Outside the BoxPicture this: Somewhere, a counselor sits with a client who is struggling to make progress. Traditional talk therapy isn’t moving the client forward. The counselor thinks, “I wish I were more of an artist because I’d love to try out a painting exercise with this client.” Substitute photography, dance, music or any other of the wide range of creative interventions for the word painting, and you’ll find the reason why so many counselors hesitate to fully embrace creativity in counseling — they think they have to be experts at the particular artistic enterprise themselves.

That idea couldn’t be further from the truth, says Heather Trepal, associate professor of counseling at the University of Texas at San Antonio (UTSA) and president of the Association for Creativity in Counseling, a division of the American Counseling Association. “I think some people get afraid of creativity because they think it needs to be creative arts — that you need to be a van Gogh, be trained in an instrument or really be an expert in whatever you might try with your clients,” Trepal says. “Creativity can be anything. It can be any out-of-the-box moment that helps a client to therapeutically move.”

Thinking and working creatively as a counselor is key to finding an approach that’s right for each client, Trepal says. “Clients are as individualized as they come, and I don’t think there’s a one-size-fits-all approach to counseling. It’s so important to find what works and what speaks to our clients, and it’s not always traditional talk therapy.”

Suzanne Degges-White agrees. An associate professor of counseling and development at Purdue University Calumet who also works in private practice, Degges-White remembers one client who made significant progress after being introduced to the sand tray. The client, a 42-year-old woman, was struggling with her husband’s controlling behavior. So Degges-White invited her to create her world in the sand tray.

“She was a little surprised at first that the sand tray and figurines were not just for kids, but she moved easily to the shelves and began to contemplate the images represented,” says Degges-White, who coedited the 2010 book Integrating the Expressive Arts Into Counseling Practice: Theory-Based Interventions with Nancy Davis. “[The client] would pick up a figure, hold it in her hand and pause as she apparently was reflecting on the issues she was facing.”

After about 15 minutes of setting up the sand tray, the client began to share her life story. “She noted that she was a small, scared bunny trying to hide behind a shrub,” Degges-White says. “Her husband was the fierce lion standing on top of the mountain, able to see whatever she was doing wherever she went. Even her children were depicted by small animals cowering in fear.”

Although Degges-White primarily used talk therapy with the client during the next few months, the woman would often return to the sand tray on her own. “It was as if she was using it to acknowledge the progress she was making toward her goals and to make tangible her progress for her own sense of forward movement,” Degges-White says. As a result, the client made headway in initiating discussions and addressing issues with her husband, who was willing to change his behavior to maintain his relationship with his wife and children. “At our termination session, she asked to do a final tray,” says Degges-White, a member of ACA and ACC. “The main images had shifted dramatically from her first session with the sand. Here, she had her husband represented as a smaller lion standing beside the mountain — no longer did she feel that she was under his predator’s gaze.”

The client chose to represent herself with an elephant because she had grown to see herself as a stronger player in her relationship with her husband. She told Degges-White that although they often move slowly, elephants are powerful, which perfectly symbolized how she was now feeling. She said counseling had enabled her to “move carefully and deliberately through her world as she uprooted trees in her path.”

Adds Degges-White, “She acknowledged that the ability to ’step outside’ of her problems and work with a metaphor or visual image had given her a perspective that helped her see how important change really was in her life and relationship if it was to continue.”

Bringing creativity into the counseling session is all about uncovering new perspectives and new solutions for issues that are plaguing clients, Degges-White says. “To encourage clients to exercise creativity is, in essence, to give clients permission and confidence to expand their current ways of thinking, believing and doing into more successful or productive processes. Creativity is about breaking out of the patterns or ruts that keep us from reaching our goals.”

Creative expression often serves as the pathway for unearthing feelings that were previously hidden beneath the surface, Degges-White says. “The arts, in brief, make the unconscious conscious. They bring light to the darker recesses of our psyches. Moreover, they do it in a nonthreatening way in which we frequently reveal hidden sides of ourselves [through] metaphors or visual representations rather than through a stereotypic, psychoanalytic talk-therapy way.”

The art of a science

Creativity has long been part of the counseling profession, says Stella Kerl-McClain, associate professor and codirector of the Community Counseling Program at Lewis and Clark College. “Counselors have been more creative than other mental health professionals,” says Kerl-McClain, a member of ACA and ACC. “Counselors have been less tied to the science. While we do have research, we’ve been more open to the art side of counseling since the profession started.”

