Inscape

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Authenticity and survival working with children in

chaos

Caroline Case

To cite this article: Caroline Case (2003) Authenticity and survival working with children in
chaos, Inscape, 8:1, 17-28, DOI: 10.1080/17454830308414050

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Published online: 02 Jan 2008.

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 AUTHENTICITY AND SURVIVAL
Working with children in chaos
by Caroline Case
ABSTRACT
This article considers two kinds of clinical presentation
involving chaotic aggression and destruction, when defences
break down. The first set of case material is taken from art
therapy work with a neglected and deprived child, traumatised
through physical abuse, in a context of domestic violence. The
second set of case material is taken from work with an
‘entangled child’ on the autistic spectrum. It is primarily Tustin’s
ideas about entangled/confusionaI children that are used in this
I distrust the incommunicable:i f is the source of all
violence. (Jean Paul Sartre [1905-19801, ’Qu’est-ce que
la litterature?’, Les Temps modemes, July 1947)
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Introduction
The authenticity and survival of client and therapist
in the art therapy session is the focus of this article.
The child who has experienced the external trauma of
physical abuse may present in a frozen or
disassociated way. The entangled child may present
with a cluster of autistic symptoms, which form a
carapace, i.e. a hard outer shell, over an internal
trauma of separation. There is a difficult stage in
therapy: when defences break down and anger, fear
and pain surface in both kinds of children. These two
types of case present very differently, but both make
particular demands on the resilience of therapist and
child: for this reason it is interesting to consider them
together. In entangled children there is a wish to
remain merged and not to separate into their own
individuality. This stage can be chaotic, aggressive
and destructive, having a huge impact on the room
and the therapist. The client has to survive their
emerging emotions and the therapist has to survive
attacks on the room and themselves. Art therapy can
offer an intermediary arena of potential containment
if a transitional space can be established (Winnicott,
1951). The first image to emerge after a chaotic stage
may reveal to the therapist what was being protected
by the angry outburst or aggressive phase in therapy.
It can help us both to understand this child but also
to be more aware of underlying feelings when we
find ourselves in this situation again. For the child,
what is made can be a means of containing helpless,
fearful, angry or passionate feelings. The making of
images within the therapeutic relationship may allow
some authentic expression of the ’child within the
defences’ for the first time.
Inrcopc Volume Eight No. I 2003
second example (Tustin, 1992). In treatment, the therapist
needs to facilitate their becoming real in an authentic way and
remain real to clients herself when under intense pressure. The
word ‘authentic’ is being used to describe the child within, who
is hidden by a carapace of defence. Art therapy can offer an
intermediary arena of potential containment if a transitional
space can be established. Both chaos and the importance of
the first image to emerge after such a stage will be considered.
Thinking about aggression and violence
Parsons and Dermen (1999) give a readable and
accessible introduction to thinking about the violent
child and adolescent: ‘We are all capable of reacting
violently in extreme circumstanceswhen our very
survival (physical or psychological)is at stake.’ Their
main thesis is that violence is the most primitive
(physical)response to a perceived threat to the
integrity of the psychological self. Parsons and
Dermen suggest that the ultimate danger the violent
individual defendsagainst is the experience of
helplessness in the absence of a protective adult.
Children who have experienced such helplessness
will have had failure in their earliest nurturing. The
violent child lacks an intemalised protective
relationship and therefore lacks a flexibility of
response that would allow him or her to register
anxiety as a signal of an impending threat and to
mobilise appropriate defences. The experience of
helplessness would feel like annihilation. Such people
are very vulnerable to ordinary emotional contacts
that abound in everyday life. Any threat that does
penetrate the barrier will be experienced as traumatic,
and may trigger the most primitive defences. They
may appear to others as unpredictably violent
because the trigger may not be apparent.
Winnicott (1945,1950,1951,1963) noted that
aggression is a ~ t ~part ~ ofalifel and a major source
of energy. He saw aggression as having a vigorous
side of enjoyable somatic expression to do with
’feeling real‘ as well as having a ’true-self-protective’
function as a response to environmental
impingement. Without aggression we would not be
able to assert or protect ourselves actively or progress
from dependence towards independence.Aggression
plays a healthy role in allowing the development of ‘I
am’and separateness from Mother. The fact that
Mother can survive these attacks allows her to be
seen as a separate person in a shared reality.
17
 AUTHENTICITY AND SURVIVAL
Winnicott proposed two elements which need to
function together in males and females for healthy
life: to be able to ’be with’ and to be able to ’do with’
female and male elements (Winnicott, 1971). A
mother also needs to hold her child in mind, in her
comprehension of the true self of the child for healthy
development.
