By L. Samuel. La Salle University.
From the father in "Hansel and Grethel abana 60pills on-line," who revealed his weak willpower and selfish de- sires (shame and doubt) cheap 60 pills abana overnight delivery, to the stepmother’s bitterness in "Cinderella 60 pills abana visa," 91 Defense Mechanisms and the Norms of Behavior these tales rely on their layers of meaning buy abana 60 pills with visa, so the child can find his or her own answers to budding internal conflicts. However, it must be reiterated that adults and children view these tales of violence in different ways. When the stepsisters’ eyes are pecked out by pigeons the adult sees exces- sive punishment; yet the child, who uses excessive thought, understands that the people reprimanded must have done something very horrid to warrant such a punishment and thus learns unconsciously through the acts of others. Conversely, myths and fables present problems in the form of super- human attainments that the young child could never emulate. Instead, the young child requires symbolism that will reward him, provide a sense of optimism, and unite the personality. Therefore, myth becomes important to youths who have passed latency (11 years and onward). As the phase of formal operations approaches, their quests become a search for the self; they branch out into the larger world, looking at their environment with a critical eye. One hopes that they hold within themselves a positive out- look for their future exploits. It is now the time for superego development, and at this stage myth, historical stories, and classic literature come to life. Gone are simplistic first names or general titles (stepmother, father, hunts- man); instead, myths tell of specific people, with distinct names and fam- ily histories, and in so doing they forsake the generalized formula of fairy tales. If you have assessed the stage of development properly, the client will be mesmerized by these timeless stories that speak gently to internal struggles (regardless of age). I prefer to utilize the metaphors within the fairy tale, fable, myth, or legend by choos- ing the story that meets the client’s needs. From time to time as I read the story I stop reading and direct the participant or group members to draw what they see. It is important that the protagonist (main character), fam- ily members, helpful or kindly figures, antagonist (evil figure or obstacles), and story ending (the last paragraph of each story) be drawn. In addition, story transformations (repetitious sayings, journeys or quests) and any in- teraction between the protagonist and antagonist are also good drawing subjects. This technique can be employed with any story that will propel the client forward and can be used with any medium (e. Whether fables, myths, or fairy tales, these stories touch the soul and speak to our unconscious thoughts, needs, and desires. Thus, he or she will collect all sorts of items in a haphazard array that ends up in a pocket, a drawer, or the floor of a room. Yet these treasured items are still not classified or ready for display: The 10-year-old simply wants more and more, and therefore selec- tion is not important. However, as the child’s interpersonal skills increase (age 11), trading and bartering become central, and with this the need to increase selectivity gains prominence. By age 12 the collection takes on greater meaning, and the child often spends time talking about and look- ing at the acquisitions. Once the age of 13 arrives, however, collections have all but lost their fascination (Gesell, Ilg, & Ames, 1956). These developmental phases are important for any clinician to know and understand, as they are a useful intervention tool. The urge to collect is a structure of mid- to late latency (roughly the ages of 8 to 12), and im- pairments in this structure can show themselves in many guises regardless of age. As an example, the client who is impulsive, destructive, or prone to fights and otherwise exhibits no mechanisms for restraint is acting out not only overstimulation but an impairment in this very necessary develop- mental phase. It is at this juncture that communicative therapy, which leads the client to talk about the problem at the traumatic root, may be be- yond his or her capacity and would indicate a fixation more than thera- peutic resistance. A simple method with which to decipher whether a cli- ent (of any age) is unable to support latency, through a failure of the symbolizing function, is to ask him or her to relate the plot of a favorite movie, book, or television show. If the client has navigated the age of la- tency, he or she will discuss the interpersonal details of the chosen medium. However, if the client relates the excitement, noise, or battles for supremacy, then impairments must be addressed (Sarnoff, 1987). The act of bringing together not only is good for increasing restraint but becomes a metaphor that promotes sharing (see Erikson’s identity versus role confusion stage).
