Cancer Treatment Centers of America

Creative play: Helping children cope with cancer

Author: Bridget McCrea

When Jenni Rogers walks into a room of children and teenagers whose family members are managing cancer, the certified child life specialist at Cancer Treatment Centers of America® (CTCA) in Goodyear, Arizona, knows she has to break the ice quickly and efficiently. “Kids can be fearful in any new environment,” Rogers says. “It can be hard for them to know who to trust, and this can be especially true when a loved one is coping with cancer.”

To help build a connection, Rogers brings along a few “splat eggs.” Upon entering the room, she will hand an egg to one of the teenagers and say, “Go ahead, throw it at the floor.” Confused but interested in the outcome, the teen throws the egg (fake but meant to look like the real deal) at the floor and watches as it splats completely flat and then, laughing, watches as it quickly regains its shape.

“Encouraging kids to be kids gets them smiling and comfortable pretty quickly and helps establish that this is a safe environment where they can express themselves freely,” says Rogers, who works frequently with children and teens whose families are dealing with cancer in the Parenting Through Cancer program at CTCA®. “Through therapeutic play, children learn how to cope with stressful experiences, gain understanding of medical equipment and express their feelings in a nonthreatening way.”

The power of play

According to the Association for Play Therapy (a4pt.org), “Play therapy is a way of being with the child that honors their unique developmental level and looks for ways of helping in the ‘language’ of the child—play.” Play therapy can be used as a supportive therapy to help kids work through a range of emotional issues, including fear, anger, confusion and grief, that may be associated with a loved one’s cancer diagnosis.

As she interacts with kids, Rogers uses familiar toys, art supplies and games to engage them and help them share their feelings and work through their experiences. Recently, while talking with a teenage boy, she inquired about the barriers between him and his father, who had been diagnosed with cancer. “I’m afraid,” “I don’t want him to worry about me” and “I’ve been reading about cancer on the Internet and learned that this type of cancer is really bad” were just some of the worry points that the teenager shared.

As the boy talked, Rogers began stacking up “stress bricks,” which she uses to represent feelings, or worry points, that can stack up when a parent or child chooses to avoid talking about the cancer—each representing a single barrier. After a short conversation, the teenager saw that the bricks were piling up to create a wall between him and his father. “Oh, now I see why I can’t talk to my dad right now,” he acknowledged.

Rogers says that this simple form of creative expression can help teens open up and facilitate better conversations within families. “Many times this is the first step in working through communication issues and getting through to children during what otherwise would be a difficult time for them,” she says.

Rogers says the use of this type of play to cope with cancer started in children’s facilities, such as children’s hospitals, where young patients were managing their own illnesses. “It’s there that we began to see the benefit of art and play and its importance to kids,” she says. More recently, the same approach is increasingly being taken to help the children of adult patients cope with the experience. “Cancer impacts more than just the patient,” Rogers notes. “It affects the whole family.”

Fear masks

Rogers says creative play helps kids and teens begin identifying and expressing the feelings associated with what is going on in their lives from a “safe distance.” She notes, “Most children don’t readily respond to adults asking direct questions about how they feel, but when we engage in play, whether through toys or games or through creating art projects together, they can express themselves without having to put those feelings into words.” Art, in particular, can be very productive in helping kids express themselves. “Kids are most comfortable when they express themselves through play—and art is an extension of that play.”

One especially successful strategy that Rogers uses when working with children and young adults involves the use of “fear masks.” Meant to represent both children’s internal feelings and the faces they show to the outside world, the masks help children and teens identify with how they cope within themselves and their environment. “By identifying these two different worlds, we can support kids in finding ways to bridge the gap between the two,” Rogers says. Kids decorate the inside of the mask to reflect their “inside” feelings (a sad expression or a tear streaming from one eye, for example) and the outside to show external feelings (a rainbow, a happy face, or other expressions of outward display).

Rogers says the masks help children of adult patients express themselves openly without having to worry about the impact that that expression will have on their parents. “Kids are aware of what their parents are going through, and they know that they don’t feel well and make frequent trips to the hospital,” says Rogers. “They don’t want to burden their parents with their own worries and concerns, and so they wind up ‘holding it together’ for their parents.” And while those brave faces often lead adults to think that their children are coping well, in fact the opposite may be true. “Just because a young child or a teen doesn’t speak up about his or her fears,” says Rogers, “doesn’t mean those apprehensions aren’t there.”

Cornstarch as a catalyst

Rogers recently worked with an eight-year- old girl whose mother was having a difficult time with her cancer treatment. At first the child could not even speak to Rogers about her mother’s condition and its impact on her. When Rogers added a little cornstarch to the equation, however, the girl began to speak freely about her own fears and concerns.

“When you mix the right amount of cornstarch and water in a bowl, the substance acts as both a liquid and a solid,” Rogers explains, noting that the cornstarch looks like a liquid in the bowl and then becomes a solid when it is touched. Fascinated, the girl grabbed a handful of the stuff, held it static in her hand, and watched it liquefy and drip back into the bowl.

“Once she got her fingers messy and was distracted by the sensory experience, it allowed her to open up and share the feelings that she was struggling with,” says Rogers, who learned that, like many kids, the child wanted to spend time with her mom, but her mom did not have the strength to play with her daughter like she used to. “By talking through these feelings, we were able to come up with some ideas of how she could play with mom in a different way that required less activity, still allowing for connection through play but modified to meet Mom’s physical needs,” Rogers says.

Steve White, LCSW, Mind-Body Therapist at CTCA in Goodyear, says that children are natural candidates for creative therapy because they thrive in playful, nurturing environments. In most cases, he says, a child life specialist would introduce the types of activities that Rogers uses—particularly if the child is exhibiting stress or not managing well the experience of his or her parent’s diagnosis.

White says that the different types of creative expression made available through play and art therapy allow kids to open up about their concerns in a nonthreatening way. “It’s quite therapeutic for children to express their fears by drawing and then talking to the therapist,” he says, adding that other creative outlets for children include writing letters and creating memory boxes.

Stepping stones

To parents, grandparents and caregivers looking to ease the emotional burden of a cancer diagnosis for young family members, Rogers recommends reminding children that it is normal to get mad or sad: “It’s okay to have emotions. What is most important is that we allow kids to feel those emotions and then help them fnd a way to express or cope with them. Anger is an emotion; it’s how you channel and express that anger that makes the difference. Instead of telling children and teenagers that they can’t be mad when their parent is sick (because for example, it isn’t happening directly to them), allow them to vent and express their anger and fears—bottling things up is never good.”

One exercise that Rogers uses to help kids express frustration in a productive way is placing a piece of blank paper at the bottom of a bucket and then giving the kids straws through which they can blow watercolor paint. When they blow through the straws, they release stress and frustration with their breath, which relaxes them—and results in a creative piece of art.

“Whether it’s blowing paint, tearing pages out of an old phone book or running up and down the stairs until they are tired, when we help kids release tension related to their emotions, oftentimes they can more easily share what they are struggling with,” Rogers says. “Then, when they have had a chance to calm down, we can help them figure out what caused their stress and how they can cope with it better next time.”

And, Rogers says, parents can help, too: “A parent can come alongside their child or teen and say, ‘Hey, I see you’re having a hard time. It’s okay to be mad/sad/frustrated. Let’s figure out together how we are going to get through today. Do you want to go for a bike ride? Call a friend and shoot hoops? Spend some time listening to music?’” By providing kids with options for dealing with their emotions in healthy ways, she says, a child will be better prepared to cope more effectively with future challenges.