Expressive Arts Therapy: What It Is & How It Can Help

What Is Expressive Arts Therapy?

Expressive arts therapy (sometimes abbreviated to EXA) is a form of experiential therapy that supports clients in processing their experiences, feelings, and thoughts by tapping into creativity and imagination. The emphasis is on the process of creating, not necessarily the product created. Therefore, EXA requires absolutely no arts experience, just a willingness to explore—and perhaps make a mess!

By engaging in the creative process in this way, clients may feel more comfortable in sharing their inner worlds, as well as gain new insights into their challenges and strengths. Expressive arts therapy can take place in-person, as well as virtually (with a bit of planning). While providers will vary in style and approach, contemporary expressive arts therapy is often practiced from a strengths-based, collaborative, and culturally-responsive lens.

What Happens During an Expressive Arts Therapy Session?

During a session, an expressive arts therapist may offer a directive such as creating a sculpture or acting out a scene based on an issue a client has raised. A therapist may also facilitate non-directive art-making in which they provide guidance and support for the client as they explore with art materials without a specific goal in mind.

While EXA is often thought of as a non-verbal form of therapy, many client/therapist teams will incorporate talking into sessions as it feels appropriate. This may be during art-making or toward the end of the session to process what’s taken place.

What’s the Difference Between Expressive Arts Therapy & Creative Arts Therapy?

While there is overlap between expressive arts therapy and art therapy, there is also a key difference: EXA is a multimodal approach, meaning it incorporates not only visual art (as in art therapy), but also elements of drama therapy, music therapy, dance therapy, writing, and so on. In EXA it is common to use these modalities in tandem during the course of a session. For example, a client may create a drawing and then write a short poem or create a soundtrack (i.e. a playlist of songs) based on that drawing for the purpose of deepening their process.

It is also important to note that EXA is a relatively new field, developed in the early 1970s, and continues to evolve. Many therapists dovetail EXA with other therapeutic approaches such as narrative therapy, trauma-informed therapy, cognitive behavioral therapy, or feminist therapy.

Expressive Arts Activities

A therapist engages the client in choosing the art material or method of their liking so they can participate in a creative activity that embodies therapeutic value in a safe and supportive environment. Activities used during expressive arts therapy could include coloring, painting, sculpting, movement and dancing, music, journaling, and more.

Common activities you might participate in during expressive arts therapy sessions might include: 

• Drawing and Painting: This activity serves to facilitate the expression of uncomfortable feelings that are too hard to put into words. It can also be useful for reducing anxiety, enhancing cognitive functioning in older adults, facilitating autistic children to express negative emotions, and so much more.^1,2
• Coloring or Creating Mandalas: This creative method involves drawing a circle and filling/coloring it with symbols, patterns, and any images that represent the person’s feelings. This technique can be beneficial for improving mood, dealing with anxiety, and processing traumatic memories, among other things³
• Sculpting: This activity consists of using any material (clay, wood, glass, etc.) and giving it a three-dimensional shape. The process of molding the object into something tangible can help people externalize thoughts and feelings and bring a soothing sensation, enhancing mood and other health-related benefits.⁴
• Movement: Based on the interconnection between body, mind, and spirit, this activity employs dance and/or physical movement in a variety of settings to address psychological concerns, substance use problems, body image issues, trauma etc. while promoting a sense of wellbeing and community.^4,5
• Role-Playing: Often in a group setting and employed diversely, role-play can bring healing and wellness by offering an opportunity for the individual to confront a particular experience/situation and then enact and rehearse healthy ways to cope, better interact, communicate, and problem-solve.⁵
• Collage: This activity does not require much artistic talent and involves assembling pieces from various images or materials to create something that represents or symbolizes an experience, emotion, or concept depending on the concern the person wishes to address.⁵
• Creating Self-Portraits: This activity may entail various techniques and media (like drawing or photographing the self-image or representing the self abstractly) giving people room for self-reflection and expressing how they view themselves. These self-portraits can foster emotional balance, improve mood, or reduce anxiety.⁶
• Making Masks: Using various art supplies, a client is encouraged to create a mask that embodies their thoughts, emotions, and behaviors. Typically done within a group setting, the person can gain self-awareness, develop a healthier perspective, and feel more optimistic with less stress and negative feelings.⁷
• Writing Poetry: This medium allows for indirect and symbolic expression of painful emotions or other stress-related thoughts and feelings while helping someone gain a healthier life perspective. Through the act of writing poetry many find comfort and mood improvement during periods of stress, trauma, or grief.⁸
• Journaling: Writing down what’s on your mind provides a private space serving as an outlet to examine, reflect, and process thoughts and feelings. This tool can help bring self-awareness to better cope with upsetting situations, release tension, promote emotional wellness, enhance mood etc.

