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The History of Art Therapy at the National Institutes of Health

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 Art Therapy
Journal of the American Art Therapy Association

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The History of Art Therapy at the National

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Megan Robb

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 Art Therapy: Journal of the American Art Therapy Association, 29(1) pp. 33–37

brief report
The History of Art Therapy at the National Institutes of
Health
Megan Robb, Edwardsville, IL
Abstract
The National Institutes of Health (NIH) Clinical Research
Center is a government facility that has a long history of ground-
breaking research. Art therapy research began at NIH in 1958
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with Hanna Kwiatkowska, whose work contributed to the foun-
dation of art therapy with families, and with Harriet Wadeson,
who conducted psychodynamic art therapy research. This arti-
cle describes the early history of art therapy research at NIH, its
loss of salience at the institute as government funding priorities
shifted, art therapy’s reestablishment there as a clinical practice
in palliative care, and possible directions for future research.
Art therapy was purely a research pursuit in the initial
years of the National Institutes of Health (NIH), a U.S. gov-
ernment agency with a long history of groundbreaking re-
search. As part of NIH, the Clinical Research Center is a
research hospital that provided art therapy with a strong re-
search foundation that supported clinical practice but did
not extend past the 1970s. Due to a shift in funding, art
therapy faded in interest and had no presence at NIH for
decades until it returned in NIH’s clinical arena of pallia-
tive care. This article presents the history of art therapy at
NIH, the loss of the research agenda, and the shift to clini-
cal services. Possible directions for the future of art therapy
within the government-funded Clinical Research Center are
discussed as they relate to clinical care and also to NIH’s cur-
rent research agenda.
The Beginning of Art Therapy at NIH
The National Institutes of Health, a federal agency that
funds biomedical research, traces its roots to 1887 and the
Laboratory of Hygiene at the Marine Hospital in Staten Is-
land, New York (NIH, 2008). NIH provides research sup-
Editor’s Note: Megan Robb, MA, ATR-BC, LPC, is an As-
sistant Professor in the Art Therapy Counseling graduate pro-
gram of Southern Illinois University Edwardsville. Correspon-
dence concerning this report can be addressed to the author at
mrobb@siue.edu
33
C AATA, Inc. 2012
port around the world; in the United States, the Clini-
cal Research Center of Bethesda, Maryland, is the agency’s
own research hospital, established in 1953 (NIH, 2011).
Only a few years later, in 1958, art therapy pioneer Hanna
Kwiatkowska started the first government-funded art ther-
apy research protocols there (Wadeson, 2006a).
Kwiatkowska had formerly practiced art therapy at St.
Elizabeth’s Hospital, a mental health institution in Wash-
ington, DC (Wadeson, 2006a). Through a connection with
psychoanalyst Frieda Fromm-Reichman, she began working
at NIH in its family studies program (Junge, 1994). The
program had been started by family system therapy pioneer
Murray Bowen and continued with Lyman Wynne, who
later became chief of the Adult Psychiatry Branch until
his retirement in 1971 (Wadeson, 2006a). Thanks to the
leadership of Bowen and Wynne, art therapy research was
funded for inclusion in the psychodynamic family research
agenda and led to the development of a standard evaluation
technique.
According to Wadeson (2006a), the connection to art
therapy “began accidentally when family members visited
patients and attended their art therapy sessions” and discov-
ered that “both their individual and conjoint art pieces re-
veal[ed] family dynamics” (p. 56). In recounting this history
Wadeson also described family art therapy sessions where
family members drew their perceptions of their family and
made joint pictures to explore family dynamics. Family art
therapy allowed family members to use art to share their in-
ternal conflicts with one another when verbalizations were
not accessible (Stabler, 1967). In addition to her family
work, Kwiatkowska participated in monozygotic twin re-
search with Loren Masur.
Kwaitkowska’s position was as head of the art therapy
program for the adult psychiatry branch of the National
Institute of Mental Health and her research protocols
resulted in the development of the Family Art Therapy
Evaluation. As reported in a 1967 issue of The NIH Record
(a biweekly bulletin for agency personnel), the Fulbright
Foundation sponsored Kwiatkowska’s international travel,
teaching activities, and research for the Family Art Therapy
Evaluation (Stabler, 1967). Her first of three Fulbright
trips was noteworthy as art therapy’s first nationally funded
 34 HISTORY OF ART THERAPY AT NIH
science excursion (Junge, 1994). The article in The NIH
Record also noted that “an appealing aspect [was] the
fact that families the world over respond very similarly to
art therapy regardless of cultural and social differences”
(Stabler, 1967, p. 3). A 1970 article in The NIH Record
highlights the value of Kwiatkowska’s family art therapy as
indicated by the “growing number of requests to conduct
seminars on her techniques” (Wardell, 1970, p. 11). Overall,
Kwiatkowska’s research focused on the practice of family art
therapy based in psychodynamic theory.
