The Use of Expressive Techniques in Counseling

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The Use of ExpressiveTechniques in CounselingLoretta J. Bradley a , Peggy Whiting b , BretHendricks a , Gerald Parr a & Eugene Gordon JonesJr. aa Texas Tech Universityb North Carolina Central UniversityPublished online: 11 Oct 2008.

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© 2008 by The Haworth Press. All rights reserved.44 doi:10.1080/15401380802023605

WCMH1540-13831540-1391Journal of Creativity in Mental Health, Vol. 3, No. 1, April 2008: pp. 1–26Journal of Creativity in Mental Health

The Use of Expressive Techniques in Counseling

Bradley et al.Journal of Creativity in Mental Health Loretta J. BradleyPeggy WhitingBret Hendricks

Gerald ParrEugene Gordon Jones, Jr.

ABSTRACT. This manuscript explores and identifies the use of expres-sive techniques in counseling. Although verbal techniques are important,sometimes the best of verbal techniques are not sufficient. Creative,expressive techniques can add a new, important dimension to counseling.Such expressive techniques as cinema, art, and music are described to helpcounselors deal with ethical dilemmas, grief and loss, and substance abuse.These techniques can assist counselors and their clients in reframing ideas,shifting perspectives, externalizing emotion, and deepening an understandingof an experience or an issue.

KEYWORDS. Art, cinematherapy, counseling, creativity, ethics,expressive techniques, grief, loss, movies, music

Loretta J. Bradley is Paul Whitfield Horn Professor and Coordinator of CounselorEducation at Texas Tech University.

Peggy Whiting is a Professor of Counselor Education at North Carolina CentralUniversity.

Bret Hendricks is Assistant Professor and Gerald Parr is Professor of CounselorEducation at Texas Tech University.

Eugene Gordon Jones, Jr. is a doctoral candidate at Texas Tech University.Address correspondence to: Loretta J. Bradley, Texas Tech University, Counselor

Education, COE Box 41071, Lubbock, TX 79401-1071 (E-mail: [email protected]).

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Bradley et al. 45

Centuries ago, the Chinese had a saying: “People forget what they aretold but they remember what they do.” The activity of expressing the selfis the essence of drama, art, writing, music, and dance. Additionally, theancient Greeks and Romans used techniques of the arts to sooth the souland calm the mind (Gladding, 2005). It can be said that these creativeendeavors offer multidisciplinary ways to give voice to the human inter-nal experience and to act as catalysts for learning about the self and theworld at large. Expressive arts modalities continue to be used as creativeoutlets for teaching and healing, two important aspects of the roles ofcounselors. These techniques can assist people in reframing ideas, shift-ing perspectives, externalizing emotion, and deepening understanding ofan experience or an issue.

In more recent times, such expressive techniques as art (Buser, Buser,& Gladding, 2005; Sassen, Spencer, & Curtin, 2005; Somody & Hobbs,2006/2007), cinema (Ber & Alroy, 2002; Edwards, 2006; Hyde & Fife,2005; Marshall, 2003; May, 2007), drama (Scholl & Smith-Adcock,2006/2007; Stahler, 2005); dream work (Daire, Casado-Kahoe, & Len,2005; Freeman & Vogel, 2005), music (Buser, Flannery, Bentley, &Gladding, 2005; Duffey, 2005a, 2005b; Duffey, Somody, & Clifford, 2006/2007; Freeman & Vogel, 2005; Gladding, 2005; Hendricks, Bradley,Robinson, & Davis, 1997; Rosenthal, 2001), storytelling (Pehrsson,2005a), and writing (Pehrsson, 2005b; Valadez & Evans, 2005) have beenused in teaching counseling concepts to help clients better express theirconcerns and issues. For example, expressive techniques have been used inteaching such concepts as diversity (Gerster & Ziogar, 2006; Molina,Monteiro-Leitner, Garrett, & Gladding, 2005; Pinteritis & Atkinson, 1998;Tyler & Guth, 1999), ethics (Baldwin & Olivarez, 1993; Berger & Pratt,1998; Bradley, Jones, Parr, Hendricks, & Whiting, in press; Butchart,2006; Champoux, 2006; Izzo, Langford, & Vitell, 2006; Kahana, 2005;Marshall, 2003; van Es, 2003), family systems (Connolly, 2005;Edwards, 2006; Hudock, Warden, & Gallagher, 2001), grief and loss(Bissler, 2005; Brown, 2005; Duffey, 2005a, 2005b; Haberstroh, 2005;Scofield, 2005; Thompson, 2003), and peer relationships (Tyler & Guth,1999; Wedding, Boyd, & Niemiec, 2006; Welfel, 1998).

