Table of Contents Author Guidelines Submit a Manuscript
Evidence-Based Complementary and Alternative Medicine
Volume 5, Issue 1, Pages 17-25
http://dx.doi.org/10.1093/ecam/nem033
Review

The Life Threatened Child and the Life Enhancing Clown: Towards a Model of Therapeutic Clowning

1Department of Child Life, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
2Therapeutic Clown, Therapeutic Clown Services, Toronto, Ontario, Canada

Received 24 March 2006; Accepted 3 March 2007

Copyright © 2008 Donna Koller and Camilla Gryski. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citations to this Article [66 citations]

The following is the list of published articles that have cited the current article.

  • Ae-Na Choi, Myeong Soo Lee, and Hyun-Ja Lim, “Effects of Group Music Intervention on Depression, Anxiety, and Relationships in Psychiatric Patients: A Pilot Study,” The Journal of Alternative and Complementary Medicine, vol. 14, no. 5, pp. 567–570, 2008. View at Publisher · View at Google Scholar
  • Laura Vagnoli, Simona Caprilli, and Andrea Messeri, “Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option?,” Pediatric Anesthesia, vol. 20, no. 10, pp. 937–943, 2010. View at Publisher · View at Google Scholar
  • Elodie Speyer, Aline Herbinet, Anne Vuillemin, Serge Briançon, and Pascal Chastagner, “Effect of adapted physical activity sessions in the hospital on health-related quality of life for children with cancer: A cross-over randomized trial,” Pediatric Blood & Cancer, vol. 55, no. 6, pp. 1160–1166, 2010. View at Publisher · View at Google Scholar
  • Sara Costa Fernandes, and Patricia Arriaga, “The effects of clown intervention on worries and emotional responses in children undergoing surgery,” Journal Of Health Psychology, vol. 15, no. 3, pp. 405–415, 2010. View at Publisher · View at Google Scholar
  • Elodie Speyer, Anne Vuillemin, Aline Herbinet, Pascal Chastagner, and Serge Briançon, “Effect of adapted physical activity on health-related quality of life among hospitalized children and adolescents (the ACTIV'HOP randomized controlled trial): Design and methods,” Contemporary Clinical Trials, vol. 31, no. 2, pp. 165–171, 2010. View at Publisher · View at Google Scholar
  • Dafna Tener, Rachel Lev-Wiesel, Nessia Lang Franco, and Shoshi Ofir, “Laughing Through This Pain: Medical Clowning During Examination of Sexually Abused Children: An Innovative Approach,” Journal of Child Sexual Abuse, vol. 19, no. 2, pp. 128–140, 2010. View at Publisher · View at Google Scholar
  • Ae-Na Choi, Myeong Soo Lee, and Jung-Sook Lee, “Group Music Intervention Reduces Aggression and Improves Self-Esteem in Children with Highly Aggressive Behavior: A Pilot Controlled Trial,” Evidence-Based Complementary and Alternative Medicine, vol. 7, no. 2, pp. 213–217, 2010. View at Publisher · View at Google Scholar
  • Susana Pendzik, and Amnon Raviv, “Therapeutic clowning and drama therapy: A family resemblance,” The Arts in Psychotherapy, vol. 38, no. 4, pp. 267–275, 2011. View at Publisher · View at Google Scholar
  • M. Pinquart, D. Skolaude, K. Zaplinski, and R. F. Maier, “Do Clown Visits Improve Psychological and Sense of Physical Well-being of Hospitalized Pediatric Patients? A Randomized-controlled Trial,” Klinische Padiatrie, vol. 223, no. 2, pp. 74–78, 2011. View at Publisher · View at Google Scholar
  • Marc Gelkopf, “The Use of Humor in Serious Mental Illness: A Review,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, pp. 1–8, 2011. View at Publisher · View at Google Scholar
