Psychiatrist Harry Stack Sullivan brought the interpersonal relationship between therapist and patient to its highest point. One of the primary features of his system was the idea of consensual validation, by which he meant that both the patient and the psychiatrist had to agree on whatever was in question. He was vilified in the extreme, perhaps in part because of some suspected "taint" of homosexuality.

Many authors have contributed to the development of the art and artist paradigm. The basic idea is that the patient, or the symptom, or the therapist, or the therapeutic process is like the unsuccessful artist, the work of art, the artist, or the art process.

Georg Groddeck, one of the leading figures in the development of psychosomatic medicine, whom Freud was allegedly seeking out shortly before he succumbed to mouth cancer, characterized certain physical symptoms as works of art gone awry. He would query patients on what they were trying to accomplish by way of their symptoms, often eliminating the symptoms in the process and enabling patients to find better ways to accomplish their goals.

Freud's once favorite disciple, Otto Rank, referred to the neurotic as a failed artist. He also advanced the view that the artist who could give up their protection by art would be the representative of a new type of humanity.

The philosopher Suzanne K. Langer put forth the idea of the artist as a "presentifier," who presents their work rather than themselves for the purposes of public scrutiny. Langer introduced the idea of "significant form," by which she essentially meant the "non-discursive" articulation of feeling, as the hallmark of all genuine works of art.

Existentialists such as Jean-Paul Sartre, author of works that included Existential Psychoanalysis and Psychology of Imagination, and Phenomenologists such as Maurice Merleau-Ponty, advanced the notion of the artist as hero. In "Cezanne's Doubt," for example, Merleau-Ponty's idea is that the true artist has no interest in rearranging what has already been created. Instead, he or she wants to take everything in, then create something entirely new. The "meaning" of what the artist creates does not exist beforehand. Nor is it possible to predict whether it will ultimately become "meaningful" on its own.

Les Demoiselles d'Avignon by Pablo Picasso

For Fritz Perls, the model of the patient as an actor on stage and the therapist as the director, was central to his development of Gestalt Therapy. Perls also focused at length on the artist's working process. For example, he noted that although the artist might not be able to tell you beforehand or while they are doing it what it is that they are actually doing, they can tell you in retrospect everything that led up to it. He also elaborated on the theme of the artist's "guilt of creation." This refers to the artist's tendency to repeat the same success over and over again. The basic goal of Gestalt Therapy is integration, based on the lively play of "figure" and "ground." This is the idea of the "good gestalt." Gestalt Therapy draws additional inspiration from a number of different sources, including the ideas of Otto Rank, Gestalt Psychology, Lewinian Field Theory, Zen Buddhism, Taoism, and Sensory Awareness. According to its founders, it would have been called Existential Therapy, except that at the time they felt that Existentialism was too "nihilistic."

In his book of the same name, Eugene T. Gendlin introduced the absolutely luminous phrase "experiencing and the creation of meaning." For Gendlin, concepts are used to refer to experiencing, and the result is to produce something that is genuinely meaningful. This in turn allows us to go on to the next step.

Psychotherapist J. Bugental focused on the "art of the psychotherapist." For him, the most important element is therapist "presence."

Joseph Zinker has been a Fellow of The National Expressive Therapy Association practically since its inception. In his first book, Creative Process in Gestalt Therapy, he described his generally traditional use of art in therapy. In his second book, In Search of Good Form, he responded to the idea of the client as an unsuccessful work of art. He talked about "recreating" the work within himself, so he can offer suggestions. His goal is to teach clients to be more authentic, more spontaneous, and more truthful, enabling them to become beautiful works of art.

Some psychoanalysts, especially women analysts, dared to make physical contact with their patients. Others occasionally attended concerts and other cultural events with patients.

Lore Perls, one of the co-founders of Gestalt Therapy, had been known to sit down at the piano with patients who had the necessary background, and play piano with them.

At a conference of The National Expressive Therapy Association, held in Cambridge, Massachusetts in 1986, Anna-Teresa Tymieniecka, President of the World Institute for Advanced Phenomenological Research and Editor of Analecta Husserliana, in an address called "Phenomenology of the Creative Act," urged expressive therapists to draw alongside their patients.

The uniquely American form of painting known as Abstract Expressionism (also called "Action Painting") sought the evocation of the human spirit. It introduced a strong element of spontaneous interaction between the artist and their art work. The artists involved, Willem de Kooning, Franz Kline, Jackson Pollock, Mark Rothko, etc., created works of sublime beauty. Interest in artistic process grew directly out of Abstract Expressionist painting.

Painting as a record of the artist's interaction with it inspired some artists, such as Yves Klein, to act out their works even more. This led to a greater focus on the artist as shaman and the urge to act completely outside the world of art itself, most notably in the work of Joseph Beuys. This movement in general was known as Action Art.

Conceptual art raised the question of what actually constitutes a work of art. The critic Alan Kaprow championed conceptual art as an "interactive form of communication." Performance art grows partly out of the desire of some artists to relate more directly to people.