How did the history of art therapy begin? Meet its pioneers, from Adrian Hill's idea in a sanatorium to the two different approaches of Naumburg and Kramer.
Imagine a painter confined to bed for months in a tuberculosis sanatorium. Time drags, and the uncertainty of the illness makes every day heavier. When he picks up paper and pencil, he notices that something changes, and he wants to offer the same opportunity to the patients around him. In the West, the history of art therapy is often told through this scene. But the story does not begin with a single person; it follows a long road stretching from ancient healing centres to darüşşifas (historic Seljuk and Ottoman hospitals), and from post-war hospitals to university programmes. In this article we describe the field's pioneers, their very different approaches and where the field stands today. In doing so, we take care to separate historically documented information from stories added later, because the story of the creative therapies is one that lends itself easily to exaggeration.
Where Does the History of Art Therapy Begin?
The idea that art affects the human soul is much older than the name "art therapy". Yet reading these old ideas as a therapy method in today's sense would be misleading. It is more accurate to think of the history in layers.
The ancient world: Ancient healing centres such as the Asclepion of Pergamon (Bergama) are described as places where sleep and dreams, water, theatre and music were used together. The details of this account are debated; but it shows that art has long been considered alongside the idea of healing. The idea of "catharsis" described by Aristotle in the Poetics, that tragedy brings about a kind of purification through pity and fear, is also frequently mentioned in the history of the creative therapies.
The Islamic world and the darüşşifas: Philosopher-physicians such as al-Kindi, al-Farabi and Ibn Sina (Avicenna) treated music as a serious science. It is also said that music had a place in care in Seljuk and Ottoman darüşşifas; for example, Evliya Çelebi writes that in the darüşşifa in Edirne an ensemble performed music for the patients three days a week. The practices of this period rested on the theory of the four humours, which has since been abandoned. In other words, these were historical practices and beliefs; they should not be confused with today's scientific evidence.
Knowing these roots also helps us understand why there is so much interest in creative methods today. For centuries people have sung, painted and told stories in the face of pain, loss and uncertainty; lullabies, laments and handicrafts are everyday examples of this.
These roots are valuable; but art therapy in the modern sense, meaning structured work in which a trained professional uses art materials within a therapeutic relationship, took shape in the middle of the 20th century.
From Asylums to Sanatoriums: How an Idea Was Prepared
In the early 20th century, some psychiatrists began to take an interest in the paintings and sculptures their patients made spontaneously. One frequently mentioned example is the Prinzhorn collection, which general art history accounts associate with Heidelberg and which is reported to consist of works by psychiatric patients; the collection is also mentioned together with the movement later called "art brut". However, this kind of interest was directed more at the works themselves, that is, at their being found "interesting" from an artistic or psychiatric point of view; no therapy method had yet been defined. This interest also brings with it ethical questions that are still debated today: the consent of the people who made the works, and the question of to whom the works belong.
The devastation caused by the two world wars, however, changed the picture. Soldiers who stayed in hospital for long periods, patients lying for months in sanatoriums and people living with the psychological scars of war created a need for new forms of support. In this setting, art began to be seen not merely as a pastime but as a space for expression and recovery.
Adrian Hill: The Birth of the Term "Art Therapy"
The painter Adrian Hill is credited as the first person to use the term "art therapy" in the United Kingdom. According to accounts, Hill noticed that painting did him good in the sanatorium where he stayed because of tuberculosis, and then encouraged other patients to draw and paint too. He described these experiences in his book Art Versus Illness, published in 1945. Sources give the year the term was first used variously as anywhere between 1942 and 1948; so rather than a precise date, it is more accurate to say "the 1940s".
Hill's approach is simpler than the theoretical models that developed later. What mattered to him was that, amid the anxiety and monotony brought by illness, a person could occupy their mind with a creative pursuit, express themselves and experience the sense of vitality that comes from making something. Today this approach is seen as an early example of the line of thought that emphasises art's "healing in itself" side.
Why a sanatorium?
It is no coincidence that Hill's story took place in a sanatorium. At that time, treatment for tuberculosis required long periods of rest; patients stayed in the same place for months, sometimes years. Uncertainty, loneliness and inactivity were factors that increased the psychological burden. In these conditions, art came to the fore as a tool that both made time meaningful and opened up space for feelings that are hard to put into words.
Margaret Naumburg and Edith Kramer: Two Different Perspectives
The theoretical foundations of art therapy were shaped largely in the United States through the work of two women pioneers. These two names still represent the two main tendencies in the field today.
Margaret Naumburg: In the 1940s she conceived art therapy as a form of dynamic psychotherapy. In her approach, the person draws spontaneously, that is, without planning in advance; the drawing is then discussed through free association. Here the picture is a means of communication through which unconscious material becomes visible. What matters is that the meaning of the picture emerges through the person's own associations.
Edith Kramer: She placed the emphasis on the process of creating itself rather than on interpreting the work. For Kramer, making art allows difficult feelings to take shape and be transformed; this process is valuable in its own right. Kramer's path is also striking: in the 1930s she taught art to refugee children in Prague. Her experience of working with children living through hard circumstances nourished her process-focused perspective.
Naumburg saw the picture as a doorway into conversation, while Kramer saw creating as a space of healing in itself; today's practice usually carries both perspectives together.
Reading personality from drawings: a side road in history
A topic that is often confused when the history of art therapy is told is the use of drawings as psychological tests. In the 20th century, certain projective tests such as human figure, house and tree drawings became widespread, and the idea of "reading personality from a drawing" also settled into popular culture. However, later scientific reviews call for caution on this point. A comprehensive review published in 2000 reported that, among projective tests, human figure drawings are among those with the most limited evidence of validity. For tools intended to detect child abuse from drawings, findings replicated by independent teams are also almost non-existent.
