164:
Individuals can fluctuate from level to level depending on personal and situational factors. They may also display an integration of all of the first three levels of functioning. This integration indicates that the individual is operating on the fourth and final level of functioning, known as the
Creative level. The Creative level both transcends and intersects the prior three levels, in which the individual is either equally incorporating all aspects of the ETC
107:
Horowitz. Lusebrink and Kagin collaborated to fuse their respective ideas into a framework that described how the targeted initiation of creative mental activity could yield therapeutic results by integrating overly differentiated kinds of information processing. Based on her earlier work with individuals who had developmental and intellectual challenges, Kagin made major contributions to the development of the
54:
client by assisting the art therapist in choosing a developmentally or situationally appropriate activity or art medium. By analyzing an individual's art making process and the resulting artwork using the ETC, art therapists can assess strengths, weaknesses, and disconnect in various levels of a client's cognitive functioning - suggesting or substantiating diagnosis of, or recovery from, a mental health condition.
188:
providing sensory and kinesthetic feedback for the artist. If an individual is operating at the kinesthetic end of the spectrum, he or she may find satisfaction in movementāi.e. pounding at a piece of clay or scribbling frantically with a crayon. In contrast, if the individual is gravitating towards the sensory end of the spectrum, he or she might take more pleasure in the
226:
individuals are able to step outside their own sphere of perception and emotional expression and focus on ways that they interact with the world around them. They may begin to use satire and hidden meanings in their pieces to best express their unique response to their surroundings or situation (symbolic) or use art to plan and to problem-solve (cognitive).
134:). The article introduced the framework and exposed readers to concepts and terminology that were unfamiliar in art therapy at the time. The two presented the Expressive Therapies Continuum to their peers at the 1978 annual conference of the American Art Therapy Association, but the foreign-sounding ideas did not resonate with attendees.
234:
The final level, which either intersects the previous three levels or transcends above them, is the
Creative level. This level symbolizes a wholeness, in which the individual achieves a sense of joy, fulfillment, or wellbeing by taking part in the creative process and expressing the self. This may be
199:
This level is particularly useful for young children but may also be useful for anyone needing to focus on sensorimotor skills. In addition, functioning at this level may allow for better access to preverbal memories or expression of extreme emotions. Individuals may identify operation at the K/S as
158:
The first three levels of the ETC reflect three established systems of human information processing: the
Kinesthetic/Sensory (K/S level); the Perceptual/Affective (P/A level); and the Cognitive/Symbolic (C/S level) ... The fourth level of the ETC is the Creative level (CR). It is seen as a synthesis
53:
This schematic model serves to describe and assess an individual's level of creative functioning based on aspects such as the artist's purpose for creating a piece, choice of medium, interaction with the chosen medium, and imagery within the piece. Conversely, it also serves to meet the needs of the
78:
that served individuals with developmental and intellectual challenges. The institution received funding to study the adaptive behavior of residents, and this allowed Kagin to investigate their responses to media experiences in art therapy. Her thesis research revealed three discernable agents
163:
A diagram of the ETC, as pictured in the top right of the page, can be read from left to right and from the bottom, upwards. The model flows in a direction that travels from simple information processing and image formation to increasingly complex thought processes and interactions with the media.
208:
The second level of the ETC, the
Perceptual/Affective level may or may not include verbal thought processes. However, the focus has shifted from the experience alone (with little focus on the outcome, as in the K/S level) to using the media to create an intentionally expressive or self-satisfying
187:
As the first level of the ETC, the
Kinesthetic/Sensory level is described as a form of preverbal information processing that is "rhythmic, tactile, and sensual". This simple type of interaction with various art media stimulates primal areas of the brain and meets basic expressive needsāall while
106:
When
Lusebrink learned about Kagin's Media Dimension Variables, she realized that task complexity, task structure, and media properties could be modified on an individualized basis to create therapeutic shifting among the levels of information processing that had been proposed by both Bruner and
216:
By working with individuals at the P/A level, art therapists can help clients to perceive images or notions in a new way, strengthening communication and assisting with the formation of meaningful relationships. They can also focus on the identification and healthy expression of one's emotions.
225:
Operation at the third level of the ETC, the cognitive/symbolic level, requires "complex and sophisticated" information processing, in which the individual consciously and strategically plansāprior to creating the art pieceāfor an expressive and self-satisfying final product. At this level,
137:
Despite additional publications by
Lusebrink, the development of knowledge and skills related to the ETC remained limited to Lusebrink and Kagin's students at the University of Louisville for several decades. During that time the two expanded their ideas, and the ETC evolved into an
235:
accomplished through the integration of the three previous levels (where there was inclusion of all expressive operations in the art-making process; a feeling of oneness) or success in fulfilling an individual's need at any given level, which may be healing in and of itself.
