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Art Therapy: Journal of the American Art Therapy Association
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Art Therapy With Orphaned Children: Dynamics of Early Relational Trauma and Repetition Compulsion
Ksenia Meshcheryakova
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NY, New York Published online: 13 Jun 2012.

To cite this article: Ksenia Meshcheryakova (2012) Art Therapy With Orphaned Children: Dynamics of Early Relational Trauma and Repetition Compulsion, Art Therapy: Journal of the American Art Therapy Association, 29:2, 50-59, DOI: 10.1080/07421656.2012.683749 To link to this article: http://dx.doi.org/10.1080/07421656.2012.683749

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Art Therapy: Journal of the American Art Therapy Association, 29(2) pp. 50–59

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articles
Art Therapy With Orphaned Children: Dynamics of Early Relational Trauma and Repetition Compulsion
Ksenia Meshcheryakova, New York, NY
Abstract
This article explores the dynamics of orphaned children’s engagement with art therapy in a group of preadolescent children living in a Russian orphanage. The phenomenon of repetition compulsion (i.e., origins in past traumatic experiences, destructive consequences, and protective psychic function) is discussed with respect to the children’s artwork and its impact on engagement, countertransference, and termination. The therapeutic relationship and the art-making process are two vehicles that help restore a child’s capacity to feel and to engage in new relationships without the interference of repetitive defenses of traumatic origin. (Kopytin, 2002). A dearth of resources required inventiveness on the part of practitioners in finding venues that would support learning about and experimentation with art therapy practices. In my case an interest in the healing properties of art was incorporated into the work of a multidisciplinary research team that sought to address problems of psychological support for orphaned children. I viewed art therapy as a catalyst for facilitating a child’s greater autonomy and coping skills in the absence of formative interpersonal relationships and other deficits of institutionalized care (Zhedunova & Meshcheryakova, 1999). Ten years later, I returned to my collection of the children’s artworks with the task of reexamining them. Some of the difficulties I had in building relationships with children in the orphanage had a great deal to do with what I recognize today as the phenomenon of repetition compulsion. I assert that understanding this phenomenon is crucial for professionals working with people who experienced disruption of their important early relationships. This article is an attempt to share my insights into how repetition compulsion presents itself in the therapeutic relationship and in the art-making process itself.

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Introduction
This article is informed by materials from an art therapy program that took place in the late 1990s with a group of children living in a Russian orphanage. The collapse of the Soviet Union gave rise to economic and social instability, which directly impacted the well-being of families across the country and tripled the number of children in state care. Unfortunately, even with recent improvements in domestic adoption laws, the number of children living in Russian orphanages remains persistently high (Russian Federation Ministry of Education and Science, 2008). The problem of reintegrating children raised within the state institutional care system continues to exist, making the dialogue surrounding the impact of early relational trauma experiences a topic of contemporary importance. Art therapy in Russia ceased being a prerogative of psychiatric institutions and entered the social sector realm in the mid-1990s; however, access to other practitioners as well as to literature on art therapy continued to be extremely limited
Editor’s Note: Ksenia Meshcheryakova, ATR, LMSW, formerly a practicing psychologist in Russia, currently works with the Jewish Board of Family and Children’s Services in Brooklyn, NY. She is a human rights activist and the founder of several Russian nonprofit organizations servicing underprivileged populations. Correspondence concerning this article may be addressed to the author at kss99@mail.ru
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Repetition Compulsion and Early Traumatic Relationships
Freud (1920/1954) believed that people tend to “revive” past unwanted and painful experiences in their transference relationship with a therapist and may repeat these unpleasant experiences “under the pressure of a compulsion” (p. 20). He further theorized that the emergence of repetition compulsion represents an individual’s shift from having been a passive recipient of a traumatizing event to currently being in active relationship with the event through its repetition. Therefore, the purpose of the compulsion to repeat painful past experiences can be seen as an attempt to master them. This idea was further conceptualized by a number of authors (Cohen, 1980; Horowitz, 1976; Loewald, 1971). However, repetition compulsion rarely leads to mastery and integration of a traumatic past on its own (Chu, 1991; van der Kolk & Greenberg, 1987).

