Why this book
Before accepting my first position in a hospice, I sought to gather as much information as I could. I wanted to prepare myself, to understand what awaited me. I soon discovered that the available resources were extremely scarce. The literature on art therapy in end-of-life settings is sparse and fragmented. So I relied on what I had: my training, my sensitivity, and the courage to put myself on the line.
This memoir was born from that place — from the need to fill a void. It is not a manual, nor does it aspire to be one. It is a testimony intended for art therapists who work — or wish to work — in delicate care settings: hospice and wards dedicated to Permanent Vegetative State and Minimally Conscious State. My aim is to share practical tools, reflections, and above all the stories that taught me how to do this work.
Why work with this population
When I tell colleagues or acquaintances that I work in hospice and vegetative state wards, the reaction is almost always the same: “How brave, what courage — I could never do that!” In truth, this work offers something that few settings can provide. Accompanying people in the final phases of life is, first and foremost, an act of love — toward others and toward oneself.
Working here teaches you to put everyday problems in perspective, to cherish every moment, to cultivate a profound empathy. The therapeutic relationship, in these wards, nourishes both parties. But one must be prepared to face the limits and the suffering: the fears, the breathlessness, the abandonment, the anger of patients and their families — and what all of this stirs within us.
One receives many tears, but also unexpected smiles, profound testimonies, legacies of immense meaning. The work happens through gazes, gestures, the touch of a hand, narratives — or sometimes only through the artwork itself. Attention to the smallest bodily signals becomes crucial. And despite the exhaustion, it is always an experience that enriches.
Within the multidisciplinary team there is no shortage of moments of conviviality and sharing, precious spaces for breathing, listening, and kindness, which nurture the well-being of those who dedicate themselves to this mission.
My path
I began working in hospice and vegetative state wards after gaining experience in Integrated Day Centers and Residential Care Facilities. During the final year of my three-year training in Clinical Art Therapy at the Lyceum Academy in Milan, I completed my internship in a day center, discovering how much creativity and vitality can still emerge in elderly people, even in the most advanced stages of life.
In residential care I observed how impoverishing life in an institution can be: the scarcity of stimulation, the absence of beauty, the pervasive passivity. It was there that I became acutely aware of cognitive decline, physical frailties, and the emotional challenges that accompany advanced age. Working in hospice was a natural continuation: I wished to deepen my understanding of finitude, to explore my own fears, to respond to profound questions.
This choice was interwoven with my personal story. My father had been diagnosed with an adenocarcinoma of the colon, subsequently complicated by widespread metastases. The prognosis was a matter of weeks. We would care for him at home, with the support of domiciliary palliative care. At the time I was already working in hospice, and the clarity of the clinical picture allowed me to face that phase with greater awareness. This experience, together with my work, taught me the importance of a gentle and respectful approach, one capable of adapting to the needs, the rhythms, and the vulnerabilities of each person.
How this memoir is structured
The narrative follows a threefold perspective of intervention:
- The patient — the approach to the therapeutic relationship, the choice of art materials, attention to individual needs
- The caregiver — emotional support, dedicated expressive spaces, group interventions
- The multidisciplinary team — activities that strengthen cohesion and address the emotional toll of the work
At the heart of everything lies the therapeutic relationship, understood as a space for listening and dialogue, and the importance of adapting every intervention to the needs and possibilities of the person before me.