ادغام و کار از طریق هنر درمانی

The idea that the artistic creative process has inherent therapeutic qualities is taken almost for granted by most people in contact with the field of artistic expression. However, in discussions between art therapists and colleagues from other therapeutic disciplines, the question almost invariably arises as to the nature of the curative process that takes place when the patient creates a work of art. Buried within this question is the issue of working through unresolved emotional contents in art therapy. In this article, we shall address the nature of the healing process in art therapy. First, we shall present a brief survey of the psychodynamic literature on the issue of working through unresolved archaic contents and the fundamental theoretical points regarding the transformation of primary impulses and fantasies into works of art. We shall then outline our theoretical approach regarding the issue of working through in art therapy, an approach that bridges these two disciplines, which we shall illustrate through two case studies. We conclude by clarifying our approach in the light of the case presentations. In artistic expression, the core of the creative process is the translation of the unconscious primitive impulses and fantasies into tangible forms in the present, using art materials. The transformation of the intrapsychic ideations to external representations gives rise to a visual product that retains within it primitive themes identical to those originally directed towards the primary internalized self and object representations. The source of inspiration is in repressed primary impulses and fantasies that were directed towards significant figures in early life McMurray and Schwartz–Mirman 1998, McMurray et al 2000, Molloy 1997 and Robbins 1989. In the creation of art, the rigid need to repeat recurrent creative patterns reduces the flexibility of emotional experience and prevents the growth of expression using art materials. This rigidity reduces the possibilities for varied artistic expression and impedes the flexible transition from the crude source of inspiration to the ‘controlled’ act of creation Kramer 1979, McMurray and Schwartz–Mirman 1998 and Robbins 1989. The unconscious compulsion to repeat rigid patterns of expression precludes recognition of the repressed primitive impulses and fantasies Freud 1914 and Fenichel 1941. Thus, in art therapy, the rigid need to repeat inflexible patterns of creation replaces the process of linking the repressed primary impulses and fantasies that are the basis for inspiration to the associated emotions and consequently prevents the expansion of creative expression using art materials. The repetition compulsion supplants the varied and flexible transformations of the primary internalized self and object representations into tangible forms using art materials. According to Freud (1923), the primary impulses and fantasies, which obtained verbal representations in early childhood, can be brought back into consciousness in maturity. The preverbal impulses and fantasies, which originate either in external or internal stimuli, are repressed into the unconscious and cannot be recalled directly in later life. The pictorial imaging of repressed primitive impulses and fantasies precedes verbal representation. These pictorial conceptions stand near the unconscious. Affective states are experienced directly, and there is no distinction between unconscious and conscious. The emotions associated with repressed primitive impulses and fantasies can pass directly from the unconscious to the conscious. It follows that emotional states associated either with archaic preverbal impulses and fantasies or those associated with later developmental stages can gain direct verbal representation in maturity. We hold that in art therapy, the source of inspiration for the creative artistic act is in primitive impulses and fantasies repressed close to the unconscious. The intrapsychic pictorial images motivating the visual creative act are founded on the nonverbal representations of primary object relations. Visual ideation of early internalized self and object representations are closer to the unconscious than verbal representations. Therefore, in art therapy, the compulsion to repeat rigid creative patterns supplants the linking of the pictorial images close to the unconscious to the associated affective states arising directly from the unconscious. We believe that in art therapy, ongoing, consistent, and flexible creative expression leads to the working through of the repressed primitive impulses and fantasies. The connections repeatedly made between the repressed internalized object relations and the associated affective states enables the ego to gain gradual control over the primary impulses and fantasies, which previously have been warded off Echegoyen 1999, Freud 1914 and Fenichel 1941. Working through can be regarded as the gradual encounter with the ego via the rediscovery of previously repressed archaic impulses and fantasies through various paths. The aim of this controlled confrontation is to integrate primitive contents in the ego that have