Unlike Piaget with his structured stages, Freud viewed his psychosexual stages as overlapping and therefore deficient in organized configuration. His theory is based upon the belief that deprivation of nurturance (specifically maternal) during infancy results in neurotic difficulties that persist well into adulthood. "In a strict sense Freud was not proposing stages in personality development but tracing the vicissitudes of the sexual energy which he posited and termed libido and deemed a motivating force in all human behavior" (Lidz, 1976, p. 85).
Thus, if an individual passes through the five phases (oral, anal, phallic or Oedipal, latency, and genital) without becoming fixated within any specific stage, he or she has achieved sexual maturation through the substitution of new object-cathexes for instinctual object-choices. However, if a fixation occurred, Freud believed the individual would develop a select series of defense mechanisms and behaviors that directly link to specific phases.
Freud's first phase, the oral, is comparable to the age of infancy (birth to 12 months) and represents a stage of dependency. The infant busily places things in the mouth, bites, and sucks, which provides pleasure as well as a sense of protection. However, frustration can develop from the separation of the object (bottle, nipple, food, nurturance) from the infant's mouth, which brings on a reaction to hold on. "The mouth, therefore, has at least five main modes of functioning, (1) taking in, (2) holding on, (3) biting, (4) spitting out, and (5) closing. Each of these modes is a prototype or original model for certain personality traits" (Hall, 1954, p. 108). In Piaget's cognitive model the infant has learned to adapt to the environment by the age of 12 months; however, if in Freud's theory, the infant is faced with separation, the manner in which he or she integrates the division will produce a representation that will serve throughout the growing child's adult years.
Therefore, Freud hypothesized that in the early stages of the oral phase incorporation is utilized; either this can be sublimated, as an adult, into a quest to incorporate knowledge, interests, and activities (acquisitiveness), or frustration can develop, and the now adult will incorporate (hold onto) things in order to control their comings and goings (greediness). These symbolic behaviors continue through the phases and can be linked to defense mechanisms that appear and persist in a client's behavior.
As such, projection is often utilized as a defense against dependency in the oral phase of development. If in infancy the child develops a dependent attitude instead of seeking assistance the individual may feel an overpowering need to assist others or purchase lavish gifts. Equally, the desire of dependency may bring on feelings of shame, and a reaction formation may develop that finds the individual resisting dependency on anyone (Hall, 1954).
Oral aggressiveness, the act of biting after teeth have formed, can bring about an adaptation that relies upon sarcasm, verbal retorts, and a dominant attitude. Overall anxiety produced throughout the oral phase of development can cause not only a fixation but also an inability to move into the succeeding phases.
Freud's second stage is known as the anal phase and stretches roughly from the ages of 12 months to 3 years. This phase is identified by the process of withholding and letting go and centers around toilet training and bowel functioning. Freud (1963) describes the process of defecation (expulsion) in the first year of life as a pleasurable activity that reduces tension. However, by the second year of life the child must decide if he or she will let go of feces, at the love object's request, or withhold them for purposes of autoerotic gratification, thus asserting self-will. If toilet training is particularly punitive, the child when grown to adulthood may retaliate against authority figures through irresponsibility and obstinacy. The same punitive toilet training may cause a reaction formation in the adult, and a sense of orderliness may develop in the personality structure that encompasses collecting, possessing, and holding onto objects. This overcontrolled behavior may express itself through compulsive qualities (anal retentiveness) that involve frugality and parsimony. Freud (1963) further states that there are definitive commonalities that exist between an interest in money and defecation.
Wherever archaic modes of thought predominate or have persisted—in ancient civilizations, in myth, fairy-tale, and superstition, in unconscious thought and dreams, and in the neuroses—money comes into the closest relation with excrement. We know how the money which the devil gives paramours turns to excrement after his departure, and the devil is certainly nothing more than a personification of the unconscious instinctual forces. ... It is possible that the contrast between the most precious substance known to man and the most worthless, which he rejects as 'something thrown out,' has contributed to the identification of gold with feces. (pp. 31-32)
Freud likens the goose that lays golden eggs in the English fairy tale "Jack and the Beanstalk" to the finding of a treasure in association with defecation. In fact, fairy tales (which is explored later in this chapter) deal with the basic needs of maturation and development. Therefore, the whole of "Jack and the Beanstalk" deals with the growth and regression to earlier stages of a boy as he achieves puberty, while the golden goose can be seen as merely one phase of his development.
