1849050317

Using Expressive Arts to Work with Mind, Body and Emotions
by the same author Emotional Healing and Self-Esteem

Inner-life Skills of Relaxation, Visualization and Mediation for Children and Adolescents
Mark Pearson
ISBN 978 1 84310 224 3
Emotional Release for Children

Repairing the Past, Preparing the Future
Mark Pearson and Patricia Nolan

ISBN 978 1 84310 225 0
of related interest Foundations of Expressive Arts Therapy

Theoretical and Clinical Perspectives
Edited by Stephen K. Levine and Ellen G. Levine

ISBN 978 1 85302 463 4
Art Therapy and Clinical Neuroscience Edited by Noah Hass-Cohen and Richard Carr
Foreword by Frances F. Kaplan

ISBN 978 1 84310 868 9
Focusing-Oriented Art Therapy

Accessing the Bodys Wisdom and Creative Intelligence
Laury Rappaport
ISBN 978 1 84310 760 6
Authentic Movement: Moving the Body, Moving the Self, Being Moved
A Collection of Essays Volume Two
Edited by Patrizia Pallaro

ISBN 978 1 84310 768 2
Principles and Practice of Expressive Arts Therapy

Toward a Therapeutic Aesthetics
Paolo Knill, Ellen G. Levine and Stephen K. Levine

ISBN 978 1 84310 039 3
Self-Healing Through Visual and Verbal Art Therapy R.M. Simon Edited by S.A. Graham
ISBN 978 1 84310 344 8
Using Expressive Arts to Work with Mind, Body and Emotions

Theory and Practice
Mark Pe arson and Hele n Wil son
Jessica Kingsley Publishers London and Philadelphia
First published in 2009 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright Mark Pearson and Helen Wilson 2009
All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saff ron House, 610 Kirby Street, London EC1N 8TS. Applications for the copyright owners written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. All pages marked be photocopied for personal use, but may not be reproduced for may any other purposes without the permission of the publisher. All worksheets should be enlarged to A3 size for use with clients. Library of Congress Cataloging in Publication Data A CIP catalog record for this book is available from the Library of Congress British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84905 031 9 ISBN pdf eBook 978 0 85700 189 4
Printed and bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear
Contents
Introduction: After Weve Talked What Then?
7 13 35 65 90 129 153 202 223 248 267 289 305 308 316
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Evolution and Practice of Expressive Therapies Towards Freedom, Choice and Empowerment: Evolution of Theory Attachment, Integration and Renewal Emotions and our Body: Working with Somatic Awareness Emotion-focused Processes Expressive Writing as Emotional First Aid Exploring Art as Therapy Use of Music in Expressive Therapies Dreamwork Transpersonal Inuences: Spirituality and Counselling
REFEREN CES LIST OF ACTI V I TI ES SUB JECT I N D EX AUT HOR I N DEX
Introduction
After Weve Talked What Then?
This book has emerged from a need to update our previous literature describing expressive therapies (ET), to clarify frameworks and principles, and to share some new activities. There is an urge to communicate some of the excitement that results from an integration of study, clinical observations, creativity in adapting to client needs, and both early and recent research. This book continues a strong interest to document ET, to present them in as clear a form as possible, to explore the links with other styles of counselling, and to propose some new developments. Preference in therapeutic style is often linked to personality (Barnett 2007). The evolution of ET a client-centred, activity-focused and exible method inevitably parallels the authors personal evolution. MARKS STORY Around the age of 16, my self-assessed neurosis led to a brief encounter with a psychiatrist. Therapeutically the appointment seemed to be of no help. He questioned me, I talked a little, avoiding anything of importance, he prescribed. After we talked, what then? I had no desire to return. I felt judged, patronized, a little pathologized, and the smell of his pipe set a sense memory that lingered creating an aversion towards therapy that involved interrogation from behind a desk. The experience turned me towards what was then considered alternative therapies, as a way to attempt to understand myself and make meaning of my world. My relationship with ET may have formed in the sandtray while at kindergarten. Memories remain of sand, water, blocks, building, creating and being happy. The state of satisfaction with creating something has remained a lifelong memory and a goal. When there are long periods of
7
USING EXPRESSIVE ARTS TO WORK WITH THE MIND, BODY AND EMOTIONS
simply managing life, struggling with business activities, attending to domestic requirements, all that is required for maintenance, a creative part inside feels restless. The drive to have something to show for my time, an outcome, may well have foundations in some compensatory need. It has been suggested by many current and past writers on human growth that creativity is both a major goal in the psyche and an inbuilt drive that emerges after survival and emotional stability is somewhat assured. My innate interest in self-knowledge made itself known at that difficult time around 16, when I began to read Freud. I suppose, looking back, I was attempting to make sense of myself. This interest expanded when transcendental meditation became a regular practice for a few years. There were some genuine, yet momentary, experiences of expanded awareness, and a sense of balance and calm. At teacher training college I fell in with a group of lecturers and peers who created and shared poetry, discussed the meaning of life, studied the work of experiential psychotherapists, and explored serious pathways for growth. It was a golden age. As a primary school teacher I felt great care for my young pupils. Looking back, it seems my focus was to solve all their emotional problems. I worked hard to be a mix of teacher, grandparent and perhaps therapist, constantly assuring them of their worth and trying to inspire them to feel good about themselves as well as enjoy learning. As exhaustion took hold, a friend suggested I might need to look at the projection of my needs onto others. This hit like a thunderbolt. How could I quickly resolve childhood and move on, in a constructive, self-caring way? This led to seeking some therapeutic help. I had worked with intensive relaxation, massage, meditation, sacred dance, philosophy, Reichian de-armouring, and solo attempts at primal screams. But I had not found a way to open my emotional defences, to begin the work of clearing the residue from early years. After leaving teaching I indulged my interest in food, running cafs and restaurants for several years. What I discovered was that a restaurateur has to cater to the emotional needs of patrons. It became apparent that our team had to resolve marital disputes, heal relational tensions, and bring families together through the provision of good food, a pleasant ambience and friendly banter. Through this time I continued an interest in personal growth. There were moments when balance, clarity, insight and contentment emerged. Of course these moments of harmony were quickly whisked away by some difficult domestic exchange, or through the helplessness of being a new
INTRODUCTION
parent. There were many opportunities to create. But there was not a clear focus for the future, a direction, a deeply fullling way to live and work. Arriving at the age of 36, I was still wondering what I would do when I grew up. My rst experiences with sandplay therapy, dreamwork, the use of art, breathwork therapy and emotional release processes left no doubt about my future. I felt that at last I had found direction. HELENS STORY Why am I involved in writing this book? Ive asked myself that question many times over the last 12 months sitting, as I do, chained to my laptop, which has now become my constant companion. Picnics, visits to the river, late nights, early mornings, weekends away, have all become times to sit, ponder and write about what it is in ET that has been so useful for my personal journey and professional life. The creative arts was an area of endeavour I wanted to ignore but I could never quite avert my interest after feeling scarred somewhat by having unceremoniously failed art as an impressionable 11-year-old schoolgirl. What was more pressing than my interest in the arts, though, was the emotional turmoil and pain I lived with for much of my life. It seemed I was one of those kids who was just too sensitive and too concerned about the deeper mysteries of the universe. Like a sponge I soaked up lots of inuences my siblings seemed to take in their stride and regard as normal. Anxiety, uncertainty, helplessness and darkness became constant companions in those years of young adulthood. Some time in therapy brought very temporary relief but soon my old companions took over once again. In my early 30s parenting brought everything to a nal, screeching halt, and I realized I needed help. Verbal therapy just wasnt working for me and after another year or more of working on my issues, hoping the pain would stop, it felt as though I had failed again to get it right the art experience all over again! Then I had one of those 180-degree turns that life presents a corner I didnt see coming and I found myself yet again at the door to the therapy room. Some people might call this an epiphany. For me the events of that time represented the end of my identity as I had known it, and at the same time the beginning of a whole new life. In this crazy, tumultuous place, being introduced to experiential creative therapy was like opening a window on a whole new sunny world. I often tell students that I would love to be able to say that I had researched all the available therapeutic frameworks, considered which one offered the best outcome, and nally chosen ET on the basis of an in-depth, fact-nding mission. But I cannot say that suffering and emotional strain
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made me begin a non-negotiable exploration of what ET had to offer. What I can say is after that rst session I knew I was going to make it! Life and my world quickly began to look very different. ET AND US After our training, working with clients, and close collaboration with colleagues, a blend of personal growth and therapy tools began to develop. Originally categorized as emotional release counselling (ERC), by 2000 the term we preferred to use was expressive therapies (ET). ET involves adaptations and processes created from a blend of creative arts therapies, emotion-focused approaches, Gestalt, Jungian and transpersonal psychology, with a psychodynamic orientation. The common threads in this newly emerging style were use of an experiential, multi-modal framework and respect for, and cooperation with, each persons innate healing mechanism. The highly experiential nature of the therapeutic activities, and the depth of response from clients, stimulated our creative thinking and our interest to keep exploring, for the next two decades, what it was about our approach to ET that worked, and how and why it worked. In the years since we began our own training as therapists and trainers, there have been many changes of emphasis, and many renements in methods. In the late 1980s there was a strong focus on working towards breaking down resistance and evoking powerful catharsis. Much of our early training involved techniques that purported to open the psyche, release blocked energy and celebrate a sense of empowerment. Dramatic emotional release was the aim, the outcome, the methodology and the prize. We have been extremely fortunate in being able to follow our individual and collective passions in adapting the ideas of greater minds, sharing think-tank times with colleagues, and creating a package of techniques that, from the reports of clients and students, have been helpful in transforming pain into peace, and trauma into tranquillity. The result has been the privilege of working with and supporting many wonderful people who live life fully, with less fear and anxiety even with all its ups and downs. We now have a greater appreciation of approaching defences with respect, allowing time and creating a sense of safety in order to support gradual, digestible psychological integration. For many clients some catharsis is inevitable, benecial, and a great relief. A central assumption in our approach is that emotional expression is a vital activity in the healing journey. Over the years respect has been growing for the wide range in a clients preferred depth and degree of emotional, physical and energetic expression. The importance of time and activities
INTRODUCTION
11
to support cognitive integration has become clearer. Experimenting and discovering the ease with which ET can be tailored to individual clients, families, couples, children and adolescents has been a great reward. Perhaps we could say our clients have been patient, skilled teachers! For one client the ow of their 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 clients process, and without integration, without reection on the process, and linking individual experiences with the larger life narrative, the longterm benets of emotional release are diminished. We have acquired much more respect for individual difference, while appreciating the environmental interactions each of us is part of, understood more about other theoretical frameworks, and reached an unshakeable trust in the unique way that an individuals growth unfolds. One of the starting points of Western psychotherapy involved exploration by Freud and his colleagues, of the use of catharsis with patients (Guinagh 1987). Freud observed that strong emotional release brought benets in terms of relaxation and resolution of extreme emotional states (Guinagh 1987). Theories of emotional and energetic release have moved between the foreground and background of psychotherapeutic thinking since then. Some non-Western cultures have long traditions of healing rituals that evoke cathartic release and expand consciousness. For example, the allnight re dance of the !Kung Bushmen of the Kalahari, based on an ancient tradition of sacred songs and rhythms handed down from the wise women, brings forward both cathartic and awareness-expanding experiences that dramatically contribute to individual and communal healing and cohesion (Katz 1982). Between us we have around 40 years of personal experience with these modalities, consulting colleagues, being supervised, conducting supervision, undertaking further study, and of course endless reading and research. We have created and directed the Expressive Therapies Institute of Australia, providing specialized extension training and personal development with ET, around Australia and New Zealand, and introduced ET into Singapore and Malaysia. We have worked with counselling students and with highly qualied and experienced practitioners in many settings and many cultures. The life of a counselling trainer is one of lifelong learning. At the start of the journey of developing these methods, of testing, combining and evolving experiential psychotherapeutic activities, there was little in mainstream literature that reected our early observations and inclinations.
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There was, of course, the inspiration from reading about Janovs theories that were fundamental to his primal therapy methods; Fritz Perls dynamic dreamwork; Jungs optimistic approach to the personal and collective conscious; Dora Kalff s reassuring condence in sandplay therapy; and above all our experiences and training in holotropic breathwork and transpersonal psychology with Stan Grof. Stan and Christina Grof s vision of transpersonal psychology has made a major contribution to our understanding of psychological processes. All these inuences, methods and theories supported our application of a core principle in ET of meeting a client where they are, and beginning therapeutic work in a way that is most appropriate for each client. This book outlines many of the foundations, principles, methods and activities of this somatically oriented, emotion-focused, creative form of expressive therapies. It includes a variety of material from clients (whose names have been changed when specically referred to). The book is, in many ways, a replacement for the earlier works Emotional First-aid for Children (Pearson and Nolan 1991), Emotional Release for Children (Pearson and Nolan 2004), Emotional Healing and Self-esteem (Pearson 2004) and The Healing Journey (Pearson 1997). Detailed information on sandplay therapy is not included in this volume, although it is one of the most popular and effective therapies used in the ET framework. For information on our approach to sandplay therapy and symbol work see Pearson and Wilson (2001). May you enjoy this book and the synthesis of methods new and old. May it excite your passion about the helping profession, may it contribute to a continuing search for sensitive, appropriate and effective ways to meet the therapeutic needs of clients, and the need of therapists to be sustained, stimulated and creative in their daily work. Mark Pearson and Helen Wilson Fremantle, Western Australia March, 2009
Chapter One
Evolution and Practice of Expressive Therapies

A CLIMATE CHANGE IN COUNSELLING? This style of expressive therapies (ET), with an extensive range of activities developed primarily by the authors, is an integrated collection of processgenerating, growth-focused, change-oriented, creative techniques designed for use in counselling, psychotherapy and personal growth. While this approach acknowledges an extensive debt to creative arts therapies (art therapy, music therapy, movement therapy) and expressive methods from both ancient arts and contemporary healing practice worldwide, it carries signicant emphasis on emotional and somatic processes, and practises with a great sensitivity to the psychological rights of a client. This chapter discusses the evolutionary process of this unique brand of ET. Originally referred to as emotional release counselling (ERC), the more generic term expressive therapies (ET) is now widely used to designate this coordinated, creative and effective treatment approach. Originally (Pearson and Nolan 1991), use of the words emotional release accentuated the highly expressive nature of many of the activities. And while emotional release is one outcome, as practice has evolved over the last 20 years there has been more informed recognition of the need for integrating emotional expression with somatic experience and cognitive insight. With specic principles and frameworks that unify what may appear at rst to be an eclectic mix, ET offers a comprehensive way of supporting psychological and emotional well-being. As a result of requests in 1987 by several welfare agencies for group and individual counselling for severely emotionally disturbed children and adolescents, the formulation of ET began. Staff of these agencies had become aware of the effectiveness of expressive methods used with adults, and asked about the possibility of developing a programme that adapted the experiential processes for use in child and adolescent therapy,
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14
especially with their client population. The result was a wide range of agespecic activities known generically as expressive therapies that are now routinely used with clients from about six years of age onwards. ET is an approach to psychotherapy and counselling that encourages client interest in self-discovery, and views change as a result of intrapersonal processing. ET principles have an emphasis on working through challenging emotional distress as a way to develop emotional resilience. The core principles underlying the techniques were inspired by the work of pioneers in the eld of experiential psychotherapy, including, in particular, Carl Jung, Stanislav Grof, Fritz Perls, Dora Kalff, Leslie Greenberg, Virginia Axline, Helen Bonny, Harriet Wadeson, and more recently the new understanding from neuroscience from the work of Alan Schore, Louis Cozolino and Daniel Siegel. Over 20 years ago the present authors began working with expressive modalities for themselves, researching through the lived experience the effectiveness of the methods, and gaining insight through peer support. Since then the proactive tools for reection, self-awareness, externalization, emotional release and emotional integration have been developed and enhanced, and the development of a safe, secure therapeutic alliance has been found to be a prized key ingredient. The exercises, frameworks and guidelines introduced here have been in clinical use and development since 1987. The processes that now form the extensive repertoire of the welltrained expressive therapist have been developed from an ever-expanding understanding of the human psyche. This understanding has been gained by merging extensive personal experience in the client role with a study of the pioneers in experiential therapies, and integration of contemporary, emerging neuroscientic research. THE HEART OF THE MATTER CORE MODALITIES Expressive therapists have at their disposal an extensive range of activities from which clients can choose the ones they think will be most helpful. Core techniques used include self-awareness and somatic awareness exercises, emotional release processes, energy release games, individuation processes, body focus, emotional mapping, expressive writing and use of journals, self-discovery worksheets, expressive artwork, process drawing, use of mandalas for integration, sandplay therapy, symbol work, bioenergetics, movement exercises, use of music, role-play, dreamwork, visualization, relaxation and simple forms of meditation. Some of these activities have been inspired and adapted from the literature on experiential therapy; however, many of the unique adaptations and some of the specic modali-
EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES
15
ties, such as body focus exercises, symbol work, emotional release processes and self-discovery worksheets, were created by the present authors. ET provides both therapeutic and psycho-educational benet. In addition to anticipated therapeutic outcomes, ET simultaneously aims to develop long-term skills that enable clients to regulate their emotional responses more capably during times of stress. The inner-life skills (ILS) of ET (Pearson 2004) offer both therapeutic and educational components. These skills include developing emotional literacy, building resilience and regulating feelings through expressive activities. ILS provide multiple ways that can assist a client with construction of new personal narratives. Those same tools operate as the groundwork for reconstruction of that narrative in support of emotional well-being and ongoing positive, adaptive behaviour. Encouraging healthy self-awareness, cognitive clarity and creative, positive problem-solving, and providing opportunities for safe release of distressing unresolved emotions, aids emotional and physical integration and well-adjusted self-esteem. As clients utilize these skills they both grow and change, they heal and learn for the future. ET AND THE THERAPEUTIC ALLIANCE ET is client-focused, valuing and supporting client resilience and selfdiscovery. This growth-focused approach includes offering choice, invitational relating, working to build a sense of rapport and trust between client and counsellor and remaining aware of the emotional proximity from which a client can successfully address distress and challenge. It aims to support positive changes in emotional states, behaviour, beliefs and attitudes, the purpose of which is interactional effectiveness in both the selfrelationship and relationship with others. Using ET achieves this through combining an affinity with the personcentred approach developed by Rogers (1951) with experiential changeoriented techniques offered by counsellors who have acquired relevant skills in invitational relating and safe, supported emotional release. In practice, a clients distinctive psychological and emotional healing impetus is assessed and used as the basis for determining the pace and direction of the therapeutic process. Rogers called this the actualizing tendency (Bozarth 1991, p.45). The customary counselling tool of developing and maintaining the interpersonal relationship between counsellor and client is highly valued in ET and used as a focus before, during and after a client engages in any specic activity. Only when there is a stable level of trust and rapport with the therapist can clients prepare to tap into deeper underlying issues, resolution of which may be pivotal to a positive therapeutic outcome.
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Throughout the evolution of this form of ET, there has been increasing application of a constructivist-related view of client development. Dale and Lyddon (2000), for example, point out the extensive links between contemporary constructivist theory and the theory and practice of sandplay therapy. A constructivist style of therapy is personal rather than authoritative, aiming at being creative rather than corrective, with a focus on meaning-making and personal development (Neimeyer and Mahoney 1995). The constructivist style of empathic grasping of the clients outlook, and treating emotion as something to be respected rather than controlled, mirrors the approach of ET-trained counsellors. Developing an invitational relationship with clients is central to an ET therapists practice framework. Inviting, rather than directing or instructing, represents a subtle yet powerful enhancement of both the therapeutic relationship and the degree of client motivation to participate in the process. Each time a client is given an option to discuss, express, stay with or go deeper, leave a subject, and choose a modality or topic of focus, they have the right to make the decision to participate or not. The decision to engage becomes theirs, offering some measure of feeling in control of events. Coping (defence) mechanisms are respected as having been vital to survival or an integral part of identity. If a client chooses not to participate, or responds to the therapeutic setting in a hostile manner, the calm accepting manner of the counsellor aims to allow time to re-establish a sense of connection. Baloche (1996) also found that giving clients choices added signicantly to their creativity and motivation to participate. The decision to open up, share, reveal, become vulnerable, move on, is a clients. This may seem heretical according to some practice frameworks. However, the authors have found that where a trained facilitator supports choice and remains open to a clients direction, within a genuinely empathic environment, that individual can experience a sense of briey regaining directorship of their life. ET therapists aim to relate in a way that minimizes the dynamic in which the therapist or therapy becomes another factor against which the client tries to pit their strength. WORKING WITH EMOTIONS Working directly with emotions is a core activity in ET. Emotions are recognized as a driving force behind thoughts, behaviours, beliefs and self-care. In principle, the key focus is that activities, attitudes and emotions from the past which are an active force in the psyche, along with present reactions can be felt, mobilized, released safely and understood. Emotional expression, when followed by integration activities, results in a stronger connection to self and a clearer, more direct, relationship to those
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around us. Once clients become less emotionally charged, they can be supported to easily recognize creative strategies for problem-solving. Flowing with a clients choice of technique, being prepared to engage with a clients preferred intelligences, and becoming aware of a clients level of involvement, provides a safe holding environment. ET encourages a therapeutic alliance that fosters client empowerment and self-responsibility. Working with emotion directly has been extensively described and researched by Greenberg and colleagues (Greenberg 1998, 2001, 2004; Greenberg and Webster 1982; Greenberg, Watson and Lietaer 1998). Greenberg (1998, 2001) argued for the central role of emotion in functioning and in psychotherapeutic change. This view of psychotherapeutic theory and treatment underlies the emotional release processes that are a central intervention in ET. Greenberg (1998) stated that full awareness of emotions enhanced adaptive functioning. He also argued that emotion schemes needed to be activated in therapy in order to access intra-psychic information and make maladaptive components of the psyche available for change. Disrupted or incomplete emotional processes are usually at the core of psychological disturbances. Completing emotional expression is often at the core of psychological healing. Similar to ET, Greenberg described the technique of allowing and accepting of emotional pain (1998, p.47). He cites empirical support for the effectiveness of using a complex integration of emotionally focused intervention strategies (Greenberg, Watson and Lietaer 1998, p.48). The ET technique of creating imaginal encounters has many similarities with Gestalt empty chair techniques, which McMain, Goldman and Greenberg (cited in Dryden 1996) found to be the most effective method for working through unresolved emotional experiences referred to as unnished business McMain et al. (in Dryden 1996) found that clients using the empty chair methods were signicantly more tolerant of, and condent towards, the signicant other who had been the focus of the process work than those who received a simple empathy treatment. Greenbergs emotionfocused approach for adults, which uses imaginal confrontations featuring a two-chair dialogue that can elicit emotional release, has been well researched (Clarke and Greenberg 1986; Elliott et al. 1990; Greenberg and Webster 1982; Lowenstein 1985; Paivio and Greenberg 1992; Wiseman 1986). Generally, these studies report signicant clinical changes in clients beyond those found in clients treated with behavioural problem-solving methods. The description of the stages and steps for applying this technique, as outlined by McMain et al., corresponded with the stages of sessions recommended by the ET approach. Integration is regarded as crucial in ET sessions where emotion-focused activities are offered. McMain et al. (in Dryden 1996) advocated supporting
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a client in full expression of emotion, and recommended following this with an integration stage. The concept of integration after experiential processes represents one of the missing elements in research on catharsis. The absence of the integration phase in the release process minimizes the relevance of the research ndings against the use of catharsis. Counsellor skill with integration allows emotional release by clients to lead to positive outcomes (Pearson and Nolan 2004). EMOTIONAL HEALING ET includes a range of experiential approaches that can explore the emotional, somatic and attitudinal patterns behind conicts, difficult behaviours and attitudes towards self. Many of these causes originate in the past and may not be conscious. They can have a negative effect on the way we live, often causing unfullling, and even destructive, emotional and relational patterns. This impact is seen in the acting-out that often leads children into conicts at school and at home, or leads adults into marital conicts, and signals a need to work with a counsellor. Many researchers have investigated the problem of why and how interpersonal deprivations and failures early in life attachment issues establish a foundational matrix for a personality that would be at risk of later violent or aggressive behaviour (Dozier, Stovall and Albus 1999; Schore 2002). Mindful of the match between what the client is seeking and what therapy offers, ET focuses on emotional healing, with the degree of involvement in emotion-focused processes being determined by a range of factors, the most important among them being the clients stage of readiness. AN IN-BUILT MECHANISM FOR HEALING A basic principle of ET is that the psyche has a self-activated, inbuilt, corrective, healing drive and organizing principle referred to as the inner healer (Grof 2000; Pearson and Wilson 2001). This drive of the psyche seeks ways to release dynamic tensions, and this need for release is manifested as an attempt at emotional healing through acting-out behaviour. ET responds to this need by providing many structured exercises for therapeutic release. (See more in Chapter 2.) Like many developments in psychotherapy and counselling that have evolved over the last 40 years, ET has an intra-psychic focus and supports exploration of, and a reconnection between, body, mind and feelings. It can also activate the innate healing potential in the psyche, the autonomous healing tendency rst described as individuation by Jung (Fordham 1991 [1953]). Cooperation with the natural movement within the psyche towards healing and wholeness is paramount in ET. The concept of an
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innate healing drive towards expulsion of foreign, disorienting material in the psyche informs the theory and practices of play therapy, sandplay therapy, Gestalt therapy and transpersonal therapies. This concept has echoes of Rogers self-actualizng tendency as a force that strives to move us towards fullment, differentiation and constructive social behaviour (Bozarth 1991). 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 (Perls 1969b). In play therapy trust in the childs natural ability to use play to deal with relevant emotional and psychological material, without direction from the therapist, is viewed as crucial to the process (Axline 1989 [1947]; Landreth 1991). In relation to sandplay therapy, Allan and Brown (1993) refer to the Jungian concept of activating the self-healing force in a clients psyche. Samuels and Rockwood Lane (1998), in proposing the use of creative media in supporting healing of hospital patients, also endorse freeing the healer within (p.2). The person-centred ideas of Carl Rogers have taken a central place within the family of therapeutic approaches since the late 1940s. The person-centred ideology that Rogers (1951) proposed makes immediate sense when working with neglected or disempowered clients. Rogers distinguished between therapists who agreed with the person-centred principles in theory, and those who through self-development were able to actually embody this approach, to embrace person-centredness at an operational level (Rogers 1951). Taking on board the concept of embodiment of the principles from which a therapist works, one advantage of the experiential training of ET is extensive in-depth practice in developing an operationally sound allegiance with a growth-focused, person-centred approach. THE ATTRACTION OF EXPRESSIVE THERAPIES Creating grounded, secure rapport, and providing treatment that works for an individual client in the words of Duncan and Miller (2006), applying practice-based evidence has been argued by those researchers to be much more valuable than comparing approaches. Waschbusch et al. (2002) argued that failure to distinguish disparate aspects behind the development of aggressive and antisocial behaviour contributed to misconceptions about the origins of aggression and its developmental pathway. The possibility of using active (even seemingly aggressive) behaviours to resolve intra-psychic tension may seem to some an unpalatable concept. Since behaviour is driven by both conscious and unconscious impulses, it is useful to allow all causes to emerge within therapy, and be worked through.
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If the focus remains one of seeing the client as having some form of pathology, then it is difficult to think beyond this image. In ET, responsibility is viewed as something which a client may not have been adequately prepared to assume, due to adverse life experiences. They may have an overload of intra-psychic pain where automatic defences re up to avoid further emotional suffering. Using expressive therapies activities means that a therapist has tools at his or her disposal to help create a connection with a client. ET offers interventions that meet a client where they are whether that client feels helped by the therapist who, from witnessing the creation of a written activity or drawing, can feed back an accurate assessment of how the client is feeling; whether they feel helped when the therapist sits silently in resonant observation while the sandplay is constructed, then conveys a sense of feeling what the client feels; or when the activity chosen is one that helps build a sense of a therapeutic alliance containing core Rogerian principles (Bachelor and Horvath 1999). A rationale for including expressive therapies as a highly effective tool in the professional repertoire is encapsulated by outcomes-related factors cited by Synder (1997, p.82). ET can: awaken dormant creativity reach clients through artistic expression of what lies within lead clients to a better understanding of their unconscious be a means for accessing hidden resources provide clients with a vehicle for expressing internal conicts.
In addition, Synder cites a range of researchers such as Amster (1943); Arlow and Kadis (1993); Burns and Kaufman (1972) who have documented expressive arts capacity to relieve stress, pressures and tensions, often changing negative aggression into positive energy (see more on the use of art in Chapter 7). ET AND FACTORS COMMON TO EFFECTIVE COUNSELLING ET contributes to positive therapeutic outcomes in many ways. Recent research into the effectiveness of the therapeutic alliance (Hubble, Duncan and Miller 1999) argued that there are four key therapeutic factors that combine to account for 100 per cent of positive outcomes for clients. Building on the work of Lambert (1992), these researchers claimed the principal elements were: client extra-therapeutic factors factors inside the client and within their lived experience outside the therapy room; relationship factors specically, the quality of therapistclient relating; placebo,
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hope and expectancy referring to a clients positive expectation of achieving change from seeking help; and model/technique factors relating to the particular therapeutic technique and theory base. Client/extra-therapeutic factors include the clients strengths, supportive elements in the environment, and even chance events. These factors are what the client brings to therapy and what inuences their lives outside therapy. Lambert (1992) estimated that these factors accounted for 40 per cent of outcome variance. ET is a strength-based approach, helping clients arrive at connection to strengths after working through weaknesses and attachment challenges that may incline them to believe they have few strengths. The wide range of ways used in ET that help a client open up and talk about their outer and inner life can lead them to bringing forward, in the counselling room, their unique qualities, many of which will seem to be rmly in the background by the time they seek or are forced into counselling support. Common factors across therapy styles include the relationship variables. Lambert found that 30 per cent of successful outcome variables could be attributed to caring, empathy, warmth, acceptance, mutual affirmation and encouragement of risk-taking. The ET use of a person-centred and invitational relational style where clients are often provided with a range of choices about topics, modalities and depth of process has been observed to quickly create positive counsellorclient rapport. Pearson (2003) found that after introducing the use of ET in schools, counsellors reported a dramatic improvement in counsellorclient rapport. Placebo, hope and expectancy were found by Lambert to contribute to 15 per cent of outcomes. These factors are linked to the client being aware of treatment, the credibility of the counsellors rationale and techniques. In the early stage of the counselling process, expressive therapists may deliberately offer an activity that would revive the clients hope of change, and provide some early evidence of positive change. This contributes to the clients positive alliance, and their willingness to face more challenging issues. Lambert suggests that the fourth factor the model and technique also contributes about 15 per cent to positive outcomes. Large sections of this book will provide descriptions, examples, documentation, research, and the authors observations on the value of the ET techniques and the way various models are woven together to create the background framework. EVOLUTION OF ET PRINCIPLES The underlying theoretical frameworks and modalities of ET have been developed from research, experiential involvement, and training with
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Jungian psychology (Fordham 1991 [1953]; Jung 1964; Sidoli and Davies 1988), sandplay therapy (Ammann 1991; Kalff 2003 [1980]; Mitchell and Friedman 1994; Pearson and Wilson 2001), Gestalt psychology (Oaklander 1988; Perls 1969a, 1969b), bioenergetic therapy (Lowen 1975; Lowen and Lowen 1977), transpersonal psychology (Boorstein 1997; Cortright 1997; Grof 2000), emotion-focused therapy (Greenberg 1998, 2001, 2004), and humanistic psychology (Maslow 1968; Mearns 2003; Rogers 1951). ET has much in common with Axlines play therapy (Axline 1989; Landreth 1991), with art therapy (McNiff 2004; Robbins 1980; Wadeson 1995), and in a more indirect way, music therapy (Bonny 1973). ET modalities have an activity base designed to utilize a wide range of intelligences. This construct is in keeping with Gardners (1983) model of multiple intelligences (see more in Chapter 2). ET techniques focus on developing intra-personal stability, emotional awareness and regulation, integration and creative application of insights. Drawing on the psychodynamic model (Jacobs 1988), therapeutic work revolves around resolution of long-held feelings, anxieties, fears and distress generated in the past and often stored at an unconscious level. This resolution of incomplete emotions helps to free the client energetically, emotionally and cognitively. The outcome is an increased ability to formulate more creative rational life choices. So, ET is a somatically based, emotion-focused, individuation accelerating, person-centred, experiential, creative arts-based, transpersonal approach to counselling and psychotherapy. The leading style is determined by the clients need and preferences. After learning all the principles, skills and activities, after personally exploring the methods, after learning how to construct a solid session plan, and after practising being present to clients, ET calls us to let go and meet the client where they are, and learn from them the best way forward. The theory and practice of ET are presented within a context of respect for a clients essential spiritual nature. While no spiritual or religious frameworks are introduced in the ET counselling relationship, expressive therapists maintain an openness to supporting clients to explore this realm if it unfolds organically. It is not unusual for clients using sandplay therapy, for example, to eventually create scenes that contain images of a core spiritual nature and to naturally initiate conversation about these concepts (Weinrib 1983). Gardner (1993) has hypothetically labelled the human interest and ability in the spiritual nature of existence as existential intelligence. Inclusion of the principles of transpersonal psychology (Boorstein 2000; Cortright 1997) in the ET paradigm and the counsellors practice framework offers a broader scope for relating with a client.
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PUTTING PRINCIPLES INTO PRACTICE The combination of action methods that constitute ET practice can be categorized into several focal areas: building connection, developing selfawareness, processing emotions, transformative learning through use of symbol and metaphor, enhancing self-esteem, supporting integration, and developing emotional literacy and inner life skills (ILS).
Building connection
Acknowledged as perhaps the most critical activity in counselling and psychotherapy (Lambert 1992; Wampold 2001), activities to build connection are most relevant in initial consultations and the opening phase of subsequent sessions, specically in developing the therapeutic alliance, extending emotional literacy and encouraging clients to talk about themselves. Connection-building activities include discussion questions, body awareness exercises, use of music (for developing emotional literacy), and writing and drawing as a stimulus for communication.
Developing self-awareness
Strengthening the capacity to self-reect can be achieved, with relative ease, through activities that encourage use of the intra-personal (emotional) intelligence. Counsellors can support this strengthening through increasing client alertness to somatic responses, helping them become more receptive to acknowledging affect, and becoming more aware of beliefs and cognitive patterns. Specic self-awareness activities include use of relaxation, body focus with emotional mapping, expressive writing prompts, exploring dreams, and use of symbols and metaphor to illustrate internal states.
Processing emotions
Expressive use of body, mind and feelings allows completion of unprocessed and unexpressed reactions, using projective externalization followed by integrative activities. Activities that can be used to catalyse emotional processing include: energy release games that use sound and movement, bioenergetic exercises, creating dialogues with imaginary encounters. Drawing, music and symbols can also serve to support release of emotions.
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Transformative self-learning through use of symbol and metaphor

This category of activity involves concretizing and expressing internal states using symbolic forms. This is particularly useful with children and traumatized clients who may initially prefer to deal with issues at a distance. The use of symbols (miniatures) in sandplay therapy, directed symbol work, role-play, fantasy art, dreamwork, along with self-discovery worksheets that engage a client in using metaphor to link awareness with previously obscure experiences, can enhance self-learning and communication.
Enhancing self-esteem
This category of activity is offered both in early stages of getting to know a client to support a positive start to the therapeutic process, and at the termination phase to consolidate previous work and complete with a future focus. Promoting healthy, positive self-esteem, nding language for positive aspects of self, provides focal points for these activities. Modalities used this way include visualizations, use of symbols to denote positive personal assets, role-play and exercises to support reconstructing life narratives.
Supporting integration
Throughout the therapeutic relationship, and most particularly toward the end of a session that involves spontaneous or planned emotional arousal (with subsequent managed expression), there is a strong focus on integration activities and closure. Integration activities are designed to support linking right-brain experience into left-brain language. They support a connection between mind and body, and also reinforce the boundaries between process and everyday relating. This important category uses reection (verbal and written), completion drawings, relaxation, a focus on problem-solving and planning, and meditative visualizations.
Inner life skills a path to emotional literacy

Some of the tools used in ET to develop emotional literacy include: selfdiscovery worksheets, body outlines, mandala artwork, feeling word lists, texture examples and words, use of colours, lines, shapes, and use of recorded music and music creation. Informal feedback from practitioners using these tools over many years indicates that a client (and group participants) rapidly develop a sense of optimism and condence about self and about communicating emotional experience when they gain emotional literacy skills.
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The skill of emotional literacy requires some competency in understanding the application of what Gardner (1993) identied as the intra-personal intelligence. Gardner dened intra-personal intelligence as knowledge of the internal aspects of a person: access to ones own feeling life, ones range of emotions, the capacity to effect discriminations among these emotions and eventually to label them and to draw upon them as a means of understanding and guiding ones own behaviour (Gardner 1993, p.24). The present writers have observed that the more experienced a client becomes with intra-personal exploration, the more effective and sustainable are therapeutic outcomes. Providing options for choosing from an array of tools for emotional literacy supports nding and making use of a clients individual, preferred intelligence. When access to experience is directed through the preferred intelligence/s, the person is more able to communicate openly, express more freely, process, learn and understand (OBrien and Burnett 2000a). The use of experiential methods can develop intra-personal skills in the client that may be useful throughout life. ILS provide improved means of dealing with personal issues, and access to the intra-personal intelligence. Ability with ILS is reinforced as clients repeat some activities and reect on their process of growth and change over a period of treatment. Engagement with ILS in everyday living outside the session room provides an adjusted, more optimistically focused template for interacting with the outer environment. There are three main categories of ILS that can be acquired both directly and indirectly during the exploration of ET activities: 1. intra-personal self-focus skills that deal with the world of emotional literacy and affect, imagery, belief, attitudes, body awareness 2. interpersonal focus on others and relating, what happens between me and others 3. transpersonal beyond the individual psyche; engaging existential intelligence, dealing with metaphysical/spiritual experiences and concepts.
Intra-personal skills
Primarily for relating to and understanding self, intra-personal skills include: self-awareness and self-knowledge through somatic focus, focusing on emotions, observing positive and negative beliefs about self, sensitivity to energy, and the ability to work with and employ relaxation, visualization, imagery and symbols.
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Skills for relating to the inner world can be developed through dreamwork and exploring symbolic imagery, reviewing behaviour and beliefs with guided reection, developing personal mythology, awareness of cultural inuences and cultural mythology. Relating to and dialoguing with the less known levels of the psyche might also include connecting with intuition or inner guidance. Self-expression and communication skills, or emotional literacy, include the ability to sense and locate emotions in the body, recognize and name emotions, communicate about them, speculate about causes and express or process them in a suitable way. Ability with emotional literacy supports emotional healing, therapeutic release, the integration of emotional experiences, and the ability to regulate expression of feelings beyond the therapy room. Emotional literacy contributes to the speed with which rapport can be established in counselling sessions and in groupwork. Clients can learn to use symbols as a source of creativity, self-understanding and expanded communication. In the area of art they may develop abilities to use line, colour, shape and images for self-discovery and communication. Skill with written and spoken words is supported with verbal and written prompts. Clients are also encouraged to use the body as a means of expression, using gesture, posture and facial expression. Skills to manage and regulate emotional and physical release enable clients to participate in emotion-focused activities, and this in turn develops emotional management skills. The calm presence of the counsellor, who is not reactive when clients express, provides useful modelling that can lead to better emotional regulation beyond the counselling room. There are many supports for the client to become self-directed and motivated. They may gradually learn to sense their energy, and any energetic build-up, and how to express it in positive ways. After processing emotional stress there is a focus on the clients self-evaluation, often using visualization and reection questions, that can guide creative use of energy and the formulation of new strategies. ET can build clients skill in reconnecting to their hopes, dreams and positive directions for the future. Taylor (1996) argues that effectiveness in education is enhanced by personal development. He regarded the aim of personal development as making young people more able to manage themselves. Taylor found personal development helped young people become more competent, enterprising and self-reliant, as well as more sensitive to others and better able to respond cooperatively within an educational setting. For the young people he worked with in a group personal development setting, Taylor found a development in the skills of concentration, awareness, empathizing, listening, speaking and supporting. The ILS developed through ET regularly enhance these skills in clients of all ages, and in students.
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Interpersonal skills in groupwork

While relating with a counsellor may be somewhat one-way, groupwork can, of course, amplify interpersonal skills. Learning how to deepen relationships with others and understanding some of the dynamics of a group, classroom or family will provide valuable instruction that can inform future choices. A group setting can provide experience in dealing with negative reactions and projections, such as disliking someone without really knowing them, or mis-attributing motives of others; also learning to deal with attractions and positive projections, and visualizing and considering others needs. In groupwork there are opportunities to be supportive of others and learn the skills of active listening, providing emotional support, and using silent empathic support.
Transpersonal skills
Dealing with existential or transpersonal concepts and experiences may emerge spontaneously during a course of therapy. Kalff (2003) identied a stage in the sandplay therapy process, for example, when connection with, and expression of, spiritual interest emerged. Boorstein (1997) recommended inviting clients to share any spiritual or religious beliefs and practices, and recommended therapists to become sensitive and familiar with these areas. Cashwell and Young (2004) noted an increase in the number of counsellor training courses that included spirituality or religion as areas of study. A therapists personal spiritual orientation is usually not shared with a client. However, if a client makes reference to a particular religious framework or supportive belief or practice system, this interest could be drawn out. Clear messages should be given that this area will be treated with respect, and that it is safe to share sensitive or precious spiritual experiences. The use of art, symbols and metaphor can help a client develop language for spiritual questions, aims, experiences and goals. Skills to recognize, experience, formulate and share metaphysical concepts and experience seem to grow naturally when creative arts media, and a highly respectful environment, are provided. KINAESTHETIC COMPONENTS OF ET Increasing awareness of the messages of the body and responding to reports of somatic symptoms is a signicant movement in helping clients learn the skills of exploring internal changes, rather than simply searching for relief of or diversion from symptoms.
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Somatically oriented aspects of ET involve awareness of how, in everyday life, a person communicates emotional disturbance through body behaviour. Therapy that includes awareness of bodily based symptoms can highlight subtle internal processes, sensations and feelings that are present but sometimes hidden in the language of the body. Many therapists (for example: Grof 2000; Janov 1990; Rothschild 2000) recognize the close connection between memory storage, somatic symptoms and therapeutic processing. When appropriate, ET highlights the clients focus on listening to messages held in the body. The works of Lowen (1975), Pierrakos (1987) and Reich (1951, 1973) form the basis of the ET adaptation of bioenergetics, and the occasional use of breathing exercises. ET practitioners have found the introduction of occasional short breathing activities valuable in helping clients develop greater emotional awareness and connection. Deep breathing has been used for many years as an aid to relaxation in multiple-component cognitive-behavioural programmes (Feindler and Ecton 1986). When used more intensively over a longer period, deeper breathing aids the loosening of psychological defences, which in turn can support release of unconscious experiences (Grof 2000). Pierrakos core energetics (1987) is kinaesthetically oriented, aiming to assist the process of de-armouring to release feelings and energy held in the body. Wilner (1999) described the application of Pierrakos action methods in therapy, and commented on the current use in the American therapeutic setting. As with ET, a primary technique used in core energetics is breathing exercises, a concept rst developed by Reich (Eiden 2002; Young 2008). See if you can take another deep breath is a refrain heard frequently during an ET session (see more on this in Chapter 4). WHO SAYS IT WORKS? There are similarities and parallels between ET, creative arts therapies, sandplay therapy, art therapy, play therapy, music therapy and narrative methods: in theory construction, principles, methods, counsellorclient relationship, expected outcomes and categories of clients who can be helped. Most of these approaches use projective techniques, highly regarded in the literature as a way of enabling clients of all ages to increase their means of communication (Clark 1995). There is a recurring theme across these approaches of the need for playful interaction with young clients and for development of a clients ability to experiment with interpersonal spontaneity within session. A playful approach is seen as useful for bypassing defences and accommodating increased client involvement.
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Like ET, many of these approaches utilize what appear to be noncognitive activities, but are described in much of the literature as enabling clearer cognition, informed by emotion, that leads to change. There have been many contributions in the research and literature supporting the value of expressive and creative counselling, referenced throughout this book. ET has an emerging research basis, that is amply augmented by a predominantly qualitative research tradition in ET, and extensive practicebased evidence based on many years of documentation. The literature on methods closely allied to ET indicates that ET methods would prove equally effective (Booth and OBrien 2008; Pearson 2003; Pearson and Wilson 2008). Booth and OBrien recommend an holistic approach for counsellors working with young clients, especially incorporating a multiple intelligence hence multi-modal approach. They advocate that counsellors explore beyond the traditionally used verbal linguistic and logical mathematical intelligences, pointing out that client choice in modalities can foster positive outcomes and enhance the counsellorclient relationship. We are indebted to Dr Patrick OBrien (1999) for his research identifying and illuminating the links between ET and Gardners theory of multiple intelligence (Gardner 1983, 1993). Gardner (1983) rst proposed that people have at least seven different ways of learning and knowing seven intelligences. He found that students learning increased when more than two or three intelligences were operating in learning tasks. Gardners work provides the counselling profession with valuable material for reection on practice modes and preferences. If utilizing more of the intelligences in education as proposed by Gardner results in quality education, does initiating access to a broader range of intelligences in counselling result in more holistic and effective therapy? Working with children displaying extreme behavioural challenges, OBrien (OBrien and Burnett 2000a) found that the theory of multiple intelligences (Gardner 1983, 1993) could be effectively applied to enhancing counselling with children. Informal analysis by OBrien (OBrien, personal communication 1993) of a range of ET activities suggested the techniques employed a signicantly higher usage of the range of intelligences as compared with verbal and cognitive-behavioural approaches. While OBriens opinion has not been tested more thoroughly, both in the general client population and with several specic client populations, we have found this to be true. Conventional counsellor training concentrates on application of verbal/linguistic intelligence (questioning, communicating issues and telling the story) and logical/mathematical intelligence through spotlighting cognitive problem-solving. Many areas of therapy now specialize in one or
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two of the intelligences. ET has integrated the central precepts of multiple intelligences into a cohesive framework that invites and allows for client preferences and works to expand client options (see more in Chapter 2). OBrien and Burnetts research (2000a) represented a major contribution to validating the use of sandplay therapy and associated ET modalities for counselling in school settings. In this study links were drawn between sandplay, symbol work and associated ET activities and Gardners (1983) theories of multiple intelligence. OBrien produced some of Australias rst statistical evidence on the effectiveness of ET methods. Rather than primarily using the logical/mathematical intelligence central to most behaviour management programmes OBrien found that children prefer to problem-solve using a variety of intelligences. Similar to non-directive play therapy and ET that empower children by encouraging choices in the use of media (hence intelligence), OBrien (OBrien and Burnett 2000a) found that the non-directive and least intrusive interventions were the most effective. For his counselling practice, OBrien developed and used multiple intelligence questions similar to the self-discovery questions routinely used by ET therapists. An important nding in OBriens study was that all nine subjects (each identied as exhibiting behaviour problems) did not favour using the logical/mathematical intelligence. This nding carries implications for school-based programmes where the reasoning process is most often used as a basis for attempting to change behaviour. An unpublished Masters project, Time travellers an experiential, peer support group process for children dealing with separation or divorce (Tereba 1999), has documented success using ET methods in a peer-support grief and loss primary school programme. Tereba used ET activities, including symbol work, self-discovery worksheets, music and artwork, to create a primary-aged peer support programme designed for children affected by separation or divorce. Tereba found that the experiential nature of ET and the use of symbols enhanced the degree of selfdisclosure and increased the number of times children shared and the number of supportive comments made by the students. Murphy and Tracey (2001) used sandplay as an adjunct to remedial classes with children with learning difficulties. They found sandplaysupported improvements in reading comprehension and mathematic ability. Holian (2001) investigated the effectiveness of three ET modalities symbol work, journal writing and creative visualization to promote metacognition and enhanced learning in a secondary school. Holian claimed that a 12-month programme based on ET modalities resulted in Year Seven students (12- and 13-year-olds) becoming better learners. She found that
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using ET modalities enhanced emotional intelligence and provided students with tools to safely express strong emotions. Use of ET exercises also facilitated a bond within the student group, and provided teachers with insights into students preferred learning styles. Regular journal writing was part of the programme and was found to help develop students expression, selfexploration and communication. An important outcome of Holians work was students sharing of their journal writing. The researcher posited that this helped the teachers gain more insight into the students. Using the ET style of symbol work was found to be successful in offering students experiences of making critical observations of themselves. The ability to reect on or think about ones thinking is a critical aspect of metacognition. Vaney (in Pearson and Wilson 2001) has used sandplay miniatures with great success as an aid to teaching literacy. Year Two students are invited to create an alphabet with blocks, then to select two or three favourite gurines and place them on the beginning letter block, or the last or middle sound of a word. The students are then encouraged to combine story map cards who? what? where? when? with the miniatures to create stories. Spontaneous stories such as butteries landing on boats and aliens leaning up against birds (Vaney, personal communication 2000) have given young people freedom to experiment with words and ideas without concern about there being a right way for what is in their minds to go together. The central idea is that their ideas can nd expression through nonverbal means that ultimately enhance verbal expression and interest in literacy. Abbott (2007) conducted a government-funded study on the effectiveness of ET with seven young clients (between 10 and 18 years) who had been diagnosed with spina bida hydrocephalus. This was a pilot study to determine if ET could be useful for developing self-esteem in this group of young people. Each person participated in six sessions, and the sessions included the use of: a body outline, open sandplay, and an integration phase followed by drawing a mandala. The young people who participated in the study reported becoming more independent, more condent and trying new things (p.22). These enhanced feelings of strengthening personal resourcefulness (p.21) correlated with parental reports of increased evidence of maturity and independence with greater interest in health and personal decisions (p.22). The research observed a movement amongst young participants from compliance to spontaneity, with overall gains in creativity and curiosity. Overall outcomes included positive emotional, social and academic outcomes. Fox (2000) analysed four contributions the theory and practice of ET could have for classroom teachers to enhance effective interaction with children. The four areas highlighted in this study were the usefulness of
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imagination, understanding the concept of the inner child, awareness of the need to validate a childs experience of their body, and being emotionally present. ET IN SCHOOL SETTINGS There is a growing number of articles recommending the use of ET and sandplay therapy, creative arts and art therapy, as well as play therapy, in school settings (Chetty 2008; Johnson et al. 1999; OBrien and Burnett 2000a; Tunnecliff and OBrien 2004). Campbell (2004) pointed out that sandplay therapy, with its multiple intelligences perspective, could meet specic needs of children with particular cognitive and socio-emotional difficulties. She argued for recognition of the published case study material (for example: Allan and Berry 1987; Carey 1990; Carmichael 1994; Sharpley 2003) as valid clinical evidence for the therapeutic efficacy of the method. Research currently underway (Booth, personal communication 2008) suggests that sandplay therapy in a school setting may support positive change in the emotional well-being, interpersonal behaviour and selfesteem of older students diagnosed with an autistic spectrum disorder. Chetty (2008) used the ET style of expressive writing particularly using sentence starters with secondary-school students with remedial writing needs. The study explored whether the ET activities would enhance writing skills and develop emotional literacy. What Chetty found was that the creative process in the activities broke down resistance to learning. She found the sentence starters effective in opening doors to construction of writing. She also found that using different types of background music supported focus, attention, learning and engendering a calm state in students. Investigating therapeutic interventions for use across the board in school settings, Tunnecliff and OBrien (2004) posited that sandplay therapy would be extremely valuable. They suggested that the nonverbal nature of the process and its ability to allow clients to use their preferred intelligence provided student clients with safety and an ability to externalize concerning issues with ease. An extensive quantitative study in a Texas school (Nelson-Ray 2007) evaluated the use of non-directive sandtray work at the classroom level, with at-risk junior high students. The research showed that use of sandtrays had a signicant positive effect on academic performance and on school satisfaction. Students reported that the intervention had a soothing effect: I really liked it because it helped me relax (Nelson-Ray 2007, p.114). Research by Pearson (2003) investigated the proposal that ET can support positive emotional and behavioural changes for primary and secondary
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school students. Twenty guidance officers and school-based counsellors trained in ET responded to a detailed questionnaire. The most often indicated response was a willingness and keenness (on the part of child clients of school counselling) to return for further support. The second most reported descriptor supplied by participants was that their clients found the sessions were fun. Also of signicance were client responses of enjoyable, relaxed and happy. None of the participants reported negative responses from their clients. Positive improvement in the counsellorclient relationship was indicated by 100 per cent of the participants. The most common observation regarding changes in the way clients related to the participant during sessions was improved rapport. Reports indicated that clients were perceived as more relaxed, and some participants felt their clients had a higher level of trust. Further investigation may highlight whether participants themselves felt more relaxed, or whether the trust that was perceived to be in the client was actually in the helper. All participants in Pearsons research (2003) observed improvements in the way they related to their clients following the introduction of ET, and improvements in their awareness of clients emotional states. Seven participants indicated an improvement in their trust of the clients inner resources and ability to resolve problems. Responses about client motivation (after the inclusion of ET in the helping context) indicated that all participants reported improved motivation to attend and participate in counselling sessions. The mean increase in perceived motivation, based on participants estimates, was 65.3 per cent. Another nding, according to 100 per cent of participants, was the belief that the effectiveness of the assistance given was enhanced. The mean increase in perceived effectiveness of counselling after the introduction of ET, compared to previous methods, was 71.3 per cent (based on participants estimates) (Pearson 2003). Outcomes beyond the counselling room included reports of clients exhibiting emotional well-being and a more calm emotional state both at school and at home. Observations of consistent positive behavioural outcomes from having engaged in ET processes included references to clients whose levels of aggression and anger were signicantly reduced, and references to clients who were experienced as being more cooperative. Observations of consistent positive emotional outcomes from using ET included references to reduced anxiety. In addition, several participants reported observations of an increase in self and peer referrals (to counselling). In the Pearson study (2003) the ET techniques observed by participants to be most favoured by their clients were sandplay and symbol work. The next most popular modality was drawing and artwork. Anger work
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and bioenergetics for physical and emotional release rated third most popular. In reviewing positive outcomes for clients, over half the participants indicated that sandplay and symbol work were perceived as the most useful modalities. Interesting is that the technique that participants believed to be the most useful was, in turn, the one most favoured by end-users. Some participants highlighted the philosophical approach of trusting the clients process as making a major contribution. In the Pearson study (2003), 13 of the 20 participants expressed an opinion that ET would make a constructive contribution to the professional training of guidance officers and school counsellors. Comments also indicated a perception of ET training as effective in developing self-awareness in professionals. Summary
The creativity that emerged during the years of development of ET, and the creativity that typically emerges in the practice of therapists who train in and implement this approach, is an outcome of a focused, experiential learning process. In short, the notion that we learn best by doing became a foundational premise of ET. To some extent we have, over the last 20 years, been our own laboratory rats! The present authors have observed that experiential learning develops confidence and an ability to be fluid in application of theories, principles and activities. Finding new creativity, confidence and fluidity tends to have a dramatic impact on practice, supporting counsellors in attaining enhanced professional satisfaction. It also supports an optimistic view of clients, that can, in turn, bring forth client creativity and satisfaction with self.
Chapter Two
Towards Freedom, Choice and Empowerment

