Expressive Arts

What Actually Happens in an Expressive Arts Session?

If you've landed here, you might be intrigued by expressive arts therapy but unsure what you'd actually be signing up for. Maybe you're picturing yourself being handed a paintbrush and asked to "paint your feelings" while someone watches and interprets. Maybe you're worried you'll be judged for stick figures. Maybe talk therapy hasn't quite reached the thing you're carrying, and you're wondering if there's another way in.

Let's get concrete and demystify the process.

First, what expressive arts therapy is (and isn't)

Expressive arts therapy uses creative processes such as drawing, painting, movement, writing, music, drama, and ritual as a way to explore what's happening inside you. It's still therapy. We still talk. We still set goals, track patterns, and build skills. The art is simply another language, one that often reaches places words can't get to on their own.

What it isn't: an art class, a performance, or a test. There's no grade and no right answer. I'm not going to look at your drawing and tell you what it "means." You're the expert on your own images. My role is to guide you through the creative practices, help you make sense of what comes up, and support whatever steps you want to take next.

And one more thing I want to say clearly: you do not need to be creative, talented, or even comfortable with art to benefit. Expressive arts therapists have a phrase for this: low skill, high sensitivity. What matters isn't technique. It's paying attention to what you notice, what you feel, and what surprises you as you create. Some of the most powerful sessions I've witnessed started with someone saying, "I haven't drawn anything since third grade."

Where this approach comes from

Expressive arts therapy took shape in the 1970s at Lesley University in Cambridge, Massachusetts, through the work of Shaun McNiff, Paolo Knill, and their colleagues. What made it distinct was the idea of working intermodally, moving between art forms instead of staying with just one. A session might begin with movement, shift into drawing, and end with a few written lines.

I trained in this tradition at the California Institute of Integral Studies, where Natalie Rogers, a pioneer of person-centered expressive arts, once taught. Rogers observed that creative forms feed each other: how we move changes how we draw, and what we draw changes how we feel and think.

The arc of a typical session

Every session is shaped around the person in front of me, but most follow a gentle rhythm with a few phases.

1. Arriving and checking in

We start the way most therapy sessions start: talking. How has your week been? What's on your mind? What's showing up in your body today? This part might last ten minutes or most of the session, depending on what you need. Nothing super creative happens until you're ready.

2. Settling into the body

Before we make anything, I'll often invite a short grounding practice. That might be a few slow breaths, noticing where your feet meet the floor, or a small stretch. My background in yoga shapes this piece. The goal is to shift out of "thinking about" your experience and into actually noticing it.

3. The creative invitation

This is the part people are most curious about. Based on what you've shared, I'll offer an invitation, never a demand. A few examples:

  • If you've been describing a heavy, stuck feeling, I might ask, "If that heaviness had a color and a shape, what might it look like?" and offer oil pastels and paper.

  • If you're caught in a loop of overthinking, we might try a few minutes of free writing where your pen doesn't stop moving.

  • If you're feeling disconnected from yourself, we might explore a simple gesture or movement that matches how you feel right now, and then one that matches how you'd like to feel.

  • If there's a relationship you're struggling with, we might build a small collage from magazine images that captures it.

You can always say no, change the invitation, or switch materials halfway through. Declining is valuable information too.

I also pay attention to your energy that day. If you arrive exhausted, we might start with something soft and low-effort, like pastels or writing just three words. If you're buzzing with anxiety or frustration, something more physical often helps, like shaping clay, tearing paper, or finding a movement that lets the tension out.

4. Making (the quiet middle)

While you create, I'm present but not hovering. Some people like a bit of conversation; many prefer quiet. This stretch is usually five to twenty minutes. People often tell me this is where something shifts. The hands start doing something the mind hadn't planned, and a feeling surfaces that wasn't accessible in conversation.

If your inner critic shows up, whispering that it looks messy or childish, that's welcome too. We treat that voice as information, not a verdict. Noticing when and how it appears is often part of the work.

