The Ans in Psychorkrap~. Vol. 19. pp. 367-377. 1992 Pruned in the USA. All rights ~t~~cd.

0197455&92 $5.00 + .oo Copyright C 1992 Pergamon Press Ltd.

ARTHUR ROBBINS. EdD and MARC ERISMANN. MD*

This paper will demonstrate how a clinical case presentation seminar, facilitated through nonverbal processing and a stone sculpting workshop, guided by a psychotherapist/artist. can provide a necdcd alter- native supervision technique for psychotherapists from all mental health disciplines. In describing this joint workshop, WC will explore countcrtransfercnce issues and pay particular attention to the development of those emotional and cognitive resources that con- tribute to psychothcrapcutic artistry. Central to this exploration will be the group processing of conflicts that arise in the transitional space as therapists work with patients. The authors hope to provide a penetrat- ing glimpse of the countertransference conflicts that are inevitable in the therapist/patient relationship and to share with the reader the rationale behind their particular approach to supervision.

Historically, the training of a psychotherapist in- cludes study of such areas as psychodynamics, trans- ference and resistance, psychopathology, diagnosis, and personality development. Rarely does the tradi- tional curriculum relate to the subject of therapeutic artistry. More specifically, there is very little attention focused upon the therapist’s integration of the cre- ative and therapeutic processes. For the most part, personal therapy is assumed to be sufficient to free the therapist in his or her work as a psychotherapist. (We

will return to this topic at a later point in the paper.) At times, supervision addresses the issues of psycho- therapeutic artistry, although there are strict lines drawn between the discussion of such emotional ma- terial as is thought to belong in personal treatment, and the teaching of therapeutic technique. We are, of course, referring to any psychodynamic supervision regardless of the background and discipline of the particular therapist. Supervising therapists as well as therapists under supervision must be willing to take emotional risks. They must have made sufficient progress in personal therapy to be able to move from an emotional subjective position to a didactic and cog- nitive approach. Traditional supervision focuses upon the patient and the techniques that are required and the theory that is applicable to do the therapeutic process- ing. The authors of this paper work from the assump- tion that the traditional format of personal therapy, supervision and coursework does not make room for the kind of integration that encompasses the creative process of the therapist, the particular characterolog- ical defenses and style as well as the variety of emo- tional inductions that are part of countettransference.

We have stated the following in an earlier text:

A good therapy session contains many of the characteristics of a work of art. Both share a

*Arthur Robbins is full Professor of Arl Therapy at Pratl Institute. Director of the Institute for Expressive Analysis and member of the Faculty

of the National Psychological Associalion for Psychoanalysis.

Marc Erismann is President of the Swiss Arl Therapy Associrrion. Director of the Swiss AI-I Therapy Seminars. artist. and in private practice

in Bern. Switzerland.

367

ROBBINS AND ERISMANN

multiplicity of psychic levels and release of en- ergy that radiates along the axis of form and content. Therapeutic communication, like art. has both sender and receiver and is defined by psychic dimensions that parallel the formal pa- rameters for which art is expressed. In any one session, we can detect in patient-therapist com- munication both verbal and nonverbal cues that can be examined within the artistic parameters of sight. sound, and motion; that is, in rhythm. pitch and timbre; in color, texture, and form; and in muscular tension, energy and spatial re- lations. These elements of therapeutic compo- sition have their own principles and require the utmost skill in therapeutic management. (Rob- bins. 1981)

Thus, from our perspective, the typical verbal ar- ticulation of a therapy session has many limitations. If there arc so many nonverbal parameters to a session, then we must adopt a language that can describe them. The language of art accurately and tellingly describes some of the important dimensions of the therapist/patient interaction. Our workshop also pro- vided a format in which to do nonverbal processing and thus fulfill a need WC consider very important in therapeutic education.

We return to a description of a patient/therapist interaction. Ideally. there is a meeting of two minds where there is an experience of both separateness and oneness. Making this space alive and meaningful be- comes the work of treatment. This space can also be referred to as transitional in nature as it is constantly moving and changing. During this patient/therapist communication, sensory channels become potential organizers of images, which in turn offer us clues and guidance in the process of shaping and reshaping transference and counter-transference material. The complexity of this material often leads to decisions as to use of therapeutic technique. For instance. the im- ages formed in the therapist’s mind during the treat- ment process may mirror significant affect states ex- perienced in the past by the patient. The clinical use of these affect states then becomes part of the treat- ment process. More often than not, these inductions are toxic in nature, ranging in affect from rage to despair, from disassociation to intrusion, and from powerlessness to grandiosity. The creative challenge for the therapist becomes an imposing one-on the one hand we must be open enough to take in these very complex emotional states of being; on the other,

