healing icons: art support program for patients with cancer

Sue P. Heiney, PhD, RN, CS

Heidi Darr-Hope, MFA Healing Icons: ArtSupport Program forPatients with Cancer

OBJECTIVES: The purpose of this report is to describe the structure

and process of an art support program for patients with cancer

who are age 16 and older.

MATERIALS AND METHODS: Healing Icons is a six-session art support

program for cancer patients. During the program participants

create a three-dimensional mixed-media art piece to convey a

unique personal perspective on receiving a diagnosis of and being

treated for cancer. Concurrently, the patients spontaneously share

common experiences about their cancer, which leads to strong

emotional bonds. The purpose and goals of the program, method

of implementation, and evaluation are described. Information

and suggestions that clinicians might find useful in developing

similar programs are discussed. Patient participants, their families,

and staff in the cancer center have reported positive clinical

evaluations.

CONCLUSIONS: The benefits of Healing Icons are derived from the

therapeutic factors present in a traditional support group blended

with the creative process. This kind of program opens new av-

enues for expressing feelings and thoughts but should be struc-

tured in such a way that group processes are not allowed to nega-

tively impact participants. Healthcare professionals interested in

collaborating with artists on similar programs for cancer patients

may approach artists through local art councils, art schools, and

artists guilds. Brainstorming sessions with artists would help to

capitalize on the expertise of artists within the community. Initiat-

ing a pilot project would help gauge patient interest and would

provide valuable feedback from the healthcare team. Research is

needed to validate the clinical outcomes derived from this pro-

gram, as empirical findings would greatly enhance the clinical

evaluations.

KEY TERMS: Art; Psychosocial oncology; Psychosocial support

program

Since ancient times, art has been used to express innerfeelings and portray humankind’s story. Art expression

as a therapeutic modality has been used in psychiatry since1940, and by 1960 art therapy was an acknowledged pro-fession.1,2 More recently, a new direction for art in health-care has emerged.3,4 This focus has taken two parallel andsometimes complementary courses: bringing the visual, lit-erary, and performing arts into the hospital to promote amore humanistic environment; and having artists and pa-tients work together to increase coping with the disease.3,5

Although the one-on-one interaction of artist and patienthas been described,5,6 no reports were found of cancerpatients in a group program led by a studio artist and anurse psychotherapist. This article discusses the HealingIconsy (HI) program, its goals, the structure and process ofthe individual sessions, and the clinical evaluations frompatients, families, and staff.

Program DescriptionHI is an art support program for cancer patients. Dur-

ing the six weekly 1.5-hour sessions, the patients create artpieces that represent their personal perspectives on havingcancer. Concurrently, they spontaneously share commonexperiences about their cancer, which leads to strong emo-tional bonds. HI has been offered for the past 3 years at theCenter for Cancer Treatment and Research, Palmetto Rich-land Memorial Hospital, in Columbia, SC. This article rep-resents the synthesis of six programs.

Sue P. Heiney, PhD, RN, CS, FAAN, Manager, PsychosocialOncology Center for Cancer Treatment and Research, PalmettoRichland Memorial Hospital, Columbia, SC.

Heidi Darr-Hope, MFA, Professional Artist, Founder of Heal-ing Icons, Center for Cancer Treatment and Research, Colum-bia, SC.

This research was partially funded by Very Special Arts ofSouth Carolina, MedCorp Health Systems, Inc., and the South Caro-lina Arts Commission in association with the National Endowmentfor the Arts. Healing Icons is a registered trademark of Heidi Darr-Hope and is used with permission.

Address correspondence to: Sue P. Heiney, PhD, RN, CS,FAAN, Manager, Psychosocial Oncology Center for Cancer Treat-ment and Research, Palmetto Richland Memorial Hospital, Colum-bia, SC 29203.

