Art as Therapy

Theory of change

The person changes when impulses, affects and conflicts can be turned into an integrated artistic form that strengthens the ego and transforms discharge or defence into creative mastery.

Core ideas

1. Art possesses a therapeutic potential of its own

   Kramer holds that artistic creation can be therapeutic through its own structure and not merely because it provides images that will later be interpreted. Making art compels the person to transform experience into a symbolic equivalent, engages perception, skill, affect and imagination and offers a concrete form of mastery and satisfaction; the plastic medium therefore constitutes the centre of her intervention, while verbal interpretation remains secondary and art therapy can complement psychotherapy without becoming an illustrated version of it. (Kramer, 1958, Art Therapy in a Children's Community; Kramer, 1971, Art as Therapy with Children).

2. Sublimation transforms impulsive energy into an achievement of the ego

   The central mechanism of change is sublimation: the energy of sexual and aggressive impulses and of other conflicts is diverted from direct gratification and invested in the acquisition of skills and in the creation of a socially communicable work. The transformation preserves an emotional core, but the ego manages to organise it within a form and derives pleasure from mastery, achievement and recognition; this reconciliation between inner forces that previously clashed strengthens the integrative function of the ego. (Kramer, 1958, Art Therapy in a Children's Community; Kramer, 1971, Art as Therapy with Children; Kramer, 2000, Art Therapy and Sublimation).

3. Art therapy strengthens the ego rather than interpreting the unconscious

   Although Kramer works within a Freudian framework and regards an understanding of unconscious processes as indispensable, her therapeutic manoeuvres are oriented mainly towards supporting organisation, identity and maturation. The intervention seeks to enable the person to function under tension without collapsing or depending on defences that impoverish their development, and avoids bringing raw unconscious material into consciousness when doing so might stimulate acting out, regression or further repression. (Kramer, 1971, Art as Therapy with Children; Kramer, 2000, Credo, as an Artist and as Art Therapist).

4. Process and product form a single artistic reality

   Kramer questions the idea that the product is irrelevant in therapy. A work with internal coherence can only come about through a process of integration that engages multiple functions, and the product makes that achievement visible; the art therapist can therefore accept fragmentary attempts and phases of exploration without giving up on helping the process reach form. The finished work also offers a tangible experience of competence that cannot be replaced by mere praise of effort. (Kramer, 1971, Art as Therapy with Children; Kramer, 2000, The Unity of Process and Product).

5. Artistic quality indicates the degree of integration achieved

   Quality is defined neither by academic beauty nor by naturalistic likeness, but by a production's capacity to integrate form and content and to communicate an experience with economy and coherence. A technically skilful work may still be defensive or empty, while a simple image may be artistically successful if its organisation sustains what it expresses; this way of looking makes it possible to distinguish sublimation, stereotypy, pictograph, discharge and formed expression without confusing clinical acceptance with aesthetic indifference. (Kramer, 1971, Art as Therapy with Children, chapter III).

6. The art therapist combines the functions of artist, educator and therapist

   The art therapist's competence depends on holding three positions in balance: accepting limits and diversity as a therapist, teaching and facilitating learning as an educator, and retaining formal discrimination and technical skill as an artist. If one of these functions dominates, the treatment may turn into psychotherapy that uses drawings, into rigid art teaching or into simple recreational activity; the specificity of the model lies in using psychological knowledge to increase the therapeutic value of art without doing violence to the laws of the creative process. (Kramer, 1958, Art Therapy in a Children's Community; Kramer, 2000, Credo, as an Artist and as Art Therapist).

7. The Third Hand helps without replacing authorship

   The most characteristic artistic intervention consists in lending competence where the patient cannot move forward and withdrawing it before the help becomes an imposition. The therapist must be able to enter other people's styles, improvise solutions and perform technical actions in the service of an image that is not their own, accepting that their proposals may be refused; the effectiveness of the help is measured by how far it increases the person's capacity to realise their own intention. (Kramer, 1971, Art as Therapy with Children, chapter V; Kramer, 2000, The Art Therapist's Third Hand).

8. Aggression changes when it is transformed into form and mastery

   Kramer draws a clear distinction between sublimation and cathartic discharge. An image of violence can be deeply therapeutic when the creator organises the aggression, contains it in a work and experiences mastery over it, whereas an explicit instruction to take symbolic revenge may drag the patient and the group into a shared regression; artistic transformation requires sufficient control, authorship and formal elaboration, not simply the release of energy. (Kramer, 1958, Art Therapy in a Children's Community, Art Therapy and Aggression; Kramer, 1971, Art as Therapy with Children, chapter VII).

9. The work confronts the person with their way of functioning

   The plastic product endures and can be contemplated, repaired, rejected, destroyed or shown, and so gives the creator concrete evidence of how they organise experience. Kramer uses this quality to point out observable patterns of rigidity, catastrophising, repetition or control without necessarily penetrating their unconscious meaning; when a person learns to recognise the sequence before repeating it, they cease to be merely the victim of their functioning and gain a capacity for choice. (Kramer, 1971, Art as Therapy with Children, Projection and Confrontation and Interpretation of Reality and of Functioning).

10. Art is also communication and shared culture

    Creation reaches its full function when it can be received by an audience, because art makes it possible to communicate complex experiences without reducing them to verbal language. In work with children, Kramer uses the group, spontaneous traditions among peers and the exhibition of works to reduce isolation, sustain mutual identification and turn individual production into a contribution to community life; the audience does not replace the intrapsychic process, but it widens its social dimension and reinforces recognition and belonging. (Kramer, 1958, Art Therapy in a Children's Community, The Individual and the Group and Leadership and Tradition; Kramer, 2000, Leadership and Cultural Tradition).

Influences

• Freudian psychoanalysis
• Psychoanalytic ego psychology
• The art education of Friedl Dicker-Brandeis
• Bauhaus (Johannes Itten)
• The art education of Viktor Lowenfeld
• Susanne K. Langer's philosophy of art
• Ernst Kris's psychoanalysis of art

Key references

• Kramer, E. (1958). Art Therapy in a Children's Community: A Study of the Function of Art Therapy in the Treatment Program of Wiltwyck School for Boys. Springfield, IL: Charles C Thomas.
• Kramer, E. (1971). Art as Therapy with Children. New York: Schocken Books.
• Kramer, E. (2000). Art as Therapy: Collected Papers. L. A. Gerity (Ed.). London & Philadelphia: Jessica Kingsley Publishers.
• Kramer, E. (2000). The Unity of Process and Product. In L. A. Gerity (Ed.), Art as Therapy: Collected Papers, 36-38. Jessica Kingsley Publishers.
• Kramer, E. (2000). Art Therapy and Sublimation. In L. A. Gerity (Ed.), Art as Therapy: Collected Papers, 39-46. Jessica Kingsley Publishers.
• Kramer, E. (2000). The Art Therapist's Third Hand: Reflections on Art, Art Therapy and Society at Large. In L. A. Gerity (Ed.), Art as Therapy: Collected Papers, 47-72. Jessica Kingsley Publishers.
• Kramer, E., & Schehr, J. (2000). An Art Therapy Evaluation Session for Children. In L. A. Gerity (Ed.), Art as Therapy: Collected Papers, 73-93. Jessica Kingsley Publishers.
• Kramer, E. (2000). Leadership and Cultural Tradition. In L. A. Gerity (Ed.), Art as Therapy: Collected Papers, 94-111. Jessica Kingsley Publishers.