‘The fourth hand’: a conceptual framework for art therapy spaces in pediatric hematology/oncology settings

BackgroundThe impact of the physical art therapy space on therapeutic outcomes has not been widely explored in the art therapy literature.ContextThis paper explores the role of the physical art therapy space in open studio pediatric hematology/oncology care in hospitals in the northeastern United States.ApproachResearchers from Drexel University and art therapists from Tracy's Kids (TK) collaborated on a framework to conceptualise the impact of TK's physical art therapy spaces on their patients and caregivers based on clinical experiences and observations.OutcomesOur model of 'the fourth hand' in pediatric hematology/oncology spaces includes spatial considerations of maintaining boundaries to create a safe space, creating autonomy within the space, facilitating social connections through the space, facilitating community art displays, and adapting the space to patients' unique needs.ConclusionsThe 'fourth hand' represents a conceptual model for the impact of physical art therapy spaces on the therapeutic encounter, supported by insights from TK art therapists in pediatric hematology/oncology spaces.Implications for ResearchFuture research should explore the impact of the art therapy space on therapeutic outcomes in diverse settings, as well as cultural considerations in curating art therapy spaces.Plain-language summaryThis paper describes a conceptualisation for the role of the art therapy space in medical pediatric hematology/oncology (hem/onc) settings. We argue that physical space is 'the fourth hand' in providing a holding environment for art therapy services, and that the ecology of these spaces impacts the therapeutic experience. To illustrate this model, we examine the role of space in an open studio art therapy programme, Tracy's Kids (TK), in pediatric hematology/oncology settings throughout the northeastern United States. We provide examples of these spaces and their impact on patients and caregivers. TK art therapists identified that the art therapy space should support boundaries to maintain a safe space, support autonomy, facilitate social connections, involve community art displays, and be responsive to each person's unique needs. Based on our model, we make preliminary recommendations for the design of art therapy spaces and discuss suggestions for future research in this area.