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DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
Development of a Postcard Exchange Art Therapy Program: Improving the Emotional
Wellbeing and Hospitalization Experience for Pediatric Patients
Lauren A. Chapman
Department of Counseling, School Psychology, and Special Education
Edinboro University
ARTT 790: Research Project in Art Therapy
Dr. Penelope Orr
12/4/2021
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Abstract
A postcard exchange art therapy program was developed to improve the emotional wellbeing and
hospitalization experience for pediatric patients. The literature was reviewed to explore the
central themes of the pediatric patient hospitalization experience; art therapy within the medical
setting; positive psychology and positive art therapy; and mail art, art exchange, and
connectivity. The research suggests a growing need to continue to find effective ways to provide
additional emotional support to children in these difficult circumstances. By developing program
resources that combine these aspects, art therapists may offer additional support to enhance
holistic wellness and the hospitalization experience for pediatric patients.
Keywords: Art therapy, hospitalization experience, pediatric patients, positive
psychology, positive art therapy, wellness, postcard exchange
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Contents
Abstract ........................................................................................................................................... 2
Section 1: Introduction .................................................................................................................... 5
Statement of the Problem .................................................................................................... 5
Purpose of the Project ......................................................................................................... 6
Significance of the Project .................................................................................................. 6
Theoretical Framework ....................................................................................................... 6
Conclusion .......................................................................................................................... 7
Definition of Terms............................................................................................................. 8
Section II: Literature Review .......................................................................................................... 9
Pediatric Patient Experience ............................................................................................... 9
Art Therapy in the Medical Setting .................................................................................. 11
Positive Psychology and Positive Art Therapy ................................................................. 13
Mail Art, Art Exchange, and Connectivity ....................................................................... 15
Conclusion ........................................................................................................................ 17
Section III: Program Development ............................................................................................... 18
Purpose of the Project ....................................................................................................... 18
Program Overview ............................................................................................................ 19
Program Participants ......................................................................................................... 19
Curriculum Overview ....................................................................................................... 19
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Positive Emotions ................................................................................................. 19
Engagement........................................................................................................... 20
Relationships ......................................................................................................... 20
Meaning ................................................................................................................ 20
Accomplishment ................................................................................................... 21
References ..................................................................................................................................... 25
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Section 1: Introduction
Art therapy was originally established with the treatment of physical illness by Adrian
Hill, the founder of art therapy in Great Britain, who wrote about the impact painting had on his
recovery from tuberculosis. Hill later went on to write two books on his experiences and brought
artmaking to other patients with physical illnesses, setting the stage for art therapy in medical
settings (Malchiodi, 2007). Art therapy with pediatric patients presents unique challenges with
the need to resolve not only internal conflicts but also to navigate physical illness and treatment
(Councill, 1993). “The process of art making is recognized as being important to physical
healing, whether in the form of recovery or rehabilitation, learning to cope with illness or
symptoms, or finding meaning for the experience of serious or life-threatening illness”
(Malchiodi, 2007, p. 169). Additionally, hospitalization due to emergent or acute illness or
injury, or chronic illness, can cause children significant psychological distress associated with
pain, trauma, and anxiety (Styles-Turbyfill et al., 2017). The arts in healthcare movement
recognized the healing powers of artmaking for both physical and psychological distress as
artmaking provides transcendence beyond illness, pain, fear, and anxiety; the experience of
normalcy; and a sense of control and autonomy (Malchiodi, 2007).
Statement of the Problem
The challenges of pediatric hospitalization impact a significant number of children in the
United States each year. In 2016, there were over 5.5 million children under the age of 17
hospitalized for an average stay of four days (Ernst, 2020). The primary use of the medical
model approach to patient care during hospitalization focuses on the physical dimension of
wellness while other dimensions, including emotional, environmental, financial, intellectual,
occupational, social, and spiritual, may not be as well-attended. The postcard exchange art
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therapy program may contribute to the creative, emotional, social, and spiritual dimensions of
wellness to support a more holistic approach to the hospital experience. The function, role, and
contribution of a postcard exchange art therapy program to holistic care could be better
understood by examining the pediatric patient experience and implications of art therapy within
the medical setting.
Purpose of the Project
The purpose of developing a postcard exchange art therapy program was to provide an art
therapy resource that may improve the emotional wellbeing and hospitalization experience for
pediatric patients. The postcard exchange art therapy program was created to foster positive
emotions, engagement, relationships, meaning, and accomplishment/achievement.
Significance of the Project
This project was intended to develop a postcard exchange art therapy program that could
contribute additional knowledge to art therapy programming for the medical population,
identified by the American Art Therapy Association as an art therapy priority research area
(Kaiser & Deaver, 2013). It would enable the development of program resources that could be
shared with other medical art therapists for implementation in pediatric hospitals nationwide.
Finally, a postcard exchange art therapy program could provide alternative means to group
engagement and connection to others when pediatric patients are room-bound due to treatment
requiring physical isolation, limited mobility due to medical equipment requirements, or
restrictions based on hospital policies and infection control protocols.
Theoretical Framework
This program was developed through the theoretical framework of positive psychology
and positive art therapy. Positive psychology, also known as the “science of wellbeing,” formally
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founded in 2000 by Martin Seligman, is a subfield of psychology described by Hugo Alberts as
“the scientific and applied approach to uncovering people’s strengths and promoting their
positive functioning” (Ackerman, 2020, Definition 7). Positive art therapy, originally outlined in
2009 by Rebecca Wilkinson and Gioia Chilton, incorporates the principles of positive
psychology into the field of art therapy while realizing the natural complement of the two fields
to contribute to optimal functioning (Wilkinson & Chilton, 2013).
With a focus on hospitalized pediatric patients, these positive strength-based approaches
balance the challenges of the disease basis of human functioning of the medical model and
instead work to support five facets of wellbeing, known as the PERMA model: positive
emotions, engagement, relationships, meaning, and accomplishment/achievement (Seligman,
2011). This shift in focus to wellbeing through an overlap of these two related theoretical
frameworks therefore functions to support an improved hospitalization experience.
Conclusion
As a natural complement to the medical model, art therapy for pediatric patients promotes
holistic wellness and emotional wellbeing and improves the hospitalization experience. Art
therapy has the capacity to encourage interconnected emotional and physical healing (Shella,
2018). When the art is able to give a voice to a child’s emotions, quality of life is enhanced, the
immune system functions better, and the child experiences less distress and has a greater
opportunity to reflect on and find meaning within their healing journey (Rollins et al., 2012).
Through a positive psychology and positive art therapy framework that focuses on strengths and
positive functioning, the development of a postcard exchange art therapy program fostered five
components of wellbeing. These components of wellbeing included positive emotions,
engagement, relationships, meaning, and accomplishment/achievement.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
Definition of Terms
Art Therapy: Art therapy is an integrative mental health and human services profession that
enriches the lives of individuals, families, and communities through active artmaking, creative
process, applied psychological theory, and human experience within a psychotherapeutic
relationship. Art therapy facilitated by a professional art therapist effectively supports personal
and relational treatment goals as well as community concerns. Art therapy is used to improve
cognitive and sensory-motor functions, foster self-esteem and self-awareness, cultivate
emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and
distress, and advance societal and ecological change (AATA, 2017).
Dimensions of Wellness: The nine dimensions of wellness are a comprehensive and integrative
approach to wellness that is complex and interconnected including physical wellness, emotional
wellness, financial wellness, intellectual wellness, career wellness, social wellness, creative
wellness, environmental wellness, and spiritual wellness (Melnyk & Neale, 2018).
Pediatric Patients: Pediatric patients include hospitalized children, adolescents, and young
adults receiving health care for the diagnosis and treatment of acute and chronic diseases
(Committee on Pediatric Workforce, 2015).
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Section II: Literature Review
This review of the literature focused on exploring the central themes of the pediatric
patient hospitalization experience; art therapy within the medical setting; positive psychology
and positive art therapy; and mail art, art exchange, and connectivity. This review of the
literature guided the development of a postcard exchange art therapy program for pediatric
patients in the medical setting and fostered positive emotions, engagement, relationships,
meaning, and accomplishment/achievement.
Pediatric Patient Experience
For pediatric patients, being hospitalized can be compared to visiting a foreign country.
The hospital experience involves unfamiliar sights, sounds, and smells, medical terminology, and
the replacement of a child’s normal routine for that of the unpredictable and often invasive
rhythm of the treatment routine. From receiving the bad news of a new diagnosis or experiencing
an acute injury or illness, children’s lives are permanently transformed (Hall, 2019). Children
may experience identity confusion, embarrassment, frustration, anxiety, fear, helplessness,
isolation, withdrawal, and loss of autonomy and sense of control (Councill, 1993; Councill &
Ramsey, 2019). Children often go through a process of grieving their formerly healthy lives and
mourn their loss of freedom and independence (Hall, 2019).
As treatment progresses and side effects and complications intensify, children may
display extreme distress, discomfort, angry outbursts, difficulty sleeping, nightmares, increased
anxiety and depression, disturbances of body image and self-esteem, and overwhelming trauma
(Councill, 1993; Councill & Ramsey, 2019; Hall, 2019; Prager, 1995). Anxiety and fear are
linked to an increased sense of physical pain that can create a vicious cycle of emotional and
physical pain for pediatric patients (Styles-Turbyfill et al., 2017). Case examples indicate themes
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of separation anxiety, alienation, anger, aggression and fear, body-image and self-concept,
beliefs about disease and treatment, and the concept of death itself. When pediatric patients
internalize their troubling feelings, it often results in increased depression, withdrawal, selfblame, and alienation. However, sometimes such denial and withdrawal allow for the child to
conserve their emotional resources for future obstacles and complications rather than indicating
pathological depression (Councill, 1993).
