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Expressive therapies

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Related terms
Background
Practice
Theory/evidence
Safety
Author information
Bibliography

Related Terms
  • Aerobic dance, artistic expression, art therapy, dance therapy, drama therapy, expressive therapists, literature, music therapy, poetry therapy, psychotherapy, self-expression.

Background
  • Expressive therapies include dance, drama, literature, music, poetry and the visual arts combined with the practice of psychotherapy. Psychotherapy is an interactive process between a person and a qualified mental health professional in which the patient explores thoughts, feelings and behavior to help with problem solving. Expressive therapists may use a variety of therapies to engage patients in the resolution of psychological difficulties.
  • Expressive therapy is a new and emerging field. Lesley University created the nation's first academic expressive therapy department in 1974, and just recently graduated its first doctoral expressive therapy class. Expressive therapists use multiple art modalities along with psychotherapy in their clinical practice, but often focus on a specific modality. The field of expressive therapy recognizes the importance of the arts and creative expression in the process of healing. This type of therapy is commonly used to treat conditions such as depression, anxiety, and grieving, among a variety of other disease states.
  • Art therapy: Art therapy became established as a mental health profession in the 1930s and, like the other forms of expressive therapy, is now practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses and private practices. It involves the application of a variety of art modalities including drawing, painting, clay and sculpture. It is believed that these methods of art may help people deal with inner conflicts, such that they become more aware of the "inner self."
  • Dance/movement therapy: This category of expressive therapy includes martial arts as well as many types of dance. It aims to help people release pent up emotions and gain inner peace. It may be particularly useful in gaining a sense of peace with one's body after being subject to some type of abuse. This type of therapy became distinct in the 1940s, and is known as a psychotherapeutic use of movement. There are currently dance/movement therapists in 43 United States territories and in 21 countries.
  • Drama therapy: Drama therapy is the intentional use of drama and/or theater processes to achieve therapeutic goals. It is an active therapy, which is based on experience. It can provide an alternative context for a patient to relate his or her inner struggles and feelings. It can actively explore inner experience and strengthen interpersonal relationship skills.
  • Music therapy: Music was recognized as a tool of healing in the ancient writings of writings of Pythagoras, Aristotle and Plato. In more modern times, music therapy became recognized in the early 20th Century, when local musicians played for those suffering from the traumas of war at Veterans' hospitals across America.
  • Poetry therapy: Creative writing was instituted as a treatment modality in the United States over 200 years ago in a Pennsylvania hospital. It is currently used to treat a vast array of conditions among many different populations. It may be used as primary therapy or ancillary therapy.
  • Psychotherapy: The generally acknowledged father of modern psychotherapy was Sigmund Freud, a neurologist in 1880s Vienna, Austria, who noted that some of his patients did not seem to have a physical cause for their symptoms. Freud primarily used dream interpretation, free association, and the three levels of consciousness: the id (primitive drives and impulses), the ego (normal waking mental functioning) and the superego (conscience, self-regulation of right and wrong) in his practice.

