Expressive Therapies Continuum

A Framework for Using Art in Therapy

Lisa D. Hinz

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000497311
• Edition: 2
• Topic: Psychologie
• Subtopic: Psychotherapie

Distinctive in its application as a foundational theory in the field of art therapy, this up-to-date second edition demonstrates how the Expressive Therapies Continuum provides a framework for the organization of assessment information, the formulation of treatment goals, and the planning of art therapy interventions.

In addition to the newest research supporting the uses of art in therapy, this volume offers the latest research in media properties and material interaction, the role of neuroscience in art therapy, emotion regulation, and assessment with the Expressive Therapies Continuum. It provides case studies to enliven the information and offers practical suggestions for using art in many and varied therapeutic ways.

Through rich clinical detail and numerous case examples, this book's easy-to-use format and effectiveness in teaching history and application make it an essential reference for practitioners and students alike.

Part I

Historical Perspectives and Foundations

Chapter 1

Overview of the Expressive Therapies Continuum

Introduction

Every therapist who uses art in therapy faces decisions when working with clients similar to those of an artist facing a blank canvas or an unformed lump of clay. These are questions such as: How do I begin – how do I break into that inviting yet intimidating untouched surface? What direction shall I take – how can I make the best possible use of time and resources? And, how do I decide when the process is complete? There are no hard and fast rules in art or in art therapy, and no easy answers to these and other questions. This book demonstrates that the model of the Expressive Therapies Continuum (ETC) can provide a framework for addressing these and other difficult therapeutic decisions. Just as the muse inspires the artist but does not dictate, the ETC animates and directs, but does not command or require a specific course of treatment. The organizing structure of the ETC is underscored by an understanding that working with the complex nature of the human psyche requires great latitude for individual differences.

The art therapy literature demonstrates that various media and methods work effectively with a variety of clients, whether they present in similar or different ways. For instance, Cox and Price (1990) in their twelve-step approach to working with substance use disorder used tempera paint on paper to break down resistance and help clients recognize their powerlessness. The authors chose to work with paint because it is difficult to control, and they wanted the art experience to reflect the concept of unmanageability from the first step of the Alcoholics Anonymous twelve-step recovery program. In a less emotional and more cognitive approach to the disorder, Horay (2006) used collage and oil pastels to help clients evaluate the pros and cons of their current situation, determine feeling states, and plan a future course of action. Feen-Calligan (1995) used art therapy in an addiction recovery program to help participants experience the spiritual aspects of their journey. The author described using drawing with the eyes closed, drawing with the non-dominant hand, and translating physical gestures in the air into drawings on paper. Feen-Calligan used these experiences to help clients give up notions of how images should look and instead allow the healing images to come intuitively from within. Each practitioner mentioned above was using art in therapy to help clients with similar presenting problems. However, the different media and approaches evoked decidedly different therapeutic experiences.

Answering the question of how to decide the appropriate media for clients and under what circumstances their use will be therapeutic has been one crucial aspect involved in defining the field of art therapy (Junge, 2016; Malchiodi, 2012c; Wadeson, 2010). Wadeson stated that students often ask to be taught a list of specific techniques. She explained that what is more desirable than isolated descriptions of techniques is a theoretical framework from which to select appropriate materials and methods. Ulman (1975a) added that not only is a theoretical foundation necessary, but also that it should be so well ingrained that it can inform the “lightning quick decisions” that characterize therapeutic work. The model of the Expressive Therapies Continuum, developed by Kagin (now Graves-Alcorn) and Lusebrink (1978a, 1978b) and further elaborated by Lusebrink (1990, 1991b, 2004, 2010, 2014, 2016; Lusebrink, Mārtinsone, & Dzilna-Šilova, 2013) provides such a framework; it explains the therapeutic dimensions of various expressive experiences and the restorative power of creativity. This is a theoretical and practical guide, which provides a way to answer questions about what media to use, under what circumstances, and with which particular clients. In addition, because the ETC has a comprehensible visual structure, which is presented in Figure 1.1; it can easily be internalized by visually-oriented practitioners to provide needed guidance for moment-to-moment therapeutic decisions.