5. Reflecting together

When you're finished, we look at what you made together. I'll ask open questions like:

  • What do you notice when you look at this?

  • What was it like to make it?

  • Is there a part that draws your attention, or one you'd rather not look at?

  • If this image could speak, what might it say?

There's a concept in expressive arts called decentering. Instead of staying fixed on the problem, we step for a while into the world of imagination, where there's more room to play and experiment. When we return, the problem often looks a little different, and new options appear that weren't visible before.

This is where the art becomes a bridge back into words, often with more clarity or feeling than when we started. Sometimes a single detail, like a color you didn't expect to choose or a shape pushed into a corner, opens up a whole conversation.

6. Closing and carrying it forward

We wrap up by naming what feels important to take with you. Sometimes that's an insight, sometimes a small practice for the week, and sometimes just the experience of having expressed something that had been held in. You're welcome to take your artwork home or leave it with me.

I also make sure you don't leave feeling wide open. If something big came up, we'll take time to settle and ground before you go, so you can return to your day feeling steady.

How this fits with other approaches

Expressive arts isn't a replacement for evidence-based care. It works alongside it. In my practice, I integrate creative methods with approaches like DBT (Dialectical Behavior Therapy) and IPSRT (Interpersonal and Social Rhythm Therapy), especially with clients navigating depression, anxiety, and mood disorders. A collage might help you recognize an emotional pattern; DBT skills help you respond to it differently. The two strengthen each other.

Who tends to find it helpful

Expressive arts therapy can be a good fit if you:

  • Feel like you've "talked it all out" but still feel stuck

  • Find it hard to put emotions into words

  • Tend to intellectualize your feelings

  • Carry experiences that feel too big or too tender to speak about directly

  • Are a teen, or a parent of a teen, looking for a less intimidating way into therapy

  • Simply want therapy that engages more of who you are

When it may not be the right fit (yet)

I want to be honest here: expressive arts work tends to go best when you have some basic ways of grounding yourself, since creative work can stir up strong feelings. If you're in an acute crisis, we'd focus first on stabilization and safety. Creative work can come in when you're on steadier ground. That's part of why I pace the creative invitations to where you are, rather than jumping straight to the deep end.

Common questions

Do I need any art experience? None at all. The process matters far more than the product.

Will you analyze my artwork? No. I won't tell you what your art means. We explore it together, and your interpretation is the one that counts.

Do I have to do art every session? No. Some sessions are mostly conversation. Creative work is always an invitation, never a requirement.

Can expressive arts therapy happen over telehealth? Yes. Many creative practices translate well online. You can use simple supplies at home, like paper, pens, or even your phone for sound or photography.

What materials do I need? For in-person sessions, I provide everything. For telehealth, a few basic supplies are plenty, and I'll suggest what might be helpful.

If you're curious, that's enough

You don't have to know exactly what you're looking for or feel ready to "be creative." Curiosity is a perfectly good place to begin.

If you'd like to explore whether expressive arts therapy is right for you, I offer both in-person sessions at my Wheat Ridge office and telehealth across Colorado and California. You can schedule a consultation or call (720) 381-4110.

Further reading

Amanda Rebel, BFA, MA, LMFT, is a Licensed Marriage and Family Therapist and founder of Open Circle Counseling in Wheat Ridge, Colorado. She trained in Expressive Arts Therapy at the California Institute of Integral Studies and integrates creative, mind-body, and evidence-based approaches in her work with adults, adolescents, and parents.

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Beyond Words: How Expressive Arts Therapy Can Deepen and Support Your Ketamine Journey

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Why Art Therapies and Ketamine Work So Well Together

Here's what makes this combination so powerful: both ketamine and creative expression tap into the same non-ordinary states of consciousness. Both can bypass our usual mental defenses, such as those parts that are often dominated by analyzing, judging, and trying to make everything make sense.

