A systems oriented approach to the expressive therapies: The expressive therapies continuum

The Arts in Psychotherapy, Vol. 18, pp. 395403. Q Pergamon Press plc, 1992. Printed in the U.S.A. 0197-4556191 $3.00 + .oO

A SYSTEMS ORIENTED APPROACH TO THE EXPRESSIVE THERAPIES:

THE EXPRESSIVE THERAPIES CONTINUUM

VIJA B . LUSEBRINK, PhD, ATR*

The expressive therapies focus on the application of various expressive aspects in therapy, aspects that involve other modalities in addition to the verbal modality (i.e., art therapy-visual and tactile; dance/ movement therapy-kinesthetic; music therapy-auditory; and drama therapy, which combines all the other modalities). The expression and information processing accessed in these modalities are multileveled and are therefore difficult to contain within a particular theoretical paradigm.

This paper represents an attempt to organize the different levels dealt with in expressive therapies within the framework of a systems approach. Such a viewpoint incorporates and accommodates the multileveled character of the different expressive therapies and provides a unifying basis for all the expressive therapies. It also has the advantage of accommodating different therapeutic approaches.

Multileveled/Sequential Conceptual Models

Several authors in the different disciplines that comprise the expressive therapies have proposed multileveled approaches to therapy. The Expressive Therapies Continuum (ETC) (Kagin & Lusebrink, 1978; Lusebrink, 1990, 1991) is an application of the systems approach used in art therapy. It is described here in an attempt to define the commonali- ties of the use of all the expressive modalities in therapy. The ETC consists of three hierarchically

ordered levels: kinesthetic/sensory (K/S), perceptual/ affective (P/A), and cognitive/symbolic (C/Sy) (Fig- ure 1). These levels are based on the sequence of increased complexity in cognitive and emotional development. An expression can be on a creative level (CR), which crosses all other levels. Each component has a healing dimension and an emergent function. The healing dimension is specific to a particular level and component of the level; it denotes an opti- mum intrapersonal functioning on the particular level. The emergent function develops characteristics of the next higher level (Lusebrink, 1990).

Each level of the ETC is characterized by a reflective distance that denotes the time span between the impulse or stimulus and reaction to it. The reflective distance increases with the consecutively higher levels of the ETC from the kinesthetic to the perceptual and cognitive components. The reflective distance varies for the sensory, affective and symbolic components. A similar concept of affective distance is used in drama therapy by Landy (1986) through underdistancing and overdistancing. These concepts denote the degree of emotional involvement in the expression. In underdistancing, the individual experience is based on affect and involvement in the experience. Overdistance is characterized by cognitive processing and distancing from feelings, or repression. According to Landy spontaneous creative experience occurs in the midpoint between in- hibited and impulsive expressions.

*Vija Lusebrink is Professor and Director of Expressive Therapies, University of Louisville, Louisville, KY.

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CCSY PI KKS

Figure 1. Schematic representation of the Expressive Therapies Continuum. From: V.B. Lusebrink (1990), Zmager~ and visual expression in therapy (p. 92). New York: Plenum Press.

In drama therapy, Johnson (1982a, 1982b, 1986, 1990) and Landy (1986) have proposed developmentally based and hierarchically organized sequences. Johnson (1982a, 1982b, 1986, 1990) bases his approach on the developmental sequence of thought and its representation. The latter begins with pure sound and movement at the sensory-motor stage, then progresses from the symbolic stage of representation to the reflective stage and representation through words. According to Johnson (1986, 1990), the benefit of such a sequence is the continuous transformation of feelings and the development of a full range of expression across all modalities and all developmental levels. The verbal interpretation(s) of actions afterwards integrates the experience on a cognitive level, making conscious links between the dramatic scene and the client’s other relationships.

According to Landy (1982), the range of therapeutic and dramatic aims combines psychomotor affective and cognitive aspects. Landy (1986) has presented a model of drama expriences used in edu- cational drama and theatre. This model is conceptualized along a continuum: sensory-motor play <--> dramatic play <--> applied dramatic exercises and games <--> improvisation and role playing <--> extended dramatization <--> theatre performance (p. 90). This continuum is interactive as indicated by the arrows, whereby one level embodies aspects of other levels. Blockage at any point of the continuum indicates problem areas.

Fink ( 1990) conceptualized a triangular interactive sequence between behavioral, affective and cognitive expressions and approaches to emotions in

drama therapy. The affective approach decreases the emotional distance of the client, whereas the use of the cognitive approach contributes to overdistance. The behavioral approach, such as the use of improvisational techniques in drama therapy, emphasizes action and experience of affect through action.