Evolution of Theory
APPROACHES TO COUNSELLING By 1987 over 450 identied therapeutic methods had been created in the practice of counselling and psychotherapy (Guinagh 1987). The eld has continued to expand with Miller, Hubble and Duncan (1996) noting that since the 1960s the number of psychotherapy approaches and theories has grown by approximately 600 per cent. It seems as if there are more and more approaches to human well-being claiming the title of therapy. Each claims a core theory, a core focus, core methodology and stated outcomes. Rivalry between approaches has been the subject of long-standing debate, involving many claims and counter-claims about value, efficacy and outcomes. Behavioural theorists have placed little importance on non-observable intra-psychic phenomena and viewed aggressive behaviour as a learned, maladaptive response resulting from specic environmental events and inuences (Rosenberg, Wilson, Maheady and Sindelar 1997). The behaviourist approach subscribed to the belief that behaviour is learned and can therefore be unlearned. Change in behaviour is the goal and is partly achieved through the use of positive and negative reinforcers (Porter 1996). Another perspective put forward from learning theory conceptualized aggressive behaviour as the result of frustrated attempts by the organism to satisfy basic needs (Rosenberg et al. 1997). From a social learning perspective the external environment would be seen as a major contributing factor in the acquisition and maintenance of defensive behaviour (Espelage, Bosworth and Simon 2000, p.326). The cognitive hypothesis, the behavioural hypothesis and the thwarted needs hypothesis can all be viewed as
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contributing factors; however, they are not the only causes of challenging, symptomatic behaviour or distorted thinking. Accurate understanding of cognitive patterns is essential for effective support, and cognitive behaviour therapy (CBT) in particular focuses on the problems generated by inaccurate perceptions of others and awed expectations (Teyber 2006). CBT combines behaviourist approaches and the cognitive styles of the client with methods and interventions aimed at inuencing or adjusting patterns of cognition (Porter 1996). Brands (1987) discussion of the primacy of emotions over cognition contrasts with approaches to behaviour management and counselling which have a predominantly cognitive focus. Brands discussion supported the claims of ET that indicate the need to deal rst with emotions in order to improve behaviour and cognitive focus. Brand described links in the brain between language, cognition and emotion. She indicates that the properties of language with which the brain empowers us enable change, which she sees as the basis for psychological healing. Many young clients nd it very difficult to use language as an aid to emotional healing; however, the use of art and symbols with the written word are their keys to enhanced expression. Rogers person-centred approach has had wide inuence in the eld of therapy (Thorne 2003). A central focus in Rogers way of working from a person-centred focus (Rogers 1951) is offering a climate of nurturance for a clients emotional needs, creating conditions that can activate an actualizing principle, establishing a democratic relationship with the client, and establishing ownership of the problem (Mearns 1997). Rogerian theory centres on unconditional positive regard for each client with the emphasis on listening, helping a client rehearse assertiveness, and fostering a sense of collaborative problem-solving. The psychodynamic approach to therapy views problems as having their origin in past experiences and events that have an emotional charge, stored at an unconscious level. Symptoms are considered to be the result of unresolved conict and impairments in ego function (Leichsenring, Beutel and Leibing 2007, p.59). There is a long-established method of focusing on resolving patterns from the past, on supporting the integration of unconscious impediments to healthy functioning in the present. This then leads to consideration of the argument that experiences with a similar emotional charge, for example experiences of loss or bereavement, become stored together in a type of cluster formation within the unconscious, forming a condensed system of experience (Grof 2000). The extension of Grof s argument is that, in the present, experiences that contain similar emotional charge activate unprocessed, incomplete past experiences containing that same emotion. How this could look is that
TOWARDS FREEDOM, CHOICE AND EMPOWERMENT
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a person feels abandoned by their partner, and that sense of abandonment is made all the more acute and urgent if there are unprocessed past experiences of emotional suffering from being left or abandoned. This concept adds direction to the aim of psychodynamically oriented therapists working to support the release and integration of emotional energy tied up with anxieties from the past and recent past (Jacobs 1988). In the past, psychodynamic frameworks have relied heavily on the verbal/linguistic abilities of a client. This has led to a notion that emotional release techniques based on a psychodynamic paradigm are allied with intense emotions in session, replete with verbalization and excessive, dramatic sounding such as screaming, yelling or crying. In ET emotional transformation is not always accompanied by these stereotyped expressions, but has been observed to be unique to each client, and the degree of emotional expression spans a wide range and depth. Creative arts therapies include using tools that facilitate expression without undue focus on language. Some of the techniques we use in ET include artwork in therapy, music for therapy, sandplay therapy, use of drama in therapy, dance and movement therapy, poetry therapy. One underlying principle is the use of some form of creative process often symbolic as a method for externalizing internal states by offering something the client can do or create and then relate to. Constructing metaphor through art, music, movement, symbol or some other means becomes a language for activating the change process often offering ways of expressing the inexpressible. De Robertis (2007) claimed that the use of metaphor is not that of camouaging or sidetracking, but of activating material that is still emerging. ET marries elements of creative arts therapies with a psychodynamic focus, while moving beyond original theorists to include more recent research and dynamic exploration of experiential techniques. A clients problems are assessed, not just in terms of the intensity of disruption to their psychosocial environment, but also in terms of the intra-psychic inuences on the individual. Perinatal and transpersonal factors (discussed in Chapter 10) are also considered as part of the therapists assessment of signicant inuences on mental health and overall well-being. An occasional criticism of ET has been that it appears, on the surface, to lack a clear theoretical basis. An approach that actively considers the unconscious without interpreting its contents, does not view resistance as something to be reduced, largely ignores transference, and supports if not encourages expression of defensive, symptomatic behaviour is bound to be greeted with some confusion. However, practised by an experientially trained, well-supervised counsellor, ET based as it is on several core theories utilizes a wide range of practical methods, allows clients
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to largely direct the in-session process, and leads to many of the outcomes agged as the aim in a variety of other approaches. ET offers experiential therapeutic activities centred, as much as possible, on tailoring therapeutic context and methodology to the individuals style. This effectively catalyses emotional healing in both conscious and unconscious levels of the psyche. Relief from symptoms and changes in attitude and behaviours ow on from this essential work with emotion. The aim of ET is to create a doorway, through a supportive therapeutic relationship and provision of activity-based, change-oriented techniques, that leads to positive changes in behaviour, beliefs, attitudes and relationships. This is done by means of creative, expressive activities that focus initially on intra-personal emotional exploration, processes and skills, ultimately clearing the way for cognitive clarity, choice, and productive interactions. Invitational relating, clinical competence with the methods, offering choice, supporting expression of symptomatic, defensive behaviour, forming healthy, practical relationships, with a focus on client-specic emotional healing, sums up what has become central to our style of ET. EXPRESSIVE EXPERIENTIAL COUNSELLING Robbins (1980) saw one of the tasks of therapy as the facilitation of the activation, organization and release of emotional energy through verbal and nonverbal means. Oaklander (1988) placed great value on expressive activities in therapy with children. Her eclectic interventions, evolved from Gestalt therapy, included drawing, nger- and foot-painting, clay modelling, sculpture, collage, storytelling, writing, puppets, sensory experience, drama, play therapy and sandplay. Eriksons claim that whatever the client did could be used in a positive way (cited in Combs and Freedman 1990) has links to our ET approach. Erikson believed that people do not have to understand consciously how, or why, or even what, they have changed in order to change. This is evident for us when young clients achieve positive behaviour change through using art or sandplay therapy without necessarily demonstrating or providing clear evidence of cognitive understanding of their process. Combs and Freedman (1990) recommended a multidimensional approach to counselling, working with conscious and unconscious elements of the psyche, verbal and nonverbal communications, active and passive intentions, positive and negative emotions, the individual and the group. These authors see the use of symbols, stories, ceremonies and metaphor in counselling as effective tools, and refer to the smallest units of metaphor as symbols words, objects and mental images which are dense with meaning. They describe how a symbol is a discrete thing that sets off powerful
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associations (1990, p.xiv). In symbol work and sandplay therapy it is the multiple associations that the small gurines can carry for a client that heighten the effectiveness of the process. Metaphor allows the process to bypass client defences and helps the counsellor build a foundation before being direct, as well as encouraging more active mental search on the part of the client (Combs and Freedman 1990). This active engagement opens access to forgotten resources, stimulates new associative pathways and elicits client creativity and responsiveness to the therapy process. Client engagement in the session, and with the counsellor, is seen as a key to effective outcomes (Ammann 1991; Bachelor and Horvath 1999; Hubble et al. 1999). HEALING OUR EMOTIONS The core principle of ET that the tendency towards emotional healing is a natural, inbuilt movement in the psyche, just as it is in the body draws support from Jungs theoretical frameworks. Jung developed an understanding of the positive healing forces in the unconscious (Fordham 1991 [1953]). His clinical observations, along with his anthropological investigations, lead him to propose that the psyche contained drives manoeuvring us towards wholeness and existential meaning. This view set Jung apart from the aggressive and libidinous drive model described by Freud (Tarnas 2006). Implicit in this healing movement is trust in an organic wisdom within each client as to when, where and what needs to be dealt with for what Ammann (1991) called the process of transformation. Tapping into and following this movement is the aim of an expressive therapist. Developing an honest and trusting relationship between client and counsellor is an important rst step in creating an environment open to, and supporting, emotional healing. A team relationship, an energy of connection with the client, a relationship that says we are in this together, supports a feeling of safety that is a requirement for natural unfolding of the healing drive. The Jungian concept of individuation has parallels with Maslows (1962) proposals on the need for self-actualization. Rogers is cited as having summed up the core conditions necessary for self-actualizing: the therapist is congruent without faade the therapist is acceptant and prizing, empathic, understanding and, most important: the client becomes aware of these qualities. (Thorne 2003)
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One of the most important conditions that support the unfolding of the natural healing process is trust. A client needs to feel that the counsellor is straightforward, genuine, empathic, exible in relation to the therapeutic agenda, prepared to wait, to respect defences, comfortable when emotions emerge, able to be silent and allow inner processes to work through (even if the client is not able to explain them), and responds optimistically, no matter which way the session unfolds. In Rogers (1951) words, clients would need to feel the person-centred approach as operational in the counsellor. Time may be needed for the development of trust and rapport. Where there is a diagnosis of post-traumatic stress, a signicant number of sessions may be needed to engender trust as a prelude to deeper level healing. Rothschild (2000) found that for some highly traumatized clients re-establishment of trust becomes the core of therapy. With these qualities for effective clinical work in place, the issues, topics, feelings and timing for emotional healing proceed logically, and become directed by this innate healing drive. Part of the initial assessment process attempts to understand how this resourcefulness has been operating as a way to process conicts or protect the individual. During initial sessions a counsellor may try to understand in what ways this inner healing movement has been attempting to bring about resolution and transformation, or in what ways the persons resourcefulness has tried to strengthen and maintain defence against further emotional pain (Teyber 2006). Symptomatic behaviour can be the result of attempts to kick-start the healing process. The inter-relatedness between challenging behaviour and a clients inner healing resources may not be immediately observable or overt. For example, a client may exhibit anger, when in reality the deeper issue to be addressed is unresolved loss or grief. As a therapist it can feel challenging to surrender some control and develop trust in a clients inner resources and begin to resonate with the direction in which they need to proceed. Even if the process does not immediately make sense to our logic, we can at the same time create optimal conditions for a natural process to unfold. ET achieves this through engaging a client in activities that seek to open more inner space for self-discovery. Cooperation with this drive towards healing usually depends on awakening interest in self-awareness and self-discovery. Many clients come to counselling with rmly held beliefs about being defective, inadequate or unloved. Maladaptive patterns of feeling, behaving and thinking have perhaps supported an assumption that there is little in life about which to be optimistic. In initial sessions motivation to get to know, or allow and follow, their inner processes is often low, masked by fear of being overwhelmed by the magnitude of painful feelings. In ET, the rst session may often focus on awakening self-interest through nding strengths,
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recognition of positive qualities, or an activity that offers a glimpse of the way their psyche works. The invitational approach is essential in developing a sense of safety. Permission to say No, to make choices, usually supports clients to open up when they are ready. A cautious adolescent, who has been assured that her responses to expressive writing sentence starters can remain private, often becomes more willing to begin the process of sharing her thoughts and feelings. INDICATORS OF EMOTIONAL HEALING The most obvious, and most often used, measure of emotional healing is positive behaviour changes. The closure of recent and past emotional wounds, or resolution of unmet needs, or positive changes in relating, are also signs that emotional healing has taken place. The impact of past experiences may have been evident through, for example, disruptive, destructive or highly reactive behaviours. These begin to soften as the background emotional charge and the drive for release and resolution is reduced. The process of emotional healing can be enhanced by externalizing conicts within the therapeutic setting. Having at your disposal a wide range of creative arts techniques is ideal for externalizing conicts so they can be recognized, articulated, worked with, and resolved. The storage of unresolved negative emotions in the psyche can result in the client feeling negative about self and about the world. The future seems dark, dim or even pointless. It is as if storm clouds have obscured the sun. The sky seems dark, clouds may ll their gaze, but, of course, the sun is still there. When clients are able to process some of the backlog of emotions and issues, they usually view the world and their future in a much more hopeful and positive way: the clouds part, the sky is blue again, there is warmth and hope. Completion or resolution of emotional stress can unblock creativity, and release energy for clearer rational choice and action steps. Our clinical observations indicate that processing, resolving and gaining closure on what Kubler-Ross (1997) called unnished business promotes the ability to relate more clearly and focus on new learning tasks. Greenberg (2001) found that people who do well in therapy move from talking about external events in a detached way, to focusing on internal feelings, to readily accessing feelings to solve problems. We have frequently observed that emotional healing supports access to helpful feelings that in turn support positive problem-solving. Adults and children experience emotional healing in different ways. Adults are more often interested to participate in what Wilber (2000) described as an inward arc of development coming to self-knowledge at
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a deeper level. A childs psyche develops along an outward arc where the aim is ego consolidation, being interested in how they may be perceived by others and striving to belong (Neven 1996). In general terms, this means an adult client may present as more willing and interested to connect with, and reect on, problematic feelings, whereas the focus for a young child will be on survival and establishing an identity. Generally children will deal with the degree of emotional stress that satises the immediate need for resolution, and then return to focusing on moving ahead. What is evident is an increase in self-acceptance, often observed after processing distressing emotional material. Therapist reports indicate that young clients supported through ET become more relaxed, calmer, have an increased sense of well-being, as well as becoming less aggressive (Pearson 2003). Many clients experience increased freedom and ability to make choices particularly in behaviour and ways of relating since the psyche is no longer driven by an emotional charge. This may be followed by a freeing up of creativity and resourcefulness for problem-solving. A reduction in emotional triggering is often noticed after emotional healing. Relating becomes more effective. There is a reduction in misattributing the motives of others previously interpreted through the lens of unresolved conict. The psyche is less reactive and more able to respond. Useful outcomes of healing include: more secure, stable moods, less aggression, less anxiety, increased self-assurance and assertiveness (Pearson 2003); sense of freedom, lightness and balance (Pearson and Wilson 2007); connection with a sense of control and emotional strength, resourcefulness and creativity, increased sense of self-acceptance, reduction in self-blame, and a more hopeful view of the future (Pearson and Wilson 2001); condence (Pearson 2006); and aliveness and meaning (Fosha 2000). A developing interest in self-care and self-regulation goes hand-inhand with self-awareness clients are more willing and able to be aware of self when troubling emotions and psychosomatic symptoms have been processed and resolved. Emotional and behavioural regulation is more possible when impulses to express feelings are addressed, when a client feels heard, their affect understood and responded to, and establishes a range of alternative means for self-expression (Teyber 2006). Awareness of emotional arousal is increased, so that rather than experiencing shame, blame or guilt, help-seeking behaviours can be activated before inner tension creates an explosive outburst. Evidence of this awareness is presented by ET counsellors working in schools who reported increases in self- and peer-referral (Pearson 2003) after their clients started participating in ET sessions.
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Since emotionally charged scripts are reduced through emotional release processes, there is often a dramatic decrease in self-sabotaging thoughts or behaviours. Clients who previously felt too overwhelmed to follow through with constructive plans for new behaviours can participate more effectively in behaviour management programmes. And this, of course, greatly supports a newly emerging positive sense of self. Selfperception becomes a feeling of being more creative and, in particular, young clients may play more, utilizing the inner life skills (see more on pp.2427) gained through the counselling process to successfully negotiate developmental challenges. Increased creativity in daily living is a frequently reported outcome from emotional healing. This appears not only in creative problem-solving and renewed energy for life, but for many it manifests through artistic pursuits. There have been cases of young adult clients gaining a better understanding of career interests through the use of metaphor and symbol work. Some clients nd that artistic endeavours have a renewed attraction for them. Interests, hobbies and careers develop, curiosity about personal abilities increases, willingness to experiment with new ideas develops, and there is strength in appreciating their unique way of expressing and relating. THE COUNSELLING RELATIONSHIP IN ET Research has consistently indicated that the quality of the therapeutic relationship is a major indicator of positive outcomes in therapy (Lambert 1992; Wampold 2001). The ET approach values being able to work in a eld of paradox: the counsellor being separate, neutral and objective, and at the same time warm, empathic and available. While a counsellor listens intently, ready to follow any doorways to exploration of issues, they also support focus, providing some direction, helping the client negotiate emotional terrain and link mind, body and feelings. There is a dance between following and leading, watching and suggesting, waiting and supporting forward movement. Silence is considered of great value. Sadly, it is an important aspect of human interaction that is often experienced as discomfort, even by the most well-meaning of therapists, and so the space can quickly become lled with words. Before being silent the counsellor may invite a client to tune in to their feelings, sensations, their energy state, any emerging imagery, or answers to their own questions that materialize from within. Silence provides time and space for the client to reect, review, feel and formulate an expression, a response. Silence is an important aspect of therapeutic communication, something to be seriously considered and fully
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explored (Cozolino 2004, p.89). Premature invitations to relate, discuss or reveal may actually interrupt the internal therapeutic process. Bradway, Chambers and Chiaia (2005) advocate the use of silence during sandplay therapy, claiming it can support a deeper relationship between counsellor and client, and support the client in accessing deep levels within. In line with Rogers assertion that a counsellor should be congruent and genuine (Thorne 2003), an expressive therapist would need to nd their own way to be natural, to drop any persona or role, to let go of the temptation to use any learned mannerisms and to work with what Cortright (1997) refers to as an optimistic heart focus. To enable this it is imperative that a counsellor engage in personal development and possibly undertake their own journey as a client. A counsellor would benet from resolving any need to control the client, or to focus on their own issues during the clients time, or to display their knowledge and skills. Many traditional counselling skills may be utilized, such as reection or mirroring, and offering a summary of the clients narrative when the content is varied and extensive. Summarizing may also be offered when the discussion indicates or highlights some energetic, emotional or cognitive confusion. Guidance may be offered when it would appear useful for the client to do a review of the session or process so far. INVITATIONAL RELATING Clients interpret therapist behaviours in different ways (Bachelor and Horvath 1999). Therapy is not a one size ts all methodology. To accommodate variance in client-preferred therapist behaviour, ET encourages offering choice, using invitational relating, and reminds ET students to both follow the clients process and meet them where they are (Pearson and Wilson 2007). Invitational ways of relating with counselling clients form a core element in a person-centred, growth-focused ET paradigm. The aim of inviting, rather than instructing, supports the process of reection and decision-making about life experiences, and even the therapeutic process. This reection may be brief, it may even involve little conscious effort; however, the result is decision-making that reects intelligence preference (see p.00 for discussion on this). [AQ ] Brief moments of client decisionmaking also result in growth of self-acceptance, of trust in the relationship, relaxation of defences, and more open and full engagement in the therapeutic process. By inviting a client to participate more fully or keep their distance, to reveal or retain a sense of privacy until they are ready, to use action or stillness, words or pictures, to tell the story or share the feelings through all this the clients own sense of readiness is afforded
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utmost respect. Through this reection, motivation to participate increases (Pearson 2003), a more democratic relationship evolves, there is a reduction in transference onto the counsellor, and a client discovers how to make decisions that are life-giving, how to discern what they want, in a relaxed way. Baloche (1996) claimed that offering choice in group work dramatically increased motivation to participate, and results in an increase of creativity in group member participation. Invitational relating requires an attitude of curiosity in the counsellor. Rather than making statements, the focus is enquiry and active listening. Invitational relating aims to promote allowing rather than doing. In offering questions that facilitate choice, skills of discernment are drawn out and reinforced in a client. Simple, open-ended questions that encourage an increase in self-awareness support making choices about therapy and about life. Here are some examples of questions that aim for invitational relating: Is there a way you would like to begin today? How about drawing, writing, working with the symbols or some movement? When you feel ready, can you say anything about what happened? Would you be willing to share anything about your drawing/ worksheet/symbol with me? Do you feel ready for us to move on to the next activity?
The following questions might draw the clients focus to sensory, somatic, cognitive, energetic or emotional ways of knowing. For example: Is there a particular activity that might help you express this? How about drawing, moulding, writing, shaping the sand, choosing symbols? If you tune in to your body, could you describe the main feeling you have? Are there any thoughts, feelings, sensations that seem more important to you in this moment? Would you be able to take a couple of minutes to tune in to your feeling self right now? Is there anything in particular you notice? Does anything stand out?
While trainee counsellors may often wish there was a textbook of prescribed questions, we believe the question to ask becomes easy to nd
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through focused presence, active listening and paying attention to what a client says, to their nonverbal messages, to the energetic component of the interaction, and to the embodied resonance experienced by the therapist. All the clues are there, so we become like a detective, observing carefully, waiting for and valuing even the smallest clue. We support the client in developing a similar attitude towards their internal experiences. OFFERING CHOICE Another element that supports clients being guided by their inbuilt healing drive is choice from a wide range of expressive modalities. Some young clients seem to have had no choices in any areas of their life. They feel empowered by being offered choice within the containment of a counselling session. Using an invitational approach supports a feeling that the therapeutic process is about the client not about pleasing the counsellor or following an external agenda. If the client can relate to the therapist and the therapeutic setting using their preferred intelligence (discussed in Chapter 1) in a way that does not evoke further anxiety or heighten challenge beyond a level that is acceptable for them, it is likely that participation in counselling will be more effective. For example, while many young clients like drawing, many also have memories of being embarrassed by past attempts at artistic productions, so do not resonate well with using art in initial phases of counselling. For them, being able to choose from sandplay, symbol work, modelling, writing, worksheets or movement facilitates engagement, and eventual deepening of rapport with their own resourcefulness and with the counsellor. Duncan and Miller (2006) claimed that there is no evidence supporting the positive outcomes from formulation and adherence to treatment plans. While an ET therapist would engage in assessment and planning of how best to respond to client distress, setting the agenda, categorizing, interpreting, pathologizing, emoting for the client, giving advice or problem-solving are not part of the clinical repertoire. BEING, NOT DOING To create a connection with a client, and provide a positive emotional environment for self-exploration and revelation, expressive therapists aim to operate from an attitude of openness and curiosity about the clients world. Creating an attitude of openness can be supported by holding questions in mind, such as:
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How does the clients psyche work? What particular coping mechanisms have been in place? How is the client trying to process what has happened? Which elements are to the forefront at the moment? What is this client saying is most urgent and important?
Expressive therapists would aim to develop their trust in the clients own healing mechanisms, their self-actualizing tendency, even if the therapeutic direction seems unclear. Remaining interested in understanding the logic of the clients internal drives to protect and heal can lead to the client feeling accepted, and gaining trust in their own way of working through problems. Part of providing unconditional acceptance includes validating a clients feelings, if not their actions, and helps them recognize the differences between who they are and what they do. The principle of the counsellor joining with the client can support the development of rapport, and the clients sense of acceptance. The client is not made to t in with, or validate, the counsellors assumptions and theoretical framework. In this sense, if a client needed to talk for an entire session, and was not ready or interested in engaging with the expressive modalities, the session could still be described as ET. In the way a counsellor interacts with a client and guides their focus, there is a primary aim: to enhance the clients self-awareness. Self-awareness can be directly and indirectly encouraged as the client focuses on body sensation, energy, mood, and self-image. Occasional use of reective questioning, mirroring and feedback may also achieve this. In relating with clients there is always an aim to support reclaiming of resourcefulness. Resilience can be enhanced through clients gaining a sense of satisfaction in their level of involvement in the therapeutic process. After clearing emotional blockages, the client usually has better access to their own ideas, plans and action steps. Stimulate clients formulation of their own strategies and give feedback on appropriateness. DEPTHS IN THE PSYCHE Murphy, McKone and Slee (2003) found the structure of memory to be quite complex and sensitive to both external and internal factors, while Josephson (2001) argued that memory is a mechanism which constructs the past, the present, and also the anticipated future. A broad, useful denition of memory is that memory is the way past events affect future function (Siegel 1999, p.24). Common misconceptions about memory are that
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a person would always be aware of an event they had experienced; Siegel (1999) claimed that a usual misconception is that when a person remembers something, there is an accompanying feeling of recollection. Siegel (1999) also points out that generally, when memory was considered, it was believed that the mind is somehow able to make a sort of photograph of experiences that are then stored without further modication. He argues that this is not the case. The available literature on the functioning of implicit and explicit memory adds weight to the argument for the veracity of nonverbal recall. Research by Neborsky (2003, p.284) stated that implicit memory circuits can contain a hidden lefor which there is no language, only image and feeling. Siegel (1999) asserted that when an implicit memory is reactivated at some future time, that memory need not be accompanied by a sense of time or awareness that something is being recalled; instead, the person experiences the re-creation of a mental experience of perception, emotion or behaviour. If this is the case, then reliance on verbal methods alone, in therapy, leaves a gap in processing the past. Ultimately, for long-term change, healing may need to take place in three identied spheres of inuence within the human psyche: biographical, perinatal and transpersonal (Grof 2000). The biographical domain relates to experiences from birth to the present time and is the focus of most counselling approaches, including ET. This sphere of inuence includes memories of impactful events, pre-verbal experiences as well as the personal unconscious. The perinatal domain relates to experiences, inuences and events from conception to immediately after the birth. Many writers have catalogued the impact of physical and emotional difficulties experienced in the pre- or perinatal time (Chamberlain 1998; Grof 1988, 2000; Janov 1990; Leboyer 1974; Verny and Kelly 1981). Unresolved tensions and emotional issues from this time may be the subject of deeper psychotherapeutic interventions; however, these interventions are not commonly used within counselling. The transpersonal domain relates to the study of psychological, emotional and somatic forces that originate beyond the normal range of ego awareness. Vaughan (1995) described transpersonal psychotherapy as extending the areas of psychological inquiry to include spiritual experiences. She suggested that on the inward arc of human development (Vaughan 1995) healing remains incomplete unless the human striving for transcendence is actualized. A growing number of writers and researchers on transpersonal psychology and psychotherapy (Boorstein 1997; Cortright 1997; Grof 1988, 1998, 2000; Wilber 2000) all point to the therapeutic value of responding to the issue of spirituality. Boorsteins view (1997,
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2000) of transpersonal psychotherapy is that it builds on and includes the techniques and aims of traditional psychotherapy by broadening the conceptual framework. He writes that transpersonal psychology and psychotherapy presuppose the existence of a spiritual dimension in human beings (1997). See more on this in Chapter 10. While all these three levels may be foundational in the development of personality and in the development of personality difficulties, it is work with available emotions that may contribute most in the counselling session. WORKING THROUGH EMOTIONAL DISTRESS There is no one standard way of responding to emotional expression in the therapy room. Some clients emphasize the need to gain cognitive understanding. Some seek physical release of body tensions that result from emotional distress. Some may be ready to connect more fully with their feeling state and focus on discussing how they feel (Bachelor and Horvath 1999). The expressive therapists role is to create supportive conditions that allow the client to proceed in their own way, without a xed agenda about the starting point, the topic, the focus or depth of therapeutic work. For useful outcomes all ways of knowing and processing need to be considered and a comprehensive range of methods for access made available. An inclusive emotional healing process offers combined cognitive, somatic, kinaesthetic and intra-personal reconnection with sources of past and present experiences. On a cognitive and verbal level, processing may begin with talking about what happened, writing or using colours, lines and shapes to depict what happened and the associated feelings. This initial cognitive/verbal level may include discussing attempts at problemsolving and any efforts to set goals, strategies and boundaries and to gain emotional support. Those initial discussions may be supported through drawing feelings, some process drawing, talking about feelings, clay modelling, sandplay or symbol work. At a somatic level, enhancement of connection to the body and the need for physical release may be indicated. This awareness might emerge through the use of body focus exercises, bioenergetics, or, for a young client, energy release games. Feelings can be expressed as colours, through symbols, by using metaphor or body shapes, or using music. As a follow-up to a counselling session it may be appropriate to recommend kinaesthetic homework that includes, for example, increased participation in sport, jumping on a trampoline, bicycle riding, walking and running. These are especially useful alternatives to disruptive or destructive responses to outer and inner experiences. Naturally, quieter homework
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can also be offered in tools such as drawing, journal writing, quiet time in nature, or taking time-out to listen to quiet relaxation music. PROJECTIVE ACTIVITIES IN ET Clients usually approach emotional healing activities with caution even within a safe and empathic therapeutic relationship. Without necessarily intending to, they can successfully circumnavigate impactful issues and experiences, moving slowly at an acceptable pace towards a more direct contact with painful feelings and memories once safety and rapport are established. For some the psyche will begin obliquely, expressing through symbolic form, through metaphor or other forms of projection, as means to lessen their emotional load without having to confront pain or fearful memories directly too early in the therapeutic process. Projective techniques have long been used for assessment of personality by psychologists and psychiatrists, but have been less widely used as therapeutic tools in counselling until recently (Robbins 1980). Examples of long-established therapeutic projective activities are sandplay therapy, dating back to Lowenfelds world technique (use of miniatures in a sandtray for nonverbal thinking) in 1930, and art therapy, developed since the 1940s. Projection is a natural phenomenon in the psyche, through which intra-psychic material is externalized. ET uses a range of projective methods for supporting healing and insight. Through projection emotional states can be externalized and processed without intellectual defences. Since the mind works associatively, free association is used to trace the source of symbols, to access layers of the psyche and nd meanings. ET also uses the associative mechanism in the form of role-play exercises, developed from Gestalt techniques. Role-play can support clients to connect with deeper aspects of their psyche in a gentle way, to search beneath the surface layer, and make more meaningful connection with emotions, self-image and energetic states (Pearson and Wilson 2001). Robbins (1980, p.124) describes this as a progressive peeling off or spiralling down to the more core issue and essential energy in the psyche. See more on projection on p.205. SYMPTOMATIC BEHAVIOURS AND RESOLVING EMOTIONAL STRESS There are many ways in which feeling and affect remain active and inuential in the psyche, in the mind, body and emotions. The hormonal system is involved in transmitting and storing emotion (Pert 1997); the body has the ability to respond to difficult feelings and create and use its own sedatives,
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tranquillizers and feel-good hormones. The muscular system is involved in inhibiting expression or releasing impulses physically. The existence of and documentation of the bodys energy system is becoming more widely understood in Western cultures (Brennan 1993; DiCarlo 1996), and has been catalogued and used therapeutically in Asia for centuries. Symptomatic behaviours are frequently the result of unresolved experiences from the past. Feelings that are too strong for a child to deal with, or are not accepted by others, or are not safe to express, become relegated to the psychological background a sort of backdrop on which future scenes and players act out the drama. Despite attempting to exclude these experiences and the associated feelings from awareness, despite more or less effective repression, the feelings remain, creating the basis for emotional stress. Reich wrote extensively of his observation of muscular armouring (Reich 1979), the layers of chronic tensions that develop over time in order to hold back emotions and energy. As far back as 1895, Freud observed that after release and integration of a distressing experience the body returns to a more relaxed state (Guinagh 1987). Learning to work with the physical aspect of emotional blockage involves alertness to somatic signs of emotional arousal. Transforming tensions may involve connecting awareness with the physical state and then opening to some of the underlying emotional causes. Ventilation or catharsis may be emotional and physical, may involve gross motor movement, and can lead to signicant cognitive changes. When bodymind awareness is stimulated, and a client feels safe and ready to allow processing and completion of unnished business, there is often a need for some ventilation of unexpressed emotion. There are many aspects of support that enable catharsis to be used safely and effectively. ET practitioners are trained to support a wide spectrum of release processes, and to complement these with integration activities. Cathartic processes are benecial in a context of support and when they are accompanied by integrative activities. The theory and practice of counselling especially in educational settings has focused primarily on cognitive approaches (Porter 1996). The assumption that altering thinking can change emotion and behaviour has prevailed. Writing about art therapy, Robbins (1980) commented that when neurological pathways are less activated by unresolved emotions, there is space for improved learning and an interest in academic work. Anecdotal reports that come our way from parents of young clients echo Robbins claims. These parental reports have frequently conveyed positive comments from classroom teachers on signicant transformation in attention span and academic interest after only a few sessions using ET.
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The presumption of the primacy of cognition over emotion has been challenged by recent ndings in brain physiology (Brand 1987; Cozolino 2002; Greenberg 2001; Siegel 1999). Recommendations from recent research in the eld of neuroscience suggest a more holistic approach to treatment, specically treatment that includes both left and right brain activities and linkage, use of body, sensory awareness, emotional connection and cognitive reection (Fosha 2004; Rothschild 2000; Schore 2002). An aim in therapy is to create the conditions that allow new plasticity in the brain, that allow change processes, that support the formation of new neural networks (Cozolino 2006). Siegel (2005, 2007) and Schore (2002) suggested that the best conditions for rewiring the brain are similar to the ideal state of early parental love, acceptance and protection: essentially, positive attachment. These are the roles that therapists need to develop in order to support long-term change. The body manufactures substances that assist or block the conveying of impulses in the nervous system. It is interesting that the area of the brain that is involved in the regulation of emotional expression is also the area that is most active and grows through the initial stages of good childparent bonding (Schore 2002); the attachment area seems also to be the emotional regulation centre. This suggests another argument for allowing the development of temporary healthy attachment within the therapeutic setting, for creating conditions for a corrective experience that is supportive at a deep neural level. Due to many adults discomfort with the world of strong emotion, childrens emotions are often controlled, diverted, reasoned away, modied, soothed and calmed, squashed or ignored. Many adult clients have identied their family of origins particular style of dealing with emotions, and can recognize they develop a speciality in terms of coping mechanisms. Emotional stress can have more inuence on behaviour than conscious plans, and begins to shape a sense of self, and to inuence character. Symptomatic behaviour may begin as a way of reducing tension; however, the negative aspects of the behaviours come to be regarded as an intrinsic part of personality, creating a downward spiral of deteriorating self-esteem. Where an adult is unable to process signicantly challenging aspects of their own emotional world, and unable to reect on their own coping behaviours, they are less able to cope with the emotional demands of a work colleague, a friend, a child or even a client. Unresolved emotional stress may eventually be acted out in destructive, disruptive or aggressive ways, or may implode, causing withdrawal. It contributes signicantly to learning difficulties and can eventually lead to health problems. The churning emotional energy needs to move, to be expressed, which is why some clients nd it difficult to be still or mentally focused on a given task for extended periods of time. Trying to constantly
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constrict unnished business and unconscious feelings creates emotional stress, which in turn impacts on the bodys tension and energy eld. The respiratory system then becomes an ally in the containment or expression of emotion. Reich identied ways in which healthy breathing was disrupted by the need for emotional and energetic containment (Gilbert 1999). Breath becomes shallower and slower when signicant amounts of repressed experiences become contained and constricted within the person. Reich drew links between muscular armouring of the chest, emotional protection mechanisms in the body, and the free ow of breath. Grof (2000) described how many cultures have used breath to expand consciousness and increase self-awareness, listing the use of breath to support psychological and emotional health through yoga, zen meditation, shamanic practices, chanting, singing, and deep experiential psychotherapy methods such as holotropic breathwork. To support emotional health and long-term change in behaviour, to reduce acting out, the unconscious feelings need a safe avenue for expression. While many clients need to learn behavioural boundaries and emotional control, the therapeutic principle is that, to be healthy, emotions need to move (e-motion). Many clients are able to contact and process feelings with ease in a direct way; some nd it difficult to acknowledge feelings. There is a wide spectrum in the way clients will engage in an emotional release process. This can range from direct and dramatic catharsis, to subtle contact with emotion, that may be accompanied by few external signs. Some adult clients report growing awareness of the way energy in and around their body changes in relation to their emotional uidity. When there is an accumulation of unaddressed issues, the energy is described as blocked, static, stuck, dull, contracted, heavy. When issues have been addressed and client reports catalogue experiences of feeling a more emotionally free state, energy is described as owing, light, expansive, alive. Obviously, emotional release should not be considered relevant or suitable for all clients. There are many categories where activation and direct expression of negative affect may be contraindicated. Within ET there are a very wide range of modalities that allow some form of gentle processing, without the client needing to access experiences in a direct way. Acknowledging, validating and accepting clients emotional life, and providing a comprehensive range of expressive activities, allows education about natural, regular expression and promotes a sustainable state of well-being.
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THERAPEUTIC RELEASE AND ACTING OUT Therapeutic release through ET is supported by a trained facilitator, in a safe and private place. There are signicant differences between acting out feelings and the therapeutic process of emotional release. Acting out is usually disruptive or destructive and unfair. It usually leads to a decrease in self-esteem. While acting out may sometimes leave the individual with a temporary sense of reduced tension, clearly it does not lead to resolution, therapeutic change or enhanced cognitive awareness. Skilled facilitation avoids directing clients to confront prematurely material that is too sensitive. When the indicators are present in the therapeutic process, clients are supported to focus on original causes of current emotional stress. The reason the present feels challenging may lie in the past. In dealing with current reactivity a client might be asked: Have you felt like this before? Is there anything familiar about this feeling? Responding to the clients own readiness, their history may be explored, with encouragement to open to and focus on any emerging experiences, or somatic or emotional clues. Taking into account preferred intelligence and style of communication, the methodology for therapeutic release offers a client choice of expressive modalities. The goal is to meet the client where they are, rather than require a leap of faith on their part to validate and support our particularly loved framework or method. This directorship of the process can engender a feeling of empowerment for the client; it helps them feel successful as a client. Therapeutic release takes place emotionally through the body and is accompanied by enhanced understanding. It is an holistic process that may have stages of specic focus on one area of functioning, and which ultimately releases the feelings from the body, and provides time and a framework for understanding what has happened. In distinction to acting out, therapeutic release is not disruptive or destructive. No one is offended or hurt. It may be that occasionally an angry client may wish to rip up some newspaper or release physical tension into a cushion, or even express themselves in a verbally colourful way. It may be that a grieving client is nally able to release the dammed-up tears, and risk connecting with the vulnerable feelings that had to be quarantined for so long. Whatever level of expression or catharsis emerges, at the completion of the process the world is intact, the therapeutic relationship is strong, the client feels supported. They have dealt with issues that have caused suffering, or may have caused feelings of exclusion and alienation. And now they sense acceptance, support and lack of judgment. Important for them is witnessing a model of emotional calm and stability in the counsellor, which helps them become less identied with old feelings.
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A nal stage in bringing closure to therapeutic release utilizes integrative activities. Integration allows the body time to relax from the activation and adrenaline release that accompanies emotional expression. The client is given time and the means to connect emotional experience with understanding, to experience the past in relation to their whole life narrative. Left and right hemisphere integration is supported by putting the experience into words, using writing and language, and reecting on the process. Therapeutic release often leads to an increased ability to solve problems creatively. Clients learn to prefer therapeutic release over acting out. Their ability with emotional self-regulation evolves. They develop takehome skills. Once emotional overload is reduced, once the underlying drive to complete emotional processing can relax, clients see their problems in a different light. What seemed dominant at the forefront of their psyche recedes into the background. Where previously there seemed no way to change their life, clients begin to formulate new ideas, new ways of making internal and external changes. Instead of acting on an impulse to be hurtful as they feel hurt they can process their own feelings. Clients may learn to create a series of drawings, engage in a ow of writing, or simply channel agitation into movement such as unstructured dance or bioenergetic movements. They may come to the stage of simply allowing and staying with activated feelings, without having to do something. Having experienced, they can move on. CATHARSIS AND COGNITION From analysing a broad spectrum of therapeutic methods, Guinagh (1987) identied two general patterns in psychotherapy: the cathartic approach that encourages emotional expression, and the cognitive approach that seeks change by modifying the clients thinking. Investigating the relationship between catharsis and cognition in psychotherapy, Guinagh claims that catharsis and cognition complement each other: Both processes lead to change and need to be respected in ourselves and in others (1987, p.v). After a cathartic experience clients are able to engage in clearer decision-making and exhibit less reactivity towards their environments (Guinagh 1987; Pearson and Nolan 2004). Guinagh recommends a combination of cathartic and cognitive therapeutic methods. Catharsis on its own is not recommended within the ET framework. Cathartic expression must be embarked on with great respect, sensitivity and awareness, and only after extensive experiential training for the support role. Some ET modalities have evolved from cathartic methods (developed largely from Grof [1988, 2000], Janov [1990] and Reich [1979]). However,
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as a whole, ET bridges both cathartic and cognitive approaches, through combining a somatic focus and emotional processing methods that incorporate integration. An important component of catharsis is the reduction of tension. Scheff (1979) believed that effective therapeutic catharsis should lead to a decrease in tension, an increase in mental clarity and feelings of well-being (p.66). Perls (1969a) also noted that completion of unnished business led to a reduction of tension. This relates to stages four and ve in the basic stages for planning an ET session (see p.23), where, after some expressive work, clients are encouraged to integrate the experience through discussion, drawing, writing, and possibly physical rest. Positive future activity is then envisaged. Greenberg (2001) recommended nding a safe and private space for anger expression. He pointed out that after anger expression we are more able to decide what we want and take action, and we are more able to set boundaries. He clearly delineated the differences between acting out anger and becoming informed by it, recommending that within the therapeutic relationship clients fully experience, express, and work through each feeling, with a focus on helping clients discern messages or information from their emotions (2001, p.230). We have repeatedly observed clients in a relaxed state after an emotional release process. These clinical observations contrast with some of the earlier research on the value of catharsis for reducing anger and aggression, which found that catharsis, or ventilation, of anger may in fact increase the emotional charge (Bushman, Baumeister and Stack 1999; Geen, Stonner and Shope 1975; Holt 1970). However, these studies were conducted with adults (who were not counselling clients) in experimental settings that bear very distant resemblance to the safe, emotionally warm conditions of individual counselling sessions. Long-term neurological change, re-organization of the synapses, is enhanced by an accepting, warm environment (Schore 2002). In the studies cited there appeared to be no allowance for creating psychological safety, relatedness, warmth, or regard for an individuals choice in modes of expressing anger, nor for the availability of integration techniques. When emotional release is included in the ET repertoire, clients are supported to reconnect with any signicant experiences that they feel remain unresolved. What happens then is observing and identifying feelings experienced at that time, allowing a few moments of re-experiencing that feeling, followed by nding preferred ways of releasing emotions in a safe, supported environment. These steps can ow, largely in nonverbal exchange. This is followed by reection on the signicant memories, feelings and insights, in an emotionally calm state. Integration activities support the client to move from the symbolic and language-free processes of the
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right hemisphere to the use of language and the time-frame development processes of the left hemisphere. The integration phase of ET activities seeks to develop the skill of meta-cognition through encouraging clients, in the nal phase of the session, to then nd language for articulating their experience of the therapeutic activity, to identify their own resourcefulness and to participate in creative problem-solving. Increased emotional well-being after expression could be seen as a major contributing factor in more willing cooperation with the process of counselling and subsequent positive behaviour changes. Another reason for combining cognitive aspects of therapy with expressive work is that, although emotions may be discharged through some cathartic release, clients may still be inuenced by long-term, established behaviour patterns. In other words, although the emotional driving force may be reduced through expressive activities, the attitudinal and behavioural habits that developed as a result of these feelings may also need time, support, clarity and intent to change. COUNSELLING AND GARDNERS MULTIPLE INTELLIGENCES In 1983 Howard Gardner described his research that led to the theory of multiple intelligences. Initially he described seven intelligences; later an eighth intelligence was added. Under ongoing discussion, but unconrmed at the time of this publication, is a possible ninth intelligence (Waterhouse 2006). All of these are outlined below. For the most part, Gardners ideas have been positioned within the eld of education, claiming that Western education was biased towards verbal/linguistic and mathematical/logical intelligences. He proposed that quality education depended in part on providing instruction and learning experiences that include a wide range of intelligences. Multiple intelligence theory suggests a possible explanation for the wide range of creative arts therapies available today. OBrien and Burnett (2000a) explored the link between Gardners theory and the eld of counselling, and found evidence that Gardners theory has a signicant role to play in counselling, despite the resources and time that are often required for implementing a range of experiential strategies and techniques. Their results indicated that it is possible to address each of the intelligences in counselling sessions, and that knowledge of a clients preferred intelligences can be useful to the counsellor in both selection and construction of activities. Multiple intelligence theory also illuminates the way counselling and psychotherapy styles seem to specialize in one or two of the intelligences.
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The verbal/linguistic intelligence is utilized in verbal therapy, expressive writing, journal work, use of worksheets, and bibliotherapy. It is ideal for clients who think and learn through written and spoken words, and have the ability to memorize facts, ll in workbooks, respond to written tasks, and enjoy reading. The musical/rhythmic intelligence would be utilized when spontaneous music-making or recorded music is used in therapy. It can be connected with the kinaesthetic intelligence through dance to rhythms, and to the verbal/linguistic intelligence through the rhythms of poetry in therapy. It is ideal for clients who can recognize tonal patterns and environmental sounds, and who learn through rhyme, rhythm and repetition. CBT and behaviour modication programmes depend to a large extent on a logical/mathematical intelligence. These approaches may be most helpful for clients who emphasize the cognitive aspect of their life, who can think deductively, deal with consequences, numbers and recognize patterns. Use of the interpersonal intelligence is an important part of developing rapport between a counsellor and client. Almost all approaches to counselling (perhaps with the exception of recent developments in the use of computer programs) utilize interpersonal connections. The approach of humanistic psychology, developed by Rogers and others, focuses on creating an extremely positive interpersonal connection. In this style the enlistment of the interpersonal intelligence is the main method. This intelligence is in action in clients who learn and operate one-to-one, and through group relationships and communication. Art therapy and the use of drawing, sandplay therapy and symbol work primarily use the visual/spatial intelligence. While a very wide range of clients are able to express and communicate via these modalities, they are particularly useful for clients who can think in and visualize images and pictures, and have the ability to create graphic designs and communicate with diagrams, images and symbols. The bodily/kinaesthetic intelligence suggests an ability with sensory awareness and movement. These are utilized in bioenergetics, dance therapy and movement therapy. Clients who enjoy use of these modalities can learn through physical movement and body wisdom, and may have a sense of knowing through body memory. They may have easy access to sensory clues to internal processes. The naturalist intelligence is developed, encouraged and utilized in wilderness experiences, vision quests, and through therapeutic use of relating to pets, for example in equine assisted therapy. This intelligence involves an ability to recognize categories in nature and have an interest in growing things and an affinity with animals.
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The intra-personal intelligence (more widely known as the emotional intelligence [Goleman 1995]) is highly utilized in ET and the psychodynamic approach. A client with a preference for the intra-personal might enjoy and learn through self-reection, participate in meta-cognition and like working alone. Clients in this category may have an enhanced awareness of inner spiritual realities. Developed emotional intelligence skills are integral components of good mental health (Kaufhold and Johnson 2005). The proposed ninth intelligence has been identied as the existential or spiritual intelligence. It includes the ability to deal with metaphysical concepts. Use of this possible intelligence and associated activities is an essential aspect of transpersonal psychotherapy and the therapies that utilize spiritual techniques. One of the tasks for a counsellor is to discover and work with techniques that utilize the intelligences with which a client is naturally adept. Beginning with the predominant intelligence and concomitant communication style, the goal, depending on client tolerance, would be to eventually offer activities that stimulate intelligences and skills that have been less dominant. This builds a clients sense of competence and allows him or her to communicate and work through issues in a way that is experienced as non-threatening, non-oppositional. From their study with children exhibiting challenging behaviours, OBrien and Burnett (2000a) pointed out that sandplay therapy can include all the intelligences identied by Gardner (1983). This may be one explanation for its effectiveness. (For more on sandplay therapy see Pearson and Wilson 2001.) The setting for OBrien and Burnetts (2000b) study indicated some of the ideal attributes of a multiple intelligence or ET work space: The counselling room was arranged so children could elect to play with a variety of media. The areas included a sandplay area, a drawing and painting area, an area to use clay, an emotional release area, and a musical area consisting of a tape recorder, a range of audiotapes and a moog synthesizer (p.146). Of course, play therapists have long practised in rooms that support free choice of activity, and hence intelligence (Axline 1989 [1947]). Viren, Furnham and Kannan (2006) found that the adults in their extensive study presumed that the verbal intelligence, and to a lesser extent the logical/mathematical intelligence, were predictors of overall IQ. It may be that counsellors, psychologists, therapists and educators have held similar assumptions, possibly presuming that clients unable to follow reason and logic, and unable to articulate, may be at a disadvantage in terms of IQ. Continuing to offer counselling with these two intelligences as the predominant components may in fact greatly disadvantage many clients who may excel in other intelligences. In their study, OBrien and Burnett (2000a) found that the logical/mathematical intelligence was the least
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preferred with their young clients. Similarly, Longo (2004) found that the use of experiential treatments can have a positive and profound impact in treating adolescents with sexual behaviour problems, noting that these approaches can open up thinking and emotions in ways that may not occur with traditional talk therapies. He noted that ET provided a clinician with an opportunity to use a variety of learning styles, and that adolescents display a range of preferred learning styles. EXPERIENTIAL TRAINING AND EMOTIONAL RELEASE An expressive therapist would be expected to have undertaken experiential training and to have participated in opportunities to process signicant issues in their own life experience. The core training in ET involves repeated experience in a client role, working with real-life issues. This reduces the likelihood of projective identication with a client, of making an inaccurate assessment, of directing clients into a process prematurely, or of diverting the client from emotional challenges. Having accepted and worked through some difficult aspects within their own psyche, ET-trained counsellors practise being non-judgmental and accepting of elements within a clients psyche that may be viewed as challenging or labelled as a resistant. ET training focuses on developing the capacity to stay open, stay with, be less rigid and exercise more exibility, all of which models a reective, creative response to distress. One of the hallmarks of an expressive therapist is the ability to maintain therapeutic boundaries without dampening a clients spontaneous expressive ow. The development of compassion and empathy is heightened through involvement in growthful experiences and encounters with depth in their own psyche. Through experiences of self-confrontation they can remain centred, stable and aware when confronted with chaotic and intense emotional states. They develop a uid way of working that supports clients to externalize, release, process and integrate at their own preferred level, at their own pace, and through their own preferred intelligences. Their own growth processes mean they come to feel comfortable with not knowing exactly what to do, condent in knowing there is something that can and will happen, when to offer support, if they should, and when to refrain, and when to do nothing at all. The way the therapist relates to a client becomes just as important sometimes more important than what they do with a client. The positive assumptions that underlie the therapeutic relationship encourage a clients ability to work through issues and build resilience. While inviting a client into some therapeutic activity if indicated the therapist will relate to the client with a certainty that they have the resources to work with their
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material. The client feels they can do it; they have an experience of success and self-direction, they develop emotional processing skill, self-awareness, that is useful in daily life. A theme in ET literature is the personal enrichment that practitioners nd through offering these methods to clients. This theme became evident during in-depth interviews that formed part of school-based ET research conducted by Pearson (2003). Participant reports included claims that after training in and applying ET, there was increased job satisfaction, a more relaxed working attitude (which has a positive impact on clients and the development of rapport), and a professional satisfaction from the increased efficiency of the counselling. Wiener (1999) concluded, in his introduction to Beyond Talk Therapy, that counsellors who make action methods an important part of their work will nd themselves personally enriched and enlivened by their use (p.xviii). COUNSELLORS USE OF SELF As far back as 1937 Freud acknowledged that analysts do not in their own personalities come up to the standards of psychic normality which they set for their clients (Rowan and Jacobs 2002). Freud even suggested that analysts be re-analysed every ve years! In the psychoanalytic tradition the training analysis gradually came to have more and more signicance. There was an emphasis on personal qualities and personal knowledge. Therapeutic work within the training of counsellors and psychotherapists can aim at developing the potential for empathic understanding and communication, some rst-hand experience with the unconscious, skill in introspection, and insight into character structure and symptomology that indicates dis-ease or distress (Fleming and Weiss 1978). In ET the use of current personal material in the training context provides not only the personal development that allows counsellors to be more objective and empathic, but essential skills in understanding both invitational relating when offering experiential activities, and the experience of receiving a suggestion to draw how you feel. In the training of expressive therapists there are aspects of personal development which could be seen as obligations for those intending to offer support to others. The rst is developing self-knowledge. A counsellor will work more objectively, compassionately, skilfully and be able to assess client needs more effectively if they have an awareness of their own deeply held beliefs and scripts; if they are aware of and have some understanding of somatosensory signals from within themselves. Emotional responses and reactions, along with awareness of any tendencies toward projection, should be explored by the counselling student (Johns 1996).
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In order to offer a therapeutic and reective space to a client, counsellors should be capable of listening to their own inner world, aware of the legacy of their own past, and be able to pay close attention to present-day experience, as well as desires and needs for the future. Any nexus of unconscious problems that remains ignored or non-elaborated profoundly alters a persons sensitivity to the other (Marinucci 2004, p.88). Client self-acceptance can be increased through authentic modelling of that acceptance. If a counsellor harbours a signicant degree of self-criticism, if their own critic is overly active and unexplored, it may be difficult to be congruent in terms of acceptance. In the development of a counsellor, after self-knowledge, engagement in some emotional healing, some awareness of emotional wounds, could be seen as a second obligation. It certainly brings more compassion into the therapeutic relationship when a counsellor has real and extensive experience of self in the client role, and when they have experienced at rst hand the patience and acceptance of a counsellor or peer. Developing and actualizing self is the third obligation for becoming an empathic counsellor, especially one working within a transpersonal paradigm. Some components of self-actualizing include becoming aware of levels in consciousness, moving beyond the established comfort zone opening to new challenges, developing a stronger connection to spirituality, and being able to transcend limits of the personal ego at times, in order to support the client fully. Experiential activities within counsellor training are vital to provide opportunities for transformational learning that is, learning which not only informs but stimulates emotional growth. Experiential activities also support personal development in such areas as, for example, self-awareness, resolution of attachment and family of origin issues and transpersonal development. Engagement in these activities can sharpen the counselling students use-of-self skills. Both directly and indirectly, counsellors learn through practice. They gain important skills, such as attentive listening, being less directive, providing non-judgemental feedback, responding with respect for spiritual autonomy, and being comfortable with creative doubt as a doorway to practising holistic knowing and use of intuition. These activities can also provide opportunities for interpersonal skills practice and deepen understanding of theoretical frameworks. Hence counsellors can be more adaptive in response to client needs.
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A PARADIGM FOR CLIENT EMPOWERMENT Developing a code of respect for clients which becomes operational supports the re-empowerment and the development of self-respect for clients. The therapeutic relationship contributes to rebuilding and consolidating a strong sense of self.
Code of respect for clients

Uphold the dignity of the client. Offer unconditional support. Validate the clients feelings and experience. Work from an optimistic stance. Co-operate with the clients need to feel safe. Presume the client has the resources to grow and change. Encourage the client to create their own strategies. Provide multiple ways for the client to tell their story and process difficult emotions. Offer freedom through presenting choices wherever possible. Discover the logical causes of any resistance, apprehension or defences. Respond to acting out as a symptom of the drive towards healing. Respect the clients timing. Help the client discover their own meaning in their creations. Avoid imposing interpretations. Work towards building client self-awareness from the rst session. Respect the spiritual autonomy of the client. Remember, the client is the client.
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Summary
Freedom, choice and empowerment are inspiring words. Each of these is an aspect of life that many counsellors, therapists and psychotherapists would like to believe a client can integrate into their own cultural environment and uniquely lived experience as a result of skilled facilitation of those times when our inner world feels stuck and moving forward can be experienced as overwhelming or problematic. So how have they influenced the evolution of theory that supports ET? Chapter 2 sought to remove any notion that ET is an approach that suffers from right-brain overload, thereby ignoring a firm intellectual and theory-informed basis. The chapter provided a representation about some prevailing psychological frameworks and also discussed theories that have most strongly influenced ET. This chapter grounds ET practice in well-researched methodology and thinking and is important in setting the scene for practice that is respectful, mindful, informed and professionally skilful. One of the aims in this section of the book was to nurture understanding of the enormous value, depth and acceleration of the therapeutic process, that can come from sitting in and working with emotions rather than trying to ignore or bypass these essential indicators of the most effective way to achieve well-being. Addressing the counselling relationship, adopting an accepting, invitational attitude to questioning, commitment to offering a client choice within a session and the concept of being, not doing were highlighted as critical factors in developing a productive alliance and ultimately building capacity within a client through modelling these ways of relating and interacting. Gardners theory of multiple intelligences was included to illustrate the potential for working with a larger repertoire of ways for clients to reflect, experience and offer information that can stimulate sustainable change.
Chapter Three
Attachment, Integration and Renewal

