Expressive Arts Are Neurodiversity-Affirming

"Express It to Address It" from the journals of Cathy Malchiodi, Ph.D.

Source: ©2022 Cathy Malchiodi, Ph.D., used with permission

Neurodiversity-affirming or “neuro-affirming” practices and models emphasize that there is diversity in human cognition, emotions, behavior, senses, and being. The term neurodiversity first emerged in the 1990s when Judith Singer used it to describe the natural variations in human brain development that result in differences in behavior, cognition, affect, perception, and communication (Singer, 2017). Along with the concept of neurodiversity, other terms are now commonly used, such as neurotypical and neuronormative, two words that suggest that there are brain types that may be more “normal” due to more frequent occurrences in the general population.

When it comes to the definition of neurodiversity, there is still a lot of debate about what “neurotypes” exactly are included. Practitioners agree that autism and ADHD fit the definition. But others believe categories like developmental trauma, post-traumatic stress disorder, anxiety and depression, and even medical conditions such as cerebral palsy or epilepsy should be considered neurodivergent because they involve identifiable characteristics in brain functioning.

As a psychotherapist interested in neuro-affirming strategies to support people of all ages, I am particularly intrigued with how non-verbal and implicit approaches may be helpful. While psychotherapy typically focuses on communication through language and mostly cognitive approaches, most neurodiverse individuals require different strategies. Expressive and sensory-based approaches are one way to support individuals’ strengths and preferences when it comes to neurodiversity.

How and why is expressive arts therapy a form of psychotherapy that supports a neurodiversity-affirming model of practice? While expressive arts therapy is a complex field, when it comes to neurodiversity there are three relevant concepts: 1) non-verbal and implicit expression and communication; 2) expression through multiple senses; and 3) prioritizing capacity over pathology.

Express It to Address It

Traditional psychotherapy is generally language-driven and involves strategies and interventions that depend on verbalization. But when it comes to neurodivergent individuals, talk alone may not be the best approach for various reasons. In fact, for many neurodivergent individuals, verbalization may be at the very least frustrating and often impossible. When words are a struggle or unavailable, the nonverbal possibilities of expressive experiences are essential.

Child psychiatrist Daniel Siegel coined the phrase “name it to tame it” when it comes to addressing emotional challenges. However, children do not have the language to “name it” in most cases. In my experience with trauma survivors, individuals of all ages can struggle with words to express their sensations, emotions, and memories, particularly when trauma is chronic or complex. My response to expanding accessibility is by a lane change in communication. “Express it to address it” opens up possibilities that are less exasperating, more satisfying and accessible, and ultimately support self-agency. In other words, when we do not have words to convey our experiences, we simply may not be able to “name it to tame it.”

Shift Happens

In expressive arts therapy, practitioners take an integrative arts-based approach to working with people. In other words, rather than introducing one art form such as drawing or movement, a therapist invites a purposeful combination of expressive experiences. While the individual may respond or prefer one art form to another, the goal is to provide opportunities to express through multiple senses. This is what is called the “intermodal shift” or, as I like to say, “shift happens” (Malchiodi, 2023).

This is an important concept in working with those individuals who identify as neurodiverse. It provides the opportunity to communicate through a variety of implicit and explicit pathways—rhythm, sound, image, movement, enactment, gesture, and vocalizations, to name a few. Often it is through this shift that individuals find a resonant form of conveying sensations, emotions, and thoughts in a resonant way because the body’s experiences are centralized rather than words alone.

This strategic shift serves another purpose. It helps individuals to differentiate one affective, sensory, or cognition state from another through engaging the body in an action-oriented way. Word-based approaches to psychotherapy generally cannot capture these shifts. But introducing movement, rhythm, sound, image making, play, and/or enactment are related to sensory processing—interoception, exteroception, proprioception, vestibular functioning, and gravitational security. This supports awareness of the internal felt sense (interoception) and experiences of taste, touch, hearing, seeing, and smelling (exteroception). Movement, rhythm, and enactment bring awareness to the world around us (proprioception) and our stability within an environment (vestibular function and gravitational security). This sensory processing and integration often go unaddressed in language-driven psychotherapy, yet are very important to a neurodiverse individual’s world.

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Expressive Arts Therapy Focuses on Capacity

When it comes to introducing expressive arts therapy to any individual, my focus has always been on capacity. The arts are not expressions, catharses, or manifestations of pathology or disorders; they exist to transform, reveal, and heal. Humans have applied the arts within ceremonies, rituals, and procedures for thousands of years as a remedy for distress, trauma, crisis, and loss (Malchiodi, 2020; 2022).

In “Traumatic Stress and the Circle of Capacity,” I proposed a model as an alternative to the popular “Window of Tolerance” model (Siegel, 2009) used by many trauma specialists. Instead of teaching individuals ways to increase their window of tolerance for hyperactivation or hyperarousal, expressive and sensory-based approaches encourage us to increase capacities for regulation and resilience and for joy, enlivenment, curiosity, and playfulness. In particular, expressive arts therapy provides actual moments of identifiable self-agency, confidence, and mastery, something words alone cannot provide and are often not the focus of most psychotherapy approaches. I believe it naturally helps therapists to move away from compliance-based models that emphasize behavior modification. It is a psychotherapeutic shift to truly supporting individuals as empowered participants in their own health and well-being.

A Neurodiversity-Affirming Model Emphasizes That We Are Always Learning

What I enjoy most as an expressive practitioner is offering individuals of all ages ways to communicate that feel authentic, resonant, and accessible. But despite decades of using and developing these approaches, I still know that I am constantly learning from those who identify as neurodivergent.

As psychotherapists, most of us learned medical models that involve pathology-laden language, particularly when it comes to the prevalence of “disorders” and “disabilities” within the mental health system. In contrast, neuro-affirming models of practice encourage us to continually reflect on our approaches. I know I am still evolving my abilities in this area. Equally, I am encouraged by how expressive strategies enhance capacity, communication, and empowerment. They have the potential to be neurodiversity-affirming forms of transformation, reparation, and restoration for all individuals when words are not enough.

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