Fink’s (1990) model proposed additional interme- diate steps of the physical/affective, cognitivelbe- havioral and cognitive/affective approaches. The cognitive/affective approach balances the extremes of cognitive overdistancing and affective underdistancing with the end goal of catharsis through purifica- tion. The cognitive/behavioral approach deals with role playing and improvised enactment of preplanned aspects of roles. The physical/affective approach to emotion in drama therapy deals with improvisational techniques with emphasis on nonverbal expression through sounds and movement. Fink’s “doing-thinking- feeling” approaches to emotions help to “dissect the components of emotional control in order to understand the operations of the whole system and to be specific in the application of its parts” (p. 16).

In music therapy, Thaut (1990a) has proposed an integrative model of music therapy that differen- tiates three different properties of music as used in therapy.

1. The psychophysical properties influence the activation level and/or the reduction of anxi- ety experienced during the immediate stimulation through music.

2. The collative properties evoke experiences of structures through perceptual responses to music. These include the perception of time-ordered elements of music. Cognitive responses involve the perception of order, clarity and tension relief experienced in listening to music. In addition, emotional responses are evoked in processing music.

3. The ecological properties refer to personal responses, such as memories, moods and personal images associated with the experience of music.

In music therapy the levels of the ETC have been used in the assessment in group therapy describing the sensory, affective, cognitive and symbolic components of the expression as well as creative engagement with the arts (Goldberg, Cohn, Coto-McKenna, & Warga, 1990; Goldberg, NcNiel, & Binder, 1986).

THE EXPRESSIVE THERAPIES CONTINUUM 397

Boxhill (1985) listed sequential levels of awareness and musical behaviors in response to musical stimuli. These range from manipulation of musical instruments properly and their use in ways related to musical stimuli, rhythmic patterns and melodic rhythm, melodic line and chords.

All the above models propose several levels of information processing and expression. Both Johnson’s (1982, 1986) and Landy’s (1986) concepts are similar in their organization to the ETC (Kagin & Luse- brink, 1978; Lusebrink, 1990). They also can be seen as systems based because their simpler levels become parts of a more complex system.

A Systems Approach to the Use of Imagery in Therapy

A systems approach assists in understanding the interaction that takes place between the individual and the medium of expression, be it art in therapy, dance/movement therapy, drama therapy or music therapy. From the general systems perspective, living organisms are seen as open systems. An open system is defined as “a system in exchange of mat- ter with its environment, presenting import and ex- port, building up and breaking down its material components” (Bertalanffy, 1968, p. 141). The open system is contrasted with a closed system, which does not conduct exchange with the environment. Bertalanffy stated that living systems maintain themselves in a “steady state,” which is some distance from equilibrium. Living systems as open systems may evolve toward increased differentiation and hierarchical order or different subsystems. In living systems, the hierarchical order of parts may be de- termined or affected by the interplay of processes of the component parts.

The present application of the systems theory is a modification of Schwartz’s (1984) proposed model of the general system perspective to the psychophysiology of imagery and healing. Schwartz described nine levels of physiological, psychological and social processes using imagery in therapy with the corresponding psycho-neuro-physiological processes involved with each of these levels of imagery: motor skills, conditioned and learning responses, behavioral-emotional-cognitive self-control, insight, motivation and social interaction. The combination of these processes associated with imagery proceed from micro processes to macro processes as the imagery evolves toward a higher level of the hierarchy.

Schwartz’s approach was based in the general systems principle that parts of the system in interaction regulate each other and form emergent wholes. “Pos- itive feedback” or added information leads to connection of different parts and to self-regulation. Dis- connection of parts can also occur at any level of the system and leads to impaired self-regulation. One of the basic tenets emphasized by systems theory is that the higher or macro levels integrate information that, on the lower or micro levels, appears to be disparate and competing.

A Systems Approach to the Expressive Therapies

The client’s interaction with the expressive media on different levels of expression and information processing constitutes a system. The therapeutic focus of the interaction between the levels is a goal- directed functioning of the individual. The multileveled aspects of information processing and expression can be placed on different hierarchically organized levels of the ETC (Kagin & Lusebrink, 1978; Luse- brink, 1990, 1991): kinesthetic/sensory (K/S), perceptual/affective (P/A), cognitive/symbolic (C/Sy) and creative (CR). On each level the two components can either enhance each other or they can constitute a polarity in the extremes of their manifestations. For example, sensory and kinesthetic expressions can elaborate and enhance each other; complete involvement in a kinesthetic activity, though, decreases awareness of the sensory components and vice versa.

