The Pioneer of Art Psychotherapy: A Multidimensional Exploration of Edith Kramer’s Influence ()
1. Introduction
With the rapid social development, technological progress, and the advent of the post-pandemic era, many people are experiencing suboptimal mental health. Against this backdrop, mental health issues have become increasingly prominent and a focus of widespread attention from all sectors of society. Amid fast-paced lifestyles, heavy work pressure, fierce competition, and the popularity of virtual social networks, people’s minds are often clouded by anxiety and depression. These issues have spawned a growing demand for psychological support that does not require medication but urgently needs psychological healing. As a non-verbal and non-pharmaceutical healing approach, “art therapy” has emerged in contemporary society. People have long recognized psychological phenomena in artistic activities and the impact of art on human psychology and spirit, leading to multidimensional explorations at both theoretical and practical levels. The vigorous development of psychology and art theory in the 20th century jointly contributed to the formal establishment of art therapy as a distinct therapeutic form by Margaret Naumburg in the 1940s (Malchiodi, 2007; Rubin, 2010). Naumburg elaborated on art as an intuitive manifestation of unconscious content, noting its ability to accurately capture the essence of dreams, convey deep inner feelings, and serve as a bridge for spiritual communication. She “emphasized the use of art in therapy” (Edwards, 2016: p. 2). Naumburg’s art therapy philosophy, rooted in psychoanalytic theory, posits that spontaneous artistic expression releases the unconscious, facilitated by the transference relationship between the therapist and client and the encouragement of free association. The therapeutic effect depends on the development of this transference relationship and the client’s ongoing efforts to interpret the symbolic meaning of their paintings, which form the basis of communication between the client and therapist (Edwards, 2016).
Another giant in art therapy in the 1950s, Edith Kramer (1916-2014), argued that the artistic creation process itself is a process of channeling, transformation, and integration, emphasizing the core value and significance of this process (Malchiodi, 2007; Rubin, 2010; Samuels et al., 1986).
At the intersection of art and psychotherapy, Edith Kramer pioneered a new frontier with her unique art therapy philosophy and practice. As one of the most influential art therapy pioneers of the 20th century, Kramer redefined the role of art in psychological healing with her core theory of “Art as Therapy” and promoted art therapy from a marginal practice to a systematic discipline. As a holder of triple identities—artist, art teacher, and art therapist—Kramer’s career spanned nearly 80 years, integrating psychoanalysis, artistic creation, and educational practice, and her ideas continue to profoundly influence the global field of art therapy. This paper explores how Kramer constructed her unique therapeutic philosophy through the interweaving of multiple identities, starting from her life experiences, identity transitions, ideological theories, academic achievements, and influences.
2. The Intertwined Journey of Art and the Psyche
As a pioneer in art therapy, Edith Kramer’s life spanned three fields—art, education, and psychotherapy—reflecting her exploration and integration across multiple identities. Kramer was born on August 29, 1916, in Vienna, Austria. She grew up in a bohemian environment rich in artistic atmosphere and diverse ideas, composed of actors, visual artists, political idealists, and psychoanalysts. Her father, Richard Kramer, an artist and active participant in the newly established Austrian Communist Party, was an important part of Kramer’s family background. Her mother, Josephine Neumann, came from a Jewish middle-class family in Vienna and excelled in costume design and production, adding a strong cultural dimension to the family atmosphere. The social circle of Kramer’s parents included many artists, further enriching the artistic and cultural nourishment in her growing environment. Another notable member of the Kramer family was her aunt, Elisabeth Neumann, a talented actress. Her uncle, Siegfried Bernfeld, was a renowned scholar in psychoanalysis, whose academic achievements and insights were highly respected in the psychological community. When Kramer was only 17, her mother, Josephine, introduced her to Freud’s classic work Introductory Lectures on Psychoanalysis. This academic guidance not only greatly promoted Kramer’s in-depth understanding of psychoanalytic theory but also sparked her strong interest and enduring enthusiasm for intellectual exploration. Looking back on the formation of her academic interests, Kramer specifically emphasized the important influence of her uncle Siegfried Bernfeld on her interest in psychoanalysis, indicating that her academic path was to some extent inspired and shaped by this psychoanalyst. Kramer described Bernfeld as follows: “Over the years, he has had an important influence on me—he taught me how to think, I learned about the unconscious and its power—from this man” (Marlow, 2018: p. 17). In such a growing environment, she “did not need to struggle to ‘be herself’; in such an environment, it was normal to be a strange, stubborn, and willful person” (Kramer, 2018: p. xvi).