Given that the literature attests to the benefits of expressive techniques fora variety of counseling/client issues, this manuscript is written to illustratethe use of expressive techniques in counseling and teaching. Specificallythis manuscript will focus on such concepts as using cinema to teachethics, using expressive techniques to help clients deal with grief and loss,

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46 JOURNAL OF CREATIVITY IN MENTAL HEALTH

and using music techniques to help clients deal with such issues asdepression, alcohol abuse, and substance abuse.

ETHICAL ISSUES AND THE CINEMA

Although numerous books and ethical codes have been developed tohelp counselors understand ethics, it is evident that counselors profit frompractice in ethical decision making. Cinema (films) can be used to teachethical concepts. In the following paragraphs, we focus on three films—Good Will Hunting (Bender & Van Sant, 1997), What About Bob?(Ziskin, Williams, & Oz, 1991), and Mean Girls (Michaels & Waters,2004)—that we have found useful for teaching ethical concepts.

Good Will Hunting

The Massachusetts Institute of Technology (MIT) is the setting for thefilm Good Will Hunting (Bender & Van Sant, 1997). Will Hunting(Matt Damon) is employed as a maintenance worker. While cleaning at MIT,Will notices an unsolved math problem on the board. He secretly solves themath problem, which even the “brightest of the brightest” at MIT have beenunable to solve. Will leaves the solution on the board and returns to his clean-ing work. The math professor who placed the math problem on the board isamazed that someone was able to solve the “impossible” problem. Aftersearching for the person who solved the problem, the professor locates Will.

Despite Will’s academic capabilities, he has many personal challengesincluding problems with others and the law. Realizing that Will needshelp, the professor refers Will to a friend (Robin Williams) for counsel-ing. The relationship between Will and his counselor is strained as Willresists dealing with his issues. Through counseling Will’s journeybecomes successful, but the counseling depicted in the film illustratesnumerous ethical dilemmas.

Using the ACA Code of Ethics (2005) and vignettes from Good WillHunting (Bender & Van Sant, 1997), we ask counselors to discuss ethicaldilemmas. For example ethical considerations occur in the following:

1. The counselor counsels Will on a park bench in an open area of thepark.

2. The counselor grabs Will by his shirt collar.3. The counselor uses curse words in the counseling session.

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Bradley et al. 47

4. The counselor becomes angry at Will during the counseling sessionand allows his anger to get out of control.

5. The counselor hugs Will.

Counselors are instructed to state which aspect of the code (e.g., B.1.a)applies to ethical situations. In instances where the ethical code is notspecific, the counselor is asked to implement an ethical decision-makingmodel (e.g., Cottone & Claus, 2000; Cottone & Tarvydas, 2007).

What About Bob?

In the movie What About Bob? (Ziskin et al., 1991), the main character isBob (Bill Murray) who is a troubled but likeable client with numerous fears.The movie begins with Bob seeking help from Dr. Marvin, a psychiatrist(Richard Dryfuss). In that initial session, Dr. Marvin says he is going onvacation for the next month. Bob’s problematic behavior escalates as heenvisions that he will not be able to see his psychiatrist for an entire month.Bob, consumed by the need to see Dr. Marvin, “tricks” the secretary intotelling him where he is vacationing. Bob follows Dr. Marvin to Maine wherehis problematic behaviors continue to increase. Throughout the film, theviewer is exposed to a psychiatrist who is interested in personal fame and aclient whose compulsions and observations present various ethical issues.

