Table 1 Category definitions for the concepts used in the research questions

How are patient’s ultimate life goals and experiences of contingency expressed in the work of art as created in a process of co-creation?

1. Experience of contingency^a

The experience of a disruption of one’s life narrative, possibly to the extent of an existential interpretation crisis, caused by a conflict between a life event and one’s ultimate life goals and world view. The life event, which was “neither impossible nor necessary, it could have happened otherwise”, irreversibly introduces a new and undesired future, in which one’s existence and life goals are threatened. This makes one wonder and even doubt one’s own life’s fundamentals.

2. Ultimate lifegoals^a

People’s personal goals come forth from their beliefs and world view. One’s goals are anchored and justified by one’s world view, which determines the meaning one attributes to a life event. Ultimate meaning in one’s life comes from one’s ultimate life goals or values. Ultimate life goals and values are formulated in an abstract way and cannot be replaced by something else.

3. Expression in the work of art^b

The expression in the work of art of one’s experience of contingency in combination with an evaluation of one’s ultimate life goals.

How do the four phases of integration of experiences of contingency unfold during co-creation?

1. Art communications^b

1.1 Tracing different aspects within the life story of the patient

1.2. Communication through the senses and choice of art material

The patient’s life story is explored by looking for important elements that are valuable to the patient. These so-called ‘different voices’ within the life story can sometimes oppose each other. Aspects of the life story are uncovered which the patient was not (fully) aware of.

Experiences of contingency within one’s life story are explored by using all the ‘senses’—touch, smell, hearing, vision, bodily sensations -- and emotions as a first entry. A further elaboration of these experiences of contingency unfolds by using one specific aspect of the senses to focus on certain elements in more detail. Subsequently, specific art materials are linked to the exploration of these experiences of contingency and used for a further exploration and expression of inner feelings.

2. Element compilation^b

Various combinations of the elements originating from the expression of the ‘different voices’(see 1. Art communications) are put together, representing alternative story lines of the life narrative. The iterative combinations of these elements lead to compilations which create a new perspective on one’s life story

3. Consolidation^b

The artist together with the patient or the artist alone create the actual work of art. The elements that came forth from the patient’s expression inspire the design of the art work.

4. Reflection^b

Patients can simultaneously reflect upon the created work of art, their new life narrative and on the (co-creation) process of arriving both at the work of art and at their new life narrative. Standing on its own, the work of art has a capacity to transcend time. The patient can allocate new meaning to the work of art in his/her own unique way every time he/she observes the work of art.