Expressive Therapies Institute Pty Ltd

Our training team has just expanded to include Lynette Fox (Brisbane, Cairns and Sydney courses), Monique Rutherford (Sunshine Coast, Northern NSW and New Zealand courses), Jo Ablett (Phillip Island, Victoria courses), and Kerna Thomas (Cairns). All are highly experienced ET practitioners, and have worked very closely with Mark and Helen.

The task of working through the emotional and cognitive results of difficult experiences is at the heart of the psychodynamic approach used in the ETIA style of Expressive Therapies. One of the main sources of challenges clients experience in their journey towards health and wholeness is becoming aware of the complex of issues and scripts developed through early attachment.

Attachment has been explored at length by many writers and researchers. Most notably, Bowlby (1969/1982) described attachment as having implications for social and emotional experiences throughout life. Peluso, et al. (2004) suggest that one reason that attachment theory has not been fully integrated into the therapeutic context is that there is a lack of literature applying the theory to clinical practice. Theory on the way the psyche deals with early attachment, and practical methods to support clients to work through these complexes, have been a core component of Expressive Therapies practice as developed by the founders of ETIA.

Parent child attachments - particularly in the first year of life - are seen as crucial to early brain development and affect the trajectory of development of the self (Siegel, 2005; Schore, 2002). Early attachments have been found to impact on a counsellor's style of relating and ability to develop empathy (Marotta, 2002; Trusty, Ng & Watts, 2005; Kennedy & Kennedy, 2004). This area of study is equally relevant in support of clients' attempts to resolve relational difficulties, and in counsellors' ability to offer treatment objectively. Several writers have commented on the way that attachment styles impact on the development of the therapeutic relationship (Pistole, 1989; Marotta, 2002; Trusty, et al., 2005). Through years of supervision support of new counsellors, we have observed the way that the counsellor�s 'internal working model' - or scripts - make a strong contribution to the empathic style of relating, and in fact often forms the centre of difficulties in working with particular clients.

Attachment theory is utilised in many styles of counselling and we have found it to be central in supporting clients' long-term adjustment. The ET modalities provide means to effectively facilitate discovery, communication, release and integration of the emotional power of attachment scripts.

We have been working for many years to evolve a working description in simple client-friendly language, of how these issues are generated and play out for clients.

A child�s lack of secure attachment and the experience of on-going un-met needs can contribute to the formation of sub-personalities (Stone & Stone, 1993) or scripts - what Bowlby named the 'working model' - made up of:

Two of the most impactful scripts that present in the consulting room and often need attention, develop from disruptions, inadequacies, and adaptations in early attachment. These two scripts can be summarised as the hurt inner child, and the inner critic. They are often in action together, and can lead to self-esteem and behavioural distortions, poor lifestyle choices, and unsuccessful - even damaging - drives to seek resolution of needs and win approval.

While scripts may be active in the psyche, we are usually unaware of them. They are part of the conditioning that limits fulfilment and freedom. How do these scripts develop? How do we become aware of them and their impact? How do we separate from them in order to make useful, positive choices?

Freedom from childhood scripts first requires awareness of the internal conditioning, then emotional processing of the 'unfinished business', and that we begin to notice and dislike the impact the scripts have on us. It does not support emotional healing and long-term change if there are attempts to comfort and protect the hurts of the inner child. This could be seen as handing the keys of your brand new car to a five-year old!

Emotional healing, that leads to diminishing the effects of childhood scripts, involves connecting with and working through feelings and reactions from the past, as well as the present. Processing frees energy, motivation and creativity for moving on, living with enhanced fulfilment and enabling choice. Emotional healing processes may at times involve a form of psychological and emotional open-cut mining. Processing feelings means to trace back through the layers of emotion and memory - feeling, expressing therapeutically, integrating, formulating new strategies and new directions.

Joan Abbott, Brisbane Social Worker, trained in both ET with Children and Sandplay Therapy - conducted a Qld Health funded study on the effectiveness of Expressive Therapies with seven young clients (between 10 and 18 years) who had Spina Bifida and Hydrocephalus. This was a pilot study to determine if ET would be useful for these clients. Each participated in six sessions, and the sessions included the use of: a body outline, open sandplay, integration stage, mandala.

The participants reported strengthening their personal resourcefulness. Parents reported increased maturity and independence. The research observed the participants moving from compliance to spontaneity, and they gained in creativity and curiosity. Overall outcomes included positive emotional, social and academic outcomes. We look forward to this being published in full!

Victorian teacher, Intha Chetty, has just completed a PhD project using the ET style of Expressive Writing - using sentence starters - with secondary school slow learners. The aim was to enhance writing skills and develop emotional literacy.

