OOCCUUVolume 9 Number 2 January 1994

FF A Guide toAIDSResearch and Counseling

SSThe ancient image of the Hero appears

in countless myths and folktales, and hisexample motivates many therapists today.For healers working with AIDS, the heroicideal often takes the form of an uncon-scious fantasy about rescuing other peo-ple, conquering illness, or defeatingdeath. Against an adversary like HIV, how-ever, which cannot yet be conquered,heroic efforts often lead to therapistburnout. Is there an alternative to theideal of the hero?1,2 Myths and folktalescan provide a surprising answer—theTrickster.

The Trickster is usually considered ajuvenile delinquent or a sociopath, butthis is wrong. Contemporary research infolklore reveals that the Trickster is apowerful, positive, generative figure, whotypically brings to humanity language,fire, and healing. In fact, the Tricksterembodies an alternative to the Hero forpeople with HIV disease, and perhaps,most poignantly, for their healers. Inparticular, the Trickster shows how thera-pists can avoid heroic burnout. A fairytale from the Grimms—“Brother Lustig”—highlights the Trickster’s wisdom andoffers five insights for therapists.2

“Brother Lustig”Once upon a time, a man named Lustig

served in the King’s army. After 25 yearsof loyal service, the King dismissed Lustigwith only a loaf of bread and four coins.Lustig decided to wander the road, and ashe traveled, he met three beggars oneafter the other. Lustig gave each poor mana slice of bread and a coin, not knowingthat the beggars were really St. Peter indifferent disguises.

St. Peter reappeared as a soldier andstarted traveling with Lustig. They cameto a kingdom where the daughter of theKing had just died. St. Peter went to theKing and offered to resurrect the Princess.Assisted by Lustig, the apostle cut up thePrincess’ body, boiled the pieces in a potuntil only bones were left, laid the skele-ton on the bed, and commanded thePrincess to arise. She reappeared, healedand whole. The overjoyed King and Queenoffered a great reward, but St. Peterrefused anything. So Lustig hinted forsomething, and the King filled his knap-sack with gold. The two men parted ways,and Lustig continued his travels on hisown.

Lustig soon spent all his money. Hecame to another kingdom where thedaughter of the King had just died, so,thinking he could win a great reward, hetried to raise her from the dead. Unfortu-nately, Lustig could not revive the Princess.St. Peter, still disguised as a soldier,passed by and saw Lustig in his plight.The apostle, after making Lustig promisenot to take any reward, resurrected thePrincess. To prevent Lustig from beingtempted to raise the dead again, St. Petergave him a magic knapsack. What-everLustig wished to go into the pack, theapostle explained, would do so.

Lustig resumed his journey and came toa haunted castle. Unafraid of ghosts, hedecided to stay the night. At midnight, hewas attacked by many demons. He foughtback, but was soon in desperate straits.Then he remembered the magic knapsack.“Into my pack with you demons!” he criedout. Instantly, the demons were trapped inthe pack, and Lustig slept peacefullythrough the night. In the morning, heasked a smith to pound his pack, killingall the demons except one tiny imp, whoescaped back to Hell barely alive.

After many years, Lustig met a holy

Beyond the Hero-HealerAllan B. Chinen, MD

hermit who told him he could take one oftwo paths: a long, difficult trail that wentto Heaven, or an easy, pleasant road end-ing in Hell. Lustig took the easy route andsoon arrived at Hell. When the gatekeepersaw Lustig, the devil locked the door. Hewas the imp who had escaped the beatingin Lustig’s knapsack! He told all thedemons in Hell not to let Lustig in, lestthe old soldier wish everyone into hispack. So Lustig labored up the narrowpath and reached Heaven. Lustig recog-nized his old comrade, but St. Peterrefused to admit him to Heaven.

Lustig shoved his magic pack throughthe gate. “If you won’t have me, I don’twant anything from you, so take yourknapsack back.” When St. Peter put thebag next to him, Lustig cried out, “Into thepack with me!” Lustig climbed out of theknapsack, and St. Peter did not have theheart to throw him out of Heaven.

Healers as Comrades The tale begins with the collapse of the

heroic ideal: a soldier, an archetypal hero-ic figure, is dismissed with almost nothingto show for his 25 years of loyal service.Lustig dramatizes the plight of therapists

working with AIDS: after long, heroicstruggles with the epidemic, we often feelwe are left with nothing but despair, cyni-cism, and exhaustion. The King’s betrayalof Lustig highlights another response ofhealers—feeling abandoned by society,given few emotional and financialresources for work with HIV-infectedclients.

