Art Therapy for Chinese Canadian Breast Cancer Survivors in Toronto

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*Corresponding author: Email: tsylee@yorku.ca;
Journal of Scientific Research & Reports
4(5): 421-429, 2015; Article no.JSRR.2015.044
ISSN: 2320-0227
SCIENCEDOMAIN international
www.sciencedomain.org
Art Therapy for Chinese Canadian Breast Cancer
Survivors in Toronto
Tsorng-Yeh Lee
1*
, Gail Joyce Mitchell
1
, Jen-Jiuan Liaw
2
, Grace Ho
3
,
Terry Cheng
4
, Patricia Ki
5
and Winnie Wong
6
1
School of Nursing, York University, HNES Building, 4700 Keele St. Toronto, ON M3J 1P3, Canada.
2
School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist.,
Taipei City 114, Taiwan.
3
South Riverdale Community Health Centre, 955 Queen St. East, Toronto, ON M4M 3P3, Canada.
4
Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Center, University Health
Network, 610 University Ave, Toronto, ON M5G 2M9, Canada.
5
School of Social Work, York University, 4700 Keele St. Toronto, ON M3J 1P3, Canada.
6
University Health Network, 399 Bathurst St. Toronto, ON M5T 2S8, Canada.
Authors’ contributions
This work was carried out in collaboration between all authors. Authors TYL, GJM, GH and TC
designed the study and wrote the protocol. Authors TYL, GH, PK and WW collected the data. Authors
TYL, JJL and GH analyzed the data. Author TYL wrote the first draft of the manuscript. All authors
read and approved the final manuscript.
Article Information
DOI: 10.9734/JSRR/2015/13946
Editor(s):
(1)
Arun Kumar Nalla, Department of Cancer Biology and Pharmacology University of Illinois College of Medicine, USA.
Reviewers:
(1)
Anonymous, Università degli studi del Molise via De Sanctis snc, Italy.
(2)
Anonymous, Unidad de Investigación Médica en Genética Humana. IMSS, Mexico.
(3)
Anonymous, Gulhane Military Medical Academy, Turkey.
Complete Peer review History:
http://www.sciencedomain.org/review-history.php?iid=744&id=22&aid=6689
Received 11
th
September 2014
Accepted 14
th
October 2014
Published 24
th
October 2014
ABSTRACT
Aims:
The major purpose of this study was to evaluate the feasibility and efficacy of an art therapy
support group program for Chinese Canadian breast cancer survivors. The sub-purpose was to
understand the experiences of Chinese breast cancer survivors during and after the arts-based
intervention.
Study Design: A qualitative design was used in this study.
Place and Duration of Study: The study was conducted at an urban community health centre in
Toronto, Canada between February 2014 and June 2014.
Original Research Article

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422
Methodology:
A convenience sample of 12 Chinese women were recruited to participate in six 3-
hour monthly art therapy workshops at the urban community health centre. Focus group interview
was used in this study. The interviews were audio tape-recorded and transcribed verbatim.
Krueger’s framework of analysis guided the data analysis.
Results: Five themes were emerged from the data: a) an aesthetic means to explore personal
inner world, b) a vehicle to share and communicate life experience with others, c) a reflection to
make a constructive or positive change in one’s life, d) regaining a sense of empowerment and
control, and e) looking forward to a much brighter future.
Conclusion: This study suggests that breast cancer survivors may benefit from participating in art
therapy workshops. Chinese Canadians with breast cancer seem to find passion and pleasure in
making art. The findings suggest that art therapy is a useful avenue to address psychosocial
challenges posed by breast cancer and can enhance non-verbal expression of personal feeling.
The finding also suggests that a culturally and linguistically friendly art therapy program is more
appropriate for Chinese immigrants who suffered from emotional distress.
Keywords: Breast cancer; art therapy; focus group; Chinese women.
1. INTRODUCTION
Art therapy is a form of psychotherapy which
includes a therapeutic use of art making by
people who experience illness, trauma or
challenges in living, and by people who seek
personal development [1]. Art therapy has been
used as a significant support tool for people with
all kinds of diseases, including cancer [2-4]. It is
an effective psychosocial tool to cancer patients
at different stages in the course of their illness,
especially during isolation for bone marrow
transplantation [5,6], during radiotherapy
treatment [7], and after treatment [8,9]. Evidence
suggests that art therapy can increase self-
esteem, gain a sense of control, reduce stress
and anxiety, enhance cognitive functioning, and
improve a person’s quality of life by becoming
more expressive and livelier through creating art
and reflecting on the art products and
psychological and emotional processes [10-12].
