Josh Birch often puts on a strong front as he undergoes cancer treatments for non-Hodgkins lymphoma. But the 13-year-old's steel facade cracked when an artist in residence at the University of Maryland Children's Center recently asked him to draw the first thing that popped in his head.
Josh sketched out a beach — and then he started crying.
His family typically spends the summer splashing in the waves of Ocean City, which Josh calls his "happy place". But this year they couldn't go to the beach because of his illness.
As Josh wept, artist-in-residence Marty Weishaar gently prodded the teenager to talk more about what he was feeling. Sometimes, it can be difficult living with cancer, Josh told Weishaar.
"It just made me feel better," Josh said of drawing the picture. 'I was talking to him and getting all my feelings out."
Weishaar was hired this summer as the University of Maryland hospital's first artist in residence with funding from the Yumi C.A.R.E.S. Foundation, a nonprofit started by Maryland first lady Yumi Hogan. An artist who has made art therapy her key issue, Hogan has sold her own paintings at fundraisers to benefit art therapy programs.
She started the program at the children's hospital, because her husband, Gov. Larry Hogan, was treated for non-Hodgkins lymphoma at the medical system shortly after taking office in 2015. During his stay, the Hogans were inspired by pediatric patients and their families who showed "optimism and positive energy," despite dealing with grave illnesses, Yumi Hogan said via e-mail.
Her first grandson, Cam, was born with breathing difficulties and received treatment in the hospital's neonatal intensive care unit.
"Art therapy is very new in our state's medical programs, but I have seen firsthand how healing art can be so beneficial to pediatric patients," said the Korean-born first lady, whose own work is a mix of media and styles but incorporates East Asian painting techniques. "I wanted to give back to our state and especially to UMMC and to the pediatric patients we met during my husband's ongoing treatment."
Yumi C.A.R.E.S. stands for "It's You-Me" working together. C.A.R.E.S. is for Children's Art for Recovery, Empowerment and Strength.
Art therapy is a growing field that has gained newfound attention in recent months in both Maryland and across the country, thanks to Hogan and another high-powered political spouse. Karen Pence, wife of Vice President Mike Pence, also has made it her signature issue. Pence, a watercolor artist, was active in promoting art therapy before her husband took office.
Art therapy uses media such as painting and drawing to help patients cope with illness. It can help a patient unleash pent-up anxiety and stress resulting from living with a debilitating disease, art therapists say. For people who have difficulty expressing themselves through traditional talk therapy, it offers an alternative way to work through emotions. It also can help build coping skills.
"A lot of patients don't have the ability or don't want to verbally talk about how they are feeling," Weishaar said. "By using the creative process, they have a non-verbal way of discussing it."
Weishaar sometimes asks children to draw pictures depicting weather to show their current emotional state. Some draw storm clouds, or a black sky and rain, which may mean they are feeling sad and depressed. Kids who have suicidal thoughts may draw themselves falling. Those who have stable relationships will draw people closer together than those who don't, he said.
"You can really start reading into the metaphors or symbols that they're drawing or rendering," Weishaar said.
Hogan said participating in art therapy can help kids with the sadness they may feel being stuck in a hospital rather than at school or playing with their friends.
"I have personally seen the power of healing art and the potential it has in helping pediatric patients express their emotions and cope with the challenges of their life-threatening illnesses," she said in her email. "When they are focused on painting or drawing or crafts, they are not thinking about the IVs in their arms, or being in bed all day. Instead, they are enjoying themselves with fun colors and hands-on activities."
Research has found that art therapy can be helpful for patients with cancer, autism and depression. It also has been shown to help soldiers with post traumatic stress disorder or people traumatized after living through a natural disaster or coping with abuse. Traumatic memories are stored in the non-verbal part of the brain, said Donna Betts, board president of the American Art Therapy Association.
Art therapists are specially trained in both art and mental health. Pence is often quoted as saying art therapy is not arts and crafts. Adult coloring books are also not art therapy, said Betts, an associate professor of art therapy at George Washington University.
The field of art therapy has existed only for about a half-century, Betts said. Not all insurers cover the practice, which has limited its use. In Maryland, private insurers that provide mental health coverage include art therapy as a treatment they cover. Medicaid, the government insurance program for low-income people, covers some art therapy, but not in all states, Betts said.
Because the University of Maryland Children's Hospital art therapy program is funded through Hogan's foundation, it is offering services to patients and their families for free and won't require people to have insurance.
Integrating art therapy into children's hospitals is a "fairly new phenomena," said Dr. Steven J. Czinn, chair of the department of pediatrics at the University of Maryland School of Medicine and director of the University of Maryland Children's Hospital.
"We aren't only healing the physical ailments, this gives us the opportunity to treat our patients' emotional and mental well-being," Czinn said. "This is really something that needs to be a part of all children's hospitals."
Weishaar treats patients in an art therapy room at the children's hospital or he will visit patients' rooms to hold sessions. He said patients can use the program as much as they like.
Josh Birch said he comes as often as he can.
During a recent session, Weishaar drew a circle on a large piece of paper. Then he, Josh and the teenager's mother drew pictures within the circle, but they weren't allowed to speak. The idea of the session was to see what emotions were revealed in the drawing.
Josh drew a tree with many limbs coming out of it. He said the limbs represent all his thoughts. Because when you are living with cancer you have a lot of thoughts and worries.
Sarah Birch drew a mountain with a rainbow coming out of the side, the sun shining in the sky and a bird flying overhead. She wasn't sure why she drew it at first. It was the first thing that popped in her head. Then she thought about the symbolism.
"I feel we have climbed a mountain, but now we are at the steepest point and things are getting better," she said. "I know he is going to do big things one day and I just want to get him healthy."
She said art therapy has helped her son open up about his true feelings, given him something to look forward to and kept his mind off his chemotherapy. He has one treatment left.
"He was always the most composed of all of us, trying to put up a tough guy persona," Sarah Birch said. "But I thought it had to be affecting him. With art therapy he let his guard down. He was able to try and deal with some of the feelings he was going through rather than be so happy for everyone else."