Unlike the Hero, who would rebelagainst and defy an unjust king, Lustig isnot angry at his plight. He remains active,involved, and open to new events. This isa major task for therapists: leaving thehero’s anger and despair behind, andembracing a flexible exploratory attitude,more typical of the Trickster. Indeed,when therapists, like Lustig, remain open,astonishing developments occur.

As Lustig travels, St. Peter appears invarious disguises and plays tricks on him.The apostle functions as the Trickster. YetSt. Peter also helps the soldier, later givinghim the magic knapsack. St. Peter is, infact, a helpful companion, acting as men-tor and teacher to Lustig. Yet the two menalso treat each other as comrades, and thevery title of the story, “Brother Lustig,”emphasizes their fraternity. The story

FOCUS2 January 1994

Perhaps all psychotherapyinvolves interpreting metaphor.The unmentionable, the awe-some, the overwhelming in ourlives is most often conceived inmetaphorical terms, allowing the conscious to distance itselffrom what it is too disturbing to approach. AIDS, stigma, dis-ability, dying, and death, itself,certainly meet this definition,and the epidemic’s challengeslend themselves to metaphor to help integrate and masterthem.

Jung, the Swiss psychologist,was the master of the use ofarchetypal symbols: metaphorsfor the fundamental, universal,but ultimately unknowable“ordering principles of the col-lective psyche” (see the first“Recent Report” in this issue).Jung saw these devices as thebridge between the unconscious

and the conscious, betweenunknowing and awareness.

Therapy and Archetypes In this issue of FOCUS, we

present two applications of thearchetype to HIV-related therapy.Using folkloric stories to identi-fy basic archetypal symbols,Allan C. Chinen debunks themyth of the Hero as it relates tothe healer. He presents, instead,an equally venerable archetype,the Trickster, and offers thera-pists an analysis that suggestsalternatives to burnout. RobertBosnak approaches the archetypefrom the perspective of client-centered counseling, explaininghow therapists can use dreamsto help clients define and workthrough emotional responsesand their physical manifesta-tions.

Chinen and Bosnak both offer

ways to hook into the universaltruth represented by archetypes,but they approach it from oppo-site directions. Chinen uses thestory, the folktale, told to us byour parents and teachers: a re-ceived truth that crosses cultureand time. Bosnak searches forthe reflection of these truthsinside our dreams, where we arethe storytellers, where the truthis ultimately personalized. Eachopens the door to a cognitiveexploration that urges truthtoward transformation.

Defining Universal MetaphorsPractitioners might find such

alternative therapeutic approach-es useful as tools to help themhandle the response to an epi-demic that is becoming more,not less, complicated. It is espe-cially crucial—at a time whencultural differences threaten toimpair understanding amongpractitioners and between thera-pists and clients—to defininguniversal truths and commoncultural metaphors.

Editorial: Truth and MetaphorRobert Marks, Editor

FOCUS3 January 1994

contains a vital insight here: healers, noless than Lustig, need comrades, mentors,and teachers.

For therapists, this may mean joining asupport group, finding a spiritual advisor,seeing a therapist, or seeking supervision.But the helpful “brother” can be an innerfigure, too, who may appear in dreamsand visions. For example, C. G. Jung,during his mid-life crisis, turned to“Philemon,” a Trickster figure who firstappeared in Jung’s dreams. The chiefobstacle in finding a helpful comrade,inner or outer, is reluctance to ask forhelp. Heroes, after all are supposed to besolitary, like John Wayne. In seeking help,however, therapists break free of thehero’s spell, and move on to the nextstage of the journey, which involves thepower to heal.

St. Peter resurrects the two Princesses,he demonstrates the most dramatic formof healing. The story reveals that theTrickster is a healer, andin the mythology ofmost cultures, theTrickster brings vitalmedicines and healingrites to humanity. TheTrickster is closely relat-ed to the oldest knownhealing figure—theShaman—and St. Peter’sritual directly reflectsancient shamanic tradi-tion across the world.Shamans are typicallyinitiated by a vision ofbeing dismembered,reduced to a skeleton and then resurrect-ed, and shamans use this imagery in theirhealing rituals. Lustig’s tale thus empha-sizes an unexpected aspect of the Trickster:he is a shaman. Indeed, as Jung andJoseph Campbell suggest, the Shaman andTrickster constitute a single archetype. As“Brother Lustig” demonstrates, the imageof the Shaman-Trickster offers therapistsvital advice.