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Levi (2000) proposed that repetition compulsion could be conceptualized as a response to posttraumatic stress. He suggested that it consists of two primary components, the reappearance of which does not diminish with time: (a) the reexperiencing in the present of feelings, beliefs, and sensations that originated in a past stressful event; and (b) the compulsive repetition of defenses that are designed to avoid the reencountering of the traumatic stressor. Levi further argued: “As the compulsion to repeat is a repetitive, selfdefeating, and rigid way of being in the world that causes the individual distress, this process needs to be understood as a maladaptive attempt of mastery” (Levi, 2000, p. 47). Compulsive repetition aims to maintain a person’s psychological sense of safety; however, its fixation on the past often puts the individual at the risk of revictimization, selfdestructive behaviors, and victimization of others (van der Kolk, 1989). Compulsive repetition and reexperiencing often lead to a reenactment of the traumatic past. The reenactment of traumatic themes within a person’s family system or community is linked to the phenomenon of the intergenerational transmission of victimization and violence (Krugman, 1987; Shabad, 1993). Russell (2006a) emphasized the interpersonal aspect of repetition compulsion and its connection to early trauma. He noted that the interruption of a significant nurturing relationship could cause arrested development in an array of a child’s competencies—in particular, the child’s affective competence. Attached to the loss in the past, repetition compulsion is based on a dysfunctional feeling system that operates at the expense of a person’s capacity to feel and experience connectedness that is necessary for growth. Russell (2006b) observed two conditions where affective connectedness can be interrupted: (a) when one has lost an affectively nurturing relationship in the past and (b) when one experiences a relationship in the present that cannot afford such nurturance. In the former condition the loss is experienced as a traumatic event; in the latter, the relationship and environment itself are traumatizing, which is a more pervasive and costly experience for the individual and falls under the category of complex trauma. Van der Kolk (2005) defined complex trauma as “the experience of multiple, chronic, and prolonged developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset” (p. 402). Along with other authors (Green, 1983; Terr, 1981), he posited that children tend to incorporate their experiences of trauma into their worldview and personality structure, and may organize their relationships and life choices around the possibility of the trauma’s recurrence.

Institutional Care and Repetition Compulsion
Unfortunately, orphanages historically have had very limited resources available to compensate for the loss of affective connectedness that a child may have experienced prior to or during orphanage placement. The structure and

content of a child’s relationships with orphanage caregivers are determined by the conditions of group living, the daily routine, and any deficit of individualized attention. Such relationships tend to be limited in terms of time and emotional depth; impacted by staff turnover or burnout; and mediated by various styles of relatedness to children, including being overly disciplined, overprotective, or emotionally withdrawn (Dubrovina & Ruzskaya, 1990). The deficit of intimate nurturing relationships with caregivers and a strictly disciplinary, group-oriented system of care often results in overcompensation on the part of the children, which is manifested in disobedience, running away, psychosomatization, self-injurious behavior, rebellion, and so on. In the absence of the child’s own capacity to negotiate his or her needs the child is forced to comply by neurotically merging with the orphanage environment. In the long run this merger leads to the development of a dependent life scenario and complicates the child’s future integration into society (Baiborodova, Zhedunova, Posysoev, & Rozhkov, 1997; Zhedunova, 1997). Thus, children living in the orphanage environment are coping not only with the disruption of relationships with their families but also with an ongoing deficit of nurturing relationships that an orphanage cannot afford to offer. Real relationships are substituted with the compulsive repetition of defenses, hindering the child’s capacity to be in touch with the self and to negotiate connectedness with others. In her analysis of the attachment behavior of children ages 3 to 5 years who were living in Russian orphanages, Bardyshevskaya (1995) hypothesized that the earlier the disruption took place, the costlier the event was to the child’s development. She proposed the following hierarchy of coping styles based on a child’s ability to establish a personal relationship with a caregiver: (a) avoiding type in children who perceive the world as a threat and, when attempting to establish contact with others, experience tension that is usually reduced by avoidance and aggressive attacks on others; (b) clinging type in children who crave exclusive bodily contact with any adult, even those least known to them, because such physical contact provides feelings of containment, stability, and warmth, despite the fact that it also complicates the completion of contact; (c) undifferentiated attachment type in which emotional relationships with adults are superficial, disorganized, easily substituted, defined by positive moments while negative moments are ignored, and where the presence of a caregiver stimulates learned helplessness in the child; (d) ambivalent attachment type in children who have contradictory, conflicted relationships with adults that are defined not so much by pleasant interactions but by the traumatic experience of frustrated or aborted contact; (e) socially anxious attachment type in children who form a strong attachment to one particular caregiver that results in heightened fear and anxiety around all other adult strangers; and (f ) harmonious type in children who develop normal, hierarchically organized systems of attachments that are relatively open and flexible. Similar categories of attachment behavior in children are found in the research literature of various disciplines (Kaiser & Deaver, 2009).