Art therapy has been proven to provide a uniquely humanizing influence amidst an
experience that challenges a child’s sense of self and trust in the world (Rollins, 1990). Art
therapy can enhance quality of life in hospitalized children to promote problem solving, express
and regulate mood and feelings, increase authentic connection, and facilitate communication
with family and the health care team (Councill, 1993). Art therapy provides distraction from
pain; safety; choice and a sense of control; independence and autonomy; and means of finding
balance between processing the facts and feelings during a time of great distress. It can help
pediatric patients and their families process and integrate their difficulties, challenges, strengths,
and successes (Councill, 1993; Councill & Ramsey, 2019; Prager, 1995). “Art therapy can
provide a valuable outlet for reflection of feelings about loss and self within a supportive
environment” (Councill, 1993, p. 82). Art therapy allows for the therapeutic process of exploring
profound existential themes and questions and the search for meaning when words are too
difficult to either say or hear (Councill, 1993).
The efficacy of art therapy intervention with medically ill children is demonstrated,
especially through the following therapeutic benefits:
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1. Patients control their own choices of art materials, subject, and verbalization regarding
their artwork, enabling them to experience themselves as active creators as opposed to
victims of a disease or helpless recipients of treatment.
2. Patients maintain communication with the treatment team through art expression at
times when relationships are strained by anger, withdrawal, fatigue, and feelings that are
too emotionally charged to be said with words.
3. Patients continue the process of development through visual communication,
supporting social and mental growth and mitigating the isolation of the hospital
experience.
4. Patients rehearse troubling events and work out concepts of self in art expression,
supporting a sense of mastery over feelings about illness and treatment. (Councill, 1993,
p. 86-87)
Art Therapy in the Medical Setting
Hospitalization can be a stressful and anxiety-producing experience. Whether
hospitalized for trauma, sudden illness, planned surgical intervention, or as a readmission
for a chronic condition, a patient may experience a myriad of emotions, including but not
limited to fear, worry, confusion, and mood disruption (Bar-Sela, Atid, Danos, Gababy,
& Epelbaum, 2007; Tully et al., 2011). Comorbid issues of depression and anxiety are a
common experience for medically ill hospitalized patients (Gaus, Kiep, Holtkamp,
Burkert, & Kendel, 2015; Glinzak, 2016; Maujean, Pepping, & Kendall, 2014; Pederson,
Majumdar, Forhan, Johnson, & McAlister, 2016; Soloreli et al., 2016). (Shella, 2018, p.
59)
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The hospitalization experience is a major and often unanticipated event to happen in a
child’s life. It is a uniquely individual and subjective experience, with a lengthier stay not
necessarily equating to a more traumatic experience than a shorter one (Rollins et al., 2012;
Wajcman, 2018). In addition to other stressors in a child’s life, such as parents that are fighting
or are separated, school problems, bullying, etc., the stress associated with hospitalization adds to
that which already exists (Rollins et al., 2012), which can also worsen and be worsened by
physical pain (Angheluta & Lee, 2011). The length of hospitalization, readmission rates, and
treatment compliance have been linked to unacknowledged or poorly managed psychosocial
needs, including high levels of stress and symptoms of anxiety and depression (Carter et al.,
2016; David & Ilusorio, 1995; Pederson et al., 2016; Rollins et al., 2012; Shella, 2018). Children
are submitted to endure painful procedures and complicated treatment regimens that can leave
them feeling powerless, afraid, and confused (Rollins et al., 2012).
“Art therapy (AT) has been shown to help unaddressed psychosocial distress in
hospitalized patients and to promote better management of physical symptoms, overall wellbeing, and socialization (Angheluta & Lee, 2011; Kapitan, 2012)” (as cited in Shella, 2018, p.
59). While traditional medical care addresses one aspect of wellness, art therapy provides an
alternative and complementary piece of the wellness puzzle. Art therapy in the medical setting is
considered a complementary therapy in the treatment of medical illness because it is concerned
with the overall human experience, including psychological, emotional, and spiritual wellness
(Zammit, 2001). Complementary therapies help manage symptoms and improve overall wellbeing by working in conjunction with other treatments and supporting conventional care (Nainis,
2008). These additional therapeutic services can decrease tension, assess trauma, and create a
sense of normalcy for both patient and family (Wajcman, 2018).
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Art therapy is based on the theory that the mind and body are mutually and
bidirectionally connected and has been shown effective in dealing with symptoms of pain and
anxiety (Nainis, 2008). Research suggests that art therapy helps improve coping with the
challenges of treatment and hospitalization and improves resiliency and adaptability to stressful
and traumatic experiences (Deane et al., 2000; Favara-Scacco et al., 2001; Gabriel et al., 2001;
Mulcahey & Young, 1995; Nainis, 2008; Trauger-Querry & Hahighi, 1999). Nainis (2008) noted
that several patients expressed that artmaking gave them a sense of control and allowed them to
express their feelings without words. Shella (2018) reports results that indicate art therapy within
an inpatient hospital environment had an immediate positive impact on improving mood,
anxiety, and pain regardless of other factors such as choice of media, age, sex, or diagnosis.
The efficacy of art therapy addressing these psychosocial issues for patients could
potentially decrease length of stay and improve patient satisfaction, and may even reduce
the need for pain medications. Art therapy may be a safe and cost-effective intervention
as an adjunct to traditional medical management. (Shella, 2018, p. 63)
Positive Psychology and Positive Art Therapy
Positive psychology shifts the focus of psychology from dealing with repairing the worst
situations in life to building up the positive qualities. At the subjective level the focus is on
experiences such as wellbeing, contentment, and satisfaction for the past, hope and optimism for
the future, and optimal functioning and happiness in the present. At the individual level it is
about personal traits such as capacity for love, purpose, courage, interpersonal relationships,
perseverance, forgiveness, originality, future mindedness, spirituality, and wisdom. Finally, at
the group level it is about civic virtues and citizenship such as responsibility, nurture, altruism,
civility, moderation, tolerance, and work ethic (Seligman & Csikszentmihalyi, 2000).
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The research suggests a couple of common themes among contributions to the field of
positive psychology that are especially relevant to this project. The first is the recognition that
people exist within a social context (Buss, 2000; Larson, 2000; Massimini & Delle Fave, 2000;
Myers, 2000; Schwartz, 2000; Seligman & Csikszentmihalyi, 2000; Winner, 2000). The next are
the studied positive physical effects of cognitive optimism and resiliency, including patients
showing symptoms later and surviving longer, that indicate a direct physiological impact that
possibly slows down the course of illness (Gable & Haidt, 2005; Salovey et al., 2000; Seligman
& Csikszentmihalyi, 2000; Taylor et al., 2000).
This research has shown a clear link between positive emotional experiences and physical
health. Positive emotions serve to provide a buffering function for negative emotions and
suffering health. Specific physical and psychological health benefits that are associated
with positive emotions include immune system improvements, faster physical recovery
from injury or illness, fewer physical complaints, and longevity. (Styles-Turbyfill et al.,
2017, p. 187)
These themes speak directly to the context of this project being facilitated in the medical setting.
Positive art therapy, the intersection of positive psychology and art therapy, uses the
power of art and creativity to promote wellbeing through the healing effects of engagement, or
creative flow, the automatic and highly focused state of consciousness experienced when one is
completely present in the moment and devoted to a meaningful challenge (Csikszentmihalyi,
2008). Positive art therapy also shares themes of cultivating positive emotions, relationships,
meaning, and achievement to promote wellbeing and resiliency (Gerity, 2010; Wilkinson &
Chilton, 2013). The use of art making becomes the central aspect to engage in meaning making,
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finding purpose, and self-expression (Wilkinson & Chilton, 2013) as a means of distraction from
the distress of hospitalization and coping with acute or chronic illness.
What starts out as a fun distraction from medical problems may become an outlet for
deeper emotion. This is the point at which the art therapist’s knowledge of therapeutic
techniques and understanding of metaphor allows the patient to safely process the
complex issues that emerge. (Nainis, 2008, p. 117)
Mail Art, Art Exchange, and Connectivity
Like art therapy, mail art can involve both a practice and a product. It consists of making
and exchanging visual art with others (Colletti, 2010). As an exchange, recipients interact with
the art of others. They may participate in collaboration, collection, trading, or forwarding the art
received, creating a community of contributing artists (Colletti, 2010). The process of exchange
and interchange does not operate linearly; instead, the dynamic is fluid and flexible.
Those who participate in mail art embrace the adventure of communicating with
strangers. The person-to-person exchange crosses geography, language, and culture,
creating an unquantifiable network of mail artists that is always waxing and waning. As
new people join the network, others stop participating, or withdraw and rejoin at a later
date. ... No invitation is required, only a giving nature and a desire to embrace what one
receives in return. (Colletti, 2010, p. 184-185).
The benefits of joining in exchanging art with others may include an increase in inspiration,
motivation, creativity, productivity, and purpose; exposure and insight into a variety of personal
perspectives; freedom and safety through anonymity to express thoughts and emotions;
temporary escape from everyday burdens, challenges, and concerns; discovery of new ideas and
artistic techniques; and catharsis (Chilton et al., 2009; Colletti, 2010). Themes of expression
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between patients in cancer recovery encompassed fear, sadness, grief, anxiety, gratitude, hopes,
dreams, miracles, grace, kindness, and generosity (Chilton et al., 2009; Gerity, 2010).
