What is the Expressive Therapies Continuum Theory?
Before I begin to answer this question, I need to take the reader on a little side trip to explore what is meant by “theory”. It’s true that several credible sources in Expressive Therapies Continuum (ETC) literature identify the ETC as a theory—and my name is included among the authors who’ve described the ETC this way!—but if you dig into the definition of a theory, the Expressive Therapies Continuum doesn’t really fit.
A theory is an idea, and in psychotherapy a theory is an idea that describes why people suffer and what can be done to alleviate that suffering. It tends to be associated with worldview, and that has a lot to do with the evolution of psychotherapeutic theories over the decades.
Did you know the field of psychotherapy currently has over 500 theories?
A Framework is not a Theory
By contrast, a framework is a system that supports the organization of data and the orchestration of whatever it is that needs to be done based on the data. It does not describe why suffering occurs, it does not propose solutions to end the suffering, and it does not revolve around worldview.
A framework is generally broader and thus more inclusive than a theory, and when applied to psychotherapy, it provides a structure for understanding various facets of an individual client’s data and administering responsive services based on this individualized data.
Is the Expressive Therapies Continuum a Theory or a Framework?
All that said, the Expressive Therapies Continuum is actually a framework, not a theory.
There was Once Formal Training in the Expressive Therapies Continuum
Now for information about the Expressive Therapies Continuum, which is what you probably were hoping to read about. The co-creators of the ETC were my professors in graduate school. As such, they trained me to organize client data and orchestrate responsive services within the framework of the Expressive Therapies Continuum.
I can’t overstate the importance of their expert mentoring during the two-year period in which I acquired knowledge and skills in the Expressive Therapies Continuum and then applied these with real, live clients.
What is the Expressive Therapies Continuum, and Who Created It?
The Expressive Therapies Continuum is often mischaracterized as a model that promotes client creativity in art therapy or prescribes a particular sequence of interventions in art therapy. There are other ETC myths in circulation as well, but the truth of the matter is that the Expressive Therapies Continuum is a framework for making responsive, outcome-informed decisions in client-centered care.
Meet the Co-creators of the Expressive Therapies Continuum
Art therapy pioneers Vija Lusebrink and Sandra (Kagin) Graves-Alcorn first developed the ETC in the 1970s. At that time it was a rather static model that identified how different levels of information processing, or experiencing, were characterized by different combinations of modifiable agents of change in art therapy.
The levels of information processing came from the work of Vija Lusebrink, and the modifiable agents of change came from the work of Sandra (Kagin) Graves-Alcorn. The two met while teaching at the University of Louisville and discovered that the research each had done prior to their academic employment somehow complemented or completed the work of the other.
The Expressive Therapies Continuum was Rejected by Early Art Therapy Practitioners
Lusebrink and (Kagin) Graves-Alcorn tried to introduce their American art therapy peers to this model they’d developed, but their findings and ideas were very foreign to the art therapy audience at that time.
The Terminology of the Expressive Therapies Continuum was Ahead of its Time
It was the 1970s, after all. Art therapy and all of psychotherapy were still enamored with psychodynamically oriented approaches. The words that Lusebrink and (Kagin) Graves-Alcorn incorporated into the ETC were still decades away from being embraced my mainstream psychotherapy.
Things like Kinesthetic, Sensory, Perceptual, Affective, Cognitive, and Symbolic (well, maybe not symbolic) were strange sounding to art therapists at the time, and although the world has changed since then, this terminology made art therapists question what the Expressive Therapies Continuum had to do with art therapy at all.
Meet the Components and Levels of the Expressive Therapies Continuum
By the way, Kinesthetic, Sensory, Perceptual, Affective, Cognitive, and Symbolic are components of the Expressive Therapies Continuum. I use capital letters at the beginning of each word when I’m writing about the ETC to signify specific rather than general or generic usage.
For example, using an art material involves some degree of kinesthetic activity, but a client’s process only meets the threshold for Kinesthetic information processing when action or effort are predominant.
Anyhow, these six components of the ETC—Kinesthetic, Sensory, Perceptual, Affective, Cognitive, and Symbolic—are associated with different ways of experiencing within the nervous system (but the Expressive Therapies Continuum doesn’t explain neuroscience—that’s one of the myths!).
What is the Relationship Between the Components and Levels of the ETC?
There are two components on each of three levels: The Kinesthetic/Sensory level is physical in nature, the Perceptual/Affective level is emotional, and the Cognitive/Symbolic level is intellectual. There was a fourth level proposed by Lusebrink and (Kagin) Graves-Alcorn, and they named it “Creative”.
The Creative level has since been redesignated as the Creative dimension to separate it from the other levels of the ETC, as those focus on information processing while the Creative dimension describes a transformational and integrative experience.
