Creative Activation Therapy (CreATe™):
A Framework for Pre-Creative Therapeutic Engagement.

By Dr. Gregory Lyons, PsyD, LCPC.
 8/18/2025, Revised 2/26/2026
DOI: 10.13140/RG.2.2.15739.17445


Creative Activation Therapy (CreATe™) is conceptualized as a structured therapeutic framework situated within a psychotherapeutic context that respects both cognitive and experiential dimensions of treatment. It is not intended to replace established therapeutic modalities; it can be used as a clinician-guided experiential framework that clients can practice outside sessions and bring into sessions to enrich the therapeutic relationship. Through repeated engagement, the framework may become internalized as a self-regulatory and reflective understanding of internal creative experience. CreATe introduces structured creative practices that provide a narrative and communicative vehicle for clients to explore thoughts, emotions, and internal experiences while supporting rapport, insight, and behavioral alignment in psychotherapy.

This paper outlines the theoretical architecture of the CreATe framework, including the EAGER™ Model, the Archetypal Self-Recognition Model, and the Preparatory Attunement Practice (PAP™). These components act as clinical guides that support sequencing, attentional preparation, and reflective engagement. They were also designed to foster the client’s gradual ability to recognize and apply these practices over time. Two implementation pathways are also introduced: the Structured Research Informed Method and the Expressive Intuitive Method. These are complementary modes of engagement that may support different clinical needs and therapeutic styles within the broader CreATe framework.

This paper explores how creative engagement functions as a mechanism for emotional regulation, prompts a personal investigation of what meanings drive their artistic intentions, and narrative reorganization when embedded within a structured therapeutic framework. Case vignettes will illustrate CreATe's adaptability across developmental stages, clinical presentations, and treatment environments. It will also address clinical applications, ethical considerations, and directions for future study, positioning CreATe as an integrative experiential framework designed to organize experiential material prior to modality-specific interventions across psychotherapy settings.

Introduction.

Across many clinical settings, individuals who enter the therapeutic process frequently struggle to verbalize their internal experiences, which can lead to an inability to discuss their feelings and emotions with a clinician in their sessions. This can possibly prevent them from learning constructive behavioral practices that could help them address their symptoms. This situation can also be found with individuals who have experienced trauma, deepening their experiences of feeling anxiety, shame, or chronic depression, which can also impair their cognitive clarity and narrow an individual's capacity for behavioral interpretation.

CreATe is based on the premise that understanding the processes of artistic preparation can be an essential therapeutic component. It was designed to help the client develop structured practices for relaxation, identifying compelling thoughts or actions, identifying triggers, and reflecting on past instances that may be important for behavioral and personal change. Mindfulness practices make up a large part of the CreATe framework; some of these involve grounding, breathwork, and sensory awareness, which can prime the nervous system for safer, more regulated expression and the de-escalation of negative behavioral attributes.

Most clinical models of creative self-expression are based on the premise that focuses on analyzing the creative process during and after its outcome. This approach can neglect the nuances that precede artistic expression. CreATe hypothesizes that the genuine act of transformation lies not in the completed work but in the silent self-evaluation or the process before implementation (Mezirow, 1991; Winnicott, 1971), which may be seen as the initial moment when the individual places the pencil to paper. CreATe encourages the participant and the clinician to examine which levels of feeling, or possibly driving emotions, were involved in their thoughts about their expressive representation that arises from moments of cogitation and from the symbolic identification of a moment in time or memory with an individual's life experiences. In the long term, CreATe may also function as a discipline that individuals can use to support the long-term practice of mindful discipline and emotional release. This hypothesis is supported by studies showing that creativity is often used in therapeutic dynamics (Csikszentmihalyi, 1996; Stuckey & Nobel, 2010) to encourage clients to enhance self-awareness, identify feelings, and promote internal emotional healing (Malchiodi, 2013). Other articles present theories suggesting that expressive representation can be identified and acknowledged for its capacity to alleviate emotional blockages, represent psychological distress, and facilitate connections with repressed facets of emotional identity. They also state that clients may use mindfulness practices as an avenue of self-expression and as a means of a subconscious inventory of emotions that, at times, are limited or inhibited by an individual's ability to express them.

CreATe encourages individuals to learn its mindfulness techniques that involve identifying emotional states and reflective strategizing, followed by producing a creative representation in an artistic medium. It can foster an examination of the underlying reasons for creation, thereby facilitating deeper meaning and potentially enhancing the therapeutic relationship with oneself.

Theoretical Background.

CreATe was designed from a convergence of clinical psychology, expressive arts therapies, mindfulness research, affective neuroscience, and trauma-informed practice (Malchiodi, 2013; Siegel, 2012; van der Kolk, 2014; Davidson & Lutz, 2008). It is built on theories of therapeutic traditions that emphasize awareness, relational safety, and symbolic meaning-making, while remaining distinct in its focus on pre-creative orientation and post-creative rumination as structured therapeutic processes.

Elements of the framework resonate with established therapeutic orientations. Some examples of these incorporated ideas include Gestalt therapy, which emphasizes present-moment awareness (Perls, Hefferline, & Goodman, 1951), and Person-Centered Therapy, which supports the reprocessing of experience within a nonjudgmental, relational space (Rogers, 1951). Representatives of Jungian theory are also introduced through archetypal symbolism, a means of recognizing recurring emotional and behavioral patterns (Jung, 1964).

Aspects of the Expressive Therapies Continuum (ETC) can be seen as a meaningful theoretical anchor, as it describes processing during art engagement. Where ETC primarily describes how creative endeavors engage cognitive and emotional processing, CreATe organizes the experiential arc surrounding creative engagement through preparatory attention, sequential processing, reflective journaling, and therapeutic integration. Rather than mapping creative experiences and how they are used, CreATe structures how individuals enter, move through, and integrate meaning from expressive representation experiences within psychotherapy. CreATe draws conceptually from these traditions without replicating them methodologically. The framework can bring to the surface parallels with symbolic interactionism, presenting that creative acts carry personal and relational meaning (Blumer, 1969), and represent aspects of Gendlin’s Focusing process, in which bodily felt senses precede articulated understanding (Gendlin, 1981).

CreATe encourages participants to cultivate awareness of their underlying motivations and to explore internal experiences. This process is supported by a reflective journal, in which participants document their thoughts, emotions, and experiences as they progress through the stages of creative engagement (Pennebaker & Chung, 2011; Smyth, 1998).

The participant's reflective journal is an essential tool in this framework, serving as a record of their journey and providing a structured point of rumination that can be shared and examined to inform emotional and behavioral practices. In subsequent sessions with the clinician, the reflective journal will serve as a conversational anchor to facilitate dialogue about the participants' emotions, feelings, and experiences that emerged before they engaged in their creative work. This ongoing exchange is meant to further support the examination of their expressive representation practices and strengthen the therapeutic relationship. Unlike traditions that prioritize outcome analysis, CreATe emphasizes intention and perception prior to expression, fostering a space for emotional assessment and integration.

From a cognitive perspective, creative engagement has been associated with neural networks linked to imagination, symbolic reasoning, autobiographical memory, and narrative formation (Beaty et al., 2016; Schacter & Addis, 2007; Dietrich, 2004). These networks overlap with systems involved in emotional processing. When individuals externalize internal states through drawing, writing, sculpting, or movement, they may create symbolic representations that can be explored from a degree of psychological distance (Kross & Ayduk, 2011).

Trauma-informed perspectives show that traumatic stress disrupts integrative brain functions, particularly those involved in language and executive processing (van der Kolk, 2014; Lanius et al., 2010). Engagement in expressive representation can provide an alternative approach by engaging sensory, motor, and symbolic systems that remain accessible during heightened emotional states. This may allow the effect to be externalized while maintaining a sense of agency and containment.

CreATe integrates mindfulness, intentionality, and structured reflection, with experiential processing structured around client-centered expressive representation engagement. Prior to initiating creative work, participants are invited to examine emotions, thoughts, and memories that motivate the impulse to create. This suggests that repeated engagement in preparatory practices may gradually develop into a personal discipline, with structured rituals serving as attentional signals linked to shifts in cognitive and emotional states (Bouton, 2007; Brooks et al., 2016). Research on ritualized behavior and procedural learning shows that patterned activities preceding open-ended tasks may reduce uncertainty and support task initiation (Graybiel, 2008; Hobson et al., 2018).

The framework also helps the participant build somatic awareness and a regulated state of readiness in which self-evaluative monitoring softens, creating space for exploratory behavior and creative openness (Kabat-Zinn, 2003; Lutz et al., 2008; Damasio, 1999). It is believed that creative work then becomes a cognitive baseline through which internal sensations, emotions, and narratives are translated into external form, followed by structured cognition to support insight and identify the meanings involved in expressive representation practices.

This framework is intentionally flexible and adaptable across developmental levels, creative styles, and clinical contexts. CreATe provides containment for individuals who may otherwise feel overwhelmed performing structured creative tasks in an Art Therapy session while supporting authentic self-expression. CreATe is designed to complement cognitive-behavioral, psychodynamic, trauma-informed, and humanistic orientations and may be particularly relevant for individuals who benefit from embodied and symbolic modes of expression.

Comparison with Traditional Art Therapy.

Traditional art therapy has a long-standing history as a clinically validated method of self-expression within psychotherapy (Rubin, 2016; Malchiodi, 1998). The standard process often involves the client creating artwork within a session with a clinician, followed by facilitated reflection, dialogue, and therapeutic analysis. This may include consideration of symbolic content, color, choice of medium, spatial arrangement, and the stylistic qualities through which the client expresses their experience. Sessions may occur individually, in groups, or with varying levels of clinician involvement (Kaplan, 2000).

CreATe shares the recognition of the psychological value of expressive representation with art therapy but differs in its emphasis. The framework introduces mindful, self-analytical reflections prior to creative engagement and conceptualizes the preparatory stages of expressive representation as therapeutically meaningful. It suggests that while the act of creation can serve as an entry point for emotional exploration, the processes of attunement, intention, and internal awareness preceding expression may also play a central role in therapeutic engagement (Gendlin, 1981; Mezirow, 1991).