The Therapist as Shaman-TricksterFirst, the Shaman-Trickster emphasizes

that therapists must accept the darkunderworld, which is so evident in AIDSwork. Where the hero tries to conquer eviland suffering, slaying the dragon or thewitch, shamans descend into the under-world, where they suffer greatly at thehands of evil spirits. Only then do shamansgain the power to heal. Psychologicallyspeaking, as therapists, we must descendwith our clients into the underworld of

pain, helplessness, fear, despair, and rage.From this experience of death and rebirthcomes unexpected new life. Most thera-pists have witnessed such transforma-tions in some HIV-infected clients: indi-viduals who have struggled throughdespair and rage arrive at an inner sereni-ty, often resolving life-long conflicts anddoubts. Because the descent is difficult, itis another reason therapists need an inneror outer companion. We, ourselves, needhelp as we enter the underworld with ourclients.

Second, the Shaman-Trickster stressesthat the power of healing does not comefrom the ego. When Lustig tries to resur-rect a dead princess on his own, he fails.The power of life comes from St. Peter, thedivine Trickster, not Lustig, the mortal.The capacity to heal ultimately comesfrom a transcendent source. Indeed, inmythology, the Trickster is sent specifical-ly by the Supreme Deity to clear the world

of demons and dis-ease, making it safefor humanity.Whether conceived ofas God, the life force,a great mystery, or aHigher Power, thepower of healingcomes from beyondthe healer’s ego.Relying only on theego, in fact, quicklyleads to burnout.

For therapists,transcending the egomeans suspending

tidy preconceptions about healing,because healing may take unexpectedforms with our clients. Therapists alsoneed a spiritual practice, whether medita-tion, prayer, or communal worship,because responding to the challenges ofAIDS is ultimately a spiritual problem,involving painful questions about themeaning of life, suffering, and death.

Third, the story tells us that therapistsmust acknowledge their own needs. St.Peter declines any reward for curing thefarmer or resurrecting the princesses,while Lustig asks for something. The storynicely summarizes a conflict most thera-pists feel: the idealistic urge to help, onthe one hand, as symbolized by the saint-ed apostle, versus the need for personalreward, on the other, as personified by thepractical soldier. As a spirit, St. Peter doesnot need to eat, while Lustig—and thera-pists—do.

Transcendent spirituality is important

References1. Chinen AB. Beyondthe Hero. Los Angeles:Tarcher, 1993.

2. Chinen AB. OnceUpon a Midlife. LosAngeles: Tarcher, 1993.

3. Grimm J, Grimm W.The Complete Grimms’Fairy Tales. New York:Pantheon, 1972.

The Trickster’sultimate purpose isnot to defeat death,

but to bring lightand meaning into

suffering.

AuthorsAllan B. Chinen, MD isAssociate ClinicalProfessor of Psychiatryat the University ofCalifornia SanFrancisco and atherapist in privatepractice. He lectureswidely on the use offairy tales and mythin psychotherapy andthe psychologicaltasks of midlife andaging.

for healers, but so is takingcare of our own humanneeds. Excessive altruismleads to burnout and oftenreflects a hidden arrogance—the hero’s secret belief thathe has infinite resources,that he can do anything hewills or wants.

Fourth, the Shaman-Trickster brings an irrever-ent humor that is useful intherapy. Lustig’s story con-tinually makes fun ofChristian doctrines, like

presenting St. Peter as a Trickster ratherthan a holy patriarch. Satire is a vitalfunction of the Trickster. In NativeAmerican tradition, Tricksters take theform of holy clowns who carry out outra-geous antics during solemn tribal rituals.

The Trickster’s irreverent humor hastwo vital lessons for therapists. Dark withelps us cope with tragedy. As Freudpointed out, gallows humor is actually oneof the most mature forms of defense. Suchblack humor is essential for preventingemotional exhaustion from AIDS work,and can be healing for clients too. TheTrickster’s satire, in fact, breaks downsocial conventions, and helps HIV-infectedclients break free from traditional rolesand beliefs so they can discover theirown, unique, authentic selves.