  • Shauna Kingsnorth, Stefanie Blain, and Patricia McKeever, “Physiological and Emotional Responses of Disabled Children to Therapeutic Clowns: A Pilot Study,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, pp. 1–10, 2011. View at Publisher · View at Google Scholar
  • Mario Bertini, Elena Isola, Giuseppe Paolone, and Giuseppe Curcio, “Clowns Benefit Children Hospitalized for Respiratory Pathologies,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, pp. 1–9, 2011. View at Publisher · View at Google Scholar
  • Amnon Raviv, “Still the Best Medicine, Even in a War Zone,” TDR/The Drama Review, vol. 56, no. 2, pp. 169–177, 2012. View at Publisher · View at Google Scholar
  • Amnon Raviv, “Still the best medicine, even in a war zone,” TDR - The Drama Review - A Journal of Performance Studies, vol. 56, no. 2, pp. 169–177, 2012. View at Publisher · View at Google Scholar
  • Stefanie Blain, Shauna Kingsnorth, Lindsay Stephens, and Patricia McKeever, “Determining the effects of therapeutic clowning on nurses in a children's rehabilitation hospital,” Arts & Health, vol. 4, no. 1, pp. 26–38, 2012. View at Publisher · View at Google Scholar
  • Zohar Grinberg, Susana Pendzik, Ronen Kowalsky, and Yaron “Sancho” Goshen, “Drama therapy role theory as a context for understanding medical clowning,” The Arts in Psychotherapy, vol. 39, no. 1, pp. 42–51, 2012. View at Publisher · View at Google Scholar
  • Shoshi Ofir, Rachel Lev-Wiesel, Dafna Tener, and Nessia Lang-Franco, “The Use of Medical Clowns as a Psychological Distress Buffer During Anogenital Examination of Sexually Abused Children,” Journal of Loss and Trauma, vol. 17, no. 1, pp. 12–22, 2012. View at Publisher · View at Google Scholar
  • Adam Rapoport, Laura Beaune, Maria Rugg, Christine Newman, and Kevin Weingarten, “Living life to the fullest: Early integration of palliative care into the lives of children with chronic complex conditions,” Current Pediatric Reviews, vol. 8, no. 2, pp. 152–165, 2012. View at Publisher · View at Google Scholar
  • Betty L. Leef, and Donna Hallas, “ The Sensitivity Training Clown Workshop: Enhancing Therapeutic Communication Skills in Nursing Students ,” Nursing Education Perspectives, vol. 34, no. 4, pp. 260–264, 2013. View at Publisher · View at Google Scholar
  • G. Margherita, M. L. Martino, F. Recano, and F. Camera, “Invented fairy tales in groups with onco-haematological children,” Child: Care, Health and Development, 2013. View at Publisher · View at Google Scholar
  • Ido Wolyniez, Ayelet Rimon, Dennis Scolnik, Alejandro Gruber, Oren Tavor, Eli Haviv, and Miguel Glatstein, “The Effect of a Medical Clown on Pain During Intravenous Access in the Pediatric Emergency Department: A Randomized Prospective Pilot Study,” Clinical Pediatrics, vol. 52, no. 12, pp. 1168–1172, 2013. View at Publisher · View at Google Scholar
  • Cindy Dell Clark, “A clown most serious: Patch Adams,” International Journal of Play, vol. 2, no. 3, pp. 163–173, 2013. View at Publisher · View at Google Scholar
  • Ruth Sancho Huerga, Jennifer Lade, and Florian 'Floyd' Mueller, “Three themes for designing games that aim to promote a positive body perception in hospitalized children,” Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), vol. 7822, pp. 198–203, 2013. View at Publisher · View at Google Scholar
  • Claus Barkmann, Anna-Katharina Siem, Nino Wessolowski, and Michael Schulte-Markwort, “Clowning as a supportive measure in paediatrics - a survey of clowns, parents and nursing staff,” BMC Pediatrics, vol. 13, no. 1, pp. 166, 2013. View at Publisher · View at Google Scholar
