Integrating Expressive Arts and Play Therapy with Children and Adolescents

Eric J. Green, Athena A. Drewes, Eric J. Green, Athena A. Drewes

• Publisher: Wiley
• Year: 2013
• Print ISBN: 9781118527986
• eBook ISBN: 9781118775615
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Interventions and approaches from the expressive arts and play therapy disciplines

Integrating Expressive Arts and Play Therapy With Children and Adolescents presents techniques and approaches from the expressive and play therapy disciplines that enable child and adolescent clinicians to augment their therapeutic toolkit within a competent, research-based practice.

With contributions representing a "who's who" in the play therapy and expressive arts therapy worlds, Integrating Expressive Arts and Play Therapy With Children and Adolescents is the definitive bridge between expressive arts and play therapy complementarily utilized with children and adolescents in their healing and creative capacities.

Chapter 1

The Expressive Arts Therapy Continuum: History and Theory1

Sandra L. Graves-Alcorn and Eric J. Green

INTRODUCTION

What are the expressive therapies, and what important clinical information do they contextualize for the creative practitioner? In my opinion, we become therapists and utilize expressive art therapies to help others make changes in their lives and guide them toward happier and more fulfilling existences. There are many avenues within the therapeutic milieu to achieve this end. Although the theoretical foundations are often similar, the methods of caregiving to our clients change with our training and chosen area of expertise. Becoming an expressive art therapist and play therapist with children requires accumulating an arsenal of diverse, creative strategies to help clients communicate their experiences and feelings in nonverbal, less threatening ways. It also requires competency based on specified training, credentialing, supervised practice, and ongoing professional development.

Traditional talk therapy alone is generally unsuccessful when working with children and adolescents, especially within the developmental context of young childhood (Green, 2010). Play is a child’s work. Toys are their words and play is their language (Landreth, 2012). As an adult, play becomes a necessary balancing act to mitigate typical psychosocial stressors, often bringing out the “natural child” in each of us. Within the venue of play, we find multimedia and multidisciplinary fields. That is not to say that all of the expressive, creative therapies are a form of play therapy, especially given the credentialing and specificity of studies in each professional arena, but for the sake of simplicity and also as a rationale for why we are integrating these fields in this book, I am going to approach integration by highlighting the similarities. I will be explaining the Expressive Therapies Continuum in this chapter as an attempt to lay a foundation of synthesis so all of the therapies can be understood as simply as possible and to formulate a way for the clinician to plan treatment based on integrated theories.

The following definitions of four of the separate disciplines—art therapy, music therapy, drama therapy, and dance therapy—will lead us to what they all have in common and what differences need to be learned in order to be an effective therapist. For the professional standards and criteria, refer to the Specialized Training and Resources section at the end of most chapters for a list of websites and credentialing processes. The information contained in the following four paragraphs was adapted from Expressive Therapy (2013):

Art Therapy, sometimes called creative arts therapy or expressive arts therapy, encourages people to express and understand emotions through artistic expression and through the creative process. Art therapy provides the client-artist with critical insight into emotions, thoughts, and feelings. Key benefits of the art therapy process include: (a) self-discovery, (b) personal fulfillment, (c) empowerment, (d) relaxation and stress relief, and (e) symptom relief and physical rehabilitation.

Music Therapy is one of the expressive therapies consisting of an interpersonal process in which a trained music therapist uses music to help clients improve their psychological functioning, cognitive functioning, motor skills, emotional and affective development, behavior and social skills, and quality of life. Music therapists employ (a) free improvisation, (b) singing, (c) songwriting, (d) listening to and discussing music, and (e) moving to music to achieve treatment goals and objectives. Music therapy is used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities.

Dance-Movement Therapy (DMT), or Dance Therapy, is the psychotherapeutic use of movement and dance that influences emotional, cognitive, social, and behavioral forms of functioning. As an expressive therapy, DMT assumes that movement and emotion are directly related. The purpose of DMT is to find a healthy balance and sense of wholeness. DMT is practiced in places such as mental health rehabilitation centers, medical and educational settings, nursing homes, day care facilities, and other health promotion programs.