During her growth, Kramer was also exposed to psychoanalytic educational methods and child analysis concepts advocated and practiced by figures such as Anna Freud and Erik Erikson. She was deeply influenced by art educators Henry Schaeffer-Simmern and Viktor Lowenfeld. She also often “recalled the sculptures made by blind students under Lowenfeld’s guidance” (Feen-Calligan, 2014: pp. 179-182). In the core field of psychoanalysis, Kramer studied alongside Annie Reich, systematically receiving training in psychoanalytic theory and actively participating in psychoanalytic teaching working groups, further deepening her professional knowledge and practical capabilities in this field.
In addition, Kramer pursued advanced studies at the Vienna School of Arts and Crafts, taking art-related courses, and had the opportunity to study sculpture under the renowned Austrian sculptor Fritz Wotruba. Among Kramer’s teachers, the one who had the deepest influence on her was Friedl Dicker-Brandeis, whom Kramer regarded as her mentor and a pioneer of art therapy. Dicker taught Kramer professional skills such as painting and sculpture, and was always strict with her, cultivating her as a professional artist and often severely criticizing her works. This laid a solid foundation for Kramer to become an artist in the future.
From 1934 to 1938, a critical period on the eve of World War II, Kramer reunited with Friedl Dicker-Brandeis in Prague. At that time, Dicker was arrested for participating in underground anti-fascist activities. After being released from prison, Dicker moved to Prague, her mother’s hometown in Czechoslovakia, and continued to engage in anti-fascist communist activities (Sun, 2020). Czechoslovakia played a key role in accepting refugee groups from Nazi Germany, with a large number of refugees forced to live temporarily in camps built with simple materials, waiting for opportunities to migrate to other safer areas. During this special historical period, Kramer, as an assistant, collaborated with Dicker to organize and implement a special educational assistance program specifically targeting underage refugee groups who had lost their fixed residences and endured long-term hardships due to the war, systematically teaching them artistic creation skills. During this process, she observed the children’s identification with the aggressor (Hitler) in their paintings and “the rigidity, chaos, and fragmentation seen in traumatized children” (Koodrin et al., 1994: p. 180). For Kramer, these works not only attracted people with their beautiful images but also were true reflections of the children’s inner worlds. Dicker told Kramer to accept the children’s developmental laws and corresponding abilities in children’s art teaching and to be full of enthusiasm in teaching (Kramer, 2018: p. 41). The art education methods constructed by Dicker profoundly shaped Kramer’s professional teaching philosophy as an art teacher in subsequent educational practices.
By delving into Kramer’s personal memories of that turbulent era, we can easily find the initial germination and manifestation of Kramer’s art therapy philosophy. Looking back on that experience, Kramer said, “When I observed the artworks of these uprooted and traumatized children, I began to recognize their disturbed emotions, confused images, distorted body images, meaningless repetitions, and most importantly, their identification and justification of the aggressor. And I also learned how to use art materials to help these children achieve emotional balance” (Kramer, 2018: p. 39). This period of art teaching work made her initially develop the idea that “artistic creation is therapy”. This was also the moment Kramer first experienced art as a healing force in children’s art education practice.
In 1938, to escape Nazi persecution, the 22-year-old Kramer immigrated to New York, USA, as an artist. Her first job in the United States was as a handicraft teacher at the Little Red School House, a progressive elementary school in Greenwich Village. During this period, she made puppets and masks with the children, built stools and bookshelves, and used her free time to teach herself the necessary knowledge. It was at this time that she began to gradually put her art therapy philosophy into practice. Later, Kramer also worked as a private art teacher. From 1943 to 1944, when the United States entered the war, Kramer worked as a machinist in a tool and die factory. This not only allowed her to earn more money but also enabled her to stay in the workshop to practice painting after work (McMahan, 1989). Looking back on that time, Kramer said, “At that time, there were rows of machine shops on Grant Street. If one wanted to become a toolmaker, one could start working at one end of Grant Street and work all the way to the other end, and eventually receive sufficient training. I enjoyed working there very much. I had an agreement with my boss that I could stay in the workshop to paint after work. I devoted myself to painting happily every night” (Kramer, 2018: p. xvii). This experience made Kramer deeply appreciate the healing power of art on the soul and prompted her to begin thinking about how to apply art to a broader field of psychological therapy; at the same time, this experience further deepened her critical observation of industrial society. In her view, the professional training received by art therapists usually emphasizes the keen perception of work details, the observation of material usage methods, and the identification and response to implicit signals in clients’ creations and behaviors. Since most of these practitioners have a high degree of visual sensitivity, they often lack systematic training in language expression and have relatively limited interest. Therefore, they are easily inclined to move closer to those who hold discourse power and are good at expression in society, and even imitate their way of speaking and writing—to a certain extent, they may default to the idea that such academically polished expressions are more authoritative than their own simple and straightforward language.
