity, safety, and connection in the therapeutic process.