Art Therapy - Painting

Dagmar Brauer

Last update: 19.12.2017

The following information is based on the guidelines of the Association for Anthroposophic Art Therapy in Germany (AAArTiG) for treatment in the specialties therapeutic painting, drawing, sculpture, music and speech formation. Status February 2017. (1).

Anthroposophic art therapy encompasses the specialties of painting (and drawing), music (and singing), sculpture, and speech formation. It has the aim of holistically activating all available healing resources and encouraging spiritual, psychological, functional and physical self-regulation through the arts and through therapeutic relationships. The artistic therapies are based on integrative insights and understanding that extend conventional medicine through specific diagnostic and therapeutic procedures.

Painting and drawing therapies take as their starting point the patient’s relationship to self and world, with an understanding of how this can be represented, communicated and shaped. Basic elements are colors, surfaces, and lines, using primarily watercolors and plant dyes, charcoal, colored chalks and graphite pencils. These specific media and their effects are used as regulatory agents in therapy. The main process can be either expressive or impressionistic, using activating methods to encourage activity, experience and/or insight. The therapeutic process involves phases of communication, interaction and self-discovery.

Anthroposophic art therapists undergo special training in order to be able to work between these kinds of general measures and specific, more individualized methods. These can be acquired in a variety of certified training courses.

Diagnostics in art therapy

General diagnosis in art therapy begins with the therapist’s first impression of the patient, then moves through a phenomenological observation of the person’s fourfold constitution, with subsequent consideration of the patient’s functional threefold nature, in line with the criteria of anthroposophic anthropology. A full therapeutic diagnosis then summarizes the findings regarding the patient’s constitution, temperament, fourfold nature and problem zones, in accordance with an anthroposophic understanding of disease. The patient interview also considers parallel therapies, biographical particularities, symptoms and any previous experience with art.

For a course of art therapy that might specialize in painting, initial diagnosis is based on a perception of the patient’s state of health, the patient’s complaints, biographical situation, medical diagnosis, and perception of their actions and abilities in the creative process. This latter step then comes alive through two or more freely chosen or prescribed works, as well as a summarization of any perceived one-sidedness, deficits, inherent resources and prospects for healing.

When considering the creative process as a whole, art therapists look at how the image is developed, what the patient experiences, how the patient evaluates his or her work, the quality of the relationship between the patient and therapist, and the essential gesture or quality that can be drawn from the overall process.

To consider a work of art in terms of the patient’s fourfold nature, art therapists look at the following: the physical part of the painting as an external impression; the quality and structure of the painting organism as it reflects dynamic processes; the feelings expressed in the painting as a psychological aspect; the contribution of the individuality as a central creative force and spiritual aspect. Expressions of any disorders in the interaction of the four parts of the painting—such as dominant and deficient parts of the picture—are typical of certain diseases, and may point to future-oriented aspects that are not yet fully developed, as well as individual intentions of the patient’s “I”.

Therapeutic method

Artistic therapies rely on the interaction between the patient, the therapist and the creative artistic process. As a specific example: wet-on-wet watercolors are often used in painting. This process stimulates a person’s ability to express and act on their emotions. It sensitizes an individual’s perceptive faculties, so that tension can resolve into relaxation. In contrast, other exercises in form drawing make use of the conscious formation of lines. Still other rhythmic, artistic movements work with the polarity of light and dark and help address issues like impaired orientation and concentration. Drawing therapies generally require and reinforce differentiated use of visual acuity, movement orientation, the sense of balance and fine motor skills. Within those activities a more specific sensory or emotional effect can be cultivated, depending on the type of drawing activity selected. Artistic activities allow a person to capture and experience different color moods and stroke qualities, which consistently connect them with inner experiences, intentions and motifs.

Successful healing transformations can be experienced through creating a work of art. It has been repeatedly observed that this kind of process influences a person’s self-awareness, self-esteem, and ability to cope with the illness in their own way, and also often affects behavioral changes and lifestyle, as well as supporting an improvement in a person’s overall condition.

Active principle

In treatment, the specific instruments and effects of painting and drawing are employed to:

  • harmonize and stabilize metabolic function,
  • strengthen life forces,
  • improve access to a person’s inner emotional life,
  • improve self-awareness, one’s ability to clarify things for oneself through artistic activity, one’s ability to relate to the artwork and the environment, as well as to any changes,
  • improve sensory function,
  • compensate for tendencies towards one-sidedness and/or deficiency,
  • develop and improve an individual’s ability to focus on problems and move, as needed, between activities that are structuring, flowing, boundary-forming or connecting.