After the end of World War II, Kramer briefly returned to Vienna but came back to New York a few years later and finally chose to settle there. Compared with life in Europe, life in New York was simpler and easier, and she also liked the many new places in the United States that could be visited and painted. She also began to think about doing something completely new. From 1950 to 1957, she served as an art teacher at the Wiltwyck School for Boys. Since this was a therapeutic school for troubled children, she was awarded the title of art therapist, and thus began to combine her ideas as an artist and methods as an art teacher to become an art therapist. Her work was to teach art to children with severe emotional and behavioral problems. Based on her experiences as an artist and art teacher, her understanding of child development, and the Freudian analysis research she began in Vienna, Kramer adjusted her teaching methods (McMahan, 1989). Because the children at the Wiltwyck School for Boys had much more difficult childhoods than the children in the concentration camps, and these children were more destructive (Kramer, 2018: p. xix). Poor family relationships and a poverty-stricken living environment made these children lack self-support and self-identity during their growth. At the same time, they had serious emotional and behavioral problems. Therefore, when teaching at the Wiltwyck School for Boys, she combined her experience as an assistant to Dicker in the Prague concentration camp, her teaching experience at the Little Red School House, and from the perspective of an artist’s insight, integrated the content of Freudian psychoanalytic theory she received in Vienna, and developed a set of art teaching methods more suitable for the children at the Wiltwyck School for Boys. Through her identity as an artist, her love for life, her understanding of fairy tales, her perception of beautiful things, her keen and delicate insight, and her tenderness and patience with children, she naturally integrated art, education, and psychology into three disciplines, creating a unique, warm, inclusive, and self-cognitive art classroom for the boys. She recalled: “I combined these concepts with the informal training I gained at work. When I attended case conferences and ward rounds, I gained a deeper understanding of my work and my role in the team. Over time, my understanding was enriched through exchanges with more and more practitioners who also had no formal training” (Kramer et al., 1994: pp. 91-92).
The main purpose of Kramer’s art education is based on a theoretical framework that integrates psychological intervention and aesthetic education. It evokes children’s psychological motivation by stimulating their creativity, and then, according to each child’s different understanding of art, releases, transforms, and sublimates the originally destructive, anxious, sensitive, and fearful emotions through artistic creation. Here, the influence of the concept of “sublimation” in Freudian psychoanalytic theory on Kramer is also clearly visible. Its core teaching philosophy is reflected in three dimensions: first, by creating a supportive creative space, the teacher constructs a psychological support system and capacity development framework, guiding children to achieve self-cognitive reconstruction and emotional transformation in art practice; second, by emphasizing the systematic creative norms of visual language (including composition, color, structure, spatial relationships, and other elements), thereby reconstructing the disordered inner psychology; third, through the group art therapy model, stimulating children’s sense of subject identity with the help of work mutual evaluation, and promoting the reconstruction of self-cognition. This multi-angle art teaching method realizes the transformation of emotional energy, systematically transforming destructive psychological energy into orderly expressive behavior through art, and ultimately forming a path from emotional catharsis to psychological integration, which also confirms the clinical therapeutic value and psychological repair function inherent in the artistic creation process itself.
3. Artistic Creation as Therapy and the Metaphor of the “Third Hand”
During her study of psychoanalytic theory in Vienna, Kramer absorbed Freudian psychoanalytic theory, linking psychoanalytic knowledge with the ability of artistic perception and creation, and forming her unique philosophy of “art as therapy”. Like Freud, she believed that sublimation is one of the most effective ways to deal with the threats of unconscious drives, which can constructively use its potential destructive power to sublimate through art and transform inner emotions of anxiety and fear. Unlike Freud, however, she believed that verbalization and transference are unnecessary means to achieve this end, and sublimation is the ultimate goal. She developed a unique teaching method that combines the principles of projective testing with artistic media. Kramer put this theory into practical transformation in the teaching case of the Wiltwyck School for Boys. As an art teacher and also an art therapist, her curriculum was designed to help students achieve the symbolic reconciliation of id impulses and superego norms through free association-based painting guidance. Kramer also believed that “art therapy is completely different from psychotherapy. Its therapeutic potential depends on the psychological processes activated in creative work” (Kramer, 1993: p. 25).