This pre-expressive representation orientation offers a shift in perspective within the broader landscape of creative therapies. Rather than focusing primarily on the interpretation of the completed work, the framework invites examination of motivations, emotional states, and cognitive processes that emerge prior to creative action. By prioritizing preparatory introspection and mindfulness, it encourages participants to explore emotions, memories, tensions, and intentions before beginning creative work. This orientation may also support introspective awareness and strengthen the relationship between emotional experience and conscious choice.

Applications and Methodology.

CreATe can support an eclectic group of existing therapeutic modalities. It may be implemented in individual sessions or within therapeutic group environments with a licensed facilitator present. It facilitates three steps:

CreATe was designed to support the participants' autonomy, allowing them to select the mode of expressive representation that resonates with them and to engage in it at a pace that feels emotionally safe and productive. This flexibility can be understood as an essential element in fostering a supportive environment where participants can authentically express themselves without external pressure or predefined expectations. Examples of possible alternative expressive representation approaches include creating mandalas, writing poetry, sculpting, dancing, composing music or playlists, and creating collages (Curry & Kasser, 2005; Henderson et al., 2007).

For more easily identifiable, applicable purposes, examples throughout this paper will reference painting as the primary medium for expressive representation. This choice is intended to support clarity in describing the framework's implementation and to promote familiarity with the engagement sequence. Clinicians facilitating the CreATe framework need to have basic familiarity with the expressive representation or a working understanding of the medium selected by the participant. This will provide insight and support their ability to guide the participant through the process and maintain its relevance to the individual’s emotional and psychological needs.

Participants will be encouraged to maintain a reflective journal that documents their cognitive practices, emotional insights, and reflective purpose before and after each personal act of expressive representation, fostering a stronger, more integrated communicative dynamic in therapeutic dialogue.

Flexible implementation contexts.

CreATe encourages self-engagement between therapeutic sessions, making it adaptable to varying clinical environments, client capacities, and therapeutic settings. Creative engagement may occur either through the participant's self-inspiration or within the therapeutic setting, depending on individual needs, treatment goals, and practical considerations. For some participants, between-session practices of expressive representation support autonomy and extended cogitation; however, in-session implementation may be equally appropriate when external practice is limited by time constraints, motivational barriers, accessibility concerns, or clinical appropriateness.

In these situations, the clinician may collaboratively guide parts of the framework during session time, with participants' practice of expressive representation exploration functioning as an experiential component of psychotherapy rather than as prescribed homework. The therapeutic emphasis remains on attentional regulation, personal introspective awareness, and identification of self-motivative meanings, feelings, or emotions rather than on the production of artistic outcomes. This flexibility allows CreATe to function as a process-oriented framework that can be integrated alongside diverse therapeutic modalities while remaining responsive to real-world clinical practice.

Archetypal Self-Recognition as a Pre-Process Orienting Mechanism.

As part of the CreATe framework, Jungian-inspired archetypes are adapted and can be presented to participants as an orienting tool rather than as diagnostic categories or fixed roles (Jung, 1964). Their purpose is not to serve as a specific form of classification but to help participants identify their habitual creative philosophies. Through self-reflection, identification, and acceptance of their creative patterns, the participants can accept the definitions of a specific archetype, which can lead to a more personalized and accessible entry into the CreATe framework, thereby enhancing meaningful engagement and immersion.

The five archetypal are: The Seeker, The Pathfinder, The Nurturer, The Innovator, and The Guide. These archetypes serve as descriptors of expressive representation practices or approaches, offering a lens through which participants can engage with the CreATe framework constructively. Participants may resonate with one orientation, several, or none at all, and they may shift over time, across contexts, mediums used, creative practices, or throughout developmental stages.

Each archetype presents a common pattern of creative orientation:

The archetypes were designed to form a possible approach involving metacognitive attunement, helping individuals notice the practices that support their creative engagement at a given moment (Flavell, 1979).

The participants' identification of their archetype can serve as a pre-process form of cognitive personal inventory, help stabilize functioning, mitigate performance-driven engagement, support a smoother progression through the CreATE framework, and benefit the experience of autonomy and self-directed engagement. This aligns with the principles of Self-Determination Theory, which highlight the importance of intrinsic motivation and personal agency for sustained behavioral engagement (Deci & Ryan, 2000).

The EAGER Model.

The EAGER model was developed to describe the cognitive-emotional sequence that forms the structural core of CreATe. It is intended to support introspection, regulation, creative engagement, and reflective integration. The EAGER model functions as a guiding framework that prepares participants for expressive representation, supports their engagement during expressive activity, and facilitates contemplation of their experiences afterward.

The EAGER model represents five interconnected phases:

Emergent Stillness:
 Emergent Stillness is the foundational first stage, in which the participant grounds their attention, slows their internal pace, and cultivates mindful awareness. The purpose is not to reach a state of complete calm, but rather to the emergence of a quieter internal space from which authentic expression can arise. Techniques such as deep breathing, body scans, sensory grounding, and brief guided meditations should be practiced throughout the EAGER model. This supports nervous-system regulation, increases interoceptive sensitivity, and reduces reactivity, creating optimal conditions for the therapeutic work ahead.

Awakening Intention:
 In this stage, participants are encouraged to mentally imagine the tangible act, purpose, emotional cue, or internal curiosity that will guide their creative work. The theory is that awakening Intention does not require a polished goal; instead, it invites a gentle recognition of what the participant wishes to explore, express, or understand. This may take the form of emotion, memory, image, bodily sensation, or a question. Intention-setting increases cognitive clarity, focuses attention, and aligns the creative process with the participant’s personal reflective understanding of internal creative experience. Throughout each stage, it is important to be mindful of somatic experiences by practicing deep-breathing techniques, body scans, and sensory grounding.

Generative Possibilities:
 Generative Possibilities represent the moment from internal awareness to expressive representation activation. In this stage, they experiment with ideas, materials, symbols, colors, shapes, or words, which can help multiple expressive avenues emerge. The goal is to consider the act of exploration rather than perfection. This stage encourages cognitive flexibility, divergent thinking, and emotional openness. It is the moment when previously inaccessible internal states become expressible through symbolic form.

Engaged Creativity:
 Engaged Creativity is the focused, immersive stage of expressive representation. The participants commit to shaping their expressive practices with presence and intention, whether through drawing, writing, movement, sculpting, or another artistic medium. This stage deepens the connection between internal experience and external symbols. Theories based on flow states and embodied cognition suggest that such focused creative engagement can enhance emotion regulation, narrative coherence, and a sense of agency. Participants can often experience a blending of curiosity, concentration, and emotional processing. Again, the participants need to be cognizant of their cognitive and somatic experiences. They should also frequently pause during and between the stages, consider their experiences, and then thoughtfully write them down in their reflective journal.

Reflective Reasoning:
 The final stage transforms the creative act into therapeutic insight. The participants should personally consider and examine the symbols, patterns, choices, emotions, and themes present in their expressive representation. This can be a point where the participant comes to meditate on the completion of the process, self-regulate their breathing, and ground their sensory awareness in an alert, cognitive state. Later in sessions, clinicians discuss with the participant what they wrote in their reflective journal, examining the thoughts, emotions, and feelings that arose during the process of expressive representation.  This can be seen as an attempt to evoke insight, promote emotional literacy, or connect the creative material to real-life experiences. Towards the end of this stage, the participant's self-reflective reasoning experiences can be evaluated through their initiation of a subconscious inventory, thereby enriching their cognitive and emotional framework. This can possibly support behavioral change, self-understanding, and ongoing growth. This stage is essential to ensure that their expressive representation practices not only express but also inform.

Collectively, the EAGER model comprises five stages that form a coherent sequence designed to support participants' experience by grounding them in intention, exploration, creation, and cogitation. The model is flexible, adaptable across developmental levels, and compatible with a wide range of therapeutic orientations. The EAGER model was designed to provide a structure that can present the CreATe framework as a safe, empowering, and transformational experience.

Again, the participant's journaling about their experiences throughout these stages serves as a vital tool that will be brought up in the subsequent therapeutic session. The purpose is to foster meaningful dialogue and guide participants through an in-depth rumination on their experience of expressive representation. This CreATe framework is intended to support established modalities used in ongoing therapeutic work, aiming to deepen the participant’s insight and facilitate further emotional and psychological growth.

The Preparatory Attunement Practice Analogy.

Mindfulness and embodied cognition form the physiological and psychological foundation of the CreATe framework. Before participants enter the expressive representation moment, their nervous system must prepare for the shift from states of reactivity or dysregulation into a grounded mode capable of curiosity and symbolic processing. CreATe incorporates gentle, accessible mindfulness practices that can be seen as a precursor to help participants work.

 It integrates the EAGER model practices, such as mindful diaphragmatic breathing, grounding through the senses, mindful posture, and focused attention. This encourages the activation of neural pathways associated with regulation and executive functioning. It was also designed to reduce sympathetic arousal, support prefrontal engagement, and increase interoceptive awareness.

Research suggests that the body and mind are inseparable in the processing of emotion, memory, and meaning (Damasio, 1999; Niedenthal, 2007). It presents that emotional states influence posture, movement, breathing, and physical action, and that these embodied processes, in turn, shape emotional experience and regulation (Barsalou, 2008; Koch et al., 2014). By inviting participants to notice their embodied state before creative engagement, CreATe emphasizes that the body may be seen as both a messenger and an active participant in the therapeutic process. This orientation was designed to align with the somatic and embodied framework of psychotherapy, which increases bodily awareness and may help participants to recognize early indicators of tension, anxiety, fatigue, or physiological activation and respond to these signals with curiosity, attunement, and regulation rather than avoidance or suppression (Ogden et al., 2006; Payne et al., 2015).

The consistent practice of these preparatory steps can help individuals reduce the uncertainty that often accompanies the start of a creative endeavor. The predictability of the sequence may alleviate anticipatory performance anxiety, providing a sense of safety and reliability. Establishing clear contextual cues before engaging in creative tasks supports task initiation and fosters an environment in which the participant is mentally and emotionally prepared to engage in their practice of expressive representation with greater focus and presence.

