Doctor's Review: Medicine on the Move

January 27, 2022
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Art for therapy's sake

Creativity that soothes and heals the troubled soul

Have you ever glanced down at a paper on your desk covered in doodles after a lengthy and perhaps emotionally draining phone call and wondered what all the interlocking shapes and cross-hatchings might mean? What about that funny character with the big nose? Or the strange lady with the long, long arms? If you’re a doodler, you’ve been dabbling in a little art-therapy-self-diagnosis and chances it’s brought some relief from the tension or the tedium of the call.

Art therapy is a young field, having only been officially recognized in the 1960s, but its roots lie in the work of Sigmund Freud. The Austrian neurologist popularized the notion that images have a power that words do not with his suggestion that dreams are messengers from the unconscious mind which come bearing insights about a person’s inner world. Although Freud noted that patients frequently expressed their certainty that they could draw dreams that they could not otherwise describe to him, it was not until the 1940s that psychiatrists took his observations one step farther by actually inviting patients to draw in a psychiatric context.

American psychologist, educator, artist and author Margaret Naumburg is considered to have been one of the first major theoreticians of art therapy, which she introduced as a therapeutic modality in the 1940s in New York City. Her “Dynamically Oriented Art Therapy” was based primarily on Freudian psychoanalysis and she viewed it as a form distinct from psychotherapy. Her method — and many forms of art therapy that were to follow— uses the transference process between the therapist and the patient who makes the art. The therapist both elicits the patient’s own interpretation of the work and provides additional interpretation of the client’s self-expression. The patient’s own participation in the interpretation process makes art therapy an active and engaging act, and can distill a sense of self-determination.


Margaret’s sister, Florence Cane, herself an art educator, provided Margaret with the therapeutic technique that she used with her patients, which was essentially doodling with closed eyes and then elaborating on the resulting scribbles with eyes open. Florence was a powerhouse of inspiration to the generations of young art students who came through the Walden School, founded by Margaret in the early 1920s. Florence had undergone psychoanalysis as a child and was a firm believer that the method brought deep inner thoughts, memories, emotions and catharsis to the patient. In 1952, she published a book called The Artist In Each of Us, which became the bible for early art therapies.

Florence was also inspired by Eastern philosophy and the work of Carl Jung, who spent the years between 1915 and 1930 invoking a voluntary confrontation with the unconscious through the active engagement of what he called his “mythopoetic imagination.” The results of this exploration can be seen in The Red Book, a manuscript containing rich images and calligraphic notes which chart his visionary journeys. It was published posthumously in 2009.

Rather than regarding art products as information packets which contain insights to healing, some therapists have focused on the creative process itself as the vehicle for transformation. This duel potential is referred to by art therapists today as “art as therapy vs. art in therapy.” The two perspectives can be observed arising in parallel waves throughout the development of art therapy.


Between 1876 and 1888, Paul-Max Simon, a French psychiatrist known as “the father of art and psychology” amassed a large collection of artwork by mentally ill patients and found that those with specific illnesses could be associated with recurring themes and visual elements in the drawings. He also noted that the act of making the images seemed to lift the spirits of their creators.

This amassing of art by mentally ill patients, most of them untrained as artists, became a cultural craze of sorts that had a lasting influence on the art world. Hans Prinzhorn, a German art historian turned psychiatrist, gathered his own collection, soliciting patients’ drawings from other doctors and hospitals nationwide, and publishing them in 1922 in his influential book, Artistry of the Mentally Ill, which was richly illustrated with examples from his collection. French painter and sculptor Jean Dubuffet was inspired by the artworks, and coined the term “Art Brut,” known in the English-speaking world as “Outsider Art.” Rather than attempt to apply critical analysis to the works in his collection, Prinzhorn believed that art-making was a “universal creative urge” that brought solace and healing.

European therapists who emerged around the same time as those in the US and Canada have also been credited with establishing the practice of art therapy. In England, artist and educator Adrian Hill used the term “art therapy” in his 1945 book, Art Versus Illness, and in his case, it referred primarily to the health benefits to be gained by the practice, rather than the analysis of art. He discovered the positive effects of the creative process while convalescing from tuberculosis in 1938 and observed that drawing objects from his hospital bed aided in his recovery. Soon afterwards he was invited to teach drawing and painting to other patients.

Art appreciation also furthered recovery, Hill thought, and arranged to have reproductions of famous artists’ works lent to hospital wards all over England, where speakers were engaged to discuss the art with patients. This evolved into programs for both art instruction and appreciation in long-stay mental asylums, which became a major influence on the British development of art therapy. In 1964, Hill became president of the British Association of Art Therapists.


On this side of the pond, art therapy was catching on at a hospital in Topeka Kansas, founded by Charles Menninger and his two sons in 1925. The Menninger clinic promoted “activity therapies” as a recovery tactic for mental illness and employed Mary Huntoon, an artist not a therapist, to teach classes at the hospital. She coined the term “art-synthesis” to describe the process of self-discovery that many of the participants experienced after completing an artwork. In 1969, artists Don Jones and Robert Ault, who worked at the hospital, formed the American Art Therapy Association, which formally established art therapy as a professional field in North America.


One of the many tools to emerge from the profession is art-based assessments, diagnostic tests which can provide insights into mental functioning. The classic test is the “Draw-A-Man” test, developed by Florence Goodenough in 1926. It initially ascribed levels of intelligence based on the number of details in a drawing, but was later discovered to convey just as much information about personality as it did about intelligence. The “house-tree-person” test and the “road drawing” test follow similar guidelines, in which therapists consider everything in the drawing from line length, space usage, placement on the page, and the number of colours used to gain insights about the patients. A newer exercise called “body tracing” is used to show patients with eating disorders the difference between their perceived and actual weights.

The panoply of uses for art therapy is ever-growing. Studies have shown that art-making — or even simply being in the presence of soothing landscape paintings in a hospital room — effectively reduces stress. Cancer patients’ symptoms have been show to be alleviated when they draw and paint, children with autism spectrum disorder are able to increase their social skills through art making, and at-risk teens can be averted from self-destructive behaviours when they engage in the creative process. Prison inmates, disaster victims, bereaved children and depressed retirees have all benefitted from art therapy.

The separation of art and mental health has been narrowed considerably in the last 50 years. The power of personal creativity to heal now has a central place in treatment. Its influence continues to grow to the benefit of both the profession and patients.

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Showing 2 comments

  1. On April 15, 2015, Samantha said:
    This was not only very informational but put all the varies tid bits Ive found in my research together into one fluid article. I have been doing a research paper as well as considering art therapy as a profession going forward in my studies and this really helped me put it all together. Thank you!
  2. On April 28, 2015, Laura said:
    Great to see this article! Well-balanced and insightful. I started my training 16 years ago and still wonder why we haven't embraced art therapy into the more conventional practices of healthcare. Hopefully, after reading this article more interests will be peaked! Thank you.

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