Different from Margaret Naumburg’s “art psychotherapy” (symbol analysis), Kramer believed that artistic activities themselves (such as painting movements and material touch) can release unconscious repression. For example, the fluidity of watercolor can alleviate the control desire of obsessive-compulsive disorder patients. She believed that artistic creation is not only a way to express oneself and explore the inner world but also an effective way to achieve psychological healing. This concept forms a sharp contrast with the traditional psychotherapeutic orientation, which often regards art as a method of non-verbal imagery communication or symbolic expression, while Kramer attaches more importance to the therapeutic value of the artistic creation process itself. The core of Kramer’s practice is to give form to experience. She emphasized “art as therapy, rather than psychotherapy that uses art as a tool” (Kramer, 1971). She asserted: “The only reason one becomes an art therapist is that he has something special to offer, which only art can give” (McMahan, 1989: p. 107). Naumburg adopted the concept of “sublimation” from Freudian psychoanalytic theory, while the concept of “sublimation” developed by Kramer, that is, the artistic creation process, is “the organized use of an individual’s potential destructive power to transform it into the most effective driving force to control dangerous threats” (Kramer, 2004: p. 85). Naumburg proposed the concept of “dynamically oriented art therapy”, whose theoretical foundation is deeply rooted in Freudian psychoanalytic theory, emphasizing the role of analysis and dynamic mechanisms in art therapy. At the practical level, Naumburg guided patients to engage in free painting creation and then guided them to conduct free association-based analysis of the paintings. Its core proposition is to express unconscious content through art as a medium and achieve therapeutic purposes by in-depth analysis of symbolic elements in works of art.
Naumburg particularly focused on strengthening the verbal expression and transference process through symbolic communication, retaining the key points of Freudian psychoanalytic theory that reveal unconscious conflicts in relationships. She helped patients transform conflicts hidden in the unconscious into conscious cognition through two complementary processes: verbalization and transference. In Naumburg’s cognitive framework, art is an important means to assist psychotherapy. Specifically, unconscious conflicts are first presented through artistic creation, and then psychological intervention and treatment are performed on patients with the help of the transference mechanism. Based on this, the concept of art therapy advocated by Naumburg can be defined as psychodynamically oriented art psychotherapy, which is more inclined to the conceptual category of psychiatry. Unlike Naumburg, Kramer advocated “artistic creation as therapy”. Although Kramer was also influenced by Freudian psychoanalytic theory, she focused on the concept of “sublimation” in Freud’s theory, shifting the focus of treatment to strengthening mature ego defense mechanisms to help patients independently cope with unconscious conflicts. Kramer believed that sublimation is one of the effective ways to deal with the threats of unconscious drives, which can constructively use potential destructive power to resolve the contradictions and conflicts between instinctual needs and social needs.
Kramer pointed out that verbalization and transference are not indispensable means in the art therapy process. She emphasized that art therapists should act as allies in patients’ creative activities, providing technical support and emotional encouragement. Works of art produced through patients’ creative work can serve as containers for unconscious conflicts, recreating relevant psychological situations. Under this concept, the concept of art therapy advocated by Kramer should be understood as art-oriented art therapy, which is closer to the concept of art healing as we understand it today. Kramer clearly stated that art therapy is a beneficial supplement to psychotherapy, not a replacement. She once mentioned, “In the process of art therapy taking shape and gradually building a system, a division quietly emerged. This division has run through the development of art therapy and is still visible today: one side advocates that art is the core element of this emerging profession; the other side believes that art therapy should be delimited within the scope of psychotherapy. Supporters of the latter created the term ‘Art Psychotherapy’” (Junge & Wadeson, 2006: p. 19). However, what Kramer advocated was “art therapy”, expressed in English as “Art Therapy”, which is more inclined to the concept of healing; while “Art Psychotherapy” is more in line with the concept advocated by Naumburg, which is inclined to psychotherapy. For Kramer, art therapy is first and foremost a way to support self-development. Through the creative process of art, it helps individuals form a resilient psychological structure that enables them to maintain normal functions under pressure, avoiding reliance on rigid psychological defense mechanisms due to breakdown. From this perspective, art therapy is regarded as an important part of the therapeutic environment, which can effectively supplement and support psychotherapy, but does not replace the role of psychotherapy itself.
