What is expressive arts therapy and how does it combine drawing, music, movement and writing? Read how a session flows, who it may suit and what evidence says.
Some feelings arrive as a colour, some as a rhythm, and others as a tightness in the body. Some people find relief in pouring their anger onto paper in hard lines; some notice they can cry while humming the refrain of a folk song; others feel they can only breathe while walking or while opening and closing their arms. Expressive arts therapy is an approach that brings these different paths of expression together in a single process. Rather than sticking to one art form, such as drawing, music, movement, writing or enactment, it moves between them according to what the person needs in that moment. In this article we explain the core idea of the approach, how it differs from methods that work with a single art form, how a session might unfold, who it may suit, and what research says about this field.
What Is Expressive Arts Therapy?
Expressive arts therapy is an approach in which more than one art form is used for psychological support, in ways that complement one another. In this approach, the visual arts (drawing, clay, collage), music and sound, body and movement, creative writing and enactment can all be part of the same process. In the literature it is sometimes also referred to as a "multimodal" or "expressive arts" approach.
The core idea is this: human experience does not flow through a single channel. A memory can be stored as an image, as a sound and as a bodily sensation all at once. A feeling that gets stuck in one art form may find its way out through another. For example, someone who cannot bring anything out while drawing may make contact with the same feeling for the first time when expressing it through movement; then putting that experience into a few written sentences may help them make sense of it.
This approach is related to methods that focus on a single art form, such as art therapy, music therapy, dance and movement therapy and drama therapy; but unlike them, it uses movement between art forms as a deliberate tool. If you would like to learn about the approach that works with drawing and materials alone, you can read our article what is art therapy.
Why Does Moving Between Art Forms Matter?
Moving between art forms serves several purposes:
- Opening a new door: When one form of expression is blocked, another can step in. Someone who cannot draw what they cannot put into words may be able to express it through sound or movement.
- Deepening the experience: Expressing the same feeling in different forms makes it possible to see its different sides. A sharp red in a drawing may become a sudden stop when turned into movement, and the sentence "my boundary was crossed" when turned into writing.
- Adjusting distance: Some forms of expression are closer to the feeling, others further away. Movement and sound can stir a feeling very directly; writing can help a person look at it from one step back. The practitioner arranges these transitions according to the intensity the person can tolerate.
- A sense of wholeness: Body, emotion and thought meeting in the same process can help a person feel more whole.
The aim of this work is not to produce a piece in every art form, but to discover together in which form a feeling is able to breathe.
No talent is needed for this approach either. You may think you cannot sing, cannot dance or cannot draw; but no aesthetic judgement is made here. Humming a note, tapping a rhythm on the table with your fingers or drawing a single line on paper can all be meaningful expression. In our culture, many forms of creative expression are already part of everyday life: joining the halay (a Turkish line dance) at a wedding, singing an old song together around the holiday table, a mother changing her voice as she tells her child a fairy tale. This approach aims to use these ways of expression that people already know within a deliberate and safe framework.
What Happens in an Expressive Arts Therapy Session?
Sessions can be held individually or in groups. The room usually contains both drawing and painting materials and an open space for movement; sometimes there are also simple percussion instruments, scarves or writing notebooks. A rough flow might look like this:
- Warm-up and introduction: A short conversation about how the person is feeling that day, followed by breathing, stretching or a simple rhythm exercise.
- First expression: The practitioner offers an open-ended invitation. For example, "Could you show the feeling that has taken up the most space inside you this week as a colour or a shape?"
- Transition: What has been created is carried into another form of expression. "If the shape in this drawing could move, how would it move?" or "If this colour were a sound, what kind of sound would it be?"
- Putting it into writing or words: The experience is gathered up in a few sentences, a title or a short poem.
- Conversation and closing: The person and the practitioner review the process together. The practitioner does not impose interpretations; the person finds the meaning. The session ends with a calm closing so that the person can leave with a sense of safety.
Imagine a woman in her thirties who has moved to a new city and has not been able to connect with anyone at work either, and who says she feels as if she has been "uprooted". When she is invited in a session to draw this feeling, she draws a small plant at the edge of the paper with its roots hanging in the air. When she is asked to show with her body how the plant moves, she sways without being able to plant her feet on the ground. She then writes a short letter in the plant's voice: "A little soil would be enough." This sentence becomes the starting point for talking, in the following weeks, about what she needs.
Who Might It Suit?
This approach can be used across different age groups and for different needs:
- Children: For children, who naturally move with ease between play, drawing, movement and sound, this approach can offer a familiar language.
- Adolescents: Young people who find face-to-face conversation difficult may open up more easily through music, song lyrics or drawing.
- Adults who struggle to name their feelings: For people who say "I don't know what I'm feeling", trying different ways of expression can make it easier to reach the feeling.
- People experiencing grief and loss: Where words are not enough to describe the loss of a loved one, sound, colour and writing can be used together.
- People living with chronic illness or long-term stress: Body-focused work and creative expression can help support mood.
