Art Therapy with Young Survivors of Sexual Abuse

Lost for Words

Jenny Murphy

• Publisher: Routledge
• Year: 2003
• eBook ISBN: 9781134626601
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Dealing with the aftermath of childhood sexual abuse remains one of the major issues in child and adolescent mental health. Yet, until now, little has been written for art therapists and related professionals involved in this sensitive field. Art Therapy with Young Survivors of Sexual Abuse is a guide to practice with this group. Containing a range of illustrative case material from both individual and group therapy, the book addresses the important issues faced by professionals, including:
* male therapist countertransference
* the therapist's relationship with the client's family and wider networks
* assessment using art therapy
* the value of art therapy with groups.
Art Therapy with Young Survivors of Sexual Abuse will provide not only art therapists, but other professionals working with sexually abused children and adolescents, with a stimulating discussion of the current issues in this area.

Part I
The therapeutic relationship in context

Chapter 1
Containing the bad object

Observations and thoughts on the generation of bad feelings between people in an organisation, a professional network, a therapist, and a child attending individual art therapy

Louis Thomas

INTRODUCTION

In this chapter I shall attempt to describe some of the key issues experienced through the conducting of one-to-one art therapy with a pubescent girl (‘Joany’) who had accused her grandfather of sexual abuse.

As part of Joany’s testimony in court she had been found to be clearly lying about one aspect of her account of events leading up to her abuse. She had admitted in court that she had lied, but said she had only done so to try and make sure her grandfather was imprisoned for his crime against her. As a consequence, her other evidence was then treated with suspicion by the jury and her particular attempt to secure safety for herself influenced the direction of the case. As a compromise in what became a very convoluted enquiry, the court forbade Joany’s grandfather any contact and he was subject to a restricted movement order.

It was at this point that Joany came to my attention, carrying all the ambiguity that her family and professional network were unable to bear. They had become resolutely split into those who believed her and those who did not. Grandfather was seen as either an evil man who deserved an unpleasant death, or someone incapable of any wrong-doing. Joany was seen as either a crazy liar or a child giving an accurate account of an abusive experience that she had suffered. There was little space for anything in between. The anxiety created in Joany by the splitting of her family and professional network only served to compound her already fragile mental state. In a stark and transparent way the case of Joany mirrored many of the difficulties inherent in this work ever since Freud (1905) began uncovering and attempting to unmesh the reality of both actual abuse and childhood sexual fantasy. But perhaps most ironic of all was the way that this case highlighted for me how very susceptible we can all be today to employing splitting as a defence against unbearable uncertainty.

This chapter concerns itself with the generation and dynamic movement of bad feelings between the one-to-one therapy relationship, the professional network and the organisation. It will therefore be useful first to provide selected information on the organisation and the context within which the following casework transpired. (The example organisation is no longer in operation.)

PART ONE

The organisation

With current political and ideological concerns moving towards caring for vulnerable children in a family setting wherever possible, the organisation (hereafter referred to as t.o.) took steps to develop a much needed service which would begin to address topical child protection needs. A special project was created which aimed to provide therapy for children who had experienced sexual abuse, or where it was deemed ‘highly likely’ that they had experienced such abuse.

Several months into the life of the project an emergency meeting was called because of increasing unrest over difficulties being experienced in working with this client group. In response to this disquiet, in-house training was provided for the worker/therapists. A feeling expressed at this training was how ill-equipped people felt themselves to be for the job of therapy. Also, increasing concern was voiced as to what forms of support worker/therapists would receive in the event of a false accusation or ‘honest lie’ (Ironside 1995) being levelled at a therapist ‘specifically in the therapy situation’.

It is interesting to note that the two main ways of dealing with these particular anxieties were: (a) seek further training and clinical supervision, or (b) do not undertake therapy work, but instead attempt to deal with the emotions raised by teaching the children how to ‘say no to paedophiles’. The latter option was considered but eventually rejected. There are likely to be many reasons why this second option even got as far as it did. However, I think one partial reason is because it is a serviceable way of unconsciously converting the emotionally disturbing material brought by the child into anxiety-relieving action, which in turn, by processes of projective re-introjection, pulls the primary anxiety now embellished with guilt and shame back into the child. This is a quite ordinary defence against experiencing overwhelming emotional pain, but a form of splitting that, if not promptly addressed, creates additional problems for the child and sows the seeds of divisive defences to become underwritten as part of team culture.