Using the 2005 ACA Code of Ethics and vignettes from What About Bob?(Ziskin et al., 1991), we ask counselors to discuss the ethical issues presentedin the film. Some examples of potential ethical issues are as follows:

1. Marvin agrees to see Bob although he knows that in 24 hours he isleaving on vacation for a month.

2. During the initial session, Dr. Marvin gives Bob a copy of his book.Without mentioning the cost of the book to Bob, Dr. Marvin tells hissecretary to bill Bob for both the counseling session and the book.

3. During the initial session, Dr. Marvin does not conduct an intake,discuss the counselor/client relationship, mention informed consent,or describe confidentiality.

4. After Bob locates the psychiatrist at his vacation home, Dr. Marvinmeets with Bob.

After discussing the above, as well as other ethical dilemmas in themovie, the counselors are asked how they would avoid and/or solve theethical dilemmas.

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Mean Girls

Cady Heron (Lindsay Lohan) is the main character in Mean Girls(Michaels & Waters, 2004). Cady is the daughter of missionaries whohave home schooled their daughter during elementary, middle, and a por-tion of high school. The family returns to the United States, and Cadyenrolls in a large public high school. At the new school, Cady is exposedto a school culture characterized by problematic and manipulative peerrelationships. As the film continues, manipulation escalates and revengeoccurs. Initially, Cady seems to deny the intensity of the relationshipproblems; at the end of the movie, however, she realizes what she hasbecome as a result of the conflicts.

In this film, ethical issues are illustrated in the following vignettes:

1. After a fight occurs, the principal moves the girls to the gym andopenly talks to the girls (minors) about their behavior without acounselor being present.

2. During the meeting in the gym, the math teacher asks the students toconfess in front of their peers. Then the students are asked to turntheir backs, fall from the stage, and trust the others to catch them.Although this situation was directed by the math teacher, counselorscan be asked about the possibility of an ethical issue if a schoolcounselor had directed the activity.

3. The meeting in the gym was conducted by the principal and mathteacher, not the school counselor.

Using the above and other scenes from Mean Girls (Michaels & Waters,2004), counselors are asked to discuss the ethical issues, illustrate whereviolations are referenced in the ACA Code of Ethics (2005), and describehow the ethical issues could be solved. In addition to using the cinema todepict ethical issues, we have used expressive techniques to teach counse-lors ways to counsel children who have experienced grief and loss.

GRIEF AND LOSS

Working with children experiencing grief and loss requires acceptingthe fact that children are the experts on their grief, not the counselor, care-giver, or other family members. The counselor’s role is to assume a curi-osity about children’s experiences and walk beside them as they navigate

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the wilderness of grief. In addition, the counselor’s role is to honor thechildren’s stories of loss and to accept where they are on the journey andhow they go about the process of mourning, without attempting to “fix”them. Expressive techniques help children express and understand theiremotions of grief because “healing is promoted when children put theirfeelings outside themselves” (Goldman, 2004, p. 176).

EXPRESSIVE ARTS ACTIVITIES FOR CHILDREN EXPERIENCING GRIEF AND LOSS

Sharing Circle

This technique is intended for use in group counseling. It is ideal forchildren ages 8 and older. The materials needed are butcher paper, markers,crayons, colored pencils, and paints.

Directions: On a large piece of butcher paper, draw a circle that is largeenough to leave room on the inside while also leaving room on theoutside. The group members are asked to sit around the paper and draw adot on the inside of the circle, and then draw a line from their dot to theoutside of the circle. On the outside of the circle, the group members writethe names and/or draw pictures representing their loved one who has died.When this activity is complete, the counselor asks the group members towrite about or draw pictures of the ways they have been coping with theirloss.