Even without face-to-face contact, interaction through mail art exchange fosters intimate
connection and collaboration, a dynamic force of energy uniting people. Communicating with
others fights against isolation and loneliness. The exchange of art provides the receiver a gift of
fellowship and support (Chilton et al., 2009).
It is through the mundane sharing and caring that we strive to be human and connected. A
life of exile can be wonderful … but can we really thrive in a vacuum, or do we need to
plug into the “other?” (Weston, 2007). (Colletti, 2010, p. 191)
Positive psychologists have found that it is more beneficial for people to see themselves as part
of the greater universe rather than as alone and isolated (Gerity, 2010). Art exchanges can reduce
isolation, build community, and foster connection (Chilton et al., 2009).
Resiliency is required in order to weather the storms of life. By learning and practicing
resiliency, it is strengthened like muscles in the body. Gerity (2010) explained Ron Palomares’
perspective from his work running the American Psychological Association’s school-based
resiliency training program.
Palomares offered five practices that children can use to strengthen their resilience. The
first is to be a friend and have a friend, because relationships make people stronger. The
second is to take charge of what is controllable (such as one’s own behavior), because by
taking action, people can be the heroes or heroines in their own stories, rather than
perceiving everything as happening to them. The third is to set goals and plan how to
achieve them, because goals give people hope. The fourth is to find good things wherever
and whenever possible, because when people see the good in their lives, it gives them
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strength. The fifth is to believe in yourself, and practicing the first four makes this one
easier to do. (p. 157-159)
Seven components of resilience include insight and honesty, independence from sources of
trouble, fulfilling and lasting connection and relationships with others, initiative in solving
problems, using creativity and imagination for self-expression, finding humor in tragedy, and
acting with integrity (Gerity, 2010).
Conclusion
This review of the literature focused on exploring the central themes related to patient
wellbeing in the hospital setting. These themes, the pediatric patient hospitalization experience;
art therapy within the medical setting; positive psychology and positive art therapy; and mail art,
art exchange, and connectivity guided the development of a postcard exchange art therapy
program for pediatric patients in the medical setting to foster emotional wellbeing through a
focus on the five themes of the PERMA model within positive psychology; positive emotions,
engagement, relationships, meaning, and accomplishment/achievement.
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Section III: Program Development
The purpose of the literature review was to explore resources that addressed the central
themes of the pediatric patient hospitalization experience; art therapy within the medical setting;
positive psychology and positive art therapy; and mail art, art exchange, and connectivity. The
literature review was conducted to guide the development of a postcard exchange art therapy
program for pediatric patients in the medical setting and fostered positive emotions, engagement,
relationships, meaning, and accomplishment/achievement.
The literature indicates that a positive psychology and positive art therapy theoretical
framework approach fosters positive emotions, engagement, relationships, meaning, and
accomplishment/achievement that improve the pediatric patient experience throughout
hospitalization. There are significant challenges associated with child illness and hospitalization.
Therefore, the research suggests a growing need to continue to find effective ways to provide
additional emotional support to children in these difficult circumstances.
The research is somewhat limited in regard to specifically utilizing art exchange as an art
therapy intervention with pediatric patients. Therefore, more research and program resources are
needed to further explore and confirm the impacts of combining art therapy and art exchange
from a positive psychology and positive art therapy theoretical framework approach with
hospitalized pediatric patients. By developing program resources that combine these aspects, art
therapists may offer additional support to enhance holistic wellness and the hospitalization
experience for pediatric patients.
Purpose of the Project
The purpose of developing a postcard exchange art therapy program was to provide an art
therapy resource that may improve the emotional wellbeing and hospitalization experience for
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
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pediatric patients. The postcard exchange art therapy program was created to foster positive
emotions, engagement, relationships, meaning, and accomplishment/achievement.
Program Overview
The postcard exchange art therapy program was developed from the theoretical approach
of positive psychology and positive art therapy, which focus on wellbeing, fulfillment, flow,
connection, purpose, and perseverance.
Program Participants
The postcard exchange art therapy program resource was developed for art therapists
working in the medical setting to utilize with pediatric patients. The flexible, thematic
curriculum of art therapy interventions was created to promote holistic wellness in pediatric
patients with the purpose of cultivating positive emotions, engagement, relationships, meaning,
and accomplishment/achievement.
Curriculum Overview
The thematic curriculum within this program was designed to support person-centered,
non-directive engagement to promote a sense of control in an unpredictable environment. The
curriculum maintains flexibility to allow for patient choice and non-linear participation as they
are willing and able to join in and engage with the program.
It was organized around the five themes of the PERMA model within positive psychology:
positive emotions, engagement, relationships, meaning, and accomplishment/achievement.
Positive Emotions
Positive emotions go beyond happiness and include emotions such as hope, joy, love,
compassion, and gratitude (Madeson, 2021). Positive emotions are a key indicator of flourishing,
or finding fulfillment in life, in essence, “living the good life” (Seligman, 2011). Positive
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emotions can be learned or cultivated to improve wellbeing and promote resilience (Fredrickson,
2001). “Increasing positive emotions helps individuals build physical, intellectual, psychological,
and social resources that lead to this resilience and overall wellbeing” (Madeson, 2021, PPositive Emotion).
Engagement
The concept of engagement, or flow, commonly referred to as “being in the zone,”
involves living in the present moment and being completely absorbed in and focused on the task
at hand. This state of engagement or flow occurs when challenge and strength are in perfect
balance (Csikszentmihalyi, 2008).
Relationships
Humans are innately social beings. Positive relationships are those in which the
individual feels supported, loved, and valued by others (Seligman, 2011). Social connections
have been found to play a critical role in contributing to better physical health and wellbeing and
increased satisfaction (Siedlecki et al., 2014).
Meaning
Another innately human quality is the search for meaning and purpose and the need to
have a sense of value, worth, and belonging. Having a sense of purpose in life is guided by
personal values and helps people focus on what really matters, especially in the face of
significant challenges (Madeson, 2021). Kashdan et al. (2009) described that people who report
having found purpose and meaning in life live longer, more satisfying lives and have fewer
health problems (as cited in Madeson, 2021).
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
Accomplishment
A sense of accomplishment, achievement, or competence comes from working towards
and reaching goals, mastering an undertaking, and being motivated to finish what you started
(Seligman, 2011). This includes perseverance and an internal motivation, or working towards
something solely for the sake of personal interest and development (Quinn, 2018).
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Section IV: Program Guide
A stand-alone program guide was created to be utilized by art therapists in the medical
setting, with this paper serving as supplementary and background information supporting the
development of an art therapy postcard program. The program guide contains an introduction to
the program, recommendations for the exchange process, and a five-part curriculum based on
positive psychology’s PERMA model, including themes of positive emotions, engagement,
relationships, meaning, and accomplishment with three example art therapy directives for each
theme.
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Section V: Summary of the Project
Discussion
The development of an art therapy postcard exchange program may be a valuable
resource for art therapists working in a medical setting to incorporate into their important work.
It supports connection and communication through the art process to overcome the psychological
distress associated with acute and chronic medical conditions and the hospitalization experience.
Based on a positive psychology framework with an emphasis on holistic wellness, the art therapy
postcard exchange program supplements the medical model of care by capitalizing on patient
and family strengths, values, and motivations to increase physical and psychological outcomes to
improve overall wellbeing and quality of life.
Program Limitations
The art therapy postcard exchange program provides a general outline and
recommendations for use, but must be utilized by an art therapist with individual considerations
for the unique settings, populations, and individual needs and goals of each patient. There is a
high level of responsibility placed on the role of the art therapist to ensure patient safety as well
as a great deal of logistical considerations and documentation requirements that may prove time
consuming and difficult to maintain depending on case load and other duties. Additionally, this
program has yet to be implemented in clinical practice, therefore evidence of the specific
benefits remains unconfirmed at this time.
Suggestions for Future Exploration
The postcard exchange art therapy program was designed with flexibility and adaptability
in mind for opportunities of continued growth and implementation. There are possibilities for
submitting grant proposals to provide program funding as well as the potential for developing an
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ongoing gallery installation within the hospital itself or planning an annual art exhibition to raise
awareness for the patient experience and the impact of art therapy within the medical setting.
These options lend additional opportunities to foster community consciousness and engagement
with the associated medical institution and the relatively new and rapidly growing field of art
therapy.
The postcard exchange art therapy program could also be expanded to be utilized in a
variety of physical and mental health settings with diverse patient populations. Examples include
adapting the art therapy directives to serve adult inpatient medical populations, reconfiguring
logistics to work within a variety of outpatient clinics, fostering age-diverse connectivity
between pediatrics and adults, promoting uninterrupted program engagement and continuity
through both inpatient and outpatient experiences, and finally cross-country collaboration
between hospitals to create a national network of support through the use of art therapy.
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References
Ackerman, C. E. (2020). What is positive psychology and why is it important. Retrieved from
https://positivepsychology.com/what-is-positive-psychologydefinition/#:~:text=%E2%80%9CPositive%20psychology%20is%20the%20scientific%2
0and%20applied%20approach%20to%20uncovering,functioning,%E2%80%9D%20(Hug
o%20Alberts)
American Art Therapy Association. (2017). Definition of art therapy. Retrieved from
https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf
Angheluta, A. & Lee, B. K. (2011). Art therapy for chronic pain: Applications and future
directions. Canadian Journal of Counseling and Psychotherapy, 45(2), 112-131.