CANCER PRACTICE July/August 1999, Vol. 7, No. 4 183© American Cancer Society 1065-4704/99/$14.00/183 183–189

Participants

All patients on the psychosocial mailing list receive abrochure that provides information on registering for theprogram. The brochure emphasizes that no art talent isneeded to participate; therefore, patients self-select to at-tend the program. The number of participants ranges fromfour to nine per program. Of those who attended the firstsession of each program, one dropout occurred in eachgroup. The reasons for dropping out included personalpreference or comfort with the material as well as being tooill to attend. During the first HI, the participants includedthree men with prostate cancer; all remaining participantswere women. Of the women, all had breast cancer exceptone patient each who had received diagnoses of multiplemyeloma, liver cancer, synovial sarcoma, and squamous cellsarcoma of the face. The participants ranged in age from 24to 68 years, with a mean age of 54.28 years (n = 25). Mostparticipants were professional women such as nurses, law-yers, and business executives. Some participants held blue-collar jobs. Patients chose to attend the program at anypoint from receiving the diagnosis to survival, but mostparticipated after treatment was completed.

Purpose

The purpose of the HI program is to provide cancerpatients with an opportunity to use the creative process asa vehicle for self-discovery within the context of a support-ive group environment. Four goals were established for HI:developing a nurturing community; creating opportunitiesfor emotional healing; finding meaning in the cancer expe-rience; and acquiring self-knowledge.

Goals

Traditional psychotherapy may not provide the bestapproach to working with cancer patients. Even if diag-nosed with an adjustment disorder related to their diagno-sis,7 most patients do not view themselves as needing psy-chotherapy.8 Instead, patients want to regain a sense ofcontrol, find meaning in their experience, and ventilatefeelings.9 Therefore, an intervention that introduces creativ-ity and group support may meet these needs.

The first goal is to provide an environment that devel-ops into a nurturing community. The support from otherswith similar experiences promotes interpersonal growthand increases personal responsibility for emotional heal-ing.10 Group leadership techniques are used to promote thedevelopment of curative group factors known to emergefrom group interaction because of its social nature.8 Thesefactors include universality (commonality), reality testing,catharsis, interpersonal learning, and instillation of hope.Therefore, participants are encouraged to relate to commonthemes among group members.

The second goal is to create opportunities for emo-tional healing. Principles from grief counseling were

adapted to address the enormous losses suffered by cancerpatients and the process of grief that follows. The programfacilitators use Wolfelt’s11 metaphor of a grief gardener whounderstands that grief is a normal life process and creates anenvironment in which the bereaved may mourn in theirown unique way. Similarly, the patient’s emotional re-sponse to cancer and its treatment is a complex but normalreaction to a life-disrupting situation. Therefore, the facili-tators’ task is to support the participant to “bloom whereplanted.”

A third goal is to help the participants to find meaningin their experiences.12 In narrative therapy, the therapist’sposition of power is de-emphasized and the client’s activeparticipation is emphasized. This approach encourages theindividual to use self-exploration to gain insight. Partici-pants are encouraged to explore their cancer story and toportray it nonverbally through art.13

The fourth goal is to promote creativity as a vehicle forself-knowledge through the creation of an icon.14 Althoughassociated with the Russian Orthodox Church, the paintingof icons was first practiced by the Greeks. Icons, derivedfrom the Greek word “eikenai,” meaning “image,” served aunique religious function. These objects permitted theviewer to experience the heavenly presence of a sacredperson by serving as a visual link to the sacred. Icons as-sisted the viewer in developing a personal relationship withthe spiritual.15 Although HI is not grounded within any spe-cific religious dogma, the extrapolated principle is that theicon is a visual metaphor for the cancer experience. Creat-ing the icon opens the passage from the external self to theinternal self. Participants are not forced to uncover uncon-scious processes but are encouraged to respond to theirintuition as they construct the icon. As this occurs, thefacilitators support the participants in becoming more self-aware. The patient’s art piece is not used to interpret, di-agnose, or treat a mental health problem.16 Participants areurged to trust their intuition and to use it to develop self-understanding about their cancer experience.17

