Creative therapy refers to a group of techniques that are expressive and creative in nature. Creative therapies aim to help clients find a form of expression beyond words or traditional therapy, such as cognitive or psychotherapy. Therefore, the scope of creative therapy is as limitless as the imagination in finding appropriate modes of expression. The most commonly used and professionally supported approaches include art therapy, writing, sand play, clay modeling, movement therapy, psychodrama, role play, and music therapy.
Creative therapy includes techniques that can be used for self-expression and personal growth when clients are unable to participate in traditional “talk therapy,” or when that approach has become ineffective. Appropriate clients include children, individuals who are unable to speak due to stroke or dementia, or people who are dealing with clinical issues that are hidden within the subconscious, beyond the reach of language. The latter often occurs when the focus is on trauma or abuse that may have occurred before the client
was able to speak, or in families where there is a strict code against talking about feelings or “negative” things. Creative therapy is also effective when used to explore fears around medical issues, such as cancer or HIV.
Caution is indicated when strong emotions become overwhelming, thus debilitating the client. Possible indications for caution include the presence of flashbacks, panic attacks, recently revealed trauma or abuse, and vivid and realistic nightmares. Other indications for caution include individual characteristics, such as a tendency toward overly emotional responses, difficulty managing change or surprises, and poor coping skills. Therapists should also take care with patients with psychosis or borderline personality disorder.
Visually expressive forms of creative therapy include drawing, painting, and modeling with clay. The goal is to provide a medium for expression that bypasses words, thus helping individuals connect with emotions about various personal experiences. The scope of the drawings is limited only by the imagination of the individual and by the creativity of the therapists. This technique can often be continued by clients on their own after beginning the work in session.
Movement and music therapies are often used in conjunction with relaxation approaches. Movement therapy involves dance and the interpretation of feelings or thoughts into movement, and is often set to music. For teens in particular, music and movement are often healthy releases for stress and emotions. These therapies can also help people develop appropriate coping skills. Movement and music may be used in nursing homes, gym class, residential treatment centers, a therapist’s office, or a home.
The physical and emotional health benefits of journaling techniques have been studied extensively. The application of journaling is broad and can be used in various therapeutic approaches. Journaling can be used on a regular basis for stress relief by writing down whatever comes to mind, or it can be used for specific problem areas, such as focusing attention on goals or on unresolved feelings of grief or anger. In journaling, it seems to be more important to focus on emotional aspects, rather than using it to simply record daily events.
Other techniques include sand play, pet therapy, play therapy, and horticulture therapy. Sand play is a specialized form of play therapy in which sand is used to form designs or set up stories using play figures. Play therapy is an approach used with children, and is quite extensive in background theory and application. It is a psychological therapy in which children play in a therapist’s presence. The therapist then uses a child’s fantasies and the symbolic meanings of the play as a medium for understanding and communicating with the child. Pet therapy and horticulture therapy are often used in hospitals and residential treatment centers. Although these therapies are not expressive in the same way as other approaches, they offer a different experience for the individuals participating in them—helping people feel a sense of joy, connection, or accomplishment that may be missing from their lives.
Little preparation is needed for the visually expressive forms. Drawing is often used in a first session with young children. When used with adults, drawing or painting is often helpful, especially at a time of impasse when “talk therapy” is not effective, or when focusing on more emotional aspects of the therapeutic work.
Role playing requires the review of specific family roles to determine goals for the work. If the family work is focused on communication, each member may be asked to adopt the role of another family member to clarify perceptions of current roles for themselves and the other family members. The purpose of adopting these roles is to gain insight and understanding about each person’s perspective in terms of their thoughts, feelings, and actions. Taking on the role of another helps to build empathy and provide a mechanism for personal growth and change.
A genogram or diagram of family members is sometimes helpful as a guide in identifying specific roles and directing the drama.
For most of the creative therapy techniques, aftercare will largely be maintained by the individual client, unless the individual is participating in a support group or ongoing therapy. One advantage of creative therapy is the ease of implementation. Little special equipment is needed, and many of the techniques easily lend themselves to use in the home. If an individual is participating in a support group or individual therapy following hospitalization, the techniques can be maintained as part of those activities.
Genogram —A family tree diagram that represents the names, birth order, sex, and relationships of the members of a family. Therapists use genograms to detect recurrent patterns in the family history and to help the members understand their problem(s).
Journaling —Involves writing out thoughts and feelings in an unstructured format. A “stream of consciousness” approach (writing whatever comes to mind) is suggested for greatest effectiveness.
Psychodrama —A specific form of role play that focuses on acting out “scripts” of unresolved issues within the family, or helping family members adopt new approaches and understanding of one another.
Role-playing —Involves adopting the role of other family members, oneself, or significant people within the life of the individual and acting out various life situations in order to explore the relationships of those involved.
Risks occur when the client is exposed to intense emotional material or memories before the necessary preparatory work has been completed in therapy. Such negative reactions may include a psychotic break, or a need for hospitalization, although this is a rare occurrence.
A more likely risk is that of altering existing family relationships. Working through certain issues surrounding trauma or abuse may alter participants’ feelings or thoughts about significant people in their lives. Conflicted feelings about these individuals may arise when clients recognize certain patterns or behaviors. The increased awareness and insight may make it impossible for the clients to continue some relationships. The resulting conflict may be uncomfortable for them.
Typical results include increased awareness, the release of suppressed emotions, a general lifting of depressive feelings, increased energy, and the resolution of internal conflict. Ongoing health benefits, such as lowered blood pressure, may result from decreased stress and improved coping skills. Clients often experience a greater sense of self-acceptance and decreased agitation.
Unusual results include increasingly intense feelings of agitation and stress. For some individuals, the techniques may appear to have no benefits. It is recommended that these individuals seek clinical help.
Bannister, Anne. Creative Therapies with Traumatized Children. London: Jessica Kingsley Publishers, 2003.
Carey, Lois, ed. Expressive and Creative Arts Methods for Trauma Survivors. London: Jessica Kingsley Publishers, 2006.
Gallo-Lopez, Loretta, and Charles E. Schaefer, eds. Play Therapy with Adolescents. Lanham, MD: Jason Aronson, 2005.
Ollier, Kate, and Angela Hobday. Creative Therapy: Adolescents Overcoming Child Sexual Abuse. Melbourne: ACER Press, 2004.
American Art Therapy Association, Inc. 1202 Allanson Road, Mundelein, IL 60060. Telephone: (888) 290-0878. <http://www.arttherapy.org>.
Arts in Therapy Network. <http://www.artsintherapy.com>.
Deanna Pledge, PhD
Ruth A. Wienclaw, PhD