In the phallic or Oedipal phase, pleasurable activities shift from the anal erotic zone to the genitalia (phallus). This is also a time when the child begins to exhibit sexual longing for the parent of the opposite sex. Freud termed the boy's shift—from identifying with his father to becoming a rival while sexual wishes emerge toward the mother—the Oedipus complex. The equivalent situation for the girl, her desire to possess the father while renouncing the mother, was termed the Electra complex. By way of example I am appending a letter (Figure 2.28) that I wrote to my father, which I believe offers an example of Freud's Electra complex. My parents lovingly saved this letter and would retrieve it from its secret hiding place every so
often, usually during family gatherings and such. They had a very caustic sense of humor.
However, the welling up of sexual feelings toward the opposite-sexed parent brings about its own anxiety and fear (the castration complex) and is therefore quickly dispatched to the unconscious, where it is repressed. The child must then identify with the lost love object or with the rival.
In addition, "the super-ego, too, the moral agency which dominates the ego, has its origin in the process of overcoming the Oedipus complex" (Freud, 1959, p. 268).
Lidz (1976) notes that "The 'oedipal transition' is considered a central event in personality development and critical to the patterning of all subsequent interpersonal relationships" (p. 87). Thus, if we compare the prior stages (oral and anal) to the phallic stage we can say that the shift has moved from an egotistical, inward process to one of outward expression, which will culminate in the union of the opposites of sexuality (genital phase).
Freud's latency period, ages 5 to 12, is characterized by sublimatory activities designed to fend off the temptation toward self-gratification. Pre-pubescent children "tend to become attached to activities (which would later be carried out almost automatically) such as going to sleep, washing, dressing and walking about; and they tend also to repetition and waste of time" (Freud, 1959, p. 116). It is at this point that sexuality lies dormant while feelings arising from the ego, such as shame, disgust, and inhibitions, arise. Beyond repression and sublimation the defense mechanism of reaction formation is employed.
If we refer back to the discussion on conversion (Figure 1.9), this client was molested in the midst of the latency period, yet she had repressed the traumatic experiences until they were not only disguised but also expressed through a reaction formation. The overwhelming shame and belief that she was "damaged" was articulated in its opposite form through the external expression of flawlessness. This continued well into her adolescent years, until the unconscious was made conscious through the artwork.
At puberty, when biochemical and glandular changes take place, the latency period ends and a period of socialization, peer groups, and love interests (which can now be fulfilled physiologically) comes into play. This is a time of adult tasks and responsibility and a phase that lasts until senility. Moreover, as Hall (1954) points out, "the displacements, sublimations, and other transformations of the pregenital cathexes become a part of the permanent character structure" (p. 119).
Thus, Freud and his psychosexual phases traced the origins of adult neurosis and fixations to earlier stages of development, while Piaget outlined adaptive functioning through cognitive development. With these two very different approaches it is important to note that alone they stand for the polarities of human maturity (adaptive and maladaptive), yet together they can yield a wealth of assessment information. And if we apply this knowledge to the art medium, we can achieve a very accurate representation of a client's developmental level.
By way of example, an individual's choice of media and how it is applied will offer a multiplicity of clues. Thus, a client who "regresses" with the use of wet clay (e.g., smearing it or displaying intense dislike at its mention) could be in the anal phase of development. Conversely, the use of pencil and nothing else yields information on a need for safety through a controlled medium (orderly phase of anal development). As children reach latency and are sublimating their sexuality through order (based on collecting), their images often contain a series of objects (e.g., weapons, boats, airplanes, flowers, hearts). However, an adolescent or adult who continues to draw in this manner (a multiplicity of objects on a single page) is expressing a significant deviation from the norm, which suggests a regression to the stage of latency. Figure 2.29, with its violent theme, is an example of such a fixation.