The counselor should begin processing this exercise by asking volun-teers to tell about the words and/or pictures they have drawn. Volunteersshould begin with their story about the person who died and end withthe ways they have learned to cope. After volunteers have shared, thecounselor asks them to draw a line on the inside of the circle connectingtheir dot to the dot of the person sitting next to them. Members proceedto tell their stories and connect their dots until the inner circle is com-plete. Any group members who do not wish to participate may draw theline connecting their dot to the next person’s dot, thus indicating a“pass” for the discussion. When the circle is complete, the counselormay ask the group members to speculate about the reason for connectingthe dots. Although each experience is unique, the group members areusually able to see common threads among the stories. Group cohesionis enhanced as group members begin to understand how they can sup-port each other.

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CD Covers

This technique is intended for use in individual counseling. The idealage for participants is 11 to 13 years. The materials needed are a blankCD case and various expressive tools, such as markers, glitter, magazines,pieces of foam, bric-a-brac, paper of several textures, charcoal, pastels,ribbons, sponges, and paint.

Directions: The counselor invites clients to decorate the CD case so thatit reminds them of their loved one who died. Clients are then invited to tellabout what the CD case represents and how it relates to their experiences ofloss. The counselor should listen for such themes as unfinished business,guilt about ambiguous feelings toward the loved one, spiritual questions,and themes that might suggest the ways the clients are coping and/or thedifficulties with which clients are dealing. The counselor should use thethemes to continue the conversation and find meaning in the clients’ stories.An extension of this technique might include asking clients to compile atrack list of favorite songs or record a mix of songs to include in the CDcase. It is helpful if the counselor listens to the songs with the clients,talking with them about the significance and meaning of each selection.

T-Shirt Memories

This technique is intended for use in individual or group counseling,and it is ideal for all ages. The materials needed are a plain white t-shirtand expressive tools such as acrylics, puffy paint, and markers. This tech-nique has been used in African American ceremonies.

In African American culture, it is common for a bereaved family tomake t-shirts to commemorate the death of a loved one. In using this tech-nique, the counselor should assure children that excellence as an artist isnot the issue. Children are asked to draw and/or paint their loved one’spicture. If children do not want to draw a picture, a favorite phrase orquote may be placed on the t-shirt. After their t-shirts are complete, thecounselor invites them to talk about their picture or favorite quote. Thenthe counselor can expand the technique by asking children to talk aboutthe activities they shared with their loved ones. Also the counselor mightask children to describe things about the loved ones that were special tothem. Following the discussion, the counselor may give the child aclothes hanger. The clothes hanger is a symbolic message conveying thatsometimes it is alright for the children to “hang up” the memories,although the shirt will always be available for them to wear wheneverthey need or want to remember their loved ones.

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Counselors working with children who have experienced grief and losscan use the above activities to provide the children with opportunities tobetter deal with and perhaps better accept their loss. Because expressiveactivities can tap into children’s worlds of creativity and play, it is a naturalway to help externalize the internal conversations of grieving children.Additional expressive techniques may be found at the website for theAssociation for Death Education and Counseling (www.adec.org).

MUSIC LISTENING TECHNIQUE

Music in counseling has many therapeutic benefits. Music has beenused with a variety of populations and in a variety of settings (Duffey,2005a, 2005b; Duffey, Lumadue, & Woods, 2001; Oostuizen, Fouche, &Torrance, 2007; Rainey-Perry, 2003). The music listening techniquedescribed below is effective with children, adolescents, and adults. Thetechnique may be used in group or individual settings to address a varietyof themes. In the following section, the technique is described and anexample is provided of an effective music selection.

First, the counselor selects a song to play during a counseling session.The song selection is based upon therapeutic messages for the clients.At the beginning of the session, the counselor explains the format of thetechniques by inviting clients to listen to the music and pay particularattention to rhythm and lyrics while visualizing a color. Following theexplanation of the format, the counselor plays the song. When the song iscomplete, the counselor asks clients to share thoughts and feelings evokedby the song’s rhythm and lyrics. Clients also describe the color they visu-alized while listening to the song. The following example illustrates lyricswhich have been used effectively with this technique.

