An Introduction to Expressive Therapies
Expressive therapies involve the use of various creative arts techniques to facilitate the counselling process. While there are a range of different modalities encompassed under the umbrella of expressive therapies, in a nutshell, expressive therapies are those that use creative expression as a therapeutic device. Activities such as drawing, painting, sculpture, music, writing, creative movement, and play are used to enable clients to express their thoughts and feelings in non-verbal ways.
While ‘talk therapy’ is still the traditional method of counselling, there has been an increasing recognition of individual differences in the way in which people engage and communicate. For example, people have different verbal abilities, learning styles, cognitive abilities, and are at different developmental stages. The use of expressive techniques can harness a client’s existing expressive capacities and enable the counsellor to communicate with them more effectively and authentically – to “meet the client where they are” (Malchiodi, 2005). Over the last few decades, counsellors have increasingly been finding that the use of expressive modalities can help individuals to communicate relevant issues in ways that traditional talk therapy cannot (Malchiodi, 2005).
There has been a long and rich tradition of using creative arts with the aim of healing. For example, drama, music, and dance have long been associated with healing and the restoration of mental health (Gladding, 2016). Even as far back as ancient Greek and Roman times, such artistic endeavours were involved in therapeutic processes. For example, drama and comedy were ‘prescribed’ for individuals suffering from manifestations of anxiety or depression (Degges-White & Davis, 2011). Additionally, artistic expression has been, and continues to be, a way of expressing and processing emotions for many indigenous cultures. “Rituals of dance, music and poetry celebrate and honour traditions of burials, marriages and other life transitions. These action therapies bring us into active involvement with the ‘stuff of life’, including the hurts, pains, joys and celebrations that are part of therapeutic landscape” (Richardson, 2016, p. 3).
Of course, expressive therapies, in their current form, have only been in development for the last hundred or so years. Expressive therapies have evolved alongside the broader theoretical developments in counselling and therapy, and many expressive techniques reflect traditional theoretical principles. Expressive work in the arts operates very much “on the borderline between conscious and unconscious” – in making the unknown known through the use of symbols and metaphors (McLeod, 2013). Therefore, it is not surprising that psychoanalytic and psychodynamic principles inform the theory and process of many expressive therapies (McLeod, 2013).
However, there has been a movement towards using expressive techniques in conjunction with other theoretical approaches such as person-centred, gestalt, and cognitive behavioural approaches (McLeod, 2013). For example, Natalie Rogers, the daughter of Carl Rogers, has developed a person-centred expressive arts therapy model based on the person-centred principles of offering a climate of nurturance for a client’s emotional needs, creating conditions that can activate an ‘actualising principle’, establishing a democratic relationship with the client, and establishing ownership of the problem (Pearson & Wilson, 2009).
While expressive therapies have evolved into separate and specialised therapeutic modalities based upon the art form used (e.g., art therapy, music therapy, etc.), they are more related than they are different, and share the common aim of self-development and healing through expression (Richardson, 2016).
A client-focused process with a strong counsellor-client relationship
Research has shown that the quality of the therapeutic relationship between a client and counsellor contributes to a large proportion of positive counselling outcomes (Pearson & Wilson, 2009). Counsellors using expressive approaches are generally client-focused and aim to “follow the client’s process” and “meet them where they are”. The counsellor’s role is “personal rather than authoritative, aiming at being creative rather than corrective, with a focus on meaning-making and personal development” (Neimeyer & Mahoney, 1995, cited in Pearson & Wilson, 2009, p. 16). Expressive counsellors focus on congruity and genuineness in how they relate to clients and relinquish control to the client in the creative process (Pearson & Wilson, 2009).
Expressive therapists/counsellors tend to utilise an “invitational relating” approach. This means that the client is invited rather than instructed in the therapeutic process, with the counsellor facilitating the client’s process of reflection and decision-making. Pearson and Wilson (2009) suggest that invitational relating has many benefits including:
- Increased client autonomy and independent decision-making
- Increased self-acceptance
- The development of trust between counsellor and client
- The relaxation of defences leading to increased openness and engagement in the therapeutic process
- Expressive therapies are ‘action therapies’ – clients explore and communicate thoughts and feelings through ‘doing something’. Art and music making, dance and drama, creative writing, and all forms of play are action-orientated and require participation and the investment of energy from the client (Malchiodi, 2005). All expressive therapies invite clients to become active participants in their own therapeutic process, facilitated via a client-focused, invitational relational approach. The experience of doing and creating can energise individuals, redirect attention, and alleviate emotional stress. This increased energy also acts to support the achievement of client goals (Malchiodi, 2005).
In expressive therapies, self-expression through the various art modalities is a central part of the therapeutic process. As you may remember from your counselling training, psychodynamic theory posits the existence of intrapsychic material that has been internalised and “buried” thus becoming unconscious. The inherent projective nature of techniques used in art modalities such as drawing, music, expressive writing and sand tray play therapy, allow powerful and hidden intrapsychic material such as unconscious impulses, memories and emotions to emerge safely without triggering defence mechanisms (Pearson & Wilson, 2009).
While the expression of past experiences, thoughts and emotions through a painting, movement or poem is often cathartic for clients, the aim of expressive therapies is not just to help clients to express their innermost thoughts and feelings, but to help them to contain and transform them. Gladding suggests that using the arts in counselling speeds up this process of self-exploration and allows people to experience themselves in new ways as well as “exhibit and practise novel and adaptive behaviours” (1992, cited in Malchiodi, 2005, p. 6).