Both were influenced by Freud’s view that the inherent pleasure-seeking and pain-avoiding instincts of the human psychological system give rise to three typical pain mediation mechanisms: first, as a direct response mechanism driven by instincts, the hallucinogenic effect induced by chemical substances can temporarily block pain perception, but this exogenous neural inhibition strategy will ultimately exacerbate the experience of existential emptiness; second, the strict control of instinctual impulses through superego suppression can construct a formalized pain defense system, but at the cost of self-castration of the subject’s vitality, ultimately leading to an existential predicament of nihilism; third, following the principle of psychological energy conservation, libido achieves creative displacement through the sublimation mechanism, transforming primitive impulses into socially and culturally acceptable forms of expression, forming a more constructive path of pain transformation. Regarding the third point, “If people can greatly increase the pleasure derived from the roots of psychological and intellectual activities, they can gain the greatest benefits. If this is possible, fate will be almost powerless against people. Artists find pleasure in creating and expressing fantasies, and scientists find pleasure in solving problems or discovering truths” (Freud, 2019: p. 27). Following Freud’s core theoretical framework of sublimation as a response to the potential destructiveness caused by unconscious impulses, Kramer developed a unique theory in her educational practice. She advocated that the sublimation mechanism itself constitutes the ultimate goal of psychological transformation, rather than using language interpretation and transference relationships as the medium to achieve sublimation, as emphasized in classical psychoanalytic theory. This theoretical turn essentially deconstructs the linear intervention structure from symptom analysis, consciousness raising, and sublimation in Freudian analysis, and instead constructs an immediate transformation path centered on creative expression, directly realizing the energy transformation of aggressive drives through the symbolic reconstruction of artistic media.
As an artist initially, Kramer felt this pleasure of sublimation from art, and in repeated experiences, continuously confirmed, supplemented, and improved this theoretical concept. She regarded artistic creation as an internal therapeutic process, not just an auxiliary tool for psychotherapy. Kramer believed that when people create, they can reorganize internal needs and conflicts and stimulate self-healing through the expression of works. Artistic creation can occur under psychological pressure, bringing magical power to mental growth without stimulating the client’s psychological defense mechanisms. Therefore, artistic creation becomes an indispensable form of treatment in the therapeutic environment that complements psychotherapy, but cannot replace psychotherapy. She emphasized that even without revealing and explaining the meaning in the subconscious, the expressive art medium itself and this process can lead to therapeutic changes. When she carried out art therapy work with “troubled children” at the Wiltwyck School for Boys in the United States, she reduced their aggressiveness by guiding them to create tempera paintings. She proposed that therapeutic art experiences can partially neutralize children’s potential destructive drive energy through the transformative defense mechanism of “sublimation”. For example, a little boy used plasticine to make a figure of a student who bullied others, and after making it, hit it hard, tore it into pieces, and threw it against the wall. Kramer believed that in this way, children can vent, re-experience, and channel conflicts in a safe therapeutic environment without harming themselves or others.
In addition, her theory was also deeply influenced by Susan Langer’s semiotic aesthetics and Lowenfeld’s theory of children’s art development, emphasizing art as a therapy rather than psychotherapy that uses art as a tool. For art therapists, it is not always easy to reconcile the therapist’s working methods with their functions as artists and teachers. Here, she was deeply influenced by the pioneering art educator Lowenfeld—this master once actively promoted research related to “the therapeutic function of art education”. As a teacher, she was committed to guiding children or adults with psychological distress into the world of art. Therefore, she must calmly accept the limitations of the individuals in her care, pay attention to their progress at any level, and, with sufficient flexibility, understand and tolerate diverse styles, and finally find ways that truly help them according to each person’s specific needs.
As an art therapist, the theoretical framework for her understanding of child psychology is mainly based on Freudian psychoanalytic ideas. Although art therapists encourage patients to adopt unconventional forms and content in artistic creation, they also strive to cultivate patients’ artistic expression. Verbal expression in psychotherapy and play and conversation in clinical therapy are usually formless and fluid, with content rather than form being essential. In art therapy, form and content are equally important, and the order and structure that artistic creation endows to experience constitute a powerful aid in sorting out and mastering experience. As Susan Langer said: “The main function of art is to objectify experience so that we can contemplate and understand it” (Langer, 1962).