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For a child who experienced the traumatic loss of a caregiver and subsequent placement in an orphanage, the appearance of a potential new caregiver such as an art therapist brings up anxiety and compulsive repetition of protective, defensive measures that the child used when the early relationship failed. The repertoire of such behavior communicates the child’s unique coping style and particular need for the restoration of relatedness. For example, children with an avoiding attachment style can be expected to experience contact with the art therapist as extremely uncomfortable; engagement in creative activities will be jeopardized until a sense of safety in the therapeutic relationship is established. For children with a clinging type of attachment, the need for physical contact with an adult is so urgent that it completely undermines any possibility of interpersonal involvement. Children with an undifferentiated attachment often produce stereotyped drawings because their art activity is guided by the need to please the art therapist, and they likely will meet creative challenges with learned helplessness. Children with ambivalent and socially anxious attachment styles will rigorously test the relational space before engaging in the creative process. Children who are capable of harmonious attachment may engage in the art therapy process without reliance on maladaptive interpersonal defenses; their presence in the group art therapy space can be very beneficial for other children and serve as a model of a healthy relational negotiation and the potential use of art for nurturance. It should be noted that in actual practice these various coping styles may overlap (Mechtcheriakova, 2004). In working with repetition compulsion the therapeutic advantages come from two sources: (a) the transference, which communicates the experience of a failed relationship, and (b) the reality that the therapist is a different object from whom the transference derives. According to Russell (2006c) “the therapist must negotiate to be both the person with whom the initial negotiation failed and the person with whom it might be different” (p. 64). Russell (2006a) also insightfully noted that the paradox of repetition compulsion within the context of therapy is that it is both “an invitation to a relationship and an invitation to repeat the interruption of some important earlier relationship. It is both adaptive and suicidal because, in this context, relatedness is what the person most needs and cannot yet feel” (p. 611). The reparation of an early relational injury can be possible when “some present relationship survives the recreation of everything that made inevitable the earlier loss of connectedness” (p. 612). Phillips (2003) proposed that art and art materials represent a “more durable attachment” in circumstances where there is a high turnover of caregivers (p. 145). In her work with children in foster care she emphasized the innate nurturing aspect of art, stating that “fostering the client into the art, responding mostly to the art, and so on all help the child relate to and deal with issues without the dependence on the ‘person’ of the therapist” (p. 145). The internalized nurturing capacity of art can become a lifelong resource of self-sufficiency and self-reliance for a child.