OVERVIEW Humans often nd it difficult to give something they feel they were never given. Genuine reciprocal relating is challenged by a sense of emotional incompleteness. The longing to be loved can sit inside the human heart directing our search for a sign of willingness, from another, to respond. The task of working through a legacy of challenging life experiences is at the core of the psychodynamic approach (Jacobs 1988). In working with ET techniques an understanding of psychodynamic inuences is regarded as essential. One of the main sources of challenge experienced in the journey towards health and wholeness is developing awareness of growth-inhibiting, interaction-limiting issues, patterns and scripts that result from less than optimal early attachment. In this chapter we explore the ET perspective on childhood experiences, the concepts of attachment, and subsequent development of patterns of interaction. An overview of the way these patterns develop is provided, along with essential therapeutic steps in addressing any legacy of distressing affect or behavioural disruption. This chapter reviews the effect of early environmental factors on adult relating and looks at the focus for professional therapeutic support using experiential, expressive methods. What follows, rather than being a restating of attachment theories and research, or a survey of treatment trends, is an evolving working description, in simple client-friendly language, of the way these issues are generated and play out for clients. The stages of treatment, from an ET perspective, are described.
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ATTACHMENT THEORY AND ET While the brain is regarded as a relational organ (Siegel 2005) and neuroscience suggests the mind is developed as a by-product of interaction (Siegel 1999), people can often be heard to claim they are people who do not need people. An individual cannot develop in isolation, as development always takes place in interaction with the social environment and also always has an effect (Willi 1999, p.33). Infants simply cannot escape the other (Orange 1995). They are, if one accepts the rationale of attachment theory, inextricably linked to the emotional life of a carer. Theory about the way the psyche attempts to cope with less than optimal attachment in infancy and childhood, and corresponding practical methods to support clients to work through early experiences of omission and commission, combine to form a core component of ET practice, as developed by the present authors. In ET practice methods are offered that seek to effectively facilitate reconnection with experience, uncomplicated communication, expression, discovery, and integration of unresolved underlying emotions linked to attachment difficulties. Attachment has been explored at length by a range of writers and researchers (Bowlby 1969, 1973, 1988; Cassidy and Shaver 1999; Howe 2005; Mikulincer and Shaver 2005; Pistole 1989; Rholes and Simpson 2004; Schore 2002; Trusty, Ng and Watts 2005). Most notably, Bowlby (1969) described early attachment as having implications for social and emotional experiences throughout life. While Peluso, Peluso, White and Kern (2004) argued that Bowlbys theory has not been fully integrated into clinical practice, the key elements of attachment theory appear, nevertheless, to have been well considered in the conceptualization of a range of counselling and therapeutic frameworks (art therapy [Hass-Cohen and Carr 2008]; psychodynamic therapies [Prochaska and Norcross 2007]; family and couple therapy [Byng-Hall 1999]). While it is reasonably common for many adults to acknowledge that there may be some discrepancies in their inner resources (Levin 2001), the present writers have found resolution of attachment issues for clients in therapy to be crucial in supporting longterm emotional and psychological health. ATTACHMENT THE GENESIS OF MODELS OF INTERACTING Loosely speaking, attachment relates to survival based on protection from danger. The central tenet of attachment theory is that the quality of a childs earliest relationships provides a template, or internalized working model, of beliefs and expectations about oneself and others (Bowlby 1988). This framework suggests that the ways a child develops, in relation
ATTACHMENT, INTEGRATION AND RENEWAL
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to their social and physical world, and the ways that same child then resolves later developmental issues, are signicantly inuenced by that very early foundational template. Attachment develops not just in cases where there is a positive connection available for a child, but also where connections may be insecure, problematic or even threatening. Development of a childs attachment style is complex; it is developed whether the source of the attachment is a danger or a comfort. Regardless of the quality of relationship available, attachment with the other is sought, even in the face of disturbances in hoped-for feelings of connection and security. One of the key concepts ET extracts from attachment theory is acknowledgement of parentchild interactions, and main caregiver and family contexts, as the primary settings within which children live and within which they normally develop emotional regulation, competency and resilience. This means that how an individual was related to in the early years can signicantly direct how the individual relates to themselves and to others across the lifespan. The early relationship also sets patterns in self-esteem and responding to stress. Secure parentchild attachment, particularly in the rst years of life, has been regarded as critical to early brain development, and has been cited as an important inuence in the development of a solid sense of self (Cozolino 2006; Schore 2002; Siegel 2005). Much of the therapeutic work in a psychodynamic approach explores the difficulties, longings, lack of fullment, and neglect in early years as sources in resolving current presenting problems of clients (ByngHall 1999). In the psychodynamic tradition, symptoms are regarded as consequences that have a basis in biological and psychological sources (Leichsenring et al. 2007). Attending to resolving those biopsychosocial disturbances that make their presence known through symptomatic behaviour is the therapeutic direction in the way we work with expressive therapies. Bowlby (1969) used the term working model to dene and describe the emotional scripts that are: a collection of unresolved, unmet needs unexpressed or repressed feelings learned behaviour patterns that were adaptations to the early environment.
In place of Bowlbys term, we use the word script to dene those patterns of needs, feelings and behaviours that have been referred to elsewhere in the literature as emotional schemas (Fosha 2003; Greenberg 2001; Schore 2002; Siegel 1999), personality patterns, blue-prints (Peluso et al. 2004), prototypes (Janov 1990; Stone and Stone 1993) or injunctions (Corey and
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Corey 2006). Scripts are conditioned emotional codes default settings that incline us to react to, and unconsciously recreate, certain situations in the same way, over and over. Scripts can be like a lens through which we see and respond to the world, a lens through which life appears to have a particular colour or distortion. If, as therapists, we remain unaware of them, scripts generated in childhood can impact strongly on how we care for ourselves and our clients, and how we deal with stresses, and this applies particularly to those working on the frontline of the caring profession. While scripts may be active in the psyche, their workings are usually undetectable in everyday awareness. However, uncomfortable, disturbing feelings or less than desired behaviours and choices evidence activation of these scripts or default settings. How do these scripts develop? How do we become aware of them and their impact? How can objectivity be developed in order to make useful, productive, positive choices in our personal and professional lives? Scripts are part of the conditioning that limits emotional growth, fullment and freedom. ET theory states that helping a client look at the past can provide a pathway to repair of the present, and can enliven the future. To demonstrate the mechanisms of these scripts we discuss two particularly challenging examples that frequently present in the consulting room. These develop from disruptions, inadequacies and adaptations in early attachment and are characterized in ET terminology as the hurt inner child, and the inner critic. They can be hypothesized as internal mechanisms working collaboratively and leading to behavioural and cognitive distortions and reduced self-efficacy. The inner child and the critic have radar-like mechanisms that maintain vigilance to detect, and react to, perceived slights against us. These radars are alert for proof that the past experiences are the norm, and are also evident in the present reality. HEALING CHILDHOOD SCRIPTS A child seeks (and needs) to be loved, and, in an ideal world, would probably prefer that love to be exclusive and without limit. The reality is that sometimes a parent, by virtue of adverse circumstance, trauma or generational patterns of interaction and social formation, may experience the demands of children as negative personal feedback and feel challenged, or distressed. The parent then either resists or avoids responding, or feels a sense of failure to provide ongoing, satisfying responses to childrens demands. While childhood lacks and longings, resulting from insufficient positive attachment experiences, remain outside awareness, the resultant tensions in the psyche seek resolution in later life. This can lay down a
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template of inability to be openly responsive and to reciprocate in the present. Decisions are made, built on conclusions from past experience (Levin 2001). Picture generation after generation psychologically and emotionally looking back towards the previous generation, awaiting fullment. For example, in current relationships an unconscious drive attempts to reproduce something similar to the early situation in order to correct it, to get it right, to nd affirmation, love and safety. Unconscious playing out of inner child scripts does not resolve emotional stress, or help us move on. More often than not, unproductive emotional exertion results. In attempting to transfer the past onto the present, an external condition is created that is in some way similar to the original (in attempting to satisfy past needs). This transference from, and struggle with, the past does not accomplish the goal. The unconscious drive to recreate and overcome signicant disruption in early relating occurs through seeking in partners, friendships, and even in the workplace aspects of a parent who is viewed as, or believed to be, the source of disappointment, insult, or hurt. Current relationships become the battleground on which relief from past hurts is unconsciously sought in attempting to extract from the present situation satisfaction that was originally lacking. The past is transferred onto the present and wrestled with in a way that not only fails to resolve the original hurt, but also sabotages uncomplicated relating in the present. It all adds up to an almost endless emotional struggle to achieve what was lacking in the early years. Limits in satisfaction of their own early attachment needs may leave adults with some rupture, or, in cases of childhood abuse and neglect, absence of ability to create positive models of relating. An unconscious search for what was missing may begin in childhood and continue throughout life, unless extant feelings of lack, abuse or neglect can be processed with the aim of positive forward movement (Howe 2005). While hurt, disappointment, unfullled need, or fears, shocks or trauma from early years remain unconsciously active, moving forward emotionally is inhibited as if for a boat anchored to a shore from which it needs to depart. This striving by the inner child aspect in the personality, to nd what was missing, may come to underpin motivation for many important decisions in life, particularly relationship choices. In the natural movement of the psyche towards resolution, inner scripts can exaggerate apparent faults in the other, even draw them out in order to struggle, unconsciously hoping for resolution. The emotional and psychological battles wins and losses that were not completed in childhood are re-enacted. The therapeutic process may unearth unconscious recreation of the past through choice of intimate partners. Partners may be chosen because they not only exhibit characteristics of the parent who came closest to
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fullling core needs, but also embody characteristics of the parent who fell short in giving and receiving affection. The inner child can evoke, in partners, elements that are somewhat similar to a parent, in an effort to change the present so as to eliminate recurring internal discomfort from the past. This can sabotage the ourishing of communication, love and intimacy. (See Figure 3.1.)
Figure 3.1 Adult female: Unable to move away.
The potential for joy and spontaneity is within us, but may be in the background, eclipsed by aspects of attachment requiring attention as if the sun were always covered by stormclouds. Positive life experiences and fullled areas of the psyche that contribute to building personal strengths do not require resolution. Most clients seek emotional healing for these childhood scripts which store hurts, wounding and lacks, along with feelings and behaviours that have been denied, repressed, stied or squashed. It is these scripts that drive behaviour. Self-sabotage (and maybe even selfharming) are indicators of the hurt inner child in action. Children often blame themselves for parental deciencies, taking on the burden of family shortcomings. Where the early insults have been turned inwards, blaming self, maintaining feelings of inadequacy, or seeing the source of the challenge as some decit in self, keeps alive some hope that if only we could change enough, then the prize would be more of what we need. Maintenance of these erroneous beliefs ensures:
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ongoing low levels of self-esteem a jaundiced view of self-efficacy in the world perpetuating negative beliefs about self that carry on into adulthood.
It can sabotage healthy living and lead to unproductive life choices. Some approaches to personal growth and development of psychological well-being direct attention to building emotional strength through focusing on happy and fullled times. And, this can indeed assist a person to gain some relief from their distress. Clinical observations, along with anecdotal reporting by clients, indicate that this approach may be a limited, short-term support. The good feelings generated by remembering happy experiences and times of strength may be unsustainable in the face of recurring outer stressors and reactivated, unresolved inner tensions. Following the positive thinking style may in fact ultimately provide more material for the inner critic, so that the client may come to experience themselves as having yet another failure failure to be a successful client in therapy. The negative feelings that, in an ideal situation, could have been directed outwards may have been turned inwards, evoking ongoing cycles of self-punishment, self-blame or self-sabotage. Often an individual will nd it easier to be angry than to feel the more threatening feelings of sadness or hurt (Teyber 2006); or, in an effort to defend against the overwhelming, but unconscious, burden of self-criticism, blaming and shaming may be turned outwards someone or something in the external environment can always be located and seen as the catalyst. With therapeutic support, revelation of underlying resentment towards original family members, resulting from disruption in early attachment, can lead to an ability to let go of the past and move on. While it is neither possible nor healthy to concentrate completely on inner processes and search for a self independent from external inuences (Willi 1999), emotional processing techniques, used in session, provide a safe, supportive context for unconscious material to be expressed, redirected and released. When indicated by a client, supporting them to create imaginary encounters with the family of origin assists release, resolution and renewal. Renewal often involves a refreshed view of the relationship that caused the original hurt or insult, and reduction in shame and self-criticism. The effects of revitalized relating become actual in the self-relationship and with people with whom we interact (Willi 1999). A signicant moment of realization for a client is when recognition dawns that the inner child is unable to achieve what it most needed. Holding on to hope of overcoming the pain, hurt or fear by defending against feeling
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a failure, or by attempting to control the environment (often excessively), can be a way of coping with past feelings of powerlessness, shame or blame. In this way future well-being and satisfaction are sabotaged by continuing to reproduce, and then attempting to master, an old situation. The positive present possibilities are overshadowed. Any negative aspects of a current situation partner, friendship, professional relationship that offer hope for an inner child to struggle for relief from its needs, are also the aspects that make it difficult for us to become creative, mature adults, and freely to give and receive what we want. THE INNER CRITIC Internalized negative self-perceptions may be experienced as indicators of inadequacy and blueprints for attempts to re-mould the personality. In the absence of receiving evidence to the contrary, a child may begin to internalize and believe negative feedback about themselves (Wellwood 2000) and continually experience themselves in a frame of reference shaped by family judgments and negative commentary. As a way to create some sense of identity, a child may internalize others perceptions of them (Wellwood 2000). Criticisms, judgments or admonishments on how to be cloud the lens through which the self is viewed. Life assumes tones that reect back to the person not who they really are, but who they have come to believe themselves to be. Unconsciously this internal feedback loop can continue throughout life, sabotaging adult condence. Out of this process, the inner critic is born (J.E. Elliott 1992; K.J. Elliott 1999; Stone and Stone 1993). Self-criticism the incessant activity of the inner critic supplies an explanation for why we did not get the love, recognition or safety that we needed. The self-critical voice can often be experienced as tyrannical aiming to correct us, in the hope that we can then get what we needed (Stone and Stone 1993). Keeping the hope of fullment alive through the effort to be different can result in a confused or weakened sense of self, and may establish a foundation for later relationship disappointments. The inner critic can be likened to a script, self, or perhaps even voice, scolding us from the inside imposing prohibitions on what we do, what we need, how we feel. The inner critic develops early in life, absorbing and then mimicking judgments from signicant others, absorbing the expectations of family and society, motivated by creating self-protection and maintaining some sense of emotional equilibrium. When constant judgments have been with us since early childhood, the running commentary of the inner critic feels like a normal part of who we are. Elliott (1999) describes the critic as a source of self-blame, and identies it as the origin of three negative messages: (1) imperative shoulds; (2) disparaging statements about our
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thoughts, feelings and behaviour; and (3) negative predictions. Often in families these messages are strengthened through threats of punishment, expulsion, or excommunication, if the shoulds are disobeyed. Elliotts (1999) clinical observations supported the usefulness of the concept of the inner critic in therapy, with clients experiencing relief, rst, by becoming aware of this inner process, and then by experiencing a sense of liberation from belief in the negative messages. The inner critic is one script which, if unimpeded, can easily hinder therapeutic success, sabotage personal growth and diminish the potential for self-compassion, empathy and connection. It can be useful to sensitively assist a client to bring to light the familiar phrases of an inner critic, process any underlying emotions, and then understand and challenge its dynamics. Clients report that the inner critic announces everything that it sees as wrong within: in our actions, relationships, and abilities. Even with great effort, we cannot please and quieten an inner critic. No matter how carefully we listen to it and try to change ourself in the way it indicates, it follows us, always nding fresh energy for inner and outer criticism, which often results in unintended outcomes. The original function of the inner critic was to spare us shame and pain (Stone and Stone 1993). The main message we received in those formative years was that if only we could improve, all would go well. This inner voice may echo the views of parents, grandparents, religious or social ideals, or other important facets of early development. The inner critic wants to be able to criticize us before anyone else can! Anxious for us to avoid rejection, ridicule or abandonment, its aim is to have us succeed in the world and be accepted and approved of by others. Paradoxically, all personal outcomes are, at the same time, judged as negative. Information that was to be used for our defence is used against us. Stone and Stone (1993) note that the inner critic destroys creativity, is the source of low self-esteem and shame, and can generate depression. MOVING TOWARDS FREEDOM Moving towards freedom and away from the negative inuence of early scripts requires awareness of our internal conditioning, then some processing of the unnished business, and post therapy increased awareness of the motivations for our tendencies. Emotional healing and long-term change are best supported by paying attention to any tendency to comfort and protect the hurts of the inner child. Unlike the choices we so willingly provide for our own offspring, allowing our inner child to make decisions and direct a course of action in our adult lives could be compared with handing the keys of a brand new car to a ve-year-old!
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Emotional healing, that diminishes the effects of childhood scripts, involves connecting with and working through feelings and reactions from the past, as well as the present. This therapeutic work frees energy, motivation and creativity for moving forward, nding in life enhanced fullment, and enabling the client to make informed choices. Depending on a clients stage of readiness and willingness to participate in therapy, processes that stimulate emotional healing may involve a form of psychological and emotional open-cut mining. This tracing back, or going down through layers of emotion and memory, involves feeling, giving expression to feelings, giving time to integration, and focusing the mind to formulating strategies and positive directions. As a therapeutic intervention ET delineates nine clear steps in the emotional release process: 1. Commitment to self The rst step in the emotional healing process involves agreement to allow some awareness of available feelings. This rst step is given time and space and is attended to with care and sensitivity, as for many clients it may seem to be the opposite of their own defence mechanisms or coping strategies. 2. Opening to awareness Once the rst layer of feelings has been reconnected with, the second step brings recognition of efforts to forgive or ignore the past. Trying to forgive or ignore may be ways of coping that maintain distance from underlying, more painful, experiences. 3. Letting go The next stage comprises a letting go of defensive efforts to understand the early situation through rationalizing, nding reasons and explanations. These mechanisms may have attempted to obscure young hurts with information. 4. Accessing, experiencing and expressing A central challenge is accessing and expressing deeper layers of reaction. Although the pathways to contacting these layers of experience are different in each individual, clinical observations over many years, reveal a basic pattern. Some people nd it easier to access feelings of anger, resentment, hate or revenge that, although often below the surface, break through and impact in daily life. While this is not a linear, sequential process, using the analogy of an onion can be useful as a way to visualize the process. Beneath the surface feelings there will be a deeper layer containing personal connections with the hurt of not being loved, seen, listened to, held,
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respected or kept safe. For some, an even deeper layer emerges that is connected to survival fears. 5. Staying with what is In working directly with emotions in therapy, support is offered for a client to stay with and experience feelings even challenging emotional states rather than nd a way to understand, avoid, ignore or rise above them. At the core of emotional processing is the effort to stay with, and allow a natural therapeutic process to unfold. 6. A new connection with the persons unique inner resources In the later stage of the process a client may move into a more quiet, tender, creative state. The resulting more centred connection with self means that sustainable problem-solving can take place with more ease, and appropriate aims and life strategies are more easily formulated and followed. 7. Separation After working through limiting and negative childhood scripts, psychological distance called separation in ET from their inuence can take place. The scripts no longer represent factual evidence in the psyche. Beginning within the therapeutic alliance and then extending into daily life beyond therapy, regular practise at separating behaviour, cognition and feelings from the vortex of past patterns brings relief, freedom and renewal. 8. Increasing a capacity and willingness to love Eventually there may be a development in the persons capacity for loving a maturation process from expecting love, to feeling love and care for self, to being able to share love with others enhancing the capacity and willingness to give and receive love. 9. Beyond the personal process In this nal step, the client becomes conscious of more than their personal reactions, and develops awareness of clearer, more positive interactions with surroundings, be it family, friendships, partnerships, social groups, or culture. IMPACT OF EARLY SCRIPTS ON RELATING As was stated at the beginning of this chapter, Bowlby (1973) described the internalized working model of attachment, or script, as a mental representation that provides some structure to the self and its relationship with others. It is a schema of the rules, perceptions, expectations and
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beliefs about self, others, relationship, and how emotions are expressed. The present writers observation is that a large number of adult clients enter counselling to address some distressing aspect of a relationship difculty. Very often the distress is connected to the way a script, related to attachment difficulties, is being played out. If chaotic or distant attachment was the norm, we may put up with what we learned to accept during childhood. We may settle for less than we want neglect, unfaithfulness, no connection, even abuse can seem more bearable than abandonment, isolation and aloneness. One client described her adult relationship as, at times, being like two children struggling to get something from one another, relating to the other as a child not an adult. She also commented that feeling herself as a child, or seeing her partner as a little boy, did not spark up intimacy. This is by no means an atypical scenario. Studies by Bowlby (1988) and Erickson, Sroufe and Egeland (1985) are echoed in all too many client reports, that friendships and romantic relationships feel incompatible when in fact they have taken on the shape and avour of (and then sadly conformed to) early models of relating. If childhood experience has resulted in disconnection from emotional life and positive qualities, these may be projected outwards. For example, the start of a romance may be a time of immense positive projections (Johnson 1983; Sandford 1980). All that is good, noble, beautiful or attractive is believed to reside in the chosen partner, lover or friend. This is followed by feelings of disappointment, and nally perhaps resentment, when the real person emerges and fails to match the projected image. Peluso et al. (2004) reiterated the work of early researchers in this eld, proposing that the relational aspects of experience during childhood play out in later life, and described the generalization of early relational experiences as forming the blueprint for future interactions (p.140). They describe the way a child begins to form a framework of expectations concerning the availability and responsiveness of others. This framework provides a sense of worthiness of love and care. Past expectations provide a basic context for guiding behaviour, interpreting experience and negotiating later interactions (Belsky and Nezworski 1988). When transference of attachment takes place, a therapist may see a client involved in unconscious efforts to play out a role that was valuable or valued in the dynamics of the family of origin. For example, a client may feel appreciated, or even loved, because of their skill as peacemaker, pleaser, scapegoat, or perhaps the clown. While initially engaging, our observations show that these roles keep relating at a supercial level, and in the long term become self-defeating and detrimental to developing more congruent and authentic relationships.
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When a hurt inner child script is active, neediness around others presides in the psyche. Or, in order not to feel needs, early rejection, past hurts or disappointments, we stay angry, avoid relating, or remain alone. There are many ways in which scripts from childhood inuence current relating: experiencing the present through the lens of early expectations and needs, and so misinterpreting the actions of the other pretence at being present, attentive and involved, while maintaining defensive emotional distance remaining emotionally unable, expecting or demanding help and support from outside focusing on winning love and approval through compulsive appeasement and accommodation of others needs avoiding rejection or emotional suffering by focusing on constant amusement of others, preventing deeper connection feeling reactive, rather than proactive and interactive.
Awareness of any of these permutations in relating can alert us and our clients to possible activation and overlay of past experiences. SELF-CARE On reviewing self-relating, a client often discovers that they eventually related to themselves in the same way as others related to them in the past. Self-care may be compromised. If there was no point in expressing needs in early relationships, we may not ask for what we want in the present, hoping or expecting it to be known. This may be followed by reaction to the lack of provision, and a cycle revolves. Scripts may incline us to depend on external sources to supply affection, approval, entertainment, belonging, or a sense of spiritual fullment. Personal resourcefulness and self-care may be underdeveloped. When external provision is absent, feelings of emptiness, resentfulness, worthlessness, abandonment can emerge in a way that adds fuel to relationship res. GROWTH AND HEALING After emotional processing, the pull of the past is diminished and past inuences can be left behind. When we are free of maladaptive drives, or wasted hopes of one day getting what was wanted from the past, the need
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to be loved by a parent loosens its grip on current relating. We can seek a lifestyle, a partner, social connections, a career, with the aim of reciprocating in nourishing, life-giving connections. When we are no longer seeking to be loved from a child perspective, self-acceptance grows, fear of being left reduces, and willingness to give and receive love increases. Love and affection are exchanged rather than demanded. When past pain has been processed, and critical inner messages become less controlling, open, reciprocal love is possible. This possibility for mature loving is most signicant for parents hoping to give the best support to their children, and to enrich their intimate life as a couple. Systems theory (Goldenberg and Goldenberg 2008) describes how, when one persons previously selective contribution to a group dynamic changes, others are affected, and are presented with an opportunity to change and grow. A positive chain reaction can begin. Transgenerational patterns may be broken (Kaslow 1995). In a relationship, when one, or ideally both, partners personal development reaches a stage where separation from past patterns has been somewhat achieved, then: each can experience compassion for themselves and the other communication becomes clearer and is less selective further self-development opportunities can open up positive choices for life can be followed through with much less risk of sabotage cognitive intents and problem-solving efforts can be more effective.
Ironically, when newly formulated action plans are initiated, the potency of past patterning can seem to escalate. When intended steps have not been taken, changes not made, the motivation and enthusiasm that was available for change and growth can be blocked and the world view of the past patterning again moves to the foreground of the psyche, eclipsing the sense of direction previously felt with certainty. Taking new, forwardfocused steps, stepping out of the so-called comfort zone, will sometimes activate old emotional fears. Regression takes place, and another round of the healing and separation process may be required. This process does not represent pathology. It is not uncommon for a client to progress through cycles of achievement and apparent regression, rather like learning to drive much rehearsing is usual before a new driver effortlessly merges with the freeway traffic.
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The ET therapist understands that after a therapeutic growth experience a client returns to a life very different from the holding environment of the therapy room. Conditions outside the therapeutic relationship have been constructed from old conditioning. The rewards for working through negative childhood scripts and moving steadily towards living out a more free, creative, mature self can be experienced as the foundation of a life-long journey of growth, discovery and fullment. DIFFERENTIATING SCRIPTS FROM A CREATIVE SELF Since inner child scripts can be largely unconscious, their presence and inuence on us may be detected through behaviour, mood and insights that result from their impact on the personality. Table 3.1 lists some of the avours that interactions take on when past patterning dominates relating with self and with the outer environment. We have also indicated an ideal alternative as a basis for comparison.
Table 3.1 Differentiating scripts from a creative self
Childhood scripts complicated/confused struggle focus on getting from outside fear of aloneness, emptiness fear of abandonment avoid or dislike confrontation reactionary or rebellious stance self-judgment feeling unheard, unknown invisible dependent Free creative self simple, straightforward owing naturally, or conscious effort recognition of inner resources ready to face unknown space comfortable with self able to receive challenge and address conicts condently clear response based on self-awareness self-acceptance aware of inner critic able to express personal views without energetic or emotional charge interdependent
RENEWAL WITH THERAPEUTIC SUPPORT Useful therapeutic direction for processing the inuence of impaired attachment emerges through the healing of any backlog of underlying, unresolved emotional distress. With skilled therapeutic support, a client can often develop awareness of ways in which their attempts to defend
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against emotional pain have inadvertently added to the current situation that causes them distress. This is evident when misinterpretation of communication begins to go awry. For example, attempting to isolate oneself in order to avoid further rejection or ridicule can be experienced by signicant others family, friends or colleagues as a lack of desire for connection, as aloofness, or even arrogance. Activation of a clients scripts by an incident may bring to the forefront unconscious resentment and hurt from the past. Unreconciled past hurts emerge alongside current feelings, and the past seems convincingly the present. What results is process under the guise of communication, and so it happens in an exaggerated way, with reactions out of proportion to the activating incident. An ET perspective is that the happy, fullled aspects of childhood have been successfully integrated into the personality. What actually requires attention in order to achieve sustainable long-term emotional regulation and stability are the much less attractive, and sometimes embarrassing, inner trends towards reactivity, withdrawal, struggle, self-loathing or neediness. Rather than seeing lacks in attachment as something negative that needs to be passed over, a therapist can receive them openly as a voice drawing attention to what has been neglected (Jung cited in Fordham 1991 [1953]), and this moves the person closer to the opportunity for resolution and growth. In order to work more objectively with clients and to be able to empathize accurately with their challenges, dealing with personal issues should be a component of counsellor training. Without experience in the client role, of dealing with real concerns, it may not be possible to formulate an accurate assessment of the suitability of therapeutic processes for certain clients. It might be unprofessional, and even dangerous, to offer the client a challenge that the counsellor has not also faced. Condence and competence in processing these often highly emotive attachment issues is partly achieved through the willingness to plunge into personal exploration, both in peer-practice training sessions and in some individual times of personal exploration with a therapist. PROCESSING DISTRESSING FEELINGS When a client chooses to speak about early life experiences, an expressive therapist maintains a keen attitude of open curiosity. Dialogue may be heavily imbued with revelations of growth-inhibiting beliefs relevant to past scripts. These scripts carry internalized messages such as Im not lovable, I dont deserve, I could never do, Nothing good happens to me, Ill never be good enough notions that have been internalized without question. No less rich a source of information is what is not said in the therapeutic encounter. Expressive therapists are trained in using silence, stillness
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and pause time to provide a holding environment for a client. Silence supports reection and contact with emotion. Silence allows the clients selfawareness to venture deeper. A secure, stable therapeutic alliance has been proven to be a positive force in healing family of origin scripts, reducing their impact, and repairing attachment (Slade 1999). Reconnection with uncomfortable feelings, moving carefully toward thinking the unthinkable, re-experiencing and releasing unresolved emotional distress, may require some degree of re-experiencing pain that was originally repressed. The very thing that may have been viewed as too distressing to consider can become the core of healthy emotional growth. Emotion-focused therapy (Greenberg 2001) referred to the process of treating emotion, with emotion. Elliott and Greenberg (2007) also talked of active expression or experiential processing something Janov (1990) called active suffering. Expressive therapists simply refer to emotional release processing. THE VULNERABLE THERAPIST IN A WORLD OF MIRRORS Several writers have commented on the inuence that attachment styles exert on development of the therapeutic relationship (Marotta 2002; Pistole 1989; Trusty et al. 2005). Interestingly, in the absence of resolution, a therapists early attachment experiences have been found to wield some authority over their style of relating and ability to develop empathic relating skills (Kennedy and Kennedy 2004; Marotta 2002; Trusty et al. 2005). A therapists ability to offer interventions or treatment objectively can be impaired, judgment can be clouded, if curiosity about client problems has not been extended to self-enquiry and self-discovery. Without knowing themselves, therapists run the risk of their own internalized working model acting as a default setting, with unexplored assumptions making the relational eld less than clear (Cozolino 2004; Johns 1996). The unconscious overlay of old beliefs on the present moment can form the crux of difficulties with, or attraction to, working with particular client populations. Professionals may have blind spots in relation to their work with clients whose story or material mirrors their own. It is not unusual for a therapist to nd mirrored, through a client who turns up for support, exactly the issue that has been avoided or remained unconscious in their own psyche. Scripts from childhood, when activated, can have a strong impact on clients behaviour and on the effectiveness of counsellors. It is helpful to know about our own scripts in order to be able to reduce the emotional strength of them, so there is minimal intrusion into our professional and personal life.
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In work with clients our reactions, responses, patience, and acceptance of them our counter-transference may be highly coloured by aspects of our own story. When old imprints and early scripts are active, reaction to the past can overlay current professional action. We may nd ourselves exhausted, running out of patience, beginning to give in to clients and ending up somehow demanding of them. This could even be an early sign of burn-out. Wolgien and Coady (1997) found that effective counsellors attributed some of their effectiveness to their ability to deal with distress from their family of origin. Trusty et al. (2005) found that counsellor trainees who were higher in avoidance rated signicantly lower in developing the counsellorclient bond. The avoidant style of relating they developed from early models contributed to professional difficulties. Trusty et al. also found that counsellor trainees who were high in anxiety and low in avoidance had the highest levels of empathy. They claim that it would seem obvious that counsellor trainees who do not avoid their issues, and who are highly attuned to their own emotions and vulnerabilities, would be more attuned to the emotions of others. They argue for inclusion of the wounded healer paradigm, a concept developed by Jung and several Jungian writers (Fordham 1991 [1953]; Kalff 2003), as an element in counsellor training. These ndings add weight to the evidence that experiential and transformational learning is highly valuable in the training of student counsellors. Somewhat surprising, at rst, is the nding by Watts, Trusty, Canada and Harvill (1995) that counsellors who were rated more effective tended to perceive their parents relationship, and their own parentchild relationships, more negatively than did less effective counsellors. In other words, their early experiences had alerted them to what was needed for good connection. Positive, joy-lled aspects of childhood are incorporated into the adult personality and character. We feel these when we allow ourselves to feel child-like and enjoy life with a sense of wonder like a healthy child. It is probably this part that is responsible for the great pleasure some professionals feel in starting to work with young clients. Conversely, it may be the unresolved childhood issues and scripts that incline many counsellors to avoid working with young clients. Needs that have been forgotten, or well managed, can be activated as we are confronted with similar needs in our clients. Our supervisees have reported nding these inner needs triggered by the demands of giving. When we are able to move on from what is unfullled, giving can be truly enriching both to the client and to us rather than depleting. Having practical supervision, support to work through the past, releases energy
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and frees us to be creative and fullled now. Our professional work with clients then becomes less taxing and we discover new ways, new creativity, to support them in opening to their full potential. Professional support workers can experience alarming rates of exhaustion. We hear of many gifted and caring workers in this eld leaving and choosing alternative careers with simple, steady, non-emotional interactions. They may not have had the help needed to cope with the emotions stirred up by the daily demands of caregiving, and working in an environment that is essentially problem-focused. Some foundational causes of burn-out may include: an exhausting effort to satisfy the inner child of the client compulsive energy of our own scripts to save another the tension of suppressing emotional pain that has been activated through supporting clients the struggle to get it right in accordance with the inner critic vicarious traumatization: the long-term exposure to suffering and the results of violence in clients.
THREE INFLUENTIAL WORLDS Within the frameworks of transpersonal theory, Grof (2000) proposed a model of three distinct domains exerting inuence within the psyche. In long-term therapy all these domains might need to be dealt with in conjunction with attachment scripts. Grof s cartography of the psyche (as detailed in Chapter 10) identied the genesis of these signicant forces as: perinatal experiences from conception, months in the womb, the organismic experience of the birth process, and immediate postnatal treatment biographical experiences from birth until the present transpersonal the story of our transcendent and pre-physical embodiment experiences.
While Grof (2000) claimed that any or all of those domains can exert inuence on an individuals psychology, it is generally the biographical domain that a counselling client has most ready access to, and can work with most easily. Researchers in the eld of perinatal psychology (Chamberlain 1998; English 1985; Grof 2000; Verny and Kelly 1981) have detailed ways in which pre-attachment experiences can set basic psychological patterns that may add to the inuence and intensity of post-natal
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attachment experiences. Material from both the perinatal and the transpersonal domains can emerge spontaneously, however, and would need to be worked through in deeper experiential psychotherapy. Summary
In this chapter we have briefly explored the concepts of attachment and the development of emotional scripts, how these develop in the early years, and how they can sustain relational dysfunction. Two scripts that appear repeatedly in clients processes have been described as the hurt inner child and the inner critic. Nine steps in the therapeutic process have been outlined whereby the power of early conditioning can be reduced, and clients can focus more positively on the present and the future. Some ways in which these scripts impact on adult relating and professional support work have been explored, and a summary of key emotional and attitudinal indicators of scripts in action has been provided. Some of the changes that take place after successful therapy have been described, as has the positive maturational effect of working with emotional processes.
PRACTICAL ACTIVITIES The following three activities provide examples of the range and depth of ET technique. Activity 1 would be appropriate in the early stages of therapy, when clients may be less aware of the automatic quality of selfcriticism. Activity 2 moves closer to exploring possible links between current problems and past difficulties. The professional reflection questions are useful for counsellors to engage in some reflection on any possible attachment scripts impacting on their professional work. EXPRESSIVE WRITING ACTIVITY (1)
Exploring the messages of the inner critic

The focus of this activity is support for a client to externalize the should, must, if only messages of an inner critic part. You can have the prompts pre-prepared on an A4 sheet (keeping the reverse side blank for extra writing space if needed). Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels.
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Age range: 12 years to adult. Suggest that the client take one or two slow, full breaths, releasing the breath with a slow sigh. After giving an outline of the activity, take a moment in silence for both therapist and client to disconnect from the talking part of the session. When ready to begin, indicate to the client to allow themselves to respond to any or all of the sentence starters that catch their interest. Assure the client that they do not have to show the writing to anyone.
Note: The writer (client) can use single words, bullet points, phrases, or create whole sentences as a way of completing the following prompts.
INSTRUCTIONS FOR THE CLIENT
Take a slow breath and give yourself time to look over the prompts on this sheet. See if there are two, three or perhaps more that grab your attention as you scan the page. Then relax as much as you can, choose a pen or pencil. Returning to the prompts that seemed most interesting, take some time now approximately 1015 minutes to finish the sentences. Once you finish the two or three you have chosen to begin with, see if there are any others youd like to write about. Your writing does not need to be sequential, carefully constructed or like a narrative. Simply allow yourself to respond spontaneously to the prompts.
Exploring critical inner messages
I really dont like people who If only we could What I think needs to change is I often tell myself that There are rules I worry about
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I would feel better if For a long time
When it seems that the writing part of the activity is complete, allow time for the client to silently reflect on what they have written. Then suggest the following steps: Take time to review what you have written, see if any further words or phrases emerge, and record these on the page. Underline the most interesting words. Tune in to yourself, see if you can imagine hearing the tone of voice the inner critic would use.
Together with the client, take time to discuss the responses that they have recorded. Ask the client if there are any ways to increase awareness of a critical inner voice. Discuss these. Consider whether a homework task would be appropriate and supportive. From the discussion, reflect on treatment planning how to continue working with the client, or what ET activity could be most useful for this client at the next session. EXPRESSIVE WRITING ACTIVITY (2)
Exploring the impact of childhood scripts now and then

This activity aims to provide an opportunity for exploring any possible parallels between emotional needs in a current relationship and emotional needs in the past. Age range: 16 years to adult. Resources: Art paper (usually A3 size), crayons, coloured pencils, pastels.
Take a moment to take in a slow, full breath. Let the breath out steadily. Let your body relax. When you feel ready, draw a line down the middle of a piece of art paper. The left-hand side of the page represents THEN. Label that lefthand side of the page with the word THEN. The right-hand side of the page represents NOW. Label that righthand side of the page with the word NOW.
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Right-hand column Now
Allow yourself to recall a current problem, irritation or frustration. Now take a few minutes to write briefly about it what are the main feelings you experience, what happens, how frequently does this occur, how long has the problem been happening, what do you think needs to happen? After writing about the problem, irritation or frustration, take some time to complete the following six steps.
1. Write about the reasons for this problem occurring. 2. Write about any attempts you have made to understand, any efforts you have made to rationalize, or maybe even forget. 3. Write about any feelings and reactions that you think may still be beneath the understanding. (For example, anger, resentment, irritation, disappointment, rejection, desire to blame, and so on.) Trust yourself to find the words to describe your feelings and reactions. 4. Take a slow breath and allow yourself to connect with any feelings of hurt or loss (perhaps from not being loved, treasured, appreciated, important, etc.). 5. Take a couple of minutes to write about any feelings you connect with, any memories or remembrances from that time. Give yourself permission to use simple words to describe this. 6. Feel free to use coloured pens or crayons to illustrate the writing. Perhaps certain colours, shapes or lines could amplify a statement or feeling.
Left-hand column Then
Allow yourself to recall the relationship you had with your parents when you were a child. Take a few minutes to write about that relationship. What was it like? Did you feel closer to one parent than the other? Can you describe how you felt about your parents and how you think they felt about you at that time?
1. Make a note of any ways (behaviours, thoughts) that you tried to understand or rationalize or explain to yourself why things were the way they were.
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2. Thinking back to childhood, write down any negative feelings you may have had about them at that time. 3. Take a moment to reflect, take a breath and write a few words about what you think was the basic hurt underneath all this. What was most hurtful or upsetting for you? 4. Feel free to use coloured pens or crayons to illustrate the writing. Perhaps certain colours, shapes or lines could amplify a statement or feeling.
Both columns
Draw a line across both columns. Then say to the client: Take time to review both columns, looking to and fro at what you have written. If you feel the need to write more, add colours, lines, shapes, please do so.
1. Is there anything that seems or feels the same between your feelings about the current problem and the hurt you felt as a child? 2. Are there any similarities between the relationship with your parents (then) and the current situation causing you hurt (now)? 3. Thinking back, was there anything you needed or struggled to get, or correct (perhaps prove something, or overcome, win out over something), in both situations? 4. Are there any other situations in your life where you feel drawn to try and overcome this same hurt? 5. Could you think of a new adult wish or intent you might like to formulate about this insight something that might help separation from past patterns of reacting? After completion of the writing task, invite the client to stand up and stretch their body, take a deep breath and relax. Then say to the client: Imagine it is possible to shake out old beliefs from your body with some light movement and that movement becomes an energy wake-up. If possible, allow some gentle shaking now perhaps starting with a foot or hand, then an arm or leg, allowing the movement to refresh your energy.
After a couple of minutes gentle movement, invite the client to sit quietly. Then say:
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Take a moment to take a breath and connect with your energy. Inside your mind take a moment to affirm any new wish or intent you want to have in your current life. Take time to write/journal any sense of direction or intention.
PROFESSIONAL REFLECTION QUESTIONS
Exploring the impact of scripts on professional relating

This activity is for therapists. It could be used for individual personal reflection on professional practice, or it could be used as a point for discussion in peer supervision. A supervisor could use this activity as a framework for working with a therapist discussing casework. Could you describe your particular role in your family of origin dynamics? Was there one significant thing you learned about yourself from your family? If you could state a main wish for your clients, what might that be? Do you see any connection between the way you were responded to as a child, and the way you think clients should be treated? If so, could you describe this? How do you imagine people will respond when they meet you for the first time? Can you comment on any comparison between any present life challenge you are encountering and early family difficulties? Could you discuss any similarities in the emotions you feel now and felt then? Do you notice any pattern in responding or reacting? If so, can you comment on or discuss this pattern?
Chapter Four
Emotions and our Body

Working with Somatic Awareness
OVERVIEW If we think about how we convey caring and compassion to someone, talking with that person would be one way only. A touch of the hand, a facial expression, sitting together in silence, are some of the body-centred ways that we relate and connect. The tendency when thinking about mind has been to locate it in physical proximity to our brain. More recent arguments have claimed that mind is located throughout the body (Pert 1997). Regarding bodily experience as something independent from thoughts or feelings also fails to take into account (for example) physical reactions to perceived insults from the interactional environment. Bodily experiences, in current thinking, result from the relationship between body and brain, body and environment (Diamond 2001; Levine 2004). Just as mind is a product of interactions within the environment (Siegel 2005), connection to somatic experiences can open a doorway to environmental inuences and background internal thoughts and feelings. When a somatic problem or symptom becomes distressing, the mind and body are clearly attempting to alert the individual to achieve some resolution of the disturbance. In the absence of any organic or physiological cause, somatic symptomology indicates a need for emotional or psychological resolution. It is not uncommon for a client to discuss long-term, persistent body pain such as migraines, cluster headaches, back pain, and other distressing physical sensations. These body messengers are often regarded as an annoyance or intrusion; less often thought of as being helpful signallers of needed repair or change. They are more likely to be viewed as disruptive to the expected enjoyment of daily living. While some therapeutic approaches stress the need to recognize and repair cognitive dysfunction, in ET it is equally critical to pay attention to somatic experience and understand the importance of psycho-physiological
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EMOTIONS AND OUR BODY
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connections (Levine 2004). What seems evident is that if we focus on removing the symptom only, then in terms of healing potential this is tantamount to killing the messenger (Rossi 1990). Rather than aiming for relief of, or diversion from, presenting symptomology, ET increases the ways a counsellor can draw the clients attention to the bodys messages. Along with expanding the range of ways they respond to reported somatic symptoms, this focus can lead to assisting a client in, and increasing their skills for, selfexploration and achieving emotional and psychological change. The body is viewed in ET practice as inextricably linked to mind, to feelings, to our earliest interactions with carers and others, and to our spiritual self. Psychotherapy that is body-based can bring awareness to the subtle internal processes that are sometimes disguised in the language of the body. Diamond (2001, p.42) referred to the historical struggle to understand body symptoms in the psychotherapeutic context. Along with other theorists and researchers in the eld of counselling and psychotherapy (Levine 2004; Roberts 2004; Rothschild 2000), our style of working with ET emphasizes the importance of approaching somatic symptoms as the bodys call for expression of some disturbance. That disturbance could be physiological, psychological, or even spiritual in origin. What is required is a shift in perspective, such that we see symptoms as communication-focused, rather than problem-focused; then they can become a crucial player in the healing process (Diamond 2001; Roberts 2004). Emotional healing involves giving a voice to the symptom so that it can fully express and discharge, thereby freeing the bodys own innate healing response. Healing is not merely achieving the absence of symptoms (Roberts 2004). This conceptualization of a somatic symptom as a healing direction is at the core of body focus work, an ET modality that creates a dialogue with symptoms (see pp.101104). Supporting development of somatic awareness through exploring and understanding mindbody connections brings useful self-discovery and activates the intrinsic self-healing potential. INCLUDING OUR BODY IN THERAPY Charles Darwins claim that emotions are adaptive in the sense that they prompt an action that is benecial to the organism, as opposed to something personal that happens inside of us, challenged the prevailing view (de Gelder 2006, p.242). Exploration of Freuds early work readily yields many case studies involving bodily identication (Diamond 2001). However, Freud steadily moved away from his original, biologically based libido theory (Young 2008). This movement away from a bodily basis for psychotherapy culminated with the eventual expulsion of Reich (widely considered the grandfather of modern somatic approaches) from the
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Psychoanalytical Association in 1934, and it was at this point the split from the body became complete and psychoanalysis, and subsequently most of cognitive psychotherapy, went its own un-embodied way (Young 2008, p.5). This shift then inuenced the ruling therapeutic paradigm that evolved to focus on cognition. However, Reichs legacy remains inuential, and has been a signicant source for the ET perspective for including work with the body in counselling. BODY, MIND AND THERAPIST Some people tend to be action-oriented always making sure they are doing something, creating something. Others are awareness-oriented reecting, feeling, sensing. Some take reection to the extreme, and become highly cognitive. Harmony involves allowing our actions to inform our awareness and our awareness to guide our thoughts and actions. ET aims to meet a client in their preferred way. We might start with action, ideas, reection or awareness. Somewhere in the therapeutic journey the somatic focus will be crucial. So much goes on in the body! Offering support that is most suitable, acceptable and effective for clients means that we need awareness, understanding, skills and activities, not just in body-focused activities, but also in understanding the way trauma has been absorbed by the body. It is important to understand the link between emotion and action, and how the eld of contact between therapist and client can inuence sensory experiences. At any moment in time the body is attempting to process a wide range of information from within and from without. Unintegrated emotional, psychological and physiological tension, deep perinatal tensions, recent shocks our whole history is held inside. The ideal therapist has been described as one who validates a clients model of the world, and facilitates unfolding solutions that are conducted within the language and logical boundaries of that world (Roberts 2004). However, reading a sampling of current texts on counselling and psychotherapy reveals that some approaches introduce, in varying degrees, constructs that can tend to disrupt a clients model of the world in favour of a therapists particular training orientation. Methods that speak to a clients internal experiential process, rather than requiring them to respond to the therapists (external) diagnoses and interpretations, enable progressive resolution of somatic factors, and can develop skill in body awareness.
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BODY LANGUAGE Utilizing non-directive, non-interpretive, neutral, encouraging language is supportive of a client being able to make the most of communicating the meaning, the metaphor, that underlies a somatic symptom (Lawley and Tompkins 2000). An expressive therapist might focus on engaging a client in their healing process by: kindling a clients interest in who they are recognizing signicant inuences in the clients relation to the world around them observing how the clients interactions with themselves, and their outer world, impact their body state.
Long-term positive outcomes may depend in part on locating and healing causes of symptoms. Understanding our emotional body language (de Gelder 2006) by acknowledging body symptoms and habitual postures or stances, and developing skills to de-code these, is a vital rst step on the way to discovering causes of symptoms and resolving them. Post-therapy, having the skill of body awareness can provide guidance for new self-care strategies and develops some compassion for the bodys needs. SOMATIC AWARENESS AND RESONANCE IN ET Being attuned to self and client involves keen attention at many levels of awareness. Counsellors often become sensitive to clients postures and the way they resonate within the therapy setting. Reecting on improving outcomes for bodywork practitioners, Blackburn and Price (2007) list the areas of awareness practitioners may develop: visual What do I see in a clients bodily movement and expression? auditory What is being said and how is it being said? emotional What do I notice on an emotional level? energetic What is the energetic quality of the experience? kinaesthetic What do I feel under my hands? somatic What do I feel in my own body?
When somatic awareness is indicated, and before offering activities to a client, ideally give some conceptual frameworks, some reason for the activities. Providing a rationale for exploring body signals and symptoms
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gives a client enough facts to make an informed choice. Some of the more useful concepts revolve around the notion that body symptoms can represent unprocessed emotional reactions to past, recent or current stressful interactions. Understanding that the emergence of symptoms is part of the psyches inbuilt movement towards wholeness helps the client agree to work with them, rather than divert attention from them or eradicate them. Ensuring that a client is attending to regular and thorough medical investigation of any persisting symptoms is also a critical part of care. MUSCULAR ARMOURING Reich, originally a protg of Freud, developed his own style of therapy which focused as much on somatic as on verbal analysis (Reich 1979). He developed the concept of character armour. Armour was the term Reich coined to describe chronic muscular holding that was part of the way the bodymind contained emotion and energy. The term referred to habitual patterns of muscle tension and constricted breathing that kept strong feelings from conscious attention, blocking both awareness and expression (Gilbert 1999). Reichs understanding of emotional inputs and bodily dysfunction have been incorporated into many different modern therapies (Gilbert 1999). In Reichian theory, holding back emotional and energetic expression takes place through muscular tension and reduced respiration (Gilbert 1998). The tension of blocked feelings is believed to lead to chronic armouring, and was seen by Reich to lead to health problems, and character and behavioural difficulties. Reich encouraged patients to kick and scream, if necessary, to release emotions, and to breathe heavily to the point of activating emotional expression. Reich worked with breathing from several directions: directing breathing to facilitate emotional awareness and release; using his observations of breathing as a diagnostic tool; and studying the uctuations in breathing quality as an indicator of uctuating emotional states (Gilbert 1998; Reich 1979). IMPROVING OUTCOMES WITH BODY FOCUS The present authors have repeatedly observed acceleration of the therapy process that seems to be a result of clients ability to focus on their bodily experience. Giles et al. (2007) report on the effectiveness of an intensive multi-modal group treatment that included somatic approaches for women recovering from abuse. Treatment for women recovering from childhood sexual abuse, using both bodywork and emotional processing, was explored by Price (2006). Her study revealed signicant decreases in post-
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traumatic stress disorder, number and severity of physical symptoms, and a trend toward decreased dissociation for the experimental group compared to the control group. Feedback from the participants who underwent treatment revealed the positive impact of body-oriented therapy on their sense of inner security and psychotherapeutic progress. Rohricht and Priebe (2006) describe the rst randomized controlled trial specically designed to test the effectiveness of what they call bodyoriented psychological therapy (BPT) on negative symptoms in chronic schizophrenia. They noted that neuropsychological considerations and older reports in the literature point towards its potential benet. They compared BPT with supportive counselling, offered in small groups. Patients receiving BPT attended more sessions and had signicantly lower negative symptom scores after treatment. As we have frequently observed in our clients, Leijssen (2006) also reported that the effects of body-oriented interventions on the clients process are: greater awareness, engagement in the present, deepening of experience, opening the body memory, cathartic release, resolving blocks, and exploring new possibilities. COUNSELLORS SOMATIC AWARENESS Being self-aware while offering counselling supports our self-care, provides a model of calm focus, and helps a client experience our presence and support. Weiss (2008) summarizes some of the ways that mindfulness appears in Western psychotherapy and medicine. He shows that it has become a legitimate area of scientic inquiry, and that it shares common objectives with Western treatment approaches. He explores the role and power of the Buddhist concept of an internal observer. Siegel (2007) discusses the way new neural networks can form through focus of attention science and spiritual traditions continue to meet! Focusing attention internally, he argues, can build new neural pathways. The mindfulness practice has implications both for clinical integration of therapy, and for spiritual exploration through focused attention. Hinterkopf (1998) recommends a focusing practice to support clients to reconnect with their spirituality a simple process that can activate individual existential search, which in turn can generate new experiences of meaning and personal satisfaction (see more on this in Chapter 10). In a similar way Blackburn and Price (2007) describe and advocate the practice of presence in the therapist as a support of healing and transformation in manual therapies. They see the therapists sensitive accompaniment as fundamental to the clients journey towards self-awareness. Their
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clinical experience indicates that the state of presence, and the choice to practise being present, can enhance the therapeutic process. Shaw (2004) describes research on therapists somatic experience during the therapeutic encounter that led to the development of a theory on psychotherapist embodiment. This study revealed the importance of the therapists body awareness within the therapeutic encounter. This recommended two-way attention is similar to the outcome Lowen (1975) describes as the aim of bioenergetics. Lowen describes the task of dividing the attention between the outer world and the world within. He found that a healthy person can alternate between two points of focus inner and outer easily and rapidly, so that almost at the same time there is awareness of the somatic self and of the environment. It may be that how we are conveys empathy, and conveys the emotional state we would most wish a client to attain. Berrol (2006) describes the effects of mirror neurons and empathy, as conveyed through dance and movement therapy. Intentional mirroring has been used as a signicant aspect of dance therapy. There is also a similar internal, unconscious process at work. Berrol discusses recent studies that reveal that in an individual who is simply observing another person, sets of neurons may be stimulated that are identical to those that are active in the one who is actually engaged in an action or behaviour, or the expression of an emotion. The areas of behaviour and the mirror neurons under investigation span movement and psychosocial and cognitive functions, including specic psychosocial aspects related to attunement, attachment theory and empathy (Berrol 2006). The area of motor neuron signicance is especially important for counsellors, whose moods, postures and empathy can have a direct impact on the client (Siegel 2005). Our responsibility to the client may include being in a relaxed and open state, so that we provide a useful model. Experiential training courses support counselling students in developing extended selfawareness and enhanced use of self. Research has indicated that a positive alliance between the counsellor and client is one of the best predictors of outcome (Horvath and Symonds 1991), and a positive alliance may begin with the emotional modelling a counsellor provides. This alliance may be up to seven times more important than the treatment model (Krupnick et al. 1996). How we are as counsellors may sometimes be just as important in forming a good alliance as what we do. The intent to be present is a good starting point for developing the use of self and practising a more sensitive relational style. There are six foundational concepts that inform the relational style ideally used in applying the ET modalities: developing the willingness and capacity to be present
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feeling and conveying acceptance and compassion practising an invitational style of relating developing self-awareness as a practitioner fostering an interest in empathic attunement or resonance owing with creativity in responding to clients needs.
In terms of facilitation, this perspective sees the therapeutic task as one of support and guidance, not intervention and advice. Grand (2005) described training counselling psychology students in a somatic-based programme. He described the way in which, during clinical work, students are encouraged to practise embodied becoming: their own creative use of both unconscious and conscious material as they approach working with clients. This includes working with dreams, exploring bodily feeling and expression, and working with movement, sound, art and other creative means. As we have found over many years, Grand also found that students ability to be present with clients was aided by experiential work in which they participated in body-based exercises that impacted on their self-organization and their presence with others. BODY, ENERGY AND PERSONALITY The ET framework integrates the psychological, physiological and energetic concepts of Reich (1979), Lowen (1975) and Jung (1964) that explore the way the body, the mind and our emotional energy work together. ET theory conceptualizes four distinct concentrations of energy, emotion and personality in both the body and the mind. This framework considers the way in which psychological structures, musculature, affect and energy can interact together. A simple scheme that helps us develop a map of this framework would display these interactions as operating in four distinct physical and psychological layers, best represented by four concentric oval shapes, and described as follows.
1. Core/self
This could be theorized as an imaginary stream inside (the innermost oval), running through the centre of the body and permeated by strong, alive energies and feelings. Reich (1979) hypothesized this core energy as always healthy, alive, owing and moving towards expression and creation. Eiden (2002) agreed with Reichs theory that human beings operate from an inner core, which is spontaneous, positive and life enhancing, having
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the capacity for self regulation (p.28). Contact with this core energy is sometimes experienced as feeling more real inside ourself, more alive and optimistic.
2. Emotional layer
This is a layer of unresolved, unexpressed or blocked feelings (a second oval, around the rst). This layer may contain both what is considered positive and negative. Here lie emotional and energetic responses that were not accepted within family, community or cultural contexts. Creative energies that have not had an outlet are also visualized as residing in this layer (Reich 1979). In an emotionally deprived or traumatized child, or one simply carrying an overload of emotional pain, muscular armouring develops to deal with the impulse to express what is not acceptable, along with the perceived need to contain these feelings and reactions. In unhealthy or unsatisfactory interaction the core energy cannot expand. Its natural orientation is towards expression, so it pushes against this armouring.
3. Armouring/shadow/unconscious
The third layer works physically and psychologically to hold in feelings and energy, and is largely unconscious. This layer of armouring and defence mechanisms stops the ow of both negative and positive energies. Tension is used to control and block expression, along with restricted respiration and hormonal and neurological inhibition. In this layer much positive and natural expression is also blocked and tends to turn into its more negative forms: destructiveness, spite, rage, anxiety, fear, etc. Psychologically this layer is where most of what Jung called the shadow is held. In polite society, this layer is usually buried beneath an outer layer.
4. Personality/persona (or mask)/ego/conscious self

Reich called this layer in the personality the faade, or social veneer. When young, we may be encouraged to develop a mask, to pretend to be happy, or to be compliant. Another form of conformity is for a rebel persona to develop. We may come to believe in this mask self, and we may be encouraged to strive to behave as if it were our authentic self. Feelings of failure may then develop when behaviour in contradiction to the mask emerges, or when there is a clash between the layers. In psychotherapeutic treatment it may be appropriate to explore beneath the mask. Trust is needed before the mask can be dislodged. ET activities can help in freeing up the armour, the holding, so that the core
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energy can again express in its natural positive way. Long-term emotional health may depend on the relaxation of armouring, resolving of incomplete emotions and a return to free-owing of the body energy. Connection between the layers in this framework is restored. Contact between the outer persona and the inner core layer can contribute to a stronger sense of self and to becoming more resilient. FIRST, TAKE A SLOW BREATH BREATHING ET practice is to gently encourage a client to expand inhalation and relax their exhalation from time to time, as a way to support easier access to emotional experience. Gilbert (1999) points out that breathing is very linked to emotional states, and describes the legacy of Reich, with particular emphasis on his contributions to understanding the therapeutic signicance of disruptions in breathing. Facilitating emotional and physiological release is a goal of many somatic-focused therapists. The respiratory system, like the muscular system, is often linked with specic emotional material still unwelcome in the conscious mind. Emotional states such as grief, suppressed anger, frustration and anxiety may maintain dysfunctional breathing patterns (Gilbert 1998). From his clinical observations Gilbert noticed that certain feelings, at certain times, are clearly expressed through our breathing as changes in rhythm, depth, location, or regularity (p.224). He noted that irregular breathing rhythm is characteristic of individuals more prone to anxiety. ET practitioners have found the introduction of occasional breathing exercises valuable in helping young clients develop greater emotional awareness. Inviting older clients to take a deep breath, especially at times of close connection to troubling emotions, can facilitate the awareness, expression and resolution of the emotions. Wilner (1999) described the application of Pierrakos (1987) core energetics action methods in therapy. A primary technique used in core energetics is breathing exercises. Deep breathing has been used for many years as an aid to relaxation in multiple-component cognitive-behavioural programmes (Feindler and Ecton 1986). WHAT MY BODY FEELS TUNING IN TO THE BODY 1. Discuss any known causes of somatic symptoms, especially any lifestyle changes. This may include focus on any recent medical diagnosis, and any recent psychological or social changes. This
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discussion may help a client connect events and reactions to symptoms. 2. Take time to listen to the client describe the impact of the symptoms on their daily life, relationships, work, self-image. Is there any sense of loss? Any reactions from signicant others? 3. Focus discussion on the clients beliefs or attitude to their body or the body in general. 4. Explore any possible sources, or models, for these beliefs and attitudes. 5. If time allows, and after evaluating the appropriateness of the activity, invite the client to take time to read their body from the inside the body focus exercise. This involves relaxation followed by focus on each part of the body. This can be followed by the client drawing what stands out on a body outline. (See Figure 4.1 below and What my body tells me on pp.99101.) Discuss what the client liked or disliked about the activity; invite them to share how what was found in the body connects with the symptoms. FOCUSING ON BODY LANGUAGE 1. Introduce the body focus exercise Dialoguing with physical symptoms (see pp.101104). This activity helps understand body symptoms and promotes a deeper connection with what lies behind those symptoms. 2. Assess the extent and sensitivity of symptoms before and after an activity. This can be done through recording the outcome of body focus activities using two body outlines. Clients will often notice a reduction in the severity or extent of the symptom after a therapeutic activity. 3. Offer bioenergetic exercises that use stress positions and active movements to de-stress the body and to help contact emotions, to rehearse and feel permission for release, and to begin some emotional and physical release. 4. Offer emotional release processes as a way for a client to nd their own emotional body language, to explore and communicate feelings about their body, in the body, and to release some held-in feelings.
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5. Set self-care homework tasks to support the overall process of counselling. These might include a clients use of relaxation, visualization or meditation exercises, massage and developing lifestyle habits to keep body energy alive and owing. Summary
Localizing mind by referring to it as residing purely in the head is now thought of as an outmoded idea. Emotions have been shown to be contained throughout our body. Concentrating on changing thought patterns, or cultivating a mask of positivity, does not ensure a happy, healthy life. Offering opportunities to engage in emotional expressivity in a safe, supported, integrative way, that includes a focus on bodybased symptomology, offers a holistic approach to mental health and wholeness. Emotional states shift our consciousness and activate different moods and different memories, and act as a link between our physical and mental realms. There is a wealth of information stored in and being processed by the body at any point in time. Our physiology can be run by our emotions. Chapter 4 has reminded us about body symptoms and their role as important primers that call for bodily focused attention in the work of unravelling body sensations, trauma or past memories. We can work with emotions stored in the body so that, rather than seeing them as an impediment, we come to regard them as a potentially unifying and integrating force that can help us act and behave in a more cohesive way. Muscular armouring, body language and the viewpoint that our energy and ultimately personality can be influenced by emotion-charged experience stored in the body emphasizes the need for activities that engage in scanning the body to draw attention to bodily stored emotions than can unlock the key to healing and continued good health. This chapter also talked about enhancing mindful practice through therapists somatic awareness, both of their own body language and that of their clients. It included experiential activities that, with training in emotional expressivity, can be highly effective in focusing on the sensations of the body and operate to mediating between body, mind and spirit.
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Figure 4.1 Adolescent male, body outline: Anger in chest and hands.
SELF-AWARENESS ACTIVITY
What my body tells me

Resources: Coloured pens, pencils and crayons, drawing paper (A3 size), pen and A4 paper for writing (or personal journal). Quiet relaxation music in the background.
PREPARATION
1. Prepare a large body outline drawing, and have crayons and a pen available. 2. Invite the client to relax in a comfortable chair, on cushions or, if they prefer, on the floor. 3. Invite the client to close their eyes if possible and encourage them to take several steady, deep breaths.
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INSTRUCTIONS
1. Guide the client to tune in to their body and then connect to each part: Take a couple of minutes to tune into your body. Imagine you could check around inside your body, and see what is there, what you can discover. Begin with checking inside your head, and move your awareness gradually from your head down through your body to your toes. 2. The next step is to see if you can imagine moving your awareness through your body and look for the different feelings I am going to mention. If you find them, draw them on the body outline beside you. It will be like creating a map of whats happening to your body. Allow yourself to choose colours and lines that best describe what you find. 3. Then relax again and wait for the next thing to look for. If you do not find anything just relax and wait for the next thing that I mention. Sometimes you might find a feeling in one part of your body, sometimes in several places. 4. Look for the things I mention to you in your head, your shoulders, your arms and hands, your chest, belly, hips, legs and feet. 5. Take a steady, deep breath each time you relax, then tune in again and wait for the next search. (Use different ways to encourage the full breath.) 6. Search for six to eight of these:
cool or cold warm or hot pain/pleasure sadness/happiness anger/loving weakness/strength fear/courage tight, holding parts/relaxed, free, soft areas parts you dont like/favourite parts agitated, upset or worried areas/peaceful parts a place that feels like an animal, bird or fish may be hiding or moving about.
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7.
Ask: Is there anything you have found inside that has not been mentioned?
8. Draw a key (legend) beside the outline, showing what was found.
DISCUSSION
1. After several searches, discuss the body outline drawing. Invite the client to describe what was found and how they felt doing the exercise. 2. Encourage conversation that may enlarge the clients self-awareness and some possible causes for what was found. 3. Take some time to draw out connections between what was found in the body, what is happening in the clients life, and any emotions that may be linked.
INTREGRATION
Take some pause time to allow the client to digest what has been discovered and shared in the session. Invite the client to say anything more they want to or need to, and ask if they have any questions about the process or about what has been discussed. Consider follow-up work indicated by what was found by the client and indicated on the body outline.
BODY FOCUS ACTIVITY
Dialoguing with physical symptoms

Aim: This activity helps clients tune in more deeply to, and understand causes of, feelings and impulses underneath body symptoms. (See Figure 4.2.) Resources: Coloured pens, pencils and crayons, drawing paper (A3 size), pen and A4 paper for writing (or personal journal). Quiet relaxation music in background. Note: This activity is one that would be suitable after the therapeutic relationship has been established and therapist and client have experienced openness, trust and rapport with each other. The activity invites the client to assume a lying-down position. Assess whether this is appropriate for the client and in the setting in which you work. The activity can be done just as effectively in a relaxed sitting position.
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Figure 4.2 Adult male: Headache transforms into new excitement.