In summary, HI is based on artistic concepts developedby Darr-Hope and the synthesis of principles from psycho-therapy. The artistic process is used to uncover innerstrengths for coping with cancer and to tap imaginativeinternal resources. The nonconfrontational structure of theprogram aids the control of anxiety about self-disclosurethrough balancing group tasks with group processes.18 Theprogram resembles the quilting circle, in which commonlife concerns are discussed while the quilters work. As eachpatient works on the art piece, the group’s interpersonalenvironment becomes more trusting, and sharing becomesa natural part of the creative process. The synthesis of theseprocesses creates a gestalt that is more than support andmore than art.

Facilitators

The artist who created HI holds a Master of Fine Artsdegree and has worked as a studio artist for more than 15years. In addition, she has provided art education to chil-

184 CANCER PRACTICE July/August 1999, Vol. 7, No. 4

dren and adults with special needs, senior citizens, prison-ers, and delinquent youth. HI was offered for cancer pa-tients in collaboration with a nurse psychotherapist. Thenurse facilitator has 16 years of experience in leading sup-port groups for cancer patients.

The roles of the artist and nurse psychotherapistblended art education with group leadership techniques.Therefore, the artist and nurse served as facilitators of theartistic process, group support, and individual insight. Forexample, if a participant seemed stuck on how to incorpo-rate an object or image into their composition, the artistmight have suggested scaling the size up or down by colorphotocopying the image. Toward the end of the sessions,participants were supported to finalize the various ele-ments of their icon and were provided with gentle guidanceto integrate their thoughts and ideas with their images andobjects.

Overall Format

The structure has evolved over time based on the fa-cilitators’ and patients’ evaluations from four HI programs.The details given here describe the program in its presentformat. Examples from each session are discussed to pro-vide an understanding of the richness of the individual’sresponse.

Each session is structured in a similar format consistingof three components: group discussion; a didactic compo-nent; and studio time. Initial sessions focus on the processof group interaction, and later sessions focus on the task ofmaking the icon. Group discussion assists the participantsto focus on their inner selves and builds trust and intimacyamong members, resulting in increased self-disclosure. Dur-ing the didactic component, concepts and tasks for creatingthe icon are presented. The nurse psychotherapist inter-jects information for developing personal insight. In studiotime, participants work on their individual icons, and theartist circulates among the participants offering encourage-ment and clarifying directions. Simultaneously, the nursepsychotherapist observes the overall group process and in-dividual emotional reaction to provide additional support.Unlike a traditional group, no attempts are made to bringthe group to psychological closure. Instead, the closureoccurs at the beginning of the next session. After the firstsession, each meeting builds on the last one by discussingassignments and using the personal reflections of groupmembers. The final session includes a formal closure andevaluation.

Although it is the most structured, the first session setsthe stage for all subsequent ones. Participants check in atregistration, receive name tags, a three-ring binder of mate-rials, and a journal. Handouts include a copy of the groupcontract, an agenda, the artist’s manifesto, and content re-lated to the didactic component of the group. All othersessions follow a similar format.

The following information is derived from processnotes maintained by the nurse psychotherapist and the pro-fessional artist.

Session One

Group Discussion

This session began with the nurse psychotherapist in-troducing the purpose and goals of the program with themajor focus being emotional healing. This introduction wasfollowed by a review and an agreement on the group con-tract. “Scribble In” was introduced as a getting-to-know-each-other and focusing activity. During this activity, par-ticipants related how they were feeling at the moment bydrawing a specified letter of the alphabet.19

Didactic Component

The professional artist gave an overview of the historyof icons, their purpose, and the extrapolated principles andgoals for the program. A slide lecture was presented todemystify the creative process, introduce art as a languageof self-discovery, and visually elucidate the guiding prin-ciples of the program. For example, participants were in-structed, “each night as you enter the room, leave yourrational mind in the parking lot and enter a new worldwhich focuses on the intuitive self.” An overview of theicon-making process was demonstrated. The artist empha-sized that learning would occur as the sessions proceed andthat no art talent would be necessary.