To date, art therapy has been used worldwide;
however, its effect on immigrant women with
breast cancer has not been wildly explored
[13-16]. Breast cancer is the second leading
cause of cancer death among Canadian women
[17]. In 2014, approximate 24, 400 Canadian
women will be diagnosed with breast cancer and
5,000 will die from it [18]. Ethnic women are a
high-risk group for developing cancer in Canada
[19]. Cancer treatments are a very stressful and
traumatic experience to cancer patients. High
psychosocial distress among ethnic women is
well documented in the literature [20]. It is very
important for healthcare professionals to provide
an effective complementary therapy to ease
patients’ emotional stress and pain [20,21].
Art therapy has been used by Western breast
cancer patients, demonstrating positive effect in
improving their physical and psychosocial well-
being [15,22]. Yet, little research has been
conducted on Chinese immigrant women with
breast cancer in Canada. Chinese is one of the
fastest-growing immigrant groups in Canada.
Cultural studies have shown that Chinese
women do not generally participate in
mainstream support group or workshops due to
language barrier and cultural differences [20,23].
Art therapy, as psychosocial intervention, can be
a powerful non-verbal means to communicate
and to explore personal and family challenges
posed by cancer, especially for non-English
speaking Chinese population. Engaging in art
appreciation and creating artwork would allow
survivors’ individual life narrative unfolds in a
meaningful way and to lessen their emotional
pain, anxiety and depression as well as increase
adaptation, personal growth, and coping.
Therefore, the major purpose of this study was to
evaluate the feasibility and efficacy of an art
therapy support group program for Chinese
Canadian breast cancer survivors. The sub-
purpose was to understand the experiences of
Chinese breast cancer survivors during and after
the arts-based intervention. Specifically, the
study sought to answer the following question:
What experiences are described by Chinese
breast cancer survivors during and after the arts-
based intervention?
2. METHODOLOGY
To answer the research question, a qualitative
research design and focus group interview were
used in this study. The major purpose of using
focus group interviews was to “understand, and

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423
explain the meanings, beliefs and cultures that
influence the feelings, attitudes and behaviours
of individual participant” [24].
2.1 Recruitment and Sample
A convenience sample of 12 Chinese women
were recruited to participate in six 3-hour monthly
art therapy workshops at an urban community
health centre in Toronto, Canada. Institutional
ethics approval was received from York
University, Toronto. Eligible participants were
selected based on the following selection criteria:
a) had a diagnosis of breast cancer; b) were able
to read or speak Mandarin; c) were over the age
of 18 and d) were willing to attend six workshops.
Potential participants were identified, contacted
and invited by an outreach worker at the
community health centre and a member of the
research team, to attend the workshops.
Recruitment flyers were also emailed to potential
participants by the outreach worker with her
contact information. Interested participants
contacted the worker who explained the study
and invited them to attend the workshops.
Consent form was signed at the first workshop
allowing their artwork to be photographed and
their sharing experiences on the process of art
making and the focus group discussions to be
taped.
2.2 Data Collection
Four of the research team members were
involved in the delivery of the workshops. All of
them are Chinese and are fluent in Mandarin and
Cantonese. Together, they have extensive health
experience working with Chinese people with
various illnesses. The art therapy workshops
were led by an experienced art therapist, who
has conducted a variety of art therapies with
different patient populations. The first and fourth
authors have experience in conducing focus
group interviews and serve as group facilitators
facilitating the group discussions. The last author
is a health coach and assisted with observational
note-taking during the workshops and focus
group interviews. The interviews were audio
tape-recorded and transcribed verbatim by the
last author. The questions asked during the focus
group interviews included: “Could you please
share with the group your experience of
participating in art-therapy workshops?”, “How do
you feel about the changes that art had played to
your thinking/feelings/philosophies of life in
general compare to before, If any?” and “What it
was like to express your experiences
artistically?” Probing questions, such as “Can
you tell the group more?” and “What do you
mean?” were used. An honorarium of $20 was
given to each participant in appreciation for her
participation in this study.