Appleton, V. E. (1993). An art therapy protocol for the medical trauma setting. Art Therapy,
10(2), 71-77. https://doi.org/10.1080/07421656.1993.10758985
Archibald, M., Scott, S., & Hartling, L. (2014). Mapping the waters: A scoping review of the use
of visual arts in pediatric populations with health conditions. Arts & Health, 6(1), 5-23.
https://doi.org/10.1080/17533015.2012.759980
Carter, P., Reynolds, J., Carter, A., Potluri, S., Uppal, H., Chandran, S., & Potluri, R. (2016). The
impact of psychiatric comorbidities on the length of hospital stay in patients with heart
failure. International Journal of Cardiology, 207(1), 292-296.
Chilton, G., Gerity, L., LaVorgna-Smith, M., & MacMichael, H. N. (2009). An online art
exchange group: 14 secrets for a happy artist’s life. Art Therapy, 26(2), 66-72.
https://doi.org/10.1080/07421656.2009.10129741
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
26
Colletti, D. (2010). Inspired by a stranger: Exploring mail art. In C. H. Moon (Ed.) Materials and
media in art therapy: Critical understandings of diverse artistic vocabularies. Taylor &
Francis Group.
Committee on Pediatric Workforce. (2015). Definition of a pediatrician. Pediatrics, 135(4), 780781. https://doi.org/10.1542/peds.2015-0056
Councill, T. (1993). Art therapy with pediatric cancer patients: Helping normal children cope
with abnormal circumstances. Art Therapy, 10(2), 78-87.
https://doi.org/10.1080/07421656.1993.10758986
Councill, T. (2012). Medical art therapy with children. In C. A. Malchiodi (Ed.), Handbook of
art therapy (2nd ed.) (pp. 222-240). Guildford Publications.
Councill, T. D. & Ramsey, K. (2019). Art therapy as a psychosocial support in a child’s
palliative care. Art Therapy, 36(1), 40-45.
https://doi.org/10.1080/07421656.2019.1564644
Cowell, E., Herron, C., & Hockenberry, M. (2011). The impact of an arts program in a children’s
cancer and hematology center. Arts & Health, 3(2), 173-181.
https://doi.org/10.1080/17533015.2011.561356
Csikszentmihalyi, M. [TED]. (2008, October 24). Mihaly Csikszentmihalyi: Flow, the secret to
happiness [Video]. YouTube. https://www.youtube.com/watch?v=fXIeFJCqsPs
David, I. R. & Ilusorio, S. (1995). Tuberculosis: Art therapy with patients in isolation. Art
Therapy, 12(1), 24-31. https://doi.org/10.1080/07421656.1995.10759120
Dean, K., Carman, M., & Fitch, M. (2000). The cancer journey: Bridging art therapy and
museum education. Canadian Oncology Nursing Journal, 10(4), 147-151.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
27
Elkis-Abuhoff, D. & Gaydos, M. (Eds.). (2019). Art and expressive therapies within the medical
model: Clinical applications. Routledge.
Ernst, K. D. (2020). Resources recommended for the care of pediatric patients in hospitals.
Pediatrics, 145(4). https://doi.org/10.1542/peds.2020-0204
Favara-Scacco, C., Smirne, G., Schiliro, G., & Di Cataldo, A. (2001). Art therapy as support for
children with leukemia during painful procedures. Medical & Pediatric Oncology, 36(4),
474-480.
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broadenand-build theory of positive emotions. American Psychologist, 56(3), 218–226.
Gabriel, B., Bromberg, E., Vandenbovenkamp, J., Walka, P., Kornblith, A. B., & Luzzatto, P.
(2001). Art therapy with adult bone marrow transplant patients in isolation: A pilot study.
Psycho-Oncology, 10(2), 114-123.
Gerity, L. (2010). Fourteen secrets for a happy artist’s life: Using art and the internet to
encourage resilience, joy, and a sense of community. In C. H. Moon (Ed.), Materials and
media in art therapy: Critical understandings of diverse artistic vocabularies. Taylor &
Francis Group.
Gibson, D. (2018). A visual conversation with trauma: Visual journaling in art therapy to combat
vicarious trauma. Art Therapy, 35(2), 99-103.
https://doi.org/10.1080/07421656.2018.1483166
Gladding, S. T. & Drake Wallace, M. J. (2018). Scriptotherapy: Eighteen writing exercises to
promote insight and wellness. Journal of Creativity in Mental Health, 13(4), 380-391.
https://doi.org/10.1080/15401383.2018.1486259
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
28
Hall, T. (2019). Creative, culturally-sensitive counseling for pediatric oncology patients
undergoing treatment. Journal of Creativity in Mental Health, 14(1), 70-80.
https://doi.org/10.1080/15401383.2018.1527738
Itczak, M. (Ed.) (2021). Pediatric medical art therapy. Jessica Kingsley Publishers.
Kapitan, L. (2018). Introduction to art therapy research (2nd Ed.). Routledge.
Kaiser, D. & Deaver, S. (2013). Establishing a research agenda for art therapy: A Delphi study.
Art Therapy, 30(3), 114-121. https://doi.org/10.1080/07421656.2013.819281
Luginbuehl-Oelhafen, R. R. (2009). Art therapy with chronic physically
ill adolescents: Exploring the effectiveness of medical art therapy as a complementary
treatment. Charles C. Thomas.
Madeson, M. (2021). Seligman’s PERMA+ model explained: A theory of wellbeing.
PositivePsychology.com. https://positivepsychology.com/perma-model/
Malchiodi, C. A. (1999). Medical art therapy with children. Jessica Kingsley Publishers.
Malchiodi, C. A. (2007). The art therapy sourcebook (2nd ed.). McGraw-Hill.
Malchiodi, C. A. (Ed.). (2012). Art therapy and health care. Guildford Publications.
Melnyk, B. M. & Neale, S. (2018). 9 dimensions of wellness. American Nurse Today, 13(1), 1011.
Mulcahey, A. L. & Young, M. A. (1995). A bereavement support group for children: Fostering
communication about grief and healing. Cancer Practice, 3(3), 150-156.
Nainis, N. A. (2008). Approaches to art therapy for cancer inpatients: Research and practice
considerations. Art Therapy, 25(3), 115-121.
https://doi.org/10.1080/07421656.2008.10129597
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
29
Pederson, J. L., Majumdar, S. R., Forhan, M., Johnson, J. A., & McAlister, F. A. (2016). Current
depressive symptoms but not history of depression predict hospital readmission or death
after discharge from medical wards: A multisite prospective cohort study. General
Hospital Psychiatry, 39(1), 80-85. http://dx.doi.org/10.1016/j.genhosppsych.2015.12.001
Peterson, C. (2015). “Walkabout: Looking In, Looking Out”: A mindfulness-based art therapy
program. Art Therapy, 32(2), 78-82. https://doi.org/10.1080/07421656.2015.1028008
Prager, A. (1995). Pediatric art therapy: Strategies and applications. Art Therapy, 12(1). 32-38.
https://doi.org/10.1080/07421656.1995.10759121
Quinn, A. (2018, February 3). Theory of well-being: Elements and interventions. GoodTherapy.
https://www.goodtherapy.org/blog/theory-of-well-being-elements-interventions0203184#:~:text=According%20to%20Seligman%20(2012)%2C,something%20bigger%
20than%20the%20self
Rollins, J. H. (1990). Helping children cope with hospitalization. Imprint, 37(4), 79-83.
Rollins, J., Drescher, J., & Kellher, M. L. (2012). Exploring the ability of a drawing by proxy
intervention to improve quality of life for hospitalized children. Arts & Health, 4(1), 5569. https://doi.org/10.1080/17533015.2011.564194
Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and wellbeing. Atria Books.
Seligman, M. E. P. & Csikszentmihalyi, M. (2000). Positive psychology: An introduction.
American Psychologist, 55(1), 5-14.
Shella, T. A. (2018). Art therapy improves mood, and reduces pain and anxiety when offered
bedside during acute hospital treatment. The Arts in Psychotherapy, 57(1), 59-64.
https://doi.org/10.1016/j.aip.2017.10.003
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
30
Siedlecki, K. L., Salthouse, T. A., Oishi, S., & Jeswani, S. (2014). The relationship between
social support and subjective wellbeing across age. Social Indicators Research, 117(2),
561–576.
Styles-Turbyfill, H., Rogers, A., Zink, R., & Kwiatkowski, J. (2017). Effectiveness of arts for
life programming: Combating negative effects of hospitalization in children. Arts &
Health, 9(2), 186-198. https://doi.org/10.1080/17533015.2016.1223708
Trauger-Querry, B. & Haghighi, K. R. (1999). Balancing the focus: Art and music therapy for
pain control and symptom management in hospice care. Hospice Journal—Physical,
Psychosocial, & Pastoral Care of the Dying, 14(1), 25-38.
Wajcman, K. (2018). Developing an art therapy program in a children’s hospital. Art Therapy,
35(2). 104-107. https://doi.org/10.1080/07421656.2018.1483168
Wilkinson, R. A. & Chilton, G. (2013). Positive art therapy: Linking positive psychology to art
therapy theory, practice, and research. Art Therapy, 30(1), 4-11.
https://doi.org/10.1080/07421656.2013.757513
Wilkinson, R. A. & Chilton, G. (2018). Positive art therapy theory and practice: Integrating
positive psychology with art therapy. Routledge.
Zammit, C. (2001). The art of healing: A journey through cancer: Implications for art therapy.