Kramer’s theory that art itself is therapy has had a profound impact on the field of art therapy. She promoted the advancement of art therapy from a marginal field to the mainstream mental health field, encouraging future generations of art therapists to maintain their love for and sensitivity to art in practice. This theory emphasizes the therapeutic power of art itself, providing a new perspective and method for art therapy.
Kramer believed that what patients need most in art therapy is for the therapist to guide them to develop and strengthen mature ego defenses to cope with the inevitable unconscious conflicts in independent life; therefore, the role of the art therapist is to be an ally in the patient’s creative activities, providing technical assistance and emotional support. Under this concept, Kramer proposed the concept of the “third hand”, “a metaphor I created to describe an aspect of the art therapist’s functioning, namely the use of artistic competence and imagination in empathically serving others” (Kramer, 1986: pp. 71-86). Through supporting artistic competence, it can extend intuitive and empathic support to others, which is helpful for the process of sublimation in psychoanalysis. This concept is a metaphor used to describe the subtle support provided by the art therapist to the patient during the therapeutic process. It is also Kramer’s profound understanding of the role of the art therapist when she transitioned from an artist to an art teacher and then to an art therapist. She emphasized that the intuition extended by the therapist through artistic competence and empathic support for the patient can promote the patient’s self-expression and sublimation process. This theory emphasizes the unique role played by the therapist in the artistic creation process. This concept breaks through the binary relationship between the therapist and the client in traditional psychotherapy, constructing a dynamic interaction model through artistic media. At the same time, Kramer believed that the “third hand” is a hand that assists the creative process, which does not interfere, distort, or impose ideas or preferences that are alien to the client. This hand provides functional and artistic support during the creative process, such as preparing palettes, soaking brushes in paint, and even guiding the client to paint on paper hand in hand. More importantly, the “third hand” is sensitive to the recognition of the client’s wishes, goals, and emotions; it provides support without imposing meaning, ideas, or preferences on the client. What the therapist helps to achieve is the client’s self-psychological cognition and sublimation, not the realization of the therapist’s own artistic goals and preferences.
In Kramer’s concept, the core of art therapy lies in supporting the process of transforming emotions into visual forms. This means that all interventions of the therapist should aim to help the client create image expressions that can vividly convey their inner experiences, and the achievement of this goal is always limited by the client’s personal abilities and specific situations.
To assist the image communication process involving highly personal content to produce therapeutic effects, art therapists must cultivate special abilities. Kramer, paraphrasing Theodore Reik’s metaphor of the psychoanalyst’s “third ear”, they must cultivate a “third eye” trained to perceive the multifaceted messages embodied in works of art created during art therapy—messages that may defy translation into words. However, a third eye alone is not enough. In conjunction with this special vision, art therapists must also command a “third hand”, a hand that helps the creative process along without being intrusive, without distorting meaning or imposing pictorial ideas or preferences alien to the client. This third hand must be capable of conducting pictorial dialogues that complement or replace verbal exchange (Kramer, 2000). Like all artists, art therapists need to master the basic skills and relevant knowledge of media such as drawing, oil painting, and sculpture. However, unlike artists who may be committed to developing a unique personal style, art therapists must learn to “decenter” their personal style when working with clients. Correspondingly, they can freely pursue their personal artistic goals in the studio, but in the therapeutic context, they must give priority to adapting to the client’s style and imagery. This requires art therapists to cultivate a conflict-free professional competence area separate from their personal artistic creation—an area where technology, imagination, originality, and improvisational ability are transformed into a resonant, empathic tool dedicated to serving others.
According to the sublimation theory, artistic creation begins when the artist no longer directly acts on inner impulses but transforms their fantasies into equivalents of visual images. When these creations can be understood and resonated with by others, they become true works of art. Therefore, the complete act of sublimation is embodied as a process of conveying complex inner content to the group in a visual form, which is often difficult to effectively convey through other media. In this process, form and content are integrated into an inseparable whole. The need for such expression and communication stems from multiple psychological motivations. First, the repressed psychological content has a tendency to emerge spontaneously and seek expression; second, the inherent narcissistic tendency of humans makes it difficult for them to accept that any part of themselves is hidden or unliked, thus showing the repressed self through creation. In this process, the artist diverts part of their primitive narcissistic energy to the work, endowing it with the beauty and completeness they can achieve, so that it can be accepted and cherished by others like themselves. The last and fundamental reason lies in the human need to overcome the inherent loneliness of life. Art enables individuals to enter the inner world of others while maintaining their own integrity and gaining a sense of security and emotional connection in this resonance.
