Expressive therapies continuum

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A diagram of the Expressive Therapies Continuum, depicting three horizontal levels of information processing and their potential for integration through creative mental activity, represented by the vertical "CR" level or dimension.  The diagram first appeared in Imagery and Visual Expression in Therapy by Vija B. Lusebrink (1990). Expressive therapies continuum.png
A diagram of the Expressive Therapies Continuum, depicting three horizontal levels of information processing and their potential for integration through creative mental activity, represented by the vertical “CR” level or dimension.  The diagram first appeared in Imagery and Visual Expression in Therapy by Vija B. Lusebrink (1990).

The Expressive Therapies Continuum (ETC) is a model of creative functioning [2] used in the field of art therapy that is applicable to creative processes both within and outside of an expressive therapeutic setting. [3] The concept was initially proposed and published in 1978 by art therapists Sandra Kagin and Vija Lusebrink, who based the continuum on existing models of human development and information processing. [4]

Contents

This schematic model serves to describe and assess an individual's level of creative functioning based on aspects such as the artist's purpose for creating a piece, choice of medium, interaction with the chosen medium, and imagery within the piece. Conversely, it also serves to meet the needs of the client by assisting the art therapist in choosing a developmentally or situationally appropriate activity or art medium. [5] By analyzing an individual's art making process and the resulting artwork using the ETC, art therapists can assess strengths, weaknesses, and disconnect in various levels of a client's cognitive functioning - suggesting or substantiating diagnosis of, or recovery from, a mental health condition. [2]

History and Development

The Expressive Therapies Continuum was conceptualized by co-creators Lusebrink and Kagin after Lusebrink joined the faculty of the Institute of Expressive Therapies at the University of Louisville, which had been founded by Kagin. [1] [6] Kagin had earned a master's degree in special education and child psychology while working at a state facility in Kansas that served individuals with developmental and intellectual challenges. The institution received funding to study the adaptive behavior of residents, and this allowed Kagin to investigate their responses to media experiences in art therapy. [6]  Her thesis research revealed three discernable agents of change in the artmaking process; these could be therapeutically modified to affect client responses. She called these agents of change “Media Dimension Variables”, which consist of task complexity, task structure, and media properties. [1] [6]

Lusebrink's background included experience teaching art and volunteering at a state facility in California that served psychiatric populations. While at this institution she facilitated art therapy sessions and conducted research on individuals who had schizophrenia. She became involved in a study that examined the progression of schizophrenia among individuals who were not taking medication versus those who were. The brain wave studies that were collected in this research sparked Lusebrink's interest in the mental image formation process and the shift from nonconsciousness to consciousness. This interest ultimately led her to the work of psychologist Jerome Bruner and psychiatrist Mardi Horowitz. Each hypothesized a three-tier model related to the development of internal imagery based on physical, emotional, and intellectual information processing, and Lusebrink became fascinated with these concepts. [1]

When Lusebrink learned about Kagin's Media Dimension Variables, she realized that task complexity, task structure, and media properties could be modified on an individualized basis to create therapeutic shifting among the levels of information processing that had been proposed by both Bruner and Horowitz. Lusebrink and Kagin collaborated to fuse their respective ideas into a framework that described how the targeted initiation of creative mental activity could yield therapeutic results by integrating overly differentiated kinds of information processing. Based on her earlier work with individuals who had developmental and intellectual challenges, Kagin made major contributions to the development of the Kinesthetic and Cognitive components of the ETC. Lusebrink's previous work with people who had schizophrenia positioned her to take the lead on formulating the Affective and Symbolic components. [1]

In 1978 Lusebrink and Kagin published a paper, “The Expressive Therapies Continuum”, in the journal Art Psychotherapy (now The Arts in Psychotherapy). The article introduced the framework and exposed readers to concepts and terminology that were unfamiliar in art therapy at the time. The two presented the Expressive Therapies Continuum to their peers at the 1978 annual conference of the American Art Therapy Association, but the foreign-sounding ideas did not resonate with attendees. [1] [7]

Despite additional publications by Lusebrink, the development of knowledge and skills related to the ETC remained limited to Lusebrink and Kagin's students at the University of Louisville for several decades. During that time the two expanded their ideas, and the ETC evolved into an outcome-informed system that includes assessment, treatment planning, intervention, progress monitoring, and case conceptualization. [1] In 2009 a former student of theirs, Lisa Hinz, published the first edition of Expressive Therapies Continuum: A Framework for Using Art in Therapy, and the ETC finally began to receive widespread recognition among art therapists in the United States. [8] By that point in time the larger mental health field had begun to espouse ideas that aligned with the ETC; Lusebrink and Kagin's concepts and terminology no longer sounded so foreign to art therapy professionals.