“Don’t Laugh at Me”

The lyrics of “Don’t Laugh at Me” (Shamblin & Seskind, 1998) referto themes of diversity, peer relationships, and acceptance. The lyricistsarticulate the differences seen in everyday life and emphasize that thesedifferences should be celebrated and accepted, not ridiculed. Diversity ofbody type, belief systems, and social standing are celebrated in this song,which has become an anthem for multiculturalism.

We suggest that the counselor play the song through, and then focus onone aspect of the song which seems to refer to the clients’ issues. Forexample, the lyrics “I’m fat, I’m thin, I’m short, I’m tall” might be used to

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help children who have been laughed at because of their physical stature.The counselor might help clients get in touch with feelings such as pride,self-confidence, and self-assurance. This song might be used for individualor group counseling.

These lyrics, especially poignant for adolescents and young adults,provide rich discussion points. The authors use this music in a treatmentcenter for adolescents diagnosed with substance abuse. These lyrics areused repeatedly to stimulate group discussions. The previously mentionedquestions pertaining to rhythm, lyrics, and color evoke emotionalresponses ranging from sadness to regret and fear. Color visualizationsunderscore these feelings and provide even further descriptions of thefeelings.

Additional questions might include the following:

1. Have there been other times that you felt these feelings?2. Was there a time when you laughed at someone?3. Was there a time when someone laughed at you?4. What thoughts did you have while listening to the music?5. What color did you visualize?

The questions below are provided as examples to use regarding sub-stance abuse:

1. When you have felt shame in the past, what did you do to “self-medicate”?

2. What role does shame play in how you feel about yourself?3. Does shame encourage some people to act out and shame others?4. How does substance use/abuse contribute to feelings of shame and

self-blame?

The questions below are provided as examples to use regardingdepression:

1. When you have felt that others make fun of you, did you then feeldepressed?

2. What role does anger play with depression? When others have madefun of you or ridiculed you, have you been angry?

3. When you have felt shame, were you more or less likely to seek thecompany of others?

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Bradley et al. 53

“I Shoulda Listened”

Another song that we have found useful is “I Shoulda Listened”(Flip, 2002). In this song, good advice was provided but ignored. Forexample, “I shoulda listened when you said ‘keep playin’ basketball,’ butI was makin’ more money standing in the hall” (Flip, 2002). These lyricsprovide a good avenue for talking with clients about things they chose notto listen to. The counselor using these lyrics might focus on such issues asdrug trafficking, dropping out of school, teen pregnancy, and makingmoney illegally. This song may be used for either individual or groupcounseling. It is a song which elicits strong emotion and identificationamong adolescents.

Music Listening Technique: Discussion

Many songs might be used for this technique; however, the authorsstrongly suggest that only one song is used per session, thereby encouragingsufficient time to discuss and process the music. Counselors should listencarefully to the clients’ responses so that accurate affective inferencesmight be derived, whereas understanding that feeling identification maynot be easily or quickly accomplished by many clients. A “feelings chart”is helpful to encourage affective expression. With regard to music selec-tion, counselors are only limited by their imaginations and creativity.While “Don’t Laugh at Me” (Shamblin & Seskind, 1998) has been usedeffectively, a selection of additional songs that we have used is providedin Appendix A. Operation Respect, www.dontlaugh.org, publishes a listof questions and a computer download, complete with music, pertainingto “Don’t Laugh at Me” (Shamblin & Seskind, 1998). Themes that areaddressed in these questions include compassion, multicultural issues,and self-concept, among many others.

For additional information on music and other creative techniques, thereader is referred to the Association for Creativity in Counseling website(www.aca-acc.org).

