Who Created the ETC?
Once upon a time, two pioneer art therapists met at the University of Louisville in the United States. One was Vija Lusebrink, who would go on to ensure that her ideas made it onto the radar of American art therapists, and the other was Sandra (Kagin) Graves-Alcorn, whose ideas contributed to the knowledge base of many art therapists despite the fact that quite a few don’t know her name.
Birth of a Historical Relationship
At the University of Louisville, (Kagin) Graves-Alcorn had established the Institute for Expressive Therapies after being hired to revive a dormant master’s degree program in art therapy. She invited Lusebrink to join her on the faculty.
(Kagin) Graves-Alcorn arrived at the university in 1969 and Lusebrink came in 1974.
Birth of the Expressive Therapies Continuum
As the two became familiar with each other, Lusebrink realized that their research-based ideas were complementary and that (Kagin) Graves-Alcorn’s work offered a missing link that completed her own work. What grew out of their subsequent endeavor to synthesize their individual research became a framework that encapsulated the art therapy experience as seen through the lens of the nervous system and interventive inputs.
They called this framework the Expressive Therapies Continuum, or ETC, after the Institute for Expressive Therapies.
Importance of Understanding the ETC’s Co-creators
What were the specialized areas of research each of these pioneers had engaged in prior to meeting? Knowing this information can help all expressive therapists (art therapists, dance/movement therapists, drama therapists, and music therapists) understand how the Expressive Therapies Continuum is an ahead-of-its-time model with implications for contemporary practice, education, and research.
Introduction to the Co-creators of the Expressive Therapies Continuum
I studied at the University of Louisville in the graduate art therapy program Sandra (Kagin) Graves-Alcorn revived, and I would love to introduce you to the genius of my former professors. It’s typically easiest to start with the work of Vija Lusebrink because her name is the one most people associate with the ETC.
Accordingly, her ideas are better recognized by art therapists.
Vija Lusebrink’s Introduction to Art Therapy
Lusebrink emigrated to the United Sates from Latvia secondary to the events of World War II. She earned a bachelor’s degree in chemistry and eventually went on to earn a Master of Fine Arts degree in painting.
While she was at an arts-based personal growth and exploration workshop, she noticed that all the images created by participants were somehow familiar to her in terms of their evocative potential. She decided that she wanted to become an art therapist—whatever that was.
Vija Lusebrink’s Introduction to Art and the Brain
She pursued coursework that seemed appropriate for someone wanting to enter into a psychotherapeutic field and volunteered at a state hospital where she was able to focus on conducting art therapy and research with individuals who experienced schizophrenia.
This research was done in conjunction with a larger project that sought to examine the course of illness with and without psychotropic medication. While Lusebrink collected patient artwork, other researchers were obtaining brainwave images of the patients.
Lusebrink’s “Aha” Moment
Lusebrink realized that different brain states tended to be associated with certain characteristics in the artwork, and she rejected the prevailing art therapy assumption that client artwork is a projection of symbolic, intrapsychic material.
Vija Lusebrink’s Scholarly Inquiry
Lusebrink hoped to find an explanation for what she had observed at the state hospital. In particular, the ideas of Hanz Prinzhorn, Jerome Bruner, and Mardi Horowitz became important to her. Prinzhorn had published a book about the artistry of people with mental illness, and he had identified categories that were defined by visual characteristics of the images.
Jerome Bruner, who is well known in the field of cognitive psychology, had postulated that the evolution of mental imagery happens in three modes that are sequentially related to each other and based on physical, emotional, and intellectual activity.
Levels of Mental Imagery Expression
Horowitz, a practicing psychiatrist now known for research on stress responses who also trained at a fine art school, had built upon Bruner’s ideas and speculated that there are three interrelated modes of mental imagery expression; these translate physical, emotional, and intellectual data into external representations.
Finding information from these three people—especially Horowitz’s work—made Lusebrink realize that client artwork could be categorized into three broad levels, each related to the others but characteristically demonstrative of experience and expression that is predominantly physical, emotional, or intellectual.
Sandra (Kagin) Graves-Alcorn’s Introduction to Art Therapy
A few years prior to Lusebrink’s research activities, Sandra (Kagin) Graves-Alcorn was working on her own investigative studies. More on that in a bit. She had earned a Bachelor of Fine Arts degree and along the way took a class in child psychology, where she first heard of art therapy, before moving on to pursue a master’s degree in child development and special education.
(Kagin) Graves-Alcorn had sought out psychodynamic art therapy training, which was all that was available at the time, but her career path found her working at a state facility for individuals with severe intellectual and developmental disabilities—and she recognized that psychodynamic art therapy was not going to help the population she served.
(Kagin) Graves-Alcorn’s “Aha” Moment
Due to the setting she was in she very quickly became skeptical about the idea of art therapy being strictly about the projection of unconscious material, and she began to wonder if client artwork was at least in part a response to what the art therapist had asked a client to create, how the art therapist had asked for this, and the art media offered or proposed by the art therapist. In short, she suspected that therapist input yielded client output.
Sandra (Kagin) Graves-Alcorn’s Scholarly Inquiry
The facility where she worked received significant funding for the study of adaptive behavior, so (Kagin) Graves-Alcorn was able to engage in scholarly experiments that provided the material for her master’s thesis. Through this series of research endeavors that focused on finding the aspects of art therapy most responsible for producing therapeutic change in the facility’s residents, (Kagin) Graves-Alcorn ultimately identified three distinct agents of change that influenced each other and could be modified on a client-by-client basis to facilitate the achievement of treatment goals.