For the next session, participants were told to bring 10small objects that have meaning or power for them andrelate these objects to the cancer experience they wantedto be expressed in their icon. Also, they were encouragedto begin writing in their personal journal, by recording theirfeelings, dreams, and daily thoughts. The purpose of jour-naling in the HI program was to promote attention to theintuitive self.

Studio Time

Participants used the remaining time to think about thestructure and form of their icon. As the measuring and cut-ting was done, discussion slowly emerged about treat-ments, kinds of chemotherapy, and doctors. Camaraderiedeveloped among group members, but the sharing seemedmore intellectual than emotional. Slowly, feelings and sup-port emerged. For instance, as one woman worked, shebecame tearful, and the participant sitting next to her qui-etly put a hand on her shoulder while another patient of-fered an encouraging glance. With this support, the patientwas able to verbalize her fears about the recurrence of hercancer.

Sessions Two Through Six

Group Discussion

After a brief centering activity, the discussion focusedon the object assignment. One participant shared note

Art Support Program / Heiney and Darr-Hope 185

cards and objects given by friends and family during herrecovery from surgery. The most common objects sharedwere items from nature, and participants often related na-ture to their coping. For example, a 50-year-old prisonguard spoke of nature as a source of newly discoveredstrength. During his walks after work, he would pick upvarious kinds of leaves. The leaves were integrated into hisicon and represented his feelings about coping with cancer.Another participant used shells to depict the process ofemotional healing after extensive and disfiguring surgery.She related picking up bits and pieces of shell to her puttingthe pieces of her life back together. This discussion helpedparticipants select objects for placement in their icon asrepresenting their cancer experience. The discussion con-cluded with the facilitators commenting on commonthemes that emerged and reiterating the program’s prin-ciples, such as trusting the intuitive self while formulating avisual language.

Studio Time

During the second session, more intimate sharing oc-curred as participants began working on their icons. An-gered by the loss of her hair, a participant described hergrowing hat collection. Another woman related wearing awig throughout her time as president of a national organi-zation and then giving her last speech to this group withoutwearing her wig.

Session Three

Group Discussion

By session three, participants were familiar with theformat of the program and discussion began more easily.The opening discussion centered on the homework assign-ment of noticing and reacting to color in the environment.One participant had noticed the large clusters of lantanablooming over the city; another participant described thefeeling of the sun on the body on a brisk winter morning.The artist interjected information about the use of color inthe icon and made the transition into studio time.

Studio Time

Participants chose the color scheme for the outside andinside of their icons. Discussion naturally evolved aboutcolor, images, and shapes. The theme that emerged was thedifficulty of narrowing choices by rejecting or discardingimages, objects, and colors. Participants wanted to includeevery significant object they collected or all their favoritecolors. The process of making decisions and choices aboutthe icon paralleled the emotional task of grieving lossesrelated to having cancer and finding ways to cope with thecancer experience. As the participants struggled to makevisual representations of their illnesses, they examined theirexperiences with cancer. For example, one participant, af-

ter vacillating between several ideas, chose to depict a va-cation cabin. She used handmade bark paper as the framefor the image of the cabin to express feeling safe, nurtured,and peaceful.

Session Four

Group Discussion

The opening discussion revealed more self-disclosure,indicating greater trust among members. For example, oneparticipant shared a photograph of a toxic waste dump andrevealed that this image conveyed how she felt about herbody. Another woman held up an old flannel shirt and dis-cussed how alive and at peace she felt when she was camp-ing. Participants were instructed to begin writing about thesymbolism within their icon.