In the end, individuals who compensate for their anxiety through their words and actions become helpless before the art media. The art does not utilize language; it is a nonverbal communication that allows the unconscious mind to speak the truth.
2.29 Belying the Stage of Calm 76
Erik Erikson is noted for his numerous writings on the healthy ego through his theory of psychosocial personality development. In his early adulthood he taught art in an American experimental school in Vienna. The school taught the children whose parents had come to Vienna to join Freud's psychoanalytic trainings. It was through this experience that he met Anna Freud, and soon thereafter he began psychoanalytic training and analysis for himself (Maier, 1978). Ultimately, "he converted the Freudian notion of psychosexual development of libidinal phases to one of psychosocial stages of ego development" (Maier, p. 73). This theory relies upon the premise that within each phase (totaling eight and often referred to as "spanning womb to tomb") emerging conflict must be mastered in order to prepare the individual for future growth and integrity. Each of Erikson's phases identifies a division that incorporates either an encouraging or a detrimental result, and it is society that will help the individual meet his or her needs and surmount his or her struggles by providing the norms of behavior, which ultimately will yield the desired integrated identity.
Erikson attributes five of his phases to childhood (these coincide with Freud's psychosexual stages) and the remaining three to adulthood (thus broadening and extending Freud's theory). Erikson gives much emphasis to the first five stages, as he believed that personality development was based upon the early stages of the life cycle. His first stage, which encompasses birth to the first year, was termed basic trust versus basic mistrust and corresponds closely to both Freud's and Piaget's first phases. The child, completely dependent upon the caregiver, incorporates (orally) the objects in the environment through grasping and sucking until adaptive behavior and experimentation develop. The infant experiments with his or her understanding of not only his or her inner world but the external world as well, and it is through this understanding (found through consistency) that trust emerges (both within and from the outside).
In the second year of life, Erikson's stage titled autonomy versus shame and doubt, the child's musculature develops and experimentation and exploration become the norm of behavior. Erikson speaks of the same concept as that of Freud's anal phase: holding (on) and letting (go). However, toilet training (self-control) is simply one example of the child's burgeoning autonomy, while shame and doubt are the result of parental overcontrol.
As the child reaches out to his or her environment and symbolization develops, art and play offer a sense not only of self-control but also of lim-
its. Figure 2.30, painted by a 2-year-old (over a 2-week period) with minimal intervention from her parents, offers an example of the child's capacity to release (top) and to eventually adapt to (bottom) the thick tempera paint; Figure 2.31 shows her ability to retain (see disk to view both figures in color). In Figure 2.30 her paints have combined to form one color, a smeared blue; however, through continued attempts (bottom) yellow and red peek out from beneath the blue brushstrokes.
One month later (Figure 2.31) her colors stand alone; the image is bold, while shapes and boundaries have been established.
According to Erikson (1963),
This stage, therefore, becomes decisive for the ratio of love and hate, cooperation and willfulness, freedom of self-expression and its suppression. From a sense of self-control without loss of self-esteem comes a lasting sense of good will and pride, from a sense of loss of self-control and of foreign over-control comes a lasting propensity for doubt and shame. (p. 254)
At the end of the 3rd year of life (initiative versus guilt) the child's basic family takes on growing importance. It is at this stage that children model themselves after their parents, a process that corresponds loosely to Freud's Oedipal conflict. However, Erikson believed this process to be a power struggle of will against the controlling parent more than a sexual struggle, as Freud postulated. Thus, children's initiative increases as they seek out who they will be and how they will interact within their environment. This shift from egocentricity toward responsibility and increased social participation also sees the emerging superego (conscience) produce guilt and fears whenever conflict surrounding their behavior arises. In contrast, Pi-aget felt that the child exhibited shame and humiliation at this age (3), with guilt predominating from the age of 7 onward. Yet the two theorists agreed that, as the forces of conflict emerge, play becomes an indispensable tool with which the child can master and balance the inner and outer worlds. "The child uses play to make up for defeats, sufferings, and frustra tions, especially those resulting from a technically and culturally limited use of language" (Erikson, 1940, p. 561).