She points out that creativity is particularly relevant to counselors because they cannot use the same standard protocol with all of their clients. Creative counselors let each session “emerge,” she says, following the client’s lead rather than mapping out a plan beforehand.

Creativity also goes hand-in-hand with counseling because creativity is primal, says Stacey Goldstein, who has worked as a counselor and supervisor with several nonprofit agencies over the past nine years and is now transitioning into private practice. “We are all creative beings,” Goldstein says. “It’s beyond function. Look throughout history. Look around us. Creativity is evident in many cultures throughout history with elaborate architecture, dress, jewelry, dancing, drumming, paintings, murals, imagery and, eventually, photography and other modern mediums. It continues to evolve. It documents history and shares a story.”

“Even if we don’t consider ourselves an ’artist,’ many things around us and about us are [artistic],” says Goldstein, a member of ACA and ACC. “We are the artists of our own journey. This is why it’s so important for counseling. The connection or relationship with clients is fundamental to counseling, and what better way to make that connection than by tapping into a spiritual place that has the potential for healing?”

Being creative as a counselor means more than simply incorporating expressive arts, says Victoria Kress, an ACC Board trustee and chair of ACC’s Graduate Student Committee. “Creativity in counseling is about clients and counselors creating and identifying new ways, paths and approaches,” says Kress, who is also a professor and director of the Community Counseling Clinic at Youngstown State University. “Creativity is about clients and counselors being more cognitively flexible, opening themselves to new ideas and experiences, tolerating ambiguity and garnering a sense of enthusiasm, energy and playfulness. This is the backbone of creativity in counseling. Expressive arts activities only serve as a vehicle for inspiring creativity.”

Creative approaches can work with almost any client, Trepal says, but they are especially useful with clients who are stuck in a rut and for whom talk therapy is ineffective. She emphasizes that creative interventions can take many different forms: shooting hoops while having a counseling session with kids or teens, encouraging survivors of domestic violence to make collages of what healthy relationships look like or using photos when working with older clients to spark memories and stories. “Creativity matters in counseling because different clients respond to different approaches,” she says.

“Creative techniques may be especially helpful when working with clients who have limited verbal ability, who are working with issues/experiences that are difficult or traumatic to verbalize, or who tend to get stuck in rationalizations or verbal circles in sessions,” Degges-White says. “Children, by nature, are creative beings. Inviting them to use visual arts, drama play, movement or music to express themselves in sessions arises very naturally.” Counseling may also seem less threatening or intimidating to adolescents when they’re able to engage in something other than talk therapy, she says.

“Some adults may be hesitant to engage in expressing their creative sides due to self-consciousness and a fear of judgment — by self or by the counselor,” Degges-White adds. “However, even with reluctant adults, a counselor can bring expressive modalities into session by proper introduction of the technique and borrowing from Gestalt practice, even couching the arts experience as an ’experiment’ for the client to try.”

Just as it does with almost all clients, creativity offers benefits to almost all counselors, Degges-White contends. “Any counselor in any setting could successfully incorporate the expressive arts into their work. Virtually all clients enter counseling because they are wrestling with an issue for which their current problem-solving skills are insufficient. Ergo, creative imagining and experiencing are ways in which new and innovative solutions may be found.”

Trepal echoes those sentiments and once again emphasizes that counselors shouldn’t shy away from creative interventions because of a lack of “expertise.”

“Everybody can be creative,” she says. “Don’t let your experience limit you. Even if you are not a trained photojournalist, you can still use photos in counseling.”

Therapy through a tape recorder

Kerl-McClain recalls a tense situation that she defused with a little creative thinking and an unorthodox counseling technique. At the time, she was working with clients in assisted-living facilities. She was called in when one couple kept engaging in repeated fights. The husband would try to explain something to his wife, who had Alzheimer’s disease, and she wouldn’t remember or would become upset. In turn, the husband would get angry and yell at her.

Kerl-McClain first tried to teach the husband to be kinder but soon realized that wasn’t working; whenever his wife got upset, so did he. So instead, Kerl-McClain had the husband speak kind and loving words into a tape recorder. Then, whenever the wife became agitated, she would put on the headphones and listen to her husband’s calming voice, which soothed her. When the wife calmed down, so did the husband.

The tape recorder and the sand tray are just two examples of creative interventions in counseling. Trepal notes the wide range of others — music, arts, play, photography, movement or dance, pets and even plants, to name just a few. Trepal finds music especially helpful in her work at a clinic at UTSA, where she teaches a practicum.