Earliest forms of aggressive urges concern the baby’s
need to get rid of intolerable feelings in order to
achieve a sense of safety and comfort (Edgcumbe,
1976).When little babies are hungry or tired or
frightened, they cannot make themselves feel better,
and have to rely on others. If their needs are not
adequately met, their distress, frustration and
helplessness may become overwhelming. They can
only use a physical response - cry, kick, yell, scream,
flail their arms (Parsons and Dermen, 1999).If their
needs are met they have the experience of a
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protective, comforting relationship. They can make a
demand and it is met.They have the experience of an
empathic and receptive person. They begin to be able
to tolerate feeling vulnerable because helplessness is
assodated with a protective relationship that can
encompass their needs. If there is environmental
failure then the child’s internal world will be shaped
differently. When infants experience extreme danger
they feel annihilation, disintegration and
fragmentation. If babies have unmanageable amounts
of anxiety they may resort to pathological defensive
behaviours such as avoidance, or freezing or fighting
(Fraiberg, 1982).An unadaptive pattern of relating
will then develop. This earlier work of Fraiberg’s has
been supported more recently with the findings of
neurobiologists. It is now thought that trauma limits
the developing strudure of the brain, affecting babies’
abilities to take in the world about them (Fox et al.,
1994;Perry et al., 1995; %ore, 1996).Neurobiologists
have also shown that young children who are
continuously exposed to traumatic experiences
develop a neurological connection that responds to
increasingly less stimulus: so that they become
hyperactive. They respond as if there were a large
threat when in a situation of a small threat (Schore,
1994; van der Volk and Greenberg, 1987).
Crucial to the child’s development is the way that the
parents deal with their own aggressive impulses.
Children need to learn how to be assertive but not
damaging, or need help to master aggression and
channel it into other activities. Ways of ‘making
good’, reparation and forgiveness facilitate the
development of a healthy and non-punitive
conscience. If a parent is tolerant of their own
aggression they can see their child‘s aggression as
that of a child and respond appropriately, not react. If
a child is smacked or hit in order to control
aggressive impulses, he or she gets punished but also
receives physical contact that can be exciting to both
18
child and parent. The child gains no experience of
containment or help with frustration, but has had to
give in to a superior force under threat of more pain.
Such a response lays down a pattern of future
relationships where sex and violence intermingle:
violence is sexualised. A sado-masochisticform of
relating is a mixture of punishment, humiliation,
control and excited contact (Parsonsand Dermen,
1999). The solution for the child who is attacked and
controlled is to become identified with the aggressor.
This offers an escape route and perpetuates the
pattern. It is the internalisation of violent and
disturbing objects (usually violent parents) which
then become a part of the child, allowing a vehicle for
the child’s destructiveness (Hodges et al., 1994). It is
at times when people are f l d e d by disturbing
thoughts, fantasies and flashbacks that they are more
likely to be an aggressor to avoid feeling helpless. If a
space for thought can be developed, it is possible that
they can resist behaving destructively.
Art therapy literature and destructive
outbursts
Historically, art therapy literature has focused on the
images made, and for this reason perhaps, there is a
scarcity of detailed reference or consideration of
technique when one is confronted with sessions or
stages of aggression in therapy. For patients with
poor impulse control, or who have experienced
physical abuse, or for whom intimacy is threatening,
moments or stages of aggressiveness in the sessions
are likely to occur.Fox refers to ’savage acts of
vandalism and blind rage’ in work with autistic
adults suggesting that the artwork functioned as
transitional objects which the client created and
destroyed (Fox, 1998).Stack also mentions phases of
self-mutilating and acting-out destructive behaviou
in encapsulated autistic adults (Stack, 1998). Hallam
d k u s s e s ‘destructive room wrecking outbursts’ and
how contact with his mentally handicapped client
group is made through narrative, ‘talking about what
the therapist is doing, then what the client is doing,
then this leads towards stories’ (Hallam, 1984).
Pearson in relation to adults, and Rabiger in relation
to children, also discuss aggressive/ destructive
behaviour within the same client group (Pearson,
1984; Rabiger, 1984).
In a previous paper (Case, 1994),the creation of a
mise-en-dne of domestic violence was discussed, in
which the child is both director and actor, leaving the
therapist in the ’helpless observer‘ role, which mirrors
the child‘s situation in the past. In this sort of
scenario, when the child cannot make any artwork
with the materials, but uses the whole room to create
representations of past traumatic events, it was
suggested that the therapist‘s own artwork (after the
child‘s art therapy session) could have a vital role as a
Inscape Volumc Eight No.1 2003

'reflective countertransference'. It could help the
therapist understand, for instance, their own violent
feelings which were aroused in the session, and, by
making use of this countertransference, those of the
child. In a later paper, the alternating and fluctuating
positions of the 'terrorised' and the 'terrorising'
between therapist and client in sessions with
physically abused children were discussed (Case,
1998). Boronska has written about working with
children who are identified with an aggressor,
describing sibling work with families who have
experienced domestic violence and the difficulty of
containing violent outbursts from children (Boronska,
2000). The first piece of case material below considers
the Unpredictable one-off outburst which is
sometimes encountered with children who have been
physically abused.
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Colin: a one0off destructive outburst
Colin was referred for therapy when he was eight
years old. He had lived with his birth parents until he
was four, when he became a 'looked after child',
living in a foster family. It is known that he was
locked in a room for extended periods of time
without emotional contact. His father was convicted
of physical abuse against him. Little detail is available
of these early experiences.Colin was tiny and
undersize for his age, his weight on a borderline of
eating disorder. He looked like a five-year-old child.
His symptoms on referral included verbal and
physical aggression, controlling and obsessional
patterns of behaviour, unpredictable mood swings,
withdrawal, inexplicable outbursts of anger,
sexualisedbehaviour and language, fire raising and
enuresis. He also hid faeces, and hoarded food,
presenting a very deprived picture.
