Nathan's Story from: A Month-Long Study of the Effects of Holistic Interventions for a 68-Year-Old Widower Coping with Cancer

by Rondi Lightmark, M.A.

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ABSTRACT

This qualitative single case study explores the impact of a month-long program of holistic interventions, including self-massage, toning, meditation, painting, creative writing, dreamwork, visualization and prayer, for a 68-year-old widower with cancer. Other elements included semi-structured interviews and viewing of videos on psychic awareness, life after death and family systems therapy.  

The research question was whether holistic practices would help the participant manage the challenges of his illness, clarify and deal with any unresolved issues, and envision new paths to self-actualization.

The participant responded positively and stated that he was interested in continuing some of the practices -- especially toning, creative writing and meditation - in the future. A significant finding was that the use of different reference points helped reveal key elements in the participant's life, primarily supporting work with unresolved issues, and creating a memoir for family members. In addition, the research design provided structure and a sense of proactivity for both participant and caregiver.  



OVERVIEW  

This case study report covers a 4-week period of time in the life of a 68-year-old widower dealing with an aggressive form of non-Hodgkins lymphoma. In this study, he is called Nathan. At the time of the study, he had had cancer for 5 years and his disease was in remission for 3 months following a second course of chemotherapy. A week after the study was nearly concluded, his cancer returned.  


REVIEW OF THE LITERATURE  

While the causes of cancer remain unknown, this study considers the possibility of the influence of psychological factors, taking into consideration the research linking negative emotions and their effect on the immune system (Pert, et al, 1998). The primary interest in considering this question is to offer support for a holistic approach in dealing with the disease. 

Certain kinds of cancer have been specifically linked with emotional states such as loneliness and depression (Achte, 1971; Kissen, 1967; Penninx et al, 1998; Schmale & Iker, 1971). Other studies reinforce the belief that one population particularly vulnerable to illness or early death is the bereaved (Bowling, 1994; Creed, 1985; Fredrick, 1977, Martikainen, 1996; Stroebe & Stroebe, 1983). Men handle the stress of bereavement more poorly than women (Brabert et al, 1992; Bennett, 1998; Doka & Martin, 1998; Gilbar & Dagan, 1995; Jacobs, 1977; Wolfelt, 1990). Additional stressful life changes such as retirement, change in body image, change in residence, and loss of social support due to the deaths of friends and family members often leads to depression in the elderly (Hendrickson, 2001), and can cause illness, even in healthy older adults (Lutgendorf et al, 2001).  

By contrast, cultivation of positive emotions through love (Siegel, 1986), laughter (Berk et al., 1989; Cousins, 1979), prayer (Byrd, 1988, Dossey, 1993; Rosch, 2001), social support (Classen et al, 2001; Spiegel et al, 1994), spirituality and religion (Cole, 1999; Horrigan & Lukoff, 2000); and creative self-expression (Dacey et al, 1998; Dossey, 2000) can be important factors in stimulating and strengthening the body's healing response, both in cases of cancer and in other life-threatening situations. Stress-reduction through meditation (Kabat-Zinn et al., 1992), and through exercise (Ardies, 2002), has also been beneficial. 

In their discussion of systems theory and personal creativity, Montuori et al (2003, p. 7) point to Barron's 1960s research indicating that ego-strength (an ego that is "capable of becoming disorganized and then re-organized without falling apart"), is a factor in recovering from illness. This research suggests to me that healing protocols should directed towards helping the patient achieve "systemic coherence" (Montuori et al, 2003), through discovering and addressing those issues that contribute to disequilibrium and the inability to engage fully with life.  

The model I created for my study attempted to provide Nathan with numerous opportunities for enhancing physical wellbeing, relieving stress, discovering and making peace with unresolved issues in the past, cultivating a positive outlook, and affirming inner strength. Sources for this model included in particular the work of Taylor (2001) and Klinghardt (1998), as well as the family systems therapy of Hellinger (2001), the personal mythology and dreamwork of Feinstein and Krippner (1997), and writings on creativity (May, 1975).  

