What Are the Levels of the Expressive Therapies Continuum?
The Expressive Therapies Continuum, a framework for making responsive, outcome-informed decisions in client-centered care, was co-conceptualized by art therapy pioneers Vija Lusebrink and Sandra (Kagin) Graves-Alcorn.
It preceded by decades the neuroscience-oriented models that are now prevalent in psychotherapy, though the Expressive Therapies Continuum remains standing solidly without the need for modification despite the years that have passed since its introduction in 1978.
The Levels of the Expressive Therapies Continuum are Associated with the Nervous System
One of the core features of the Expressive Therapies Continuum, or ETC, is the identification of levels that are associated with different ways of processing information via the nervous system.
The Levels of the Expressive Therapies Continuum are Important for Differentiating Client Behavior
Understanding the distinctions among these levels is important for differentiating among observable, measurable client behaviors and making sense of how these pair with assessment, treatment planning, intervention, progress monitoring, and case conceptualization.
The Levels of the Expressive Therapies Continuum Help Therapists Make Outcome-informed Decisions
In short, understanding the levels of the ETC framework helps a clinician respond to clients as they demonstrate how their nervous systems process information. It is only when a clinician has mastered thinking within the framework that they can see client behavior within the framework and make outcome-informed decisions within the framework.
There are Three Levels of Information Processing Within the Expressive Therapies Continuum
Once upon a time when Lusebrink and Kagin (subsequently Graves-Alcorn) proposed and published about ETC, there were four levels. Now there are three, and the remaining level has been designated as a dimension.
More on that later. First let’s cover the three levels.
Information Processing is Important to All Organisms
The three levels of the Expressive Therapies Continuum constitute developmentally sequential yet inclusive ways of processing information. What does it mean to process information? It means to transform data. And why would data need to be transformed?
To make it useful for the organism—in therapy’s case, the organism is the human being in question: the client.
Information Processing Ensures Survival
What kind of data is useful for human beings? Very broadly speaking, physical, emotional, and intellectual data are all useful in ensuring survival as well as the important achievement of homeostasis.
Homeostasis Prevents Hypo- or Hyper- Arousal and Activation
Homeostasis is a condition in which equilibrium is constantly sought after as a primary goal; whether a person is aware of it or not, their internal systems are perpetually tasked with regulation to prevent hypo- or hyper- arousal and activation.
This is something most therapists already know about due to trauma-informed training and trauma-informed self-reflection.
The Kinesthetic/Sensory Level of the Expressive Therapies Continuum is Physical
Physical data was once thought of as irrelevant in psychotherapy, but Lusebrink and (Kagin) Graves-Alcorn recognized that the body is the primary source for all other material that gets processed or transformed.
Using models that were in existence at the time, they conceptualized the physical level of the ETC as having two extremes: Kinesthetic and Sensory.
Some People Have a Native Preference for Making Sense of the World at the Kinesthetic/Sensory Level
Kinesthetic relates to information processing that is externally directed through muscular activation and engagement. Sensory relates to information processing that is internally directed to the body from the outside world or comes from within the body itself.
Information that gets processed at the Kinesthetic/Sensory level is body-based, and people who have a native preference for making sense of the world through Kinesthetic/Sensory means are likely physically oriented with a need for embodiment in all they do; this is how they achieve homeostasis.
The Perceptual/Affective Level of the Expressive Therapies Continuum is Emotional
Moving to the next level, emotional data actually builds upon physical data to result in information processing that combines the two but leans heavily toward a “felt” state. At this level, direct bodily encounters aren’t necessary for the processing of information, but previous somatic experiences now edify the emotional data to be transformed.
Again using models that were in existence at the time, Lusebrink and (Kagin) Graves-Alcorn conceptualized the emotional level of the ETC as having two extremes: Perceptual and Affective.
Some People Have a Native Preference for Making Sense of the World at the Perceptual/Affective Level
Perceptual relates to information processing that is internalized from the external world as impressions or schemas. Affective relates to information processing that is externalized from the internal world of mood and motivational drives.
Notice how important the body is for having emotional information to process; Perceptual information requires active or previous engagement with the external world while Affective information requires active or previous engagement with the internal world.
People who have a native preference for making sense of the world through Perceptual/Affective means are often emotionally oriented and have a “felt” sense of what needs to be done to achieve homeostasis.
