Brief, structured, group art therapy for women with breast and/or gynaecological cancer

ABSTRACT

Background

This paper describes a structured group approach for women vulnerable to psychological distress following treatment for breast and/or gynaecological cancer.

Aims

Set in Hong Kong, the aim was to develop and pilot a brief art therapy intervention sensitive to local concerns and the specific needs of service-users.

Methods

A mixed methods study was developed and piloted in two phases over six-years in collaboration with female service-users recovering from breast and/or gynaecological cancer treatment. Key therapeutic goals and core themes were identified in phase 1 leading to the piloting of a six-session structured intervention with six groups in phase 2. This was evaluated using qualitative and quantitative methods: through service-user feedback and reflections; informal feedback captured through the art therapy process; and pre and post assessment of emotional distress (Distress Thermometer) and mental wellness (C-SWEMWBS).

Results

A consistent six-session structure was developed addressing four therapeutic goals: stress release and relaxation; amelioration of psychological and emotional distress; exploration of self-image; promotion of self-acceptance and awareness. Six core themes relating to loss and readjustment were established through the art therapy process. Participants experienced statistically significant reductions in psychological distress and increased mental well-being.

Conclusion

A new brief, structured, group art therapy approach was developed for women recovering from breast and/or gynaecological cancer treatment.

Implications for practice/policy/future research

The study contributes to the evidence base for the efficacy of art therapy in psycho-oncology and highlights the importance of service-user involvement in the design of a tailored, culturally sensitive, intervention responsive to local concerns.

Plain-language summary

This paper describes a brief art therapy group approach for women in recovery from treatment for breast and/or gynaecological cancer who are finding it difficult to adjust to changes in their bodies and the way they see themselves in the world. The aim of the project was to explore the use of a participatory approach to develop and test a brief art therapy intervention designed to meet the specific needs of such women. The project took place in Hong Kong, in a community cancer service offering support with the emotional impact of a cancer diagnosis and treatment. The theme-based group model was developed in two phases over six years in collaboration with female participants, all of whom were over the age of eighteen and had received treatment for breast and/or gynaecological cancer in the previous two years.

Four therapeutic goals were identified: relaxation, reduction of emotional distress; exploration of feelings about oneself in the world, and awareness and acceptance of various aspects of oneself and one’s situation. Common issues relating to feelings of loss and difficulties adjusting to bodily changes led to the further identification of six core themes. These were creatively explored through the art therapy process leading to the development of a consistent six-session structure.

The themed group approach was evaluated through service-user feedback and reflections, informal feedback during the art therapy process, and established measurement tools for assessing emotional distress and mental wellness.

Results suggest an overall reduction in emotional distress with improvements in mental wellbeing. This contributes to the evidence base for the efficacy of art therapy in cancer care. Positive outcomes also reflect the participants’ involvement in the design of a culturally sensitive intervention responsive to local needs.

KEYWORDS:

• Art therapy
• breast cancer
• gynaecological cancer
• readjustment
• acceptance
• community-based
• psycho-oncology
• identity

Acknowledgements

The authors wish to thank all participants in the research and Hong Kong Cancer Fund, particularly Ms Sally Lo (BBS, MBE), the founder and chief executive, for funding the art therapy service and supporting the study. As well as all staff members and volunteers involved and supported the service. The first author would also like to acknowledge Ms Maria Pang (art therapist) and Ms Chow Sau Fong. They originally formed the female service-user group in 2009 and adopted the name ‘Inner Beauty’. The authors wish to thank Ms Katie Pang, Sin Ying, as a research assistant for the study, she input and developed the data set and helped with data analysis. She is a registered expressive arts therapist. Since qualifying in 2015, she has worked with children, adolescents, and elderly with mental health issues at schools and non-governmental organisations. She began working in cancer care in 2019, is certified in Thanatology with the Association of Death Education and Counselling (USA), and is a contributing author to Nan, J. K. M., Pang, K. S. Y., Lam, K. K. F., Szeto, M. M. L., Sin, S. F. Y. and So, C. S. C., 2020. An expressive-arts-based life-death education programme for the elderly: A qualitative study. Death studies, 44(3), pp. 131–140.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Chan, upon reasonable request.

Additional information

Funding

This work was supported by Hong Kong Cancer Fund.

Notes on contributors

Nga Chee Tristan Chan

Tristan Chan Nga Chee is an HCPC registered art psychotherapist. She is a recognised clinical supervisor and a professional member of BAAT. Since qualifying in 2009, She has worked mainly with children and adolescents with mental health issues in hospitals and NGOs. She began working in cancer care and palliative care in 2012 and achieved the title of ‘Certified In Thanatology’ from the Association for Death Education and Counselling (USA). She was the former vice president of HKAAT, and the writer of ‘Embracing Imperfect: Wild Art Therapist’ published in 2016, and ‘Conveying grief and separation and be at ease – Art and Therapy at challenging times’ in 2021. As the first author on the paper, she was the practicing art therapist and mainly involved in the research design and implementation. The presentation and structuring of this article was formulated and delivered with extensive support of the second author.

Debbie Michaels

Dr Debbie Michaels is an HCPC registered art psychotherapist working mainly in independent/private practice. She has contributed to psychoanalytic and art psychotherapy literature, as well as the literature on practice-based research, and is an Associate lecturer with the Art Therapy Northern Programme with whom she has worked for many years. She supervises art therapists working across a range of client groups and organisational settings and has recently completed an art-based Ph.D. at Sheffield Hallam University exploring the psychosocial role of reflexive artmaking in honing sensitivity to the affective dimensions of human situations and experience. She has personal experience of gynaecological cancer and, as second author on the paper, her contribution has mainly involved advising and supporting the first author in structuring, interpreting, and editing material for publication. She was not involved in the original research.