When Kwiatkowska retired from NIH in 1971, she
joined the George Washington University Art Therapy Pro-
gram and, in 1973, received the prestigious Honorary Life
Member award of the American Art Therapy Association
(Davis, 1974). Two years before she died, she published
Family Therapy and Evaluation Through Art (Kwiatkowska,
1978).
In 1961, 3 years after Kwiatkowska began art therapy
research at NIH, Harriet Wadeson joined the unit as a
volunteer and was later hired (Wadeson, 1980). At the time
art therapy research was conducted from its own protocol
rather than as an addendum to the research studies of others.
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Wadeson described her role as that of art therapist both
for clinical evaluations and continual care during clients’
hospitalizations. She wrote that her experience at NIH was
“eye-opening [and] exhilarating” as she felt “perched on the
leading edge of psychiatric research” (Wadeson, 2006b, p.
86). Art therapists were hired primarily as researchers to
develop theory and connect psychopathology to artwork,
not as clinicians to provide care.
In gaining understanding of the research climate Wade-
son had to learn how the politics of institutions affected the
art therapist’s clinical work. She observed that patients in re-
search studies at times were “valued only for the data they
provide” (Wadeson, 1980, p. 19). In the hierarchy of the
medical community she found that the art therapist had to
“start near the bottom” (pp. 19–20). This parallel status of
patient and art therapist residing at the bottom of the hos-
pital’s hierarchy may have led her to become a patient advo-
cate. She was designated as a “gadfly championing patient’s
rights” (p. 20).
For an art therapist who was in the position of generat-
ing research at NIH, Wadeson’s role as “near the bottom” in
the agency’s hierarchy is a surprising reflection. This implies
that within a system such as a hospital, an art therapist may
not be able to attain power or status. Although the work of
Kwiatkowska and Wadeson did not have a lasting impact at
NIH itself, their contributions to the foundation of family
art therapy and the psychodynamic theory of art therapy is
evident.
As part of the 25th anniversary celebration of NIH,
Wadeson exhibited “Portraits of Suicide” (Figure 1) for
which she received the Benjamin Rush Award for Scien-
tific Exhibits (Wadeson, 2006b, p. 88). Wadeson pushed
for the recognition of art therapy beyond family work to in-
clude other areas in the adult psychiatry branch of NIH. Dr.
Wynne (as cited in Wadeson, 1980), Chief of the Adult Psy-
chiatry Branch at the National Institute of Mental Health,
referred to art therapy’s place in NIH research when address-
ing a patient’s prognosis as gleaned from art therapy out-
comes:
These findings are documented by collaborative research
which suggests that the patient’s recovery style can be eluci-
dated by the quality and the expressiveness of his or her picto-
rial representation. The recovery style can then be a determin-
ing factor in planning the best type of treatment by all the staff
and in deciding whether drug therapy or other approaches are
indicated. (p. xxii)
It is clear from Wynne’s claim above and from early pub-
lications at the time that art therapy research at NIH fo-
cused on changes in artwork that could be correlated with
psychopathology. Wadeson disseminated her art therapy re-
search findings in more than a dozen papers on a breadth
of topics, including the impact of television on the forma-
tion of delusions (Wadeson & Carpenter, 1976b), indica-
tors for various psychiatric illnesses (Wadeson & Carpenter,
1976a), the correlation of suicide with certain features in
drawings (Wadeson, 1975), and conjoint family art therapy
(Wadeson, 1972). In addition to her prolific output of peer-
reviewed articles, Wadeson wrote Art Psychotherapy (1980)
based on her research at NIH.
In 1973 NIH funding priorities changed from psycho-
dynamic theory development to biomedical research (Wade-
son, 2006b). According to Junge (1994), two art therapy
publications were produced by the agency during this tran-
sition time: a bibliography of art therapy literature from
1940–1973 by Linda Gantt and Marilyn Schmal and a
booklet entitled Art Therapy in Mental Health complied by
Rosanna Moore. The Public Health Services agency, which
administered the National Institute of Mental Health arm
of NIH, was restructured into a new entity called Alco-
holism, Drug Abuse, and Mental Health Administration in
1973 (NIH, 2011). Many renowned psychiatrists left NIH,
as Wadeson did 2 years later (H. Wadeson, personal com-
munication, April 6, 2010). With the reorganization and
change in leadership of NIH, which by then included no
medical staff who supported art therapy research, art ther-
apy research faded. The new leadership brought new ideas
but did not make room for art therapy.