Levine (1999) suggests that “imagination is the central concept which informs the understanding of the use of arts and play in therapy” focusing on the transformative role of the arts in a therapeutic context. He suggests that suffering, while part of the human condition, can be reshaped and transformed through the imagination and creativity (Levine, 2009).
McNiff also focuses on the role of imagination in expressive therapies, developing his own therapy of imagination. He proposes that art itself is the healing agent in counselling/therapy, encouraging the active engagement with the imagination through whatever artistic means necessary to express and heal (Richardson, 2016).
The role of imagination in the practice of expressive therapies is key. Engagement in the arts help clients move beyond their preconceived beliefs and narratives through imaginative thinking and ‘pretend’ – offering the possibility for trying out inventive solutions and subsequent change and transformation. The use of imagination in expressive therapies is helpful for clients who tend to be ‘stuck’ in their way of thinking or who feel ‘emotionally cut off’ as a result of trauma (Malchiodi, 2005). Additionally, imagination, when combined with the arts in counselling, frequently results in the creative production of a tangible product that gives a client insight, leading to transformation and change.
A key feature of expressive therapies is their use of the senses – visual, auditory, touch and movement – to effect therapeutic change. They are therefore considered mind-body interventions (Malchiodi, 2005).
There has been increasing acknowledgement of the connection between emotional disturbances and bodily based functions and symptoms. Malchiodi (2005) highlights the contribution of the field of neuroscience in understanding how mind-body interventions work, particularly in the areas of mood and stress disorders as well as physical illness. She gives the example of how art, drama and play therapy are used in the treatment of posttraumatic stress and the processing of traumatic of memories through artistic expression. Other examples of the influence of expressive therapies through mind-body connections cited by Malchiodi (2005) include:
- The use of music, art, and dance/movement in tapping the body’s relaxation response resulting in enhanced health, wellness and happiness (Benson, 1996).
- The use of writing to reduce symptoms in some chronic illnesses (Pennebaker, 1997).
- The use of expressive therapies, particularly dance, art, and play therapies, in re-establishing and encouraging healthy attachments through sensory experiences, interactions, movement, and hands-on activities (Malchiodi, 2003; Riley, 2002).
While there are many core features that characterise expressive therapies, it is important to remember that each form of expressive therapy has its unique properties and roles in therapeutic work depending on its application, practitioner, client, setting, and objectives. Machiodi (2005) suggests that “visual expression is conducive to more private, isolated work and may lend itself to enhancing the process of individuation; music often taps feeling and may lend itself to socialisation when people collaborate in song or in simultaneously playing instruments; and dance/movement offer opportunities to interact and form relationships” (p. 3).
Why use expressive therapies?
There are numerous reasons for using expressive techniques, but one of the main benefits involves the potential for enhanced communication between counsellor and client. The arts are often considered a universal language in their ability to convey feelings and thoughts in a simple but direct way – “sometimes a picture or movement is worth a thousand words. By sounding off musically, visually or dramatically, clients are often able to help their counsellors understand their predicaments better” (Gladding, 2016, p. 15).
As traditional counselling is primarily a verbal/auditory process, it can be limiting for some clients (e.g., a person who has limited language skills, speaks a different language, or has acquired disabilities such as an elderly person who has lost the ability to talk because of a stroke or dementia). Expressive therapies are unique in their use of techniques that facilitate expression without undue focus on language. These forms of expression encourage non-verbal clients to participate meaningfully in counselling relationships. They are also well suited to children and adolescents in order to facilitate self-expression in a developmental age group that often struggles to put words to complex internal processes (Gladding, 2016).
An important rationale for using expressive therapies is their appropriateness in counselling culturally and linguistically diverse populations and clients with diverse capabilities. Because of the universal nature of the creative arts, they can be used with any client, regardless of gender, ethnicity, ability, age, language, cultural identity or physical functioning.
Of course, expressive therapies are not entirely “non-verbal”. They are in fact, both non-verbal and verbal, as the verbal communication of thoughts and feelings between client and counsellor is a key part of the therapeutic process. For example, a client can be encouraged to express their anger in a drawing and the client and counsellor can then discuss what the drawing symbolises and the feelings it evokes (Malchiodi, 2005). Therefore, while talk is still the traditional method of exchange in counselling, expressive therapists/counsellors are able to include various non-verbal techniques in their work with clients, enabling effective and authentic communication in the counselling relationship.
Expressive therapies are also highly useful for people who have excellent verbal skills. Those who “tend to over-intellectualise may erect a wall of words so that more typical talk therapy becomes challenging. Art making can be employed to cut through the chatter and get to the important themes” (Boyd, 2006, p. 40). The arts can also encourage concrete thinkers and those of limited mental abilities to expand their thinking and expression (Gladding, 2016).
The use of expressive techniques encourages clients to perceive themselves and the world in new and different ways. By their very nature, expressive processes foster different ways of experiencing the world – as Gladding (2016) states, they are “enriching, stimulating and therapeutic in their own right. When used in clinical situations, they help counsellors and clients gain unique and universal perspectives on problems and possibilities” (p. vii)
Editor’s Note: This is an excerpt from the AIPC’s Advanced Study Major on Introduction to Expressive Therapies Advanced Study Major, available to students studying the Diploma of Counselling.
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