Common Expressive Arts Therapy Techniques Used by Therapists

Here are some examples of techniques used in expressive arts therapy:

Follow the Metaphor

Metaphor serves an important role in EXA and may even help guide treatment. As an example, if a client relates to their depression as a dark well, a therapist may invite a client to create a piece of art or writing further exploring that metaphor. In turn, if a client is having difficulty accessing their feelings, a therapist may offer the use of art cards (cards with a variety of different images) to help a client identify a metaphor that resonates.

Aesthetic Response

An aesthetic response is used by both therapists and clients as an expressive reflection of something they have experienced or felt in or out of the therapy room. It may take the form of movement, music or any art form.

Collaboration

In addition to therapists working collaboratively with clients to determine a course of treatment, therapists and clients may work on art processes together in session as either a rapport-building intervention or as support to the client.

Curiosity

EXA therapists do not assess or analyze client artwork, rather they remain curious and ask exploratory questions to better understand the client’s experience and to support the client in gaining insight. Therapists may also use a “feel back” as opposed to traditional feedback. An example may sound like: “When I see the orange in your painting, I feel hopeful.” The client then has the opportunity to respond if they desire.

This is not an exhaustive list, and EXA therapists and clients may utilize some, all, or none of these depending on preferences and style.

What Can Expressive Arts Therapy Help With?

Expressive arts therapy may be helpful for a wide range of challenges and mental health issues ranging from depression and anxiety to more chronic mental health conditions such as schizophrenia or bipolar disorder. EXA may also be utilized to support clients in accessing their strengths and resiliencies. It will be important to connect with a therapist who has expertise in a specific concern.

Additionally, expressive arts therapy is useful for clients of all genders and ages, as well as for individuals, couples, families and groups.

Expressive Arts Therapy Examples

Expressive arts therapy is an evolving field of therapy and may look differently depending on the therapist and client.

Here are three specific examples of how the expressive arts may be incorporated into a therapy session:

1. Painting & Metaphor to Process Trauma

Kylie is a 45-year-old, biracial, cis-gendered woman. Three months ago Kylie experienced a serious illness that required hospitalization and since that time she has expressed feeling on edge, difficulty sleeping, and nightmares related to illness. An EXA therapist may support Kylie in first sharing as much or as little of her experience through creative expression. In this case, Kylie chooses painting as she finds the texture and movement of brush strokes soothing. An EXA therapist may validate the client’s feelings and explore with the client different elements of her painting to better understand her experience. An EXA therapist may also invite the client to title her artwork. In this case, Kylie names her artwork “The Storm.”

In subsequent sessions, the EXA therapist may utilize the metaphor identified in Kylie’s title, and invite Kylie to create another piece of art that represents shelter from the metaphorical storm. Through this process, the EXA therapist is helping Kylie experience a feeling of calm and identify a safe place in her imagination, and may then talk with Kylie about accessing that space in her imagination when she has difficulty sleeping or feels on edge.

2. Making a Mask to Express Inside & Outside Representations

Miles is a 16-year-old, transgendered, African-American boy. Their parents and teachers report that after recently transferring schools, Miles is frequently irritable, socially isolated, but continues to maintain high grades. In session, Miles shares with their EXA therapist that they have transferred to a new school where they are one of a few BIPOC students and the only openly trans student. Despite doing well academically, they report feeling out of place and like they can’t be their true self. The EXA therapist validates Miles’ feelings and collaborates with them about how to best utilize their time in therapy. Miles reports that they like to make visual art and that they often find it soothing.

Given what Miles has shared about their experience, the EXA therapist offers an art directive called an Inside-Outside Mask, in which a client paints or decorates a paper mâché mask with the outside representing the parts of themselves they share with the world, and the inside representing the parts of themselves they keep hidden. After Miles has completed the art directive, the EXA therapist reflects back what they notice to Miles and ask exploratory questions about their process in making the mask. Miles shares that they are interested in further exploring their different parts and the EXA therapist role plays with Miles a conversation between the different parts they have identified.

3. Utilizing Dance to Combat Body Dysmorphia

Candace is a 20-year-old, white, cis-gendered woman. Candace is currently enrolled at college, but reports feeling “seriously distracted” by her thoughts and feelings about her body. Candace shares that she has been in “talk therapy” for almost three years and feels like it has helped some, but she wants to try something different. She reports he has always identified as a dancer despite not feeling at home in her body. The EXA therapist normalizes Candace’s feelings and reflects back Candace’s desire to feel at home in her own body. After Candace confirms that the therapist has understood directly, the EXA therapist invites Candace to utilize movement to explore her relationship with her body and how it has changed over time.

