The International Handbook of Art Therapy in Palliative and Bereavement Care

Michele Wood, Becky Jacobson, Hannah Cridford, Michele Wood, Becky Jacobson, Hannah Cridford

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351616348
• Edition: 1
• Topic: Medicine
• Subtopic: Diseases & Allergies

The International Handbook of Art Therapy in Palliative and Bereavement Care offers a multicultural and international perspective on how art therapy can be of help to individuals, groups, families, communities, and nations facing death and dying as well as grief and loss.

Over 50 art therapists from around the world write about the transforming power of art therapy in the lives of those facing terminal illness, dementia, loss, and grief. They offer practical descriptions and techniques for working with adults and children to guide professionals, including those new to using art therapy and creative approaches in end-of-life care services.

This international handbook is essential reading for arts therapists, social workers, medical personnel, faith leaders, and psychologists interested in a collaborative and accessible approach to working with patients and families affected by loss.

Section Two
Art Therapy for Groups, Families and Communities

Death, dying, grief and loss not only impact one person at a time; they leave a profound impression on entire families and communities. In Section One we considered specific instances of art therapy with individuals. In Section Two we present authors working with groups, families and communities, supporting patients in a more collective and systems-focused manner. Art therapy offered to people gathered together can look quite different from art therapy offered to individuals alone, enabling healing and meaning to be found in shared experiences. The following chapters, while offering different perspectives, all indicate that connecting with others can be beneficial for the healing process.

Family and community-based art therapy may be held in a medical institution, a public space, outdoors, or in many other settings. Art therapists are equipped to be flexible in how they work and in how they create a safe, therapeutic and creative space, considering structure, guidelines and boundaries before the first session begins. Within these boundaries a number of approaches are possible, the two most frequently used in art therapy are:

• an “open studio” approach—where art materials and the therapist’s non-judgemental attention are provided, but not specific instructions
• a directive art therapy approach—where the art therapist will present a theme, question, or specific materials

Claudia McKnight (Chapter 18) outlines a closed art therapy group for children diagnosed with a chronic illness, siblings of children diagnosed with cancer, and bereaved siblings. The cohesiveness and safety of the group is maintained by ensuring only one member of each family attends any given group. McKnight’s model of groupwork sits between a fully structured and open studio format, with a fixed membership, and time for spontaneous art making. Annalie Ashwell and Hannah Cridford’s chapter (14) focuses on a large-scale art therapy project, combining the use of therapeutic arts activities, community engagement arts, and art psychotherapy. This example shows how a more directive project helped to promote greater understanding of palliative care by engaging the community at large as well as those receiving and delivering hospice care. This resonates with the digital art project mentioned by Michèle J.M. Wood in Section One (Chapter 11).

Innovation in models of art therapy and the development of partnerships are strong in this area of practice, overcoming barriers to engagement. Jones et al’s chapter (23) describes the process of piloting an art therapy intervention delivered at distance for those living in rural Wales, where travelling to cancer services can be an onerous task. In this group the therapist and patients connect using videoconferencing. McMahon et al (Chapter 22) discuss another pilot project implemented within a public area of an inpatient palliative care unit in Ireland. A collaboration between art and music therapy, this chapter details how the creative arts were able to ensure a safe, secure and therapeutic venue for group members.

Several chapters focus on the support art therapy interventions provide for carers and family members, both pre- and post-bereavement. Ofira Honig and colleagues, working in Israel (Chapter 15), present an innovative art therapy intervention for carers of people with dementia. The support art therapy offers to caregivers facing the challenges of looking after their relatives with dementia is outlined throughout the chapter. Heidi Bardot and Jean McCaw’s (chapter 20) focuses specifically on the use of art therapy within a grief camp for bereaved children and the impact it had on those who participated. In Chapter 21, Kayleigh Orr provides a view of art therapy with families, differentiating art therapy with patients, bereaved relatives and siblings.

In addition to these contributions from professionals working in the field, Lynda Kachurek (Chapter 25) provides a moving account of her experiences as a service user. She discusses how joining a bereavement focused art therapy group after the death of her husband greatly benefited her healing process. Personal narratives are examined further by Judy Thomson (Chapter 17), whose research inquiry offers the reader valuable insights into the Australian palliative care system. The roles and experiences of several art therapists working in palliative care are explored through the research methodology of immersive visual analysis. These accounts illuminate the anger, frustrations, enthusiasm and passion of art therapists working within this field. The chapter draws attention to the power of stories that art therapists encounter and participate in as they go about their work, and emphasizes the unique properties of visual art making as a tool for healing.

13 Snapshot of Practice

Art Therapy in Paediatric Oncology

Urania Dominguez

About Me

I studied my master’s and got my training in art therapy in Barcelona, Spain. I mostly worked in multicultural educational settings and I specialized in cultural sensitivity within art therapy. Upon arriving in Puerto Rico, after seven and a half years living and working in Spain, my focus in art therapy changed since Puerto Rico is not culturally diverse. I did some training for teachers regarding the creative process in the classroom and related to working with special needs children.

However, when I began to work in a children´s hospital setting, I focused my work on pediatric cancer and the different aspects this entails such as grief, loss, trauma and emotional support during chemotherapy. I combine art therapy goals with child life goals to provide better psychosocial care. Both art therapy and child life professions are unknown in Puerto Rico; it has been challenging for me to be taken seriously and for other professionals to understand how my work helps them do theirs.

Currently, I work in the Oncology, Intensive Care, Pre-Op and Mental Health units of a local children’s hospital as an art therapist and child life specialist.