I focused my approach as follows:  

1. Physical body: including the material body as well as the "energy body" as proposed by Klinghardt (1998);

2. Psychology: including the mental, emotional and social aspects of the human being. Personal creativity is the major force that creates identity and meaning (May, 1975). Issues of choice and behavior are also on this level. 

3. Spirituality: including the unconscious, mythic and transpersonal aspects of the human being. Also in this category are relationship to ancestral identity, the dead that have gone before, and the meaning of death (Hellinger, 2001). 


RESEARCH DESIGN   

I chose a single case study design, suited as a method for investigating and generating findings in the complex, unorganized field of holistic healing, which thus far has been primarily validated through anecdotal evidence (Lukoff et al, 1998).  

The participant  

Nathan is a 68-year-old wealthy Jewish heterosexual widower. We became casually acquainted through his wife "Mary," whom I knew as a friend and who died in 1996. Nathan contacted me for support in the fall of 2002, so that he would not be living alone during his chemotherapy treatment. Four months later, he became interested in my studies in bereavement and holistic healing and offered to be a participant for my thesis. He was given a comprehensive overview of the scope of the study and signed a consent form, which was reviewed by the Institutional Review Board of Saybrook Graduate School and Research Center in San Francisco, California.  

Instruments  

There were three semi-structured interviews, which I designed to create a context for Nathan's reactions to the intervention part of the study. These were audio taped, transcribed and checked with Nathan for accuracy. They included:  

1. A comprehensive interview exploring perceived strengths and challenges in relation to physical self and environment, mental/emotional self, and relationship to spirituality or traditional religious beliefs;  

2. A 1/2-hour interview designed to evaluate experiences of the different interventions. This was limited in scope because Nathan was hospitalized at the time; 

3. A review of the first interview to check for revisions and inaccuracies. Due to the return of Nathan's cancer; it was not conducted. 

There were also three 15-minute reviews at the end of each week.  


Interventions  

Nathan was invited to participate in a series of holistic healing practices on a daily or weekly basis as follows:  

Physical body and "energy body":  

1. A daily whole body rubdown, performed on himself when waking -- two to three minutes daily over 23 days 

2. Vocal toning (I participated) -- five minutes daily over 23 days

3. Meditation (I participated) -- five to ten minutes daily over 23 days

4. Fifteen to thirty minutes of wet-on-wet meditative watercolor -- 1/2 hour or more over 2 days. 

Psychology 

1. Visualization exercise from Feinstein and Krippner (1997, pp. 28-31) work in personal mythology - one hour for 1 day

2. Creative writing exercises to enhance self-awareness -- half an hour for 2 days 

3. Painting and writing using symbology from dreams to facilitate self-expression -- half an hour for 6 days 

4. An empowerment visualization to use in case of emotional upset -- half an hour for 1 day 

5. Viewing and discussion of Hellinger (2002) video about relationships and sense of self.   


Spirituality 

1. Daily practice (after meditation) in taking a moment to center himself and experience gratitude (giving blessing out of a sense of heightened well-being), followed by a few moments of being open to receive blessings from an unnamed source of power -- five minutes for 23 days;  

Nathan also explored his dreams in the following exercise, based on the work of Feinstein and Krippner (1997, pp. 71-73):

2. Nightly dreamwork exercise - five minutes over 12 days. 

3. Viewing and discussion of the Sheldrake (1996) video about psychic interconnection -- 1 hour; 

4. Viewing and discussion of excerpts of Home Box Office video "Life Afterlife" (1999) concerning the question of life after death -- 1 hour; 

5. Viewing and discussion of excerpts of the Hellinger (2000) video concerning life and death -- 1 hour; 

6. Viewing and discussion of excerpts of Hellinger (2002) video concerning relationships -- 1 hour. 

Total time involved for this study was designed to be approximately 40 hours. It ended up lasting about 35 hours.  


Data collection and analysis  

Nearly 100 pages of transcript were collected from the interviews, reviews and discussions. Nathan also created seven works of creative writing and 11 paintings. I kept a daily journal. 