Practice
  • Expressive therapists may work in psychiatric hospitals, prisons, rehabilitative facilities, medical hospitals, outpatient clinics, day treatment centers, agencies serving developmentally disabled persons, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools or private practices.
  • Art therapy: Art therapy involves the expression of inner thoughts or feelings in the form of a painting, drawing or other form of art when a person is not able to verbalize them. The patient may work with a variety of mediums, as suggested by the art therapist. People involved in art therapy are given the tools they need to produce paintings, drawings, sculptures, and many other types of artwork. The formal use of art therapy usually involves discussion and interpretation of the meaning of what the person has created with an art therapist, and possibly with peers in a group situation. Such discussion may encourage helpful insights into what the work might reveal about the person's life, aspirations, feelings or needs. Another form of art therapy requires the patients to look at pieces of art, often in photographs, and then talk with a therapist about what they have seen. A professional art therapist is required to earn a master's degree. Sessions may cost up to $75-$150 per hour in the United States.
  • Dance/movement therapy: Dance therapy involves using dance as a form of expression. The therapist may observe a person's movements to make an assessment and then design a program to help the specific condition, having the patient perform certain therapeutic movements. An ongoing verbal narration may accompany the dance as a form of reflecting the group or individual process. Rhythmic movements may be used as an organizing and illuminating force, thus using the dance therapy as a cohesive group process. This type of therapy is used for patients of all ages and backgrounds, and can be done individually or in groups. Becoming a dance therapist requires postgraduate training in the area, with already established qualifications and experience in the dance and social sciences.
  • Drama therapy: A drama therapist will assess a client's needs, and then design a treatment approach based on those needs. It may include individual or group therapy, and will be based on the person's skill and ability levels, interests, and goals. Techniques may include improvisation, theater games, story telling or enactment. It may be enriched by the use of text, performance, or ritual. One type of drama therapy is playback theater, when group members actually act out a difficult situation one group member has experienced. The therapist may also instruct a patient to perform story telling, where a group member explains past experiences using the third person to convey the message.
  • Music therapy: Music is often used to improve people's quality of life by influencing their physical, emotional, cognitive and social well-being. Music therapy may involve either listening to or performing music, with or without the presence of a music therapist. Music therapists are professionally trained to put into practice specific uses of music according to an individual's needs. These applications of music may include improvisation, receptive listening, song writing, lyric discussion, imagery, performance or learning through music. Sessions can be designed for individuals or groups based on the specific needs of the participants. Infants, children, adolescents, adults, the elderly and animals can all potentially benefit from music therapy. There are various methods of music therapy. Receptive therapy involves listening to and then responding to music. Improvisation involves creating music spontaneously, while recreation involves singing or playing music, which has already been composed. Composition methods of music therapy entail creating pieces of music as a mode of self-expression. Any of these methods, individually or combined, may be chosen by the music therapist in order to address a specific patient's needs.
  • Poetry therapy: A trained poetry therapist will actively engage a patient to identify and transform issues through the use of language arts. They may train a patient to use writing as a vehicle of expression, to let out emotions that had been previously suppressed. The therapy may involve keeping a journal, which may lead to an increased sense of "self." The reading and writing of poetry will likely also be involved, in an exploration of a person's psychological difficulties on paper. The therapist may use a poem to invite a conversation about a patient's personal issue.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, expressive therapist, or other trained practitioner). Its function is the exploration of thoughts, feelings and behavior for the purpose of problem solving or achieving higher levels of functioning. Expressive therapy combines various modes of the arts, such as fine art, dance, poetry, or drama, with psychotherapy.

