The role of the psycho-oncologist in improving the psychological adjustment of children with cancer through painting therapy is defined within the framework of comprehensive psychosocial care and focuses on supporting the child to cope adaptively with the physical, emotional, familial, and social changes caused by the disease and treatment. Having cancer in childhood can disrupt the normal course of life and expose the child to experiences such as hospitalization, avoidance of School and friends, medical procedures, pain, fatigue, nausea, changes in appearance, and worry about the future. These conditions may affect the child's sense of security, independence, control, and belonging, and in some cases lead to increased anxiety, fear, anger, sadness, or withdrawal. By assessing these reactions and paying attention to the child's developmental stage, the psycho-oncologist can consider painting therapy as a Complementary intervention should be included in the psychological support program.
From this perspective, painting therapy is not merely an artistic activity or hobby, but can be a means of communication, self-expression, emotion regulation, and recognition of the child's inner experience. Children, especially at an early age, may not have enough vocabulary or cognitive ability to accurately describe their fears and concerns , and painting allows a part of their experience to be expressed through images. The psycho-oncologist can design activities in collaboration with the art therapist in which the child draws on topics such as "my world," "what I am afraid of," "where I feel safe," "I am in the hospital," or "the future I love." The main goal is to discover the personal meaning of the experience for the child and to make it possible to have a conversation about it, not to definitively interpret the elements of the painting.
Theoretically, this intervention is related to the perspectives of emotion regulation, self-efficacy, psychological adjustment, and child development. Drawing can help the child organize complex emotions in a tangible and visible way. When the child turns a difficult experience into an image, it is possible to take a relative distance from the experience and look at it. The psycho-oncologist can start painting after the painting is finished with simple questions such as "What does this part represent?" Or, "If you could change something in this picture, what would you change?" Give the child time to explain the meaning of the effect himself. This process can help identify the child's concerns and coping resources.
One of the most important uses of painting therapy is to facilitate the expression of anxiety and fear. The child may be worried about injections, surgery, chemotherapy, separation from parents, or changes in his or her body, but he or she may not be able to express these concerns directly. Painting can provide a low-pressure space to represent these experiences. The psycho-oncologist can use the content of the conversation about the painting to better understand the child's needs, and if need to add other psychological interventions to the program. Here painting is not a substitute for clinical evaluation, but is used as one of the pathways of communication with the child.
Painting can also play a role in fostering a sense of control. Illness and cancer treatment influence a large part of a child's life in medical decisions, but in the process of painting, the child can decide on the subject, color, size, and shape of the work. This simple experience can provide an opportunity to practice choice and agency. The psycho-oncologist can link this feeling to other coping strategies and help the child better understand the difference between the controllable and uncontrollable parts of his or her life. This does not mean that the child can control the course of the disease with his or her attitude or behavior; the goal is to strengthen the child's sense of ability to face the situation.
Painting therapy can also be important in reconstructing a child's identity. Cancer may cause a child to experience themselves as a "patient" more than anything else, and their connection to previous roles such as student, friend, athlete, or active family member is reduced. Activities such as drawing interests, abilities, friends, dreams, and a picture of the future can help maintain identity continuity. In adolescents, this becomes even more important, as adolescence itself is an important stage for identity formation and independence, and the physical changes caused by cancer and treatment may further complicate this process.
A psycho-oncologist can also use painting to strengthen a child's relationship with the parents. Drawing a parent and child together or discussing a work can create an opportunity for emotional interaction in which the family's focus is not just on illness and treatment. Parents should be trained not to judge or modify the child's painting and not to determine its meaning on the child's behalf. Questioning about the work and listening to the child's descriptions can strengthen communication. In such a situation, the parent assumes the role of companion and supporter rather than becoming an evaluator of the painting.
In a hospital setting, painting can also help create a meaningful routine and activity. The child can do an activity that suits their energy during waiting times or breaks and experience part of the day outside of a purely medical space. For children who have taken a break from school and routine activities due to treatment, creating creative opportunities can help maintain a sense of connection with daily life. Of course, the child's physical condition, fatigue, pain, nausea, and medical limitations should be considered before any activity.
The available evidence on art interventions in children with cancer and serious illnesses suggests that art activities can be associated with reduced anxiety and distress and improved psychological experience in some settings, but the effectiveness of painting therapy alone for all dimensions of psychological adjustment still needs to be investigated more closely. Differences in children's age, type of cancer, treatment conditions, method of intervention, and measurement tools make it difficult to generalize the results of studies equally . Therefore, the psycho-oncologist should assess the child's changes with a combination of clinical observation, dialogue, and validated tools, and avoid drawing conclusions solely on the appearance of the painting.
It is suggested that painting therapy programs be designed based on the child's age, stage of development, physical condition, and psychological needs. For young children, simple, play-based activities are more appropriate, and for older children, narrative painting, personal notebook, or multi-session projects can be used. The goals of each session should be clear, but the child should also have relative freedom in choosing the topic and how to perform. The psycho-oncologist collaborates with the art therapist, oncologist, nurse, and family can help to better coordinate the intervention with the treatment plan.
Challenges to this approach include individual differences, energy limitations, pain, complications of treatment, lack of interest in painting, time constraints, and different access to professionals. Also, interpreting the symbols of the painting without paying attention to the child's explanations can lead to misconceptions. Painting should not be seen as a tool for definitively diagnosing a mental disorder, and any worrying signs should be checked with validated psychological methods. On the other hand, the child should not be pressured to paint or express difficult emotions, as a sense of authority and security is an important part of the intervention.
The psycho-oncologist can use painting therapy as a complementary tool to facilitate the expression of emotion, reduce distress, strengthen a sense of control, support identity, and improve the child's relationship with the family and treatment team. The effectiveness of this approach is most expected when the artistic activity is implemented in a structured clinical setting, tailored to the child's developmental needs, and coordinated with medical treatment. Painting therapy is not intended to cure the disease or replace specialized oncological and psychological treatments, but can be part of a holistic care system in which the child's human experience is taken into account alongside the cancer treatment process.