During her most recent six-month tour of the Central African Republic, art therapist Karen Abbs saw firsthand the effects of enforced female circumcision, ritualized burning and cutting, and ongoing fighting between government and rebel forces. The result was kids suffering from sleep disorders and nightmares, and a population beset by general anxiety.

The 36-year-old, who was on her second stint with Médecins Sans Frontières, has just returned to visit family in 100 Mile House and recharge her batteries.

"I saw people with such bad trauma issues," Abbs told the Georgia Straight by phone. "You have no idea."

Her first MSF tour to war-torn Kashmir, in 2005, lasted nine months but was equally gruesome. Abbs had to deal with her own trauma resulting from bomb blasts and an earthquake in the long-disputed region in the Indian subcontinent.

"When I came back from Kashmir, I had to work, through art, to get over that experience," she said. "I was also there through the earthquake of 2005, and I relied on art to heal myself, as the trauma tends to get embedded."

Abbs completed a two-year diploma in art therapy at the Vancouver Art Therapy Institute in 1998, and in 2005, she received a master's degree in expressive art therapy from the European Graduate School in Saas-Fee, Switzerland.

The Web site of the B.C. Art Therapy Association lists around 45 art therapists in the Lower Mainland. Crudely defined, art therapy is a form of expressive therapy that uses art materials such as paints, chalk, and markers.

Abbs has used her training to heal herself, but her main work involves helping others, especially children who have suffered sexual abuse, domestic violence, or the pain of their parents' divorce. She said knowing the trauma firsthand provides crucial insight and empathy.

"In my opinion, in order to do counselling with someone else, you also need to have explored your own stuff and to know yourself very well," she said. "That is really the philosophy behind a lot of the training programs - you need to do your own therapeutic work before you can begin to do somebody else's work."

In her own life, aside from the MSF tours, Abbs went through the stress of what she calls "an early marriage and early divorce". She said the two-year program at VATI required some personal trauma work. The art therapy helped her deal with the resulting trauma and grief from her four-year marriage in a different way from the traditional on-the-couch verbal counselling between client and counsellor.

"It was an incredible experience, especially when you work with art," she said. "I have done verbal therapy with a therapist, but when you do verbal therapy, it is very easy to censor what you are going to say and to say, 'I am going to say this, but I am not going to say that.' Whereas when you work in the creative means, it helps you to access your issues much more quickly and much more deeply."

According to Abbs, art therapists refer to the art as providing a "safe container" that "externalizes what has happened to you through a creative means".

"For me, the art is a more powerful, and also safer, way," Abbs said. "So if I having difficulty with things going on in my life, I can draw them and then talk about the picture....When you speak about trauma, you speak it and it is just out there, but when you draw a picture about trauma, the trauma is contained within that painting. You can choose to look at it, destroy, or whatever you wish to do, and it creates that safe place."

Vancouver-based art therapist Katherine Kortikow told the Straight she sees art as a nice way "to begin to create another language" for people to access inner feelings.

"I work a lot with women who have been touched a lot by domestic violence," Kortikow said. "I find that a good percentage of those have experienced trauma earlier in their lives - a variety of them have different types of traumas. I get a lot of referrals from the Vancouver police department Domestic Violence [and Criminal Harassment] Unit."

Kortikow said she also works with people with learning disabilities, and that art therapy is a "wonderful modality" for those individuals because "they may not be able to articulate or have the same capacity for immediate insight". Kortikow added that she is also studying sensorimotor psychotherapy, which deals a lot with stress that has manifested in the body.

"I think for adults, if there has been trauma in a preverbal time, you are never going to access language," she said. "How can you, if you didn't have language at the time the trauma happened? One way is perhaps through art making and perhaps something like sensorimotor psychotherapy as well, because the trauma is in the body."

"Everybody's trauma is different," Abbs said. "My trauma is different to your trauma, and something that traumatizes me may not traumatize you."

According to Vancouver art therapist Monica Franz, the term trauma also needs qualifying in order to understand what a therapist is dealing with.

"We use the term trauma very easily," Franz said by phone. "A very difficult and a very unpleasant experience is sometimes named as trauma. That is not really what I identify as trauma. Where there has been that catastrophic event for a person, so that their lives have been literally turned upside down - disorganized - and they are not able to return to the usual forms of functioning. That is trauma, not just having a difficult experience. I really want to clarify that because I think we use the word far too easily, and that is what alarms me."

What Abbs has seen in war-torn countries more than meets Franz's definition. She will soon see more of the same in either Chad or Sudan, where she plans to go on her next MSF mission. She said it will be tough, but after seeing art therapy help the people of Kashmir and the Central African Republic, she knows it will be a worthwhile trip.