The therapeutic setting and my theoretical orientation

The Centre was based in the community. My manager, colleague therapists and I each had our own dedicated therapy rooms and there was also a comfortable waiting area.

My own practice is informed by a range of psychoanalytic theories and recorded modern practice with children by child development researchers, for example: Stern (1985) and Piontelli (1992), baby observation and personal psychotherapy. I employed a variety of public or shared toys and art materials together with private art folders. I saw children on an individual basis once weekly for up to three years. I also offered discussion time to parents on a less intensive basis. Frequently, my manager, co-therapists and I would work jointly with a family, usually with one of us providing work for the parents while the other/s worked with the child or children, Here, we found an ‘open systems’ approach (Skynner 1987:307) invaluable.

The network

The professional network consisted of the usual public-sector children’s services including the more well known voluntary childcare agencies.

The therapy team

Good case management supervision was provided by my manager. However, it was part of t.o. policy that external clinical supervisors should not be used for reasons of security of sensitive information. I was very fortunate in being able to retain essential external clinical support in the form of a ‘discussion group’ which was accepted as an extension of the further training I had embarked on before taking up the post.

Although it was difficult for t.o. to appreciate the therapist’s needs for external profession-appropriate supervision, t.o.’s training committee rapidly responded to requests for clinical support by recommending a private consultant who specialised in the use of auto-suggestive techniques. To give an example of the person’s style: when attempting to explore awful feelings of adversity (splitting) causing acting-out within the team, we were advised to visualise (in difficult moments) a child’s potty in the middle of the floor in which we were to imagine defaecating.

Even after consultative experiences of this nature, the pursuance of profession-appropriate supervision was still discouraged, as it was felt by t.o.’s training committee to be more important to continue to seek support from what was described as more open-minded, ‘eclectic’ therapists rather than from people familiar with what was felt to be more medically sympathetic practices. Of course, this view led to tensions developing, which were all the more difficult to digest because, ironically, different ideas from outside t.o. could not penetrate to help circulate and process the many feelings that were coming to light during the unfolding of much disquieting work. The individuals that combined to make up t.o. had by now become pierced by a quite paralysing and indiscriminate fear of intercourse. There seemed little difference between the fear of abuse and the feelings raised when suggestions were made to involve an external supervisor. Although this defence is primarily one driven to protect, it does so by incestuous means.

The concept of ‘difference’ and the quality of the emotions this idea raises in people working specifically in this field does seem to be a key issue to try and understand. The lack of acceptance of profession-appropriate clinical supervision, coupled with the tendency to idealise eclecticism, points (in this instance) to a confusion developing between accommodating to unsatisfactory working relationships and relating by having different needs and qualities recognised, nurtured and built upon. Particularly noxious tensions develop around forces that pull towards skills mixing or forces that push for individual recognition and the complementation of unique strengths and skills. Perhaps one way of beginning to understand the conflicting anxiety and resistance surrounding these concepts is by observing the tendency of many of the referred families to have difficulty with the range of emotions that help demarcate the needs of the adults from what is healthy for the children in their care. Often it is deeply disturbing for families operating on this enmeshed level to allow their children an ordinary level of separate functioning. The need to project inappropriate personal qualities into the child, and subsequent unsuccessful attempts to control these in the ‘object’ of their fantasies, is indeed massive. Absorbing such disturbing material in large quantities and without access to clinical supervision greatly increases the chances of such dynamics needing to find an outlet in t.o. and team. It became a struggle at times to disentangle identifications made with the abused and deprived parts of the children in therapy from the more ordinary management and worker agitations stirred up, for instance, by time restrictions necessary due to a growing waiting list.