Art Therapy Program
The art therapy program site was arranged by the Russian Department of Education, which allowed me to organize my work with the children with minimum bureaucratic interference from the orphanage administration. I was present at the orphanage for two fall semesters (4 months each) in 2 consecutive years. Because I had no prior experience working in the Russian orphanage system, I spent the first semester orienting myself to the new environment, its specific opportunities, and its limitations. As my clinical experience and theoretical knowledge grew, I moved toward a more structured art therapy program that focused specifically on the developmental needs of the children. In each of the 2 years I arranged to work with a new group of about 20 children, aged 7 to 12 years old, who were living together as a group while attending the first and second grades. The office space was well equipped for individual and small group sessions. I made an effort to establish friendly relationships with the two teachers who supervised the group’s living quarters and the children’s daily activities. The group home schedule permitted me to use the 3-hour early evening recreation break for my art therapy sessions. I received weekly supervision from an experienced clinical psychologist. I made a conscious decision to refrain from accessing the children’s case files and from making inquiries into their life histories. This was an attempt to avoid a bias that I believed would interfere with my ability to build a genuine relationship with the children. In congruence with common art therapy methods, I chose to learn about the children as they presented themselves through their art and in contact with the art therapist. This decision also was in agreement with the conceptual framework of research that encourages focusing on psychological resources available to the child rather than psychopathology (Zhedunova, 1997).
Pictorial Reenactment of Relational Trauma

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The phenomenon of repetition compulsion—its origins in past traumatic experiences, its destructive consequences, and its protective psychic function—was manifested in the art therapy program and in children’s artwork. In one instance I found two 8-year-old boys sitting on the floor near the bathroom, giggling over their drawings. With some hesitation and embarrassment they agreed to show me their imagery and became engaged in discussing it with me. Figure 1 depicts a massive figure of a woman hanging by hooks on long chains with open wounds to her chest and lower body. A fire is burning underneath her. Little balls are coming out of her mouth and rolling down to the right. As they roll downward the balls grow in size and turn into unidentified creatures. One of the boys explained that he had drawn a picture of a mother and that she was being punished because she was a bad mother. In the second drawing (Figure 2) two adult men (presumably father figures) with disfigured bodies are depicted. The boy said that he had drawn two criminals being punished for their bad deeds. He described in detail the

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Figure 1 Mother Figure Hanging by Hooks (Color figure available online)

suffering each man had been subjected to; for example, one man has a distorted mouth, some bones scattered inside his body, a mutilated right leg and left hand, a body cavity opening up on his side, and an outline of his torso that seems purposefully misshaped. The other man is hanging on a hook connected to a chain (like the mother in Figure 1) and his throat is being attacked and wounded by some sort of mechanism. He also is shown with an open wound to the side of the torso. Both men are not wearing any protective gear and they appear to be castrated. Finally, the children pointed out with excitement and shame that they were the two males portrayed in the drawing. The pictorial expression in Figure 1 suggests a degree of dissociation from the mother, who is not a nurturing figure: Her face is unemotional, her chest is wounded, and her breasts are displaced. Her oral aggression is depicted with the objects/creatures coming out of her mouth and rolling down and out into the world. It seems that the boys gained control over her powers by assuming the role of an aggressor and by victimizing her—she is chained, hanged, burned, and mutilated. In contrast the male or father figures in Figure 2 retain their powers by defying the social order. Their harmful aggression is pictorially neutralized by physical punishment and bodily mutilation. Identification with the aggressor is literal—the boys claimed their association with their abusive, self-destructive, and socially ostracized male role models.

Figure 2 Disfigured Father Figures (Color figure available online)

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This encounter with the children took place during my first months at the orphanage. The meeting occurred spontaneously in their living quarters. The content of their drawings indicates the presence of a highly conflicted, early relational history in the lives of these children and is suggestive of the ambivalent attachment style as a means of coping with past trauma. Identification with a hostile and aggressive caregiver is a compulsive defense mechanism that aims to bind the rage against a traumatizing relational environment and to avoid self-fragmentation (Kramer, 1971). When such a caregiver is the only relational model in the child’s repertoire, a future cycle of reenacted abusive relationships, selfdestructiveness, and violence against others may result.
Encounter With an Art Therapist: Working With Repetition Compulsion