Levels of functioning

According to Lusebrink:

The first three levels of the ETC reflect three established systems of human information processing: the Kinesthetic/Sensory (K/S level); the Perceptual/Affective (P/A level); and the Cognitive/Symbolic (C/S level) ... The fourth level of the ETC is the Creative level (CR). It is seen as a synthesis of the other three levels of the continuum. [4]

A diagram of the ETC, as pictured in the top right of the page, can be read from left to right and from the bottom, upwards. [3] The model flows in a direction that travels from simple information processing and image formation to increasingly complex thought processes and interactions with the media. Individuals can fluctuate from level to level depending on personal and situational factors. They may also display an integration of all of the first three levels of functioning. This integration indicates that the individual is operating on the fourth and final level of functioning, known as the Creative level. The Creative level both transcends and intersects the prior three levels, in which the individual is either equally incorporating all aspects of the ETC or is able to find a satisfying and meaningful creative experience on one of the three levels alone.

However, an individual cannot wholly operate at both ends of a level, as each level is bipolar. [9] For example, if the individual is more focused on the quick and scribbly movement of a chalk-pastel on paper, then he or she is less focused on the sensory aspects of the media, such as the sound of the chalk against the paper or the powdery feel of chalk in one's hand.

Kinesthetic/Sensory Level (K/S)

As the first level of the ETC, the Kinesthetic/Sensory level is described as a form of preverbal information processing that is "rhythmic, tactile, and sensual". [3] This simple type of interaction with various art media stimulates primal areas of the brain and meets basic expressive needs—all while providing sensory and kinesthetic feedback for the artist. [3] If an individual is operating at the kinesthetic end of the spectrum, he or she may find satisfaction in movement—i.e. pounding at a piece of clay or scribbling frantically with a crayon. In contrast, if the individual is gravitating towards the sensory end of the spectrum, he or she might take more pleasure in the feel of finger-paints or the smell of scented markers.

This level is particularly useful for young children but may also be useful for anyone needing to focus on sensorimotor skills. In addition, functioning at this level may allow for better access to preverbal memories or expression of extreme emotions. Individuals may identify operation at the K/S as a personal coping mechanism, in which the experience rather than the product is viewed as therapeutic.

Perceptual/Affective Level (P/A)

The second level of the ETC, the Perceptual/Affective level may or may not include verbal thought processes. However, the focus has shifted from the experience alone (with little focus on the outcome, as in the K/S level) to using the media to create an intentionally expressive or self-satisfying final product. [3] The process may be characterized either by an individual's intent to express his or her own literal reality or be characterized by content that is "emotional and raw...without regard to form". [3]

By working with individuals at the P/A level, art therapists can help clients to perceive images or notions in a new way, strengthening communication and assisting with the formation of meaningful relationships. They can also focus on the identification and healthy expression of one's emotions.

Cognitive/Symbolic Level (C/Sy)

Operation at the third level of the ETC, the cognitive/symbolic level, requires "complex and sophisticated" information processing, in which the individual consciously and strategically plans—prior to creating the art piece—for an expressive and self-satisfying final product. [3] At this level, individuals are able to step outside their own sphere of perception and emotional expression and focus on ways that they interact with the world around them. They may begin to use satire and hidden meanings in their pieces to best express their unique response to their surroundings or situation (symbolic) or use art to plan and to problem-solve (cognitive).

Creative Level (Cr)

The final level, which either intersects the previous three levels or transcends above them, is the Creative level. This level symbolizes a wholeness, in which the individual achieves a sense of joy, fulfillment, or wellbeing by taking part in the creative process and expressing the self. [3] This may be accomplished through the integration of the three previous levels (where there was inclusion of all expressive operations in the art-making process; a feeling of oneness) or success in fulfilling an individual's need at any given level, which may be healing in and of itself.

Related Research Articles

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.