2.3 Structure of the Art Therapy
Workshop
Each art therapy session followed a protocol
designed by the art therapist. The contents were
designed to reflect Chinese beliefs and norms. A
topic was assigned for each session to allow
exploration of meaning of breast cancer and its
impact on life. The topics of the six sessions
were as follows: Session one: Introduction and
description of the purpose of art therapy, Session
two: Fan of Life, Session three: Flowing with
Change, Session four: Facing Imperfection,
Session five: Sharing stories, and Session six: A
Group Mural. Each session would start and end
with a 5-minute breathing exercise. After the
breathing exercise, the art therapist would begin
the workshop by introducing the assigned theme
of the workshop and inviting the participants to
select any available art materials (e.g. chalk
pastels, markers, coloured pencils, and
watercolour paints) as they wish. Participants
were asked to draw by using the selected art
materials on a piece of drawing paper, noticing
the various effects and textures that different art
materials made. The art therapist would spend
the next 2 hours guiding them to draw a
particular picture (e.g. a fan) geared to the theme
of the workshop (e.g. Fan of Life). For the
remaining hour, the group facilitators would invite
the participants to share their experiences,
thoughts and emotions during the exercise of art-
making.
2.4 Data Analysis
Krueger’s framework of analysis guided the data
analysis. Krueger’s framework has been used for
individual and focus group interviews, which
provides a series of clear steps in managing the
large amount and complex nature of qualitative
data [24]. The five key steps are: familiarization,
identifying a thematic framework, indexing,
charting, mapping and interpretation [25]. Data
were analyzed by the first, third, and fourth
authors. The three authors individually read all
the transcripts and the observational notes
several times to immerse in the details of the
participants’ experience and get a sense of the
whole [24]. During this process, major themes
began to emerge. The three authors worked

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424
together to identify a thematic framework and
develop descriptive statements. The next step is
to manage the data which includes indexing and
charting. Through continually comparing and
contrasting, the data were reduced and similar
quotes were cut and pasted together under the
emerging themes. The final step is to map and
interpret the data. The three authors identified
the relationship between quotes and the links
between the data as a whole [24,25]. Five
themes were identified. A theme was not
accepted until three authors reached consensus.
Member check was used to ensure the rigor of
the analysis. An audit trail was formed for
confirming the findings.
3. RESULTS
This study was conducted from February 2014 to
June 2014. The mean age of the sample was
59.2. Eight Chinese women were born in
mainland China and four were born in Hong
Kong. Majority of Chinese women were married
(8/12). All of them were homemakers. Seven
women had completed high school and five had
completed college/university. Half of the
participants reported having a religious or faith
belief including Buddhists, Christians, and
Taoists. Regarding their stage of breast cancer
when diagnosed, six were at stage 1, three were
at stage 2, and three were at stage 4. The
average length of living with breast cancer was 7
years, ranging from one year to 13 years. The
average length of being in Canada was ten years.
The results presented do not intend to interpret
the meanings of individual art product, but rather
to focus on the experience of the participants
sharing during the focus group interviews. The
five themes that emerged from the data were: a)
an aesthetic means to explore personal inner
world, b) a vehicle to share and communicate life
experience with others, c) a reflection to make a
constructive or positive change in one’s life, d)
regaining a sense of empowerment and control,
and e) looking forward to a much brighter future.
3.1 An Aesthetic Means to Explore
Personal Inner world
Ten out of twelve participants stated that they
have not drawn since graduating from the
elementary school. The art therapy sessions
brought their memories back to at least fifty years
ago when they were still very young. In the
beginning of the art therapy, some of the
participants focused more on the end product of
the art work, not on the therapeutic process of
drawing. They tried to compare the current
experience with their experience back to the
elementary school. Participant 5 expressed that:
“Art therapy makes me think back my experience
with my art teacher when I was in the elementary
school.” She further explained that her teacher
often gave the students a model for painting
which she followed and copied. In the beginning,
she thought she needed previous skill or talent to
attend the workshop; however, later on, she
realized that she could benefit therapeutically
from art making by expressing her inner world
aesthetically towards a life challenge. Participant
11 also mentioned that the art therapy allowed
her to discover her art potentials and understand
herself more. Participant 7 expressed that she
had heard music therapy before, but not art
therapy. She was very surprised to find an
alternative new way she can use to express her
personal thoughts and feelings. Participant 1
believed that different colours represented
different meanings and different meanings meant
different feelings. The following statement from
participant 10 illustrated poignantly most of the
participants’ experience towards the art therapy.