She found that the creative process broke down resistance to learning. She found the sentence starters effective in opening doors to constructing writing. She also explored the use of different types of background music, which proved to support focus, attention, learning and engendering a calm state in students.

Keran Thomas, of Birdwing Therapies in Manunda, Cairns now offers those addicted to symbol collecting another way to satisfy or inflame their cravings.

ET training courses aim to support counselling students in developing enhanced use of self. Research has indicated that a positive alliance between the counsellor and client is one of the best predictors of outcome (Hovath & Symonds, 1991). This alliance may be up to seven times more important than the treatment model (Krupnick, et al., 1996).

At a recent meeting of the ETIA trainers we identified some foundational concepts that inform the relational style we believe is so valuable in applying the ET modalities.

The main concepts are: 1. developing the capacity to be present; 2. feeling and conveying acceptance and compassion; 3. practicing an invitational style of relating; 4. developing practitioner self-awareness; 5. fostering an interest in empathic attunement or resonance; and 6. flowing with creativity in responding to client needs.

We have found that how we are as counsellors may be just as important as what we do. Obviously, to develop use of self and practice a more sensitive relational style, experiential training is essential.

Sitting in silence, the two of us watch as the picture emerges � perhaps mysterious at first, sometimes very familiar. The client works without knowing what the finished product will be; the facilitator holds the energy, keeping the 'space' open for the person's unconscious to keep revealing its contents.

What a privileged position as a therapist - to watch the process of transformation and healing unfold through the use of tiny symbols. The symbols have been gathered from various sources; sometimes from the local Lifeline shop, sometimes from diligent searches of flea markets and interesting curio shops, and sometimes simply from devouring copious Happy Meals.

The whole thing looks so easy � client engaged with sand and symbols, therapist watchfully holding the space and then simply talking about the story.

Sandplay work presents as deceptively simple. The whole process looks so easy and it's tempting to consider Sandplay or the use of symbols as a DIY tool or a playful way to engage in counselling.

Over the years we have both pursued our voyage of learning and discovery into using Sandplay. Buying the sandbox, sand and symbols was very easy. After the practicalities, came the advanced learning phase. What is it that happens in the Sandplay? The exchange between sandtray and client takes therapist and client into a world where pain can be ameliorated, negative energies transformed, decision-making can become creative and informed, and the spiritual journey can begin.

While Sandplay can look like child's play, there is often misunderstanding about what is actually happening during a Sandplay session. An extensive understanding of the psyche is vital. Experiential and theoretical training is essential. A context of counsellor training, skill and extensive experience makes it safe. Ethical professional application of the Sandplay Therapy technique does require extensive training!

It is now 12 years since the death of Dora Kalff - the creator of the Sandplay process, based on Lowenfeld�s World Technique. Much of the sandplay research has been conducted in the late 1980's and early 1990's, and there is a resurgence, particularly in the area of sandplay with children. It is wonderful that Kalff's first book on Sandplay has been republished in 2004!

(1) by those following Dr Margaret Lowenfeld's work, where sandplay is used primarily as a diagnostic tool, and attempt to quantify their findings (eg Charlotte Buhler, ); and

(2) by Jungian-oriented therapists who follow Dora Kalff's framework - they prefer to present detailed case studies (eg. Estelle Weinrib, Ruth Amman).

There is today a requirement of solid research on the effectiveness of therapeutic interventions. Further research on the use of sand and symbols as compared to other counselling models would be valuable. Most of the research and publication on sandplay has been qualitative and primarily supported by case studies. While there is positive research evidence applicable to Cognitive/Behavioural Therapy (CBT), we are not aware of any longitudinal studies comparing gains made with CBT and with Sandplay or ET. The extensive body of sandplay literature confirms our own clinical observations over the last fifteen years, that it has in most cases both short and long term benefits in terms of positive behaviour changes and sustainable emotional well-being. We have listed most of the studies we are aware of in our book Sandplay & Symbol Work (2001, ACER Press), and there have been several new ones since.

Kalff, D. (1980). Sandplay: A Psychotherapeutic Approach to the Psyche. USA: Sigo Press. (Re-published in 2004 by Temenos Press)

Unaddressed issues from childhood are so often the cause of our inability to fully create the life we want. In dealing with personal problems through counselling and growth work, the bottom line - that finally makes sense of the difficulties we have in claiming what we want and letting go of what we don�t want - is so often childhood scripts.

We know from the research into pre and peri-natal psychology that womb and birth experiences can have a strong impact on the way we grow, live and view the world. However, the storehouse of feelings connected with childhood scripts are usually more accessible within the counselling context than the underlying influences from birth and pre birth.