Art Therapy, 18(1), 27-36. https://doi.org/10.1080/07421656.2001.10129450
Development of a Postcard Exchange Art Therapy Program: Improving the Emotional
Wellbeing and Hospitalization Experience for Pediatric Patients
Lauren A. Chapman
Department of Counseling, School Psychology, and Special Education
Edinboro University
ARTT 790: Research Project in Art Therapy
Dr. Penelope Orr
12/4/2021
1
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
2
Abstract
A postcard exchange art therapy program was developed to improve the emotional wellbeing and
hospitalization experience for pediatric patients. The literature was reviewed to explore the
central themes of the pediatric patient hospitalization experience; art therapy within the medical
setting; positive psychology and positive art therapy; and mail art, art exchange, and
connectivity. The research suggests a growing need to continue to find effective ways to provide
additional emotional support to children in these difficult circumstances. By developing program
resources that combine these aspects, art therapists may offer additional support to enhance
holistic wellness and the hospitalization experience for pediatric patients.
Keywords: Art therapy, hospitalization experience, pediatric patients, positive
psychology, positive art therapy, wellness, postcard exchange
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
3
Contents
Abstract ........................................................................................................................................... 2
Section 1: Introduction .................................................................................................................... 5
Statement of the Problem .................................................................................................... 5
Purpose of the Project ......................................................................................................... 6
Significance of the Project .................................................................................................. 6
Theoretical Framework ....................................................................................................... 6
Conclusion .......................................................................................................................... 7
Definition of Terms............................................................................................................. 8
Section II: Literature Review .......................................................................................................... 9
Pediatric Patient Experience ............................................................................................... 9
Art Therapy in the Medical Setting .................................................................................. 11
Positive Psychology and Positive Art Therapy ................................................................. 13
Mail Art, Art Exchange, and Connectivity ....................................................................... 15
Conclusion ........................................................................................................................ 17
Section III: Program Development ............................................................................................... 18
Purpose of the Project ....................................................................................................... 18
Program Overview ............................................................................................................ 19
Program Participants ......................................................................................................... 19
Curriculum Overview ....................................................................................................... 19
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
4
Positive Emotions ................................................................................................. 19
Engagement........................................................................................................... 20
Relationships ......................................................................................................... 20
Meaning ................................................................................................................ 20
Accomplishment ................................................................................................... 21
References ..................................................................................................................................... 25
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
5
Section 1: Introduction
Art therapy was originally established with the treatment of physical illness by Adrian
Hill, the founder of art therapy in Great Britain, who wrote about the impact painting had on his
recovery from tuberculosis. Hill later went on to write two books on his experiences and brought
artmaking to other patients with physical illnesses, setting the stage for art therapy in medical
settings (Malchiodi, 2007). Art therapy with pediatric patients presents unique challenges with
the need to resolve not only internal conflicts but also to navigate physical illness and treatment
(Councill, 1993). “The process of art making is recognized as being important to physical
healing, whether in the form of recovery or rehabilitation, learning to cope with illness or
symptoms, or finding meaning for the experience of serious or life-threatening illness”
(Malchiodi, 2007, p. 169). Additionally, hospitalization due to emergent or acute illness or
injury, or chronic illness, can cause children significant psychological distress associated with
pain, trauma, and anxiety (Styles-Turbyfill et al., 2017). The arts in healthcare movement
recognized the healing powers of artmaking for both physical and psychological distress as
artmaking provides transcendence beyond illness, pain, fear, and anxiety; the experience of
normalcy; and a sense of control and autonomy (Malchiodi, 2007).
Statement of the Problem
The challenges of pediatric hospitalization impact a significant number of children in the
United States each year. In 2016, there were over 5.5 million children under the age of 17
hospitalized for an average stay of four days (Ernst, 2020). The primary use of the medical
model approach to patient care during hospitalization focuses on the physical dimension of
wellness while other dimensions, including emotional, environmental, financial, intellectual,
occupational, social, and spiritual, may not be as well-attended. The postcard exchange art
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
6
therapy program may contribute to the creative, emotional, social, and spiritual dimensions of
wellness to support a more holistic approach to the hospital experience. The function, role, and
contribution of a postcard exchange art therapy program to holistic care could be better
understood by examining the pediatric patient experience and implications of art therapy within
the medical setting.
Purpose of the Project
The purpose of developing a postcard exchange art therapy program was to provide an art
therapy resource that may improve the emotional wellbeing and hospitalization experience for
pediatric patients. The postcard exchange art therapy program was created to foster positive
emotions, engagement, relationships, meaning, and accomplishment/achievement.
Significance of the Project
This project was intended to develop a postcard exchange art therapy program that could
contribute additional knowledge to art therapy programming for the medical population,
identified by the American Art Therapy Association as an art therapy priority research area
(Kaiser & Deaver, 2013). It would enable the development of program resources that could be
shared with other medical art therapists for implementation in pediatric hospitals nationwide.
Finally, a postcard exchange art therapy program could provide alternative means to group
engagement and connection to others when pediatric patients are room-bound due to treatment
requiring physical isolation, limited mobility due to medical equipment requirements, or
restrictions based on hospital policies and infection control protocols.
Theoretical Framework
This program was developed through the theoretical framework of positive psychology
and positive art therapy. Positive psychology, also known as the “science of wellbeing,” formally
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
7
founded in 2000 by Martin Seligman, is a subfield of psychology described by Hugo Alberts as
“the scientific and applied approach to uncovering people’s strengths and promoting their
positive functioning” (Ackerman, 2020, Definition 7). Positive art therapy, originally outlined in
2009 by Rebecca Wilkinson and Gioia Chilton, incorporates the principles of positive
psychology into the field of art therapy while realizing the natural complement of the two fields
to contribute to optimal functioning (Wilkinson & Chilton, 2013).
With a focus on hospitalized pediatric patients, these positive strength-based approaches
balance the challenges of the disease basis of human functioning of the medical model and
instead work to support five facets of wellbeing, known as the PERMA model: positive
emotions, engagement, relationships, meaning, and accomplishment/achievement (Seligman,
2011). This shift in focus to wellbeing through an overlap of these two related theoretical
frameworks therefore functions to support an improved hospitalization experience.
Conclusion
As a natural complement to the medical model, art therapy for pediatric patients promotes
holistic wellness and emotional wellbeing and improves the hospitalization experience. Art
therapy has the capacity to encourage interconnected emotional and physical healing (Shella,
2018). When the art is able to give a voice to a child’s emotions, quality of life is enhanced, the
immune system functions better, and the child experiences less distress and has a greater
opportunity to reflect on and find meaning within their healing journey (Rollins et al., 2012).
Through a positive psychology and positive art therapy framework that focuses on strengths and
positive functioning, the development of a postcard exchange art therapy program fostered five
components of wellbeing. These components of wellbeing included positive emotions,
engagement, relationships, meaning, and accomplishment/achievement.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
Definition of Terms
Art Therapy: Art therapy is an integrative mental health and human services profession that
enriches the lives of individuals, families, and communities through active artmaking, creative
process, applied psychological theory, and human experience within a psychotherapeutic
relationship. Art therapy facilitated by a professional art therapist effectively supports personal
and relational treatment goals as well as community concerns. Art therapy is used to improve
cognitive and sensory-motor functions, foster self-esteem and self-awareness, cultivate
emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and
distress, and advance societal and ecological change (AATA, 2017).
Dimensions of Wellness: The nine dimensions of wellness are a comprehensive and integrative
approach to wellness that is complex and interconnected including physical wellness, emotional
wellness, financial wellness, intellectual wellness, career wellness, social wellness, creative
wellness, environmental wellness, and spiritual wellness (Melnyk & Neale, 2018).
Pediatric Patients: Pediatric patients include hospitalized children, adolescents, and young
adults receiving health care for the diagnosis and treatment of acute and chronic diseases
(Committee on Pediatric Workforce, 2015).
8
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9
Section II: Literature Review
This review of the literature focused on exploring the central themes of the pediatric
patient hospitalization experience; art therapy within the medical setting; positive psychology
and positive art therapy; and mail art, art exchange, and connectivity. This review of the
literature guided the development of a postcard exchange art therapy program for pediatric
patients in the medical setting and fostered positive emotions, engagement, relationships,
meaning, and accomplishment/achievement.
Pediatric Patient Experience
For pediatric patients, being hospitalized can be compared to visiting a foreign country.
The hospital experience involves unfamiliar sights, sounds, and smells, medical terminology, and
the replacement of a child’s normal routine for that of the unpredictable and often invasive
rhythm of the treatment routine. From receiving the bad news of a new diagnosis or experiencing
an acute injury or illness, children’s lives are permanently transformed (Hall, 2019). Children
may experience identity confusion, embarrassment, frustration, anxiety, fear, helplessness,
isolation, withdrawal, and loss of autonomy and sense of control (Councill, 1993; Councill &
Ramsey, 2019). Children often go through a process of grieving their formerly healthy lives and
mourn their loss of freedom and independence (Hall, 2019).
As treatment progresses and side effects and complications intensify, children may
display extreme distress, discomfort, angry outbursts, difficulty sleeping, nightmares, increased
anxiety and depression, disturbances of body image and self-esteem, and overwhelming trauma
(Councill, 1993; Councill & Ramsey, 2019; Hall, 2019; Prager, 1995). Anxiety and fear are
linked to an increased sense of physical pain that can create a vicious cycle of emotional and
physical pain for pediatric patients (Styles-Turbyfill et al., 2017). Case examples indicate themes
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
10
of separation anxiety, alienation, anger, aggression and fear, body-image and self-concept,
beliefs about disease and treatment, and the concept of death itself. When pediatric patients
internalize their troubling feelings, it often results in increased depression, withdrawal, selfblame, and alienation. However, sometimes such denial and withdrawal allow for the child to
conserve their emotional resources for future obstacles and complications rather than indicating
pathological depression (Councill, 1993).