Finally, the Shaman-Trickster teachesthat the role of therapy is to integratedarkness and light. In the final episode,Lustig travels to Hell and Heaven, to theunderworld and the upper world. Hisjourney represents what is perhaps thecentral task for therapists working withAIDS: to come to terms with the suffering,despair, and rage—Hell—and yet not tolose sight of spiritual development andtranscendent insights—Heaven. Most ther-apists have witnessed such profoundpersonal transformations in HIV-infected

clients—the breakthrough, in the midst ofsuffering, of radical peace and moments ofwholeness. These epiphanies remind us ofthe Trickster’s ultimate purpose—not todefeat death, but to bring light and mean-ing into suffering.

Traveling to Hell and Heaven is also acentral function of shamans. The storyshows how Lustig has become a masterShaman-Trickster, having learned from St.Peter, his spiritual mentor. Lustig hasmatured from a youthful Soldier-Hero to awizened Shaman-Trickster, and his devel-opment demonstrates the healer’s innerjourney.

ConclusionThis is a brief discussion of an abbrevi-

ated tale. The story has many more sym-bolic meanings, but its principal messageis clear for therapists: when the ideal ofthe heroic healer collapses, destroyed bythe tragedy of AIDS, the Shaman-Tricksteroffers an alternative to the heroic cycle ofvaliant struggle, exhaustion, and burnout.

The image of the Trickster can be sup-portive for people with HIV disease aswell. The tools of the Trickster—healinginstead of heroism, humor rather thanhierarchy, communication over conquest,and exploration in lieu of exploitation—are a prescription for living with HIVdisease as well as maintaining ourselveswhile ministering to clients.

One final gift from the Shaman-Tricksteris crucial: he is a storyteller, and throughtales like “Brother Lustig,” he gives usinsight and encouragement. We can, inturn, use these stories with clients. As aHasidic proverb says, “Tell someone a factand you reach their mind. Tell them astory and you touch their soul.” Throughsuch soul-stories, outrageous and touch-ing, spiritual and practical, the Shaman-Trickster brings the promise of healing tothe mortal world.

FOCUS4 January 1994

ReferencesDesjarlais RR. Dreams, divination, andYolmo ways of knowing. Journal of theAssociation for the Study of Dreams.1991; 1(3): 211-224.

Dieckmann H. Twice-Told Tales: ThePsychological Use of Fairy Tales. Trans.

Matthews B. Wilmette, Ill: ChironPublications, 1986.

Feinstein D. A mythological perspec-tive on dreams in psychotherapy.Psychotherapy in Private Practice.1991; 9(2): 85-105.

Freeman A, Boyll S. The use of dreams

and the dream metaphor in cognitive-behavior therapy. Psychotherapy inPrivate Practice. 1992; 10(1-2): 173-192.

Karterud SW. Group dreams revisited.British Journal of Psychotherapy. 1992;35(2): 207-222.

Kugler PK. The “subject” of dreams.Quadrant. 1992; 25(2): 63-83.

Means JR, French CJ. Esthetics theory:A model for the understanding of

Clearinghouse: Stories and Dreams

The Shaman-Trickster offers analternative to the

heroic cycle ofvaliant struggle

and burnout.

A man with AIDS presents a dream in adream group:

I’m in a familiar room with other people Idon’t feel connected to. I see my father whorejected me when he heard I had AIDS. Nowhe tries to make it up to me. I don’t want tohave anything to do with him and push himaway. Then I see a corridor behind the housewhere many people go in and out of rooms.There I see my deceased grandmother. Shedoes not know I have AIDS or that I’m gay.She embraces me.

Group dreamwork is based on C. G.Jung’s notion of the reality of the psyche.

Whereas Freud positsthat psyche is ultimatelyderived from externalevents and dreamimages should, there-fore, be reduced to theirexternal causes, Jungbelieves that psyche is arealm unto itself, relatedto external reality butnot reducible to it. Soreal is the dream-worldthat most individuals,anywhere on the planet,are most of the timeconvinced that they areawake while they aredreaming. It is onlywaking consciousness inits daytime arrogance

that declares the dream-world less real.Our dreamwork makes use of the reality

of the psyche by leading the dreamer backto the direct experience of dreaming. We doso by lowering the threshold of conscious-ness until it hovers above dreaming, stay-ing just abreast of falling asleep. If we fallasleep, the work stops. If we move too farinto wakefulness, the sense of the reality of

the dream-world diminishes. The dreamgroup assists the dreamer in the effort tostay in this in-between consciousness. Inthis way, there emerge emotional realitiespreviously hidden from awareness.