been repressed Freud 1914 and Fenichel 1941. In art therapy, the process of interconnecting the various tangible products of the present to the emotions that surface during the creative activity enables early object relations to be experienced. The multiple transformations of previously warded off primitive contents into a variety of tangible visual forms in the present enables a vivid exploration of the primary object relations. The varied and repeated examination of early object relations, by means of flexible ongoing creative activity using art materials, enables the ego to gain gradual control over the previously repressed primitive impulses and fantasies. Flexible ongoing and consistent artistic activity brings about the said integration in the ego of the warded off and isolated archaic contents. In art therapy, the interconnection between the repeated translation of internalized early object representations that stand close to the unconscious as pictorial images and the associated emotions that themselves surface directly from the unconscious, enables the integration in the ego of the repressed primitive impulses and fantasies almost directly in the unconscious. In other words, the repeated connection between the pictorial forms stored close to the unconscious and the associated affective states, the source of which is in the unconscious, brings about the integration of early intrapsychic experiences near to the unconscious. Thus, in art therapy, the working through of previously warded off primitive impulses and fantasies takes place close to the unconscious. Kernberg 1980 and Kernberg 1997) holds that the integration of primitive impulses and fantasies in the ego does not constitute the actual process of working through, but precedes it. The integration in the ego of the early internalized self and object representations is a prerequisite for the working through of previously warded off archaic contents. This integration enables the transformation of primitive defense operations into mature defenses and the recognition of whole early object relations. The transformation of partial and split self and object representations into whole objects and their integration in the ego enables a more realistic perception of early childhood experiences. According to Kernberg 1980 and Kernberg 1997), the repeated interconnection at a more mature organizational level between the primary object relations and the variety of associated emotions is what constitutes the process of working through. Working through only takes place once repeated recognition of whole-object relations has been enabled. Our impression is that in art therapy, a disturbance in the ability to integrate early split and part self and object representations appears as a defect in the consolidation of the visual product into a unified entity. The final visual product is characterized by a controlled combination of a variety of separate creative components, which lack a common style. When the disturbance in the capacity for integration is especially severe, the separate components are placed in an isolated and disconnected manner and are unrelated one from the other. The final visual product is characterized by a chaotic and disjointed composition. In creative products where the impairment is less severe, the component parts are interrelated, but the composition lacks an overall unifying theme. For patients who have a disturbance in the integration of early object relations in the ego, art therapy can serve as a transitional space in which the patients can externalize their primitive split impulses and fantasies, originally directed towards the internalized object representations Cavallo and Robbins 1980 and McMurray et al 2000. The transformation of disjointed and chaotic intrapsychic perceptions into tangible visual forms enables the examination of the same primitive fantasies and impulses that are the motivating force for the creative activity. The creative artistic product constitutes an external tangible representation, to which it is possible to relate in reality, while retaining a certain distance from these primitive impulses and fantasies. The split and disconnected primitive impulses and fantasies are given a tangible visual meaning through the creative artistic activity. The creation of art leaves behind a tangible visual documentation in reality while preserving a certain distance from the early intrapsychic experiences that are the basis for inspiration. The translation of the previously warded off primitive impulses and fantasies into visual representations using art materials, enables their reinternalization at a higher level of integration Cavallo and Robbins 1980 and McMurray et al 2000. The transformation of split and disjointed primitive self and object representations into tangible forms, on a shared visual plane, enables their reinternalization as a single entity. The visual documentation of the part object relations, characterized by a variety of separate pictorial representations created on a common plane, enables them therefore to be related to as a single entity. The interconnection between the perception of the work of