Many of the teen clients are mandated to come to the clinic by the court system and find nothing wrong with sitting through an entire counseling session without saying a word. Instead of forcing them to talk or just sitting in silence, Trepal often tries connecting over music. She might ask clients about their favorite singer and what speaks to them about that performer’s music. Sometimes, Trepal and a client will play the music or write down lyrics and then talk about how it connects to the client’s life. “It’s interesting how different things speak to different people,” she says.

For counselors just beginning to integrate some creativity into their sessions, Degges-White suggests the addition of dramatic role play. “Clients may be willing to try out new responses and patterns of interaction within the safe environment of a counselor’s office, and as the counselor grows more comfortable with encouraging dramatic role play, they may begin to encourage greater explorations of playing out different parts by the client.”

Another easy step is adding visual arts, she says. “One activity might include using a body outline to represent the inner turmoil, pain or past traumas that may currently be negatively influencing the client’s life. These can be life-sized actual outlines drawn of the client or smaller, photocopied, simple outlines. The client can be led through a body scan guided visualization and then asked to use art materials — colored pencils, crayons, markers, paints, magazines for collages — to tell their ’embodied story’ via creative expression. This can be a very powerful experience. Counselors, as in any setting in which deep and significant trauma is addressed, must be ready to provide support and emotional triage if needed.”

When teaching counseling students about how to integrate creativity, Kerl-McClain often uses the example of musical chronology, an idea developed by Thelma Duffey, founding president of ACC. The exercise asks clients to go through their life and identify the different songs they connected with during each time period. “The songs access all kinds of things, including a sense of identity that you might not otherwise be able to reach,” Kerl-McClain says. (For more on this creative technique, read “A Musical Chronology and the Emerging Life Song” on page 32.)

Another idea is encouraging clients to try out yoga poses or other movements. Degges-White says this helps clients “be in their bodies” in ways they don’t normally experience. “Helping clients get back in touch with their physical presence and the space that they claim in this world can be truly enlightening for those who move through life in a stilted or shrinking manner,” she says.

Another gentle way to introduce creativity is through photography, Degges-White says. “Inviting a client to use their cell phone or a camera to take a digital diary of their day can be a powerful awakening in many instances. If they are struggling with depression and seldom leave their home, the digital imagery will illustrate how they are limiting their lives. If they are engaging in risky behaviors or dealing with codependency or adolescents being in places that are poor choices, the digital diaries can bring these situations to light.”

Goldstein agrees. She grew up with photography — her father is a professional photographer, and her mother is a professional videographer. “Watching my family connect with others through the lens of a camera and the art of memories has ingrained in me the innate ability to blend the arts as a medium for connection, engagement, communication and healing for myself as well as others,” she says. “Utilizing my life experience with imagery and my life’s work in the helping profession, I have chosen to fuse my practices and my experience to integrate a creative, holistic approach to healing and counseling.”

Goldstein offers a handful of ways to incorporate photography into counseling. One way to increase mindfulness with clients is to ask them to walk through a park or someplace else of interest while taking photos of what they see. In session, the client and the counselor can explore what the person noticed and what feelings came to the surface. Other ideas Goldstein suggests include incorporating role play by having clients act out their feelings or perceptions of what was taking place in family photos, adding a photo to the empty chair technique or, in a group setting, asking members to bring in pictures or magazine clippings of things they want to let go of and then staging a virtual bonfire.

“Photography is a powerful tool,” Goldstein says. “It’s in effect a third eye or a unique perspective. When using a camera, you look through the lens and see things you may not have considered, or you may find something in a photograph otherwise unnoticed. When looking at a photo, everyone sees something different and unique. It’s your own journey.”

Goldstein adds that photography is particularly practical because it can be used with a variety of counseling theories and techniques. Plus, cameras are fairly affordable, even if clients just use disposable models. “Most anyone can use [cameras] without a lesson, but at the same time, they can become an ’artist,’” she says. “I think this can be very empowering.”

Hungry for hints

ACC was founded in 2004 to offer a “divisional home” to counselors wishing to focus on creative, diverse and relational approaches across all theories and types of counseling, Trepal says. Although creativity has always been a part of counseling, she says, it wasn’t until ACC’s inception that counselors implementing creativity in all kinds of counseling theories could come together and connect.