Drama Therapy is the use of theatre techniques to facilitate personal growth and promote mental health. Drama therapy is used in a wide variety of settings, including hospitals, schools, mental health centers, prisons, and businesses. The modern use of dramatic process and theatre as a therapeutic intervention began with Psychodrama. The field has expanded to allow many forms of theatrical interventions as therapy, including role-play, theatre games, group-dynamic games, mime, puppetry, and other improvisational techniques.

MEDIA DIMENSION VARIABLES

In my early pioneering years, I was struck by how expressive arts media had a direct effect on the healing process. So I went about exploring through scientific inquiry and developed what became known as Media Dimension Variables, which later transmuted into the Expressive Therapies Continuum. I will briefly overview my seminal research in the expressive arts field. Next, I will explain how the media from each expressive arts therapy field can have similar characteristics developmentally and how to incorporate this data clinically.

Early on I defined the use of art and craft materials in therapeutic service as an exploitation of media dimension variables (MDV) (Graves, 1969). MDV were those qualities or properties inherent in a given medium and process utilized in a therapeutic or educational context to evaluate and/or elicit a desired response from an individual (Kagin, 1969). The premises on which the concept of MDV were developed were that (a) the reinforcement value of making art is inherently a therapeutic process; (b) all individuals can be creative to some degree; (c) dimensions of art media are discernible and can be classified; and (d) media dimensions can be therapeutically applied.

Creativity elucidates a modification of behavior. Creativity, therefore, is a compilation of unconscious and/or conscious information channeled into some overt action (Kagin, 1969). A type of cause-and-effect relationship transpires when individuals engage in creative processes that are based on an energy source (motivation) and a data retrieval system leading to problem solving. This original concept was, at that time, based on Guilford’s (1965) model for creative performance, which encompassed a need for individuals to experience achievement or self-esteem, a need for expression, and a need for producing order (homeostasis in the organism). This creativity was determined by the efficiency with which an individual was able to bring schemata, or information, out of storage for indirect use in coping with situations. Guilford (1965) further divided memory storage into various classes, one of which was visual-figural data, which we see manifest in graphic expression as line, form, and shading.

Art is generally thought to be a socially acceptable mode of creative performance, which may provide enough satisfaction to channel otherwise destructive and/or antisocial actions into constructive and appropriate channels, as well as alleviate emotional distress. There is an unconscious attempt by an individual when creating art to build schemata. This process increases environmental awareness and heightens self-esteem, thus aiding the efficiency with which schemata are used. Ultimately, art making can be viewed as a perpetuating creative cycle (Kagin, 1969).

The theoretical underpinnings of art therapy in the early years of its professional development were that the projections of unconscious material, aided by the spontaneity of graphic expression, would assist the client to gain awareness and insight into inner conflicts that needed resolution. Little attention was given to the media by which these projections were promoted. I, therefore, began looking at specific properties of art media and attempted to hypothesize general emotional or other behavioral responses.

No attention had been given in the literature to different responses when directions were given or not given on the subject or use of the media, or how difficult and complex a project might be and whether it would therefore be suitable for any one individual or group. I also was looking at the physical properties of media, such as fluidity, malleability, indestructibility, expansiveness, unpredictability, and adaptability. Three generalized variables were delineated: (1) structure, (2) task complexity, and (3) media properties.

Media whose properties were soft, aqueous, malleable, and easy to manipulate, such as finger paint, soft clay, polymer acrylics, and so on, were in the fluid range. Resistive materials were defined as hard, brittle, slightly pliable to nonmalleable, and difficult to manipulate, such as hard or highly gorged clay, metal, wood, poster boards, heavier papers, pencils, and so on. A project was considered of high complexity when three or more sequential steps were required for completion, not to include simple repetition of a single process (such as pounding a nail), or of low complexity if the project required only one or two steps.