PREPARATION
Have quiet, gentle music in the background to aid relaxation and inner focus. After opening discussion, ask client to create two body outline drawings. Use A3 or large scrapbook-sized paper.
INSTRUCTIONS
1. Invite the client to relax and sit back in a comfortable chair, or, if they feel comfortable, to recline in a lying-down position on a yoga mat (or similar). The counsellor sits near the persons head ready to listen and record. 2. The therapist takes the client through the relaxation sequence:
Become aware of your breath. Allow it to be a little fuller. Tune in to the warmth of your breath as it comes in and out of your body. With each breath, allow your body to relax a little more.
3. The therapist then takes the client through the focusing sequence:
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Take time to check through inside from your head to your toes for any areas that stand out to you. See if there is some part calling for your attention some part that is standing out from the rest. It may feel troublesome, in pain, stressed, or filled with a very strong energy, even excitement. Take some time to scan through your body, see what stands out. Then see if you can express what you find, using colours, lines, shapes, on one of the body outlines.
4. Allow time for the client to talk about what they found. If more than one, choose strongest area to focus on for this activity. 5. The client relaxes again. The counsellor says:
If you can reach it easily, put your hand on the part. Use the touch as an anchor for your awareness. Listen to the questions that are about to be asked of that part. Let your mind surrender let the part hear and give its answer. Give permission for that part to use your voice and words to answer. See if you can allow any feelings to come forward. Take a full breath after each question.
QUESTIONS FOR THE FOCUS AREA
1. Are you something new, or old something ancient or recent? 2. Are you deep inside or near the surface? 3. Are you in the bones or tissues? Or in the muscles or skin? 4. Are you a tight, holding energy or diffuse and spread out? Are you free or held? 5. Go right inside that part become the part totally and take time to listen deeply. Do you have a shape? Describe your shape and how far you spread. 6. What colour are you? Can you be specific? Can you describe the range of colours?
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7.
Is the energy in you still or vibrating? Quiet or excited?
8. Did somebody else cause you? Or the person whose body you are in? 9. Do you have a name? 10. Do you relate to the persons outer life? 11. What do you want of the person whose body you are in? Is there anything you want them to do for you? 12. Is there somewhere youd like to move to? 13. Is there any image or memory you would like to share? Be with that for a while. 14. Allow any feelings or movement. Allow any change in the bodys position. 15. Is there anything else the part would like to make known? The client is invited to draw how they feel now on the second body outline. For more examples of body focus drawings, see Figures 4.3 to 4.6 (p.110).
INTEGRATION
1. When the client feels ready, invite them to share their insights. Supportive questions could be offered; for example:
Has the sensation changed? How does the energy feel now? What do you notice when you look at the two body outlines? Are there any new connections, new understandings? What might need to happen in the future?
2. Invite the client to rest and be still for a while, or to dance or move around, whatever feels right for them. 3. Allow time for the client to record any significant insights and/or create a mandala of the new energy state.
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BREATHING ACTIVITIES FOR YOUNG CLIENTS These games are designed to activate the body energy and stimulate emotion through strong breathing. They can be used before process work and as a way to help young clients let off steam.
The feather group activity

The children form a circle and sit down facing the middle. They imagine a feather lying in the middle. They try to blow this imaginary feather to the other side of the circle. Then put a real feather in the middle, and they repeat the exercise. There is a magical quality about its movement as it rises up in the air.
The young tree

The children gather in a circle, facing the centre. One child volunteers to be a young tree, standing in the centre. The group becomes the wind, blowing the tree, making it sway and bend. Then they blow the tree one at a time, so that the direction of the breeze keeps changing, flowing around the circle. Several children take turns at being the tree.
The horse
In a circle, the children gallop around the room (all going in the same direction). They are told it is a very cold morning, and the horse is snorting very strongly, so strongly that you can see its breath. They become the snorting horse, galloping over the hills.
The rabbit
Children become rabbits, jumping around the field enjoying their lunch. Suddenly a fox appears; they freeze, holding their breath. Then they dash home to their burrows, and sit panting for a while.
Other suggestions
Be a whale exhaling imagine a fine spray of water bursting out. Become a dragon breathing fire how far can you send the flames? Blow up some imaginary large balloons.
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BREATHING MORE FULLY Vary the ways of giving the instruction to take deep breaths so that it does not become boring or mechanical. Emphasize relaxation on the outbreath. When the client is sitting or lying down, say: Put your hand on your chest. Is it tight or willing to expand? Take a big breath and let it out. Make your chest huge with a breath. Put your hands on your ribcage, feel what happens as you empty all your breath out this time. Take a breath in through your nose; let it out through your mouth. Take three fast breaths. Take a big breath in through your right nostril and let it out through your left. Then in through the left, and out through the right. Take a big breath very, very slowly. How slowly could you breathe in? Take six slow, big breaths as if you were a balloon being blown up. Take in a breath with each number I count: 1, 2, 3, etc. After 6 let the breath out with some noise, as if someone suddenly let the balloon go!
RELAXATION Relaxation is used in ET as a basis for developing sensory awareness, and has proved useful in supporting clients therapeutic process. Relaxation is introduced to clients to enhance their self-care skills base, and is used in sessions as an integration process, particularly after expressive work with emotions. Various types of relaxation are incorporated in ET exercises, such as progressive relaxation (similar to Jacobsons sequential contraction and relaxation of major muscle groups [1929, cited in Lusebrink 1990]), and use of imagery e.g. a rag doll, melting cheese on a pizza (similar to Schultzs autogenic training, which uses images of warmth and heaviness to invoke relaxation [in Lusebrink 1990]). The importance of the let it happen attitude to relaxation and the passive concentration on breathing recommended by Schultz in autogenic training (Benson and Klipper 2000) also reects the approach to relaxation adopted in ET.
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Figure 4.3 Adult male, body outline at end of session: Feeling alive.
Figure 4.4 Adult female: body outline using symbols.
Figure 4.5 Five-year-old male, body outline: All anger.
Figure 4.6 Nine-year-old male, body outline: Highly traumatized.
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Relaxation training has proved useful in many elds of endeavour (Carlson and Hoyle 1993; Goldfried and Trier 1974; Ost 1987). Biophysical methods using muscle relaxation have added to the success of cognitive-behavioural approaches for many years (Rosenberg et al. 1997). Using body outline drawings to map emotions and sensations a standard ET activity has proved useful in developing awareness of the connection between body pain and emotional distress (Flemming and Cox 1989; Pearson and Nolan 1991), and is used both as a diagnostic tool and as a means to support client self-awareness, leading to motivation to engage in relaxation. Benson and Klipper (2000) refer to the extensive medical research on the value of relaxation, and describe the inherent relaxation response as an innate mechanism within us. The key ingredients that support this relaxation response are a quiet environment, the use of a mental device, a passive attitude and a physically comfortable position. All these are utilized in the ET relaxation exercises, which are often conducted while the client lies on a carpeted oor or reclines on large soft cushions (Pearson 2004). Holian (2001) found the use of ET creative visualizations highly effective as an adjunct in supporting relaxation, as well as increasing concentration. Morton and Cescato (2000) found that a school-based relaxation training programme reduced students stress and anxiety levels, and recommended such programmes as a preventative strategy.
RELAXATION SEQUENCE PLANNING
Creating relaxation sequences for young clients

In creating a relaxation activity aimed at a particular client or group, take a moment to consider typical interests of the age group, any cultural interests, and possible gender differences in interests. Before commencing relaxation activities, creating an appropriate calm and attractive environment will add to the success. Make the work space as private as is possible. Dimmed lights can help the eyes relax and lead to enhanced physical relaxation. Create a sense of order in the room and maybe have a beautiful focus area such as a centrepiece, cloth, flowers and candle, etc. Present an overview of the exercise and give brief reasons for doing it: Im going to invite you to take an imaginary journey that I hope will be relaxing for you; see what you can discover about yourself. Bring forward any trust issues, especially if there is any resistance or embarrassment in the client, or group. Allow the client to acknowledge their mood before relaxation begins. This is especially important for adolescent clients.
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In presenting relaxation, use an invitational approach, give options for the way clients participate. Offer questions rather than statements. For example: Could you let your body go a bit more floppy? 1. Release agitation and warm up: use some brisk walking, shaking, bioenergetics, taking some deep breaths. 2. Direct clients to tune in to what is there, without the need to change: How do you feel right now? Guide their attention to turn inward to the sensations of the body. Bring the clients awareness into their body. 3. Plan a structure for the relaxation sequence. Consider whether to focus on the whole body, or for specific areas. Consider whether the sequence will aim to move awareness around the limbs, or through the centre of the body. Will the focus progress down the body, up the body, or around the body? 4. Relaxation imagery can help convey the sense of letting go. Plan to use some images that help convey the concept and experience of relaxation. For example: floppy like a puppy asleep; soft like melted cheese on a pizza; imagine you are warm chocolate sauce on a steamed pudding. 5. Direction from the presenter will guide the clients attention and call it back when distracted. 6. Will you use a story or journey? In a visualization story create some signposts along the way; for example, a special tree, a gate, a landmark, etc., which is included both at the beginning and at the end of the journey. Is there a safe, enjoyable place the client can imagine arriving at? Is this place imaginary or a real place that they know? 7. Allow a central time of stillness and silence, some time in the exercise where nothing is said or done. The length of this time will depend on the clients attention span.
8. Gently, gradually, return to reconnect with the outer world. 9. Private expression and recording of the experience could follow through choices of drawing, writing, modelling, choosing symbols to represent the experience, etc. After some integration time there could be an invitation to share the experience. In a group setting the listening to others, and possibly asking questions, can help create a sense of community and develop some social
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skills. Assess from the discussion and artwork (if any) what follow-up work may be needed if any doorways to the clients inner world have opened. RELAXATION ACTIVITY
Tension and surrender I am a star

This is a relaxation and grounding exercise to release tensions and support centring. It is supportive to use before quiet relaxation work. It uses overstressing to assist a deeper relaxation. Ideal for young people who are not ready for quiet, still relaxation work. The facilitator gives a brief explanation of, and reason for, the exercise. The client lies on their back on a carpeted floor, and stretches out their limbs. Ask the client to tune in to how they feel. Then direct them to contract and expand their whole body a few times, and then relax and be still. The client visualizes themself: as a five-pointed star, with each limb and their head as a point floating, twinkling in a clear night sky.
Ask them to make their body into this shape. Say: Now the star is going to try some star-aerobics! Begin tightening the muscles of your body, in this order: right hand, right arm, hold for a moment, let go right foot, right leg, hold for a moment, let go left foot, left leg, hold for a moment, let go left hand, left arm, hold for a moment, let go face, trunk, hold for a moment, let go.
Work around the limbs about six to eight times. Establish a rhythm: Tense! Tense! Hold! Relax! (In group work you can use a drumbeat to help establish the rhythm.)
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Invite them to tune in to themself, and say: Be still now. Remember you are a star. Can you feel inside? How does it feel inside you now? (Pause.) What colours and lines and shapes would go with how it feels inside?
Invite the client to draw how they feel. Encourage discussion on: how they felt before, during and after the exercise any creative activities their energy would enjoy participating in.
MOVEMENT AND BIOENERGETICS The work of Reich (1979), Pierrakos (1987) and Lowen (1975), with their focus on body-oriented aspects of therapy, forms the basis of the ET inclusion of somatic elements in counselling. The work of these writers informs the ET adaptation of Lowen and Lowens (1977) bioenergetic exercises for use with children, and the occasional use of breathing activities. Lowen and Lowen (1977) describe bioenergetics as a way of understanding personality in terms of the body and its energetic processes. They considered bioenergetics as a form of therapy that combines work with the body and the mind to help people resolve emotional problems and realize more of their potential for pleasure and joy in living. Bioenergetics was developed in the 1960s by Lowen and Pierrakos students and colleagues of Reich. The basic bioenergetic exercises have been adapted for use within ET, to develop a deeper self-awareness, reduce defensive muscular tension, and as an adjunct to emotion-focused processes. Ideally the body, mind and feelings work in ow together. However, whatever feelings are denied or inhibited, what we refrain from expressing, remains incomplete. Holding back emotion requires muscular tension. When defensive tension becomes chronic it becomes armouring. The incomplete emotional process impacts on cognition, engendering negative and destructive thoughts and attitudes. These patterns can then express as negative and destructive actions. Emotional inhibition and armouring can also lead to eventual health problems.
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Figure 4.7 Asian students explore dance and rhythms.
For emotional healing feelings and energy need to return to a owing state. Bioenergetic exercises can mobilize physical energy as well as emotional energy, and can help clients open to their emotions and feel more alive. The exercises can be used safely to ventilate, and to catalyse emotional release processes. The exercises often use temporary intentional tension and movement to mobilize and stretch muscles in order to reduce armouring. The depth of impact of the exercises can depend on the duration and purpose of participation. Bioenergetics are most helpful for clients who are depressed or have long suppressed feelings, and can activate these to be worked with in a counselling session. An atmosphere of fun, and use of rhythm and imagery, will help wholehearted participation. Counsellors should explore the exercises personally and participate energetically in them, model them enthusiastically. Lowen (1975) observed that being guarded, armoured, distrustful and enclosed was almost second nature in his culture. He suggested that people pay a great price for defence mechanisms and self-protection. Protection eventually causes wounding, worse than the original vulnerability that was being defended against. He emphasized working with the basic functions of breathing, moving, feeling and self-expression.
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Awareness of sexuality and its inhibition, through armouring, was also part of his clinical practice. Part of Lowens work was, rst, to bring body sensation into sharper focus, through directing attention. He recommended that we then divide our attention partly to the outer world and partly to the world within. The mind can direct a persons attention either inward or outward, toward the body or toward external objects. He maintained that a healthy person can alternate these two points of focus easily and rapidly. Bioenergetic exercises help a client shift from scattered attention to a deeper awareness of feelings and body sensations. They help a client to be more in touch, and to connect more readily with the core of an issue. The exercises can de-armour and relax the body so that feelings and energy can ow more easily. Bioenergetics can also help rehearse a release process in a way that greatly supports effective therapy. FOLLOW-UP STRATEGIES FOR SELF-AWARENESS ACTIVITIES The symptoms of sensation and emotion in the body may be a sign that emotional healing is needed and/or is underway. There are two types of follow-up strategies that can be offered (after enhancing self-awareness): those that attempt to reduce or manage symptoms; and those that process and can heal the causes of the symptoms. Both approaches can be appropriate at times, depending on the assessment of the level of emotional well-being in the client, and depending on their therapeutic needs and interests. To begin to heal the causes of symptoms, involve the body; support connection with, and release of, emotions; then encourage reection on the experience. For long-term healing some form of expression will promote well-being. Sustained awareness can also bring some resolution in some cases, as, for example, in meditation. Follow-up activities after self-awareness exercises might include discussion and speculation on any known causes of symptoms, encouragement of cognitive review and insights. Relaxation can be offered to reduce the effect of symptoms, along with use of sustained awareness. Bioenergetics, energy release or dance could be used to encourage physical release of the identied symptoms. (See Figure 4.7.) Body focus exercises combining focused attention and relaxation with exploratory questions (see pp.101104) can be used to catalyse the therapeutic process.
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Emotional release processes might be indicated, that focus on contacting, processing and resolving underlying emotions. In a more indirect way of working, role-play of images and symbols that accompany body symptoms can sometimes bring resolution, insight and a reclaiming of positive qualities.
BIOENERGETIC ACTIVITY
Using tension to enhance self-awareness

Offer a brief introduction to some basic principles of bioenergetics. Prepare drawing materials and a circle for mandala completion drawing. Have gentle relaxing music available for later stages.
STANDING
Tension in arms: explore the effect of tension in arms and hands. One arm stretches forward, then relaxes. Compare awareness of sensation of energy, then work with the other arm. Bound and free: wrap arms around body, tighten body, hold tension and breath, burst free and shake body, running on the spot. Face: tighten eyes and jaw, hold, take a big breath in and hold it, release breath, open eyes and jaw wide, blink and move jaw a little. Shoulders: bring shoulders up to the ears, hold tension, hold breath, drop shoulders, release breath, shake shoulders. Arms: bring hands together, fingers touching, turn fingers in facing towards chest, extend arms out away from chest to create tension, hold tension, breathe, then soften, relax, repeat. The star: feet apart, relax knees, stretch out arms and fingers, open chest, stretch arms out wide, as far back as possible, hold, let go, repeat. The arch, or bow (as in bow and arrow) a basic stress position: bend knees, rest hands gently on lower back, open chest, leaning back slowly without letting head drop back, until the whole front of the body feels open. Breathe deeply and slowly, allow any
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vibrations in muscles to build up. Alternate with bending forward and shaking gently, going floppy.
LIE DOWN AND RELAX
Heart opening: lie down on back over a large cushion, so that the chest is in an open position. Bring awareness to the breath, relax, allow a sense of opening. (Use gentle background music.) Energy in legs: from a lying position, stretch each leg, imagine it is growing longer, let the leg respond to the image, then relax. Alternate legs, then rest. Keep focus on energy in legs. Rest with inner focus: from a lying position, tune in to the energy in the body, be still. Remain aware of how the body feels and how the energy within and around it feels.
SIT AND DRAW
Mandala: in a circular framework, draw lines, colours, shapes or images that go with how you feel now. Is there a word or two that goes with how you feel inside now? Discussion: client is invited to share how they found the exercises and how they feel now.
MOVEMENT ACTIVITIES
Ways of using movement to support integration

Young clients will often want to move rather than be still after challenging emotion-focused work, especially after releasing frustration and anger. Helping them gradually quieten may be achieved in stages. When presenting movement activities, generally move from stronger expression to more subtle and gentle work and then, perhaps, some stillness. Emphasize self-awareness as the clients move. Follow the movement with some quiet self-focus, then perhaps complete with drawing how they feel. 1. Support release of tension and energy by:
stretching breathing deeply shaking alternating tension and free movement
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running on the spot going for a brisk walk.
2. Moving and role-playing aspects of nature for example, in the activity The sunset (pp.116117) clients explore being ants, a snail, a bee, a tree, the sunset. 3. Slow walking relaxation (see pp.117118) 4. Free dance moving from powerful rhythms to gentle flow. For example, use the dance sequence from Gabrielle Roths Five Sacred Rhythms, using the CD Initiation, Tracks 1 to 5 (Raven Recordings 1984) (Gabrielle Roth is music director of the Mirrors. Her primal trance-dance music grew from her involvement with ballet, drama, movement therapy, ritual and shamanic principles. As she encouraged her dance students to move and emote, she noticed a natural rhythmic progression, which she calls The Wave or the Five Rhythms.)
Figure 4.8 Adult male: The dark clouds are parting, the sun is shining.
MOVEMENT AND RELAXATION ACTIVITY
The sunset
Age range: 6 to 10 years.
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Resources: Paper and crayons; music for shaking in Step 2, and for relaxation in Steps 6 and 7 (optional). 1. Ask students to take the body stance of, or play-act, the following attitudes, and feel what happens in their body:
a. I dont want to do this game! b. Im brave, Im ready, Ill try anything.

2. Now see if you can shake out any worries or problems that may be inside you. Take some deep breaths while you do this. Imagine ants running all over you quickly shake them off. See if you can keep shaking for a while! 3. Did you know that your breath is magic? It helps you change into lots of different things. Take a huge breath, let it out and become these things. Let yourself move and make sounds like:
a busy ant a tired snail a bee in a hurry to get home a robot all children on earth at the end of school on Friday.
4. Now imagine you are a young tree. There is space around you, a breeze is blowing from all directions, it changes directions. You are flexible. Feel your roots in the earth. Feel your branches reaching up. 5. Take another breath. Lie down. You are now the sunset the most beautiful sunset ever. Imagine you are the colours across the sky. The sun has gone down behind the hills. You stretch over the rooftops, over the trees. It is the end of the day. Around you birds are becoming quiet, the humans settle down, the world becomes still. You are the colours now, the sky, the view, you are the distance, stretching so wide. 6. Be the sunset for a while. See if you can be still and quiet. What is the main feeling of the sunset now? Is it peaceful? Colourful? Relaxed? What is it? 7. Take another deep breath and come back to being yourself and draw the colours and shapes of the sunset you were.
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DISCUSSION
Talk about the main feeling of you as the sunset. Show your drawing if you wish. When and where would this feeling be useful?
RELAXATION ACTIVITY
Slowing down, slow walking

Aim: Supporting body awareness, relaxation and stillness. Resources: Space to move, crayons, drawing paper. Notes: The counsellor could participate with the client. Bare feet may enhance the experiential quality of the activity and therefore its effectiveness. 1. As the client begins to walk around the room, say:
Begin to feel the floor under your feet. Relax your whole body:
drop tension in your neck allow your shoulders to drop let yourself take some full breaths allow your belly to be as soft as it can.
Be aware of your knees. How are they? Tight? Relaxed? Now slow down your walking. Take three large breaths and let them relax out. Become aware of your feet, feel how your toes, soles and heels touch the floor. Can you walk and relax your ankles at the same time? Can you practise walking and feeling your feet from the inside for a while?
2. The counsellor can decide whether the conditions make it suitable to walk outside and with bare feet. If bare feet, choose a path which provides different textures for the feet to experience.
Direct the clients attention to sensations in the feet, to differences in:
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texture temperature hardness/softness.
Remind them to bring their attention back inside themselves to feel their feet.
3. The client comes to a quiet place and stops, closes their eyes for a moment and feels the earth under their feet. 4. Draw an outline of feet on an A3 page. The client uses colours and lines to express the sensations they felt in the feet. 5. Discuss:
what it felt like to walk this way why attention is drawn to the outside how the client feels after this exercise.
MEDITATION Simple forms of inner focus and meditation are used in ET and taught as a self-help skill when a client experiences anxiety, or for developing ego-strength (Boorstein 1997; Pearson and Nolan 2004; Vaughan 1995). Another outcome from meditation is the activation and release of repressed memories and the feelings that go with them (Robbins 1980). Meditation can therefore be seen as a valuable inuence in hastening the therapeutic process. This is one reason why meditation is occasionally used in ET within a safe, supported context, where any emerging feelings can be skilfully dealt with. In ET, brief meditation exercises and visualizations are also used to foster an experience of a quieter emotional state. These activities are also used as a way of integrating after more active and intense emotional processes. Meditation activities help develop concentration and cultivate the practice of accessing a calm state (Boorstein 1997; Vaughan 1995). The rst experience a client has with a meditation exercise may bring an experience of a busy mind, a tense body, a vulnerable emotional state. Remaining focused on this agitation is not pleasant, and meditations should be offered in a context where self-acceptance is strongly supported. Engaging in active tension-releasing exercises or bioenergetics before quiet inner focus with young clients allows a reduction in tension and agitation, and can be a valuable preliminary to quiet focus.
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Meditation research
Transcendental meditation has been shown to provide clear physiological changes and benets (Wallace 1970). Mindfulness meditation is being researched more fully in recent times. Kabat-Zinn et al. (1992) found that it can effectively reduce symptoms of anxiety and panic, and help maintain these reductions in patients with generalized anxiety disorders, panic disorders, or panic disorder with agoraphobia. Kabat-Zinn et al. (1998) also found that mindfulness meditation can support the reduction of skin problems. Bogarts (1991) survey of the literature on the use of meditation within therapy pointed out that its use may need to be determined by the therapeutic goals, and, while indicating areas where it might be contraindicated, suggests that it has great value in that it can awaken deeper levels of consciousness and helpfully reorient a sense of well-being and purpose in life.
Meditative practice in schools

Miller (1994) regarded contemplation as a form of self-learning. In particular he regarded insight meditation as educationally valuable in that students can learn and grow simply by mindfully watching their own inner experience. This essentially constructivist approach also aids selfreection, which again can improve performance (Holian 2001). In Beauchemins study (2008), a mindfulness meditation programme with adolescents with learning difficulties, all outcome measures showed signicant improvements participants had decreased anxiety, enhanced social skills and improved academic performance. Kristeller and Hallett (1999) found that a six-week meditation-based intervention was helpful in treating binge-eating disorder. Counselling students in Christopher, Christopher, Dunnagan and Schures study (2006), who undertook a programme of self-care and mindfulness meditation, reported signicant improvements in their personal lives, stress levels and clinical training. Leoni (2006) argued that meditation and therapeutic listening can have an important place in schools. She explains the benecial effect these approaches can have on self-esteem and emotional literacy. She found that the awareness students gained through meditation allowed more fruitful and authentic talking and listening afterwards. She also described the benets she gained from practising some meditation before working with the students. The students perceived her to be calm, and therefore safe. Students reported that their own meditation practice allowed them to calm down and leave emotional baggage behind. Meditation was found to relieve stress and increase mental clarity. It helped prevent projection and
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transference. Person-centred listening skills allowed the students to talk without being judged, which allowed the boys to join in. Leoni concluded: focusing on affective learning created positive conditions for effective learning (p.126).
MEDITATION ACTIVITY
At home in my hands
Repeating this exercise on a regular basis can be beneficial for developing the skills of self-awareness, body focus, stilling the mind and relaxation. Resources: Coloured pens, pencils, crayons, A3 drawing paper, pen, apple or orange (or tennis ball if fruit not available).
INSTRUCTIONS
Either work in silence, or have very quiet music in the background, with a gentle, even rhythm and relaxing, subtle melody. Invite the client to sit comfortably, in a way that allows their breath to be relaxed and full, and their body to be in alignment. Suggest they place their hands in a resting pose on their knees, with palms facing up. The activity begins with the client holding an apple, orange (or tennis ball) in their dominant hand.
The meditation
The inner focus is on the dominant hand, sensing the weight of the fruit/ball. Focus on the temperature, texture, weight of the fruit or ball. Encourage the client to expand their focus gradually to include: what is their hand its temperature, its weight, its texture relaxed breath the sensations of the hand the temperature of the air on their skin
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the area where their hand rests on their knee the blood flow, temperature, energy inside their hand.
Mention to the client that thoughts, ideas, distractions may intrude. The aim is to keep coming back to the focus on their hand, to let thoughts float away, take a deep breath and start focusing again. After about one minute the focus and the ball or fruit is moved to the other hand. (Note: If the attention span is short, change the hands more frequently.) Move the awareness and the fruit from hand to hand a few times, then ask the client to put the fruit down while imagining that they are still holding it. Spend a few minutes shifting awareness between the hands. Invite the client to focus on the middle of their body and tune in to the movement of breathing in both the chest and belly areas. End with a simple question such as: What is it like to be more at home, inside yourself?
INTEGRATION
Invite the client to respond to the final question with a drawing, or in words, or with symbols. Then discuss their experience with them if they wish.
SENSORY MEDITATION ACTIVITY
Using my nose instead of my eyes

PREPARATION
Have drawing paper and crayons ready, with three circles prepared on one page. Play quiet, relaxing music in the background. Prepare three bowls of herbs or spices with strong aroma, e.g. cloves, bay leaves, garam masala, basil, cinnamon bark, etc.
Let your eyes close. Tune in to your body. Take some deep breaths.
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Let your hand reach out and feel for bowl. Take a little of the herbs in the bowl. Crush the herbs between your fingers. Breathe in the aroma. See how it makes you feel. Does it bring an Oh, yes or a No? Is it a comfortable or uncomfortable smell? Take another breath in. Let the aroma come into you. Is it exciting? Is it boring? What happens in your mind? Does the smell remind you of anything? What happens in your body as the smell comes in? Do you like the smell? Are there any feelings the smell reminds you of? See if any pictures or places come to mind, perhaps a scene you know already or one that your imagination is making up right now. Let the smell inspire your imagination.
Can you imagine what sort of a landscape would go with that smell? Inland? Coastal? Desert? Marketplace? Rainforest? Perhaps some place from the past or the future? A high place? A low place? Is it a place you know or a place you would like to go? What colours would go with this smell? Do any particular words come into your mind with this smell?
Are there some words that sum up how you respond to the smell?
EXPRESSION
Take time for the client to draw, in the first circle, any pictures or colours and lines that came into their mind. Client writes any words that came to mind around the edge of the circle. Repeat the process with the other two herbs.
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DISCUSSION
Share drawings, words and inner experiences. MOVEMENT MEDITATION
Slow motion for self-awareness

Aim: Working with slow-motion movements assists paying attention internally to connect with the body and the subtle experience of body energy. Resources: Quiet relaxing music in the background. Coloured pens, pencils, crayons, A3 drawing paper; pen, A4 writing paper or personal journal. Note: If the client or some group members are agitated, excited or fidgety, then precede this activity with some energetic movement for about two minutes perhaps some free movement (like dance) or some bioenergetic exercises (see pp.114115).
INSTRUCTIONS
Begin with simple centring, asking the group or the client to stand in a relaxed way. Ask each person to take a slow, deep breath, letting it flow out of the body in a relaxed way (imagine that the lungs can simply deflate as the diaphragm gently releases and alll the air is pushed out). Repeat this two or three times. Allow a pause after the breathing. Then in a quiet voice begin the instructions listed below, letting them know that this is an exercise in slow motion. Allow time for each person to receive the instruction and to move their body slowly.
1. Neck : let your eyes close. Let your neck relax, allow your chin to move slowly down toward your chest. Do it very slowly, feel each degree of let-go. Let yourself be in your muscles. Imagine you could keep letting go throughout your whole body. 2. As you do this, allow some sighing out of old air. 3. Head: let your head move slowly all the way down and then up so that it is tilting back.
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4. Arms: slowly raise your arms up in front of you until they are about level with your shoulders, then slowly let go. Your wrists are loose. Feel the use of tension as they rise and the degrees of letting-go as they flow down again. 5. Knees: slowly bend your knees. Keep some awareness in the centre of you. Feel the let-go as your body goes down, and the adding on of strength as you rise up. Keep the rest of your body more or less straight, but not rigid! 6. Arms and knees: let arms and knees move together now. The arms rising as the knees bend down. Each time you come up, feel the tall point. Keep allowing your breath to release. Keep it slow. 7. Wrists and palms: allow your arms to flow by themselves. Then add tension slowly through your hands as arms go down, bend your hands back at the wrists. As your arms rise, wrists are loose; as your arms let go, wrists are tensed. You can feel this tension through the palms of your hands. 8. Arms, wrists and knees: let your arms, wrists and knees flow together. There is no right way, you cannot make a mistake. If you get confused, simply begin again with just your arms, then add the wrists and knees. 9. Arms, wrists, knees, neck : continue, then add your neck if possible. Your neck goes down as your arms rise. Keep it slow! 10. Let your head be free and see if you can let your body flow into some free dance. 11. Come to stillness sit or lie down. 12. Feel what it is like inside you now. 13. Take a few minutes to rest your body.
INTEGRATION
Invite the client to share how they feel and to express this with a drawing. An alternative would be to offer time for some brief journal-writing about the experience.
Chapter Five
Emotion-focused Processes
OVERVIEW Traditionally, conventional approaches that study, and attempt to change, how we think and behave have not focused on emotion. Early portrayals of emotion in therapy gave the impression that emotionality was regarded as irrational, disorganizing and stressful. From current viewpoints, however, emotional regulation is seen as important for effective social interaction, and for our optimal cognitive functioning (Greenberg 2001). However, the supposed great divide between cognitive function and emotions has, in consequence of recent research into cognitive and affective neuroscience and the neuroscience of therapy (Campos, Frankel and Camras 2004; Cozolino 2002; Dodge and Pettit 2003; Greenberg 2004), been all but eliminated. For therapists, it is useful to appreciate the benet for a client of developing their capacity to experience, tolerate, symbolize, and express and understand emotion. In ET this process is considered as a vital aspect of ongoing optimal health. This chapter, therefore, looks at emotional processing techniques. EMOTION CREATING VALUABLE CONNECTION BETWEEN BODY AND MIND Emotion is regarded now as being in continual interaction with cognitive processes. For each of us, the ability to experience a full range of emotions is important in promoting physical and mental well-being. In practice, a fundamental tenet of ET is that any reservoir of unintegrated or freeoating anxiety, pain or distress that remains unprocessed heightens the vulnerability of an individual to negative alteration in psychological and behavioural responses. Affective neuroscience has conrmed Freuds early observation that emotions can be active in the psyche, although we are not aware of them (Winkielman and Berridge 2004), and pre-existing emotions can add fuel to new emotional responses (Campos et al. 2004).
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In the latter stages of her career, Elisabeth Kubler-Ross advocated strongly for people to process emotional blockages that inhibit forming positive end-of-life connections with signicant others (Kubler-Ross 1997). From her pioneering work with loss and grief, programmes were created that provided dramatic experiential methods for strong emotional release. Whilst there has been both criticism and acclaim for her work, the essence of Kubler-Rosss ideas that life is much less fully lived if processing and clearing negative and growth-inhibiting patterns of negative interaction remains unattended continues as a fundamental principle for the practice of ET. Clients may have spent many years attempting to avoid difficult emotions, believing them to be a threat to their external security. They may never have developed productive help-seeking behaviours. Disconnection from their emotional experiences can mean that the price is paid at some later stage in feelings of isolation, anxiety or depression (Fosha 2000, p.13). Before supporting a client through an emotional release process a therapist needs to have developed professional and personal exibility, along with the ability to create and maintain safe psychological spaces for a client. Professional exibility and reexivity are regarded as essential for working effectively in a eld of tension between the paradox and challenge of a) activating and following a natural therapeutic direction emerging from within a clients psyche, and b) maintaining quality practice frameworks. What this means is that it is important both to let go of some control and to trust that clients will work on the relevant material in the right way, at the right time. The counsellor who remains calm while a client experiences and expresses strong emotion provides a new model, one that supports the development of emotional regulation (Fosha 2004). Furthermore, the warm, safe, accepting context of therapy, in which the client works through raw feelings, actually changes the feelings (Davidson and van Reekum 2005). Natural therapeutic direction refers to the concept of an intrinsic, positive healing potential in the psyche, likened by Jung to the physical bodys ability to self-heal (Fordham 1991 [1953]). As humans we tend to learn best when we have a signicant other to help us feel safe, show interest in us and what we do, and encourage our understanding of our world (Cozolino 2002; Cozolino and Sprokay 2006; Orange 1995). Working together with a trusted guide to make sense of ones experiences can provide something of a new beginning emotionally (Orange 1995). ET emphasizes the building of strong rapport as the prerequisite (along with a clear assessment) for attempting to guide clients towards deeper emotional experiencing.
EMOTION-FOCUSED PROCESSES
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Positive outcomes in therapy are derived from patiently developing good rapport and a sense of safety, and providing some rationale for reversing previously employed self-protective mechanisms. When a client feels safe, accepted, and provided with tools from which they can choose to experiment (play), express and communicate, then the willingness to relax defences and access feelings and the mechanism of self-healing are set in motion. Trust and cooperation with the intrinsic movement towards emotional healing within the client emerges through the counsellors efforts to understand his or her own emotional experiences and to nd personal meaning through some experience with emotional release processes. Within ET sessions, there is a consistent drawing on intra-personal focus in the client to help re-establish the connection with this natural movement toward emotional healing, resilience and resourcefulness. Inexible coping mechanisms are loosened and replaced by an open, more conscious cooperation with this movement toward healing. After processing unresolved negative emotions, the client has improved access to positive and forward-moving emotions. Fosha (2000) argued that core affective states contained inuential adaptive forces and processes that hold valuable therapeutic potential, and described these forces as powerful, adaptive, wired-in organismic tendencies towards self-healing (Fosha 2004, p.33). These forces can be seen emerging naturally when children are safe and free to play (Allan and Brown 1993; Lowenfeld 1935). Greenberg (2004) points out that the (often playful) creativity associated with emotions like joy and interest motivates people to learn and achieve more than they otherwise would. Positive emotion improves problem-solving by creating more exible, imaginative and efficient thought processes (Greenberg 2004). Emotion-focused processes work in such a way that background emotions that have been inuencing behaviours, persuading attitudes and impacting on relating are re-experienced, given safe ventilation, and expressed in symbolic form. This occurs in a way that releases the emotional charge, relaxes the body, and supports the client to return to a calm and balanced state. In an emotion-focused approach emotion is seen as foundational in the construction of the self (Greenberg 2004). Unprocessed emotion from the past can colour the way we view ourselves and our world. Personal meaning is enhanced through the effort to understand our own emotional experience; and optimal adaptation involves an integration of reason and emotion. Greenberg (2004) has pointed out that neuroscience ndings emphasize emotion as an indispensable foundation for many cognitive processes, particularly decision-making, and concluded that changing emotions lead to change in modes of cognitive processing. The current
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authors have regularly observed that clients move into a clearer emotional and cognitive state after emotional processing, and are more able to formulate appropriate positive plans. ET theory sees the reconnection with, and the working through, emotions as primary. Many clients feel confronted by their difficult emotions and may initially request help to control or cope with the feelings and/ or the resultant behaviour. Developing emotional intelligence involves honing the capacity to use emotions as a guide, without being a slave to them (Greenberg 2004). The key to gaining information and guidance from emotions is in processing. Self-validation and access to the adaptive tendencies underlying emotions are productive outcomes from working through emotional difficulties (Fosha 2004) and completing the process of safely ending unnished emotional expression. Claiming that emotion often precedes cognition, Greenberg (2004, p.3) argued that recent research has shown that a common earlier view, that emotion is post cognitive, is inadequate, stating that emotion makes a central contribution to information processing. Sustainable emotional and behavioural change requires neurological change, neural re-organization, plasticity in the brain (Schore 2002). Using multi-modal activities employing and combining somatic, emotional and cognitive experiences has the possibility to support neurological change in this way. When activated emotions can be brought to awareness and processed, when the emotional charge attached to past events can be reduced, resulting in a sense of moving forward with less intra-psychic restriction, and less energy is spent on processing negative or self-deprecating patterns of interaction, then we would recognize that emotional healing is underway. Emotional healing can be said to have occurred when incomplete emotions, impulses, urges, actions in the psyche are completed; when unnished business no longer intrudes on cognition or motivation, or causes reactivity. The therapeutic aim of ET, to continually enhance the clients selfawareness, supports healing. Fosha (2000) claimed that the experiencing of emotions provided healing in and of itself. An effective therapeutic experience that leads to change produces a combination of increased emotional, somatic and cognitive awareness. And increased awareness can lead to a more effective therapeutic experience! Fosha (2000) suggested that, within the therapeutic setting, contact with powerful emotion contributed to metamorphoses of the self , and became the central agent responsible for therapeutic change. Concentration on activated emotions provided the gateway to adaptive forces according to Foshas (2000, 2004) clinical observations. After analysing several re-
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search projects, Greenberg (2001) conrmed that expression and reection both together in a therapy session led to benecial outcomes. Emotional healing may involve addressing intra-psychic material within three key dimensions of the psyche: the biographical (from birth to the present), perinatal (around the birth), and the transpersonal or metaphysical domain (Grof 2000) see more in Chapter 10. While, traditionally, therapists are trained most readily to support clients to access feelings and issues from the biographical domain, an individuals psyche may ultimately benet from some resolution of conicts or stress from any or all of these three dimensions. The concept that therapy works most profoundly to promote change through activation, expression and completion of processing of deep, and sometimes painful, emotions (Greenberg 2001) underpins the practice of ET. Long-term change is supported by a movement from an intellectual understanding of oneself to an emotional experience of oneself (Greenberg 2001). Greenberg claimed that processing bodily felt experience and deepening this in therapy in a good therapeutic relationship environment may be a core ingredient of change in psychotherapy (p.7). ACCESSING AND EXPERIENCING EMOTIONS ET can enhance facility with the world of emotion, awareness of body sensations, and regulating and learning from emotions. Using expressive, experiential techniques also supports a client to utilize emotions for guidance in positive problem-solving and productive self-direction (Greenberg 2001; Pearson 1997). While emotion is considered necessary for rational thought (Damasio 2000), a signicant allied outcome from deep emotional experience is that a client experiences increased aliveness and meaning (Fosha 2000). Body sensations cue awareness of emotion, underlie emotions and form the basis for weighing consequences, deciding direction, identifying preferences (Damasio 2000). Awareness of body sensations may be a foundation for accessing emotional messages that support returning to a more emotionally balanced, rational state. (See more in Chapter 4.) There are usually six stages in an ET session: joining and rapport-building developing self-awareness in the client focusing on emotional processes integration reection on strategies future focus, self-care and homework.
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It is the second stage, developing self-awareness the opportunity for clients to become more aware of their sensory experiences that opens a doorway to more direct connection with the world of feelings. In the third stage the focus would more directly centre on unprocessed emotion; the fourth stage, integration, invites reection on the process; and the nal stages support reection on future actions. It is becoming more widely recognized that emotional experience is not processed through language and logic alone (Fosha 2004; Greenberg 2001; Rothschild 2000). ET provides a wide range of activities that make use of image, draw attention to sensations, open memories and enhance connection to emotional drives techniques that motivate activity in the right cerebral hemisphere (Gil 2006). The promotion of healthy brain development through the modulation of emotion (Stien and Kendall 2004, cited in Gil 2006) therefore becomes a most useful adjunct to therapeutic assistance. The right hemisphere of the brain speaks a language of images, sensations, impressions, and urges toward action; therapeutic discourse must be conducted in a language that the right hemisphere speaks (Fosha 2004, p.229). The integration stage of a session links right hemisphere activity with reection, naming, description and time-sequencing activities that the left hemisphere favours. It is this stimulation of the left hemisphere that can result in positive actions and more optimistic motivation (Stien and Kendall 2004, cited in Gil 2006). Bohart (1977) reported that clients in a treatment that promoted the expression of unresolved angry feelings combined with post-expression reection resolved their feelings more effectively than those in a condition that promoted either expression or reection. Therapy that brings a synthesis of expression and reection would appear, therefore, to offer optimal results. In terms of neurological processes during therapy, it would seem that emotional and somatic awareness should be the initial focus, followed by developing reection on the process and on possible future actions. Siegel (2005) indicated that long-term change depended on neural plasticity. Adaptability, the ability to change in the brain, is reected in synaptic change. Synapses are the gaps, the junctions between neurons. When neurons re up, new connections can be made. Siegel pointed out that one important activity that res up neurons is attention. Where our attention goes, neural ring is activated, new neural pathways are created (Siegel 2005, 2007). Supporting clients to connect to self, tune in, value intra-personal awareness, may build new neural pathways and reverse tendencies towards defensive dissociation. Before therapy a client may have some recognition of emotional and physical impulses that are being acted out or held in check. They
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frequently report cognitive confusion. During therapy, once rapport, safety and motivation have been established, a client is sensitively supported by a trained facilitator to reconnect with experiences that need physical, symbolic or emotional release. New experiences alter connections in the patterns of nerve cells, networks and systems (Ratey 2001, cited in Gil 2006). So, turning attention inwards (a new experience for many clients), building up somatic awareness and emotional awareness frequent activities in ET res up new neural connections. Without new awareness, or new experience, the oldestablished neural pathways (that is, the old ways of being and behaving, the default settings, the old scripts or emotional schemas) tend to repeat. Clients have reported to the present writers that strong emotions were felt as owing to and from, as well as throughout, specic locations in the body. We have received much in-session feedback indicating that clients have a felt sense of their emotions, their body and their energy moving between contraction and expansion, control and expression. After emotional release activities clients often report feeling a lighter or freer state, feeling calm and more expansive, as well as being aware of clearer cognitive process. HOW EMOTIONAL STRESS AFFECTS US Clients are affected by emotional stress more or less, depending on their level of resilience (Rothschild 2000), but the impact of stress may be positively reduced where there has been good early attachment and stability in the home environment (Doyle 2003; Howe 2005; Schore 2002; Siegel 2005). The degree of acceptance of emotional expression in daily life varies in different cultures and different families. Some people, some families, nd it easier to shout than grieve, or to cry rather than assert themselves. There are many situations where emotional expression does not bring approval; for example, in some families individuals frown upon expressions of anger, whereas others may nd vulnerability more difficult to tolerate. Prior to introducing an emotional release activity, the therapist must assess the suitability of such a technique for a particular client and their support system. Emotional stress has many causes, present and past, internal and external, and can be generated by withholding expression of feelings. Children, in particular, can develop emotional stress from living in a negative emotional environment. Emotional stress can build up as a result of suppressing or repressing feelings either intentionally or unconsciously or both or blocking out the feeling states of surrounding people. The effort to ignore
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emotional pain our own and others creates tension. An environment of marital and relational tension, which can be keenly felt by children, leads to emotional stress. War, famine, trauma, loss and sudden changes, of course, dramatically contribute to the build-up of emotional stress. The internal mechanisms that enable us to ignore, suppress and repress difficult feelings occur through several systems of the body (Cozolino 2002; Janov 1990; Reich 1979; Saarni 1999). The brain and nervous system are involved in calming affect (Cozolino 2006), and allowing or impeding electrical connections and molecules of emotion (Pert 1997). The muscular system is involved in the containment of emotional expression, and chronic muscular activation leads to what Reich called armouring (see Chapter 4). The respiratory system is involved through a decrease in volume and speed of breath: controlled breathing and disrupted breathing patterns may become part of the organic defence mechanism (Gilbert 1998; Meurle-Hallberg and Armelius 2006). Reichs descriptions of the human energy system, which were in striking accord with traditional Chinese theory, noted that with the restriction of emotions came the restriction of energetic ow. As well as somatic defences, defensive behaviours may also develop, that contain or deect emotion, or release emotional overload. Emotionally defensive behaviours include: dumping emotion onto others, being overly reactive, behaving as if all causes were outside oneself; rationalizing, attempting to replace emotional suffering with cognition; blaming, nding present causes for old suffering; projecting, unconsciously perceiving internal feelings as imposed by external inuences. Long-term emotional stress may be a cause of behaviour difficulties, such as acting out (explosion) or withdrawal (implosion). Stress may lead to learning problems, as the neuronal pathways seem to be overloaded with emotional issues. Chronic physical tension, a response to emotional stress, can lead to poor blood circulation, reduced resilience of the immune system and a decrease in general health. In clusters, symptoms of emotional stress indicate that some therapeutic work with emotions may be needed. These symptoms may include: reactive behaviours, headaches and stomachaches, mouth ulcers, skin problems, nausea and digestive upsets, body pains, muscle cramps, bladder problems, nightmares and eating difficulties. Behaviours that attempt to release emotional stress include, of course, acting out, and this is a frequent presenting problem with young clients referred for counselling. Unfortunately, acting out eventually adds to emotional stress even though it may be an attempt of the psyche to reduce stress. Acting out is a symptom of the need for emotional processing. In
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attempting to bring relaxation and resolution, acting out erupts in the wrong place and at the wrong time. It is played out unfairly onto others, without therapeutic support. So it does not have any therapeutic value. Acting out does not lead to a useful action, and it does not help the person deal with the underlying causes. Obviously, acting out in distinction to therapeutic release does not lead to approval, support and self-esteem, or reclaiming of underlying positive feelings. There are treatments that aim to manage and control acting out. However, if the underlying feelings are only managed and controlled, with no resolution or safe expression, they are most likely to seep out disruptively at some stage and explode destructively or they may implode, leading to social or emotional withdrawal and eventual health concerns. Kaufhold and Johnson (2005) surmise that developed emotional intelligence skills are integral components of good mental health. A key principle in ET is that allowing feelings to be felt, appropriately expressed and understood promotes ongoing mental health. Having no option but to hold in feelings can result in a sense of heaviness, irritability, tiredness, depression, or a lack of enthusiasm and frustrated feelings contribute to behaviour problems. LAYERS IN THE PSYCHE PLUMBING THE DEPTHS Feelings are often experienced as if stored or held in layers. There is a distinction between the original or primary emotion and the overlaying or secondary emotions. Secondary emotions can be reactions to the primary emotion; for example, anger can be a reaction to feeling hurt or afraid. Ideally, for long-term therapeutic benet, a therapist would aim to deal with the primary emotion. It can be helpful to teach clients to take time to track back to the primary feelings at times of imminent reactive behaviour. Anger can also be a reaction to the suppression of positive qualities, such as excitement, individuality, creativity, vitality. The authors have frequently had young clients referred for anger work. With some, it does not take long before the underlying causes of anger hurt, loss, injustice, etc. emerge to be worked through (Figure 5.1). Negative feelings that may be apparent to all, and take a central place in the initial assessment, often cover underlying vulnerable or positive feelings: anger can overlay sadness, sadness can overlay a sense of strength. In the acquired practice of withholding emotions, a sense of connection to strength is restricted. Personal authority, aliveness, assertiveness and a positive sense of self diminish when emotion has no outlet, resulting in low self-esteem, even depression. When the feeling and energy trapped in
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Figure 5.1 Twelve-year-old female: This is my anger.
the symptoms become available to the child, the symptoms go away very quickly, and are replaced by vibrancy (McCarthy 2007, p.109). One of the key aims in emotional processing is liberating the core states of positive emotion and the emergence of a positive sense of self (Fosha 2004). Clients can experience transformation from being overwhelmed by emotional pain to states of calm, relaxation, depth of feeling, clarity and often remarkable eloquence (Fosha 2004, p.33). In the calm state after emotional processing, clients are more able to make meaning from their life events. OUTCOMES FROM FOCUSING ON EMOTION There is a wide range of emotional, cognitive and social outcomes reported and observed in clients who have completed ET sessions that include some emotional release and emotional healing (Pearson 2003). Some emotional outcomes include: a calmer mood, less aggression, less anxiety, more assertiveness, increased condence (Pearson 2003); sense of freedom, lightness and balance; connection to a sense of strength, resourcefulness and creativity; increased sense of self-acceptance; more hopeful view of the future (Pearson and Wilson 2001); condence (Pearson 2006); and aliveness and meaning (Fosha 2000). (See Figure 5.2.)
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Figure 5.2 Adult male: After releasing the hate, I feel more loving.
Some of the cognitive outcomes include: improved attention span and interest in learning; increased capacity for creative problem-solving. Relational or social outcomes include: improved capacity to relate positively, more willingness to cooperate, a more hopeful worldview which can have a positive social impact (Pearson 2003). Fosha (2000) describes an energetic outcome from processing deep emotion: access to new resources and renewed energy. This leads to what she terms adaptive action tendencies; and the ability to adapt is at the heart of developing resilience. There are several outcomes from introducing ET in schools. Pearson (2003) reported that the mean increase in effectiveness of counselling (using ET) to achieve positive emotional and behavioural outcomes was 71 per cent, compared with the results of previous methods. Other outcomes included clients exhibiting emotional well-being and a calm state at school and at home, reduction in aggression, and positive improvement in behaviour. Some school counsellors reported that clients gained increased self-understanding. Other indicators were an improvement in relationships, and positive feedback from school staff. Increases in self-
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acceptance, condence in engaging in school activities and improvement in participation in schoolwork were all indicated. This is a summary of our observations that indicate movement towards increased emotional health in clients: deeper self-awareness expanded self-esteem more honesty in self-expression more energetically alive clients with hyperactive energy seem quieter, calmer more willingness to reveal vulnerability increased ability to co-operate with others more spontaneous, more imaginative, more creative increased ability to concentrate extended attention span, which can lead to academic improvement.
EMOTIONAL RELEASE PROCESSING Emotional release processes are structured, safe, private, supported counselling activities that allow an internal encounter with incomplete emotions and reactions from the present and the past. After processing, these feelings are no longer acted out in disruptive or destructive ways or imploded in a way that causes withdrawal or health problems. Processing allows safe release and clears the way for creative problem-solving, improved ability to learn, and clear relating (Fosha 2004; Pearson and Nolan 2004). Emotional release processes are only offered when understanding and trust between the client and counsellor are sufficiently developed. Effectiveness depends on the readiness of the client to relax defences and open to feelings. Some types of therapy have traditionally tried to lead clients around, over or under feelings (Greenberg 2001). ET enables the client to move into a process where they can connect with and experience the feeling. This connection can provide the client with an opportunity to acknowledge and express, and progress towards resolution. Processing offers clients the opportunity to cross the threshold from talking about, to experiencing emotions, working through them and then connecting with positive strengths. Counsellors may notice movement between layers in the psyche as the client accesses defences, then layers of emotion. For example, observed layers may be: bravado, resistance, efforts to understand or forgive or forget, frustration or depression, anger,
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resentment, hate, grief, sorrow, fear, a more loving and tender state, selfacceptance, and nally a calm self-connection. Processing emotions usually takes place in three basic stages. The rst stage is discussion of current and recent life, especially any emotional difculties or current reactions. This is followed by strategies to catalyse emotional release, leading nally to time for integration. The overall process, in conjunction with the essential integration stage, develops self-awareness, understanding, emotional literacy, ability with emotional regulation, and self-empowerment within the client. SIX WAYS TO WORK THROUGH EMOTIONS 1. Somatic and kinaesthetic bioenergetic exercises physical release games moving and dancing to strong music. expressive symbol work exercises using miniatures to support imaginary encounters, and as models for role-play with younger clients, for example moving and sounding like an angry bear. (See Figure 5.3.) process writing letters that are not posted (support an imaginary encounter) free-ow sentence starters prompts may include phrases such as: What makes me mad How I feel about What I want to say is Its not fair
2. Symbolic
3. Expressive writing
reective writing with guiding questions completion writing any insights that the client may have had during the counselling session, including a summary of the most signicant aspects/feelings during the session.
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Figure 5.3 Adult female: Using symbols to support emotional release.
4. Using art body-outline drawings locating feelings in the body process drawing using continuous drawing for emotional release drawing to emotional music moulding feelings in clay completion mandalas. creating a verbal or written dialogue or encounter with imaginary others who have been sources of frustration and emotional reactivity. selecting music to correspond to feelings developing emotional uency drawing to emotionally evocative music movement and dance to music music making.
5. Emotional release processes
6. Using music
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CREATING A SUPPORTIVE ENVIRONMENT FOR PROCESSING The physical and emotional environment that can support a client into focusing on emotion requires some planning. Helping the client connect with their resourcefulness and creating a warm, accepting therapeutic alliance are the rst steps. Emotional release processes are best offered by a qualied facilitator who has the capacity to reect on his or her own emotions and experiences and has been trained experientially with these processes. The activities need to be structured, with clear time and space boundaries. They should be conducted in a private, supportive space that has the necessary equipment and conditions such as drawing materials, symbols, large cushions, privacy. Finding the right timing is essential. Emotional processes should only be offered when both client and counsellor trust in themselves, in each other and in the therapeutic methods. These activities should only be offered when there is time for integration and closure, time for reection and discussion, time for body and mind to readjust after the process. For the physical space, soft light helps the eyes to relax. Consider whether this is appropriate for your particular clients and your work context. There are several ways in which music can support the session: background music supports privacy and intra-personal focus; energetic, strong music can encourage release of anger; gentle music may support work with grief or loss; and calm, slow music can support integration. A supportive workspace is ideally sound-proof and private. The workroom is ordered, clean, respectful. Some attractive impressions help to create a psychologically safe place for clients to confront inner chaos. There is space to move about if needed, and carpet, mats or soft oor covering. The room should appear to the client to be safe and comfortable. Have some large cushions to support safe expression of anger. Useful materials might include: tissues; a towel to wring, roll up or throw; paper to rip materials for moulding for example: beeswax, clay, plasticine drawing paper and crayons writing materials collection of symbols recorded music equipment and a good selection of CDs
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music-making instruments e.g. drums, percussion instruments, keyboard.
Establish a positive emotional environment, develop trust by allowing the client to share any fears, apprehension or hesitations. Allow resistance to be acknowledged and respected. Condentiality and privacy should be discussed and assured, with the limits explained. Allow the client to express their feelings about being at the session: Is there anywhere you would rather be? Is there anything you would rather be doing now? It takes time for the client to feel orientated to the counselling room and to the counsellor. SUPPORTING EMOTIONAL RELEASE After developing good rapport and establishing trust, it might be appropriate to validate the clients feelings, then allow the client to be with their feelings: give time and permission for the client to experience the feeling fully, before moving the process onwards. Offer minimum verbal direction; quite often, the less we speak, the better. Silence is a powerful tool that can provide time for clients to think and feel at their own pace (Bradway, et al. 2005; Cozolino 2004). Step back from trying to direct the clients process, and allow their psyche to lead. Give some structure and framework, but avoid giving advice or solutions or imposing viewpoints during processes. There are several changes in the counsellors role during emotional release sessions: rst, the counsellor is active in directing the client towards self-awareness and helping them move through fear, self-criticism, and any beliefs about their lack of ability or distance from internal resources. When the emotional contact is established the counsellor might be more of a facilitator, providing the holding environment. Fosha (2004, p.41) describes it well: The therapist here functions as an assistant to Mother Nature. When core states of positive emotion emerge, the role moves into one of being a witness, a fellow traveller, seeing and acknowledging the new experience of self. Keeping the theoretical frameworks and the structure of the processes in mind, follow the clients process. Trust the logic of their natural healing trajectory, stay open to what needs to happen next. Use self-discovery questions as prompts to encourage reection and feeling. Adult clients will often apologize when they contact deeper emotions which are unfamiliar to them. The facilitator can offer support by gentle affirmation. In supporting emotional release, encourage staying with, and free expression of, feelings. There are no special manoeuvres to apply to the
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clients feelings; simply give permission, encouragement and time for them to complete, if they are ready to do that. Even some ways of trying to relay empathy, e.g. attempting to name the clients emotional experience, can actually create distance, and may be interpretations. It is important to refrain from imposing interpretations onto the clients experience. Use open self-discovery questions to help them make connections and gain their own insights. It is not essential for the counsellor to understand everything that is happening. If you tell a client what something means you may be quite wrong, you rob them of self-discovery, and you could further an attitude of dependence in them. Since how we are as a counsellor and therapist is a key ingredient in making emotion-focused work safe and effective, remain aware of self. Be aware that you wish the client to discover for themselves, and then step back. Regularly return to self-awareness and relax, be aware of self and observe your own breathing. Take care of yourself. Allow the client to steer their own journey. Note any of your own expectations, issues or feelings that may arise and may need to be dealt with later in supervision. Whenever you feel unsure, take a deep breath, return to your selfawareness practice. Welcome creative doubt this is a calm state of notknowing, and waiting for clues on how to proceed. Relax with that. Allow yourself to be in touch with intuition and creative energy. Focus on how to be, and not what to do. It is normal to be unsure of what to do or say next. INTEGRATION AND CLOSURE A central task of therapy is facilitation of the activation, organization and release of emotional energy through verbal and nonverbal means (Robbins 1980). An important fourth element that ET provides to expand this framework is integration (Pearson and Wilson 2001). Integration is an essential nal step in dealing with emotions a step not identied in existing research on the process of emotional ventilation. Integration follows activation and expression and can involve linking heart and head, body and brain, left and right hemisphere functioning (Siegel 2005). We have found that integration using calming verbal and nonverbal reective activities, and the sharing of the experience with a trusted guide, consolidates a transformational experience, as Greenberg says (2001). The aim of integration stages is to support a client to make sense of their experience and start to view their life from a broader perspective, and in this calmer space begin to plan self-care and new directions. Within ET training courses it is considered unethical to guide a client into activation
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and expression of emotions unless there is adequate time for full reection and integration (Pearson and Wilson 2007). An essential part of an emotion-focused session, integration activities can last anything between approximately 5 and 15 minutes. The integration stage provides the client with time to think about their process, life and feelings. Integrating and bringing closure after dealing with the release of strong feelings can take place through a range of modalities: 1. Verbal discussion is the most frequently used activity. Clients may wish to talk about the impact of exercises. It may be appropriate to discuss and assess any further support, or to focus on the clients hopes and projects for the future. We might invite reection on possible new strategies, or practical steps. Clients may want to consider some new ways to use their energy positively or to channel emotions into productive activities. 2. Completion writing this could be free writing, perhaps in a journal, or with set questions, or with free-ow sentence starters that prompt reection. 3. Completion drawing may be offered, where the client spontaneously draws how they feel after the activity. They may respond well to drawing in a circle, using the mandala concept and structure. (See more in Chapter 7.) 4. Physical rest may be essential. Allow the client to relax and sit in silence, especially if they have been working through grief or loss. The use of a relaxation activity and/or a visualization might support further recovery. 5. Movement or dance is especially relevant for younger clients, who may like to leap, jump and somersault around the room, using large cushions and mats. Some clients will benet from taking an informal walk. A garden would be an ideal setting for this. Quite often a client will be able to relax when they move outside the workroom but remain within the therapeutic relationship. CONTRAINDICATIONS WHEN NOT TO PROCESS EMOTIONS There are two main types of emotional release processes. First, those that allow some expression of current emotional stress, where the counsellor simply follows and supports the client. Second, there are those that activate a focus on emotional release, dealing with what might be under the
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surface, where the counsellor and the choice of activity may lead the client towards their feelings. Exercises that lead the client towards their feelings or activate issues and initiate release should not be used if there is insufficient trust on the part of either the client or the counsellor, or if you dont know the client well enough to make a clear assessment. If there is no support or understanding from family, carers or parents, use activities that allow, but do not activate. In the case of young clients, activities designed to activate emotional release should be avoided if there is a clash of counsellor and carer paradigms. Dont attempt emotion-focused work if the client doesnt want to do it, or especially if the setting is not right, or if the client has no prior experience with you. Research (Duncan and Miller 2006) has shown that a good predictor of client return is some connection between the counsellors theoretical framework and the clients assumptions about the process of counselling. So dont offer emotion-focused work if the client has no framework or rationale for it. Time is another factor: recovering from emotional expression can take time, so dont lead into deeper emotion-focused processes if there is not enough time for integration. Obviously the presenting problem will be one guide for the choice of methods offered. If the client has shown a consistent lack of boundaries with behaviour, or has exhibited explosive emotional reactiveness, dont offer a process that might invite further emotional overload. If the client has been dealing with any mental health problems, or has any history of psychiatric treatment, work more slowly and gently, and attempt to consolidate rapport and understanding of the therapeutic process. In this situation work with symbols and metaphor can be valuable, to reduce emotional stress without direct emotional challenge. Some medications represent a contraindication for emotional release, especially medication designed to keep emotions under control. Initial assessments should provide information about medication, and appropriate treatment plans can be developed, without activating activities. If you are not comfortable with any of the processes described in this book, it is obvious that you should not attempt these. Undergoing a training course, gaining a thorough personal experience of the process and having good supervision in place would be pre-requisites. It is also essential to listen to intuition. If you have some idea, feeling or sensation that indicates that emotionally expressive activities may not be appropriate for a particular client, even if the reasons are not clear, trust this internal guidance. Dont use an activity that you have not explored personally.
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Summary
The natural healing movements in the psyche can be a third presence in therapy, alongside the counsellor and the client. An expressive therapist aims to be alert for clues from the clients psyche that indicate the direction of these movements, and aims to follow and support the depth and focus that is individually appropriate. Therapy can be enhanced when clients focus their awareness on deeper self-connection, when rapport is well established, and when the client feels safe. The task of building rapport precedes focusing on, or activating, emotions. Initially it is appropriate to process emotional experience through focusing primarily on right hemisphere methods such as art, music, symbol work. This is usually followed by left hemisphere methods such as language, writing, sequencing, planning. Training and experience are needed to enable counsellors to confidently offer activities suitable for each hemisphere at the appropriate times. Counselling and therapy using ET supports the processing of emotions, finding balance and building resilience. Resilience leads to adaptability and recovery, and can be developed through the quality of the therapeutic relationship. Neuroscience findings can help counsellors discern a spectrum of treatment, using activities that support management of behaviours and symptoms, and activities that contribute to long-term therapeutic change.
EMOTIONAL EXPRESSION ACTIVITY
What am I feeling?
Resources: Worksheet 5.1 (enlarge to A3 size), crayons, pen, journal.
PREPARATION
Give a brief overview of the exercise. Confirm that the client does not have to show you their worksheet.