Art therapy has been proven to provide a uniquely humanizing influence amidst an
experience that challenges a child’s sense of self and trust in the world (Rollins, 1990). Art
therapy can enhance quality of life in hospitalized children to promote problem solving, express
and regulate mood and feelings, increase authentic connection, and facilitate communication
with family and the health care team (Councill, 1993). Art therapy provides distraction from
pain; safety; choice and a sense of control; independence and autonomy; and means of finding
balance between processing the facts and feelings during a time of great distress. It can help
pediatric patients and their families process and integrate their difficulties, challenges, strengths,
and successes (Councill, 1993; Councill & Ramsey, 2019; Prager, 1995). “Art therapy can
provide a valuable outlet for reflection of feelings about loss and self within a supportive
environment” (Councill, 1993, p. 82). Art therapy allows for the therapeutic process of exploring
profound existential themes and questions and the search for meaning when words are too
difficult to either say or hear (Councill, 1993).
The efficacy of art therapy intervention with medically ill children is demonstrated,
especially through the following therapeutic benefits:
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
11
1. Patients control their own choices of art materials, subject, and verbalization regarding
their artwork, enabling them to experience themselves as active creators as opposed to
victims of a disease or helpless recipients of treatment.
2. Patients maintain communication with the treatment team through art expression at
times when relationships are strained by anger, withdrawal, fatigue, and feelings that are
too emotionally charged to be said with words.
3. Patients continue the process of development through visual communication,
supporting social and mental growth and mitigating the isolation of the hospital
experience.
4. Patients rehearse troubling events and work out concepts of self in art expression,
supporting a sense of mastery over feelings about illness and treatment. (Councill, 1993,
p. 86-87)
Art Therapy in the Medical Setting
Hospitalization can be a stressful and anxiety-producing experience. Whether
hospitalized for trauma, sudden illness, planned surgical intervention, or as a readmission
for a chronic condition, a patient may experience a myriad of emotions, including but not
limited to fear, worry, confusion, and mood disruption (Bar-Sela, Atid, Danos, Gababy,
& Epelbaum, 2007; Tully et al., 2011). Comorbid issues of depression and anxiety are a
common experience for medically ill hospitalized patients (Gaus, Kiep, Holtkamp,
Burkert, & Kendel, 2015; Glinzak, 2016; Maujean, Pepping, & Kendall, 2014; Pederson,
Majumdar, Forhan, Johnson, & McAlister, 2016; Soloreli et al., 2016). (Shella, 2018, p.
59)
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
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The hospitalization experience is a major and often unanticipated event to happen in a
child’s life. It is a uniquely individual and subjective experience, with a lengthier stay not
necessarily equating to a more traumatic experience than a shorter one (Rollins et al., 2012;
Wajcman, 2018). In addition to other stressors in a child’s life, such as parents that are fighting
or are separated, school problems, bullying, etc., the stress associated with hospitalization adds to
that which already exists (Rollins et al., 2012), which can also worsen and be worsened by
physical pain (Angheluta & Lee, 2011). The length of hospitalization, readmission rates, and
treatment compliance have been linked to unacknowledged or poorly managed psychosocial
needs, including high levels of stress and symptoms of anxiety and depression (Carter et al.,
2016; David & Ilusorio, 1995; Pederson et al., 2016; Rollins et al., 2012; Shella, 2018). Children
are submitted to endure painful procedures and complicated treatment regimens that can leave
them feeling powerless, afraid, and confused (Rollins et al., 2012).
“Art therapy (AT) has been shown to help unaddressed psychosocial distress in
hospitalized patients and to promote better management of physical symptoms, overall wellbeing, and socialization (Angheluta & Lee, 2011; Kapitan, 2012)” (as cited in Shella, 2018, p.
59). While traditional medical care addresses one aspect of wellness, art therapy provides an
alternative and complementary piece of the wellness puzzle. Art therapy in the medical setting is
considered a complementary therapy in the treatment of medical illness because it is concerned
with the overall human experience, including psychological, emotional, and spiritual wellness
(Zammit, 2001). Complementary therapies help manage symptoms and improve overall wellbeing by working in conjunction with other treatments and supporting conventional care (Nainis,
2008). These additional therapeutic services can decrease tension, assess trauma, and create a
sense of normalcy for both patient and family (Wajcman, 2018).
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
13
Art therapy is based on the theory that the mind and body are mutually and
bidirectionally connected and has been shown effective in dealing with symptoms of pain and
anxiety (Nainis, 2008). Research suggests that art therapy helps improve coping with the
challenges of treatment and hospitalization and improves resiliency and adaptability to stressful
and traumatic experiences (Deane et al., 2000; Favara-Scacco et al., 2001; Gabriel et al., 2001;
Mulcahey & Young, 1995; Nainis, 2008; Trauger-Querry & Hahighi, 1999). Nainis (2008) noted
that several patients expressed that artmaking gave them a sense of control and allowed them to
express their feelings without words. Shella (2018) reports results that indicate art therapy within
an inpatient hospital environment had an immediate positive impact on improving mood,
anxiety, and pain regardless of other factors such as choice of media, age, sex, or diagnosis.
The efficacy of art therapy addressing these psychosocial issues for patients could
potentially decrease length of stay and improve patient satisfaction, and may even reduce
the need for pain medications. Art therapy may be a safe and cost-effective intervention
as an adjunct to traditional medical management. (Shella, 2018, p. 63)
Positive Psychology and Positive Art Therapy
Positive psychology shifts the focus of psychology from dealing with repairing the worst
situations in life to building up the positive qualities. At the subjective level the focus is on
experiences such as wellbeing, contentment, and satisfaction for the past, hope and optimism for
the future, and optimal functioning and happiness in the present. At the individual level it is
about personal traits such as capacity for love, purpose, courage, interpersonal relationships,
perseverance, forgiveness, originality, future mindedness, spirituality, and wisdom. Finally, at
the group level it is about civic virtues and citizenship such as responsibility, nurture, altruism,
civility, moderation, tolerance, and work ethic (Seligman & Csikszentmihalyi, 2000).
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
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The research suggests a couple of common themes among contributions to the field of
positive psychology that are especially relevant to this project. The first is the recognition that
people exist within a social context (Buss, 2000; Larson, 2000; Massimini & Delle Fave, 2000;
Myers, 2000; Schwartz, 2000; Seligman & Csikszentmihalyi, 2000; Winner, 2000). The next are
the studied positive physical effects of cognitive optimism and resiliency, including patients
showing symptoms later and surviving longer, that indicate a direct physiological impact that
possibly slows down the course of illness (Gable & Haidt, 2005; Salovey et al., 2000; Seligman
& Csikszentmihalyi, 2000; Taylor et al., 2000).
This research has shown a clear link between positive emotional experiences and physical
health. Positive emotions serve to provide a buffering function for negative emotions and
suffering health. Specific physical and psychological health benefits that are associated
with positive emotions include immune system improvements, faster physical recovery
from injury or illness, fewer physical complaints, and longevity. (Styles-Turbyfill et al.,
2017, p. 187)
These themes speak directly to the context of this project being facilitated in the medical setting.
Positive art therapy, the intersection of positive psychology and art therapy, uses the
power of art and creativity to promote wellbeing through the healing effects of engagement, or
creative flow, the automatic and highly focused state of consciousness experienced when one is
completely present in the moment and devoted to a meaningful challenge (Csikszentmihalyi,
2008). Positive art therapy also shares themes of cultivating positive emotions, relationships,
meaning, and achievement to promote wellbeing and resiliency (Gerity, 2010; Wilkinson &
Chilton, 2013). The use of art making becomes the central aspect to engage in meaning making,
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
15
finding purpose, and self-expression (Wilkinson & Chilton, 2013) as a means of distraction from
the distress of hospitalization and coping with acute or chronic illness.
What starts out as a fun distraction from medical problems may become an outlet for
deeper emotion. This is the point at which the art therapist’s knowledge of therapeutic
techniques and understanding of metaphor allows the patient to safely process the
complex issues that emerge. (Nainis, 2008, p. 117)
Mail Art, Art Exchange, and Connectivity
Like art therapy, mail art can involve both a practice and a product. It consists of making
and exchanging visual art with others (Colletti, 2010). As an exchange, recipients interact with
the art of others. They may participate in collaboration, collection, trading, or forwarding the art
received, creating a community of contributing artists (Colletti, 2010). The process of exchange
and interchange does not operate linearly; instead, the dynamic is fluid and flexible.
Those who participate in mail art embrace the adventure of communicating with
strangers. The person-to-person exchange crosses geography, language, and culture,
creating an unquantifiable network of mail artists that is always waxing and waning. As
new people join the network, others stop participating, or withdraw and rejoin at a later
date. ... No invitation is required, only a giving nature and a desire to embrace what one
receives in return. (Colletti, 2010, p. 184-185).
The benefits of joining in exchanging art with others may include an increase in inspiration,
motivation, creativity, productivity, and purpose; exposure and insight into a variety of personal
perspectives; freedom and safety through anonymity to express thoughts and emotions;
temporary escape from everyday burdens, challenges, and concerns; discovery of new ideas and
artistic techniques; and catharsis (Chilton et al., 2009; Colletti, 2010). Themes of expression
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
16
between patients in cancer recovery encompassed fear, sadness, grief, anxiety, gratitude, hopes,
dreams, miracles, grace, kindness, and generosity (Chilton et al., 2009; Gerity, 2010).