The first interview was condensed into the three general themes: physical, psychological/ social, and spiritual. Further analysis of the content, however, showed that there were cross-references from one category to another. I therefore created the following subgroups: perception of physical body and needs in environment; perceived mental capacity; perceived emotional capacity; family background and parental support; educational experiences; career choices and identity; social, family, and romantic relationships; creativity and self-expression; regrets; the impact of the illness; spiritual beliefs, and questions of meaning, purpose, and fulfillment.  

Additional analysis of the different subgroups was based on looking for links between the different areas, in order to see if there were any underlying patterns, particularly in areas where there were unresolved issues that might be positively affected by the interventions. For example, Nathan stated that he had a need for a spacious living environment; this was later reflected in another statement about a need for independence and freedom. 

With this interview as a basis, the different interventions were also analyzed in terms of how they related to the key issues. For example, the issue of freedom showed up again in one painting Nathan did that had a bird shape in it, and also in a dream about flying.  


Ethics and personal bias 

It seems important to note the special qualifications and potential biases brought to this project. I lost my spouse to melanoma cancer three years before the death of Nathan's wife, and my mother to cervical cancer three years ago. I have been researching bereavement and holistic healing since 1994, have worked as a hospice volunteer in the bereavement program, and recently became certified in the phenomenological family systems therapy of the German psychotherapist Bert Hellinger (Hellinger, 2001). Part of my research included exposing Nathan to this approach through viewing of excerpts from two videocassette recordings of Hellinger's training workshops.  

Because I am not a professional health caregiver or psychologist, I primarily chose the sorts of activities that the average person can be exposed to from books, other media and workshops available on the market. I have also had nearly two decades of experience working in communities teaching holistic healing and spirituality and I am familiar with the field from a layperson's perspective. I drew on this background and my own practices to act as a guide, participant, and facilitator of Nathan's process.  


RESULTS  

Participant profile prior to study  

Nathan presents as a sensitive, courteous person with a good sense of humor, who can also be impatient, volatile, defensive and scattered. He became ill with chronic lymphocytic leukemia (CLL) in 1996, six months after his wife "Mary," died of cancer of the mouth. CLL is a serious, but not necessarily lethal blood cancer for which there is no known cure. He was treated with chemotherapy and the disease went into remission. 

In late 2002, a blood test revealed that the cancer had returned and the CLL had gone through a "Richter's transformation" (Giles et al, 1998), and became large-cell lymphoma, a much more deadly manifestation of the disease. The prognosis for individuals with this illness has been poor, with survival for many only around 5 months, and conventional chemotherapy has not been very successful. Up to the time of the study, Nathan had worked almost exclusively with one oncologist, a traditional doctor in his late thirties who, according to Nathan, discounts the usefulness of complementary/alternative cancer therapies and does not even offer the more standard advice about helpful dietary changes or exercise.  

The study was initiated at the end of May 2003 and concluded 4 weeks later, at the end of June. I had been a caregiver for Nathan for 7 months and he had sustained another treatment of chemotherapy, which had put his disease again into remission during the study.  


The first interview  

Perception of physical body and needs in environment  

"I've always trusted my body," said Nathan, "I've always felt pretty good in my body, until this illness." He points to his prowess as an award-winning athlete as an important part of his identity, calling his gift "a door-opener, the equivalent of being a beautiful woman."  

Even though he knows he tends to be disorganized, Nathan affirmed the importance of having his environment neat and attractive. Above all, he said the perfect environment is "space, ample space," relating this to his "deep need for independence and freedom."  

Perceived Mental Capacity   

 "I've always thought I was smart, could figure things out," said Nathan. He thinks he may have a learning disability, because "I tend to want to get information verbally, not literally. I don't know if that is because of dyslexia." He calls this difficulty of processing written information, "laziness." He feels at his intellectual best "discussing contemporary events." 

Perceived Emotional Capacity  

Nathan affirmed that he, "like everyone," can feel emotions and expresses them today more than he used to. Alluding to his occasional outbursts of temper, he said, "When I really feel something and I express what I feel, I've never once felt bad. However, "when I have said something stupid in a public environment, then I toss and turn and I feel bad."  

Nathan is most comfortable being himself "with two or three people around a table, and also in teaching." Although he said "there are very few environments where I have difficulty expressing myself," he also admitted "there are many environments where "actually I really don't say much, because I'm uncomfortable . . . maybe because I think that no one is terribly interested in what I have to say anyway."  

