In current counselor education, counselors are trained to attend to verbal and nonverbal cues from the client. Attending to nonverbal cues, such as facial expressions and body movement from the client, minimally addresses the deeper significance of these manifestations. There are elements of the human condition that are inexpressible through monocular dialogue (Markell, 2002). Through the integration of approaches designed to explore and facilitate nonverbal communication, counselors are able to provide their clients with more holistic mediums of expression. Greater expression enhances the clients' ability to use internal resources and develop their sense of power (Hogan, 2001).

By their definition, integrative approaches to counseling are not grounded in a particular theoretical orientation. In general, these approaches are supported by the belief that therapy is not merely a science but more accurately an art. According to humanistic theory, it is the open expression of self, free of interference, which allows the client to make a transition from ideal states to experiential reality. For many people, self-expression is manifested through various means, and, more important, reliance on verbal disclosure may interfere with the client process of insight building and growth. Not every aspect of the human condition can or should be expressed through words. The ability to work with and connect with a client beyond verbal psychotherapy has found meaningful and effective outcomes in the therapeutic relationship (Hartz & Thick, 2005).

Expressive Arts

Expressive art therapies are based on the belief that the client's dilemma responds to the freedom of artistic expression (Levine & Levine, 1999). This response to the artistic medium aids clients in holistic expression and awareness of self beyond the limits of verbalized communication of their cognitive and emotive states. The Western assumption that talking is the best form of expression is challenged by the reality that nonarticulate clients also have a valid and meaningful reality to share and explore. In this way the client's expressive use of the artistic medium becomes the point of therapeutic change. The techniques used to promote the therapeutic process from an expressive arts approach are derived from one of the following four therapeutic forms: (a) art therapy (specifically visual art), (b) dance/ movement therapy, (c) drama therapy, and (d) music therapy. These therapeutic forms are often integrated with each other, producing creative interventions that stimulate awareness of the clients' issues from various aspects of their expressed self. The use of two or more of these expressive arts approaches must still be based in theory. Conceptually, counselors must consider the purpose of their interventions and whether they are best suited to the client's goals for counseling. The best expressive art interventions are intended to encourage experiential awareness of client issues (Feder & Feder, 1981).

A central practice of expressive art counseling is to allow clients to freely experience and alternatively define themselves beyond conventional limitations. The liberating concept of this approach to counseling is supported by the idea that the client's expression of self is currently stifled by some form of suffering (Levine & Levine, 1999). To effectively "move the client along," expressive art counselors create a therapeutic environment in which clients can fully and safely convey self without the constrictions that currently stifle their growth. Deriving meaning from the expressive art approach is like asking someone the meaning behind Mona Lisa's smile. Invariably, meaning is derived from personal interpretation. Similarly, the meaning of a certain picture, song, movement, or object is determined by clients' personal interpretation of its value to them and their current reality (Hogan, 2001). The expressive art counselor is aware that clients operate on multiple levels of thoughts and emotions and, thus, are best facilitated in their growth through various methods of experiencing and validating their process. Unique to this approach is the ability for the client to create meaning and interpretation, without the counselor or therapist applying a diagnosis or definition onto the client's suffering (Levine & Levine, 1999).

The process of change for the client is supported by an openness and familiarity with the healing and validating aspects of the expressive arts by the counselor. Counseling based on sound therapeutic practice suggests counselor competency with the use and comprehension of the expansive nature of integrative approaches. The more informed and versed the counselor is in effective and appropriate integrative interventions, the greater the benefit is to the client receiving services. A fluent acquaintance of the expressive arts does not require expertise in their use but an apt knowledge of their function, applications, and how theories best support each form.

The openness of the client toward the expressive arts is a factor in this approach to integrative counseling. Clients may have certain expectations about the process of therapy and may not be willing to risk looking foolish as they engage in artistic representations of their issues. As a rule, the use of expressive arts in therapy is dictated by the clients' willingness and need to fully or alternatively expressive self through artistic means. This approach has been found to be successful in work with resistant clients who may be uncomfortable with verbally opening up to a counselor (Hartz & Thick, 2005). By offering clients an opportunity to express their reality in a way that they may find less threatening, the efficacy and rapport of the therapeutic relationship are strengthened.

In the following excerpt from a counseling session based in the Gestalt theory of counseling, the counselor uses music therapy as an integrative approach to encouraging deeper reflection on the client's presenting grief issues. The client discloses her feelings of guilt surrounding her mother's death after listening to a song the counselor has played for her in session:

Client: Wow, I, urn . . . I always thought of my mom as "the wind beneath my wings," but I.. . I never seemed to do much to help her. I just thought there would be more time, (laughs) It's really funny how a song can trigger so much... so much.... (crying) I could have been a better daughter, (composing herself)

Counselor: It seems like you still have some regrets. You weren't good enough?

Client: Yeah, and I thought I was over this stuff. I kind of feel guilty about not being there more, (sigh)

Counselor: This guilt you feel, tell me how do you feel it?

Client: How? . . . Oh, all over I guess. Listening to that song reminds me of my sister singing it to Mama last year on her birthday. I would have joined in too, but. . . I should have.

Counselor: You should have? Sing the song here as you believe you should have sung it.

The counselor integrated music into her work with the client and in turn facilitated the client's awareness of unresolved feelings. The counselor, using the trademark directives and experiments of Gestalt theory, encourages the client to attend to her unfinished business in session through further expressive art. From this intervention, the client can begin to work on acceptance and forgiveness of self, a process that may not have been accessed if the counselor had not decided to be integrative in the counseling style to better assist the client.

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