In one-on-one counselling based on Expressive Therapies theory and methods it is quite often the exciting insights about the past impact on the present, and the release of long held emotion, that provides powerful first steps in growth and change.

While we support the psyche from an understanding of all levels � biographical, perinatal and transpersonal � it is frequently the biographical level that holds the keys for first steps in breaking free, moving on, claiming re-empowerment.

Theory around the impact of childhood has been in development for many decades � Freud wrote about it, Klein focussed on it, Jung studied parental complexes, Bowlby looked at this area, and Dora Kalff had a central tenet of providing safety and protection through creating a sense of positive parent/child unity for her clients.

What has often been baffling in the psychotherapeutic and counselling profession - especially in educational settings - has been what to do or how to apply this theory. It has often seemed easier to apply behavioural techniques or cognitive techniques that deal with everyday here-and-now functioning than to address underlying intrapsychic forces.

The acceptance and expansion of Expressive Therapies methods within the Australian educational counselling community has meant that now family of origin issues, childhood dramas and traumas can be effectively dealt with using an expanded range of therapeutic possibilities.

The Institute's perspective on counselling utilises an experiential client-centred approach that aims to empower clients and counsellors through choice of modality. The philosophy of our methods is in keeping with the principles of Constructivist Psychology, where the client's personal meaning-making is highly valued. While offering a wide range of emotionally expressive modalities, we also understand the need for integration and closure techniques. We apply the theory of Multiple Intelligences in counselling, and introduce ways to support clients' growth in using self-support skills.

The many techniques that help clients externalise troubling emotions, and then gain cognitive clarity through reflection, are offered with respect for the intrinsic healing mechanisms of the individual psyche.

Spirituality: A simple, but powerful element of human nature which is available to each human being. It involves a direct, personal experience of realities beyond our limited selves, which gives meaning to our lives by adding a sacred dimension. Christina Grof: Rites of Passage (1992)

Mark's research project (Pearson, 2003) was an extensive gathering of opinions of school counsellors and guidance officers in Australia, who have trained in Expressive Therapies and Sandplay. The project illuminates the effectiveness and positive outcomes of using Expressive Therapies in school settings. Participants indicated a 65% increase in motivation to attend counselling in clients, and a 73% increase in effectiveness of their counselling work, after training in the expressive therapies and implementing these modalities.

The style of Expressive Therapies (ET) we use developed from Transpersonal and Emotional Release Counselling (TERC). It is a blend of expressive personal growth, counselling and psychotherapeutic methods. The exercises that support children and adolescents were first developed in 1987 by Mark Pearson and Patricia Nolan. Over the last eight years the style has been strongly influenced by Dr Stan Grof's Holotropic Perspective and the practical therapeutic methods for both adults and young clients used at the Institute have been further developed by Helen Wilson and Mark Pearson.

TERC was originally formulated seventeen years ago as a result of requests by several welfare agencies for group and individual counselling with severely emotionally disturbed children and adolescents. These agencies had prior knowledge of the effectiveness of expressive methods being used with adults by Pearson and Nolan. These practitioners were requested to develop adaptations suitable for counselling children and adolescents. ET training in the style taught by Mark and Helen and their staff has been underway in Australia since 1989, and in South East Asia since 2001.

This style of Expressive Therapies aims to support positive changes in behaviour, beliefs and attitudes, and to improve both the self relationship and relationships with others, through catalysing 'emotional healing' in both the conscious and unconscious levels of the psyche. ET provides many experiential exercises that promote self-awareness, self-esteem, cognitive clarity, release of troubling unresolved emotions, emotional and physical integration, and opportunities for creative problem-solving. Like the Humanistic approach, developed in the late 1940s by Carl Rogers, ET is client-centred; it values and supports client empowerment and self-discovery.

The Inner-Life Skills component of ET offers both a therapeutic and educational application and impact. It skills clients to manage their feelings through expressive activities, to access positive feelings and to construct narratives that support emotional well-being and on-going positive adaptive behaviour.

ET modalities have an activity base designed to utilise a wide range of intelligences (Gardner, 1983) and focus on developing intrapersonal awareness, emotional stability, integration and creative application of insights. The modalities include emotional release processing, body focus, dreamwork, bioenergetics, energy release games, journal writing, use of self-discovery worksheets, expressive artwork, creation of mandalas, sandplay therapy, symbol work, visualisation, gestalt role-play, relaxation, meditation and breathwork; as well as the traditional modality of developing the interpersonal relationship with the counsellor. Some of these modalities and exercises have been adapted from research and documentation of expressive therapies, and many were created by the pioneers in TERC.