By the 6th year of life the fourth stage of Erikson's model appears, industry versus inferiority. This stage is characterized by the child's radius of relationships branching out into the neighborhood and school. As the prior period was based on a sense of direction and purpose, this phase revolves around a sense of competency. In a stage closely aligned with Freud's latency stage (one of calm), the child now receives approval, regard, and affection based on achievement, which ultimately depends on his or her competence, or conversely, suffers a continuing sense of inferiority (Lidz, 1976). Thus, the ability to complete tasks and be productive is essential for the development of ego mastery. However, if the child feels inadequate, the polarity of this stage becomes a pull toward less production and a satisfaction with slothful behavior. Not unlike Piaget's stage of concrete operations (logical thought about physical objects and their relationship), Er-ickson's fourth phase sees the child applying his or her thoughts and energy to new skills and tasks. "He can become an eager and absorbed unit of a productive situation. To bring a productive situation to completion is an aim which gradually supersedes the whims and wishes of play" (Erikson, 1963, p. 259).
As adolescence approaches, the child enters the fifth phase, identity versus role confusion, which could easily be defined as 'to be or not to be." It is at this point that a search for the self begins just as the adolescent is attempting to consolidate an identity. If we return to Figure 2.26, this 14-year-old is exploring the youthful struggle of "Who am I to be?" through both the artwork and the written word. Erikson believes that phase five (identity versus role confusion) is where the prior four phases have coalesced toward an ego identity and mastery of skills. Yet, as with all of his phases, the polarity of opposites exists: If the adolescent has not gained a sense of competence, purpose, and self-control, he or she will be unable to cope with growing frustrations as peer groupings and models of leadership become the norm. It is at this juncture that an individual, feeling a sense of loss and isolation, may turn toward antisocial behaviors, thoughts, and attitudes in order to secure any identity, no matter how dysfunctional. It is this growing identity that often causes parents and clinicians the most problems, for parents often do not know how to deal with the issue, and clinicians often overlook its importance, especially when dealing with an adult population. An individual's sense of identity persists well into adulthood: It knows no barriers but instead is found within. Therefore, if an identity is that of an addict, a criminal, or a dependent mentally ill framework, this will be brought into the therapeutic hour. It will be projected, transferred, and played out in myriad ways. Of the hospitalized patients I have worked with, very few have had a secure job, a driver's license or photo identification, a high school diploma or college education, a viable support system, or even a home to return to: thus, their identities had become linked with institutionalization. As an example, Figure 2.32 shows two samples of work completed in a group with long-term institutionalized adults.
The directive was to draw "Who are you?" and this directive was given seven times over as the patients moved from one self-disclosure statement to another. The drawing on the left (Figure 2.32) was the first drawing completed by one member and expresses quite bluntly his identity in his mind's eye. Another member, in therapy for drug sales and possession, depicted himself with hoards of money in his first drawing (Figure 2.32, right side). Both of these renderings, as the first drawings, are not mistakes but instead unconscious perceptions. It is commonly believed that the first drawing identifies the artist's self-concept and identification (Machover, 1949). The identity diffusion that these gentlemen and this population experience is further complicated by the continuous struggles that were not mastered in adolescence.
Erikson's sixth phase, intimacy versus isolation, is directly linked to the previous one, for if the adolescent fails to find a true sense of identity the shift to intimacy with another is difficult at best. One of the major obstacles, therefore, is retaining a sense of one's own identity while becoming involved in a united partnership. Given the same group directive as Figure 2.32, a young adult male answered the question "Who are you?" by drawing four of his seven images with the opposite sex.
