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Journal of Creativity in Mental Health
Volume 11, 2016 - Issue 1
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Integrating Feminist Therapy and

Expressive Arts With Adolescent Clients
Tiffany L. Otting & Elizabeth A. Prosek
Pages 78-89 | Published online: 18 Feb 2016

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http://dx.doi.org/10.1080/15401383.2015.1019167

In this article

ABSTRACT

Adolescent development

Rationale

Assumptions

Objectives
 Process

Requirements and limitations

Conclusion

References

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Abstract
Utilizing expressive arts interventions within a feminist theoretical orientation may
prove impactful for adolescent clients. Tenets of feminist therapy and support for
integrating expressive arts interventions into counseling practice are presented.
Assumptions and objectives for utilizing expressive arts interventions with adolescents
in feminist therapy are offered. Two feminist theory ecological models of identity
development are described, with corresponding expressive arts interventions to address
adolescent identity development.

KEYWORDS: Adolescents, creativity in counseling, ecological, expressive

arts, feminist therapy

Counselors adopted feminist theory not only as a therapeutic practice, but also as a
counselor identity. A key component of feminist therapy is the counselors identity as a
feminist, profeminist, or antisexist counselor (Ballou, Hill, & West, 2008 Ballou, M. B.,
Hill, M., & West, C. M. (2008). Feminist therapy theory and practice: A contemporary
perspective. New York, NY: Springer. [Google Scholar]; Brown, 2004 Brown, L. S.
(2004). Subversive dialogues: Theory in feminist therapy. New York, NY: Basic
Books. [Google Scholar]). Brown (2004 Brown, L. S. (2004). Subversive dialogues:
Theory in feminist therapy. New York, NY: Basic Books. [Google Scholar]) purported
that the numerous labels for counselors who practice feminist therapy allows for
inclusivity of male counselors to identify as profeminist or antisexist. Through the
central lens of female reality, women practice feminist therapy (Brown, 2004 Brown, L.
S. (2004). Subversive dialogues: Theory in feminist therapy. New York, NY: Basic
Books. [Google Scholar]). In the spirit of equality and in alignment with modern
feminism (Funderburk & Fukuyama, 2001 Funderburk, J. R., & Fukuyama, M. A.
(2001). Feminism, multiculturalism, and spirituality: Convergent and divergent forces in
psychotherapy. Women & Therapy, 24(3/4), 118. doi:10.1300/J015v24n03-01
http://www.tandfonline.com/doi/abs/10.1300/J015v24n03_01 ), we refer to any
counselor who practices feminist therapy or who self-identifies as feminist as a feminist
counselor, regardless of gender.