Return of Art Therapy
There is little mention of art therapy in the record of the
National Institute of Mental Health or the larger National
Institutes of Health from the mid 1970s until the 1990s. In
the 1990s, however, a return of art therapy occurred within
the large Recreation Therapy section headed by recreation
therapist Dr. George Patrick. The Recreation Therapy en-
tity of NIH had spent the previous few years transitioning
recreation therapy away from general recreation toward a
clinical approach with specific treatment goals for clients
(G. Patrick, personal communication, April 8, 2010). As
part of that transition, Pain and Palliative Chief Dr. Ann
Berger supported expressive therapies and nontraditional
therapeutic modalities, including yoga, tai chi, acupuncture,
 ROBB
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Figure 1 “Portraits of Suicide,” Harriet Wadeson (Color figure available online)
music therapy, and art therapy for patients in pain and
palliative care units (A. Berger, personal communication,
March 23, 2010). Art therapy was provided as a clinical
service rather than as a focus for research.
Now falling under recreation therapy and pain and
palliative services, art therapy crossed over many institutions
and protocols, thus increasing awareness for art therapy.
Art therapy practice was extended to patients who were
participants in psychiatric research as part of the Recreation
Therapy section’s new mission. In 1996 art therapist Esther
Epstein was hired. She primarily provided clinical art
therapy for children and in the psychiatric units; these
services included no emphasis on research protocols (G.
Patrick, personal communication, April 8, 2010). There
are two mentions of her work as a medical art therapist
in NIH’s historical documentation: Epstein initiated a
window-painting project and she used medical supplies as
art media on a pediatric unit (Kendall, 1999; Brown, 2003).
After Epstein left NIH, I served as an art therapist from
2006 to 2010. I was hired to provide palliative art therapy
and did not conduct research. As the only art therapist in a
234-bed inpatient hospital at the time, I provided services
to patients who, due to NIH’s scope and mission, could
35
be from any country in the world and could have a rare
or chronic disease. Thus, the type of work I practiced de-
manded both breadth and depth, due to the wide spectrum
of medical and mental illnesses present. The average length
of stay in 2009 was 8.7 days; some patients (as in the psychi-
atric units) resided at NIH for months, whereas others stayed
for as little as 2 days. The work was fast-paced and interdisci-
plinary, just as Wadeson described her work in the 1970s (H.
Wadeson, personal communication, April 6, 2010). How-
ever, today patients with a range of diagnoses arrive from all
over the world rather than solely from local communities.
Patient-centered care commonly defines clinical prac-
tice in medical settings. In addition, the view of art ther-
apy as an agent of social change and advocacy is widely held
(e.g., Allen, 2011; Argue, Bennett, & Gussak, 2009; Kaplan,
2000; Newman, 2010). Therefore patient rights, reduction
of stigma, and communication as a form of social advocacy
were focal areas in my patient-centered care. For example,
in collaboration with patients, caregivers, and the staff, pa-
tients told their stories of illness and hospitalization in small
paintings that resulted in a permanent art therapy exhibit
first displayed in March 2009. Common themes expressed
in the artwork were isolation, hope, fear, being cared for,
 36 HISTORY OF ART THERAPY AT NIH
and—most frequently—a healthy sense of self. The artwork
showed another side of the patients and helped to address the
stigma associated with medical and mental illnesses. Such an
approach to art therapy echoes Wadeson’s earlier role as pa-
tient advocate when conducting her research. In my situa-
tion the patient art project could have been conducted as a
qualitative research project but the latter was prohibited by
the hospital administration so as to protect the patients who
were already involved in other research protocols. My role
was to focus on patient-centered care; this example under-
scores the difference between being hired as a clinician and
being hired as a researcher.
Discussion
Much of the fundamental diagnostic work of
Kwiatkowska and Wadeson is still followed in the United
States, which becomes clear when art therapists com-
municate to others the phenomena of clients creating
artwork and their products. In treatment team meetings,
the psychiatrists with whom I worked were in support of
reviewing a client’s artwork and comparing works made
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over the course of a client’s symptom change. For example,
when working with children who had childhood-onset
schizophrenia, which is often misdiagnosed as pervasive
developmental disorder or autism, the staff psychiatrist
confirmed that the content and form of the art products
and process of art making helped her diagnose correctly
(J. Tossell, personal communication, May 8, 2010). This
is one example of what past research has brought us—a
structure for looking at artwork as well as an indication of
needed development in assessment (Slayton, D’Archer, &
Kaplan, 2010).