Preparatory Attunement Practice (PAP) process is a core concept of CreATE. It draws on inspirational practices rooted in the spirit of ceremonial preparation and is a mindful identification of self-presence and intention, and the mindful transition into a meaningful moment. This supports emotional regulation, psychological containment, and attentional priming prior to expressive representation practice. PAP involves the ritualization of the preparatory phase of expressive representation. It establishes a predictable sequence, deliberate pacing, and symbolic reflective understanding of internal creative experience, meant to support autonomic regulation and cognitive organization. The slow, intentional, planned process and interaction with space and materials were designed to promote parasympathetic activation through sustained attention, controlled breathing, and reduction of performance-driven urgency. This process was designed to assist participants who experience anxiety, emotional dysregulation, attentional fragmentation, or who may have difficulty transitioning into reflective states.

This is achieved through psychological containment, established by the clear demarcation of a dedicated creative space and the consistent spatial arrangement of materials. These external structures provide a stabilizing practice that mirrors internal boundary formation, allowing participants greater tolerance and making them feel less overwhelmed. The repetitive, orderly placement of tools, medium, and vessels is designed to establish a sense of safety, continuity, and predictability, which may be especially beneficial for participants who experience heightened sensitivity to chaos, ambiguity, or internal disorganization. Participants can apply these skills to regulate arousal, identify internal cues, and identify a reflective understanding of internal experience from a psychological place of calm and safety, rather than emotional urgency. Through the PAP process, participants learn that creativity is not an escape from emotion but a deliberate and compassionate approach to it. The PAP components strengthen the therapeutic power of the CreATe framework and deepen the participant’s capacity for introspection and transformation.

It is important to note that if the participants' choice of archetypal roles includes the Pathfinder or Guide, who is recommended to practice the Structured Research Informed Method, should initiate that method before the PAP process begins. These archetypes emphasize direction, structure, and informed choice, and the Structured Research-informed Method involves conducting pre-research and identifying images for the participant's personal creative presentation. The data that is collected and compiled for this process should be done first, then the PAP process can be implemented.

For participants who have chosen archetypal roles of the Seeker, Nurturer, or Innovator, the Expressive Intuitive Method is recommended. It can be interpreted as a more fluid, improvisational method. Usually, individuals who practice artistic habits that tend to be more inspired or spontaneous have a “favorite” set of tools, medium, and expressive representation preferences. This can be based on familiarity, ability, and confidence in their artistic style, as well as on the availability of the medium and substrates to them, and on how they plan to use them in their expressive representation practices. The PAP is still a valuable process and can take the form of a fluid, responsive extension of their intuitive orientation. Rather than serving as a strictly structured preparatory phase, PAP can be practiced so that it unfolds in harmony with the participant’s spontaneous and experiential approach to creative engagement.

Beginning of The PAP Process.

Mindful Space.

The approach begins by cultivating awareness of the environment dedicated to the participants' creative practices. The participant pauses to acknowledge the space as the starting point of their creative experience. This moment should be idealized as a ritual and as a psychological orientation toward presence, intention, and attentiveness.

A dedicated workspace would be ideal for this approach. It can represent a place where the participant traditionally practices their ideal approach, creating a personal representation of their artistic abilities. It can be a kitchen table or an art desk. It should be free of unnecessary clutter to support focus and psychological readiness. If a dedicated workspace is unavailable, a library, café, wellness room, or another form of personally identifiable space can be used, if it is a safe, comfortable place that allows participants to work in peace and find moments of quiet reflection and calm. This also may mean that the participant will carry their own predetermined tools and substrates, but the steps of PAP can be modified so the expressive mindful elements can still be practiced. The applicable meditative space can be physical or conceptual, but ideally should allow for comfort, concentration, and minimal distraction.

The introduction of music can also be a useful setting, but it is important for the participants to note what they were listening to in their reflective journal. It should be considered whether it may have made them sad or happy, or whether it was used as a creative driver to assist them. This should be discussed in a session with their clinician, to explain their thoughts of how the music had a perceived influence on their experience of their personal creative presentation.

This moment, area, and perception of the beginning of the creative endeavor should be approached with reverence, contemplation, and attentiveness to surrounding elements. One possible example of this is the rikishi ritual in Japanese culture, which includes the sumo wrestler's entry into and acknowledgment of the ring before their bout begins. This should be thought of as a moment that should include a cognitive acknowledgement of calming and clearing one's thoughts, as an act of preparatory purification.

This stage corresponds to the application of the practices involved in the “E” section of the EAGER model: Emergent Stillness. This is where the participant grounds their attention, slows their internal pace, and cultivates mindful awareness. It will be important for the participant to focus on maintaining the emergence of a quieter internal space from which authentic expression can arise. Deep breathing, body scans, and sensory grounding should all be practiced mindfully. Moments, thoughts, or experiences that the participant feels are important should be recorded in their reflective journal.

The Working Field.
 This involves the participants identifying and choosing the substrate they wish to paint on, such as paper, canvas, or another material, for the creative process. They are encouraged to feel and explore the tactile elements of the chosen substrate: the texture and thickness, imagining how these qualities will influence the artistic representation they are about to engage in; the smell (if any); and what the substrate's color selection represents. The participant should pause and mindfully express gratitude for others' actions in producing the substrate and for its role as a vehicle for creative expression. The chosen substrate is then placed in the center of the workspace, symbolizing its importance. In the case of painting, the choice of substrate is important because it can limit other options, such as which tools they can use effectively or the medium the participant may need for self-representation as they move forward. If it is too thin, it will wrinkle when water is applied; if it is too small, the expressive representation must be small, which may limit the participant's vision of what they wish to present; clarity of the purpose may be lost.

It is important for them to be mindful and conscious of their choice of how to begin and how this choice may radiate through the rest of the process. If they have a negative experience with the choice, this may make the participant feel unproductive, hurt, or personally dismissed about their creative abilities, leaving them unsatisfied with the process and perpetuating a negative experience, which will hinder their acceptance at the end of the personal creative representative process.

One element of this process that the clinician can introduce to the participant is that these choices can be visualized as symbolic representations of the beginning of a day, a goal, or an idea they wish to see through to fruition. It is a clean slate, but it must also be acknowledged and accepted that the substrate chosen may have limitations in capabilities that affect the expectations of its final representative creative endeavor.

This stage is designed to correspond with the “A” in the EAGER model, which represents Awakening Intention. The participants are encouraged to imagine the tangible act of production, and the purpose, emotional cue, and internal curiosity that have guided them to this point of creative purpose. They are encouraged to pause, consider, accept the choice they have made, and be mindful of how this action relates to decisions that will affect future choices as they continue to bring their artistic presentation to fruition. The participants should be mindful of their emotions and bodily sensations, focus on the creative process, and write down these experiences in their reflective journal for further review by them and in sessions with their clinician.

Exploration of Resources.

The next step is for the participant to conduct an inventory of available tools that they are going to use to facilitate their expressive representation. This can be identified as brushes, markers, pens, or pencils. In this example, the tools will be represented as brushes. In this setting, they will engage in an inventory of the brushes available to them, pausing to consider each brush's specific purpose and its potential for efficiency. The participant should be mindful, intuitive, listen to their instincts, and reflect on their experiences using these tools for the production of their personal creative presentation.

Different bristle materials in brushes have specific application purposes, meaning they can only be used for watercolors, acrylics, or oil paints. Different tips, such as fantails, blunt, or pointed, offer their own limitations for medium application and should be rated by the participant.

As in the selection of the substrate, the decision about which brushes or other tools to consider for use has a profound impact on the process moving forward, and if chosen poorly, they can cause the participant to feel undeserving or dismissed for their creative abilities, leaving them unsatisfied with the process and hindering their acceptance of the PAP Process.

The idea that the participant and their clinician should discuss is that these tools represent the participant's personal, social, and behavioral tools they have available to them in day-to-day situations. This conversation can promote cognitive idealization and adapt the participants' personal practices; through the decision of the “tools” they choose to adapt in different interactions. They are tools they have familiarity with, and can be viewed as habits they can have confidence and a sense of assurance with, and can constructively use in their ability to facilitate situations and foster the best possible outcome. The brushes the participant has cogitatively decided upon should be set alongside the substrate, which has been placed in the applicable workspace they have chosen. They can be applied on the right or left side to accommodate left- or right-handed participants. It would be best placed so that if the brush contains medium, it will not be swung or dragged diagonally or across the substrate during the poisoning process. They should be placed beside the substrate in an orderly manner reminiscent of sadō/chadō, or of a Japanese tea ceremony. This step is performed with mindful consideration, reinforcing a sense of ritual and readiness, and the participant should be mindful of their heart rate, breathing practice, and sensory grounding throughout this stage.

Mode of Expression.
 The next step is for the participant to decide what medium would be best to use for the preparation of their expressive representation. The choice of the intended medium might be aligned with considerations arising from the former choices involving the substrate and brushes. These two decisions have a direct influence on how the final personal artistic representation may take shape, due to their specialized, functional forms and their interactions. An example is that hard brushes on textured watercolor paper will cause the medium to pick up the paper's texture and make it difficult for the participant  to use fine brushes for crisp fine lines. This is not meant to discourage the participant in their choices, but rather it is mentioned so they can make an informed decision.

It should be taken into consideration that, since the materials we are discussing are usually taken from the participant's inventory, they are very familiar with how the paper, the brushes, and the medium will react in different situations.

Psychologically, the participants' choices can represent personal problem-solving or evaluation skills, (tools) towards the purpose or task they wish to investigate creatively, and as the substrate (The beginning of the participants' day, the baseline examinations of personal reflections of emotions, or past events being reinvestigated using a “blank slate” for re-interpretation) have a direct correlation with one another. They most likely were able to “experiment” with their available substrates, brushes, and mediums, which can be pointed out by the clinician as an example of how individuals think, ruminate, and try different approaches to their personal issues they have experienced before. These subjects should be contemplated and documented in the participant's reflective journal for discussion with the clinician later in the session.