About the Context in Which I Work

The island of Puerto Rico is the smallest island of the Major Antilles, settled between the Atlantic Ocean and the Caribbean Sea. Its 100 × 35 mile span holds over 4 million inhabitants, almost one million of those live in the metropolitan area. Puerto Rico is a self-governing commonwealth in association with the United States. The chief of state is the president and the head of government is an elected governor. Puerto Rico has authority over its internal affairs. The United States controls interstate trade, foreign relations and commerce, customs, control of air, land and sea, immigration and emigration, nationality and citizenship, currency, maritime laws, military service and bases, legal procedures, treaties, communications, agriculture, highways, the postal system, Social Security and other areas generally controlled by the federal government within the USA (Welcome.topuertorico.org, 2019).

There are only three free-standing pediatric hospitals on the island. I work as an art therapist and child life specialist in one of these hospitals, San Jorge Children’s hospital, and my work is mostly with pre-surgical, mental health and oncology patients, including at their end of life stage. It is the most complete privately-owned children’s hospital.

A pediatric cancer diagnosis can bring serious distress to the whole family because of the implication that the child may die. However, depending on the type of cancer, 5-year survival rates can be as high as 75–85% (CureSearch for Children’s Cancer, 2019). The most common cancer in children is leukemia, but I have also worked with osteosarcoma (with and without amputation), neuroblastoma and patients with Hodgkin’s disease. The oncology unit has strict guidelines for visiting hours and number of visitors allowed; therefore, my interventions are much anticipated and provide emotional support for the patients and the family as well.

Case Example

Oncology patients often have long and repetitive hospitalizations. Being in the hospital for long periods of time may cause serious emotional distress to children of all ages. Many may feel sad, fearful, nervous and angry, and their physical, social and emotional development can also be affected by their circumstances.

Interventions in the oncology unit may vary in purpose and procedure depending on the needs of each child. One of the objectives when working in this unit is helping the children express their emotions and adjust to the clinical setting. As an art therapist, I understand that expression comes in many forms; knowing that children nowadays enjoy picture taking, I decided to plan a therapeutic photography activity as an alternative means to accomplish my goals.

The pursuit of photography as a form of self-help is usually done as a means to gain personal insight or a better understanding of oneself. It could also be used to gain mastery over a certain element of a person’s life.

(Natoli, 2011, p. 2)

The photography activity consisted of providing a professional grade digital camera to children individually and inviting them to take pictures, in and out of their rooms, of things and/or people they liked, found interesting or that were important to them. Ten children participated in the activity from ages 6 to 16 and their subject choices varied.

Everyone took pictures of their surroundings and of people that mattered to them. Some of the photographs taken showed aspects of the hospital; details of the play room, the movie theater, the intravenous bags and medications, empty beds or simply the water fountain in the hallway. Some pictures showed their personal belongings such as coloring books, crayons and stuffed animals. In other pictures, we saw how the children viewed themselves within their hospitalization, taking pictures of their shadow, their feet, their IV and IV stands and even their blood transfusion bag.

Though not a conscious process, taking photographs allowed them to view the hospital and their hospitalization in another light, as if from the outside looking in. They depicted objects and people that were part of their hospital routine and that they were accustomed to. It also allowed them to explore familiarity and communication with these objects and people. The pictures also established their passage through the oncology unit, evidencing it as an important part in their life’s story.

Furthermore, the activity of taking pictures in itself allowed for a process of normalization. For example, a boy who had a recent amputation wished to take pictures of different things in the unit. There were no wheelchairs available that I could quickly grab, so I used a rolling office chair and pushed him wherever he wanted to go. This chair gave him more liberty than a wheelchair because it would roll and turn in every direction. He was free from the constraints of a wheelchair, which helped him feel like any other person on a rolling office chair and not a patient with an amputated leg.

Advantages of Art Therapy in My Context

Though the creative process is a beneficial tool to exteriorize inner conflicts and express emotions, in my experience many patients in a clinical setting welcome art activities, mainly as a means of distraction and as a normalization process. Their artwork expresses the things they like or like to do. They use art to decorate their hospital rooms and make their space feel more like home. This form of creative expression provides the hospitalized child a means to control their environment and give their personal space a less clinical feel.

The mere process of creating helps children to focus on more pleasant issues, helping their mind to relax and be able to manage difficult emotions such as anxiety, fear, anger and sadness, while at the same time the body also relaxes, helping them cope with pain associated with their condition or treatment.

Furthermore, creative activities provide patients with the opportunity to make choices, giving them a sense of control and empowerment in a place where they have lost all control of what they can do, how they can dress, what they can eat and when they are going to be tested, prodded or pricked.

Lastly, the artwork made in medical art therapy can help patients communicate their understanding and feelings regarding their condition, treatment and hospitalization. This allows the therapist to correct any misconceptions and address the patient’s concerns and fears while at the same time helping them to develop their motor and communication skills.

One Idea that Shapes My Work

Often, I have been told: “I couldn’t do what you do”, or I have been asked: “How are you able to work with patients who are sick or dying?” My answer is that my patients are first and foremost children, not their condition or their medical situation. I have to keep in mind that my job is to help them have quality of life in their time in the hospital. It is important to remember that children understand the world around them through play and communication with others; creating art is a form of play and a form of communication. Therefore, providing art opportunities helps patients in their healing process, continuing their healthy development. Thus, when I provide medical art therapy to these patients the first thing I ask myself is if what I am doing is beneficial and therapeutic, and whether it provides tools for managing stress, an...