February 5, 2026 | By Megan L. VanMeter, LPC, LMHC, LPC-AT/S, ATR-BC & Lisa D. Hinz, PhD, ATR-BC
This post is the second in a three-part series.
In the first blog article in this series, we identified ourselves as students of Expressive Therapies Continuum co-creators, Drs. Vija Lusebrink and Sandra (Kagin) Graves-Alcorn. The origin of ETC myths was explored through a familiar parable, and the specific myths we explored were related to the nature and purpose of the framework developed by our mentors. We also helped readers understand why eradicating myths is important for the profession in terms of the way stakeholders view art therapy and art therapists; accurate and consistent messaging is necessary for increased acceptance and perceived legitimacy.
The next ETC myth category we want to explore is myths about the nature of treatment within the framework. Although this category covers a number of myths and we can’t possibly present all of them within the context of a blog article, below are the ones that stood out to us as needing attention.
Myths About the Nature of Treatment Within the Expressive Therapies Continuum
Framework: Myths in this category feature erroneous views of how treatment occurs when using the ETC framework as a guide. They include, but are not limited to, ideas about how many steps are involved in treatment, how to shape treatment around diagnosis, how to shape treatment around a client’s presentation, and what order the components should be presented in.
Myth: The ETC is a three-step treatment model.
Truth: This myth seems to be based on a literal interpretation of Lusebrink’s use of the word “stepwise” to refer to the developmentally progressive levels of information processing (Lusebrink, 2010; Lusebrink, 2014; Lusebrink, et al., 2013). These are the horizontal levels of the Expressive Therapies Continuum. Lusebrink stated that each level contains and expands upon the level(s) beneath it (Hinz, VanMeter, & Lusebrink, 2022). From a developmental perspective, an individual grows to incorporate physical, emotional, and intellectual processes in a sequential pattern that ensures appropriate linkage. When these three levels of information processing are sufficiently integrated, information flows from one level to the one(s) above it without disruption. Information can also flow in the reverse order if linkage is sufficient (Hinz, 2020). This premise does not mean that treatment via the Expressive Therapies Continuum is a three-step process, nor is it strictly a bottom-up or top-down process. The linkage between the levels is developmentally hierarchical, but this is not synonymous with the way treatment is orchestrated; treatment within the ETC framework involves finding the client’s preferred starting point through ETC assessment and then proceeding into the therapeutic journey through multiple steps that are determined by the client (VanMeter & Hinz, 2024).Myth: The ETC targets one component implicated by client diagnosis.
Truth: Diagnosis per the DSM-5-TR (American Psychiatric Association, 2013) or any other diagnostic classification system is not the focus of the Expressive Therapies Continuum. As such, treatment within the ETC is not diagnostically driven. This myth confuses remote methods of understanding a client’s condition with more intimate, relational approaches that honor and privilege the client’s unique expression of nervous system activity. Targeting one ETC component is not client-centered; even if the component targeted was the one identified through ETC assessment as the client’s preferred way of organizing and experiencing information, treatment would eventually need to follow the client’s organic journey toward other components (VanMeter & Hinz, 2024). This client-centered journey would be prevented by an art therapist who insists on using the DSM to pick an ETC component that treatment should focus on.Myth: ETC-based treatment targets the component opposite to the component associated with a client’s presentation in session.
Truth: This myth appears to completely disregard the client’s artmaking process, art product(s), and verbalizations about them as sources of data in determining what ETC component the client is actually embodying. Joining the client on that component is important for responsive treatment, and the Expressive Therapies Continuum is a responsive framework. Meeting the client where the client is at will help facilitate organic movement on the Creative dimension to another way of organizing and experiencing information when the client is ready (VanMeter & Hinz, 2024). Trying to target treatment toward the component opposite the client’s behavior alone will not achieve relationally resonant or empathically attuned therapy, and the client will likely experience disjointed or disruptive internal shifts if treatment is pursued in this manner.Myth: ETC-based treatment introduces the components in sequential order..
Truth: There is no prescribed order in which the ETC components are presented over the course of therapy. The most important thing for an art therapist to understand is that treatment within the Expressive Therapies Continuum framework is client-led. The art therapist’s decisions are informed by the client’s responses to previous decisions; these responses constitute outcomes. Outcome-informed treatment is guided by client responses (VanMeter, 2021). Client responses shape the therapist’s rationale for subsequent decisions and are thus monitored carefully for indicators of which ETC component(s) the client is experiencing. This series of actions is the process of progress monitoring, where the client’s artmaking behavior, art products, and associated verbalizations are used as data to track which ETC components the client’s journey has included, currently focuses on, and may be ready to incorporate in the near future (VanMeter & Hinz, 2024).Are You Ready to Learn More About Expressive Therapies Continuum Myths?
Accuracy and uniformity are important assets when members of a profession write about and give presentations about its collective knowledge base. We hope the idea of eradicating myths about the Expressive Therapies Continuum will provide you with the motivation to reexamine your own beliefs about the framework.
Watch for the other two blog articles in this series, and if you are inspired to learn even more about ETC myths and their effect on the profession, please join us for a two-hour webinar on Thursday, February 19, 2026, at 7:00pm ET/4:00pm PT. “Separating Expressive Therapies Continuum Truth from Myth: Guidance for Art Therapy Practitioners, Educators, and Researchers” will be sure to elevate your understanding of the framework and gently correct some of the erroneous stories and tall tales that have been spun about it.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. Author.
Hinz, L. D. (2020). Expressive Therapies Continuum: A framework for using art in therapy (2nd ed.). Routledge. https://doi.org/10.4324/9780429299339
Hinz, L. D., VanMeter, M. L., & Lusebrink, V. B. (2022). Development of the Expressive Therapies Continuum: The lifework of Vija B. Lusebrink, PhD, ATR-BC, HLM. Art Therapy: Journal of the American Art Therapy Association, 39(4), 219-222. https://doi.org/10.1080/07421656.2022.2131951
Lusebrink, V. (2014). Art therapy and the neural basis of imagery: Another possible view. Art Therapy: Journal of the American Art Therapy Association, 31(2), 87-90. https://doi.org/10.1080/07421656.2014.903828
Lusebrink, V. B. (2010). Assessment and therapeutic application of the Expressive Therapies Continuum: Implications for brain structures and functions. Art Therapy: Journal of the American Art Therapy Association, 27(4), 168-177. https://doi.org/10.1080/07421656.2010.10129380
Lusebrink, V. B., Mārtinsone, K., & Dzilna-Šilova, I. (2013). The Expressive Therapies Continuum (ETC): Interdisciplinary bases of the ETC. International Journal of Art Therapy, 18(2), 75-85. https://doi.org/10.1080/17454832.2012.713370
VanMeter, M. L. (2021, October 23-24 and December 18-19). Creating highly effective art therapists: Deliberate practice and the Expressive Therapies Continuum [Paper presentation]. American Art Therapy Association 52nd Annual Conference, virtual. https://at-institute.arttherapy.org/products/self-study-pp-144-creating-highly-effective-art-therapists-deliberate-practice-and-the-expressive-therapies-continuum#tab-product_tab_overview
VanMeter, M. L., & Hinz, L. D. (2024). A deeper dive into the Expressive Therapies Continuum: Structure, function, and the creative dimension. Art Therapy: Journal of the American Art Therapy Association, 41(2), 107-110. https://doi.org/10.1080/07421656.2023.2240682