Welcome back to the fourth installment of the Choose Your Own (Therapy) Adventure series. In this segment, we’ll be covering some of the creative and expressive therapies: narrative therapy, dance therapy, art therapy, and sandtray (or sandplay) therapy.

Like somatic and movement therapy, and certain approaches to trauma therapy, the creative/expressive therapies hint at a specific important point when it comes to therapeutic healing: Not everything can be put into words. We are complex human beings and the first couple of years of our life were spent pretty non-verbal as our brains developed. But just because we weren’t born knowing how to talk doesn’t mean we didn’t know how to communicate – spend any time with a toddler, and you’ll know they get their point across very well.

The creative and expressive therapies are, unsurprisingly, often indicated in working with children, who may not have the vocabulary or be in a developmental stage where they can express complex ideas and emotions. Some forms of creative, expressive therapy harken back to somatic and movement therapy (like dance therapy) or offer clients an ability to move objects through space (sandplay therapy), which can be compared to Pesso-Boyden System Psychomotor Therapy, in which clients relied on groupmates to create tableaus in space to help them process particularly activating moments from their lives.

The creative and expressive may be uniquely suited for work with children, but that doesn’t mean that adults can’t benefit from them too. And while culturally, we certainly prioritize verbal communication (perhaps to an ableist fault), there’s no reason why the field of therapy shouldn’t offer alternatives to meet people of all ages where they’re at with regard to verbal communication. If you’re someone who struggles putting your thoughts and feelings into words in daily conversation, here are some therapy options you might want to look into.

Art Therapy

According to VeryWellMind, art therapy “integrates psychotherapeutic techniques with creative process to improve mental health and well-being,” decrease clients’ stress, and help facilitate clients’ deeper self-awareness and self-understanding. Art therapy can include any number of artistic media: drawing, painting, sculpture, collage. When I was studying for my sex education certification, I remember reading an article about sexual subjectivity, in which adolescent girls were given cameras and encouraged to take photos of things that drew them in throughout their days, making the girls, so often objectified (made the ‘object’ of others’ desire), into the beholders. Then, researchers prompted the girls to talk about the photos they had taken, and were able to garner insight into the girls’ sexual subjectivity, or sense of themselves as subjects with a right to desire, pleasure, and authentic expression. When I think of art therapy, I often think the purpose is similar. It allows us to be the protagonists, the beholders, the creators, of our lives and realities.

Art therapy also makes me think of another exercise that was part of my training as a sex educator. On a day that we were studying sexuality and orientation, our instructor set out art supplies on our tables – paint, markers, crayons, glitter, glue, pipe cleaners, you name it, and it was there. We were instructed to create a visual image of our sexuality, and I was struck by the vibrant colors I chose, as well as a small, dark corner of deepest black where tendrils reached out across the page. If I had been in an art therapy session, the therapist might have asked me what came to mind as I worked on that corner. “Through exploring their art, people can look for themes and conflicts that may be affecting their thoughts, emotions, and behaviors.” Art therapy is not completely non-verbal; rather, the pieces that clients create serve as a jumping off point to explore more deeply aspects of themselves that might have been harder to put into words.

Dance Therapy

Dance/movement therapy (DMT) strives to bring a greater connection between mind, emotion, body, and movement to the work that a client does in therapy. Generally speaking, movement is good for our bodies – movement releases endorphins, can improve mood, and can even in some cases help manage pain, though pain management through movement of course must be pursued cautiously and with a lot of attention paid to the feedback of the client. In her Movement for Trauma Level 1 course that I took back in October/November of 2020, Jane Clapp mentioned a study that suggested that when clients were given the task of engaging in simple balancing exercises, they actually reported lower pain levels during and after the exercise. An important thing to remember, though, is that dance and movement can be complicated: The type of movement and exercise are important (strengthening and balancing exercises, for example) and the point is not athleticism or weight loss, which often get conflated with exercise. Similarly, movement and exercise can be contraindicated with some conditions, such as chronic fatigue, something that we’ll sadly likely be hearing a lot more of as more and more people come forward with their experiences of long COVID

If dance/movement therapy is something you’re interested in, you can expect to be guided through movement behavior to learn how integrate previously disparate ways of being: physical, cognitive, emotional, social, and embodied. Like art therapy, the movements are interpreted, but instead of color and texture, together with your therapist you would analyze things like speed, fluidity, and flow or choppiness of motion, to name a few things.

Sandplay/Sandtray Therapy

When I was in my Masters Program, one of my classmates’ final projects was about sandtray or sandplay therapy. This somewhat niche therapy contains echoes of that above mentioned Pesso-Boyden Systems Psychomotor therapy – except instead of a client’s groupmates standing in to create the clients’ tableau, clients have a sandtray of items with which to construct the tableau.

An important word within the name of sandplay therapy is the word play, an integral element of the creative therapies, for a couple of reasons. First, if we consider playing, rather than confessing or divulging vulnerable information, the effect can be a lower stakes engagement with our own psyche. Perhaps we’ll feel less under the spotlight or awkward in the room with a therapist (who is also hopefully doing the work of creating a warm, relaxed, and non-judgmental atmosphere to the best of their ability.)

