This basic ego defense is popularly defined as an emotional conflict that has been transformed into a physical disability. However, the symbolic guise of conversion is not measured merely in terms of somatic complaints. Laughlin (1970) has offered the most comprehensive definition, which I will utilize for the purpose of this section.

Conversion is the name for the unconscious process through which certain elements of intrapsychic conflicts, which would otherwise give rise to anxiety if they gained consciousness, instead secure a varying measure of symbolic external expression. The ideas or impulses, which are consciously disowned, plus elements of psychologic defenses against them, are changed, transmuted, or converted usually with a greater or lesser degree of symbolism, into a variety of physical, physiologic, behavioral, and psychologic manifestations. (p. 32)

He further delineates six types of conversion behavior. We shall be exploring the fifth and sixth: conversion delinquency and antisocial and criminal behavior. These classifications "result from unconscious impulses, seething resentment, and hatred being converted so as to erupt into external violence" (Laughlin, 1970, p. 38).

The case we will discuss revolves around a teenaged girl who found herself placed in a residential treatment center for two counts of assault, both against family members. The minor's parents had divorced by the time she was a toddler and her biological parents fought over guardianship for numerous years. Eventually, she was transitioned into her mother's home with her half-sister and stepfather, on a permanent basis. By late latency her stepfather began molesting her; she told no one for months. However, once she found the courage, her mother immediately reported the abuse and her stepfather turned himself in that day. Since then, the client has verbalized feelings of guilt for taking away her mother's husband and her sister's father. Prior to her arrest the client was involved in private counseling to address the molestation issues, which the client felt she had sufficiently discussed. Yet her behavior spoke to the contrary. She had adopted the role of the parentified child and not only mediated between her biological parents, but would act as caretaker to her younger half sibling. She possessed a warm and sunny disposition and was involved in numerous team sports. Overall, she was the perfect student, the perfect sister, and the devoted child. Yet she had repressed the traumatic experiences until they had been not only disguised, but also symbolized through the external expression of flawlessness. However, when faced with a failure, she lashed out toward the world all that had been unconsciously hidden. The shame and guilt once again tucked safely away she returned to the perfect student, the perfect sister, the devoted child.

This resistance to exploration (even though she was exceedingly verbal) and the abuse and ensuing conflicts proved an obstacle in therapy. So thoroughly had she repressed her anxiety that verbal therapy was ineffective. It was at this point that an art project was introduced. The client was given plasticene clay and told to make anything that she wished. Figure 1.5 shows what she created in the first session.

What do you see? What visceral feeling or thought comes to mind? When interpreting art, this is an important ability to develop. At this juncture the mortar and pestle were viewed as a symbolic penis and vagina. The function of a pestle is to grind, pound, or stamp; therefore not only its shape, but also its practical use was taken as a representation for this client's sexual abuse. It is important to note that this interpretation was not made to

1.5 Mortar and Pestle the client. Instead it was simply identified as one possibility and noted for future reference.

As outlined earlier, symbols cannot only be construed through a common understanding (i.e. the dove as a symbol of peace) but they are intensely personal. The image of the mortar and pestle is not one most teenagers gravitate toward. Thus, it was surmised that this represented a personal symbol that would need to be taken into account with the final art production. In the next session clay was once again offered and she created three items—the die, flower, and butterfly (Figure 1.6).

As with the first session, no interpretation was given; she was simply allowed to create as much or as little as she chose. These three items were then assessed next to the mortar and pestle figure. Was the die an attempt to convert into oppositional behavior due to the dislike of the art project? Were the flower and butterfly her attempt to rectify her angry emotions (reaction formation)? Was the die perhaps a symbol for her feelings? Note there is only one, not two. Was it a wish that her emotions could just "pass away?" As these were clearly personal symbols, there was no way of knowing without directly interpreting and exploring, and due to her level of repression this was not a prudent choice. Thus, a decision was made to provide her with containment. If she were truly converting the repressed memories of her sexual abuse, she would need something to surround the welling up of feelings. In other words she would require a symbolic boundary where she could safely place her anxiety and anxious thoughts. Thus, heavy cardboard and paint were introduced. The clay remained available, however, the focus was now placed on making a painting. Figure 1.7 is the painting that she created.

The tissue paper creations on the bottom half of the painting are trees.

1.6 Feelings in Clay
1.7 Converting Memories of Sexual Abuse

She then went on to make a clay figure (Figure 1.8). This, she stated, was a "man without a body." It is completed in a primitive style, a circular mass with eyes and mouth, devoid of detail it has the power to bring forth what one sees (remembers) and not what is actually present.

In the ensuing session (Figure 1.9) she placed all the disparate clay productions (i.e., the die, mortar and pestle, and now the bodiless man) into some order. A new addition was the "Hot and Spicy" wrapper that at first she placed below, changed her mind, and fixed under the sun.

As with Figure 1.5, examine the final art product. These items that she had made singularly have now been placed into a cohesive order. Thus, where she placed an item, where she chose not to, how she arranged the figures, both in proximity and distance, all take on significance. It is at this point that the whole must be taken into account.

What is your first impression?

Note the closeness of the "bodiless man" next to the symbolic genitalia. Note the feeling. Why place a candy wrapper into the picture? And if doing so is necessary, why place it under the sun?

After having looked the entire image over, take your hand and block the lower third. What a very different image this mixed media production

Man Blocking Sun With Hand
1.8 Man without a Body
Man Blocking Sun With Hand

1.9 Hot and Spicy 29

becomes. A rainbow bursting with color spreads across the page while three birds and a butterfly move freely. The only image out of context is the "Hot n' Spicy" wrapper glued into place under the oversized sun's rays. While making the image the client struggled with where to place this wrapper and initially wanted to place it on the lower third.

Now hold your hand over the upper two thirds of the page and notice the linear quality. Everything forms a straight line across the bottom of the boundary. Green tissue paper trees look like explosions, especially directly above the bodiless head. At the end of the line rests a single red flower.

There are numerous ways that this project could be interpreted. It could be taken apart, dissected, and assessed in a singular fashion (i.e., from a standpoint of general symbols and their understanding: the sun being representative of parental love and support, a source of warmth, butterflies being associated with the search for elusive love and beauty, flowers representing a need for love and beauty, color symbolism, etc.). Or it could be explored from a position of personal symbolism and the client's free associations with the mortar and pestle, the bodiless man, and the affect generated. Or, finally, it could be assessed from the point of view that the abuse, rather than having been explored and processed, was quietly and efficiently repressed, and any direct interpretation or questioning would produce a multiplicity of verbal statements, all designed to minimize the experience. In this way, the shame and guilt all converged into a host of defenses (i.e., conversion, intellectualization, reaction formation) that provided a safe forum where the traumatic memories were not relived.

Yet who but the client can decide the path of therapy? Therefore, utilizing the art as the product of transference, the therapist gently questioned her. Her response to how the mortar and pestle fit with the image was dismissal; she didn't know. This reply offered all that the therapist required. She was not ready to allow this intensely personal symbol to be explored— not directly, at any rate. It is interesting to note that the client sat quietly after the question for quite some time, after which she stated, "Can we now please not do this any more and go back to your office and talk?"

In the office she followed through on her statement and slowly began to discuss the molestation with less intellectualization and more process. Whether the art was the impetus for this is up to you to decide.

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