2. Lines that go with the feeling:
Worksheet 5.1 What am I feeling?
1. Colours of the feeling:
3. An image or picture that goes with the feeling:
4. Words that go with the feeling: ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ...............................................
Note: Enlarge to A3 size for use with clients.
Copyright Mark Pearson and Helen Wilson 2009
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PROCESS
Guide the client to get comfortable, relax as much as possible, and then tune into their body. Ask them to scan through their body and identify any areas where they find feelings such as anger, grief, sadness, happiness, or anything that doesnt seem to have a name. The client indicates which feeling is strongest, one that stands out from the others. Invite the client to identify where it is, and what the feeling is (if they can identify it). Then they relax and tune in to it again. The process continues as follows:
1. Colours
While focusing on the sensation of the feeling, the client is invited to ask the feeling what colours it would use to express itself. How would it show itself in colours? It might be one colour, several colours, light or dark colours. These colours are then shaded into segment 1 of the worksheet. The client relaxes again, takes a deep breath and tunes in to the feeling again. The client then asks the feeling what type of lines would best show how it feels for example, straight lines, sharp, jagged lines, smooth, curving lines, fat lines, thin lines, broken lines, lines with sharp edges or lines with fuzzy edges. These are drawn into the segment 2 of the worksheet. The client is invited to relax again and tune back into the feeling. They then ask the feeling if there is an image from nature that illustrates how it feels. For example, is the feeling like a place, a landscape, the weather (raining, a storm, hot and dry, windy, etc.), a plant, a tree, an animal, a bird, a fish or an insect?
2. Lines

3. Image
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Mention that there is no need for precision drawing or artistic skills. The imagery is drawn into the oval, segment 3 of the worksheet. The client is invited to relax again and tune back into the feeling. They then ask the feeling if there are any words, statements or questions it wants to express. If it could speak or write, what would it say? These are written on the lines in segment 4 of the worksheet. Suggest: There might be just a few words, or lots of them! Write them big or small. More words might come into your mind once you begin. Sometimes words may come quickly, sometimes they may take a while, sometimes there may not be any. See what you find.
4. Words

INTEGRATION
Stand, stretch, breathe, then sit again. Invite the client to take some time to tune into the feeling again and examine whether it feels the same, or whether there has been any change: It could be a small change or it could be a big change. See what you notice. Invite discussion on: how they feel now any changes they noticed in their feelings during the activity whether there is any movement they would like to make that goes with the feeling any possible causes of the feeling how the feeling relates to their life is it a frequent feeling? one-off? whether there is anything external that needs to change. Any steps to take?
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A completion mandala is suggested as an integrating expression. A final summary statement is formulated, either from the feeling, or about it. This statement can be written under the lines on the worksheet, or on the back of it or beside the mandala, or in the clients journal.
Chapter Six
Expressive Writing as Emotional First Aid

OVERVIEW She positioned herself in a somewhat withdrawn, silent repose on the oor of the therapy room unable to speak or connect, paralysed, unable to cope with distressing mental images of a frightening ordeal. A trail of feeling extremely unhappy in temporary care placements had left this adolescent with a legacy of uncertainty, distrust, and disabling of developing communication skills. Conforming with classroom demands was challenging; nding a safe place to be was tough; life seemed one perpetual struggle. Drawing was out of the question a strong shake of her head conrmed that. An invitation to choose a symbol or two received a similar response. Silence worked well, and so we sat for the complete session simply taking in each others presence getting to know each other energetically rather than through information exchange. In our second session some drawing was used, with her enthusiastic involvement, to express anger. Subsequent sessions established a good working alliance between us some talking, some drawing, some symbol work. But it was writing that brought this young person to life. Writing helped activate and open up neural pathways that had, up until then, been used for dealing with the trauma. Before any suggestion that this young person should forsake the survival habit of withdrawing into her private world of pain, she needed to nd something that she could relate to a meaningful activity, something real to do. My (HW) ego would rather enjoy the claim that it was my expertise that made the breakthrough, but this was not the case. Out of all the possibilities available in the ET repertoire, this young girl spontaneously decided what would help her get well and began writing between sessions, bringing her written questioning and musing along to each session as the starting point for our work together. I then became simply the provider of a safe space,
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resources, and a support system (as recommended by Tallman and Bohart 1999). Through creative writing, it seemed, neural pathways were gradually freed for reorganizing learning processes through which she could catch up with chronology, express and comprehend her reactions to life experiences, and begin to consider how she wanted her life to be. Counsellors and therapists sometimes nd themselves sitting with a client whose level of distress inhibits easeful articulation of complicated life experiences. In this chapter we will explore a range of ways of using writing with clients, techniques that can initiate reection and self-awareness and may lead to easier formulation of the issues they wish to share. We explore techniques through which a client can express and communicate inter- and intra-personal awareness. The methods and ideas in this chapter are presented in conjunction with an overview of what Gardner (1983) (discussed in Chapter 2) described as the verbal/linguistic intelligence, to initiate and deepen self-connection. We discuss the strength of reective writing, process writing and completion writing as vehicles for circumventing the possibility that the therapeutic experience remains one of passivity and powerlessness (Bolton 1999). MULTI-MEDIA COMMUNICATION CATALYSTS Writing in therapy can take many forms. A client can use written words in personal letters, in a statement of feelings, in lists of opposites, in poetry, or in autobiographical writing. Media can be combined so that drawing, writing and using symbols come together in one activity to provide a richly textured representation of the problem being discussed. All these forms can be utilized to summarize a clients discoveries and to describe and chronicle their progress (Payne 2006). Some clients will be highly procient in language, others will excel in producing an artefact such as a clay symbol or collage, whereas others prefer applying crayons to paper, presenting an image to symbolize what they need to express. With this in mind, offering a varied range of activities to stimulate or catalyse reection and communication can be helpful (OBrien and Burnett 2000a). When a client can express thoughts, feelings and conicts they feel more emotionally satised, gain a clearer sense of identity, and more easily accept inner direction (Case and Dalley 1992; Dalley, Rifkind and Terry 1993; Landgarten 1981; Oster and Gould 1987; Rubin 1978). One of the fundamental principles of our approach to ET is that a client presents for therapy with the answer to their problems already within them (Bohart and Tallman 1996) much like the young client mentioned earlier. She did not suppose that she knew how to get well; dedicated carers
EXPRESSIVE WRITING AS EMOTIONAL FIRST AID
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brought her to therapy with hope and an expectation that the answers and the relief would come from the therapist. Even though we can look at life events and see similarities, each client has a different story, a different experience and a different way of communicating their narrative. The therapist is like the producer of a movie, but the client always occupies the role of director our part is to make sure there are sufficient resources, ideas, experiential techniques, rapport, space and time for activation of the clients aptitude for ingenious and capable therapeutic change. Activities that harness the energy of undisclosed emotion while maintaining an atmosphere of partial anonymity and privacy for the client can be useful for respectfully exploring coping mechanisms, supporting uncomplicated communication and providing doorways to safe disclosure. When obstacles to the ow of expression become problematic for the client, encouragement to begin the process of more explorative communication means nding ways and allowing time for extending the skills of mutual exchange and the conscious processing of emotion. Providing activities that gently support reection and review, and offering a range of modes of expression, enhances a clients potential to process information and willingly and more easily bring to light more of what is distressing them. Writing as an expressive activity assists the process of selecting what to focus on in therapeutic exploration. At the same time, a client experiences the capacity to control the pace of disclosure. Writing activities can act as a stimulus for more creative, resourceful problem-solving (Riordan 1996). Focusing on feelings, prioritizing issues, or simply trying to express the inexpressible can present a signicant hurdle. What we do know is that creating opportunities for a client to share as much as possible of what they bring to the process is crucial to effective outcomes (Lambert 1992; Wampold 2001). In devising our ET style of therapeutic writing activities we attempted to create formats that could take the form of creating an autobiography or future autobiography, and writing about a particular life event. We use reective writing, self-discovery worksheets (SDWs), sentence starters, process writing (continuous ventilation) and completion summaries, exploring client-generated imaginary narratives, and responding to guiding questions to enhance and record somatic awareness (Pearson 1997). Riordan (1996, p.267) claimed that writing in therapy clears the mind and gives perspective to troubling thoughts and feelings; it also helps in the acquisition and retention of new insights and encourages problem-solving. Progoff (1975) found that the use of journalling to record bodily experiences on an ongoing basis assisted the movement towards new resolutions and awareness that help solve problems (p.207).
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In recommending a multidimensional approach to counselling, Combs and Freedman (1990) advocated addressing both conscious and unconscious elements of the psyche, verbal and nonverbal communications, active and passive intentions, and positive and negative emotions. These authors suggested using symbols in combination with stories to deepen the therapeutic process and consolidate client integration. Expressive or therapeutic writing has made a signicant contribution to such a multidimensional approach, since the reection initiated through writing, and the practice of encouraging spontaneous ow of associations, tends to help a client cross internal boundaries. Pearson (2006) and Pearson and Nolan (2004) have provided an extensive range of activities for the purposeful use of writing in therapy or for self-development. The act of engaging in creative forms of writing and recording is satisfying, constructive, and an effective tool for self-expression (Carr 1998; Kenardy and Piercy 2006; Oaklander 1988; Pennebaker and Seagal 1999; Wright and Chung 2001). This view is mirrored in the formulation of ET techniques that offer activities combining metaphor and words, collage and words, linking symbols and words, or having narratives recorded by another person, as ways to increase motivation and articulation (Pearson 2006; Pearson and Nolan 2004; Pearson and Wilson 2001). ET writing is not conned to use with adult clients or older adolescents. A younger client can benet greatly from support to engage in some recording (Oaklander 1988). Oaklander described a number of ways to engage young clients in using words and writing to enhance their sense of inner strength for example, completing sentences, writing about opposites, and, when a client has an affinity with written expression, writing longer essays that reect desires, needs, inclinations and emotions. Writing activities offer a client space and time to organize communication in their own distinctive manner, and to exert control over the rate, depth and intensity of their therapeutic work (Rasmussen and Tom 1992, p.3). Bolton (1999) described how a client can learn to trust writing to pace itself to their needs and desires, rather than to a therapists needs. Trusting a clients inner resources enough to afford them a sense of in-session control supports their ability to let go of defensiveness more readily, when they wish. This appears greatly to enhance the therapeutic alliance. However, the use of writing for therapeutic outcome has been linked to a much broader spectrum of personal well-being. This includes enhanced immune functioning, improved liver enzyme function, reduced frequency of health centre visits, less time absent from work, and greater effectiveness in coping with job loss and regaining employment (Kenardy and Piercy 2006; Pennebaker and Seagal 1999).
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THERAPEUTIC USE OF WRITING Mentioning writing as a therapeutic approach sometimes makes professional helpers cringe; opponents of this technique decry writing as too challenging, or argue that some clients are too difficult, not able, or simply not interested in writing. However, where a counsellor has found personal benet through writing, their own allegiance to the modality may have a positive effect on clients, enabling them at least to try it. When a client can create and write in their own way, they take up the role of active participant in their healing process they take up the position as the only expert on their internal world, and, through writing, can begin consolidating a better sense of self (White and Epston 1990). An example would be Joe Simpsons Touching the Void (Simpson and Bonington 1988), where an individuals narrative of a terrifying experience stands as evidence of the potency of autobiographical writing. We can feel inspired, horried, repulsed, motivated by autobiographical material, and none of those responses is necessarily wrong with reection they can all help us decide what we want to do, or in which direction we wish to go. For our clients, nding multiple ways of communicating feelings and committing to certain identied and desirable changes is likely to enhance the therapeutic outcome. Writing that activates an increase in associative thinking may help a client make links and more rapidly and easily dene goals and identify drives. It is all about letting the client tell their story and then using that as a launch-pad for collaboratively engaging in closer exploration of the detail of their life. All the while the client remains the privileged author-narrator, and the therapist a privileged listener. Writing is currently used for expression in self-reection (Riley-Douchet and Wilson 2008), as email therapeutic support (Wright and Chung 2001), in education (Beveridge 1997; Spalding and Wilson 2002; Woodward 1998) and in ET (Clark 1995; Pearson 2006; Pearson and Nolan 2004). The use of writing as part of Western therapy dates back to Allports (1942) use and description of the therapeutic benets of materializing thoughts and feelings. Riordan (1996) cited several authors who addressed the clinical use of writing in the 1950s (Farber 1953; Landsman 1951; Messinger 1952). Expressive and reective writing has been argued as valuable in the training of counselling and psychotherapy students (Johns 1996; Wright 2005), in the training of nurses (Riley-Douchet and Wilson 2008) and in higher education (Beveridge 1997; Spalding and Wilson 2002; Woodward 1998). As one of a group of professionals training in ET, Jane, aged 38, used her journal to record insights, acknowledge reactions, record awareness of any childhood scripts, and set intents and goals for future direction (see Figure 6.1). Through the experiential training, she was well into uncovering the impact of the past on her present behaviours. Jane wrote:
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Figure 6.1 Adult female, worksheet: Life review.
I see a clearer view of my old belief system: My body is disgusting. No one would want me. I cant speak directly what I feel. If I speak the truth it will bring separation. I have to earn my place in the world. (Not being wanted from the start.) All problems in my life come from not saying what is true for me. I dont say what seems true in order to keep some connection. My body wants touch, company, relationship so much that it will gladly ignore my minds sense and my intuitive knowing, and forsake connection with myself. The hurt inner child, through my body, has responded to anyone. I feel great joy in escaping from all this imprinting. Now I understand this, I know I will be more helpful to my clients.
The participatory basis of writing in therapy can be seen to help minimize power imbalances that are often inherent within the helping relationship (Bacigalupe 1996). In particular, the client-centredness of writing with and by the client opens wide a doorway for working appropriately in cross-cultural contexts (Bacigalupe 1996). In writing activities the focus is
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always on using the clients preferred language, rather than having a client try to match the language of the counsellor. Using their preferred language gives them freedom to draw on their own resources and to express themselves in a form familiar to and understood by them, instead of engaging in what might seem, to some clients, ineffective efforts to be understood by another person. JOURNALLING, CREATIVE JOURNAL WRITING, EXPRESSIVE WRITING In the 1970s Progoff devised the intensive journal process (Progoff 1975), and this form of journalling subsequently became inuential in shaping and inspiring the foundations of using writing in ET. While Progoff s formats have been modied, what has persisted in therapeutic writing is his notion that journals offer neutral, open-ended tools and a place where no categories or interpretations are imposed on the writer. The journal was seen as playing a crucial role in reconstructing a life (Progoff 1975, p.9); Progoff regarded emotional growth as stemming from therapeutic use of active techniques that enabled an individual to draw upon their inherent resources for becoming a whole person (p.9). In contemporary ET, creative journal writing would be the more commonly used term. Creative journal writing, or creative journalling, is a generic term used to describe activities that range from one-day, weekend or sometimes longer personal development workshops that combine art, collage and writing to deepen therapeutically oriented use of these tools and processes. So what would this look like? Some clients initially imagine that journalling involves lengthy written discourse in a literary narrative style a bit like an essay or assignment one would produce for school or university purposes. In practice, therapeutic writing embraces the use of words, symbols, imagery and metaphor from within a person, as well as accessing the world of poetry, story, myth and legend. The writing activity can be structured, sometimes brief, sometimes spontaneous and chaotic, sometimes resembling a mind or body map, sometimes poetic, introspective and always creative.
One adult client, who at the beginning of therapy considered herself as lacking creativity, gradually opened more to her own unique way of recording the search to create her own identity. Buying bagfuls of books from charitable organizations, and in due course discarding these tomes, became an innovative and imaginative part of her healing journey. Circling or highlighting relevant passages with a variety of brightly coloured pens; pasting emotionally expressive images, cut from magazines and newspapers, on
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pages that contained words mirroring her experience, was a process of transformation from being locked up in a dark world to opening to painful emotional wounding, with the desire to create an identity free from the injunctions of the past. Her dedication to her creative journal work helped her to process past pain and alter the trajectory that had shaped her interactions in relationships up to that point. One of these creative journals was particularly interesting. Opening the cover and ipping past the rst couple of pages, one found that the remainder of the book had been carefully glued together, page after page, and the middle then hollowed out. In the space created, a rock had been placed, nestling like a child in a crib, and seen only by those who bothered to open the book.
Hunter (1999) described the therapeutic use of writing as a valid means of self-exploration, decision making, relating to the environment and examining life stages, and as a way of diagnosing problems. Through writing a client can accumulate validation of their personal growth as it is taking place. Presence of a tangible record has proved to be very supportive when the time comes to terminate the counselling process; a client can undertake a nal evaluation of the journey they have taken by reviewing their own unique record of the process. Intentional use of therapeutic writing has been described by Riordan (1996) as a way to augment therapeutic outcomes. For example, we have found that reviewing completion writing from a period of therapeutic work builds the concept of life as a journey of growth and discovery, rather than an endless litany of problems to be confronted, dealt with and overcome. PRACTICAL USE OF JOURNALS Expressive writing and creative journal writing are suitable for clients who feel comfortable using these medias, or who have some affinity with the verbal/linguistic intelligence. A writing activity or work in a journal can create the meeting place between an individuals inner life and their outer experiences. Taking time for reection and writing can lead to increased self-awareness and preparation for more effective, direct communication, and can support a client to open to the potential for personal healing and transformation. Prior to embarking on using this ET technique, therapists are encouraged to engage in their own reective writing, to become personally familiar with the process. Only through expanding our own comprehension can we assess the suitability of any of the ET media for use with a particular client.
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Sometimes, when a client uses therapeutic jargon convincingly (Willi 1999), the therapist can suppose that solid progress is being made! When we become reexive practitioners, recording and reecting on our own experience, we are more able to hear the difference between our voice and a clients authentic voice (are they simply mirroring us?). We can hear if we are moving things along too quickly, or if our expectations of a client are more in line with what we want, rather than where the client is. Handing over the reins through the simple step of offering a client choice, acknowledging to ourselves their inner resourcefulness and capacity to effect change, means that we have the opportunity to focus our attention on contributing factors creating the clients environment, to witness opening or closing of doors to new ideas, and to practise tolerance, patience, compassion and respect for difference. Within ET, writing is used to proactively support development of the therapeutic relationship, client self-awareness and emotional processing, as well as session review, integration and forward planning. Writing is used to deconstruct distress, then reconstruct, consolidate and reinforce new inuences, ideas or possibilities that can restore a clients interest in life, self-care, and interacting more effectively with their external environments. Expressive writing can involve regular recording in a personal journal (kept by a client and used for out-of-session recording of inner processes), spontaneous in-session writing on single sheets, or intentional use of more formal, structured worksheets. In essence, the process includes writing down and commenting on thoughts, feelings, attitudes, sensations, dreams, hopes and plans. Journal techniques, especially for younger clients, may combine sentence completion, prose writing, writing spontaneous phrases, word lists, sketches, mandala drawing (see Chapter 7), ow charts, mind-maps, collage and taking photographs that are accompanied by a brief narrative relating to the photo. Writing in a journal, over time, can allow a profound, sensitive, poetic or spiritual side of an individual to emerge. In an environment where abuse and neglect prevail, this aspect of personality may remain underdeveloped or eclipsed by survival mechanisms. Allowing the emergence of poetic or ritual language can be comforting, can be used to assist personal growth and a sense of worth, and can support a clients deeper connection with the realms of creativity, the sacred, or their innate spiritual nature. Writing offers a space for safe, private, open expression. Feelings, realizations and insights can change as the writing progresses, and these can become clearer. The uncensored ow of written words means it can easily be used for private emotional release, and may become a valuable selfhelp tool for some clients. What has been written can form the basis for a client to make choices about what they share with the counsellor. Having choice supports their motivation to share (Baloche 1996). Writing can be
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likened to a preparatory activity, or a rehearsal, that builds condence and provides an experience of doing things differently an experience that contains words, ideas, phrases and sentences that belong to the client and not the therapist. Where creative writing might take the form of a wish-list of grandiose therapeutic goals or unrealistic life ambitions, this can still be useful. What has been written can be examined in a collaborative effort to focus on what can be achieved. When suggesting journal work, encourage a client to write as honestly as possible. Emphasize that the writing need not be sequential or make sense; handwriting, spelling, grammar and punctuation are not being evaluated; the writing is their private world. It should be made clear to a client that they have choice in terms of how much or how little they share of what they have written. The process is for them, not for the counsellor, yet it can form the foundations of a bridge which the client may choose to cross in opening up to the counsellor. Journal writing is a way of developing connection with the inner world. It can offer a respite from survival mode, presenting a space where the client can safely be more congruent with their private world. Journals can support the direction of a persons inner healing mechanism. Secrets can be condentially acknowledged. Hopes, dreams and longing can be acknowledged. Within a journal clients can create a dialogue with, and clarify the values and purposes of, different parts of themselves. In the absence of diagnosed pathology, when a client becomes aware of conicting aspects of self, in-session support for each aspect to be heard may bring enhanced clarity about action steps, choices and new directions (Stone and Stone 1998). For instance, an angry part can dialogue with a compliant part; a dragon part (perhaps symbolizing a guardian, anger or strength) can talk with a princess (perhaps symbolizing beauty, youth or love). A client who becomes aware of an internal, critical, self-deprecating part constantly overriding a more spontaneous and optimistic aspect may gain both cognitive clarity and relief from a simple process of allowing space in session for both aspects to have their say. Research has shown that processing writing with a therapist leads to better resolution (Murray, Lamnin and Carver 1989). Writing in ones journal can be incredibly insightful, helpful and healing. However, where the emotional burden of shame, blame, guilt, fear and pain is such that the person can go no further on their own, what can happen is that personal writing may tend to become an increasingly self-destructive process. We are not denying the extraordinary magnetism or usefulness of the works of authors expressing a view of humanity as essentially awed, or even apparently meaningless. Perhaps all writing and maybe all art could be viewed through a wider lens of being therapeutic and healing at some level. However, what we are concerned with in this chapter is the use of
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writing within a therapy context and its place in supporting a person who has been traumatized, who may carry emotional wounding, or who may seek support to reconnect with resourcefulness and resilience. With that in mind, an important exception to our encouragement for using private journal writing is the consideration that, unsupervised, the inner critic aspect of a clients persona may judge their writing both the perceived quality of it as well as the content as evidence of unworthiness or the intolerability of feelings. The present authors have consistently found that processing written work in an ideal therapeutic environment of warmth, safety, acceptance and gentle challenge supports better overall outcomes than solo, out-of-session writing that focuses on material from which painful feelings resurface, without any support. In other words, the clients inner critic or negative early imprinting may be the lens through which writing is self-analysed, and where ego strength is impaired this may lead to an increasingly complex appraisal of self-worth. Without accessing support from a counsellors ability to guide reappraisal, model acceptance and facilitate deeper exploration of what has been written, the journal entries are liable to accentuate feelings of shame, blame and fear motivated by the inner critic. To optimize the use of journal writing, therapists need intimate knowledge of the workings of both their own and a clients inner critic. Expressive writing can support exploration of issues about counselling and adjustment to the counsellor and counselling environment. For example, responding to sentence starters such as What I want is, What I dont want is and I would rather be allows a client to reect on their situation and gain a feeling of some control or ability to identify some limits to involvement in the therapeutic process. Reection and writing can help a client gain a clearer focus and access to issues needing attention. Expressive writing is an alive process that helps a client become more aware in the present, and more present to the process of transformation and the changing nature of their psyche. By means of some free-ow or ow-of-consciousness writing, clients can safely ventilate any jumble of associations, or revolving thoughts, within the contained setting of therapy. This can begin the process of freeing up emotional expression and assist in discriminating among topics to address, prioritizing issues, and thinking clearly about what is the most vital issue to focus on. WRITING AND TRAUMA Professional helpers reading this book know only too well that in distress or crisis a clients perspective can be coloured or even overwhelmed by past trauma. When beginning to work therapeutically through the legacy of trauma, clients often report a feeling of having no control. They often
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display cognitive and emotional dysfunction (Rothschild 2000). Labelling and describing a trauma through writing has been reported by Riordan (1996) as enabling a client to begin processing an event and gain a sense of control. Pennebaker (1995) reported that writing enhanced the speed with which a client overcame traumatic experiences, and that even though there was a homeopathic effect initial worsening of affect followed by marked improvement when clients wrote about traumatic experiences, reported outcomes included signicant improvements in immune responsiveness and physical health and a decrease in psychosomatic symptoms. The use of writing in working through trauma has also been documented by Anderson and MacCurdy (2000). These authors outline their survey of the elds of psychology, trauma theory, neuroscience and education that supports the use of writing in the classroom both to produce good writing and to provide experience of positive psychological benets. In discussing the value of narratives of trauma as indicators of future post-traumatic stress disorder, Eid, Johnsen and Saus (2005) found that positive emotional expressions in trauma narratives were associated with a lower level of psychological distress, while negative emotional expressions were associated with more symptoms of post-traumatic stress. These researchers reported one implication of their ndings as the need to direct early preventive interventions towards survivors with increased levels of negative emotional processing of trauma narratives. Their study was inspired by Pennebakers assumptions that early trauma narratives could represent a valid indicator of mental health, and that the narrative could help the individual to organize complex and potentially threatening emotional experiences (Pennebaker and Seagal 1999). Fosha (2000) made the point that there is a world of difference between being alone with overwhelming emotions and being with a trusted other in the affect storm (p.570). Writing is one of the ways used in ET to chart a safe, secure passage through the often stormy search for self. HEALING STORIES Creating our own stories is part of self-discovery and the search for meaning two important aspects of therapeutic change (Anderson and Goolishian 1988). Taylor (1996) states that stories have a healing power and that people are inuenced by cultural and social stories, adding that many of us need to heal broken stories (p.113). Taylors comments echo a narrative therapy approach, where a clients personal story is seen not so much as broken, but as thin, needing to be lled out with forgotten moments of strength, courage or success (Payne 2006). In narrative therapy words are seen as generalized symbols inviting the reader to supply meaningfrom
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her own store of associative linkages (Payne 2006, p.8). There is a focus in narrative therapy on initiating powerful associations through the careful use of language that can bring alive the therapeutic dialogue. LETTER WRITING Creating therapeutic letters has been widely used as a way to enable clients to contact and express deeper levels of emotion and communicate in a safe way (Bass and Davis 1988; Detis 1988; Lindahl 1988; Rudes 1992). Letters that allow an emotional release process, and are not meant to be posted, have proved to be valuable in helping clients work through issues in ET sessions. We have often observed that committing deep feelings to paper with an intended recipient in mind (creating an imaginary encounter) allows blocked emotions to complete the journey of expression, restoring a calmer, more focused state.
A 15-year-old girl, sent for counselling for aggressive behaviour towards her mother, revealed early in her rst session the seemingly unconnected event of her grandfathers death six months prior to the session. Her anger towards her mother had emerged in the weeks after her grandfathers death, as she was forbidden to speak about him, attend the funeral, or reminisce. She felt he was the only one who really loved me. Opening this topic moved her into a deep feeling of grief and she quietly cried for several minutes. During her second visit she identied a need to say farewell to her grandfather. So a letter was started. She imagined him opening the letter, and wrote, largely in silence, as rivers of tears owed. The thought that she was addressing him directly allowed the months of suppressed grieving to unlock. Over the next few weeks her mother reported a dramatic reduction in her daughters anger and aggressive behaviour.
REFLECTIVE, PROCESS AND INTEGRATIVE WRITING ACTIVITIES Writing can help a client begin to tolerate and process their remembrance of the intolerable, record observations and experiences over time to better understand personal tendencies, review the past and identify emotional and behavioural scripts, explore family patterning, resolve present issues and clarify future action steps and directions. Some clients and therapists may prefer a writing activity over drawing or selecting symbols. Chan and Horneffer (2006) compared the psychological effects of writing versus drawing about a stressful experience, and found that journalling had a positive effect for participants who initially exhibited high levels of
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psychological distress. The acquisition of new insights and preservation of the gains made in therapy (Riordan 1996) are two compelling reasons to include writing activities in the therapeutic repertoire. ET incorporates writing for three specic aims: reection, emotional processing, and integration and completion. Reective writing is used to review, ponder, reect, prepare (What happened was); process writing is used to work through emotional overload (I feel [sad, angry, etc.] about); completion writing is an integrative step, to support closure (I realize that I can, What I can do next is). These styles of writing are used at specic stages of ET sessions. Reective writing may be offered in the initial stages of the therapeutic relationship and in early stages of some later sessions. Process writing may be offered once rapport has been developed and the client is in touch with some distressing, reactive or overowing feelings that they cannot express verbally. Completion writing is offered in the nal stage of a session where integration, closure, calmness, cognitive understanding of the process, and future focus may be encouraged. Reective writing is used as a tool for developing self-awareness. During reective writing tasks there can be cognitive and emotional focus on clarifying intra-personal processes. For example, challenging decision-making can be supported by dividing a writing page into two columns to represent the pros and the cons or the YES and the NO, then reecting on the decision or issue. This is followed by listing ideas under both headings initially allowing ideas to ow randomly without having to make sense. The unloading of jumbled or conicting ideas onto the page can be, in itself, a clarifying process. Reviewing and making sense of lists, prioritizing reasons and envisioning outcomes from each step all this can lead to improved clarity and development of appropriate action steps. Recalling events with the help of guiding questions or sentence starters can help clients bring to the fore the issues they wish (or need) to focus on. Process writing may include spontaneous, silent emotional release through writing out reactivity. This can be very effective in emotionfocused processes where a client feels so overwhelmed by strong feelings that they cannot articulate. Process writing can include more structured activities, such as creating letters that are never sent, or more spontaneous release processes that involve an imaginary encounter. Where a client is in an emotionally charged state, the page can suggest a boundary for the expression of the feeling the expression goes onto the page and is contained in that eld. A client can write single words or short phrases in random fashion, for example across a page, around in circles, in diagonal lines. For some clients living in a stressful situation, process writing can be used as a self-help or self-management skill. It is the process, not the
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product, that is signicant. Often the product is consigned to the bin, sometimes in a thousand pieces. The cognitive activity of completion writing assists integration, brings experiences together, links up feelings, attitudes, memories, provides an overview, and may consolidate valuable insights. As mentioned earlier, if, in earlier stages of a session, a client has been using primarily right hemisphere modes, such as imagery, music, symbols, then the left hemisphere actions of naming, describing, summarizing, putting in sequence, can support a more balanced state. This can, of course, also be achieved through conversation with a counsellor. However, a client can come to value quiet writing and review time which generates a feeling of achievement, enhances personal meaning and carries opportunity for feelings of peaceful condence. The structure offered to support completion may include sentence completion tasks, review questions, poetry frameworks, or no structure at all. WRITING FOR HEALING A young adolescent client who worked over several years with HW used therapeutic writing to express the inexpressible the loss of her mother through suicide. This loss was followed two years later with another: her father also took his own life. Describing herself as paralysed by sadness, Veneta wrote of her confusion, inexpressible loss and future potential for healing in the following extract from her writings (used with her permission).
Mum! Im home! Mum! Im home! Mum! Where are you! Ive got great news. Mum I dont have time to play games, I dont nd it funny mum! Has anyone seen my mother? Mr Smith have you seen my mother? Did she go down the shops? Dont worry Ill wait here, she shouldnt be long. Sorry darling she wont be coming back. Shes gone. Mum! How could you?
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Im sorry things had to be this way. Im sorry. Was it because of me? Im sorry. I only wanted one last chance. Dont worry it wasnt meant to happen. Dont worry it was never because of you. Dont worry you can always have another chance when you think of me. Accept that it happened. Accept that I would never let it happen because of you. (You should know that.) Accept that when you think of me No matter what happens in your mind You will always have As many chances as you need.
Veneta used spontaneous writing in between sessions to move closer to talking directly in session about the trauma of being present on separate occasions when two loved parents disappeared from her life. This burden of loss had captured this young person at a point in time, a point from which she felt unable to move forward. She described the situation succinctly when she announced to me that people think Im fourteen, but really, Im only seven years old inside. Her writing was discussed at each session and Veneta began to hope that one day she would write a book that would help other young people dealing with parental suicide. In our clinical work we have commonly found that a client nds expression through creating poetry either during end-of-session integration time or when they are processing the session between visits. Anecdotal reports from these spontaneous poets provides rich evidence of increased clarity and satisfaction in their communication during later sessions. Their reports carried stories of feeling an emotional freedom that came with writing in this form; of feeling more integrated within themselves; of feeling more authentic; and of enjoying a reduction in inner tensions. Best of all, there was the benet of a sense of deeper self-understanding. During the 1970s and 1980s, poetry was often cited as one of the most widely used forms of creative writing in counselling (Brand 1987; Harrower 1972; Mazza 1981; Rothenberg 1987). Fuchel (1985) found that clients who write poetry can experience enhanced personality integration, tension reduction, and selfunderstanding. Combs and Freedman (1990) recommended the use of metaphor in counselling, and Jacobs (1988) describes how, in psychodynamic thought and practice, use is made of metaphor to describe experiences, aspects of
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personality and the inner workings of the mind. The 14-year-old Veneta used an extended metaphor to help describe her personal feelings about life. The following extract from her writings employs nature images of land, bush, the forest and a (rare) bird of beauty. Juxtaposed against this is the image of a young persons transformational journey from being loved, to shattered dreams of belonging, to understanding, to respect for riches to be honoured and protected, and some riches remaining invisible.
The Bird of Beauty It was the forest of all forests in the world. As the legend of the forest was handed down through time people wondered why this forest never got chopped down or harmed. Only one person had been there, only to nd that his dream of building a farm would not come true because one day he was digging and found out that the soil was too dry. The next day he started packing up his things and planned to leave after lunch. Two hours after he had been walking through the bush he stopped to listen. He listened to the animals go about their day. What he didnt realize was that a bird was watching him. No, not just any bird a Bird of Beauty. A Bird of Beauty only lives in this particular forest and protects it from any harm. When the sunset began the Bird came out of hiding and sat next to the young man. The young man turned around, startled by the noise. The Bird of Beauty started to get very angry with the young man because he showed no respect for the land which didnt belong to him. He stared at the Bird and said he was sorry for harming the forest. At rst it didnt seem like saying sorry was any good. But when the man listened to the Bird of Beauty he began to understand why the bird got so angry. He promised not to tell anyone about the Bird of Beauty and the forest in which it lived. People always talked about the man who never told them of the beauty of the things he saw. He did this not only as a promise to the Bird but because he didnt want to see the forest or the Bird destroyed. He knew that someone would end up destroying it. Do you know where this place is or maybe you feel the same about your life and places in it? Are you the Bird of Beauty? Veneta, aged 14, 1998.
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Simple as it seems, this story carries potent themes of impending destruction, disrespect/respect, protection, ending and beginning, awakening and awareness, transformation, and beauty above the ordinary. In the tale someone abandons a dream of productivity because of nding barren ground, only to nd deeper respect for the landscape through realization of what the forest represents. The farmer becomes the protector of a unique and beautiful environment. Although this story was written early in her therapy, Veneta continued to write, allowing her work to be the preferred medium for sharing her suffering. After some time Veneta ceased her writing; she then used music as a form of communication in the next phase of therapy. More about her way of using music can be found in Chapter 8. SELF-DISCOVERY WORKSHEETS The self-discovery worksheets described here represent an activity we have developed over the last 18 years. They were developed using Gardners theory of multiple intelligences (Gardner 1983) as a guiding concept. What we were looking for was an activity that could help a client create a multifaceted overview of their inner world and so provide client and therapist with multiple ways to discuss the problem. Frequent use of imagination is encouraged. Utilization of imagination is one way to access the clients inner world, what is under the surface. Self-discovery worksheets (see, for example, Worksheet 6.1) are an ET method that combines reective writing and use of metaphor and imagery. Self-discovery worksheets provide catalysts for reection, structured spaces for writing and recording images that can expand and enhance communication. The worksheets offer an organized but limited space in which to record self-expression. Important is that right and left hemisphere functioning is coordinated in this activity, which can bring the client into a state of balance and integration (Siegel 2005). Siegel claims that more resourceful, creative decision-making processes emerge from integrating right hemisphere functioning with the left hemispheres more verbal, linear and logical style. In its most simplistic explanation, this means that when a client engages in ET, using right hemisphere modes (such as imagery, music or symbols) in combination with left hemisphere actions (naming, describing, putting in sequence) can support a calmer, more stable state. Self-discovery worksheets extend the range of intelligences used by a client, as well as the modes of expression. Imagery and metaphor are often invited as a starting point to convey feelings, attitudes and parts of self and to describe other people, providing helpful aids for reection and communication. Including metaphor, image
Worksheet 6.1 Life Review map

Copyright Pearson & Wilson 2008
CHILD
Colour in the mood of this stage: Colour in the mood of this stage: Colour in the mood of this stage:
- - Life Review Map - ADOLESCENT FUTURE
BABY
TODDLER
Colour in the mood of this stage:
Colour in the mood of this stage:
2 or 3 images or symbols for this stage: 2 or 3 images or symbols for this stage:
2 or 3 images or symbols for this stage:
Major events: Major events:
Major events:
Major events:
What is next?
Words for how it felt: Words for how it felt:
Words for how it felt:
Words for how it felt: ................................ ................................ ................................
Desired qualities: .................................. .................................. ..................................
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SUMMARY: Impact on my life: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SUMMARY: Impact on my life:
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Note: Enlarge to A3 size for use with clients
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symbolism allows the client, gradually and safely, to contact and begin expressing feelings, memories and beliefs. Referring to Figures 6.2 and 6.3, we see that the clients discussion could begin with an animal chosen to represent the person. Just as easily, the discussion could focus on the colour chosen for that person, or on their big problem. The story is told from the clients perspective without any additional interpretation from the therapist nothing new is added,
Figure 6.2 Eleven-year-old female, worksheet: People in my life.
Figure 6.3 Eight-year-old female (informal), worksheet: People in my life.
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nothing is reframed or paraphrased, just as nothing is taken away. When we become curious about who the client is and how they have experienced their world, if we respectfully listen to exactly what it is they say, in a eld of non-judgment and acceptance, there is an activation of a clients curiosity about who they are. If we are interested in them, they will become interested in themselves. This interest can expand to an interest in understanding how others feel, or the impact a clients reactions may have on others. Designed for clients of all ages, SDWs have been used very successfully with individual clients, within personal development groups, in therapist training groups and in school classrooms. The worksheets support developing new, more intricately layered language to communicate about feelings, memories, beliefs and hopes. Worksheets used in ET have many roles and can develop intra-personal and interpersonal communication skills. They can activate the cognitive skills of reection, review, summarizing and deduction, and provide opportunities for expression, externalization, ventilation, drawing, abstract use of colour and line, and use of miniatures (symbol work). The formats provide support for nonverbal thinking (Lowenfeld 1993) and communicating. Self-discovery worksheets may reect back to a client that there are many parts to the personality, and help to reduce environmentally induced over-identication with negative aspects of self. The sense of positive progression as a client can be reinforced at a review session during which the worksheets provide tangible evidence of the work that has been done and the ways in which growth has occurred. The completed worksheets provide both client and counsellor with an overview, while providing many specic doorways for detailed discussion. Time-line worksheets, in particular, can illustrate and clarify psychodynamic concepts, stages of life, progression and future focus. For some clients they can bring a sense of order in dealing with emotions that may feel chaotic and overwhelming. The self-discovery worksheets can be used as a starting point in one-on-one counselling sessions, and can be followed by more in-depth processing. They can be used with small groups to build cohesion, communication and support disclosure. They can be completed with the counsellor giving directions, or, with older clients, can be completed in private during the session or for homework then discussed at a subsequent session. When using the worksheet it is important to specify before the client starts whether the work is private or to be shared with the counsellor. Venetas spontaneous collage (see Figure 6.4) created between sessions as a way to process unfathomable loss You are coming back, arent you? poignantly records an inner dialogue that highlights the depth of her well of grief.
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Figure 6.4 Fourteen-year-old female recovering from trauma, collage: You are coming back, arent you?
WRITING FOR PERSONAL DEVELOPMENT AND STUDENT WELL-BEING Exploring the use of journal writing with high-school pupils, Berman and Schiff (in Anderson and MacCurdy 2000) found this an effective way to address the often problematic topic of suicide. In Bermans research, feedback from participants indicated that healing was felt to have taken place through the writing, through sharing their feelings on this subject, by listening to the writing of peers, and through empathic comments from the writing teacher. A range of self-discovery worksheets was trialled by Pearson (1999) with pupils in Year 7 classrooms (12-year-olds), with the activity supervised and reported on by classroom teachers. Designed in an inclusive, mixed media style, the worksheets in this study were found to enable proactive participation in the process by all pupils, irrespective of academic ability. Teachers involved in the project commented positively on the appropriateness of the design, the non-threatening stimulus for in-depth communication, and commented on the sense of positivity embedded in pupils responses (Pearson 1999). Feedback gathered from teachers and students showed that using the worksheets achieved the aims of promoting reection and engendering feelings of balance and calm. One teacher recognized the worksheets as a useful basis for autobiographical and creative
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writing a skill that was seen as valuable for both personal and academic growth. Chetty (2008) used the ET style of sentence starters as therapeutic and developmental tasks with high-school pupils who were underperforming. She explored whether sentence starters would enhance writing skills and develop emotional literacy. What she discovered was that the creative process minimized resistance to learning. Chetty found the sentence starters effective in opening doors to the process of constructing writing. In addition, this research investigated the use of different types of background music as an adjunct to the writing process. The study found that using gentle background music supported focus, attention and learning, and engendered a calmer climate within and amongst the students (Chetty 2008). In an earlier study Holian (2001) also found that journal writing in a Year 7 classroom provided pupils with an undemanding avenue for expression, self-exploration and communication. This study also found that when pupils shared some of their journal writing with their teacher, this helped the teacher gain not only more insight into their preferred learning styles, but also improved awareness of them as individuals. ONCE UPON A TIME STORIES, PLAY AND RESILIENCE ET and narrative therapy are complementary approaches to counselling. ET provides a straightforward way of augmenting the skills and tools of narrative therapy by providing exercises and modalities that extend techniques in the narrative framework. ET encourages actively listening to the clients story and allowing them to tell it as often or as many times as they need to, letting them develop, expand or change the narrative in any way they need to. We have found that activities where a client is engaged in using what Freeman, Epston and Lobovits (1997) called linguistic externalization (p.8) facilitates gaining relief and some distance from problems. Aiming for collaborative change within a session, ET employs as does narrative therapy reexive or self-discovery questions that are intended to help facilitate and inspire both a therapists inventiveness and a clients reection and choice. These are questions that seek to generate experience rather than gather information (Freeman et al. 1997). ET exercises also offer a structure for projection of stories and meanings that can be therapeutic for young clients (Pearson 2004; Pearson and Nolan 2004; Pearson and Wilson 2001). When working with young clients, we have found they dislike being questioned or asked to comment directly about a problem. However, when provided with a free and protected space (Kalff 2003 [1980]; Pearson
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Figure 6.5 Adolescent female, worksheet: About my life.
and Wilson 2001) where they can engage in change-oriented processes in a symbolic, playful way, then we are utilizing that childs playfulness, imagination and inventiveness in relation to serious problems (Freeman et al. 1997). The outcome is the creation of several doorways through which we can enter their world and understand their experience in a richer way. A benet of playful interaction with a young client is that the child can feel much better about their competency and creativity (Freeman et al. 1997). One of the key ingredients of resilience has been cited as the feeling that you are good at something (Doyle 2006). Playful communication allows children to take responsibility for sifting through problems with support, and then experiencing themselves as being resourceful in solving them in their own way. Interest in playful approaches may involve games, imagination, fantasy, mystery, magic tricks, symbolism, metaphor and storytelling. What is produced whether a sand tray with only three gurines, or a drawing that looks like scribbles on a page, or three minutes of pretending to be a dragon does in fact contain treasures central to that childs motivation and ability to resolve problems (Freeman et al. 1997; Kalff 2003 [1980]; Lowenfeld 1993).
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EXPERIMENTING WITH SENTENCE STARTERS Sentence starters are designed to initiate some ow in reective and completion writing. The practice of using spontaneous associations can help maintain the balance between the strength of current coping mechanisms and the desire for relief from distressing affect. The term sentence starters refers to an A4 or A3 page that has (each on a separate line) about six to eight phrases as starters or prompts of three or four words each, resembling the beginning of a sentence. A client is invited to choose as few or as many of the sentence starters that seem, in the moment, most interesting, and then take time (often around 515 minutes) to complete and extend the sentence. (See Figure 6.5). We usually suggest responding to at least two or three starters; however, completing all the sentence starters can be useful where time allows, or if a particular client is uent, articulate and willing. Correct grammar and spelling and legible handwriting are not important. We encourage use of the language that is most readily accessible or most preferred by a client. Spontaneous, rather than carefully planned, responses have been found to lead more naturally to issues relevant to the client. Again, this depends on the clients preference some are naturally more methodical than others. We nd children complete the sentence starters very quickly using only a small number of words, whereas clients often take more time to consider how they want to complete and construct the sentences. A client is invited to pay attention to the words and phrases forming in their mind as they read the sentence starters. Recording what feels urgent and springs to mind immediately is suggested, as well as taking time to reect on and record what may be lying in the periphery. Verbal encouragement is given to express feelings and thoughts that may be disagreeable, unpleasant or unwanted. The writing does not need to make sense, be sequential, or link with what went before or what comes after. We ask adult clients to endeavour not to censor what they write, assuring them that they can keep their written responses private if they wish. If writing prose is difficult, dot-points or a list of single-word responses is a useful way to respond. These can be expanded later. If no words or phrases emerge, we suggest simply moving on to the next prompt. Any left out or missed can be completed later, or ignored completely, or used as a point for discussion. Sometimes it is useful to review any of the starters that were passed over, or to which the client may have felt an aversion, or to which the client rmly chose not to respond.
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Guidelines for review and reection with sentence starters

When the writing phase appears nished, the next phase is to allow time for a review of what has been written. The following review and reection guidelines are presented as questions in an inviting, querying tone, with pauses in between to allow a response. The response may be verbal, or it could be made in silence. Look over what you have written. Is there anything that stands out for you? Can you underline, circle or highlight any words or phrases that seem very important? Which do you think is the most interesting response? Are there words that seem similar or connected? Could you extend these with further writing? Are any statements or words opposing or at odds? Is there anything you didnt write on the page that you wanted to?
Can you write, or discuss with me, how you feel now?
While discussing their writing, a client can add adjectives, metaphors, images, colours, shapes that might enhance the clarity and depth of communication. That helps make the writing more authentic and more meaningful and may utilize a preferred intelligence to extend vocabulary. The nal phase of this activity is to take time to open the space for discussion of any feelings experienced by being asked to complete the sentence starters anything a client wishes to comment on anything more a client feels they want to talk about. (This may or may not be directly related to what has been written.)
An invitation is offered for the client to create a summary statement from their writing, some completion. Counsellor and client then take time to discuss that summary statement. If a client is not enthusiastic about writing there are several variations that can be suggested for responding to the sentence starters: offer the activity as a verbal discussion
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allow responses to take the form of drawing perhaps a cartoon, or abstract colours and lines ask if they feel able to select symbols or create images that go with each starter offer the use of collage to create a response (if time and setting allow).
CREATING STORIES AND LEGENDS SYMBOLIC PERSONAL NARRATIVES Stepakoff (2007) found that traditional stories, songs and dances have a transformative effect on traumatized clients. Myths and legends are stories which form the shared cultural background of groups. The characters and symbols that appear in legends across many cultures share similarities, have similar patterns and have archetypal links (Campbell 1972). ET uses the construction of stories or legends, the form of which may resonate with deeper cultural archetypal underpinnings, to allow adolescent and adult clients to gain a wider view of their experience and to begin to make meaning of it. The idea of healing through stories is not new; it can be traced back in history to the days of the rst libraries in Greece. In a review of the literature, Riordan and Wilson (1989) found that the majority of studies show mixed results for the efficacy of bibliotherapy (the use of books for therapeutic benet) as a separate approach to solving problems. They concluded that it generally appears to be more successful as an adjunctive therapy. The use of stories, however, is central to bibliotherapy a family of techniques for structuring interaction between a counsellor and a client based on a sharing of literature (Pardeck and Markward 1995). If clients have been emotionally damaged, their personal myths may be distorted to some degree (Carr 1998). Hopeful, positive outcomes will not be assured. They may be living out negative myths, based on negative scripts, rather than acting from the innate positive drive towards wholeness that underlies the myths of the collective psyche. In most cultures there is a warrior or hero myth (Campbell 1972). The story provides both entertainment and cultural ideals. Campbell describes key components of the warrior/hero myths that appear in many cultures: a great deed to be performed, a call to adventure a leaving of home and security meeting a blockage, obstacle or challenge
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using a higher power, magic or special helper achieving the task, creating union rising to a new world or higher state a return.
Campbells structure has been used in the projective activity Creating a legend (see pp.191196). This activity engages clients in what they may perceive as non-threatening, non-therapeutic and enjoyable creation. Each stage of the activity can elicit useful associations or connections with the clients outer and inner life. The sense of achievement, the positive model of the created legend, seems to activate optimism, and can act as positive reinforcement for clients new directions, aims and view of self. CLIENTS WRITING AND PROFESSIONAL CARE The following comments concerning safety for a clients written work are suggested with a clear understanding for therapists absolute commitment to a duty of care to clients and to the principle of doing no harm. Mandatory reporting requirements, as well as the physical, emotional and spiritual safety and well-being of a client, are paramount considerations. The recommendation that writing activities are offered in a climate of openness, trust and respect for privacy is an important distinction that separates ET from some other approaches. In ET a client always has the option to keep their writing condential, so what is written can be straightforward, authentic and uncensored. Comments about following a clients lead, offering freedom of choice and the right not to share any of what they write must always be moderated alongside your assessment of a clients mental health, the strength of the therapeutic alliance, and the considered direction for their therapeutic work. Our experience has been that it is rare for a client not to want a therapist to review and discuss written activities. After all, there is often a great sense of relief in being able to make known a burden that has been carried too far. And so it is normal for written work, worksheets and artwork to be offered freely for observation and comment by a therapist. Privacy and condentiality around what is created in session is important if a client lives in an environment where there is a need to mask feelings of vulnerability. In some cases caregiver contexts do not afford respect and privacy; well-intentioned adults may assume that they have the right to read a childs work without seeking permission. Sometimes this happens when a parent or caregiver has particular concerns about their child. It is vital that parents, family members and caregivers who have an optimistic
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outlook for a young client be involved in the helping process. Our practice is to inform the carers that we are willing to listen to and discuss any concerns they have about the young persons safety and well-being. However, in terms of the content of a therapeutic session, a child is afforded the same right to condentiality as an adult client. From the intake information, assess whether the home environment can provide safety and respect for privacy around artwork, written work or personal journalling relevant to the therapy. If this is not possible, then suggest that such material be left with the counsellor for safekeeping. If ET is used in an organizational context, then therapists will, of course, be aware of and conform to the protocols of the employing body with regard to the privacy of artwork or writing produced by clients. Summary
In Chapter 6 we considered the advantages available through including writing activities as an important part of developing emotional literacy and working with expressivity. The aim is to offer our client space, time and a simple, familiar way to reorganize their focus, to review utilization of their inner resources, and to organize communication in their own distinctive manner. In this part of the book we have highlighted the fact that through writing a client has available the means to exert control over the rate, depth and intensity of their therapeutic work (Rasmussen and Tom 1992, p.3). Through focused writing activities a client can experience a feeling of taking control of some part of the session rather than being a submissive responder assuming they need to meet the therapists needs, or indeed the desires or expectations of significant others.
PRACTICAL WRITING ACTIVITIES EXPRESSIVE WRITING FORMATS
Seven ways to explore my world

The focus of the following list of seven activities is to suggest straightforward, rapid ways to extend client involvement in the session and for understanding more about what happens in their world and within their worldview.
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Resources: Coloured pens or pencils, crayons, A4 paper (white or light coloured), A3 paper for drawing and writing. Age range: 10 years to adult. 1. Use prompts, associative phrases or sentence starters to initiate free-flowing or spontaneous writing. (See activities on pp.179181). Sentence starters can be pre-prepared on an A4 sheet (keeping the reverse side blank for extra writing space if needed). Before using sentence starter activities, refer to the relevant section in this chapter (pp.172174). 2. Use topic headings for free associating. For example, ask a client to jot down three or four words that come to mind about:
school/work friends home time alone.
This can be done by simply writing four headings across a piece of blank art paper, or with four pieces of different coloured paper. 3. Set questions for the client to write their response. For example:
What is it that you really like? What do you really dislike? If you were the counsellor, what would you ask a client to talk about? If you were the counsellor, is there anything you would not ask about?
4. For young adult and adult clients, use continuous, flow-of-consciousness writing with no set structure about a particular life experience. An example: HW was working with a middleaged adult male whose relationship with his much younger second wife was not working well, and their marriage was under threat. Unexpressed grieving about the loss of his first wife to cancer was seeking a safe, contained space. Two of our sessions involved using writing activities. One of those was flow-of-consciousness writing beginning with the prompt It was a time when. This evoked his despair at not being able to save his wife, and his bewilderment at not being able to make his new wife happy.
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5. For young clients, use a scrapbook format to create a special book about them. Their special book can include collage from newspaper and magazine headlines, cutting and pasting clip-art or downloaded images, photographs, and drawings from counselling sessions, as a way to focus on the challenges addressed in therapy. This process is very useful for small groups that come together in a time-limited setting. However, the process can be used just as successfully with an individual client. The end result a special book about themselves usually becomes a very positive reminder of resourcefulness and inter- and intra-personal change processes. 6. Writing can be suggested as a way for a client to explore meanings behind their choice of symbol work miniatures. For example: an 11-year-old male was brought to the therapy room by a caring but emotionally exhausted parent. His volcanic outbursts had become a source of great strain. While his mother wanted to talk only about his problem with anger the young boy did not seem ready to engage on that topic. His eyes kept wandering sideways to the shelves of symbols. When asked, he identified a small cutglass lotus as the source of interest. We began talking about the lotus and he was able to talk about what he liked most, what really interested him and what he wanted to be when he grew up, how he felt awful about himself when he felt angry, and his wish to be able to not get so angry. Because of the physical and emotional tension he was exhibiting during this first session, the activity was done in discussion mode; however, the format has worked just as well as a writing activity. In a later session his mother was given a writing activity while her son attended to a drawing activity. Both then came together to talk about what they had created, as a way to strengthen their connection. 7. Self-discovery worksheets that use a mixed-media approach through combining writing, using metaphoric language, with the use of colours, images and symbols.
SENTENCE STARTER ACTIVITY
My thoughts about me
Aim: This reflective writing activity was designed to help young clients focus their thoughts and decide on possible topics for communication. It would be used in the early stages of developing the working relationship. The appropriateness of the sentence starters and the style of language
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for any particular individual must be assessed by the counsellor prior to offering the activity. Resources: Coloured felt pens, crayons, coloured pencils, pen, spare A4 paper (white or light coloured). Age range: 12 years to adult.
Take a slow, deep breath and allow your body to relax. It isnt important where you start or end. Look over the list of sentence starters on this page. See if you can choose two or three of the phrases that you would feel interested to complete. If you wish, you can take time to complete all of them. See if you can think of some words that you would add to finish off these phrases. Take time to let the words come into your mind and then write them down as if finishing off the sentence.
List of sentence starters
I think everything would be better if The things I dont like are What I need to say is I worry about I feel alone when People think I am People tell me I should If I could change anything it would be What I really want is
INSTRUCTIONS FOR THE CLIENT AFTER WRITING/DISCUSSION
Take some time now to look back over what you have written. Can you highlight, circle or underline what seems to you most interesting?
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Can you write down a word or two perhaps on the back of the sheet about how you feel now? Is there anything more you need or want to say, either about this activity or what you have written? If you want to record more, take some time now to write it anywhere on the sheet front or back.
Pause and allow time while the client responds to the instructions.
Allow some pause time for additional recording. If needed, the next step would be to open the space for some discussion between yourself and the client about what their writing might mean to them, anything they liked or didnt like about the activity, or anything more they want to say. SENTENCE STARTER ACTIVITY
After self-exploration
Aim: This activity is useful as completion writing after engagement in an earlier activity. The writing supports the practice of reflection and helps consolidate insights. Resources: Coloured felt pens, pencils or coloured pencils, crayons, preprepared A4 sentence starter sheet with prompts listed, spare A4 paper (white or light coloured), A3 paper for drawing. Age range: 10 years to adult.
See if finishing some of these sentence starters can help you write down what you might want to express: What I liked best was The most difficult thing was I felt good when I didnt like The strongest feeling was In the past I In the future I One new idea is
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I now want to I would like to know more about
INSTRUCTIONS FOR THE CLIENT AFTER WRITING/DISCUSSION
Take some time now to look back over what you have written. Can you highlight, circle or underline what seems to you most interesting? Can you write down a word or two perhaps on the back of the sheet about how you feel now? Is there anything more you need or want to say, either about this activity or what you have written? If you want to record more, take some time now to write it anywhere on the sheet front or back.
Pause and allow time while the client responds to the instructions.
Allow some pause time for additional recording. If needed, the next step would be to open the space for some discussion between yourself and the client about what their writing might mean to them, anything they liked or didnt like about the activity, or anything more they want to say. SELF-DISCOVERY WORKSHEET
How do I feel when Im with?