we must be able to separate ourselves from these in- ductions and creatively transform them into positive mirrors where patients can view themselves. In short, we take in their pathology and offer them back health. Our sensitivity and vulnerability to these various in- ductions and projections will vary from therapist to therapist. These inductions and projections are the raw meat of treatment and commonly fall under the category of transference. Furthermore, our ability to transform these projections will be contingent on our ability to identify with the patients and at the same time be free enough of these identifications to dis- cover the positive constructive force that lies buried in these transferences. In many respects, transference becomes the art form of the patient. though the art form may well be rigid and sterile as a result of the patient’s attempts to mask personal trauma (Rose, 1987). The therapist’s art form, on the other hand. may be his or her creative use of the countertransfer- ence to mirror back health rather than pathology.

In view of this subtle and complex interplay be- tween the personalities of patient and therapist, ther- apeutic technique cannot be separated from the per- sonality of the therapist. Indeed. how we navigate as therapists in this gray arca of therapeutic communi- cation will demand a high degree of artistry. The verbal description of therapeutic communication leaves much to be dcsircd. Rarely can it capture the textural and nonverbal elements of treatment. The nonverbal frame then becomes a place to externalize the image as well as a means to explore the depths of its meaning.

For a review of the literature on transference and countertransference as they bear on this process, we refer the reader to two main sources-Robbins ( 198 I ) and Epstein and Feiner (1983). There are two main perspectives on the subject of countertransference. The more traditional perspective holds that counter- transference interferes with the processing of thera- peutic material and should be attended to in one’s personal therapy. The concept of countertransference has more recently come to be used in a general sense to describe the whole of the therapist’s feelings and attitudes toward the patient. The authors of this paper take the latter position and work with therapists uti- lizing both their character problems and defenses as well as inductions as important issues that can facil- itate or impede the flow of treatment process. One further issue needs to be addressed here. Creative art therapists differ widely as to how and where to work with both the transference and countertransference.

DEVELOPING THERAPEUTIC ARTISTRY

Many believe that material of this nature shotrId be addressed mainly by work in the nonverbal modality. Others believe that this is an undue restriction and prefer to work both within the relationship as well as within the modality to process transference/ countertransference material. For a review of this area. we refer the reader to the Americun Journal of Arr Therapy (1981). However, there is nothing in the literature that directly relates to the use of stone carv- ing and other nonverbal media as a means of process- ing transference and countertransference material.

The Theoretical Structure of a Counte~ransference Training Group

The format for a countettransference group has been discussed in detail in one of the author’s texts (Robbins. 1988). In brief. the format of these partic- ular training groups typically involves a case that is presented in an open-ended fashion at the onset of the group. This creates a climate that encourages free- association. fantasy and the processing of spontanc- ous feelings. The group tends to take on a life of its own; there is no fixed order as to who is presenting. Often. cases rcflcct a particular group thcmc. Samc- times the sessions take on the atmosphere of group therapy in their openness and nonjudgmcntal nnturc; at the same time, firm boundaries arc maintained bc- twccn the presenting of material that is too far afield from the case at hand, or could possibly turn the group into a more personal therapy experience. We maintain a policy that transference issues among group members, or with the leader, are not processed unless not doing so interferes with the total leaning experience. All members have enough personal treat- ment behind them to enable them to move back and forth from deeply emotional forms of communication to a more cognitive learning position. Out of this mix evolves a structure for learning that is affectively “loaded” but generally supportive. This atmosphere can only take place in a climate that encourages trust and rapport between members and leader. Given the usual political problems in an institute. this model is more suited to a private practice setting.

As the interplay of group dynamics evolves, a splitting process can arise in which parts of the patient in question are projected onto various members of the group or the leader. The ensuing dynamic is handled in a variety of traditional and nontraditional forms, through confrontation, mirroring, fantasy, or dra- matic dialogue, all of which contribute to an alive and

charged atmosphere. Talking like our patients, sitting and moving like them. drawing our patients and their parents, as well as our own parents-these activities create a rhythm of nonverbal organization that be- comes projected into the room. As it does, we take turns in organizing and shaping the space, each one of us developing his or her own unique style and man- ner. In short, we learn how to be close to our patients, be one with our patients, and yet at the same time understand how to remain enough outside of the tran- sitional space so that we can play with it, giving it shape and form. Playing, in this sense, requires a capacity to work on dual levels of consciousness.