Theory / Evidence
  • Art therapy: Art therapy is used as a complementary therapy in integrative medicine programs as a means to attain both the psychological and physiological benefits of self-expression. It is based on the principle that creative self-expression is intrinsically curative and life enhancing. Art therapy enables the expression of inner thoughts or feelings when a person is not able to verbalize them. The visually pleasing component of an artistic creation is thought to elevate one's mood, increase self-awareness and improve self-esteem. Art therapy may also stimulate neurological pathways from the brain to the hands, increasing hand-eye coordination. Art therapy is commonly used in the treatment of anxiety, depression and other mental and emotional problems; substance abuse and addictions; family and relationship discord; abuse and domestic violence; and coping with disability or medical illness. Independently, the creation of art is considered a therapeutic form of self-expression. Children seem to be particularly responsive to art therapy. They may be able to express difficult issues that they cannot verbally communicate and reconcile various emotions by drawing, painting and constructing with an art therapist. Art therapy may also be an effective means of improving quality of life in the elderly. There is evidence that the non-directed use of visual art (pictures) as a means of encouraging communication among elderly nursing home residents may increase well-being, happiness, peacefulness, satisfaction and calmness. It may also reduce blood pressure, and improve medical health status with regard to reported dizziness, fatigue, pain and use of laxatives. Through creating and discussing art with an art therapist an individual may be able to increase awareness of self, cope with symptoms of various illnesses, cope with stress or trauma, and enhance cognitive abilities. Research has recognized that emotional expression has positive benefits for the immune, nervous, and cardiovascular systems. The psychological and physiological benefits attained through art therapy may contribute to improved quality of life and, theoretically, to the improvement of the medical course of illness. Art therapy may also be a helpful intervention for hospitalized, suicidal adolescents. There is evidence that it can be used to aid in developing a sense of identity and optimism about the future, hopefully leading to less suicidal tendencies. It may also encourage relaxation and more open communication, and may result in shorter hospitalization
  • Dance therapy: The outcomes of dance therapy have been shown to be mostly beneficial. It has been shown to affect a client's emotional and physical health, well-being, and ability to cooperate with others in every-day life. It involves body movements, steps, expression, and interaction. The physical benefits of dance therapy as exercise are well documented. Studies have shown that physical activity is known to increase special neurotransmitter substances in the brain (endorphins), which create a state of well-being. And total body movement such as dance enhances the functions of other body systems, such as circulatory, respiratory, skeletal, and muscular systems. Regarding its unique connection to the field of medicine, many researches have been undertaken on the effects of dance/movement therapy in special settings with physical problems such as amputations, traumatic brain injury, and stroke, chronic illnesses such as anorexia, bulimia, cancer, Alzheimer's disease, cystic fibrosis, heart disease, diabetes, asthma, AIDS, and arthritis. Dance movement therapy may stabilize the sympathetic nervous system, modulating serotonin and dopamine concentrations. This may improve psychological distress in adolescents with mild depression.
  • Drama therapy: Currently, there are few scientific studies conducted on the use of drama therapy. It is theorized to help individuals recovering from addiction, developmentally disabled individuals, abuse survivors, prison inmates, homeless persons, and people with HIV/AIDS, along with the general public, by achieving behavior change, skill-building, emotional and physical integration, and personal growth.
  • Music therapy: Research suggests that music may stimulate the release of natural opiates and endorphins from the body, which are known to enhance a person's feeling of well-being, and improve blood pressure, blood flow, pulse rate, and breathing. All forms of music may have therapeutic effects, although music from one's own culture may be most effective. Types of music differ in the types of neurological stimulation they evoke. For example, classical music has been found to cause comfort and relaxation while rock music may lead to discomfort. It has been postulated that music may achieve its therapeutic effects in part by elevating the pain threshold. Structured music therapy programs have been found to improve mood in institutional long-term care workers facing burnout, tumor patients, and stem cell transplant patients. There is also evidence that combining music with guided imagery may lead to reduced fatigue, mood disturbance and blood levels of cortisol (a stress hormone). Music therapy, by enhancing a state of physiological relaxation, may accelerate many of the body's healing responses. This relaxation state is characterized by reduced heart rate, reduced blood pressure, reduced tension, and many other beneficial changes. Evidence that music therapy can lead to the relaxation response has been found in studies with heart bypass surgery patients, healthy college students, infants, patients on mechanical ventilation, healthy males and acute myocardial infarction patients. There is also reliable scientific evidence supporting the use of music therapy to treat Alzheimer's dementia, anxiety, autism, cystic fibrosis, depression, grief in children, infant development, pain, schizophrenia, and sleep quality, among other conditions. Music may also be used in the classroom to aid children in the development of reading and language skills.
  • Poetry therapy: This type of therapy may be useful for emotional expression of adolescents, dealing with grief or bereavement, cancer patients, depression, developmentally disabled, HIV/AIDS, marriage counseling, severe trauma, sexually abused patients, and substance abusers. A poetry therapist may provide a bereaved person the opportunity to express their emotions when they otherwise could not, and may then be able to support the patient. Journal writing and spontaneous writing may help an individual clarify his or her thoughts and feelings. Further scientific study is needed in this area.
  • Psychotherapy: Psychoanalytically oriented psychotherapy may reduce depression associated with adjustment disorder. It may improve sexual and social adjustment, and encourage weight gain in patients with anorexia nervosa. Psychodynamic group therapy and cognitive-behavior group therapy may both reduce aggression in male veterans with a history of committing assault. Child-parent psychotherapy may improve quality of attachment (ability of young children to bond or interact appropriately) and social-emotional functioning of both anxiously attached infants and toddlers of depressed mothers. Preventative psychotherapy for parents might reduce occurrence of impaired neurological development of very low birth weight, premature infants. There is good evidence that psychotherapy may enhance cancer patients' quality of life by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. A broad range of psychotherapies are effective for the treatment of depression, including behavior therapy, cognitive-behavioral therapy, and interpersonal therapy. Brief dynamic therapy, marital therapy, and family therapy may work best, depending on the patient's problems and circumstances. Any form of psychotherapy can be combined with a type of art to yield expressive therapy.

Safety




Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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