Who Created the Expressive Therapies Continuum?

All good ideas come from somewhere.  The Expressive Therapies Continuum is no different—in a nutshell, it’s a broad framework that is used by some art therapy practitioners to make responsive decisions in the individualized treatment of a vast array of client populations and a wide range of clinical issues.

But using it in this way is contingent upon understanding where it came from, or more accurately, who it came from.  Without understanding the ideas and intentions of the minds that made the Expressive Therapies Continuum, the model easily becomes oversimplified and reduced to something that is a mere shadow of its potential.

“Who Created the Expressive Therapy Continuum?”

I saw this question on Google, and it made me suspect that the people who’ve been typing it into the query box probably mean Therapies rather than Therapy.  But regardless of the words used, the question is proof that people are curious!

As for who created the Expressive Therapies Continuum…I’ve heard Lisa Hinz’s name come up because she wrote the seminal book on this comprehensive, outcome-informed framework that guides treatment in a manner believed to integrate the nervous system, but Dr. Hinz actually studied under the framework’s co-creators.

So who were these people?

Vija Lusebrink, PhD, ATR-BC, HLM

In order to understand how the Expressive Therapies Continuum came into being, it’s important to know about the backgrounds of the co-creators.  One was Vija Lusebrink, a pioneer in art therapy.  Vija hailed from Latvia originally, but the events of World War II forced her to leave her home country and ultimately emigrate to the United States.

She earned a bachelor’s degree in chemistry before returning to a long-time love of engaging in artistic endeavors, which resulted in a Master of Fine Arts in painting.  Her ability to balance science and creativity explains why she was not satisfied to believe that artmaking was limited to mental processes that could not be named or known.

Early Exploration of the Brain and Visual Expression

Vija went on to volunteer at a state hospital in California where she was involved in a study that focused on people who experienced schizophrenia.  Their artistic output was of interest to her.  The study included brainwave imaging, and Vija was taken by the idea that various states of brain functioning could correspond to various kinds of artistic expression.

She became increasingly convinced that there was more to artistic expression than merely symbolizing internal experiences, the main focus of art therapy at the time.

Three Interrelated Modes of Mental Image Formation and Visual Expression

After the state hospital, Vija pursued her ideas through her own scholarly research.  She came across the work of psychiatrist Mardi Horowitz, now known for his contributions to trauma and grief treatment.  

His notions about the expression of mental imagery were based on the thoughts of cognitive psychologist Jerome Bruner.  Bruner had posited that the mental image formation process consists of three distinct but interrelated modes.

Three Interrelated Levels of Information Processing

Horowitz expanded upon Bruner’s work to describe three distinct but interrelated modes of mental image expression.  Both men had conceptualized these three modes as being action-based, impression-based, and language-based.

These modes, coupled with Vija’s observations of differences in the images of people in inpatient mental health treatment vs. those who were not, influenced her concept of the three levels of information processing identified within the Expressive Therapies Continuum, but I’m getting a little ahead of myself.

Sandra (Kagin) Graves-Alcorn, PhD, ATR-BC, LPAT

In the 1970s Vija was hired to teach in the graduate art therapy program at the University of Louisville.  The program was administratively housed within the Institute of Expressive Therapies, which had been founded by art therapy pioneer Sandra (Kagin) Graves-Alcorn.

Prior to hiring Vija, Sandra had started the Institute of Expressive Therapies on the heels of earning her master’s degree in child development and special education.  She’d focused on the writings of developmental psychologist Jean Piaget and art educator Viktor Lowenfeld, whose ideas related Piagetian concepts to graphic expression.

Early Exploration of Materials and Methods as Agents of Change

While Sandra was in school, she was employed by a state facility in Kansas that served individuals who today would be identified as having intellectual or developmental disabilities.  She quickly realized that her training in psychodynamic art therapy—the only kind available back then—was not going to help the clients she worked with.

This caused her to wonder if the magic of art therapy had less to do with projections of the unconscious and more to do with the materials and methods involved in artmaking and their influence upon client output.

The facility she worked at had robust funding for research that examined the adaptive functioning of the residents, so Sandra embarked upon investigative studies that looked at impactful aspects of the artmaking process.

Media Dimension Variables

She ultimately found that three such aspects had the greatest impact on client output—and different combinations of these aspects could result in therapeutic progress toward treatment goals.  Sandra named these three aspects “Media Dimension Variables” and adjusted them to support client achievement on an individualized basis like a scientist would adjust variables in a research project to harness their effects.