The Relationship of Psychoaesthetics and Interpretation

In understanding the art form, our processing will be approached from a psychoaesthetic and pictorial he~eneutics perspective. For a full desc~ption of this point of view the reader is referred to The Psy- chr~uesrhctic Experienre (Robbins. 1989). Psychoaes- thetics is concemcd with the dynamic creative expres- sion of the artist/patient’s interior self to the outside world. Within this context, the communication pro- cess in its verbal and nonverbal dimensions is viewed as an acsthctic structure composed of energy ranging from form to formlcssncss. By formlessness we refer to a moving boundary from an interior space that becomes identified with the crnter of one’s existence and dcfics definition. On the other hand, the outside world demands definition and meaning, that is, form. In the tmnsitional space, color, tone, rhythm and sen- sation ail create a composition that becomes an invi- tation to the mind of the therapist/viewer. If this in- vitation is met by the therapist, he or she then recre- ates the work of art that is embodied in the message of the sender. Problems in aesthetic form shed new light on the therapeutic process and create an aesthetic re- sponse on the part of the therapist. We recognize problems in aesthetic form when we lose our presence in encountering the patient. Thus, when our minds wander and there is not a dynamic engagement that moves between form and formlessness, we invariably are at a juncture point that touches the periphery of an emotional conflict. In short, emotional conflicts rep- resent themselves as problems in aesthetic form when we find ourselves blocked and lose our engagement and presence with our patients. These issues also be- come reflections of the patient/artist’s object relations that lend insight into the patient’s organization of self

ROBBLNS AND ERISMANN

and other. Our ability to move back and forth from the center of ourselves to the outside reality becomes a basic ego rhythm and creates a framework for attune- ment between the therapist and the patient. Under- standing the balance of forces in this aesthetic mix of transference and countertransference becomes the therapeutic challenge. Through the psychoaesthetic interaction of patient and therapist, we lend balance, resonance. structure and mirroring. all of which em- anate from this meeting (and not meeting) of minds between therapist and patient.

The unifying concept of all these levels is one of transitional space. We can see this concept at play in a variety of experiences. The artist, through the work of art, creates a transitional space where the art is constantly moving and changing as the viewer be- comes more deeply involved with the message of the art. This is equally true for patients and their commu- nications. Here the patient is constantly attempting to define himself in the transitional space provided by the therapist. The problems in shaping this space. giving it meaning and life arc all important dimcn- sions of trcatmcnt. In either instance. two minds arc constantly meeting. be it in the art form of therapy or in the actual att medium. Psychoacsthctics attempts to synthesize the language of the artist and the meaning of psychodynamic communication.

The Theory of the Stone Carving Workshop

In addition to the above learning expcrionces. there is no substitute for a hands-on experience with one of the studio arts. Many therapists have dcvelopcd artis- tic skills with an art teacher. Rarely, however, are students provided opportunities to attend a studio workshop conducted by a therapist skilled in both therapeutic and artistic processes. We know of only Robert Wolf and Elaine Rapp who have utilized this technique with therapists. However. the theory and scope of our workshop was conceived independently of these two professionals and developed along dif- ferent lines. In the studio experience that we facili- tated, students confront personal issues regarding the interplay of space and resonance, feeling first-hand how personal conflict interferes with the total com- position of the artwork. In this setting, psychoaesthet- its becomes alive: space, color, form and rhythm are revealed as components of personality when they ap- pear as aspects of the process of artistic creation. Such personal issues as perfectionism. fear of judgment and attack, and reluctance to deal with accidents emerge.

This last issue can become a catalyst for an entire creative exercise: Errors in artwork. like errors in psy- chotherapy, demand creative and therapeutic atten- tion. It is rare that our unconscious does not spill out, in spite of our wishes to be careful and thoughtful regarding either our patient’s space or the integrity of our artwork. Accepting our vulnerability to error and accident, and openly investigating it with our pa- tients, becomes a curative experience. Now there are two people grappling with humanness, frailty and vul- nerability. In a similar way, the examination of the implications of resistance in art has enormous value in the context of treatment. Especially in stone, the art form has a mind of its own and must be worked with. Accidents cannot always be repaired and demand a new innovative approach. The stone experience often helps participants circumvent the difficulty of words or the limitation of language by providing a concrete experience of the interrelationship between space, form and energy. Nonverbal mastery. as well as de- feat, gives one the chance to think and see as well as feel in a new modality, creating the possibility of carrying these new insights into one’s clinical work.

