Foundations of Expressive Arts Therapy: Theoretical Clinical Perspectives

Edited by Stephen K. Levine and Ellen G. Levine
(Philadelphia, Pa., Jessica Kingsley Publishers, Ltd., 1999, pages 275, $35.00 paperback)

Reviewed by Kate T. Donohue
Journal of Sandplay Therapy. Vol. 9 (2), 2000

While reading Stephen and Ellen Levine’s book Foundations of Expressive Arts Therapy: Theoretical and Clinical Perspectives, I found myself imaging I had been invited to Babette’s Feast, a culminating masterly presentation of the honed experience of Expressive Arts Therapy masters and pioneers. This book is a long awaited gift to the thirty-year-old field of Expressive Arts Therapy. The editors attempt to give form to the field without deadening its creative soul, thus allowing expressive arts to remain vital as a “work in progress” (p.8).

The editors of this feast invited twelve of the pioneers and innovators in the field, from Europe, Canada, Israel and the United States, to offer a “multiplicity of perspectives which represent the field of Expressive Arts Therapy at this point in time” (p. 9). The book is separated into two sections: Part One: “Philosophical and Theoretical Perspectives,” and Part Two: “Clinical Perspectives”. The second part is also deliciously full of theoretical considerations and perspectives that help guide the authors’ clinical applications.

As an expressive arts therapist and educator, I greatly appreciated this savory sampling of perspectives. Each chapter has history and depth. The authors do not simplify their ideas into a cookbook, leaving room for the reader to be inspired but not directed. The Levines are two pioneer expressive arts therapists, trainers and authors, and a perfect choice for editors of this type of book. Both of these artist-therapists have the global and interdisciplinary perspective and sensitivity that created the temenos that would foster the emergence of this contribution.

For those unfamiliar with the thirty-year history of Expressive Arts Therapy, the introduction offers a good appetizer. They trace our roots back to the early 1970s and the work of Paolo Knill, Norma Canner and Shaun McNiff, who founded the Lesley College Graduate School program in Expressive Therapy. This new program moved away from a specialization in a particular art therapy by developing a philosophy that embraced an interdisciplinary approach to the arts, indigenous healing systems, contemporary philosophical developments (phenomenology, hermeneutics and deconstructionism), and community art-making within the program as an essential component of this approach. Following the conception of the Lesley Expressive Therapy program, numerous other training programs sprang forth, in the both North America and Europe Interdisciplinary Studies (ISIS) were established.

Expressive Arts Therapy was a blossoming as a profession. By 1994, expressive arts therapists and trainers knew they needed a professional community for the exchange of ideas, research and professional development of this intermodal, multi-arts approach. These founding members formed the International Expressive Arts Therapy Association (IEATA). IEATA exists to support the professional use of integrative, multi-modal arts processes for personal and community transformation. They provide a global forum for professional dialogue and promote guiding principles for the professional practice of the expressive arts.

The second part of the introduction will entice both newcomers and seasoned expressive arts therapists as the Levines grapple, as we all do, with clarifying but not limiting the definition of Expressive Arts Therapy. I was moved by the first aspect of their exploration of definition.

“ Expressive Arts therapy is grounded not in particular techniques or media, but in the capacity of the arts to respond to human suffering. The fundamental concept of aesthetic responsibility (Knill, Barba and Fuchs, 1995) implies an ability to use appropriate media for therapeutic purposes. The expressive arts therapist must therefore be prepared to work with sound, image, movement, enactment and text as they are required in the encounter with the lived situation of the client.” (P.11).

I have found this concept of aesthetic responsibility to be the essence of Expressive Arts Therapy, and one that clearly defines our distinct character. Each of the clinical application contributors emphasized the next point that the Levines cite: the importance of the lived bodily/sensory experience as it unites with the imagination as one moves toward a creative source of meaning. We call upon “poiesis” linking us to the common origin of artistic expression. The expressive arts therapist specializes in the “junctures at which one mode of artistic expressive needs to give way to, or be supplemented by another.”(P.12). This is the Intermodal or multi-arts approach. Stated another way, the expressive arts therapist emphasizes “low skill, high sensitivity” (Knill). Expressive Arts Therapy embraces these concepts as the key parts of their identity. While giving the profession an essential form, the editors’ definition leaves the field open to creative interpretation and inspiration.