The tenets of feminist theory in counseling are well documented (Ballou et al., 2008
Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist therapy theory and practice: A
contemporary perspective. New York, NY: Springer. [Google Scholar]; Brown, 2004
Brown, L. S. (2004). Subversive dialogues: Theory in feminist therapy. New York, NY:
Basic Books. [Google Scholar], 2010; Corey, 2009 Corey, G. (2009). Theory and
practice of counseling & psychotherapy (8th ed.). Belmont, CA: Brooks/Cole. [Google
Scholar]; Evans, Kincade, Marbley, & Seem, 2005 Evans, K. M., Kincade, E. A.,
Marbley, A. F., & Seem, S. R. (2005). Feminism and feminist therapy: Lessons from the
past and hopes for the future. Journal of Counseling & Development, 83, 269277.
doi:10.1002/j.1556-6678.2005.tb00342.x[CrossRef], [Web of Science ], [Google
Scholar]; Feminist Therapy Institute [FTI], 1999 Feminist Therapy Institute. (1999).
Feminist therapy code of ethics-revised. Retrieved from
http://chrysaliscounseling.org/feminist-therapy-ii.html ; Healey, 2010 Healey, A. C. C.
(2010). An Adlerian-feminist model for self-injury treatment: A holistic approach.
Journal of Individual Psychology, 66, 366383. [Google Scholar]; Trepal & Duffey,
2011 Trepal, H., & Duffey, T. (2011). Feminist theory. In S. Degges-White & N. Davis
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York, NY: Springer. [Google Scholar]; Whalen et al., 2004 Whalen, M., Fowler-Lese,
K. P., Barber, J. S., Williams, E. N., Judge, A. B., Nilsson, J. E., & Shibazaki, K. (2004).
Counseling practice with feminist-multicultural perspectives. Journal of Multicultural
Counseling and Development, 32, 379389.[Web of Science ], [Google Scholar]). The
key components are: (a) The personal is political; (b) the voices of the marginalized are
valued and privileged; (c) patriarchal gender roles are analyzed and challenged on the
basis of equitable power distribution; (d) therapy is a process that occurs in and out of
counseling sessions with attention to mutual respect, social change, and empowerment,
rather than pathology; and (e) the therapeutic relationship is egalitarian in nature,
wherein the counselor is aware of the client-expert (Trepal & Duffey, 2011 Trepal, H.,
& Duffey, T. (2011). Feminist theory. In S. Degges-White & N. Davis (Eds.),
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Springer. [Google Scholar], p. 110) imbalance and takes action to disrupt this inequality.
Counselors who identify from the framework of feminist therapy employ these key
components as foundational to their guiding theory when working with couples,
families, groups, and individuals across the life span (Carlson et al., 2006 Carlson, T. S.,
McGeorge, C. R., DeJean, S. L., Grams, W. A., Linde, S., & Michael, R. V. (2006). A
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The versatile framework of feminist therapy allows for authentic integration of other
techniquesfor example, the infusion of expressive arts activities. Degges-White and
Davis (2011 Degges-White, S., & Davis, N. L. (2011). Integrating the expressive arts
into counseling practice: Theory-based interventions. New York, NY: Springer. [Google
Scholar]) highlighted the use of expressive arts practice in counseling within several
theoretical orientations, including feminist therapy. Expressive arts in the counseling
field may include drama, visual art, music, dance or movement, writing,
imagery/visualization, puppetry, sandplay, and adventure/wilderness therapy (Degges-
White & Davis, 2011 Degges-White, S., & Davis, N. L. (2011). Integrating the
expressive arts into counseling practice: Theory-based interventions. New York, NY:
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couples for various mental health concerns in a variety of settings including private
practice, residential treatment, inpatient and outpatient settings, and community
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Creative solutions: Innovative use of the arts in mental health settings. Journal of
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[PubMed], [Google Scholar]). According to the Substance Abuse and Mental Health
Services Administration (2013 Substance Abuse and Mental Health Services
Administration. (2013). Results from the 2012 National Survey on Drug Use and
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4805). Rockville, MD: Author. Retrieved from.
http://www.samhsa.gov/data/NSDUH/2k12MH_FindingsandDetTables/2K12MHF/NSD
UHmhfr2012.htm ), in 2012, approximately 28% of adolescents received mental health
services in inpatient, outpatient, school, or medical settings. Thus, adolescent clients are
frequently served in settings that may utilize expressive arts modalities. Further
investigation of the adolescent population is warranted to understand how to best
implement expressive arts into treatment.

Adolescent development
Eriksons (1950 Erikson, E. (1950). Childhood and society. New York, NY: W. W.
Norton. [Google Scholar]) developmental stage of identity versus role confusion is
commonly referenced to describe the tasks and stages of adolescent development
(Allen, 2006 Allen, B. P. (2006). Personality theories: Development, growth, and
diversity. Boston, MA: Pearson/Allyn & Bacon. [Google Scholar]; Crain, 2011 Crain,
W. C. (2011). Theories of development: Concepts and applications. Boston, MA:
Prentice Hall. [Google Scholar]; Erford, 2010 Erford, B. T. (2010). Orientation to the
counseling profession: Advocacy, ethics, and essential professional foundations.
Columbus, OH: Pearson. [Google Scholar]). He suggested adolescents aged 12 to 18
years old experience a crisis of identity and are eager to create a sense of self (Erikson,
1950 Erikson, E. (1950). Childhood and society. New York, NY: W. W. Norton. [Google
Scholar]). Wastell (1996 Wastell, C. A. (1996). Feminist developmental theory:
Implications for counseling. Journal of Counseling & Development, 74, 575581.
doi:10.1002/j.1556-6676.1996.tb02295.x[CrossRef], [Web of Science ],
[CSA], [Google Scholar]) purported several limitations of Eriksons model, including
the adherence to Western cultural values that foster autonomy. Moreover, Conarton and
Kreger-Silverman (1988 Conarton, S., & Kreger-Silverman, L. (1988). Feminist
development through the life cycle. In M. A. Dutton-Douglas & L. E. Walker (Eds.),
Feminist psychotherapies: Integration of therapeutic and feminist systems (pp. 3767).
Norwood, NJ: Ablex. [Google Scholar]) disagreed with the stereotypical male model of
development proposed by Erikson that highlights achievement of independence, rather
than relationships with others. Their model advanced a feminist perspective of life-span
development and is closely aligned with Gilligans (1982 Gilligan, C. (1982). In a
different voice: Psychological theory and womens development. Cambridge, MA:
Harvard University Press.[CrossRef], [Google Scholar]) model of relational and
emotional development. Although Conarton and Kreger-Silvermans model honors
feminist theory tenets, the model is written specifically for women. Therefore, gender-
inclusive models that apply to adolescent development remain sparse. Smetana,
Campione-Barr, and Metzger (2006 Smetana, J. G., Campione-Barr, N., & Metzger, A.
(2006). Adolescent development in interpersonal and societal contexts. Annual Review
of Psychology, 57, 255284. doi:10.1146/annurev.psych.57.102904.190124[CrossRef],
[PubMed], [Web of Science ], [Google Scholar]) surmised that ecological models
represent a growing trend in adolescent development research and practice. Ecological
models seem to inclusively capture elements of feminist theory. For example, both
consider the clients life outside of counseling. Some feminist theorists have developed
models that infuse principles of feminist theory into ecological models. Therefore, these
models may be considered appropriate for use with adolescents.

