Expressive Therapies Continuum

Erin Plew Lyles

Department of ArtTherapy/Counseling, Southwestern College

AT/CN 593: Art Therapy Techniquesand Materials

Magdalena Karlick, M.A.,ATR-BC, LPCC

March 5th, 2022


The Expressive Therapies Continuum (ETC) is comprised of subsequent developmental levels elevating from simple to complex which provide a framework for conceptualizing a client’s art making level. This hierarchal developmental continuum deploys a formula for therapists to identify how clients process information and use their cognitive abilities to create artwork. The ETC aids therapists in deciding which materials are appropriate for specific clients and lays the foundation to create attainable therapeutic goals (Hinz, 2019 pp. 3-7).

            The ETC is arranged in three complementary bipolar components of cognitive processing: Kinesthetic/Sensorimotor, Perceptual/Affective and Cognitive/Symbolic. The fourth level of the ETC is the Creative Level, which exists singularly and can be a combination of all preceding levels. The first three components are bipolar in that each component represents extreme pathologies on either end of this developmental scale. When one extreme is fully accessed, it blocks or decreases the ability to achieve the other extreme (Hinz, 2019 pp. 7).

Emergent Functions are the results attained by working with materials within the framework of one of the component levels of the ETC. The resulting emergent functions can move the client to a higher cognitive processing level, moving the client up to the next level of the ETC. As the client moves up the ETC to higher and more complex processing, a greater sense of self-worth is often attained (Hinz, 2019 pp.7). 

Reflective Distance is the space between the person and the process. This distance allows the client to step away from the medium and artwork and analyze the cognitive processing which resulted in artistic choices during the creative process. The observation and analysis of the artwork results in reflection and allows the client the space to understand and potentially verbalize the meaning inherent in their creation (Moon, pp. 52). 

Art materials can be described on a continuum from resistive to fluid (Gusaak, 2011). Highly structured resistive media demonstrate a clients need for organization, stability and control. Some examples of resistive materials and modes are drawing with pencil, wood carving, structure building or collage making. On the other hand, fluid material is known to evoke emotion. Those who experience a high affect may be more drawn to fluid materials such as watercolor on wet paper, free form clay modeling or finger painting. It is important that the therapist is cognizant that offering an excessive variety of materials can sometimes prove overwhelming. Similarly, offering the wrong kind of materials can be destabilizing to a client if the material offered is outside of their cognitive level or if their affect is out of their control (Moon, 2010). There are, however, clients who enjoy the autonomy in choosing their own materials when offered an open studio with limitless supplies (Moon, 2010).


The Kinesthetic sense is one of the most basic cognitive processing components. Kinesthetic senses encompass the physical sensations that provide information to the brain based on bodily movements and physical action. The kinesthetic senses are formed in the right brain and part of the preverbal limbic system. Art therapy performed on this level can be helpful in accessing preverbal material. All art making involves some sort of somatic movement, but kinesthetic experiences in art making are where the movement, rhythm and actions of the body are used directly for therapeutic purposes (Hinz, 2019 pp. 41).

Jackson Pollack is a great example of an artist who used his body and kinesthetic movement to create artwork. His resulting paintings tell the viewer the story of the action and movements of the artist as he danced over the canvas holding his paint soaked brushes. This is an example of isomorphism, a visual representation of physical action. Pollack paintings could be the inspiration for an isomorphic art directive where clients are urged to view the act of painting as a dance, releasing kinesthetic energy by splashing paint on a large surface on the ground. After the energy and paint is released, the client would have the chance to step away and view the image which reflects this physical release (Hinz, 2019 pp.45).

The Sensorimotor component is described as the exploratory level of the ETC and focuses on sensations that are experienced through physical interactions with media. The senses activated in the Sensorimotor component are the visual, auditory, gustatory, olfactory and tactile sensations. A human begins processing sensory information as an infant and stores all of this information in the right side of the brain. These early sensory cognitive processes are primarily preverbal and form the foundation for processing emotional experiences. Therefore, using sensorimotor art materials such as clay can elicit emotional responses or bring up preverbal memories.