The ETC provides a systems-based framework for looking at the client’s internal processes, interaction with media and expression. The ETC has the following characteristics of a system as defined by Bertalanffy (1968):

1. The expression and interaction with the media on the different levels of the ETC function as whole, and changes occurring on separate levels are interrelated.

2. The characteristics of the expression and interaction on the different levels of the ETC are defined not only by the separate levels, but also by the levels being in relationship to each other.

3. Progress toward differentiation of the expression and interaction occurs in progressing from the K/S level of the ETC to the hierarchically higher levels.

4. The progressive differentiation leads to en-

VIJA B. LUSEBRINK 398

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hanced cognitive and emotional functioning of the individual. This progressive differentiation leads to the emergence of a hierarchical order in that expression on a particular level of the ETC has the characteristics of a system at a lower level. For example, an image can denote a symbol, which has kinesthetic, affective, structural and cognitive components (Lusebrink, 1990, p. 113).

Schwartz’s (1984) concepts of connection and disconnection can be applied to imagery and interaction with media on different levels of the ETC. When the levels are in accord, the information is transmitted and transformed from one level to an- other in a fluid manner and the organism functions in a goal-directed manner. Imagery and interaction with the media can foster connection between different levels or lead to disconnection between them. In creative expression several or all the levels of the ETC are present and connected. Characteristics of each level, healing dimensions and emergent functions and their uses by art, dance/movement, drama and music therapists on each level will be discussed in the following examples to illustrate approaches used by different expressive therapists.

The Kinesthetic/Sensory Level in the Expressive Therapies

The kinesthetic component of the K/S level focuses primarily on releasing energy and expressing it through bodily response and action, spontaneous movement, gestures and acts of doing. Exploration of the media in the different expressive modalities takes place on the K/S level.

The sensory component of this level emphasizes inner sensations as well as tactile and other sensations experienced through external stimulation and interaction with different media of expression. Sen- sations and sensory images below the level of consciousness (Kunzendorf, 1987-88) may be brought to the level of consciousness through sensory and kinesthetic activity. Inner sensations are amplified through relaxation and withdrawal from external stimuli. Sensory involvement requires that individuals let go of conscious control and “immerse themselves in unpredictable sensory activities’ ’ (McNiff, 198 1, p. 51). The reflective distance between the stimulus and the reaction to it on the K/S level is minimal (Lusebrink, 1990).

The kinesthetic and sensory components of the K/S level modify each other. The kinesthetic component is slowed down and enhanced in expressive- ness through the sensory component whereas the sensory component is given an external expression through the kinesthetic component.

In art therapy, on the K/S level arts media act as facilitators for kinesthetic actions or awareness of sensations. For example, the kinesthetic component is manifested through pounding on clay or scribbling on paper. The sensory component is amplified through the exploration of fingerpaint. For example, many of Jackson Pollock’s paintings could be considered as expression on the kinesthetic level.

In dance/movement therapy, spontaneous movement improvisation emphasizes expression of the kinesthetic level of the ETC. Responses to inner stimuli mark the beginning of “authentic movement” as defined by Whitehouse (Levy, 1988); the expression of such movement starts on the sensory level and then is actualized through movement on the kinesthetic level.

In drama therapy, sensory/motor play and impro- visations based on nonverbal action and sound are predominantly on the K/S level. In improvisation an individual executes action in the movement without preplanning (Fink, 1990). Drama therapy uses expressions based on Artaud’s “cruelty theatre” (Landy, 1986) that also are on the K/S level. According to Landy (1986), improvisation is characterized by “underdistancing,” and it liberates intuition.

In music therapy, the kinesthetic exploration of different instruments and the sensory responses to different sounds take place on the K/S level. Pure auditory stimulation without reaction to mood or meaning -for example, John Cage’s compositions - have a predominant sensory component (Priestley, 1975).

Sensations-visceral, tactile, audio or visual- and proprioceptive/kinesthetic movement form the basis and become components of emotions and affective and other mental images. Healing dimensions for the kinesthetic component are energy release and rhythm. For the sensory component these dimensions are based on awareness of internal sensations and slow and flowing rhythm. The emergent function on the WS level gives rise to internal and external form perception, image formation and expression of affect and thus leads to a developmentally higher level of information processing and expression.


