The Practice and Ethics of
Using Expressive Therapies
with Traumatized Clients
Scott Pelking, MFA, MA, LPCC
Why Use Expressive
Therapies?
 Expressive therapies often provide
unexpected insight to the client and the
therapist.
 Unlike with talk therapies, expressive
therapies are difficult for the client to
hide important information—it may
come out symbolically or literally.
“Expressive methods can and do
stimulate the flow of traumatic
memories, either in the form of trauma
narratives (stories about the event) or
implicit experiences (sensory memories
of the event) because of the tactile,
kinethetic, auditory, inherent to creative
activities.”
(Malchiodi, 2008)
 Sometimes it’s difficult for clients—
especially young ones––to talk about
traumatic memories. They may do
better playing, drawing, painting, or
working in the sand tray.
 Young children think concretely. Play
therapy allows children to process
abstract occurrences into more concrete
experiences in a language they can
understand: play.
 Almost everyone connects with music. If
using songs, find and provide copies of
the lyrics. Encourage clients to bring in
or suggest songs or other music they
find meaningful.
 Some clients find it easier to
talk while they’re busy doing
something else.
Ethical Considerations
Expressive work should be
taken for what it is, nothing
more. Some clinicians read
more into the products of
expressive work than is
prudent.
“Your initial inclination will be to glance at a
sketch and start interpreting….Don’t. The one
reliable thing you can do is to see how it feels
to you. Then put it in a spot where you will
see it often for a few days.
“If you notice yourself placing phallic
references all over or negativity about one
area consistently, stop and consider yourself.
Are you inserting your experiences into the
interpretation?”
(Coles, 2003)
Use digital photo to document
sand tray scenes, art work, and
even play room constructions.
Include color prints of the photos
with session documentation.
Be careful to keep the client
out of the picture.
Be watchful for abreaction,
and be prepared to address it.
Sometimes expressive
therapy can be surprisingly
overwhelming in its effect
on the client—
and the therapist.
Know what you’re doing.
As with any other therapeutic
approach, get sufficient
training and/or supervision
before using expressive
therapy interventions.
Integrate expressive therapy
with your own
theoretical foundation.
Interventions must make
therapeutic, clinical sense in
terms of treatment.
Differences between
Dynamic and Stagnant
Posttraumatic Play
(Gil, 2006)
Differences between
Dynamic and Stagnant
Posttraumatic Play
(Gil, 2006)
Dynamic Posttraumatic Play
• Affect becomes available
• Physical fluidity becomes
evident
• Interactions with play
become varied
• Interactions with clinician
become varied
Dynamic Posttraumatic Play
• Play changes, or new
elements
are added.
• Play occurs in different
locations
• Play includes new objects
• Themes differ or expand.
Dynamic Posttraumatic Play
• Outcomes differ, and
healthier, more adaptive
responses emerge.
• Rigidity of play loosens over
time
• After-play behavior indicates
release or fatigue.
Dynamic Posttraumatic Play
• Out-of-session symptoms may
remain unchanged or peak
at first, but then
decrease.
Stagnant Posttraumatic Play
• Affect remain constricted.
• Physical constriction remains.
• Interactions with play remain
limited.
• Interactions with clinician
remain limited.
Stagnant Posttraumatic Play
• Play is precisely the same.
• Play is conducted in the same
spot.
• Play is limited to specific
objects.
• Themes remain constant.
Stagnant Posttraumatic Play
• Outcomes remain fixed and
nonadaptive.
• Play remains rigid.
• After-play behavior indicates
constriction/tension.
• Out-of-session symptoms are
unchanged or increase.
References
 Coles, J. (2003). Signals from the child: Learn to read
the secrets of drawings and refrigerator art. Denver CO:
EMBA House, LLC.
 Gil, L. (2006). Helping abused and traumatized children:
Integrating directive and nondirective approaches. New
York: The Guilford Press. Quoted in Malchiodi, C. A.
(2008). Ethics, evidence, and cultural sensitivity. In
Malciodi, C. A. (2008). Creative interventions with
traumatized children. 34. New York: The Guilford Press.
 Groke, D. and Wigram, T. (2007). Receptive methods in
music therapy. Philadelphia: Jessica Kingsely
Publishers.
References
Henderson, P., Rosen, D., and Mascaro, N.
(2007). Empirical study on the healing nature of
mandalas. Psychology of Creativity, Aesthetics,
and the Arts. Vol 1, No 3, 148-154.
Malchiodi, C. A, (2008). Ethics, evidence, and
cultural sensitivity. In Malciodi, C. A. (2008).
Creative interventions with traumatized children.
22- 40. New York: The Guilford Press.