The three Media Dimension Variables, or MDV, are task complexity, task structure, and media properties.  Today’s art therapists know media properties as the fluid-to-resistive continuum of art materials, but very few realize that this came from Sandra’s work.

Also, most art therapists are unaware of the other two MDV or how Sandra defined them.

Creation of the Expressive Therapies Continuum

When Vija began working with Sandra at the University of Louisville, she learned about MDV and realized that different combinations of MDV corresponded to her understanding of three interrelated modes of the mental image formation process and visual expression.

She and Sandra began to unpack their respective suitcases of wisdom and ultimately co-created a framework that explained how the mental image formation process and its expression could be influenced by MDV.

Vija’s three modes became the three levels of information processing, and each was associated with different combinations of Sandra’s MDV.  The two wrote an article and gave a conference presentation about this framework, which they called the Expressive Therapies Continuum, in 1978.

Early Rejection of the Expressive Therapies Continuum

Neither of these debuts were considered successful; Vija and Sandra’s art therapy peers at the time were taken aback by the strange vocabulary and concepts of the Expressive Therapies Continuum, or ETC.  It’s worth noting that the strange vocabulary and concepts are now fairly mainstream in the broader field of mental health.

But back in the 70s almost no one thought the body had a place in psychotherapy, and practitioners were preoccupied with the resolution of unconscious conflicts rather than the integration of nervous system functions that were not sufficiently linked. 

Evolution of the Expressive Therapies Continuum

Although Vija and Sandra’s ideas were rejected by the art therapy community, the two continued to develop the ETC and teach it to their students.  That’s where I come in.  By the time I arrived to study art therapy at the University of Louisville, the ETC had been expanded to incorporate assessment, treatment planning, intervention, progress monitoring, and case conceptualization.

Formal Training in the Expressive Therapies Continuum

The ETC had become an entire system of comprehensive service—and it was rolled out to students in a scaffolded manner that started with a semester-long experiential lab to cement the learning process by way of embodiment.

This was built upon over the course of two years through class lectures and discussions as well as formal feedback via graded assignments and then clinical supervision as we began to apply the ETC in our internship work with clients.

Legacies

Vija Lusebrink was dedicated to the pursuit of her contribution to the ETC—the three levels of the mental image formation process and its expression.  She continued to write scholarly materials about this until her death in 2022.

It was a big assist to Vija when neuroimaging advances began to attract the attention of mainstream psychotherapy; it meant that she could pursue her ideas with more data to support her premise.  Sandra (Kagin) Graves-Alcorn, on the other hand, wasn’t so drawn to academic writing, even though the same advances in neuroimaging might have helped her articulate her knowledge to a new audience.

Missing Information

Sandra died in 2021 and did not leave behind nearly as much of her genius as Vija left of hers.  It’s largely for this reason that most people who know about the ETC don’t know about Sandra’s contribution of MDV and, more importantly, how to calibrate and titrate the three MDV to achieve intentionally therapeutic shifts among the levels of the ETC.

Level Up Your Understanding of the Expressive Therapies Continuum

Are you interested in learning more about the Expressive Therapies Continuum from someone who studied it for two years with the co-creators?  You can find information on upcoming live webinars, supervision groups, and other learning opportunities by visiting my “for Expressive Therapists” page.

Sign up for the ETC newsletter and announcements and get an ETC bibliography for free!  If you need customized ETC consultation, training, or other services, please contact me about what you’re looking for.

Do You Know Someone Who Could Benefit from Treatment via the Expressive Therapies Continuum?

I also provide Expressive Therapies Continuum-based treatment for anxiety and depression via online art therapy in Texas, online art therapy in Indiana, and online art therapy in Arizona.

References:

Graves-Alcorn, S., & Kagin, C. (2017). Implementing the Expressive Therapies Continuum: A guide for clinical practice. Routledge. https://doi.org/10.4324/9781315624303

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.

Hinz, L. D., VanMeter, M. L., & Lusebrink, V. B. (2022). Development of the Expressive Therapies Continuum: The lifework of Vija B. Lusebrink, PhD, ATR-BC, HLM. Art Therapy: Journal of the American Art Therapy Association, 39(4), 219-222.

Kagin, S. L., & Lusebrink, V. B. (1978). The Expressive Therapies Continuum. Art Psychotherapy, 5, 171-180.

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.