Therapeutic Clowning: Healing Connections Through Play


A child’s world is anything but simple. We may confuse their limited experiences and responsibilities with a lack of complexity. However, a child’s development is a continuous, multi-faceted, intensive evolution of their mind, body, spirit and senses. Translate that complexity into a hospital setting – full of unfamiliar people, noises, smells and stuff – and a child’s world can feel turned upside-down.

The new therapeutic clown program at The Credit Valley Hospital aims to alleviate a child’s fears of being in hospital, and to make deeper connections that allow children to feel free to be themselves. That freedom, believes the hospital’s pediatric care team, has a positive impact on the healing process and in providing vital comfort or distraction from their illness.

Lucia Cino is Credit Valley’s first therapeutic clown. She has studied various forms of the art of clowning and physical theatre from as far away as Italy. Lucia calls her character Nuula. She chose the name – a variation of the Italian word nulla, meaning nothing – to symbolize that, “Out of nothing, something might be born. There are infinite worlds and possibilities.”

That is precisely what Nuula wanted Amy* to believe. Amy is a five-year-old patient at Credit Valley who at first appeared afraid of the mysterious, colourful visitor appearing at the door. When Nuula looked at her, Amy would hide her eyes or duck under the covers. Sensing her apprehension, Nuula did not enter and instead began to blow bubbles to Amy’s more receptive grandmother.

“Nuula always asks permission to enter a child’s room, by way of knocking, miming or her unique accent,” says Lucia. “The clown is nothing without the child who sets the tone, type and length of play.”

Amy gradually opened up, using her foot to pop the bubbles and competing with her grandmother to see who would get them first. Nuula then knew they had found their connection. Still tentative however, Amy declined hand painting. Then, after seeing a magical rainbow on her grandmother’s hand, Amy let Nuula paint a bear on hers.

Lucia believes that, “Amy’s sensitive grandmother allowed Nuula to play through her in order to reach the child. It was a delightful and silent complicity that allowed Amy to join the play in her own time.”

When most people think of clowns, they think of performers, says Colleen Butler, nurse manager in pediatrics. “They think of a party or the circus, where there is a distance between the clown and the children. The therapeutic clown approach is to establish a connection through a quiet presence on a whole other level.”

Credit Valley’s interest in therapeutic clowning developed several years ago after staff saw a presentation by Toronto’s Hospital For Sick Children (HSC) on their innovative program, which now consists of three therapeutic clowns, one of whom is Nuula. The hospital also investigated the renowned Big Apple Circus in New York that coordinates therapeutic clown visits for dozens of hospitals.

“We were impressed by what we had seen,” says Colleen. “We knew exactly what we wanted and just needed to find the funding to do it.”

Enter Therapeutic Clowns Canada. While working in Britain in the late ’90s, marketing consultant Mary Hirst also met someone from The Big Apple Circus and immediately knew this was something she wanted to do in Canada. Inspired by programs in Toronto and Winnipeg, Mary joined Heather Spinks and Joan Barrington (a.k.a. “Bunky” the therapeutic clown at HSC) in June 1999 to found Therapeutic Clowns Canada. Their goal is to have therapeutic clown programs in every paediatric health-care facility in the country. This completely volunteer initiative has since helped a number of hospitals – including the Children’s Hospital of Eastern Ontario, Montreal Children’s Hospital, Winnipeg Health Sciences Centre, and Credit Valley – to develop or expand their unique programs.

“It just makes me feel good to do this,” says Mary. “Lots of people could use a smile or a hug, particularly children with chronic illness who have to return to hospital again and again. As soon as donors learn about the program and see how it works, they are ready to give more.”

The foundation generated funds for one year of Nuula’s two-day a week role at Credit Valley. Cori Chapman, administrative director of paediatrics says this is the first such funding for a community hospital. She adds, “We are hopeful the success of the program will help generate community support to not only continue but also expand to full-time positions and therapeutic clowns in other areas of the hospital such as mental health, emergency, surgical day care, diagnostic imaging and ambulatory care.”

The feedback has been overwhelmingly positive. Colleen says the therapeutic clown can transcend any cultural or language barriers. “There is an immediate acceptance of Nuula, by parents and children, because of the intuitive, sensitive way she interacts with them.” Colleen adds that Lucia’s reports on those interactions provide the rest of the care team with valuable insights that may not otherwise be gained by more traditional methods.

“Play”, adds Lucia, “Brings a fullness and spirit out that already exists in a child. All are open, playful, imaginative and creative. The potential of the clown is to help them to feel comfortable enough to express their emotions, and perhaps work through any issues affecting them.”