  • Karen Ford, Helen Courtney-Pratt, Leigh Tesch, and Caddi Johnson, “More than just clowns - Clown Doctor rounds and their impact for children, families and staff,” Journal of Child Health Care, vol. 18, no. 3, pp. 286–296, 2014. View at Publisher · View at Google Scholar
  • Benjamin R. Heilbrunn, Rachael E. Wittern, Justin B. Lee, Phung K. Pham, Anita H. Hamilton, and Alan L. Nager, “Reducing Anxiety in the Pediatric Emergency Department: A Comparative Trial,” The Journal of Emergency Medicine, 2014. View at Publisher · View at Google Scholar
  • Amnon Raviv, “The clown's carnival in the hospital: a semiotic analysis of the medical clown's performance,” Social Semiotics, pp. 1–9, 2014. View at Publisher · View at Google Scholar
  • Alberto Dionigi, Diego Sangiorgi, and Roberto Flangini, “Clown intervention to reduce preoperative anxiety in children and parents: A randomized controlled trial,” Journal of Health Psychology, vol. 19, no. 3, pp. 369–380, 2014. View at Publisher · View at Google Scholar
  • Fiona Finlay, Anna Baverstock, and Simon Lenton, “Therapeutic clowning in paediatric practice,” Clinical Child Psychology and Psychiatry, vol. 19, no. 4, pp. 596–605, 2014. View at Publisher · View at Google Scholar
  • Mauro Fantini Nogueira-Martins, Daniele Lima-Costa, Luiz Antonio Nogueira-Martins, and Maria Cezira Fantini Nogueira-Martins, “Perceptions of Healthcare Undergraduate Students about a Hospital Clown Training,” Creative Education, vol. 05, no. 08, pp. 542–551, 2014. View at Publisher · View at Google Scholar
  • O Bok Yun, Shin-Jeong Kim, and Dukyoo Jung, “Effects of a Clown–Nurse Educational Intervention on the Reduction of Postoperative Anxiety and Pain Among Preschool Children and Their Accompanying Parents in South Korea,” Journal of Pediatric Nursing, 2015. View at Publisher · View at Google Scholar
  • Michele Capurso, and Benedetta Ragni, “Psycho-educational preparation of children for anaesthesia: A review of intervention methods,” Patient Education and Counseling, 2015. View at Publisher · View at Google Scholar
  • Kannan Sridharan, and Gowri Sivaramakrishnan, “Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials,” European Journal of Pediatrics, 2016. View at Publisher · View at Google Scholar
  • Carmelo Vázquez, Gonzalo Hervás, and Covadonga Chaves, “Positive interventions in seriously-ill children: Effects on well-being after granting a wish,” Journal of Health Psychology, vol. 21, no. 9, pp. 1870–1883, 2016. View at Publisher · View at Google Scholar
  • Alberto Dionigi, and Carla Canestrari, “Clowning in health care settings: The point of view of adults,” Europe’s Journal of Psychology, vol. 12, no. 3, pp. 473–488, 2016. View at Publisher · View at Google Scholar
  • Margareta Rämgård, Elisabeth Carlson, and Elisabeth Mangrio, “Strategies for diversity: Medical clowns in dementia care - An ethnographic study,” BMC Geriatrics, vol. 16, no. 1, 2016. View at Publisher · View at Google Scholar
  • Stanislav Kocherov, Yaniv Hen, Sol Jaworowski, Israel Ostrovsky, Arthur I Eidelman, Yakov Gozal, and Boris Chertin, “Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial,” Journal of Paediatrics and Child Health, 2016. View at Publisher · View at Google Scholar
  • Dafna Tener, Shoshi Ofir, Rachel Lev-Wiesel, Nessia L. Franco, and Avi On, “Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals,” Social Work in Health Care, vol. 55, no. 4, pp. 296–313, 2016. View at Publisher · View at Google Scholar
  • Avital Dvory, Yaron Goshen, Shoshana Ruimi, Sergei Bikov, Raphael Halevy, and Ariel Koren, “Dream Doctor Intervention Instead of Sedation: Performing Radionuclide Scanning Without Sedation in Young Children: A Study in 142 Patients,” The Journal of Alternative and Complementary Medicine, 2016. View at Publisher · View at Google Scholar