The other important thing about play is that it is a creative, curious state of being – a state that we simply cannot access if we are activated, actively traumatized, or in survival mode. Curiosity requires a sense of safety. To be in a state of play means that, in that moment at least, we feel safe and secure.

Sandplay therapy is particularly well-suited for clients who have experienced some type of trauma or abuse. As you might imagine, it’s one of the therapies that can be particularly effective for children, for whom play has been compared to a full time job. Adults work (unfortunately – and as an anti-capitalist and anti-oppressive therapist, I’ll be the first to say that I think adults are forced to work too much, and far more than is healthy or natural); children play, to make sense of the world, and to engage in the work of tending to their incredible developing brains.

In sandplay therapy, clients’ are given a wide array of toys with which to create a world in the sandtray. Often these toys are heavy with symbolic meaning: houses, gates, doors, various animals, dinosaurs, roads. As they build their world, the therapist observes, and refrains from interrupting. The theory is that clients’ will create a world that “represents their internal struggles or conflicts” upon which both the therapist and client can strive to glean insight. It’s another form of alternative communication, and one that, “is based on the notion that if a therapist provides a client with a safe space, the client will use the sandtray to create solutions to problems on their own.”

Narrative Therapy

As a writer, I had to include narrative therapy among the creative/expressive therapist, though it differs from the above mentioned therapy in that it does include an emphasis on words and verbal communication. Narrative therapy is close to my heart, however, especially because of its emphasis on clients being the expert – or protagonist – of their own lives.

According to VeryWellMind, narrative therapy is focused on making meaning. The importance of how we make meaning cannot be understated – one need only to read Viktor Frankl’s Man’s Search for Meaning to understand how our process of making meaning is at the center of healing from trauma – even a trauma as great and terrible as having been a survivor of Nazi concentration camps. (Unsurprisingly, Frankl was also the founder of a related school of therapy, known as logotherapy, an existential and humanistic therapy concerned with life’s search for meaning).

A key tenet of narrative therapy is the idea that people are separate from their problems; that is, the ways in which we are struggling do not define the totality of who we are. Narrative therapy is non-judgmental and non-pathologizing, centers respect, non-blame, and the client as the expert in the room (rather than the therapist), which can be a relief for people who have experienced therapy as heavily influenced by a medical model, rife with hierarchy. Its focus on reality as socially constructed rather than objective makes it, in my opinion, very well suited for therapists who are practicing from a social work background. Most importantly, it gives us room to tell stories, something humans have done for eons in order to make sense of the world, understand and resolve trauma, and form life-saving connections (attachments) with others.

I am particularly interested in narrative therapy because I am a writer, and because stories have always been a central way for me to understand my life. Part of this is undoubtedly why I was drawn to therapy – studies have shown, for example, that the more people are exposed to stories from narrators who are different from them, the higher they score on tests of empathy. (I could go into another rabbit hole here about why literature and the arts are so deeply necessary and need more funding in our public school systems, for the social and emotional well-being of young people, but I digress.) But the other is purely personal: While I haven’t ever worked formally with a therapist who practices narrative therapy, storytelling has deeply impacted my life and healing, specifically through the act of writing fanfiction for years as a teen and a young adult. Writing (fan)fiction is slightly different than a formal narrative therapy approach with a therapist, but I include it here under the umbrella of creative/expressive therapy; when I consider sexual subjectivity, and my way into my own subjectivity, I have to tip my hat to the Mary Sue’s I wrote as a teen, slogging through anxiety, trauma, sadness, self-loathing, and body image issues, to write myself as a protagonist in the world long before I learned to embody that in real life.

A Note About The Creative/Expressive Therapies

As noted in previous installments of this series, the more niche a therapeutic approach is, the more challenging it may be to find a therapist in your area to work with you. Training for sandplay therapy in particular is quite expensive, often leading to high fees for therapists who conduct that type of therapy.

The good thing about the creative therapies, though, is that many of them are things that you can experiment with on your own, and you can ask your therapist if they would be willing to have you bring some of your experimentations into session. For example, I’ve worked with clients who have read me poems, or talked to me at length about characters or fan fiction that has been especially meaningful to them. Clients have also brought me memes they’ve created, or shown me drawings and paintings via Zoom that have helped them uncover things about themselves that have otherwise been hard to put into words.

If you can challenge yourself to move past some of the shyness or self-consciousness around creating, it can be an incredibly rewarding experience to experiment with ways of being and ways of knowing outside verbal communication. Certainly for my part as a therapist, I am nothing but excited to engage with people in the ways that resonate most clearly for them. Finally, I cannot emphasize enough how important it is to remember that with the creative/expressive therapies, the point isn’t to produce, but rather to express. The pieces that you create don’t have to be “good” in any type of way; in fact, I challenge clients to release judgments like “good” or “bad” or “skilled” entirely in therapy, as a shame and comparison-based capitalist framework that, once a week for forty-five minutes, we can try to do without.

Next up: The relational therapies!

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