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New encounters with prospective caregivers (such as the art therapist in this case) can be potentially uncomfortable and anxiety provoking. The new relational territory will be tested by repetition compulsion. If a new relationship survives the child’s guarded deployment of repetitious defenses, it opens an opportunity to restore the capacity to feel and to connect genuinely to others and to the self. The relationship also will elicit a need for grieving and reintegration of early losses. To reduce anxiety and to ensure some sense of safety in the presence of a new adult, my first encounters with children in the orphanage took place in small peer groups. In my first meeting I asked the children to draw themselves on

a shared paper that was drawn to resemble the room where our sessions took place. I repeated the assessment in our final meeting. The objective of the projective assessment was to understand the relational and coping resources available to each child, as well as to observe their defenses as they encountered a new adult and engaged in a spontaneous artmaking process. Misha (pseudonym), a 7-year-old boy who presented with a harmonious attachment style, drew himself as a magician with a magic wand, hat, rollerblades, and tape player (Figure 3). He depicted his friends as a ninja turtle, a cat, and a biker. (The biker character was in reference to another child who had been adopted by a French couple, an event that impacted many drawings of children who wished to be adopted.) Misha’s characters are all resourceful in that they are depicted as possessing special powers, friends, and belongings that make them self-sufficient and happy. In contrast Serega (pseudonym), an 8-year-old boy with an ambivalent attachment style, drew himself with a bottle of vodka and a cigarette in his mouth (Figure 4). Within the context of his first encounter with an art therapist, his drawing was a statement of disobedience and rebellion. It illustrates another example of identification with the aggressor, in this case with a dysfunctional caregiver. Reference to alcohol and nicotine use is a culturally conditioned claim of masculinity in Russia and can be interpreted as a metaphor for failed affective nurturance being substituted by the selfdestructive consumption of illicit substances. Dima (pseudonym) was a 7-year-old boy with an attachment style that tended toward clinginess and a high level of anxiety in the presence of a new adult. In drawing his

Figure 3 Misha’s Self-Portrait (Example of Harmonious Attachment) (Color figure available online)

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Figure 4 Serega’s Self-Portrait (Example of Ambivalent Attachment) (Color figure available online)

self-portrait he declared that he was a “robot-transformer.” His agitation noticeably grew as he started demonstrating the protective and offensive powers of his ammunition. These included firearms and the burning head and hands of his character. Less than one minute later Dima destroyed his drawing (Figure 5). He withdrew from the activity with sadness and shame while other children continued to work on their drawings. It may be inferred that first contact with a new adult was emotionally overwhelming for Dima. Responding with anxiety, his search for pictorial protections led to the destruction of his self-portrait and to emotional withdrawal. Dima created his next drawing approximately 1 month later. He had had a difficult day and his teacher decided that it would be useful for him to spend some time away from the group. Dima drew himself with a bloody nose while sharing his feelings about a fight earlier in the day with other boys in the class (Figure 6). In contrast with the example described above Dima was able to relate to me in the present moment and to process his emotional distress caused by his peer relationships. His affect was contained with a degree of introspection that suggested developmental movement toward affective competence and the ability to self-regulate. Later in the program I asked Dima to draw a character that he knew intimately. He depicted a truck that was delivering gifts to other children and he named the truck “Dima.”

Figure 5 Dima’s Self-Portrait (Color figure available online)

(“Robot-Transformer”)

On that day he had to draw the character independently without my presence. After the drawing was completed, I inquired about the character’s self-sufficiency, supporting the development of his narrative. The boy said that the truck’s food source was at the gas station, and that he slept at the garage and had friends who were the children he delivered gifts to. Dima had created a personally meaningful image that could be used for further ego-supportive explorations. Petya (pseudonym) was 7-year-old boy with an ambivalent attachment style. He began his self-portrait, a small figure of a boy, with a light green pencil. As he worked his agitation grew and was reflected in a series of ever more provocative self-portraits. He started by drawing a “strong, naked, pissing Petya” and continued with “defecating Petya” followed by “scared, fat, ugly Petya,” and “Petya ninja-turtle.” He finished with the portrait of an alien-looking character (Figure 7) that had a different last name from Petya’s (a reference to the classmate who had been adopted by a French couple). Significantly, Petya’s first self-portrait is realistic and colored with lighter pressure, and is both smaller and less defined than the rest of his

