What the Expressive Therapies Continuum (ETC) Offers to Arts Therapies
By Huma Durrani.
When a client stays in their head—focusing on facts, lists, and tidy narratives—artmaking can feel overwhelming. Reading Lisa D. Hinz’s recent case study reminded me why I often lean on the ETC to meet a client where they are at and broaden their capacity to feel, relate, and repair at a pace that feels safe.
Hinz describes a 65-year-old client with narcissistic personality features who began with purely cognitive tasks (writing, lists, diagrams). Over time, the work moved toward body-based and image-based processes (like body mapping), as the client-therapist relationship experienced a series of ruptures and repairs. By the end, the client reported greater access to emotion and healthier relationships, and fulfilled only one NPD criterion instead of three.
ETC in plain language
The Expressive Therapies Continuum is a framework that describes how a person processes experience in their body and brain through artmaking and art materials. Think of three horizontal paired lanes and a vertical one running through them (See Fig. 1a).
- Kinesthetic / Sensory (K-S): movement and touch. Big strokes, clay, textures. Great for grounding and releasing tension (bilateral work is particularly effective here).
- Perceptual / Affective (P-A): form and feeling. Lines and shapes that create order on one side; freer, more emotional colour and mark-making on the other. Structure helps contain; expression helps access and differentiate.
- Cognitive / Symbolic (C-Sy): thinking and meaning. Diagrams, lists, and plans versus personal symbols and metaphor. Thinking helps solve problems; symbols help reconnect with parts of self that have gone quiet.
- Creative (CR): essentially combines the other three. It fosters a sense of wholeness/integration, promoting healing through self-expression.
How I use the ETC across client needs
I work with children, teens, and adults across developmental differences (ADHD, autism), trauma and grief, anxiety/depression, and personality-style concerns. I keep two questions in mind: where is the client most regulated today, and what’s the smallest next nudge that expands capacity without overwhelm?
1) Developmental differences (ADHD, autism, learning profiles)
I usually begin with Kinesthetic/Sensory → Perceptual. Rhythm, pressure, and texture regulate the system; simple forms organize attention. A session might start with large-paper bilateral movement drawing, then shift to borders and shapes that structure space. When the client’s ready, I add light Cognitive scaffolds—a tiny visual checklist (border → shapes → colour → name) to support executive skills inside the art task.
2) Emotion regulation & anxiety (tweens/teens)
I might begin with Perceptual → Affective → Symbolic. Boxes, maps, and patterns contain intensity; then I invite feeling. I might map zones (green/amber/red) with textures for sensations, build to “scribble storms” or anger monsters (big colour, pressure, energetic marks), and later use metaphors—“volcano pressure,” “ice vs. melt”—to narrate triggers and choices.
3) Trauma and grief
I initially focus on Sensory/Perceptual aspects, with an emphasis on explicit safety and pacing. Soft pastels, clay, bilateral drawing with breath cues; then clear “containers” like circles, nests, or body outlines that hold what emerges (Hinz’s body mapping is a good example). Later, Symbolic remembrance (memory boxes, then/now maps) and Cognitive meaning-making (timelines, coping menus) help integrate the story.
4) Narcissistic defences, perfectionism, high intellect
Here I start with the Cognitive → Perceptual/Affective. Respecting intellect lowers shame and power struggles. We might diagram “how process shapes experience,” sort values, or try non-dominant-hand dialogues to loosen control. Then we bridge to body maps, small colour studies, or “two-self” diptychs (persona vs. private self). Naming and negotiating ruptures early helps maintain agency integrity.
Why this matters
Art therapy isn’t “make something and talk about it.” It’s precision pacing with materials. The ETC provides us with a shared map for pacing and a common language for why today is pencil and next month might be paint.