The Expressive Therapies Continuum at First Glance

The Expressive Therapies Continuum represents a means to classify how clients interact with art media or other experiential activities in order to process information and form images (Kagin & Lusebrink, 1978b; Lusebrink, 1990, 2016). The ETC organizes media interactions into a developmental sequence of information processing and image formation from simple to complex. Image formation and information processing are categorized in a hierarchical fashion from simple kinesthetic experiences at one end to complex symbolic images at the other. The ETC is arranged in four levels of increasingly complex processing. The first three levels are bipolar or complementary, as shown in Figure 1.1. The two components on each of these first three bipolar levels represent two ends of a continuum of information processing. The extreme ends of each level represent possible pathological variations in visual expression on that level (Lusebrink, 2016). The fourth level, the Creative level, can occur with any single component or level of the ETC where it represents optimal functioning, or can represent the integration of functioning of all components. Thus, a single and simple experiential activity has the power to be a creative experience or may involve the combination of diverse experiences. Although it is situated at the “top” of the ETC, reaching the Creative level is not the goal of or the termination point in art therapy. Art therapists hope that their clients have creative and enriching experiences during the majority of their art therapy sessions.

Starting at the bottom of Figure 1.1, information processing begins at the preverbal level with kinesthetic and sensory experiences, and thus is called the Kinesthetic/Sensory Level (capital letters are used throughout the book to distinguish the Kinesthetic and Sensory components of the ETC from other uses of the words). Information gathered through these channels does not require words; it is rhythmic, tactile, and sensual. Developmentally, this is the first way in which babies process information. Infants up to the age of eighteen months take in information through their senses and receive feedback about their behavior predominately through their own movement, but also through internal and external sensations. For this reason, experiences on the Kinesthetic/Sensory level of the ETC are indispensable in therapeutic work with children. Children need to physically manipulate and handle materials in order to form internal images of them (Lusebrink, 1991a). The Kinesthetic/Sensory level of the ETC represents the simplest form of information processing.

Figure 1.1 The Expressive Therapies Continuum (Figure reprinted with permission of the American Art Therapy Association from Hinz, L. D. (2008). Walking the line between passion and caution: using the Expressive Therapies Continuum to avoid therapist errors, Art Therapy, 25(1), 38–40)

Moving up the developmental hierarchy, information processing and image formation occur on the Perceptual/Affective Level. Information processing may or may not need words at this level. It is beginning to take form or be absorbed in the creation of formed images on the Perceptual pole. Perceptually influenced images and expressions typically are characterized by careful attention to the formal elements of visual expression. On the Affective end of this level, information processing can be emotional and raw, expressed in an image through vibrant colors without regard to form.

At the third level of the ETC, the functions represented are Cognitive and Symbolic. Information processed on the Cognitive/Symbolic level of the ETC is complex and sophisticated; it requires planning, cognitive action, and intuitive recognition. Verbal input is often, but not always, required to gather meaning about the complex cognitive operations or the multidimensional symbols involved on this level.

Although ETC components and levels are conceptualized and presented here as discrete functions, it is at times difficult to provide pure experiences with one component. Increasingly complex functioning at higher levels of the ETC often emerges from a creative endeavor and is referred to in this model as the emergent function (Lusebrink, 1990). The emergent function of each ETC component will be discussed in detail in later chapters. In addition, experiences on lower levels of the ETC inform and are incorporated into experiences on higher levels.

