What Are the Levels of the ETC?

I get asked this question from time to time…mostly by people who are brand new to the Expressive Therapies Continuum and are looking for info about the basic structure of the model.  To clarify, the Expressive Therapies Continuum (or the ETC) is a dynamic framework that incorporates a client’s response to intervention into the therapist’s decisions about subsequent steps.

It utilizes an outcome-informed approach in that sense, making it very different from models of therapeutic practice in which the therapist gives the client a prompt or a directive that is typically based on the client’s diagnosis or presenting problem.

“What Are the Levels of ETC?”

This overview of the levels will be basic, but it’s a great place to start if you’re just encountering the ETC.  And it’s really called “the ETC”, or “the Expressive Therapies Continuum”.  Most people who are familiar with the framework would not ask “what are the levels of ETC?”, but I found that exact phrasing on Google, signifying that some online searches are done without conversational grammar!

The Expressive Therapies Continuum is About More Than Levels

To be clear, “ETC” doesn’t stand for et cetera.  Not in this case anyhow.  Though et cetera means “and all the other things”, and there are a lot of other things that go into the Expressive Therapies Continuum—not just the levels.

You’ll Understand the Levels Better if You Do This First

There are three (3) levels of the ETC, but there used to be four (4).  We’ll get to the fourth one in a minute.  First let’s focus on the three remaining levels.  To do that, I’m going to ask you to think about your own experiences in life.

• What is your physical experience right now?

• How does your physical experience influence your emotional experience?

• How does your emotional experience influence your intellectual experience?

Relationships Are Important

These questions have made you think about the relationships between your physical self, your emotional self, and your intellectual self.  More on that below.

Identify the Levels of the ETC

The three levels of the Expressive Therapies Continuum are (1) Kinesthetic/Sensory, (2) Perceptual/Affective, and (3) Cognitive/Symbolic.  While the definitions of these terms can be found elsewhere (such as this longer article about the levels of the Expressive Therapies Continuum), just know that the Kinesthetic/Sensory level is physical, the Perceptual/Affective level is emotional, and the Cognitive/Symbolic level is intellectual.

Relationships Among the Levels Are Important

The levels are all interrelated.  You found that out by reflecting on your own physical experience and how it relates to your emotional and intellectual experiences.  You can also do this in reverse: think about your intellectual experience right now.

How is it influencing your emotional experience?  And how is your emotional experience influencing your physical experience?

The Levels of the ETC Represent Different Kinds of Experiencing

You get the picture.  These three levels of experiencing are all about the processing of information.  Different kinds of information—physical, emotional, and intellectual information.  And in the best-case scenario, your nervous system can put all this information together simultaneously to help you generate the most beneficial response to whatever your circumstances are.

• If you need to move your body, you engage your muscles.

• If you need to scratch an itch, you use your fingertips to find relief.

• If you need to organize a closet, you sort and impose order.

• If you need to express your feelings, you find a listening ear.

• If you need to think through a decision, you create a list of pros and cons.

• If you need to understand the meaning of a dream, you consult your intuition.

Different Kinds of Information Are Used to Achieve Different Kinds of Goals

These are examples of the ways we use different kinds of information to achieve different kinds of goals.  And when someone comes to us for therapy, it’s often because they’re having problems connecting information in their nervous system to the achievement of their goals.

Meet the Creative Dimension of the Expressive Therapies Continuum

Now for the fourth level of the Expressive Therapies Continuum.  It’s called the Creative dimension.  It used to be the Creative level back when ETC co-creators Vija Lusebrink and Sandra (Kagin) Graves-Alcorn first conceptualized the ETC.

But the Creative level is not about processing a certain kind of information like the other ETC levels are.  Instead, it’s based on the potential for art therapy interventions (and other expressive therapies interventions—think dance/movement therapy, drama therapy, and music therapy) to generate a stronger connection between information in a client’s nervous system and the achievement of their goals.

“Creative” and “Integrative” Aren’t the Same Thing

In short, the Creative level got redesignated as the Creative dimension because it’s about integration.  But not any old creative activity is integrative, so this is something to be careful about if you’re new to the Expressive Therapies Continuum (or if you think you know about the Expressive Therapies Continuum).

I’d Like to Share the Expressive Therapies Continuum with You

Learning to integrate among the levels is a task for training.  That’s why Lusebrink and (Kagin) Graves-Alcorn took their students on a two-year journey to learn the art of integration.  I was one of their pupils, and now I’m happy to share what they taught me so the Expressive Therapies Continuum can move forward into another generation of therapists who want to help clients connect the information in their nervous system to the achievement of their goals.

Are You Looking for Expressive Therapies Continuum Support?

If you’d like to understand more about this framework for making responsive, outcome-informed decisions in client-centered care, please join my mailing list and receive a FREE Expressive Therapies Continuum bibliography of written and recorded works by the co-creators and their educational descendants.

I offer webinars, supervision, and other opportunities for deepening and strengthening appreciation and utilization of this nervous system-informed model.  And I’m also available for speaking engagements and special projects that suit your custom needs.  Contact me for details.

I Also Offer Expressive Therapies Continuum-based Art Therapy Services

Do you know of someone who is having problems connecting the information in their nervous system to the achievement of their goals?  I have a private practice where I offer online art therapy services to adults in Texas, Indiana, and Arizona.

Please share my information with them and let them know I’d be happy to have a free conversation about their needs and how we can work within the Expressive Therapies Continuum to help them integrate and find the balance they’ve been seeking in life. 

References:

Hinz, L. D. (2020). Expressive Therapies Continuum: A framework for using art in therapy (2nd ed.). Routledge.

Hinz, L. D., Rim, S., & Lusebrink, V. B. (2022). Clarifying the creative level of the Expressive Therapies Continuum: A different dimension. The Arts in Psychotherapy, 78.

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.

Kagin, S. L., & Lusebrink, V. B. (1978). The Expressive Therapies Continuum. Art Psychotherapy, 5, 171-180.

VanMeter, M. L., & Hinz, L. D. (2024). A deeper dive into the Expressive Therapies Continuum; Structure, function, and the creative dimension. Art Therapy: Journal of the American Art Therapy Association, 41(2), 107-110.