Dreamwork is particularly helpful forpeople infected with HIV because it releas-es the energy it takes to repress the hostof unconscious emotions HIV infectionprovokes, energy that HIV-infected peoplecannot spare. Working with HIV-infectedpeople in groups also breaks through theisolation of serious illness. To experienceothers in the dramatic struggle with anoften harsh inner world gives members ofthe group a profound sense of belonging.

Dreamwork can be practiced by anyskilled psychotherapist. The most impor-tant attitude is the realization that adream is an unconscious product and,therefore, in principle, unknowable. Staywith the uncomfortable confusion of theunknown, a state full of profound emo-tions. In addition, Jung believed thatparadox is one of the most fundamentaland healing experiences a human beingcan go through. Look for the most con-trasting emotions in dreams, and try tofeel them as close together as possible.

The Dreamwork Process The group leads the dreamer of the

“grandmother” dream back to the experi-ence of being in the room with his fatherby helping him conduct a thorough inves-tigation of the room. “What kind of light isin the room? Objects? Where is the coffeetable? What is on the coffee table? Is it alarge book? Are the pictures in the bookcolor or black and white? Where is fatherin relation to the coffee table? What isfather’s posture?” As the dreamer remem-bers more and more detail, he finds him-self back inside the space where, only afew hours ago, he actually met this like-ness of his father, this father of his dream.

FOCUS5 January 1994

Dreamwork isparticularly helpful,because it releasesthe energy used to

repress the emotionsAIDS provokes,

energy that infectedpeople cannot spare.

dreams and transformational therapy.Journal of Mental Imagery. 1992; 16(3):191-204.

Ostow M. The interpretation ofApocalyptic Dreams. Dreaming. 1992;2(1): 1-14.

Scheidlinger S. The dream in grouptherapy: A reappraisal of unconsciousprocesses in groups. Group. 1993;17(1): 21-22.

Seirup JF. Dreams as the mirror image

of AIDS: A study of dream symbols inmale homosexuals at risk for AIDS.Dissertation Abstracts International.1986; 47(4-B): 1744.

Sontag S. AIDS and Its Metaphors. NewYork: Vintage Books. 1989.

Von Franz ML. Individuation in FairyTales. Dallas, Tex.: Spring Publications,1977.

Wallas L. Stories for the Third Ear:Using Hypnotic Fables in Psychotherapy.

New York: W.W. Norton & Co., 1985.

ContactsAllen Chinen, MD, 340 Spruce Street,San Francisco, CA 94118, 415-931-6252

Robert Bosnak, JD, IAAP, 19 Kelly Road,Cambridge, MA 02139, 617-354-2499.

See also references cited in articles in this issue.

Dreamwork and AIDSRobert Bosnak, JD, IAAP

This detailed recollection evokes theatmosphere of the dream, and the dreamersobs profoundly upon recalling his father’srejection. He feels the rage against hisfather and the father-world that rejects hissexuality. When the atmosphere recreatedby the dreamwork truly feels as if it accu-rately resembles the atmosphere of thedream, we begin to observe the father close-ly. We observe how he stands and moves,and what emotions he conveys. Suddenlywe find ourselves identified with the father,and we can feel the remorse in the father’sheart. Although he can’t forgive his father,the dreamer feels less alienated from him.

The corridor behind the house is starkand hollow, like a hospital, where peoplewander in and out of rooms. When thedreamer returns to the detailed recollec-tion, finding himself once again in thecorridor, he remembers that it feels as if itis the afterlife, the corridor separatingdeath and life. He can feel how AIDS haspermanently located him here. The stark-ness of this realization makes the 14 groupmembers shudder. Many of us weep. Thealienation the dreamer is feeling breaks,and he finds himself in his grandmother’sarms, feeling her total acceptance.

The dream group then returns to theprevious feeling of rejection and helps thedreamer move back and forth between thepolar opposites of rejection and accep-tance. After a while the dreamer is able toexperience these feelings simultaneously,thus moving to the heart of the paradox.The contrast between this acceptance andthe earlier feeling of utter rejectionstretches the dreamer’s soul to the utmost,making it tense like a violin string. Sud-denly he can feel the release of catharsis,and experiences it as quiet and sad. Thegroup feels the catharsis with him, like anaudience of a classical tragedy witnessingthe torment of the protagonist. For amoment we are all heartbreakingly close.