During ketamine sessions, our defenses are often lowered, and we access parts of ourselves that aren't available during the day-to-day. This experience parallels what can happen when we’re engaged in a fulfilling creative process.

For example, someone may have a picture, image, or dream-like experience come up during a ketamine journey. Say someone had the imagery or feeling of being underwater, unable to reach the surface. Rather than limiting this to verbal processing, that person could begin sculpting with clay, creating figures breaking free from the water, or a cocoon, or any other object that symbolizes the water. With each piece, this person isn’t just remembering their session; they are also continuing the work their psyche had begun, and they are finding a strength-based action (figures breaking free) to what very well may have been a difficult journey. Perhaps this then leads the person to discuss how their body feels when they create figures breaking free, thus continuing the work of integrating and making new meaning. This process also helps us establish an ongoing relationship with ourselves and our healing process, which we can access independently.

The Neuroscience That Backs This Up

Recent neuroimaging studies give us some fascinating insights. Ketamine primarily works on the brain's default mode network—that's the area responsible for rumination, self-criticism, and those repetitive thought patterns many of us are familiar with. When ketamine quiets that network down, space opens up for new neural connections.

At the same time, expressive arts therapy activates the brain's creative networks—the right hemisphere's visual-spatial centers and the corpus callosum, which facilitates communication between both sides of the brain. Dr. Michael Mithoefer refers to this as "bilateral integration," which means that we're not just thinking differently—we're experiencing ourselves and life differently; much deeper work than just thinking.

When you combine these approaches, you're essentially giving those new neural pathways formed during ketamine sessions a means to strengthen and remain intact. Instead of insights fading back into old patterns, they become embodied, visual, and tangible.

How This Actually Works in Practice

Based on clinical experience, here's what tends to be effective in ketamine-arts integration:

Capturing What Can't Be Said People often emerge from their ketamine journey with profound realizations that are beyond words (ineffable). They commonly express frustration with the limitations of language when trying to convey their experience. Art becomes their way of preserving those wordless knowings—the feelings, the body sensations, the sudden understanding that lives deeper, or beyond, language.

Building Their Personal Healing Map The imagery and symbols that appear during ketamine sessions typically aren't random occurrences. They often represent communications from the unconscious, pointing toward what needs attention in the healing process. When we create art or find ways to express the information, we are essentially building our own roadmap for integration. Noticing what comes up when we engage in an art process can deepen the ketamine experience.

Making Sense of the Difficult Sessions Not every ketamine experience feels positive or enlightening. People do encounter painful memories, difficult emotions, or confusing material. Creative practices provide a way to be with these challenging sessions without the immediate pressure to understand or resolve them. With a trained art therapist, there are creative processes that can calm people if they are very dysregulated coming out of the ketamine journey. And often, what initially seemed negative or unhelpful reveals its therapeutic value through the creative process. Engaging in a creative activity with a trained therapist can increase feelings of safety, balance, and regulation after a difficult journey.

Getting Past Creative Resistance It’s very common to be hesitant to engage in a creative activity, often due to past experiences where someone was told they weren't artistic or they got the messaging that creativity wasn't valuable or as important as other things. These beliefs can create resistance to anything non-linear or intuitive. Interestingly, ketamine naturally softens these limiting beliefs, making treatment an optimal time to reconnect with innate creative capacities.

Working with Whatever Therapy Model You Use Arts integration adapts well to various therapeutic approaches. Whether you're also engaging in IFS, ACT, CBT, or other modalities, creative elements can be woven into existing frameworks. Art becomes a bridge that connects ketamine insights with the existing therapeutic approach.

Practical Guidance

Research suggests that timing plays a significant role in integration work effectiveness. Here's what tends to work well:

Before the Session Gentle, opening activities work best—perhaps going for a walk and picking objects that you like, and playing around with placing this objects in different places to enjoy looking at—and perhaps writing down why these objects ‘called’ to you. Is it the smoothness of a stone that is comforting? The leaf that had a beautiful shape that is engaging to look at? This sensory and creative activity is designed to engage you in a way that feels safe and bypasses the need for words or logic, allowing you to open up to the present moment.

