Understanding Therapeutic Clown

Humour: personal mastery and imaginative play

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hen children are hospitalized their environment changes drastically and they are confronted by a very different reality. This is especially true when kids are dealing with a disability or a chronic illness. That is where we come in. The therapeutic clown program at Bloorview Kids Rehab has been a mainstay for the inpatient population for 5 years. The goal of our program is to help humanize the healthcare setting through humour, personal mastery and imaginative play. We seek to help empower each child we see through play. Once they are admitted a child has very little power over the course of their stay, so we aim to provide them with a unique opportunity where they have complete control over at least one situation: their visit with the clowns. Bloorview Kids Rehab is Canada’s largest pediatric children’s rehab hospital and for more than a century Bloorview has been helping children with disabilities. Children in this sort of healthcare institution spend a good deal of time being taken care of by a wide assortment of professionals, however when they visit with the clowns they have the opportunity to take on the role of the caregiver.

Whether it is a 5-year-old boy with a chronic illness who is driving us in his own makeshift ambulance to the hospital or a 17-year-old girl who is teaching Dr. Flap and Ricky how to behave nicely towards each other, it is clear that we need their assistance while we navigate the halls of Bloorview. The clowns embody a spirit of playfulness, absurdity and wonderment. Within this world of silliness anything is possible and in a setting overwhelmed by limitations this can be very liberating.

‘We are not your typical clowns’

Over five years the program has grown from one to three clowns; two clowns working in the very successful duo format and a third as a casual staff member. Donned only in our red noses and a simple costume we are not your typical clowns. We wear no make-up and have only a ukulele and an egg shaker between us. We are the puppets and the children of Bloorview pull our strings. It is not our goal to help to change or fix the children we work with. We do not act as therapists, and yet the value of our work can be deeply therapeutic. Quite often a child will graciously let us in to their world of imagination.

This can be a turning point for many children as they see that opening up in this way is not as frightening as they may have thought. As well, it is an opportunity for each child to gain a sense of self-confidence by having complete mastery over not only a situation, but total control over the clowns’ very movements. Just the ability to say “no” to seeing the clowns and have us comply can be incredibly therapeutic for the kids we see. To a child who has never seen us before we may sometimes appear to be a strange addition to the healthcare team, however the minute that a child understands that the very wave of their hand could knock us to the ground we are quickly embraced as an integral part of their world. Few other disciplines inhabit this world of spontaneity, so it is not surprising that our program has had such an impact on the inpatient population. Due to the fact that hospitalized children may be defined by their disability or illness, we offer ourselves as a therapeutic tool to celebrate what is healthy and well about every child. We approach each play opportunity with no agenda and every play interaction is totally unique to that individual moment.

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Boo !

Red Uke Wow !

Yeah !

We have discovered that our presence is particularly profound with the children we see on the Complex Continuing Care unit at Bloorview. Many of these children have extremely limited forms of communication. This proved challenging at first when we began to work on this unit, but over time we discovered it was here that our work had the greatest impact. Our profession is all about communication and discovering in what direction the child would like us to go. We learned that every child has their own ability of expressing themselves: we simply had to learn how to interpret their movements and gestures. One 18 year-old boy we see has extremely limited means of communication. He guides us exclusively with his eyes and because this has been our main form of connection with him it has been necessary to find new ways to make this system better. Over time as he saw he could control us with his eyes he created new and exciting ways to build on this system. Instead of simply up and down for yes and side to side for no we discovered that he was able to twirl his eyes around or move them up and down in rapid succession. So based on this, we complied with a variety of responses to his directions. This has included everything from twirling across the room, running faster and faster around his bed, or being sent off to the corner of the room for our own personal ‘time out’ due to excessive silliness.

Future of Therapeutic Clown

Therapeutic clown is a growing profession and is proving to be an integral part of the multi-disciplinary allied healthcare team in many pediatric facilities. There are now 17 hospitals across Canada with a therapeutic clown program and since 1999 the number of professional therapeutic clowns has grown from 4 to 52. The challenge of this profession is that it absolutely requires training within two separate fields.

It is necessary for artists doing this work to have extensive and ongoing training in clown and the theatre arts, as well as a keen awareness of the hospital environment they are working in. Five years ago the Canadian Association of Therapeutic Clowns (CATC) was formed to help create both a code of ethics and a standard of practice so that in time the art and practice of therapeutic clowning could stand apart from the many different forms of clown and soon be a registered profession and an essential part of the complementary healthcare field.

Bloorview Kids Rehab has shown their commitment to this discipline and our program by collaborating with us. Very recently, a research team, led by a psychologist and a bio-medical engineer, received a seed grant to determine the effects of therapeutic clowning on Bloorview’s inpatient and nursing population.  It will be the very first quantitative study on therapeutic clowns in Canada. This union is a sign of things to come, as this profession begins to be set apart from all other forms of clowning. The uniqueness of this style of clown is that the focus is not on the artist, but always on the client. So when the imaginative world of a young boy transports the clowns to a make believe hospital or the clowns resolve their mounting conflicts due to the inspiration of a young girl’s song it can have a powerful impact on the child: ‘If the clowns can be healed in this building I can heal as well.’

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