Rhythm is a common healing denominator for the different expressive modalities on the K/S level, es- pecially for movement and music. Rhythm is the most basic perception that is amodal in infants. Rhythm is based on temporal discrimination in the central nervous system, and it has a temporal structure that affects the perception of acoustic events, motor activity and visual stimuli. Rhythmic stimuli influence the motor system, increasing physical alert- ness and body awareness (Thaut, 1990b; Thaut & Smeltekop, 1990). Thaut (1988) stated that “temporal awareness is intrinsically related to the coordi- nated interaction of various muscular systems and sensory modalities. Rhythmic movement involves the synchronous sequencing of any act in a coordi- nated manner” (p. 127). The rhythmic organization of music facilitates not only perception of musical information, but also helps to organize, understand and remember diverse incoming stimuli (Gfeller, 1990a).

In dance/movement therapy, the healing characteristic of rhythm is used in Espenak’s psychomotor therapy, which stresses the repetition of rhythmic exercises facilitated by music. The structure pro- vided through these exercises helps to organize movement and thinking (Levy, 1988).

The Perceptual/Affective Level of the Expressive Therapies

The perceptual component of the P/A level focuses on the formation of schematic forms and representational images. This level emphasizes the formal and structural qualities of images and utilizes the structural qualities of the different expressive media. The differentiation of form is used to define an ap- propriate schematic representation of inner and outer experiences.

The affective component of the P/A level emphasizes the expression of emotions and affective images. The dialogue between the medium or mode of expression and the individual expressing the images creates an isomorphic interaction (Amheim, 1972) between the two, including related affect. The intensity of affect associated with specific images may mark them for recall or repression. The intensity of affective memories activates other mood and intensity associated areas.

On the P/A level the perceptual and affective components interact with each other in that the perceptual aspect gives form to emotions (i.e., empha-

sizes the schematic aspect of emotions). The affective component, in turn, gives a dynamic quality to forms and endows them with personal qualities. Ex- pression manifested in the extreme of either the perceptual or affective component can block the modifying effect on the opposite component; thus, elaboration and accentuation of the form and structure become means to control emotions. An emphasis on the emotional qualities of the expression distorts or de- fies the restriction of structure and form (Lusebrink, 1991).

The reflective distance on the P/A level varies from being extensive (when the perceptual and structural aspects of the expression are overemphasized) to minimal (during overwhelming experience of affect) (Lusebrink, 1990).

In art therapy, the perceptual component of the P/A level focuses on the formal elements of form, color and pattern. Resistive media or media with high structural qualities (e.g., felt tip markers) are more likely to invoke form definition than fluid media (e.g., watercolors) where the individual has to impose structure on the medium. The affective component is emphasized through the dynamic manner of application of the media. Intense colors and fluid media enhance the expression of affect.

In dance/movement therapy, on the P/A level the emphasis is on the formal aspects of movement and the dynamic expression of affect through movement. Levy (1988) pointed out that different dance/movement therapists emphasize these two aspects to different extents. In her integrative treatment model, Leventhal (1980) emphasized structure and bound- aries in form and space. Schoop (Levy, 1988) used externally prompted action to generate expression of a particular emotion or chose a feeling and then supported its full development in a dramatic movement expression that stressed a rhythmic release.

In drama therapy, on the P/A level the cognitive/ behavioral approach of Fink’s (1990) model, such as role playing with some aspect that has been preplanned, is an example of expression emphasizing the perceptual component. The affective component of the P/A level is present in improvisation based on Stanislavski’s method of acting with emphasis on affective memory and its reconstruction in the present. According to Landy (1986), the affective mode of experiencing the past (when the individual relives the past instead of just remembering it) is characterized by underdistancing. Fink’s (1990) affective properties of drama therapy encompass the affective


component of the ETC. Fink pointed out that satis- factory release of memories stored in the body is not achieved through mental command alone, but also requires physical/affective methods of expression.

In music therapy, an emphasis on the structure of the musical expression focuses on the perceptual component of the P/A level. Music is organized in a time frame and its perception requires the individual to respond in an organized manner (Thaut & Smeltekop, 1990). In music, similar to visual expression, some patterns are more readily perceived than others because they represent “good gestalts” (Gfeller, 1990a). The moods and feelings expressed and/or evoked through music emphasize the affective component via the engagement of the limbic system by musical processing (Thaut & Smeltekop, 1990). Music provides “guiltless” expression of emotions as well as expansion of emotions (Gfeller, 1990b; Priestley, 1975). Priestley suggested Brahms’ First Symphony as well suited for expansion of emotions or the first movement of Bartok’s Fifth Symphony to facilitate the release of aggression.

