Expressive therapies are defined by the National Coalition of Creative Arts Therapies as the use of art, dance/dancelike movement, music, poetry, drama, creative writing, play, and so forth in the context of therapy, counseling, or rehabilitation for individuals with psychological disorders, such as substance use disorders.
These therapies are more correctly referred to as integrative therapies when they are used in combination with standard treatments for substance use disorders. The notion of an integrated therapy is that the therapy is integrated in the normal treatment paradigm for a substance use disorder; it is not a standalone approach to the treatment for substance use disorders.
What Types of Interventions Are Used as Expressive Therapies?
According to the book Expressive Therapies, the range of expressive therapies is extensive and includes the following techniques:
- Art therapy: Art therapy uses images, art media, and the creative process to aid in the development of an individual’s abilities, reconcile emotional conflicts, foster self-awareness, develop social skills, solve problems, reduce anxiety, increased self-esteem, and manage behavior.
- Drama therapy: This is the intentional use of drama or theater products, processes, and associations to help individuals achieve therapeutic goals associated with treating their substance use disorders. This can be done a number of different ways, such as helping clients relate their own personal stories via performing. Drama therapy incorporates a cathartic approach and can help to release emotional conflict.
- Music therapy: Music therapy uses music to institute positive changes to the individual’s psychological, cognitive, physical, or social functioning.
- Dance/movement therapy: Dance therapy is based on the notion that the mind and body are related. It uses psychotherapeutic movement as a process that helps to improve the emotional, physical, and cognitive integration of the person in treatment.
- Play therapy: Play therapy uses therapeutic play to help people resolve psychological difficulties and achieve optimum development.
- Poetry therapy (bibliotherapy): These interventions describe the use of literature and/or poetry for healing and the development of personal growth.
- Sand play therapy: This is a creative form of therapy that uses a sandbox and miniature models to help clients explore deeper layers of their own inner personal beings. Clients construct a series of “sand pictures” to integrate various aspects of their personality and emotional functioning.
- An integrated arts approach (also known as intermodal or multimodal therapy): This approach combines two or more of the above expressive therapies to encourage psychological growth and the development or facilitation of personal relationships.
Therapeutic Effects of Expressive Therapies
Expressive therapies use the creative process as a means of therapeutic intervention or change. The creative process can be utilized through creation, interpretation, reflection, discussion, and so forth. Individuals who actually create art, poetry, music, or are involved in dance or play therapy are not evaluated on the quality of their final product but instead are expected to use the creative process to foster change and to help reach therapeutic goals.
Several aspects of the creative process associated with expressive therapies contribute to this process, such as:
- Self-expression: All of the aforementioned techniques encourage individuals to engage in self-exploration through self-expression. Some sources suggest that using the arts as a part of therapy may actually speed up the process of self-exploration and allow individuals to experience themselves from a different vantage point. Expressing oneself through dance, poetry, art, etc. may help to make sense of one’s past experience and act as a catharsis (a term used in therapy for self-realization and the release of emotional burdens). Self-expression in most of these techniques typically involves the use of some form of verbal expression or reflection; however, it can also involve body movement as in dance, visualization as in painting or sculpting, and even tactile expression during play.
- A sense of active participation: These methods are all action-oriented methods by which clients explore issues and communicate their feelings and thoughts. These are not passive techniques. These techniques require individuals to invest energy in them and be committed to experiencing them. They are also sensory in nature in that they utilize different sensory modalities.
- The establishment of mind-body connections: These techniques are designed to facilitate the capacity of the mind to influence body functions and symptoms, and vice versa. These forms of expression are effective in helping to cope with stress and in establishing meaningful ways of communicating one’s issues. In addition, some of them are physical forms of expression, such as dance and play, and have the benefit of promoting health and wellness.
- Imagination: According to the book Foundations of Expressive Arts Therapy: Theoretical and Clinical Perspectives expressive therapies are founded on the notion that imagination is a healing agent inherent to all forms of self-expression. Often, the word creativity is used to describe the function of expressive therapies, and this includes the notion of imagination.
How Do Expressive Therapies Assist in Substance Use Disorder Treatment?
There are a number of specific effects found for different types of expressive therapies used as adjunctive therapies in the treatment of substance use disorders. According to the book The Use of Creative Therapies with Chemical Dependency Issues:
- Expressive therapies may be useful in decreasing denial in individuals with substance use disorders.
- Expressive therapies are potentially useful in reducing opposition to treatment for individuals with alcohol use disorders and other substance use disorders.
- Expressive therapies help to disseminate issues with shame and regret that are associated with past substance usage.
- Expressive therapies have been shown to help individuals engage in seeking and participating in treatment.
- Expressive therapies are useful in developing communication skills, self-esteem, and personal insight, and they offer variety in the therapeutic process.
- Expressive therapies can be used to help motivate individuals to change.
Expressive therapies can be useful in the treatment of substance use disorders. It is important to realize that these integrative treatments are used as part of an overall substance use disorder treatment program that includes the traditional notions of therapy, medically assisted treatment, group counseling, peer support, and so forth.
There are several considerations involved with choosing to use expressive therapies in a substance use treatment program:
- First, it is important to understand that the use of any techniques or materials in expressive therapy should be practical for the individuals involved and should be appropriate for the age, maturity level, and ability of the people using them. Many individuals may not feel artistic or may not feel that activities, such as acting, are appropriate for them, and these people should not be forced into using these techniques.
- There are some contraindications to using expressive therapies. Individuals with severe cognitive issues, severe psychological issues such as psychosis, physical disabilities, or neurological problems may not be appropriate to involve in expressive therapies and may not benefit from them.
- Using any form of interpretive process discussion regarding any individual’s performance or work in a group setting with the person’s peers should be undertaken with great care. The goal is not to criticize someone’s artwork, acting, etc. but to discuss the creative process and the experiences that went into the expression. It is extremely counterproductive to critique a person’s art, acting, etc. Those who do not wish their work to be viewed by others should have their wishes respected by therapists.
- No one should ever be coerced into participating in expressive therapies.
- Expressive therapies can only be administered by individuals trained specifically in the type of expressive therapy being used. These therapies should not be used by individuals who are not specifically trained and certified in their use, and this includes licensed therapists. Licensed therapists should only use these techniques if they have been specially trained in them.