Initially in art therapy, Colin was frozen emotionally
and sat on the floor putting things out and putting
things away, unable to use the materials for some
weeks. Gradually, he had been able to use them but
rarely spoke. It had felt hugely difficult for him to
bear my presence in the room, so I had confined
myself to sitting quietly and describing what he was
doing. It was mentioned in Colin's referral notes that
he would on occasion wreck his room and destroy his
toys and I encountered a mood like this four months
into therapy. He had arrived at school in a mood and
had a difficult morning. He had not wanted to come
to therapy. He had come into the session head down
and tense and not looking at me. He pushed chairs
over and went to the paint, starting to pour it out
onto the carpet. I noticed that it was yellow paint and
it felt like hope draining away. I stopped the pourin&
suggesting that it should go onto paper. He left it and
smashed all his clay models; then he turned to the
scissors. He began to cut up paper, his large plastic
folder, things he had made, and two puppets that
Inscap Volume Eight No. I 2003
AUTHENTICITY AND SURVIVAL
were in my room. He took particular sadistic
pleasure, I thought, in cutting the fur off the puppets
and cutting their body or skirts off.
This kind of destructively violent and angry mood in
children leaves them very hard to reach and contain.
They need to give expression to the mood and to be
kept safe, and the therapist and the fabric of the
building also need to be kept safe. Destructiveness is
to do with the destruction of emotional links to one's
inner world of feeling. In this way actions are
separated from thought or feeling and people in this
state of mind can appear like a machine at work,
quite unstoppable. Destructiveness relates to
mindlessness. RiviGre (1937)writes that the
combination of aggression dissociated from love and
denied becomes destructiveness. Heat and rage and
turmoil transform into coldness and the alienation of
cynicism.
I had set limits:I stopped the paint going on the floor,
but otherwise I had tried to talk to the 'tipped-out'
and 'in-pieces' quality that was present in the session.
When he had attacked the puppets, I had given voice
to the feelings of the puppets in the face of this
inexorable quality,saying how helpless they felt.
They were softand did not know what to do; helpless
in the face of the cutting that they could not stop. I
had also commented on how all the contents of his
art folder would drop out if he continued to cut the
bottom of the folder. He changed to cutting up the
edge. Finally, he had tried to take the cupboard door
off by unscrewing the door hinges and screws, but
had not been able to do this, so I had not intervened.
Then, he had tidied up, clearing away the pieces
everywhere.
He had not spoken until the very end, when he said
that he never wanted to come again. I felt through
this that there was a sense of Colin wanting to get
inside: into the folder, and into the cupboard that he
could not open. I thought that this had two aspects:
firstly, a wish to be safe inside there himself, and
secondly, a wish to attack the phantasy babies with
the scissors, babies whom he imagines Mother has
inside, and who are apparently secure. He had been
abandoned before becoming a 'looked after' child,
and this can arouse mixed feelings of hate and a wish
to be reunited with an ideal mother. There had been
identification with a violent father, and an attack on
his baby-self in the form of the puppets. There had
also been an attack on me, and what I could provide
in terms of materials, and attack on the containment I
could offer. This had been true in a concrete way, in
terms of the attack on the folder that contains the
paper and his drawings and paintings. It was
attacking also in the silent menace and destruction he
had created in the room, which had affected my
capacity to be with him in a fruitfulway.
19
 AUTHENTICITY AND SURVIVAL
I am going to discuss briefly the two following
sessions, to see this session as part of a sequence. At
the next session, he had come with a school project on
homes and houses and showed me ticks and
comments from his teacher - ’good and ’very good‘
on almost every page. He had then spent the whole
session filling in and colouring the houses. I had
talked of how scary it was to come to therapy and
how he needed to know what he was going to do - it
would be very difficult to come not knowing what
was going to happen. I had also talked of him
wanting me to see what good work he could do. He
had also expressed a wish to have a home, in therapy
and outside, that was safe.
The following session he had come empty-handed
and had asked me if I had any colouring books. I had
said no, but there was paper here and he could
perhaps draw and colour in. He had then taken white
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paper and begun to draw earnestly (Figure 1).It had
become a figure - after an uncertain start - which he
had filled in with pencil saibble, then brown pencil.
All this had been in silence. He had then said, ’There‘.
A silence had begun to gather. I had begun to speak,
but he had said, ‘It’s a teddy bear’, very sharply. The
image had felt incredibly exposing. He had begun to
clear up and tidy lots of materials. He had then gone
on to mend things that he had attacked in the cutting
up session. Later I had tried to talk about the drawing
again but he had shaken his head so I had accepted it
as a mute offering; he had had no words at this time.
It had felt exposed and vulnerable and deeply
connected to the cutting up. I thought it was an
image of a vulnerable baby self that feels rejected and
unwanted. Another part of Colin that is identified
with the aggressor acts with these mutilating cutting
attacks in a sadistic way. This is something he has
witnessed and been part of in his parents’ violent
relationship. It is possible that in being able to voice
the puppets’ feelings in the cutting up session
something of this did reach him though not
acknowledged at the time, and he had been able to
show me this little figure inside. This image gave
expression to the reverse of the destructive violence,
and I wondered if when touched by intimacy or
under threat, the violence emerged to defend against
feeling this intense helplessness. I continued to work
with Colin, who started to speak to me and
developed a broader personality.
