What is Expressive Arts Therapy?

‍ ‍By Nik Thoma, LICSW

Part of what drew me to the path of expressive therapies was asking, “Before psychotherapy existed as we knew it…what did people do for mental health?” The answer I found was often art, music, ritual, dance, community, and play. So, I wanted to return to the roots of how we instinctively know to heal. And was delighted to find that expressive arts therapy is also an evidence-based practice with a credentialing body, academic journals, dozens of books, annual conferences, Master’s and Doctoral degrees, and currently 4,477 peer-reviewed articles at my alma mater’s database collection.

What Is Expressive Arts Therapy (EXA)?

The International Expressive Arts Therapy Association (IEATA) defines intermodal expressive arts therapy as: “embrac[ing] the connection and interplay of the various arts modalities, including:

• All forms of visual art, including photography and craft

• Movement/dance/somatics

• Voice, rhythm, sound, and music

• Drama and enactment

• All forms of writing, including poetry and storytelling

• Guided meditation, use of the imagination, and nature-based practices” (IEATA, 2026)

In other words, expressive arts therapy offers an externalized way to explore thoughts/feelings/patterns through various flows of creativity unique to you. So, one way of exploring identity could start with a Pinterest board of gender envy, that becomes a collage, that becomes a poem and ends with a playlist to tap into desired gender vibes (and maybe a shopping wish list!).

Expressive arts therapy does not ask anyone to be an artist, identify as a “creative”, or even “good” at any of the activities listed above to benefit greatly from this modality. The focus is on the process of making rather than the outcome of what is created. Which means squiggly lines and stick figures and experimenting with a medium you’ve never used before is welcomed and encouraged!

‍ Who is it for?

‍ Continuing IEATA’s definition of intermodal expressive arts, they also added: “reclaiming the intermodal aspect of the arts is essentially remembering that we were born with the ability, and the right, to express ourselves creatively in myriad ways.” (IEATA, 2026).

‍ ‍So, according to our licensing body — everyone!

‍ ‍But if I had to narrow it down, I’d say the expressive arts therapies are for people who have a willingness to try something new, have foundational grounding/coping strategies for what might come up, a vague understanding of goals they’d like to attain, and not currently in active crisis.

Expressive arts therapies can foster greater understanding of self, explore emotions/thoughts/patterns, build regulation strategies, increase connection to your body, and often spark other surprising but welcomed benefits.

For a short (but by no means, exhaustive) list of who may find EXA helpful, would be those experiencing:

• Alexithymia ( a name for people who struggle to experience/identify/understand and/or express their emotions)

• Neurodivergence (ADHD, Autism, AuDHD, and more)

• Being part of marginalized communities

• Grief

• Chronic illness/pain/disability

• Anxiety and Stress

• Anger

• Burnout

• Uncertainty about what’s next

What does a typical expressive arts therapy session look like?

It depends!

Everything in an EXA session is an invitation that you are free and welcomed to reject, modify, or pivot entirely from to best reach your therapeutic goals through a process that feels authentic to you.

Casual incorporations of expressive arts therapy could be invitations to explore an idea or feeling in or out of session. If I observe you repeatedly tapping on your left shoulder, I might invite you to explore that - is there a move you feel drawn towards after the tap? What does it feel like if you tap the other shoulder? What’s happening in your body as you move from one tap to another?

Or perhaps we’re discussing self-compassion, and I ask if you’d be interested in exploring your current fandom and bring in examples of your favorite characters displaying self-compassion to your next session.

I could also change up the “how was your week?” question with an invitation to show me how you’re feeling, only using your hands, or a song, or a color.

One of the more formalized experiences comes from a collaboration in the 1970’s between Lesley University and what is now the European Graduate School who created a framework for a therapy session: (1) filling in, (2) decentering, (3) aesthetic analysis, and (4) harvesting (Levine et al, 2004).

It sounds fancier than it is!

Let’s use the example of you seeking therapy to process grief over a break-up.

1)      The filling in portion is inviting you to share your experience of the break-up, exploring what you’d like to see change, your strengths, and anything else that feels relevant to you (Levine et al, 2004).

2)      The decentering is the creative exploration: perhaps you want to begin by listening to your favorite break-up song, and then I may offer an invitation to start to move during the next round of it, perhaps then you gravitate towards creating something with clay, and then finish with some free-writing that turns into a new affirmation for this chapter of your life (Levine et al, 2004).

3)      The aesthetic analysis orients therapist and client to the creations themselves through exploring the concrete details of the creation through four areas:

• Observations: what are we both noticing about what was created:. “Wow, that blue there is repeated here and here and here.”, “I noticed a pause between stanzas 4 and 5 of the poem as you read it.”, “These colors remind me of the ocean.” 

• Process: we begin to explore what it was like for you using questions along the line of: what did you want to add but didn’t, what changed during the creation of it, how did you know to make that pivot? What feedback would have been helpful?

• Experience: reviewing what it was like for you with explorations like: how did you feel emotionally when you began this experience, and how are you feeling now, did you have a sense of what began to shift your emotional experience, was anything difficult, and how did certain moments of the experience feel in your body?

• Beginning dialogue w/ the creation: if you had to give this experience a name or title - what would it be?, if you had to coach someone to sing this song- what would be important for them to know? Is there anything you’d like to say? (Levine et al, 2004).

4)      And, finally, harvesting ties it back to the grief: have you noticed any connections in what we observed in the aesthetic analysis to the conversation before decentering? It’s okay if you don’t! Sometimes it takes time. But often there is insight to be gained (Levine et al, 2004).

Homework could be an option given at the end of a session to continue the intermodal process - perhaps we ran out of time, and you didn’t get to free-writing, or you had an idea for some photos you’d like to take. Or perhaps the harvested insights tie to a direct action like “book that flight” or “send a text back” that would be followed up on during your next session. (Levine et al, 2004).

The de-centering processes could be completed over more than one session, if needed/wanted.

If you’re feeling really curious, Natalie Rogers wrote a book called “The Creative Connection” that offers a different, less structured approach to intermodal expressive arts. Her “creative connection describes the process of allowing one art form to influence another directly” (Rogers, 1994, pg. 43).  She often would start with movement, sound, and/or meditation and then flow into visual arts/clay, then writing.

For those feeling a little skeptical or nervous about jumping into the deep end creatively, there is an underlying theory called the Expressive Therapies Continuum that we can use to help provide scaffolding. This could be a blog of its own, but essentially, there are ways to begin in an area of creativity that feels comfortable for you (like coloring in a coloring book) and then gradually explore other options to help you reach your therapeutic goals. (Hinz, L., 2020).

If you feel like this might be a good fit or you have additional questions, please fill out our contact form and our intake coordinator can get you scheduled for a free 20 minute virtual consultation.

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Resources:

Hinz, L. (2020). Expressive Therapies Continuum: A Framework for Using Art in Therapy. Routledge.

IEATA. (2024, May 11). What is Intermodal Expressive Arts?https://www.ieata.org/what-is-intermodal-expressive-arts/

Levin, Stephen K., et al. (2004). Principles and Practice of Expressive Arts Therapy: Toward a Therapeutic Aesthetics. Jessica Kingsley Publishers. 

Rogers, N. (1994). The Creative Connection: Expressive Arts as Healing. Science & Behavior Books, Inc.

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