Studio Time

Participants solidified their ideas and worked intenselyon completing their icon. Similarly, their discussion dem-onstrated deeper insight and more intense emotions. Oneicon had evolved into a theater stage with a decorativeborder made from pills and suppositories. Another womandeclared that she was failing miserably, did not have a cre-ative bone in her body, and could not believe she had con-tinued with the sessions. The artist reflected that a shape inher collage suggested power, strength, and direction. Theparticipant began to share her feelings of powerlessnessover her body. At the end of the session, she took hersupply box home to think and work.

Session Five

By this session, the three components had merged intoone continuous process. Previous delineations about home-work, didactic teaching, and studio time were not needed.Participants felt they needed more time to complete theirwork (Fig. 1) and anticipated the final session with reluc-tance. The homework assignment for the final session wasgiven, and termination was emphasized. The assignmentencouraged participants to finalize their written statementsabout the icon and the experience. The results of the cre-ative process began to emerge much like a butterfly from acocoon. The participant from the previous session who hadderided her artistic ability shared her icon. The backgroundof her collage was filled with words about her cancer, suchas horrified, blessed, frantic. Her self-esteem had grownthrough the creative process.

Session Six

This session differed greatly from previous ones: Mostof the time was devoted to group discussion, termination,and evaluation. First, participants reflected on their com-


pleted icons and disclosed the meaning and value of theirexperiences. The facilitators reinforced the idea of termina-tion and expressed their own perspectives. Finally, a clos-ing ritual provided structure for obtaining closure and say-ing goodbye to group members. This ritual evolved into acandle lighting ceremony and a group reading of hope.Participants were given their candles to take home as areminder of the time shared, the healing community thatwas established, the relationships made, and the insightsgained.

Exhibition

After each HI was finished, the icons were mountedand displayed in the Arts and Healing Gallery at the Centerfor Cancer Treatment and Research. Each participant’s writ-ten statement about the icon was mounted beside the art-work. The exhibit allowed family, friends, and coworkers toshare in the healing process and to gain better understand-ing of what it is like to live with cancer. The art is a spokes-person for the patient, expressing emotions that are diffi-cult to verbalize. The exhibition continues for at least amonth and provides educational outreach to other patients,

hospital staff, volunteers, and the community. The benefitsascribed to the exhibit included providing an opportunityfor others to be connected to the patients, to gain a differ-ent, more personal perspective on the disease and its treat-ment, and to hear the voices of the patients through a visuallanguage. A guest book in the gallery encouraged visitors towrite their comments about the exhibit by adding to thestories told through art.

Clinical Evaluations

The clinical evaluation consisted of written feedbackfrom the participants and critiques by the cofacilitators.

Participants Evaluation

At the end of the sessions, participants were given awritten evaluation tool consisting of open-ended questionsand forced-choice Likert-type items. This scale was adaptedfrom one used to evaluate other support groups.20–24 Theevaluations ascertained feelings about attendance, the valueof the activities, and the presence of therapeutic groupfactors (Table 1).

The major themes from the open-ended responses in-cluded decreasing isolation, expressing feelings, gainingnew perspectives, and improving current and future cop-ing. Examples of comments that show the benefit of de-creasing isolation and increasing support include the fol-lowing: “Being involved in the creative process helped melook at things from a different, broader perspective.” “Thestrong support interaction was not anticipated and the ca-maraderie that developed through the time spent sharingeach others’ experiences, offering suggestions, and devel-oping new friendships was invaluable.” “It is a wonderfulfeeling to know that I am not alone.”

Participation in the HI offered an alternative means toexpression and a validation of intense emotions. Examples

Figure 1 Example of a completed art piece created by aparticipant—a nurse who has cancer—in the HI program (shown inblack and white).