  • Julio C. Sánchez, Luis F. Echeverri, Manuel J. Londoño, Sergio A. Ochoa, Andrés F. Quiroz, César R. Romero, and Joaquín O. Ruiz, “Effects of a Humor Therapy Program on Stress Levels in Pediatric Inpatients,” Hospital Pediatrics, vol. 7, no. 1, pp. 46–53, 2016. View at Publisher · View at Google Scholar
  • Lennard T. van Venrooij, and Pieter C. Barnhoorn, “Hospital clowning: a paediatrician’s view,” European Journal of Pediatrics, 2016. View at Publisher · View at Google Scholar
  • Alberto Dionigi, and Paola Gremigni, “A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children,” Journal of Clinical Nursing, 2016. View at Publisher · View at Google Scholar
  • Yongfu Zhang, Yuan Yang, Wing YT Lau, Samradhvi Garg, and Jianxin Lao, “The effectiveness of pre-operative clown intervention on psychological distress: A systematic review and meta-analysis,” Journal of Paediatrics and Child Health, 2016. View at Publisher · View at Google Scholar
  • Covadonga Chaves, Gonzalo Hervas, and Carmelo Vazquez, “Granting wishes of seriously ill children: Effects on parents' well-being,” Journal of Health Psychology, vol. 21, no. 10, pp. 2314–2327, 2016. View at Publisher · View at Google Scholar
  • Jennifer Lade, Ruth Sancho Huerga, and Florian Mueller, “Designing play to support hospitalized children,” CHI PLAY 2016 - Proceedings of the 2016 Annual Symposium on Computer-Human Interaction in Play, pp. 401–412, 2016. View at Publisher · View at Google Scholar
  • Mariana Sato, Artur Ramos, Carolina Costa Silva, Gustavo Rosa Gameiro, and Camila Morato da Conceição Scatena, “Clowns: A review about using this mask in the hospital environment,” Interface: Communication, Health, Education, vol. 20, no. 56, pp. 123–134, 2016. View at Publisher · View at Google Scholar
  • Shoshi Ofir, Dafna Tener, Rachel Lev-Wiesel, Avi On, and Nessia Lang-Franco, “The Therapy Beneath the Fun: Medical Clowning During Invasive Examinations on Children,” Clinical Pediatrics, vol. 55, no. 1, pp. 56–65, 2016. View at Publisher · View at Google Scholar
  • Margherita Felluga, Ingrid Rabach, Marta Minute, Marcella Montico, Rita Giorgi, Isabella Lonciari, Andrea Taddio, and Egidio Barbi, “A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children’s anxiety and pain levels in emergency department,” European Journal of Pediatrics, 2016. View at Publisher · View at Google Scholar
  • Alberto Dionigi, “Personality of Clown Doctors An Exploratory Study,” Journal Of Individual Differences, vol. 37, no. 1, pp. 49–55, 2016. View at Publisher · View at Google Scholar
  • Tabea Scheel, Dorothea Hoeppner, Anne Grotevendt, and Winfried Barthlen, “Clowns in Paediatric Surgery: Less Anxiety and More Oxytocin? A Pilot Study,” Klinische Padiatrie, vol. 229, no. 5, pp. 274–280, 2017. View at Publisher · View at Google Scholar
  • Uri Ilan, Avigail Davidov, Joseph Mendlovic, and Giora Weiser, “Disaster zones—should we be clowning around?,” European Journal of Pediatrics, 2017. View at Publisher · View at Google Scholar
  • Florence Vinit, Caroline Simonds, Laurent Dupic, Philippe Hubert, Guillaume Mortamet, and Nadia Roumeliotis, “Is there a role for clowns in paediatric intensive care units?,” Archives of Disease in Childhood, vol. 102, no. 7, pp. 672–675, 2017. View at Publisher · View at Google Scholar
  • Özgür Alparslan, and Gülçin Bozkurt, “The effect of clown model implemented in hospital on the anxiety and depression level of ill children and their mothers,” Arts & Health, pp. 1–13, 2017. View at Publisher · View at Google Scholar