This is why art therapy and "interpreting pictures" are not the same thing. Both Naumburg and Kramer placed importance on meaning being discovered together with the person. Stock interpretations such as "a child who uses black paint is unhappy" or "a figure drawn without hands reveals a secret" belong not to the history of the field but to a popular and mistaken side road. We emphasise the same principle in the articles where we discuss this topic in detail: a picture is a doorway that opens up conversation; it is not a diagnostic tool.
Returning to the approaches of Naumburg and Kramer, these two perspectives are not rivals. In a session today where creative methods are used, sometimes the resulting picture is talked about, and sometimes what really matters is the experience of making it. We describe the field's current framework separately in our article what is art therapy.
Sister Fields: Psychodrama, Dance, Music and the Sand Tray
Art therapy is not the only creative approach that developed in the 20th century. In the same period, fields working with other art forms also became institutionalised.
- Psychodrama: Jacob Levy Moreno gives 1 April 1921 as the birthday of psychodrama; the date is based on a performance at the Komödienhaus in Vienna. We discuss this method in detail in our article what is psychodrama.
- Dance and movement therapy: Marian Chace was one of the founders and the first president of the American Dance Therapy Association, founded in 1966.
- Music therapy: After the world wars, community musicians in the United States played in veterans' hospitals; this experience created a need for training. The first undergraduate music therapy programme opened in 1944 at Michigan State College. The national association founded in 1950 merged with another association in 1998 and took the name American Music Therapy Association.
- The sand tray: Building on Margaret Lowenfeld's "World Technique", Jung's student Dora Kalff developed the "sandplay" approach in Switzerland in the late 1950s. For details, see our article on sand tray therapy.
- Expressive writing: James Pennebaker's experiments in the 1980s marked the beginning of a broad literature investigating the effect of putting difficult experiences into writing.
What these fields have in common is that they offer another way of expressing oneself where verbal expression is not enough. Where they differ is in the tools they use and the theoretical frameworks they rest on.
How Is the History of Art Therapy Unfolding in Turkey?
In Turkey, the institutionalisation of creative approaches has a more recent history. The role of Prof. Dr. Abdülkadir Özbek in establishing psychodrama is often mentioned; he is said to have been influenced by a lecture given by Moreno in 1958. Psychodrama training is still largely provided through associations and institutes today.
In the field of music therapy, Anadolu University's Institute of Health Sciences has a music therapy department and a non-thesis master's programme. In addition, music therapy is among the methods defined in the Regulation on Traditional and Complementary Medicine Practices (Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği), which came into force in 2014.
Art therapy, on the other hand, still appears to be at a developing stage academically in Turkey. It can be said that a separate postgraduate programme under the name "art therapy" is not widespread, and that training in the field is mostly offered in the form of certificate programmes and workshops. Meanwhile, the number of university theses studying the subject is gradually increasing. This means that the history of the field in Turkey is still being written.
What should you keep in mind when looking at history?
Articles on the history of the creative therapies often show two extremes. In one, everything is tied to the past with "our ancestors already knew this"; in the other, the field is told as if it had been born entirely in the West. A more balanced view is this: the idea that art affects the soul has existed in many cultures for a long time; but the transformation of this idea into a professional practice that is tested through research and has its own training and ethical principles is the work of the 20th century.
From History to Today: Evidence, Limits and Use in Therapy
The fact that a field has a long history does not in itself show that it is effective. However interesting the history of art therapy may be, its current use must be evaluated through research. That is why we also need to look at how far art-based approaches are supported today.
A health technology assessment published in 2015, which examined art therapy in adults with non-psychotic mental health problems, found a significant positive change in symptoms compared with the control group in 10 of the 15 randomised controlled trials it reviewed; however, it reported that the quality of the studies was generally low. A review published in 2018 that examined 27 quantitative studies from 2000 to 2017 similarly found the results promising but the methods limited. In short, art-based work can be supportive; but it should not be seen as a treatment in its own right, and where necessary it should be considered alongside psychotherapy and medical treatment.
Today, tools such as drawing, clay or collage can be used in psychological support as elements that complement verbal work. For example, in individual therapy, drawing a feeling within a structured framework such as cognitive behavioural therapy (CBT) can open a new path where conversation gets stuck. The basic principle remains the same here: the person who made the picture decides its meaning; no diagnosis is made from a drawing.
In situations such as unhappiness or anxiety lasting for weeks, or being unable to recover after a loss or trauma, it may be helpful to speak to a mental health professional. If you are having thoughts of harming yourself, call 112 (emergency services) without delay.
Frequently Asked Questions
Who founded art therapy?
It is hard to speak of a single founder. The painter Adrian Hill is credited in the United Kingdom as the first person to use the term "art therapy". In laying the theoretical foundations, Margaret Naumburg and Edith Kramer stand out in the United States.
What is the difference between Naumburg's and Kramer's approaches?
Naumburg saw the picture as a means of communication to be discussed through free association, and conceived art therapy as a form of dynamic psychotherapy. Kramer, by contrast, emphasised that the process of creating itself can be healing. Today's practice usually draws on both perspectives together.
Can the Ottoman darüşşifas be considered the beginning of art therapy?
It is said that music had a place in care in the darüşşifas, and this shows an old intuition about the effect of art on the soul. However, these practices rested on the theory of the four humours and were not a therapy method in today's sense. It is more accurate to see them as a historical root than to equate them with modern art therapy.
Has art therapy been scientifically proven?
Research contains promising findings; however, most studies have small samples and are methodologically limited. For this reason, art-based approaches are regarded as supportive and, where necessary, are used together with psychotherapy or medical treatment.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
Eğitimler