Aim: Using a self-discovery worksheet, the aim is to assemble a collection of images, memories and vocabulary to support reflection about self. The content of the worksheet addresses moods, emotions and reactions that emerge within different contexts. Using sight, touch, memory, imagery and words to develop emotional literacy, this activity encourages reflection using drawing, metaphor and writing. The appropriateness of the worksheet and the style of language for any particular individual must be assessed by the therapist prior to offering the activity. Resources: A3-size copy of Worksheet 6.2, coloured felt pens or pencils or crayons, pen, personal journal or writing paper, additional A3 drawing paper. Age range: 12 years to adult.
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PREPARATION
Have all art materials and the prepared worksheet ready. A small box (a shoebox perhaps) filled with materials that have different textures could be useful to support finding meaning and language for the My texture column. The box could include, for example, sandpaper, rough and smooth, a scrap of soft, furry fabric or silky, smooth fabric, a seedpod, a small piece of bark, a soft spongy plastic toy, some metal chain. Do not assume the automatic right to read the completed sheet. After completing the activity, a client is invited to tell you about, or read some or all of, the contents. You can also ask permission to review the worksheet.
This worksheet has been designed to help us discover more about what feelings you have when you are with different groups of people. This can help with understanding yourself more fully and with being able to choose how you want to respond when you are in these situations. Take some time to think about the people listed in the first column. Then, working across each column from left to right, see if you can record something about what is asked for in each column, for each group of people. Once you have finished you can decide if you want to show your worksheet to anyone or keep it private. However, it would be helpful if we could take some time to talk about what stands out to you as important in what you have written and drawn. 1. Starting with the first column, take a moment to think about your good friends or a best friend, and how you feel when you are with them. 2. In the second column, headed My colour, draw in a colour or colours that best go with how you feel when you are with them. 3. In the third column, headed A shape I feel like, draw any shape that somehow goes with how you feel when you are with them. For example, do you feel round? square? blobby? angular? etc. 4. Keep working along the columns, left to right. However, feel free to skip a column if you are not ready to do it, and come back to it later. 5. Write down:
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a texture that goes with how you feel when with them for example, smooth, rough, jagged, rounded, etc. an animal, bird or fish you might feel like when with them. For example, do you feel like a snake, a tiger, a mouse, an eagle, a whale? Think of all the animals, fish or reptiles you know of. anything that you might want to say. Remember, you can keep this worksheet private if you want to. It could be something you want to say, but would feel uncomfortable about saying it out loud. a few words that go with how you feel with good friends or a best friend.
Then, move back to the first column and think about your family. Work across the columns again, finding different ways to describe how you feel. 6. When you have finished family, continue with the next two categories. 7. Discussion
How did you feel doing the worksheet? Are there any parts of the worksheet you didnt like? With which group did you feel most real, most like yourself? Was there a group where you felt you had to pretend? Were there any discoveries you made about yourself? What parts of the worksheet seemed most important to you?
8. Integration Take time now to write down some of your own private thoughts about the worksheet and the questions you have been discussing. 9. Optional (but recommended) Take time to draw how you feel now. You could use colours, lines, shapes or pictures that go with how you feel now. You can add some words to your drawing if you wish. 10. Closure

A SHAPE I FEEL LIKE MY TEXTURE ANIMAL, BIRD OR FISH I FEEL LIKE WHAT I WOULD REALLY LIKE TO SAY SOME WORDS FOR HOW I FEEL
Worksheet 6.2 How do I feel when Im with?
PEOPLE/PLACE
MY COLOUR
A good friend
Family
People I dont know
Myself alone
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What would you like to do with the worksheet? Your options are:
keep it in your own private journal or scrapbook leave it with me, to keep in a special folder destroy it if it contains sensitive material.
The counsellor may wish to use some of the material from the worksheet to create a homework assignment for the client. With this decision, it is also important that the counsellor understands a clients home environment, since homework is not a viable option in an environment where they may face hostility, ridicule or non-acceptance regarding the counselling process. SELF-ESTEEM WORKSHEET
My journey from problems to treasure

Aim: Designed for clients who have progressed through the early stages of therapy, this activity aims to create an overview of how dealing with some problems can lead to resourcefulness, and aims to support a future focus. Resources: Prepared copy of Worksheet 6.3, coloured pencils or crayons, pen, personal journal or writing paper, additional A3 drawing paper, sheet of completion sentence starters (see Integration, p.193). If available, symbols may also be used. Age range: 10 years to adult. (Suggested for advanced stages of the therapeutic process.)
PREPARATION
Have all art materials and the prepared worksheet ready. Do not assume the automatic right to read the sheet. After completing the activity, a client is invited to tell you about, or read some or all of, the contents. You can also ask permission to review the worksheet.
This worksheet has been created as something that might help you explore some feelings, ideas, dreams and hopes from your inner world. The aim is to help you learn more about the feelings that go with any difficulties in your life, as well as acknowledging the strengths (treasure) you already have inside you that sometimes might feel unseen, invisible or hidden.
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Spend some time working through the three columns. You can keep your work private or share what you discover about yourself. You are free to say as much or as little about yourself as you wish. You can decide if you want to show your worksheet to me or anyone else or keep it private. Starting with the column headed Problems and challenges, take a moment to think about any problems. Even if you havent any clear ideas, maybe theres a feeling inside you that seems upsetting, like a problem. If there dont seem to be any problems, simply move on to the second column. In the first circle, see if you can use colours, shapes, lines or pictures that somehow express or go with your problems. Next, can you think about some words that might go with the feelings of any problems? Write these on the dotted lines under the circle. The next step would be to think of any images from nature that somehow seem like your problems. For example, are your problems like a thunderstorm, an ocean, a desert, a jungle, like wild animals, like tiny ants? Perhaps you could find the image from nature by thinking about places close to nature that you have visited, or maybe even animals you have seen at a zoo, or on TV.
Problems and challenges
(Pause and allow the client time to reflect and record.)
(Pause and allow the client time to reflect and record.) Treasure In the next column you are invited to think about the positive qualities, the treasures or strengths inside you. Could you find words that go with the treasures that might be hidden within you or that you think other people dont know about?
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Next there are the images from nature that go with these treasures. What comes to your mind? Some people like to think of gems, crystals, beautiful places, beautiful birds or animals. Then use colours and lines and shapes and pictures to express in the second circle how these treasures feel, or what you think they might look like.
(Pause and allow the client time to reflect and record.) Future The third column looks towards the future. Take a moment to close your eyes and reflect on the future generally, and your own particular future. Allow yourself to watch in your minds eye and see if any colours, lines or pictures emerge. Then draw them in the circle. Next find some words that might describe the feelings of your future. What words would you use to talk about your feelings for the future? For example would it feel: good, dark, scary, bright, happy? etc. Then again, think about nature. Are there any pictures from nature that come to your mind, that go with the future?
INTEGRATION
Take time now to write down (or discuss) a summary by finishing these sentences: The part I liked The part I didnt like The main strength or treasure inside me is This treasure could help me deal with problems by If I found all the treasure inside me it would make my future more Right now I feel
Worksheet 6.3 My journey from problems to treasure

Copyright Pearson & Wilson 2007
SELF-ESTEEM WORKSHEET: My Journey From Problems to Treasure Treasures inside me Problems and challenges My future
Express the future with colours and lines: Words for the hidden treasures in you: ................................... ................................... ................................... ................................... ................................... ................................... Nature images that are like your treasure: ................................... ................................... ................................... ................................... ................................... ................................... Express the treasures with colours and lines:
Express your problems with colours and lines:
Words for the feelings of your problems: ................................... ................................... ................................... ................................... ................................... ...................................
Words that go with your feelings of future: ................................... ................................... ................................... ................................... ................................... ................................... Nature images that go with your future: ................................... ................................... ................................... ................................... ................................... ...................................
Nature images that are like your problems: ................................... ................................... ................................... ................................... ................................... ...................................
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DISCUSSION
This stage of the activity is when the counsellor begins to explore elements of the story with the client. Below are six questions that have traditionally been used to open this discussion phase. However, following a clients lead is also very important. Would you like to share anything from the worksheet or your sentences? Were there any parts of the worksheet that seemed more important to you? Were there parts of the worksheet you didnt like? How did you feel doing the worksheet? What were your main discoveries about yourself? Can you say anything more about the future?
Ask the client what they would like to do with the worksheet keep it on file (record the session date on it), discard the worksheet or take it home. Examples of completed worksheets are shown in Figures 6.6 and 6.7. WORD ASSOCIATION ACTIVITY
Really rapid writing!!

You have a minute or two to write on the topics and key words that I suggest. Write as much as you can in the time, as fast as you can! Dont stop to think or correct or worry about spelling. Try not to worry about logic, sequence or control. I will give the word or topic, then count to three. Then, write as much as you can. Leave a space after each bit of writing so that you can come back and add to it later. When I say stop you put your pen down. (You can choose another instruction for the writing to cease.)
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Figure 6.6 Twelve-year-old female, worksheet: Problems to treasure.
Figure 6.7 Twelve-year-old female, worksheet: Problems to treasure.
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Suggested topics and key words
alone fear helping secrets confidence
The chances life offers My body now knows Being connected is The best thing excitement
A counsellor may devise a list of topics specific to the issue a client has been working through.
DEVELOPING AND EDITING
Take some time now to review what you have written. Scan through and select the writing that interests you most. Take a few minutes to add to the writing.
DISCUSSION
What stands out to you? How do you feel now? Could you read out your favourite bit of writing? Is there another topic that should be included?
STORY CREATION ACTIVITY
Creating a legend
Aim: This activity is discussed on pp.175176. Resources: Worksheet 6.4, pen, music (light, rhythmic, quiet in the background). Age range: From 11 years. Note: Prior to engaging in this activity please refer to the notes on pp.175 176 of this chapter.
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PREPARATION
Have Worksheet 6.4 prepared. The counsellor uses the worksheet to jot down brief notes and key words that will be used by the client later to weave together and create the unique legend. Have a pen ready to write down the key points of the emerging images or story.
Take two or three slow, full breaths and let your body relax as much as possible. There are several stages to this journey. As we move through each stage of the journey, allow your mind to open to whatever images present no matter how unusual, unlikely or unconnected they may seem at first.
Visualizing stages of the legend
Take a steady breath and let it flow out. As I talk through the different stages, allow images to come into your mind try to pay attention to the first ones your imagination presents and describe them to me. I will write down what you say. Remember, there is no need to be concerned about making a story at this stage.
The setting for the legend
Legends, stories, myths, all begin somewhere. What might be the setting for the beginning of your legend? (Pause.) Is the starting point a mountain top? Another planet? A forest? Heaven? Under the water? (Pause.) What do you see as the starting point?
The atmosphere
What is the atmosphere at the start? Does it seem like turmoil? Happiness? Panic and fear?
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Is there an angry attacker? A problem? A mysterious threatening force? Or is the atmosphere peaceful? Does it feel calm and happy? What sort of weather comes with the start of this legend? (Pause.)
The hero/ine
Most legends have a hero or heroine. What do you know about the appearance of the heroine or hero in this story? (Pause.) What do you know about their character? (Pause.) What do they look like? What can you tell about who they are inside?
Setting out on the journey or the search
Most legends involve leaving a familiar place, setting out on a journey. Is the journey in this story to find an answer? A power? The magical weapon? Or protection? Is it a search to find a key to a problem or a riddle? To find the wise person? Or the treasure? Is there a reason, a focus, for the journey or the search?
Obstacles
At some stage there may be obstacles. Somewhere along the way there could be barriers or opponents or challenges. There could be a time when all seems impossible, when there is a big difficulty. What can you see in your minds eye about obstacles, barriers, opponents?
Unexpected support
In most legends, myths and stories, there is often some unexpected support. When things seem difficult, unexpected support arrives. This support is usually from something overlooked or not noticed before.
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On this journey, what would be the unexpected support? Does the support come from an animal? An insect? A bird or a fish? A human helper? A magical force? A spirit force?
You do not need to try to bring the story together at this stage. See if you can focus on the images that appear first, the ones that appear spontaneously.
The big clash
At some stage there is a challenge, a battle, a confrontation. There may be a big change, a tense moment. This is usually followed by resolution, relaxation. What images come to you about the clash, the battle, the confrontation and how that ends?
Journeys end
Eventually the journey comes to an end. At some stage the search is complete, the journey nears its end. Then there is the return, coming back to the familiar. What can you see about the return of the hero or heroine? What can you see about the last stage of the journey?
The legend ends

REVIEW
At the end of the adventure, there is usually a sense of renewal. The world seems new. Somehow the world is restored. At the end there may be a sense of togetherness, of hope. How could this happen? How are things renewed? How does this legend end?
Ask the client to review the notes you have made: Does anything seem to be missing?
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Is there anything you would like to add? For example, other characters, other settings, other events, scenes that link the others together? Is there anything you would now like to leave out of the story? Feel free to take time to change any part of the legend.
LEGEND MAKING
Support your client to weave the story together, without adding your interpretation or your ideas about how the legend should or could begin, proceed or end. The client can: discard any aspect of the story let any new ideas appear allow the story to be reorganized let the story take its own shape and direction. verbally through drawing with additional writing.
Then invite the client to express the legend:
INTEGRATION
After completion the client is invited to tell or read the legend again. Let them change the facts as the legend unfolds this second time. Support any new ideas, any developments or changes in the story. Listen attentively, supporting mutual enjoyment of the story. Invite discussion on any elements of the legend that the client finds particularly exciting or distressing. Notes: With a client over approximately 14 years old, invite them, if it seems appropriate, to discuss any links, similarities or differences between the story and their life now or in the future. If you have extended time available, or if presenting this activity in a group programme, you may wish to add a further step to the integration phase. This step would involve inviting the client to create some illustrations for their legend, do a quick sketch of an image from the legend, or choose symbols from your symbol collection that go with the story, and photograph these.
Worksheet 6.4 Creating a legend
The obstacles, the barriers, the opponents: Unexpected support:
Write in key words and phrases that go with each stage of the clients story
The setting:
The atmosphere:
The heroine or hero:
The big clash, the battle, the big change, the tense moment:
The journey, the search:
The end of the journey, then the return:
The ending the world renewed:
Chapter Seven
Exploring Art as Therapy

OVERVIEW Art provides humankind with a means of expressing and communicating experiences from the deepest recesses of the human heart. The captivatingly mysterious and other-worldly images in Aboriginal rock art and the cosmic view of landscapes that capture the beauty of the land speak to us from the creations of Australian Aboriginal artists. Cave paintings in Lasceaux, hieroglyphs in ancient Egyptian tombs, the timeless beauty of Michelangelos sculptures and the creations of our children in the preschool art room all carry the seeds of an inner truth about the human soul that is as perennial as the art itself. Fortunately we live in a time when art, or the creation of art, is no longer the domain of privilege, wealth or overwhelming passion. The humble therapy room can instantly transform into a palatial gallery lled with truth, beauty and mystery. Watching a client in therapy start tentatively scratching a pastel or crayon across an innocuous piece of paper is a thrilling moment. A wet brush touches stretched linen and colour, life, movement attach, adding form and energy to what was inert, inanimate. The emergent images are something unique, precious a treasure that will never be repeated and from which so much can be gleaned. Ulman (1975) dened the arts as a way of bringing order out of chaos and emphasized the healing quality of the creative process. Coleman and Farris-Dufrene (1996) claimed that combining art therapy and psychotherapy was a natural process: drawing combines the cognitive and reective domains with the affective, expressive domain, while the use of imagery has been shown to be highly effective in helping people change (HassCohen and Carr 2008; Lazarus 1982; McNiff 1992, 2004; Rogers 1993; Skovholt, Morgan and Negron-Cunningham 1989; Wolpe 1958). Creating art, using art, as part of therapy, provides access to a wider range of intelligences for learning, communication and resolution; allows expression of
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EXPLORING ART AS THERAPY
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nonverbal thinking; provides an opportunity for pre-conscious and preverbal issues to emerge; and contributes to enhancing client resilience. BUT I CANT DRAW INSIDE ART AND ET Gladding (1998) outlined several reasons for using the arts in therapy. He saw the inclusion of creative activities as increasing congruence for the client building better internal connections; engendering action activating new energy and providing reinforcement; generating improved focus; enriching and expanding self through creativity; establishing a new sense of self; providing concreteness evidence of the personal journey; and developing insight. Art was also seen by Kramer (1958) as contributing signicantly to development of psychic organization. From the ET perspective, creation within or around a counselling session is an opportunity to channel energetic drives, process reactions and pursue an integrated emotional and mental state. No matter which form of expressive therapy used, there is a focus on treatment through the creative use of imagery. Creativity is regarded as preventative as well as remedial. It has been recognized as a developmental need, particularly as part of the self-actualizing of a child (Crane 1999). In the psychoanalytic tradition, art has been considered as a form of positive defence mechanism or sublimation (Gladding 1998). From a Gestalt point of view creativity is seen as an integrative process (Oaklander 1988). Artistically expressive, activity-based techniques are often interpreted as meaning drawing with crayons or pastels, or painting with a brush and canvas. This can certainly be the case, but with help from todays wonderful array of technology, still and video cameras and software programs that allow manipulation of digital images, therapists have at their disposal the means to mentor or support a person through the stage of thinking I cant draw, I wouldnt know what to draw. Nature and the world around us provide an unending source of imagery that can become useful metaphors providing entry into the inner world. Back in 1997 a young eight-year-old client with whom HW worked for around 18 months found taking some time out from the therapy room a transformative experience. HW and Lewis began to take ten minutes each week to wander around the garden, with Lewis choosing the subject of the photo spiders webs, insects, lilies on a pond, grasses or a fence-post. He created a small album of his photographs, for which he was awarded a prize from the local scout group. The sojourn in the garden and the resultant photographs connected Lewis with a safe and beautiful world. Prior to his encounters with nature through the camera lens, he viewed life through an inner lens that reected danger. His extremely aggressive
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behaviour and disorganized moods ceased and he began to connect directly with the world rather than from behind the camera. Almost a year after completing therapy a letter arrived from Lewis, and with it was a photo of him cuddling a very compliant, large, deliciously furry pet cat. They both looked very happy. Feedback from Lewis mother conrmed that interpretation of the image and the fact that this young boys happiness was now the norm. Within ET, transformation through art is the goal, rather than educating or instructing so that a nal product can be admired. It is so easy to have a goal, an outcome in mind, and miss those small moments of emotional, energetic and cognitive transformation that hold such healing potential. Healing can be enhanced by accessing, symbolizing and externalizing internal conicts so that they can be recognized and worked with, through a range of expressive modalities (Malchiodi 2005; McNiff 2004). For this to occur within the therapeutic setting, a sense of trust and safety is essential (Fosha 2000; Greenberg 2001; Pearson 1997). The use of symbolic expression that is wholly accepted, and not necessarily followed by therapist analysis, can in itself contribute meaningfully to building a sense of safety for the client. In the case of Lewis, it took several sessions of working with his fear for him to feel safe enough to allow access to a more tender, gentle side of himself without fear of exposure, or too much vulnerability. Using creative arts therapies provides action-based methods that may be liberating and provide an openness of expression not readily available in the primarily verbal, one-to-one, therapist and client methods (Moreno 2005, p.35). A drawing created spontaneously by a young client (see Figure 7.1) reveals more than a conglomeration of marks on a page. In the therapy session this drawing revealed, according to the client, inner chaos overwhelming, tragic and premature loss. Suffering from post-traumatic stress, this young person let her shock, grief, trauma and loss of love emerge wordlessly on the page. While the page might look like scribbles representing a disordered state, at the same time there are shapes symbolizing the very thing this young client was seeking and seeking, unproductively, in internet chat rooms and short-lived liaisons in which sex became a substitute for love, warmth and physical contact. By writing with enthusiasm about the use of art and music as close companions in the therapy room (in this chapter and in Chapter 8), we are not implying that anyone can simply turn into an art therapist or music therapist. Both these elds have extensive training requirements covering both artistic and therapeutic knowledge. ET employs artwork and music produced by clients as an integral part of practice, but within a comprehensive framework bounded by important therapeutic guidelines. In offering
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Figure 7.1 Fourteen-year-old female recovering from trauma: Scribbles, Lost love.
the use of any modality, an experienced therapist must assess and gain feedback on the clients response to the media. An expressive therapist avoids giving any analysis of the clients creation (even if there seem to be obvious interpretations that the client is not seeing in that moment). To ensure the clients safety and a positive outcome, praise or value judgments are avoided. The expressive therapist works to elicit a clients responses and descriptions about their creations, without turning interest and curiosity into interrogation. What becomes most valued and accepted is the meaning attributed by the client. Each client has his or her own individual way of responding to the media, to the task, and to the nished product. A client may not feel ready to reveal their interpretation or self-analysis from a piece of art privacy and choice in following up with verbal discussion is essential. Some clients claim the nished work has no meaning. It can take some time for both the counsellor and the client to trust that the process of expression and creation has made a growthful contribution, even if reective discussion is not to the clients liking. PROJECTIVE TECHNIQUES IN ET Projection is a natural phenomenon in the psyche through which intrapsychic material that has been disowned can be externalized (Grant and Crawley 2002) without immediate recognition of the contents. The use
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of projective techniques is an ideal intervention with neglected, abused and traumatized clients, for whom overload of the nervous system, or retraumatization, should be avoided (Rothschild 2000). Much of the way artwork and music are used in ET involves some level of projection as a pathway towards information about, and ultimately greater understanding of, inuences, feelings, beliefs and motivation. Projective techniques allow focus on reparative methods rather than beginning with a problem focus. These non-threatening techniques offer a means other than direct verbal disclosure for the client to express. With the use of projective techniques defensiveness diminishes, thanks to the participatory and absorbing nature of the activities (Clark 1995). For example, the drawing of human gures is a simple projective technique that can be used as a starting point to foster a better relationship between counsellor and client (Bender 1952; Cummings 1986). A favourite ET activity is one in which a client draws a body outline shape and maps sensations or feelings in the body, using colours, lines and shapes. Over the last 20 years of using body outline drawings we have found this to be a non-threatening but accurate method of deepening self-connection. Examples of two body outline drawings can be found in Figure 4.1 and Figure 7.2. A fundamental assumption of projective techniques is that the client expresses or projects his or her personality through the use of symbols writing, art, musical expression, selection of meaningful recorded music, selection and arrangement of miniatures and the completion of set tasks (Clark 1995). The symbols provide alternative means to traditional verbal disclosure. In working with projective techniques in counselling the focus is on providing an opportunity for clients to create their story, express their perception of reality, rather than concentrate on establishing literal facts. Some features of projective techniques include using open-ended directions and relatively unstructured activities, and allow for virtually unlimited responses on the part of the client. Projective techniques can greatly enhance clientcounsellor interaction, since there is an intermediate activity that elicits involvement and also diminishes defensiveness in the client. The activities are designed to be interesting in themselves and to offer the client multi-modal freedom of expression. Projective techniques contribute to building rapport, understanding clients, therapeutic release of emotional stress, and to gathering data to plan possible future activities for clients. ARTWORK AS THERAPY Creative expression through art can provide individuals with a safe outlet for expressing painful feelings that have been at the heart of ongoing
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problems. The history of art in Western psychotherapy can be traced to the 1940s, when it was rst used by the early American art therapy writer Naumburg (Coleman and Farris-Dufrene 1996). Her method was based on releasing the unconscious through spontaneous art expression. A decade later Kramer (1958), using Freudian ego psychology, concentrated on the therapeutic value of using art. Kramer dened the goals of art therapy as those leading toward personality growth and rehabilitation (p.7). She explored the value of art in sublimation, a process wherein direct instinctive gratication is relinquished and a substitute activity is found that permits symbolic gratication of the same need in a socially productive way. While language is a critical part of the therapeutic process, there are times when language can be a less than helpful friend. Providing a space for a client to engage in artwork helps in communication with verbal psychotherapies. In ET the aim is to have the narrative externalized and organized in forms that offer a client maximum opportunity to express what has not been or could not be thought about, or tolerated, because it is too painful and threatening to an established sense of stability. Oster and Montgomery (1996), in discussing the clinical use of drawing, state that the use of verbal communication alone limits articulation of complex and multi-layered feelings. A client may nd it difficult, or demanding, to articulate feelings about a traumatic incident. They may not have adequate language to describe something they had not experienced until the moment of the actual trauma. Simply being asked to see if they can put some lines, shapes or colours on a page that goes with what it is like on the inside can open a doorway to articulation. (See Figure 7.2.)
Figure 7.2 Twelve-year-old male, body outline: Recovering from traumatic shock.
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Introducing art into the therapy room offers an alternative outlet for release of frustration built up from the challenges some clients feel with verbal expression. Drawings enhance a clients willingness to talk, supporting the sense of becoming unstuck and being able to do something (Oster and Montgomery 1996). Drawings expand counsellorclient interaction, as well as increasing opportunities for self-expression for the client. Extreme feelings can be channelled more safely through images. Providing a safe, accepted avenue for cathartic outlet, drawing increases spontaneity and allows access to unconscious material that may otherwise be too threatening or too difficult to express verbally. In psychodynamic thought and practice wide use is made of image and metaphor to describe experiences, aspects of the personality and inner workings of the mind (Jacobs 1988). Encouraging client artwork in session or as a homework tool has always been a core ingredient in the authors approach to ET. Imagery can enhance a clients active involvement in the healing process (Lusebrink 1990; McNiff 2004). From a simple drawing that gives form to a migraine headache (Figure 7.3) to a magnicent mandala created after deep release of lifelong feelings of failure at relating (Figure 7.4), clients have found the instruments of art to be a medium through which much more can be conveyed than through language. When a therapist can maintain passive receptivity towards the client, access to imagery, fantasies, and early parentchild dyads is facilitated (Robbins 1980).
Figure 7.3 Adult female: Migraine.
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Figure 7.4 Adult female: Release of tension in my head.
Drawings provide a focal point for discussing or experiencing change, and offer an ongoing record of the experience. The possibilities for interpersonal understanding increase and sometimes the creation or reection on their artwork is the most useful method for reaching a depressed or withdrawn client (McNiff, cited in Coleman and Farris-Dufrene 1996). Gladding (1998, p.65) offered a range of expressive methods for externalizing feelings. He identied ve main areas of benet in using visual arts in counselling: tapping into the unconscious and tapping into conicts symbolizing feelings and helping to externalize a distressing event inspiring clients, giving them hope, and helping them to contact the transcendent and growth side of their personality visual arts are usually non-threatening and self-interpreted the medium is extremely exible and can be combined with other modes of expression.
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BLACKS SUCH A MESSY COLOUR EMOTIONS AND ART ET uses images as a medium to support transformation of personality a means of reconciling opposite emotions in the conscious and unconscious. Emotions, as well as their inhibition, inuence the physical and psychological health of the individual (Coughlin Della Selva 2006; Lusebrink 1990). As discussed in Chapter 2, in an emotion-focused approach to therapy, resolving and clarifying emotions often needs to take centre stage. Lusebrink (1990) recognized a close link between imagery and emotions, highlighting that negative and stressful emotional experiences and associated images can depress the functioning of the immune system. It has been fascinating to observe, over the years, the way clients mood, optimism and health all seem to take a turn for the better after clearing stressful emotions. Imagery is an intermediary between the physiological experience of emotion and its symbolic processing, and can positively inuence a clients active involvement in the healing process (Lusebrink 1990). Important is that the use of imagery strengthens the link between body, mind and emotion. The process of translating body sensations and emotions into symbolic images gives the individual a means to deal with stress on a cognitive level. When clients can express their thoughts, feelings and conicts they feel more emotionally satised, gain a clearer sense of identity, and more easily acknowledge and consent to their own inner direction (Case and Dalley 1992; Dalley et al. 1993; Gil 1994; Landgarten 1981; Oster and Gould 1987; Rubin 1978). Many writers have reported on the positive impact of using art and drawing as part of therapy (Henley 1999; Malchiodi 2005; McNiff 1992, 2004; Oster and Montgomery 1996; St Clair Pond 1998). One challenge in conducting therapy is that psychological wounds may be pre-verbal and therefore are not able to be accessed and processed through verbal representation (Humphreys and Leitner 2007). The act of creating a piece of artwork or a symbolic representation of inner tension facilitates communication, expression and alleviation of stress by supporting expression of both conscious and unconscious feelings and thoughts (Proulx 2002). The expressive arts approach can open the door to images and sensations relevant to a clients pre-verbal world. A child, for instance, can nd their need for emotional expression blocked by the pain of their caregivers, or the childs feelings are not allowed to run the course which would see them reach a natural conclusion (Teyber 2006). To reach that original affect the use of symbolism and drawing are valuable ways to support processing early distress. Sometimes verbal articulation or clear recognition of early experiences is not possible; however, the act of expressive creation in and of itself accelerates positive change. (See Figure 7.5.)
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Figure 7.5 Ten-year-old male, reective drawing: The proud monster.
Group therapy is another very supportive environment where creative tools can be helpful in accessing and processing pre-verbal wounding. Using drawing and symbols provides a veil of anonymity within a group so that the participants have at their disposal the right to disclose only as much as they wish to. Self-disclosure is more likely within an environment of respect for their pace and timing and with acknowledgement of the uniqueness of their creation. As well as the usual guidelines around condentiality and respect for other participants, in group therapy using ET the ruling principle is that only the person who creates the artwork can know the full meaning of the creation. Students of ET often ask about colour symbology. Does red always mean a client is angry? Could black be interpreted as a depressed state? While there has been some research exploring connections between emotion and colour, the studies were not focused on the use of art and colour in therapy (Terwogt and Hoeksma 1995). Clinical observations by the authors over a period of over two decades has indicated almost no consistent use, by clients, of colour symbology for specic feelings. The only colours that seem to be regular visitors on the art paper are black and red, or black, red and orange for intense feelings of anger and frustration. However, if a client is encouraged to use continuous drawing, then the colours change and become softer the lines change from angular, sharp, piercing shapes to softer, owing strokes. The three drawings (Figures 7.6 to 7.8) created
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in session by a young man of 15 indicate that shift from frustration to being in touch with gentle, more open feelings. For accurate understanding and development of client resourcefulness, it has proved important to draw out from clients any meanings they have attached to colours used.
Figure 7.6 Black and red: Frustration.
Figure 7.7 Blue and black: Thats just me.
Figure 7.8 Pink: Sort of soppy.
RESEARCH ON ART IN THERAPY Payne (1993) listed a large number of research projects investigating art therapy, but explained that few art therapists conduct research, owing partly to unfamiliarity with research methodology and the complexity of conducting research in clinical settings. The wide range of variables within clients makes objective data gathering a challenge. In discussing the difficulties of research on the creative arts in counselling, Gladding (1998) identies the difficulty of controlling and isolating variables that promote or hinder clients growth. Research difficulties revolve around the highly subjective nature of the methods to be assessed. However, there is a large body of documentation of practitioners observations of positive outcomes.
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In 1958 Kwiatkowska (inuential art therapy and family therapy writer who published in the 1960s and 1970s) introduced art therapy to patients participating in family art therapy and individual art therapy (Coleman and Farris-Dufrene 1996). The family art therapy approach proved suitable for application in community mental health centres. Armstrong and Simpson (2002) provide a rationale for including young children in family therapy, and demonstrate how a family play therapist can use expressive art activities. They point out that art activities allow children to express positive and negative feelings without the fear of consequences. These activities such as drawing the family, creating pictures from scribbles often elicit thoughts and feelings that children may be unaware of or have difficulty expressing. The activities can provide the therapist with a rst-hand view of the verbal and nonverbal communications of clients. Family therapists would be particularly interested to observe how clients work together on a joint task, during which many of the dynamics of relationships come to the surface.
Figure 7.9 Eleven-year-old female: My family at dinner.
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There are many reports of art being useful in treatment of clients in recovery. Jones (1997) reports on the way treatment teams used art therapy to support stabilization with a community of survivors after the Oklahoma City bombing. Stepakoff (2007) reported on the value of using a range of traditional and new creative arts activities with survivors of war atrocities; the symbolization of their experience led to recovery. Gilroy (2006) lists articles that outline the value of art therapy with clients affected by abuse and trauma, addictions, dementia, eating disorders, learning difficulties, and with offenders and those in palliative care; in the elds of depression, personality disorders, psychotic and related disorders; with children and adolescents affected by ADHD, autistic spectrum disorders, and children affected by sexual abuse. While there is extensive practice-based evidence (Duncan and Miller 2006) in the literature, over a long period, it is still surprising how long it is taking, in Australia, for art to be routinely included in the training of counsellors. ET, ART AND SCHOOL SETTINGS The ET approach we have developed has a foundational premise relating to emotional healing: To acknowledge and feel emotions and energy and to let them be expressed with support at appropriate times supports mental health (Pearson 2004, p.13). Kramer (1958) described art therapy as a means of supporting the ego, fostering the development of a sense of identity, and promoting maturation in general (p.8). As families become multi-stressed and resources for meeting the needs of children are being diminished, the indications are that there are more disturbed children in the school system (Frostig and Essex 1998). In school settings drawing, using miniature symbols, painting and sculpting are highly effective ways of working with these children. Through play, feelings are more able to be expressed in a nonverbal form (Boyd Webb 2003; Lowenfeld 1993). The domain of symbolic play is a world to which a child still has easy access. In the early school years the world of imagination, image and symbol is easily accessible, and so playful, activity-based techniques are relevant when trying to support comprehension and understanding of emotions (Allan and Brown 1993; Pearson 2004). Counsellors, guidance officers or teachers trained in ET work with respect for a childs unique way of communication and try to match language and activity to that preferred style. While there is always some verbal exchange with a young client, trying to support children by relying on verbal therapy alone can be ineffectual and may ultimately leave both therapist and client feeling as though the process has failed (Boyd Webb 2003). The attitude that a child exhibiting symptomatic behaviour has some sort of malfunction or deciency that can be xed through the exchange of information is not conducive to working with ET.
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When considering the keys to success in including artistic expression for children with special needs, we return to the prerequisite need for the therapist or helper to be exible, accepting, and able to be a secure, stable and self-aware presence. Security and stability does not necessarily mean enforcing rules and boundaries, but being secure in who we are and stable in what can sometimes be a highly chaotic and uid environment. Guidance officers and school counsellors responding to research on ET in schools (Pearson 2003) scored the use of art as both the second most favoured ET modality with young clients and the second most effective counselling tool (after sandplay and symbol work). Art therapy, in particular, has been successfully applied in a variety of contexts as a treatment regimen for traumatized children (Eaton, Doherty and Widrick 2007). Difficult behaviour can be channelled and transformed into socially constructive forms of self-regulation through supported creative activities (Henley 1999). ET has proved to be highly effective with children with aggressive and impulsive behaviour related to hyperactivity and social anxiety. Henley (1999) reported on the successful use of expressive therapies in a therapeutic camp setting over a ve-year period. St Clair Pond (1998) found art therapy interventions to be valuable in working with lonely children, and especially helpful in aiding students communication skills. Rogers (1993) reports on the successful use of an expressive arts programme in a school, for working through loss and grief, which was developed from a person-centred approach to empathic listening. DRAWING OUT EMOTIONS IN THERAPY While there are many forms of the visual arts that can be used therapeutically (for example, painting, drawing, collage, print-making, photographs, sculpting, etc.), expression with crayons is the most commonly used form in the ET counselling room. These forms of expression all draw on the intra-personal intelligence, utilize the visual/spatial intelligence, and allow it to link with the verbal/linguistic and the interpersonal. Use of the intrapersonal intelligence may be unconscious during the creation process. Reection on, and discussions of, the clients art may increase their awareness of their inner world, as well as provide some insight for the counsellor into the clients deeper needs. As with expressive writing, there are three main types of drawing commonly used in ET: reective drawing, process drawing and completion drawing. Reective drawing begins with a topic and is designed to allow both the conscious mind and the unconscious to express, and for reection on the topic to follow. As the name suggests, process drawing involves the use of colour, line and shape as a means to express and release strong feelings. Process drawing can support ventilation and catharsis. Completion
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drawing often executed in mandala form is invited towards the end of a counselling session as a means to support integration, bring closure and in some way summarize an experience.
Reective drawing
Reective drawings may be spontaneous in a session, or emerge as a response to suggested topics. They result from or initiate reection, introspection or recall. They will often express feeling memories. This category of drawing may include the depiction of specic events; for example, a picture of family, scenes from holidays or special times, dramatic events in life, or domestic scenes, such as Figure 7.9, My family at dinner (Pearson and Nolan 2004, p.81). Reective drawing can be used to open a discussion with a relatively new client. For example, divide an A3-size page into four segments, and invite the client to select colours and draw lines and shapes, or images, that represent parts of their life such as: 1. How I feel at school. 2. How I feel at home. 3. How I feel with friends. 4. How I feel when alone. Reective drawing can be suggested as a self-support, self-care strategy, a type of occasional homework, which may also be used as a starting point for subsequent sessions. Body mapping is another form of reective drawing. This involves self-awareness, drawing onto a body outline, and expressing sensations and emotions both visually and verbally (Pearson and Nolan 2004, p.66). It provides a foundation for self-reection, information about moods, emotions, sensations and even psychosomatic symptoms, and provides a stimulus to verbal disclosure that strengthens connection. The client quickly sketches a body outline on a large sheet of paper. After a short period of relaxation and guided self-focus, they draw onto the body outline various moods, sensations, emotions and thoughts, using colours, lines and images. The counsellor then engages in respectful listening as the client shares what they have created, and what they found inside. The activity Emotional Reection with Drawing and Music (see pp.221 224) aims to encourage a spontaneous ow in the clients drawing expression and overcome negative beliefs about drawing (if these exist). Four pieces of music that express different energies, moods or emotions are selected and listened to, and responses with colour, line and image are
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invited. Discussion may follow on ways to use drawing as an emotional release strategy, and any times when this might be benecial.
Process drawing
In supporting the client to use art to work through issues and release reactivity, we may offer large amounts of paper and crayons. Process drawing is an emotional release exercise using continuous drawing of feeling reactions to reduce emotional stress. (See pp.224226 for a process drawing activity.) Process drawing focused on anger typically progresses to becoming darker, with more jagged lines, then becomes lighter and more owing, with curving lines and shapes. Words may be added as more ideas emerge. If the client is ready and able to release the intensity of feeling, the process may naturally end with the use of soft colours and calm lines. (See Figures 7.10 to 7.13.) After the resulting art is reviewed and discussed, the drawings are usually not kept beyond the session. The product is usually no longer important. In fact many clients enjoy dispatching them to the bin often in small pieces!
Figure 7.10 Anger is expressing now.
Figure 7.11 Strong and happier.
Figure 7.12 I can share the pain.
Figure 7.13 Calm now.
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Completion drawings mandalas

A specialized use of drawing for completion in ET is the creation of mandalas during the integration stage of counselling sessions. These are drawings or paintings prepared with a circular frame. The circle shape suggests a centre and can have a centring, calming effect on the client. Research has shown that artwork executed within a circular frame indicated measurable differences signifying a more relaxed state compared to artwork created within a square (Slegelis 1987). One interpretation of the word mandala draws its derivation from the Latin manda, meaning essence, and la, meaning container. The term mandala has also been referred to as denoting a ritual or magic circle used as an aid to contemplation (Fincher 1991; Jung 1973). In Western psychotherapeutic practice the use of the mandala was introduced by Jung (1973) who observed that clients became calmer when expressing in a circular frame. Through his travels, Jung determined that circles have been used in all cultures as a support in healing and meditative practice. Jung saw mandalas as symbolic of the inner process by which individuals grow toward fullling their potential for wholeness (Fincher 1991), as symbols of wholeness and integration (Jung 1973), and also as possible signs from the unconscious about where the psyche was going. Drawing harmonious patterns within a circle was hypothesized by Jung as a way to help overcome imbalances in the psyche.
Figure 7.14 Adult female, mandala surrounded by symbol work: Finding the spirit alive in me.
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The authors have used the tool of inviting clients to express feelings inside a circular frame with a wide range of age-groups and presenting problems. While, in traditional cultures, mandalas such as Tibetan tangkas or Navaho sand pictures are complex and highly structured, in therapy mandala drawings are usually not premeditated. A client is encouraged to allow the drawing to ow out so that the choice of colour, shape, image and representation is as spontaneous as possible. The aim is to provide a contemplative, meditative activity that is not necessarily reective, but rather provides a hint of something new, unknown, nourishing or renewing. In this centring activity we have noticed that some mandala drawings seem more planned, and these seem to harness a clients ability to plan, bring order or symbolize balance. Offered as an integration tool in the closure phase of a session, what we witnessed was a distinct calming effect when time was given to this task. Figure 7.15 was created by a 12-year-old male client after working through anger.
Figure 7.15 Twelve-year-old male, mandala: Calm after expressing anger.
How the mandala appears to others, and the level of drawing skills, are not important. The circle on a large blank page marks a particular, dened space for the nonverbal world and for a clients creativity to express. Sometimes a client is invited to imagine they could offer their hand, their eyes and the crayons for a few minutes to be at the service of their imagination. Mandala drawings have been used to support the affective domain of learning, to develop interpersonal competence, self-awareness and selfreection, with student nurses preparing to work with clients with a mental illness. The teaching technique used in an experiential exercise asked the
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students to create a group mandala, using art materials, on circular pieces of butcher-block paper (Marshall 2003). Marshall claimed: As a creative, active learning strategy, the mandalas helped the faculty meet the clinical objectives for the course and the learning needs of a new generation of students (p.517). Clients of all ages have, on the whole, responded well to invitations to use mandala drawings. Optimism, renewed energy and a sense of lightness are commonly reported by clients after drawing a mandala or colouring in a mandala shape. (See Figure 7.16.) Believing that children diagnosed as HIV-positive would benet from a safe outlet for expressing feelings about living with the virus, Wiener and Battles (2002) analysed the themes and contents of 32 mandalas created, during therapy sessions, by children and adolescents living with HIV. The main themes identied concerned concrete aspects of living with HIV. However, nearly half the subject matter of the drawings evidenced resilience, with recurrent themes of happiness, optimism, social relationships, and the normality of everyday life (Wiener and Battles 2002).
Figure 7.16 Young adult, mandala: I feel united and strong.
HW suggested to an adult client with a life-threatening illness that colouring in pre-prepared mandala shapes be used as an activity to maintain focus and a sense of calm during hospitalization for an intensive medical procedure. The client found the activity useful not only as a tool for staying calm but as a source of personal encouragement. Figure 7.17 shows one of the mandalas coloured by Amanda during her illness.
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Figure 7.17 Adult female: A way to stay calm.
Figure 7.18 Eight-year-old female, mandala: Happy at the end of a session.
Gerteisen (2008) explored the use of art therapy in a group within a residential treatment centre, with children experiencing both child abuse trauma and some form of foetal alcohol spectrum disorder (FASD). She found that
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the use of art and the introduction of the mandala concept (using mandala shapes as a colouring-in activity) facilitated childrens nonverbal expression. Using mandala drawing as an activity for children diagnosed with attention decit disorder (ADD) and attention decit and hyperactivity disorder (ADHD), Smitheman-Brown and Church (1996) found that the drawing increased the childrens ability to pay attention and decreased their impulsive behaviours. Henderson, Mascaro, Rosen and Skillern (2007) found that clients suffering from traumatic distress could gain signicant improvements in posttraumatic stress disorder (PTSD) symptom severity by working through their trauma with the creation of mandalas. (See Figure 7.18.) Mandala drawing was used to support cognitive, socio-emotional and spiritual integration, and to address issues of community in a teacher-education classroom (Young 2001). In addition to drawing a mandala, written reection on the created mandala or the process of creating it was encouraged. Young wrote: The development of mandalas in the classroom offers an opportunity for individuals to learn more about themselves in a way that includes the heart as much as the mind (p.27).
Figure 7.19 Adult female: Heart is open, in ow now.
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When a child returns home from a day in pre-school or kindergarten, signicant artwork produced that day is often proudly displayed for the household to admire in many homes the gallery is often the refrigerator door. Sharing a series of mandalas created within a group programme (Figure 7.20) is also a very encouraging activity and fosters within the group a deepened sense of understanding or feeling of knowing the artist at a heart or soul level, rather than identifying them with their problem. Although some expressive art therapists attribute specic meanings to art images (Glaister and McGuinness 1992), it is now customary to avoid projecting any interpretations of clients creations on to their artwork (Goodman, Williams, Agell and Gantt 1998; Wadeson 1995). This approach is in line with ET methodology. While a counsellor may consider themselves able to analyse the work of a client, all analysis is withheld. However, a therapists suppositions are used to formulate self-discovery questions (Pearson and Wilson 2001) that are designed to offer a client more emotional and psychological space in which to tell the therapist more of their life narrative or about their journey. We want to enhance the clients ability to articulate their own process, rather than position them as a passive recipient where what we say consumes their attention. If we impose our interpretation on a clients creation, it is as if we cannot leave the space open but have to ll it with our own cleverness.
Figure 7.20 Adult female sharing mandala drawings at the end of a course.
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THERAPEUTIC GUIDELINES FOR USING ART IN ET Exploring imagery created, imagined or borrowed as a core activity in ET has been effective in helping people change, as many writers have observed (Lazarus 1982; McNiff 1992, 2004; Skovholt et al. 1989; Wolpe 1958). The outcome from skilful therapeutic help that includes accessing creative, intuitive processes to activate self-healing and individuation processes in the psyche often leads to recovery from psychological distress (Eaton et al. 2007).
Physical environment
Create space in the consulting room that is uplifting, inspiring, and suggests freedom of expression (i.e. it is not risky to be expressive with the materials). The environment of the counselling room is very important in allowing trust and freedom of expression. Since many clients are dealing with emotional chaos, some external order is ideal. This would include arrangement of furniture and a general sense of tidiness. In the sensitive state in which most clients enter a counselling room, beautiful impressions can be very helpful. It might be helpful to spend time arranging a special place of beautiful and natural objects, perhaps with a candle. It does not take much effort to convey the message that the counselling room is a caring, safe and special place. At the same time we do not want to create a static, perfect setting that would disincline the client to feel totally free to express and create (Pearson and Wilson 2001).
Emotional safety
Aim to develop rapport as a rst step. A sense of calm in the counsellor and in the room is important. Ideally all material and equipment should be ready and accessible prior to the clients arrival. Be aware of the possible need for safety or privacy for clients artwork. The usual rules about client condentiality apply equally to their artwork. Do you need to keep a folder for it with you? Is there any risk that families or friends could ridicule the artwork? Would taking it home create the risk of subjective analysis and reaction? Kalff (2003 [1980]), in describing the environment best suited for young clients, aimed to create a free and protected space.
Non-interpretive attitude
It is a basic principle in ET to use a non-interpretive approach in discussing a clients artwork. Allow the client to place their interpretation or meaning onto the images, colours and shapes if they wish. Do not interpret
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drawings for them, and allow them not to discuss their creations if they prefer. Accept the clients current interpretation of their work, even though it may change and you, as a counsellor, may suspect it contains more than they are aware of. A key ET principle in dealing with clients art recommends the use of self-discovery questions. Coleman and Farris-Dufrene (1996) emphasize that while the clients art can be interpreted from a variety of theoretical orientations, it is important to understand the clients own interpretation. Similarly, Wadeson (1995, p.99) says: interpretation that is not centred in the art-makers experience may actually interfere with ones more accurate understanding of the art.
Assessment or diagnosis
Do not use clients artwork for formal assessment or diagnosis. While an experienced therapist will often learn more about a clients inner world from their art, they can only form a hypothesis, not make clear judgments. Clients who suspect diagnosis is underway may perform rather than spontaneously create.
Offer choice
Free choice of media will be helpful. Try to provide a wide range of media, such as pencils, crayons, watercolours, acrylics, clay, collage materials, etc. Also, be ready to offer or supply activities that utilize other intelligences if clients change in their attitude towards the current media. Some clients blame the media for their emerging uncomfortable feelings, and may suddenly claim it is boring!
Empathic listening
Some clients will be inspired and enabled to talk about their experiences through art creation. Some will prefer to remain silent. Accommodate both the extrovert and the introvert. Verbal processing of creations is not essential for the process to be useful; however, if the client perceives that the counsellor is attentive, present, without judgment, they may be more inclined to open up. The invitational approach demonstrates a respectful attitude towards the clients creations. Invitations encourage reection, choice and empowerment for clients.
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Overcoming reticence
As a support for overcoming any negative beliefs about drawing ability, and to stimulate interest and a ow in expression, it can be useful at times to invite the client to try drawing with their non-dominant hand. Responding to music with drawing can also help to establish a creative ow.
Summary
In this chapter we have reviewed research and documentation of therapists observations in regard to the great value of including art within therapy. We have described a wide range of applications looking at how, when, why and by whom art is being used in therapy and therapy training, with groups and individuals of all ages. Reasons for the use of images, symbols and art as part of the healing process have been reviewed, and there has been a brief overview of application with specific client groups. We have discussed projective mechanisms in the psyche, that underlie the therapeutic use of art. The connection between processing emotions and the use of art has been made, and we have advised against applying therapists interpretations to clients artwork. Three specific ways of using drawing in ET have been detailed: reflective drawing, process drawing and completion drawing using mandalas. We have given several important guidelines for safely inviting clients to use art. Several ET art activities are now described in full, for use by counsellors.
ART AND MUSIC ACTIVITY
Emotional reection with drawing and music

Aim: To encourage a free flow in the clients drawing expression, and overcoming negative beliefs about drawing (if these exist). It provides opportunities to talk about self and life experiences. This activity can be used in on-on-one sessions or with a small group (45 participants). Resources: Four different pieces of music; crayons, pencils or pastels; large art paper (A3), or large quantity of A4 paper if working with groups. Age range: 9 years to adult.
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Note: Questions are always offered in a respectful, invitational way. We recommend that the therapist take a slow, deep breath before asking each question, so that the process does not feel more like an interrogation to the client. Time and emotional space are allowed between questions, so that the person has time to connect with how they actually feel, rather than taking on a submissive responder role.
PART ONE: DRAWING MUSIC
The therapist selects four pieces of music expressing different energies, moods or emotions, e.g. strong drumming, gentle flute, militaristic, flowing orchestral, hot rock music, techno, hip-hop, relaxation music (NB not music with words). The client (participant) is asked to divide a large page (usually A3 size) in four or you can use four separate A4 pages. Before commencing, take time to discuss with the client their beliefs or attitudes about being invited to draw. Invite the client to sit comfortably, or stand. Take a few deep breaths. Invite the client to close their eyes (if it feels comfortable), and open to listening. The therapist can participate in Part One, along with the client or group. Play each piece of music for about two minutes.
Instructions for the client
Allow yourself to listen to the music. Can you feel its effect on your body? Does the music make you want to move? Feel free to move if you wish. Imagine the colours that go with the music. How does it make you feel? Does it affect your mood? Is there anywhere the music dances in your body? Does your body say YES or NO to the music? Are there any pictures that the music brings to your mind?
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Choosing any one of the four spaces on the page (or on a piece of paper), allow yourself to draw as quickly as possible now use whatever lines, colours, shapes, images you feel go with the music. Dont think much about it, see if you can simply let it happen. Somewhere in the space used, can you add a word or two that goes with the colours and mood?
Discussion phase
Do you feel willing to share what you have drawn? Can you tell me how it felt to draw to the music? Have you ever felt like this music? Can you describe that feeling? Was there anything in your life that the music reminded you of? If so, can you say something about that?
Repeat the process with each selection of music.

PART TWO: DRAWING FEELINGS
Part Two of the exercise is done without music.