Sally and aggression from internal trauma
When Sally, age eight, was referred for assessment it
had been difficult to distinguish different
characteristics of developmental delay, learning
difficulties, environmental factors, genetic and
emotional factors, as well as autistic and psychotic
traits and possible trauma. For instance, Sally usually
presented as mute, with language only in one
20
Figure 1. Teddy Bear.
specified area to do with animals. It was clear that she
had a language disorder as well as delayed language.
She was known to be enuretic and encopretic. I
thought about this in relation to the sense of flow,
and pouring out, around her activity with the paints.
There was little sense of her being contained either
physically or emotionally, which might link with
psychotic anxieties of leaking away. She moved from
one activity to another in an abrupt, cutting-off way,
so that 1 felt I was seeing fragments of her inner
world.
The word ‘autism’ comes from the Greek autos,
meaning ‘self’.It was given because of the defining
characteristicof withdrawal, of absorption in one’s
own internal experience.Tustin (1992) gave names to
two types of state. She used the term ’encapsulated
to describe the state of autistic withdrawal, and the
term ’entangled to describe psychotic confusion. She
saw that both kinds of children shared submergence
in a sensory-dominated world where emotional states
were not apparently felt but the children lost
themselves in the sensory quality of objects in their
environment. Cognitive and emotional development
becomes impaired and the world lacks meaning,
therefore becoming a very frightening place. Sally
had the shell-like exterior, mutism and withdrawal of
the classic autistic child, but in other ways fitted into
the entangled picture.
Entangled children mould to others physically and
mentally, showing a lack of separation, and are
compliant. There is altogether a lack of separation,
with indistinct speech and a sense of living in a
phantasy world. There is confusion of identity, and a
wish not to change this,which, T u s k saw, made
them hard to treat. She thought that the encapsulated
child suffers from too premature an awareness of the
separateness and otherness of the object.
The entangled child has a similar terror of human
attachment and defence against dependency/but it is
~ ~~
Inscape Volume Eight No. I 2003

~
thought that there has been some kind of awareness
of relationship followed by fear of separation and a
clinging onto the object as part of oneself. In this case
no differentiation of self and other is allowed to exist
but the two are blurred into a fusion of self and other
as a defence against the reality of separateness. T u s h
saw them as having the illusion of being enfolded
inside a body other than their own, and they
therefore get confused and entangled with other
people. Entangled children are fused and confused
with the object and can ricochet between warmth and
fury, between apparent closeness while locating
themselves inside the object and rage at not having
the object under their control (Tustin,1992). They are
good at attacking the therapist's ability to think
because at all costs they do not want any awareness
of separateness to impinge on them. They can appear
to be in relationship but there is an underlying
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phantasy of being the same, which they will fight to
hold onto. All reality and common sense is perversely
twisted to hang onto this delusion and there is a
hatred of the reality of a separate object. The swift
change from a soft invasiveness to hard furious
hatred of the object makes for hard work. Spensley
makes a good introduction to the life and work of
T u s h (Spensley, 1995).
An awareness of a bodily separateness is a necessary
precursor to the development of a sense of individual
identity. In entangled children, the lack of space
between mother and child impedes the development
of object relations. Tustin (1992) suggests that there is
a delusionary state of fusion with Mother's body,
which increases omnipotence, and these children then
have no practice at dealing with life. A mixture of
factors may contribute to the illusionary fusion, such
as genetic susceptibility, and environmental pressure.
McDougall describes cases of fusion between mother
and child where a child can be used as an object to fill
her mother's emptiness and loneliness, that is a 'cork
child' (McDougall, 1986,1989). The fathers of
entangled children may lack a presence in the family.
The weakness of father's influence may then
contribute to the illusion of fusion with mother in that
the Oedipus Complex and awareness of mother and
father's relationship gives structure and discipline to
the personality.
Mother and child's relationship
Sally's mother suffered from deep depression and the
whole family could arouse despair in workers trying
to help them. At the time of my assessment with
Sally, I had met with her parents, and had been very
affected by Mother's mental state and vulnerability.
Within minutes of meeting her I had felt tears come
to my eyes and I had had to struggle with trying to
contain my own countertransference responses.
Mother had p o d out her history and the different
Inscap Volumt Eight No. 1 2003
AUTHENTICITY AND SURVIVAL
traumas she had experienced and her own despair
about Sally. Sally had been her mother's first child. It
became clear that they had an entangled relationship
with a confused joint identity or overlap, and at a
certain point actually changed roles. Mother
described how Sally would work her mother up to
tears and despair and would then take on a role of
comforting her. Father was a silent and unfathomable
presence. He had given up work to help Mother with
the children. As I started work with her there was a
big push from all concerned to help the parents to get
the children into their own bedroom. Mother had
said that Sally's fear of the dark prevented such a
move, but it only now emerged that the children had
slept with the parents since birth because Mother
feared they would die in the night if in a separate
room. This move was achieved without anybody
dying, to Mother's amazement.
Drawing and clay work
When Sally was referred, one of the aspects of the
work we discussed was Sally's physical attacks on
staff, when playing as an animal. From the account I
received, I suspected that she did not actually play as
an animal but was the animal in her o m mind, as she
could become quite aggressive and frightening. She
would also make bullying attacks on people to get
them to make things for her. Once you become a pair
of hands for an 'entangled child', your skills are seen
as a n extension of their own more limited ability, and
there is no incentive to struggle with the painful
reality of their creations. It is another instance of the
blurring of 'me' and 'not-me' described by Tustin
(1992);it is treating another person as a pencil or pair
of scissors, relating to them as an inanimate object
rather than as a person with a mind of their own. .
