By Arushi Sinha

Every Friday afternoon for six months after her breast cancer diagnosis in March 2000‚ Sandra Morrow Riggs of Dexter‚ Michigan‚ sat with art therapist Linda Hiller‚ MA. Together they began a journey of color and design that would transform both of their lives in ways they could never have foreseen. As Riggs explored her own experience of breast cancer‚ she found herself drawing her dreams‚ images of water‚ and images of light.

Riggs‚ whose sunflower basking in a “healing light” is as meaningful as it is beautiful‚ describes drawing as an opportunity for reflection‚ giving her a chance to articulate her hopes and represent her fears.

“I was no longer feeling invisible or alone‚” says Riggs of her lone sunflower warming itself in beams of warmth. The watercolor image combines the isolation of the cancer experience with the process of finding hope and the return to life among family and friends.

The American Art Therapy Association defines art therapy as the “therapeutic use of art making‚” adding that art therapy is not just art‚ but a combination of art along with an understanding of the art process.

“Ultimately‚ the art therapy process should help participants move from isolation to connection‚ from powerlessness to personal empowerment‚ and from denial to hope‚” says Malinda Ann Hill‚ MA‚ bereavement coordinator‚ The Children’s Hospital of Philadelphia. At its most profound‚ art therapy‚ also called image–making‚ gives voice to one’s feelings and is facilitated by a trained art therapist.

“A professional art therapist typically undergoes a two–year master’s program during which time they learn to deal not only with the expression of difficult feelings and thoughts‚ but also how to deal with these feelings and thoughts after they have been expressed‚” says Paola Luzzatto‚ PhD‚ art therapist‚ Memorial Sloan-Kettering Cancer Center (MSKCC)‚ New York.
Because art therapy can positively impact the quality of life of cancer patients‚ several prominent cancer centers now offer art therapy programs specifically for patients and their caregivers.

“We have known for years that it has beneficial effects‚” says Hiller.

Art as Part of Healing
New research published by Alastair Cunningham‚ PhD‚ clinical psychologist‚ Ontario Cancer Institute‚ Toronto‚ followed patients through a complementary program that included an art therapy component. Dr. Cunningham’s research demonstrates that those patients determined to have a high level of involvement may have prolonged survival. In a study of 22 patients‚ all having roughly a life expectancy of one year‚ two patients experienced complete remission‚ and several others lived beyond three years.

Although Dr. Cunningham is cautious about drawing conclusions from these findings and wants to conduct further research‚ he is convinced that “changing behaviors changes thoughts and ultimately changes reality.” As a cancer survivor himself‚ Dr. Cunninghamés research has personal meaning.
Riggs says that working with the inner images of art brings those “Aha! moments.”

Several months after helping Riggs find her voice through art‚ Hiller‚ who lives in Ann Arbor‚ Michigan‚ found herself on the other side of the fence after discovering a lump in her own breast. Hiller says that while Riggs’ art is bright and colorful‚ her own images are “very powerful and very personal.” And she says‚ working with Riggs and her drawings “contributed profoundly to my own strength.”

Since her breast cancer diagnosis‚ Hiller says her life has changed in many ways. She continues with her art and is constantly looking for new media with which to work. “I asked the hospital to give me the body molds that they used for my radiation therapy‚” she says‚ “but I haven’t decided what to do with them yet.”

The Non-Talking Cure
Riggs says she began art therapy classes offered by the University of Michigan Comprehensive Cancer Center (UMCCC)‚ Ann Arbor‚ because she kept missing the breast cancer support group meetings while undergoing treatment.

“For me‚ the art was a fun way to express myself rather than just talking‚” she says‚ adding that the act of putting pencil to paper to create images was another avenue for healing‚ a place for creativity. “You don’t even have to be an artist‚” she says‚ describing herself as an amateur.

“The image-making process fulfills two functions‚” says Dr. Luzzatto. “It fulfills the need for expression as well as the need for privacy.” Patients can choose to share their drawings and what their drawings mean to them‚ or they can choose to keep their drawings private. ”

When the images are shared‚ they provide an opportunity for communication that might not exist otherwise. Patients can share their thoughts visually with each other or with family members. “Artwork allows an opportunity for group support and also serves as a safe outlet to express overwhelming emotions‚” says Hill.

