Terapias Expresivas y Creativas · 1978
Expressive Therapies Continuum (ETC)
Change is facilitated by adjusting the expressive medium and flexibly shifting processing between the Kinesthetic/Sensory, Perceptual/Affective and Cognitive/Symbolic levels so as to foster creative integration of experience.
The Expressive Therapies Continuum (ETC) is a conceptual and clinical model developed by Sandra L. Kagin and Vija B. Lusebrink to organise the different modes of processing and expression activated through interaction with artistic and expressive media. Its architecture distinguishes three bipolar levels of increasing complexity—Kinesthetic/Sensory, Perceptual/Affective and Cognitive/Symbolic—and a Creative level or axis that may manifest within any of them or integrate contributions from several levels. The ETC holds that the physical properties of the medium, the degree of mediation, task boundaries and reflective distance alter how a person processes experience; selecting materials and directives is therefore a clinical intervention in itself. The therapist observes both the creative process and the formal elements of the artwork to identify resources, blocks and predominant modes of processing, and may facilitate horizontal transformations between the two poles of a single level or vertical transitions between levels. The aim is not necessarily to ascend linearly towards cognitive levels, but to increase connection, differentiation, flexibility and integration among modes of processing, with creativity able to emerge at any point on the continuum. Although Lusebrink later related the ETC levels to neuropsychological processes and brain systems, these correspondences should be understood as theoretical hypotheses rather than demonstrated neurobiological localisations of each component.
Theory of change
Change occurs by identifying how the person is processing experience, selecting media and tasks that allow work to begin from that point of entry, and facilitating connections, differentiations and transformations among ETC components until processing becomes more flexible and creative integration is possible.
Core ideas
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Artistic expression involves multiple levels of processing
An artwork is not merely an image with symbolic content: it includes motor action, sensation, perception, affect, cognitive operations and meanings that may participate with different weight at different moments. The ETC provides a language for differentiating these modes without reducing them to a single psychological explanation. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum).
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The art medium is an active clinical variable
Fluidity, resistance, texture, structure, quantity, boundaries and mediation alter the experience that can be produced; choosing a material is therefore not a decorative decision, but an intervention that changes possibilities for action, sensation, organisation, affect and meaning. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum).
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The three main levels are organised as polarities
Kinesthetic/Sensory, Perceptual/Affective and Cognitive/Symbolic are not six independent compartments, but three pairs in which the components complement one another and may inhibit each other at their extremes; flexibility requires the capacity to use and coordinate both poles. (Lusebrink, 1991, A Systems Oriented Approach to the Expressive Therapies).
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Kinesthetic and Sensory form the most immediate foundation
Movement, energy, rhythm and sensory feedback provide the initial elements upon which perception, affect and more complex images may subsequently be organised. Their therapeutic value does not depend on immediately translating them into verbal language. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum; Lusebrink, 1991, A Systems Oriented Approach to the Expressive Therapies).
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Form can contain emotion without eliminating it
At the Perceptual/Affective level, increasing differentiation, figure–ground and organisation may provide structure for an intense emotional experience, while allowing colour, dynamism and fluidity may restore affect to an excessively controlled artwork. The aim is integration rather than the absolute dominance of one pole. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum).
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Symbolic meaning should be discovered, not imposed
Symbols condense sensory, affective, perceptual and autobiographical components whose meaning may be partly unknown. Therapeutic elaboration explores those components and the person's own associations to allow meaning to emerge, avoiding turning symbolic work into a standardised translation of images. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum; Lusebrink, 1990, Imagery and Visual Expression in Therapy).
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Reflective distance can be regulated
The degree of fusion with action or emotion and the capacity to contemplate it from some distance may be modified through materials, mediators, boundaries, perceptual organisation and verbalisation. Optimal distance depends on the person's state and the clinical goal; it is not simply a matter of maximising reflection. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum).
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Each component has its own healing possibilities
The ETC does not regard lower levels as merely primitive or as levels to be abandoned. Rhythm, sensory awareness, perceptual organisation, channelling of affect, cognitive insight and symbolic resolution each have therapeutic functions and may be the appropriate clinical focus at different times. (Lusebrink, 1991, A Systems Oriented Approach to the Expressive Therapies).
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Functioning at one level may generate emergent functions
Organisation achieved in one mode of processing may create the conditions for another, more complex mode to appear: action and sensation may produce form and affect, and the interaction of perceptual and affective schemata may facilitate symbolisation, insight and creative problem-solving. (Lusebrink, 1990, Imagery and Visual Expression in Therapy; Lusebrink, 1991, A Systems Oriented Approach to the Expressive Therapies).
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The Creative level runs throughout the continuum
Creativity is not a destination reserved for the end of a hierarchical progression. Kinesthetic, Sensory, Perceptual, Affective, Cognitive or Symbolic creativity may occur, as may a synthesis of several levels; its defining qualities are integration, transformation and the appearance of a new form of experience. (Kagin & Lusebrink, 1978, The Expressive Therapies Continuum; Lusebrink, 1991, A Systems Oriented Approach to the Expressive Therapies).
Influences
- Art as Therapy
- Dynamically Oriented Art Therapy / Art Psychotherapy
- Gestalt Art Therapy
- Phenomenological art therapy
- Cognitive art therapy
- Florence Cane — integration of movement, emotion and thought
- Elinor Ulman — creativity and sublimation
- Jerome Bruner — enactive, iconic and symbolic modes of representation
- Jean Piaget — cognitive development
- General systems theory
- Gestalt psychology
- Cognitive psychology and visual information processing
- Graphic development and art education
Key references
- Kagin, S. L., & Lusebrink, V. B. (1978). The Expressive Therapies Continuum. Art Psychotherapy, 5, 171–180.
- Lusebrink, V. B. (1990). Imagery and Visual Expression in Therapy. New York: Plenum Press.
- Lusebrink, V. B. (1991). A Systems Oriented Approach to the Expressive Therapies: The Expressive Therapies Continuum. The Arts in Psychotherapy, 18(5), 395–403.
- Lusebrink, V. B. (2004). Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy. Art Therapy, 21(3), 125–135. https://doi.org/10.1080/07421656.2004.10129496
- Lusebrink, V. B. (2010). Assessment and Therapeutic Application of the Expressive Therapies Continuum: Implications for Brain Structures and Functions. Art Therapy, 27(4), 168–177. https://doi.org/10.1080/07421656.2010.10129380
- Lusebrink, V. B., Mārtinsone, K., & Dzilna-Šilova, I. (2013). The Expressive Therapies Continuum (ETC): Interdisciplinary Bases of the ETC. International Journal of Art Therapy, 18(2), 75–85. https://doi.org/10.1080/17454832.2012.713370
- Lusebrink, V. B., & Hinz, L. D. (2019). Cognitive and Symbolic Aspects of Art Therapy and Similarities With Large Scale Brain Networks. Art Therapy. https://doi.org/10.1080/07421656.2019.1691869