A S-day workshop was offcrcd to clinical thcra- pists, including psychiatrists, psychologists and art thcmpists. In the mornings. participants focused on countcrtransfcrcncc within a verbal case presentation format. In the afternoons. the participants worked in an art studio setting under the guidance of a coleadcr whose training is in artwork as well as in clinical dynamics. The art medium was limestone or marble, and the participants were directed to focus on the figurative motif of the human body. Throughout the day, the coleaders attempted to relate issues that emerged in the case presentations to the students’ work in stone. In the afternoon art studio sessions, an important issue for discussion was the students’ relat- edness with the stone as both material object and in- terpersonal object, drawing analogies between work- ing with sculpture and working with clients. Specific topics included the interpersonal implications of the use of space, light, lines and planes, surface and vol- ume; the interpretation of the students’ relative com- fort with the tools and technique, and the students’ responses to incompleteness or deficiency in the por- trayal of aspects of the human body. The crucial point was that a student create a pictorial image and senso- rially explore it. rather than prematurely interpret in

DEVELOPLIG THERAPEUTIC ARTISTRY

words its manifest and latent significance. In the par- ticular material chosen for a sculpture lie potentialities for certain kinds of physical interactions, and not oth- ers. Thus, the physical responsivities of a particular material tend to lead to ceflain affectual expressions as well. and not to others. Because of this, selecting their stone becomes a passionate process for the par- ticipants. Conscious planning as well as unconscious and preconscious projections and identifications can lead to love at first sight. but can also lead to doubting and helplessness. “Do I choose a stone that’s very hard to maneuver? Do I want one that’s big and tall’? Or flat and light? Can I trust its structure and cohe- siveness? How do I place it on my work table’? Does it have firm footing. or can it be easily pushed?”

On first meeting the Ftone, as in meeting our pa- tient. we must open up our senses to hear its powerful but silent language. We approach it. engage ourselves physically with it by touching it, handling it. feeling its textures. its weight. its volume. As one feels the stone, thcrc occurs the unique reciprocal of the tactile experience: the “touching” emotional cxpcricnce of being touched. We are led to assttciations that are often the memory traces of our carlicst, most intimate cxpcricnccs. Perhaps thcsc may bc tracrs of our early states of self-object differentiation, experiences in which through physical touch WC knew our mothers and began to know ourselves. Or, our associations may Icad us to memories of the act of sexual intcr- course, in which WC define ourselves through the dc- sire of and for the other. Next, through the language of the hammer and chisel, we begin to learn the rhythm and music of this patticular stone. And we soon become enmeshed in the dance between the stone and ourselves, a dance that oscillates between intimate closeness to the stone and cooler observation of it from a distance. We can touch the stone directly with our hands, or we can indirectly touch it through the intermediary of the hammer and chisel, or we can touch it only with our eyes from an observing distance.

As we work on our stones, at times we feel an almost irresistible temptation, a deep need to touch the sculpture. Drawn to the surface of the stone, some of us proceed to grind and even polish its surface to a smooth, shining “skin.” When we do this. we learn to know the electrifying. sensuous and sensual feel- ing that the new touching of it could evoke. We learn

that. on the one hand. smoothing a surface effects a sort of closure of the form, imparting to it autonomy, otherness. And, on the other hand. retaining rough- ness in the surface preserves a feeling of openness and access into the material; roughness can preserve a kind of umbilical cord to the creator.

For man! therapists, work on the stone will at first be a welcome relief from the challenges of emotional containment and responsiveness to patients. For. with the stone, the therapist can freely allow vivid expres- sion of emotion concerning the patient. Another sat- isfying aspect of working with the stone and not the patient is that with the stone there is a constant pic- torial presence. a constant image of the transitional space, an image that does not fade away in the flow of dialogue as happens with patients. This pictorial pres- ence is not only intellectually reassuring to the thcr- apist: it also offers a degree of object pcrmancnce that is not possible with the patient or any living being. And so, emotional relief and the reassurance of object constancy can offer positive satisfrrctions when begin- ning work on the stone.

But as the therapists continue working on their stone. they soon discover that a stone has a character and life of its own with which the artist must negotiate even while feeling some semblance of mastery and control. The physical resistances and anomalies ot that particular stone thus bccomc quite analogous to the emotional rcsistanccs of a patient. However. un- like the situation in therapy. the artist can simply walk away from the stone when work on the stone’s rcsis- tance bccomcs too frustrating and difficult. The artist/ therapist may even express his or her frustration and fury by hammering away at the stone without fear of retaliation. However. if the participant directly con- fronts the stone’s resistance in this way. he or she risks pcnctrating the stone or injuring its skin, perhaps even splitting apart its physical integrity. And thus one risks injuring the matrix of one’s imagination. the field of expression itself. Perhaps by becoming aware of the stone’s physical vulnerability, we face our own vulnerability to narcissistic injury. It seems also that, with a stone, we can experience directly a sense of our power to damage or injure, a power that has its ana- logue in therapy.

Thus, recognizing the nature of the stone’s resis- tance is quite similar to respecting the nature of a patient’s resistance: If we superimpose our own rhythm on the stone, or. conversely, treat it as too fragile. we will never really meet the stone itself at all, never feel its unique resonance nor hear its mys-

ROBBLKS AND ER1SMrZN.C

teriec. Some particlpannts came to realize that they

could not do what they wanted to do with their stones:

They had to face up to the inherent limitations of the

stone itself. as well as face their own limitations of

bodily strength. and the constraints of time and place.