“The group therapy experience is amazing because similar images can help patients to find a common bond‚” says Hill.

“Patients may need to feel negative‚” says Dr. Luzzatto. Just because a person draws a scary image does not mean the patient is afraid. Instead‚ the image can be a release of the pent-up anxieties individuals undergoing treatment face on a daily basis. She adds‚ “Even though a patient may draw a cheerful image‚ it may trigger a sad feeling in someone else.”

The Creative Journey
Dr. Luzzatto describes different steps in the creative journey fashioned into a 10-week course offered to cancer patients at MSKCC. The first step is rather meditative‚ she says. Patients are asked to sit quietly‚ emptying their minds. They are then given suggestions about how to develop personal‚ meaningful images from a variety of different sources. Patients may play with art material‚ they may draw inspirations from objects in the room‚ or they may visualize their state of mind. Free association is an important component to the art therapy process. In the end‚ patients may share the meanings of their images‚ but they do not have to.

Once their drawings are complete‚ patients are asked to explain the meaning of the drawing. “This is probably the most important step‚” says Dr. Luzzatto.
Programs at the Ontario Cancer Institute vary from four weeks to one year‚ depending on the level of patient interest‚ and include topics like stress reduction‚ coping‚ and spirituality. “Cancer treatment without reference to spirituality is like marriage counseling without reference to sexuality‚” says Dr. Cunningham.

The goal is to make patients active partners in their healthcare. “Passive patients only show up for the appointments. Active patients look for additional ways to help themselves‚” says Dr. Cunningham. He also finds that patients go through several phases in the cancer journey‚ from absorbing the event to taking control‚ shifting to an inward focus‚ and finally finding a new sense of community.

Using Art Therapy
Recalling the work of artists such as Jackson Pollock and Paul Klee and the expressive art movement of the ’50s‚ art therapy relies heavily on art as a form of emotional expression. It gives voice to anxiety‚ guilt about the past‚ and hopes for the future. It also offers the possibility for transformation of moods and thoughts‚ giving the patient a different perspective on what has been expressed.
“We had one patient who was so frustrated and so angry that she couldn’t do anything during the art therapy session‚” says Shannon Scott‚ MA‚ art therapist at UMCCC. “So we just gave her pieces of paper that she tore into small pieces‚ and she eventually made a beautiful collage out of them.”

At MSKCC‚ art is used to create the “invisible” support group. A sheet of paper is passed along from room to room in the women’s oncology ward. Each patient adds her own contribution to the final product. It can be a poem‚ a drawing‚ or a few words. In this way‚ even though patients do not meet face-to-face‚ they can still communicate.

In another method‚ patients use a body outline in a variety of artistic ways. “Some patients use it as a map to show where they feel pain while others draw healing energy to surround the figure‚” says Dr. Luzzatto.

It’s not just patients who can benefit from art therapy. Hill says she gets the most feedback from nurses and physicians for whom she conducts art therapy classes. “These are people who have to deal with 20‚ 30‚ or 50 families every day‚ all with the same level of pain. They need an outlet‚ too.”

In the age of the increasing complementary therapies‚ healing environments (CURE‚ Summer 2002)‚ and support group debates (CURE‚ Summer 2002)‚ art therapy is designed to make patients feel better about the often terrifying cancer experience.

“So much of the cancer experience is out of the patient’s hands‚” says Scott. “Art therapy gives patients a sense of control to come to the studio and have the time and the space to do what it is they want to do. Unlike so many other things about their treatment‚ at least they can always say no to art therapy.”
“We should not make patients feel guilty for not participating‚” agrees Dr. Luzzatto. “After all‚ expression is not a magical solution to all problems. The therapeutic process may be a long process for some people.”

Having worked in the field for many years‚ Dr. Luzzatto finds that cancer patients share similarities with those going through other life-changing events.
“The issues that cancer patients represent are issues that we all struggle with‚ but cancer makes them more immediate and more intense‚” Dr. Luzzatto says. “What makes the art of cancer patients unique is they are more aware than ever of their vulnerability and of the preciousness of life.”