What is Assessment Within the Structure of the Expressive Therapies Continuum?
Assessment is a very important element of art therapy and any form of therapy, for that matter. Assessment drives the entire therapeutic journey ahead, as data from the assessment is used to help the therapist (sometimes in conjunction with the client) develop a blueprint for what the journey will look like or consist of.
Assessment Protocols
No matter how a therapist is trained, they likely have preferred assessment instruments or protocols. What’s a protocol? A protocol is a process that gets followed and is the same each time the process is used.
Step 1 of the Expressive Therapies Continuum Assessment Protocol
The Expressive Therapies Continuum uses a protocol for assessment, and this is how I gather data for planning treatment with each client on a case-by-case basis; no two clients are the same, so their treatment plans will reflect this!
I offer a variety of traditional and non-traditional art materials and arrange them in a left-to-right sequence that puts highly fluid materials on one end and highly resistive materials on the other. What goes in-between are other materials that follow the continuum from fluid to resistive.
The Fluid-to-Resistive Continuum
What’s fluid? What’s resistive? Well, these qualities get down to how much force is needed to get an art material to move. Fluid materials are easy—they generally don’t require much force or effort to sustain movement and can actually require intentional control in some cases.
Fluid materials are associated with emotional expression. Resistive materials, on the other hand, require more force to get going and deliberate effort to sustain movement. They are associated with emotional containment.
Origin of the Fluid-to-Resistive Continuum
The fluid-to-resistive continuum was conceptualized by art therapy pioneer Sandra (Kagin) Graves-Alcorn, one of my former graduate professors and co-creator of the Expressive Therapies Continuum.
Step 2 of the Expressive Therapies Continuum Assessment Protocol
Once I’ve made sure a client knows how to use the materials I’ve put out in this fluid-to-resistive arrangement, I spend time collecting data. I invite the client to use the materials—any they want to use—in whatever way they want.
I observe the process. I don’t pay as much attention to what they create as I do to how they create, how the art product is the result of this, and spontaneous verbalizations offered by the client.
Number of Data Points to Collect
We go through this process until the client has created three or five different art products. This might happen in one session or over a series of sessions—it depends on each client. But three or five art products are important.
Why? Because an odd number always means there won’t be a tie.
Strengths vs. Challenges in the Way a Person’s Nervous System Processes Information
A tie between what? That’s where the structure of the Expressive Therapies Continuum comes in. The Expressive Therapies Continuum is a broad framework for making responsive, outcome-informed decisions in client-centered care. The structure of this framework examines the relationships among different ways information gets processed in a person’s nervous system.
The strengths and challenges among these relationships are unique from person to person; each individual’s pattern is going to be unlike the next person’s pattern.
What the Therapist Needs to Know
Assessment within the structure of the Expressive Therapies Continuum is dependent upon the art therapist’s familiarity with the different kinds of nervous system information processing and their correlates as far as the client’s measurable/observable data are concerned.
Three Sources of Client Data and Six Kinds of Information Processed by the Nervous System
The client’s measurable/observable data can be found in the client’s artmaking process, their art products, and their verbalizations. These three things contain indicators of how a client’s nervous system engaged during the assessment process.
There are six ways information gets processed via the nervous system, per the structure of the Expressive Therapies Continuum: Kinesthetic, Sensory, Perceptual, Affective, Cognitive, and Symbolic. More about those in a bit, but it’s important to understand that they can flow together with relative ease in someone who is experiencing a sense of balance between their inner world and outer world. For clients who come to therapy, however, that balance has pretty much been thrown off.
Data Points and Imbalance
Assessment within the structure of the Expressive Therapies Continuum seeks to find where the imbalance lies. And that’s why it’s important to have an odd number of client art products to work with.
Five are better than three (more data points to ensure that a pattern is clear), but sometimes three are sufficient if the pattern of information processing is very strong.
Insights About How a Client’s Nervous System Processes Information
Assessment within the structure of the Expressive Therapies Continuum looks for patterns of native preferences (strengths) vs. aversions (challenges) as the client engages in the assessment process. These patterns can reveal insights about how a client attempts to create homeostasis between their inner and outer worlds and any imbalances they experience when trying to integrate information within their nervous system.
Another Look at the Kinds of Information Processed by the Nervous System
Now that we’ve covered the basics of the Expressive Therapies Continuum assessment protocol and the insights that can be gleaned from following it, it’s worth being more specific about some of the terms used. Remember the ‘six ways information gets processed within the nervous system’ mentioned earlier?
Physical, Emotional, and Intellectual Information
Kinesthetic relates to information processing that is externally directed through muscular activation and engagement. Sensory relates to information processing that is internally directed to the body from the outside world or comes from within the body itself.