Laughter comes most easily to Nathan when it concerns "mockery of the human condition, because the essence of Jewish humor is self-ridicule." He said, " over the years I've cried mostly when I've anguished about my kids, and obviously loss of Mary. Occasionally when I think about me dying."  

Nathan said he has felt love often in life, but thinks, "sometimes it was lust." Today, he defines love more as "companionship, a strong support system, strong friendship. It's to some extent a kind of elegant dependence."  

Nathan mentioned more than once in the interview that he has "always had a fear of loneliness."  

Compared to a hermit, Nathan said he "needs people," although they usually make the effort to see him:  

You see, I don't make phone calls. I don't call people up, [possibly because of] fear of rejection. That's probably the most logical one. Who would want to see me? 

Later on, Nathan corrected himself and said he had no problem calling women on the phone:  

I guess what I'm saying is that it wasn't terribly important that I saw [my male friends]; it was important that I had someone to have dinner with Saturday night.   


Family Background and Support  

Nathan spoke of his parents with high regard, and said he had a "very, very lucky childhood."  

Later in the interview, Nathan added to the picture:  

They weren't paying attention. I was kicked out of schools because I was a difficult kid. I wasn't very good at obeying the rules and that's not a credential, because I think it was about getting attention.  

Nathan said his big mistake was his choice of career, made he believes now, to please his father:

I was an engineer in college. . . I had no interest in engineering. I don't know why I did it; it was a mistake. [If I had done it differently], I think probably I might have studied acting [something in the arts]. I was exposed to painting as a kid and I didn't pursue it. 


Career and Identity in Work  

Nathan said he went into business "because it was the easiest way for me to make a living." I think I'm a B minus, B businessman. I don't know exactly, but I think I could have been A+ in something. What I am [now] is an A+ dilettante."  


Relationships  

In general, Nathan said that he makes friends easily and is very easy to get along with: "I don't have demands; and I don't think that's good or bad. You don't get up and decide to make demands; it's just how you are."  

Nathan spoke of "screwing up" two of his romantic relationships because he did not want any more children. He also said he thinks he missed out on "learning from what the person had to offer" in some of his relationships, and mentioned Mary's gift for foreign languages as a missed learning opportunity.  

Nathan said he had "never taken the fidelity part of marriage or in a relationship terribly seriously," and he has been very wary of being manipulated and judged by the women he is with: He thinks need and partnership are really a defense against loneliness, and points to elderly people who die after their partner dies, saying "there's a reason why that happens," and it is about "a silent support system, the strength and girth of which you don't notice until it's gone." 


The Impact of the Illness   

Nathan said the biggest physical challenge he has ever dealt with has been the cancer, and the worst emotional challenge of the illness was when he was told he was out of remission. He summed up his approach to dealing with these challenges by saying, "Tough it out, it's going to pass. Kind of grasp the optimistic responses around you." 


Spirituality

Nathan has not thought about drawing on his Judaism for spiritual strength in a crisis, but considers he might in the future. He expressed ambivalence about prayer; in one part of the interview he said he had not; in another he said he thinks he has, in fact, "mumbled prayers at times," maybe during the illness.  

Nathan expressed an interest in his dreams, believing "they do reflect who you are." He also described times he felt he could transmit healing power to others. He is curious about the afterlife, "one of the biggest adventures of living." He is "hard pressed to think that there is nothing afterwards" and sometimes says aloud to Mary "Tell me what it's like." He "fully expects to see her somewhere" after he dies. 


Regrets

Nathan says he has few regrets because he has tried "not to live a compromised life." His greatest regrets concern his personal relationships and missed opportunities: "I didn't put a big value on love that I should have. . . ."  


Questions of meaning, purpose, and fulfillment  

Nathan said he had always thought there was some meaning and purpose in his life, but could not define it: 

That's why I'm here. I'm here to do something. And I don't know what that something is. I've occasionally said to myself, "Is there a master task, is there a larger task for me to complete before I die?" 