<span class="mw-page-title-main">Music therapy</span> Health profession

Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program." It is also a vocation, involving a deep commitment to music and the desire to use it as a medium to help others. Although music therapy has only been established as a profession relatively recently, the connection between music and therapy is not new.

<span class="mw-page-title-main">Occupational therapy</span> Healthcare profession

Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.

Dance/movement therapy (DMT) in USA and Australia or dance movement psychotherapy (DMP) in the UK is the psychotherapeutic use of movement and dance to support intellectual, emotional, and motor functions of the body. As a modality of the creative arts therapies, DMT looks at the correlation between movement and emotion.

The expressive therapies are the use of the creative arts as a form of therapy, including the distinct disciplines expressive arts therapy and the creative arts therapies. The expressive therapies are based on the assumption that people can heal through the various forms of creative expression. Expressive therapists share the belief that through creative expression and the tapping of the imagination, people can examine their body, feelings, emotions, and thought process.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

Multimodal therapy (MMT) is an approach to psychotherapy devised by psychologist Arnold Lazarus, who originated the term behavior therapy in psychotherapy. It is based on the idea that humans are biological beings that think, feel, act, sense, imagine, and interact—and that psychological treatment should address each of these modalities. Multimodal assessment and treatment follows seven reciprocally influential dimensions of personality known by their acronym BASIC I.D.: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biology.

<span class="mw-page-title-main">Play therapy</span> Childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working with the therapist to develop skills for testing and changing beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A cognitive case conceptualization is developed by the cognitive therapist as a guide to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

Educational Therapy is a form of therapy used to treat individuals with learning differences, disabilities, and challenges. This form of therapy offers a wide range of intensive interventions that are designed to resolve learners' learning problems. These interventions are individualized and unique to the specific learner.

Family therapy is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

<span class="mw-page-title-main">Florence Cane</span>

Florence Cane was a notable American art educator whose ideas influenced the field of art therapy.

Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.

Natalie Rogers (1928–2015) was an early contributor to the field of humanistic psychology, person centered psychology, expressive arts therapy, and the founder of Person-Centered Expressive Arts. This combination of the arts with psychotherapy is sometimes referred to by Rogers as The Creative Connection. The daughter of Carl Rogers, one of the founders of humanistic psychology, she established her own center, the Person-Centered Expressive Therapy Institute. Her writings, teachings, and practice introduced many to the power of creative arts for healing both within and outside the therapeutic setting.

References

  1. 1 2 3 4 5 6 7 Hinz, L. D.; VanMeter, M. L.; Lusebrink, V. B. (2022). "Development of the Expressive Therapies Continuum: The lifework of Vija B. Lusebrink, PhD, ATR-BC, HLM". Art Therapy: Journal of the American Art Therapy Association. 39 (4): 219–222.
  2. 1 2 Lusebrink, V. (2010) Assessment and therapeutic application of the expressive therapies continuum: Implications for brain structures and functions. Art Therapy: Journal of the American Art Therapy Association, 27(4), 168-177
  3. 1 2 3 4 5 6 7 8 Hinz, L. (2009). Expressive Therapies Continuum. New York: Taylor & Francis Group
  4. 1 2 Kagin, S, and Lusebrink, V. (1978) The expressive therapies continuum. Art Psychotherapy, 5, 171-180
  5. Rubin, J. (1984). The Art of Art Therapy. Levittown, PA: Taylor & Francis Group
  6. 1 2 3 Graves-Alcorn, S.; Kagin, C. (2017). Implementing the Expressive Therapies Continuum: A guide for clinical practice. New York: Routledge. pp. 2–10. ISBN   978-1-138-65238-5.
  7. Hinz, L. D. (2020). Expressive Therapies Continuum: A framework for using art in therapy (2nd ed.). New York: Routledge. pp. xviii. ISBN   978-1-138-48971-4.
  8. Malik, S. (2021). "Using neuroscience to explore creative media in art therapy: a systematic narrative review". International Journal of Art Therapy. 27 (2): 48–60.
  9. Lusebrink, Vija Bergs; Mārtinsone, Kristīne; Dzilna-Šilova, Ilze (2013-07-01). "The Expressive Therapies Continuum (ETC): Interdisciplinary bases of the ETC". International Journal of Art Therapy. 18 (2): 75–85. doi:10.1080/17454832.2012.713370. ISSN   1745-4832.