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Creative Arts Therapy and Expressive Arts Therapy

Here is a basic guide to creative, brain-wise approaches to therapy.

Creative interventions have been formalized through the disciplines of art therapy, music therapy, dance/movement therapy, drama therapy or psychodrama, poetry therapy, and play therapy, including sandtray therapy. Each discipline has been applied in psychotherapy and counseling with individuals of all ages, particularly children, for more than 70 years.

Art, music, dance, drama, and poetry therapies are referred to as “creative arts therapies” because of their roots in the arts and theories of creativity. These therapies and others that utilize self-expression in treatment are also called “expressive therapies” (Malchiodi, 2005; 2013; 2014).

Expressive arts therapies are defined as the use of art, music, drama, dance/movement, poetry/creative writing, bibliotherapy, play, and sandplay within the context of psychotherapy, counseling, rehabilitation, or medicine. Additionally, expressive therapies are sometimes referred to as “integrative” when various arts are purposively used in combination in treatment.

Individual approaches to creative arts therapy are defined as follows:

Art therapy is the purposeful use of visual arts materials and media in intervention, counseling, psychotherapy, and rehabilitation; it is used with individuals of all ages, families, and groups (Edwards, 2004; Malchiodi, 2012).

Music therapy is the prescribed use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems (American Music Therapy Association, 2014; Wheeler, 2014).

Drama therapy is the systematic and intentional use of drama/theater processes, products, and associations to achieve the therapeutic goals of symptom relief, emotional and physical integration, and personal growth. It is an active approach that helps the client tell his or her story to solve a problem, achieve catharsis, extend the depth and breadth of his or her inner experience, understand the meaning of images, and strengthen his or her ability to observe personal roles while increasing flexibility between roles (National Association for Drama Therapy, 2014).

Dance/movement therapy is based on the assumption that body and mind are interrelated and is defined as the psychotherapeutic use of movement as a process that furthers the emotional, cognitive, and physical integration of the individual. Dance/movement therapy effects changes in feelings, cognition, physical functioning, and behavior (American Dance Therapy Association, 2014).

Poetry therapy and bibliotherapy are terms used synonymously to describe the intentional use of poetry and other forms of literature for healing and personal growth.

Play therapy is the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development (Crenshaw & Stewart, 2014; Webb, 2007).

Sandplay therapy is a creative form of psychotherapy that uses a sandbox and a large collection of miniatures to enable a client to explore the deeper layers of his or her psyche in a totally new format; by constructing a series of “sand pictures,” a client is helped to illustrate and integrate his or her psychological condition.

Integrative approaches involve two or more expressive therapies to foster awareness, encourage emotional growth, and enhance relationships with others. This approach distinguishes itself by combining modalities within a therapy session. Integrative approaches are based on a variety of orientations, including arts as therapy, arts psychotherapy, and the use of arts for traditional healing (Estrella, 2005; Knill, Levine, & Levine, 2005).

While some practitioners define art, dance/movement, music, or drama therapies as play therapies, creative arts therapies and expressive therapies are not merely subsets of play therapy and have a long history in mental health with distinct approaches. While the arts may sometimes be a form of play, encouraging individuals to express themselves through a painting, music, or dance involves an understanding of the media beyond the scope of play. In brief, the arts therapies are different from play therapy because they integrate knowledge of art with principles of psychotherapy and related fields.

In addition to the disciplines and approaches mentioned above, many therapists integrate activities that enhance relaxation as part of trauma intervention. Relaxation techniques often include creative components such as music, movement, or art-making. For example, guided imagery or visualization, meditation, yoga, and other methods of stress reduction are also used with individuals who have experienced trauma or loss.

Finally, art, music, and dance/movement therapies and other creative interventions such as play have sometimes been incorrectly labeled as “nonverbal” therapies. They are both verbal and nonverbal because verbal communication of thoughts and feelings is a central part of therapy in most situations. In fact, most therapists who use these methods integrate them within a psychotherapy approach, including but not limited to psychodynamic, humanistic, cognitive, developmental, systems, narrative, solution-focused, and others.

There are also creative interventions that specifically focus on verbal communication and self-expression as part of treatment, such as drama therapy, creative writing, and poetry therapy, and bibliotherapy. In all cases, these approaches are "brain-wise" interventions that stimulate whole-brain responses to help individuals of all ages experience reparation, recovery and well-being.

Cathy Malchiodi, PhD, LPCC, LPAT, ATR-BC, REAT

© 2014 Cathy Malchiodi, PhD


American Dance Therapy Association. (2007). What is dance therapy?

American Music Therapy Association. (2014). Music therapy makes a difference: What is music therapy?

Crenshaw, D., & Stewart, A. (eds.). (2014). A Comprehensive Guide to Play therapy. New York: Guilford Press.

Estrella, K. (2005). Expressive therapy: An integrated arts approach. In C. A. Malchiodi (Ed.), Expressive therapies (pp. 183–209). New York: Guilford Press.

Knill, P., Levine, E., & Levine, S. (2005). Principles and practice of expressive arts therapy: Towards a therapeutic aesthetics. London, UK: Jessica Kingsley.

Malchiodi, C. A. (2005). Expressive therapies. New York: Guilford Press.

Malchiodi, C.A. (Ed.). (2013). Art therapy and healthcare. New York: Guilford Press.

Malchiodi, C.A. (2014). Creative arts therapy approaches to attachment issues. In C. Malchiodi & D. Crenshaw (Eds.), Creative Arts and Play Therapy for Attachment Problems (pp. 3-18). New York: Guilford Press.

National Association for Drama Therapy. (2007). Frequently asked questions about drama therapy: What is drama therapy?

Webb, N. B. (Ed). (2007). Play therapy with children in crisis: Individual, group, and family treatment (3rd ed.). New York: Guilford Press.

Wheeler, B. (2015). Music therapy handbook. New York: Guilford Press.

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