By leading the dreamer to the core ofthe paradoxical emotions inherent in theAIDS experience, the dreamwork releasesa profound new vitality. Michael Dupre, inan advanced stage of AIDS, refers to thisphysical release in an article in which hedescribes dreamwork: “I will share withthe reader that as part of the aftermath ofthis dream, I enjoyed three weeks of nor-mal bowel movements. It’s funny to hearthat, but the experience was wonderful.”1

The Value of DreamworkDreamwork can provide a counterforce

to the sense of rejection—a volatile mix-ture of shame and self-loathing—that

many people with HIV disease suffer. Thisself-loathing cannot be approached in arational way: the societal encouragementto accept oneself evaporates in the face ofthe poisonous feelings of alienation.Often, these feelings, as well as the animalfear of death, are repressed with a kind ofpseudo-spirituality that enables a personto leave behind the suffering body andexperience a kind of disembodied tran-scendence. The result of repressingunwanted emotion into the body is afeeling of well-being leading to an increaseof physical symptoms.

Dreamwork helps to avoid this falsesense of well-being, because it offers a pathbetween repression and pseudo-transcen-dence. Through dreamwork a person withHIV disease can experience the fear of deathand alienation, and the bliss of love andacceptance simultaneously. This insight intolife’s paradox has a healing result.

Group dreamwork is body-centered, andthe dreamer explores each emerging phys-ical sensation. When these sensations arefocused on, they can “melt” into deeplyfelt emotion. This relieves the body and,at the same time, provides a visceral expe-rience of emotion. In this way, emotionsbecome undeniable, leaving the dreamerno option but to acknowledge them.

ConclusionDreamwork can deal with death and

dying like few other forms of therapy. The“grandmother” dreamer was able to expe-rience what it is like to be in the corridorbetween two worlds. He did not experi-ence this as concept, this in-between, butas an actual location. Dreamwork mayorient people in their illness and give backto them a sense of direction and feeling ofidentity. Therapists working with peoplewith HIV disease should consider harness-ing this powerful technique.

FOCUS6 January 1994

References1. Dupre M. Russia,dreaming, liberation.Dreaming. 1992; 2(2):123-134.

AuthorsRobert Bosnak, JD,IAAP is a Jungiananalyst in Cambridge,Massachusetts. He isthe author of Dreamingwith an AIDS Patient(Shambhala Publishers,1989) and A LittleCourse in Dreams(Shambhala Publishers,1988).

Comments and Submissions We invite readers to send letters

responding to articles published inFOCUS or dealing with current AIDSresearch and counseling issues. Wealso encourage readers to submit arti-cle proposals, including a summary ofthe idea and a detailed outline of thearticle. Send correspondence to:

Editor, FOCUSUCSF AIDS Health Project, Box 0884San Francisco, CA 94143-0884

Archetypal Symbols, Death, and DyingWelman M, Faber PA. The dream in terminalillness: A Jungian formulation. Journal of AnalyticalPsychology. 1992; 37(1): 61-81.

Using dream imagery can help clini-cians treating terminally-ill patients byoffering insights into the unconsciousprocesses intrinsic to life-threateningillness, according to an overview ofJungian dream archetypes and a dreamhistory of one patient. Such therapy alsoassists patients by providing some relieffrom the uncertainty and isolation engen-dered during the dying process.

As part of a larger study, researchersconcentrated on the dreams of one cancerpatient—a 70-year-old man who was ter-minally ill with prostate cancer—whosedream material reflected the materialrecorded by other study participants.Over six months, the patient recorded

seven dreams, each of whichconsistently revealed allusionsto death and post-mortalexistence. Researchers inter-preted the dreams as a series,that is, conclusions regardingany one dream were support-ed or refuted by related dreammaterial, and refuted materialwas excluded in the finalanalysis. In order to preventinfluencing subsequentdreams, researchers did notrelate the dream interpreta-tion to the dreamer.

According to Jung, archety-pal dreams anticipate andorchestrate psychical transfor-mation that occurs duringcritical developmental stagesincluding dying. Archetypesare the universal and funda-mental ordering principles ofthe collective psyche. Archetypalsymbols derive from archetypes,pertain to the problems andmysteries of everyday life,and mediate between theconscious and the uncon-

scious. Archetypal dreams —as opposedto personal dreams—allude to archetypalsymbols, and typically display irrationalplot development, intense emotion, andremoteness from everyday events.