Through the voices of Paolo Knill, Shaun McNiff, Majken Jacoby and Steve Levine in Part One, the editors help the reader grapple with the one the hardest questions in Expressive Arts Therapy, that of our philosophical and theoretical base. Of particular controversy is the relevance of psychological theory. Starting Chapter One, Levine challenges the philosophical views of the Greeks and Europeans and stresses that expressive arts therapist create their own theoretical principals.

Paolo Knill, the grandfather of Expressive Arts Therapy, in Chapter Two moves us closer to the idea of developing our own expressive arts philosophical base by exploring the imagination, play and this Intermodal language. Knill suggests we shy away from the paradigm of seeing the use of arts in therapy as “superior” to other therapies. He suggests we create a new paradigm. His new paradigm focuses on “being in the world” where art combined with a healing relationship helps us “come to be with and pass away suffering” (p. 37). Consequently, Expressive Arts Therapy offers “soul nourishment” (p.49) and can provide us with a “preventative diet as well as medicine to ensure human well-being” (p.52). In his vast contributions to the profession, Knill has given us a new paradigm and language which has helped to make expressive arts clearly distinctive and understood as a profession.

Though we leave the philosophical and theoretical perspectives behind, Part Two is still rich with these ideas and concepts. In part one, the editors questioned the relevance of psychological theory. The authors in Part Two emphasize their psychological underpinning. Perhaps it is important to acknowledge whose “backs” we are standing on and still create own new paradigm. For in scientific thought, similar paradigms do coexist. It is important to acknowledge the psychology influences that most of the authors stated helped shape their ideas and work in Expressive Arts Therapy; such pioneers as: C.G. Jung. D.W. Winncott, Carl Rogers, Rollo May, Roberto Assaggioli, Jacob Moreno, Arthur Lowen, Paolo Knill and Steve Levine.

Part Two is more than clinical applications; the contributors portray their journeys towards becoming an expressive arts therapist, their philosophical underpinning and their style of Expressive Arts Therapy. Each contributor is rooted in the arts and uses multi-arts, body-oriented approach, but many seem solidly rooted in one primary modality with the other modalities woven in around the primary one. Many of the contributors could be seem as movement based expressed arts therapist, or music-based, etc. This section presents numerous case studies and programs that use the arts in various settings and addresses a variety of issues. This section is essential reading for any one entering the field of expressive arts, and provides “soul nourishment” for the more seasoned expressive arts therapist!

In Norway and Israel, Melinda Meyer and Yaacov Naor present their Expressive Arts Therapy work with survivors of trauma. Melinda Meyer, founder of the Norwegian Institute for Expressive Art Therapy, psychodramatist and expressive arts therapist, shows us how Expressive Arts Therapy helped Bosian refugees who sought asylum in Norway. Those who live in exile lose everything, “the house of the family, the house of community and the house of the human body” (p.244). Melinda moves through the process she developed to help those in “exile from the body,” re-integrate a sense of the house of the body. This program was the first healing encounter the refugees experienced after their trauma. Melinda uses this transitional space of “waiting room” and reframes it into the playroom in which survivors can reintegrate the body. She also delves into the “therapist in the ruins” (p.252) and discusses how the expressive arts helps the therapist communicate with different cultures and deal personally with the horror they re-experience with their clients of trauma.

Yaacov Naor, founder of ISIS-Israel, expressive arts therapist and psychodramatist, introduces us to his workshops in Israel and Germany, “Confronting the Holocaust through Psychodrama” designed for Jewish children of Holocaust survivors and Germans of the generation after World War II. Yaacov helps understand the trauma that this generation experiences, and the healing power of the theatre. This chapter is incredibly moving as Yaacov is a child of two Holocaust survivors and also tells how his own story was changed by one of the encounters in these workshops. Yaacov quotes Paolo Knill in closing, “peace is not the absence of conflict; it is the ability to live with differences.”(p.238).