We propose two feminist ecological models for consideration. Brown (2010 Brown, L.
S. (2010). Feminist therapy. Washington, DC: American Psychological
Association. [Google Scholar]) described the feminist conceptualization of the human
experience through the biopsychosocial/spiritual-existential axes of personal power.
From this model, feminist practitioners help clients identify areas of interpersonal axes
(e.g., somatic, intrapsychic, social-contextual, spiritual) in which clients feel
disempowered and invite clients to notice where power is available to them on each axis
(Brown, 2010 Brown, L. S. (2010). Feminist therapy. Washington, DC: American
Psychological Association. [Google Scholar]). Clients will likely be unaware of areas on
each axis in which they are empowered or disempowered. Increased awareness of
power on each axis is a key component of empowerment in feminist therapy (Brown,
2010 Brown, L. S. (2010). Feminist therapy. Washington, DC: American Psychological
Association. [Google Scholar]). Ballou and colleagues (2008 Ballou, M. B., Hill, M., &
West, C. M. (2008). Feminist therapy theory and practice: A contemporary perspective.
New York, NY: Springer. [Google Scholar]) created their contextual ecological model to
honor the lived experience of the client (p. 43). Considering the contextual layers
(e.g., microsystem, exosystem, macrosystem) of a clients world allows for value of the
lived experiences. Further, understanding clients from the layers creates opportunity to
find similarities of experiences of an identified cultural group (Ballou et al., 2008
Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist therapy theory and practice: A
contemporary perspective. New York, NY: Springer. [Google Scholar]). Both models
infuse feminist principles into ecological models. Counselors may employ these models
to understand the identity development of adolescents.

Rationale
Counselors can promote the following developmental tasks by integrating expressive
arts activities into feminist counseling practice: (a) exploration of multiple identities
within an ecological system, (b) advancement of creative self-efficacy, and (c)
expansion of the clients worldview (Franz, 2012 Franz, B. (2012). Immigrant youth,
hip-hop, and feminist pedagogy: Outlines of an alternative integration policy in Vienna,
Austria. International Studies Perspectives, 13, 270288. doi:10.1111/j.1528-
3585.2012.00484.x[CrossRef], [Web of Science ], [Google Scholar]; Trepal & Duffey,
2011 Trepal, H., & Duffey, T. (2011). Feminist theory. In S. Degges-White & N. Davis
(Eds.), Integrating the expressive arts into counseling practice (pp. 107132). New
York, NY: Springer. [Google Scholar]). Adolescent clients often experience a
juxtaposition of thoughts, identities, and oppressive external forces as they develop into
young adults (Ballou et al., 2008 Ballou, M. B., Hill, M., & West, C. M. (2008).
Feminist therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]; Slyter, 2012 Slyter, M. (2012). Creative counseling
interventions for grieving adolescents. Journal of Creativity in Mental Health, 7, 1734.
doi:10.1080/15401383.2012.657593[Taylor & Francis Online], [Google Scholar]). A
logical implication of expressive arts practice is the application of a feminist framework
to address gender issues, societal context, self-esteem, and power differentials, which
are often of concern to adolescent clients. Utilizing feminist and expressive arts
approaches with adolescent clients supports empowerment, increases self-awareness,
and provides the innovative approaches called for by Schuchman (1997 Schuchman, K.
M. (1997). Feminist approaches to working with adolescents. Women & Therapy, 20,
101110. doi:10.1300/J015v20n02_08[Taylor & Francis Online], [Web of Science ],
[CSA], [Google Scholar]) with regard to the implementation of feminist attitudes
toward youth as a vulnerable population. Schuchman also stated that feminist
approaches are essential for fostering improved outcomes and enhancing adolescent
development.