 When it comes to painting, the types of medium, watercolors, acrylics, oils, or ink, should be considered for their viscosities, opacity, and transparency applications. The participant should ruminate and write in their reflective journal about subjects such as what the colors they selected make them feel, why they were chosen, and what past events, feelings, or experiences they feel are linked to them.

The choice of the medium can psychologically represent the participant's feelings and emotions about the subject they are presenting. They should be cognizant and document in their reflective journal for later discussion about what these elements subconsciously suggest about them and how they may present as an inward reflection of how they feel about the subject they are working on, and if their choices suggest what they feel is a possible answer to their original concept before they started the creative process.

After choosing, the participant should arrange the medium above the substrate while actively practicing focused calming breathing and inwardly reflecting on their thoughts. This stage was purposely designed to be slow and meditative for the participant, emphasizing serenity and presence rather than speed. They can be placed by hues, throughs of what will be used more often, or by what is color they like best. Although these actions may appear straightforward and habitual to the participant, they can yield valuable insights and enhance discussions with their clinician regarding the significance of these choices and their representation in the reflective journal. Again, somatic monitoring of heart rate and breathing, and the practitioners' mindfulness or special influences, should be enhanced during this stage.

The Anchor.

This stage represents the participant's identification of an object, space, or element designated to serve as a thought, object, or a symbolic conductor that anchors the creative engagement. It serves as the marker of the transition into the creative process and may take different forms depending on the creative artist's approach: a water vessel in painting, a journal in writing, an instrument in music, or the mental confirmation of the establishment of the prepared physical space where they will begin their creative personal representative practices. The participants, cognizant of the choice and preparing this element with mindfulness and intentionality, reinforce psychological readiness and support the ritualized entry into creative engagement. It can be seen as the closing stage of artistic preparation and symbolizes a pause before creative engagement. It symbolizes acknowledgment of past steps, reflection on the choices made, and expectations for what the process will bring to fruition. There should be a moment of acceptance of any outcome, an acknowledgement of the sacredness of the creative process, and the participant's acceptance of the path as they move forward. They should be practicing breathing and deep body scans as they were in the other steps.

In this instance, the Creative Anchor is represented by a vessel containing water. This vessel should be reserved exclusively for creative use and thoroughly cleaned before each session. It should be considered as the holder of the soul of the artwork, since the water will be a conductive element of the application of the medium to the substrate. Its placement and preparation should be performed with gratitude and mindfulness, contributing to the overall ritual. A thought of mindfulness should be observed as it is placed above the substrate, on the left or right side, to accommodate the participant. Like the strategy involving the brushes, it should be applied when the participant will not move across the substrate, and they should be aware of their heart rate and practice slow, mindful breathing throughout the experience.

These three stages represent the Generative Possibilities of the EAGER model. This is where the participant moves from internal awareness to creative activation. This can be an act of experimenting with colors, substructures, and an inventory of what they feel they need to fulfill their creative ambitions.

Emotional Alignment.
 Once all the elements above are arranged, the Engaged Creativity Stage of the EAGER model begins. This is where the participant immerses themselves in the creative process, blending curiosity, concentration, and emotional processing through creative engagement. They must still be mindful of their emotion regulation, personal-narrative coherence, use of body scans, and monitoring of their breathing. Exploration of their feelings, emotions, and personal experiences during this stage is the most important part, not perfection.

The participants should be reminded that holding rigid expectations through these methods can be counterproductive to their creative process. If the resulting artwork does not align with their predetermined standards or expectations, participants may feel disappointed, doubt their creative abilities, or lose motivation to continue engaging in creative activities.

Creative expression within therapeutic contexts does not necessarily result in a fixed or clearly personally creative representative project. The CreATE framework and other literature suggest that the value of artistic engagement lies primarily in the creative process rather than in the production of a finalized aesthetic outcome (American Art Therapy Association, 2017; Malchiodi, 2020). Artistic expressions often emerge from subjective emotional and sensory experiences that may be abstract, fluid, or difficult to articulate verbally (Malchiodi, 2020). Because these experiences are not always representational, creative work may reflect evolving perceptions and internal exploration rather than concrete objects or definitive imagery. Accordingly, therapeutic creative practice prioritizes exploration, meaning-making, and emotional expression over technical perfection or completion of a static product (Rubin, 2016).

Participants are encouraged to pay close attention to their experiences involving increased cognitive flexibility, divergent thinking, and a sense of emotional openness, which should be written within their reflective journal afterward. These moments are significant as they allow participants to access internal states that may otherwise be difficult to reach or articulate. By recognizing these experiences, participants can begin to translate them into symbolic forms within their creative work.

If the participant wishes, they are welcome to modify, add, or reintroduce colors, medium, brushes, or other elements. If they do, they should specify the rationale for why they felt it was needed and how it effectively achieves their original personal creative intent in their reflective journal. The PAP process is not intended to be a rigid discipline for creative endeavors, but rather an act of cognitive preparation to engage with and, ideally, deepen the participant's capacity for introspection and transformation. At any time, if any of the suggested steps would make the participant uncomfortable or limit their ability in their creative process, the participant should omit them or are allowed to adapt them to practices or actions that accommodate their needs.

 After they have concluded their project, the stage of Reflective Reasoning begins, involving the investigation of creative intent and its manifestation into therapeutic insight. Participants should take a moment and reflect on the finalization of their expressive representation. examine the symbols, patterns, choices, emotions, and themes present in their work. Later in sessions, clinicians will continue the Reflective Reasoning stage and use the EAGER model to formulate questions based on the participant's notes in their reflective journal. Since the PAP process involves the EAGER model, it will support a smoother, more self-reflective, and richer communication dynamic. It should also provide entries that can help the participant evoke insight, promote emotional literacy, or connect the creative material to real-life experiences. It can aid in the practice of self-reflective reasoning and can integrate into their attempts to engage with a subconscious inventory, thereby enriching their cognitive and emotional framework. This can possibly support behavioral change, self-understanding, and ongoing growth.

Engaging in the PAP process may increase cognitive clarity, helping participants focus their attention on other behavioral and personal practices and helping them identify elements of their creative activities that can be used to diversely meet other intuitive cognitive practices.

Planning and Psychological Approaches in the CreATe Framework.

Within the CreATe framework, planning and psychological preparation are important elements of the creative process, forming the foundation for intentional and effective creative engagement. As defined earlier, two complementary methods of creative engagement can be considered: the Structured Research Informed Method and the Expressive Intuitive Method.

The Structured Research Informed Method emphasizes intentional planning, cognitive organization, and clarification prior to implementation. This method is typically set into motion before the PAP process because it helps participants decide which tools, substrate, medium, or artistic approach would be best for capturing the theme or feeling of their expressive representation. This method helps the participant devise personal behavioral approaches that may encourage psychological containment, reduce ambiguity, and build connection, while recognizing that the creative act has identified therapeutic goals. This method supports existing creative and artistic practices that align with the archetypes represented by the Pathfinder and the Guide. Individuals who are comfortable with a more focused, mindful approach to their creative endeavors may be attracted to this method because it can encourage them to become more immersed in the dynamic of artistic experience. Although there are some time limits involved in individual stages, the overall set time frame for the process can be as long as the participant feels comfortable with, and participants are welcome to document their thoughts, emotions, and feelings as they engage with the research applications of this approach to better understand the underlying drive for self-expression.

The Expressive Intuitive Method can be interpreted as more spontaneous, perceptual engagement, and mostly takes shape after the PAP process is engaged. It shifts the attentive process from planning to experiential responsiveness, encouraging the organic unfolding of emotional expression, intuitive movement, and symbolic exploration. This method aligns with the archetypes described as the Seeker, Nurturer, and Innovator.

This approach may seem attractive to individuals who frequently carry a sketchbook along with pens, pencils, or a compact watercolor set. For these individuals, the PAP process may be more simplistic because of their familiarity and comfort with the materials from repeated use. However, it is important to recognize that while this familiarity can simplify the process, it does not diminish the significance of mindful implementation. Intentional and reflective engagement remains a central priority, ensuring that the practice retains its therapeutic and introspective value regardless of the participant’s prior experience with their materials.

In time, participants are encouraged to engage with both methods as complementary disciplines rather than opposing styles. Each approach affords access to distinct emotional, cognitive, and relational experiences, and alternating between them may deepen self-awareness, highlight internal preferences or resistances, and expand the individual’s capacity for flexible engagement. Together, these methods support a balanced creative process that integrates intention with expression, structure with emergence, and reflective planning with embodied experience.

The Structured Research Informed Method.

This approach emphasizes the value of engaging in disciplined practices commonly adopted and practiced by professional artists. By focusing on preparation and intentionality, participants are encouraged to approach their creative work methodically. This method involves conducting thorough preliminary research on the subject matter they wish to depict, which may include specific themes or scenes, such as a beach at sunset. The deliberate nature of this preparation aims to foster a deeper connection with the creative subject and enhance the overall quality of the artistic outcome. As it contains the structure of the EAGER model, mindfulness of somatic practices, such as their heart rate and the concentration of their breathing, should be focused on by the participants throughout the stages, accompanied by a reflective pause of their experiences.

Research and Emotional Engagement.
 As a foundational step, participants are guided to explore and collect a variety of images related to their chosen topic. This approach involves them observing what they consider unique, attractive, meaningful attributes of each image, or how the overall atmosphere makes the image compelling. Throughout this exploration, the participants are encouraged to remain mindful of the emotional and cognitive responses triggered by specific elements within the images they have considered or accepted. The participants need to identify and document their thoughts and emotions in their reflective journal, noting what draws them to particular visual components, to gain insight into their personal motivations and preferences, which can inform and enrich their creative work. This step can be presented as Emergent Stillness in the EAGER model, where the participant grounds their attention, slows their internal pace, and cultivates mindful awareness; and Awakening Intention, and is encouraged to mentally imagine the tangible act, purpose, emotional cue, or internal curiosity that will guide their creative work.

