Traditional Intervention Strategies
Interventions in the integrative approaches are quite numerous and unstandardized. There are no set interventions that can be classified as belonging to any single approach because of the amount of overlap in creative expression techniques. Some counselors may consider certain techniques as specifically narrative or exclusively expressive art. The actual application and client process within these interventions access two or more of the integrative approaches, as the use of symbolism is always present in counseling. The following is a list of some creative interventions based on the concepts of expressive arts, narrative, and symbolism:
• Collage/mobile crafting: This intervention strategy is usually longitudinal in nature. Clients are provided various art supplies (e.g., glue, colored paper, pipe cleaners, etc.) and, in one form of this technique, instructed to create a collage based on a current feeling, thought, fear, or dream that they are experiencing that day. This technique may be used at the beginning, end, or throughout each counseling session until clients have created a mosaic-style mobile of their collages. Not only does this art-making technique serve as a reminder of the client's progress throughout the session, but also the actual art serves as a focusing point for therapeutic exploration.
• Songioriting: As an intervention, this technique is an integrative part of music therapy with narrative features. Clients can be given homework to write a song (specifically lyrics) for their life, week, or day. The song's length and style are left to the client's imagination. In session the counselor may ask the client to experiment with singing the lyrics at varying rhythms and in styles to invoke shifts in the meaning and essence of the issue portrayed in the music. As in narrative-based approaches, clients' stories are embedded in the words and also in their chosen method of delivery.
• Finger painting: This intervention is often considered child's play, yet there is a great amount of therapeutic potential in its practice. Usually a nondirective process, clients are provided with tire basic instructions to paint a picture of a dream, their family, or themselves, among other things (Synder, 1997). The counselor acts as a process observer, noting the colors used, pace of work, fluidity of movement, and so forth. Clients are encouraged to discuss the meaning of their art, discussing the feelings and thoughts that may be associated with different parts of the painting.
Art therapy is the construction of visual images for the therapeutic expression of thoughts and feelings by clients. The use of art as a projective intervention of the client's inner reality is a common practice in analytic theory. In the field of psychology, analysts encourage their clients to produce drawings or paintings that are then interpreted by the analyst as an expression of the clients' unconscious. The therapeutic use of art as an empowering tool for clients can be traced back to the work of Margaret Naumburg (Rubin, 2001). Na- umburg is known in the field of expressive arts for opening the Walden School in 1914, the first school to integrate art as an educational and therapeutic tool. In her early work with children at Walden, Naumburg discovered much concerning the link between art and cathartic expression (Naumburg, 1955). While not the first or only analyst to use art in therapy, Naumburg is credited as the first therapist to use dynamic art therapy as her primary therapeutic orientation with clients. Naumburg believed that her clients' art was a form of symbolic speech that she as an analyst could not interpret (Rubin, 2001). This belief is still central in current art therapy approaches and empowers clients to construct their own meaning through their art.
Art as a counseling intervention is grounded in the belief that the creation of visual symbols of the client's inner reality provides a framework to begin deeper exploration and awareness. The integrative use of art in counseling is commonly seen in therapeutic work with children. As a component of play therapy, art is used to help children express aspects of their lives that may be too painful or complex to disclose through verbal means. The inclusive and expansive nature of art allows for many unique and engaging therapeutic applications.
Dance/movement therapy uses physical movement and positioning as a means of client expression of and liberation from psychodynamic trauma and stress. The techniques used in dance/movement therapy range from simple stretching exercises and physical repositioning to vigorous and rhythmic dance. The underlying principle of dance therapy is that by stimulating the body, the mind is free to objectively explore constructive thoughts and emotions. In this way, the art of free movement is seen as cathartic and increases bodily awareness in the client. This concept of mind-body connectedness is also present in the Gestalt approach.
Harpin (1999) offered the following concepts as a summarization of the therapeutic value of dance and movement in counseling:
1. Movement is an integrating process. Movement of the legs in the form of stomping may cause the client to feel aggression, just as the gentle swaying of the whole body may produce feelings of serenity or calmness. In this way movement and emotion are integrated.
2. Movement evokes emotions and cognitions that in turn can be used to express other feelings and thoughts. The feelings and thoughts that constitute the client's inner reality are expressed during movement. As a client suffering from esteem issues engages in forceful movements, she or he may begin to feel powerful; this feeling in turn may produce feelings of sadness as the client realizes that she or he does not feel empowered in life.
3. Movement, emotion, and form when expressed in relation to each other can lead to increased awareness and insight. Movement can produce awareness of the union between mind and body. As clients become more aware of their bodies, postures, and gestures, they also more fully experience their mental state.