Assumptions
To incorporate the infusion of feminist therapy and expressive arts effectively with
adolescents in counseling, the following assumptions are considered:

1. The counselor identifies as a feminist counselor and understands that

adolescent clients are a vulnerable population whose voices are to be heard and
valued (Schuchman, 1997 Schuchman, K. M. (1997). Feminist approaches to
working with adolescents. Women & Therapy, 20, 101110.
doi:10.1300/J015v20n02_08[Taylor & Francis Online], [Web of Science ],
[CSA], [Google Scholar]).

2. The counselor and client work together in an egalitarian relationship (Ballou

et al., 2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist therapy
theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]).

3. The counselor abides by ethical codes of competence with regard to

theoretical orientation and expressive arts interventions (FTI, 1999 Feminist
Therapy Institute. (1999). Feminist therapy code of ethics-revised. Retrieved
from http://chrysaliscounseling.org/feminist-therapy-ii.html ; Gladding, 2005
Gladding, S. T. (2005). Counseling as an art: The creative arts in counseling
(3rd ed.). Alexandria, VA: American Counseling Association. [Google Scholar]).

4. The client is enmeshed within a culture from which she or he cannot be

separated (Evans et al., 2005 Evans, K. M., Kincade, E. A., Marbley, A. F., &
Seem, S. R. (2005). Feminism and feminist therapy: Lessons from the past and
hopes for the future. Journal of Counseling & Development, 83, 269277.
doi:10.1002/j.1556-6678.2005.tb00342.x[CrossRef], [Web of Science
], [Google Scholar]).

Objectives
The integration of feminist therapy and expressive arts when counseling adolescents
incorporates the following objectives:

1. Provide a voice to the silent experiences and intuitions of adolescent clients

(Ballou et al., 2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist
therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]; Degges-White & Davis, 2011 Degges-White, S., &
Davis, N. L. (2011). Integrating the expressive arts into counseling practice:
Theory-based interventions. New York, NY: Springer. [Google Scholar]).

2. Promote identity development of the holistic self through increased self-

awareness and other awareness, known as connectedness (Ballou et al., 2008
Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist therapy theory and
practice: A contemporary perspective. New York, NY: Springer. [Google
Scholar]).

3. Offer insight to both the client and counselor regarding the effect and
influence of multisystemic powers on the adolescent (Ballou et al., 2008 Ballou,
 M. B., Hill, M., & West, C. M. (2008). Feminist therapy theory and practice: A
contemporary perspective. New York, NY: Springer. [Google Scholar]).

4. Empower clients by conceptualizing them from a perspective of resilience and

resistance (Brown, 2004 Brown, L. S. (2004). Subversive dialogues: Theory in
feminist therapy. New York, NY: Basic Books. [Google Scholar]).

5. Increase self-esteem, gender-role elasticity, social action, and awareness of

oppressive societal forces (Evans et al., 2005 Evans, K. M., Kincade, E. A.,
Marbley, A. F., & Seem, S. R. (2005). Feminism and feminist therapy: Lessons
from the past and hopes for the future. Journal of Counseling & Development,
83, 269277. doi:10.1002/j.1556-6678.2005.tb00342.x[CrossRef], [Web of
Science ], [Google Scholar]) through expressive arts activities.