The EXA therapist also encourages Candace to choose her own music for this process and while Candace uses her therapy time to express herself through movement, the EXA therapist witnesses and creates Aesthetic Responses through visual art that she then gives Candace at the end of each session. Before ending the session, Candace and her therapist talk about feelings that arose in the process and any insights she may have had.

Is Expressive Arts Therapy Effective?

Yes, expressive arts therapy can be quite effective. Here are several recent studies about the effectiveness of expressive arts therapy:

• A 2016 study published in the Journal of the American Art Therapy Association revealed that engaging in a creative activity for brief periods (often less than an hour), regardless of the type of art medium or artistic abilities, can significantly reduce someone’s stress levels and promote an overall sense of wellness.⁹
• A 2018 comprehensive analysis about art therapy’s efficacy highlighted a study in which adults with depression demonstrated improved social functioning after three months of attending a group painting class. The same study also cited an art therapy program that effectively eased depressive symptoms and enhanced the emotional health in prison inmates.¹⁰
• A 2021 review of the research regarding the use of expressive arts therapeutic interventions in adult health and nursing care noted that art making and other forms of creative activities were positively correlated with a patient’s personal growth and symptom reduction, as well as a better quality of care from medical staff.¹¹
• The efficacy of expressive arts interventions for children/adolescents have been well documented, with recent studies demonstrating many benefits. These include using creative arts to help kids and teenagers cope with trauma, improve communication and problem-solving skills, enhance academic performance, ease mental/emotional distress, ameliorate problematic behaviors, and foster a healthy self-image.^12,13,14

Limitations of Expressive Arts Therapy

Expressive art therapy or others within this vein may not be appropriate for everyone. Some individuals tend to disregard its efficacy and hold misconceptions like needing to be artistically skilled, viewing it as “childish,” superficial, or thinking EXA will not work. For these clients, any type of EXA will likely not be helpful.^15,16

Another drawback refers to more serious concerns in which people may experience harmful effects such as high anxiety or stress, inability to give closure to triggered emotions, or having difficulty coping should therapy end abruptly. At this point EXA may worsen someone’s distress or make them averse to other well-suited forms of treatment.^15,16

How to Find an Expressive Arts Therapist

Searching for the right therapist, no matter what modality, can be a challenge. Qualifications, fee, location and of course personality are all factors to take into consideration when choosing a provider. In addition to internet research, online directories and word-of-mouth referrals, you may also choose to contact established Expressive Arts Therapy graduate programs, such as Lesley University and California Institute of Integral Studies for alumni referrals in your area or the International Expressive Arts Therapy Association.

Who Is Able to Offer Expressive Arts Therapy?

Expressive arts therapists may have varied training and qualifications, so it is important to clarify training experience and licensure status when interviewing potential therapists. It is common for EXA therapists to also be licensed mental health professionals such as Licensed Marriage and Family Therapists or Licensed Clinical Social Workers, however this is not always the case.

Unlicensed EXA therapists have typically received advanced degrees in counseling psychology and expressive arts therapy, but chose not to pursue state or national licensure, which holds clinicians to rigorous clinical and ethical standards. Instead, unlicensed EXA therapists may have the initials “REAT” after their names – Registered Expressive Arts Therapist. This certification is granted by the International Expressive Arts Therapy Association.

Key Questions to Ask Before Beginning Expressive Arts Therapy

After you’ve collected your referrals and scheduled consultations, you’re ready to begin interviewing.

Here are several questions to get you started as you begin the interview process:

• What modalities do you most often use? (dance, visual art, drama etc.)
• What are your credentials?
• What are your areas of expertise?
• What can I expect from an EXA session with you?

How Much Does Expressive Arts Therapy Cost?

The fee for expressive arts therapy will range widely depending on both your geographic location and the education and licensure of the provider. Additionally, some providers may offer a sliding-scale rate or accept healthcare insurance.

What to Expect at Your First Appointment

Your first appointment should go at your own pace – no pressure! Just as in psychotherapy, expressive arts therapy is rooted in relationship building between therapist and client. Sometimes client and therapist will engage in an art process together, listen to a song or sometimes talk for the full session. There are no hard and fast rules here for how a session should unfold.

When a client is ready, a therapist may ask for history and background information to help contextualize the issue at hand, as well as to better understand the client’s overarching journey. In addition to acknowledging your challenges, an EXA therapist may also pay close attention to your strengths and resiliency factors.

Toward the end of the session, a therapist may ask a client for feedback about the first session and any thoughts they may have about the next session. Collaboration is an essential part of EXA.