  • Jeff Gordon, Yoram Shenar, and Susana Pendzik, “Clown therapy: A drama therapy approach to addiction and beyond,” The Arts in Psychotherapy, 2017. View at Publisher · View at Google Scholar
  • Rachel Chimbwete-Phiri, and Stephanie Schnurr, “Negotiating knowledge and creating solidarity: Humour in antenatal counselling sessions at a rural hospital in Malawi,” Lingua, vol. 197, pp. 68–82, 2017. View at Publisher · View at Google Scholar
  • Shevach Friedler, Saralee Glasser, Gila Levitan, Dana Hadar, Bat-El Sasi, and Liat Lerner-Geva, “Patients’ Evaluation of Intervention by a Medical Clown Visit or by Viewing a Humorous Film Following In Vitro Fertilization and Embryo Transfer,” Journal of Evidence-Based Complementary & Alternative Medicine, vol. 22, no. 1, pp. 47–53, 2017. View at Publisher · View at Google Scholar
  • Meltem Yildirim, Ecem Koroglu, Cagla Yucel, Senay Kirlak, and Sevim Sen, “The effect of hospital clown nurse on children’s compliance to burn dressing change,” Burns, 2018. View at Publisher · View at Google Scholar
  • Anne Lelièvre, Stéphane Gérard, Sophie Hermabessière, Monique Martinez, Bruno Péran, and Yves Rolland, “La thérapie par l’humour, le rire et l’intervention de clowns en gérontologie,” Soins Gérontologie, vol. 23, no. 130, pp. 37–43, 2018. View at Publisher · View at Google Scholar
  • Tony Wall, Julia Fries, Nick Rowe, Niamh Malone, and Eva Österlind, “Drama and Theatre for Health and Well-Being,” Good Health and Well-Being, pp. 1–13, 2018. View at Publisher · View at Google Scholar
  • Julia Gray, Helen Donnelly, and Barbara E. Gibson, “Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children’s Rehabilitation,” Journal of Medical Humanities, 2019. View at Publisher · View at Google Scholar
  • Nadja Könsgen, Stephanie Polus, Tanja Rombey, and Dawid Pieper, “Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis,” Systematic Reviews, vol. 8, no. 1, 2019. View at Publisher · View at Google Scholar
  • Alfonso Santarpia, Marjorie Romani-Cesaro, and Caroline Simonds, “Hospital Clown Narratives in Pediatric Palliative Care,” Journal of Humanistic Psychology, pp. 002216781985000, 2019. View at Publisher · View at Google Scholar
  • Helle Nygaard Kristensen, Erik Elgaard Sørensen, Jennifer Stinson, and Helle Haslund Thomsen, ““WE do it together!” An ethnographic study of the alliance between child and hospital clown during venipunctures,” Journal of Pediatric Nursing, 2019. View at Publisher · View at Google Scholar
  • Y Kanemoto, T Tanimoto, and H Shimmura, “Modified clown therapy using traditional Japanese-style costumes for elderly patients in post-disaster Fukushima,” QJM: An International Journal of Medicine, 2019. View at Publisher · View at Google Scholar
  • Elena Antonelli, Laura Vagnoli, Enrica Ciucci, Chiara Vernucci, Federica Lachi, and Andrea Messeri, “A Comparison of Nonpharmacologic Interventions on the Emotional State of Children in the Emergency Department,” Pediatric Emergency Care, vol. 35, no. 2, pp. 81–88, 2019. View at Publisher · View at Google Scholar
  • Emiliana Bomfim, Eliane Tatsch Neves, Denise Sayuri Calheiros Da Silveira, Michelle Darezzo Rodrigues Nunes, Lucila Castanheira Nascimento, Gabriela Pereira-Da-Silva, Luís Carlos Lopes-Júnior, Regina Aparecida Garcia Lima, and Karin Olson, “Systematic review protocol examining the effectiveness of hospital clowns for symptom cluster management in paediatrics,” BMJ Open, vol. 9, no. 1, 2019. View at Publisher · View at Google Scholar