CONCLUSION

Expressive techniques provide an arena in which counselors can betterunderstand ethical concepts. In addition, expressive techniques are impor-tant in helping children understand grief and loss and helping adolescentsrecognize the symptoms of depression and substance abuse. Although

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there is no technique that is “perfect,” expressive techniques have thecapability to enhance the successful outcome of counseling.

Because this manuscript focused on a small sampling of expressivetechniques, counselors are encouraged to explore books, journals, and con-ference presentations to obtain information about a variety of techniques.Counselors might review books written by Gladding (2005), Hensley andHensley (2001), Solomon (1995), Tipton and Tiemann (1993), Weddingand Boyd (1999), Wedding, Boyd, and Niemiec (2006) and book chaptersby Bradley, Gould, and Hendricks (2004) and Vernon (2004).

Although students and counselors usually give positive verbal feed-back on the use of expressive techniques in counseling, we recommendthat a written evaluation be solicited. An example of our evaluation isincluded in Appendix B. This written evaluation takes about five minutesto complete. We have found the additional information that the evaluationprovides to be very beneficial.

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RECEIVED: 12/6/2007REVISED: 2/19/2008

ACCEPTED: 2/20/2008

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APPENDIX A

Suggested Titles: Music Listening Technique

Another Day: Adams, B., & Vallance, J. (1987). [Recorded by B. Adams].On Into the fire [record]. Vancouver, British Columbia: A & M Records.

Ballad for a Friend: Dylan, B. (1962). On a Leed Music demo. RetrievedDecember 6, 2007 from http://www.bobdylan.com/moderntimes/songs/forafriend.html

Caged Bird: Keys, A. (2001). On Songs in A minor [CD]. United States:J Records.

Caribbean Wind: Marley B. (1994). On Panic attack [CD]. Carribean SoundSteel Band.

Don’t Fade Away: Perry, B. (1994). [Recorded by Dead Can Dance]. On DeadCan Dance (1981–1998) [CD]. United Kingdom: 4AD.

Dreams: O’Riordan, D., & Hogan, N. (1993). [Recorded by The Cranberries].On Everybody else is doing it, so why can’t we? [CD]. United Kingdom:Island.

Giant: Etheridge, M. (2004). On Lucky [CD]. United States: Island.I Believe: Santos, A., Santos, L., Santos, M., & Santos Jeter, H. (2002).

[Recorded by Aventura]. On We broke the rules [CD]. NY: Premium LatinMusic.

Kinder: Taylor-Good, K. (2001). On Kinder [CD]. Nashville, TN: K T GoodMusic.

The Last Memory: Ewing, S., Anderson, B., & Moore, D. (1998). [Recorded byM. Wills]. On Wish you were here [CD]. United States: Mercury.

You’ve Got a Friend: King, C. (1971). On Tapestry [record]. United States:Ode Records.

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APPENDIX B

Evaluation

Directions: Using a five point scale (1 = low, 5 = high) please list your ratingsto the 10 statements listed below.

Statement Rating

1. I enjoyed the use of expressive techniques to study counseling issues.

1. _______

2. The incorporation of expressive techniques makes it easier for me to understand the concepts.

2. _______

3. The incorporation of expressive techniques helped me to better remember the concepts.

3. _______

4. The incorporation of expressive techniques stimulated me to think of other expressive techniques that would be useful.

4. _______

5. The films used in the ethics training helped me to better understand and interpret ethical codes.

5. _______

6. The techniques used in the grief and loss training helped me to better understand grief and loss.

6. _______

7. The music techniques used for helping adolescents deal with depression and substance abuse were beneficial.

7. _______

8. The use of expressive techniques made the presentation more interesting.

8. _______

9. The use of expressive techniques in counseling helped me to have more confidence in using expressive techniques.

9. _______

10. The use of expressive techniques should be continued. 10. _______Comments: ______________________________________________________ ________________________________________________________________________________________________________________________________

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Documents

The Use of Expressive Techniques in Counseling