Stimulation of the senses is the desired goal with art directives in the Sensorimotor component of the ETC (Hinz, 2019). Working with clay can be a primarily sensorimotor experience if it is not used to hand build or create a structure. Clay has a tactile and visceral quality and records even the subtlest touch by the person working with it (Moon, 2010 pp.17). It can be manipulated into a shape and then deconstructed with a smashing of the hand and rebuilt anew within seconds. Clay does not require a mediator, so the client has direct physical contact with this fluid and dynamic substance. Allowing a client to manipulate the clay without a specific directive would allow for a sensorimotor experience.


The perceptual component of the ETC requires a higher level of cognitive processing as it entails using visual imagery to communicate internal experiences. Clients creating artwork on the perceptual level engage in a new visual language utilizing line, shape, color, form, pattern and direction to create forms in order to process information. Some of the therapeutic functions of the perceptual component are achieving order out of chaos, bringing awareness to boundaries and limits, and this component can also help to reduce anxiety. Talking about the formal elements of a finished artwork on this level can provide a way for clients to speak about important internal experiences that may otherwise be difficult to talk about.

Schroeder describes a kingdom making process that she used in a family therapy session. She divides a large piece of paper into sections with a marker and allows each family member to draw their own personal kingdom. After everyone is finished with their individual creation, she gives the family the option to connect the kingdoms by bridge or tunnel or any other means if they have the desire to do so. Family members use line and forms to create graphic images which communicate boundaries and relationships within the family system (Schroeder, 2005).

The opposite of the perceptual is the affective component of the ETC. This component involves emotion expressed through art media. Creating art provides a socially acceptable release of emotions and can decrease anxiety and help regulate emotions. Working within the affective component can bring awareness of appropriate affect and teach the client to visually communicate affective states. The ability to communicate emotional states helps the client to learn to self-regulate their emotions (Moon, 2010 Ch. 9). Reflective distance in the affective component is relatively low as the client is often caught up in an emotional state while artmaking on this level (Hinz, 2019).

The affective component often employs the use of fluid materials such as watercolor on wet paper. As described by Schroeder in Chapter 6 Exploring/Containing Sadness, the messiness of the material and the uncontrollable nature of the watercolor reflected appropriately the affect of her client who was grieving. This process allowed for an emotional release from the client that reflected her internal experience (Schroeder, 2005).


The cognitive component necessitates more complex cognitive processing as it includes storytelling, problem solving, sequencing events and planning. This component often involves multiple steps and requires the ability to manipulate more resistive art materials to achieve a desired result. Abstract thought, a lengthened attention span, and the ability to perceive others as having a different experience than oneself are other qualifiers for the cognitive component in art making. This component assists in the organization of thought and allows for the client to be able to recognize experiences and relate those to other past or future experiences.

            A directive utilizing the cognitive component of the ETC is to create a floor plan of a client’s childhood home. Not only does this require planning, mapping and problem solving, but it also requires the client to access memories and to draw based on these memories. Re-creating this space allows for containment of this space, which sometimes holds traumas and emotions, and can contain early childhood attachment issues (Hinz, 2019).

The reverse of the cognitive component is the symbolic component of the ETC. As cognitive processing is increased, a person’s capability for creating and understanding symbolism also increases. Symbolic art making requires intuitive, idiosyncratic and abstract thought and the ability to create forms that symbolize an idea or thought.Sometimes, material that is not easily verbalized that may threaten the ego is disguised in artwork using symbols that arise from the unconscious of the maker. Symbols can be used to sublimate primal urges and as defense mechanisms.One’s personal meaning within a broader social context can be realized through the making and understanding of symbols they create.

Clients will often have idiosyncratic relationships to materials. Physical materials become psychic materials based on past associations and a specific client’s relational memories attached to physical objects (Moon, pp.65). It is useful for therapists to remain cognizant of this reality and not to let their personal associations inform what they believe the clients association may be. Moon used the example of creating artwork out of wire framed hangers. No matter what shapes the hangers are bent and cut to form, they will always retain the associations we have with hangers. Hangers are everyday objects that most people in the United States encounter regularly in our homes. These thin wired hooked objects also evoke the thought of back-alley abortions in places where abortion clinics are not accessible. Wire framed hangers can also have a myriad of other associations based on the client’s or viewer’s personal history with these objects. Art objects created with this material will inherently suggest abundant associations no matter the appearance of the final product (Moon, pp.65-72).

