Expressive Therapy

Expressive therapy, also known as expressive arts therapy and creative arts therapy, is the use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final product. Expressive therapy is predicated on the assumption that people can heal through the use of imagination and the various forms of creative expression.

Defining Expressive Therapy

"Expressive therapy" is a general term for many types of therapy. Some of the most common forms of expressive therapy are:

• art therapy;
• dance therapy, also known as dance/movement therapy;
• drama therapy, or therapy through theater methods;
• psychodrama, or role-playing therapy, where patients act out parts of their own lives to gain insight;
• music therapy;
• writing therapy, a term that may encompass journaling, poetry therapy, and bibliotherapy;
• expressive arts therapy, an intermodal discipline where the therapist and client move freely between drawing, dancing, music, drama, and poetry.

However, there are many other types of expressive therapy in which creative work is used to promote healing. All expressive therapists share the belief that through creative expression and the tapping of the imagination, a person can examine the body, feelings, emotions, and his or her thought process. Although often separated by the form of creative art, some expressive therapists consider themselves intermodal, using expression in general, rather than a specific discipline, to treat clients, altering their approach based on the client's needs, or through using multiple forms of expression with the same client to aid with deeper exploration.

History of Expressive Therapies

Only recently have the various forms of expressive therapy begun to be grouped together; however, forms of dance, music, and art therapy have all existed for a long time.

Music has been used as a healing implement for centuries. As early as 400 BC, Hippocrates played music for mental patients. Music therapy as we know it began in the aftermath of World Wars I and II, when, particularly in the United Kingdom, musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma.

Dance has been used as a healing ritual in the context of fertility, birth, sickness, and death since early human history, but the actual establishment of dance as a professional type of therapy occurred in the 1950s, beginning with future American Dance Therapy Association founder Marian Chace, who is considered the principle founder of dance therapy in the United States

Visual art used as a form of professional therapy began in the mid-20th century, arising independently in English-speaking and European countries. The British artist Adrian Hill coined the term "art therapy" in 1942, when he was recovering from tuberculosis in a sanatorium and discovered the therapeutic benefits of drawing and painting while convalescing. The American Art Therapy Association was founded in 1969. 

Efficacy of Expressive Therapies

Music therapy has been used in the treatment of many psychiatric disorders. Music therapy is used with schizophrenic patients to ameliorate many of the symptoms of the disorder, and individual studies of patients undergoing music therapy have showed diminished symptoms (such as reduced flattened affect, reduced speech issues, and increased interest in external events). Music therapy has also been found to have numerous significant outcomes for patients with major depressive disorder. A systematic review of five randomized trials found that people with depression generally accepted music therapy, which was found to produce improvements in mood when compared to standard therapy.

Various hypotheses have been proposed regarding the mechanisms by which dance therapy may benefit participants. There is a social component to dance therapy, which can be valuable for psychological functioning through human interaction. Another possible mechanism is the music that is used during the session, which may be able to reduce pain, decrease anxiety, and increase relaxation. Since dance requires learning and involves becoming active and discovering capacities for movement, there is also the physical training that could provide benefits as well. 

Studies have demonstrated the efficacy of art therapy, as applied to clients with memory loss due to Alzheimer’s and other diseases, stroke residuals, traumatic brain injury, post-traumatic stress disorder (PTSD), depression, dealing with chronic illness, and aging.

Criticisms of Expressive Therapy

The expressive therapies, because they are more recent than many types of therapy, have been relatively less studied and as such their mechanisms may not be well-understood.

Systemic Therapy

In psychotherapy, systemic therapy seeks to address people not only on the individual level, as had been the focus of earlier forms of therapy, but also as people in relationships, dealing with groups and their interactional patterns and dynamics.

Defining Systemic Therapy

Systemic therapy should be distinguished from group therapy: in group therapy, individuals with similar treatment needs meet with one or more therapists and gain additional benefits from the group setting. Systemic therapies, such as family and marital counseling, are designed to treat a system (such as a family unit or a couple) and its interactional patterns and dynamics.

Family therapy, an important subset of systemic therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. This type of therapy also includes marriage counseling. Family therapy uses a range of counseling and other techniques, including the following:

• Structural therapy: identifies and re-orders the organization of the family system.
• Strategic therapy: looks at patterns of interactions between family members.
• Systemic or "Milan" therapy: focuses on belief systems.
• Narrative therapy: restoring of dominant problem-saturated narrative, emphasis on context, separation of the problem from the person.
• Transgenerational therapy: dealing with transgenerational transmission of unhelpful patterns of belief and behavior.

A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations, as well as interaction patterns in the session, apparent for both the therapist and the family.

History of Systemic Therapy

Systemic therapy has its roots in family therapy, or more precisely, family systems therapy, as it later came to be known. Early schools of family therapy represented therapeutic adaptations of the larger interdisciplinary field of systems theory, which originated in the fields of biology and physiology.

As a branch of psychotherapy, the roots of family therapy can be traced to the early 20th century, with the emergence of the child guidance movement and marriage counseling. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from learning theory and behavior therapy. Significantly, family therapists began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals.

Efficacy of Systemic Therapy 

According to a 2004 French government study, family and couples therapy was the second most effective therapy after cognitive-behavioral therapy. Of the treatments looked at in the study, family therapy was presumed or proven effective in the treatment of schizophrenia, bipolar disorder, anorexia, and alcohol dependency.

Family therapists tend to be more interested in the solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to place blame on one or more individuals, with the effect that for many families a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used, as opposed to a linear route. Using this method, families can be helped by finding patterns of behavior, what the causes are, and what can be done to better their situation.

Criticisms of Systemic Therapy

Since issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in systemic therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy, as well as the role of the therapist’s own values in the therapeutic process, and how prospective clients should go about finding a therapist whose values and objectives are most consistent with their own.^[33][34][35] Specific issues that have emerged include an increasing questioning of the longstanding notion of therapeutic neutrality, a concern with questions of justice and self-determination, connectedness and independence, "functioning" versus "authenticity," and questions about the degree of the therapist’s "pro-marriage" versus "pro-individual" commitment.