The expressive arts, narrative, and symbolic approaches are excellent therapeutic tools for clients. As a means of holistic exploration and client development, these approaches have much to offer to the field of counseling. However, this ever-emerging field in counseling and psychotherapy is seriously limited by the lack of research studies centered around the effectiveness of these approaches. Currently, the potential for greater support and development from the therapeutic community is hindered by lack of scholarly interest in these integrative approaches to counseling.

The use of the integrative approaches is limited by their dependence on integration with theory. This is seen as a limitation because many counselors who use these approaches in their work with clients do so exclusive of any counseling theory, relying solely on the concept of client interaction with medium. This is an ethically unsound practice that can lead to pseudoexperimental work with clients. The expressive arts, narrative, and symbolic approaches do not, as of yet, have a fully developed theory of personality from which to work. Best practices dictate the use of these approaches from some theoretical base (Levine & Levine, 1999; Rubin, 2001).

Summary Chart: Integrative Approaches: Expressive Arts, Narrative, and Symbolism

Human Nature

The integrative approaches in counseling are based on the concept that the use of mediums such as art, writing, and symbolic meaning, when combined with counseling theory, is an effective method of client expression and exploration. Clients, from an integrative perspective, benefit from the use of techniques and modalities that holistically address their experiential living and meaning.

Major Constructs

Unlike theoretical constructs in counseling, the integrative approaches do not have universally accepted concepts of client development and role of the therapist, among other concepts. The major constructs of the integrative approaches are the expressive arts, narrative, and symbolic approaches. Each construct uses different modalities as a means of encouraging client awareness and expression.


The first goal of integrative approaches is to enhance theoretically based counseling with more holistic means of therapeutic guidance and intervention. The second goal of the use of the expressive arts, narrative, and symbolic approaches is to facilitate greater client expression and awareness of self through active experiencing of issues based in psychically disturbed thoughts and feelings.

Change Process

Counselors who use integrative approaches in counseling believe that (a) clients change when their current life perspective no longer represents their desired goals; (b) clients change by accepting control, responsibility, and power for the construction and insightful living of their inner realities; and (c) client change is a process of authentic reflection, accountability, and openness toward growth and resolution.


Interventions in the integrative approaches are quite numerous and unstandardized. There are no set interventions that can be classified as belonging to any single approach due to the amount of overlap in creative expression techniques. Most counselors will find the use of integrative approaches as an opportunity for clients to better communicate latent emotions and thoughts. Some counselors may consider certain techniques as specifically narrative or exclusively expressive art.


The integrative approaches are limited by the lack of empirical research on the effectiveness and applicability of the expressive arts, narrative, and symbolism in counseling. Also, these approaches are dependent on the use of theoretical integration with fully developed counseling theory for their practical and effective use.

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