THE INTERVENTIONS  

Overview of mood during the practices  

Despite his willingness to be a subject in my study, Nathan seemed in the beginning to be tense and resistant. This could have been the result of negative experiences in the past with learning new skills, suggested by his comments concerning problems in school. There was also his concern, mentioned in the interview, about being manipulated. While pondering the source of the tension, I remembered a note he wrote for me to read in the early days of my time at his home last winter: "I must be strong and find my own way. I can rely on no one else for this task, Miss Rondie" (1/7/03).  


Descriptions and results of the Interventions  

The different practices, along with Nathan's responses to the aforementioned evaluation interview, were as follows: 

Four powers exercise  

The purpose of this exercise was to ground and center Nathan by affirming his strengths. After choosing words, symbols, images, or colors for his powers, Nathan was to imagine standing in the center of his "ring of power." He was invited to use this visualization at times when he felt disoriented and off-center. Nathan chose to use words; his four powers were:

I run fast; 

I support the underdog;

I teach well; 

I debate well.  

Nathan's assessment: When we discussed his positive reaction to this exercise, Nathan said, "It was like going into a closet and closing the door and finding on the wall, photographs." 


Body rub  

The purpose of this intervention was to enhance Nathan's awareness of his body and to stimulate his circulation and promote a sense of wellbeing. It consisted of a 5-minute self-massage, beginning at the top of the head and ending up with the feet, followed by some deep breathing and stretching.

Nathan's assessment: " I found it a pleasant exercise. But I didn't feel any different. I might continue." 


Vocal toning

The purpose of this intervention was to expand the chest, introduce vibration into the body, exercise the lungs, and increase the ability to produce and hear overtones in a tone. 

Nathan's assessment: The toning I like. I've done it alone since. I think the biggest benefit was that it made my voice stronger and I've heard people who sing live longer, so I would continue. At times it did feel like a release of tension. 


Meditation

The purpose of this exercise was for stress reduction and to increase awareness of inner resources. In general, Nathan only wanted to meditate about 5 minutes, although near the end of the study, we were sitting for about 7 or 8 minutes. 

His review of the practice showed his ambivalence and ways in which the practice touched on some painful issues: 

Nathan's assessment: "I don't know. I didn't wildly look forward to it and I didn't not look forward to it. It's almost neutral. It's about emptying yourself of thought. Where it helped me the most was [when I was in the hospital]. It is probably something I would like to pursue."

When I asked if the practice helped with anxiety, Nathan responded: 

No, no. I think it might help me get better. Half the time, Rondi, I don't know whether I'm afraid of living or dying. I don't know which it is. But maybe when all is said and done, like before, the problem that I had with anxiety after the chemo and I was in remission, I said, "wait a second, I don't have a mission." That of course makes you feel like someone who has no idea how to wander into the woods and find a path. And I don't like that, and I fear loneliness. I've always feared loneliness. So there are things that I think I should try that I think would be helpful.  

The purpose of this intervention was to acquaint Nathan with an exercise akin to prayer, enhancing a sense of connection to transpersonal dimensions of experience, but not requiring the naming of a deity or adherence to a specific religion. It was based on a visualization that began with inviting healing energy into your body, as in the concept of feeling the presence of the Divine (Paloma, 1993). This exercise was to be done at night, just before he went to sleep.

Nathan's assessment: "I couldn't wrap my arms around it." At the end of the second week I could see that the exercise was not working for him. I therefore invited him to draw on his memories of doing healing practices with his children, as described in the initial interview. I suggested that he imagine sending healing energy to someone before he went to sleep. He reported later that he visualized sending it to himself and in the assessment said: 

It could make some sense to do, almost like a feeling of a great something that would start at the top of my head, pierce my body, and push all of the cancer cells out through my feet.   