Process
Regardless of the population, symptomatology, or selected intervention, the basic
process of feminist therapy should remain intact. The first task is to provide informed
consent to the clients describing the nature of feminist therapy and the clients rights and
responsibilities therein (Brown, 2010 Brown, L. S. (2010). Feminist therapy.
Washington, DC: American Psychological Association. [Google Scholar]). Adolescents
often worry about confidentiality in the helping profession setting (Del Mauro &
Jackson Williams, 2013 Del Mauro, J. M., & Jackson Williams, D. (2013). Children and
adolescents attitudes toward seeking help from professional mental health providers.
International Journal for the Advancement of Counselling, 35, 120138.
doi:10.1007/s10447-012-9172-6[CrossRef], [Google Scholar]), reinforcing the
importance of an informed consent conversation. Based on informed consent,
counselors and clients begin to forge an egalitarian relationship. Next, feminist
counselors and clients assess and analyze ways that the clients are oppressed or
disempowered on multiple axes, described by Brown (2010 Brown, L. S. (2010).
Feminist therapy. Washington, DC: American Psychological Association. [Google
Scholar]) as the biopsychosocial/spiritual-existential axes of personal power: (a)
somatic, (b) intrapsychic, (c) social-contextual, and (d) spiritual. The contextual
ecological model by Ballou et al. (2008 Ballou, M. B., Hill, M., & West, C. M. (2008).
Feminist therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]) designated the following layers: (a) microsystem, (b)
exosystem, (c) macrosystem, and (d) other realities coordinates. With the analysis of
each axis or layer, counselors can utilize interventions to increase empowerment in
areas where it is lacking. Areas in which clients feel disempowered are opportunities to
integrate expressive arts into counseling practice (Trepal & Duffey, 2011 Trepal, H., &
Duffey, T. (2011). Feminist theory. In S. Degges-White & N. Davis (Eds.), Integrating
the expressive arts into counseling practice (pp. 107132). New York, NY:
Springer. [Google Scholar]). In lieu of a traditional case example, we offer suggestions
for how to effectively infuse expressive arts from the feminist theory ecological models
of Brown (2010 Brown, L. S. (2010). Feminist therapy. Washington, DC: American
Psychological Association. [Google Scholar]) and Ballou et al. (2008 Ballou, M. B.,
Hill, M., & West, C. M. (2008). Feminist therapy theory and practice: A contemporary
perspective. New York, NY: Springer. [Google Scholar]), respectively, when working
with the adolescent population.
Biopsychosocial/spiritual-existential axes of personal power

Somatic

The primary focus of the somatic axis of personal power is connection with and
compassion for the physical body (Brown, 2010 Brown, L. S. (2010). Feminist therapy.
Washington, DC: American Psychological Association. [Google Scholar]). Jones (1998
Jones, A. (1998). 104 activities that build: Self-esteem, teamwork, communication,
anger management, self-discovery, coping skills. Richland, WA: Rec Room. [Google
Scholar]), in her body-beautiful intervention, provided an opportunity for adolescent
clients to view their bodies in a positive and powerful way. Materials needed for this
activity include butcher paper, coloring utensils, and scissors. Clients lie down on the
paper, and counselors trace the body shape of clients. Then, clients write specific skills
or tasks that can be accomplished with each part of the bodyfor example, writing
fast runner on a foot or good listener on an ear. This activity is not limited to able-
bodied clients and can be adapted to clients utilizing wheelchairs by including the
wheelchair in the drawing. Another adaptation could be utilized for clients whose arms
are not able to draw. Counselors could provide magazines with pictures to represent
tasks completed by various body parts, and clients could place the pictures on the body
as in a collage. Together, clients and counselors analyze the creation to gain more
appreciation for client resilience and increased self-awareness and other awareness.

Intrapsychic

The intrapsychic axis, visually constructed by Brown (2010 Brown, L. S. (2010).

