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Expressive Arts Therapy Is a Culturally Relevant Practice

Humans have recognized these forms of trauma reparation for millennia.

 © 2019 Cathy Malchiodi, PhD Trauma and Expressive Arts Therapy; graphic design by Jedediah Walls
Four-Part Expressive Arts Therapy and Trauma Model
Source: © 2019 Cathy Malchiodi, PhD Trauma and Expressive Arts Therapy; graphic design by Jedediah Walls

Expressive arts therapy is increasingly calling upon neuroscience to explain just how arts-based approaches work. But in studying how expressive arts therapy may mediate the impact of trauma, there is an equally compelling area of explanation—cultural anthropology and ethnology.

In fact, the healing practices that form the foundation for contemporary expressive arts therapy originally emerged and evolved within various cultural groups in service of health and well-being over millennia. In most cases, these practices materialized in the form of rituals, conventions, procedures, and ceremonies in response to individual and collective experiences of trauma and loss.

Ethnologists like Dissanayake (1995) define the arts and related activities as processes that have helped humans return to psychological and social equilibrium. She observes, “Art is a normal and necessary behavior of human beings like other common and universal occupations such as talking, working, exercising, playing, socializing, learning, loving, and caring…”(p. 18).

Neuroscience is undoubtedly still an important piece of current investigations of expressive arts to determine best practices. However, the bulk of the neuroscience focus still rests on language and the implicit assumption that human experience resides in the brain; this infers that reparation occurs through the “head” and words.

In contrast, the countless traumatized individuals and groups I have worked with over decades already have identifiable capacities to repair. These are universal approaches found throughout human behavior across all cultures that have yet to be fully acknowledged and integrated into trauma-informed systems of clinical and community practices. I believe that they form a foundation for what we define as “best practices” in addressing traumatic stress in the same way that many of the current methods that have been derived from science. To clarify how psychotherapists can apply these approaches, I arrived at a model for clinical practice that places them into four major categories – movement, sound, storytelling, and silence, explained as follows:

Movement is a foundation for almost all expressive arts and healing practices and is central to cultures throughout history. Dance is the expressive art form probably most associated with movement for well-being. It has numerous sociocultural and anthropological explanations that support its importance to strengthening not just the individual, but also the social bonds within the community throughout history. Some propose that it is, in fact, an experience that has helped humanity to develop empathy and adaptation to the environment because of its emphasis on interconnectedness, rhythm, and synchrony.

Many cultural groups have specific dances that often go beyond movement to include spiritual and symbolic components, such as Polynesian Hula, Australian Aboriginal Corroboree or Native American Sundance. There are “energy arts” such as Tai Chi and practices such as yoga that have deeper meanings and significance beyond just movement. Also, there are many other activities and practices, including movement-based sensory integration, bilateral movement via two-handed drawing, or clay work and play-based experiences.

Music and music-making are arts-based wellness practices across cultures, but they also fall into the broader category of sound. Oliver Sacks (2007) summarizes the value of music, noting “Music can lift us out of depression or move us to tears—it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more—it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.”

Sacks underscores that music possibly influences and impacts emotions quickly and effectively, encourages movement and speech and generally enlivens individuals. Singing (whether individually or in a group) and playing musical instruments are core expressive arts approaches. The larger realm of sound reaches beyond music to include chanting, praying and recital of verse or stories, sound vibrations and listening.

Storytelling, the third category, is often perceived as a language-driven activity and often writing or oral storytelling comes to mind. But in fact, stories are communicated in many ways through expressive arts and play-based experiences. Visual art (drawing, painting, clay work, collage, photography, and film) are forms of graphic or symbolic storytelling through images; play and particularly sand tray work with miniatures conveys narratives. Any form of dramatic enactment, performance, role play, improvisation communicate stories; ceremonies and rituals that include movement, sound, imagery, and language have a similar function. There are also implicit narratives that individual communicate through movement; even body language including posture and gesture tell a story on a sensory-based level.

The final category—silence—emphasizes the way many expressive arts can quiet the mind and regulate the body. Silence is an important health-giving experience; we most often think of this in the form of contemplative practices such as mindfulness and meditation. In particular, art-making as a source of mindful focus and mindful movements such as yoga and labyrinth walking fall into this category. Silence is also a factor in how expressive arts enhance the ability to “look inside” oneself through interoception (the sense of the body’s internal state) and experience a “felt sense” of what is perceived and sensed in one’s body. Finally, attending and witnessing theater, performances and art objects in museums often involve silence as a core experience and are a form of focused contemplation.

Although I have identified four distinct categories, there are overlapping functions due to characteristics of the arts themselves. For example, silence can be found in some forms of movement practices such as labyrinth walking or yoga; art-making can be a silent practice that may eventually communicate stories; movement in the form of dance often takes place with sound in the form of music. In using expressive arts to address traumatic stress, these overlapping functions are key to supporting neurobiological experiences of self-regulation, grounding and anchoring, and the interoception of safety—the core foundations of repair and recovery from trauma (Malchiodi, 2019; 2020).


Dissanayake, E. (1995). Homo Aestheticus: Where Art Comes from and Why. Seattle: University of Washington Press.

Malchiodi, C. A. (2019). Expressive Arts as Healing Engagement. Keynote Presentation given at the 30thInternational Trauma Conference, Seaport World Trade Center, Boston MA on June 1st2019.

Malchiodi, C. A. (2020). Trauma and Expressive Arts Therapy: Brain, Body and Imagination in the Healing Process. New York: Guilford Publications.

Sacks, O. (2007). Musicophilia: Tales of Music and the Brain. New York: Random House.

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