At Sally's assessment I had noted that her drawing -
which was solely of animals - had a lyrical and
attractive quality which contrasted with her
paintings, which became dark messes. In order to be
able to draw in that way there has to be a thinking of
oneself into the animal, together with observational
skill or identification with the thing drawn. In the
wish to avoid the experience of separation, 'entangled
children' locate themselves in others by processes of
adhesive equation ("ustin, 1990). It seemed most
probable that the drawings of animals were in fact
drawings of her animal-identified self, not a symbolic
act, but rather her being the animal. I think this is
similar to the way that Donna Williams (1992) writes
of taking on characteristics of other people, actually
becoming them so that this persona is the part that
interacts with the rest of the world. It is only when
she is an animal in play that she is animated and
comes out of her rigid body armour. When she tries
to work in clay she comes up against her two-
dimensionality, which is caused by her flattening
21
 AUTHENTICITY AND SURVIVAL
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herself into another, her mother or her pets, and not
developing an identity of her own.
It is not very helpful in the long term to make things
for children. I decided to take a firm stance and not
make things for Sally, although I would offer
assistance if re+ and it felt appropriate. During
an early session she had got the clay out and dumped
it in front of me, saying 'Make'. She got some animals
from the box to show me what I was to do. There had
been a tussle of wills as I said that I would be with
her while she tried to make herself. She kept
repeating 'Just start it', pushing it at me and telling
me of other people who did, but I held firm.
Eventually she tried to make a dolphin but kept
pushing it at me to do it, which had effectively spoilt
any shape she had made. As I was desaibing what
was happening and how frustrating it was for her,
she pushed a toy horse into the clay, making an
imprint, and kept this (Figure 2). She was repeatedly
forceful in trying to get her own way, and so I
experienced some of the mental battering her mother
experiences. I talked of how angry she might be
feeling about the restrictions but she responded that,
'Her dog is angry'. In a similar situation, the next
session she responded by painting a black and dark-
blue bird, and when I asked if h s was her pet bird
that she had painted before, she said 'No, it is a blue
tit' (Figure 3). The blue tit painting was an
unconscious response to my not being prepared to be
her hands for her; her experience of a with-holding
cold breast, the jokey and punning, creative response
of the unconscious. This was the first time that she
had painted or drawn an animal that was not a pet,
so I felt that this was a new departure, though not a
conscious play on words. The imprinted animals had
22
Figure 2. Horse imprint in
clay.
made me wonder whether they were a response to
me, in the sense of making an impression on her.
There was a refusal or inability to struggle with
making something herself, so in this way they had
been a semi-defiant response: she would make an
animal without me. In some way, this was a solution
to the problem that she could not use the clay
without making it go wrong. It was not totally
satisfymg, because they did not stand up or sit, which
is what she would have liked them to do. She had
wanted them to look real. The imprinting feels like a
move towards a three-dimensional image in reverse,
an implosion rather than a n explosion, a relief in
reverse. I wondered whether she experienced my
holding of a sense of myself as separate, not an
extension of herself, as an impingement or intrusion.
Like the concave shape, it made a dent in the armour
that she put around herself. It challenged the illusion
of sameness of things and people. I soon found
myself experiencing the change from soft
invasiveness to the hate previously described.
Transference relationship - from softness to
hate
Session example
I was aware that Sally entered the room with a
softened look, loving and possessive. It was
extremely intense. She stared at me, a look suffused
with love, which felt naked and intimate. I said that I
thought she was thinking about me. She said 'No'.
Again she looked with an almost unbearable naked,
soft look. She said, stuttering and with a distorted
first sound, 'What's your other name?' I said that my
name was Caroline Case and that I thought she had
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Figure 3. Blue Tit
missed me in the gap since last session. She said,
’Yes’. I said that it had felt like a long week. She
nodded sIightly and then changed expression in the
way she did when she was about to become a dog.
The dog play that followed was first of all about
chasing. I had to chase her but not catch her and
there was a different quality to this, a grim and hard
satisfaction with suppressed ajoyment. This then
changed to playing that it was night-time. We were
meant to be in bed and asleep, but various
disturbances woke us up. During this,while I had
been talking of what feelings I thought were present,
she suddenly came under my chair and tipped me
out, sitting in it herself.
The play had begun to spiral into something more
intrusive, possessive and aggressive, so that it was
hard to keep thinking on my feet. She began to jump
at me like an excited dog, m h g the wastepaper
basket beyond repair, clawing at me, spitting and
growling as differentanimals. For the first time she
became a succession of different dogs: a collie that is
friendly, an Alsatian that guards me at night, and a
wild terrier that attacks me. When I talked of these
different dogs as parts of her and as different feelings,
she became more aggressive: there were farting
attacks, and also increased attacks on the room,
shredding the wastepaper basket and clawing at my
clothes and beads. I felt myself getting angy, and a
moment came when she knew I was angry and let go.
She then lay down by the radiator and I was flooded
with feeling. I felt tearful and shaken, rather
shredded like the wastepaper basket. This was very
powerful and I felt loved, hated and violated for the
rest of the morning. I recalled one of the comments
lnscapc Volume El& No. I 2003
AUTHENTICITY AND SURVIVAL
on referral: that Sally would work her
mother up to tears and then they would cry
together. It was time to clear up, so I talked
of this and of the gaps between the sessions.