Creative writing

These exercises were based on the work of the poet Paul Matthews (1994), who writes, "The laws of grammar are an outward manifestation of the laws at work in the human soul, and that same 'Logos' is involved in the shaping of the world around us" (p. 3). Nathan has a history of writing humorous poems, all of which rhyme, so this approach was new to him and he was tense and unsure in the beginning. I hoped that Matthews' writing exercises would stimulate Nathan's imagination and to help him develop a sense of different voices within him: the affirmative, the inquisitive, the enthusiastic, and the determined. There were 7 sessions with this focus; I present two here: 

Session III (6/6/03):

In this exercise, I asked Nathan to focus on his body and write using a poem using the four voices: statement, question, exclamation, and command (as in Matthews, 1994, pp. 8-11). Nathan ended the exercises with his own verse that summed up how he felt about the subject of his writing:

Creative writing: Focus on body 

Statement  
     My legs are leaden 
     I've always trusted my body 

     I don't miss my spleen 
     It ain't bad not having hair  

Question  
    What is happening inside? 
    Why is it happening?  
    Where will it go?   
    Will my strength return? 

Exclamation  
    Boy, this is a drag!  
    Make the best of it! 
    Other things open up!  
    Life is okay! 

Command  
     Stop complaining  
     Start creating  
     Use your time  
     Appreciate what you have 

Free writing  
    A fear my friend I must confide 
    is what perhaps goes on inside 
    while my legs are leaden  
    where am I heading  
    I'll stop complaining 
    during years remaining. 


Session IV (6/7/03): Writing about a dream.  

I asked Nathan to do a 5-minute stream-of-consciousness writing (Matthews, 1994, pp. 70-71) about one of his dreams, then to choose his 10 favorite sentences and to write them with the words "I remember" at the beginning of each sentence (pp. 26-27), while turning the second half of the sentence into a simile (pp. 45-46). Next, he was to write, "I am" (pp. 55-56) at the beginning of the same sentence while turning the simile into a metaphor (pp. 49-50).  


Creative writing: Three approaches to a dream 

Exercise 1. 

Driving north on Lumber to Scuttlehole, left turn feel good sunny day come to Sag turnpike, take left. Road unrecognizable trees branches covering road. Careful. Road starts twisting. Where am I? Road veers left becomes narrow brook. Road becomes stream. I ride on edge, dangerous. Afraid that I will topple into stream. I ask some girls to help me push bike up incline. They are unable to help. Wonder how I'm getting home. Finally I'm able to move bike. where am I? I think if I travel south I will get to Rte 27. How did I get to the North Shore? I am surprised I am able to move bike but relieved. I feel okay not worried not fearful of being lost. 

I remember driving north on Lumber to Scuttlehole Road like emerging from an underground tunnel to the sunlight.

I remember the canopy was like a warm quilt on a cold winter morn. 

I remember the unrecognizable road was like going to a dinner party and forgetting everyone's name.

I remember the road veering like the staggered path of an inebriated partygoer. 

I remember the road became a stream like the leaves of summer turning to Tuscan red. 

I remember thinking where am I like a blinded man groping for a telephone receiver. 

I remember feeling ok like a weight has evaporated from my shoulders.

I remember traveling south like the migratory sunseekers do in the frosty north.

I am a dinner party, forgetting everyone's name. 

I am the staggered path of a drunken partygoer. 

I am the blinded man groping for a telephone in a strange room. 

I am the weight removed from my shoulders. 

I am the migratory sunseeker traveling south to seek escape from the frosty north. 

Nathan was very pleased with the results of this exercise, and especially liked the third verse. I was fascinated by the way his writing leads one from outer to inner experience, each time becoming deeper and more rich. Nathan commented on "I am the weight removed from my shoulders," saying, "It's like you are your own worst enemy."

Nathan's overall assessment of the creative writing: 

It had real benefit. All of the exercises were interesting in one way or another. I like some of the images and the surprise endings like, "I am a dinner party, forgetting everyone's name." They were unpredictable, but worked, almost were like double talk. I could build on some of those, write more. The exercises opened doors into a room I've never been and I'm curious to explore the contents of that room, so the benefit is really in the future.


Painting

This exercise had two related goals. The first was to provide Nathan with a relaxing, fun experience and to stimulate his senses with color. The second was to allow him to explore some of his dreams in a rather "dreamy" medium. The exercise was done with a one-inch soft brush on a wet piece of watercolor paper that was laid on a flat surface. The only colors used initially were red, yellow and blue. In later sessions, green, orange and black were added to the palette. The color mixing was done on the wet paper. The exercises were inspired by the watercolor painting approach taught in schools based on the work of the Austrian philosopher/mystic Rudolf Steiner (Alexander, 2000). 