Meyer and Naor truly depict the cross cultural and transcendent power of Expressive Arts Therapy in healing severe trauma. These are two chapters not to be missed in this book.

The power of sound is explored in two chapters, by Paul Newham from England and by Margareta Warja of Sweden. These two chapters explore the potency of “therapeutic voicework” and “music as mother” through expressive and receptive music therapy. Both Newham and Warja are solidly based in artistic and psychological theory and emphasize the relationship between voice, music, touch and movement.

Paul Newham, founding director of the International Association for Voice Movement Therapy, therapist, and teacher, traces the development of therapeutic voicework grounded in avant theatre and portrays case studies that demonstrate its effectiveness.

Margareta Warja, training director of the Swedish Expressive Arts Therapy Training Institute, and music psychotherapist schooled in expressive music therapy and the Bonny Method of Guided Imagery in Music, gives a strong developmental look through theory and case studies at the mothering function of music as it travels the pre-verbal layers. Margareta provides a wonderful exploration of music and the co-transference relationship.

Through her love of music, she shows how “Music, the queen of time, takes us to the never-ending now”(p. 171 &192), heals trauma and builds internal and community power.

Foundations of Expressive Arts Therapy ends with an article by co-editor Ellen Levine, co-founder of ISIS-Toronto, pioneer expressive arts therapist and core faculty at EGS, interweaving child play therapy and Expressive Arts Therapy. I was intrigued with Ellen’s ability to weave psychoanalytic theory and expressive arts, and grapple with the use of interpretation as tool in the expressive arts process. I also appreciated how she was able to critique herself and acknowledge two different expressive arts approaches to the same child’s situation. She demonstrates through case studies the connection between child psychotherapy and expressive arts therapy, “ the capacity of the imagination to shape experience” (p.272). I was surprised that Ellen did not mention the use of Sandplay with children. As an Expressive Arts Therapist who works with children, I was disappointed that the Levines did not include a chapter on Sandplay Therapy with children from Lauren Cunningham or Kay Bradway. I was also intrigued by this omission. Is sandplay considered play therapy? Does it seem less based in the art discipline itself? Only the California Institute of Integral Studies includes Sandplay Therapy class as part of their curriculum. This omission aroused my curiosity. I would to see a chapter on Sandplay Therapy and its place in the world of Expressive Arts Therapy in the next edition of this book, but more importantly in dialogues in this journal!

Even though this is masterly accomplishment and completes a missing link in the field of expressive arts, there are a few ideas that needed more development in this book. After a great feast, one desires after dinner conversation to help digest the meal. I wish the Levines had added a final chapter that would help with digesting this great feast. I think the chapter could include a healthy dose of comparing and contrasting the approaches. I would have loved the Levines, both creative and independent thinkers, to dialogue with each other about the field and the contributors’ gifts. I also would have liked contributors to share a little more about their trials and errors in developing their approaches. The only contributor that hinted at this was Ellen Levine. Many of us are frequently asked challenging questions about the profession, and I was glad that Natalie Rogers used this as template to explore her approach. I wish there had been more of this type of serious grappling with the difficult questions that are posed to expressive arts therapists. I appreciated Shaun McNIff’s ideas about arts based inquiry, but was left with the idea that Expressive Arts Therapy is a well-researched field. As an Expressive Arts Therapy educator, I know this is not the case. I wish there had been room in this first section to discuss the research already conducted, as well as that still needed, in the field. Perhaps a closing chapter could have addressed these points that need more time for exploration.

Even though Stephen Levine posed a non-foundational base to expressive arts, I think Foundations of Expressive Arts Therapy poses a paradox for it offers a solid investigation of the foundation that has been created over the last thirty years by the contributors to the field. I enjoyed engaging with this paradox. Perhaps the Levines used this irony to keep the profession alive and vital. The reader has a delicious feast in store as they engage with this book. I have enjoyed and appreciated the creativity, care and compassion that went into the creation of this collection. I will look forward to the next encounter with this work-in progress, and to being invited to another of Babette’s Feasts in “Foundations of Expressive Arts Therapy II”!