Organising oncological chaos through art-based witnessing in cancer survivorship

Background: Cancer survivorship often involves profound psychological, existential, and identity disruptions that are not easily addressed through conventional frameworks. Art therapy offers alternative expression and meaning-making, yet the experience of art-based witnessing in survivorship is underexplored.Aim: This study examined how women with cancer experienced witnessing, self-witnessing, and mutual witnessing in long-term art therapy and developed frameworks to illustrate how art-based processes support the organisation of survivorship experiences.Methods: Using Interpretative Phenomenological Analysis (IPA), we conducted an in-depth qualitative study with 16 women in a nine-month art therapy studio, facilitated by a trained therapist. Data included semi-structured interviews, reflective journals, and visual materials from the studio process and a public museum exhibition.Results: Two contributions were identified. Oncological Chaos captures the nonlinear, disordered, and overwhelming nature of the survivorship experience. The Ecology of Witnessing, comprising self-witnessing, mutual witnessing, and artwork as witnessing, describes interdependent processes through which participants organised, articulated, and made meaning of their experiences. These layers support emotional regulation, identity reconstruction, and relational and existential coherence.Conclusions: In a therapeutic context, art-based witnessing provides a significant means for survivors to navigate the complexities encountered post-treatment.Implications: Findings highlight the value of long-term open-studio art therapy in survivorship care. Future research should examine the applicability of the Ecology of Witnessing across diverse populations and settings and its relevance to psychosocial oncology policy and programme development.Plain-language summary Many people who have had cancer continue to face emotional, psychological, and identity-related challenges long after their treatment. Standard clinical and verbal approaches do not always help people express or make sense of these experiences. This study explored how cancer survivors experienced being witnessed, having their suffering seen, heard, and acknowledged, through participation in a weekly art therapy open studio group over nine months, ending in a public exhibition.Sixteen women with cancer took part. Data were collected through interviews, personal journals, and artwork created during the studio. We used Interpretative Phenomenological Analysis (IPA), a qualitative research method that focuses on how people make sense of meaningful experiences, to analyze the data.Three forms of witnessing emerged. The first was self-witnessing: moments when participants noticed and acknowledged their own emotions, fears, hopes, and changing sense of identity through the creative process. The second was mutual witnessing: being seen and recognised by other group members, which created a sense of safety, belonging, and connection. The third was the artwork as witness: the artwork itself became a container for experiences that were too difficult to put into words, including unfinished works shared as silent testimony to ongoing struggles.We introduce the term Oncological Chaos to describe the non-linear, disruptive nature of life after cancer; a state in which identity, meaning, and bodily continuity are deeply unsettled. We also propose the Ecology of Witnessing, a three-layered framework showing how self-witnessing, mutual witnessing, and the artwork working together can help survivors organise and make sense of their experiences.These findings suggest that art therapy open studio groups can provide meaningful support for cancer survivors by offering multiple, interconnected ways to feel seen by others and by the creative process itself.