She also got herself together and was able to
say the time of the next session before
leaving.
There had been a very powerful attack on
words and thinking in this session. It had
been unbearable for Sally to hear me talk
because it had confronted her with my
separateness.In this state of mind, thought is
really attacked and denuded and one is left
exposed to the power of these emotions. In a
sense this all follows from an awareness of
time. She had just learnt to tell the time; her
teacher and I had thought this was
connected to the regularity of the therapy
sessions. To exist in a timeless world is much
safer. The timeless world is a world of no
boundaries. A sense of time brings with it a
sense of comings and goings and separation. It may
have been a shock to her to hear me say that I had a
different name. She had been confronted with my
difference from herself. As she had taken control in
my seat, there had been a massive use of projective
identification and I had felt the floods of feeling
between her and her mother, in the counter-
transference.
Messy painting - engulfment
The next phase brought with it a very different use of
art materials. At the beginning of this phase with
Sally there were some attempts to paint that usually
degenerated quite quickly. Messy painting has been
mentioned by several authors in art therapy
literature. In ‘Hide and Seek’(Case, 1986), the
function of a ’messy area’ in an art therapy room is
described, in work with bereaved children. Here,
images could safely be made but also destroyed in
private if the child felt too disturbed to keep them.
Hughes also explores this theme in work with people
with learning difficulties (Hughes, 1984). She
describes what she thinks is happening when pictures
are ’painted out‘. She suggests that the destroying
and repairing is the picture being used as a
transitional object to help against actual and felt loss.
‘Painting out’, destroying a subject, can be seen as losing
symbolically, the retainedjgures in the picture can be seen
as kept whole and the abstract paintings can perhaps be
seen as releasing, destroying and evacuatingfenrs.
(Hughes, 1984: 182)
In ’Reflections and Shadows’ (Case, 1990), the
’controlled or boundaried’ messy session was
explored as a way of bringing to life and animation
23
 AUTHENTICITY AND SURVIVAL
children who were flattened emotionally by what life
had dealt them. ?he child in this study at first
'embodied' the mess on her own body, extemalising a
'bad, rejected baby', and later confined the mess to
pi-, playing with dark and light and tom parts.
Aulich, in her work with adolescent sex offenders,
writes of 'splattering, pouring and smearing paint on
the paper', and how one client described this as shit
and wanted to wrap it around her (Aulich, 1994).
Aldridge discusses the fluctuation and change from
perceiving art material messes as shit or chocolate
where there has been sigruficant loss and neglect
(Aldridge, 1998).
Mess is also discussed by therapists working with
c h i l b who have been sexually abused. Sagar wrote
about messy packages representing 'the secret' that
the child had to keep (Sagar, 1990). Murphy reports
from her research that many therapists saw positive
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aspects to mess-making. They see at times that it can
be an attack on the therapist and room but also that it
permits exploration of boundaries in a physical way.
Malung a mess 'allowed for the sense of internal
damage to be conveyed and for an acceptable
reawakening of sensory experience' (Murphy, 1998,
p. 15).
O'Brien, in a paper given at the TAoAT Conference
2002, linked relational abuse, neurological damage
and 'mess' in the art therapy room. Traumatic
experiences may be held in the body, inaccessible to
verbal memory. Her experience in working with a
very damaged child in art therapy was that this
memory seemed possible to access in art therapy,
through the sensuous use of paint.
Extract from a clinical session with Sally
sally began to squeeze the paints out with
tremendous force. The first colour went into the first
well, but the successive colours went on top of all the
preceding ones before reaching an empty well. In this
way the first wells in the palette were soon brimming
over the edge and pouring onto the table. There was
an inexorable force about her in this process. I talked
about the need to keep paint in the wells or on the
paper and commented on the loss of the bright
individual colours. She began to tip the palette up
onto the paper but with a twist so that it flicked up
onto the wall, the floor and me. The spilling and
splashing continued and she rubbed it in, squashing
the paper and foldingit and opening it. She tried to
flop it onto the table and then onto the chair, so that
heavy drips of paint went everywhere and I said that
we needed to try to keep this on the table. As I tried
to help her to contain it safely she began to try to
wrap me in it. Eventually, I got the paper onto the
table, but the room had become covered in paint and
was impossible to work in I felt that I was to be
engulfed in her mental state, as Mother and Sally
24
engulfed each other; the painting was being used
quite concretely in this way.
For several months the sessions spiralled into mess
and chaos and were difficult for us both to survive. A
large part of the work focused on containment of
anxieties. It was not possible to use words very much,
as these were experienced as attacking and would
escalate into destructive behaviours. Any sense of
separateness would provoke her to attack my
containing capacities, either directly by leaping at me,
or by attacks on the room. There was a lot of
shredding of materials and wrecking. so that for both
our safety some materials and objects had to be
removed. I made it clear that they would be returned
if they could be used appropriately. At times she
seemed to be searching desperately for something
bigger to contain her, t y n g to get into her art folder
or her emptied box of toys, under tables or under my
chair and into me. Another part of her tried to
destroy anydung that was whole, pretty, beautiful;
wanting to downgrade, destroy, break, fragment or
shred, soil or smear. The struggles of the confused
and entangled child can be seen clearly in this
alternation between wanting to be inside and part of
the object, and the ensuing rage when reality intrudes
on this phantasy. Understandably, such attacks on the
therapist arouse great anxiety, so that children enter
the next session in great fear of what they will find.