Expressive Therapies have a psychodynamic focus. The exercises help clients resolve anxieties, fears and difficult emotions generated in the past and stored at an unconscious level. This resolution of past emotions helps to free the client energetically, emotionally and cognitively thus enabling the client to form rational creative choices.

Some of the underlying theoretical frameworks and modalities come from Jungian Psychology (Jung, 1964, Sidoli & Davies, 1988), Sandplay Therapy (Kalff, 1980; Mitchell & Friedman, 1994; Pearson & Wilson, 2001), Gestalt Psychology (Perls, 1969; Oaklander, 1988), Primal Therapy (Janov, 1973, 1990), Bioenergetic Therapy (Lowen, 1975; Lowen & Lowen, 1977) and Transpersonal Psychology (Grof, 1988, 2000). ET with children also has close parallels with Play Therapy (Axline, 1947, 1971; Landreth, 1991), Psychodynamic Counselling (Jacobs, 1988), and Humanistic Psychology (Rogers, 1951). References available on request.

In several of his books, Canadian professor Dr. Leslie Greenberg (1998, 2002) argues for the central role of emotion in psychotherapeutic change. His view of psychotherapeutic theory and treatment most closely reflects and illuminates the research basis of Emotional Release Processing, a central intervention in ET. Greenberg states that full awareness of emotions enhances adaptive functioning. He also argues that emotion 'schemes' (what we usually refer to as 'scripts') need to be activated in therapy in order to access intrapsychic information and make maladaptive components of the psyche available for change. This view sums up our own observations and is in harmony with several of the writers on Sandplay Therapy and Transpersonal Psychotherapy.

It is interesting that Greenberg describes how disrupted emotional processes - what has often been termed 'unfinished business' - are at the core of psychological disturbances resulting from trauma. He describes in detail the technique of allowing and accepting of emotional pain. In some fields of therapy this may seem like a radical idea, as so much emphasis has been given to bypassing or soothing emotion or attempting to combat feeling with cognition. Greenberg cites empirical support for the effectiveness of using a complex integration of emotionally focussed intervention strategies - a phrase that could sum up the ET approach.

McMain, Goldman & Greenberg (in Dryden, 1996) advocate supporting the client in full expression of emotion, and recommend following this with an integration stage. Integration is regarded as highly important in ET. It represents one of the missing elements in research on catharsis. The absence of the integration phase in the release process minimises the relevance of the findings against the use of catharsis. Counsellor skill with integration allows emotional release by clients to lead to positive outcomes. The research by McMain et al. found that clients using the empty chair methods (similar to Emotional Release Processing) were significantly more tolerant of, and confident towards, the significant other - the person who had been the focus for the process work - than those who received a simple empathy treatment.

Greenberg's Process-Experiential Approach for adults, which uses imaginal confrontations featuring a two-chair dialogue that can elicit emotional release, has been well researched. Generally, these studies report significant clinical changes in clients beyond those found in clients treated with behavioural problem-solving methods.

A basic principle of ET is that the psyche has a self-activated, inbuilt, corrective, healing drive and organising principle - referred to as the 'inner healer' (Pearson & Wilson, 2001; Grof, 2000). This drive of the psyche seeks ways to release dynamic tensions. This need for release is manifested as an attempt at emotional healing through client's acting-out or apparently irrational behaviour. ET responds to this need by providing many structured exercises for therapeutic release.

The use of the inner healer concept can also be inferred in the Gestalt approach where unintegrated contents of the psyche are described as being in the foreground of the psyche seeking closure. In Play Therapy counsellors trust in the child�s natural ability to use play to deal with relevant emotional and psychological material, without direction from the therapist. In relation to Sandplay Therapy, Allan and Brown (1993) refer to the Jungian concept of activating the self-healing force in a client�s psyche. Samuels and Rockwood Lane (1998) in proposing the use of creative media in supporting healing of hospital patients, also focus on freeing the healer within.

Grof's discussion on allowing the client's inner healer to direct the process (Grof, 2000) relates to the context of Holotropic Breathwork sessions where participants may be working in non-ordinary states of consciousness. It is a useful concept to apply to counselling, although it does not imply that the counsellor relinquishes responsibility for offering focus questions, suggesting modalities, or offering frameworks or interventions that can support the client.

Grof writes: 'I have described the 'radar function' that operates in holotropic states and that automatically brings to the surface those unconscious contents that have a strong emotional charge and are most readily available for processing. This is an extremely useful and important mechanism that saves the therapist from the impossible task of determining what are the truly relevant aspects of the material the client is presenting.'