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tinct steps that were pictorially represented in his process of creating his self-portrait. In the first step he returned to compulsive defenses, as seen in the left section of Figure 8. Petya depicted himself with a distorted body that he called “ugly and unattractive.” He was emotionally overwhelmed with anger and disappointment in his therapist’s departure and he protested verbally and pictorially. In his second step he attempted to cope with the loss of connectedness to his self, seen in the middle section of Figure 8. Petya could not accomplish this attempt to create a selfportrait; it was left unfinished after several trials and erasures, suggesting a symbolic loss of affective connectedness and speaking to the cost of return to compulsive defenses. Petya’s third step was reintegration, which can be seen in the right section of Figure 8. He finished the art therapy session with a realistic self-portrait and left the session calm and composed. Termination is an especially complex and potent moment in therapy for a person with a history of early attachment disruption. The termination period brings up anxiety and defenses against the risk of reencountering the feelings of early loss of the caring object. The formative gain of living through the stress of termination is in the opportunity to achieve closure with a subsequent relationship that was not disruptive to the individual’s well-being. In the long run the child internalizes the capacity to manage the ability to enter and leave relationships without the interference of repetitive defenses of traumatic origin.

Discussion
Figure 6 Dima’s Self-Portrait (With “Bloody Nose”) (Color figure available online)

self-representations. Such defensive “acting out” imagery reflects his testing of the art therapist’s ability to provide a space for containment. The child’s sense of safety and intimacy may be restored if his relationship with the art therapist and art materials is able to withstand the work of the repetitive trials on behavioral, verbal, and pictorial levels. During individual sessions Petya told me that he was a 4-year-old when he arrived at the orphanage. He remembered his older siblings but his family had not visited him since his placement. Petya shared his sadness and hope that one day they would come to visit him. Later in the course of the program, when I asked him to draw a character that he knew intimately, Petya drew the ego-supportive “Dinosaur Sisinov and his son.” He said that the dinosaurs slept in the forest where they fed on the leaves from the trees and that they carried a supply of these leaves on their backs. Petya created what appeared to be an intimate and nurturing father–son relationship with a capacity for self-care (food) and survival (shelter). Figure 8 illustrates Petya’s coping with termination from art therapy. I announced the impending termination of the program in advance to allow time for processing. In the final session I asked the children once again to draw pictures of themselves. Petya’s coping can be described in three dis-

Work with early relational injury requires a wellthought-out therapeutic position that is focused on the present moment, offers the child emotional attunement/containment during the contact, and facilitates the development of interpersonal mutuality and partnership. The working through of repetition compulsion will vigorously test the boundaries of the therapeutic relationship and its capacity to carry out a protective and reparative function. In this respect I have found that two major sources of countertransference may interfere with the therapist’s ability to respond to the child’s reparative needs. First, the reenactments of a child’s early relational trauma may trigger the therapist’s own experiences of abandonment, rejection, and loss. Therefore, work with one’s own past interpersonal traumas can be a potent resource for a therapist’s expanding ability to provide clients with restorative relational space. In my case entering the orphanage environment brought back memories of my own childhood fears of being lost or separated from my caregivers. Addressing these issues in supervision and personal psychotherapy gave me the opportunity to reconnect with the complexities of my personal attachment history and helped me to better adjust to the institutional structure of the orphanage. Second, working with a child who is deprived of parental love and care may evoke a desire to act as a substitute for the missing parental figures. This aspiration may arise in the form of a fantasy or a real urge to take the child home, and/or the temptation to provide food, clothes, toys, and art supplies. The realization of one’s