As humans cheap 60pills abana visa, we are complex creatures purchase abana 60pills with visa, for we are not the same today as we were 10 years prior purchase 60pills abana overnight delivery, nor will we remain unchanged by life’s events 10 years into the future purchase abana 60pills line. Thus, a basic understanding of the norms of development can offer the cli- nician insight into the complexity of issues that may besiege a client at any given point in life. For the purposes of this book only three theorists, out of a host of researchers, are featured, because their models have been use- ful in assessing the difficult client. In the end, the clinician should seek the repetition of behavior that is calling out for mastery. The recurrence of be- havior in clients’ life stories; their behavior outside of the therapeutic hour; their self-concept, fears, and defenses; and of course the symbolism inher- ent in their art is what I refer to as a symbolic abundance of ideas. This patient, a regressed schizophrenic, had a propensity to- ward theft, flushing rolls of toilet paper down commodes, and hoarding found items. All of this information was offered by staff, and these habits were definitely a point of contention in the dorm where the client lived. Arieti (1955) outlined four stages of the progression of the disease of schizophrenia. In the third stage he not only discusses hoarding but also in- dicates that an absence of symptoms prevails, as the client has learned to conceal his hallucinations and delusions, if only on a surface level. He states: The schizophrenic seems to hoard in order to possess; the objects he collects have no intrinsic value; they are valuable only inasmuch as they are pos- sessed by the patient. The patient seems almost to have a desire to incorpo- rate them, to make them a part of his person.... Thefact remains that this tendency is a non-pathognomonic manifestation of advanced schizophrenic regression. At this juncture, it was becoming more and more ap- parent that this patient was "screaming" to collect, to possess. When developing a treatment plan, one must meet the client within and slightly above his or her level of development to encour- age further developmental growth. Thus, in this case the therapist chose ages 6 to 12: the stage of latency (Freud), concrete operations (Piaget), and industry versus inferiority (Erikson). It was of the utmost importance for the client to complete this treat- ment plan with another person (to promote a sense of social participation and action) and for the clinician to follow through on statements in a timely manner (to circumvent the client’s feeling that only one chance is available and to promote trust). However, the client was not merely pre- sented with an array of models: He had to earn them through a token econ- omy system and incorporate budgeting into his thinking. Consequently, if he was going to "incorporate" as part of his fixation and collect as part of 98 Adaptation and Integration his need to possess, he should do so in a manner that bespoke of mastery and production. Ultimately, utilizing the steps outlined in this chapter, therapists can base treatment plans on not only knowledge of the client (their needs, fears, and defenses), but also knowledge of the existing literature by a wide range of researchers, clinicians, and theorists. In the end Piaget believed that the individual must master emerging conflict in order to prepare for future growth and integrity. It is this pattern of living that provides us with our self-concept, our identity, our abilities, and our worth. This ethereal quality that lives nowhere but ex- ists within us all changes for the better or the worse with time and em- braces our anxieties, joys, resentments, responsibilities, pleasures, and fears. How does one break through the well-honed defenses that protect us from psychic pain and emerge with an unvarnished view? In its use the disguise of language, developed ever so carefully over a lifetime, is dropped, and in its place a psyche is projected onto a blank piece of paper—a reflection of not only an individual’s self-concept but his or her concept of others. A pro- jection of ourselves and our environment as we see it, from our own view- point, without any influence from external subjective material. Projective testing has always had many detractors, and we review this literature later in the chapter; however, it is my belief that although the un- conscious nature of art certainly makes its study difficult such study is by no means impossible. In that vein, this chapter focuses on projective methods of personality analysis and spotlights three techniques: the Draw-A-Person (DAP), the House-Tree-Person (HTP), and the Eight-Card Redrawing Test (8CRT). I have selected the first two procedures because they are the most frequently utilized of the art projective tests. I include the 8CRT because in my own 103 Reading Between the Lines work with the difficult client this assessment tool has proven to be indis- pensable for evaluating personality decompensation. The history of art projective testing can be traced to Florence Good- enough’s Measurement of Intelligence by Drawings (1926).