4. Movement can deepen and expand a client's sense of being and creativity. Through the integration of movement in counseling, clients gain a sense of presence with their bodies and with the essence and flow of life. Clients are motivated and empowered to confront and move away from destructive patterns of living as they take on the new identity as a vital and creative force.
Thespians have known for centuries the therapeutic benefits of dramatic expression. The origins of drama in therapy can be traced back to J. L. Monreno, the father of psychodrama. Drama therapy is based on the experiencing of human emotion through dramatic performance. Dramatic expression provides clients with an alternative reality to their current state of perceiving their situations (Emunah, 1999). The active experiencing focus of this approach allows clients to try out a new self or role play a personality characteristic that they find limiting. For example, shy introverted clients can, through dramatic play, develop their assertive voice. Other clients may have a moment of insight as they role play an abusive parent whom they have spent years trying to understand or forgive.
Counselors practicing this approach may also integrate the psychoanalytic approach and use a free association method wherein they encourage the client to act on whatever behavior or emotions come to mind. This use of improvisation is a common element in drama therapy. As with dance/movement therapy, the dramatic approach is used in family systems and Gestalt counseling as a means of helping the client fully experience the latent self to promote holistic acceptance in the client.
Music therapy is the integration of acoustic stimuli into counseling to promote the experience and recognitions of latent feelings and thoughts by the client. Music therapy is founded on the belief that sounds, melodies, and rhythms produce ebb and flow that the client experiences internally. This experience resonates with the client's movement between different emotional and cognitive states (Koelsch, 2009). Since its creation, music has been a catalyst for human response, triggering memories, feelings, and cognitions. The integration of music into counseling provides clients with an intervention that they may be familiar with and comfortable experiencing.
Some counselors use the guided music and guided imagery technique by choosing a musical selection for the client to listen to in hopes of inducing certain emotive or cognitive states in the client (Butterton, 2004; Koelsch, 2009). Both methods of music selection are called receptive music therapy. These approaches in music therapy are presented to clients in a relaxed state in which they can fully attend to feeling and thoughts as they are evoked through the music (Warja, 1999).
Expressive music therapy is yet another method commonly used to stimulate the client's awareness. With this method, the client creates the music through playing an instrument or by singing (Warja, 1999). The use of this method is not focused on musical mastery or certain criteria of quality, pitch, and rhythm. Expressive music therapy is intended to be a free manifestation of clients' interpretation of self or their problem.
The narrative approaches use therapeutic interventions centered on the exploration of the clients' perceptions and beliefs. A common intervention strategy used in the narrative approach is poetry. Poetic creation is a deeper form of narrative therapy, because it uses the client's imagination and may focus on more abstract elements in the client's life, such as beauty, fantasy, and imagery (Fuchs, 1999). Poetry is often experienced by the reader as a stimulus to the senses. Therapeutically, this intervention strategy can produce vivid expressions of the client's life narrative.
Another major intervention strategy used in the narrative approach is journal writing. Journaling is a reflective process that is intended to slow down clients' thought process by inscribing them to paper. This intervention is developed on the belief that thoughts and feelings are connected through words (Thompson, 2004). Journaling is often used as a homework assignment that helps to structure the client's emotions and cognitions for the upcoming session but does have several techniques that are ideal for brief interventions. According to Thompson (2004), there are several exercises within journaling that helps promote client insight.
One narrative intervention that can successfully be used with various client populations is clustering, a technique to help focus client thoughts and alleviate cognitive stress. The client creates a mind map of her or his thoughts without attending to grammar or structure. This brief approach to narrative journaling tends to produce good results with clients who may lack the academic or intellectual capacity for more formalized narrative writing but can still benefit from the expressed word.
As stated earlier, the symbolic approach does not use any specific approaches. The integrative use of other interventions includes symbolic imagery, themes, and meaning.
Role-play reversal, for example, is strongly grounded in symbolism but is not exclusive to the symbolic approach. Role-play reversal is a modification of psychodrama and requires active performance from clients. Clients are directed to become a different role, usually someone in their lives with or for whom they have a conflict or affinity. The counselor requires clients to stay in character and act out behaviors that are troubling them. For example, clients may have conflict with their father, whom they feel is too judgmental. In this approach, clients will be asked to be and stay in the judgmental role of their father to promote insight into the possible dynamics and experience of this person. Through this process, clients gain perspective on their relationship to the person whom they perform as in this technique. The counselor processes feelings, assumptions, and meanings derived from the exercise with the client.