Each participant had to find some kind of compromise

for each of thcsc issues. So too. muxt uc face limi-

tations in our clinical work. We cannot alwavs do

what we want to do for our patients: our patients

themselves have limitations. as do we, in mind and

body: and in therapy as in the art studio. we face

constraints of time and place.

Problems with tools and their use were a particular

focus in the discussion of limitations. Some people

found that their instruments wcrc not apprnpriatc for

the task at hand. Could they give up one tool and

decids to choose another’? Some became particularly

attached to a hammer. even though it was too big or

too small for their hand or the stone. Finding the right

tooI that expresses the needs of both stone and artist

thus became an immediate encounter in creating a

living tranGtional space. one that is alive on both

\idcs. In some casts. the choice of an inapproprialc

tool turned out to rctlcct a resisfanrc again\1 involving

themsclvcs in the process. In other ca\cs. whcthcr the

tchd chosen was appropriate or not, participants would

only scratch the surface of the atone, as the stone

~~mcd cilhcr too big or too ominous or too frugilc to

treat more aggrcssivcly. Sonic participants had dil’li-

culty in changing the stone at all. cvcn scratching its

surface. They were more comlortahlc in trcaling their

stones as “found objects” or “ready-made.” treating

the stones as not needing change 31 all. The new

participants, fhosc who wcrc caking this workshop for

fhe first time, were particularly tentative about mov-

ing into the heart of the work: “Is my stone too much

for me’! Should I choose another?” Fears about hurt-

ing one’s back or arm wcrc often .voiced, as well as

doubts of bodily effectiveness: “Could I really be so

in charge of my body as to really express the inner

part of me outwardly, through and with the stone?”

Thus, projections into the stone began. For some.

fragility soon became evident; for others. omnipo-

tcnce. Some feared the stone would break. Other pro-

jcctcd “Will I bc destroyed if I USC too much force?”

The &pt*ritwce of One Purricipunr: Mtrrt

The therapist. Marc. complains that hc is out of

\ync with his patient. Nothing seems to tlow, intcr-

pretations arc dctlcctcd, empathic resonance falls

dead or is not heard. There is a feeling of disconnec-

tion and of being out of tune with the patient. The

therapist feels exasperated trying to work with this

case. Marc draw-s a picture of his client (Figure I ).

There are sharp, cutting. penetrating lines as well as

soft undulations. Yet, he cannot find a way of re- sponding to either. He cannot seem to connect with

the patient. His hands feel tied. He cannot be one

with the patient. and feels uncomfortable being sep-

arate from the patient for then he feels alone and

disconnected.

As we look at the picture we see repetitive hori-

zontal elements broken through by bundles of vertical

and oblique lines. Thcsc lines form dysrhythmic con-

vergenccs and divergences. crcatinp tensions and

blockings. Although thcrc are circular elements re-

sembling a brad at the top of the draw-ing. thcrc is no

conncctlon between this circular head and the straight

lines on the bottom of the drawing. Further. one is

struck by the fact that the cutoff hands on the portrait

unintentionally give the form a deeper meaning, a

meanmg that is applicable to both the supervision and

the sculpting. We want to remind the reader regarding

our position with rcspcct to interpretation of any art

form, bs it vcrhal or nonverbal: Therlrpists may offer

any number of subjectivciobjccfive meanings and all

DEVELOPING THERAPEUTIC ARTISTRY

can be appropriate and helpful. The ultimate test is not one of finding an absolute truth but of defining the effectiveness of our interventions in facilitating treatment process.

We then moved into role-playing to get a better sense of the relationship between Marc and the pa- tient. in the diaiogue, the “patient” played by the presenting therapist interjects a volley of questions. The “therapist” played by one of the leaders feels inclined to respond to these tempting tidbits. Upon which the patient throws his arms open wide and saps, “Come into me and fill me up!” Yet, when the thcr- apist attempts to respond to the question. the patient tersely responds. “No. That’s not it.” and the volley of questions continues, “Should I stay with my wife, or go with my girlfriend‘?” His girlfriend. of course. satisfies him sexually, but. on the other hand, he feels loyal to his wife. and so forth. What should he do’! What should he do? And he states that the therapist has no answers for him. He oscillates back and forth, rcqucsting engagcmcnt, and then turning it down so that there is no cngagemcnt. The patient’s questions are obviously not the real ones. yet the patient’s pc’r- plcxity hides somsthing very real.