Agents of Change in Treatment
These three distinct agents of change she noted are collectively called Media Dimension Variables, and they consist of (1) task complexity, (2) task structure, and (3) media properties. Today’s art therapists know media properties as the fluid-to-resistive continuum, and it is the one aspect of (Kagin) Graves-Alcorn’s work that made its way into mainstream art therapy knowledge.
Unfortunately, most art therapists who know this continuum don’t know the name of the woman whose research led to the conceptualization of it.
Levels of Expression + Agents of Change
When Lusebrink joined (Kagin) Graves-Alcorn at the University of Louisville, she came to appreciate that the latter’s Media Dimension Variables defined operant functioning among and within the levels of mental imagery she herself had identified.
The two worked together to explore and expand upon their respective ideas, and the resulting brainchild of their combined efforts is the Expressive Therapies Continuum. The ETC was originally conceptualized as a somewhat static framework that paired Lusebrink’s different levels of mental imagery experience and expression, or information processing, with specific combinations of (Kagin) Graves-Alcorn’s Media Dimension Variables.
Four Levels of the Expressive Therapies Continuum
The pairings that were identified by the Expressive Therapies Continuum’s co-creators described the kind of artistic/therapeutic input and output associated with each level and its components. Each level of information processing is made of two components; these components are polar opposites of each other but related.
The physical level consists of Kinesthetic and Sensory information processing, the emotional level is comprised of Perceptual and Affective information processing, and the intellectual level contains Cognitive and Symbolic information processing.
Lusebrink and (Kagin) Graves-Alcorn identified a fourth level, which they named Creative, as an integrative conduit that could synthesize multiple kinds of information processing via therapeutic experiences that generated feelings of closure, completion, and joy in the client.
Evolution of the Expressive Therapies Continuum
The two geniuses published an article about their newly minted Expressive Therapies Continuum in 1978 and gave a conference presentation about it to the American Art Therapy Association that same year, but those who were introduced to it via these channels didn’t know what to make of it and so didn’t do anything with it at all.
Undeterred, Lusebrink and (Kagin) Graves-Alcorn taught the ETC to their students and continued to work on it, eventually expanding it into a dynamic framework that features an outcome-informed system of assessment, treatment planning, intervention, progress monitoring, and case conceptualization.
Embodiment of the Creative Level
The Creative level in particular was given embodiment through experiential student learning opportunities that clarified the relationships between information processing levels and combinations of Media Dimension Variables.
This hands-on clarification allowed for the development of student responsiveness when working with clients, and supervision further helped students identify opportunities for adjusting Media Dimension Variables to create therapeutic movement among and within the levels of the ETC on a client-centered basis, thus supporting integratively focused treatment.
Vija Lusebrink’s Contribution to Art Therapy
Lusebrink and (Kagin) Graves-Alcorn both retired from teaching in the 1990s, but by then Lusebrink had begun to disseminate her ideas in the form of a book and a few articles. Although she predominantly wrote about the levels of information processing she had originally conceptualized before she met (Kagin) Graves-Alcorn, she referred to these as the Expressive Therapies Continuum and did not focus a great deal on the Creative level.
She continued to write long after her retirement, a portion of her life that lasted nearly three decades. During this time she greatly advanced awareness of the ETC’s three levels of information processing. The final piece of literature that bears her name was published posthumously.
Sandra (Kagin) Graves-Alcorn’s Contribution to Art Therapy
(Kagin) Graves-Alcorn, on the other hand, did not take to writing, which means her genius was largely left undocumented and exists in the memories of the students she taught. These individuals can speak toward her brilliance and its clinical application.
If not for (Kagin) Graves-Alcorn’s Media Dimension Variables, the Expressive Therapies Continuum would not exist. But her media properties (the fluid-to-resistive continuum) survived as perhaps the first aspect of the ETC that art therapists were willing to embrace.
Help for Understanding the ETC
Sometimes when an idea is as big as the Expressive Therapies Continuum, the only thing people can absorb of it is a small bite. I am fortunate to have learned the ETC from the two minds that created it, and I’ve spent the last 15+ years helping other art therapists understand this important framework in small bites and larger portions too.
Expressive Therapies Continuum Resources and Opportunities for You
Interested in leveling up your knowledge of the Expressive Therapies Continuum? Subscribe to the ETC newsletter and receive a FREE Expressive Therapies Continuum bibliography, a compilation of written and recorded works by Lusebrink and (Kagin) Graves-Alcorn as well as their educational descendants.
Be the first to know about upcoming learning opportunities like ETC webinars and workshops.
Online Art Therapy for Healing Hurt
I’m the art therapist the co-creators of the Expressive Therapies Continuum trained me to be. I offer online art therapy services to adults in Texas, Indiana, and Arizona, and I’d love to offer them to you or a loved one who struggles with anxiety, burnout, depression, grief or loss, or trauma.
A Partner for Creating Your Healing Journey
Please contact me to find out how art therapy can help integrate lost ways of being and unmask all the potential hiding behind current difficulties; they’re usually a sign that better days are waiting to be created.
Let’s create them together.
References:
Graves-Alcorn, S., & Kagin, C. (2017). Implementing the Expressive Therapies Continuum: A guide for clinical practice. Routledge. https://doi.org/10.4324/9781315624303
Graves-Alcorn, S. L., & Green, E. J. (2014). The expressive arts therapy continuum: History and theory. In E. Green & Drewes, A (Eds.), Integrating expressive arts and play therapy with children and adolescents (pp. 1-16). Wiley.
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.