Perceptual relates to information processing that is internalized from the external world as impressions or schemas. Affective relates to information processing that is externalized from the internal world of mood and motivational drives.
Cognitive relates to information processing that is filtered through the rules of external, objective logic to comprehend and connect concepts. And Symbolic relates to information processing that is filtered through the rules of internal, subjective logic to comprehend and connect concepts.
Information Processing Patterns and Treatment Planning
Knowing which specific ways of information processing are native preferences for a client, which are aversions, and what the overall pattern looks like for each client is important for helping the therapist figure out what the treatment journey ahead is going to look like.
Generally speaking, treatment begins where the client has the strongest native preference, because that’s where the client is comfortable. The treatment journey itself will ultimately incorporate all six ways of information processing as the client organically demonstrates readiness to integrate them into their nervous system for balancing inner and outer worlds.
Assessment Results that Reveal a Story
Let’s close with a tale of assessment within the structure of the Expressive Therapies Continuum! To recap, assessment within the structure of the Expressive Therapies Continuum is a technical process and relies on an understanding of the Expressive Therapies Continuum itself as well as the relationship between the client’s measurable/observable data and correlates in the six different ways of processing information within the nervous system.
The results can be pretty astounding, as they reveal the story of how a client tries to navigate the difference between internal needs and external demands.
Expressive Therapies Continuum Assessment Results that Make Sense of Other Evaluation Results
The parents of a child were at odds with each other about their son’s behavior, and they were both at odds with the school district I worked for.
I evaluated this student using parent/teacher/child interviews, parent/teacher/child versions of the Conners Comprehensive Behavior Rating Scales™, the Drawing from Imagination subtest of the Silver Drawing Test of Cognition and Emotion, and assessment within the structure of the Expressive Therapies Continuum.
The evaluation report I wrote covered the results of each of these separately. However, the results of the process-oriented assessment within the structure of the Expressive Therapies Continuum ultimately helped me see patterns among the results of the other evaluation methods I used and understand how they related to the student’s attempts to find emotional equilibrium.
Expressive Therapies Continuum Assessment Results that Bring Opposites Together
The conclusion of the evaluation report integrated all findings, using the results of the assessment within the structure of the Expressive Therapies Continuum as the thread that connected all other results.
At the end I proposed an individualized, Expressive Therapies Continuum-based treatment plan to address the student’s needs. I sent a copy of the evaluation report to the parents and called them so we could review it together.
Our conversation had barely begun when the parents remarked that they’d never before seen an evaluation report from the school district that reflected what they saw in their child at home. A few days later they signed the paperwork necessary for art therapy services to begin. Assessment within the structure of the Expressive Therapies Continuum brought together people on opposite sides of an argument about what the client needed, why the client needed it, and what could be done to provide it.
Get Expert Guidance for Leveling Up Your Understanding of the Expressive Therapies Continuum
Would you like to learn from someone who studied the Expressive Therapies Continuum under its co-creators? My training and continued correspondence with them has informed the work I do today. I offer live webinars and supervision in addition to customized services, and I am available for speaking engagements.
Contact me to discuss your needs—I am here to help others understand and utilize this comprehensive framework in conjunction with the ideas and intentions of the two art therapy pioneers who developed it.
Get Expert Expressive Therapies Continuum Assessment and Treatment Services
I also provide Expressive Therapies Continuum-based art therapy for adults in Texas, Indiana, and Arizona. If someone you know is grappling with anxiety and depression in response to an imbalance between their needs and the demands of the world, please send them my way for a free 15-minute phone consultation to see if we’re a good fit for rebalancing things.
References:
Graves-Alcorn, S., & Kagin, C. (2017). Implementing the Expressive Therapies Continuum: A guide for clinical practice. Routledge.
Graves-Alcorn, S. L., & Green, E. J. (2014). The expressive arts therapy continuum: History and theory. In E. Green & Drewes, A (Eds.), Integrating expressive arts and play therapy with children and adolescents (pp. 1-16). Wiley.
Hinz, L. D. (2020). Expressive Therapies Continuum: A framework for using art in therapy (2nd ed.). Routledge.
Lusebrink, V. B. (2010). Assessment and therapeutic application of the Expressive Therapies Continuum: Implications for brain structures and functions. Art Therapy: Journal of the American Art Therapy Association, 27(4), 168-177.
VanMeter, M. L., & Hinz, L. D. (2024). A deeper dive into the Expressive Therapies Continuum; Structure, function, and the creative dimension. Art Therapy: Journal of the American Art Therapy Association, 41(2), 107-110.