Less and less represen- tative members are imaginatively farther and farther away from the center cheap abana 60 pills with visa, giving the categories a radial structure generic abana 60 pills with mastercard. However generic abana 60pills visa, typicality is not the only feature of category members which accords them differential significance in reasoning purchase 60 pills abana with visa. Consider your own concept of a typical doctor and then your concept of an ideal one. The ideal doctor is selfless, always available, calm, caring, intelligent and well informed. The stereotypical one is 16 CHAPTER 1 more likely thought of as rich, intelligent but arrogant, intemperate, ambitious and emotionally distant. And then there are salient members of a class: particular ones coming to mind because of recency (you heard of them lately) or primacy (you heard of them first) effects, or something else causing them to be especially vivid in the imagination: Hippocrates, Everett Koop, Jocelyn Elders, Michael Debakey, Jack Kevorkian, your childhood doctor. In these and many other ways categories have texture which affects reasoning about them and about individuals as members. The "basic level" consists of middle sized enduring objects and vivid, relatively discrete actions or states of being with which we are intimate early and throughout life, with which we deal more facilely, and which are the most accessible and recurrent entities in bodily experience. Ask someone under no particular mandate to describe objects in a waiting room and she or he will usually respond on the basic level, viz. Other answers are appropriate only in less usual, more specified or constrained contexts of questioning: ladder back chairs, Mission end tables, torchere lamps, Italians, National Geographic; or legs, casters, light bulbs, fingernails, boards; or carbon, oxygen, sulfur, nitrogen, photons; or mammals and human made objects. This list illustrates how, in the absence of special discourse, the basic level categories are those which come to mind most readily. So the default category of "things in the waiting room" consists of the basic level objects there. More general and more specific levels of objects ("superordinate and subordinate") are objects described in generic levels metaphorically "above" and more highly specified levels "below" the basic level. Other non-basic level categories are of parts of objects which are typically considered as wholes. Cognitive scientists have discovered that the basic levels in general-to-specific hierarchies are at the mid-level, are usually learned earliest in life, often have the shortest names, take the least time to call to mind, are the level on which our common knowledge is best organized, are perceived holistically and thus are the highest level of which we can have a representative image (so we can imagine a generic chair or human but not a generic piece of furniture or mammal) and the highest level for which we have general motor programs directing our interaction with them. This means that basic level categories are treated differently in informal reasoning and that there are reasons why they should be. We shall see later that the structure of certain categories like "cause," "effect," "goal" and "value" constrains and yet facilitates reasoning about means and ends. And in medicine, categories like "cost," "benefit," "health," "disease" and "diagnosis" illustrate these effects. However, there are basic level concepts of illness, namely symptoms which are part of a conceptual hierarchy, but not a taxonomic one. I will defer addressing these until we have taken up metaphor later in this chapter, because the structure of value concepts is also not often taxonomic like the classification of objects. Instead, value is a large family of concepts generated often metaphorically from central, usually embodied, prototypical experience. Image Schemas Mark Johnson gave the name image schemas to recurrent figurative themes of experience on which conceptual relationships are often based. In his words, an image schema: " is a dynamic pattern that functions somewhat like the abstract structure of an image, and thereby connects up a vast range of experiences that manifest this same recurring structure. These patterns emerge as meaningful structures for us chiefly at the level of our bodily movements through space, our manipulation of objects, and our perceptual interactions. There are things in front of and behind us, above and below, things oriented horizontally and vertically, things connected and separate, large and small, heavy and light, active and inert, lasting and transitory, things inside and outside of others, things close up and far away, appearing and disappearing, obvious and hidden, changing suddenly and gradually, rigid and deformable, hot and cold, loud and quiet, grouped and single, similar and different, harmonious and clashing. And experience is often roughly divided into a foreground on which our attention is generally focused and a background on which it takes a special effort to focus, but which is also constitutive. They exist logically as "continuous analog patterns of experience or understanding with sufficient structure to permit inferences. Thus the cognitive structures we all master and assimilate in everyday life facilitate understanding of things which are less concrete and elemental. There is probably not any inclusive list of image schemas, but the following ones are important, along with textured categories, metaphors and embodied senses of value for structuring reasoning about means and ends. This could be considered a compound schema made up of four elements which are, however, not elemental building blocks in the schema, but assume their full identity only as participants in the whole. In this schema a trajector, a foreground object which is the focus of attention and moves in relation to other objects, or landmarks, moves on a path from a source to an end point.