The difference between the structured and unstructured projects was primarily one of direction. The unstructured goals for completion were left up to the individual, and the instructions were simple (e.g., “Paint anything you wish,” “Put the metal on the board in any design you like”). The structured task was presented in a manner designed to leave little, if any, choice in the results of manipulating the materials. Specific directions on how to use the materials resulted in what would be achieved.

The following MDV examples survived not only my thesis study, but also continued on to become part of the curriculum of the Art Therapy Master’s degree at the University of Louisville and then an integral and defining element in the Expressive Therapies Continuum (ETC). It is therefore important to understand these combinations and concepts. When I taught the Methodology lab, I required students to use index cards and a portfolio to dissect each intervention into the MDV, ETC, description of materials used, the procedure and directions for each project, its rationale targeting specific populations or areas of concern to the therapeutic process, and personal reflections as the project affected the student.

Here are some examples from the original projects of my study, which questioned whether different media variables affected verbal communication. Each project was first demonstrated to each participant. The demonstration may or may not be necessary, depending on the person doing the project and the rationale for using it. I am including the instructions and description of materials because it is important that the best media you can afford is used. Many experiences fail for lack of quality media or specificity of instructions. For the sake of space and to remain focused on this chapter’s aim, I am including only three of the variables (Potter’s Wheel Pot, Mosaic, and Cut and Paste).

Potter’s Wheel Pot: HCSF (High-Complexity Structured Fluid)

Materials included a half-pound of Amaco terra cotta clay, a pan of water, clay sponges, and an electric potter’s wheel with a knee treadle. Throwing a pot generally requires a great deal of skill and craftsmanship. However, a reasonable facsimile (clay has roundness and a hole in the middle) is satisfactory. A round ball of white stoneware clay was given to the participant and placed in the center of the wheel’s turntable. The therapist formed the original ball to ensure some measure of success. The midpoint was to be found by the participant and corrected until accurate. The therapist then assisted the individual in putting pressure with both hands to the top of the clay mound and pushing it down to enable adherence to the metallic turntable. The wheel was then turned and pushed to top speed, at which time the participant applied pressure to the clay from each side, squeezing in slightly with both palms held rigid and steady in an attempt to establish the center of the clay in the exact center of the wheel. Once the clay was centered as close as possible, both thumbs were placed on center top of the mound and quickly pushed straight down to begin the opening process. The hands are then placed on each side to finish the pot.

Mosaic: HCSR (High-Complexity Structured Resistive)

Material included 30 one-inch-square enameled ceramic tiles (10 red, 10 black, 10 yellow), one pair of tile cutters, an 8-ounce bottle of Elmer’s Glue, a 5-inch-by-5-inch piece of pressed board, and a No. 2 drawing pencil. The instructions were to quickly draw lines that would divide the board into at least three areas and thus create a simple design. To color in the design, the tiles were to be glued onto the board in any desired area, and written into the chosen spaces as “R” (red), “B” (black), or “Y” (yellow). The tiles could be broken into smaller pieces by the cutter to enable filling in a smaller area.

Cut and Paste: LCSR (Low-Complexity Structured Resistive)

Materials included one red 22-inch-by-24-inch piece of medium-weight construction paper, on which were drawn in pencil 20 amorphic curvilinear forms; one pair of 5-inch steel teachers’ scissors; one 22-inch-by-24-inch piece of white Bristol board (two-ply poster board), on which identical forms to the above were outlined with pencil; and one 8-ounce bottle of Elmer’s glue. The participants were required simply to cut out the forms on the red paper and glue them onto the appropriate matched form drawn on the white paper.

Verbalizations were considered important in art therapy at that time, as they would lead to insight and problem solving. There was no significant difference between or among the variables as they related to the type of verbalization I was testing. New research in the area of neuroscience now can explain the relationship between talking and making art, or, more specifically, using the art for memory reinforcement and accuracy, and shows that the nonverbal act of drawing about an event has a much greater retention value than talking about an event (Bruck & Melnyk, 2000). However, in 1969, I was focusing on eliciting verbalizations as a measure of success with the combinations of the variables, complexity, structure, and media properties. It was a start.

