Using CancerChatCanada to Host Art Therapy Groups Online

1. Using CancerChatCanada to Host Art Therapy Groups Online Psychosocial Oncology Rounds - June 18, 2015 Sara Prins Hankinson, RCAT, Art Therapist Catherine Dunlop, Ph.D., DVATI, Art Therapist BC Cancer Agency With assistance from Kate Collie, MFA, MA, PhD, ATR, RPsych;Cross Cancer Institute

2. Overview • Art Therapy • CancerChatCanada • Project History • Method • Expressive Arts Group • Results • Conclusion

3. Art Therapy “Art therapy combines the creative process and psychotherapy, facilitating self-exploration and understanding. Using imagery, colour, and shape as part of this creative therapeutic process, thoughts and feelings may be expressed that would otherwise be difficult to articulate.” (Canadian Art Therapy Association)

4. Art therapy has been shown to provide these positive effects for cancer patients: reduce pain and other symptoms (Nainis et al., 2006) reduce distress, anger, confusion, helplessness (Puig et al., 2006) enhance self-awareness & emotional connectedness (Puig et al., 2006) improve mood (Puig et al., 2006) vitalization, respite from the cancer storm (Collie, Bottorff & Long, 2006) improve coping(Oster et al., 2006) boundary strengthening(Oster et al., 2009) improve quality of life(Svensk et al., 2009) positive distraction Benefits of Art Therapy

5. Group Art Therapy in Oncology Goals of an art therapy group for cancer patients include: support relief of emotional distress provide a venue for reflection and expression create a space for connections to occur enhance self-esteem through discovery of creativity

6. provide feelings of mastery and control (Collie & Čubranić, 1999) create possibilities for communication for people with disabilities (Collie & Čubranić, 1999) progress of an image can be easily tracked (Parker-Bell, 1990) an endless source of collage material (Parker-Bell, 1990) a natural container for imagery and image making(Parker-Bell, 1990) transferability of images makes it suitable for distance groups (Collie & Čubranić, 1999) images provide missing non-verbal communication in distance groups (Collie & Čubranić, 1999) Using Computers for Art Therapy

7. CancerChatCanada online support groups for Canadians affected by cancer operated by BC Cancer Agency facilitated by professionals at cancer centres across Canada time-limited closed groups text-based communication includes chat room and private messaging system created in 2008

8. Project History 1990’s- Kate Collie begins researching computerized and distance art therapy 2011- Sara begins leading art therapy groups for young adults at BCCA 2012- Kate and Sara meet, begin experimenting with trial group of art therapists 2013- Three trial groups on CCC held with professionals Fall 2013- Expressive Arts Group for Young Adults runs Spring 2015- Cathie Dunlop becomes facilitator, first National Expressive Arts Group

9. experimented with Skype, GoogleHangouts, CancerChatCanada used a variety of digital art tools and traditional art mediums developed several methods for hosting art therapy sessions online Online Art Therapy Trial Group Gretchen Miller Certified Trauma Consultant, Private Practice Cleveland, Ohio Kate Collie Cross Cancer Institute Edmonton, AB Sara Prins Hankinson BC Cancer Agency Vancouver, BC Mady Mooney Private Practice Vancouver, BC

10. Project Goals increase accessibility of art therapy provide alternative to text-based support discover user-friendly art-making tools develop guidelines for using technology in art therapy group provide secure place for creative expression enhance participants’ quality of life

11. Synchronous live chat + use of discussion board image making during sessions Asynchronous discussion board used for all conversation and images everything done on participants’ own time Mixed Method (Asynchronous + Synchronous) art directive sent or posted art completed on participants’ time live chat for weekly discussions Methods Developed

12. Tools Used • Digital photography • Polyvore.com • Pencilmadness.com • Traditional art materials

13. Demo of Session

14. Expressive Arts Group Spring 2015 5 participants (+2 enrolled at beginning) Participants were: • all female • aged 45 – 60 • located four provinces across Canada • mixed diagnoses • in active treatment (3) and post-treatment (2) at start of group • gave consent to share art and quotations from group

15. Approach Structure: • Guidelines • 10 weeks • 90 minutes each week (together in a chat room) • Mixed Method (chat room and individual art work) • Art Directives (vary according to group needs/interests) • Co-facilitated

16. Structure of Group Weekly Art Activities: • Photo of something that represents who you are • Graffiti art and leaving your mark • Self-portrait as a tree • Nature art – creating a resource piece • Art for meditation and relaxation • Sharing your story • Creating a wish doll • Imaginary empathy cards • Your bucket list (and jar) • Irish blessings and virtual potluck

17. Sample Directive: Mandalas While coloring, knitting, doodling and other forms of art can all be relaxing, for this next session we’re going to focus on one exercise that history has proven to be especially effective for meditation and relaxation: Mandalas. When you have a sense for what a mandala is, grab a piece of paper and a writing utensil (preferably a black ink pen or marker, but anything will do) and watch this video: https://www.youtube.com/watch?v=g16B64myG-E Begin to draw without worrying what it will look like. Remember, we’re in this for the relaxing benefits, not to make a masterpiece! It’s about the process, not the product.

18. Group Mandalas

19. Case Study: “B” “[I] Struggled a bit with the question [of introducing myself through a photograph] as there are so many different “me’s” depending on my role…Like an oyster, hard shell on the outside protecting the soft part inside and anchored to something permanent….Started getting into photography a few years ago. Trying to get better.”