Participant 10, who continued to draw at home
during the recess of art therapy sessions, stated
that “When I was very young, I loved to draw.
However, during the last 60 years I have not
done drawings at all. Now I engage drawing
again. Of course, my drawings are not good; but
the drawings represent whatever I think……It is a
way to express it.”
3.2 A Vehicle to Share and Communicate
Life Experience with Others
Art therapy also provided a vehicle to share and
communicate life experience with others.
Chinese people often are shy about expressing
their emotions. They are uneasy to express their
feelings in front of strangers, especially when
they viewed cancer as a- stigma and tabooed
disease. An art therapy workshop could offer
them a vehicle to be with other women with
breast cancer and did something interesting and
creative together. This was expressed by several
participants in this study. One of the participants
said that “I can tell my family that I am going to
an art therapy workshop instead of mentioning
cancer support group.” Most of (9/12) the
participants had been in some kind of breast
cancer support group before they attended the
current art therapy workshops. They felt the art
therapy provided them more opportunities to
share their challenged life experience with the

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425
group members. In addition to verbal
communication, they could use art works to let
other members in the group understand their
current feelings. For example, after participant 5
expressed her personal story and experience by
using a painting of hers to the group members,
participant 6 commented that “I didn’t know you
(participant 5) have such feeling, it seems you
were so happy all the time, I can see your
difficulties now after you used drawing to express
what you have in your mind.” Participants
enjoyed the sharing moment of doing art therapy.
They enjoyed not only their own art-making but
also praised others’ art skill and products. They
would observe what other participants were
drawing and made a comment on it. By
concentrating on art-making, they distracted
each other’s attention from talking “cancer” to
sharing mutual interests on art.
3.3 A Reflection to Make a Constructive
or Positive Change in One’s Life
Participants believed art work also reflected their
personality and emotional state. In the beginning
of first session, participant 5 was eager to learn
the techniques of a perfect drawing. She brought
a lot of art books to the workshop and hope the
art therapist could teach her how to make a
perfect picture or image; however, later on she
realized making a perfect painting was not the
purpose of the workshop, sharing was the goal.
She expressed that “the art work reflect my
personality. I always want things to be perfect, so
I check all of my collections to try to find some
excellent books and brought them with me to the
workshop. I want to draw a perfect chicken
image, but now I know the workshop is not for us
to learn how to draw…..Perfectionism makes my
life stressful!” She voiced that she was fully
aware that she will not be able to resume to her
previous health state, making art made her
realized the imperfection in her life; and how she
could use it to transform her life. Participant 6
expressed that she was very surprised to learn
her cancer diagnosis. She needed to take
sleeping pills to help her to deal with insomnia;
while participant 12, who was recently diagnosed
with breast cancer, described that she had
wanted to commit suicide after the diagnosis.
She felt despair and stressful. Both of them used
green colour on their paintings at session two
when they were instructed to draw their
difficulties and challenges on both sides of a fan.
Participant 6 explained that “green leaves
represent life.” and believed that her life would
improve, be more prosperous, and be healthier
thereafter. Participant 12 expressed that green
colour symbolized peace. Whenever she felt
frustrated, she would look at green trees and
grass to calm her down. Participant 10 drew an
image of “cancer devil” (Fig. 1) at session two
and expressed that she had drawn lots of devil
images at home because she was so angry at
cancer; however, after three sessions of art
therapy, she decided that she needed to get rid
of the “cancer devil” and make a positive change
in her life by saying that “When you have a
positive thinking, the body will release
substances to kill cancer. I should let go of the
devil.” She drew two birds flying on the sky and a
sunflower on the ground at sessions four and a
red flower with several birds on the leaves of the
flower at session five. She explained that art
therapy serves as a useful vehicle to let her shift
her focus from thinking of and hating the devil of
cancer to see the beauty of life and how she can
make a change in her life.