The component processes represented on the left and right sides of the Expressive Therapies Continuum can be seen as parallel with functioning and information processing differences in the two hemispheres of the brain (Lusebrink, 2004, 2016). The left hemisphere deals with information in an organized, sequential, and linear fashion. Verbal information also is processed in the left hemisphere; it is where logical thought and the labeling and categorizing of information occurs (Cozolino, 2017; McGilchrist, 2009). The Kinesthetic, Perceptual, and Cognitive components representing the left-side of the ETC are hypothesized as being involved with information processing predominately in the left hemisphere. Similarly, the dimensions of the ETC represented on the right-side of Figure 1.1 – the Sensory, Affective, and Symbolic components – can be viewed as representing processes occurring predominately in the right hemisphere of the brain. The right hemisphere is where the majority of emotional and conceptual information is processed and where spiritual connections are made (Edwards, 2012; Riley, 2004). Creative experiences have the potential to integrate information from both hemispheres of the brain (Jung et al., 2013; Riley, 2004; McNamee, 2004). The Creative level of the ETC is believed to have an integrative function (Lusebrink, 1990).

Jill Bolte Taylor (2006) provided a profoundly personal explanation of the distinct functions of the two hemispheres of the brain. Dr. Taylor is a neuroanatomist who suffered a stroke that rendered the left-side of her brain nonfunctional. With only the right hemisphere operating, the author said she experienced herself as at one with the world – awash in sensations – emotional, expansive, and mute. The left hemisphere is the part of the brain that holds language, organizes activity, and gives instructions. Dr. Taylor is a stained glass artist, and she used the creative process as one integrative aspect in her rehabilitation following the stroke. Through creative action, left and right hemisphere functions found congruent and harmonious expression.

As was stated above, the Creative level of the Expressive Therapies Continuum can exist at any or all of the levels. For example, finger-paint can be used in a soothing, sensory manner to help an individual establish an inner sense of calm. With just the right amounts of movement and sensation involved, this simple experience is a creative one; an individual can bring forth something new (a relaxed state) as the result of the sensual use of finger-paints. A sense of calm can be created without the formation of an external image; the media experience itself can induce serenity.

Additionally, a creative experience could combine elements from all levels of the Expressive Therapies Continuum. The same interaction with finger-paint might begin as a simple sensory experience as described above and evolve into something integrative and richly creative. As the fingers move paint around the paper, white lines are produced which allow forms to emerge from the background color. From an activity using the Kinesthetic/Sensory level, an experience on the Perceptual dimension evolves when forms are perceived. Further, the Symbolic component is engaged when a perceived form takes on special meaning and a personal symbol is produced. In this instance, all levels of the ETC are represented in one creative experience. This co-existence will be explained in more detail when the Creative level of the ETC is discussed in Chapter 10.

The two components forming each level of the Expressive Therapies Continuum have been described as having a curvilinear relationship in the form of an inverted-U (Lusebrink, 1991b). Lusebrink explained this curvilinear relationship by stating that opposite components of each level at first enhance the functioning of one another. When both components of an ETC level are contributing optimally to an experience, expressive functioning is most favorable. Lusebrink has termed this “creative transition functioning” occurring in the Creative Transition Area (Lusebrink, 2016). In the Creative Transition Area, functioning is optimized by the combined and interactive influences of both types of input. For example, when both Kinesthetic and Sensory input guide an experience, work in the Creative Transition Area is characterized by dynamic Kinesthetic expression with concurrent Sensory feedback or sensuous involvement propelled by movement such as the finger-paint example above.

The bipolar nature of each ETC level means that as information processing increases with one component of the level, it necessarily decreases and eventually blocks functioning with the opposite component. In the Creative Transition Area of the Perceptual/Affective Level, a moderate amount of emotional investment will imbue a perceived form or a created image with vitality – emotions bring forms to life. However, persons who are overly emotional have been described as being “caught up in emotion” and “unable to see clearly.” These common expressions describe the bipolar nature of the Perceptual/Affective level of the ETC. As emotional involvement increases past an optimal level, involvement with form (ability to see clearly) decreases and images become indistinct and formless.

On the other hand, the process of using formal art elements such as shape, size, direction, and implied movement requires visual representation, but little emotion. At first, emotional involvement might provide the needed motivation to begin to use this visual language. However, as affective involvement increases, perceptual processing abilities decrease and eventually become blo...