Thumbnail and Sketch Development.
 Once relevant reference images have been collected, the next stage involves creating a series of thumbnails and sketches to explore visual possibilities and preferences. This approach is structured in three stages, each designed to encourage rapid decision-making and the identification of compelling visual elements.

Throughout each stage, the careful identification of visual components and the intentional choices regarding which elements were carried forward should be documented in their reflective journal. This iterative practice is designed to help clarify creative preferences and inform the next steps in the artistic workflow. It also presents the Generative Possibilities stage in the EAGER model, in which the participant begins to shape their intention by consciously or unconsciously identifying internal experiences and external symbols. This clarifies creative engagement and can enhance emotion regulation, narrative coherence, and a sense of agency. All of these stages should be done within the participant's reflective journal so they can look back, review their emotions, feelings, and experiences, and reflect on the decisions they made.

At this stage, the PAP process is implemented involving:

This is the stage where the Engaged Creativity portion of the EAGER model is enacted. It can be seen as a focused, immersive stage of creative work. The participant commits to shaping their expression with presence and intention, whether through drawing, writing, movement, sculpting, or another artistic medium. This phase deepens the connection between internal experience and external symbols. Research on flow states and embodied cognition suggests that such focused creative engagement can enhance emotion regulation, narrative coherence, and a sense of agency. Participants can often experience a blending of curiosity, concentration, and emotional processing. Again, the participant needs to be cognizant of their somatic experiences by practicing deep-breathing techniques, body scans, and sensory grounding. It will be important for the participant to journal these experiences, documenting their thoughts and feelings, throughout the application of the approach.

 At the completion of the creative process, the Reflective Reasoning element of EAGER is engaged. Through guided reflection, the participants should examine the symbols, patterns, choices, emotions, and themes present in their work and log them within their reflective journal. This can be a point at which the participant meditates on the completion of their expressive representation, self-regulates their breathing, and attempts to baseline their sensory grounding in an alert, cognitive state. Later in sessions, clinicians will ask questions that the participant can ruminate on in their reflective journal entries, which may help evoke insight, promote emotional literacy, or connect the creative material to real-life experiences. This powerful act of the participant's self-reflective reasoning can integrate into their attempts to engage with a subconscious inventory, thereby enriching their cognitive and emotional framework. This can possibly support behavioral change, self-understanding, and ongoing growth.

The Expressive Intuitive Method.

This method highlights the importance of creative spontaneity and emotional expression from their imagination. While using this method, participants are encouraged to conduct a self-investigatory inventory of an emotion, feeling, or creative representation they experience during the method, allowing the imagery to emerge from their imagination without premeditation.

This approach can also be seen as a creative practice characterized by its intuitive nature, which may help participants deepen the connection between the individual's internal experiences and the external symbols they choose to express. Emergence into these “flow states” may benefit participants, and embodied cognition provides evidence that such immersive, attentive, creative engagement can improve emotion regulation, enhance the coherence of personal narratives, and foster a stronger sense of agency.

Although the expressive, intuitive method encourages a more uninhibited approach, it is still important to maintain the PAP process at the beginning. This continuity in the disciplinary process allows participants to gradually shift their nervous systems away from reactivity or dysregulation. Through the intentional application of mindfulness, individuals can move into a grounded state that fosters curiosity, thoughtful reflection, and symbolic processing. This approach also serves as a gentle, accessible precursor, helping participants establish the mindset needed for meaningful creative engagement that they can do in their reflective journal or on a separate piece of substrate.  The application of the PAP process reflects the ones presented in The Structured Research Informed Method.

By integrating mindful practices at each stage and recording them within their reflective journal, this practice not only regulates emotional responses but also prepares the participant to fully engage in the creative experience, enabling deeper exploration and authentic expression. Although his approach is more spontaneous, it is important that the participant remains mindful of visual components and intentionally chooses techniques and tools for engagement to produce their personal creative presentation. If the participant chooses, a multiple choice of mediums can be considered as a means of expression, including magazine or newspaper clippings, found objects, or pieces of other artwork. This iterative method is designed to help clarify creative preferences and inform subsequent steps in the artistic workflow. These elements should also be noted within their reflective journal.

This method should encourage the use of gestural marks such as bold strokes, squiggles, and rapid, reactive movements that the participant “feels" or presents as important in their artistic expression. These "reactionary movements," without guidelines or direction from the clinician, serve to express internal experiences.

In this method, participants are encouraged to mindfully engage and document their experience with their dynamic blend of curiosity, sustained concentration, and emotional processing. These experiences contribute to a more integrated and meaningful creative journey.

The following steps can serve as a format for the creative process, helping participants navigate a flexible practice that supports both emotional awareness and authentic artistic expression.

During this stage of implementation, participants are encouraged to mindfully encounter a dynamic blend of curiosity, sustained concentration, and emotional processing. These experiences contribute to a more integrated and meaningful creative journey. Participants should endeavor to be aware of their physical and emotional states throughout, employing techniques such as deep-breathing exercises, body scans, and sensory grounding practices. These methods support the participant in maintaining somatic awareness, which in turn facilitates a more grounded and present engagement with the creative process.

The EAGER model can still be integrated into the creative process. Emergent Stillness can be used at the beginning, when the participant grounds their attention, slows their internal pace, and cultivates mindful awareness.

The participant should recognize and journal the Awakening Intention stage through their engagement of the tangible act, purpose, and internal curiosity that guides the creative intent. This approach will also present the Generative Possibilities stage, which involves being mindful of their internal awareness and how it fosters creative activation, and the Engaged Creativity stage, as they are immersed in their creative work, shaping their expression with presence and intention.

The Reflective Reasoning stage remains at the end of the process, where the participant is encouraged to examine the symbols, patterns, choices, emotions, and themes present in their work. It is important to re-establish the cognitive practice of self-regulating their breathing and bringing their sensory awareness down to a grounded cognitive state.

Again, the participant's reflective journal will be an essential tool for discussing their experience in later sessions. Clinicians can assist participants in evaluating their experience, possibly influencing self-reflective reasoning. They can engage a subconscious inventory to examine their cognitive and emotional framework, with the hopes of supporting behavioral change, self-understanding, and ongoing growth.

Planning and Psychological Approaches in the CreATe Framework.

In CreATe, the session structure is designed to maximize the time available for the participant to express feelings, emotions, and thoughts arising from their personal creative practices throughout the session. In Art Therapy, the majority of the session is dedicated to the creation of a personal artwork representing a specific subject, with only a brief period at the end for discussion. CreATe was designed to facilitate a more thorough exploration and understanding, aimed to provide participants with greater opportunities for deep reflection and meaningful implementation of the subject they wish to represent. This framework can also help the participant avoid a rushed creative expression and a quick critique from the clinician during the session. The goal is to provide a more deliberate, thoughtful engagement with the participant's emotional and behavioral experiences from the beginning. The participant can decide whether to bring their artwork to the session, but the main focus and conversation dynamic will be guided by the experiences they have documented in their reflective journal. In subsequent sessions, the participant may be encouraged to reread journal entries or revisit creative representations to explore feelings currently being revisited. This can provide grounding and help evaluate past problem-solving techniques.

Planning and psychological preparation can be interpreted as important elements of the creative approach that help form the foundation for intentional and effective creative engagement. Participants with experience, insight into the creative process, and familiarity with their chosen medium are encouraged to adapt the elements of CreATe to fit their specific context. Although the application of the PAP Process may vary according to the materials or environment required for different forms of artistic expression, its underlying philosophies remain consistent. Central to this approach are the use of archetypes, the EAGER model, and the option to engage in either the Structured Research Informed, or the Expressive Intuitive Method. These elements provide a flexible yet structured foundation for creative engagement, ensuring the framework remains relevant and effective across a wide range of creative settings.

 The focus lies not on the medium but on the psychological intent that unfolds as the participant evaluates their feelings, emotions, and experiences in the final artistic representation.

In most applications, the clinician needs to facilitate participants' right to personal autonomy in creating, but there may be times when they may deem it as therapeutically advantageous to direct participants to explore more profound emotional aspects. They may also encourage the participant to practice different means of creative activation and seek other approaches to introduce inspirational themes and help them engage in the approach. This inspiration is not a prerequisite for engagement, but intentional processes are in place to help individuals shift from cognitive saturation or internal inertia to psychological availability. Any simple or externally derived stimulus can serve as an entry point for these activation approaches. Research in creativity studies and art therapy has produced data indicating that the value of neutral or minimally demanding prompts is to reduce performance pressure and facilitate engagement when individuals experience creative inhibition or “artist’s block” (Malchiodi, 2012; McNiff, 1998). Examples include opening a book, selecting a word that draws one’s attention, and considering the emotions it evokes and how those emotions might be visually represented through color, form, or movement. Participants can also examine existing artwork and intentionally select a single element, such as a shape, texture, or compositional feature, as a starting exercise, challenging them to replicate or adapt it, thereby engaging them without the demand for original thematic generation (McNiff, 1998).

Other activation strategies include free-association tasks, such as thinking of a common object and recording the first thought, image, or word that comes to mind, or conducting an image search and selecting the first visual stimulus that captures attention without conscious analysis. These approaches intentionally bypass evaluative judgment and narrative construction, emphasizing perceptual engagement and immediacy. Such strategies are represented in different forms of research on creative cognition, suggesting that insight often emerges through action and incubation rather than deliberate problem-solving (Sio & Ormerod, 2009).

 By engaging with simple, concrete prompts, individuals can shift from cognitive rumination or internal blankness to observable action. What emerges can be examined as an implicit or subconscious appraisal that represents the participant's current emotional states, interests, or concerns (Malchiodi, 2012). These emergent elements can then be shaped into meaningful artistic expression, allowing creative activity to proceed even in the absence of initial inspiration, consistent with mindfulness-based approaches that emphasize awareness through engagement rather than outcome (Kabat-Zinn, 2003).

Clinical and Personal Benefits.

Participants who engage in CreATe may report feeling they were able to identify their emotions and may have a clearer thought process when evaluating their presence of mind. The activation of memory and emotional states prior to creation can foster clearer personal insight (Brown & Ryan, 2003; Baikie & Wilhelm, 2005).