The individual who drew Figure 2.33 had been incarcerated after having battered a female stranger he met on the street who rebuffed his advances. These images could be interpreted on numerous levels; however,
2.32 Who Are You? 81
for the purposes of this discussion it revealed that the patient's need to find a partner and a sense of shared identity had become an obsession. Erikson (1963) explains the disadvantages of this phase in the following manner:
The counterpoint of intimacy is distantiation: the readiness to isolate and, if necessary, to destroy those forces and people whose essence seems dangerous to one's own, and whose "territory" seems to encroach on the extent of one's intimate relations. . .. The danger of this stage is that intimate, competitive, and combative relations are experienced with and against the selfsame people. (p. 264)
As the individual moves into mid-adulthood, production and care become the focus. Erikson referred to his second-to-last phase as generativity versus self-absorption. It must be noted that generativity does not merely encompass procreation but also care and concern for society at large manifested through a promotion of values, morals, education, and charity. The difficulty of this phase lies in self-absorption, which can pull the adult away from the community with an all-encompassing focus on self-love.
As with all of Erikson's phases, each depends upon not only the basic virtues (hope, willpower, purpose, competence, fidelity, love, care, and wisdom) but also the inner conflicts that create the paradox. His final phase, integrity versus despair, revolves around the ego's integration and the acceptance of the past—a past consisting of all we have been and acknowledging that which we will not be. In this vein, refer to Figure 2.34, completed by an elderly male as part of a group project. The patient was responding to the directive "Separate your paper into threes and draw in the first section where you came from, in the second where you are now, and in the last where you are going."
This patient typically used only a single color (black) and preferred to draw environments rather than people. The patient stated that the first section was a memory of his home as a child. The second section was a rendering of the hospital, with the patient relating numerous experiences in other mental hospitals. Note how the center drawing looks like an oversized home, with the sun shining brightly; this patient had been hospitalized in one manner or another since mid-adulthood, and thus a state of incarceration was truly his home. The final section depicts the board and care home he wished to be discharged to, with the cross denoting "peace" through death. At the end of his description he stated, "Nothing good ever happens to me," which calls to mind Erikson's statement that "De-
2.34 Where I Came From 83
spair expresses the feeling that the time is now short, too short for the attempt to start another life and to try out alternate roads to integrity" (1963, p. 269).
In the final analysis Erikson—who, one must not forget, was psycho-analytically trained—describes ego development in terms of a supportive social milieu where an individual must ultimately face crisis and conflict. He outlines these crises in terms of polarities that require integration. His basic virtues defined an optimistic outlook that was definitely missing in Freud's psychosexual stages and thus allowed the young adult to continue toward a maturity far beyond adolescence. Yet when one applies information from all three theories (Piaget, Freud, and Erikson), no matter how disparate the theories present themselves, a coherent understanding of personality formation comes to light. For although Erikson in later years discounted the Oedipal conflict and Piaget saw the polarities as a process of temporary equilibrium, while Freud based his theory upon a belief that deprivation of nurturance during infancy results in neurosis, each theorist offered classifications that hold special significance in treatment as they provide a clue to adaptive and maladaptive personality functioning.
To make the comparisons easier to understand, Table 2.3 not only condenses the theories presented but also explores normative behavior in children's art, preferred media, and therapeutic materials as it applies to age and developmental levels.
Therapists must not overlook the information in Table 2.3 when utilizing art with the difficult client. In my work with children, youths, and adults, the majority of my clients were significantly delayed developmen-tally. However, developmental delay, in this instance, does not refer to the diagnosis of Pervasive Developmental Disorder, nor does it indicate a lack of intelligence. It simply implies what the three theorists postulated: that in every stage of development resolution must occur, for without resolution a fixation may transpire, the individual might not be able to navigate the environment with any level of competence or skill, and thus future growth and integrity could be stunted. Any delay will therefore only gain in intensity as the child ages, making interventions all the more important. Thus, utilizing the proper materials for the stage of development becomes integral to successful treatment. One would not intervene with an alcoholic by suggesting that he or she form new relationships by visiting the local tavern, nor should one utilize the stories of Edgar Allan Poe with a client who is 5 years old or developmentally reacts as a 5-year-old.
By way of further clarification, the next four categories will discuss the use of fairy tale, myth, and literature; collecting; and appropriate media.
Birth to 1 month
Sensorimotor: grasping and sucking;
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