4 Functions of Expressive Arts Therapy

©2022 Cathy Malchiodi Ph.D. Presentation Slide on Four Functions of Expressive Arts Therapy.

Source: Cathy Malchiodi, Ph.D.

Expressive approaches capitalize on a variety of reparative factors including implicit communication, active participation, and sensory-based experiences. Expressive arts therapy, by definition, is an integrative psychotherapeutic process including movement, sound, enactment, imagery, storytelling, imagination, and play. One way to unpack how this approach works is through its four main and most general functions. These are self-regulation, co-regulation, exploration, and restoration (Malchiodi, 2022). These form a continuum of general goals in therapy, beginning with regulation of mind and body through practicing and experiencing sensory-based experiences and attunement with the practitioner to establish safety, trust, and confidence. They are the foundations necessary to expand capacity for exploration during therapy and to eventually experience restoration of the self.

Self-Regulation

Stabilization and establishing a sense of safety are psychotherapeutic goals for most individuals. Self-regulation is a term used not only to describe the capacity to manage one’s responses to stress, but also to be able to soothe and calm body and mind. It is the ability to moderate emotions, somatic responses, and cognition.

Many of the art forms used within the continuum of expressive arts therapy have good evidence on how they can support emotional self-soothing as well as measurable physiological changes that result in stress reduction (Malchiodi, 2020). The kinesthetic-sensory qualities of movement, enactment, visual imagery, touch, and sound naturally involve active engagement of the body in contrast to talk-only approaches. In particular, these qualities potentially mediate lower brain functions such as heart rate and respiration through specific approaches. The most basic function of rhythm that is found in all the arts is also key to physiological regulation. It is a source of stabilization that supports an internalized sense of safety. For many individuals, focused music listening and soothing sounds or playing instruments with calming tones are part of decreasing hyperactivation; the cadence of the voice while singing or in prosody has a similar impact. Similarly, when withdrawal or dissociation are prominent reactions, rhythm-based experiences can help the individual safely explore what enlivens or energizes, grounding and anchoring the person in the “here and now.”

Co-Regulation

Co-regulation is often defined as responsive interactions that provide support, reflection, and attunement. In order to achieve it, it requires therapists to pay close attention to the individual’s cues with consistency and sensitivity. In psychotherapy, it is dependent on the changing social interactions between therapist and individual over time. Like an internalized sense of safety, it is well-documented that a healthy connection early in life between caregiver and infant is essential in shaping an individual’s ability to self-regulate throughout life.

While the term co-regulation began as a way to describe caregivers’ support for infants, it is now used to describe regulatory support that occurs within the context of caring relationships across the lifespan. In expressive arts therapy, arts-based co-regulatory interactions are key. In general, co-regulation is less dependent on words and is sensory-specific to the characteristics of each expressive art form. For example, art and play-based experiences emphasize interaction mostly through tactile, visual, and kinesthetic senses. Music includes sound, prosody, vocalizations, social engagement, and rhythm-based experiences that can be co-regulatory. Psychodrama, improvisation, and enactment offer multi-sensory ways to establish co-regulation through roleplay, modeling, mirroring, and enactment.

Shared regulation, a form of mutual regulation, is something found in group expressive arts experiences. The synchrony of moving within a group, singing together, or participating in an improvisation troupe or dramatic enactment with others are all social experiences that stimulate shared regulatory moments. Many expressive experiences are designed to help participants “pick up on each other’s rhythms” and begin to synchronize their movements even when drawing to music.

Mirroring and entrainment are two essential techniques used to support co-regulation. Mirroring is a commonly used approach to establish and enhance the relationship between the individual and the helping professional. Within expressive arts therapy, it is generally described as the embodiment or reflection of an individual’s movement or non-verbal communications. The goal of mirroring is not only imitation of postures, facial expressions, and gestures, but also includes attunement between the individual and practitioner. The overall goal of mirroring in the form of movement is to help individuals experience their bodies in a safe way as the basis for any additional self-regulating experiences.

Entrainment, also called rhythmic synchronization, is a second expressive arts approach that can support co-regulation and shared regulation. Entrainment occurs when the rhythm of one experience synchronizes with the rhythm of another. For example, babies hear their first rhythm in utero listening to their mothers’ heartbeats; the natural way to calm infants is to sway, rock, or pat them to the rhythm of a resting heart rate. In expressive arts therapy, heartbeat, motor activity, and brain activity can fall into synchronous rhythms through the therapist’s voice and through sensory experiences that match a resting heart rate (60 to 80 beats a minute), slow it down, or speed it up and energize individuals.

Exploration

The word exploration generally refers to the action of traveling in or through an unfamiliar area in order to learn about it. It can also mean deeply examining a particular subject or theme. These two experiences form the core of any form of psychotherapy, but exploration goes beyond talk in expressive arts therapy. It engages individuals in “traveling in unfamiliar areas” through implicit communication and self-examination through multi-level and integrative experiences. Active exploration through the senses is a distinguishing feature of most expressive arts therapy sessions.

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Because expressive arts therapy is an action-oriented form of psychotherapy, the regulatory experiences described in the two previous sections support the foundation necessary for individuals to engage in expressive forms of communication with safety and within their windows of capacity. This includes supporting the ability to be improvisational, flexible, and in many cases, imaginative. It also involves relational moments that enhance and support trust, the basis of all forms of healing.

Exploration is part of normal child development. It is also an experience that may be disrupted during early childhood by trauma, loss, physical illness, attachment problems, or lack of access to conditions that support play or social engagement. These disruptions and other factors may replace the healthy curiosity necessary for playful exploration with protective reactions that result from a lack of safety. As a result, the ability to explore may be unavailable. When an individual has had early childhood adversity, exploration may even be focused on scanning for danger in the environment. In these cases, expressive arts therapy can reintroduce experiences to support curiosity through engagement with hands-on, action-oriented, and attuned moments.

Restoration

In expressive arts therapy, the goal is to ultimately facilitate restoration of the self through arts-based, sensory-focused approaches. That is, to support the individual, family, or group in recovering wholeness, well-being, resilience, and self-efficacy. Possibly the most compelling reason for the use of the expressive arts in psychotherapy is the sensory nature of the arts themselves, a restorative factor not found in strictly talk-only therapies. In recent years, neurobiology has taught us that we need to “come to our senses” in developing effective components for psychotherapy for both mind and body (Malchiodi, 2020). For example, many practitioners now agree that traumatic stress reactions are not just a series of distressing thoughts and feelings. These reactions are experienced on a sensory level by mind and body and in order for restoration to occur, addressing the senses is key.

I believe expressive arts therapy has a unique role in restoring a sense of vitality and joy because aliveness is not something we can be “talked into.” We do not know the exact mechanisms for why this occurs or even how to accurately measure these restorative moments. Perhaps for now we can just describe restoration as something beyond making meaning and as a reconnection to enlivenment, vigor, and passion. Ultimately, it is when expression—whether through image, movement, sound, enactment, story, or play—becomes an affirmation of life.

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