Feminist therapy. Washington, DC: American Psychological Association. [Google
Scholar]), is a continuum of feelings based on internal and external data. Clients and
counselors explore this axis and clients abilities to self-soothe in ways that are not
harmful to themselves or others, meaning that the focus is to be present in emotions
without being overwhelmed by them. An expressive arts intervention to meet the needs
of this axis is journaling, coupled with a transitional relaxation technique (Edgar-Bailey
& Kress, 2010 Edgar-Bailey, M., & Kress, V. E. (2010). Resolving child and adolescent
traumatic grief: Creative techniques and interventions. Journal of Creativity in Mental
Health, 5, 158176. doi:10.1080/15401383.2010.485090[Taylor & Francis
Online], [Google Scholar]). Journaling may evoke intense emotional responses;
therefore, counselors and clients predetermine a mindfulness technique before out-of-
session journaling assignments to safeguard the emotional safety of clients. Shapiro,
Sprague, and McKays (2009 Shapiro, L., Sprague, R., & McKay, M. (2009). The
relaxation & stress reduction workbook for kids: Help for children to cope with stress,
anxiety & transitions. Oakland, CA: New Harbinger. [Google Scholar]) age-appropriate
mindfulness techniques for adolescents and Hansens (2007 Hansen, S. (Producer).
(2007, April 17). Inner peace-affirmations for growing up in a crazy world [Audio
podcast]. Meditation for Children and Teens Podcast. Retrieved from
http://podbay.fm/show/164025012/e/1176939258?autostart=1 ) Meditation for Children
and Teens, a podcast of age-appropriate guided meditation, are helpful resources. The
objective is not to quell emotion, but rather to help clients experience emotion and
provide a safe space for their voices through the journal.

Social-contextual
Brown (2010 Brown, L. S. (2010). Feminist therapy. Washington, DC: American
Psychological Association. [Google Scholar]) addressed interpersonal relationships in
the social-contextual axis with specific attention to personal boundaries, personal roles
within multiple contexts, and differentiation of self as opposed to detachment. Trepal
and Duffey (2011 Trepal, H., & Duffey, T. (2011). Feminist theory. In S. Degges-White
& N. Davis (Eds.), Integrating the expressive arts into counseling practice (pp. 107
132). New York, NY: Springer. [Google Scholar]) provided an in-depth description of A
Musical Chronology and the Emerging Life Song in Degges-White and Daviss (2011
Degges-White, S., & Davis, N. L. (2011). Integrating the expressive arts into
counseling practice: Theory-based interventions. New York, NY: Springer. [Google
Scholar]) Integrating the Creative Arts Into Counseling Practice. Materials needed for
this activity are paper, writing utensils, access to music recordings, lyrics, and access to
sound equipment (speakers, audio players, recording software, etc.).

The product outcome of the musical chronology is a playlist, compiled by clients, of

songs associated with life events. Clientcounselor teams complete this activity in four
stages. The first stage begins with a discussion between clients and counselors of the
possibility of using music to develop an autobiographical scrapbook (Trepal &
Duffey, 2011 Trepal, H., & Duffey, T. (2011). Feminist theory. In S. Degges-White & N.
Davis (Eds.), Integrating the expressive arts into counseling practice (pp. 107132).
New York, NY: Springer. [Google Scholar], p. 115). During Stage 2, clients identify
important life events and songs corresponding to those events and find recordings and
lyrics of the songs to bring to session. Based on clients preferences, counselors may
assist the clients with technology and compilation. Stage 3 of the project consists of the
clients and counselors playing the songs during sessions and discussing client thoughts,
feelings, and overt or covert social contexts within the songs. Inherent in this stage are
opportunities for client insight about interpersonal behaviors and feelings associated
with interpersonal relationships. Finally, in Stage 4, clients identify two specific songs
from the playlist: (a) the song that best represents the clients current interpersonal-
contextual position and (b) a song that the client associates with a hopeful future.
Throughout this activity, clients and counselors experience opportunities for reflection,
acknowledgement of societal oppressors, and the opportunity to address any
disempowering messages in the music. Clients are empowered to reauthor historical
events from an empowered stance. We suggest a possible fifth stage to this activity in
which clients create an album cover with visual art in the style of their choosing (e.g.,
vinyl album cover, CD cover, or digital album graphic).

Spiritual

On the spiritual axis, Brown (2010 Brown, L. S. (2010). Feminist therapy. Washington,
DC: American Psychological Association. [Google Scholar]) described the existential
process of making meaning of existence and purpose within the context of past, present,
and future. A creative way to make the spiritual context tangible for adolescents is
planting and/or gardening. Counselors can encourage various adaptations of this activity
such as sprouting grass in a plastic cup, planting vegetables (Cohen, 2011 Cohen, R.
(2011). Fifteen minutes outside: 365 ways to get out of the house and connect with your
kids. Naperville, IL: Sourcebooks. [Google Scholar]), or planting a tree (Edgar-Bailey
& Kress, 2010 Edgar-Bailey, M., & Kress, V. E. (2010). Resolving child and adolescent
traumatic grief: Creative techniques and interventions. Journal of Creativity in Mental
Health, 5, 158176. doi:10.1080/15401383.2010.485090[Taylor & Francis
Online], [Google Scholar]). Depending on the counseling setting, clients and counselors
can experience this activity together in nature, or if not appropriate, clients may
experience the intervention outside of session in their own social context. In this
activity, counselors and clients utilize nature as a platform to discuss the context in
which they live and the purpose for growth and development within that context.