Table 1. Means Scores* from RepresentativeEvaluation of One Program (N = 6)†

Item Mean

I think this group would be useful to other patientswith cancer. 5.0

I liked the sharing with other patients with cancer. 4.8I would attend another group similar to this one. 5.0I received support from the other patients. 3.83The art helped me understand my inner self better. 4.5It was good to learn from other patients about

their feelings. 4.5The art helped me find a way to heal my inner spirit. 4.5

*Scores range from Strongly agree (5) to Strongly disagree (1).†Directions: Using the scale below, circle the response that best describes what

you think about the group: (SA) Strongly agree (A) Agree (U) Undecided (D)Disagree (SD) Strongly disagree


of participants’ comments included: “My feelings and ideaswere validated, and as I kept developing the icon, I felt likeI was pulling things from deep within”; “I found anger thatI didn’t realize was there, and I understand more about thefear I have had and what to do about it”.

A third therapeutic theme derived from the evaluationsrelated to patients obtaining a different perspective on theirexperience. Comments included: “I have a feeling of well-being, a sense of peace, now that I can deal with thingsmore openly”; “It’s okay not to be perfect . . . sometimes it’seven better not to be”; and “I have learned to trust my innervoice, and I’m even becoming spontaneous again.”

A final theme to the evaluations was improved copingfor the present and the future. Comments included: “Thisprogram helped me focus on my healing and what is im-portant to me”; “I had not allowed time for myself to play;this group gave me permission to find the time”; and “Myicon is a representation of my healing place.”

Program Facilitator Evaluation

The evolution of this program has occurred throughthe program facilitators’ evaluation of the program, eachfrom her area of expertise and from the working partner-ship that has developed. Each facilitator appreciates andvalues the contributions and perspectives of the other.Blending these perspectives has required extensive pro-cessing and evaluation after each session and at the comple-tion of a program. The cofacilitators critiqued the format,information, and logistical issues of the program, and re-viewed the evaluations of the participants. Based on theseevaluations, several activities were modified. For example, amajor modification was to omit traditional closure/evaluation at the end of each session and start the nextgroup as a termination of the previous one. This changeallowed participants to conclude studio time at their ownpace and focused the opening of the next session onhomework.

Clinical Implications

HI represents a new but growing interest in both thehealthcare and the artistic community. This change is pro-pelled by the consumer self-help movement and greaterawareness of the need for adjuncts to traditional medicaland psychological healing. HI demonstrates a success-ful partnership between a professional artist and nursepsychotherapist.

The benefits of the program derive from the therapeu-tic factors present in a traditional support group blendedwith the creative process. The facilitators learned severallessons that may be of interest to other clinicians and artistswho want to begin a similar program. The level of anxietyseemed to be much less than that of a traditional supportgroup, perhaps decreased by the focus on task. Therefore,members bonded quickly and self-disclosed more readily.Using creativity to help access underlying feelings andthoughts also enhanced group sharing. However, if the pro-

cess of the group is not monitored carefully, patients maydisclose too soon or too much. Also, the group may magnifypersonality problems because of the increased openness inthe group; therefore, participants may be more stronglyaffected. This kind of program opens new avenues for ex-pressing feelings and thoughts but should be structured insuch a way that group processes are not allowed to nega-tively impact participants. Another consideration is that thegroup provides an environment for individuals to addressfeelings and problems they may have suppressed. There-fore, unresolved psychological issues may emerge, and thefacilitators need a plan for how to handle these.

For example, four participants realized that the unre-solved grief of a relative’s death from cancer was blockingtheir ability to deal with their own diagnosis. The sharing oftheir cancer stories, through personal icons, built for theseparticipants a caring and understanding community. Thissupport gave them energy to better manage the stress oftheir disease. Therefore, special populations of patients,such as women with cancer, may especially benefit fromthis type of program.

Healthcare professionals interested in collaboratingwith artists on similar programs for cancer patients may findmany avenues for bringing the healing arts into cancer care.Artists who are interested might be identified by contactinglocal art councils, art schools, and artists’ guilds. Brain-storming sessions with artists would help to capitalize onthe expertise of artists within the community. Initiating apilot project will help gauge patient interest and will pro-vide valuable feedback from the healthcare team. Researchis needed to validate the clinical outcomes derived from thisprogram. Investigators need to determine the effect of thiskind of program on quality of life and mood states. Empiri-cal findings would greatly enhance the clinical evaluations.