Fig. 1. Cancer devil
3.4 Regaining a Sense of Empowerment
and Control
Most participants felt that art therapy could be a
powerful motivational tool because it helped
them to be in control of their feeling towards
cancer and to bring about a sense of self-created
activities through art making. Participant 8
expressed that she used to be lonely and sad by
pointing out her painting of a maple tree without

leaves. She explained that although it was a
beautiful autumn scene, there was no hope. Next,
she pointed out a painting with a spring scene
and explained that spring is coming
her regain a sense of empowerment and control
of her life because she did not care about others
before the cancer diagnosis. She believed the
cancer journey was a major learning experience
to her. She can now pass her experience and
love to ot
hers. Participant 10, having difficulty
with her leg due to lymph edema, expressed that
she felt a lot more of relief as a whole person
after art therapy. Since 2014 is the year of Horse
in the Chinese Zodiac Signs, she drew a head of
a horse in session fo
ur and said that
would be able to walk again like a horse and
succeed in overcoming my disease.”
feel depressed from the moment she woke upin
the morning; however, art therapy made her not
so depressed. She regained confidence and fel
she could control over her disease. She viewed
drawing as “a big inspiration” to her.
3.5
Looking Forward to a Much Brighter
Future
Most of the participants had lived with breast
cancer for many years, so they could compare
their current feelings with
previous emotional
history. Participant 4 expressed that making art
opened an unexpected door for her. She
described when she was first diagnosed; she felt
the sky was dark and the world was falling down;
however, with her current health condition being
s
table, she felt hope has returned and that she
could see sunshine again. She further expressed
her present feeling by using a famous Chinese
saying “
The storm subsides and the sky clears.”
She said that she could see hope in her life and
look forward to le
arning more art in the future.
Participants were instructed to pick two colours
they disliked and two colours they liked to draw a
painting at session three. Participant 11 shared
her feeling afterwards by saying that
used the colour that we disl
iked, it seems like a
non-
desirable life situation in front of us; such as
getting sick. However, after you used the colour
you dislike, it actually gave you unexpected
surprise. It actually didn’t look too bad; in fact, it
was quite beautiful. So don’t be
unexpected challenges in life in the future. The
better awaits you after the challenge.”
2 echoed and expressed that
“Before making
today’s art work, I was wondering the meaning
behind it but now I can see the connection.
Dislike
d colours symbolized disliked life events.
We can’t change it but the result might be good. I
Lee et al.; JSRR, 4(5): 421-429, 2015
; Article no.
426
leaves. She explained that although it was a
beautiful autumn scene, there was no hope. Next,
she pointed out a painting with a spring scene
and explained that spring is coming
, which made
her regain a sense of empowerment and control
of her life because she did not care about others
before the cancer diagnosis. She believed the
cancer journey was a major learning experience
to her. She can now pass her experience and
hers. Participant 10, having difficulty
with her leg due to lymph edema, expressed that
she felt a lot more of relief as a whole person
after art therapy. Since 2014 is the year of Horse
in the Chinese Zodiac Signs, she drew a head of
ur and said that
“I wish I
would be able to walk again like a horse and
succeed in overcoming my disease.”
She used to
feel depressed from the moment she woke upin
the morning; however, art therapy made her not
so depressed. She regained confidence and fel
t
she could control over her disease. She viewed
drawing as “a big inspiration” to her.
Looking Forward to a Much Brighter
Most of the participants had lived with breast
cancer for many years, so they could compare
previous emotional
history. Participant 4 expressed that making art
opened an unexpected door for her. She
described when she was first diagnosed; she felt
the sky was dark and the world was falling down;
however, with her current health condition being
table, she felt hope has returned and that she
could see sunshine again. She further expressed
her present feeling by using a famous Chinese
The storm subsides and the sky clears.”
She said that she could see hope in her life and
arning more art in the future.
Participants were instructed to pick two colours
they disliked and two colours they liked to draw a
painting at session three. Participant 11 shared
her feeling afterwards by saying that
“…When we
iked, it seems like a
desirable life situation in front of us; such as
getting sick. However, after you used the colour
you dislike, it actually gave you unexpected
surprise. It actually didn’t look too bad; in fact, it
afraid of the
unexpected challenges in life in the future. The
better awaits you after the challenge.”