Contextual ecological model

Microsystem

Ballou and colleagues (2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist
therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]) described a microsystem as influences that the client faces
regularly. In the adolescent world, these influences may include interactions with
parents, siblings, classmates, teachers, teammates, and members of other community
groups such religious communities, as well as intrapersonal interactions. Creating a
microsystem totem pole (adapted from Jones, 1998 Jones, A. (1998). 104 activities that
build: Self-esteem, teamwork, communication, anger management, self-discovery,
coping skills. Richland, WA: Rec Room. [Google Scholar]) is one way of helping
adolescents identify forces within their microsystems and explore the influence of each
force on clients perceptions of expectations therein. Materials needed for this activity
include construction paper, glue or tape, scissors, coloring utensils, optional craft items
such as googly eyes, feathers, puff balls, or animal stencils, and a cardboard tube.

First, counselors explain to clients the purpose of a totem pole as a Native American
tool for storytelling. Then, clients choose different animalseither premade or created
by clientsto represent each member of their microsystem. Clients coordinate
placement of each animal on the totem pole with perceived relation to self. Together,
clients and counselors discuss and analyze the influence of the members of the clients
microsystem and identify the contextual roles of clients within their microsystems.
When appropriate, counselors help the clients to address power differentials within
those relationships.

Exosystem

Ballou and colleagues (2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist
therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]) referred to the exosystem level of individual context as
formal organizations such as legal, governmental, academic, religious, and professional
systems that influence policy and normative standards. Gil and Sobol (2005 Gil, E., &
Sobol, B. (2005). Engaging families in therapeutic play. In C. Everett Bailey (Ed.),
Children in therapy (pp. 341382). New York, NY: W. W. Norton. [Google Scholar])
proposed a sequence of family sandtrays to highlight family context within the larger
social context. In adapting this activity for adolescent clients, counselors encourage
clients to create their worlds using miniatures to represent the layers of the microsystem
and exosystem in the sandtray. Through the use of the sandtray technique, clients are
provided a context in which to place emotional distress as not solely inside themselves,
but as products of greater societal stresses that have a negative impact on their
microsystems. A further adaptation of this intervention is to ask clients if they would
like other family members to participate with them in session to create the sandtray
world, thus providing opportunities for interpersonal development.

After the world is created, the counselor, client, and family member(s) (if applicable)
discuss the systems represented and identify the contextual roles each person plays in
each system. For example, the client may simultaneously identify as self, daughter,
student, sister, granddaughter, friend, and citizen. In congruence with feminist therapy,
the client and counselor further analyze gender expectations, societal norms, and
oppressive forces within and between each system. In using the sandtray intervention,
the feminist counselor provides a tool for recognizing opportunities for social action and
client empowerment.

Macrosystem

Ballou and colleagues (2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist
therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]) identified this system of global influences such as advanced
capitalism, technological access and development, nationalism, fundamentalism, and
human rights/social justice movements. According to DHaene (1995 DHaene, M. T.
(1995). Evaluation of feminist-based adolescent group therapy. Smith College Studies in
Social Work, 65, 153166. doi:10.1080/003377319509217430[CrossRef], [Web of
Science ], [CSA], [Google Scholar]), integral parts of adolescent development include
recognizing these global forces and their influence on clients lives and increasing self-
efficacy as a catalyst for social action.

Creating a personal flag (adapted from Jones, 1998 Jones, A. (1998). 104 activities that
build: Self-esteem, teamwork, communication, anger management, self-discovery,
coping skills. Richland, WA: Rec Room. [Google Scholar]) is an intervention intended
to draw attention to national identity within a global world and allows adolescents to
explore the questions, How am I unique in the world?; What is important to me?;
and How do I represent myself in the world? Materials needed for this activity include
paper, pens and pencils, coloring utensils, and the options of glitter, glue, paint, fabric,
or other available materials. A personal flag may also allow adolescent clients to
identify with various cultural groups, which Ballou et al. (2008 Ballou, M. B., Hill, M.,
& West, C. M. (2008). Feminist therapy theory and practice: A contemporary
perspective. New York, NY: Springer. [Google Scholar]) suggested is important in
building a personal identity and feeling connected to others.