Once the projects had been passed back to the original artists purchase abana 60 pills on line, they discussed what they thought of the additions (see Figure 1 abana 60pills sale. When I pointed out that the house now looked like a prison trusted abana 60 pills, I re- ceived explanations from "that’s how siding looks" to excuses that blamed the materials purchase abana 60 pills without prescription. Beyond the obvious ego regression that institutionalization had created (this is discussed later in the chapter) not one person saw the "bars" as foreboding or related them in any way to their situation. These ra- tionalizations were obviously necessary to the patients, for, as Malmquist (1985) states, "rationalizations and displacements are often required to maintain the intellectual position, perhaps because the defense is being challenged in discussion" (p. Each of the five mem- bers of this group was instructed to draw an animal; they then passed the drawings, completing various tasks to promote interaction, until the sec- 1. All the renderings were given back to the original artist, and the group had to fit all the different images into one cohesive mural. With this project I did not intervene or make any suggestions throughout the process. As we look along the bottom of the mural, we see a horse, multiple cats, two people, and an exceedingly small monkey hanging from a tree on the viewer’s left. As we move to the viewer’s right, a lion and lioness are pok- ing out from behind foliage. Beyond what each animal implies symbolically about the creators, the mural has two definitive species—those of predator and prey. As the group had to problem solve and fit all these items into one pur- posefully very small area, the discussion mainly surrounded the dinosaurs and where to put them. One member suggested a fence, but the other four members quickly rejected the idea. Note how the rocks are drawn: gingerly placed as stepping stones instead of as a means of containment. In the end only one group member continued to assert the fact that the dinosaurs needed to be fenced or they would "destroy others. Just as with intellectualization, in order to defend against their anxiety they employed this excess of thinking. The need to protect against unacceptable impulses, or situations, is so strong that even man-eating dinosaurs can be tamed if we think hard enough. This group of eight adult males was given the directive "Create a free drawing to represent any feeling you choose. At this juncture in his treatment he was stabilized on medications but had a tendency toward thought blocking and disorganized thinking. In assessing this drawing we see an extremely powerful-looking and mus- cular male standing in his cell while the cinderblock wall both frames and encloses his body. While the patient spoke of jail time, he spontaneously began to explore his feelings of loneliness and fright. Conversion This basic ego defense is popularly defined as an emotional conflict that has been transformed into a physical disability. However, the symbolic guise of conversion is not measured merely in terms of somatic complaints. Laughlin (1970) has offered the most comprehensive definition, which I will utilize for the purpose of this section. Conversion is the name for the unconscious process through which certain elements of intrapsychic conflicts, which would otherwise give rise to anxi- ety if they gained consciousness, instead secure a varying measure of sym- bolic external expression. The ideas or impulses, which are consciously dis- owned, plus elements of psychologic defenses against them, are changed, transmuted, or converted usually with a greater or lesser degree of symbol- ism, into a variety of physical, physiologic, behavioral, and psychologic manifestations. We shall be ex- ploring the fifth and sixth: conversion delinquency and antisocial and criminal behavior. These classifications "result from unconscious impulses, seething resentment, and hatred being converted so as to erupt into exter- nal violence" (Laughlin, 1970, p. The case we will discuss revolves around a teenaged girl who found her- self placed in a residential treatment center for two counts of assault, both against family members. The minor’s parents had divorced by the time she was a toddler and her biological parents fought over guardianship for numerous years.