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Figure 7 Petya’s First Self-Portrait (Color figure available online)

personal inability to save a child from orphanhood usually is accompanied by feelings of sadness and guilt. In many cases children come up with sophisticated ways to engage the therapist in a pseudo-nurturing type of relationship. For example, Dima, whose clinging attachment style was described earlier, insisted on taking an object at the end of each session—whether a pencil, an eraser, my watch, or even buttons from my shirt. He had difficulty completing and exiting our sessions and engaged in elaborate, repetitive begging for possessions that he associated with me. As hard as it was to say no to such a desperately needy child,

these ritualistic and repetitive behaviors fed his dependency and defensive merging with the environment. Blocking this maladaptive way of relating soon led Dima to give up the habitual begging and turn to the intrinsic aspects of our relationship, such as art and self-exploration. As much as the omnipotent desire to rescue is normal, it can be counterproductive when the therapist is working in an environment that fosters protectiveness and dependency over self-reliance and self-initiative. As art therapists, we can offer an orphaned child encounters of a radically different nature that include the formative and healing experiences

Figure 8 Petya’s Final Self-Portrait (Color figure available online)

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of engaging in real relationships (co-being) and personal art making (self-being).

References
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Conclusion
Children living in an orphanage environment are coping not only with the disruption of relationships with significant caregivers but also with a continuing deficit of nurturing relationships that many orphanages cannot afford to offer. As both a protective measure and a response to chronic traumatizing stress, a child may develop and maintain a system of rigid maladaptive defenses. The compulsive repetition of these defenses does not lead to the mastery of trauma; instead it has a pervasive effect on the child’s capacity to be in touch with the self and to negotiate connectedness with others. The initial encounter with orphaned children may be difficult to manage. Children present an array of reenactment behaviors (behavioral, emotional, and pictorial) that inform the art therapist about the child’s past failed significant relationships. The art therapy space, which is understood as the child’s process of relating to the art therapist and art materials, can offer a safe and reliable territory for the reenactment of traumatic themes. Survival of this relationship is an important milestone in a child’s restoration of the capacity to feel and to genuinely connect to others. Compulsive relational defenses become substituted with the centrality of the art-making process. The art therapist assumes the role of a supporter of the child’s creative process and growing ability to utilize art in relating and supporting the self. The experience of engaging with art as a self-nurturing process is an important psychic gain and potential source of self-support within the often unpredictable and inconsistent relational environment of institutionalized care. Termination is an important relational task that may include reenactment of original interpersonal defenses, loss of connectedness to self, and the reintegration of a survived relational experience. On a pictorial level, this process may include the return of regressive and stereotyped imagery, the loss of the ability to produce formed expression, and the reintegration of self-sufficiency and nurturance of the artmaking process. The formative potential of termination is in the opportunity to actively negotiate these tasks with a caring person and to internalize the experience of a manageable and therefore nondisruptive closure. Finally, practitioners who are working with this population should be aware of two common sources of countertransference, that is, one’s own personal experiences of disrupted significant relationships in the past and an omnipotent desire to compensate missing parental figures at the expense of the child’s self-determination. Working with this material under supervision and in personal therapy will help ensure that the therapist is optimally positioned to respond effectively to the child’s reparative relational needs.

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Annual Conference of the American Art Therapy Association, San Diego, CA. Phillips, J. (2003). The use of art therapy in impacting individual and systemic issues in foster care. In D. J. Betts (Ed.), Creative arts therapies approaches in adoption and foster care: Contemporary strategies for working with individuals and families (pp. 143–151). Springfield, IL: Charles C Thomas. Russell, P. L. (2006a). Trauma, repetition, and affect. Contemporary Psychoanalysis, 42, 601–620. Russell, P. L. (2006b). The compulsion to repeat. Smith College Studies in Social Work, 76 (1/2), 33–49. doi:10.1300/ J497v76n01 05 Russell, P. L. (2006c). The uses of repetition. Smith College Studies in Social Work, 76 (1/2), 51–66. doi:10.1300/J497v76n01 06 Russian Federation Ministry of Education and Science. (2008). Kolichestvo detej ostavshikhsya bez popecheniya roditelej v 2008 godu [Statistics of children left without parental care in 2008]. Retrieved from http://www.usynovite.ru/statistics/2008/1/ Shabad, P. (1993). Repetition and incomplete mourning: The intergenerational transmission of traumatic themes. Psychoanalytic Psychology, 10 , 61–75.

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