Kramer further pointed out that every child has the qualities of an artist, with independent thoughts and ways of expression. The task of the art therapist is to understand the child’s creation through empathy and identify their inner needs. When the child needs support, the therapist should not impose their own will, but act as their “third hand” to assist them in completing the artistic expression that truly belongs to themselves. In Kramer’s theoretical framework, the interpretation of works occupies almost no important position. Although she recognizes the unconscious theory proposed by Freud, she emphasizes that art therapists “usually do not directly interpret unconscious content, but with the help of professional knowledge, guide children to create works of art that can contain and express emotions”. In this process, the therapist’s empathy ability is crucial, and therapy unfolds gradually in true resonance with the child’s creation.
Kramer’s theoretical construction revolves around two core concepts: “artistic creation as therapy” and the “third hand”. The former emphasizes the healing power inherent in the artistic creation process itself, while the latter focuses on interpreting the supportive and facilitative role played by the therapist in the creation process. This theoretical framework not only deepens the connotation of art therapy but also provides an important basis for clinical practice, having a profound impact on the development of the field of art therapy. Her ideas have inspired generations of practitioners, encouraging them to maintain their acumen and enthusiasm for art in practice, thereby more effectively serving the psychological needs of clients.
Although Kramer once worried that standardized training might lead therapists to become rigid and their creativity to be constrained by academic frameworks, she ultimately acknowledged the necessity of professional training. However, she insisted that artistic creation must be included in the core of the curriculum (McMahan, 1989). In addition, she remained alert to clinical environments and practices that may inhibit artistic expression, believing that being too rigidly attached to preset therapeutic goals would limit the creative possibilities in the therapeutic process. Therefore, she often reminded students to take the initiative to find work environments where art therapy can be fully carried out, so as not to let their professional qualities and artistic abilities gradually fade in inappropriate environments. “To establish art therapy as a respected form of treatment, adjustments and even compromises are inevitably needed. However, we must never lose our identity. While striving for recognition, we must adhere to the inherent laws of artistic creation... the space for improvisation, the openness to the unexpected, and the acceptance of the eccentric. We must be brave” (Kramer et al., 1994: p. 92). People close to her often recalled her sincerity and integrity. She dared to stick to her own opinions, even if those views were not always popular, and what is most remembered is her consistent pursuit of art and unwavering trust in the creation process itself. Her innovations and teaching have deeply influenced many art therapists, art teachers, and other clinical workers, enabling them to gain valuable inspiration and growth.
4. Edith Kramer’s Multiple Achievements and Profound Influence
In Kramer’s life, she wrote three pioneering books. In addition, she was hailed as “an outstanding clinician and teacher” (Agell, 1996: p. 38) and an accomplished artist. During the 7 years Kramer taught at the Wiltwyck School for Boys, her colleague, Dr. Viola Wertheim Bernard, also played a crucial role in her career. He encouraged Kramer to write down things, so she kept detailed records of her experiences at the Wiltwyck School for Boys every night. By the fifth year, she felt that these records could be made into a book, and this plan received financial support from the school board (Kramer, 2018: p. xix). Thus, that diary recording experiences became her first book, “Art Therapy in a Children’s Community: a study of the function of art therapy in the treatment program of Wiltwyck School for Boys”, and at the same time, this book established her status as a pioneer in art therapy.
Kramer’s teaching career began in Nazi concentration camps, and later she taught at the Little Red School House and the Wiltwyck School for Boys. As an art teacher, shortly after the publication of her first book, she was employed by many well-known institutions of higher education, including the New School for Social Research (1959-1974), Turtle Bay Music School (1959-1970), Hahnemann Medical College (1968-1971), Albert Einstein College of Medicine (1974-1983), and George Washington University (1972-2000). In 1973, she taught at New York University (1973-2005) and founded a master’s program in art therapy, cultivating a large number of professional talents until her retirement in 2005. During this period, although she worried that formal training would produce dull and uncreative art therapists whose art would be sacrificed to harsh academic requirements, she ultimately acknowledged the necessity of training; however, she insisted on including artistic creation in the curriculum (McMahan, 1989).