Participant
“Before making
today’s art work, I was wondering the meaning
behind it but now I can see the connection.
d colours symbolized disliked life events.
We can’t change it but the result might be good. I
am very happy now and have a positive attitude
towards future challenges.”
Most of the
participants agreed with the above mentioned
opinions. They realized that t
here could be
unexpected results from their cancer trajectory of
treatment. The most important thing is the right
attitude. They needed to flow along what life
brings them and then act accordingly. There is
always a method or way to deal with the
unexpecte
d situations. Be fearless and looking
forward to challenging the unknown are the best
attitude they should have. At the last session, a
group mural was created and named as “The
light of life (Fig.
2)”. Participants said that what
they painted represented
what reminded them of
life and keep them hopeful. One person said that
the art therapy group is different because in other
cancer support groups people talk a lot about
difficulties and sadness, which lowers her energy
level, but in this group people talk
they like to do and things that make them happy,
and they laugh a lot, which makes her feel more
hopeful about life.
Fig. 2. The light of life
4. DISCUSSION
To the best of our knowledge, this study was the
first study using art therapy workshops on
Chinese immigrant breast cancer survivors in
Toronto, Canada. The results of this study
demonstrated that art therapy provided Chinese
breast cancer survivors an ef
fective way to
verbalize and express their experiences, feelings,
and thought metaphorically and aesthetically.
This echoes the findings of several studies
[15,20-
22] that a primary aim for art
psychosocial support services is to enhance
em
otional expression. Collie and colleagues [15]
interviewed 17 women with breast cancer in
Canada and the USA used art therapy and art
; Article no.
JSRR.2015.044
am very happy now and have a positive attitude
Most of the
participants agreed with the above mentioned
here could be
unexpected results from their cancer trajectory of
treatment. The most important thing is the right
attitude. They needed to flow along what life
brings them and then act accordingly. There is
always a method or way to deal with the
d situations. Be fearless and looking
forward to challenging the unknown are the best
attitude they should have. At the last session, a
group mural was created and named as “The
2)”. Participants said that what
what reminded them of
life and keep them hopeful. One person said that
the art therapy group is different because in other
cancer support groups people talk a lot about
difficulties and sadness, which lowers her energy
level, but in this group people talk
about things
they like to do and things that make them happy,
and they laugh a lot, which makes her feel more
Fig. 2. The light of life
To the best of our knowledge, this study was the
first study using art therapy workshops on
Chinese immigrant breast cancer survivors in
Toronto, Canada. The results of this study
demonstrated that art therapy provided Chinese
fective way to
verbalize and express their experiences, feelings,
and thought metaphorically and aesthetically.
This echoes the findings of several studies
22] that a primary aim for art
-based
psychosocial support services is to enhance
otional expression. Collie and colleagues [15]
interviewed 17 women with breast cancer in
Canada and the USA used art therapy and art

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427
making and revealed that art therapy could
promote emotional expression and gain access
to unexpected feelings. Reynolds and Prior [22]
explored two women with breast cancer taking
up art as a leisure activity and found that art
making was a meaningful activity for cancer
patients. This activity helped them to block out
negative thoughts and feelings.
This study also highlights the importance of
providing a culturally and linguistically
environment to meet the psychosocial needs of
non-English speaking women. Overcoming the
language barrier that often exists in mainstream
cancer support groups in Canada, the
participants in our study were able to express
their experiences and feelings easily and
meaningfully. Furthermore, art therapy allowed
them to integrate Chinese cultural beliefs and
norms into their art products, such as drawing a
horse image to represent “success”. In Chinese
culture, horse is not only a symbol of traveling,
but also a sign of speedy success. Therefore, the
meaning of the horse image can easily be
understood by other group members without
further explanations, which might not be possible
by a non-Chinese support group.
Our second theme was that art therapy could be
a vehicle for cancer patients to share and
communicate life experience with others. This
theme is consistent with the findings from
previous researches [3,20]. Collie and Kante [20]
interviewed 13 women with breast cancer from
ethnic minorities, including Chinese population.