Let us trnnslato this dialogus into pictorial meta- phor. The patient draws sharp lines &fining his space. The therapist responds, speaking in soft. rcs- onant tunes, the cyuivafcnt of circular, undulating lines. And nothing seems to happen; thcrc is no con- tact or play between the linear and the round part of the dialoguc. Thrn again. if the therapist responds with a c[)nfr(~ntati~?nal straight-edge by stating what is actually happening in this questioning dialoguc, the patient. as it were. dissolves and iloats away. The therapist is tied up in knots: Confrontation dots not help, and empathy appears to be wasted. Soon the therapist feels impotrnce and rage. The patient is sending out nonverbal communications replctc with the tones of sadism and impotency. The therapist, in response to this material, becomes enmeshed and loses his therspeutic distance. The challenge, then, is to be very present in the same space with the pat&t, to neither dissociate nor act out in the therapeutic dialogue. These observations are shared with the group. yet what becomes very clear is that the group recedes in the background and the focus becomes cen- tered on the leader and the presenter. In this format, the countcrtransfercnce of the leader also becomes an important factor. The leader not only experiences the role of the patient played out by the presenter hut also some of the significant issues of the prescntcr that arc

presented into this dramatic space. The leader feels playful and fatherly as some of the images of his own father&on relationship seem to filter through his con- sciousness. He feels protective and playful as well as somewhat provocative and challenging and he decides to use these affects in the further processing of the material.

We go back to role-playing: The leader plays the therapist, and the therapist plays the patient. The pa- tient asks a question. And then. with a provocative. almost evil smile, he says, “But I know therapists are not supposed to answer questions.” We explore dif- ferent ways of responding to this communication. Fi- nally. the leader offers the following response: “It’s your hard luck.” he says, “that you have such an impotent therapist, who isn’t wise enough to answer these questions. May-IX 1 should consult my supervi- sor so 1 can be more adequate to field such ques- tions.” The patient smiles genuinely and the tension visibly relaxes bctwcen them. In fact, a sense of alignment. of at-oneness. palpably arises in the shared space.

In this dialoguc. the therapist did not fight the in- duced role of impotcncc. but instead used it playfully to show his patient that even impotcncc may have its uses in a rclrrtionship. In short. the lcadcr accepts the role oft&cd by the priticnt.

The impotent rolr of the son that may be lodged in both the patient and the prescntcr now finds a voice and speaks back to ths father that appears in the pa- ticnt. In this dramatic play we discover ~~ppo~unities to process some of the unmet dialogue of father and son. Much of this processing could easily fit into an object relations framework. However. therapists whose pursonality and character structure rcsonatc with a self-psychology perspective might relate to the hid&n self of the patient that was not adequately mirrored. Again from a drive psychology position there might be a mirroring and a playing with hostility as the central feature of the interchange. From this perspective, therefore, our theoretical position and in- terventions may well be an outgrowth of both the interchange of patient and therapist as well as our charactcr~~lo~ical predis~sition to be attracted to one type of intervention or another.

We return now to the patient/therapist dialogue. We observe that by accepting and playing with failure and impotence, rather than becoming identified and fused with it, the therapeutic workshop opens up. The surface masochistic role of the therapist no longer locks him into the fear of being pushed into a sadistic

774 ROBBISS AXD ERISMUiN

role. Indeed. sadism here becomes phyfll!, converted

into therapeutic self-assertion. Aggression itself thus

becomes neither fearful nor harmful. but a form of

play that has warm. accepting ov-ertones. This mir-

roring of aggression becomes the healthy reflec-

tion of father and son becoming playful as well as

aggressive.

Marc introduces his plan for the stone: It is a drrtw-

ing of a hand (Figure 2). Speaking as the hand. Marc

says. “Let me be. 1 don’t want to be pushed one way

or another. I am just simply thcrc.” And nou 3iarc

must face his dilemma: The sculpture of the hand

must successfully integrate the lines of softness and

aggression (Figure 3). The hand must mirror the hid-

den potential of the patient. must show that even

though it is open and ready to rcccivc. it also is ca-

pable of movement and aggression. The patient must

thcrcforc not hc too frightened of feelings of impo-

tcncc and failure. If WC attcnipt to overconipcnsatc for

our feelings of failure or impotcncc by demonstrating

to the patient the adequacy of our intcrvcntions. WC

become the sculptor who irnposcs a false form on the

work of art. The presenting therapist then reflects

upon his expericncc with his son. The son challcnpes

him and tights with him. wanting to feel the loving

experience of his aggression. His aggression is play-

ful but real. angry but loving. protective but free. The

paradoxical father/son relationship searches for the

loving experience of aggression. And the therapist

fccla sccurc enough to participate in this kind of re-

lationship with his son. tlowevcr, he wonders if there

is in him an authoritative and explosive father that

may get out of control with his patient. As hc con-

sidcrs further. hc wonders if in his drawing of the

pat~cnt, the denial of the body as expressed in the

rcprc\cntation of the cutoff hand might not illustrate

the patient’s fear of an authoritarian father breaking

into consciousness. And also that in a dccpcr sense it

may rcprcscnt the cutting-off of mind from body sym-

holiIed by castration-anxiety. The prcscntcr now bc-

comes visibly centered and in touch with his patient.

t lis own fears of castration are no longer dreaded or

dcfendcd against but become a road to understanding

what is going on with the patient.