What did become clearer was how overwork with sexually abused children, together with deprivation of training, personal therapy and profession-appropriate supervision, can eventually be translated into power conflicts and controlling actions instead of emotion-attuning thought. Without the basic supports in place, sharing thoughts about the patients’ emotional lives raised too much pain and conflict to deal with effectively. For example, it really was difficult for the team to hear about Joany’s inner world and my closeness to it without becoming caught up in the fantasies stimulated by such intimate case material. Getting close to an abused child on an emotional level became a dreadfully frightening proposition for everyone concerned.

Through processes of projective identification the children are putting into the therapists the fundamental fear that closeness leads to loss of sexual control—after all, this is often part of their experience. What appears to be happening is that the revelation that sexually abused children need to use their therapy time to test out their own, the internalised abuser’s and their therapist’s sexuality, provokes yet further alarm within the system. Preparatory work in the form of pre-therapy case conferences with all involved professionals, to look specifically at the complications involved in working with transference issues with children with damaged or limited symbolising capacities, becomes an important part of the work before any kind of therapy begins. It may be that where it is known that a sexually abused child’s capacity to symbolise is impaired in any way, therapists should take the necessary precautions in securing at the very least an understanding and supportive professional network before commencing therapy.

Here it would be useful to move into the very material that instinctively raises such anxiety, as one’s own sense of intimacy meets with the child’s and the abuser’s by proxy.

PART TWO

The clinical work and commentary

Joany, Session 28, Aged 10

Joany paints a picture of herself drowning in an ocean with a lightning storm raging above her. She cries out to her mother and, drawing a speech bubble coming from the mouth of herself, writes: ‘Mam you weren’t there.’ The painting depicts a prone and spread-eagled Joany being engulfed in a ‘messy and polluted-sea’. Above, in the sky, there are two clouds, a lightning bolt and much rain. The juxtaposition of the elements in the sky gave the impression of a bristled face bearing down. As Joany painted this picture she told me that her mother and father can’t hear her when she asks for help, but that I can. (I was wary here of not wishing to collude with any possible idealisation of me, while also bearing in mind that she seemed to be expressing a need to experience me as someone who can listen to her.)

Joany told me that her mother doesn’t realise that she (Joany) needs help when she communicates this to her by ‘…not eating my food or being grumpy with other people’. I said that perhaps a lot of adults find it difficult to catch on to children’s hints. Joany replied: ‘But you do’ (meaning I do catch on). I told Joany that I knew she was unhappy and calling for help because she had both told me so and had shown me with her painting, and so in this way perhaps I had an unfair advantage over her parents. I thought aloud: ‘I wonder how your parents might hear that there are times when you need a cuddle?’ (Joany had also mentioned her needs for cuddles). I tried various other ways of attempting to lead Joany to the discovery that maybe she would benefit by telling her parents, to no effect. Eventually I just suggested that maybe she could tell her parents too? As I spoke Joany leaned on me with her elbow. I allowed her to do this as I felt she was in touch with a part of herself that had felt deprived of emotional nurture, and that she was perhaps needing to experience a benign non-sexual touch. However Joany then tried to kiss me on the cheek and I backed away, telling Joany that I could not allow kissing. Joany took a step back and slapped me across the head as she left the art therapy room to use the toilet.

When Joany returned, I asked her if she had felt rejected by my refusal to let her kiss me on the cheek. Joany confirmed this and added that she thought I was cruel and ‘even worse than cruel. You’re childish! I only wanted to kiss you on the cheek.’ (I wondered if Joany experienced my recoiling from her as a form of sexualisation, in that what she had regarded as a benign action was taken by me to be one that was malignant or perverse.) I tried to overcome what I experienced as a dilemma between maintaining the appropriate boundaries while also conveying (in a sense) that she is lovable, by recapping on the preceding interactions and feelings, giving them a...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• ILLUSTRATIONS
• CONTRIBUTORS
• FOREWORD
• INTRODUCTION
• PART I THE RRAPEUTIC RELATIONSHIP IN CONTEXT
• PART II WORKING WITH INDIVIDUALS
• PART III EXPERIENCES WITH GROUPS
• REFERENCES