I was able to develop a course of study that included all of my theoretical background and experiences, as well as promoted the efficacy of both art as therapy and art psychotherapy. In fact, I saw this well-worn argument by other professionals as a continuum of interventions, which allowed flexibility and included a wide range of populations who could benefit from our services. In the early 1970s, I founded the Institute of Expressive Therapies, with the intent to include music, dance, drama, and poetry into the curriculum. This was the beginning of observing the commonalities among the disciplines, rather than the differences. My colleague, Vija Lusebrink, joined the faculty, and together we researched the interrelationships among the various expressive therapies.

We found a commonality first in developmental theory. The well-known work of Viktor Lowenfeld (1952) in the field of art education had long been one of the foundations on which the MDV was founded. Because the field of art therapy was fixing “deviating” behaviors, then what was the “normal” or expected and acceptable behavior in the arts arena? To recognize deviations, you must know the developmental norms. Although other researchers wrote about the development of children’s graphic expression, I was especially taken with Lowenfeld (1952) and Piaget (1962, 1969). When the stages were placed side by side, they explained each other coherently. The development of schema in particular was of common importance as a pattern of thinking that built upon itself and manifest in drawing behaviors, play behaviors, and development of symbolic language.

Following Piaget’s (1962) developmental sequence with use of various arts media, properties, structure (control), and complexity (cognitive understanding), we begin with sensorimotor play, which translated into the Kinesthetic/Sensory level of the continuum. Babies practice play, repeating motions over and over until the action becomes embedded into a form of its own cognition. The Perceptual/Affective level then begins as motion becomes form and touch or other sensory experiences effects feelings. These feelings do not yet have a verbal language, but they begin to serve the function for which they were biologically created. Anger makes change in the immediate present; sadness slows down the body and mind and processes loss; fear alerts us to danger; and happiness or joy balances all of the other experiences and gives motivation for growth. As form begins to develop further into signs, a meaning becomes attached to the action that created the form. Then the Cognitive/Symbolic level is attained.

The stages of Graphic Development may be aligned with Piaget’s (1962) development of schema—or a pattern of thinking on which we all build throughout a lifetime. Lowenfeld (1952) also described schema as a visual pattern of rules resulting from early scribble behavior, to making concentric movements, to attaining control enough to create form and name it. The scribble stage occurs generally when the child is able to hold an instrument without eating it and purposely put marks on paper (or whatever background may be selected or available). This can begin anywhere from age 12 months to 18 months and is random in nature. When longitudinal scribbling begins, around age 2, the back-and-forth repetition of practice play assumes a purpose, and experimentation into circular motion occurs. When these motions are mastered, around age 3, the form is purposely constructed. The pencil or crayon is lifted off the page and replace...

Table of contents

• Cover
• Contents
• Title
• Copyright
• Dedication
• Preface
• Acknowledgments
• About the Editors
• About the Contributors
• Chapter 1: The Expressive Arts Therapy Continuum: History and Theory
• Chapter 2: Play Therapy
• Chapter 3: Art Therapy
• Chapter 4: Drama Therapy
• Chapter 5: Integrating Play Therapy and Sandplay Therapy
• Chapter 6: Working With Children Using Dance/Movement Therapy
• Chapter 7: Music Therapy
• Chapter 8: The Therapeutic Uses of Photography in Play Therapy
• Chapter 9: Poetry Therapy
• Chapter 10: Integrating Play and Expressive Art Therapy Into Educational Settings: A Pedagogy for Optimistic Therapists
• Chapter 11: Integrating Play and Expressive Art Therapy Into Small Group Counseling With Preadolescents: A Humanistic Approach
• Chapter 12: Integrating Play and Expressive Art Therapy Into Communities: A Multimodal Approach
• Author Index
• Subject Index