Children facing a life-threatening illness and their siblings often need to express their pain, anger, sadness, confusion, fear, love and hope. While some are able to communicate their experiences verbally, many rely upon symbolic, nonverbal language through art and play; allowing them to express feelings and communicate experiences which may be impossible for them to put into words. Drawings can provide a window into a child’s innermost, private self. Through art and play children are more able to cope with the ordeals of their illnesses and come to terms with their experience and prognosis. The expressive arts, which include drawing, painting, claywork, play, writing, storytelling, music, movement and sandplay allow for unconscious feelings to emerge and find form in the outer world.

Expressing feelings through art therapy – Susan Bach, author of Life Paints its Own Span, has repeatedly found that children’s drawings reveal both their psychological and physiological understanding of what is happening to them. Even before many children are consciously aware of their prognosis, their artwork may indicate a preconscious knowledge of their illness and its outcome (see A Case in Point). A child might begin to draw spontaneously or be guided with suggestions such as: “draw your feelings about your illness” or “draw someone real or imaginary who can assist and support you during this time.” In Armfuls of Time, by Barbara Sourkes, an 8 year old boy drew his feelings after finding out he had leukemia: “I turned pale with shock and chose yellow - a pale color. Scared is red for blood...I was mad -black- about alot of things: staying in the hospital, bone marrows, spinal taps...I was sad -purple- that I didn’t have my toys and that I was missing out on everything. I chose blue for lonely and green for hope...” (click for art examples).

Effects of different art mediums – it is important to be aware that different art media may elicit different responses. Structured art materials such as colored pencils, felt-tipped pens, and collage will encourage focus, containment and a sense of mastery and control. Unstructured materials such as paint and soft clay may serve to loosen inhibitions and allow access to the unconscious. If a child appears overwhelmed during their art process, the medium can be changed from paint to colored pencils or cutting and pasting on a smaller sized paper for an increased sense of control, grounding and containment. Engaging in a dual drawing with a child on the same sheet of paper provides safety and reassurance as the adult mirrors the child’s experience by drawing similar images or providing symbolic support such as drawing a helper or environment to protect them.

Interpreting the artwork – In Drawings from a Dying Child, Judy Bertoia states that: “Just as we can never really know the subjective experience of another person’s life or dreams, a viewer can never be certain of the meaning of another’s drawings.” Rather than jumping quickly to interpret their imagery, it is best to carefully listen to the child’s own explanation and associations. Start with open-ended questions such as “Tell me about your drawing”, “Is there a story that goes with this?”, “How did you feel while you were painting this?”, “What does the color blue mean to you?” This gives the child the opportunity to share their experience in a way that is meaningful to them rather than having an adult's interpretation or projection imposed on them.

Art therapy isn't just for the children – As parents and caregivers, we must also find ways to care for ourselves as we accompany the children on their journeys. Using the same art materials and methods, draw your own feelings about what this process has been like for you. Draw your love, grief, anger, helplessness, strength, hope, growth, inspiration, heartbreak and healing. Paint or sculpt the bond that you share with the children, a profound heart-felt connection that will endure and expand beyond their death.                    Andrea Bass, M.F.T & Board Certified Art Therapist