Today’s blog post is written by Jackie Kolenz, an art therapist at Cleveland Clinic Children’s! Read about legacy-making in art therapy and how hand-casting can be a way to say goodbye to loved ones. If you want to learn more about our partnership with them, check it out here.
Helping pediatric patients and their families cope with a terminal illness is a difficult and sensitive issue. Art therapy can be incorporated to ease a patient’s journey through the dying process. The artistic process can open the door to a valuable experience of encapsulating the experience of the child’s life.  When the focus shifts from pursuing curative treatment to maximizing quality of life, art can serve as a powerful instrument for expression, understanding, and acceptance.
Art therapy can assist individuals in discussing change and loss by using the therapeutic relationship and artistic process. Art therapy helps increase self-awareness and bring new perspective and meaning to one’s life.  Similarly, art therapy assists terminally ill individuals with transitioning from feelings of worry to a more realistic, fluid understanding of death and loss.  Kelley (1999) described the benefit of art therapy with hospice patients:
The courage of the human spirit is never more evident as when patients choose to take creative risks, to transcend physical limitations, to examine their lives through the arts in order to meet death with equanimity. The artwork, or gift, becomes a visible symbol of their love and will, a triumph of their spirit. (p. 143)
Creating a legacy through art therapy
Individuals of all ages with terminal illnesses may create gifts for family members during art therapy sessions.  After experiencing a loss, the artwork serves as a precious physical keepsake of the one who has died. Families who are facing the impending death of their loved one may work alongside the patient to create these legacy pieces, sometimes without even consciously acknowledging that they are doing so. Often, family members enjoy creating art that embodies their loved one and the heartfelt memories they appreciated together.
Art therapy can be beneficial for the patient and their family, friends, and caregivers . It can help family members gain a respite from and express emotions related to the constant care the patient may require.  So the growing relationship with the art therapist during sessions also helps improve the connection with family members and staff. 
When viewing patient artwork family, friends, and caregivers are welcomed into the patient’s artistic process and encouraged to connect to their loved one as a whole person, rather than an ill person.  “The whole process of making art is healing, as patients, families, and staff experience wellbeing and heightened awareness, approaching the great mystery of death.”  A genuine goodbye can be a source of continued comfort for loved ones, and allow the patient to accept that their life is coming to an end.
Thank you to Cleveland Clinic Children’s and Jackie Kolenz for sponsoring this blog post!
Specific art therapy interventions can be particularly helpful both with processing issues related to loss and enhancing quality of life.  Hand-casting provides patients a chance to reflect upon their wish to find peace, their hope and determination, their will to survive, their desire to be remembered after death, and as a means to say goodbye to loved ones. Hand-casting techniques can also help patients and their families cope with grief and loss experienced when facing a terminal illness. The technique provides an opportunity to experience something completely different from the standard assortment of art materials used in art therapy.
How does hand-casting work?
A cast is a mold made from an object and is the act of shaping materials into a mold. As the mold cools, it solidifies into the shape of the object.  Prior to hand-casting, we invite clients to sit in a comfortable position. We explain and demonstrate the process by the art therapist. Afterward, we ask them to practice each step of the art task in order to gain a deeper understanding of the process.
Additionally, we instruct clients to place each hand in a desired position. “Choosing the pose before beginning the cast is akin to choosing what to draw in a typical art therapy session” (p. 110).  Then, we mix and pour the molding gel into a large bucket. After we pour the gel, we advise clients to dip their hands into a container of water to prevent the molding material from adhering to their skin. Next, we prompt clients to insert their hands into the bucket of gel and remain inside for about five minutes.
After the gel sets, we ask the clients to gently ease their hands out of the bucket with assistance from the art therapist. Following, we mix and pour plaster into the mold and the therapist allows air bubbles to travel the service. Upon completion, we wait for 24 hours for the casts to set and a week to air-dry before being sealed.
Viewing the completed sculpture for the first time is a very powerful and delicate component of the multi-step casting process, and can allow memories to be awakened.  Although every family responds differently, the majority of the members appreciate the ability to hold, touch, and grasp this valuable keepsake. Some exhibit the completed hand casting in a place where the sculpture will be regularly viewed, such as on a mantelpiece. These legacy projects are an important part of the work we do as art therapists at Cleveland Clinic. We are humbled by the trust and faith that patients put on art therapy to help navigate the difficult journey that takes place when a child is dying.
- Feen-Calligan, H. (2008). How do we care for people? Introducing a special issue on art therapy in palliative care. Art Therapy, 25(3), 106-107. doi: 10.1080/07421656.2008.10129595
- Kelly, C. R. (1999). Transformations: Visual arts and hospice care. In S. L. Bertman (Ed.), Grief and the healing arts: Creativity as therapy (pp. 139-144). Amityville, NY: Baywood.
- Malchiodi, C. (2013). Art therapy and health care. New York: Guilford Press.
- Museum of Contemporary Art, Los Angeles. (2013). Glossary. Retrieved from http://edu.moca.org/education/curric/glossary
- Prasad, S., Howie, P., Kristel, J. (2013). Using Art Therapy with Diverse Populations Crossing Cultures and Abilities. London: Jessica Kingsley.
- Rutenburg, M. (2008). Casting the spirit: A handmade legacy. Art Therapy, 25(3), 108-114. doi: 10.1080/07421656.2008.10129592
- Safrai, M. B. (2013). Art therapy in hospice: A catalyst for insight and healing. Art Therapy, 30(3), 122-129. doi: 10.1080/07421656.2013.819283
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