During this time she would enter uncertainly.
Looking at me and realising I was whole and had
survived the last session, she would become a dog.
which enabled her freely to inspect the room, often in
particular the areas she had attacked most during the
last session.
Understanding is hated, because to experience being
understood implies that there is a separate other to
understand. One has then to confront difference. The
experience of being understood also causes envy of
the object that has this capacity. Hate is important
because it is a rage at the reality of separate existence,
but it may also offer the energy to fight, which
eventually will be in the service of development.
Greenwood has very helpfully discussed the
therapist's inability to function when under attack
from a traumatised adult client. She describes how
the absence of a capacity to think reflectively leads to
a shiftwithin the therapist to do with survival rather
than 'being understanding' as the terror becomes
located in the therapist (Greenwood,2000).
Dreams
During this chaotic period Sally had begun to have
disturbing dreams about me. In the same week that
this happened I had also dreamed of her, waking in
the night and seeing her face. Sally's dreams had
suggested a male transference to me: I had been
Inscape Volume Eight No. I 2003

experienced as a daddy coming between her and
mummy. To some extent the result of the dreams had
borne this idea out, as she on occasions woke up
frightened from dreaming and got into Mother’s bed,
swapping places with Father who went to her bed.
Working with confused and entangled children is
deeply stressful to therapists, because there are
inevitably times when they seem to be able to get
right inside you by virtue of their quite pathological
processes and use of projective identification.When
mother and child are so enwrapped there is
inevitably going to be a testing time for the therapy as
the treatment begins to bite. It is at this point that
children are often withdrawn from therapy.
Stopping the session
There have been rare occasions when I have had to
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stop a session with children who are in these extreme
states of behaviour. At moments like these, the
therapy is at risk if a child is uncontainable, if one of
you might be harmed, if the therapist feels pushed
out of control by the maddening behaviour, or if the
child is escalating the violence through fear, which
cannot be reached by words or action, then I will stop
the session. This situation is not discussed much in
the literature. Continuation would encourage a
negative, destructive part of the personality, as the
therapeutic alliance is submerged by perverse,
destructive feelings and to continue would cause
harm to both therapist and child. In these situations, I
have found that it is realistic to seek help fxom other
members of staff. This offersa model where one
parent who cannot make a situation work, hands
over to the other, so the situation can be managed
between them. I would reiterate the time of the next
session and day very clearly to the child, and say that
I was stopping in order to keep us both safe. It is
helpful if there is a sde, neutral space for a child to
go to with a member of staff until the end of a
session, when they can then leave as usual. In this
way, the remaining part of the session is a conceptual
or notional one in an in-between place that is neither
the therapy session as such, nor returning to the
everyday world. At the height of the spiral of mess
and chaos in Sally’s therapy, I had to stop the session
a couple of times and, in doing SO, was setting limits
as to what was acceptable. She responded in an
interesting way the third time I reached this moment,
saying ve’y clearly: ‘Let‘s talk about it, I want to stay
till the end of the session.’ This echoed my own
model of saying, ’Let‘s just think about this for a
momenf in the middle of play, and also the model at
school of having time to talk things over instead of
going into action.
Inscape Volumt Eight No. 1 2003
AUTHENTICITY AND SURVIVAL
Development of clay work
During this time little artwork was made. We had
mostly been engaged on a face-to-facelevel through
the play, and it had not felt as if there was space for
anydung to be made. She had sometimes said ‘Clay’
and got the bucket, and there had been the most
precarious sense in the room of something on a knife-
edge, as if the situation could have collapsed. What
was happening at this stage was that a fragle
transitional space was coming into being. The tension
was enormous as she got the clay out and made a
nest of eggs - either an open nest or, if she felt more
anxious, the day would close in on top of the eggs
and cover them. The other development had been to
want to press the animals into the clay as before, but
then to cut them out. The most enormous tension had
accompanied this activity: would they be cut out or
cut up (Case,2002)? I had felt that the cut-out
animals,which she had separated from the
background clay, represented her attempts to take
shape apart from her mother. This had been
experienced as a struggle, literally a cutting away, a
violent separation that we had been working on in
the therapy as she gained a growing sense of self.
The first picture to emerge after the chaotic
stage: a fish picture
The first picture to emerge out of this chaotic and
aggressive stage had been a fish picture. At this time,
a new dog game had developed: the owner went to
the park and the puppy did not want to come, but
then escaped from the house where it had been left
and surprised the owner at the park. She found this
very funny, especially the surprisebit and that the
puppy had been out on his own. She had been
playing out a wish that she could follow me and
appear in my life out of the session, but also with the
idea of independent moving and thinking. One
morning I sat down after a short time and said that
when you were chasing a puppy it was better to sit
down because then they were curious about what
you were doing and came to you. She disagreed, but
sat down, as I had, on a chair and asked if I had any
glue.