The American Art Therapy Association (AATA; n.d.)
posted a position statement on ARTSblog, the blog of Amer-
icans for the Arts, about challenges to the field of art ther-
apy in the 21st century. AATA noted that “the health care
environment and culture are also evolving, with alternative
and complementary health practices becoming more widely
accepted” (p. 1). An expanded research agenda with joint
research ventures with other behavioral health fields is a fo-
cus for the future. A parallel position of the Clinical Re-
search Center is to focus on biomedical research, specifically
with genetic research and neuroscience. National Institute
of Mental Health Director Thomas Insel stated that “impor-
tant discoveries in areas such as genetics, neuroscience, and
behavioral science largely account for the substantial gains
in knowledge that have helped us to understand the com-
plexities of mental illnesses and behavioral disorders over the
past 15 years” (U.S. Department of Health and Human Ser-
vices, 2008, p. iv). In a press release, NIH Director Fran-
cis Collins reiterated that there is a great need for bedside
research to “develop therapies and to take them from the
laboratory bench to the patient bedside” (NIH, 2010, para.
4). Both AATA and NIH have a shared research agenda of
interdisciplinary work that focuses on applying research to
treatment. The researcher–practitioner model or participa-
tory action research may help bridge the clinician’s role into
more of a research role.
One lesson learned from our history is to build a vari-
ety of networks for art therapy by providing patient-centered
care. Art therapy cannot rely on the interest of a few medical
doctors; rather, it needs broad institutional support from di-
verse disciplines within the health care system. Although art
therapists at NIH are hired to do clinical work rather than
research, there are ways that art therapists in any setting can
work with such limitations. They can inform research by
developing relationships with researchers and staying cur-
rent with research agendas. Given the small number of art
therapists employed either specifically at NIH’s Clinical Re-
search Center or more generally in government-funded re-
search hospitals, long-term outside collaboration is essential.
Many of the studies at the Clinical Research Center are life
history studies or other longitudinal research, which provide
an extended focus that is a critical factor in research at NIH
and many other institutes and offers future opportunities.
Currently art therapy is provided as bedside care at
NIH, but where does that leave research? From my perspec-
tive as a clinician who has worked in a research facility, I be-
lieve that joint art therapy research can be supported at NIH
and particularly in the areas of pain and palliative care and
recreation therapy. In my review of the institutional changes
at NIH from psychodynamic research and projective draw-
ings to biomedical research, I recognized that neuroscience
research on alcoholism, schizophrenia, mood disorders, and
medical illnesses are currently the focus of the Clinical Re-
search Center. Areas of potential research include the study
of art therapy as a tool to (a) increase the motivation to
stay sober (translational research with motivational inter-
viewing); (b) decrease substance abuse cravings; (c) iden-
tify graphic indicators of childhood-onset schizophrenia; (d)
decrease negative effects of schizophrenia in adults; (e) aid
with bereavement and the process of dying; and (f ) assess
the needs of diverse populations utilizing art therapy assess-
ments that have been shown to be reliable and valid. Because
medical research and government sponsorship now involve
patients from all over the world, NIH has a unique set of
populations to study—ones rich with ethnic and socioeco-
nomic diversity. Such a population sample would increase
generalizable results of research.
Another strategy is to train art therapists in methodolo-
gies that fit within a biomedical model. The advancement of
doctoral level art therapy programs and faculty is encourag-
ing, which can only bring about a more comprehensive focus
on research and better training for graduate students. Con-
nections between institutions of higher learning and research
facilities can be a positive outcome. Students may then be
prepared to meet other researchers on equal footing, just as
art therapists are equal to other mental health providers in
their clinical work.
One product of the initial work at NIH was
Kwiatkowska’s Family Art Therapy Evaluation. Since then
there has been minimal research conducted to assess this
tool’s reliability and validity. In part this may be due the
historical challenges of projective drawing assessments in
research. Betts (2006) explained that “psychoanalysts and
art therapists perceived art as a reflection of mood or
progress and attempted to understand the individual more
 ROBB
thoroughly. This approach was faulty in that it lacked sci-
entific rigor” (p. 428). Betts has advocated for improving
assessment and research in this arena.
Art therapists can incorporate research into their
clinical work at government-funded research hospitals, but
this can happen only with the help of other art therapists.
The future of art therapy research depends upon networks
of expertise, not upon one person alone. By partnering
with other professionals who have an expertise in research
design, forming relationships with researchers, and building
a supportive research network, we can increase the output
of art therapy research. The history of art therapy at NIH
suggests the power of relationships and interdisciplinary
work to further our field.
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