20. B: Graffiti Art “This is my gang sign. My gang are people fighting cancer. My gang is the Dragon Warriors…I picture cancer as a dragon, mythical, can't see it but have to fight it…Dangerous if you don't stay ahead of it. Sometimes you are tired, but you just have to pick up that sword anyway.”

21. B: Irish Blessing

22. B: There are some things I can't change, like having cancer and how it will progress, but there are things that are under my control. Not yielding to dispair, living my life, seeing my friends. Saraph: Yes! You have so much power over all those things. B: I get tempted to stay in more with my lack of hair during treatment and my weight gain, but I have to fight that and stay in the moment. Cathied: And the blossoms are for staying in the moment.... B: Don't want cancer to rob me of the pleasures of life while I am still here...I will not yield B: Irish Blessing

23. Case Study: “M” “I found the computer program hard to control so I switched to stencils and spray paint… So first the Mona Lisa - sporting her new mastectomy… So my last image - my biggest struggle has been with migraines.”

24. M: Self Portrait as a Tree “This is an ornamental Thunderchild Crabapple tree. It's really a beautiful tree but had a bad "crotch" in it. The tree had started to die right in the Y part of the crotch so I had to cut off the whole back side of the tree... I pruned it a week ago, right before we had some 110 km/hr winds… I was glad I pruned it, otherwise the back limb might have torn the living tree trunk right down.”

25. M: Wish Doll

26. M: Wish Doll M: I got kind of carried away! LOL…The sleeves are supposed to be wings because my wishes all have to do with travel. The branches are from my yard. Red Osier Dogwood. I started with the doll and then I kept asking myself questions, What would a person like that have for a necklace, a purse, jewelry, hair, etc. Cathie: The doll has a life of her own M: yes, that's what happened

27. Participants Perspectives • 100% were very satisfied with the online group • 60% said their overall experience was better than I expected; time well spent • 80% said the facilitator(s) in their online group had skills and knowledge that deepened and focused the discussion • 60% strongly agreed that because of the group, they feel more hopeful • 100% said being a member of this online group has helped them learn that they are not alone in the cancer experience • 80% said they feel more confident about their ability to cope with cancer • 60% said they gained perspective on what they’re going through

28. Participants Perspectives “While art therapy was outside of the box for me, it was successful in creating an important connection to other people with cancer.  The discussions generated by the projects helped to address real fears, frustrations and questions that were common to all of us.  The resulting moral support was invaluable.”

29. “I had seen art therapy workshops [offered] but thought it was not for me as I am not creative at all.  But I enjoyed the online group, and discovered that i too could use the art form - even digital - to communicate my feelings and ideas.  I felt a sense of relief and also achievement at my ability to take up the weekly assignments.” Quote

30. “I am by nature very shy in a face to face group. The online chat group allowed me to feel comfortable to express my feelings. Also, cancer treatments are very exhausting and I wouldn't have had the energy to get in my car to go to a support group. I felt supported and no longer alone. Good experience!” Quote

31. Collie K, Bottorff JL, Long BC. A narrative view of art therapy and art making by women with breast cancer. J Health Psychol. 2006;11(5):761-775 Collie, K., Čubranić, D. & Booth, K. (1998). Participatory design of a system for computer-supported distance art therapy. In ­Proceedings of the Participatory Design Conference 1998, (pp. 29-36). Seattle, WA: Computer Professionals for Social Responsibility. Collie, K. & Čubranić, D. (1999). An art therapy solution to a telehealth problem. Art Therapy: The Journal of the American Art Therapy Association, 16(4), 186-193. Collie, K., Čubranić, D. & Long, B. (2002). Audiographic communication for distance counseling: A feasibility study. British Journal of Guidance & Counseling, 30(3), 269-284. Collie, K., & Čubranić, D. (2002). Computer-supported distance art therapy: A focus on traumatic illness. Journal of Technology in Human Services, 20(1), 155-171. Collie, K., Bottorff, J. L., Long, B. C., & Conati, C. (2006). Distance art groups for women with breast cancer: Guidelines and recommendations. Journal of Supportive Care in Cancer, 14(8), 849-858. Nainis, N., Paice, J. A., Ratner, J., Wirth, J. H., Lai, J., & Shott, S. (2006). Relieving symptoms in cancer: Innovative use of art therapy. Journal of Pain and Symptom Management, 31(2), 162-169. Oster I, Svensk AC, Magnusson E, et al. Art therapy improves coping resources: A randomized, controlled study among women with breast cancer. Palliative Support Care. 2006;4(1):57-64. Oster, I., Astrom, S., Lindh, J., & Magnusson, E. (2009). Women with breast cancer and gendered limits and boundaries: Art therapy as a 'safe space' for enacting alternative subject positions. The Arts in Psychotherapy, (36), 29-38. Parker-Bell, B. (1999). Embracing a future with computers and art therapy. Art Therapy: Journal of the American Art Therapy Association, 16(4), 180-185. Puig A, Lee SM, Goodwin L, Sherrard PAD. The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed stage I and stage II breast cancer patients: A preliminary study. The Arts in Psychotherapy. 2006;33:218-228. Svensk, A. C., Oster, I., Thyme, K. E., Magnusson, E., Sjodin, M., Eisemann, M., et al. (2009). Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: A randomized controlled study. European Journal of Cancer Care (Engl), 18(1), 69-77. Background Research

32. Conclusion • Cancer patients have unique needs and may have difficulty accessing support services • Art therapy is an effective form of support for people with cancer • Using CancerChatCanada is an innovative way to provide art therapy services to cancer patients across the country

33. Questions?