Nathan painted 11 paintings over the four weeks; the last one was in acrylics. Of all of the paintings he created, Nathan's favorite was the first, an experience of the color blue. I believe this exercise worked well because the color limitation reduced the desire to "make something," and allowed for pure experience. His second favorite painting was of a dream he had of a winding road on which he was lost. I asked him to sit quietly before beginning, to fully review the dream and "not to think!" Then I asked him to begin by painting the emotional content in the dream, and then the details, using wet on wet watercolor and, if desired, watercolor pencils. Nathan became very excited by the different elements in the work and how they related to one another, finding them both threatening and also comforting. 

Nathan's final painting was done in acrylics, a medium with which he was more familiar. I invited him to choose one of his earlier dream paintings and do it over again. He chose the road painting. This time, however, the road became a hill-like form, consisting of many stripes of different colors, at the bottom of the canvas. Above and behind the hill loom large circular forms in different colors, suggesting clouds or balloons. In the center of each circle he painted a black blot, some of which suggest the shapes of birds (See Figure 1). 

Nathan was dissatisfied with the results, feeling that the acrylic paint did not flow as easily as the watercolor. When we talked further about this painting, I had the inspiration -- based on the writing exercises we had been doing -- to ask where he thought the "noun," "verb" and "adjective" energies were in the painting. He decided that the static aspects were the noun, the gesture of the hill was the verb, and he described the bird shape in the center of one of the round shapes as the adjective and said it could not get out of the circle. When I asked him, therefore, what the sentence for the painting might be, he replied, his voice husky with emotion, "It's always about freedom for me." 

FIGURE 1: Nathan's Final Painting

Nathan's Overall Assessment of the Painting Practices:

Yes, there was definitely benefit and it was interesting. I've never tried to paint a dream. It was frustrating also. I don't know why. This one is mixed metaphor; that one is muddy. [As far as working with the unconscious], I actually think doing some of these things may have been the genesis for the frustration in [the painting I have been doing on my own]. There, I'm tracing, in a funny way. This may have made my other work not as satisfying.

I was moved to see how the issue of freedom arose as a result of doing this painting; I also wondered, having read of Siegel's (1986) work with painting and cancer patients, whether the black blots inside the round shapes came from Nathan's intuition that his cancer was returning. In fact, at the end of the study, this was confirmed.  

Personal Mythology Visualization Exercise 

The purpose of this exercise, done one time only, was to stimulate a sense of how one's ancestry has contributed to one's identity and to discover what, if any, buried assumptions and misperceptions were created by the influences of parents and grandparents that contribute to a negative personal mythology. It was based on the personal mythology work of Feinstein and Krippner (1997, pp. 28-31). After imagining himself in the body and consciousness of his parents and grandparents, Nathan was to focus on his own body and formulate a core statement for his life, based on what he had discovered about his past influences. 

The purpose of this exercise was to learn how to pay attention to images from the unconscious arising in sleep. It was based on my own studies and the dreamwork exercises in Feinstein and Krippner (1997, pp. 71-73). During a preliminary discussion about the exercise, Nathan shared some of the dreams that he had had about Mary. Although I stressed that programming oneself to have certain dreams and to remember them is not necessarily successful, nevertheless it seemed that Nathan became quite goal-oriented, with the result that he hardly dreamt at all. The strongest dreams that he had during the study occurred before I taught him about dreamwork. 


Viewing and Discussion of Videos

In addition to the different practices, Nathan was shown excerpts from four different videos. The excerpts were chosen in order to inspire a discussion about different ways of knowing, death and the afterlife, and buried issues in relationships.

Nathan entered the hospital and died peacefully three months after the study was completed. Once he had made the decision to cease treatment, he stopped eating and focused on dying "as soon as possible." He did not seem to be afraid and at one point, observing the progressive breakdown of his body systems, he commented to me, "things are moving along quite well." In the two and a half weeks before his death, he was able to say goodbye to his closest friends and to have important and loving conversations with his children.   About a week before he died Nathan asked me to give a copy of the study to each of his children so that they would "truly know their father."

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