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This section of the chapter includes a summative overview of the content presented in previous sections. A review of current supporting research is discussed, and the limitations of the expressive arts, narrative, and symbolic approaches are presented. The section concludes with an summary chart for reference and summarization.

Supporting Research

Several microstudies and case reports suggest the benefits of the use of expressive arts, narrative, and symbolic approaches. Integrative approaches have been used for the last few decades in working with elderly people as a successful aspect of reminiscence groups (Caldwell, 2005). Also, these approaches have proved helpful in working with sexual abuse survivors (Mills & Daniluk, 2002; Mulkey, 2004), clients with eating disorders (Russell, 2000) and at-risk youth (Hartz & Thick, 2005; Ungar, 2001).

Art therapy has been found to help relieve symptoms of HIV / AIDS in clients with the diagnosis (Rao et al., 2009). Male populations of sexual abusers (Keenan, 1998) and batterers (Brownlee, Ginter, & Tranter, 1998) have received effective help through the use of integrated narrative counseling. The narrative approaches have begun to be used with soldiers and their families with the onset and extended duration of the Iraq war (Rao et al., 2009; Van der Velden & Koops, 2005), as well as with clients who have been affected by terrorism (Shalif & Leibler, 2002; Witty, 2002). Drama therapy has been used to help clients

dealing with anger and aggression issues find more positive social interactions and greater personal insight (Blacker, Watson, & Beech, 2008)

The school setting lends well to the integration of therapeutic approaches and artistic expression. School counseling has benefited from the use of drama therapy to counter bullying among students (Beale, 2001). Teachers facing burnout and occupational stress have been aided by the use of music therapy approaches (Cheek, Bradley, Parr, & Lan, 2003). Music intervention is also cited as having therapeutic benefits for clients experiencing grief and loss (Gallant & Holosko, 2001).

A major problem with the integrative approaches, namely expressive arts, narrative, and symbolism, is the severe lack of empirical research currently available (Netzer, 2009). The communities of counselors and psychologists who use these approaches have produced large amounts of models, case studies, and specialized therapeutic modalities. The studies that have been conducted concerning the integrative approaches have used small group and population numbers. The statistical significance of these studies' findings is hardly generalizable to a larger population of clients. Yet, it is this personalized approach to helping clients develop awareness and insight that is a qualitative strength of these modalities (Netzer, 2009)

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