The Kramer Method of Art Therapy: Exploring the Third Hand (Henley, 2024) offers an in-depth examination of Edith Kramer’s influential contributions to the field of art therapy. Often hailed as one of the "founding mothers of Art Therapy" (p. 16), Kramer’s work and philosophy continue to shape contemporary practices. In this book, David Henley, a former student and colleague of Kramer, provides a thorough analysis of her methods and introduces a diverse array of case studies that illustrate how the concept of the Third Hand has been interpreted and applied over time.
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David Henley, Ph.D., ATR, draws on his background as a child art therapist and former professor and chair of the Departments of Art Therapy at the School of the Art Institute of Chicago and Long Island University, New York. His previous works, including Exceptional Children, Exceptional Art (1997), Clayworks in Art Therapy: Plying the Sacred Circle (2002), and Creative Response Activities for Children on the Spectrum (2017), along with numerous peer-reviewed articles, establish him as a significant voice in the field. Henley’s work has been deeply influenced by Kramer’s teachings, as evident in this book.
Henley begins by exploring Kramer's unique approach to the Third Hand, which she defined as creating an environment conducive to artistic productivity.
This involves not only providing adequate materials and an artistic know-how, but also offering empathetic support and mindful cues during the creative process. The therapist's role includes subtle interventions - Kramer refers to them as "services" - that can assist the client at critical moments, such as offering the right-sized brush or suggesting a colour. It could also mean “coming to the rescue when pain starts to drip down the page or helping to save a sculpture from falling apart” (p. 175). These interventions aim to enhance the client's autonomy and expression, rather than taking over the creative process.
My interest in this book stems from my own challenges with applying the Third Hand in my practice. Informed by my own unique path into the profession of Art Therapy, I (somewhat controversially) don’t identify as an artist first, but rather as a psychotherapist first. My use of the Third Hand has traditionally been cautious, often reserved for moments when client safety is at risk. Working with adolescents with neurodevelopmental needs and older adults with dementia, I have grappled with the fine line between providing support and overstepping into rescuing or saving clients or their art. My hope was that this book might offer insights into how I might better practise these "measured interventions" (p. 41) in the future.
Henley argues that effective use of the Third Hand begins with establishing a strong, supportive environment, drawing on Winnicottian (1971) and Mahlerian (1975) concepts of transitional space. In art psychotherapy, transitional space refers to an intermediate area between an individual's internal and external worlds. This space allows clients to explore their inner experiences through creative expression, using art as a bridge to symbolise and understand complex emotions. Within this space, a secure relational framework allows for creative exploration and risk-taking, and opens opportunities for gentle intervention. In Chapter 3, Henley illustrates this through a vignette about Ebe, a young man with whom he worked. Hanley gently and slowly adapted the space, introducing Ebe to objects and experiences that were neither threatening or overwhelming, exemplifying a form of Third Hand intervention. By thoughtfully designing the art therapy space, Henley enabled Ebe to sublimate and integrate his experiences in healthier ways. Doing so required deliberate intervention from Hanley, but was always offered as an invitation, not a directive.
There are multiple examples of these invitations throughout the book, across different client types and client presentations. I was struck by their gentleness, their ability to relax a client’s defences, and how they contributed to the development of transitional spaces where creativity could be leaned into. The book reminded me of how keenly attuned the art therapist needs to be in order to offer these gifts of subtle intervention. Moreover, in every offering of the Third Hand, there is clinical reasoning, and an understanding of the risk in doing so.
What stood out most to me in this book is the diverse range of translations and applications of the Third Hand.
Case vignettes, often complete with images of the artwork created in session, span from parent-child dyads, adolescents, groups, disability, trauma, sexuality, domestic violence and neurodiversity. Henley discusses how the Third Hand can be used to communicate with caregivers, facilitate material access for disabled clients, critique artwork, narrate experiences, integrate personal objects, and gently “lure” clients into new territories of making and thinking. In Chapter 9, Henley recounts his time creating ceramic sculptures with special needs college students following the 9/11 terror attacks in New York. Acutely attuned to the presence of trauma, grief and loss in the room, Henley employs the Third Hand visibly through technique adjustment, and invisibly through the piece’s survival in the kiln firing process. This example serves as a wonderful reminder that at the core of a Third Hand intervention is the preservation of the client’s autonomy and vision for their artwork. The book adds breadth and depth to the definition of the therapeutic bridge that is the Third Hand. In doing so, it allowed me to reflect on the myriad of ways in which I was already offering a Third Hand to my clients, or how I may in the future.
Vaughey, G. (2024). Reflecting on the Third Hand [Digital Art]. Ireland: Personal Collection.
The book's conversational tone makes it accessible, though some familiarity with psychoanalytic and Winnicottian theories enhances understanding. With a working knowledge of these building blocks to hand, the case vignettes come into better focus for the reader. It would be well placed on the curriculum of any art therapy university course, as it does an excellent job of marrying those seminal psychotherapy and art therapy techniques and approaches. The book is rooted in practical application and real-life learning, which would be of benefit to those starting out in their careers. For those therapists already in practice, it is a fantastic reference resource and clinical companion.
The wealth of case studies in this book serves as a reminder of the importance of evidence-based care, and our responsibility to continually examine the efficacy of our work.
I highly recommend this book to any art therapist or trainee art therapist who has an interest in artistic process, artistic curation, or who is looking for their lens of practice to be challenged. The Kramer Method of Art Therapy: Exploring the Third Hand is available as a paperback or eBook. It can be ordered directly from Charles C. Thomas Publisher.
References
Henley, D. R. (1992). Exceptional Children, Exceptional Art: Teaching Art to Special Needs. Davis Publications.
Henley, D. (2002). Clayworks in Art Therapy: Plying the Sacred Circle. Jessica Kingsley Publishers.
Henley, D. R. (2017). Creative Response Activities for Children on the Spectrum: A Therapeutic and Educational Memoir. Routledge.
Henley, D. R. (2024). The Kramer Method of Art Therapy: Exploring the Third Hand. Charles C Thomas Publisher.
Mahler, M. S., Pine, F., & Bergman, A. (1975). The Psychological Birth of the Human Infant. Basic Books.
Winnicott, D. W. (1971). Playing and Reality. Tavistock Publications.
Further Reading
Feen-Calligan, H. (2014). In memoriam: Edith Kramer (1916–2014). Art Therapy, 31(4), 179-182. https://doi.org/10.1080/07421656.2015.965117
Gerity, L., & Anand, S. A. (Eds.). (2017). The Legacy of Edith Kramer: A Multifaceted View. Routledge.
Malchiodi, C. (2010, October 31). Cool art therapy intervention #1: The art therapist’s third hand. Psychology Today. Available at https://www.psychologytoday.com/ie/blog/arts-and-health/201010/cool-art-therapy-intervention-1-the-art-therapist-s-third-hand
MSc Art Psychotherapy, Ulster University (2020, May 19). Edith Kramer, Art Therapist’s Third Hand - Materials, Methods, Practice. Available at https://arttherapytrainingandstudiogroups.wordpress.com/2020/05/19/edith-kramer-art-therapists-third-hand/
Grace Vaughey
Grace Vaughey recently completed her Art Psychotherapy masters training at the Belfast School of Art in Ulster University. Based in Dublin, she is interested in the intersection between emerging technologies and mental health, mental health hubs within communities, narrative therapy, bibliotherapy and suicide prevention.