20:
A diagram of the
Expressive Therapies Continuum, depicting three horizontal levels of information processing and their potential for integration through creative mental activity, represented by the vertical āCRā level or dimension. The diagram first appeared in
41:
that is applicable to creative processes both within and outside of an expressive therapeutic setting. The concept was initially proposed and published in 1978 by art therapists Sandra Kagin and Vija
Lusebrink, who based the continuum on existing models of
90:. She became involved in a study that examined the progression of schizophrenia among individuals who were not taking medication versus those who were. The brain wave studies that were collected in this research sparked Lusebrink's interest in the
102:
and psychiatrist Mardi
Horowitz. Each hypothesized a three-tier model related to the development of internal imagery based on physical, emotional, and intellectual information processing, and Lusebrink became fascinated with these concepts.
79:
of change in the artmaking process; these could be therapeutically modified to affect client responses. She called these agents of change āMedia Dimension Variablesā, which consist of task complexity, task structure, and media properties.
146:. By that point in time the larger mental health field had begun to espouse ideas that aligned with the ETC; Lusebrink and Kagin's concepts and terminology no longer sounded so foreign to art therapy professionals.
138:
outcome-informed system that includes assessment, treatment planning, intervention, progress monitoring, and case conceptualization. In 2009 a former student of theirs, Lisa Hinz, published the first edition of
62:
The Expressive Therapies Continuum was conceptualized by co-creators Lusebrink and Kagin after Lusebrink joined the faculty of the Institute of Expressive Therapies at the
171:
However, an individual cannot wholly operate at both ends of a level, as each level is bipolar. For example, if the individual is more focused on the quick and scribbly
439:
Lusebrink, Vija Bergs; MÄrtinsone, KristÄ«ne; Dzilna-Å ilova, Ilze (2013-07-01). "The Expressive Therapies Continuum (ETC): Interdisciplinary bases of the ETC".
17:
290:
Lusebrink, V. (2010) Assessment and therapeutic application of the expressive therapies continuum: Implications for brain structures and functions.
86:
that served psychiatric populations. While at this institution she facilitated art therapy sessions and conducted research on individuals who had
400:
375:
47:
115:
components of the ETC. Lusebrink's previous work with people who had schizophrenia positioned her to take the lead on formulating the
209:
final product. The process may be characterized either by an individual's intent to express his or her own literal reality
480:
179:
aspects of the media, such as the sound of the chalk against the paper or the powdery feel of chalk in one's hand.
63:
43:
267:"Development of the Expressive Therapies Continuum: The lifework of Vija B. Lusebrink, PhD, ATR-BC, HLM"
200:
a personal coping mechanism, in which the experience rather than the product is viewed as therapeutic.
126:
In 1978 Lusebrink and Kagin published a paper, āThe Expressive Therapies Continuumā, in the journal
116:
168:
is able to find a satisfying and meaningful creative experience on one of the three levels alone.
16:
82:
Lusebrink's background included experience teaching art and volunteering at a state facility in
456:
396:
371:
67:
448:
418:"Using neuroscience to explore creative media in art therapy: a systematic narrative review"
120:
71:
142:, and the ETC finally began to receive widespread recognition among art therapists in the
474:
143:
99:
95:
87:
91:
213:
be characterized by content that is "emotional and raw...without regard to form".
452:
417:
266:
108:
38:
368:
Implementing the Expressive Therapies Continuum: A guide for clinical practice
83:
460:
112:
66:, which had been founded by Kagin. Kagin had earned a master's degree in
334:
Kagin, S, and Lusebrink, V. (1978) The expressive therapies continuum.
75:
393:
Expressive Therapies Continuum: A framework for using art in therapy
140:
Expressive Therapies Continuum: A Framework for Using Art in Therapy
98:. This interest ultimately led her to the work of psychologist
175:
of a chalk-pastel on paper, then he or she is less focused on the
292:
Art Therapy: Journal of the American Art Therapy Association, 27
271:
Art Therapy: Journal of the American Art Therapy Association
37:) is a model of creative functioning used in the field of
94:
formation process and the shift from nonconsciousness to
265:
Hinz, L. D.; VanMeter, M. L.; Lusebrink, V. B. (2022).
395:(2nd ed.). New York: Routledge. pp. xviii.