Instructions for the client
Relax, lean back or, if you feel comfortable to do so, lie down. Take two or three slow, full breaths. Allow yourself to remember a recent time of feeling: sadness, hopelessness, or even fear. Is there any of that feeling in you now? Where would it be in you? Can you find the colour of that feeling? Let it come into your minds eye. Is that colour a pure colour, or mixed? Are there several colours? Imagine the lines or shapes or pictures that go with that feeling.
Let yourself draw again, let it flow out rather than plan the drawing: let your hand and the crayons do the work. (Pause while the client draws.)
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Beside the drawing write down any thoughts you remember having at that time. (Pause to allow the client time to reflect and record.) Can you allow yourself now to remember a recent time of: courage, strength, confidence or hope? Is there any of that feeling in you now? Where would it be in you? Can you find the colour that goes with that feeling? Let it come into your minds eye. Is it a pure colour, or mixed? Are there several colours? Imagine the lines or shapes or pictures that go with that feeling.
Let yourself draw again; let the drawing flow out rather than plan it: let your hand and the crayons do the work. (Pause while they draw.)
Discussion phase
Take time to discuss the last two drawings. The following prompts are suggestions for opening that discussion. Would you be willing to talk about what you have drawn? Is one drawing more interesting than another? Can you talk about any part of the drawings that you like/dislike? Would you like to say more about the colours and lines you have used? Did you find the feelings inside you? Where in your body did you find those feelings?
Discuss ways to use drawing as an emotional release strategy, and any times in their life when this might be beneficial.
FOLLOW-UP OPTION
If there is a need to process emerging feelings further, choose music to resonate with the feelings identified by the client. Briefly listen to the music together to assess its suitability. Then invite them to stand and:
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listen to the music move with it draw several quick drawings that seem to go with the feel of the music recall any times when they may have felt like this take time to discuss the clients response and how they are feeling now.
OTHER EMOTION-FOCUSED OPTIONS FOR PART TWO
A A recent time of frustration, annoyance or anger. A recent time of peace, calmness, relaxation or stillness. B A recent time when things felt boring, dull or pointless. A recent time of excitement, aliveness, energy or happiness.
PROCESS DRAWING ACTIVITY
Drawing out troubles

Aim: To support ventilation, and then integration, of strong emotions through drawing. Resources: Crayons, pencils or pastels, large quantity of scrap paper (A3) that is blank on one side. (We recommend buying paper specifically for use in all exercises, so that there is no emotional contamination from what may be printed on the reverse side.) Age range: 6 years to adult. Note: While the format of this activity (and many others within the spectrum of techniques) may seem more suited to clients older than 6 or 9 years, the activities can be modified for use with young clients by using appropriate language and minimizing the number of instructions. Invite the client to focus on whatever it is that seems troubling. It could be an irritation, some anger, an upset or a stressful situation. They begin by tuning in to themself and sensing or imagining what colour or colours go with the feelings inside them. They then select colours, execute lines and evolve shapes that express the feelings, moods or reactions of which they are, in the moment, most aware.
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Clients are encouraged to start drawing anywhere on the page across the page, down the page, in rows, columns or free-style. Gentle encouragement is given to keep making marks on the page without thinking too much about the result, using as much paper as they wish. As they progress with making lines and shapes on the page, the counsellor gently repeats the invitation to tune in to self, and to look again over the range of crayons to see what colour or colours might feel right for the moment. As the process unfolds, the counsellor may offer supportive questions, such as: What colours and lines feel right just now? Is there more of that? Has the feeling changed? How could you show that? Do you want to continue?
Encourage the client to keep drawing until the feeling seems resolved. Offer questions that invite the client to reflect on the process, to support integration. The following questions are offered as suggestions for opening the reflective space: Are there any pages or areas of the drawing that show how your body would like to move? Would you like to try that out now? When you look at what you have done: Is it how you would like to leave it? Does it feel finished? Is there anything more you would like to add?
Would you like to tell me about the feeling inside you now? Look back over the drawings what do you notice? Is there a colour, shape or picture that you would like to end with now? Could you find some words that go with: how the exercise felt? how you feel now?
How do you want to finish with the drawing(s)?
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Walk around the room for a moment, let your arms swing free, let your body relax. Does anything need to happen now? Are there any actions needed about the problem?
COMPLETION DRAWING ACTIVITY
Breaking free with mandalas

Resources: Art paper (A3 size), crayons, pencils or pastels. Age range: 10 years to adult. Note: When choosing music for ET activities, avoid selections that unnecessarily heighten fear (for example, theme music from horror or sci-fi films). Each of us carries our own inner fears that, given support, space and time, can be addressed. Therapists do not need to get in there and force anything out or directly script connection with trauma or fear. Select three of four different types of powerful music that you consider of interest for the client. For younger clients two, or perhaps three, pieces would be appropriate, depending on assessment of concentration, attention span and emotional needs. Prepare several circles on an A3-size piece of paper, for the client. Invite them to relax, then listen to the first track of music. After listening, invite the client to move to sitting more upright (if they are leaning back or lying down), and to let their hand and the crayons take over. Encourage them to express quickly any feeling response to the music through colours, lines, shapes or images, in or around the circles. Repeat this process for each of the four chosen pieces of music. Allow time for reflection and any writing the client may wish to do as they review their artwork. Invite the client to review their creations and share any responses.
Chapter Eight
Use of Music in Expressive Therapies

OVERVIEW Listening to music stimulates the brain and the bodymind connection, it can reactivate speech centres in the brain, prompt memory and improve gait and coordination (Brey 2006). It has been claimed that since ancient times music has been used to enhance well-being and reduce pain and suffering (Kemper and Danhauer 2005). Throughout history, music has been used as an accompaniment to therapy, and in many highly creative ways for the healing of the soul (Nelson and Weathers 1998). Music can create and alter moods, facilitate the expression of emotions, reduce stress and anxiety; it can be used to capture and focus attention, elicit memories, communicate feelings, and create a sense of community (Mandsager, Newsome and Glass 1997). The elds of nursing, post-operative care and care of the aged are increasingly experimenting with, and reporting, on the therapeutic value of using music. Research in the elds of medicine and nursing has documented support for anxiety reduction, mood stabilization and pain management through including music as part of the recovery process. Music, it is argued, has effectively reduced anxiety and improved mood for medical and surgical patients in intensive care units, and for patients undergoing procedures, for children as well as adults (Kemper and Danhauer 2005). This trend echoes the relationship of music and medicine since the earliest times (Gladding 1998). This chapter describes ways that we have found highly effective for using music within an ET counselling session. The end of the chapter contains some practical activities that use music and rhythm for extending and enhancing traditional verbal expression and emotional literacy.
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USING AND MAKING MUSIC IN THERAPY Recorded music and music-making have been used as a central element in ET to support times of self-reection and inner connection, as well as for emotional activation, emotional release, relaxation, creative expression and celebration. A CD player, a wide range of CDs with a variety of music styles, and a small collection of percussion instruments particularly drums are on the essential equipment list for an ET consulting room. Improvisational tools such as harmonic whirlies (www.harmonicwhirlies. com) provide an enlivening addition to sound-making, emotional connection and expression, with an added bonus of inventiveness when telling a life narrative. Despite our personal enjoyment of, and enthusiasm for, using music in our professional practice, before proceeding to offer activities involving or including music we recommend a counsellor to have some training in using music as part of ET techniques. The musical sequence for a session has to be planned carefully so that the music is well known to the counsellor and they have explored carefully the possible emotional responses from the client. A second vital consideration is to evaluate a clients tolerance for and response to musical sounds. It is quite simple to ask a client how they would feel about having music playing softly in the background. Some clients nd the additional sounds in the room too intrusive and an interfering distraction from hearing themselves think and tuning in to their feelings. A client with a diagnosis of autistic spectrum disorder (ASD) may nd the additional sounds create stimulatory overload. Yet others willingly allow music to open their heart and nd relief in letting the sounds carry, and mask, the sound of their grief and anger. Observe and assess each persons response to music; observe your own reaction to musical sounds. Is there a particular type of music you feel drawn to? Are there certain sounds or particular music that you dislike? Once aware of your own responses to music and its effect on your mood, motivation and energy, you will better understand how a client might receive sounds. Music need not accompany each and every client session or groupwork activity. Music is simply an additional tool at your disposal. Later in this chapter we will look at some of the research into how music has been used in recovery and in healing processes. In therapy even the sound of our voice can be musical or not. While many adult clients report enjoying the soothing sounds of what has been called new age music for relaxation, many young clients do not nd it relaxing at all. They have usually become attuned to very different musical stimuli and so may nd new age music too prescriptive for their taste. As
USE OF MUSIC IN EXPRESSIVE THERAPIES
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one client retorted: That new age stuff just doesnt go anywhere. Its all the same from start to nish. However, the task is not to have music available that would be appropriate or enjoyable for every client, but to have a selection wide enough to accommodate the broadest spectrum of client preference. (See Figures 8.1 and 8.2.)
Figure 8.1 Adult female: Drawing to music, with symbols.
Figure 8.2 Adult male: Music, words, drawing and symbols.
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When choosing music for a session, keep in mind that adolescents may have very specic tastes, and it may be impossible for us therapists to keep up with what is widely and wildly popular. It can be very useful to listen to the music that a young client enjoys listening to the rhythms, the lyrics, the avour of the music provides a vast amount of information. Our tendency is often to allow a young client to bring some of their own music and to play it on the rst occasion at a volume they prefer. Sometimes this means being prepared for a sound assault on our ears for a few minutes. This acquiescence, handing over authority over the music, as well as over the actual music played, can activate useful processing of inner dynamics. Without requiring any initial verbal expression, music, it was claimed by Bonny (1973) and Moreno (2005), offers a means to bypass psychological blocks and facilitate inner contact with personal issues. The process outlined by Bonny (1973) typically saw a therapist rst involve a client or group in a period of progressive relaxation, with an explanation that soon they would hear recorded background music. After being guided to focus on travelling inwardly, a client or group participant would then be invited to share their imagery experience of what they had witnessed in their inner world while listening to the music. In ET, music has been a powerful adjunct to many of the activities, including as background during visualizations, for relaxing and tuning in prior to a meditation, as activating for dance and movement, and as something with which a persons emotional expression can blend in times of strong articulation of either grief or anger. A playground incident had left an eight-year-old girl with a permanent, disguring injury. It required ongoing medical procedures that she experienced as highly invasive, and these episodes of physical repair exponentially heightened her levels of distress. Expressing any feelings related to the trauma was almost an impossibility, as was any dialogue about her future and the ongoing medical treatment that would be part of life. After several sessions, when I (HW) felt the alliance between us was strong enough and knew she had solid, loving support from parents and family members, I offered her the collection of drums in our therapy room and asked if she thought perhaps the drums could speak for her. Eagerly, without saying anything, she took up the largest of the drums (a North American Indian-style drum) and proceeded to march around the room, beating at the drum frantically, for the next ten minutes. The rhythm was chaotic and very forceful. She continued to march, and I marched with her. We ended up with ve different drums, and she would move quickly from one to the other, beating each one with the same force, sometimes trying to beat two drums at the same time. Gradually she returned to the
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rst drum and picked up the beat. The tempo slowed and became more steady, more rhythmical. I thought the pace took on a rhythm more like a steady heartbeat. This process was repeated at her request for several sessions. Each time, after the drum beating had steadied and she appeared quietened, she would drop the drum and fall into a pile of very large cushions in the therapy room. Only then in that space would she, without prompting, express her fears for the future, her sadness, her concerns that she would never be loved because of the disgurement she had acquired. Beating out her fears, anxieties and frustrations led to opening to a deeper, more reective space, followed by reconnection with her courage and capacity to go forward. Her honesty and clear understanding for her future would always emerge, unmuddled and straightforward. The addition of music increased her coping skills (Hodas 1994), and provided the opportunity for her to express negative emotions through a nonverbal activity (Nelson and Weathers 1998). One of the major contemporary applications for music therapy is in working with children who have serious emotional disturbances with high degrees of impulsivity and limited ability to self-regulate (Layman, Hussey and Laing 2002). McIntyre (2007) found that a music therapy programme in a school for adolescent boys diagnosed with behavioural and/ or emotional disorders led to the participants making signicant gains in the areas of social interaction, self-regulation, attitude towards school and work, music skills, academic progress and self-awareness. Working with a group of three extreme behaviour-challenged boys between 9 and 12 years old, two ET colleagues, working in tandem, offered drums and keyboard in a somewhat desperate attempt to nd ways to assist the boys in articulating their experience of living in a highly dysfunctional, chaotic environment. Spontaneously creating sounds on the instruments available, the boys reported that the sounds they made matched the voices of their caregivers. They created high-pitched, pseudoscreaming, fast-paced sounds on one end of the keyboard, and booming, forceful sounds on the other end (Manseld and Manseld 2005, personal communication). (See Figure 8.3.) In another instance, a 15-year-old male communicated his frustration by making crayon marks on the page in time to the music playing in his head. This young client invented this activity for himself and reported that afterwards he felt calmer. While the work with these young people continued to present some challenges, the music-making session marked a transition in the relationship with the therapists. Spontaneous musical improvisation for the development of the relationship between therapist and client has also been used by Graham (2004). Working with adults with
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Figure 8.3 Adult female: Drawing to music, with symbols.
profound learning disabilities, she demonstrated that music can be used to establish interaction with people who may seem to have little other means of communication. Musical interventions have been found to be especially helpful for mothers recovering from depression, and for their children (Oldeld 2006). Oldeld described using music therapy involving families with a range of problems (including young children with emotional, psychological or behavioural difficulties), and a six-week group for mothers and their children. Schotsmans (2007) encouraged her young clients to bring music into the therapy room, and found it was often the rst element they would work with. She writes: Music therapy is all about the creation of new shapes and forms, about descending to the unspeakable and sing or vocalize about it (p.349). Skar (2002) explored and compared the processes of music and analysis, and explains how the use of music improvisation in therapy (with simple percussion instruments) can powerfully enhance the dialogue between the unconscious and conscious psyche, as well as deepen the relationship between the client and the therapist. For tertiary students with sleep disorders, listening to music resulted in improved subjective sleep quality, shorter sleep latency (the time taken to fall asleep after going to bed), longer duration of sleep, better sleep efficiency, reduced disturbance and less daytime dysfunction, week by week (Harmat 2008).
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Cheek, Bradley, Parr and Lan (2003), working with groups on teacher burnout, found that music therapy in conjunction with cognitive-behavioural therapy (CBT) was more effective than CBT alone in supporting lower levels of teacher burnout symptoms. They point to earlier research that suggests that the addition of music therapy in therapeutic groups offered opportunities for the participants to better express their feelings and to establish a relationship with other professionals through social bonding (Bonny 1987; Rosenblatt 1991; Yon 1984). Bensimon, Amir and Wolf (2008) report on the use of drumming with a music therapy group for post-combat soldiers diagnosed as suffering from combat- or terror-related PTSD. Some reduction in PTSD symptoms was observed following drumming, and especially an increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy. Group members also beneted from achieving a non-intimidating access to traumatic memories, facilitating an outlet for rage and regaining a sense of self-control. Husseys (2003) review of the music therapy literature delineated three broad domains of functioning where music therapy has been successfully utilized in the treatment of emotionally disturbed children: affect regulation, communication, and social/behavioural dysfunction. He reports on work with an emotionally disturbed child where the music therapist and the client viewed and discussed pictures of people, each with a different affect (e.g. happy, sad, mad, scared), and followed this by creating music in response. The client and the therapist took turns at selecting a feelings face and improvising music on the piano that matched that feeling state. MUSIC AND EMOTIONAL LITERACY Music is often used in ET to help a client develop emotional literacy. Emotional literacy involves competency in using the emotional intelligence or, as Gardner (1993) calls it, the intra-personal intelligence. Emotional literacy includes the ability to sense and locate emotions in the body, recognize emotions, name them, communicate about them and speculate about causes. It includes the ability to express or process feelings in a suitable way (Pearson 2006). Ability with emotional literacy assists the process of therapy, offering support for integration of emotional experiences following therapeutic release, and in developing emotional regulation and enhancing emotional communication. Clients experience a higher level of personal satisfaction when they experience communicating more effectively. The present writers have observed that the more able a client is with intra-personal exploration, the more effective and lasting the therapeutic experience can be.
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Gardner (1993, p.24) describes the intra-personal intelligence: knowledge of the internal aspects of a person: access to ones own feeling life, ones range of emotions, the capacity to effect discriminations among these emotions and eventually to label them and to draw upon them as a means of understanding and guiding ones own behaviour. We would argue that a core aim in therapy would be to strengthen a clients intra-personal ability in order to enhance their self-awareness, communication skills and ability with the inter-personal intelligence having connected with self, they are better able to communicate and connect with others. Bodner et al. (2007) explored the use of sad music with patients with major depressive disorders, in order to circumvent the verbal barriers they typically experience when asked to express their emotions. They examined the effect of four emotionally distinctive types of music (i.e. happiness, fear, anger and sadness) on hospitalized patients with major depressive disorder and on healthy controls. The patients chose more labels in response to sad music than any other kind, while controls demonstrated the opposite pattern. A nine-year-old boy who came to counselling work because of a recent traumatic experience displayed an extremely limited vocabulary for his feelings. There was a sense that, since the trauma, he had regressed to behaviours, language and cognition more commonly seen in a child of around six years of age. His range of emotional communication extended only to good, bad, nice or happy. MP used several tracks of music as starting points to help him nd words connected with emotion. The rst track used was John Barrys main theme from the soundtrack of the classic lm Out of Africa. This is a track that could be labelled as sad, wistful, melancholic, or expressing profound loss. This boy called the music happy. The next track offered was a piece from Scott Fitzgeralds Thunderdrums II. To this writer the music conveyed an extremely up-beat, jolly, Mardi Gras-type, celebratory mood. The boy listened for a moment, then said: No, wait, that ones happy, the other must have been sad! He also selected crayons of specic colours that, to him, matched the moods of the music. With the crayons he wrote down the feeling word that went with the music. One by one he began to create a list of feeling words. From that activity this young person was able to experiment with language and safely wonder about his own feelings. Responding to the external stimulus of the music offered him distance from the trauma, while giving him more available language with which eventually to address the issue. The music play provided a way to explore emotions without having to speak directly about the trauma, without feeling guilty or helpless in the face of great challenge (La Torre 2003). Engaging in music play alongside and with the support of the therapist heightened the therapeutic alliance. Although
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there were few changes in the boys outer circumstances, he presented as lighter and more communicative in subsequent sessions. MAKING IT UP AS WE GO ALONG Within the therapeutic process music has been used as therapy musicmaking at the forefront, as an agent of change; and in therapy where the verbal and nonverbal processing of responses to the music gives insights and leads to change. For the three agitated boys working with our colleagues, and who used the keyboard to mimic the main people in their lives, the music was the therapy. For the nine-year-old boy working with MP, who used music prompts to help name feelings, the music was in therapy. Music plays a large part in our formal training of expressive therapists. We recommend that quiet background music be playing when a client enters the room. The therapist checks with the client to nd out if the music is experienced as an intrusion, or welcoming, or is perhaps not noticed. The music is not chosen with any particular emotion in mind, but more to provide a background and signal the space as one where emotions are welcome. La Torre (2003) used tones and sounds to enhance the therapeutic relationship, claiming that they provided a nonverbal entry into the clients emotional state. She also recommended that music be used to begin the session, or at the end, as a way of promoting integration. There are several basic methods of using music in therapy (Malchiodi 2005). These methods are valuable for clients who favour the musical/ rhythmic intelligence, and can encourage those who may not have related to music previously. Improvisation involves spontaneous creation of music. Having some percussion instruments particularly drums or even a small keyboard available within a counselling room can provide the necessary materials to support music-making. Performing, interpreting, listening to and responding to pre-composed music can provide a doorway through which clients can contact, recognize, share and process emotions. Music can activate particular memories and provide a descriptive language for both internal and external experiences. Clients may use a keyboard to create representational sounds; spontaneous or improvisational songs; depict a person, place or experience; express a mood or particular emotion; or compose something at home. Composition experiences that create a specic musical product have been used as an out-of-session method for clients to deepen integration and make meaning of their experiences. Writing songs, composing lyrics or
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instrumental pieces, performing these, and even creating audio or video projects can all be supportive of the therapeutic journey. Receptive experiences, where a client listens to music and responds either verbally or through other media (e.g. drawing, use of clay, painting), have been used in ET and music therapy. In music and guided imagery work (Bonny 1973) the fantasies and imagery evoked by specially selected music are expressed and explored. The Bonny method has many similarities to the ET use of music and art. CHOOSING MUSIC Music can be used to provide a sense of privacy, to stimulate reection, to encourage expression or support relaxation. When choosing music to use in therapy, select tracks longer than two minutes, to avoid sudden changes in mood and tempo. Consider if the mood, volume and pace are consistent throughout the piece. We recommend avoiding music with words that the client can understand. Lyrics in music mean that the words can become experientially prescriptive, and reduce the ability for the client to project onto the music. Of course, clients may bring music they like, with words that are signicant for them. Avoid frightening music, or music that is too familiar to the client. Many young clients respond negatively to classical music and opera. It has been recommended (Advanced Brain Technologies 2002) that therapists using music do not use compressed music (such as MP3), because in the manufacturing process, in order to achieve a high degree of compression, some of the signicant lower and higher frequencies may have been removed. One way to build rapport with clients who are overly anxious or not ready to participate is to invite them to listen to some of your music and discuss their responses in an informal way. With some clients, inviting them to bring in and discuss some of their favourite tracks may hasten rapport and help them commence the process of opening up. Nelson and Weathers (1998) found that a large number of clients did in fact relish, and light up at, the invitation to bring into their therapy the music that moved them. They offered clients a clear option in the rst session, such as: Do you have any favourite songs? Or have you ever played a musical instrument? If so, you might bring them in. They reported frequently nding that listening to or performing music elicited for their clients profound experiences that inuenced their moods, thoughts and perceptions.
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Dinas story
Dina found it very difcult to nd the right words to express her trauma. Sometimes words owed at such an amazing rate and in a chaotic, random manner, but none of them were about what had happened. When language owed it was concerned with how people didnt understand her and her frustration with people who didnt value what they had. Sometimes she could say very little and seemed imprisoned by pain. Diagnosed with posttraumatic stress disorder, this young person used music to let me (HW) know her most important issues. The rst time it happened I was not aware of the signicance, but a week later, when Dina arrived again with a thoughtfully and carefully recorded playlist of music, I wondered if she was communicating her deepest fears and longings. Dina would walk into the room, place her tape in the tapedeck, and we would sit and listen, song by song. At the end of each song she would pause, sigh, and maybe say something about how she felt about the song. I would ask a question or two along the lines of what meaning the song held for her, why she liked it, and whether it might also be a favourite of anyone else in her life. And then the next song would be played another voice expressing what she could not. Dina was given complete control of the music equipment tapedeck, amplier and speakers. She adjusted the volume to her own needs sometimes this was so loud that the walls of our garden studio would rattle, and sometimes the volume was adjusted to soft and quiet and Dina would rest on the oor with her head beside a speaker, listening silently until the last bar of the song. This process continued for ve consecutive sessions, and then no more. Our therapy continued on as before. The predominant themes in the songs were loss, unending grief and unrequited love. Reecting on these sessions it appeared that Dina wanted to share the depth of feelings she was experiencing, but at that time needed a safe emotional distance from the underlying causes of those feelings. It was to be some time before a more direct encounter could take place with talking about those causes.
Summary
We have described ways we have found to be effective in using music with counselling clients. Documentation and research on use of music has been reviewed, and has indicated a range of populations for whom music has been found to be useful. The use of music to enhance emotional literacy was described. Practical ways in which music can enhance a counselling session were listed such as building rapport.
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EMOTIONAL LITERACY WORKSHEET
Finding feelings in music

Aim: Opens conversation. Can help a counsellor observe a clients preferred intelligence. Resources: Worksheet 8.1; CD player, a selection of four different types of music that have clear emotional tones; crayons, pen.
INSTRUCTIONS
Initiate a brief conversation about music, and the types of music that both the client and the counsellor like. Explain that the worksheet is designed to help them learn more about feelings and how to talk about them. Give the client the option to share or not to share the responses they record on the worksheet. Take time for the client to relax and tune in to him/herself.
PROCESS
Play the first music track. The client listens, and is then invited to fill in the columns (in any particular, or their preferred, order). Repeat the track while the worksheet is being completed. Invite the client to listen to the sounds around them before the music starts. Suggest taking a slow, full breath. Between tracks, invite the client to stretch, wriggle, move and re-focus within. Complete the worksheet, responding to all four tracks.
INTEGRATION
Invite the client to review the worksheet and reflect on: the response or column that came first the track they liked most, track they liked least the track that had the strongest impact the column that was easiest to complete/fill out any parts of the worksheet that stand out, attract their attention.
Allow time for the client to discuss any feelings or memories evoked by using the music and worksheet.
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With the clients agreement, take time to discuss what the client has written in the final column. The counsellor and client together may recognize particular responses that the client could explore further.
Suggested sets of music that could be useful for Finding feelings in music
SET 1
Track 9, Penny Whistle Song, from film soundtrack The Power of One by Hans Zimmer (Elektra/Wea, 1992). Track 1, main theme, from soundtrack by Out of Africa by John Barry (Varse-Sarabande, 1998). Track 2 from soundtrack 1492: Conquest of Paradise by Vangelis (Atlantic/ Wea, 1992). Track 1 from The Secret Garden by David Sun, SKU: NWCD205c (New World Music, 2003).
SET 2
Track 3 from soundtrack Gladiator by Hans Zimmer and Lisa Gerard (Decca US, 2000). Track 1 from soundtrack Braveheart by James Horner (Decca, 1995). Track 3 from All One Tribe (Thunderdrums II) by Scott Fitzgerald (World Disc, 1993). Track 1 from Healing Massage by Stevan Pasero (Sugo Music, 2002).
SET 3
Track 7 from soundtrack Dances with Wolves by John Barry (Sony, 2004). Track 12 from soundtrack compilation Moviola by John Barry (Sony, 1992). Track 7 from Percussion by Guem and Zaka (Inedit, 1997). Track 1 from Mariner by Tony OConnor (Studio Horizon, www.tony oconnor.com.au/albumpages/marinermp3.htm). EMOTIONAL RELEASE MUSIC ACTIVITY
Talking drums using rhythm and percussion

Resources: Drums and percussion instruments, drawing materials, drawing paper divided into four segments.
Worksheet 8.1 Finding feelings in music LINES AND SHAPES OF THE MUSIC THIS MUSIC MAKES ME THINK OF FEELING WORDS THAT GO WITH THE MUSIC ANY TIMES I HAVE FELT LIKE THIS MUSIC?
THE MUSIC
COLOURS OF THE MUSIC
1.
2.
3.
4.
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INSTRUCTIONS
As a warm-up, drum along with pre-recorded drumming music for several minutes. Invite the client to move about while playing the instruments. Then invite the client to play and create rhythms and sounds that go with and express their feeling reactions to these experiences: a happy time, a happy place the three or four main people in their life (respond to each separately) a time of anger, or a place that they didnt like the most peaceful or enjoyable time, or activity. ask the client if there is anything they would like to say invite them to quickly put colours and lines in the segments to show how it felt.
After each expression:
Invite the client to see if there are any words (perhaps a few lines of a song they already know, or simply words they think of in the moment) that go with the sounds they are making.
INTEGRATION
After the last round, invite the client to tune in to him/herself for a moment, and then to draw inside a circle how they feel inside, with colours and lines add a few words that go with the feelings talk about the situation.
Finally, invite the client to tune in to him/herself and see if they would like to drum and express how they feel now.
Chapter Nine
Dreamwork
OVERVIEW Despite being well worn, the clichd saying a picture is worth a thousand words has some merit. Symbols contain or transmit much more than words. In this chapter we discuss the value of exploring personal imagery and experiencing dreamwork. Working with dreams is not as simple as becoming a skilled interpreter (Signell 1998) or reading about or learning the meaning of symbols. Psychologist James Hillman (1989) has persuasively argued that contemporary psychological ills are due primarily to a pervasive impoverishment of imagination. Nelson and Weathers (1998, p.109) ask: Are we therapists actively encouraging the revitalization of our clients imaginations? Do we genuinely invite our clients to bring into therapy their own creative contributions toward deeper self-understanding and health? Developing an understanding of the way dreams can inform our life direction requires us to observe our own dreams with interest, imagination and intuition. Through dreams we can become aware of resolution needing to happen, of opposites within ourselves, of suppressed or repressed aspects. The intellect loves words, but the heart responds to images. In psychological work both are essential (Muff 1997, p.37). We have both enjoyed working with dreams presented by our clients over the last two decades almost as much as our own exploration of our own dream life. Over a decade before we wrote this book, a middle-aged female client working with HW reported being extremely puzzled by a dream in which she had discovered Elvis Presley in her bedroom closet. The dream imagery saw the client enter her bedroom and watch as the closet door slid open and Elvis, replete in fringed, white pantsuit, stepped out quietly and proceeded to greet her no fanfare, no red carpet, no adoring fans or frenetic dancing. The client had not opened the door to her closet it was as if Elvis was ready to step out and greet her. And thats where the dream ended. Were not sure what those esteemed doyens of
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dreamwork, Freud or Jung, would make of the symbology; however, as we explored the dream imagery with the client, she came to her own conclusion. She commented that at a surface level the dream helped her recognize a tendency to be reclusive and guarded about authentic emotional contact as well as hiding a more amboyant, entertainer part of herself. Obviously dreams can contain several issues and have different layers of meaning, and there was a lot more to the Elvis in the closet dream than reported here in this brief vignette. Dream dialogue revealed many more meaningful connections between the dreamer and the central dream gure. If we consider dreams from a cultural studies perspective, historical documents report them as being used since ancient times for important guidance. The Mesopotamians, Chinese, Greeks, Hebrews, Babylonians and Romans all valued dream interpretation (Van De Castle 1994). Virtually every religious tradition has sought spiritual guidance, divine revelation and creative inspiration from dreams (Bulkeley 1999). This point is illustrated by the 98 specic references to dreams and dreaming in the Old Testament (Wollmering 1997). In ancient and primitive cultures dreams were often seen as providing both personal and communal guidance, and were presumed to originate with a higher source (Harner 1980). In shamanic rituals dreams were considered sacred visions. Amazonian tribes believe that in their dream wanderings they inuence the future (Harner 1980). In this chapter we focus on the therapeutic relationship and dreams, and offer some ways of working with dreams, harvesting the riches of our unconscious and making their wisdom available for everyday living. EXPLORING DREAM IMAGERY A symbol implies something that may be vague, partially known or unknown, or somehow hidden. Dreamwork gives us a means for understanding the symbols selected or created by our unconscious in order to make its contents known. Dreams work on an emotional level as well as having a positive effect on the body. For the most part the emotional component of dream imagery has been ignored or undervalued (Signell 1998). Integrating dream imagery can help us tap into and clarify the language of our unconscious. It is through our dreams that we can become aware of the particular inuence of unconscious thoughts and feelings (OConnor 1986). Taking the time to explore a dream is a way of co-operating with the unconscious and supporting its growthful direction. Some issues that may be presented through dreams include: current problems in day-to-day life, such as signicant change, loss, bereavement, tragedy; fears that are surfacing from past events; childhood trauma; re-emergence of previously
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disowned energies or characteristics such as assertiveness or resilience; or reconnection to spiritual life. Freud stated that the interpretation of dreams was the royal road to a knowledge of the unconscious activities of the mind (Freud 1970 [1900], p.647). It was one of Freuds most signicant conclusions that the dreamers associations to a remembered dream could provide a deeper understanding of unconscious motivation. Jung believed that the contents of our unconscious mind exerted an inuence on our daily lives (OConnor 1986) through a built-in mechanism for releasing the past and resolving conicts. Jung viewed dreams as a source of personal knowledge and guidance (Jung 1964). He saw symbols in dreams and fantasies as the language of the unconscious, describing a symbol as a term, a picture, that may be familiar in everyday life, but something that also has specic implications in addition to its conventional and obvious meaning. Jung suggested that therapists need to remain open and listen to all the messages and images arising from the clients psyche (Lee 1999). DREAMS AND THERAPY Dreams are a way to decode the inuence our unconscious has on daily life, or how it might be signalling a need for change. Events that happen in everyday life can also nd expression and process through dreams. Jacobi (in Jung 1964) considered that blockages to normal development, tendencies towards regression, could be overcome when unexpected treasures were uncovered in the inner world our unconscious. By bringing these treasures into consciousness the ego is strengthened and psychic energy needed for growth can be made more readily available. Jacobi saw this as a key function of dream symbols (Jung 1964). Unconscious content of an event can be revealed to us through our dreams where the material surfaces as symbolic imagery rather than rational thought and logic. Inviting clients to talk about their dreams can provide a catalyst that seems to increase dreaming and recall of dreams. Crook Lyon and Hill (2004) found that clients who discussed dreams in therapy had more positive attitudes toward dreams, higher dream recall and more therapist encouragement for talking about dreams than clients who did not. Many clients nd that in times of stress or internal crisis, their dream life becomes more active. Working with their dreams at these times may accelerate the connection with these issues. Clients who do not discuss dreams in therapy often claim that they do not dream, or that they judge the dream silly or scary, or simply do not think that talking about their dreams in a therapy session is worthwhile. Integrating dream interpretation
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into counselling can promote client development, and enhance self-understanding, and self-efficacy (Marszalek and Myers 2006). When we display curiosity about a clients dream life, the doorway is open for exploration of deeper issues. Dreams may previously have been judged by the dreamer as random pieces of useless information or fanciful imagining. Working with dreams requires of a therapist stillness, patience and a quiet attitude, as well as an appreciation for working from a multidimensional and integrative stance. Multi-dimensional refers to the idea that dreams may contain unconscious, unremembered content, or they may contain attempts to process conscious, remembered experiences. ET works from an integrative stance in which the range of tools available is drawn from a broad spectrum of approaches and becomes simply the medium through which a client unlocks their own resourcefulness. A client may want rapid relief from their emotional pain or distress, and often it comes as a shock that we simply cannot think our way through the problem, or divert our attention from long-held suffering, by formulating goals that give us something to strive toward. We raise this point because therapists new to using dreamwork may feel some pressure to reach resolution, or may be used to relying on conscious cognition to achieve a sense of being productive and having a client feel better. So when would you open the possibility of exploring a dream with a client? Is dreamwork something that happens only within the constraints of one-to-one sessions? Diemer, Lobell, Vivino and Hill (1996) claimed that dream interpretation could be used successfully even in the beginning sessions of brief counselling as a way to develop the capacity for self-reection. Initially, exploration of dreams can often feel like searching in a darkened room for something you remember leaving there but cannot see clearly. Working with dreams offers a client a chance to re-vision events, to look at an often dramatically different or changed version of what is happening or could happen. Sometimes a dream can bring a deep questioning that feels unsettling and uncomfortable, so that what felt peaceful then becomes uncertain or even chaotic. Our therapeutic work with dreams aims at emotional and psychological integration through supporting a client to develop a tolerance for mystery and undergo a process for learning about their own capacity to nd the answer right for them. We support clients to develop an ability to temporarily delay attempts at nding a nal, conclusive understanding of their dream experiences. Our dreams are a way of gathering information from one world (the dreamworld) in order to help us survive in the real world (Wolf 1995). If a client chooses to explore their dreams, it can be helpful to know that our dream life will often resist being forced prematurely into the open. There is no quick answer to a dream. The information on offer from a dream emerges in relationship with the
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dreamer and requires integration of the dream content into the dreamers everyday life (Slater 1999). Dreamwork activities have been used by expressive therapists in both individual sessions and in group settings. Building a relationship with signicant dream images can be facilitated through a clients conscious interaction with the image through artwork, expression in a sandtray, creating dream images using symbols, dramatization through role-play, creative journal writing about crucial elements of a dream, dancing signicant actions observed in the dream, or using active imagination. In our work with groups in particular, we have often found that participants saw their dreamwork as closely connected with the emergence of their interest in spirituality and as creating a sense of personal mythology. Personal mythology, although seeming a contradiction in terms, refers to signicant symbols from dreams, fantasies, sandplay, nature, or from our culture, that hold an important meaning or energy for us personally, and convey essential concepts about life. Provost (1999) and Berube (1999) each described the value of dream exploration in counselling groups. Provost noted that such exploration helped to encourage client disclosure and exploration, and that clients may have felt less threatened than they normally might when self-disclosing. In another exploration of the usefulness of working with dreams, Davis and Hill (2005) worked with volunteer clients, some of whom received dream work in a non-spiritual style, and some who received dream counselling with a spiritual orientation. In both conditions there was increased insight into dreams, with heightened interest in spiritual insight and increase in existential well-being (Davis and Hill 2005). The prevailing understanding of working with dreams emerges from the Freudian and Jungian tradition. Working on the general assumption that dreams were not a matter of chance, but associated with conscious thought and problems, Freuds technique of free associations enabled him to use dreams as the starting point from which a client could explore the unconscious (Freud 1970 [1900]). Jung extended Freuds way of working with dreams, paying closer attention to the actual form and content of the dream. In Jungian constructs dreams are often seen as ways of balancing our energies, signs of inner development and indicators of spiritual meaning, often about the noble and growthful (Signell 1998). Dreams were also seen as providing archetypal images, images from the collective blueprint of the human psyche, the basic underlying patterns. In general, from the Jungian perspective dreams and dreamwork are about the natural movement of the person towards wholeness. Dreams are something highlighting aspects of individuation and have the potential to catalyse this development.
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Similar to Freud and Jung, Perls (1969b) considered the interpretation of dreams to be an important area of consideration for the work of mental health professionals. In the Gestalt style of dreamwork, Perls (1969b) claimed that a client can use everything in a dream as a means to reclaim forgotten qualities. Integrating disowned aspects of personality was a core theme in Perls approach. In his style of dreamwork clients were encouraged to play out each dream symbol fully, to become each part through a role-play process, and to examine every aspect of a dream in order to understand it. A useful stance to adopt when working with dreams is to look at the dream from the position of the naive observer as something completely unknown, something we would need to look at from all sides in order to understand both its origin and its function. Rather than rely on therapist analysis of dream symbols, in ET we have incorporated elements of Perls role-play method, where every symbol is regarded as representing an aspect of the dreamer themselves or an aspect of their current life. Our perspective also highlights the Jungian concept that dream symbols are essential message carriers from the instinctive to the rational parts of the mind (Jung 1964). This self-discovery approach is blended with active imagination to form an effective tool for embracing the information of our dreams. While interpretations are never imposed, the dreamer is guided through explorative facilitation to discover their own insights. Repetitive dreams may be the most important. Repetition means that something is incomplete, not yet lived out or integrated, and therefore unable to recede into the background. Dreams can be returned to consciously, to reveal deeper meaning, or through conscious focus, allowing the meaning to grow and develop. Dreams can be reviewed even after several years, and can then reveal more meaning in the light of growth and change within a clients life. HW recalls a dream in which an unusual pearl necklace dropped off my neck and fell bead by precious bead down a drain. While the initial working of the dream with an experienced therapist brought forward meaning and direction, I revisited the dream three times over the next decade. During those ten years there was no conscious intent to revisit the dream; however, the imagery returned spontaneously and presented me with the task of revisiting something in my inner world that I thought had been resolved. Dreams are sources of important information about a clients internal and external worlds; an opportunity for reclaiming or re-integrating what has been lost or buried. Dreams can inform us about our attempts to process a traumatic event or emotional wounding, repressed emotional material, undeveloped abilities, directive energies that show us what we need to do and how to live our lives, as well as presenting images relevant to our
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spiritual path. Dream images can be expanded or amplied with personal associations and collective meanings by considering past experiences and the way the image appears in mythology, literature or art (Muff 1997). ET WAYS FOR DREAMWORK In our ET style of working with dreams they are considered a reection of the context in which a client is operating and relating, and are not thought of as something divorced from everyday experience. The connection between dream imagery and a clients life circumstances is considered of vital importance. Despite differences in terminology, the function and purposes of using dreams in therapy are often described similarly by different theories of dream meaning. As in ET, the integrative model of Eudell-Simmons and Hilsenroth (2007) suggests ways in which various approaches to dreamwork can enhance and facilitate each other, as well as enriching the therapeutic process. Although there are different types of dreams, they can all provide helpful insights. Dreamwork is a means of expanding the clients personal interpretation of symbols. This can develop a sense of personal mythology their own way of describing their inner world and helps both client and counsellor understand the language of the individual unconscious. Symbols of personal mythology may appear over and over, or repeatedly attract a clients attention, or somehow hold meanings that have been explored, and now become a sort of shorthand means for communication and summarizing experience. For many sessions one young client in her mid-twenties used a small plastic symbol of a stingray. The stingray became the trusted guide that would carry her into her inner world in each session. Having the stingray physically in her hands and yet imagining, as if in a dream, being able to ride on its back to look over the troubling terrain helped her reect on events that, without the steady, slow pace of the stingray moving through the inner landscape, seemed too threatening. While our dreams are often more relevant to the workings of our inner world, working with them enables us to receive guidance for the direction of both our outer and our inner life. Dreams may show up challenges to be faced, or indicate new attitudes to what we have to face. Dreamwork is a major support in opening to our inner world and bringing its energies alive. Some issues represented through dreams may be current challenges in day-to-day life, fears that are surfacing from the past, re-emergence of disowned energies or characteristics, and even pre-verbal and perinatal stresses emerging for resolution. During a period of therapeutic support, the nature of dreams can change. Dreams offer a useful means by which
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the psyche can complete a process begun, but not completed, in a therapy session. In working with a dream we would support the client to stay in touch with their body and feelings, and surrender to whatever images, memories, feelings, sensation, impulses to move, may emerge. We guide them to connect deeply with their physical sensations, their heartbeat, breath, tensions, any sense of impatience or desire to direct the process. We suggest that a client see if they can leave behind efforts to analyse, while staying open to any insights. When efforts to think the way through a dream are surrendered, then, spontaneously, meanings emerge. ET offers many ways of working with dream content. The toolkit can include writing, using art, storytelling, free association, role-play, use of sandtrays, movement, active imagination, and amplication.
Writing
Recording important dreams credits the content with being valuable in our life. Writing is a way of consolidating recollection. It can also help the process of opening our awareness to the signicance or message within a dream. During the writing process, symbolic or emotionally charged language may stand out, providing clues for further investigation. In a written exploration, a client can write down the main symbols, then for each one write a paragraph on: self-observing the image self as the dream image any insights about the imagery presented in the dream any connection between the image and current life events.
Artwork/creating images
Drawing or painting dream images also facilitates emergence and integration of the dreams meaning. The activity of drawing or painting allows the dreamer to stay close to the contents of their unconscious, and perhaps feel, reect on and connect with clues to any life direction featured in the dream.
Telling the dream story

Having someone listen to the telling of the dream is also helpful. As the telling proceeds the dreamer might hear words, phrases, descriptions
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of aspects of him/herself that strike chords of recognition. The energy behind the dream may be activated, and this expression can be part of the resolution and integration. A counsellor might be watching for key phrases or energetically/emotionally charged words, and invite the client to sit with, and reect on, these.
Free association
Free association can be a useful method for playing with spontaneous associations arising from the dream and each symbol. Where do these associations lead? Do they signal other areas of signicance? What ideas are brought to light?
Role-play
To enhance, understand and resolve dream information, invite the client to imagine him/herself as the symbol. In role-playing dream symbols a client usually begins by exploring the symbol that holds the most emotional charge the image or symbol that stands out from the rest. The client can imagine becoming this image for a moment, then imagine what it would say, and express that, then perhaps interact with other symbols from the dream, or even speak to the dreamer. Imagining becoming a person or object in a dream can bring new awareness, emotional understanding and transformation and integration. To effectively become the symbol, it is ideal for the client to be relaxed, have their awareness focused in their body and to allow movement, sound and expression. Focusing awareness in the body can be supported through questions such as: In this moment, how does it feel on the inside? Can you feel the seat beneath you? See if you can tune in to feeling your breath come in and out of your body. Can you feel your heart beating?
Using a sandtray
Using symbols (sandplay miniatures) a client can use the sandtray to reconstruct a visual remembrance of dream content. Once the scene is set, they are then invited to let the dream story play on. This approach can help concretize the spatial connections in dream scenes, and may incorporate role-play and/or active imagination, creating and re-ordering the scene as it changes. Having the chance to reconstruct the scene assists an embodied connection with the symbols, moods and relationships from the dream, leading to understanding and resolution.
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Using movement
It can be useful to include all the senses when supporting clients to explore dreams. The somatic content of dream symbols can reveal another dimension to the inner narrative. For example, it makes a difference whether the dream character moves in a provocative manner or an inviting manner. Playing out the action of the dream and moving, or even dancing, as each symbol can suit clients who are less inhibited about movement and generally more kinaesthetically oriented. They can express the movements of the whole story, each character, the objects, and swap from being one symbol to another to explore the interactions.
Active imagination
For active imagination a client is rst invited to enhance self-focus by spending a minute or two tuning in to their breathing, perhaps slowing the breathing down a little and then relaxing their body as much as possible. The next step involves inviting the client to allow the dream narrative to continue, or parts of it to unfold in more detail. As they come into a sensitive connection with self, and watch in the minds eye as images unfold, the therapist avoids commenting on, directing or planning the action. As the client recounts the extended narrative, both client and therapist simply watch what happens.
Amplication
This is a way of adding to individual understanding through considering traditional and mythological meanings. Adult clients can be encouraged to explore mythological and collective meanings of key symbols, discerning whether any meanings from a culture other than their own add further insight to their own discoveries. Suggest research through authoritative sources such as Joseph Campbell (1972) and good-quality dictionaries of symbols, for example Chevalier and Gheerbrant (1996) and Cirlot (1971). While these resources are not considered the authority on the actual meaning of any particular dream, they offer potentials that can attract instinctive projective responses in a client in much the same way as the miniatures used in symbol work and sandplay. PROJECTIVE MECHANISMS IN DREAMS Dreams can help us become aware of projections in our outer life, and bring some healing to relationships that may be carrying the burden of projections. For example, if we dream of our partner, our children or close
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friends, exploring the characteristics of the person as a symbol in the dream may help us to reclaim certain strengths. For example, one adult client had frequent dreams about her son that seemed unrelated to his life or well-being. Upon exploring these she realized that when her son appeared in dreams he was a symbol for her own deeper essential self, her soul. The son in the dreams was often in precarious situations, lost, or malnourished. This led to recognition of the need to take better care of her own soul life, to nd the deeply nourishing activities that her inner self was calling out for. Exploring images from nightmares can help process undissolved tensions and fear. Many young clients have reported dreams of being chased by a monster or bad person. Upon playing out these dreams the threatening part has always transformed into something offering support. Similarly, we have found that working with dreams that involve threat or domination or any shadow aspects of the psyche can be most useful in enabling clients to reclaim energy and suppressed parts of the psyche in a safe way.
An adult male reported having a series of dreams where the earth was overcome and ruled by an alien tyrant. The dream scenes occurred in an atmosphere of threat, danger and fear. The tyrant in the dream conscated all food, locked up all inhabitants of earth, made all males slaves, and all females were at his disposal for frequent and brutish sex. After some discussion the client was not amused by an invitation to role-play the tyrant. However, a good rapport between therapist and client had previously been established, so he willingly entered the exploration. Initially there was a tendency to jump ahead and attempt to resolve the dream on an intellectual level. After a few minutes of role-playing the tyrant, the client found sitting in a chair uncomfortable, and when invited to see how he wanted to move, began to pace around the consulting room. On being asked to verbalize any thoughts or feelings of the tyrant, this client was surprised to hear himself say: I want food and lots of it! I want sex and lots of it! I dont want to work. You should all serve me!! Soon he was laughing, and quickly offered the realization that the symbolic meaning of this inated image of a tyrant with oppressive demands allowed him to acknowledge what had been suppressed. This clients relationships and professional life meant that he had learned to deny himself, so as to focus on his role as a helper of others. What had been denied in his life was simply surfacing to be acknowledged. At the end of the session he felt energized and no longer fearful when he remembered the image of the tyrant. Working through the dream brought awareness of how unproductive it was for a helper to ignore self-care.
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Summary
In Chapter 9 we drew attention to the value of staying open to discussing and exploring a clients dream life, viewing dreams as a source for accessing personal knowledge. Using active imagination and treating dream images as symbolic representations of personal resources that may be hidden or forgotten can bring greater understanding of ourselves and our inner processing of outer events. Some of the ways suggested for exploring dreams included using artwork, writing, free associating, using movement, role play of significant aspects of a dream, or recreating elements of the dream in a sandtray. Dreams have been discussed as a tool for bringing useful awareness to the phenomenon of projecting personal qualities onto aspects of our outer life. As with previous chapters, a number of experiential dreamwork activities have been included as ways to support, value and validate the internal reality of a client by placing importance on noticing themes, images, action sequences, confrontations and challenges that happen in the landscape of the dream.
DREAMWORK ACTIVITY
Creating dream scenes

Having access to the range of symbols used in sandplay therapy can be a useful adjunct to dreamwork. For this way of exploring dreams it is ideal to have an art pad or large sheet of cardboard, or a sandtray. This activity is more suited to a client, or group, where they maintain a dream journal, or have a number of dreams from which to choose for exploration. 1. Invite the client to relax, take a few steady, slow breaths, and then, if they feel comfortable, close their eyes just for a minute or two to allow a short time to draw attention away from outer distractions and become aware of self-focus. 2. Invite the client to imagine their dream life as a slide show or a photograph album. They imagine beginning to flip through the album (or move from slide to slide) and are asked to see which dream calls their attention. Then they are asked to recall the main images, issues, actions and feelings and thoughts that followed the dream.
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3. From the range available, symbols are selected that represent significant elements of the dream. The choice of symbols need not be representational or literal (i.e. not necessarily a human figure to represent a human being). Sometimes the symbol chosen is more representative of the energy of the dream image/figure. 4. On the large-format art pad or coloured cardboard, or in a sandtray, the symbols are arranged in a way that reflects the dream. The spatial arrangement may change as the dream is worked. 5. After constructing the dream scene the client is invited to tell the dream. During the telling of the dream the therapist maintains an attentive listening attitude. After telling the dream story has been completed, the client is invited to discuss the symbol arrangement. The therapist may ask open-ended questions to draw out any more elements of the narrative. 6. The client reflects on whether there is any emotional or energetic charge connected with any dream character or symbol. An invitation to let that symbol speak to or dialogue with other symbols can be useful. 7. If appropriate, the role-play exercise below may be useful for deepening understanding of the most significant symbols.
8. Invite the client to discuss and/or draw how they felt at the conclusion of working the dream, and to write down any important insights or record any changes to the way they previously thought about the dream. DREAMWORK WORKSHEET
Intensive journal activity

The client recalls a significant, or strongly remembered, image or symbol from a dream scene. Using Worksheet 9.1, the client follows the heading prompts, starting with the top row. The client may work in silence, discuss their ideas as they progress, or may be invited to fill out the worksheet at home and discuss it at the next session. ROLE-PLAY ACTIVITY
Understanding dream symbols

Resources: Art pad/drawing paper, crayons, coloured pens/pencils, writing paper.

Your initial, surface, assumptions about the meaning of the image Flow of consciousness writing in response to the dream Your inner feelings about the image Possible traditional or cultural meaning of the image
Worksheet 9.1 The intensive journal method beginning to explore a dream image
Describe the dream image in words
Draw the energy of the image
The relationship between the image and other elements of the dream
What would happen next for the image?
If the image could speak to you
Rekevance of the image to your inner life?
Relevance of the image to your outer life?
Summary statement
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Age range: From child through to adult. After discussing a particularly interesting or significant dream symbol, the counsellor invites the client to role-play that symbol. The following questions are asked slowly, giving the client time to reflect and feel the answer and then respond as the symbol from the dream.
Relax as much as you can and take a few deep breaths. (Pause.) For the next few minutes can you imagine or pretend you are this symbol? If you are comfortable to do so, close your eyes for a moment, allow an image of the symbol to come into your mind. Let yourself be interested in how it looks, feels, what its energy might be like. Now imagine yourself becoming this symbol. Feel your body changing, change your posture if that helps. Take a full breath and feel how it is to be this symbol.
The client first imagines him/herself as the symbol and then answers these questions, responding with I rather than it, if possible. 1. Would you be able to tell me what you are? 2. Could you describe what you look like? 3. What are you made of what is inside you? 4. What are your main qualities? Main feelings? 5. What can you tell me about your age? Are you old or young? 6. Do you have a particular sound or movement? (If they do, ask if they would like to demonstrate the sound/movement.) 7. Do you have a special purpose? What are you for? 8. Is there anything you want? 9. Do you have a message for [clients name], or anything you would like to say to him/her? Any advice, perhaps? After a pause, say:
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Now come back to being yourself, and when you are ready, gently open your eyes. You are no longer the symbol you are you now. (Pause.) Did you hear the message of the (symbol)? How do you feel about the message?
After some discussion, encourage the client to write the message in their journal or on a piece of notepaper. Invite the client to: share how they feel after the exercise share any insights about how it relates to their life discuss how this symbols message or energy might be useful in their life.
Invite the client to sketch the symbol, or its energy, and add some words about its meaning for them. DREAMWORK ACTIVITY
Active imagination and role-play

Resources: Art pad/drawing paper, crayons, coloured pens/pencils, writing paper.
Age range: From about 12 years.