The purpose of CreATe is to encourage the participant to work on subconscious elements, such as the symbolic processing of ideas or the creative expression of emotions, before engaging in creative expression, thereby helping the participant integrate fragmented memories.

Clinical observations of this approach yield positive findings, with participants characterizing the pre-creative phase as an emotionally liberating experience. Individuals may conclude that applying and participating can positively shape their agency over their narratives, reducing their dependence on unconscious influences.

CreATe supports the theory that healing originates from within. It enables the participant to experience and understand their creativity in a non-clinical context and foster a positive dynamic in which the participant can ruminate on and explore a spirit that is often hindered by adulthood or societal expectations. The framework presents as a form of self-care, serving as an internal sanctuary where individuals can reconnect with meaning.

Applications in Psychotherapy & Creative Practice

CreATe is designed to function across a wide range of clinical, educational, and community-based environments. Its structured yet flexible framework makes it adaptable for individual therapy, group settings, school-based interventions, and integrative wellness practices. Below are key application domains and examples of how CreATe can be effectively implemented.

CreATe Session Framework.

At the start of each session, the clinician conducts a brief check-in with the participant to evaluate their current mood and overall stabilization. Then they would inquire whether the participant wishes to discuss any specific situations or experiences that may be contributing to a crisis, or that the participant feels should be addressed during the session. This structure ensures that the participant’s immediate needs and concerns are prioritized.

If they were not approached in past sessions, the CreATe archetypes can be introduced to the participant as a vehicle through which they may experience a more personalized and comprehensible entry into the CreATe framework and, potentially, prepare for the acceptance of a new therapeutic approach and promote an enhanced sense of meaningful participation and immersion. It may also help the participant more easily identify which method works for them: the Structured Research Informed Method or the Expressive Intuitive Method. Worksheets will be provided outlining both the PAP process and the EAGER model, ensuring a clear understanding of the steps involved.

The clinician will then initiate a conversation with the participant about which creative methods they are interested in or practice frequently. They will be queried about which approach they feel best aligns with their personal style and therapeutic goals.

The importance of maintaining a reflective journal will be emphasized. The clinician will explain how journaling provides a valuable opportunity for self-exploration and deeper engagement with the creative journey. It should be emphasized that although the task of using the reflective journal may seem rigid, the participant’s autonomy regarding journaling practices and their specific creative interests and approaches is theirs, and they are empowered to direct their own application of the methods involved. But it should be explained that the commitment to the framework was designed to build a deeper understanding of their behavioral practices through analyzing their subconscious schemas, self-interpreted symbolism, and problem-solving practices. It is also meant to cultivate discipline, strengthen coping strategies, and enhance mindfulness throughout therapy.

If a participant forgets to bring their reflective journal to a session, they may use the clinician provided CreATe reflective journal during the appointment. In this situation, journaling time will be limited to a half-hour segment, after which the clinician reviews the experience of applying the EAGER model with the participant to reinforce thoughtful, investigative practices in their thoughts, feelings, and emotions. If the participant wishes to keep the journal with the clinician, they will both sign and discuss how it will be stored in a safe, secure, HIPAA-compliant storage container or area in the office, for ease of use and application. The participants will attend their appointment, discuss their experiences while applying the framework to their creative practices, and the clinician will use the EAGER model as structured communication prompts to enable participants to talk freely and thoughtfully about their creative experience. This structured approach fosters deeper understanding and engagement between the participant and clinician.

The EAGER model serves as the backbone of the CreATE framework, and through participants' journaling practices using the PAP process, the clinician will use the stages of the EAGER model to prompt conversational inquiries, enhance the effectiveness of subsequent discussions, and promote ongoing self-reflection. This can also encourage a comprehensive and authentic exploration of the participant’s creative journey. The participants’ self-reflections, personal observations, and summation of their experience in their reflective journal will be the foundation for the clinician and the participant to investigate, evaluate, and identify possible behavioral practices or issues they feel are related to their personal creative practices and creative representation.

Individual Psychotherapy.

In the context of CreATe, individual psychotherapy offers participants a space for introspective reflection prior to creative expression. The framework encourages individuals to identify and explore their emotions, thoughts, and underlying motivations before attending a session with their clinician. This practice can be seen as confirmation of the participant's commitment to the therapeutic process and of their personal agency in promoting emotional integration. The key element for individual sessions is to allow participants to revisit fragmented memories or unresolved feelings in a secure, therapeutic environment. The emphasis on cognitive presence before creation distinguishes CreATe from traditional art therapy, enabling participants to work at developing greater mindfulness and insight. Following the initial assessment, the clinician will present the concept of CreATe to the participant when it is determined to be a suitable intervention based on their behavioral diagnosis.

Group and Family Therapy.

The structure of the group CreATe applications closely mirrors the CreATe Session framework outlined above. Factors such as group size, session format, and intended therapeutic applications significantly shape how sessions are organized and conducted. By adjusting these variables, clinicians can tailor the CreATe framework to best meet participants' needs, ensuring that each session is both effective and responsive to the group's unique dynamics.

At the outset of each group session, participants engage in a brief check-in. The facilitator invites the group to share any immediate questions, situations, or experiences they wish to discuss. This opening allows members to express pressing concerns or sets the tone for collaborative exploration. If any participant is experiencing an immediate emotional crisis or is triggered by exercise, they may speak with a clinician at any time.

Following the initial check-in, participants are introduced to the CreATe archetypes as optional lenses for understanding their internal creative posture and therapeutic readiness. When clinically appropriate, individuals may gather in small groups based on the archetype they most resonate with at that time. This structure is not intended to categorize or fix identity, but to support shared language, normalize variation, and encourage peers to share their thoughts and feelings.

Facilitators should remain attentive to the natural progression of group development, including shifts in cohesion, role formation, and interpersonal negotiation that commonly emerge in collaborative settings (Tuckman, 1965). Awareness of these dynamics allows the clinician to maintain psychological safety, reinforce agency, and gently guide participants back toward introspective awareness and intentional creative engagement within the CreATe framework.

A worksheet based on the CreATe framework concerning the PAP process and the EAGER model will be distributed, and the facilitator will discuss the creative methods that can be applied: the Systematic, Evidence-Based Method and the Expressive Intuitive Method, and how they align with the different archetypes. These methods can be assigned to archetype-based subgroups, or the group may opt to practice only one method for the session. The facilitator or group consensus determines the most suitable approach for the session’s objectives and participants’ needs. For participants who feel less confident in their creative abilities, the Expressive Intuitive Method is often recommended. This method’s fluid and abstract nature may facilitate a less intimidating and require less preparation, allowing for a more accessible and engaging experience for all group members.

A reflective journal will be supplied at the beginning of the group process. The importance of maintaining a reflective journal will be emphasized, noting that it will be used to record individual thoughts and experiences at the end of the creative experience. The facilitator will explain that the reflective journal offers a valuable opportunity for self-exploration and deeper engagement. Emphasis is placed on the participant’s autonomy. Then, they will explain how to use the EAGER model as it is practiced in their reflective journal, and how it will later be used as a structured communication prompt that enables participants to talk freely and thoughtfully about their creative experiences. They will state that this structured approach fosters deeper understanding and engagement.

The facilitator will guide the group through the PAP process, encouraging all participants to set up their creative spaces in silence. This quiet environment helps foster focus and personal rumination as everyone prepares for the creative session. The theme for the session can either be determined collectively or left to the participants’ discretion. For those new to the process, it may be helpful to provide a general directive on the session’s subject. This allows individuals to interpret the theme in their own way as they work with the provided creative materials.

At the start of the session, the group may choose to use either the Structured Research Informed Method or the Expressive Intuitive Method, depending on which best aligns with the session’s goals or participants’ preferences. If the facilitator feels that it is an appropriate subject, the selected method can shape the session’s theme. During these initial stages, facilitation will be minimal to allow each participant the freedom to work independently, free from direct influence or interaction with others. To maintain confidentiality and encourage uninhibited creativity, participants are advised not to sign their work or include any personal identification elements that could reveal their identity to other group members.

Recommendations for the session may range from two to four hours. The group would break and decompress through breathing techniques or, if available, by walking outside, thereby removing participants from the space where they had expressed their thoughts, feelings, or experiences. At the end of the session, the facilitator should hang all expressive representations on the wall or in a separate area for display, if the participants wish. After a brief pause, the participants would either enter another room or remain in the same room without the artwork to discuss their experiences.

Again, the facilitator can use the EAGER model to encourage active sharing and a positive communication dynamic, enabling participants to share freely and thoughtfully on their expressive representation experiences. Reflections, encouragement, and thoughts by the other group members should be shared in this open forum.

Within the group, participants can share their experiences engaging with the EAGER model, such as Emergent Stillness, in which they reflect on the grounding moment, and Awakening Intention, in which they consider a creative process with a personal focus. Again, the artistic creative representations are that group members are encouraged to share their thoughts during the final phase, which can foster empathy, connection, and emotional resonance. Family therapy applications may involve discussing collaborative artworks, their symbolism, and representations of relational dynamics, or sharing their interpretations of the meaning of creative choices.

Trauma-Informed and Crisis Contexts.

CreATe is particularly suited to trauma-informed environments due to its emphasis on pacing, grounding, and symbolic engagement. The model allows participants to approach overwhelming material indirectly, reducing the risk of emotional flooding or dissociative escalation while maintaining psychological safety and a sense of agency.

The PAP process works well in this situation because of its stages that support environmental orientation, sensory grounding, and intentional preparation for engagement, helping participants regulate before any expressive activity begins. The emphasis is not on productivity, but on readiness, containment, and stabilization.

The reflective journal serves as an excellent tool for both the participant and the clinician in a trauma-informed application. Participants are encouraged to document internal observations such as emotional state, bodily sensations, activation cues, and emerging intentions prior to and during creative engagement. The reflective journal allows experiences to be externalized in a controlled and paced manner, reducing pressure for immediate verbal disclosure and supporting continuity across sessions.

