Medical clowning

Domain VIII · Creative & expressive arts therapies · Michael Christensen, Patch Adams, Wellington Nogueira · 1986 · New York

What it is

Medical (hospital, healthcare) clowning is a performing-arts practice in healthcare, not a psychotherapy and not a treatment for disease. Professional clowns, usually working in pairs and in a parody "doctor" persona, visit patients (mostly children) on wards, in clinics and during procedures. They…

Format

• Medical clowning is a programme delivered in recurring visits, not a course of sessions with a set number. Its structure runs on three levels.
• Ward briefing: get updates from the ward and talk with staff before seeing patients. EFHCO members use standard procedures for contact, information flow and preparatory reports. The work goes better when staff openly share information about each child's health status and each family's wishes.

Who practises it, and how they are trained or regulated

• Professional frame. Medical clowning is not a regulated health profession in most countries. In the UK it is not an HCPC-registered arts therapy, and it is not drama therapy. The standards come from the clowning organisations:
• EFHCO full members hold a Quality Label with on-site managerial and artistic evaluation and audits every five years. Clowns are professional artists with at least 500 hours of specialised healthcare training.
• Doutores da Alegria requires a professional actor or clown registration (DRT) and a clowning specialisation. Selection has three stages (CVs, workshops, a test in hospital), followed by a year of weekly hospital work with a trainer clown plus a weekly training day.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Over-stimulation. Keep movements slow and predictable.
• Embarrassment in front of peers, and privacy in shared bays.
• Your own grief. Arrange supervision or a debrief after such visits.
• A child who becomes sad at the goodbye. Name the next visit only if it is scheduled.
• Clinical language in clown reports. Describe what happened and avoid interpreting it.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.