In our training courses we focus on creating the essential supportive environment that allows the inner healing mechanism of the psyche to do what is needed. Students describe this approach as 'compassionate', 'gentle' and 'powerful'.

Resilience - the individual�s capacity for adapting successfully and continuing to function competently under stress and adversity (Howe, 2005).

According to the American Psychological Association�s website, basic resilience is developed through caring and positive relationships. Fosha (2003) claims that the roots of security and resilience are to be found in the sense of being understood by and having the sense of existing in the heart and mind of a loving, caring, attuned and self-possessed other, an other with a heart and mind of her own (p.228). The client-centred, invitational approach practised with ET can contribute to resilience-building.

To support the development of resilience aim to develop a warm accepting relationship with clients. Offer praise and encouragement; provide self-esteem-building activities; offer self-discovery opportunities; nurture client�s positive view of self and support their formulation of problem-solving methods. Offer both challenge and a high degree of emotional support.

Doyle (2000, 2003) found that a key factor in helping abused children is the presence of someone who can give the child unconditional, positive regard. Doyle acknowledged that this was advocated in the theories of Carl Rogers. Howe (2005) says: experiences of sensitive, mind-engaging and secure attachments promote resilience.

Offering choice and giving clients some control within sessions can also build a stronger sense of self. Children who believe they can have some control and attribute any success and achievements to their own abilities are likely to do better than children who believe they have no control (Doyle, 2006).

ET allows our clients to participate, construct, create, play, manipulate and control media, and observe outcomes (creations). They have tangible evidence of creativity - something came from within them.

Bolger and Patterson (2003) found that friendships in maltreated children led to a higher self-esteem, less loneliness and a feeling of greater acceptance than those without friends. This might incline us to offer group work, so that new bonds can form among participants. We have many reports of very effective bond-building occurring during the Innerspace Programs.

Howe (2005) indicates that secure children�s growing ability to 'mentalise' and to make sense of themselves and others as psychological and intentional beings provides them with high levels of resilience . This reinforces O'Brien's (2000) idea that the intrapersonal intelligence is like a hub, from which the other intelligences extend. Having new images of self supports good therapeutic outcomes (Siegel, 2005). So, making sense of self and others, using the intrapersonal intelligence, having a new view, or new image of self: all this unfolds so well with ET.

After training, and working with clients, and through collaboration with colleagues, a blend of personal growth and therapy tools was developed in 1987, and we coined the term Emotional Release Counselling (ERC). By 2000 the term we used was Expressive Therapies (ET). ET involves adaptations and new processes created from a blend of creative arts therapies, Gestalt, Jungian and Transpersonal Psychology, with an emotion-focussed psychodynamic orientation.

The common threads in this newly emerging style were a respect for, and cooperation with, the natural healing mechanisms of the psyche, and an experiential, multi-modal basis. The highly experiential nature of the therapeutic activities developed, and the depth of response from clients, seemed to stimulate increased creative thinking and enhanced confidence in trained practitioners.

In the years since I began training in experiential therapies, there have been many changes of emphasis, and many refinements in methods. In the mid 1980's there was a strong emphasis on the need to break down resistance and evoke powerful catharsis. Much of the early training I participated in involved ways to open the psyche, release blocked energy and celebrate a sense of empowerment. Dramatic emotional release was the aim, the outcome, the methodology - and perhaps the prize.

There is now a greater appreciation of the need to approach defences with respect, to allow time and create a sense of safety in order to support a gradual psychological integration. For many clients some catharsis is inevitable, beneficial, and a great relief. A central assumption in emotion-focussed therapy is that emotional expression is a vital activity in the healing journey. Over the last twenty years a broader concept has been developed that appreciates a wide spectrum, encourages respect for a wide range in depth and degree of emotional, physical and energetic expression.

For one client the flow of tears may seem a major event. For another, admitting to angry feelings may be a giant step forward. Prolonged grieving, or raging, may be natural for some time for another client. It is now clear that without following the emotional timing and natural depth of a client�s process, and without integration, without reflection on the process and a linking of individual experiences with the larger life narrative, the long-term benefits of catharsis alone are in question.

In ET training we learn by doing. We feel the benefits. We enjoy the exploration. Experiential learning develops confidence and an ability to be fluid in application of theories, principles and activities. This creativity, confidence and fluidity tends to have a dramatic impact on professional practice; supporting practitioners in attaining good outcomes with clients and a high level of professional satisfaction. It also supports an optimistic view of clients, that in turn brings forth their creativity and satisfaction with self.