When mothers can't speak: Art therapy in perinatal care

Many women I see within the perinatal mental health service are concerned about speaking up. One mother was terrified I'd take her child if she told me what she was really thinking. Another wouldn't write her diary anymore, as she was worried someone might read it and section her. These are different women with the same fear: that honesty would cost them everything.

This fear isn't irrational; it would seem to me to be learned. Motherhood places women under a particular kind of scrutiny that other life transitions don't seem to face. From the moment of pregnancy, a sort of surveillance system activates: obstetricians, midwives, health visitors, GPs, receptionists, all watching and perhaps assessing whether you're doing it right. If you say the wrong answer, one admission of darkness and mothers worry the machinery of intervention will start.

The myth of doing it “naturally”

Art psychotherapist Susan Hogan (2020) writes about how motherhood demands the relinquishing of power and control, wrapped in the mythology of doing things naturally. This idea of maternal instinct, that mothering should feel natural and love should be uncomplicated, can create enormous guilt if the reality doesn't match. When thoughts are dark, and feelings are complicated, when the gap between what you're supposed to feel and what you actually feel can become unbearable.

Some clients come to me in silence. However, the real thoughts, the frightening ones, sometimes stay locked away until they’re ready. Clients learn to perform acceptable motherhood in therapeutic spaces, having never found anywhere safe enough to speak the unspeakable.

Mothers worry their thoughts are too dark or scary. That speaking them aloud might somehow make them real and might infect the people around them. That a professional might be obligated to tell social services. That something they say or create could be used as evidence against them. An Orwellian nightmare, perhaps, but one that the medical system has taught mothers, in some cases, to fear, with some women experiencing misdiagnosis and even abuse by the medical system. The fear of being sectioned, having a child removed, or of being labelled "hysterical" (that old word that comes from the medicalisation of women's emotional lives), these aren't abstract concerns. 

These concerns may be based on real consequences mothers have witnessed or experienced. For some mothers, this silence is also inherited, shaped by intergenerational trauma, cultural expectations, racialised surveillance, or familial messages about not burdening others with emotions. Silence becomes a learned survival strategy long before pregnancy.

What surveillance takes away

What gets lost in this climate of surveillance is the space mothers need to reconstruct themselves. Birth itself can remove space, the loss of bodily autonomy during hospital protocols, the erosion of trust as bodily integrity is undermined, however medically necessary these interventions may be. The sense of self-identity is bound up with what we're able to conceptualise and remember, so it's not surprising that extreme fatigue, which disrupts these very faculties, proves challenging and destabilising. Motherhood requires a fundamental reorganisation of self, but how can you reorganise when you're being watched?

How art therapy can create a different space

This is where art therapy can create something different. The space offers an opportunity for the reconstruction of a lost sense of self. A disrupted sense of selfhood can be translated into image. This process of readjustment, of matrescence, the transition to motherhood, can be supported through art therapy in ways that words alone cannot reach.

What happens in the studio?

The work begins with a simple question: how can I help you to feel safe? How can this be a space for us to bear with whatever it is you need to bring? An art therapist will not judge. They should bring you a sense of safety, holding honest conversations about the boundaries of confidentiality, not to create fear but to help mothers trust the frame. When clients know exactly what will and will not trigger safeguarding, they often feel freer, not more restricted.

If someone wants to start with materials, we start there. Rather than imposing direction, instead, we co-create the pace and shape of the work, like a gentle choreography that honours their autonomy. Some clients want to talk first about why they've come, what their goals might be, and what their prior experiences have been. Others might move immediately toward mark-making or the sand tray to conceptualise the “issue.”

What the arts tend to uncover are the unconscious reasons for being together, reasons that are far more true than any logical, left-brain explanation. Creativity and play activate the right side of the brain, accessing material that talking alone cannot reach. Art also offers symbolic distance, a way to express something unbearable without having to say it directly. Images can hold fear safely, allowing mothers to approach it at their own pace.

We might work toward creating something that represents safety, an object, sensation or perhaps a symbol that's entirely individual. It could be a shell, a natural material from the basket, a smell, a memory, a dream or a wish. It might be a feeling in the body, like the heart. Whatever represents safety for that particular person becomes something they can return to, physically or in memory, throughout our work and outside of it. 

Each week, the artwork goes into a folder, ready for the start of each session. It becomes an anchor in time, a way of bringing the client back should they want to return. The locked cabinet holds this thread of what they're bringing. The work has been externalised and is being contained. Some pieces aren't finished, and clients continue working on that aspect. Sometimes work wants to be closed and moved on from. Sometimes we never fill anything up; there is silence and an inability to work more. All is fine.

This is person-centred work. Drawing on Nona Orbach's (2023) concept of permissions, permission is given to what needs to come whilst holding onto the core goals. In the background, we have the relationship itself, the trust we're building, what's being communicated between us beyond words. We work at the pace that feels right, moving toward what moves up.

It takes time to build this kind of safety. Mothers need to test whether the space is truly confidential, whether their darkness really won't be used against them. They need to know they matter, their pain matters, their self-esteem matters, and that their experience is worthy of proper attention and resources.

Why art therapy can work for wordless trauma

Trauma is often described as a “wordless event”, and art therapy can be particularly helpful when experiences feel difficult to put into language. When something overwhelming happens, the body shifts into survival mode. Memories can become fragmented, and feelings resist words. The body carries the weight of what happened without a clear story to tell.

As van der Kolk (2014) demonstrates, trauma is often stored in the body, bypassing language entirely. Art therapy provides a non-verbal route to process these experiences, through images and creative materials, which mothers can begin to give shape to what might otherwise remain unspoken. The space becomes a place where the unspeakable can exist without immediate judgment or intervention. Where trauma theory often stops at understanding embodiment, art therapy extends it, giving form, image, texture and relationship to sensations that would otherwise remain formless.

The care mothers deserve

Access to counselling as a bare minimum as women go through becoming a mother is important, to have space to process the seismic identity shift that's occurring. 

Greenspan (1998, cited in Maté, 2022, p.113) writes: “If our society were to truly appreciate the significance of children's emotional ties throughout the first years of life, it would no longer tolerate children growing up, or parents having to struggle, in situations that cannot possibly nourish healthy growth.”

Art therapy can provide space. Not with surveillance dressed as care, but with actual space. A space to express the darkness without fear, to reconstruct a sense of self and to exist fully with all the complicated, unspeakable parts included. When we create that space, mothers can finally speak, and they no longer have to fear that truth will cost them everything.

References

Hogan, S. (2020) Therapeutic Arts in Pregnancy, Birth and New Parenthood. London: Routledge.

Maté, G. (2022) The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. London: Vermilion.

Orbach, N. (2023) The Book of Permission: Reflections on art, therapy, education and being human. London: Routledge.

van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.