The expressive therapies continuum

The expressive therapies continuum (ETC) is essentially a developmental hierarchy that organizes the different levels of art marking in accordance to their sophistication. This continuum provides a framework for using art in therapy that can be used to help guide which creative processes are best used for a specific client. “Art therapists work with their clients on the level of the ETC where they feel most comfortable” (Hinz, 2009, p. 46). The ETC is comprised of 4 levels which include the kinesthetic/sensory level, perceptual/affective level, cognitive/symbolic level, and the creative level. Each level of the ETC (with the exception of the creative level) encompasses two polarities and as one polarity increases the other decreases (Lusebrink, 2010).

The first level on the ETC is the kinesthetic/sensory (K/S) level. This is considered the simplest form of information processing. The kinesthetic sense is about sensations that inform people and accompany bodily, movement, rhythms, and actions (Hinz, 2009). “Bodily kinesthetic intelligence is the potential for using one’s whole body or parts of the body to solve problems” (Hinz, 2009, p. 39). The movements involved in creating art provide stimulation that releases tension (Hinz, 2009). The healing dimension of the K/S level involves increasing or decreasing client’s amount of arousal or tension (Hinz, 2009). “Pent-up muscular tension can lead to tension headaches, lower back pain etc (Hinz, 2009). “Healing can be prompted by the use of art materials” (Hinz, 2009, p. 41). An example of said healing can be seen when working with a client who has generalized anxiety disorder. Muscle tension is a part of the diagnostic criteria for generalized anxiety disorder (American Psychiatric Association, 2013). In order to help alleviate some of the built up muscular tension the therapist can prompt the client to engage in pounding, pushing, or rolling clay. All of which are actions that emphasize movement and enhance the release of energy (often seen as resistive) (Hinz, 2009).

The second level of the ETC is the perceptual/affective (P/A) level. In this level information processing (that may or may not require words) occurs in a more sophisticated manner by requiring clients to use visual imagery to represent their internal experiences (Hinz, 2009, p. 79). “This level focuses on forms and their differentiation” (Lusebrink, 2010, p. 171). An example of this being how “a scribble drawing is primarily a kinesthetic activity but when a person perceives an image within the drawing the perceptual component is then engaged” (Hinz, 2009, p. 45). Essentially, this is the client making sense of the forms around them. The P/A level is said to have a “bipolar nature”. “As perceptual involvement increases, affective involvement decreases and eventually is blocked” (Hinz, 2009, p. 83). The perceptual component is concerned with structure and the containment of emotions. Whereas, the affective component is about the emotions aroused in the individual through interaction with art media (Hinz, 2009. P. 101). The affective component can be used to work on flat affect (the absence or apparent absence of emotional response to any situation or event) (Nugent, 2013). The therapist can prompt the use of fluid media, such as paint, in order to support a direct expression of feelings (Hinz, 2009). On the contrary, when working with a client who has trouble containing their emotions the therapist may want to prompt the use of a less fluid media, such as watercolor markers. Through the use of said materials combined with specific perceptual activities one can begin to organize their thoughts and feelings (Hinz, 2009).

The third level is considered the most developmentally sophisticated and is known as the cognitive/symbolic level (C/S). “This level is characterized by the cognitive integration of forms and lines which can lead to skills such as problem solving” (Lusebrink, 2010, p. 171). Within this level persons can process information outside of their own personal experiences (events do not have to occur in one’s personal life to have meaning) (Hinz, 2009, p. 11). It is during this level we start to see the understanding of symbolic thought. Symbols are a reminder that experiences are not entirely conscious and fully understood (Hinz, 2009). On the opposite end of the symbolic level, cognitive information processing is represented, which allows for people to make decisions and solve problems. “Whereas the cognitive component emphasizes facts and logical thought, the symbolic component is concerned with intuition or mythic thought.” (Hinz, 2009, p. 145) The cognitive component can be used to help and/or heal clients with ADHD. A part of the diagnostic criteria for attention–deficit/hyperactivity disorder is that one often blurts out an answer before a question has been completed (American Psychiatric Association, 2013, p. 60). The latter can lead to trouble or consequences when persistent in a school or work setting. The therapist can offer a cognitive activity, such as a pro and con collage. Through said activity one can begin to think through a course of action by relating past and future behavior (Hinz, 2009). This can lead to the ability to think through actions prior to consequences (Hinz, 2009, p. 143).

The final component of the ETC is the creative level. This level can exist at any or in all levels (Hinz, 2009). The creative level refers to both the “synthesizing and self-actualizing tendencies of the individual/client” (Hinz, 2009, p. 169). Optimal experiences are best seen with the integration of all levels (K/S, P/A, and C/S) (Hinz, 2009). It is during the creative level when the best integration of these levels is present. The creative level can be healing due to creative experiences creating intense joy (Hinz, 2009). Art as therapeutic experience can lead to healing and growth. By the use of art media persons can experience their own potential (Hinz, 2009, 172). The creative level can lead to creative self-actuating experiences. The creative process allows the “individual to actualize potentials not previously known or understood” (Hinz, 2009, p. 171). Persons working on the creative level of the ETC are beginning to understand themselves and their needs; this understanding is present within the client’s art work (Hinz, 2009).

All in all the expressive therapies continuum provides the basis for using art in therapy. The ETC helps therapists make decisions about which creative processes can be most healing in relation to the client’s level of creative functioning. Optimal experiences are best known to be present within the integration of all levels. Each level of the ETC provides a different form of healing in relation to the developmental sophistication of said level. Throughout each level of the ETC, healing can be prompted by the use of certain art materials. The ETC is a guide that helps direct therapist’s decisions; however, it is not a required or a specific course of treatment (Hinz, 2009, p. 11).