8:
159:of the other three levels of the continuum.
351:Levittown, PA: Taylor & Francis Group
23:Imagery and Visual Expression in Therapy
15:
244:
370:. New York: Routledge. pp. 2ā10.
366:Graves-Alcorn, S.; Kagin, C. (2017).
74:while working at a state facility in
7:
441:International Journal of Art Therapy
422:International Journal of Art Therapy
361:
359:
357:
330:
328:
322:New York: Taylor & Francis Group
314:
312:
310:
308:
306:
304:
302:
300:
286:
284:
260:
258:
256:
254:
252:
250:
248:
14:
204:Perceptual/Affective Level (P/A)
320:Expressive Therapies Continuum.
221:Cognitive/Symbolic Level (C/Sy)
183:Kinesthetic/Sensory Level (K/S)
31:Expressive Therapies Continuum
1:
453:10.1080/17454832.2012.713370
25:by Vija B. Lusebrink (1990).
497:
132:The Arts in Psychotherapy
192:of finger-paints or the
154:According to Lusebrink:
64:University of Louisville
349:The Art of Art Therapy.
58:History and Development
161:
48:information processing
26:
156:
150:Levels of functioning
19:
481:Behavioural sciences
391:Hinz, L. D. (2020).
336:Art Psychotherapy, 5
196:of scented markers.
230:Creative Level (Cr)
416:Malik, S. (2021).
347:Rubin, J. (1984).
27:
402:978-1-138-48971-4
377:978-1-138-65238-5
318:Hinz, L. (2009).
128:Art Psychotherapy
68:special education
44:human development
488:
465:
464:
436:
430:
429:
413:
407:
406:
388:
382:
381:
363:
352:
345:
339:
332:
323:
316:
295:
288:
279:
278:
262:
72:child psychology
496:
495:
491:
490:
489:
487:
486:
485:
471:
470:
469:
468:
438:
437:
433:
415:
414:
410:
403:
390:
389:
385:
378:
365:
364:
355:
346:
342:
333:
326:
317:
298:
289:
282:
264:
263:
246:
241:
232:
223:
206:
185:
152:
60:
12:
11:
5:
494:
492:
484:
483:
473:
472:
467:
466:
431:
408:
401:
383:
376:
353:
340:
324:
296:
280:
243:
242:
240:
237:
231:
228:
222:
219:
205:
202:
184:
181:
151:
148:
59:
56:
13:
10:
9:
6:
4:
3:
2:
493:
482:
479:
478:
476:
462:
458:
454:
450:
446:
442:
435:
432:
427:
423:
419:
412:
409:
404:
398:
394:
387:
384:
379:
373:
369:
362:
360:
358:
354:
350:
344:
341:
337:
331:
329:
325:
321:
315:
313:
311:
309:
307:
305:
303:
301:
297:
293:
287:
285:
281:
277:(4): 219ā222.
276:
272:
268:
261:
259:
257:
255:
253:
251:
249:
245:
238:
236:
229:
227:
220:
218:
214:
212:
203:
201:
197:
195:
191:
182:
180:
178:
174:
169:
167:
160:
155:
149:
147:
145:
144:United States
141:
135:
133:
129:
124:
122:
118:
114:
110:
104:
101:
100:Jerome Bruner
97:
96:consciousness
93:
89:
88:schizophrenia
85:
80:
77:
73:
69:
65:
57:
55:
51:
49:
45:
40:
36:
32:
24:
18:
447:(2): 75ā85.
444:
440:
434:
425:
421:
411:
392:
386:
367:
348:
343:
335:
319:
294:(4), 168-177
291:
274:
270:
233:
224:
215:
210:
207:
198:
193:
189:
186:
176:
172:
170:
165:
162:
157:
153:
139:
136:
131:
127:
125:
123:components.
105:
92:mental image
81:
61:
52:
34:
30:
28:
22:
428:(2): 48ā60.
109:Kinesthetic
39:art therapy
239:References
84:California
461:1745-4832
338:, 171-180
117:Affective
113:Cognitive
475:Category
173:movement
121:Symbolic
177:sensory
459:
399:
374:
76:Kansas
194:smell
130:(now
457:ISSN
397:ISBN
372:ISBN
190:feel
119:and
111:and
70:and
46:and
29:The
449:doi
35:ETC
477::
455:.
445:18
443:.
426:27
424:.
420:.
356:^
327:^
299:^
283:^
275:39
273:.
269:.
247:^
211:or
166:or
50:.
463:.
451::
405:.
380:.
33:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