Acknowledgment

Appreciation is expressed to Jane Zinger, School ofEducation, University of South Carolina.

References

1. Rogers F. From inkblots to art therapy. PA Med. 1990;93:16-17.2. Schikler K, Turner-Schikler L. Expressive therapy in pediatric

and adolescent gynecology. Obstet Gynecol Clin North Am.1992;19:151–161.

3. Miles MFR. Art in hospitals: does it work? A survey of evalua-tion of arts projects in the NHS. J R Soc Med. 1994;37:161–163.

4. Breslow D. Creative arts for hospitals: the UCLA experiment.Patient Educ Couns. 1993;21:101–110.

5. Graham-Pole J, Lane M, Kitakis ML, Stacpoole L. Creating anarts program in an academic medical setting. IJAM. 1994;3:17–25.

6. Lane M, Graham-Pole J. Development of an art program on abone marrow transplant unit. Cancer Nurs. 1994;17:185–192.

7. Breitbart W. Identifying patients at risk for, and treatment ofmajor psychiatric complications of cancer. Support Care Can-cer. 1995;3:45–60.

8. Heiney SP, Dunaway NC, Slade M, et al. Planning and organiz-


ing a multidisciplinary psychosocial oncology service. CancerPractice. 1995;3:343–350.

9. Spiegel D. Health caring: psychosocial support for patientswith cancer. Cancer. 1994;74(suppl):1453–1457.

10. Yalom I. Inpatient Group Psychotherapy. New York: BasicBooks; 1983.

11. Wolfelt AD. Healing the Bereaved Child. Fort Collins, CO:Companion Press; 1996.

12. Heiney S. The healing power of story. Oncol Nurs Forum.1995;22:899–904.

13. Aftel M. The Story of Your Life: Becoming the Author of YourOwn Experience. New York: Simon & Schuster; 1996.

14. Mcniff S. Art as Medicine: Creating a Therapy of the Imagi-nation. Boston, MA: Shambhala Publications; 1992.

15. Georgia International Cultural Exchange. The Sacred Art ofRussia: From Ivan the Great to Peter the Great. Atlanta, GA:Georgia International Cultural Exchange; 1995.

16. Samuels M, Rockwood M. Creative Healing: How to HealYourself by Tapping Your Hidden Creativity. New York, NY:HarperCollins; 1998.

17. Allen PB. Art Is a Way of Knowing: A Guide to Self-

Knowledge and Spiritual Fulfillment Through Creativity.Boston, Mass: Shambhala Publications; 1995.

18. Benjamin. Behavior in Small Groups. Boston, Mass: Hough-ton Mifflin; 1978.

19. Heegaard ME. Facilitator Guide: For When Someone VerySpecial Dies. Minneapolis, Minn: Woodland Press; 1988.

20. Heiney S, Ruffin J, Ettinger R, Ettinger S. The effects of grouptherapy on adolescents with cancer. JAPON. 1988;5:20–24.

21. Heiney S, Wells L, Cannon B, Ettinger R, Ettinger S. Effects ofgroup therapy on parents of children with cancer. JOPON.1989;6:63–69.

22. Heiney S, Goon-Johnson K, Ettinger R, Ettinger S. Effects ofgroup therapy on siblings of pediatric oncology patients. JO-PON. 1990;7:95–100.

23. Heiney S, Wells W, Gunn G. Effects of group therapy on be-reaved extended family of children with cancer. JOPON. 1993;10:99–104.

24. Heiney S, Goon-Johnson K, Ruffin J. The effects of a supportgroup on selected psychosocial outcomes of bereaved parentswhose child died from cancer. JOPON. 1995;12:51–58.


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