They asked those women’s opinion on the value
of art group for overcoming barriers, such as
language barrier. Women in their study stated
that offering meaningful activities to cancer
patients is very important because they are not
just coming to discuss their cancer but also to be
able to do something constructive along with that.
In addition, they think art group would allow
women to share their expertise and talent with
each other. As a breast cancer patient herself,
Stein [3] reported that art therapy facilitated
communication of her experience to others. She
explained that art was a way to represent bodily
experiences that could not easily be put into
words.
Through using the creative process of art making,
participants in our study could reflect their cancer
experiences and make a constructive or positive
change in their life. The effect of reflection on art
therapy has been mentioned in several cancer
studies [10-12,15]. For example, Collie et al. [15]
reported that art was described as a mirror that
reflected the participants’ experiences back to
them and sometimes participants could benefit
from art therapy and art making to get a better
perspective. Art therapy allowed our participants
to reflect on what happened in their life,
especially their cancer treatment experiences
and their fear of cancer. They explored and
externalized their inner world by drawing,
released those feelings, and finally made a
constructive or positive change to deal with all
those feelings. By doing this, they regained a
sense of empowerment and control over their
illness at the end of the art-based workshops.
Collie and Kante [20] mentioned that art making
is particular important for women with breast
cancer because they used art to empower
themselves and raise awareness about breast
cancer issues. Empowerment or enlightenment
was also discovered by other researchers.
Buday’s study on hospice patients [14] revealed
that art therapy can sublimate those patients’
inner and outer uncertainty into art making,
empowering patients to make decisions, and to
confront challenges in their life. Furthermore, the
enjoyment of feeling their creativity through art
making has therapeutic effects on cancer
patients [15].
Studies done by Forzoni et al. [8] and Lin et al.
[13] indicated that a great amount of patients
perceived art therapy as helpful and many of
them continued to paint after the first experience.
Lin et al. [13] mentioned that many Chinese
cancer patients expressed esthetic experience
more specifically and become more motived after
art therapy. This finding is in accordance with the
result of our study. In our study, most of the
survivors (8/12) participated in the six art therapy
workshops within a period of five months. Some
of them drew or painted at home during the
recess of workshops. They expressed that they
would continue to draw even after finishing
participating in the workshops because they
found drawing is interesting and they could enjoy
themselves while painting. Besides, making art
distracted them from fear and discomfort as
Reynolds and Prior discovered in their study [22].
A case study done by Safrai [2] found out that art
therapy can be a powerful means to establish a
therapeutic relationship between the participants
and the therapist, as evident in our study. We
also found that our participants wanted to
connect with other group members by showing
their art works to each other. Through creating
and sharing their art to others, participants found

Lee et al.; JSRR, 4(5): 421-429, 2015; Article no.JSRR.2015.044
428
a way to build up supportive relationships, which
in turn enabled them to gain confidence and a
sense of hope [11,21].
Similar to Lin et al.’s [13] study, many of our
participants’ art works were about nature, such
as sun, storm, light, trees or flowers. Keeping in
touch with nature is a way for Chinese people to
achieve harmony and peace. Participants in our
study not only drew nature images to help them
relieve anxiety, but also drew opposite nature
images to represent their feelings transforming
from being sad or hopeless to happy or hopeful.
For example, in the beginning, the drawing of a
tree without leaves represented life with no hope
and towards the end, a tree with full of leaves
represented life with full of hope. And, finally, the
group mural- “The light of life” indicated that
participants were hoping that they would have a
much brighter future afterwards.
5. CONCLUSION
This study suggests that breast cancer survivors
may benefit from participating in art therapy
workshops. Chinese women with breast cancer
seemed to find passion and pleasure in making
art. The findings suggest that art therapy is a
useful avenue to address psychosocial
challenges posed by breast cancer and can
enhance non-verbal expression of personal
feeling. The finding also suggests that a culturally
and linguistically friendly art therapy program is
more appropriate for Chinese immigrants who
suffered fromemotional distress. To replicate and
extend the current finding with a larger sample of
breast cancer patients is recommended for future
studies.
CONSENT
Consent form was signed at the first workshop
allowing their artwork to be photographed and
their sharing experiences on the process of art
making and the focus group discussions taped.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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