She got a blue sheet of paper and two white sheets
and took them all to the table. She folded a white
sheet in half and drew half a fish, then cut it out. She
called the fish a little fish and made a black eye and
rough marks in black felt-tip. She commented on the
fish shape left in the paper from cutting out the fish
and told me to ’keep that‘. I said that it was the shape
of a fish and a whole fish,but she said I was ’talking
crap’. She was annoyed that I was making a
differentiationbetween the two shapes, the figure
and ground. I think there was a difficulty here in
25
 AUTHENTICITY AND SURVIVAL

having a negative shape, left-overs, or

pieces that one might normally throw
away, because of the difficulty of
separation. It is very noticeable in
children who are struggling with
separation or denying it, that they
must also keep the background;
although it has been cut out, it is still
psychically part of the whole.
Then she decided to cut out a big fish.
She kept repeating ’This is a big fish,
isn’t it? It’s a mummy.’ She then stuck
the little fish to the third piece of paper
and cut it out so that she had a little
fish with two sides. She stuck this onto
the big mummy fish (Figure 4). She
then began to colour the big fish‘s fin
with felt tips. There was
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accompanying talk about it being a

colourful fish,that these were nice
colours. She was colouring really
carefully and then hit a patch of glue
that affected the felt, but she managed
to weather this setback, which was
quite an achievement. She then did saibbly colouring
in the main body of the fish. As she coloured she
continually asked ’Is it nice?’ I wondered whether
this was a wish for reassurance, or a difficulty in
knowing what was nice or nasty, or if she was
scribble-colouringan attack on the mummy and
wondered if I knew, or if she was drawing some of
the confused feelings in her intemalised mother. I
said that she was struggling to keep it nice and talked
about the difference between the black baby fish, the
brightly coloured fin of the mummy fish, and the
scribbly body. She said that the baby was black but
would grow into a big colourful fish like the mummy.
When she finished it was folded up and put in her
folder.
The baby fish that was stuck to the outside was a
good representation of the difficulties of mothers and
children struggling with separation. If you are stuck
like glue then all goes swimmingly well. It was an
inside baby refusing to accept that she was now
outside and a protective/ confusional mother who
had not been able to help her with being outside.
Sally’s conversation while she was making images -
assodation, reminiscence - was to develop over the
next phase of OUT work. After the making and talking
the sessions often got quite chaotic as she deteriorated
into destructive messes, but I was able to talk to her
about the struggle inside. The difference seemed to be
that although there was sometimes a relentless
quality to the destructive feelings, I now felt she was
within reach and there could be a light-hearted
quality that came from humour and a shared history
Figure 4. Mummy Fish and Baby Fish.
together. Perhaps this comes down to feeling that
there was choice. She could pull herself out of a
downward spiral, with my intervention, to spare me
her destructiveness. This first fish picture became part
of a series, embodying a wish not to be separate from
mother. The making of these fishes enabled talk
around these painful areas for the first time. They had
a different quality to the earlier pets-that-were-also-
herself pidures. At this stage, where I am going to
conclude, there were the beginnings of a balance
between the creative and the destructive and between
the speaking and the devouring in the work with
Sally. Cirlot (1971) writes: ’The mouth is the point of
convergence between the external and the inner
worlds.’ I had the thought that you cannot bite and
speak at the same time. Sally’s development in
therapy showed how her struggle with language, in
both its delay and its disorder, had been emotionally
based in her struggle with aggressive impulses
around her entanglement with her mother. There is
not space to look more fully at this aspect, which may
be the subject of a different paper, but as therapy
progressed, her speech became both expressive and
clear. I felt that the making of the fish pictures,
embodying and symbolising a wish not to be separate
from Mother, enabled talk around these painful areas
for the first time.

26 Inscape Volume Eight No. I 2003


Conclusion
In this article I have explored two different aggressive
states of mind that children may bring to therapy.
The first is a state of destructiveness and
identification with the aggressor; the second, a state
of chaos and anger as the impact of realisation of
separateness is felt by the confusional/entangled
child. The first images to be made after a chaotic
period or session allow whatever was being protected
by the aggressive behaviour to emerge, be seen and
eventually to be put into words. For Colin there was
an underlying helplessness, connected to his severe
deprivation. The cutting with the scissors had an
almost mechanical feel at times, disassociated from
feeling but with a power of being possessed by an
internal aggressor. The mixture of destruction and
helplessness epitomises the child traumatised by
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domestic abuse. M y , meanwhile, expressed an
angry determination to hang onto the illusion of
oneness, to be stuck like glue. She had been
determined to resist the reality of separateness at all
costs and, to this end, her intense terror of separation
caused her to attempt to control the therapist in
thought, word and deed. Both children made images
with scribble interiors reflecting the huge difficulty of
disentangling a confusion of emotions. At the same
time, both had clarity of outline, which suggests the
beginning of finding forms for their mental states.
Note
This article was presented at the First Exeter Art Therapy
Conference, 'Authentiaty, Pragmatism and Survival', March
2002.It was a development of two previous papers:
'Claywork and Mess: Working with an Entangled Autistic
Child presented at an Art Therapy Day at High Wycombe
1998,and a second paper presented at the workshop
'Working with Domestic Violence', BristoI 2000.
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Biographical details
Caroline Case is in private practice as an analytical art
therapist in Bristol. She also works in the NHS as a child
psychotherapist. She is coeditor of Working with Children in
Art Therapy and co-author of Handbook of Art Therapy both
with Tessa Dalley, as well as contributingnumerous articles
and chapters to art therapy publications.
Inscape Volume Eight No. 1 2003