But is it art therapy? Working with children with complex health conditions

ABSTRACT

Background

There are growing numbers of young children with complex life-limiting conditions as well as varying degrees of physical, sensory and cognitive limitations currently surviving birth.

Context

As a trainee art therapist, I needed to clarify exactly what art therapy actually was and how to implement it with this clientele, which initially looked the least likely of the creative therapies to be practical.

This article offers an account of my journey providing art therapy to a ten year-old girl during my final year trainee placement within a children’s hospice and what she contributed in terms of my development and understanding.

Approach

Neurobiological studies of sufferers of trauma (who can display similar restricted sensory, emotional and cognitive processing capacity) suggest that art can function in a direct manner on the brain, enabling expression and communication. Art therapy becomes feasible with these children if their anger and frustration is seen as embodied very much like trauma as generally understood. Initial sessions concentrated on creating routines and structures without expectation of an art product even though these could be mistaken for sensory or messy play.

Outcomes

Finally, my client engaged with art materials and was able to employ controlled gestures resulting in making marks on paper. A noticeable positive change over my client’s attitude occurred.

Conclusions

By not focussing on expectations around the marks produced in terms of art, a therapeutic relationship developed.

Implications for research

Neurobiological studies involving these children as a specific group and art therapy are recommended.

Plain-language summary

This article offers an account of providing art therapy to a ten year-old girl who has the cognitive facility of someone much younger, is registered blind, has limited fine-motor skills, and has a life-limiting degenerative neurological condition. That she could engage in any form of making art (an often assumed prerequisite of art therapy) may seem improbable. As a result, children with similar abilities are more likely to be offered sensory or messy play, as these might appear immediately more directly accessible. Nevertheless, art materials do feature in messy/sensory play, and though the end result may, indeed, present as a mess, drawing on neurological theory I reason this could still result in therapeutic value as a mode of expression/communication. Part of the initial difficulty for me involved issues around what art therapy was. Consequently, I struggled with the idea of whether what I was doing with my client was art therapy.

Although, at times, I felt I was offering sensory or messy play, I was finally able to accept that I had done so in the service of art therapy. A key factor was to do with the role of the art therapist as ‘container’ for the client’s emotions. The art therapist’s role is therefore upheld as essential to defining whether it was art therapy or not. Much of the time, what took place did not necessarily emulate what I thought of as ‘normative’ art therapy practice. However, these sessions were necessary to build up trust, and eventually, my client constructively engaged with art materials. The results were not pictorial, but they were controlled rather than random and were accompanied by a marked change of behaviour. I concluded that art therapy specifically was possible in this situation, and affirm that this client group should not be denied the opportunity because of potentially preconceived expectations.

KEYWORDS:

• Art therapy
• children with complex health conditions
• children’s palliative care
• neurobiology
• somatic-countertransference
• art therapist role
• hospice
• container and containment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Lexi’s real name is used here with full approval of her mother who chose this option on the hospice consent form. She felt strongly that this would respect her daughter as an individual with a unique identity, and not just as somebody with a condition, as is often the case in meetings with medical professionals and teachers who talk about her as if she were not there.

2 I was later informed that Lexi’s class had participated in a memorial for a classmate who had died.

Additional information

Notes on contributors

Eleanor Polihronis

Eleanor Polihronis qualified as an art therapist from the University of Hertfordshire in 2020. Throughout her training she worked both directly and with the families of children and young people living with complex health needs. In her final year she piloted an art therapy service within an established Creative Therapies team at a children’s hospice, including as part of their community outreach. Upon qualifying, the hospice asked Eleanor to continue the pilot professionally. This article was inspired by Eleanor’s experience of working as a trainee in children’s palliative care, and the strength of the families she regularly encountered. Eleanor would like to acknowledge a heartfelt thank you to the hospice, for giving her the chance to pilot art therapy, and to the family of Lexi in particular for trusting Eleanor to share their story.