Cathy A. Malchiodi
Art therapy is a distinct field with many approaches, as described in this volume and throughout the art therapy literature (Malchiodi, 1998; Rubin, 1998). However, some practitioners see art therapy as part of a larger discipline referred to as expres-sive arts therapy (the therapeutic use of art, music, dance/movement, drama, and poetry/writing) and intermodal or multimodal (moving from one art form to an-other) approaches. This chapter provides a brief history of expressive arts therapy and multimodal approaches, theoretical foundations, and expressive arts therapy as-sessment and evaluation and demonstrates the integration of art therapy, expressive arts therapy, and intermodal approaches in treatment through case examples.
WHAT IS EXPRESSIVE ARTS THERAPY?
Expressive arts therapy has been linked to the traditions and cultural precedents of world healing practices because they frequently involve the integration of all the arts (McNiff, 1981). Ceremonies in which a indigenous healer or shaman might sing, dance, make images, or tell stories recall the early roots of psychology and psychia-try. For example, in ancient Greece, dramatic enactments including dance, music and storytelling brought people together to experience cathartic release. The Navaho people in the Southwestern United States still employ the arts, including sand paint-ings, songs, dance, and chanting, to heal ill members of their communities.
Although the idea of expressive arts therapy is a development of the last half of 106
the 20th century, it is still growing in scope and definition (Malchiodi, in press).
Some characterize expressive arts therapy as the inclusion of any of the arts thera-pies—art, music, dance/movement, drama, and poetry/writing. Thus, using one or more of these therapies in work with individuals or groups is defined as expressive arts therapy. To make matters more confusing, the term “expressive therapy” is sometimes used interchangeably with expressive arts therapy. Expressive therapy has been defined as using the arts and their products to foster awareness, encourage emo-tional growth, and enhance relationships with others through access to imagination;
including arts as therapy, arts psychotherapy, and the use of arts for traditional heal-ing; and emphasizing the interrelatedness of the arts in therapy (Lesley College, 1995).
Some characterize expressive arts therapy as using one or two disciplines within treatment (Levine & Levine, 1999), whereas others take a more interdisciplinary view of these modalities (Knill, 1978; Knill, Barba, & Fuchs, 1995; McNiff, 1978, 1992). Rogers (1993) defines expressive arts therapy as using “various arts—move-ment, drawing, painting, sculpting, music, writing, sound, and improvisation—in a supportive setting to experience and express feelings” (p. 115). As in art therapy, the aesthetics of the art work are not primary, and the arts are used to self-express and to gain insight.
Some practitioners believe that expressive art therapies should be strictly delin-eated as the “intermodal” or “multimodal” use of various arts therapies. The idea of
“multimodal expressive arts therapy” has also been proposed and is defined as inte-grating various art forms into a therapeutic relationship and by working within more than one medium (Spaniol, Spieser, & Cattaneo, 1999). That is, any of the arts thera-pies may be used in therapeutic work as the therapist deems appropriate to meet the needs of the client, and in a given session, more than one art form is used to enhance therapy.
THEORETICAL FOUNDATIONS
Therapists working from an expressive arts therapy or intermodal approach have a variety of theoretical stances. Just as those practicing art therapy, practitioners of expressive arts therapy might have a Jungian, object relations, or other theoretical orientation that guides their understanding and frames the process of therapy. An underlying belief common to many approaches is the principle of unconscious ex-pression that echoes the psychoanalytic principles discussed in Chapter 4 (this vol-ume). The basic premise is that the expressive arts experiences—visual art, music, dance, and drama—allow people to explore unknown facets of themselves, communicate nonverbally, and achieve insight.
Natalie Rogers, the daughter of psychologist Carl Rogers, has proposed one of the more accepted theories of expressive arts therapy and intermodal work and inte-grates a “person-centered” approach in her work. As previously discussed in Chapter 5 (this volume), “person-centered” or “client-centered” approaches were developed by Carl Rogers and emphasize the therapist’s role as a sensitive, reflective, and Expressive Arts Therapy and Multimodal Approaches 107
empathetic individual. Person-centered expressive arts therapy embraces similar ten-ets, including the premise that each person has the capacity for self-direction and has an impulse toward personal growth and full potential.
Rogers (1993) also coined a term for encouraging and enhancing the interplay between the arts in therapy: the creative connection. She believes that one art form naturally stimulates another; for example, creative movement can affect what we express through drawing, and drawing may activate what we feel or think. This cre-ative connection can involve a variety of different sequential experiences of the arts for therapy; however, the individual is central to the process and determines, with guidance and facilitation of the therapist, the direction the process takes and the art forms used.
Other humanistic approaches to psychotherapy often use expressive arts therapy and multimodal techniques within treatment. For example, some practitioners of Gestalt therapy use what could be considered multimodal approaches, combining art, movement, and other modalities (Rhyne, 1973/1995). Therapists with a trans-personal approach may combine some form of imagery, music, movement, and cre-ative writing in their work with clients (Farelly, 2001).
Some believe that expressive arts therapy and intermodal approaches are based on the interrelationship of the arts and theories of creativity and imagination, rather than integration with psychological principles. Knill (1978; Knill et al., 1995) pro-poses that the connection between self-expression through the arts taps the healing power of imagination and is a fundamental phenomenon of human existence, as op-posed to a theory of psychotherapy. McNiff (1992) also proposes a similar philoso-phy, seeing the arts as medicine for the soul, grounded in traditional uses of art throughout history to heal and transform human suffering.
The introduction of action into psychotherapy is the basis for expressive arts therapy, no matter what theoretical stance is used. According to McNiff (1981), action within therapy is rarely limited to a single mode of expression, one form of expression tends to flow from another, and art forms complement each other in therapy. The approach also honors that each person has a different expressive style. For example, one person will be more verbal, another more visual, and a third more kinesthetic or tactile. Each art form (visual art, dance, music, drama, and poetry/writing) helps people to make sense and meaning in a specific way—vi-sual arts through image, dance through movement, music through sound and rhythm, drama through action, and poetry/writing through words (Knill et al., 1995). By opening the therapeutic experience beyond visual art alone, the therapy is enhanced in clinical depth and facilitates expression in a manner most appropriate to the particular client.
Although there are various theories and orientations in expressive arts therapy and intermodal work, all theorists who agree to employ them in treatment must pos-sess a practical knowledge of how each of the art forms functions, how people re-spond to each art form, and how to guide the client from one art form to another.
Some therapists comfortably use all arts in treatment, but, in reality, most rely on two or three that they feel qualified to use.
108 CLINICAL APPROACHES TO ART THERAPY
ASSESSMENT AND EVALUATION IN EXPRESSIVE ARTS THERAPY AND INTERMODAL WORK
There are no formalized assessments that use expressive arts therapy as a foundation.
The lack of a formal, standardized assessment is, in part, the result of a lack of quantifiable research on the intermodal use of arts as therapy. Therapists using an expressive arts therapy or intermodal approach generally make clinical observations, based on their own training, experience, and orientation, to evaluate how to proceed with treatment. However, there are a few models for understanding and evaluating clients’ uses of arts media in therapy which are used by some practitioners to guide the therapeutic process and establish goals for future treatment. These models in-clude the expressive therapies continuum (Kagin & Lusebrink, 1978; Lusebrink, 1990), the mode of representation model (Johnson, 1999), and the creative axis model (Goren-Bar, 1997).