Archetypal images manifest in dreamswhen people face particularly powerfulevents such as terminal illness or death.

Archetypes facilitate psychological trans-formation, because they call to the con-scious attention of the dreamer otherwiseunconscious emotions. Archetypal sym-bols—because of their mediation of theunconscious—can transform the dyingprocess into a more positive event, a timeof enhanced creativity in living, if thedreamer is able to relate to and conscious-ly integrate these symbols.

The cancer patient’s seven dreams pre-sented a range of symbols. Analysis mostreadily identified the image of post-mortalexistence, that is, the idea of the begin-ning of new life or the continuation ofpsychical life after death. In one dream,the patient reported having seen a brightflower and thinking that he had alwayswanted such a flower in his garden.According to Jung, flowers are archetypes—from Persian mysticism and Egyptianfolklore—that symbolize post-mortalexistence and the resurrection of thebody.

In another dream, the patient saw him-self as having two bodies fitting togetherlike two parts, one body slowly floatingaway from the other. This symbol—fromalchemist Paracelsus, and Bolivian,Eastern, and Egyptian folklore—expressesthe conviction of life after death. Otherimages included items with a violin- orcello-like shape, a reference to the motherand daughter Roman goddesses Demeterand Persephone and the allegory of death,immortality, and rebirth.

For the patient, dream analysis wasuseful. When he was first diagnosed andtold he had six months to live, the patientcontinually denied the diagnosis. Hisdreams, however, laced with deathimagery, helped the patient to confrontphysical reality. Symbolically, the patient’sdreams represented periods of confronta-tion, realization, acceptance, and enlight-enment. Indeed, when the patient did facedeath, he showed no signs of anger,regret, fear, or denial.

Art Therapy and HIV DiseaseEdwards GM. Art therapy with HIV-positivepatients: Hardiness, creativity and meaning. TheArts in Psychotherapy. 1993; 20: 325-333. (WalterReed Army Medical Center, Washington, DC.)

Art therapy helps facilitate mourningand enables therapists to define clientissues, according to a commentary on thistechnique. An analysis of the artwork ofmore than 600 HIV-infected patients sug-gests distinct themes and visual charac-teristics that can be helpful in identifyingemotional states.

FOCUS7 January 1994

Exploringarchetypal

dreams cantransform thedying processinto a time of

enhancedcreativity inliving, if the

dreamer is ableto relate to and

consciouslyintegrate them.

Recent Reports

FOCUS8 January 1994

Drawings done by patients shortly afterthey learned they were HIV infected werecharacterized by disorganization, fragmen-tation, and dark, empty areas, revealingshock and helplessness. Opposing shapes,sharp edges, and diagonals expressedanxiety and rage, and abstract geometricdesigns seemed to bind anxiety or containintense emotion. Dead trees, empty land-scapes, and coffin-like shapes expresseddepression and mourning. Divisions ofspace and content reflected isolation,stigmatization, and guilt. Faces, eyes, andboundaries represented paranoid fears,while tears, drooping flowers, and shrunk-en images represented sadness.

Artwork seemed to facilitate not onlymourning, but also, once past this stage,restitution to a more positive outlook. Atthat time, images such as the sun, rain-bows, home, church, and material com-forts began to appear. A flower, for exam-ple, expressed caring, nurturing, and thecontinuity of life. Artwork also served torestore patients by facilitating a “high”when they had produced outstanding,creative, or respected pieces of art.

Artwork also enabled patients to strength-en problem solving skills and creativity,and to create challenges, commitments,and goals. Thus, in addition to helpingdiscover, analyze, and work through emo-tions, producing art helped patients toidentify sources of meaning, and strength-en characteristics that correlate positivelywith long-term survival.

Story Telling and HIV PreventionBracho de Carpio A, Carpio-Cedraro FF, AndersonL. Hispanic families learning and teaching aboutAIDS: A participatory approach at the communitylevel. Hispanic Journal of Behavioral Sciences.1990; 12(2): 165-176. (LA CASA Family Services,Detroit, Michigan.)

An overview of a Detroit HIV preventionprogram suggests that stories can helpHispanic families explore HIV-related knowl-edge, attitudes, and beliefs, and enableparents to talk to their children about AIDS.