Who Contributed What to the Expressive Therapies Continuum?
The discernment of three levels of information processing was largely based on the work of Vija Lusebrink prior to her employment at the University of Louisville. The Creative level/dimension was largely based on the work of Sandra (Kagin) Graves-Alcorn before she arrived at the university.
Sandra (Kagin) Graves-Alcorn is the Mother of Media Dimension Variables
Her work is not as well known by today’s art therapists, largely because she did not do much in the way of publishing. But there would not be an Expressive Therapies Continuum without her. Her research identified three things she called Media Dimension Variables, and these are the modifiable agents of change in art therapy: task complexity, task structure, and media properties.
The original version of the ETC featured different combinations of Media Dimension Variables on each component. However…
The Co-Creators of the Expressive Therapies Continuum Trained Their Students
Despite their essential rejection by the American art therapy community, Lusebrink and (Kagin) Graves-Alcorn knew they were right. They taught their ahead-of-their-time ideas to their students at the university, and as the years went by, they refined the Expressive Therapies Continuum.
By the time I came along as a graduate student in the 1990s, the ETC had become a comprehensive system—a framework for making responsive, outcome-informed decisions in client-centered care. This framework includes assessment, treatment planning, intervention, progress monitoring, and case conceptualization.
That is certainly not a theory. It’s a structure for organizing and orchestrating individualized art therapy services. The ETC’s three levels of information processing have remained intact since their inception in the 1970s, but the Creative level/dimension evolved into a dynamic force powered by (Kagin) Graves-Alcorn’s Media Dimension Variables.
Sandra (Kagin) Graves-Alcorn Trained Students to Work with Media Dimension Variables
Students were taught how to engage with these in a bias-free manner for the purpose of activating each of the three levels of information processing. It’s sophisticated…and learning from (Kagin) Graves-Alcorn over the one-semester course in which the mastery of this was promoted through embodied experiences really can’t be put into words.
Let’s just say that (Kagin) Graves-Alcorn’s work is vital to the Expressive Therapies Continuum, and myths about the ETC abound, at least in part, because today’s art therapists know little about her contributions.
The Expressive Therapies Continuum Promotes Relationally Responsive Care
In summary, the Expressive Therapies Continuum is a framework, not a theory. The co-creators of this framework, Vija Lusebrink and Sandra (Kagin) Graves-Alcorn, trained their students to organize individual client data and orchestrate individualized client services by helping them to see, hear, and think within a dynamic system that includes physical/emotional/intellectual information processing (or experiencing) and task complexity, task structure, and media properties.
This leads to responsive, outcome-informed decisions in client-centered care.
Stay Informed of Expressive Therapies Continuum Events and Opportunities
Are you interested in learning more about the Expressive Therapies Continuum from someone who was trained and mentored by the framework’s co-creators? I provide webinars and workshops to help art therapists and other expressive therapies professionals understand the basics and the nuances of this ahead-of-its-time model that’s become a fascination of practitioners, educators, and researchers worldwide.
I offer an ETC newsletter and announcements to keep people informed of events and opportunities to level up their grasp of the framework. Sign up and receive a FREE Expressive Therapies Continuum bibliography, a living document that features the work of Vija Lusebrink, Sandra (Kagin) Graves-Alcorn, and their educational descendants.
Expressive Therapies Continuum-based Art Therapy is Available for You
Do you need responsive, outcome-informed, client-centered care? My comprehensive training in the Expressive Therapies Continuum enables me to provide relationally resonant services for adults who face a variety of challenges.
Get a Free Consultation for Expressive Therapies Continuum-based Art Therapy
I offer online art therapy in Texas, online art therapy in Indiana, and online art therapy in Arizona. Contact me for a free phone consultation to learn more about how art therapy with me can help you realize your creative potential in turning challenges to choices and changes.
You already have all the answers inside; you just need someone to support you in accessing them and setting them free. I’d love to be that someone for you.
References:
Cooper, M., & McLeod, J. (2007). A pluralistic framework for counselling and psychotherapy: Implications for research. Counselling and Psychotherapy Research, 7(3), 135–143.
Cottone, R. R. (2017). Theories of counseling and psychotherapy: Individual and relational approaches. Springer.
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.
Jones-Smith, E. (2021). Theories of counseling and psychotherapy: An integrative approach. Sage.
Kagin, S. L., & Lusebrink, V. B. (1978). The Expressive Therapies Continuum. Art Psychotherapy, 5, 171-180.
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(53), 1-13.
TEDx. (2024, May 30). Diane Gehart: Mental Health Unmasked: Unveiling the Secrets to Sustained Sanity [Video]. YouTube. https://www.youtube.com/watch?v=gcyDjquKoSE
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.