art as a single entity and the variety of associated affective states brings about integration of the split and disjointed self and object representations. That is, this process of repeatedly linking the perception of the visual product as a single entity to the associated emotions enables the gradual internalization of whole object relations. The source of artistic expression lies in the early healthy internalization of the transitional object Cavallo and Robbins 1980, Kramer 1979, McMurray and Schwartz–Mirman 1998, McMurray et al 2000 and Weir 1987. Artistic expression is differentiated from the transitional object in that its meaning remains private and individual, whereas the transitional object originates as an external found object (Kramer, 1979). The transitional object serves as a concrete alternative object towards which primitive impulses and fantasies are directed, identical to those originally aimed towards the primary object itself. The artistic creative product serves as a symbolic substitute that enables distancing from the primitive impulses and fantasies that were originally directed towards the significant figure in early life. In the case of the transitional object, the libidinal investment is identical to that directed to the early object itself. In the creative artistic act, the focus is not on the primitive impulses and fantasies themselves, but on the existence of an artistic creation as an entity in its own right McMurray and Schwartz–Mirman 1998 and McMurray et al 2000. The artistic creative product constitutes a more advanced level of symbolic organization of the repressed primitive impulses and fantasies than that of the transitional object. In art therapy, the visual product in the making can be regarded as a precious creative work that encompasses a reparative experience (Cavallo & Robbins, 1980). The patient has the opportunity to create a work of art of expressive value while maintaining a distance from the primitive impulses and fantasies motivating its creation. The creative artistic act, although motivated by internalized early intrapsychic contents, is deflected towards a more neutral examination of the final product. The visual product enables the patient to ‘contribute’ in a channel that is not laden with primitive impulses and fantasies. The existence of the opportunity to ‘contribute’ in a more neutral channel enables the containment of the primitive impulses and fantasies and a simultaneous reduction in levels of anxiety Cavallo and Robbins 1980 and Winnicott 1963. The opportunity to create a tangible visual product of expressive value that can be examined consciously enables the patient to contain the archaic contents that are the basis for the creative inspiration, while the ego functions are simultaneously strengthened Cavallo and Robbins 1980 and McMurray et al 2000. However, when the capacity for reliable reparation is lacking, crude anxiety and primitive defenses such as splitting and disintegration are aroused (Winnicott, 1963). Thus, in art therapy, the absence of the capacity to create a tangible visual product arouses anxiety and the widespread mobilization of primitive defenses. The absence of the capacity of the patient to utilize the materials and tools for a creative artistic act leads to regression in defense operations. In art therapy, transference develops towards the therapist when the creative process becomes blocked. The libidinal investment is diverted from the artistic activity to a charged interaction with the therapist (McMurray & Schwartz–Mirman, 1998). The compulsion to repeat rigid creative patterns leads to the deflection of the focus of emotional investment from the creative act to the therapist. Impairment in the capacity to utilize the available materials and tools for the creative activity within the therapy and to create a product that has expressive value, leads to regression and the widespread mobilization of primitive defense operations—especially splitting, projective identification, omnipotent control, unconditional idealization and primitive devaluation. In art therapy, the consistent interpretation of the transference relationship towards the therapist channels the emotional investment back from the therapist towards the creative process and enables its revitalization (McMurray & Schwartz–Mirman, 1998). When the patient lacks the capacity to utilize the materials and tools for the creative artistic act, the repeated interpretation of the primitive transference relationship towards the therapist facilitates the revival of the creative process, the creation of a visual product of expressive value, and a renewed opportunity for reparation. The opportunity the patient is given to encounter the reparative experience, through the artistic creative act, leads to the increased flexibility of primitive defense operations and to the renewal of the process of integration of the part object representations in the ego. In art therapy, this opportunity the patient has for a reparative experience, through the creative process using art materials, is a vital condition for integration of the split and disconnected object relations in the ego.