Even without face-to-face contact, interaction through mail art exchange fosters intimate
connection and collaboration, a dynamic force of energy uniting people. Communicating with
others fights against isolation and loneliness. The exchange of art provides the receiver a gift of
fellowship and support (Chilton et al., 2009).
It is through the mundane sharing and caring that we strive to be human and connected. A
life of exile can be wonderful … but can we really thrive in a vacuum, or do we need to
plug into the “other?” (Weston, 2007). (Colletti, 2010, p. 191)
Positive psychologists have found that it is more beneficial for people to see themselves as part
of the greater universe rather than as alone and isolated (Gerity, 2010). Art exchanges can reduce
isolation, build community, and foster connection (Chilton et al., 2009).
Resiliency is required in order to weather the storms of life. By learning and practicing
resiliency, it is strengthened like muscles in the body. Gerity (2010) explained Ron Palomares’
perspective from his work running the American Psychological Association’s school-based
resiliency training program.
Palomares offered five practices that children can use to strengthen their resilience. The
first is to be a friend and have a friend, because relationships make people stronger. The
second is to take charge of what is controllable (such as one’s own behavior), because by
taking action, people can be the heroes or heroines in their own stories, rather than
perceiving everything as happening to them. The third is to set goals and plan how to
achieve them, because goals give people hope. The fourth is to find good things wherever
and whenever possible, because when people see the good in their lives, it gives them
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
17
strength. The fifth is to believe in yourself, and practicing the first four makes this one
easier to do. (p. 157-159)
Seven components of resilience include insight and honesty, independence from sources of
trouble, fulfilling and lasting connection and relationships with others, initiative in solving
problems, using creativity and imagination for self-expression, finding humor in tragedy, and
acting with integrity (Gerity, 2010).
Conclusion
This review of the literature focused on exploring the central themes related to patient
wellbeing in the hospital setting. These themes, the pediatric patient hospitalization experience;
art therapy within the medical setting; positive psychology and positive art therapy; and mail art,
art exchange, and connectivity guided the development of a postcard exchange art therapy
program for pediatric patients in the medical setting to foster emotional wellbeing through a
focus on the five themes of the PERMA model within positive psychology; positive emotions,
engagement, relationships, meaning, and accomplishment/achievement.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
18
Section III: Program Development
The purpose of the literature review was to explore resources that addressed the central
themes of the pediatric patient hospitalization experience; art therapy within the medical setting;
positive psychology and positive art therapy; and mail art, art exchange, and connectivity. The
literature review was conducted to guide the development of a postcard exchange art therapy
program for pediatric patients in the medical setting and fostered positive emotions, engagement,
relationships, meaning, and accomplishment/achievement.
The literature indicates that a positive psychology and positive art therapy theoretical
framework approach fosters positive emotions, engagement, relationships, meaning, and
accomplishment/achievement that improve the pediatric patient experience throughout
hospitalization. There are significant challenges associated with child illness and hospitalization.
Therefore, the research suggests a growing need to continue to find effective ways to provide
additional emotional support to children in these difficult circumstances.
The research is somewhat limited in regard to specifically utilizing art exchange as an art
therapy intervention with pediatric patients. Therefore, more research and program resources are
needed to further explore and confirm the impacts of combining art therapy and art exchange
from a positive psychology and positive art therapy theoretical framework approach with
hospitalized pediatric patients. By developing program resources that combine these aspects, art
therapists may offer additional support to enhance holistic wellness and the hospitalization
experience for pediatric patients.
Purpose of the Project
The purpose of developing a postcard exchange art therapy program was to provide an art
therapy resource that may improve the emotional wellbeing and hospitalization experience for
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
19
pediatric patients. The postcard exchange art therapy program was created to foster positive
emotions, engagement, relationships, meaning, and accomplishment/achievement.
Program Overview
The postcard exchange art therapy program was developed from the theoretical approach
of positive psychology and positive art therapy, which focus on wellbeing, fulfillment, flow,
connection, purpose, and perseverance.
Program Participants
The postcard exchange art therapy program resource was developed for art therapists
working in the medical setting to utilize with pediatric patients. The flexible, thematic
curriculum of art therapy interventions was created to promote holistic wellness in pediatric
patients with the purpose of cultivating positive emotions, engagement, relationships, meaning,
and accomplishment/achievement.
Curriculum Overview
The thematic curriculum within this program was designed to support person-centered,
non-directive engagement to promote a sense of control in an unpredictable environment. The
curriculum maintains flexibility to allow for patient choice and non-linear participation as they
are willing and able to join in and engage with the program.
It was organized around the five themes of the PERMA model within positive psychology:
positive emotions, engagement, relationships, meaning, and accomplishment/achievement.
Positive Emotions
Positive emotions go beyond happiness and include emotions such as hope, joy, love,
compassion, and gratitude (Madeson, 2021). Positive emotions are a key indicator of flourishing,
or finding fulfillment in life, in essence, “living the good life” (Seligman, 2011). Positive
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
20
emotions can be learned or cultivated to improve wellbeing and promote resilience (Fredrickson,
2001). “Increasing positive emotions helps individuals build physical, intellectual, psychological,
and social resources that lead to this resilience and overall wellbeing” (Madeson, 2021, PPositive Emotion).
Engagement
The concept of engagement, or flow, commonly referred to as “being in the zone,”
involves living in the present moment and being completely absorbed in and focused on the task
at hand. This state of engagement or flow occurs when challenge and strength are in perfect
balance (Csikszentmihalyi, 2008).
Relationships
Humans are innately social beings. Positive relationships are those in which the
individual feels supported, loved, and valued by others (Seligman, 2011). Social connections
have been found to play a critical role in contributing to better physical health and wellbeing and
increased satisfaction (Siedlecki et al., 2014).
Meaning
Another innately human quality is the search for meaning and purpose and the need to
have a sense of value, worth, and belonging. Having a sense of purpose in life is guided by
personal values and helps people focus on what really matters, especially in the face of
significant challenges (Madeson, 2021). Kashdan et al. (2009) described that people who report
having found purpose and meaning in life live longer, more satisfying lives and have fewer
health problems (as cited in Madeson, 2021).
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
Accomplishment
A sense of accomplishment, achievement, or competence comes from working towards
and reaching goals, mastering an undertaking, and being motivated to finish what you started
(Seligman, 2011). This includes perseverance and an internal motivation, or working towards
something solely for the sake of personal interest and development (Quinn, 2018).
21
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
22
Section IV: Program Guide
A stand-alone program guide was created to be utilized by art therapists in the medical
setting, with this paper serving as supplementary and background information supporting the
development of an art therapy postcard program. The program guide contains an introduction to
the program, recommendations for the exchange process, and a five-part curriculum based on
positive psychology’s PERMA model, including themes of positive emotions, engagement,
relationships, meaning, and accomplishment with three example art therapy directives for each
theme.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
23
Section V: Summary of the Project
Discussion
The development of an art therapy postcard exchange program may be a valuable
resource for art therapists working in a medical setting to incorporate into their important work.
It supports connection and communication through the art process to overcome the psychological
distress associated with acute and chronic medical conditions and the hospitalization experience.
Based on a positive psychology framework with an emphasis on holistic wellness, the art therapy
postcard exchange program supplements the medical model of care by capitalizing on patient
and family strengths, values, and motivations to increase physical and psychological outcomes to
improve overall wellbeing and quality of life.
Program Limitations
The art therapy postcard exchange program provides a general outline and
recommendations for use, but must be utilized by an art therapist with individual considerations
for the unique settings, populations, and individual needs and goals of each patient. There is a
high level of responsibility placed on the role of the art therapist to ensure patient safety as well
as a great deal of logistical considerations and documentation requirements that may prove time
consuming and difficult to maintain depending on case load and other duties. Additionally, this
program has yet to be implemented in clinical practice, therefore evidence of the specific
benefits remains unconfirmed at this time.
Suggestions for Future Exploration
The postcard exchange art therapy program was designed with flexibility and adaptability
in mind for opportunities of continued growth and implementation. There are possibilities for
submitting grant proposals to provide program funding as well as the potential for developing an
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
24
ongoing gallery installation within the hospital itself or planning an annual art exhibition to raise
awareness for the patient experience and the impact of art therapy within the medical setting.
These options lend additional opportunities to foster community consciousness and engagement
with the associated medical institution and the relatively new and rapidly growing field of art
therapy.
The postcard exchange art therapy program could also be expanded to be utilized in a
variety of physical and mental health settings with diverse patient populations. Examples include
adapting the art therapy directives to serve adult inpatient medical populations, reconfiguring
logistics to work within a variety of outpatient clinics, fostering age-diverse connectivity
between pediatrics and adults, promoting uninterrupted program engagement and continuity
through both inpatient and outpatient experiences, and finally cross-country collaboration
between hospitals to create a national network of support through the use of art therapy.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
25
References
Ackerman, C. E. (2020). What is positive psychology and why is it important. Retrieved from
https://positivepsychology.com/what-is-positive-psychologydefinition/#:~:text=%E2%80%9CPositive%20psychology%20is%20the%20scientific%2
0and%20applied%20approach%20to%20uncovering,functioning,%E2%80%9D%20(Hug
o%20Alberts)
American Art Therapy Association. (2017). Definition of art therapy. Retrieved from
https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf
Angheluta, A. & Lee, B. K. (2011). Art therapy for chronic pain: Applications and future
directions. Canadian Journal of Counseling and Psychotherapy, 45(2), 112-131.