Right After the Journey: This is when we are still in the liminal space. In my office, I have collage materials, including lots of magazines, calendars, and other images cut out, which clients can look at and choose from. They may select some pictures that express the journey; they may also choose an image that symbolizes how they are feeling in that moment. They may pick an image that will support them over the next few days. This form of externalizing what is internal can serve as an anchor as they go back home to their lives.

Continued Integration: Depending on the individual's needs and preferences, I may offer guided imagery, ritual, writing, drawing, movement, or sound activities to help them continue processing the content that emerged during the journey and work on any other themes, issues, or goals they have.

Ongoing Practice: Even brief periods of creative engagement can help maintain active neural pathways. Many clients develop their own rituals—drawing while listening to music, keeping a visual journal alongside regular journaling, creating poetry, the ideas are endless!

Matching Methods to the person

People process information in various ways, and meeting people where they are is incredibly important.

For visual processors: Painting, drawing, collage, photography.

For kinesthetic learners: Movement, dance, working with clay, sculpture. If ketamine helped someone feel more connected to their body, these approaches can help anchor that embodied awareness.

For auditory processors: Music, sound exploration, creating playlists. Some people develop enhanced musical sensitivity during treatment—exploring sound as a healing tool can be especially meaningful.

For verbal processors: Creative writing, poetry, storytelling. This bridges someone’s comfort with words and the more symbolic, metaphorical material that often emerges during sessions.

Working Through Creative Resistance

Resistance to creative activities is extremely common, with many expressing that they're not artistic. This resistance often stems from childhood experiences where creativity was criticized or devalued compared to academic subjects. These experiences can create the same kind of mental rigidity that contributes to depression and anxiety patterns.

Ketamine therapy can help to start breaking up limiting beliefs. The inner critic that usually evaluates creative attempts as inadequate may become quieter during and after treatment. The perfectionism that would normally shut down creative exploration may becomes less dominant. This makes ketamine treatment an opportune time to reconnect with natural creative capacities that existed before external criticism took hold.

Expressive art therapy isn't aboutcreating aesthetically pleasing art—a product. Rather, it's about honoring the communications emerging from the unconscious mind—a process. A simple scribble, drawing or sketch that captures how someone felt during a session has significantly more therapeutic value than any technically perfect piece that doesn't connect to their inner experience.

What Success Actually Looks Like

Traditional therapy metrics don't always capture what happens when ketamine is integrated with arts therapy. Different markers tend to be more relevant:

Peopl often develop an enhanced ability to access and name emotions that previously felt overwhelming or vague. They typically begin treating themselves—and their creative expressions—with increased kindness and less self-criticism. When difficult feelings arise during art-making, many develop improved capacity to stay present with the experience rather than shutting down or becoming avoidant. Having a trained arts therapist is vital to guide and support a person engaged in any form of art therapy.

Perhaps most importantly, there's often evidence of what could be called "sustained neuroplasticity"—insights from sessions continue to evolve and deepen through ongoing creative practice.

Moving Forward

If you're already working with ketamine therapy or considering engaging with this medicine, I'd encourage you to think about integration as seriously as you think about the sessions themselves. Every ketamine experience without proper integration is a missed opportunity to help you maximize the healing potential.

The combination isn't just additive—it's exponential. When clients give their insights form through creative expression, they're not just remembering their healing; they're continuing to live it, develop it, and let it transform how they move through the world.

Ready to Explore This Integration?

I'd love to talk with you about how expressive arts therapy might fit into your ketamine therapy. Whether you're curious about it, want to discuss specific challenges you are having, or are wondering how to incorporate this modality into your current preparation or integration.

Your experiences deserve to be honored, preserved, and woven into the life your are living, or the life you want to live.

Let's connect: Contact me to learn more.

Because healing isn't just about getting back to where you were—it's also about re-discovering who you are.