In trcatmrnt. we are reminded that there is a con-

tinuous osciltation bctwccn an expericntiaf (pcrcep-

tualfeeling) and a conceptual (knowing) position.

This patient may need sufficient time and room for the

fathertherapist to play with him. Only then will the

patient have had the experience upon which to form

useful verbal conceptions. For if WC move too fast

into the cognitive field, the loss of the father/son ex-

change becomes painful. and the communication is

likely to be maintained on the sadomasochistic level.

Thus. the experience of playful interaction with a per-

son who is strong enough to not bc afraid of his ag-

grcssion must precede any attempt at conceptual

interpretation.

As we rcviswcd the possibilities of this therapeutic

exchange:. the theory of working with highly dcfcndcd

DEVELOPl?iG THERAPEC-TIC ARTISTRY

and ~h~cte~lo~ically resistant patients moved into the foreground of discussion. A direct attack on firmly entrenched characterological defenses seems comparable to fighting the rhythms of the stone.

Tire Experience of a Smmi Pre5enrer

The second presenter states that her patient is dv- ing of cancer. The patient’s mother and father had very little to do with each other. The mother was self-absorbed and masochistic. all-too-involved in her complaints and problems. She gave an implicit mcs- sage to her daughter. “Care for me, reash out to me. mother me. or you don’t exist.” The daughter. as a means of protecting herself from both parents. devel- oped a removed and dissociated personality. She moves in and out of relationships, not letting anyone pet too close to her. The therapist feared that few present in the group wvuld understand the very sp+ ciaf space that a therapist shares with a dying patient. The shared space is paradoxical: *‘The patient is dy- ing, and scarchcs for life. 1 reprcscnt lift, and she IS dying. How can one l~vc an empty space when it needs to hc ftllcd by taking cognizance of the patient‘s lost dreams and wishes. if only in our olficc?” The therapist states her own problem to the group: she does not know how to hring the patient to a de:epcr levef of therapeutic involvcmcnt. She says that she does not really feel the prcscncc of the patient. As the therapist speaks. anger soon appears on her fact as if a wall stood behind her eyes. She blurts out that she f&s a sense of isolation and despair. She visibly struggtcs with the tears and pain that are breaking through her wall. The group becomes hushed. A tense dialogue ensues bctwecn the leader and the prcscntcr: She wants to communicate something she believes the leader does not want to hoar. She wants to hc listensd to. Perhaps this sheds some tight 35 well upon the parallel process between the therapist and patient. Could the patient be ~on~tt~unicatin~: “Do you know what 1 really feel? How can you? You are living. and I am dying. Just listen to me, and be with mc.”

The discussion now shifts to one of the puticnt’s drawings from her first therapy sessions. It features two Large, concentric circles. Straight. sharp lines shoot out from one side. The picture is ominous, frightening, with its jagged toothlike lines. It may be that in this visual metaphor we arc being introduced to a powerful, disturbing introject. The therapist then speaks of missing the presence of the patient’s female body in the picture, The therapist says she cannot get

into these issues with the patient. partly because the patient offers only brief glimpses of her daily life. She is a runner. and her verbal expressions are likewise quick and fleeting. She seems to say, “See me. hear me. but you can never control or possess me. for my body and soul belong only to me.” We are aware of the harsh lines in the patient’s drawings. Can we mir- ror the hidden softness.in this woman and still offer her safety and strength? We see a progression in tho patient’s drawings over time. In the first drawings, there arc only harsh. straight lines. In later drawings. the patient struggles to express roundness and soft- nes5, yet is constantly pulled back to the harsh lines. Eicr draw inps often show evidence of her trying to fili something into her circles. And yet it is also evident that she destroys the\;e attempts. It seems that there is too much dread of this soft vulncrahility. In still later drawinp~, soft pastel colors begin to emerge. The therapist says that she wishes the patient would ex- plore the soft. pastel areas of hrr life as well. But formidable: harriers seem to prohibit this direction of work, even though the therapist offers olcar. firm houndarics. hoping to open a space in which the pa- tient could express softness. The evolution of lines and forms continues in the patirnt’s drawings. She moves into sensual forms. and the images hccorrtc more fi~uri~t~v~ and contrctc. less abstract. The play of flmn and cncrgy hccorncs more alive.