“Counselors are hungry for how-tos, resources and examples,” Trepal says. That need was evident at the 2010 ACA Annual Conference & Exposition in Pittsburgh, where ACC hosted a creative Day of Learning. Even at 7:30 in the morning, one session was standing room only, Trepal points out. In addition to conference presentations, Trepal says ACC tries to meet the need for practical information with the Journal for Creativity in Mental Health, which details the many ways counselors are using creative interventions in their work.

Counselors might be especially hungry for information on working creatively with clients because the topic isn’t traditionally taught in counselor education courses, Trepal says. “We teach theories, but we don’t teach how to respond with spontaneity,” she adds.

Spontaneity and flexibility are important ingredients in successful creative interventions, Trepal says. In her own work as a counselor, Trepal infuses creative exercises alongside talk therapy. This means she doesn’t split the session up into two separate parts: doing an activity and talking. Instead, she allows the timing to be spontaneous and bases each intervention on the unique character and situation of the client.

Like Trepal, Degges-White uses creative interventions to complement talk therapy. “Children, of course, engage in the expressive arts and play therapy from the first session and are often able to rely on these ways of ’working through.’ Adolescents and adults typically want to rely on talk therapy with the arts as an adjunctive process of working through, as well as [a means of] checking in on their progress.”

Be attentive to signs that a client might be particularly receptive to creative counseling techniques, Trepal says, such as if the client mentions music or asks about projects in the counselor’s office that have been created by other clients or groups. “Listen to some of the things that they talk about using to cope,” she says. “Listen to them when they’re telling you about their life and their story.”

Kress echoes the need to pay attention to a client’s interests. “If I am working with a client who enjoys writing, I will use a number of varied writing interventions,” she says. “I find that when I trust my creative process — and my clients — I can spontaneously generate activities or variations of activities I have previously used that may fit with a given client.”

Although ingenuity in session is helpful to clients, counselors acknowledge that creative interventions can come with their own set of hurdles. “The cost of materials can be prohibitive,” admits Kress, who recycles and reuses materials to make her counseling budget stretch. “I sometimes use Shrinky Dinks in counseling. No. 6 plastic to-go box containers can be used in the same way as Shrinky Dinks. I might use an empty yogurt cup and lid as a symbolic container where clients can write down and store negative cognitions or strong emotions. The client can decorate the container and symbolically store these negative cognitions or strong emotions for later reflection.”

Trepal recommends that counselors let others in their community know about the types of materials they work with in session. Oftentimes, she says, people will donate materials, such as magazines that were headed for recycling, which instead can be used for collages.

The biggest challenge, however, is counselors getting in their own way, Trepal says. “That’s what stops a lot of people — their own fear of not being creative. But it’s not about the product. It’s about the process of doing it.”

At a recent ACC conference, Trepal attended a session on Barbie and body image. The presenters talked about how average people are very different physically from Barbie and Ken. Session participants were asked to take one of the dolls and make it look like them, with one requirement: They had to use padding. Trepal says doing that exercise alongside other counselors lessened her anxiety about trying something similar in her own work as a counselor. A good idea for counselors who are nervous about trying activities with clients is first to try the activity out in supervision or to practice with another counselor, she says.

Degges-White also gives a nod to the idea of practice. “Counselors must work through their own resistance,” she says. “We must be willing to engage in the activities that we would like to encourage clients to experience. I think many of us are hesitant to try out new activities for the same reasons our clients might be — the inner critic! We, as counselors, may wrestle with the same fear of judgment or looking foolish that our clients hold. However, if I personally had not experienced my own feelings of trepidation and clumsiness as I first used dramatic role play or movement activities myself, I would feel like a fraud as I invited clients to try these things for themselves in session.”

Degges-White says counselors who feel the need to come off as the “expert” to clients must let that notion go. “We need to remember that our role is to facilitate solutions, not manufacture them,” she says. “Personal growth and development are what clients seek when they show up in our offices, but these are both processes that clients must move through at their own speed. Using the expressive or creative arts allows many clients to let go of their quest for answers and allows solutions and new ways of being to emerge as they experience the process of creative engagement.”

An additional ACA resource for counselors interested in using creativity in their work is The Creative Arts in Counseling, fourth edition (order #72909) by Samuel T. Gladding ($29.95 for ACA members; $48.95 for nonmembers). To order, visit the ACA online bookstore at counseling.org/publications or call 800.422.2648 ext. 222.

In addition, ACC will be hosting a Day of Learning focused on creativity in counseling on March 26 at the ACA Conference in New Orleans.

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org