The fundamental effect of painting in terms of anthroposophic anthropology is that “inner impulses of the astral body […] – moods such as sadness, joy, characteristic attitudes, expression – are pressed into the etheric body.” (2, p. 59)


Artistic therapies are described and recognzied in various medical guidelines. In Germany, for example, they are mentioned in more than twelve level S3 guidelines. The S3 designation indicates that there has been systematic research, selection and evaluation of scientific evidence based on the relevant clinical questions, and there are descriptions of how to approach the work methodologically, as well as assessments of their degree of effectiveness. Anthroposophic art therapies were prospectively evaluated by the Anthroposophic Medicine Outcome Study (AMOS) (3). In this large research study, outpatients were treated with Anthroposophic Medicine and therapies (including art therapy) for anxiety disorders (4), depression (5), asthma (6), attention deficit hyperactivity disorder and other chronic illnesses (7). The evaluated treatments proved all to be safe. Clinically relevant research instruments were used to determine patients’ long-term improvement of symptoms and health-related quality of life. Improvements were demonstrated for children and adults of all ages for each of the above diagnoses, with improvements still present at a 48 months follow-up.

A new questionnaire on anthroposophic painting therapy has also been successfully tested in multimodal interventional treatment of breast cancer patients with cancer fatigue (8).


  1. Unter Verwendung von: Leitlinie zur Behandlung mit Anthroposophischer Kunsttherapie (BVAKT)® für die Fachbereiche Malerei, Plastik, Musik, Sprachgestaltung. Stand Februar 2017. Herausgegeben vom Berufsverband für Anthroposophische Kunsttherapie e.V. (BVAKT), Herdecke, Deutschland.
  2. Steiner R. Kunst im Lichte der Mysterienweisheit. GA 275. Vortrag vom 30.12.1914. 3. Aufl. Dornach: Rudolf Steiner Verlag; 1990. 
  3. Hamre HJ, Kiene H, Ziegler R, Tröger W, Meinecke C, Schnürer C, Vögler H, Glockmann A, Kienle GS.  Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study. Global Advances in Health and Medicine 2014;3(1):54-70.[Crossref]
  4. Hamre HJ, Witt CM, Kienle GS, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic therapy for anxiety disorders: a two-year prospective cohort study in routine outpatient settings. Clinical Medicine: Psychiatry 2009;2:17-31.
  5. Hamre HJ, Witt CM, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic therapy for chronic depression: a four-year prospective cohort study. BMC Psychiatry 2006;6:57.[Crossref]
  6. Hamre HJ, Witt CM, Kienle GS, Schnürer C, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic therapy for asthma: a two-year prospective cohort study in routine outpatient settings. Journal of Asthma and Allergy 2009;2:111-28.
  7. Hamre HJ, Witt CM, Kienle GS, Meinecke C, Glockmann A, Willich SN, Kiene H. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings. BMC Pediatrics 2009;9:39.[Crossref]
  8. Kröz M, Didwiszus A, Gelin-Kröz B, Pranga D, Reif M, ten Brink F, Zerm R, Gutenbrunner C, Büssing A. Reliability of the inner correspondence and harmony questionnaire with painting therapy (ICPTh). European Journal of Integrative Medicine 2016;8(Suppl. 1):30.[Crossref]

Research news

Mistletoe therapy in addition to standard immunotherapy in patients with non-small-cell lung cancer indicates improved survival rates 
Immunotherapy with PD-1/PD-L1 inhibitors has significantly improved the survival rates of patients with metastatic non-small-cell lung cancer (NSCLC). Results of a real-world data study (RWD) investigating the addition of Viscum album L. (VA) to chemotherapy have shown an association with improved survival in patients with NSCLC - regardless of age, degree of metastasis, performance status, lifestyle or oncological treatment. The mechanisms may include synergistic modulations of the immune response by PD-1/PD-L1 inhibitors and VA. However, the results should be taken with caution due to the observational and non-randomised study design. The study has been published open access in Cancers

Further information on Anthroposophic Medicine