During the seven years of teaching at the Wiltwyck School for Boys, Kramer was not only an art teacher but also gained an additional identity—art therapist—during this period. After leaving the school, Kramer continued to develop her theory in multiple art therapy positions, including working in the child psychiatric ward of Jacobi Hospital for 15 years, the Jewish Guild for the Blind for 14 years, and Albert Einstein College of Medicine for 11 years. During this period, she combined art, art education, and psychotherapy to develop a unique art therapy method, gradually forming the core theory that artistic creation itself is the therapeutic process, emphasizing the concept of achieving self-growth and therapy through artistic creation. She published “Art as Therapy with Children” in 1971 and “Childhood and Art Therapy: Notes on Theory and Application” in 1979. All three books have become classic works in art therapy, and the connection of the three books represents the continuous progress and integration of her ideological concepts, as well as the transformation and overlap of her identities.
Kramer’s contributions to the profession are far more than that: she was a founding editorial member of the “Bulletin of Art Therapy” (later became the “American Journal of Art Therapy” in 1961), a founding member of the New York Art Therapy Association, and a founder of the American Art Therapy Association (Agell, 1996). Her achievements are far more than that. She has conducted research in many aspects and can be said to be a scholar in many fields. Her papers on themes such as art and emptiness (Kramer, 1961) and the evolution of human perception (Kramer, 1992) continue to inspire readers’ thinking, thereby encouraging art therapists to expand their thinking boundaries instead of being limited to a single way of thinking and to cultivate their multidimensional ideas and cognition.
Although Kramer made pioneering contributions to art education and art therapy, for herself, she first regarded herself as an artist, then an art teacher, and finally an art therapist. “Creating art is my destiny, and art therapy is my beloved profession”, she said (Wilson, 1997: pp. 102-105). In such triple identities, she regarded artistic creation as therapy itself, not a means of therapy; focused on the flow and presentation of the process, not just result-oriented; advocated sublimation in artistic creation, not just the result of therapy. Kramer emphasized art as therapy, rather than psychotherapy that uses art as a tool (Kramer, 1971). She described art therapy practice as a product based on three core pillars: art, art education, and psychotherapy. In subsequent lectures, Kramer repeatedly emphasized her core view that art therapists should not abandon artistic creation, because their professional nature is first and foremost an artist, followed by an art educator and therapeutic practitioner. Kramer always regarded herself as a painter, interpreting her themes with “respectful understanding” (Kramer, 1998: p. 102). She believed her task was to “celebrate the perishable and endangered, and nourish and cultivate the capacity for experiencing” (Kramer, 1998: p. 102). She observed that people are constantly bombarded by meaningless stimuli and tempting advertisements, which threaten their perceptual abilities. She understood people’s tendency to suppress stimuli for survival, but also believed that this behavior is “a kind of living death” (Kramer, 1998: p. 102). She believed that our only way out is to face these stimuli and understand them through artistic creation. This is similar to the existential predicament caused by modern society to humans.
You cannot escape the horrors of the present era and the madness of industrialism... but in a sense, this makes all beautiful things more precious because they are extremely perishable. You must depict them with awe... because they still exist, but are no longer eternal (McMahan, 1989: p. 120).
Kramer’s legacy continues to interrogate the developmental direction of contemporary art therapy. Essentially, she warned of the risk of professional alienation: when therapists grow accustomed to replacing open-ended natural expression with a barren artificial language divorced from lived experience, their thinking and spirit may become confined. In doing so, they risk losing what is most precious in art therapy—an intuitive embrace of life experiences, creative transformation, and empathic understanding of the depth of human nature.
5. Conclusion
As one of the founders of the field of art therapy in the 20th century, Kramer’s academic career and personal experiences have exemplary significance for contemporary art therapy research. In her eighties, she remained active in the professional field, regularly participating in the national conferences of the American Art Therapy Association and delivering keynote speeches. Her life development shows clear phased characteristics: her early growth background laid a profound humanistic foundation for her; the awakening of self-awareness in her youth guided the establishment of her academic direction; the cross-cultural experience in her immigration experience expanded her theoretical perspective; and finally, she constructed a complete academic system through diversified practical exploration. This process not only shaped her unique humanistic feelings but also organically integrated her triple identities as an artist, art educator, and pioneer of art therapy. The theoretical system constructed by Kramer has both practical feasibility and philosophical depth. This dual characteristic has had a profound impact on the paradigm establishment and professional practice of the art therapy discipline, providing a methodological basis for subsequent research and an instructive framework for clinical practice.