Other realities and coordinates

Ballou et al. (2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist therapy
theory and practice: A contemporary perspective. New York, NY: Springer. [Google
Scholar]) defined other realities as the planetary conditions and sociohistorical periods
within which the client lives. Examples of such conditions are global warming,
pollution, natural disasters, and geopolitical conflicts such as the Arab Spring and the
wars in Afghanistan and Iraq. As adolescents raise their awareness of these conditions,
opportunities arise for increased self-awareness and social action.

Coordinates, in Ballou and colleagues (2008 Ballou, M. B., Hill, M., & West, C. M.
(2008). Feminist therapy theory and practice: A contemporary perspective. New York,
NY: Springer. [Google Scholar]) contextual model of development, are socially defined,
dynamic constructs such as sex, gender, age, race, socioeconomic status, ethnicity,
ability, and sexual orientation. Individuals are socially evaluated and are assigned
privilege or disadvantages based on these coordinates. Adolescents also evaluate
themselves and others according to these coordinates.

Mixed media collages representing the multiple layers and coordinates in the lives of
adolescents can aid clients in clarifying their positions in the world at large. Materials
needed include a large drawing of the contextual ecological feminist model (see the
Appendix; Ballou et al., 2008 Ballou, M. B., Hill, M., & West, C. M. (2008). Feminist
therapy theory and practice: A contemporary perspective. New York, NY:
Springer. [Google Scholar]), magazines, scissors, glue or tape, and other craft supplies
as determined by the client and counselor. Throughout the collage-making process,
counselors and clients find opportunities to express and reflect clients thoughts and
feelings about the cultures in which they are enmeshed yet differentiated (Slayton, 2012
Slayton, S. C. (2012). Building community as social action: An art therapy group with
adolescent males. The Arts in Psychotherapy, 39, 179185.
doi:10.1016/j.aip.2011.12.010[CrossRef], [Web of Science ], [Google Scholar]).

Requirements and limitations

The examples provided here are not exhaustive of the possibilities for incorporating
expressive arts into feminist therapeutic practice with adolescents. Further interventions
for body movement, clay sculpture, drama, and adventure/wilderness therapy could also
be formulated within a feminist framework. Another limitation of this exploration of
expressive arts in feminist therapy is the focus on individual therapy. Most of the
presented interventions could be adapted for group work, and certainly, more
interventions need to be created to meet the needs of other therapeutic settings within a
feminist framework.

One limitation of feminist therapy, in particular, may be the overt nature of the
therapeutic practice. The third wave of feminists contends with negative backlash
inherited from the first and second waves (Evans et al., 2005 Evans, K. M., Kincade, E.
A., Marbley, A. F., & Seem, S. R. (2005). Feminism and feminist therapy: Lessons from
the past and hopes for the future. Journal of Counseling & Development, 83, 269277.
doi:10.1002/j.1556-6678.2005.tb00342.x[CrossRef], [Web of Science ], [Google
Scholar]; Ross, 2010 Ross, L. R. (2010). Feminist counselling: Theory, issues, and
practice. Toronto, Ontario, Canada: Womens Press. [Google Scholar]). Thus,
counselors should provide written informed consent and education about feminist
therapy to parents and caregivers of adolescents. Case examples of expressive arts in
conjunction with feminist therapy and adolescent counseling should also be compiled
and disseminated to address best practices and further ethical considerations.

Conclusion
Modern ecological models inspired by feminist principles may be utilized for
understanding adolescent identity development. Furthermore, expressive arts can be
integrated to foster identity development and alleviate symptoms of distress in
adolescents. The expressive interventions presented provide merely a starting point for
the possibilities that exist to meet the complex needs of adolescent mental health clients.

Appendix

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Additional author information

Tiffany L. Otting

Tiffany L. Otting is a Doctoral Candidate in Counseling and Higher Education at the

University of North Texas, Denton, Texas.

Elizabeth A. Prosek
Elizabeth A. Prosek is an Assistant Professor in Counseling and Higher Education at
the University of North Texas, Denton, Texas.

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