In this patient’s drawings, WC saw in thr jabbing straight linrs ths possibility of introjccts emerging with toxic cffcct. Yet we see, in the later artwork, that as the therapist offered a clear, firm structure, the material evolved into a more cohesive whole. In fact. in some of her more recent drawings, the patient rvcn attempts to draw the fern& form, although she soon ohlitcrates it. She cannot stay in the realm of thr female without experiencing great anxiety.

From the outset, the presenter works with two somehow corresponding stones. White being sculpted. the two stones are constantly in juxtaposi- tion. defining a space that is very much alive, a space that vibrates in and out between the polarities of the two different images. Indeed, we know a version of this phenomenon from the figure-ground relationship in drawings. This in-between, empty. “negative” space introduces itself to the sculptress as itself an actual sculpture-the most alive. though fragile. part of the artwork. The sculptress constantly encounters and faces the problem of how to preserve this transi- tional space without destroying either side of the walls of her two stones. She knows that for this space to

ROBBINS AND ERW4iiLVN

become a hvtng. moving experience. she must allow

a certain ambiguity to exist between the two bound-

aries of the stones. And yet she cannot. For some

deep. mysterious reason. she overdefines the space

between the two stones. It has become very important

and meaningful to her. At the same time she feels

trapped by her need for structure and clarity tFi?urer.

1. 5). The therapist then confides to us that she has had a

number of important losses this year. It has almost

been too much for her to bear. Definition of the tran-

sitional space between her sculptures. she say-s. de-

nies another upcoming loss. the separation between

her and her patient. Work then. with a dying cancer

patient. requires that one bc a hcipmate from the state

of the animate to the state of the inanimate, from lift

to death. from one foml of energy to another. All this

requires a delicate attuncment to the rhythms of sep-

aration, loss and regeneration. Yet. if we arc overrun

by too many losses and too much pain. we often need

a period of just being as we are. unchanging. hcforc

we can return to the natural rhythms oscillating he-

twecn oncncss and scparatencss. Transitional spare is

a moving, dynamic phenomenon. It is thus hccauw

we tend to constantly fill up the “empty spaces” with

rcprcscntations. And as soon as WC find a rcprcscn-

tation. the spare fades under our hands. Conclusion

In both cast prcscntations above. the cncountcrs

with transitional space in the studio arc yuitc parallel

to those we cxpcricncc in the consulting room. The

stone work leads one to new pcrcrptiona of the tran-

sitional space. and thus to new verbal conceptions of

it in intcrpcrsonal spaces as well. Through stone work

we feel and cncountcr in concrete form our particular

conllicts that WC bring to the interpersonal transitional

space. Countcrtransfcrencc is often elusive and thcre-

fore difficult to verbalize. Yet, through a medium

such as stone work, we can actually touch, look upon

and examine with others a concrete example of our

contlicts within the transitional space in which coun-

ter-transference is activated and expressed. Although

the creation of such an enduring sensory image cannot

replace our own personal verbal therapy, such as ob-

servable image offers irreplaceable knowledge of our-

sclvcs. a penetrating glimpse of our countertransfer-

ential conflicts.

We view the processing of countertransference

material as a lifelong professional challenge. An in-

tcnsivc workshop of this nature cannot substitute for

continuous scrutiny and investigation of countertrans-

fcrcnce phcnomcna. but it can offer something special

DEVELOPlNG THERAPEUTIC ARTISTRY

that individual supervision or personal treatment can- not provide. We see in bold relief the nonverbal di- mensions of transitional space taking on a very real and dramatic form. To take advantage of this unique structure, participants require neither skill nor expe- rience in the arts. All that is asked is a willingness to take a chance and dip into the unknown.

References

Apell. G.. Levick. M.. Rhyne. I.. Robbms. A.. Rubm. I.. Ulman. E.. Wang. C.. & Wilson. L. (1981). Transference and coun-

terbansference in art therapy. American Jourrrl of Art Thor- ap. 21. (17). 3-24.

Epstein. L.. & Feiner. A. (1983). Counrenruqfcrcncc. New York: Jason Arunson.

Robbins, A. (1981). Exprrssivc rhrrapy. New York: Human Sci- ences Press.

Robbins. A. (1988). Brrwcn rhrrap~srst The proccssin~ of rrans- fercncclcuuntrrrrunsfermre murerd. New York: Human Sci- ences Ress.

Robbins. A. (1989). The psychwesrheric expcrirnrr. New York: Human Sciences Press.

Rose. G. (1987). Trauma musrery in lrfeundurr New Haven: Yale Umversity Press.