The Cognitive/Symbolic Level of the Expressive Therapies Continuum is Intellectual
The next developmentally sequential level combines the other two and adds on a layer of complexity related to higher-order thinking. This intellectual level absorbs physical and emotional data as nuances that inform the way a person applies logic.
Once more using models that were in existence at the time, Lusebrink and (Kagin) Graves-Alcorn conceptualized the intellectual level of the ETC as having two extremes: Cognitive and Symbolic.
Some People Have a Native Preference for Making Sense of the World at the Cognitive/Symbolic Level
Cognitive relates to information processing that is filtered through the rules of external, objective logic to comprehend and connect concepts. And Symbolic relates to information processing that is filtered through the rules of internal, subjective logic to comprehend and connect concepts.
Note that previous physical and emotional experiences with the internal and external worlds are important for information processing on this level; concepts learned at physical and emotional levels can be explored in the absence of direct physical and emotional encounters.
People who have a native preference for making sense of the world through Cognitive/Symbolic means typically enjoy thinking and use this as a primary strategy for achieving homeostasis.
The Creative Dimension Relates to the Specific Use of Media Dimension Variables
The last level we’ll cover is the level that became a dimension after Vija Lusebrink, her former student Lisa Hinz, and their colleague Sung-ryun Rim published an article about it. The Creative dimension (previously the Creative level) is not indicative of a way of processing information or transforming data—that’s why Lusebrink, Hinz, and Rim sought to designate it as something other than a level, which is what Lusebrink and (Kagin) Graves-Alcorn had previously called it.
Lusebrink, Hinz, and Rim recognized that the Creative dimension is the integrative and interventive aspect of the Expressive Therapies Continuum. Instead of referring to the generic definition of “creative”, the Creative dimension is related to the specific use of task complexity, task structure, and media properties.
The Implementation of Media Dimension Variables is Related to Therapist Responsiveness
Different combinations of task complexity, task structure, and media properties--the three Media Dimension Variables, as conceptualized by (Kagin) Graves-Alcorn--lead to different outcomes on the levels of the Expressive Therapies Continuum. It is important to note that art therapists are not automatically practicing art therapy within the framework of the Expressive Therapies Continuum if they believe the Creative dimension relates to anything and everything done in the name of “creativity”.
Instead, Lusebrink and (Kagin) Graves-Alcorn trained their students to develop an embodied, “felt”, thoughtful respect for Media Dimension Variables and their capacity for inducing nervous system information processing shifts on an individualized, client-by-client basis.
And this relates to the topic of responsiveness, but you can find more about that in this article.
Therapists Can Get Help for Making Sense of the Expressive Therapies Continuum
I was one of those students who were trained by Lusebrink and (Kagin) Graves-Alcorn. My educational experience with them was invaluable, considering the eventual “brain burst” that erupted in mainstream psychotherapy and made the Expressive Therapies Continuum relevant for a whole new audience in a whole new century.
I enjoy helping others make sense of this comprehensive framework, beyond what can be gleaned (and possibly misunderstood) from a book or other reading materials. No one literary source can cover the model in its entirety and guarantee competence and fidelity in its implementation.
I Offer Expressive Therapies Continuum Services and Support for Therapists
Please join me for consultation, supervision, and training in the Expressive Therapies Continuum. I am available for speaking engagements as well as custom projects designed to suit your (or your audience’s) needs.
Contact me for more information and be sure to sign up for the free ETC bibliography and newsletter—don’t miss out on opportunities to level up what you are doing with this responsive, outcome-informed, client-centered framework.
Find Balance Through Art Therapy and the Expressive Therapies Continuum
I provide Expressive Therapies Continuum-based art therapy services to treat anxiety and depression in adults. These services are available online in Texas, Indiana, and Arizona. Please reach out if you are struggling to achieve homeostasis within your own nervous system—finding balance between the needs of your inner world and the demands of the outer world isn’t always easy, and sometimes what used to work doesn’t work anymore.
Let’s have a free 15-minute phone conversation to help you understand how I would address your unique situation so you can determine whether we’re a good fit for the balance-finding journey ahead.
References:
Graves-Alcorn, S., & Kagin, C. (2017). Implementing the Expressive Therapies Continuum: A guide for clinical practice. Routledge.
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.
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.