What is the Art Therapy Practice Continuum

The Art Therapy Practice Continuum is a framework that organizes art therapy interventions along a spectrum from sensory and kinesthetic experiences to cognitive and symbolic experiences. It’s about the depth and type of engagement with art materials and what those interactions can evoke in the client—emotionally, cognitively, and physically.

This continuum is often associated with the Expressive Therapies Continuum (ETC), developed by Kramer, Hinz, Lusebrink, and others. It helps therapists decide which level of art-making or processing is appropriate for each client and session.

Levels of the Continuum

The continuum typically has four to five levels:

a) Kinesthetic/Sensory Level

• Focus: Physical interaction with art materials, sensory stimulation, movement.

• Activities: Finger painting, clay modeling, working with textures, tearing, cutting.

• Purpose: Regulate emotions, develop body awareness, release tension, and engage the nervous system.

• Who benefits: Young children, trauma survivors, clients with high anxiety or stress, or those who struggle to verbalize emotions.

b) Perceptual/Constructive Level

• Focus: Using visual-spatial skills to manipulate materials; problem-solving through art-making.

• Activities: Building sculptures, arranging shapes, collage work, structured drawing.

• Purpose: Enhance planning, organization, spatial awareness, and focus; encourage self-expression within constraints.

• Who benefits: Children, clients who enjoy structure, or those needing cognitive engagement.

c) Cognitive/Symbolic Level

• Focus: Symbolism, meaning-making, and insight through images.

• Activities: Drawing metaphors, storytelling through art, journaling with visuals.

• Purpose: Explore inner experiences, identity, emotions, and relationships; facilitate insight and reflection.

• Who benefits: Adolescents, adults, and clients ready for self-reflection and verbal processing.

d) Affective Level

• Focus: Emotional expression and processing.

• Activities: Free drawing, painting emotions, expressive sculpture, mask-making.

• Purpose: Access, release, and integrate emotions safely; deepen therapeutic connection.

• Who benefits: All ages, especially clients dealing with trauma, grief, or emotional dysregulation.

e) Integration/Intermodal Processing (optional fifth level)

• Focus: Bringing together multiple modes of experience—visual, sensory, cognitive, verbal.

• Activities: Reflecting on artwork, storytelling, discussion, music, movement combined with art.

• Purpose: Promote integration of thoughts, emotions, and physical experiences; support personal growth and insight.

• Who benefits: Clients ready to process experiences across multiple modalities, often in longer-term therapy.

How Therapists Use the Continuum

• Assessment: Identify which level best suits the client’s current state.

• Progression: Start with sensory/kinesthetic activities to regulate the nervous system, then move to symbolic or cognitive levels for reflection and insight.

• Flexibility: Clients may move up or down the continuum within a session depending on their emotional state.

• Goal-oriented planning: Therapists can structure sessions to target specific therapeutic outcomes—emotion regulation, trauma processing, self-expression, or social connection.

Practical Example

Session Theme: “Where am I now?”

• Kinesthetic: Manipulate clay or colored sand to represent your feelings.

• Perceptual: Arrange shapes or colors to create a personal map.

• Symbolic/Cognitive: Draw metaphors or symbols of your current emotional state.

• Affective: Use color and form to express emotions freely.

• Integration: Discuss the artwork and reflect on patterns, connections, and insights.

The continuum provides a structured yet flexible approach, making art therapy adaptable to any client, from children to adults, and across trauma-informed, developmental, and emotional goals.