After the 6 February 2023 earthquakes, activities combining drawing, play, song and movement were widely included in psychosocial support work in the earthquake zone and in the cities to which children migrated. Volunteers singing, drawing and playing with children in tent cities, container cities and schools offered many children a safe space during a difficult period. These activities are valuable; however, it is also important to remember that there is a difference between an activity and a structured therapy process led by trained people.
In some situations this approach needs to proceed carefully and slowly. In people who have experienced severe trauma, body-focused work such as movement and sound can open up unexpectedly powerful emotions. Where severe mental health symptoms, experiences of losing touch with reality or intense thoughts of self-harm are present, creative work should only be carried out as part of medical and psychotherapeutic treatment, by people competent in the field of mental health.
What Does Research Say? The Evidence for Expressive Arts Therapy
Broad, high-quality research examining this approach on its own is limited. For this reason, it may be more informative to look at findings on its components:
- Art therapy: A review of research with adults experiencing non-psychotic mental health problems (Uttley and colleagues, 2015) found a significant positive change in mental health symptoms compared with control groups in ten out of fifteen randomised controlled trials; however, it noted that the quality of the studies was generally low. Another review examining studies from 2000–2017 also found the results promising but methodologically limited.
- Music therapy: According to a Cochrane review, when added to usual care it may reduce symptoms of depression in the short term; the evidence is of low to moderate certainty.
- Dance and movement therapy: A Cochrane review on depression found only three small studies and stated that the evidence was of low quality and that no firm conclusion could be drawn.
Studies in this field also share common limitations: samples are small, blinding is not possible because participants know what they are taking part in, measurements rely largely on self-report, and follow-up periods are short. In addition, in some studies the distinction between "therapy" and "art activity" is not clear.
To sum up: creative and expressive approaches are promising, supportive methods; but none of them replaces evidence-based psychotherapy, medication or medical treatment. The healthiest way to use them is to think of them, where needed, as a complementary tool alongside these treatments.
Multimodal Creative Exercises You Can Try at Home
The following exercises are not a course of therapy; they are creative self-care activities you can do on your own. If intense or unexpected feelings come up, take a break and share this with someone you trust.
- From colour to movement: At the end of the day, draw the feeling you have as a colour and shape on paper. Then stand up and show this shape with your body in a movement lasting a few seconds. Notice whether anything in your feeling has changed after the movement.
- From sound to words: Close your eyes and imagine what kind of sound there is inside you: a hum, a drum, silence? Hum this sound for a minute or tap it on the table with your fingers. Then write three words about this sound.
- From photograph to poem: Choose a photograph you took during the day. As you look at it, write down five words that come to mind and use them to create a short, unrhymed poem.
- From song to drawing: While listening to a folk song or a song you love, freely draw the image that comes to mind. The drawing does not need to be beautiful; focus on what the song stirs in you.
- Closing ritual: At the end of each exercise, take a few deep breaths and decide where you would like to keep what has emerged. This small ritual helps you gather up the feelings that have opened up.
If you are going to do these exercises with your child, choose curiosity over interpretation. The question "What is this movement telling us?" opens far more doors than "Why did you draw it so dark?"
When Should You Seek Professional Support?
Creative activities are a good breathing space for many people. However, talking to a mental health professional may be helpful in the following situations:
- If you have felt for a long time that you cannot express your feelings, either in words or in any other way
- If frightening feelings or memories that you cannot cope with keep coming up during creative activities
- If anxiety, low mood or anger is clearly affecting your daily life
- If difficulties with sleep, appetite and relationships continue after a loss, a disaster or a traumatic event
- If you are having thoughts of harming yourself or ending your life
If the last point applies, call 112 (emergency services) without delay or go to the nearest emergency department.
In individual therapy, creative tools such as drawing, writing or imagery can be used alongside evidence-based approaches. These tools are supportive elements that help a person recognise and express their feelings; the direction of the process is always set according to the person's needs and the pace at which they are ready. If you are curious about another creative approach that works through the stage and enactment, you can read our article what is psychodrama.
Frequently Asked Questions
Do I need to be talented for this approach?
No. In this approach, neither drawing, nor musical, nor dance skills are assessed. What matters is not how beautiful the result is, but what you experience during the process of expression.
What is the difference between art therapy and expressive arts therapy?
Art therapy works mainly with visual materials such as drawing, clay and collage. Expressive arts therapy uses music, movement, writing and enactment alongside the visual arts and makes deliberate transitions between them.
Is this approach suitable for someone who is embarrassed to dance?
It can be. Movement work is often limited to a hand gesture, a posture or the breath. No form of expression is compulsory; the person proceeds along whichever path feels comfortable.
What happens to the drawing I make or the text I write in a session?
What is created belongs to the person, and the principles of confidentiality apply to it as well. Keeping, photographing or sharing it is done only with the person's explicit permission; with children, this permission is obtained from the parent and from the child themselves.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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