In crisis or stabilization settings, clinicians may adapt the CreATe framework into shorter, containment-focused cycles, emphasizing:

Creative engagement prioritizes orientation, safety, and emotional pacing rather than interpretive depth. It would be encouraged that, if the participant feels adverse negative thoughts or flashbacks related to their expressive representation, they should stop, practice breathing and somatic mindfulness, and journal their experience. After they feel grounded or safe, journal their experiences to prompt a deeper conversation with their clinician about the thoughts and emotions that may have been triggered.

CreATe can provide a protective buffer between experience and disclosure, which can be a benefit to individuals who have experienced a traumatic event. Through the PAP and EAGER process, participants are encouraged to be mindful and to understand the impact that these events have on them. Through inter-reflection, they should be encouraged to consciously surmise what emotions or feelings inspired them to express themselves through their practices of expressive representation. Participants can represent internal states indirectly, maintaining psychological distance while still engaging in meaningful processing. This approach supports trauma recovery by privileging safety, pacing, and agency as primary therapeutic conditions.

If the participant is having issues engaging with the CreATe framework, a new modality should be introduced to their care.  They should never be pressured by the clinician to talk or document their experience unless the participant consents.

Telehealth and Digital Adaptation.

CreATe adapts effectively to telehealth platforms when clinicians provide a clear structure, guided pacing, and possibly a forum for productive personal dialogue. The model’s sequencing supports emotional containment and attentional regulation even in remote environments, where physical co-presence and environmental control may be limited. Participants may engage using household materials, digital drawing applications, photography, movement, or writing-based creative processes, depending on access and preference.

Within telehealth settings, PAP remains the entry point to engagement. Participants are guided to orient themselves to their physical space, reduce distractions, and intentionally prepare their materials before beginning. This preparatory phase reinforces psychological readiness, environmental awareness, and a sense of containment despite the remote format.

A reflective journal serves as the primary anchor across sessions. Participants document internal observations such as emotional state, bodily sensations, activation cues, intentions, and reactions to creative work. In telehealth contexts, journaling becomes particularly important as it bridges the time between sessions and supports continuity of the CreATe framework when the clinician is not physically present.

Following creative engagement, reflective journal entries, and participants' thoughts, feelings, experiences, and emotions are reviewed using the EAGER model sequence as a structured framework:

This structured review helps maintain therapeutic pacing and containment in the absence of shared physical space. It transforms journaling into an active mechanism for self-monitoring and integration rather than a passive form of documentation.

Over time, integrating PAP, journaling, and the EAGER model strengthens continuity across remote sessions, supports early recognition of emotional activation, and enhances participants' autonomy in managing their creative and personal cognitive-intuitive practices.

Across all settings, CreATe is meant to function as an adaptive, supportive framework that enhances emotional literacy, strengthens self-regulation, and deepens personal insight. Its versatility allows clinicians to tailor the model to each participant’s needs while maintaining the core therapeutic structure.

Case Vignettes

These case vignettes illustrate the flexibility, depth, and clinical applicability of CreATe. The following three examples highlight how the EAGER model and the PAP Process function across diverse participant presentations, developmental levels, and therapeutic goals.

Vignette 1: Anxiety & Emotional Overwhelm in an Adolescent

S., a 14-year-old presenting with generalized anxiety and academic stress, entered treatment describing a persistent sense of mental fragmentation and difficulty slowing her thoughts. She frequently reported feeling “scattered” and overwhelmed when attempting to focus on schoolwork.

Prior to the EAGER model sequence, S. engaged in the PAP process using a simplified immersive approach appropriate for her developmental level.  She reflected on how she chose to use The Expressive Intuitive Method, because she identifies with the Seeker Archetype, and she “always has a sketchbook and markers in her backpack.”

Through her reflective journal entry, she stated that she intentionally selected materials, noting a preference for a fine-tip black marker and heavier paper because they felt “steady” and “less messy.” She also documented her initial internal state as “too fast, like everything is happening at once.”

Emergent Stillness:

The session began with paced breathing and sensory grounding to support physiological settling and attentional anchoring. S. reported feeling “more inside my body,” noting a decrease in urgency and cognitive noise. This also acclimated the participant to the therapeutic setting and, subconsciously, shaped the participant's expectations about what should be discussed.

Awakening Intention:
 S. recorded a gentle intention in her reflective journal that stated that she wished to understand what my brain feels like when I’m overwhelmed. The intention functioned as a direction for exploration rather than a fixed outcome. The clinician was about to encourage further reflection from S. on this subject, and they discussed which practices or existing environments might be causing these symptoms.

Generative Possibilities:
 She also noted that she experimented with rapid, overlapping lines and jagged shapes, allowing movement and sensation to guide the participant's experience without evaluation or predetermined structure.

Engaged Creativity:

At this stage, she documented that the work became more focused and immersive, with the marks consolidating into a dense, vibrating cluster that layered toward the center of the page. Shaping practices can be investigated to assess possible escalation of internal pressure and cognitive congestion.

Reflective Reasoning:
 S. compared the final image with her reflective journal notes and observed, “This feels like my mind when I try to study.” With clinician support during the session, she examined visual density, pacing, and emotional activation, identifying early somatic and cognitive signals associated with overwhelm. The phase concluded with breath regulation and grounding to return to an alert cognitive baseline.

In subsequent sessions, S. continued to document internal states, medium choices, and creative responses in her reflective journal. She identified recurring patterns that she felt represented as faster mark-making during anxiety spikes, heavier pressure when frustrated, and increased spacing when regulated. These observations informed personalized regulation strategies, including slowing movement, pausing for breath, and structuring study intervals into manageable segments. Over time, integrating journaling and creative engagement facilitated early recognition of activation and improved self-regulation before escalation.

Vignette 2: Trauma Processing Through Symbolic Representation

J., a 32-year-old participant with a history of early childhood trauma, experienced difficulty with verbal expression and frequently dissociated when discussing emotionally charged material. The CreATe framework was introduced as a nonverbal pathway for exploration and emotional regulation.

Prior to creative engagement, J. documented in the reflective journal that they had participated in a modified PAP process emphasizing tactile grounding and intentional material selection. J. chose clay, noting that it felt “solid” and “easier than words.” J. shared that he used The Expressive Intuitive Method because “It seemed like the best approach to use with clay.” The initial entry identified a working intention as “to understand what happens inside me when I shut down.”

Emergent Stillness:
 The clinician supported present-moment awareness through sensory orientation and paced breathing to reduce dissociative drift. J. referenced the reflective journal to monitor shifts in internal state and reported increased bodily awareness and stability.

Awakening Intention:
 J. clarified a desire to observe the internal experience of shutdown rather than attempting to force a verbal explanation of it.

Generative Possibilities:
 J. later wrote that the interaction with the clay felt exploratory and open-ended. Rather than working toward a predetermined outcome, they allowed their hands to guide the form through sensation and impulse.

Engaged Creativity:
 During the creative process, the clay gradually formed into a small, enclosed vessel with a sealed top and rough textured sides. The structure emerged through repetitive containment movements and inward pressure applied to the material.

Reflective Reasoning:
 J. later connected the object to their internal experience, describing it as representing “something closed off so nothing gets out.” Through collaborative discussion of the journal entries and the created form, the clinician explored themes of emotional containment, fear of exposure, and protective strategies. The physical object appeared to provide symbolic distance, allowing traumatic material to be approached without requiring direct verbal re-immersion.

Across subsequent sessions, J. continued documenting internal states, material choices, and symbolic meanings in the reflective journal. Additional forms emerged representing varying experiences of protection, openness, and vulnerability. Over time, J. stated that his experiences with the process and weekly conversations with the clinician supported reductions in dissociative responses, increased tolerance for emotional experience, and facilitated the gradual development of emotional language anchored in sensory and symbolic awareness.

Vignette 3: Identity Exploration in a Young Adult

L., a 22-year-old LGBQ+ individual who uses they/them pronouns, was navigating identity uncertainty and self-esteem concerns during a transitional life period. CreATe was introduced as a structured method for self-exploration.

L. stated that they felt attuned with the identification descriptions of the archetype of the Innovator, and shared that they felt this influenced their use in the PAP process. L. intentionally surveyed available materials and selected mixed media, noting in their reflective journal an attraction to layered textures and fragmented imagery. Their journal entries described an intention to “explore who they are becoming without needing a final answer.”

Emergent Stillness:
 In their reflective journal, L. reported engaging in brief breath and body-awareness practices to support attentional settling and internal orientation. They felt that the practice was “something new they never thought of doing”, and “felt that it really helped focus”.

Awakening Intention:
 L. documented a desire to examine multiple aspects of themselves rather than define a single fixed identity.

Generative Possibilities:
 They described experimenting with color, text fragments, and abstract forms without committing to a final direction, allowing curiosity to guide exploration.

Engaged Creativity:
 During the creative process, the work evolved into a mixed-media collage combining layered colors, fragmented images, and handwritten phrases arranged in non-linear patterns.

Reflective Reasoning:
 In discussion with the clinician, L. compared the completed collage with entries in the reflective journal and observed that the piece represented multiplicity, growth, and tension between past and emerging identities. The clinician facilitated dialogue linking the visual layering of materials with psychological themes of development and transitional self-concept.

Across subsequent sessions, L. continued using variations of this format to document shifts in self-perception and to track recurring themes in the reflective journal. These reflections are increasingly centered on confidence, autonomy, and belonging. Over time, integrating creative work with reflective writing supported the development of a more cohesive narrative identity and increased tolerance for uncertainty during this transitional period.

Clinician Guidelines and Ethical Use.

CreATe was designed to provide clinicians with a structured yet adaptable framework for integrating mindfulness, creative expression, and processing into psychotherapy. Ethical and effective use of the framework requires careful attention to pacing, participant readiness, emotional safety, and appropriate application across diverse clinical contexts.