TheCreative Component

The final and singular component of the ETC is the creative component. The creative component is the highest level of the ETC and encompasses all other levels that come before it. Creativity requires sustained attention, the ability to access and symbolize memory, make complex decisions and plan and map out an artwork before immersing oneself in the creation process. This level provides the client with the highest degree of satisfaction in that they are able to make personal meaning evident through art objects and create order out of chaos. In theory, self-actualization may be achieved by attaining the skills necessary for this inventive and resourceful level of theETC. Art making provides a concrete and meaningful mirror for the client’s progress and potential. The creative level allows for the most reflective distance on the ETC because the client will likely maintain awareness of the plan and intention throughout the process, even when in the flow state. 

            The Franklin piece on affect regulation and empathic art was particularly moving in the section where he described his interaction in a group therapy session with adolescent boys experiencing depressive symptoms. He began by creating art along side the resistant boys and empathically drew an art piece based on the general feeling emitted from the group members. His drawing provided the basis for symbolism of feeling, translating an internal process into physical form. The boys' curiosity about this image and the subsequent images that he created as the group met prompted them to create images of their own conveying isomorphic depictions of their internal processes (Franklin, 164-166).


The process of writing about the ETC has helped to synthesize the ideas we have been learning in Art Therapy Materials & Techniques.  Learning the psychology behind materials and art processes as it relates to cognitive development has reinvigorated my passion for becoming an art therapist. I am fascinated and want to delve deeper and discover more about the psyche and its relationship to materials and meaning making. No matter a person’s age or developmental level, various levels of the ETC can be implemented to bring about desired therapeutic functions. The ETC is a valuable resource that I know I will reference throughout my career as an art therapist.

            Art Therapy Materials & Techniques class has allowed me to access a freedom that I had lost in art making. I no longer feel the need to play by the rules or to create the perfect piece of artwork. Each artwork is exactly the way it is meant to be, because it is a representation of my unique internal experience. When creating my response art to this paper, I allowed myself to go to the materials I was most drawn to in the moment. I love micron pens, but I had never used one on canvas or in combination with paint. It’s a thing I had vaguely sensed that I wanted to explore for years, but was always scared that I’d mess up the painting with ink or vice versa. I drew a figure on the blank canvas with the pen and then drew clouds behind them.

Micron pens are resistive materials which require cognition and a mastery of the material, which really satisfies my need for control. I have often felt out of control with my emotions, boundaries and insecurities but this resistive material is something that I am familiar with and the thin, structured lines that it makes are satisfying to me. Ink cannot be erased so any desired perfection in the image is typically not possible. This necessitates having to work with my mistakes and allow the image to become what it wants to become regardless of my desire to control.

I let myself indulge in bright colors with the fluid yet mediated material of acrylic paint on the canvas behind the figure. I thought of New Mexico sunsets and all of the beautiful warm colors they yield. I let the brush dance around and intuitively make the cloud shapes and went into a flow state. When the background was finished I thought maybe the painting was finished though I still struggle with allowing blank canvas to show through. I look forward to further exploration using both fluid and resistive mediums, allowing my affect to combine with my need to control.


Franklin, M. (2011). Affect regulation, mirror neurons, and the third hand: Formulating mindful

empathic art interventions. Journal of the American Art Therapy Association  27(4), 160-

167. Routledge.

Gusaak, D.E. (2011). Art and art therapy with the imprisoned: Re-creating identity. Routledge.

Hinz, L.D. (2019). Expressive Therapies Continuum: A framework for using art in therapy.


Moon, C.H. (2010). Materials & media in art therapy: Critical understandings of diverse artistic

 vocabularies. Routledge. 

Schroder, D. (2005). Little windows into art therapy: Small openings for beginning therapists.

Jessica Kingsley Publishers. 

Response Art to Expressive Therapies Continuum Paper. Acrylic and Ink on Canvas. 

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