Skip to main content

Verified by Psychology Today


Cool Art Therapy Intervention #1: The Art Therapist’s Third Hand

Call it mindsight, empathy, or attunement — or call it the third hand.

Cool Art Therapy Intervention #1 is not really a technique or method, but the essence of what makes art therapists different from other helping professionals who use art as form of treatment.

It's called the "third hand," and to me, it's art therapy's version of mindfulness, insight, and empathy. By definition, it's an overarching way of thinking about intervention that describes how art therapists apply their artistic competence and imagination in service of others.

Edith Kramer, a renowned U.S. art therapist, artist, and author, is credited with coining the term "third hand," an idea central to her approach to art as therapy. To Kramer, art therapy's purpose is to enable the individual to create visual images that eloquently and truthfully communicate experience, and to the best of the person's abilities. Kramer's stance echoes psychoanalyst Theodore Reik's Listening with the Third Ear, a treatise describing how psychotherapists intuitively use their own unconscious minds to decipher and understand their clients.

While it might seem that a "third eye" for seeing the metaphors, symbols, and meta-messages in art expressions would be enough, the practice of art therapy goes much deeper. An effective art therapist must have a command of the third hand to enhance a client's creativity without being intrusive, imposing one's own style or artistic values, and misinterpreting meanings found in images. Ultimately, the responses of the therapist to a client's process of art-making reflects and supports that client's worldview, creative potential, and ability to use art for reparation and recovery.

Here's an explanation of third-hand intervention in its simplest form. When working with a child client, I might develop a drawing for the child to finish as a way of establishing a relationship or communication. In another situation, I might save a child's clay figure from falling apart by showing the child how to reinforce the legs or armature. Sometimes an art therapist literally becomes the hands for an individual; an adult with a debilitating medical illness may need me to help cut and arrange photos for a collage. Other times, I might make art during the session alongside a client if it is therapeutically helpful or I might even communicate something non-verbally through an artistic expression rather than use words.

Most importantly, an art therapist's third hand perceives and capitalizes on appropriate metaphors via art-based interventions to help clients. I am reminded of a couples art therapy session facilitated by art therapist and family therapist Shirley Riley, a master of therapeutic metaphor via imagery.

The couple came to Riley for help with their marriage; they had decided that their age difference was insurmountable because the wife was eight years older than the husband. In response, Riley went along with their belief but also asked that they each bring a copy of their birth certificates to the next session. At that point, she suggested that they cut up the copies and collaboratively create a collage incorporating the pieces.

In brief, the couple realized that they could not change the age gap, but the process of cutting up the certificates and making a collage together from the pieces gave them a new vision for what worked in their relationship rather than what could not be changed. It was the perfect "third hand" metaphor to get them to re-story their relationship and recommit to their marriage.

To me, what Kramer calls the "third hand" in art therapy echoes what physician and neuroscience guru Dan Siegel speaks of as "mindsight," a capacity for insight (knowing what one feels) and empathy (knowing what others feel). Trauma expert Bruce Perry uses the term "attunement," the ability to be able to read the non-verbal communication and rhythms of others.

In other words, it is perceiving not only what individuals say, but also attending to eye signals, facial gestures, tone of voice, and even breathing rate; in art therapy, it also means attending to the content of images and creative process. If this all sounds incredibly intuitive, to some extent it is; on the other hand, it is the mindful focus essential to achieving the magical moments of success in any form of therapy.

As I said at the start of the Top Ten Coolest Art Therapy Interventions, all helping professionals know that no one intervention can be applied to all clients or all situations. That is the daily challenge of our work, to use our third hand, mindsight, empathy, attunement or whatever you choose to call it to facilitate change, insight, and well-being in those we encounter. And "third hands" down (pun intended), it's definitely the "coolest" part of my work as an art therapist.

© 2010 Cathy Malchiodi, Ph.D., LPCC, LPAT

Have you discovered Art Therapy Without Borders yet?