Boundaries and Scope of Practice.
 CreATe is regarded as a comprehensive therapeutic framework. Clinicians who use this methodology must practice within the boundaries of their professional expertise. It is imperative that all participants maintain an ethical and responsible awareness of the complexities inherent in employing CreATe. The use of this framework should be reserved solely for qualified, licensed mental health professionals who possess both the necessary vocational and academic training and a thorough understanding of the various media used throughout the creative experience. Effective application of CreATe depends on participants demonstrating adaptability, improvisational skill, and a high level of comfort and familiarity with their chosen medium for creative expression.

Establishing Safety and Regulation.
 Before introducing the CreATe framework, clinicians must assess and support the participant's level of emotional and physiological regulation. The Emergent Stillness phase serves as a protective buffer, helping participants enter the creative experience from a grounded state. Clinicians should monitor signs of activation or dissociation and adjust the pace accordingly. Any reported or observed thoughts, feelings, or intentions related to self-harm or harm toward others must be directly assessed during each encounter as a component of the structured check-in phase.

Respecting Participant Autonomy and Choice.
 Participants should have full autonomy in choosing materials, themes, and the depth of their exploration. CreATe is not about producing polished artwork; it is about expressing internal experience. Clinicians must avoid interpreting participants' work without permission or imposing symbolic meanings. Reflective Reasoning should be a collaborative process in which the participant directs the narrative.

Managing Emotional Intensity.
 Creative expression can surface powerful emotions. Clinicians must be attuned to the unfolding process in the therapeutic setting and ready to pause the session if the participant becomes overwhelmed. When necessary, the session may return to grounding, sensory orientation, or containment practices. The reflective phase should only occur when the participant is emotionally stable enough to integrate insights.

Cultural Sensitivity and Inclusivity.
 CreATe is adaptable across cultural contexts, but clinicians must be mindful of symbolic meanings, artistic traditions, and culturally informed expressions of emotion. Participants may prefer certain creative modalities based on cultural familiarity or personal comfort. The PAP process should be used as a universal metaphor for preparation, not as a cultural appropriation of ceremonial practice.

Developmental Considerations.
 This framework can be modified for children, adolescents, and adults. Younger participants may benefit from shorter phases and more concrete prompts, while adults may engage in deeper symbolic processing. For participants with cognitive impairments, clinicians should simplify instructions and rely on sensory-rich creative tasks.

Ethical Use of Creative Materials.
 Participants should never be pressured to share their artwork beyond the therapeutic context. Creative work belongs to the participant; it must be stored, photographed, or disposed of only with their informed consent. In group settings, privacy and mutual respect are essential.

Documentation and Treatment Planning.
 Clinicians should document each phase of the EAGER model as it appears in session, noting grounding strategies, participant intentions, creative themes, and reflective insights. Treatment goals may integrate CreATe with cognitive, behavioral, or psychodynamic objectives.

Contraindications and Clinical Cautions.
 CreATe may require modification or avoidance in cases of severe psychosis, acute mania, or participants experiencing overwhelming derealization or disorganized cognition. In such cases, grounding and stabilization take precedence over creative exploration.

Clinician Presence and Attunement.
 Above all, the effectiveness of CreATe depends on the clinician’s presence. Attunement, curiosity, nonjudgment, and relational safety shape the participant’s willingness to explore and talk about their thoughts, feelings, experiences, and emotions. The clinician models the internal posture that the framework seeks to cultivate a grounded, intentional, open, and reflective experience.
 When practiced with ethical awareness, cultural sensitivity, and clinical attunement, CreATe becomes a powerful framework for facilitating emotional healing, personal insight, and sustainable change.

Research Foundations and Evidence Base

CreATe is grounded in a multidisciplinary body of research spanning mindfulness, expressive arts therapies, cognitive science, behavioral activation, and reflective practice. While it is an original structured framework, its components align with established empirical findings that support its therapeutic mechanisms.

Mindfulness and Neurocognitive Regulation.
 Positive research suggests that mindfulness practices reduce amygdala reactivity, increase prefrontal regulation, and improve emotional tolerance. The Emergent Stillness phase aligns with studies showing that brief grounding exercises reduce cognitive load and prepare the brain for reflective work (Hölzel et al., 2011; Tang et al., 2015).

Intention Setting and Behavioral Activation.
 The Awakening Intention phase is supported by behavioral activation research, which underscores the importance of intentional engagement, value-driven action, and structured preparation for meaningful tasks (Mazzucchelli et al., 2010). Intention setting increases task adherence and enhances emotional clarity.

Creativity and Psychological Flexibility.
 Creative expressions can be interpreted as enhancing cognitive flexibility, reducing stress, and supporting meaning-making. Studies on art-making report positive findings that can be interpreted as reducing cortisol levels (Kaimal et al., 2016), improving mood regulation, and increasing self-efficacy. The Engaged Creativity phase draws on these mechanisms.

Symbolic Expression and Trauma Processing.
 Expressive arts research suggests that symbolic, metaphor-based creative work may enable participants to approach traumatic material gradually and safely (Malchiodi, 2020). CreATe incorporates symbolic distance by emphasizing materials, movement, and imagery rather than literal recounting.

Reflective Integration and Metacognition.
 The Reflective Reasoning phase can be linked to literature on metacognition, narrative therapy, and reflective functioning. Structured reflection improves emotional labeling, strengthens insight, and supports long-term behavioral change (Fonagy & Bateman, 2019).

Embodied Cognition and Sensory Processing.
 The framework can be traced to embodied cognition theories, which hold that physiological and sensory experiences shape cognitive and emotional states. The PAP process was designed to present grounding techniques that have favorable data showing this act, because it can be a precursor to creativity and introspection.

Integrative and Holistic Psychotherapy Approaches.
 CreATe can be compared with integrative frameworks that blend mindfulness, experiential work, narrative processing, and behavioral techniques. Its phased structure can be interpreted as helping participants experience the applicable practices within the framework and still remaining flexible enough for clinicians to adapt across modalities.

Preliminary Observations and Participant Reports.
 While formal empirical studies specific to the CreATe framework are forthcoming, early participant use suggests benefits in emotional regulation, clarity of intention, reduced session avoidance, and improved session depth. Future research should include feasibility studies, case designs, and outcome evaluations.

Within its design, CreATe can be interpreted as a theoretically coherent framework that integrates established psychological principles with creative, mindful, and reflective practice. The approach draws upon the strengths of mindfulness, expressive arts therapies, cognitive science, behavioral activation, and reflective practice, harmonizing these domains into a unified therapeutic structure.

Limitations and Future Directions.

At present, CreATe has not yet been validated through formal empirical trials (Koch et al., 2014; Slayton et al., 2010). The observations described in this paper are drawn from clinical experience, participant reports, and qualitative insights emerging from art-based and creative therapeutic practices. As such, the framework should be understood as conceptually grounded but still in need of systematic investigation.

The Expressive Therapies Continuum (ETC), originally proposed in 1978 and widely used in art therapy, provides a useful theoretical reference point. ETC describes how individuals engage in artmaking across progressive domains:

CreATe intersects with these ideas while maintaining a distinct emphasis. Rather than centering primarily on the act of artistic production, CreATe foregrounds the pre-creative pause involving mindful orientation, intentional ritual, and reflective decision-making prior to (and following) creative expression. ETC can be seen as offering a recognized conceptual anchor within therapeutic literature, while CreATe identifies itself as a framework focused on preparatory awareness, structured reflection, and the reflective understanding of the processes of internal experience surrounding creation.

This paper is meant to serve as an invitation for clinicians and researchers to explore appropriate avenues for systematic study. Future investigations could examine the application of CreATe within controlled or practice-based settings, with attention to outcomes such as emotional regulation, perceived stress, reflective capacity, and self-efficacy. Such work would help clarify both the scope and limitations of the framework.

It is also important to acknowledge the constraints of self-guided implementation. Individuals engaging with CreATe independently may vary in their capacity for introspection, emotional tolerance, and symbolic interpretation. Some participants may struggle to identify internal states or misinterpret emotions without the clinician's guidance, potentially limiting the depth or effectiveness of the process.

Future development may include creating standardized support to enhance consistency and accessibility. These may involve reflective questionnaires, structured symbolic inventories, guided journaling prompts, and audio-based mindfulness or preparatory practices designed to scaffold engagement with the framework.

Conclusion

Creative Activation Therapy (CreATe™) may represent a distinct and timely contribution to the field of expressive therapies by shifting attention from what is created to why it is created. The framework emphasizes introspection as a primary therapeutic site, inviting individuals to examine their internal experiences before engaging in creative expression (Schön, 1983; Siegel, 2012). In doing so, CreATe encourages reflection on emotional patterns, personal meaning, and symbolic themes before any artistic act, aligning with foundational perspectives in expressive therapies and symbolic processing (Hinz, 2009; Malchiodi, 2012).

Rather than positioning creativity as the intervention itself, CreATe frames it because of mindful awareness and intentional engagement. This orientation reflects research demonstrating the roles of mindfulness and reflective attention in emotional regulation, insight development, and the identification of the purpose of creative intent. (Hölzel et al., 2011; Tang et al., 2015). Individuals are supported in observing their emotional world, identifying recurring patterns, and developing symbolic coherence prior to artistic expression, which aligns with theories of metacognition and therapeutic reflection (Flavell, 1979; Siegel, 2012).

Within a cultural context increasingly shaped by automation and the commodification of creativity, CreATe underscores the intrinsic psychological value of self-expression as a reflective process rather than a product. Motivation research suggests that intrinsic engagement fosters deeper psychological integration and sustained reflective understanding of internal creative experience compared to outcome-focused performance (Ryan & Deci, 2000). Through structured introspection, individuals may become more aware of behavioral patterns, unresolved emotional experiences, or areas of distress that warrant further therapeutic exploration.

CreATe does not require individuals to identify as artists; instead, it invites participants to adopt a stance of curiosity toward their own internal experience. By redirecting attention from creative outcomes to underlying motivations and emotional drivers, the approach seeks to cultivate reflective awareness as a foundation for healing. CreATe may offer an additional pathway within expressive therapies. One that presents as being grounded in pause, intention, and the other representing the curious exploration of meaning before expression occurs (Hinz, 2009; Malchiodi, 2012).


 

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