Kernberg 1980 and Kramer 1979) notes that the majority of defense operations mobilized in the neurotic personality organization are mature defenses such as repression. Early object relations are repressed into the unconscious and are not available for recall in maturity. The projection of the fabric of early internalized object relations onto figures in the present takes place gradually and in a controlled manner. In the therapeutic process, the therapist is perceived primarily as a figure that wishes to help and benefit the patient, and the development of the transference is slow and restrained. By contrast, in the borderline personality organization, the defense operations are mostly primitive. The primary object relations are not repressed, but remain available in the present in their crude form. The transference towards the therapist is a chaotic and stormy mixture of an intense longing for a true bond to the object on the one hand, and extreme rage on the other hand. Right from the very first encounter with the patient, the therapist is perceived alternately as a totally good figure and as an inimical persecutory one. Michael displayed interest and motivation in the therapy and expressed his hope that the therapist would help him with his difficulties. He came willingly and worked intensively and with enjoyment. In the initial stages of the therapeutic relationship, Michael was pleasant in his manner, but reserved and self-controlled. He gradually became freer and began to dare to express his feelings of anger and closeness towards the therapist. Michael’s internal object relations were whole. He could simultaneously express both negative and positive emotions about himself and about the therapist. Michael’s therapy focused on working through issues surrounding what he termed “revolting things,” particularly anger and aggression. In the initial stages of the therapy, Michael stuck rigidly to inflexible patterns of creating pleasing works of art, which led to poor, schematic emotional expression. Following the therapist’s interventions, and his suggestion to work with poster paints, Michael began to create “cute things” in a more varied manner. The repeated creation of the “cute things” in their varying forms enabled Michael to work through his need to be purely a disciplined and pleasant mannered child and enabled him to dare express feelings that had previously seemed forbidden. Michael began to examine to what extent he could reveal the aggressive side of himself through the creations he termed “revolting things.” This repeated and varied creation of the “revolting things” enabled Michael to work through his fear of expressing anger and aggression and allowed him to express phallic themes for the first time. He involved himself with making monsters, dragons, and weapons out of wood, poster paints and charcoals. For the first time, he allowed himself to be naughty at school and thus gain acceptance among his classmates. By contrast, Alan was excited about coming to therapy right from the first session, but at the same time, from the moment he first entered the therapy room he displayed animosity and contempt towards the therapist. Likewise, he often expressed his longings towards the therapist and would even bring her bouquets of flowers at the Festivals, while in the sessions themselves he would repeatedly try to destroy the equipment in the room and even attack the therapist with paintbrushes laden with paint. Alan’s internalized object relations were split and disconnected. The feelings he expressed towards himself and the therapist were a chaotic and stormy confusion of all good feelings or all bad feelings. To enable future working through, therapy with Alan focused on integrating the split self and object representations in the ego towards the consolidation of whole object relations. Although Alan came to therapy eagerly and found it hard to wait for the beginning of each session, he nevertheless behaved violently towards the equipment in the room and the therapist. To enable Alan to express his destructive impulses in a more controlled manner, the therapist suggested to Alan that he use syringes to spray the green potion he had made on to a large sheet of cardboard, the potion that he had previously splattered and spilt all over. This repeated controlled spraying of materials onto the same sheet of cardboard enabled Alan to channel his destructive impulses onto a defined, fixed, and durable surface. He enjoyed discovering how the different colors mixed to form new shades. He began to create new shades by deliberately mixing the colors sprayed on the cardboard. On completion of the work after a few weeks, Alan slashed through the finished work of art using a modeling knife. The repeated creation of new colors on the same sheet of cardboard and its subsequent deliberate slashing with a knife enabled Alan to channel his constructive creative impulses and his destructive impulses onto the same surface. The therapist subsequently suggested to Alan to work in wood carving, with the aim of channeling his destructive impulses to slash and hack into creative avenues. This repeated creative activity in wood carving and the painting of the finished product using poster paints enabled Alan to moderate his destructive impulses and to integrate them with his drive towards construction, channeling both aspects onto one common surface. For the first time, Alan related to the finished product and was excited by the esthetic value of his work. His capacity to create a work of art that held expressive value in his eyes, allowed Alan to ‘contribute’ through a channel that was not exclusively laden with primitive contents. The wood carving, the creation of which had been originally motivated by destructive impulses, enabled Alan to go through a form of ‘reparative experience’, while there was a concomitant significant drop in his anxiety levels. The channeling of both the creative constructive activity and Alan’s destructive behavior onto one common surface enabled the beginning of the process of integration between the good and bad self and object representations. Alan abandoned his previous violent behavior towards the equipment and the therapist and involved himself for the first time in organized creative work, from which he gained satisfaction. For both Michael and for Alan, it was the repeated interconnection made in the therapy between the concrete visual products of their making and the collection of emotions that surfaced during the creative process that enabled each of them gradually to master their hitherto warded off primitive impulses and fantasies, while simultaneously strengthening ego functions. The consistent and ongoing link made between the creative process using art materials and the associated affective states brought about a higher level of integration in the ego of themes, the origins of which were in earlier stages of development.