Remember to follow the indications from the client as to what needs to happen. Give a brief overview of how you will work with (1) quickly sketching a dream, (2) active imagination, (3) using role-play, and (4) the idea that everything in the dream may be part of us, or in us.
SKETCHING THE DREAM SCENE
Take a moment to focus inside and recall the dream. Can you tell me a little about the dream? Can you do a quick sketch of a scene from your dream that calls your attention? The client may want to tell the dream as they draw, or to work in silence. Encourage them to let the story grow. Then, at an appropriate
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point, invite the client to share the story. Invite them to take time to reflect on the feelings and energies within the scene, and share these.
ACTIVE IMAGINATION
Do you have a sense of what might happen next? Could you allow the dream to play on?
Allow time for the client to actively imagine what might happen next.
ROLE-PLAY OF SIGNIFICANT SYMBOLS
Invite the client to indicate one or two elements of the scene that seem most important to them. What stands out for you? Are there one or two elements that intrigue you most? We could explore the meaning of each of these. Could you take some time to become that (symbol from the dream)? Could you role-play it? Pretend you are it for a moment, and close your eyes, take a big breath and relax it out. Tune in to yourself and imagine you are the (symbol). what you look like? what colour, what shape, size you are? what you are made of? what is inside you?
Can you tell me:
Remember you are the (symbol from the dream). Take a deep breath again. What are your main feelings? What are you for? What are you doing now? Is there something you would rather do?
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Encourage any movement, any dramatizing expression of the symbol and any words or sounds that go with its energies: What do you want to do? How do you move? Are there any words or sounds? Where do you want to be? Is there anything you want to say? Do you have any message or advice? What do you want to say to the person who dreamed you? When you are ready, come back to being yourself the person. Think about the message for a moment. Can you tell me how you feel about the message from this part of your dream? Look at the sketch of the dream scene again. How does it feel now? What do you notice? Is there any way you would like to add to it or change it?
Then say:
See if anything different wants to happen.
REFLECTION/DISCUSSION
What do you think this dream is suggesting? Is something being worked through? Why do you think you needed this dream? Thinking about things happening in your life, how could this dream relate to current events? Are there any actions in your daily life which this dream might be suggesting you consider? Are there any choices or changes you would choose to make as a result of working with this dream?
REVIEWING THE SCENE
A final reflection opportunity:
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Tune in to the feeling being reflected back from the sketch. Could you say how it feels now?
INTEGRATION
The client writes down the messages, insights and any new aims or directions resulting from the dreamwork. Integration through either movement or stillness can be useful. To complete, if time permits, the client can draw how they feel, using a mandala.
Chapter Ten
Transpersonal Inuences
Spirituality and Counselling
OVERVIEW How often has it happened that when a plausible explanation cannot be found for something, we either try to dismiss it as meaningless, or work to nd something to ascribe cause to. In times of chaos and uncertainty we are faced with the question of who am I?, where am I going?, what do I really want?. Some schools of philosophy regard these questions as necessarily unanswerable because the answer, as we grow and revise our direction, will inevitably alter. In the past the tendency has been to view therapy through a prism heavily weighted with Western Newtonian/ Cartesian thinking (Grof 2000). The eld of therapy now embraces practices such as meditation and mindfulness once the province of Eastern philosophies. Art and music are seen as powerful tools for shifting or expanding consciousness, and the old arguments for the supremacy of cognition over emotion seem more academic and less to do with what happens for a client in the therapeutic alliance. The doors of mysticism have been unlocked and have revealed another paradigm for enhancing our understanding of human experience. Put simply, transpersonal psychotherapy extends our exploration of the eld of human well-being by taking into account spiritual experiences (Vaughan 1995). This allows therapeutic endeavours to consider psychological health and emotional well-being in the broadest possible terms (Boorstein 1997). The relationships with family, friends and others in our environment remain critical, but added to this is respect for the longing in human nature to nd meaning, purpose and perhaps even transcendence (Boorstein 1997). Transpersonal development is seen merely as another part of the continuum of human functioning (Scotton 1996, p.3). In this nal chapter we introduce perhaps the nal piece of the ET puzzle aspects of transpersonal theory and practice. (See Figure 10.1.)
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Figure 10.1 Adult male: My spirit is alive.
NEW MAPS OF THE INNER WORLD The concept of there being multilayered levels of human consciousness presents interesting challenges both to psychological and therapeutic researchers and to counselling and psychotherapeutic practitioners. For therapists, transpersonal frameworks offer a more inclusive cartography. According to Grof (1988, 2000) the entire spectrum of human experience can be considered in a framework of three levels of inuence that extend and complete traditional frameworks. These three levels or elds are referred to as biographical, perinatal and transpersonal. The elds of perinatal psychology and transpersonal psychology are addressed by numerous researchers and writers, such as Boorstein (1997), Chamberlain (1998), Cortright (1997), Grof (1988, 1998, 2000), Scotton (1996), Sutherland (2001), Vaughan (1995), Verny and Kelly (1981), Walsh (2005) and Wilber (2000). The transpersonal domain is described simply as broader than, reaching beyond or transcending the personal. It suggests that on the
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inward arc of human development healing remains incomplete unless the drive towards transcendence is taken into account (Vaughan 1995). Scotton (1996) maintained that inclusion of a transpersonal dimension in models of the human psyche offered a system for understanding human development that could embrace moving beyond attachment to ego. Similarly, Gardner (1999) proposed that we may have an existential intelligence, a concept popularized and discussed as the spiritual intelligence. Development of this intelligence would, he suggested, result in individuals who would exhibit the proclivity to pose (and ponder) questions about life, death, and ultimate realities (p.64). The concept that there is another possible realm of awareness and experience, beyond the individual, seems linked to Jungs description of a collective unconscious (Fordham 1991 [1953]). The concept of transpersonal work can be linked to Jungs ideas of a collective unconscious. The collective unconscious is a deeper stratum of the unconscious than the personal unconscious (Fordham 1991 [1953], p.22). Cortright (1997) claimed that Jungs representation was the rst model of transpersonal psychology. In distinction from Freudian views, Jung regarded the unconscious as a redeeming power of intelligence, creativity, and spiritual transcendence (Cortright 1997, p.82). The transpersonal psychology movement evolved from Abraham Maslows interest during the 1950s and 1960s, and his exploration into links between mental health and human potential. Walsh (1994) described Maslows (1968) interest in psychological health as opposed to the prevailing view of disturbances in the psyche as pathology. Walsh acknowledged that to some degree it was Maslows study of self-actualizers that gave birth to the transpersonal movement. He became interested in what it meant to have peak experiences. Peak experiences can be described as spontaneous, ecstatic, unitive states of consciousness, times of feeling intensely loved or loving, feeling a deeper sense of understanding similar to mystical experiences that have been reported and valued across centuries and cultures (Walsh 1994). A TRANSPERSONAL PARADIGM Cortright (1997) maintained that human beings experience compelling urges toward spiritual seeking, and believe that contacting a deeper source of wisdom and guidance within is both possible and helpful to their growth. No longer does it seem enough to understand why or how human distress happens (Whiteld 2006). For people interested in transpersonal psychology, what an actual experience of distress or intense happiness and
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love felt like and what potential was contained in such experiences seems a much more important area of investigation. Humanistic psychology, the precursor to transpersonal psychology, originally researched well-functioning and high-achieving individuals. However, humanistic thinking lacked the more comprehensive framework that was inclusive of spiritual experiences (Grof, personal communication). Transpersonal psychology builds on the work of Maslow (1968) and his followers, who observed the need for personal and spiritual meaning as a more signicant drive in the lives of ordinary people. Boorstein (1997) asserted that transpersonal psychology and psychotherapy presuppose the existence of a spiritual dimension in human beings. A positive view of the human psyche and life is basic to transpersonal psychology and transpersonal psychotherapy. Transpersonal experiences can be dened as experiential expansion or extension of consciousness beyond the usual boundaries of the body-ego and even beyond the limitations of time and space (Grof 1988). Boorstein (1997) saw transpersonal psychotherapy as building on and including the techniques and goals of traditional psychotherapy, while at the same time broadening the conceptual framework. What Grof (2000) called non-ordinary states or holotropic states referred to ways of being that supported the psyche to move towards wholeness, well-being and expanded awareness. Central to the ET framework is the concept that the psyche has generative healing processes (Tallman and Bohart 1999, p.120) that are in continual movement towards wholeness and health. Jungs central concept of individuation (Fordham 1991 [1953]) related to a journey to integrate the conscious and unconscious and reconcile opposites in the psyche, as well as understand the collective unconscious and the inuence of archetypes. His way of describing this purposive movement is echoed in Maslow and the optimistic stance in transpersonal psychology. Virginia Axlines play therapy (Axline 1989) is based on the concept that, given the right conditions and materials, young clients will naturally play out the most relevant issues. An organizing principle in the psyche selects the issues most needing to be played out for relief from dynamic inner tension. In Kalff s sandplay therapy (Kalff 2003 [1980]) a central concept is that a series of undirected creations with miniatures in a sandtray reveals an organized, progressive movement of the inner healing mechanism of the psyche, eventually showing more spiritual symbols of the self. In ET the transpersonal context shapes how the client is viewed. For example, psychological growth is viewed within a context of spiritual unfolding, in which developing consciousness is central. The important opportunity on offer is that a client can, when a transpersonal dimension is
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included in therapists considerations, have a much broader experience of themselves and their potential (Cortright 1997). The meaning of life and existence can be seen from an expanded perspective. Life events, times when there is a crisis in meaning, are then viewed as containing the potential for growth. Therapy steps beyond the goal of xing the here and now, the outer layer of life, experience and emotions, and becomes interested in recognizing and exploring the meaning behind experience, particularly spiritual experiences (Cortright 1997). Including contemplative activities in therapy makes use of tools such as introspection, contemplation and meditation to offer support for development beyond what has been assumed to be the upper limit of health and well-being (Walsh 2005). The essence of our particular ET approach is close to the assumptions delineated by Cortright (1997, p.16) as underlying transpersonal psychotherapy. The main assumption is that our essential nature is spiritual. Throughout time, in every culture, there has been recognition of this inherent spiritual interest, and that consciousness is multidimensional. ETtrained facilitators are open and competent with exploration of different levels of consciousness. As we have previously pointed out, the initiative for any therapeutic direction is always driven by the client. Multidimensional consciousness covers a wide range of states, from heightened sensory and emotional awareness an extremely important state within therapy, achieved through self-focus to deeply meditative states achieved through many years of training, to non-ordinary states accessed through deep experiential therapies like holotropic breathwork or hypnosis. In non-ordinary states elements from all levels of consciousness, including the personal unconscious, the pre-personal unconscious and the collective unconscious, are accessible. (See Figures 10.2, 10.3 and 10.4.) MINDFULNESS In ET the focus is on developing the counsellors interest, awareness and practice with spiritual concepts and methods, to enable appropriate, competent support of clients. Accomplishing this level of support is dependent on the experiential training, theoretical orientation and metaphysical interest of a practitioner. Maintaining a high level of presence to, and connection with, a clients frame of reference builds on their pre-existing resources. It also opens a safe space for exploration and experiencing areas of their spirituality. Focusing attention internally is claimed to provide building blocks for new neural pathways (Siegel 2007). Mindfulness emphasizes the importance of experience over knowledge, and focuses very much on generating non-judgemental awareness in the here and now. Mindfulness practice has implications both for
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Figure 10.2 Adult female: Feeling a deep sense of peace.
Figure 10.3 Adult male: I have to nd my own way.
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Figure 10.4 Adult female: Theres more life left in my body.
integration in therapy and for spiritual exploration through focused attention. Hinterkopf (1998) recommended a focusing activity to support clients to reconnect with their spirituality; a simple process that can activate individual existential search, which, in turn, can generate new experiences of meaning and personal satisfaction. Pointing out that mindfulness has been in use in Western psychotherapeutic practice since the 1970s, Whiteld (2006) described mindfulness as supporting dis-identication with internal experiences. A client would be encouraged to observe the present moment and recognize a thought as simply a thought, and not be enticed to identify with it or follow inner experiences to the point where they could take on the mantle of reality. When mindfulness approaches are integrated into counselling, the client is supported to accept (not resist) whatever thoughts, emotions, feelings, sensations arise. These internal experiences cannot be perceived clearly or fully if the client is turning away from them. In perceiving cognitive, emotional and somatic events more closely, the client often overcomes reactive tendencies one of the aims of traditional meditation. Highlighting the fact that not all clients will benet from the inclusion of mindfulness activities, Whiteld (2006, p.206) found that combining mindfulness with cognitive approaches in individual counselling offered enhanced effectiveness. However, he also noted that clients are likely to need some emotional work before mindfulness practice can be fully effective.
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The ET practice of helping a client remain focused on their internal experience, express the feelings that accompany that experience, then separate from them (dis-identifying), can lead clients to deeply reective states that have been described as spiritual. The aspect of mindfulness highlighted in expressive therapies practice is the focus state, with attention turned within. The key is to maintain in the position of the observer rather than identify with the content. The content always contains some magnetic pull to draw us into replaying the emotional, somatic or cognitive content, ruminating on it until it dominates the foreground. INCLUDING CLIENTS TRANSPERSONAL EXPERIENCES Western psychology has until recently failed to recognize spirituality and spiritual needs as basic to human nature (Smith 1995). Therapists may previously have been led to regard the professional role they inhabit as that of a sort of sage whose learned wisdom, perceptive observations and knowledge about defects in the psyche can replace the clients own potential for solving their problems. To practise from this perspective is to disempower clients and to ignore their innate thinking-exploring-experiencing process (Tallman and Bohart 1999, p.120). This is important when we discuss transpersonal frameworks, in which clients directorship of their therapy process is maintained, and their skills in self-focus enhanced. In our professional practice with ET we have found that, as an individuals therapy moves beyond problematic aspects, creativity, positivity and spirituality begin to emerge more frequently in an organic, unstructured way. (See Figures 10.5 and 10.6.) In discussing a transpersonal approach to supporting a person diagnosed with a life-limiting illness, Smith (1995) proposed that supporting them to link their individual perspective on death to a transpersonal awareness would have a direct impact on reducing any psycho-spiritual distress. Similarly, in working with families who have relatives with neurobiological brain disorders, Le Gacy (1998) found although it may seem like a paradox that by linking individual pain to the worlds pain, personal suffering was decreased. She found that people were hungry for connection and meaning in their lives, and sometimes painful experiences like deep loss and grief provide opportunities for making that connection (Le Gacy 1998). Moore (1975) stated that when a person becomes more aware of feelings, fantasies and experiences that are part of the common heritage of human beings, they also begin to sense the interrelatedness of all things. In a training module in transpersonal psychology with Dr Stanislav Grof, the present authors were reminded that when we come to recognize
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Figure 10.5 Adult female, symbol work: The sacred in nature.
Figure 10.6 Adult female, drawing and symbols: The sacred in nature.
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and understand that interrelatedness discussed by Moore, then all of life becomes sacred (Grof, personal communication 1997). Along with other writers in the eld, we would make the distinction between religion and spirituality. However, we are very happy to leave philosophical debate to minds greater than our own. Spirituality and what constitutes a spiritual experience can be highly individual and often resists being bedded down into one single, clear description. One writer has dened a spiritual experience as a subtle, bodily feeling with vague meanings that brings new, clearer meanings involving a transcendent growth process (Hinterkopf 1998, p.11). Hinterkopf emphasized the need for a counsellor to focus on the spiritual process rather than specic content. Boorstein (1997) recommended that therapists utilize a clients own spiritual practices and aim to work from a more centred state attained through the therapists own efforts at spiritual practice. In professional work, Boorstein claimed that holding a spiritual view of clients, remembering that they are a piece of the Divine, helped professionals stay in a caring mode. When that caring is spontaneous and natural in a therapist, and is experienced as such by clients, the possibility of countering a clients lifelong view of themselves as worthless begins (Boorstein 1997). CHILDRENS SPIRITUAL WELL-BEING The spiritual well-being of children is now becoming a more widespread topic than ever before. This eld of interest is one where ET can make a signicant contribution. For example, a child who feels affected by adverse circumstances, or who seems challenged within their interactional environments, may benet from taking part in time-limited personal awareness and personal development therapeutic activities within a small peer-group setting, perhaps within the context of their school. ET activities make it possible to support childrens well-being with the noted absence of any dogma or preferred brand of beliefs or practices. The central element of school-based well-being programmes that have been created using ET (Pearson 2006) is to offer activities that encourage the spirit of the child to ourish, be nourished and communicated. A Queensland-based primary-school teacher has reported on her work using Pearsons Innerspace Program with young Aboriginal children. Her reports of being amazed at the more positive way these students were able to re-engage with the school setting after taking part in the programme attest to the stronger sense of self and identity that the ET activities engendered. The Innerspace Programs, specically tailored to suit three different age groups within a school, are a coordinated approach to supporting young people who may be displaying signs of emotional stress within their
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school setting, to connect with peers at a deep personal level. Figures 10.7 and 10.8 show some of the completed activities done by participants in the Innerspace Program.
Figure 10.7 Ten-year-old female: Sentence starter activity.
Figure 10.8 Eleven-year-old female, worksheet: Music, drawing and words.
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Mountain (2007) claimed that creative arts activities engage children in learning that is very closely related to spiritual development, involving: self-understanding understanding relationships wider environmental connectedness connection to the sacredness of our world and humanity; connection with the divine.
Without manipulation, ET allows the transcendent interest in clients to emerge and create meaning and direction. TRANSPERSONAL EDUCATION Boorstein (2000) outlined part of his working hypothesis of transpersonal support for clients as a willingness to appreciate that the core nature of consciousness is positive and loving (p.412). Is it possible to learn or teach this concept, which sees who we are through a lens of optimism? How would we convey that view of humanity to a client? Moore (1975) has summarized factors that support transpersonal understanding and working within a psycho-spiritual context. ET philosophy and practice correspond to the ideas of Moore (1975) and of Cortright (1997), Cornett (1998) and Grof (2000), with emphasis on: body awareness and sensitivity the need for teachers to transcend their own ego needs the appropriateness of myth and symbol to convey intuitive knowledge a serious approach to the arts an attitude towards science which values wonder and increased sensibility.
To this list, ET training would add a strong emphasis on learning about, reading about and, if possible, exploring cultures and mythologies other than our own. IMPLICATIONS FOR PRACTICE TRANSPERSONAL AWARENESS IN ACTION In terms of facilitation, the transpersonal perspective sees the therapeutic task as one of support and guidance, not intervention and advice. Grof
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points out that the original meaning of the word therapist is related to non-intrusion. The term is used in the sense of the Greek therapeutes, which means a person assisting in the healing process, not an active agent whose task is to x the client (Grof 2000). Symptoms are seen as a sign of healing trying to happen, so, rather than attempting to remove symptoms, therapists can encourage the emergence of underlying material awaiting processing. Having a transpersonal perspective provides useful concepts and practices that can enhance a client-centred approach to counselling. A transpersonal perspective presumes that an average person operates at a level less than their real potential and capacity, because they are identied with only a small fraction of their being (Grof 2000, p.181); Grof argued that the small fraction related to identication with body and ego. This is evident with many clients, who have become identied with what they see as shortcomings, failures, weaknesses, who carry labels placed on them by family, society, and from within their own emotional suffering. Transpersonal psychotherapy is heart-centred, optimistic and hopecentred. Accessing transpersonal states of consciousness elicits love and compassion as spiritual values that are actualized in the therapeutic alliance (Cortright 1997). If we develop a concept of our clients as being already on a healing journey, if we feel optimistic about the challenges they face, if our relating with them remains hope-centred, then it supports a transpersonal context for their growth. CULTURAL CONSIDERATIONS For working with transpersonal issues with clients from different spiritual and cultural backgrounds, Cozolino (2004) recommended openness in the areas of cultural differences and a willingness and capacity to apologize if our ignorance caused upset or offence. While encouraging therapists to practise not knowing, Cozolino (2004, p.62) outlined some points to keep in mind: make any assumptions and prejudices we have conscious list them and discuss them with colleagues make the decision that you are ignorant and need to learn about the clients religion or culture ask the client to educate you about their experience.
Some general ET guidelines for supporting clients to re-connect with their spirituality, or provide an opportunity for them to have a felt sense of the sacred:
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Enhance intra-personal focus with focus questions that support reection. Process emotions that may block the self-connection. Guide awareness to the body and the energy within it. Invite the client to share something of their spiritual orientation. Invite reection on family-of-origin attitudes to spirituality and religion. Invite the client to reect on previous peak experiences and the circumstances that evoked them. Use a multi-modal approach. Allow the chattering mind to be heard before inviting it to relax. Provide some basic relaxation techniques. If appropriate, explore some basic centring techniques. Provide times that support prolonged inner focus.
In preparing to support clients to move towards awareness of spirituality it can be helpful to take time to pursue our own personal growth, to check if we are in a compassionate state, and to seek supervision for blockages in self, or for compassion fatigue. All clients embody a rich and often curious mix of mysterious dynamics that, when combined, make them uniquely themselves. This mix signies their essence something that provides each of us with the potential to imagine, dream of and create things possible but not yet present in our senses (Hillman 1989).
Summary
As we near the end of this book, Chapter 10 has introduced a final, critical element in the search for meaning, healing and wholeness. A transpersonal paradigm is multiperspectival, embracing acceptance of different ways of knowing including those that fall outside more familiar, rational explanations, and helps us stay with what emerges in a session, acknowledging that a clients material may come from different levels of consciousness. Adopting a transpersonal stance requires us to move away from continuing to talk more about talk and allowing therapeutic endeavours that involve awareness of the potential for lived transformation.
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Integrated into a transpersonal attitude is working with respectful mindfulness and a simultaneous willingness to consider the innate healing mechanism of each individual a sort of inner compass that can guide the healing process. The process of healing is viewed as dynamic, fluid and ever-changing. What is established as true for one client is not necessarily true for another. The aim is to enhance the individuals interactions with their inner and outer worlds.
Figure 10.9 Adult female: A new look at the seasons.
EXPLORING SPIRITUALITY SENTENCE STARTER ACTIVITY
Finding my essence
The focus of this activity is to create a foundation for a client to reflect on and communicate their spiritual interests.
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You can have the prompts pre-prepared on an A4 sheet (keeping the reverse side blank for extra writing space if needed). Or a client may prefer to scan through a prepared list, choose the starters in which they feel interested, and then use another blank sheet to record their responses to those. Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels. Age range: 12 years to adult. Suggest that the client takes one or two slow, full breaths, releasing the breath with a slow sigh. After giving an outline of the activity, take a moment in silence for both therapist and client to disconnect from the talking part of the session. When ready to begin, invite the client to respond to any or all of the sentence starters that catch their interest. Assure them that they do not have to show the actual written responses to anyone.
Note: The writer (client) can use single words, dot points, phrases, or create whole sentences as a way of completing the following prompts.
Take a slow breath and give yourself time to look over the prompts on this sheet. See if there are two, three or perhaps more that grab your attention as you scan the page. Then relax as much as you can, choose a pen or pencil. Returning to the prompts that seemed most interesting, take some time now approximately 1015 minutes to finish the sentences. Once you finish the two or three you have chosen to begin with, see if there are any others youd like to write about. Your writing does not need to be sequential, carefully constructed or like a narrative. Simply allow yourself to respond spontaneously to the prompts.
Invite the client to take a gentle but full breath. Then take some time to scan through these sentence starters.
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Spirituality means The part of nature I most enjoy The feelings that seem to get in the way I am unique because I feel a more spiritual connection with nature when If I could describe my essence/true nature it would be The most special moment/s in nature was/were
When it seems that the writing part of the activity is complete, allow time for the client to reflect silently on what they have written. Then suggest the following steps: Take time to review what you have written, see if any further words or phrases emerge, and record those on the page. Underline the most interesting words. Tune in to yourself, see if you can imagine what your essence might look like, how it would present in your daily interactions with the world, what creative pursuit you might follow.
Together with the client, take time to discuss the responses that they have recorded. After some discussion ask the client if there is anything more they would like to say, ask or question. Consider whether a homework task would be appropriate and supportive. For example, ask the client what comes to mind for them to keep in touch with their essence. Some suggestions you could make if they are unsure might be, for example, taking time to walk in nature (see next activity) perhaps by a beach or around the garden surrounding their home, walking with a friend, sitting looking at a river flowing, playing with family pet/s. Remember to consider personal safety when making any suggestions. REFLECTION, WRITING AND DRAWING ACTIVITY
Colours of the seasons

Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels. Age range: 12 years to adult. Preparation: Take some time to relax your body. Take some slow, full breaths, breathing out any tension.
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Close your eyes and see what associations come into your mind when I ask you to imagine the colours of the seasons. What colours would you choose for winter? Spring? Summer? Autumn? Divide your art pad into four sections. Choosing one of the seasons and one of the four sections, use your crayons to draw colours, shapes, lines, images on that section of the page that go with the season you are thinking about. When you have finished, move on to the next season, and so on, until you have a page with colours, shapes and forms for each of the seasons. Record in your journal or on some notepaper how you feel when you think about each of the seasons. (Note: This could be done in discussion format rather than as a writing activity.) Do you resonate with one season more than any other? Can you say what makes that season special for you? How could that season relate to you, your life story? Can you recall something interesting, joyful, amazing that happened in (season)?
Take time to look at the drawings you have created. Is there anything you could say about what you see? (For example, which parts are dark, which parts are light, etc.) Can you share with me anything about your drawings or about what you have written? How do you think what youve drawn and written/talked about could help you with your life story?
REFLECTION, WRITING AND DRAWING ACTIVITY
My recent relationship with nature

Aim: This activity focuses on reflecting on a period of several days and recording in art form and writing the sensations, feelings, impressions of those days. Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels.
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Take a few moments to breathe, relax and come home to yourself. In your art pad draw four circles, squares, rectangles, blobby shapeswhatever shape seems to represent one day in your life at this point in time. Sitting quietly, reflect on the following questions, and on the one page record in image, colour and words your response. In the past few days what aspects of nature have I (the client) noticed? Wind, rain, cold, sun, trees, grasses, water, the changing light etc? What has been my relationship with nature over recent days? What has been my tolerance level for silence and my capacity for being alone? How would I describe my relationship with my most unique qualities in recent days? What has been happening with my imagination? What has been happening with my creative interests? What attention have I given to things that have heart and meaning for me?
Choose one of the shapes you have drawn. Name this shape today, and record in colour, line, shape and symbol something from your experiences today, that expresses your response to these questions.
Repeat this task, choosing a separate shape for each day of the past three days.
DISCUSSION PHASE
As per previous activities. REFLECTION, WRITING AND DRAWING ACTIVITY
My connection to nature
Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels. Age range: Adult.
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Invite the client to relax, take a deep breath and tune into their body.
VISUALIZING
See if you can recall an area in nature which attracts you, a place you love to be, where you feel safe, happy, more in touch with yourself: it could be a favourite beach, in the mountains, by a creek; it could be a lake, a river, a desert it may include the sky, trees, flowers, beautiful views it could be a special part of your garden at home or at your grandparents place.
Could you close your eyes, take a few deep breaths, and imagine being there now? What would you hear? smell? What would you touch? What are the main things you would see? Become interested in the detail of what you remember. Take time and allow the pictures to soak in enjoy them. What stands out for you? What is the most noticeable aspect?
Imagine moving through this place, or being still.
Would you like to do a quick sketch of the scene or the main thing you remember? Could you jot down your main memories of this place?
DISCUSSION
Could you share as much as you like about: The times you have been there? Who was there with you? How it made you feel to be there? Any way this beautiful place in nature is like you?
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Figure 10.10 Adult female, mandala: Gratitude for support.
INNER FOCUS OR MEDITATION ACTIVITY
Finding energy centres

Resources: Pencil or coloured pen, A4 paper (white or light coloured), crayons, coloured pencils, pastels. Age range: Adult.
Allow your body to relax as much as it can. Take a few deep breaths. Move your attention on your chest. Tune in there for a moment. Can you feel it rise and fall? (Pause.) Now see if you can move your attention down to your belly. See if you can feel it from the inside, let it relax and hang loose. (Pause.) As you breathe in, move your attention to your chest for a while. (Pause.) On the next outbreath be aware of dropping your awareness down to focus on your belly. (Repeat.) Your attention will simply fall and rise between the heart area and the belly area, along with your breathing.
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Let your breathing remain natural and relaxed. Even if you get distracted, come back to moving the focus of awareness with each breath. We will work this way for a while, feeling first the chest from the inside, then the belly. There is nothing else to do. See if you can simply stay focused inside yourself. Every time a new thought comes into your mind, and you realize it has taken your attention away from the exercise, sigh out all your breath as if you were sighing out the thoughts that get in the way. Then begin again. In this exercise it is normal to begin again and again.
Support the client to work this way for a few minutes.
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List of Activities
CHAPTER 3: ATTACHMENT
Expressive writing activity: Exploring the messages of the inner critic 84 Expressive writing activity: Exploring the impact of childhood scripts now and then 86 Professional reection questions: Exploring the impact of scripts on professional relating 89
CHAPTER 4: SOMATIC AWARENESS

Self-awareness activity: What my body tells me Breathing activities for young clients Breathing more fully 109 108 102 104
Body focus activity: Dialoguing with physical symptoms
Relaxation sequence planning: Creating relaxation sequences for young clients 111 Relaxation activity: Tension and surrender I am a star Bioenergetic activity: Using tension to enhance self-awareness 117 Movement activities: Ways of using movement to support integration 118 Movement and relaxation activity: The sunset Meditation activity: At home in my hands 119 121 124 Relaxation activity: Slowing down, slow walking 113
305
306
Sensory meditation activity: Using my nose instead of my eyes 125 Movement meditation: Slow motion for self-awareness 127
CHAPTER 5: EMOTIONAL RELEASE

Emotional expression activity: What am I feeling? 148
CHAPTER 6: WRITING
Expressive writing formats: Seven ways to explore my world 181 Sentence starter activity: My thoughts about me Sentence starter activity: After self-exploration Self-esteem worksheet: My journey from problems to treasure 190 Word association activity: Really rapid writing!! Story creation activity: Creating a legend 196 194 183 185 186
Self-discovery worksheet: How do I feel when Im with?
CHAPTER 7: ART
Art and music activity: Emotional reection with drawing and music 226 Process drawing activity: Drawing out troubles 230 232 Completion drawing activity: Breaking free with mandalas
CHAPTER 8: MUSIC
Emotional literacy worksheet: Finding feelings in music Emotional release music activity: Talking drums using rhythm and percussion 245 244
LIST OF ACTIVITIES
307
CHAPTER 9: DREAMWORK
Dreamwork activity: Creating dream scenes 259 260 260 263
Dreamwork worksheet: Intensive journal activity Role-play activity: Understanding dream symbols
Dreamwork activity: Active imagination and role-play
CHAPTER 10: TRANSPERSONAL AWARENESS

Sentence starter activity: Finding my essence Reection, writing and drawing activity: Colours of the seasons 283 Reection, writing and drawing activity: My recent relationship with nature 284 Reection, writing and drawing activity: My connection to nature 285 Inner focus or meditation activity: Finding energy centres 287 281
Subject Index
abuse 69, 76, 94, 161, 206, 214, 221 acting out 18, 53, 56, 63, 1367 therapeutic release and acting out 545 activities 23 art and music 22630 bioenergetics 11718 body focus 1047 breathing 108 drawing 2302, 232, 2838 dreamwork 25960, 2636 dreamwork role-play 2603 emotional expression 14852 meditation 1245, 1257 movement 11819, 11921 music 22630, 2457 projective activities in ET 50, 2056 relaxation 11314, 1212 self-awareness 1024, 11617 writing 849, 1836, 1946, 196201, 2836 addictions 214 adolescents 1314, 41, 60, 123, 1534, 156, 236 music therapy 236, 237 see also young people adults 18, 412, 52, 72, 156
aggression 18, 19, 20, 35, 39, 42, 52 art therapy 2034 emotional processing 138, 139 letter writing 165 agoraphobia 123 amplication 257 anger 334, 40, 56, 74, 99, 135, 137, 140 art therapy 211, 217, 219 expressing anger 143, 153 music therapy 234, 236, 240 anxiety disorders 123 art therapy 9, 13, 14, 20, 22, 24, 28, 33, 37, 142, 2023, 226 art and music activity 22630 artwork as therapy 2069 completion drawing activity 232 drawing out emotions in therapy 21523 dreamwork 255 emotions and art 21012 ET, art and school settings 21415 inside art and ET 2035 process drawing activity 2302 projective techniques in ET 2056 research on art in therapy 21214 therapeutic guidelines 2246
attachment 18, 65, 84, 96 attachment theory and ET 66 models of interacting 668 attention decit disorder (ADD) 222 attention decit hyperactivity disorder (ADHD) 214, 222 Australia 11, 30, 214, 2767 autistic spectrum disorder (ASD) 32, 214, 234 Axline, Virginia 14 behavioural problems 29, 30, 33, 237, 238, 239 indicators of emotional healing 413 behaviourist approach 356 beliefs 15, 16, 23, 25, 26, 38, 40, 66, 76, 144, 206 body 100 childrens beliefs 701 counsellors beliefs 61 scripts 80, 81 self-discovery worksheets (SDWs) 172, 173 spirituality 27, 276 bioenergetics 14, 22, 23, 28, 34, 49, 55, 58, 96, 100, 112, 122, 127, 141 bioenergetic activity 11718 movement and bioenergetics 11416
308
SUBJECT INDEX
309
biographical domain 48, 834, 133, 268 blame 42, 701, 72, 136, 162, 225 body 14, 15, 23, 24, 501, 901, 1012 bioenergetic activity 11718 body and mind connection 12933 body, energy and personality 979 body focus activity 1047 body language 93 body, mind and therapist 92 body oriented psychological therapy (BPT) 95 body outlines 24, 31, 100, 1024, 1057, 110, 111, 142, 206, 207, 216 breathing 99 breathing activities for young clients 108 breathing more fully 109 focusing on body language 1001 follow-up strategies for self-awareness activities 11617 improving outcomes with body focus 945 including our body in therapy 912 kinaesthetic components of ET 278 meditation 1224 meditation activity 1245 movement activities 11819 movement and bioenergetics 11416 movement and relaxation activity 11921 movement meditation 1278 muscular armouring 94
relaxation 10911 relaxation activity 11314, 1212 relaxation sequence planning 11113 self-awareness activity 1024 sensory meditation activity 1257 somatic awareness and resonance in ET 934 therapists somatic awareness 957 tuning in to the body 99100 Bonny, Helen 14 brain 36, 66, 67, 90, 132, 136, 233, 274 left-brain 24, 52, 145 right-brain 24, 52, 64, 134, 145 breathwork 9, 12, 28, 53, 99, 271 breathing activities for young clients 108 breathing more fully 109 Buddhism 95 burn-out 82, 83, 239 Bushmen 11 carers 66, 67, 91, 147, 1545, 1801, 210, 237 catharsis 10, 11, 18, 51, 54, 215 catharsis and cognition 557 children 1314, 18, 24, 29, 52, 131 attachment 668 breathing activities for young clients 108 childrens spiritual wellbeing 2768 condentiality 1801 emotional stress 1356 ET, art and school settings 21415 healing 412 inner critic 723
music therapy 2367, 238, 239 play therapy 19, 38, 213 problem-solving 30 stories, play and resilience 1756 see also young people choice 46 clients 1011, 20, 24, 130 body awareness 92, 93 code of respect for clients 63 factors common to effective counselling 201 including clients transpersonal experiences 2746 intra-personal skills 256 therapeutic alliance 1516 writing and professional care 1801 closure 24, 41 integration and closure 1456 cognition 51, 52 catharsis and cognition 557 cognitive behaviour therapy (CBT) 36, 58, 239 collage 38, 154, 156, 159, 161, 1734, 179, 215 colour 211 communication 23, 24, 25, 26, 28, 31, 54, 58, 59, 61, 66, 70, 78 art therapy 215 misinterpretation 80 multi-media communication catalysts 1546 nonverbal communication 38 scripts 70 silence 434 completion 41 completion drawings 24, 146, 232
310
completion cont. completion mandalas 142, 152, 21823, 226, 232, 266 completion writing 146, 167 condentiality 144, 1801, 224 conicts 18, 20, 36, 40, 41, 42, 133, 154, 204, 209, 250 connection 23 body and mind connection 12933 constructivism 16, 123 core energetics 28, 978, 99 core modalities 1415 counselling 11, 1314, 358, 64 counselling relationship in ET 434 expressive experiential counselling 389 factors common to effective counselling 201 Gardners multiple intelligences 5760, 64 counsellors 18, 23, 26 counsellors scripts 61, 813, 84, 89 counsellors self-awareness 957, 145, 215 counsellors use of self 612 Cozolino, Louis 14 creativity 78, 20, 26, 34, 37, 41, 42, 43, 203 differentiating scripts from a creative self 79 inner critic 73 cultural considerations 26, 135 transpersonal psychotherapy 27980 dance 8, 17, 146 Darwin, Charles 91
defences 8, 10, 20, 28, 39, 40, 44, 50, 63, 131, 136, 140 dementia 214 depression 73, 115, 130, 137, 209, 214 art therapy 238, 240 dialogue 17, 23, 80, 91, 142, 162, 165, 173, 236, 238, 249 dialoguing with physical symptoms 1047 drama 37, 38 drawing 14, 20, 23, 33 completion drawing 24, 146, 21516 completion mandalas 142, 152, 21823, 226, 232, 266 process drawing 215, 217 process drawing activity 2302 reection, writing and drawing activity 2836 reective drawing 215, 21617 dreamwork 9, 12, 14, 23, 24, 26, 2489, 258 dreams and therapy 2504 dreamwork activity 25960, 2636 dreamwork role-play activity 2603 dreamwork worksheet 260 ET ways for dreamwork 2547 exploring dream imagery 24950 projective mechanisms in dreams 2578 eating disorders 123, 214 emotional healing see healing emotional literacy 15, 23, 245, 26, 32, 123, 141 emotional literacy worksheet 2445
music and emotional literacy 233, 23941 writing 175, 181, 186 emotional release 9, 11, 13, 14, 15, 142 beyond the personal process 75 contraindications 1467 emotional release counselling (ERC) 10, 13 emotional release music activity 2457 emotional release processing 745, 1401 experiential training 601 problem-solving 75 supporting emotional release 1445 therapeutic release and acting out 545 emotions 1618, 101, 129 accessing 745 accessing and experiencing 1335 body and mind connection 12933 drawing out emotions in therapy 21523 emotion-focused therapy 12, 22, 81 emotional expression activity 14852 emotional stress 503, 1357 emotions and art 21012 integration and closure 1456 outcomes from focusing on emotion 13840 processing 23 processing distressing feelings 801 six ways to work through emotions 1412 staying with 75 supportive environment for processing 1434
SUBJECT INDEX
311
when not to process emotions 1467 working through emotional distress 8990 empathy 16, 17, 21, 26, 27, 60, 61, 62, 73, 81, 82, 174, 215 empathic listening 225 mirroring 96 supporting emotional release 145 therapeutic relationship 39, 40, 43, 50, 97 empowerment 10, 17 energy 53, 136 body, energy and personality 979 energy release 10, 11, 14, 23 expressive therapies (ET) 7, 910, 1012, 1314, 34 attachment theory and ET 66 attraction of ET 1920 being, not doing 467 core modalities 1415 counselling relationship in ET 434 effectiveness 2832 emotional healing 18 ET in school settings 302, 324, 13940, 21415 evolution of ET principles 212 factors common to effective counselling 201 in-built mechanism for healing 1819 inside art and ET 2035 invitational relating 446 kinaesthetic components of ET 278 offering choice 46 projective activities in ET 50, 2056 putting principles into practice 237
therapeutic alliance 1516 therapeutic guidelines for using art in ET 2246 working through emotional distress 8990 working with emotions 1618 Expressive Therapies Institute 11 externalization 14, 23, 32, 37, 41, 50, 60, 84, 173, 175, 205, 207, 209 family therapy 213, 238 free association 256 freedom 31, 42, 63, 64, 68 freedom of expression 206, 224 moving towards freedom 735 sense of freedom 138 writing 159, 168, 180 Freud, Sigmund 61, 91, 94, 249, 250, 253 Freudian psychology 8, 11, 39, 129, 207, 252, 269 friendships 69, 72, 75, 76, 216, 224, 258, 267 Gardner, Howard 57 Gestalt therapy 10, 19, 22, 38, 50, 203, 253 empty chair 17 Greenberg, Leslie 14 grief 30, 40, 99, 141, 143, 146, 173, 204, 215, 234, 236, 274 Grof, Christina 12 Grof, Stanislav 12, 14 groupwork 13, 24, 45, 252 interpersonal skills in groupwork 27 guilt 42, 162, 240 healing 18, 3941, 91 healing childhood scripts 6872
healing stories 1645 in-built mechanism 1819 indicators 413 writing for healing 16770 homework 4950, 101, 133, 173, 208, 216 hormones 501, 98 humanistic psychology 22, 270 imagery 210 exploring dream imagery 24950 imagination 248, 257, 2636 immune system 136, 156, 164, 210 individuation 14, 18, 22, 39, 224, 252, 270 inner critic 68, 71, 723 exploring messages of the inner critic 846 inner healer 1819 inner life skills 15, 23, 245, 43 integration 10, 11, 13, 14, 15, 1718, 23, 24 integration and closure 1456 using movement 11819 interpersonal skills 27 intra-personal intelligence 23, 25, 59, 215, 23940 intra-personal skills 256 invitational relating 15, 16, 38, 41, 446, 61, 64, 97, 112, 225, 227 Janov, Arthur 12 journals 14, 301, 155, 1578, 15960, 1603 Jung, Carl Gustav 14, 130, 218, 249, 250, 253 Jungian psychology 10, 12, 18, 19, 22, 39, 98, 252, 269
312
Kalff, Dora 12, 14 learning difficulties 30, 52, 123, 214, 238 letting go 74 lists 24, 154, 161, 166 loss 30, 40, 130, 143, 146, 173, 204, 215, 274 love 75, 77, 78 Malaysia 11 mandalas 14, 24, 31, 107, 117, 118, 146, 161, 216, 287 completion mandalas 142, 152, 21823, 226, 232, 266 mapping 14, 23, 111, 161, 206, 216 Maslow, Abraham 269 massage 8, 101 medications 147 medicine 233 meditation 8, 14, 24, 116, 1224, 267 inner focus or meditation activity 2878 meditation activity 1245 movement meditation 1278 sensory meditation activity 1257 memory 28, 478, 233 metaphor 23, 24, 27, 37 symbols 37, 389, 50 migraine 90, 208 mind 24, 90, 91, 101 body and mind connection 12933 body, mind and therapist 92 mindfulness 95, 123, 267, 2714 miniatures see symbols mirroring 96 movement therapy 13, 14, 37, 146 dreamwork 257 movement activities 11819
movement and bioenergetics 11416 movement and relaxation activity 11921 movement meditation 1278 multiple intelligences 22, 2930, 5760 muscular armouring 51, 53, 94, 98, 101, 114, 11516, 136 music therapy 13, 14, 22, 23, 24, 28, 37, 142, 233, 243 art and music activity 22630 choosing music 2423 emotional literacy worksheet 2445 emotional release music activity 2457 music and emotional literacy 233, 23941 music in therapy 1434, 2349, 2412 narratives 15, 28 symbolic personal narratives 17980 Naumburg, Margaret 207 neglect 19, 67, 69, 76, 161, 206 neurons 96, 134 neuroscience 14, 52, 129, 131, 148, 164 New Zealand 11 offenders 214 outcomes 15, 18, 201, 25, 28, 29, 334, 35, 38, 39 emotional healing 413 improving outcomes with body focus 945 meditation 122, 123 outcomes from focusing on emotion 13840 palliative care 214 panic disorders 123
parental inuences 52, 67, 78, 1801, 208 childhood scripts 6872 counsellors 82 partners 37, 6970, 72, 75, 76, 78, 257 peak experiences 269, 280 perinatal domain 37, 48, 834, 92, 133, 254, 268 Perls, Fritz 12, 14 person-centred approach 19, 21, 22, 36, 40, 44, 124, 215 persona 989 personal development 16, 26, 71 personality 7, 18 body, energy and personality 979 personality disorders 214 philosophy 8, 267 play therapy 19, 22, 28, 38, 213, 270 stories, play and resilience 1756 poetry 37, 58, 154, 159, 167, 168 post-traumatic stress disorder (PTSD) 40, 945, 204, 222, 239 primal scream 8, 12 problem-solving 15, 24, 29, 30, 36, 41, 42, 43, 46, 57, 75, 78 behavioural methods 17 children 30 emotion-focused processes 131, 133, 139, 140 writing 155 projective techniques 50, 2056 psyche 14, 16, 26, 41, 42 depths in the psyche 479 in-built mechanism for healing 1819 layers in the psyche 1378
SUBJECT INDEX
313
projective activities in ET 50 scripts 68, 69, 70, 77 shadow 98, 258 Psychoanalytical Association 92 psychodynamic approach 10, 22, 367, 59, 65, 67, 1689 art therapy 2089 psychosis 214 reection 14, 445, 56, 59, 81, 116, 280 art therapy 209, 215, 216, 219, 222, 225, 226, 232 cognitive reection 52, 92, 173 dreamwork 251, 254, 2656 emotion-focused processes 133, 134, 143, 144, 146 guided reection 26 meditation 123 music therapy 234, 242 reection, writing and drawing activity 283 4, 2845, 2856 self-discovery worksheets (SDWs) 1704, 186 therapists 84, 89 writing 154, 155, 156, 157, 160, 163, 166, 175, 185 writing guidelines 1789 regression 78, 240, 250 Reich, Wilhelm 912, 94, 114 Reichian psychology 8, 98, 99, 136 rejection 73, 77, 80 relationships 69, 71, 72, 73, 213 scripts 757 relaxation 8, 11, 14, 23, 24, 10911, 146 movement and relaxation activity 11921
relaxation activity 11314, 1212 relaxation sequence planning 11113 religion 27 resilience 14, 15, 47, 60, 67, 99, 131, 135, 139, 148, 163, 250 art therapy 203, 220 immune system 136 stories, play and resilience 1756 resistance 10, 37, 63, 111, 140, 144 Rogers, Carl 19, 20, 36, 39, 44, 58 role-play 14, 24, 50, 117, 119, 141 dreamwork 252, 253, 255, 256, 258, 2603 role-play of signicant symbols 2646 sandplay therapy 7, 9, 12, 14, 19, 20, 22, 24, 28, 33, 34, 37, 270 autistic spectrum disorder 32 dreamwork 256 learning difficulties 30 literacy 31 silence 44 transpersonal skills 27 young people 38, 46 schizophrenia 95 schools 18, 21, 42 ET in school settings 302, 324, 13940, 21415 meditative practices in schools 1234 Schore, Alan 14 scripts 43, 65, 678, 84, 179 counsellors scripts 61, 813, 84, 89 differentiating scripts from a creative self 79 exploring childhood scripts 869 exploring therapists scripts 89
healing childhood scripts 6872, 734, 75, 767 impact on relating 757 processing distressing feelings 801 self-actualizing 15, 19, 39, 47, 62, 203, 269 self-awareness 14, 15, 25, 40, 42, 45, 47, 61, 63, 65, 111, 140, 144 breathing 53 counsellors self-awareness 957, 145, 215 developing self-awareness 23, 1334, 141, 166 drawing 216, 219 emotional release process 74 meditation 124 movement 118, 127 music therapy 237, 240 self-awareness activities 1024, 11617, 306, 307 writing 154, 160, 161, 166 self-care 16, 42, 77, 93, 95, 101, 109, 123, 133, 145, 161, 216 self-commitment 74 self-discovery worksheets (SDWs) 14, 15, 24, 1704, 18690 self-esteem 15, 23, 24, 31, 67, 123, 140 low self-esteem 52, 54, 71, 73, 137 self-esteem worksheet 1904 self-learning 24, 123 self-regulation 42, 55, 215, 237 self-sabotage 43, 69, 70, 71, 72, 73, 78 sentence starters 32, 41, 141, 146, 155, 163, 166, 175, 1779, 1835, 1856, 2813 separation 75 sexual abuse 94, 214
314
sexual behaviour problems 60 shame 42, 71, 72, 73, 162, 163 Siegel, Daniel 14 silence 434, 141 Singapore 11 skin problems 123, 136 sleep disorders 238 somatic awareness 14, 934 therapists 957 spina bida hydrocephalus 31 spirituality 22, 27 childrens spiritual wellbeing 2768 transpersonal psychotherapy 2813 stories 1645 stories, play and resilience 1756 story creation activity 196201 telling the dream story 2556 suffering 9 20, 37, 54, 77, 81, 83, 136, 170, 204, 233, 251, 274, 279 suicide 167, 168, 174 symbol work 12, 14, 15, 23, 24, 301, 33, 34, 389, 43, 45, 46, 49, 148 art therapy 154, 21011, 214, 215 self-discovery worksheets (SDWs) 173 symbolic personal narratives 17980 visual/spatial intelligence 58 working through emotions 141, 142, 147 writing 153, 156, 183 symbols 23, 24 dreamwork 248, 250, 256, 2645 intra-personal skills 256 metaphor 37, 389, 50
transpersonal skills 27 symptomatic behaviours 36, 37, 38, 40, 1357, 148 children 214 resolving emotional stress 503 symptoms 278, 38, 42, 67, 901, 934, 138, 164, 216, 279 body focus 945, 99 100, 101, 11617 dialoguing with physical symptoms 1047 meditation 123 post-traumatic stress disorder 222, 239 stress 136 therapeutic alliance 14, 1516, 17, 23, 75, 81, 967, 240 factors common to effective counselling 201 music therapy 236, 240 transpersonal psychotherapy 267 writing 156, 180 therapists 84, 89 body, mind and therapist 92 therapists somatic awareness 957 timing 11, 40, 63, 143, 211 training 10, 11, 12, 19, 212, 55, 92, 97, 123, 145, 148 art therapy 204, 214, 226 cultural considerations 278 experiential training 34, 601, 62, 80, 82, 96, 157, 271 multiple intelligences 2930 music therapy 234, 241 self-discovery worksheets (SDWs) 173 spirituality 27, 271
transcendental meditation 8, 123 transpersonal psychotherapy 10, 12, 19, 22, 2678, 2801 childrens spiritual wellbeing 2768 cultural considerations 27980 exploring spirituality 2813 implications for practice 2789 including clients experiences 2746 inner focus or meditation activity 2878 mindfulness 2714 new maps of the inner world 2689 reection, writing and drawing activity 2836 three domains 37, 489, 834, 133, 268 transpersonal education 278 transpersonal paradigm 26971 transpersonal skills 27 trauma 24, 68, 69, 92, 98, 101, 136, 153, 168, 179 art therapy 206, 207, 214, 215, 221 dreamwork 249, 253 music therapy 2367, 239, 2401 writing and trauma 1634 trust 40, 44 violence 18, 83 visualization 14, 24, 25, 26, 30, 111, 112, 122 instructions to client 197, 286 music 236 relaxation activity 11314, 146
SUBJECT INDEX
315
Wadeson, Harriet 14 withdrawal 52, 80, 136, 137, 140 writing 14, 20, 23, 32, 141, 1534, 181 dreamwork 255 experimenting with sentence starters 1779 exploring childhood scripts 869 exploring the inner critic 846 expressive writing activity 849 expressive writing formats 1813 healing stories 1645 journalling and expressive writing 15960 letter writing 165 multi-media communication catalysts 1546 personal development and well-being 1745 practical use of journals 1603 professional care 1801 reective, process and integrative writing 1657 self-discovery worksheets (SDWs) 1704, 18690 self-esteem worksheet 1904 sentence starter activity 1835, 1856, 2813 stories, play and resilience 1756 story creation activity 196201 symbolic personal narratives 17980 therapeutic use of writing 1579 word association activity 1946
writing and trauma 1634 writing for healing 16770 young people 26, 28, 29, 31 art therapy 36, 46, 51 dreamwork 258 music therapy 242 relaxation sequences 11113, 11314 sandplay therapy 38, 46 see also adolescents; children
Author Index
Abbott, J. 31 Advanced Brain Technologies 242 Agell, G. 233 Albus, K. E. 18 Allan, J. 19, 32, 131, 214 Allport, G. W. 157 Amir, D. 239 Ammann, R. 22, 39 Amster, F. 20 Anderson, C. M. 164, 174 Anderson, H. 164 Arlow, J. A. 20 Armelius, K. 136 Armstrong, S. A. 213 Axline, V. 19, 22, 59, 270 Bachelor, A. 20, 39, 44, 49 Bacigalupe, G. 158 Baloche, L. 16, 45, 161 Barnett, M. 7 Bass, E. 165 Battles, H. B. 220 Baumeister, R. F. 56 Beauchemin, J. 123 Belsky, J. 76 Bender, L. 206 Bensimon, M. 239 Benson, H. 109, 111 Berman, J. 174 Berridge, K. 129 Berrol, C. F. 96 Berry, P. 32 Berube, L. 252 Beutel, M. 36 Beveridge, I. 157 Blackburn, J. 93, 95 Bodner, E. 240 Bogart, G. 123
Bohart, A. C. 134, 154, 270, 274 Bolton, G. 154, 156 Bonington, C.157 Bonny, H. 22, 236, 242 Boorstein, S. 22, 27, 48, 122, 267, 268, 270, 276, 278 Booth, R. 29, 32 Bosworth, K. 35 Bowlby, J. 66, 67, 75, 76 Boyd Webb, N. 214 Bozarth, J. D. 15, 19 Bradley, L. J. 239 Bradway, K. 44, 144 Brand, A. G. 36, 52, 168 Brennan, B. A. 51 Brey, R. L. 233 Brown, K. 19, 131, 214 Bulkeley, K. 149 Burnett, P. 25, 29, 30, 32, 57, 59, 154 Burns, R. C. 20 Bushman, B. J. 56 Byng-Hall, J. 66, 67 Campbell, J. 179, 180, 257 Campbell, M. A. 32 Campos, J. 129 Camras, L. 129 Canada, R. 82 Carey, L. 32 Carlson, C. R. 111 Carmichael, K. 32 Carr, A. 156, 179 Carr, R. 66, 202 Carver, C. S. 162 Case, C. 154, 210 Cashwell, C. S. 27
Cassidy, J. 66 Cescato, M. 111 Chamberlain, D. B. 48, 83 Chambers, L. 44 Chan, K. M. 165 Cheek, J. R. 239 Chetty, I. R. 32, 175 Chevalier, J. 257 Chiaia, M. E. 44 Christopher, J. C. 123 Christopher, S. E. 123 Chung, M. C. 156, 157 Church, R. P. 222 Cirlot, J. E. 257 Clark, A. J. 28, 157, 206 Clarke, K. M. 17 Coady, N. F. 82 Coleman, V. D. 202, 207, 209, 213, 225 Combs, G. 38, 39, 156, 168 Corey, G. 67, 68 Corey, M. S. 67, 68 Cornett, C. 278 Cortright, B. 22, 44, 48, 268, 269, 271, 278, 279 Coughlin Della Selva, P. C. D. 210 Cox, C. T. 111 Cozolino, L. 44, 52, 67, 81, 129, 130, 136, 144, 279 Crane, F. 203 Crawley, J. 205 Crook Lyon, R. E. 250 Cummings, J. A. 206 Dale, M. A. 16 Dalley, T. 154, 210
316
AUTHOR INDEX
317
Damasio, A. 133 Danhauer, S. C. 233 Davidson, R. 130 Davies, M. 22 Davis, L. 165 Davis, T. L. 252 de Gelder, B. 91, 93 de Robertis, D. 37 Detis, B. 165 Diamond, N. 90, 91 DiCarlo, R. E. 51 Diemer, R. A. 251 Dodge, K. 129 Doherty, K. L. 215 Doyle, C. 135, 176 Dozier, M. 18 Dryden, W. 17 Duncan, B. 19, 20, 46, 147, 214 Duncan, B. L. 20, 35 Dunnagan, T. 123 Eaton, L. G. 215, 224 Ecton, R. B. 28, 99 Egeland, B. 76 Eid, J. 164 Eiden, B. 28, 97 Elliott, J. E. 72 Elliott, K. J. 72, 73 Elliott, R. 17, 81 English, J. B. 83 Epston, D. 157, 175 Erickson, M. F. 76 Espelage, D. L. 35 Essex, M. 214 Eudell-Simmons, E. M. 254 Farber, D. J. 157 Farris-Dufrene, P. M. 202, 207, 209, 213, 225 Feindler, E. L. 28, 99 Fincher, S. F. 218 Fleming, J. 61 Flemming, M. M. 111 Fordham, F. 18, 22, 39, 80, 82, 130, 269, 270 Fosha, D. 42, 52, 67, 130, 131, 132, 133, 134, 138, 139, 140, 144, 164, 204
Fox, L. G. 31 Frankel, C. 129 Freedman, J. 38, 39, 156, 168 Freeman, J. 175, 176 Freud, S. 250, 252 Friedman, H. S. 22 Frostig, K. 214 Fuchel, J. C. 168 Furnham, A. 59 Gantt, L. 223 Gardner, H. 22, 25, 29, 30, 59, 154, 170, 239, 240, 269 Geen, R. G. 56 Gerteisen, J. 221 Gheerbrant, A. 257 Gil, E. 134, 135, 210 Gilbert, C. 53, 94, 99, 136 Giles, M. D. 94 Gilroy, A. 214 Gladding, S. T. 203, 209, 212 Glaister, J. A. 223 Glass, S. 233 Goldenberg, H. 78 Goldenberg, I. 78 Goldfried, M. R. 111 Goldman, R. 17 Goleman, D. 59 Goodman, R. 233 Goolishian, H. A. 164 Gould, P. 154, 210 Graham, J. 237 Grand, I. J. 97 Grant, J. 205 Greenberg, L. 17 Greenberg, L. S. 17, 22, 41, 52, 56, 67, 81, 129, 131, 132, 133, 134, 140, 145, 204 Grof, S. 18, 22, 28, 36, 48, 53, 55, 83, 133, 267, 268, 270, 276, 278, 279 Guinagh, B. 11, 35, 51, 55 Hallett, B. 123 Harmat, L. 238
Harner, M. 249 Harrower, M. 168 Harvill, R. L. 82 Hass-Cohen, N. 66, 202 Henderson, P. 222 Henley, D. 210, 215 Hill, C. E. 250, 251, 252 Hillman, J. 248, 280 Hilsenroth, M. J. 254 Hinterkopf, E. 95, 273, 276 Hodas, G. R. 237 Hoeksma, J. B. 211 Holian, L. 30, 31, 111, 123, 175 Holt, R. R. 56 Horneffer, K. 165 Horvath, A. 20, 39, 44, 49 Horvath, A. O. 96 Howe, D. 66, 69, 135 Hoyle, R. H. 111 Hubble, M. A. 20, 35, 39 Humphreys, C. L. 210 Hunter, A. 160 Hussey, D. 237 Hussey, D. L. 239 Jacobs, M. 22, 37, 61, 65, 168, 208 Janov, A. 28, 48, 55, 67, 81, 136 Johns, H. 61, 81, 157 Johnsen, B. H. 164 Johnson, L. 59 Johnson, L. R. 59, 137 Johnson, R. A. 76 Jones, J. G. 214 Josephson, B. D. 47 Jung, C. G. 22, 97, 218, 250, 253 Kabat-Zinn, J. 123 Kadis, A. 20 Kalff, D. M. 22, 27, 82, 175, 176, 224, 270 Kannan, K. 59 Kaslow, F. W. 78 Katz, R. 11 Kaufhold, J. A. 59, 137 Kaufman, S. H. 20 Kelly, J. 48, 83, 268
318
Kemper, K. J. 233 Kenardy, J. 156 Kennedy, C. E. 81 Kennedy, J. H. 81 Kern, R. M. 66 Klipper, M. Z. 109, 111 Kramer, E. 203, 207, 214 Kristeller, J. L. 123 Krupnick, J. L. 96 Kubler-Ross, E. 41, 130 Laing, S. 237 Lambert, M. J. 20, 21, 23, 43, 155 Lamnin, A. D. 162 Lan, W. 239 Landgarten, H. B. 154, 210 Landreth, G. L. 19, 22 Landsman, T. 157 La Torre, M. A. 240, 241 Lawley, J. 93 Layman, D. 237 Lazarus, A. A. 202, 224 Leboyer, F. 48 Lee, B. R. 250 Le Gacy, S. S. 274 Leibing, E. 36 Leichsenring, F. 36, 67 Leijssen, M. 95 Leitner, L. 210 Leoni, J. 123, 124 Levin, P. 66, 69 Levine, P. 90, 91 Lietaer, G. 17 Lindahl, M. W. 165 Lobell, L. K. 251 Lobovits, D. 175 Longo, R. E. 60 Lowen, A. 22, 28, 96, 97, 114, 11516 Lowen, L. 22, 114 Lowenfeld, M. 50, 131, 173, 176, 214 Lowenstein, J. 17 Lusebrink, V. B. 109, 208, 210 Lyddon, W. J. 16 MacCurdy, M. M. 164, 174 Maheady, L. 35
Mahoney, M. 16 Malchiodi, C. A. 204, 210, 241 Mandsager, N. 233 Manseld, C. G. 237 Manseld, R. 237 Marinucci, S. 62 Markward, M. J. 179 Marotta, S. A. 81 Marshall, M. C. 220 Marszalek, J. F. 251 Mascaro, N. 222 Maslow, A. 22, 39, 269, 270 Mazza, N. 168 McCarthy, D. 138 McGuinness, T. 223 McIntyre, J. 237 McKone, E. 47 McMain, S. 17 McNiff, S. 22, 202, 204, 208, 209, 210, 224 Mearns, D. 22, 36 Meurle-Hallberg, K. 136 Messinger, E. 157 Mikulincer, M. 66 Miller, J. P. 123 Miller, S. 19, 20, 46, 147, 214 Miller, S. D. 20, 35 Mitchell, R. R. 22 Montgomery, S. S. 207, 208, 210 Moore, T. W. 274, 276, 278 Moreno, J. 204, 236 Morgan, J. I. 202 Morton, K. 111 Mountain, V. 278 Muff, J. 248, 254 Murphy, A. 30 Murphy, K. 47 Murray, R. J. 162 Myers, J. E. 251 Neborsky, R. J. 48 Negron-Cunningham, H. 202 Neimeyer, R. 16 Nelson, D. 233, 237, 242, 248 Nelson-Ray, P. 32
Neven, R. S. 42 Newsome, D. 233 Nezworski, T. 76 Ng, K. 66 Nolan, P. 12, 13, 18, 55, 111, 122, 156, 157, 175, 216 Norcross, J. 66 Oaklander, V. 22, 38, 156 OBrien, P. 25, 29, 30, 32, 57, 59, 154 OConnor, P. 249, 250 Oldeld, A. 238 Orange, D. M. 66, 130 Ost, L. G. 111 Oster, G. D. 154, 207, 208, 210 Paivio, S., 17 Pardeck, J. T. 179 Parr, G. 239 Payne, K. 212 Payne, M. 154, 164, 165 Pearson, M. 12, 13, 15, 18, 21, 22, 29, 31, 32, 33, 34, 42, 44, 45, 50, 55, 59, 61, 111, 122, 133, 138, 139, 140, 145, 146, 155, 156, 157, 174, 1756, 204, 214, 215, 216, 223, 224, 239, 276 Peluso, J. P. 66 Peluso, P. R. 66, 67, 76 Pennebaker, J. W. 156, 164 Perls, F. 19, 22, 56, 253 Pert, C. B. 50, 90, 136 Pettit, G. 129 Piercy, J. A. 156 Pierrakos, J. 28, 99, 114 Pistole, M. C. 66, 81 Porter, L. 35, 36, 51 Price, C. 93, 94, 95 Priebe, S. 95 Prochaska, J. 66 Progoff, I. 155, 159 Proulx, L. 210 Provost, J. A. 252
AUTHOR INDEX
319
Rasmussen, P. T. 156, 181 Reich, W. 28, 51, 55, 94, 97, 98, 114, 136 Rholes, W. S. 66 Rifkind, G. 154 Riley-Douchet, C. 157 Riordan, R. J. 155, 157, 160, 164, 166, 179 Robbins, A. 2, 38, 50, 51, 122, 145, 208 Roberts, T. 91, 92 Rockwood Lane, M. 19 Rogers, C. R. 15, 19, 22, 36, 40 Rogers, N. 202, 215 Rohricht, F. 95 Rosen, D. 222 Rosenberg, M. S. 35, 111 Rosenblatt, J. 239 Rossi, E. 91 Rothenberg, A. 168 Rothschild, B. 28, 40, 52, 91, 134, 135, 164, 206 Rowan, J. 61 Rubin, J. A. 154, 210 Rudes, J. 165 Saarni, C. 136 Samuels, M. 19 Sandford, J. A. 76 Saus, E. 164 Scheff, T. J. 56 Schiff, J. 174 Schore, A. N. 18, 52, 56, 66, 67, 132, 135 Schotsmans, M. 238 Schure, M. 123 Scotton, B. W. 267, 268, 269 Seagal, J. D. 156, 164 Sharpley, C. 32 Shaver, P. 66 Shaver, P. R. 66 Shaw, R. 96 Shope, G. L. 56 Sidoli, M. 22 Siegel, D. 47, 48, 52, 66, 67, 90, 95, 96, 134, 135, 145, 170, 271 Signell, K. 248, 249, 252 Simon, T. R. 35
Simpson, C. S. 213 Simpson, J. 157 Simpson, J. A. 66 Sindelar, P. T. 35 Skar, P. 238 Skillern, T. 222 Skovholt, T. M. 202, 224 Slade, A. 81 Slater, G. R. 252 Slee, J. 47 Slegelis, M. H. 218 Smith, E. D. 274 Smitheman-Brown, V. 222 Spalding, E. 157 Sprokay, S. 130 Sroufe, A. L. 76 St Clair Pond, S. 210, 215 Stack, A. D. 56 Stepakoff, S. 179, 214 Stone, H. 66, 72, 73, 162 Stone, S. 66, 72, 73, 162 Stonner, D. 56 Stovall, K. C. 18 Sutherland, M. 268 Synder, B. A. 20 Symonds, B. D. 96 Tallman, K. 154, 270, 274 Tarnas, R. 39 Taylor, D. 26, 164 Tereba, H. 30 Terry, K. 154 Terwogt, M. M. 211 Teyber, E. 36, 40, 42, 71, 210 Thorne, B. 36, 39, 44 Tom, K. 156, 181 Tompkins, P. 93 Tracey, D. 30 Trier, C. S. 111 Trusty, J. 66, 81, 82 Tunnecliff, S. 32 Ulman, E. 202 Van Reekum, C. 130 Vaughan, F. 48, 122, 267, 268, 269 Verny, T. 48, 83, 268 Viren, S. 59
Vivino, B. L. 251 Wadeson, H. 22, 223, 225 Wallace, R. K. 123 Walsh, R. 268, 269, 271 Wampold, B. E. 23, 43, 155 Waschbusch, D. A. 19 Waterhouse, L. 57 Watson, J. 17 Watts, R. E. 66, 82 Weathers, R. 233, 237, 242, 248 Webster, M. 17 Weinrib, E. L. 22 Weiss, H. 95 Weiss, S. S. 61 Wellwood, J. 72 White, J. F. 66 White, M. 157 Whiteld, H. J. 269, 273 Widrick, R. M. 215 Wiener, D. J. 61 Wiener, L. S. 220 Wilber, K. 41, 48, 268 Willi, J. 66, 71 Williams, K. 233 Wilner, K. B. 28, 99 Wilson, A. 157 Wilson, H. 12, 18, 22, 29, 31, 42, 44, 50, 59, 138, 145, 146, 156, 1756, 223, 224 Wilson, L. S. 179 Wilson, R. 35 Wilson, S. 157 Winkielman, P. 129 Wiseman, H. 17 Wolf, F. A. 251 Wolf, Y. 239 Wolgien, C. S. 82 Wollmering, B. 249 Wolpe, J. 202, 224 Woodward, H. 157 Wright, J. 156, 157 Wright, J. K. 157 Yon, R. K. 239 Young, A. J. 222 Young, C. 28, 91, 92 Young, J. S. 27

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Using Expressive Arts to Work with Mind, Body and Emotions

by the same author Emotional Healing and Self-Esteem

Emotional Release for Children

Mark Pearson and Patricia Nolan

of related interest Foundations of Expressive Arts Therapy

Edited by Stephen K. Levine and Ellen G. Levine

Foreword by Frances F. Kaplan

Focusing-Oriented Art Therapy

Edited by Patrizia Pallaro

Principles and Practice of Expressive Arts Therapy

Paolo Knill, Ellen G. Levine and Stephen K. Levine

Using Expressive Arts to Work with Mind, Body and Emotions

Jessica Kingsley Publishers London and Philadelphia

Introduction: After Weve Talked What Then?

Evolution and Practice of Expressive Therapies

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

Transformative self-learning through use of symbol and metaphor

Inner life skills a path to emotional literacy

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

Interpersonal skills in groupwork

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

EVOLUTION AND PRACTICE OF EXPRESSIVE THERAPIES

Towards Freedom, Choice and Empowerment

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

TOWARDS FREEDOM, CHOICE AND EMPOWERMENT

Code of respect for clients

Attachment, Integration and Renewal

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

Figure 3.1 Adult female: Unable to move away.

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

ATTACHMENT, INTEGRATION AND RENEWAL

Exploring the messages of the inner critic

ATTACHMENT, INTEGRATION AND RENEWAL

Exploring critical inner messages

I would feel better if For a long time

Exploring the impact of childhood scripts now and then

ATTACHMENT, INTEGRATION AND RENEWAL

Right-hand column Now

ATTACHMENT, INTEGRATION AND RENEWAL