Appleton, V. E. (1993). An art therapy protocol for the medical trauma setting. Art Therapy,
10(2), 71-77. https://doi.org/10.1080/07421656.1993.10758985
Archibald, M., Scott, S., & Hartling, L. (2014). Mapping the waters: A scoping review of the use
of visual arts in pediatric populations with health conditions. Arts & Health, 6(1), 5-23.
https://doi.org/10.1080/17533015.2012.759980
Carter, P., Reynolds, J., Carter, A., Potluri, S., Uppal, H., Chandran, S., & Potluri, R. (2016). The
impact of psychiatric comorbidities on the length of hospital stay in patients with heart
failure. International Journal of Cardiology, 207(1), 292-296.
Chilton, G., Gerity, L., LaVorgna-Smith, M., & MacMichael, H. N. (2009). An online art
exchange group: 14 secrets for a happy artist’s life. Art Therapy, 26(2), 66-72.
https://doi.org/10.1080/07421656.2009.10129741
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
26
Colletti, D. (2010). Inspired by a stranger: Exploring mail art. In C. H. Moon (Ed.) Materials and
media in art therapy: Critical understandings of diverse artistic vocabularies. Taylor &
Francis Group.
Committee on Pediatric Workforce. (2015). Definition of a pediatrician. Pediatrics, 135(4), 780781. https://doi.org/10.1542/peds.2015-0056
Councill, T. (1993). Art therapy with pediatric cancer patients: Helping normal children cope
with abnormal circumstances. Art Therapy, 10(2), 78-87.
https://doi.org/10.1080/07421656.1993.10758986
Councill, T. (2012). Medical art therapy with children. In C. A. Malchiodi (Ed.), Handbook of
art therapy (2nd ed.) (pp. 222-240). Guildford Publications.
Councill, T. D. & Ramsey, K. (2019). Art therapy as a psychosocial support in a child’s
palliative care. Art Therapy, 36(1), 40-45.
https://doi.org/10.1080/07421656.2019.1564644
Cowell, E., Herron, C., & Hockenberry, M. (2011). The impact of an arts program in a children’s
cancer and hematology center. Arts & Health, 3(2), 173-181.
https://doi.org/10.1080/17533015.2011.561356
Csikszentmihalyi, M. [TED]. (2008, October 24). Mihaly Csikszentmihalyi: Flow, the secret to
happiness [Video]. YouTube. https://www.youtube.com/watch?v=fXIeFJCqsPs
David, I. R. & Ilusorio, S. (1995). Tuberculosis: Art therapy with patients in isolation. Art
Therapy, 12(1), 24-31. https://doi.org/10.1080/07421656.1995.10759120
Dean, K., Carman, M., & Fitch, M. (2000). The cancer journey: Bridging art therapy and
museum education. Canadian Oncology Nursing Journal, 10(4), 147-151.
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
27
Elkis-Abuhoff, D. & Gaydos, M. (Eds.). (2019). Art and expressive therapies within the medical
model: Clinical applications. Routledge.
Ernst, K. D. (2020). Resources recommended for the care of pediatric patients in hospitals.
Pediatrics, 145(4). https://doi.org/10.1542/peds.2020-0204
Favara-Scacco, C., Smirne, G., Schiliro, G., & Di Cataldo, A. (2001). Art therapy as support for
children with leukemia during painful procedures. Medical & Pediatric Oncology, 36(4),
474-480.
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broadenand-build theory of positive emotions. American Psychologist, 56(3), 218–226.
Gabriel, B., Bromberg, E., Vandenbovenkamp, J., Walka, P., Kornblith, A. B., & Luzzatto, P.
(2001). Art therapy with adult bone marrow transplant patients in isolation: A pilot study.
Psycho-Oncology, 10(2), 114-123.
Gerity, L. (2010). Fourteen secrets for a happy artist’s life: Using art and the internet to
encourage resilience, joy, and a sense of community. In C. H. Moon (Ed.), Materials and
media in art therapy: Critical understandings of diverse artistic vocabularies. Taylor &
Francis Group.
Gibson, D. (2018). A visual conversation with trauma: Visual journaling in art therapy to combat
vicarious trauma. Art Therapy, 35(2), 99-103.
https://doi.org/10.1080/07421656.2018.1483166
Gladding, S. T. & Drake Wallace, M. J. (2018). Scriptotherapy: Eighteen writing exercises to
promote insight and wellness. Journal of Creativity in Mental Health, 13(4), 380-391.
https://doi.org/10.1080/15401383.2018.1486259
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
28
Hall, T. (2019). Creative, culturally-sensitive counseling for pediatric oncology patients
undergoing treatment. Journal of Creativity in Mental Health, 14(1), 70-80.
https://doi.org/10.1080/15401383.2018.1527738
Itczak, M. (Ed.) (2021). Pediatric medical art therapy. Jessica Kingsley Publishers.
Kapitan, L. (2018). Introduction to art therapy research (2nd Ed.). Routledge.
Kaiser, D. & Deaver, S. (2013). Establishing a research agenda for art therapy: A Delphi study.
Art Therapy, 30(3), 114-121. https://doi.org/10.1080/07421656.2013.819281
Luginbuehl-Oelhafen, R. R. (2009). Art therapy with chronic physically
ill adolescents: Exploring the effectiveness of medical art therapy as a complementary
treatment. Charles C. Thomas.
Madeson, M. (2021). Seligman’s PERMA+ model explained: A theory of wellbeing.
PositivePsychology.com. https://positivepsychology.com/perma-model/
Malchiodi, C. A. (1999). Medical art therapy with children. Jessica Kingsley Publishers.
Malchiodi, C. A. (2007). The art therapy sourcebook (2nd ed.). McGraw-Hill.
Malchiodi, C. A. (Ed.). (2012). Art therapy and health care. Guildford Publications.
Melnyk, B. M. & Neale, S. (2018). 9 dimensions of wellness. American Nurse Today, 13(1), 1011.
Mulcahey, A. L. & Young, M. A. (1995). A bereavement support group for children: Fostering
communication about grief and healing. Cancer Practice, 3(3), 150-156.
Nainis, N. A. (2008). Approaches to art therapy for cancer inpatients: Research and practice
considerations. Art Therapy, 25(3), 115-121.
https://doi.org/10.1080/07421656.2008.10129597
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
29
Pederson, J. L., Majumdar, S. R., Forhan, M., Johnson, J. A., & McAlister, F. A. (2016). Current
depressive symptoms but not history of depression predict hospital readmission or death
after discharge from medical wards: A multisite prospective cohort study. General
Hospital Psychiatry, 39(1), 80-85. http://dx.doi.org/10.1016/j.genhosppsych.2015.12.001
Peterson, C. (2015). “Walkabout: Looking In, Looking Out”: A mindfulness-based art therapy
program. Art Therapy, 32(2), 78-82. https://doi.org/10.1080/07421656.2015.1028008
Prager, A. (1995). Pediatric art therapy: Strategies and applications. Art Therapy, 12(1). 32-38.
https://doi.org/10.1080/07421656.1995.10759121
Quinn, A. (2018, February 3). Theory of well-being: Elements and interventions. GoodTherapy.
https://www.goodtherapy.org/blog/theory-of-well-being-elements-interventions0203184#:~:text=According%20to%20Seligman%20(2012)%2C,something%20bigger%
20than%20the%20self
Rollins, J. H. (1990). Helping children cope with hospitalization. Imprint, 37(4), 79-83.
Rollins, J., Drescher, J., & Kellher, M. L. (2012). Exploring the ability of a drawing by proxy
intervention to improve quality of life for hospitalized children. Arts & Health, 4(1), 5569. https://doi.org/10.1080/17533015.2011.564194
Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and wellbeing. Atria Books.
Seligman, M. E. P. & Csikszentmihalyi, M. (2000). Positive psychology: An introduction.
American Psychologist, 55(1), 5-14.
Shella, T. A. (2018). Art therapy improves mood, and reduces pain and anxiety when offered
bedside during acute hospital treatment. The Arts in Psychotherapy, 57(1), 59-64.
https://doi.org/10.1016/j.aip.2017.10.003
DEVELOPMENT OF A POSTCARD EXCHANGE ART THERAPY PROGRAM
30
Siedlecki, K. L., Salthouse, T. A., Oishi, S., & Jeswani, S. (2014). The relationship between
social support and subjective wellbeing across age. Social Indicators Research, 117(2),
561–576.
Styles-Turbyfill, H., Rogers, A., Zink, R., & Kwiatkowski, J. (2017). Effectiveness of arts for
life programming: Combating negative effects of hospitalization in children. Arts &
Health, 9(2), 186-198. https://doi.org/10.1080/17533015.2016.1223708
Trauger-Querry, B. & Haghighi, K. R. (1999). Balancing the focus: Art and music therapy for
pain control and symptom management in hospice care. Hospice Journal—Physical,
Psychosocial, & Pastoral Care of the Dying, 14(1), 25-38.
Wajcman, K. (2018). Developing an art therapy program in a children’s hospital. Art Therapy,
35(2). 104-107. https://doi.org/10.1080/07421656.2018.1483168
Wilkinson, R. A. & Chilton, G. (2013). Positive art therapy: Linking positive psychology to art
therapy theory, practice, and research. Art Therapy, 30(1), 4-11.
https://doi.org/10.1080/07421656.2013.757513
Wilkinson, R. A. & Chilton, G. (2018). Positive art therapy theory and practice: Integrating
positive psychology with art therapy. Routledge.
Zammit, C. (2001). The art of healing: A journey through cancer: Implications for art therapy.
Art Therapy, 18(1), 27-36. https://doi.org/10.1080/07421656.2001.10129450