Art Therapy Helps Children Affected by Cancer Express Their Emotions

by Karen Stuyck

Simple lines, bright colors, and primitive shapes give the artwork a decidedly childlike quality, but the scenes the young artists portray are disturbing—a floating house, a person jumping from a burning airplane, a sinister bee that drinks blood.

The art that these young patients and children of patients create is “a window into the less-conscious mind,” said Estela A. Beale, M.D., a child and adult psychiatrist and associate professor in the Department of Neuro-Oncology at The University of Texas M. D. Anderson Cancer Center.

The premise behind art therapy—using a young patient’s art for a psychotherapeutic purpose—is that creating pictures allows children to express what is uppermost in their minds more genuinely and spontaneously than they are apt to do in a discussion with the therapist. “What is really important is to let the children express themselves without any influence from an adult,” Dr. Beale said.

Pictures help the therapist understand the children’s perceptions and feelings about what is happening to them and explore possible alternatives to solving problems, Dr. Beale said.

Sometimes the child’s art expresses this information quite graphically, but often the young artist’s thoughts and feelings are “concealed, disguised, or expressed metaphorically,” Dr. Beale said.

The children’s art often expresses concepts they aren’t able to articulate. When asked what he thinks about his illness, a young child may not be able to answer, but he can depict how he perceives his situation in a painting or drawing. One eight-year-old patient, for instance, drew a picture of someone parachuting from an airplane over water that is full of triangles.

“Oh, why is he jumping?” Dr. Beale asked.

“He’s jumping because the plane is on fire and about to explode,” the child told her. Beneath the man is an island surrounded by sharks—the triangles. There is also a boat in the water, but it is empty, and the child feared it might be dangerous to go there.

“Because of his illness, this child sees his life as threatened, and there is nowhere to turn for solace, encouragement, or hope,” said Dr. Beale.

This is where the therapy begins. “In the therapeutic process, you have expression of feelings and an opportunity to review the understanding of the illness, which is a cognitive process,” she said. Another very important part of therapy is to help young patients find alternatives to deal with what they feel is ominous or dangerous—to offer them hope.

Some children are able to talk about the feelings that inspired their artwork, but others become even more frightened once they put their fears into the pictures, Dr. Beale said. To counteract this, she often keeps the discussion in the picture’s metaphor. The children then, in their own time, work on the new ideas and concepts she presents to them, until they feel more comfortable with their condition and with the questions and fears that they experience, she said.

To the child who drew the burning plane and circling sharks, for example, Dr. Beale would not say, “Oh, the plane is not going to burn down, and you don’t have to worry. We’re going to erase the fire,” because that would not address the child’s terror. The plane, which is burning or disintegrating, clearly has something to do with the child’s body, Dr. Beale said, and he wants to get away from it.

Instead, she would help the child to construct alternative solutions, such as finding safety for the man with the parachute.

“Sometimes in life we feel that we are surrounded with danger,” she might tell the child. “I imagine you feel that way when you are hurting and have to come back for chemotherapy and don’t know if you are going to be able to get out of this.”

At this point, some children are willing to open up about their concerns, but other children affected by cancer are too discouraged or frightened to respond. In such instances, Dr. Beale tries to offer hope in some other area of their lives. For a child without medical problems, the therapy would probably emphasize exploring his or her internal world, she said, but in a child with cancer, the therapy must help the child deal with the illness and the fears it creates by offering an alternative to isolation as well as specific solutions that can preserve the best possible quality of life.

“You are very frightened. What would help you?” Dr. Beale might ask the child. They could then discuss, among other solutions, how the child’s parents could help.

The way children respond to a discussion of their illness is determined by how their parents talk to them about cancer. Parents who are very open about sharing information have children who are very open about their illness, their perceptions, and their fears, Dr. Beale said. “But if the parent
is too overwhelmed to permit discussion, the likelihood is that the child will be very timid about discussing their disease and will avoid bringing things up, except to express them metaphorically.”

Another eight-year-old patient drew a picture for Dr. Beale of a house that seemed to be floating off the ground. Even though her parents had told her little, the child knew she was very ill, but she had no clear information about what was happening to her body. “She was up in the air,” Dr. Beale said.

Usually, the houses in children’s drawings represent the body, which contains life, Dr. Beale said. This girl’s picture showed a primitive-looking house that was empty.

“This house is not on the ground, is it?” Dr. Beale asked her.

“No, this house is floating. It’s very light, and the people in the house like to float,” the child responded.

“But you know, this is a house that looks sad,” Dr. Beale observed.

“Yes, because all the neighbors are in another city.”

“That must be so lonesome, and I’m sure you know about that.”

The girl saw the connection and later started talking about how lonely she was, even when her mother was present. She also came to understand what was happening to her, which helped to allay her anxiety and reassure her.

Parents who do not discuss cancer with their children assume the child does not know what is happening. Usually, they are wrong, Dr. Beale said. One three-and-a-half-year-old child who was not told about her mother’s cancer drew a picture of her with hair— even though the woman was bald from chemotherapy—and insisted that she preferred “mother with hair and no cancer!” According to Dr. Beale, the child knew her mother was sick and was expressing a desire for her to be well.

Parents often think that they are protecting their children by refusing to discuss the child’s illness and telling them, “Don’t worry. Everything is going to be okay.” But in reality, when children aren’t allowed to express their concerns, they can feel isolated and more fearful, Dr. Beale said. The child’s resulting despair is as much about the lack of human connection as it is about the illness.

In contrast, a seven-year-old child with leukemia whose mother had discussed her illness with her drew a picture of a monster bee that killed people and “likes to eat blood.”

“He wants to be invisible,” the child told Dr. Beale, “but he can’t.” The cancer, Dr. Beale explained, was a clear enemy.

“If parents can just listen and not be judgmental or prematurely reassuring, they can metabolize the feelings and return them to the child in a more acceptable way,” she said.

This is part of what Dr. Beale does in therapy with the children. “Catharsis alone is not enough,” she said. The children have to be able to express their fears in the context of an accepting relationship. This helps to contain some of the anxieties they are experiencing, which can lead to reframing or expressing things in a different way. “When children find some answers to their fears in the context of a trusting relationship, hope improves—even if their illness does not,” Dr. Beale said.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

Other articles in OncoLog, December 2003 issue:

• On the Move: Efforts Under Way to Improve Outcomes for Patients with Renal Cancer
• Children's Art Project Has Been Improving the Lives of Children with Cancer for 30 Years
• DiaLog: When a Parent Is Sick: Talking to Children about Cancer

TOP

Home/Current Issue | Previous Issues | Articles by Topic | Patient Education
About Oncolog | Contact OncoLog
Sign Up for E-mail Alerts

©2008 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd., Houston, TX 77030
1-877-MDA-6789 (USA) / 1-713-792-3245  
 Patient Referral    Legal Statements    Privacy Policy