The healing dimension on the P/A level enhances the organization of visual, kinesthetic and auditory stimulation and their expression through nonverbal means into good gestalts. The healing dimension of the affective component contributes to the awareness and channeling of affect. The interaction of schemes and the formation of symbolic affect images de- scribe the emergent functions on this level.

The Cognitive/Symbolic Level of the Expressive Therapies

Emphasis on the categorical and spatial relations between individual images and operations involving representational images leads to the cognitive/symbolic aspects of the ETC. The C/Sy level is qualita- tively different from the previous levels in that it encompasses the verbalization/lexical processing and anticipatory as well as past oriented operations with images and the verbal reflection on them.

The cognitive component of the C/Sy level emphasizes the analytical, logical thought and reality- directed aspects of information processing. The mental and expressive operations of this component involve sequencing, problem solving, decision making and motivation. The different expressive modalities can be used to define constructs associated with the images present, thus arriving at alternative solutions to a problem.

The content and meaning of the symbolic component of the C/Sy level emphasizes the metaphori- cal and self-oriented aspects of the expression. It focuses on intuitive concept formation, realization and actualization of symbols and symbolic expression of meaning. Symbols are multileveled and multidimensional and encompass kinesthetic, affective and the structural components. Part of the meaning of symbolic images is implied through their structure; the affective component endows them with a special personal meaning of the individual. Sym- bolic images can be regressive and past oriented or progressive, referring to future occurrences and an- ticipations. The kinesthetic, affective and structural components of symbolic images contribute to their resolution in personal terms.

The reflective distance of the cognitive component is considerably larger than that on the previous levels of the ETC. The internal reflective distance on this level contributes to the ability to plan and to postpone actions. The reflective distance of the symbolic component depends on the type of symbol and symbolic expression. The reflective distance increases if the symbol carries emotionally threatening charges or if the symbol is progressive and points to future possibilities. The reflective distance diminishes in regressive identification with each symbol, and it is characterized by regressive behavior and primitive representation of images (Lusebrink, 1990).

The cognitive and symbolic components of the C/Sy level enhance each other. The symbolic aspects of the expression contribute an intuitive view to the cognitive aspect; conversely, the cognitive aspects provide reality feedback to the symbolic mode of processing information. The two components also can block each other. An overemphasis on the cognitive and analytical mode of information processing and expression eliminates the intuitive component; an overemphasis on the symbolic component does not incorporate reality feedback (Luse- brink, 1991).

In art therapy, the main characteristic of the cognitive component is problem solving and structuring the use of media. In the structured approach clients are asked to perform certain tasks, to select particular images from the multitude of stimuli, and to di- rect their focus on a particular aspect of their experiences and reactions (Silver, 1978). Different aspects of a problem can be presented through the choice of different simple shapes (Rhyne, 1979). Collages re- quiring comparisons (e.g., depicting one’s strengths


and weaknesses) involve a cognitive component, as do collages consisting of images elaborated with words and verbal messages (Landgarten, 1981).

The expression of the multidimensional character of the symbolic component is enhanced through the use of fluid media, which also lend themselves to the formation of ambiguous forms and figure/ground reversal. Visual and verbal associations and elabo- rations contribute to symbol resolution. Visual elab- orations with fluid media also help to introduce symbolic elements in an expression consisting of concrete images.

In dance/movement therapy, the cognitive component is emphasized in movement as communication and interactional dance. Espenak’s movement sequences designed to strengthen certain parts of the body incorporate a cognitive component. Dosaman- tes-Alperson’s externally oriented action mode in therapy deals with the world of objects and people, emphasizing the cognitive aspects (Levy, 1988).

The movement itself can assume a symbolic meaning, or the associations elicited in connection with the movement elaborate on the symbolic nature of the expression. Improvisation in dance/movement therapy used on the symbolic level is similar to free associations in verbal therapy. The difference between the two is that in dance therapy the movement can express sensations that are and have been preverbal (Siegel, 1981, 1984). The movement evokes memories, feelings, images and symbols, which then are processed verbally, linking sensation with thought (Stark & Lohn, 1989). Polarities expressed in movement represent polarities in the symbolic expression. Movement can also be used to express active imagination. Dosamantes-Alperson’s sequence, based on Whitehouse’s work, deals with awareness of “shadow movement” or “internal-intrapsychic movements” and can lead to expression on the symbolic level (Levy, 1988).