The program has three objectives. First,it seeks to allow participants to share withthe group their HIV-related behaviors, andknowledge, attitudes, and beliefs. Second,it seeks to enable participants to identifyeffective prevention strategies at theindividual, family, and community levels,and the main issues involving implemen-tation. Third, it seeks to encourage partic-ipants to model for each other HIV-relatedfamily communication techniques.

The program is based on the conceptthat discussion will help participants clari-

fy their understanding of the story andintegrate communication skills and HIVprevention into their lives. To recruitHispanic families into the prevention pro-gram, community workers approach afamily member, arrange to meet the family,and describe the program to the family.Often the family agrees to host a sessionand invite several other families to theirhouse. At the session, a counselor presentsa story and facilitates discussion by askingparticipants to respond to the children’s—the main characters of the story—concerns.

While the stories are fairly basic, theyprove useful as an opening to discussions toexplore what families know and feel aboutHIV disease. For example, to raise this issueof talking to children about the fears ofAIDS and death, the program uses the storyof a little girl who hears from a friend thatthe friend’s mother has HIV disease. Thelittle girl immediately has all sorts of fearsabout her own mother becoming infected,and relates these fears to her father.

The story has been piloted with morethan 30 parents and 12 preteens in thecommunity. Early evaluations of the pro-gram show that the story method is well-accepted by both counselors and parti-cipants, and is effective in increasingknowledge, developing skills, and over-coming attitudinal barriers, prejudices,and misinformation about HIV disease.

Next MonthSocial class represents perhaps the

greatest divide in western society,eclipsing even race as a barrier amongpeople. In the February issue ofFOCUS, Gary W. Dowsett, PhD,Deputy Head of the National Centre forHIV Social Research, at MacquarieUniversity in Sydney, Australia, reportson an Australian study of homosexual-ly active, working-class men. He dis-cusses two issues in particular: theresponses of these men to preventioneducation materials designed and dis-seminated by gay community-basedorganizations; and the relations ofthese men to established and recog-nizable gay communities.

Also in the February issue, BarryChersky, MA, a counselor and traineron discrimination in the workplace,and Michael Siever, PhD, director ofa substance abuse program, discussapproaches therapists can take whencounseling working-class gay men.

Executive Editor; Director,AIDS Health ProjectJames W. Dilley, MD

EditorRobert Marks

Staff WritersJohn Tighe

Founding Editor; AdvisorMichael Helquist

Medical AdvisorStephen Follansbee, MD

MarketingJoanna Rinaldi

DesignSaul Rosenfield

ProductionJoseph WilsonStephan PeuraLeslie SamuelsRoger Scroggs

CirculationSandra Kriletich

InternsEliotte L. HirshbergAhn NguyenJennifer PohlPeter Wen

FOCUS is a monthly pub-lication of the AIDSHealth Project, affiliatedwith the University ofCalifornia San Francisco.

Twelve issues of FOCUSare $36 for U.S. residents,$24 for those with limitedincomes, $48 for individu-als in other countries, $90for U.S. institutions, and$110 for institutions inother countries. Makechecks payable to “UCRegents.” Address sub-scription requests and cor-respondence to: FOCUS,UCSF AIDS HealthProject, Box 0884, SanFrancisco, CA 94143-0884. Back issues are $3each: for a list, write to theabove address or call(415) 476-6430.

To ensure uninterrupteddelivery, send your newaddress four weeks beforeyou move.

Linotronic plates partiallydonated by Design & Type,San Francisco. Printed onrecycled paper.

© 1994 UC Regents: All rights reserved.

ISSN 1047-0719

FOCUSA Guide toAIDSResearch and Counseling

DID YOU KNOW?FREE searchable archive

You can access a FREE searchable archive of back issues of this publication online! Visit http://www.ucsf-ahp.org/HTML2/archivesearch.html.

You can also receive this and other AHP journals FREE, at the moment of publication, by becoming an e-subscriber. Visit http://ucsf-ahp.org/epubs_registration.php for more information and to register!

ABOUT UCSF AIDS HeAlTH PrOjeCT PUBlICATIOnS

The AIDS Health Project produces periodicals and books that blend research and practice to help front-line mental

health and health care providers deliver the highest quality HIV-related counseling and mental health care. For more

information about this program, visit http://ucsf-ahp.org/HTML2/services_providers_publications.html.