In drama therapy, the cognitive component is involved in playing social roles and social acts. For example, Brecht’s social drama presents social issues in a stylized and distanced view, with narrative comments on the characters’ behavior. In the same manner telling stories instead of dramatizing provides a distance from potentially overwhelming feelings (Landy, 1986). Control of emotions is achieved through increased cognitive structuring (Fink, 1990). The cognitive component is also predominant in Fink’s category of cognitive/behavioral role playing that encompasses pre-planned techniques, either pre-

ceded or followed by discussion. Fink (1990) refers to Meyerhold’s biomechanics, which stresses sepa- ration of thought from feeling and the integration of thought with action through drama. In using educa- tional drama, Landy (1986) stressed the cognitive aspects of drama as a means to think through issues. Landy’s concept of overdistancing emphasizes the cognitive experience with concomitant detachment from the past and feelings.

Because drama therapy depends on symbolic expression, the symbolic component, with its underly- ing access to sensations and repressed emotions, is present in enactment. The enactment can entail specific symbolic roles, such as the king or witch; it can also be based on imagination, or on a symbolic ritual that requires acting in a predetermined manner.

In music therapy, the cognitive component is emphasized through focus on the structure of music and on its structured application in group interac- tions. The structure of music follows organizational principles based on objective reality. Music activities involve the cognitive skills of concentration, learning, sequential processing and problem solving (Thaut & Smeltekop, 1990). Priestley (1975) suggested Bach’s Brandenburg Concerto #4 in G as an example enhancing the cognitive component. Ac- cording to Priestley, melody appeals to the intellect because the flow of notes has to be kept in mind to form a pattern.

The symbolic component in music therapy is promoted through symbolic identification with the music. In analytical music therapy the expression through sounds is used to explore the unconscious, and also as a synthesizing agent for the released repressed energies (Priestley, 1975). Music stimulates associations that in turn can be used to elucidate symbols (Charlesworth, 1982). Charlesworth stated that music is multidimensional and touches the “deeper soul” while evading logic. He pointed out that repeated themes-for example, in Dvorak’s compositions-may indicate repressed significant events. The symbolic effect of lyrics and their analysis are also used in music therapy to produce insight (Gfeller, 1990a). Charlesworth (1982) found an inverse relationship between the presentation of songs and dreams in therapy.

The healing dimension of the cognitive component enhances the generalization of concepts and personal experience and promotes insight. In addition, this dimension of the symbolic component


promotes resolution of symbols through the discovery of personal meaning. The emergent function of the C/S level leads to creative problem solving using verbal and imaginal integration, and to insight and the discovery of new or repressed parts of self.

The Creative Level of the Expressive Therapies

A creative synthesis of expression incorporates the contribution of different components of expression, be they kinesthetic or sensory, perceptual or affective, cognitive or symbolic. Creative expression can be manifested on any of the levels of the ETC. The acknowledgment of the creative act is an im- portant responsibility of the expressive therapist. The therapeutic environment can provide a setting for developing creative aspects of the individual through diverse means of expression, plus encour- aging perceptual openness and receptiveness to inner and outer stimuli. The discovery of new levels of expression or a new level of experiencing oneself can be seen as part of the creative act. It is associated with feelings of a sense of closure and joy. The healing dimension and emergent function of the creative level lead to a creative transaction with the environment and its creative transformation (Luse- brink, 1990).

Conclusions

The ETC with its three levels-kinesthetic/sensory, perceptual/affective, cognitive/symbolic-and the broader creative level provides a systems-based conceptual model of information processing and expression that can be used by all the expressive therapies. Any expression may incorporate several levels, but one level may predominate at a particular time. The transition between the levels can occur within the same session, or one or more sessions can focus on a particular level.

The ETC systems-based model includes the systems characteristics, such as the hierarchical order of its levels, and the interrelation of changes occurring on different levels. The knowledge of the component parts of the system helps to understand the operation of the whole system. The emergent and healing functions on each level contribute to the stepwise growth and differentiation on the individual clients.

The ETC model provides a special advantage in situations where several expressive therapists are

working together but using different expressive modalities. The concept of common levels of expression contributes to the understanding of the application of the different expressive modalities of the arts therapies to a common goal for the benefit of the clients.

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Documents

A systems oriented approach to the expressive therapies: The expressive therapies continuum